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A Nurse Practitioner–Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature
An example of agenda setting in 2014 was an effort by the Nebraska Nurse Practitioners (NNP), a state nursing association, to find a state senator who would introduce a bill into the Nebraska unicameral legislative session to eliminate the Integrated Practice Agreement (IPA) from the Nurse Practitioner Practice Act (Nebraska Legislature, 2014).
The public hearing for the bill was held on January 31, 2014; the sponsoring state senator’s goal was for the bill to emerge from the seven-member Health and Human Services Committee with support from all or most of the members (Senator S. Crawford, personal communication, January 2014).
Spring 2014 Nebraska Unicameral Legislature
Prior to the bill’s introduction, the NNP had to undergo review by the Nebraska Credentialing Review (407) Program. This state-level review program had been created to evaluate current Nebraska health professionals who are seeking to expand their scope of practice or to evaluate the scope of practice of a new type of provider (Nebraska Department of Health and Human Services, n.d.).
As part of its review, the NNP submitted extensive documentation to three review bodies—an ad hoc Technical Review Committee appointed by the director of the Nebraska Division of Public Health, a second review by the State Board of Health, and a third review by the director of the Division of Public Health. These reviews represented input from the Department of Health and Human Services (DHHS) about possible concerns for Nebraskans in either public health or safety.
Spring 2014 Nebraska Unicameral Legislature
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Although the recommendations at the three levels are advisory, they serve to inform state senators when considering and voting on proposed legislation (D. Wesley, lobbyist, personal communication, June 2013). The NNP proposal received support at the first two levels; at the second level, the vote was 12–5 to eliminate the IPA requirement (Whitmire, 2013).
There also were recommendations with this second vote to (1) have practice requirements for the new graduate nurse practitioner (NP) and (2) have ongoing competency evaluations of all NPs. At the third level of review, the director and chief medical director of the DHHS were strongly opposed to the NNP proposal (Ruggles, 2013).
APRNs in Nebraska set the agenda with four goals in mind:
Decrease barriers to their full scope of practice
Provide more and needed access to health care (especially primary care and mental health care) in rural parts of the state
Meet the emerging primary healthcare needs associated with an increased Nebraska population having health insurance because of the Affordable Care Act
Decrease the exodus of APRNs to contiguous states that did not have such IPA agreements (Sundermeier, 2013/2014)
Spring 2014 Nebraska Unicameral Legislature
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In seeking passage of this bill, Nebraska NPs wanted to join the 17 other states and the District of Columbia that had facilitated full scope of practice availability for nurse practitioners. As noted by Bobrow and Dryzek (1987), this case study underscores the importance of contextual dimensions furthering agenda setting. As noted previously, there were four important contexts in setting this agenda topic at this time in this state.
This agenda, which was based on evidence-based practice studies and the promotion of all nurses working to their full potential, is also advocated by the National Academy of Medicine (Institute of Medicine, 2010). By providing legislative language to a state senator to introduce a bill, APRNs set the agenda in Nebraska.
A variety of strategies were implemented to further the agenda goal. This chapter’s author served as chair of the Nebraska Nurses Association’s Legislative Advocacy and Representation Committee (LARC). This committee worked in unison and collaboratively with the NNP, its lobbyist, the NNA lobbyist, and the sponsoring state senator to serve as the lead strategists and voices.
APRNs used public media to promote their perspectives. For example, following a negative review from the Nebraska DHHS, one APRN educated the public via an op-ed article about APRNs in the state’s largest newspaper (Holmes, 2013). She noted several of the previously made arguments as support for why APRNs wanted the IPA eliminated.
Spring 2014 Nebraska Unicameral Legislature
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The bill passed by a 43–0 vote during the last day of the 2014 unicameral session. However, the governor vetoed the legislation, and there was not time for the unicameral legislature to enact an override.
In early 2015, the bill was reintroduced, passed, and signed by the new governor on March 5, 2015 (Lazure, Cramer, & Hoebelheinrich, 2016). Other factors facilitating its passage included
(1) education regarding APRN capabilities along with advocacy during the campaigns of 17 new state senators;
(2) obtaining commitments from both gubernatorial candidates that they would not veto the bill if reintroduced in 2015;
(3) ongoing advocacy by the earlier noted nursing groups; and
(4) interprofessional health groups that both supported the bill and said they would testify at a public hearing. Nebraska is now one of 21 states in which nurse practitioners have full practice authority (Pohl, Thomas, Barksdale, & Werner, 2016).
Read the Case Study above to Answer the Questions Below:
1: How does the Kingdon model apply to the Nebraska case study?
2: How can all healthcare providers support one another and further some of the IOM goals or Healthy People 2030 goals using the Kingdon Model to get the policy process started?
Spring 2014 Nebraska Unicameral Legislature
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Nursing Education Theory
Question 1
In the recent course, the core principles that have been applied are andrology. This aspect was developed by Malcolm Shepherd Knowles (1913-1997) which was used synonymously as adult education. The core aspect of andrology is that it is both an art and a science of adult learning (Iwasiw, Goldenberg, & Andrusyszyn, 2008).
This term is sometimes viewed to be equivalent to pedagogy, which is a Greek word that refers child leading (Kearsley, 2010). The principles of andragogy are based on four assumptions. To start with, it points out the issue of self-concept, which indicates that as a person matures, they shift from becoming dependent personality to being self-directed persons (Atherton, 2013).
Additionally, andragogy assumes that as human beings mature, they accumulate experience reservoirs, which become the resources of learning (Iwasiw, Goldenberg, & Andrusyszyn, 2008). Additionally, this increases readiness to acquire knew knowledge, which increases their developmental responsibilities. This also improves their orientation learning (Atherton, 2013).
This is because a nature person’s perspective continues to change by the adoption of immediacy application of the learnt knowledge rather than postponing of the knowledge, thus shifting the learning orientation from subject centeredness to that of the problem solved approach. Additionally, the matured adult gets the motivation to learn increases (Kearsley, 2010).
Nursing Education Theory
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The core principles of andragogy that have been observed in this course include the principle of planning and evaluation of the instruction given (Iwasiw, Goldenberg, & Andrusyszyn, 2008). Additionally, in this learning process, all experiences and mistakes are viewed as effective and form the basis of learning as it broadens an individual’s way of thinking (Atherton, 2013).
Additionally, the learning by the adults is important if it gives immediate relevance or benefits to person’s lives or their jobs (Kearsley, 2010). Additionally, the adult learning problem centred as compared to content oriented. This is effective way of interacting learning and improving the knowledge as well as critical thinking skills of the learner (Iwasiw, Goldenberg, & Andrusyszyn, 2008).
The effectiveness of this learning method is based by the fact that in each of the aspect being taught must be elaborated extensively giving the specific reasons behind the concept (Kearsley, 2010). Additionally, this learning process ensures that instructions are task oriented, thus ensuring that the concepts are understood rather that memorization as compared pedagogy (Atherton, 2013).
Additionally, this learning method puts into considerations the diversity of the learners, thus allowing integration of different materials and learning methods according to each person’s experiences (Kearsley, 2010). The learning method assumes that learning instructions is self-directed, thus the learners will enable them discover new knowledge without actually depending on other people (Iwasiw, Goldenberg, & Andrusyszyn, 2008).
Nursing Education Theory
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Question 2
There is high diversity in nursing career. This includes diversity in students, contents being taught and the tutors teaching these contents. The learning method chosen must be delicate enough to accommodate this diversity (Kearsley, 2010). The diverse learning theories include the Leon Festinger’s cognitive dissonance where the students are seeking to balance between their behaviour and their attitudes (Iwasiw, Goldenberg, & Andrusyszyn, 2008). This is often important where a person seeks to choose between the learning issues that are culturally competent from those that are not.
This method is not popular in nursing because it inhibits acquisitions of new ideas that conflict the persons attitudes or even behaviours (Atherton, 2013). Carl Rogers experiential learning theory focuses on the applied knowledge which improves (Kearsley, 2010), despite the popularity, this learning method is still not widely used in nursing process. This trend is similar to Albert Bandura social learning theory (Iwasiw, Goldenberg, & Andrusyszyn, 2008).
Nursing Education Theory
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The learning theory foundation for nursing course is the adult learning theory (Iwasiw, Goldenberg, & Andrusyszyn, 2008). This is because this learning theory incorporates the aspects of the other learning theories aforementioned (Atherton, 2013). Additionally, this learning theory integrates the use of case studies, simulations, role playing as well as self-evaluation by the students (Kearsley, 2010). The students are involved during the planning as well as evaluation. The learning methods promote learning activities based on experiences (Iwasiw, Goldenberg, & Andrusyszyn, 2008).
Additionally, this learning method puts into considerations the diversity of the learners, thus allowing integration of different materials and learning methods according to each person’s experiences (Kearsley, 2010). The learning method assumes that learning instructions is self-directed, thus the learners will enable them discover new knowledge without actually depending on other people (Atherton, 2013). This helps in promoting the nursing processes principles of leadership and cultural competence.
This method also increases the student’s attentions, through the incorporation of modelled events as well as the use of observation characteristics (Iwasiw, Goldenberg, & Andrusyszyn, 2008). This learning method ensures that knowledge is retention through use of symbolic learning and improvement of motor reproduction, thus ensuring that self-reinforcement. This learning method integrates other learning methods which ensures that the student attention, motivation, memory, behavioural frameworks and cognitive abilities (Iwasiw, Goldenberg, & Andrusyszyn, 2008).
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Metaparadigm
The nursing metaparadigm is defined as the sole source of the development of many nursing concepts. Ideally, many of the conceptual models in nursing seem to have developed from the meta-paradigm of nursing. These theoretical models are defined as a given set of statements and concepts that eventually integrate the concepts into an exact configuration (Meleis, 2011). In other words, a meta-paradigm is considered as the most conventional or global perspective of a discipline and acts as a framework in which the most important structures are developed. The nursing meta-paradigm involves the following concepts; nursing, person, environment and health (Meleis, 2011).
The four concepts integrate to give an exact configuration. As such, a person is therefore defined as the primary recipient of nursing care. The nursing concept comes in to manage or alter the external environment to successfully implement the natural law of health. The environment is defined as the internal or external factors that affect the surroundings in which the patient exists (Fawcett et al., 2012). This includes factors like food, medication, water, ventilation, bedding and temperature. Health is defined as having harmony, comfort and peace. The significance of the concepts is their integration in ensuring that there is a satisfactory outcome from the exact configuration that ensues from the integration of the central concepts of the nursing meta-paradigm.
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In conclusion, the nursing meta-paradigm gives a significant association between different crucial notions of the fundamental conceptual models related to nursing and health care. Essentially, in understanding how the meta-paradigm works ensures that the provision of nursing care becomes a fully understood process. The reason being that the concepts are fully understood thus the specific components involved in the process of patient recovery are integrated into a given configuration that will ensure successful healing process.
Reference
Fawcett, J., & Desanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. FA Davis.
Meleis, A. I. (2011). Theoretical nursing: Development and progress. Lippincott Williams & Wilkins.
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Practicum Journal Entry
Children are brought by their parents to the clinic with complaints that seems to be straightforward, with most being treated appropriately. However, as advanced nurse practitioner, I am faced by the responsibility to ensure that the patient is diagnosed correctly and the disease is managed effectively. However, making of correct diagnosis can be elusive and in most cases, it will require the APN to carefully consider the possible differentials as well as identifying the most appropriate strategy to manage the problem (Burn et al., 2013).
During the practicum, a 9 year old boy of Hispanic origin reported to the clinic with sore throat and higher fever (1030F), malaise headache and general body weakness. The patient Lymph nodes were swollen. The patient had attended a local clinic where she was diagnosed with streptococcal pharyngitis and was administered with Omnicef 14 mg/kg/day. However the patient condition worsened after 3 days, and the mother was concerned that the child could be suffering from something else (Murray & Chennupati, 2012).
Practicum Journal Entry
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To identify the core area of the child current situation, I employed helpful tool of the pneumonic NEEDS. NEEDS is an acronym that stands for Nutrition, Elimination, Environment/Education, Daycare/ Development and Sleep/ Sexuality (Murray & Chennupati, 2012). In this context, nutritionally, the patient reported difficulty in swallowing but was able to drink cool liquids. The patient elimination was normal as she voided normal stool at least four times a day.
The assessment of the patient education and environment indicated that the patient was doing fine, and that she had not been exposed to sick friends or family friends. The patient general care was good and was involved in Drama club, although the patient missed practice this week. Patient rest is adequate as the she sleeps approximately for 9 hours a night, but have been sleeping for more than 12 hours since the onset of the disease. The patient reported that she had ensured medication adherence, and denied presence of persistent illness in the past (Murray & Chennupati, 2012).
In some cases, when making differential diagnoses, there could be loop holes that can make diagnoses be missed. In this case, specific and sensitive diagnostic tests should be done to facilitate accuracy, cost and precision. In this case, the poor response to antibiotics and patient clinical manifestation of persistent fever, fatigue, tonsillitis and lymphadenopathy made me consider presence of other infections such as infectious mononucleosis (IM). Other differential diagnoses that were considered included acute leukaemia, tumours of the neck, Hodgkin’s disease. Allergies are also associated with throat pain and pharyngeal tickling (Thompson, 2015).
Practicum Journal Entry
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I conducted patient physical examination, where the patient weight, Bp, BMI and height were on the 50th percentile for the patient. The remarkable physical observations were +3 erythematous tonsils that had no exudate. Tonsillar nodes were swollen. The nodes were tender and soft. Patient chest was clear and the heart sounds were normal. All other systems were reviewed and were intact. The laboratory findings were positive for IM (Burn et al., 2013).
However, the diagnosis process posed some challenges. This is because I relied in the initial impression of the clinical diagnostic, and had failed to reconsider the new data obtained during the revaluation. This is because my confidence was low, and was not keen to work with the results that I had gathered from patient assessment. It took the intervention of my preceptor, who helped me reconsider the new data gathered to frame the diagnostic options. My preceptor cautioned against this behaviour. I was also warned about premature closure, where the APN may prematurely close other potential diagnostic possibilities (Thorburn, 2010).
The final diagnosis was IM; however, there is no direct treatment for this disease. The treatment plan was to control patient clinical manifestation. This includes controlling patient fever; maintain patient body hydrated, adequate rest, and the treatment of secondary infections. Treatment is symptom based. The patient was given antipyretics to manage the patient fever. The patient was advised to be in light clothes to facilitate the dissipation of heat.
Practicum Journal Entry
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Appropriate foods as well as liquids were suggested to the mother so as to avoid irritation of the throat. This was done putting consideration of cultural sensitivity to ensure that the food selected would be tolerated by the family. I did not see the need for the patient to continue with Omnicef, but my preceptor advised that group A streptococcus is a secondary infection for patients diagnosed with IM, so the patient should continue with the mediation (Murray & Chennupati, 2012).
As an APN, it was my responsibility to educate the family about the disease, causes, symptomatic and treatment. I educated the patient on importance of finishing the dosage for fever and to avoid use of multiple blankets. The patient is taught the benefits of completing medication to manage the secondary bacterial infections even if it fails to make other clinical manifestation such as sore throat, fatigue and fever to disappear. The benefits of hydration were also monitored (Burn et al., 2013).
References
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care(5th ed.). Philadelphia, PA: Elsevier.
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Advanced Practice Roles
Introduction
Nursing is pragmatically considered to be a profession that is within the Medicare division of the overall concern of diverse families, individuals and the communities so the communities can achieve, sustain or even improve their finest health and the eminence life. Nursing can be distinguished from diverse further Medicare providers because of their aspect of work, their work technique to patient’s care, guidance and the extent of performance as the nurses usually carry out work in a broad range of performance areas that has diverse scope of performance and an intensity of the prescriber influence in every practitioner.
Nursing can be said to be a promotion, safety, and even the optimization of abilities and health, impediment of the illness and improvement of pain by the analysis and the treatment of human reaction.
Advanced Practice Roles
Purposes of nursing
Nursing as a worldwide community is normally for its professional to ensure that there is quality care for everybody as they maintain their diverse credentials, standards, code of ethics a competencies. For an individual to work in the nursing as a professional, all the nurse or the nurses practitioners holds one or even more credentials that normally depends on their scope of practice and their education.
Nurses are usually considered as not truly doctor’s assistants because nurses more often are independently caring for their patients or even assisting other nurses in the healthcare centre. Registered Nurses are mandated to treat patients, provide emotional support, record their medical history, and even provide follow-up care because nurses assist doctors in performing some of the diagnostic tests.
Advanced Practice Roles
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Advanced Practice Roles in Nursing
Roles of the Nurse Practitioner, nurse educator, nurse informatics, and nurse administrator in advanced practice nursing
Nurse educators
Nurse educators are registered nurses who have advanced education that includes advanced clinical training in a health care specialty because they combine expertise and also a passion for teaching into rich and rewarding careers selection. Nurse educators normally plays a paramount role in the aspect of strengthening the overall nursing workforce who serves as a role models in providing needed leadership skill so as to implement evidence based practice.
The nurse educators are similar with nurse practitioners in the aspect of health care provision but majorly differ in their work place because a nurse practitioner is in the health care room while a nurse educator can work from school to school so as to educate diverse people on the importance of nursing as a profession.
Nurse informaticians
Nursing Informatics is considered to be a discipline and practice that incorporates the aspect of nursing, its data and diverse awareness, with the diverse administration of data and the communication skills so as to uphold the fitness of communities. A nurse informatics usually work as developers of information and communication technologies, researchers, the principal information and nursing officers and also as software engineers who advance the healthcare facilities.
Center area of work for nurse informaticians includes the perception illustration and standards so as to sustain the evidence-based performance, education, and research. The nurse informaticians are similar with other advanced roles of nursing in the aspect of health care provision and health care improvement but majorly differ in their work place because a nurse informaticians is in the health care control room such as data centre so as to ensure that sophisticated deices and softwares are installed in the health care for improved efficiency.
Advanced Practice Roles
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Nurse administrator
Nurse administrator is an advanced role in nursing professional who are knowledgeable of the aspect of guidance practices as they have relation to the nursing professionals. This particular aspect may refer to a number of managerial supervisory and diverse tittles that assist the health care facilities in carrying on their esteemed functions. The multifaceted and complex character of contemporary healthcare facilities needs nursing guidance professionals who can craft efficient facility-wide systems and intra-departmental of healthcare delivery as they lead to a useful and proficient employees.
Nurse administrator permits for best possible patient care in any health care environment, from private hospices and hospitals to big medical care centers. Nurse administrator is similar to other advanced roles of nursing professionals in that all of the foster the aspect of healthy environment and the general provision of efficient health care services. Conversely, nurse administrator differ with other advanced roles of nursing profession in that they ensure that all the roles are efficient so as to provide a unity and productive workforce.
Selected Advanced Practice Role
Nurse Practitioner
Nurse practitioner is a sophisticated practice of registered nurses who are usually knowledgeable and vigorously skilled so as to offer health support and diverse protection by the aspect of medical analysis and the handling of severe illness and the persistent conditions (Hamric, 2013). A nurse practitioner normally has maximum capability to provide health care to all people even those who are perceived mental challenge because of their scope of work and advanced training.
Nurse practitioner differs with other advanced roles of nursing because nurses are mandated to carry out his or her duties in the health care room such as recording data and diverse healthcare services to the patients. A nurse practitioner is similar to other advanced roles of nursing as all of them involve the service that will prevent illness and promote health (Speziale, 2011).
Advanced Practice Roles
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Nurse Practitioners regulatory and legal requirements for North Carolina
Nurse Practitioners are considered to be the principal group of highly skilled practice and roles in North Carolina State. The licensure law and state practice usually provide for all the nurse practitioners to assess all the sick people, order, analyze, and then interpret the diagnostic tests with physician supervision so as to instigate and then manage treatments that incorporate recommending medications in the special licensure power of the state panel of nursing (Munhall, 2012).
The supervision physician should provide written instructions that orders medication, tests and the treatment which in turns assesses the information of Nurse Practitioners within a logical time. In North Carolina Nurses are normally taken care by a Joint Subcommittee of the North Carolina Medical Boards and the North Carolina Board of Nursing who promulgates rules so as to control the work of nurse practitioners, that then should be accepted by both panels prior to finishing the rulemaking procedure and then becoming effectual.
North Carolina Organization of Nurse Leaders (NCONL) usually exists to promote the nursing management excellence, shape general population guidelines and also toughen the leaders in nursing profession through teamwork and learning (Speziale, 2011). To become a member of the North Carolina Organization of Nurse Leaders, one is supposed to fill out the membership application that can be downloaded from the website. Membership fees dues are normally paid after January 1st is usually prorated on a quarterly basis because prorated membership dues are commonly considered only after a 12-month lapse in membership.
Advanced Practice Roles
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Required competencies for North Carolina
In North Carolina, nurse practitioners are normally required to possess high level of education so as to provide great nursing services to the public at large (DeNisco, 2012). Diverse exams are conducted so as to determine the level of competence that an individual contain. Nursing profession is considered to be a profession that needs adequate and necessary skills and knowledge because of its nature and the aspect that the profession deals with life-saving matters.
The required competencies for a nurse practitioner include pass in a nursing exams with high grades as the profession usually offers for all the nurse practitioners to assess all the patients, order, analyze, and then understand the diagnostic assessments with physician supervision so as to instigate and administer treatments that incorporates recommending prescriptions in the special licensure power of the state panel of nurses (Panel, 2011).
Some of the organizations are deemed best in working as I plan to work in North Carolina State Hospital because I feel that the medical facility environment possesses exceptional characteristics that support nursing profession. The state has a lot of people because the profession needs large population so as to embrace efficiency and experiences.
Advanced Practice Roles
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Health Policy and the Advanced Practice Role
Early childhood experience shapes health and the aspect of well being throughout the life
Early childhood social and economic conditions are considered to directly affect their respective health conditions. Diverse education and income, their neighbors resources and economic and the social factors affects their health at each stage of their life but the impacts on the young children is usually dramatic. Hamric et al (2013), the children early ages have the full potential to set up a path they are leading towards a good health or far away.
The diverse impact of these obstacles and opportunities along with diverse health effects that are accumulated over a long period of time can be transmitted in across generations as the children grow up to become parents because some of the social disadvantage in childhood such as a chronic stress can lead to a health disadvantage in adulthood. The effects of these is that, every parent want the best for all their children but it is usually considered that not all the parents have the same resources so as to assist their young ones to grow up healthy.
The policy needs to change the aspect of health care provision in that all the parents should try having the best practice and education for their children. Children should receive good education earlier so that they can embrace their good health from diverse school education that enhances good health. According to Robert Wood Jonson Foundation, nurse practitioners need diverse health policy attributes that will assist him or her ensure that the policies are helpful because as the number of negative childhood experiences increases it also increases the aspect of negative health outcome.
Advanced Practice Roles
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The process required to make the changes in the health policy should be instrumental so as to embrace productivity as a nurse practitioners have the capability to conduct numerous campaigns so as to preach the good parts of early childhood experience as it shapes health and the aspect of well being throughout the life of a child. According to Robert Wood Jonson Foundation, interested parties are normally the health practitioners, government and parents who have the responsibility to ensure that the children have a positive environment that will assist them shape the livelihood of their children.
Nurse practitioners need to be very intelligent in what they are doing so as to reveal any confidential matter that concerns a patient (Hamric, 2013). What I could that may lead the efforts to influence the change in policy is conducting numerous training so as to promote and ensure that the children have a positive environment that will assist them shape the livelihood of their children. I will attain and evaluate those missing attributes by continuous practice because this is considered to be the best way to add knowledge for a nurse practitioner.
Prediction of the effects on healthcare quality if the change is implemented
If the particular changes are implemented, children will have a better life when the attain an adulthood age because of the aspect that they have been shaped because nurse practitioners have diverse responsibilities to ensure that the children have a positive environment that will assist them shape the livelihood.
Advanced Practice Roles
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Conclusions
According to Robert Wood Jonson Foundation, nursing is considered to be one of the professions that promotes, protects, protection of the poor health and injuries, assistance of healing, and lessening of the affliction by the analysis and management of human reaction (Parahoo, 2014). Nurse practitioners use their leadership attributes to ensure that the nursing profession continues providing quality services to the whole world because nurse practitioners normally have maximum capability to provide health care to all people even those who are perceived mental challenge because of their scope of work and advanced training.
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Nurse practitioner program Application Essay
Role/contribution of Nurse practitioners(NPs) in the Canadian healthcare system Admission Essay
INSTRUCTIONS:
Write an admission essay for admission application for Nurse practitioner program at University of Toronto. I am applying for primary health care approach (PHC) nurse practitioner.
Program Requirements
To qualify for the degree, students shall complete a program of study outlined by the Graduate Department of Nursing Science.
Coursework. The MN program requires 5.5 full-course equivalents (FCEs), including:
NUR1094H, NUR1095H, NUR1097H, and NUR1138H;
a combination of courses based on the student’s emphasis:
Adult: NUR1101H; NUR1115H; NUR1140H; NUR1141H; NUR1215H; and NUR1221Y or
Paediatric*: NUR1102H; NUR1116H and NUR1216H; NUR1144H; NUR1145H; and NUR1222Y or
Primary Health Care — Global Health: NUR1114H; NUR1117H and NUR1217H; NUR1142H; NUR1143H; and NUR1223Y
NUR1221Y, NUR1222Y, and NUR1223Y must be taken alone in the final session and only after completion of all other coursework and program requirements.
This field of study is offered in a hybrid learning format including online and required on-campus, in-class learning.
*The Paediatric emphasis is available to students every other year. Visit the Nursing website for details.
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Home Visit with Sallie Mae Fisher Video
The major problems that can be identified from the home visit with Sallie Mae Fisher video, it is the social alienation of the patient, she is psychologically disturbed and with the lack of appetite the medicine will not be effective enough. She misses her husband a factor that increases the pain and the suffering that she is undergoing. She, however, points out that he used to smoke so often a factor that may be led to the condition that she is undergoing.
The discharge instructions have not been followed to the letter. There is no oxygen supply at the homestead since this was one of the discharging factors that would assist her to recover much faster at home. Lack of family to offer support also affects how the patient will cope with the ailment. The medications were not filled in time because her daughter works full time and she also has her issues to deal with.
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Home Visit with Sallie Mae Fisher Video
For the betterment of the patient, it is vital that some questions should be addressed to improve the health of the patient. The nurses should be aware of all the medicines that the patient should be taking at a given time. As evidenced, the patient mentioned that a nurse who has visited earlier didn’t assess the medications that were not available. Better and proper education should also be provided to the patient so that she can understand why some things are mandatory. Regarding the supply of oxygen in the house, she should be aware that the requirement is necessary, and it should be fixed immediately.
Home Visit with Sallie Mae Fisher Video
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Since the patient doesn’t have any family support, she should regularly be visited, or a nurse should permanently be at her home to guide her in the healing process. Psychologically, she should be involved in other activities that would make her concentrate on her health other than being psychologically being affected by those that she misses. The patient will be better if exercise is introduced into her life. Exercising rejuvenates an individual’s body energy, and this makes blood circulation to be efficient, and this will work well with the heart condition that she has.
Therapy and a holistic, multidisciplinary approach to the older people with heart conditions must be followed to the letter. It has been evidenced how effective the nurse visits have helped such kind of patients to cope with their conditions. Follow-ups by doctors and nurses are recommended, but they should be regular so that better techniques will be availed that will be used to improve the patient’s survival (Koelling et al. 2005)
Home Visit with Sallie Mae Fisher Video
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Dialogue
Nurse: “Good afternoon Sallae Mae, my name is Christine, and I will be your nurse today. I have learned that you are having issues with taking your medication?”
Mae: Yes I have not been consistently taking my drugs in the right procedure as prescribed, however sometimes I feel pain and headache all over my body that leads to lack of appetite, and how can I do it better nurse?”
Nurse: All the medications that you have been prescribed with have significance in your healing. Take them at the time prescribed so that your health will improve. In regards to the pain, body systems respond to the drug and they may cause such pain since they are fighting infections so that your body parts can function properly. I also realize that you do not have oxygen supply as indicated in the discharge prescription?
Mae: “True, I don’t want any oxygen in this house, I am just tired all I think about is my late husband, and recently I have no appetite. I am so depressed and I feel hopeless when I think of him”
Nurse: “That should not be the case mom; oxygen supply enables your breathing to be better and prevents polluted air into your systems. It will clean your lungs for healthy breathing and improve blood circulation. Be strong you need to allow your daughter to come and visit you to enable you reduce your loneliness. Hope you understand me, mom.”
Mae: “Yes I apparently don’t blame you, but I can’t stop thinking about him when my only daughter doesn’t have enough time to come and check on me, nurse.”
Nurse: “I have a solution to that, I will volunteer to be visiting you after every two days, and we start an exercise session so that you won’t be thinking about family members so much. I will also talk to your daughter to at least spare some hours and visit you. You will get better mom and all the best. I will visit you two days later and eat well never lose hope. Bye for now,”
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Stress Management Training and Home Visit Scheduling System
Introduction
Burnout has been identified as one of the main factors impacting the performance of home healthcare nurses. This mostly results from long working hours and many patients to attend to, such that they end up being too exhausted and stressed out. The nature of work that nurses do is also exhausting, given that it involves standing and running around all day, with insignificant breaks between one assignment and the other.
While the straightforward solution would be to increase the number of nurses so that the work is manageable, this may not feasible due to economic pressures, hence the need to come up with strategies to help the nurses manage their current situation better. This paper is a discussion of the impact of conducting stress management training and implementing a home care visit scheduling system to reduce burnout among nurses.
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Discussion
Stress management training
A stressed nurse is likely to have low productivity and energy levels and thereby more prone to burnout. Stress management training would be highly effective in helping nurses cope with everyday challenges and ensuring that they live a balanced life. Abel, Abel and Smith (2012), note that a majority of people are overwhelmed by stress because they are incapable of making proper decisions and plans to address their daily stressors.
Training would help the nurses in identifying their sources of stress and how these can be managed to make life easier. Training for example could help them learn how to prioritize issues and thus make proper personal plans based on the time available to them.
When people experience symptoms of stress including constant headaches, poor concentration, forgetfulness and insomnia among other signs, there is a significant likelihood that they are not aware that they are suffering from stress. Stress management training would provide nurses with an opportunity to understand stress, its causes and effects (Dhobale, 2009). This way, it is possible for the nurses to evaluate themselves and establish the stressors in their lives so as to deal with them.
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Knowledge of daily stressors ensures that they can be effectively addressed using various strategies in order to relieve the affected person (Dhobale, 2009). Once the causes of stress have been identified, it is easier to anticipate them and make necessary plans to ensure that they do not overwhelm the nurse again.
This in itself addresses the issue of burnout because absence of stress means that the individual has more energy to execute their duties. Dhobale (2009) notes that after training, self-management of stress through psychological techniques, physical exercise, breathing exercise, massage and indulgence in hobbies among other things is likely to be witnessed.
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Poor time management is a leading factor in triggering stressors as noted by Abel, Abel and Smith (2012). This is a common problem among home healthcare nurses and can be a major cause of stress. It is difficult for nurses to determine how much time they will spend with a patient because of lack of a properly laid out time plan. Stress management training places major focus on time management as a strategy to reduce stress.
Through this training, nurses would be taught how to schedule their home visits and how to plan their time to ensure that they only take the necessary amount of time to attend to a client. This will ensure that the nurses attend to more patients with lesser time, thus reducing burnout to a great extent. The fact that the nurse is likely to have adequate time for non-work activities in order to create a proper work-life balance leads to a reduction in the occurrence of burnout.
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Stress management training for nurses is not only useful to them but it can also help close acquaintances and colleagues. Milliken (2007) notes that the knowledge gained from the training may be passed on to other people, who would also benefit from better stress management. Assuming that the beneficiaries are mostly other nurses, the result would be a less burnt out workforce.
Home visit scheduling program
Designing a system that effectively schedules home visits would play a great role in reducing burnout among nurses. In the absence of a well designed system, nurses design their own schedules and often maintain unpredictable hours (Hall, 2011). In most cases, home visits are not well planned and nurses mostly end up spending so much time in one home and hence rescheduling consequent visits. They also have to travel frequently to keep up with the visits, hence increasing exhaustion.
Furthermore, a majority of nurses do not have a structured home visit plan to guide the visit and this often results in poor time planning (Mankowska, Meisel and Bierwirth, 2014). A system to schedule home visits would clearly indicate the number of homes to be visited each day, the number of hours to be spent in each house based on client needs and the issues to be addressed by the nurse during the visit. This would save time and thus reduce burnout.
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A scheduling system for home visits would ensure better coordination between healthcare workers and thus reduce conflicting schedules and information gap. Where there are different healthcare workers attending to the same patient, there may be conflict of schedules and thus difficulty in coordinating services (Pinelle and Gutwin, 2003). In the event that a nurse finds a patient being attended by another healthcare worker, they are forced to wait for them to finish with the patient or postpone the session and thus end up wasting a lot of time (Mankowska, Meisel and Bierwirth, 2014).
Due to the fact that each healthcare worker makes their own notes which are rarely shared because they are made on paper, it is difficult to track reports of other healthcare workers attending to the patient, which may bring confusion. It also becomes difficult for synchronous communication to be initiated because health workers cannot trace other healthcare workers’ schedules to know when they are available (Pinelle and Gutwin, 2003).
Such kind of communication breakdown can be addressed through the use of a scheduling system, which ensures that each healthcare worker logs in information concerning their sessions with the patient. Through the system, it is easy to follow schedules made by other healthcare workers, such that nurses can plan the most appropriate time to see clients to avoid time wastage, as well as identify the best time for synchronous communication (Pinelle and Gutwin, 2003). Improved efficiency is not only expected to increase productivity but it also reduces the probability of burnout among nurses.
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The home visits scheduling system is bound to improve efficiency in terms of number of homes visited per day and also save nurses long exhausting hours of travel (Mankowska, Meisel and Bierwirth, 2014). The system would cluster homes according to location in order to plan for effective travel. Visits would be scheduled in such a way that homes in the same area are clustered for same day visits as opposed to visiting different areas the same day. This would reduce the travelling time and also reduce exhaustion, consequently reducing burnout.
Considering the fact that the system has all the information about clients in one place, the nurse can easily retrieve information and make well-versed decisions based on the information. This works better than using client files because not only is the information easily retrievable, the nurse can make updates and easily compare notes for different clients. Such information can guide the nurse on areas of care to concentrate on, based on client history. Availability of information at the click of a button would go a long way in reducing burnout among nurses and thus enhance productivity.
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Conclusion
It is undeniable based on the discussion that stress management training and introduction of a home visit scheduling system would be effective in reducing burnout among home healthcare nurses. Notably, training nurses on stress management will ensure that they are more aware of their daily stressors, why they occur and how to deal with them. Time management taught during this training is also highly important in promoting efficiency and reducing burnout.
The home visit scheduling system would make it easier for nurses to plan visits, avoid conflict visits and promote communication synchronization. Through this system, visits would be well planned and there would be reduced rescheduling of visits. This essentially translates into less burnout by the nurses. The stress management training and home visit scheduling would therefore impact home healthcare nurse burnout in a significant manner.
Hall, R. (2011). Handbook of Healthcare System Scheduling. New York, Springer Science & Business Media.
Mankowska, D., Meisel, F., & Bierwirth, C. (2014). The home health care routing and scheduling problem with interdependent services. Health Care Management Science, 17(1), 15-30. doi:10.1007/s10729-013-9243-1. Retrieved from eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=12&sid=a576b81a-91da-4e90-bca3-a6f0a26ae995%40sessionmgr114&hid=111
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During this practicum, a 25 year old female presented to the healthcare facility with complains of severe cramp pain that occurs about one week before her menses, during the menstrual cycle and a week after the cycle ends. The patient complains that her menstrual cycles is irregular, and gets heavy periods with some clots. The patient reported to the clinic due to sharp pain that radiated from the chest. The patient had lived with this condition for 12 years. She has been managing the disease using alternative tradition medicines, which has not been effective.
Review of the system was conducted and laboratory tests were performed (urinalysis, urine culture, pregnancy test and wet prep). The differential diagnosis identified included amenorrhea, endometriosis, and ovarian cysts without explanation. Ovarian cysts were suspected due to presence of pelvic pain before the onset of period. However, this is not likely because the patient did not complain of fever and vomiting. Amenorrhea is suspected due to presence of pelvic pain. However, this is not likely as the key indicator of amenorrhea is absence of menses (Domino, Baldor, Golding, 2014).
To make a definitive diagnosis physical test was performed. Under the supervision of my preceptor, I conducted a pelvic exam. This included palpating pelvis areas to check abnormalities such as cysts and scars. The pelvic exam was negative. An ultrasound was requested to capture the image of the reproductive organs. The results indicated that the patient was suffering from endometriosis (American Congress of Obstetricians and Gynaecologists, 2011).
Treatment made included pain relive medication to help manage the painful cramps. The patient was also given Lo Loestrin Fe which has been found to be effective in management of pain. The increase and decrease of hormones during the menstrual cycle makes the endometrial implants to thicken.
Using this hormone therapy, it slows down the growth which prevents the implantation of the endometrial tissue. However, the patient was educated that although these medications manage the pain, they are not a permanent fix for this health complication. The symptoms can reoccur after stopping the treatment (CDC, 2013).
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The patient was also advised on ways to manage pain using home remedies. This includes the use of heating pad to relax the pelvic muscles, which helps in reducing pain. OTC non-steroidal anti-inflammatory drugs such as Motrin IB. The patient is advised to eat health and exercise regularly as it helps improve the pain (Buttaro et al., 2013).
During this practicum, I have learnt that issue of endometriosis is poorly understood in the society. This is probably because of the common myth of “etiquette menstruation” where the society believes that menstruation is a private affair and must not be discussed in public. Most of women conceal their suffering, which makes them to suffer in silence. As advanced nurse practitioner, it is our responsibility to raise awareness on endometriosis to encourage the affected persons to speak up, and seek medication early (CDC, 2013).
During the research, I also realized the common modalities between ovary cysts, amenorrhea and endometriosis. This includes the similarity in the clinical manifestation, test and diagnosis procedures and treatment. In these three reproductive systems disorders, they are clinically manifested by presence of pelvic pain before the onset and after menstrual cycle.
The test diagnosis of these disorders includes ultrasound, Pregnancy tests, urinalysis and urine culture. In management of the disease, most of them are managed using OTC pain killers, hormone therapy or invasive methods. Therefore, I need to research more on these reproductive disorders to ensure that I deliver effective care when serving the affected community (American Congress of Obstetricians and Gynecologists, 2011).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2013). Primary Care, 4th Edition. Philadelphia, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Domino, F. J.; Baldor, R.A.; Golding, J (Ed.). (2014). The 5-minute clinical consult standard 2015 (23rd ed, Kindle Edition). Philadelphia, PA: Lippincott Williams & Wilkins.
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