NR 603 Week 8 Reflection

NR 603 Week 8 Reflection Reflect back over the past eight weeks and describe how the achievement of the courseoutcomes in this course have prepared you to meet the MSN program outcome #4, the MSNEssential IV, and the Nurse Practitioner Core Competencies # 7. Program Outcome #4: Integrate professional values through scholarship and service in health care In week number 3 we met the PO#4 by creating a treatment plan that would not only address the acute medical needs of “Lorene” but also address the chronic medical conditions that were present and additive risk factors to her cardiovascular disease. Understanding the responsibility of the NP as a provider to comprehend how each symptom/result/finding is relevant to and has effects on whole health is gained through scholarship. Using clinical practice guidelines for different conditions and combining recommendations in to a practical treatment plan, individualized to a patient demonstrates service to patients and community. In this specific case I addressed acute care for NSTEMI/ACS and provided for appropriate follow up and treatment of co-morbid conditions and risk factors by using JNC 8 Guidelines for HTN, ACC/AHA Guidelines for the Treatment Cholesterol, American Diabetes Association Standards of Diabetes and USPSTF recommendations. PO#4 was also met in week 5 with the exploration of our APEA results. A provider has the obligation to recognize his/her own strengths and weakness and actively work to improve. In this exercise we identified weakness and designed a practical learning tool for my own improvement and the benefit of our class mates. I found that I was deficient in my ability to interpret Hep A & B screenings. By building a specific case study I was able to build my own understanding of subjective complaints, objective findings (including diagnostic testing) and treatment for Hep A&B. These are 2 examples of how I have MSN Essential IV: Translating and Integrating Scholarship into Practice Recognize that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results. MSN E IV revolves around the understanding and interpretation of research and the application of that into practice. MSN E IV was met in week 1 by demonstrating not only an understanding of each assigned disease process but the similarities and differences in pathophysiology, presentation and treatments. I was specifically able to apply my review of the current research (with in last 5 years) to my understanding of TBI vs post concussive syndrome. While there are several overlaps in presentation, there is also a continuum that is possible from post concussive syndrome into mild, moderate and sever TBI. Understanding this and sharing it with the class, mimics the dissemination of this research to a group of practice colleagues which promotes positive change in patient care. I was also able to meet MSN E IV with a clinical experience that I had. A primary patient was seen in a behavioral specialist office for ADHD and had received a prescription of clonidine 0.1 mg PO HS for sleep. When the medication history was taken on this patient the primary provider was surprised that this was ordered and disagreed with its use. Before stopping the medication, which had been very effective, my provider and I both looked up articles on the use of this medication for ADHD. While the exact mechanism is not known, it is thought that the effect is on the prefrontal cortex. The provider shared her information with her office nursing staff and with a NP that works with the group. The sharing of this information applied research to practice, facilitated change in personal practice and disseminated results. Nurse Practitioner Core Competencies # 7 - Health Delivery System Competencies NPCC #7 was met with out VISE call. Number 1 of the NPCC #7 is “Applies knowledge of organizational practices and complex systems to improve health care delivery” (NONPF, 2017). The simulation of a specialist referral call demonstrated the understanding of the interaction of complex systems and provider practices to coordinate and facilitate health care delivery. In my VISE call I presented a patient who had been assessed and treated within the scope and to the limit of primary care practice and would require further specialty evaluation. In an effective use the specialist’s time and with respect to his/her knowledge, I presented the case concisely and listened for feedback and recommendations for future practice. Both the patient and receiving specialist will be confident in my care knowing that I have the knowledge base to work within my scope, know when referral is needed and facilitate the next level of care. NPCC #7, number 7 focuses on the collaboration in “planning for transitions across the continuum of care” (NONPF, 2017). In week number 6, I focused on the planning for future needs as part of my care plan. With my Opiate Use Disorder patient, I planned for the needs beyond initial treatment. Once the initial opiate use is addressed, this patient will require additional ongoing care in field including PT, nutrition, psychology/psychiatry and possibly GI. As I continue to be the care home for this patient it will be in part my responsibility to see that transitions from my office to others and back are smoothly managed without gaps for the patient. In this case a specific example is the initiation of physical therapy for the acute shoulder injury and chronic leg pain. As the patient complete the prescribed PT, it will be important to assess the patient’s level of function and potential need for further PT. As the patient becomes stronger, it may be more appropriate to move from restorative PT to an exercise specialist to work within the patient’s capabilities for a weight loss program. Once finished with these specialists, ongoing assessment of physical functioning will indicate the need for further intervention. This is just one example to providing for coordinate and appropriate care across the continuum of patient care. I would like to thank you all for your contributions this course. I am pleased that, while I am truly a novice, things are starting to come together in my thought process and knowledge base. Our interactions have demonstrated professional relationships and have taught me skills in professional communication that will undoubtedly serve me in my future profession. Reference National Organization of Nurse Practitioner Faculties (NONPF), 2017. Nurse Practitioner Core Competencies Content. Retrieved from CoreComps_with_C NR 603 Reflection Chamberlain University Reflect back over the past eight weeks and describe how the achievements of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential IV, and the Nurse Practitioner Core Competencies # 7. NR 603 Reflection Reflect back over the past eight weeks and describe how the achievements of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential IV, and the Nurse Practitioner Core Competencies # 7. During these past weeks I have experienced many challenges and many opportunities. The experiences, skills, and knowledge I have acquired are invaluable in achieving my goal of becoming a Nurse Practitioner(NP). However, becoming an NP is only the beginning-this program is only the beginning; it is designed to lay the foundation for the student and for the future of the NP profession. With each course we take one more step into acquiring invaluable knowledge and inner growth. Knowledge and inner growth that will guide how we deliver care to our patients, how we relate to our colleagues, how we contribute to our profession, and how we meet the expectations of all stake holders involved. At the end of each course we have the opportunity to evaluate our progress-how are we as students acquiring the skills and knowledge that is allowing us to growth into our future roles. In this course we are going to review program outcome #4, MSN essential IV, and Nurse Practitioner Core competencies #7. Program Outcome #4 Program outcome #4 states that the Nurse Practitioner (NP) graduate should be able to integrate professional values through scholarship and service in healthcare. The NP should form a professional identity. In other words, meeting program outcome #4 means that the NP is able to utilize the highest possible knowledge and skills and also intergrade his or her professional values into the delivery of care. For example, at times patients may come in requesting medication refills on narcotics before the medication should have been finished. I understand that opioid abuse has reached epidemic proportions and while some patients need to take these medications others are misusing them. In these situations, I have had to utilize my skills and my critical thinking to do a thorough assessment on these patients. I would conduct a thorough physical assessment and neurological assessment. The goal is to evaluate for mental acuity and to determine the level of pain. Information obtained will allow me to determine if the patient is misusing the medication or the medication regiment is not meeting the patients’ needs. As a student I cannot prescribed any medications, but these situations allow me to utilize critical thinking and adhere to my professional values-advocate for the patient but also protect the patient from hurting him or herself by misusing medications and protect myself and the facility from any liability that may arise from these situations. Another example of how Program Outcome #4 has been achieved is when I am encountering patients who test positive for pregnancy and decide that they will not keep the baby. Regardless of what my values and beliefs are, I have to be professional and without judging assist the patient to obtain the needed information and resources she will need to terminate the pregnancy. MSN Essential IV MSN Essential IV states that the master’s prepare nurse is able to apply research data when formulating patient interventions, is able to resolve practice problems, is able to work as a change agent, and can disseminate results. In this course’s clinical practice, I have encounter many situations where I needed to think critically, utilize the best data available and also complement interventions by employing professional values. For example, it is common that medications modifications have to be made to the patient’s regiment and in some instances these situations can become challenging because of medications not being available or not being covered by insurance. For example, at times medications have been removed from the market or some may not be covered by insurance providers. In these situations, I have to be able to seek reliable information that can assist me in determining which medication alternatives are available and which data supports their use. In addition, I can relate this information to the patient or healthcare provider and assure them of the effectiveness the alternative has demonstrated. In other words, by understanding data results I can confidently promote change in therapy and answer patients’ concerns. As second example of how this essential was met is through helping to solve or clarifying practice problems. There are a significant number of patients who do not follow treatment indications because they do not have a thorough understanding of what their illness are and most of them do not understand their laboratory or radiology results. I have encounter several patients who are upset because they do not understand their results. In these situations, I have found that the best situation is to obtain a hard copy of the results and discuss each abnormal value with the patient. For example, I had a patient who only understood that her cholesterol was high but did not know which cholesterol or why that was not a normal value. At my preceptor site the doctor has liked my approach and is encouraging his other students to do the same. One of the drawbacks is the cost that will be connected with printing all this information. However, the doctor has directed us to print only for those who request a copy-all other patients can see the results directly on the computer. Nurse Practitioner Core Competencies #7 Nurse Practitioner Core Competency #7 basically incorporates all the that is expected from a Nurse Practitioner in practice setting. According to the list of competencies the NP is expected to be organized, apply knowledge and work understanding all the complexity presented in healthcare. Also, the NP is able to employ skills to create change, negotiate and form partnerships. In addition, the NP is expected to protect the patient and is also able to understand how to protect the system; is culture sensitive and understand how healthcare changes affect the patient and the practice. Lastly, the NP is able to evaluate organizational effectives in the delivery of care and is able to form professional relationships to ensure transition of care. There are several areas to consider when analyzing these competencies. It is obvious that clinical skill, practice, and clinical knowledge is not enough when considering the complexity of primary healthcare delivery. This is why NP programs are rigorous; this is necessary in order to ensure that the NP delivers the highest level of care that will meet all patients meet their needs. Some of the major goals in clinical practice is to expose the student to a diverse set of situations that will allow the student to utilize the knowledge acquired and learn how to navigate within the complexities of the healthcare system. One example of how complex the healthcare system is STD cases. Once a patient test positive for infection, medication may be given immediately depending on the type of infection and the patient is advised to notify the partner. On the provider’s side, it is required that the Department of Health (DH) is notify within 24 hours sot that the needed follow up is done. These situations have the tendency of becoming dangerous for the patient and the provider. For example, if the patient does not notify the partner he or she can be held liable and in the event the provider does not report the case to the DH, the provider may be fined. It is in these situations that the NP must have knowledge of what are the state and federal regulations, make the proper reporting so that the partner seeks treatment and at the same time protect the practice and others in the community. A second situation to consider is addressing the many needs some patient’s illnesses demand. It is imperative that the NP is capable of creating partnerships and maintaining a wide range of available resources ensures that patients receive all necessary interventions. Almost every patient will have to be referred to another provider or will have to have procedure that require specialty practices. For example, part of the treatment plan of a diabetic patient includes referrals to Podiatry, diabetic education, and may also need to be referred to other community