Exam (elaborations) NR 661 APN Capstone Practicum Chamberlain College Of Nursing

Exam (elaborations) NR 661 APN Capstone Practicum Chamberlain College Of Nursing Exemplar 1 – NR 503: Reflection of the course----------------------------------------------------4 Program outcome, MSN essential, and NONPF ---------------------------------6 Concept ----------------------------------------------------------------------------------7 Reflection---------------------------------------------------------------------------------7 Exemplar 2 NR 508: Class Discussion ------------------------------------------------------------8 Program outcome, MSN essential, NONPF ---------------------------------------10 Concepts-----------------------------------------------------------------------------------11 Reflection---------------------------------------------------------------------------------11 Exemplar 3 NR 509: Reflection of the course ----------------------------------------------------12 Program outcome, MSN essential, NONPF-------------------------------------12 Concepts -------------------------------------------------------------------------------14 Reflection ------------------------------------------------------------------------------14 Exemplar 4 NR 510 APN development Paper -----------------------------------------------------15 Program outcome, MSN essential, NONPF---------------------------------------19 Concepts --------------------------------------------------------------------------------20 Reflection -------------------------------------------------------------------------------20 Exemplar 5 NR 511Case Study-----------------------------------------------------------------------21 Program outcome, MSN essential, NONPF ---------------------------------------25 Concepts ---------------------------------------------------------------------------------26 Reflection ---------------------------------------------------------------------------------27 Exemplar 6 R601 Course Reflection -----------------------------------------------------------------28 Program outcome, MSN essential, NONPF -----------------------------------------29 Concepts -----------------------------------------------------------------------------------31 3 PORTFOLIO 2 Reflection ----------------------------------------------------------------------------------31 Exemplar 7 NR 601 Case study Assignment ----------------------------------------------------32 Program outcome, MSN essential, NONPF------------------------------------51 Concepts -----------------------------------------------------------------------------52 Reflection -----------------------------------------------------------------------------52 Exemplar 8 NR602Marginalized Women Paper -------------------------------------------------53 Program outcome, MSN essential, NONPF-------------------------------------62 Concepts ------------------------------------------------------------------------------63 Reflection------------------------------------------------------------------------------64 Exemplar 9 NR602 Case study discussion ---------------------------------------------------------64 Program outcome, MSN essential, NONPF--------------------------------------69 Concepts --------------------------------------------------------------------------------70 Reflection -------------------------------------------------------------------------------71 Exemplar 10 NR603Case study discussion --------------------------------------------------------71 Program outcome, MSN essential, NONPF--------------------------------------76 Concepts ---------------------------------------------------------------------------------78 Reflection --------------------------------------------------------------------------------78 Conclusion---------------------------------------------------------------------------------------------------79 Appendix # 1 Table of Exemplars ---------------------------------------------------------------------80 Appendix # 2Nursing Concept Map------------------------------------------------------------------ 81 References-------------------------------------------------------------------------------------------------- 82 4 PORTFOLIO 2 The primary purpose of a master portfolio is to document, categorize, and, skills, and abilities; growth; and progress of a student, and as a professional. This is especially critical for healthcare providers and students learning and working in increasingly complex communities of education and practice. This has achieved through class discussions, case studies, assignments, clinical rotation, clinical encounters, and reflection. The paper will discuss this learning using exemplars. The purpose of this paper will introduce the student personal and professional goal, as well as her professional career and plan of study using evidence-based resources and core competency at chamberlain university. The summary of reflections is based on the evidences of the knowledge that this student has learned during the entire course of MSN. Exemplar 1: NR 503 Population Health Epidemiology and Statistical Principles Summary of Reflection: This class helps the student to gain knowledge regarding the current issue and data of epidemiology. As a nurse practitioner that is the duty to provide the care across the life span without any judgment, bias and option. This class helped the student to establish a good base to be able to recognize the origin of disease processes, how to extract medical information in order to discern the problem, and how to choose the best diagnostic test and treatment options based on the disease process. During this class the student wrote the paper on Hepatitis B as well as Diabetes Mellites that provide education and emotional support are necessary to assist in coping with this potentially life-threatening disease. Student learned about the Epidemiologic Triage which provide the information on disease progression through susceptible host, causative agent and environment (CDC, n. d.). 5 PORTFOLIO 2 This class help the student to applied and integrates broad, organizational, client-centered and culturally appropriate concept in planning, delivery, management and evaluation of evidence-based clinical prevention and population care and services to individuals, family and population (AACN, 2011 P. 5). This Class helps to screening, Identify the risk factors which helps people on primary, secondary and tertiary level prevention. FNP incorporate AACN essentials to delivery of optimal care. This class was a very informative class that greatly increased her knowledge of epidemiology and its use in the medical field. She did not realize how important epidemiology was to the medical field and how it can be used to guide public health policies to promote health in our communities and across our nation. The student write one Healthy People 2020 assignment gave her the opportunity to identify sources of epidemiological data as it related to the Hepatitis B, review demographic and epidemiological data on morbidity and mortality risk, research screening and diagnostic tests available for Hepatitis , and finally identify a program plan to decrease the incidence of Hepatitis through the Healthy People 2020 goals and objectives. References: American Association of Colleges of Nursing (AACN) Essentials. (2011). Retrieved April 10, 2018, from an external site.) CDC. (n.d). Introduction to epidemiology. Retrieved March 23, 2018, from in Nursing (MSN) in Advanced Clinical and Non-Clinical Roles. (n.d.). Retrieved April 10, 2018, from 6 PORTFOLIO 2 Chamberlain Program Outcomes, MSN Essential and/or NONPF Competencies Met by Exemplar #1 Program Outcome #1: Provide high quality, safe, patient-centered care grounded in holistic health principles: This class has helped this understudy accomplish her program result # 1 by learning the ideas of the study of disease transmission and coordinate that proficient information into network and recognize the individuals in danger by utilizing abilities and information on evaluation, hazard factors, rate, predominance rate, existing observation techniques, screening tests to analyze diabetes and distinguishing their affectability and particularity and assist them with developing healthy lifestyle.. MSN Essential IV: Translating and Integrating Scholarship into Practice: This understudy accomplished this fundamental by composing task on epidemiological issue of diabetes mellitus, where she led insightful research on subtleties of diabetes mellitus and utilized it in her evaluation, conclusion, the board plan, observation strategies, and treatment plan. This data gas helped this understudy in teaching her recently determined and existing patients to have diabetes. According to Richardson, nurture experts have improved the patient results and self-viability for diabetes patients in the essential consideration groups (2014). NP Core Competency # 6 Policy Competency: Focuses on being competent with healthcare policies and utilize the knowledge of clinical practice to improve the patient outcomes (The National Organization of Nurse Practitioner Faculties [NONPF], 2017). The job of APN includes concentrating on illness avoidance and wellbeing advancement. Finding out about clinical practice rules of diabetes during this class and applying it to clinical turn has helped this understudy recognize in danger patients and has helped her met this competency. It is significant for another NP to approach social insurance arrangement to guide and bolster their training and 7 PORTFOLIO 2 give protected, productive, and quality consideration to the patient. This class has helped in remain concentrated on recent developments in the study of disease transmission to guarantee the conveyance of confirm based practice. Concepts: Health Care Systems: healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. (Pallipedia, 2019). Such healthcare infrastructure includes, home, physician’s office, nursing homes, hospitals, community centers. The role of APN varies based on the type of infrastructure and type of the patients in providing primary, specialty, and emergency care. NPs have proven their effectiveness in delivering high quality, lower cost heath care services. Interprofessional collaboration: This exemplar describes how interprofessional collaboration is active and ongoing partnerships of different healthcare professionals (HCP) who work together in solving problems and providing healthcare services. This knowledge helps her to promotes safe, cost-effective, quality care through engaged in partnerships and collaboration to other health care personals like pharmacy, other specialist, agency hospital and other health care facility. As a new NPs she should found to create respectful relationships among professionals, relay information through timely, open, and effective communication, and share decision-making activities to encourage critical discourse supporting a common plan of care (Christina et al., 2016). Reflection This class helps the student to gained insightful knowledge on how to understand and verified studies and statistics within epidemiology. This class also supported on how to use public health policies in promoting health and quality care to our communities and future 8 PORTFOLIO 2 patients. This course showed the importance of screening for conditions and providing interventions to provide patients with the best possible health outcomes. Evidence-based research should be the foundation for practice and this research evidence must be disseminated to ensure the utilization of the most up-to-date information. This course connected research to practice through our assigned discussion posts and papers. This will help the student to individualize care for patients based on their identified risk factors to promote health. This class has really opened my eyes to all of the thought that must go into who to screen for a disease and with what methods and tests, and how to determine the accuracy of the results and need for further followup. Exemplar# Two NR 508 Discussion Threads This class mainly focus on the medication, prescribing authorities as per state and safety and precautionary measured taken before prescribing the medication to all ages specially the elderly. This class also discussed about the cost-effective health care provided by healthcare workers. This class also includes medication, side effect and interaction with other medication. Mostly emphasis on what placed on the decision-making process utilized to safely and effectively prescribe and monitor pharmacotherapeutics for the treatment of acute and chronic diseases appropriate to the patient situation. In the community, however, drug addiction is becoming more prevalent. Many people misuse medications such as heroin, antidepressants and powerful pain medication. Illegal and abuse of these medications induces high rates of morbidity and mortality. It affects not only a 9 PORTFOLIO 2 patient's health condition but also their physical, social, psychological and financial status. To prevent this, a comprehensive history and assessment of pain and other non-pharmacological treatments should be done first before administering pain medicines. When narcotic analgesics are administered, constant monitoring, testing for any possible risk factors, urine drug screening, informed consent, pain consent and agreement should be done to help mitigate the risk of dependency (Hudspeth, 2016). Some measures that could be effective in reducing dependency include making patients aware of all potential treatment choices, their costs and benefits, and the effects of opioid addiction or overuse (Hudspeth, 2016). It is the professional duty of all nurse practitioners to prescribe within their field of practice and to follow state and federal laws and guidelines for patient safety and legal issue affected to licensure. By taking the pharmacology class, this student has helped understand the pharmacokinetics and pharmacodynamics of the medications and the appropriate prescription steps to prevent adverse reactions, reduce side effects and risks. The advent of electronic health records (EHRs) and pharmacy interfacing has significantly eliminated many such medication reactions and complications. This also helps clinicians monitor prescribing trends for opioids and other controlled drugs and prevent harmful drug adverse effects. That ensures patient and provider privacy and protection (Health IT, 2019). Health care providers should help patients understand whether or not there is a genuine medical problem that supports the use of controlled drugs, adequate treatment time and referral to specialists, and rehabilitation target to minimize opioid dependence and dependency (National Institute on Drug Abuse, 2018). References: 10 PORTFOLIO 2 Health IT. (2019). How can electronic health records help me prevent adverse medication events? Retrieved September 2019 from, Hudspeth, R.S. (2016). Safe opioid prescribing for adults by nurse practitioners: Part 2. Implementing and managing treatment. Retrieved September 2019 from, National Institute on Drug Abuse. (2018). How can prescription drug misuse be prevented? Retrieved September 2019 from, Chamberlain Program outcomes, MSN Essential and/or NONPF Competencies Met by Exemplar #2 Program Outcome #4 Integrate professional values through scholarship and service in health care: This course has helped me translate my current knowledge into practice while building confidence in caring for patients at all level in health care delivery system. I think this class really help to provide knowledge about prescription authority, medication information, errors and how to reduce risk among patient. This student also learned the process and importance of reconciling medicines particularly in elderly patients to avoid polypharmacy complication. On the same hand, it is very important for this student as a primary care provider to regularly interact with other specialists in order to prevent overlap and missed orders. MSN Essential IX: Master’s-Level Nursing Practice: This student accomplished this vital by actively engaging in all the class discussion, presentations and questions of the teacher using academic, revised and peer-reviewed articles that endorsed the purpose of practice on the basis of evidence (Hudspeth, 2016). 11 PORTFOLIO 2 NP Core competency # 6 Policy Competencies: Many local, state, and federal programs are available to support clinicians in preventing and mitigating drug abuse and how to administer safe medicine. This student was able to achieve this ability by studying and knowing and incorporating these policies into her practice (Hudspeth, 2016). This experience was also gained by understanding the risks of abuse of the drugs on patients and their quality of life. Concepts Safety: This exemplar explains the value of maintaining patient health both from real and possible harms. This example focuses on how NP can use its learning to provide patient-centered treatment and use available tools and evidence to ensure their health in all types of patient care (Hudspeth, 2016). Patient safety is most important part for all healthcare provider. Clinical Decision Making: This example illustrates how a new NP will use its clinical decision-making capabilities to evaluate their patient care preparation, diagnosis, implementation and assessment. Clear clinical decision taking is key to health outcomes and patient care (ANA, 2019). This expertise includes knowledge of different types of medicine that are administered to the patient with and without any other comorbidities. Reflection Throughout this class, this student regularly engaged in discussion threads and assignments focused on creating care plans for patients with various comorbidities, considering their experiences with other current medicines and medical diagnosis, and predicted medication outcomes. Advanced pharmacology awareness is very important for a good career in NP. Patient awareness about their medication was essential to this class because many drug related concerns can be easily avoided if patients have knowledge about their own medication and its effect on their body (Hudspeth, 2016). 12 PORTFOLIO 2 As a primary care provider, we need to educate our patient, and to do so, this student uses on her phone apps like epocrates to search for drug knowledge. Use EHRs makes it easy to warn patients about reactions and drug interactions with other medications. It also makes it easier to share the patient's drug history with a specialist and pharmacy who initiates the treatment process faster than to drop the script personally to the pharmacy and wait for the drugs to be ready (Porterfield, Engelbert, & Coustasse, 2014). Exemplar # Three NR 509 Advanced Physical Assessment Summary of Reflection: This course has helped student to achieve the program outcome number one in many ways. The Shadow Health assignments enabled to gain experience in providing quality and safe patient care while focusing on the holistic principles of the patients. Although the weekly shadow health assignments were system focused, other health systems were evaluated to assess and treat the patient’s overall health and wellbeing. This course has been challenging as student learned to expand knowledge and help to make assessment skills perfect. This course has strengthened assessment skills and knowledge on how to adequately obtain a thorough health history. The Student learned the importance of building a good rapport with the patient and family member that could help divulge pertinent information to help identify a diagnosis. The immersion weekend was a weekend full of very useful knowledge. Appearing at the Immersion Weekend was also one of the ideas for achieving the program's outcome. This weekend, the student learned assessment techniques, such as palpation, percussion, and auscultation, which provided her with a thorough assessment of her patients.3P Exam helped the student to identify her weak areas that need more attention. The three areas that she scored less was Men’s health, urology and pregnancy. After this, this student made sure to 13 PORTFOLIO 2 read and prepare herself for next APEA exams and national licensure exam. I plan to incorporate studying not only these three categories, but all domains to increase my knowledge and understanding of my future role. Chamberlain Program outcomes, MSN Essential and/or NONPF Competencies Met by Exemplar #3 Program Outcome #1 Provide high quality, safe, patient-centered care grounded in holistic health principles: Advance physical assessment class has helped me establish a strong framework to achieve program outcome by providing classwork information on how to complete a history and physical assessment on a patient. The “scatter group” classes gives experience and knowledge to identify, diagnosis, and treat various ailments our patients will present with. MSN Essential I Background for Practice from Sciences and Humanities: The student achieved this essential by participating in discussion during debriefing session with instructor and classmates. During the debriefing process, students reflect upon their simulation experience and revisit their assessments, interventions, observations, and patient response through virtually. The delivery of evidence-based practices ensures improved and improved patient outcomes (Melnyk, 2018). Holistic care is essential part which uses from evidence based. NP Core Competency #1 Scientific Foundation Competencies: competence was achieved through the use of scientific knowledge concepts to gather health- from patients to meet their health needs and objectives (NONPF, 2017). This class provided the student with an assessment tool and a reference to the collection of subjective and objective data, using the OLDCART, SOAP note format to collect and document the history. With advanced physical assessment class, this student learned the techniques of how to ask more questions relevant to their chief complaints and identify the difference between normal and abnormal findings. At the end of this 14 PORTFOLIO 2 class, this student learned the role of different race, ethnicity, culture, lifestyle habits increase the likelihood of developing certain diseases. Concepts Assessment: This exemplar describes skills and techniques of performing body assessment, which is the first step in nursing process (American Nurse Association [ANA], 2019). Throughout the assessment process, the new graduate NP must identify opportunities for health promotion and educate patients and coworkers as needed which includes maintaining a safe environment through the use of effective infection control concepts. Nursing Process: This exemplar defines nursing method as an integral component of patient-centered care practice (ANA, 2019). The nursing process includes the steps of assessment, diagnosis, planning, implantation and eventually assessment of interventions 'efficacy (ANA, 2019). This student learned the principles of the nursing method during this class which covers whole physical exam and will use them in future for patient care. Reflection Advanced physical assessment course has taught the student many valuable tools that the student will utilize in current and future practices. This course challenged for student and required to utilize critical thinking skills and research skills in order to perform well on weekly debriefings, assignments, and exams. This class taught the student how important is to collect detailed history which includes subjective and objective data can help to identify the future risk and established the proper diagnosis. The student gained the skills that includes writing SOAP notes, differential diagnosis, assessmnet and planning as per diagnosis. Creating the SOAP note is important and the student learned in depth about how to create SOAP note by daily practice. Also, achieving program outcome number one was by attending Immersion weekend and learning 15 PORTFOLIO 2 about different body systems, diseases, and assessment techniques while rotating through various nursing stations. These learning activities exposed the student to high-quality assessments for patient-centered care. This class will help the student to continue grow from a variety of educational and clinical experiences that will enhance future practices. Advanced physical assessment course has taught the student many valuable tools that will utilize in current and future practices. Exemplar #Four NR 510: Leadership and Role of the APN APN Professional Development Plan Paper Preparing for this assignment helped the student learn how to become a good new NP graduate. This student learned more in depth about the nature of APN experience during this task. This student carried out her own personal evaluation and built a strategy using networking and marketing tactics to get a job as a new FNP. Conducting personal assessment helped us to consider any weaknesses and strength. Due to the new work requirement and being inexperienced in the field the transitory time between the graduate NP and the newly hired NP can be very demanding and stressful. This class, however, made this student conduct their own personal and professional assessment which helped her recognize her strengths and weakness as a newly hired NP. This will help her concentrate on things she wants to pay more attention to enough knowledge and confidence will help the new NP to develop the smooth plan from one phase to another. To start from novice to expert practitioner the student uses 5 steps within the model and use of this model this student will better understand their weakness and strengths to obtain the future goal as well as set up the proper outline for the future practice. To focused care as a 16 PORTFOLIO 2 novice, a new practitioner’s drive practice by rules. From advance beginner to competent provider the new NP must prioritizing and begin to form their care by using past experiences which help to prioritize needs and routinely predict accurate outcomes. Through current geriatric experience, this student feels more comfortable to interact and establish therapeutic relationships through adults and elderly people. This student is also very positive in giving adult and their families health education. In addition to English, this student has the ability to read, write and speak Hindi and Gujarati which can be used as an additional aid in connection with her patients. With her desire to speak more than one language she feels like breaking the language barrier. Working as nursing director, this student depends on her leadership, mentoring, administrative, and managerial responsibilities. DON's position in public and private insurance and its reimbursement policies has also made her knowledgeable. The one thing that this student feels less comfortable is prescribing her patients right medications. The state of New Jersey falls in to Reduced practice states where NPs are requiring having physician supervision for some actions. Despite this, New Jersey NPs are considered as ‘licensed independent providers. They have right to diagnose and treat their patient medically without any supervision by physicians (Nurse Practitioner scope of practice, 2014). The prescription pad of NJ NPs carries information of NP and collaborative physician. Even though, the NPs of state of New Jersey are given authority to announce the death of the person, the cause of death must be determined by MD. An A.P.N. in New Jersey, prior to prescribing any medication or medical device need prescriptive authority and is required to have a joint protocol with a collaborating physician who is licensed in New Jersey ((Nurse Practitioner scope of practice, 2014). 17 PORTFOLIO 2 Professional Scope is a national occupational specialty, and advanced practice registered nursing organizations broadly defined scope of practice for each role. The state of New Jersey falls in to Reduced practice states where NPs are requiring having physician supervision for some actions. NPs should have collaboration with NJ physician in order for them to write the scripts. Such collaborative physician can be reached out off-site via means of e- mail, phone call, or video conference (Nurse Practitioner scope of practice, 2014). Newly graduated NPs could begin to practice right after completion of their NP program and before appearing for their national NP certification exam. They will also apply for work permit so that they can train before certification. The NJ state is entitled to withhold this temporary work permit if the test fails twice (Nurse Practitioner scope of practice, 2014). To overcome the feeling of making mistakes and failure, my primary focus would be on learning proper history taking and acquiring assessment skills to properly diagnose and prescribe right medications to my patients, so to avoid the complications of misdiagnosis and medication errors. In order to be productive and obtain a decent job in the current competitive job market, NPs need clear and efficient marketing and networking strategies that require careful preparation to be implemented (Phillips, 2012). An overview of your strengths, potential objectives, weaknesses, ambitions, and opportunities is also equally relevant (Phillips, 2012). Job searching can be done through web sources and newspaper ads, yellow pages, technical magazines or publications (Phillips, 2012). NPs that benefit from becoming or being a member of national or state professional organizations, such as the American Association of Nurse Practitioners (AANP), the American College of Nurse Practitioners (ACNP) (Nurse Practitioner Schools, n.d.) I am an active and current member of the National Association of 18 PORTFOLIO 2 Indian Nurses of America (NAINA) which sends various ARPNs and RNs posting jobs to their members. I expect to use work posts from this association in future to help me find a job. It takes time to apply via internet sources and removes the ability to show the employer your professional skills. Contacting and applying directly to the facility or making use of personal and professional connections in seeking a job is more accurate and efficient. NPs may use their professional and social connections to pursue a job, including their preceptor physician. AANP is one of the largest nurse practitioners 'associations that not only provides opportunities to NPs but also offers free continuing education credits, updated healthcare topics, invitations to seminars and conferences, and professional development and networking tools (AANP, 2017). Professional networking is defined as a community or person to which NPs can connect in various ways in order to promote their own work practices (Taylor, 2013). Some of the networking methods include physical face-to-face contact and virtual communication through email, video chat, telephone conversation and the use of other social media (Taylor, 2013). NPs will, however, consider networking with the community to encourage them to grow and evolve professionally, strengthen thei