Nursing Papers Archives

Nursing 5598 – Independent Study – Non Clinical

Nursing 5598 – Independent Study – Non Clinical [Formerly NURS 251] Ind Study – Non Clinical [1-6] 5999. [Clinical Continuation] [Formerly NURS 3000] MSN, post-master’s certificate, or DNP students enroll in this course to resolve an incomplete grade in a prior semester’s clinical course. Enrollment in the course is considered to carry at least half-time status. Tuition is charged at a flat rate of $200. Students may enroll in this course no more than twice. Offered as needed. [0] Fall, Spring, Summer Specialty Nursing Courses and Electives 6010 – Advanced Pathophysiology [Formerly NURS 308] This is a graduate level, advanced pathophysiology course designed to meet the educational needs of those pursuing certification as advanced practice nurses.

The course builds on pre-acquired knowledge of normal human anatomy and physiology. Classic and current research findings form the basis for analysis of pathophysiologic processes and their effect on individual and multiple body systems. Students analyze the effect and progression of selected disease entities in diverse populations across the lifespan. The course provides a foundation for clinical assessment, diagnosis and management of clients experiencing alterations or risks of alterations in their health status. Pre/corequisite: Courses in normal human anatomy and physiology. [3] Fall, Spring 6011 – Advanced Health Assessment and Clinical Reasoning [Formerly NURS 305A]

This course is the foundational didactic course for advanced nursing practice. Students differentiate abnormal from normal findings using advanced assessment techniques, interpret diagnostic study results and use clinical reasoning to formulate diagnoses for culturally diverse individuals. Health promotion and disease prevention strategies are discussed. Prerequisite: Admission to specialty and graduate level standing. [2] Fall 6011L – Advanced Health Assessment Lab This course is the foundational physical exam and health assessment lab companion course for Advanced Health Assessment, N6011 for advanced nursing practice.Advanced Practice Nurse Assignment Papers. Students differentiate abnormal from normal findings using advanced assessment techniques, interpret diagnostic study results and use clinical reasoning to formulate diagnoses for culturally diverse individuals. Students interpret data and problem-solve utilizing case studies and standardized patients. Prerequisite: Admission to specialty and graduate level standing. [1] Fall 6020 – Advanced Pharmacotherapeutics

[Formerly NURS 307] This course is designed to provide students with the knowledge of pharmacokinetics that will enable the student to safely and appropriately select pharmacologic agents for the management of common acute and chronic health problems of diverse populations.Advanced Practice Nurse Assignment Papers. Specific content of the course covers representative drugs of a pharmacologic group, indications for use, drug selection, titration of dose, key adverse effects, and monitoring of therapy and alternative therapy. [3] Fall, Spring 6025 – Applied Quality Improvement and Patient Safety [Formerly NURS 383A] This course focuses on the application of quality improvement methodology and measurement of outcomes across a broad range of health care settings. Students learn the systematic methods of continuous quality improvement, based on the work of Deming and others. The use of various outcome measurement instruments and data collection tools are explored. Prerequisite: 6065. [2-3] Spring Nursing 5598 – Independent Study – Non Clinical 6030 – Advanced Practice Nursing in Primary Care of the Adult [Formerly NURS 309A]

This course is designed to provide students with knowledge needed to assess and manage common acute and chronic health problems in the adult population. Multidimensional interventions are discussed (e.g., culturally and environmentally sensitive; health promoting). Pre/corequisite: 6101 or 6011. [3] Fall, Spring 6031 – Advanced Practice Nursing in Primary Care of the Adolescent [Formerly NURS 309C] This didactic course presents knowledge that is necessary for the practice of primary health care nursing of adolescents. Course content includes the principles of health promotion, disease prevention and assessment, and management of common primary health care problems in diverse adolescent populations. Emphasis is placed on developmental needs and the pathophysiologic processes underlying certain conditions. The impact of the family on the health of the adolescent is explored. Students are introduced to the dynamics of the managed care environment. Pre/corequisite: 6011 or 6101. [1] Fall, Summer 6032 – Advanced Practice Nursing in the Primary Care of the Woman [Formerly NURS 309E]

This didactic course presents the knowledge that is necessary for the practice of primary care of the female patient by advanced practice nurses. Course content includes the principles of health promotion, disease prevention and assessment, and the management of common primary health care problems in the female population. Emphasis is placed on management of women’s health issues in a general, primary care setting. Pre/corequisite: 6011. [1] Spring 6034 – Adult Gerontology Primary Care I [Formerly NURS 310A]

Emphasis is placed on developmental needs and the pathophysiologic processes underlying certain conditions. The impact of the family on the health of the child/adolescent is explored. This course builds on pre-requisite knowledge by exploring the pathophysiologic disease processes underlying certain conditions that are specific to the pediatric and adolescent population as well as exploring treatment of these processes. Pre/corequisite: 6011. [3] Spring Nursing 5598 – Independent Study – Non Clinical 6040 – Introduction to Health Informatics [Formerly NURS 381A] Health informatics is the management and transformation of health data into information and knowledge to improve aspects of health outcomes such as cost, quality, safety, and/or satisfaction. This survey course focuses on information systems in clinical settings and the use of information for health systems management. The recent emphasis on the National Health Information Infrastructure at the Federal level will be used to frame the topics.

Examples include organizing information pertinent to individual patient care, analyzing data to determine clinical effectiveness, retrieving needed information or knowledge at the point of care, using data to improve management of health care enterprises, and assessing the health patterns of populations and aggregates. Pre/corequisite: Basic competency in using word processing, electronic mail, bibliographic or library retrieval systems, presentation graphics, spreadsheets, and databases. These skills are not taught in the course, but students may be required to apply them to carry out course assignments. [3] Fall 6041 – Principles of Health Care Finance [Formerly NURS 385A] In this course, students learn to apply accounting and economic principles, and financial management strategies to effectively manage health care resources in health care organizations. Students acquire the knowledge and skills to utilize computer software for conducting efficient financial analysis. [3] Spring

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6045 – Professional Formation 1: Roles and Contexts for Advanced Nursing Practice This course offers an introduction to the principles, concepts, and frameworks for advanced nursing practice. Students will integrate principles of evidence-based practice, quality and safety, leadership, ethics, policy, and role development. Students will identify the role of advanced nursing practice in the healthcare environment with emphasis on leadership in quality and safety as a part of interprofessional teams. [2] Fall 6055 – Professional Formation 2: Application of Evidence in Healthcare Environments This course is the second in a series of courses facilitating Professional Formation in the Advanced Nursing Practice role.Advanced Practice Nurse Assignment Papers.

Students will develop skills to evaluate and synthesize supporting evidence and examine ethical dilemmas of implementation, to develop and articulate innovative solutions. Students will learn how to assess clinical processes, identify advanced nursing practice problems, and determine how to address problems. Prerequisite: 6045. [3] Spring 6060 – Conceptualization and Integration of Evidence for Advanced Nursing Practice [Formerly NURS 399B] This course provides the student with the opportunity to explore a relevant problem in advanced nursing practice. Concepts related to the selected problem are identified and critically appraised. Methodologies to generate evidence will be presented to examine knowledge related to the selected problem and make practice recommendations. This course builds upon prerequisite knowledge. Prerequisite: 6050. [3] Summer

Nursing 5402 – Epidemiology and Population-Based Nursing

Nursing 5402 – Epidemiology and Population-Based Nursing [Formerly NURS 228]

This course provides the student with an opportunity to explore population-based health care principles of prevention, health maintenance and health promotion within the context of Healthy People 2010. Notably, the course will focus on how these principles are used to increase healthy lifespan, decrease discrepancies in health status and health outcomes for different populations and assure access to preventive services for all.

It emphasizes epidemiologic principles and population-based holistic health promotion/disease prevention as an integral part of populations at risk for illness, disability, or premature death. Further, the course explores population-based care models and environments in which health care is delivered: community agencies, neighborhoods/communities, schools, the family, and the workplace. Legislation and policy implications for primary, secondary, and tertiary care will be discussed. [3] Fall

5403 – Health Care Systems and the Role of the Nurse as Facilitator of Learning [Formerly NURS 238]

This course addresses health care systems and the role of the nurse as teacher and facilitator of learning in health care. Course content focuses on leadership concepts, decision-making, team building, communication, managerial skills, and integrates the foundational concepts of teaching and counseling patients and families. The course also provides information on contemporary trends in the organization and delivery of health care to individuals, families and populations to include quality improvement and legal/regulatory issues.

In addition, course content will include the impact of managed care and financial pressures on health care providers along with outcomes management, financial management, conflict resolution and economic principles pertinent to the delivery of health care services. The course provides concepts related to change management and the teaching and learning processes. Corequisites: 5401, 5402, 5303. [3] Fall

5501 – Critical Thinking, Supporting Evidence and Communication, Part 2 [Formerly NURS 218B]

This course is the second of a two course sequence addressing critical thinking, research utilization, and communication. Students in this course will identify, evaluate, and engage the various steps of scholarly inquiry in order to address research problems related to professional nursing practice. Students also will explore the theoretical and research foundations for evidence-based practice in nursing. Prerequisite: 5401. [2] Spring

5502 – Advanced Practice Nurse Assignment Papers. Ethics in Nursing Practice [Formerly NURS 219]

This didactic and seminar course addresses basic ethical principles and special problems/issues as sources for ethical reflection. Ethical dilemmas in health care are discussed using professional and analytical methods of investigation. Students are expected to reflect on their personal values and beliefs, ethical principles, clinical experiences, and literature sources while engaging in all assignments. Prerequisite: 5401. [2] Spring

5505 – Health Assessment for the Registered Nurse [Formerly NURS 248]

This course is designed to provide the RN student the opportunity to learn and practice the skills of assessment in a classroom, laboratory setting, and then in a clinical area for a variety of client populations across the life span. The student’s specialty population will be considered in the choice of health care setting utilized for practice.

Prerequisite: 5303, 5402.

Corequisite: 5506. [3] Spring

5506 – Pharmacology for the Registered Nurse [Formerly NURS 259] This course extends and builds upon pharmacological knowledge from foundational pharmacology courses and pathophysiology courses. The focus of the course is the variations of drug therapy in complex situations. The course presents cases of complex drug regimens for analysis and evaluation by the student. Emphasis will be placed on pharmacological interventions to achieve safe and optimal patient outcomes in specific situations. [3] Spring

5515 – Providing Care at the Community Level [Formerly NURS 249] This course is an introduction to the scope and practice of family and community health nursing.Advanced Practice Nurse Assignment Papers. It emphasizes, through didactic and community practice, the promotion and maintenance of the health of diverse populations across the lifespan. The epidemiological process and the nursing process serve as the organizing framework for didactic content and clinical interventions to support family and community health. Social, cultural, economic, environmental, and ethical issues related to specific populations will be explored. Limited to RN students. Prerequisite: 5402; or with permission of instructor. [3] Spring

5598 – Independent Study – Non Clinical [Formerly NURS 251] Ind Study – Non Clinical [1-6] 5999. [Clinical Continuation] [Formerly NURS 3000]

MSN, post-master’s certificate, or DNP students enroll in this course to resolve an incomplete grade in a prior semester’s clinical course. Enrollment in the course is considered to carry at least half-time status. Tuition is charged at a flat rate of $200. Students may enroll in this course no more than twice. Offered as needed. [0] Fall, Spring, Summer

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Specialty Nursing Courses and Electives

6010 – Advanced Pathophysiology [Formerly NURS 308]

This is a graduate level, advanced pathophysiology course designed to meet the educational needs of those pursuing certification as advanced practice nurses. The course builds on pre-acquired knowledge of normal human anatomy and physiology. Classic and current research findings form the basis for analysis of pathophysiologic processes and their effect on individual and multiple body systems. Students analyze the effect and progression of selected disease entities in diverse populations across the lifespan. The course provides a foundation for clinical assessment, diagnosis and management of clients experiencing alterations or risks of alterations in their health status. Pre/corequisite: Courses in normal human anatomy and physiology. [3] Fall, Spring

6011 – Advanced Health Assessment and Clinical Reasoning [Formerly NURS 305A] This course is the foundational didactic course for advanced nursing practice. Students differentiate abnormal from normal findings using advanced assessment techniques, interpret diagnostic study results and use clinical reasoning to formulate diagnoses for culturally diverse individuals. Health promotion and disease prevention strategies are discussed.

Prerequisite: Admission to specialty and graduate level standing. [2] Fall

Nursing 5403 – Health Care Systems and the Role of the Nurse as Facilitator of Learning

Nursing 5403 – Health Care Systems and the Role of the Nurse as Facilitator of Learning [Formerly NURS 238]

5501 – Critical Thinking, Supporting Evidence and Communication, Part 2 [Formerly NURS 218B]

5502 – Advanced Practice Nurse Assignment Papers. Ethics in Nursing Practice [Formerly NURS 219]

5505 – Health Assessment for the Registered Nurse [Formerly NURS 248]

Prerequisite: 5303, 5402.

Corequisite: 5506. [3] Spring

5598 – Independent Study – Non Clinical [Formerly NURS 251] Ind Study – Non Clinical [1-6] 5999. [Clinical Continuation] [Formerly NURS 3000]

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Specialty Nursing Courses and Electives

6010 – Advanced Pathophysiology [Formerly NURS 308]

Prerequisite: Admission to specialty and graduate level standing. [2] Fall.

Nursing 5402 – Epidemiology and Population-Based Nursing

Nursing 5402 – Epidemiology and Population-Based Nursing [Formerly NURS 228]

5403 – Health Care Systems and the Role of the Nurse as Facilitator of Learning [Formerly NURS 238]

5501 – Critical Thinking, Supporting Evidence and Communication, Part 2 [Formerly NURS 218B]

5502 – Advanced Practice Nurse Assignment Papers. Ethics in Nursing Practice [Formerly NURS 219]

5505 – Health Assessment for the Registered Nurse [Formerly NURS 248]

Prerequisite: 5303, 5402.

Corequisite: 5506. [3] Spring

5598 – Independent Study – Non Clinical [Formerly NURS 251] Ind Study – Non Clinical [1-6] 5999. [Clinical Continuation] [Formerly NURS 3000]

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Specialty Nursing Courses and Electives

6010 – Advanced Pathophysiology [Formerly NURS 308]

Prerequisite: Admission to specialty and graduate level standing. [2] Fall

Nursing 5501 – Critical Thinking Supporting Evidence and Communication Part 2

Nursing 5501 – Critical Thinking, Supporting Evidence and Communication, Part 2

Nursing 5501 – Critical Thinking, Supporting Evidence and Communication, Part 2 [Formerly NURS 218B]

5502 – Advanced Practice Nurse Assignment Papers. Ethics in Nursing Practice [Formerly NURS 219]

5505 – Health Assessment for the Registered Nurse [Formerly NURS 248]

Prerequisite: 5303, 5402.

Corequisite: 5506. [3] Spring

5598 – Independent Study – Non Clinical [Formerly NURS 251] Ind Study – Non Clinical [1-6] 5999. [Clinical Continuation] [Formerly NURS 3000]. Nursing 5501 – Critical Thinking Supporting Evidence and Communication Part 2.

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Specialty Nursing Courses and Electives

6010 – Advanced Pathophysiology [Formerly NURS 308]

Prerequisite: Admission to specialty and graduate level standing. [2] Fall.

Nursing 5403 – Health Care Systems and the Role of the Nurse as Facilitator of Learning

Nursing 5403 – Health Care Systems and the Role of the Nurse as Facilitator of Learning [Formerly NURS 238]

5501 – Critical Thinking, Supporting Evidence and Communication, Part 2 [Formerly NURS 218B]

5502 – Advanced Practice Nurse Assignment Papers. Ethics in Nursing Practice [Formerly NURS 219]

5505 – Health Assessment for the Registered Nurse [Formerly NURS 248]

Prerequisite: 5303, 5402.

Corequisite: 5506. [3] Spring

5598 – Independent Study – Non Clinical [Formerly NURS 251] Ind Study – Non Clinical [1-6] 5999. [Clinical Continuation] [Formerly NURS 3000]

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Specialty Nursing Courses and Electives

6010 – Advanced Pathophysiology [Formerly NURS 308]

Prerequisite: Admission to specialty and graduate level standing. [2] Fall

NURS 6565 Synthesis in Advanced Practice Care

Acute and Chronic Care

Acute and Chronic Care In the acute care setting, APNs struggle with dilemmas involving pain management, end-of-life decision making, advance directives, assisted suicide, and medical errors (Shannon, Foglia, Hardy, & Gallagher; 2009). Rajput and Bekes (2002) identified ethical issues faced by hospital- based physicians, including obtaining informed consent, establishing a patient’s competence to make decisions, maintaining confidentiality, and transmitting health information electronically. APNs in acute care settings may experience similar ethical dilemmas. Recent studies of moral distress have revealed that feeling pressured to continue aggressive treatments that respondents thought were not in the patients’ best interest or in situations in which the patient was dying, working with physicians or nurses who were not fully competent, giving false hope to patients and families, poor team communication, and lack of provider continuity were all issues that engendered moral distress (Hamric & Blackball, 2007; Hamric, Borchers, & Epstein, 2012).Advanced Practice Nurse Assignment Papers. APNs bring a distinct perspective to collaborative decision making and often find themselves bridging communication between the medical team and patient or family. For example, the neonatal nurse practitioner (NNP) is responsible for the day-to-day medical manage- ment of the critically ill neonate and may be the first provider to respond in emergency situations (Juretschke, 2001). The NNP establishes a trusting relationship with the family and becomes aware of the values, beliefs, and attitudes that shape the family’s decisions. Thus, the NNP has insight into the perspectives of the health care team and family. This “in-the-middle” position, however, can be accompanied by moral distress (Hamric, 2001), particularly when the team’s treatment decision carried out by the NNP is not congruent with the NNP’s professional judgment or values. Botwinski (2010) conducted a needs assessment ofNNPs and found that most had not received formal ethics content in their education and desired more education on the management of end-of-life situations, such as delivery room resuscitation of a child on the edge of viability. Knowing the best interests of the infant and balancing those obligations to the infant with the emotional, cognitive, financial, and moral concerns that face the family struggling with a critically ill neonate is a complex undertaking. Care must be guided by an NNP and health care team who understand the ethical principles and decision making related to issues confronted in neonatal intensive care unit (NICU) practice.

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Acute and Chronic Care Societal Issues Ongoing cost containment pressures in the health care sect0r have significantly changed the traditional practice of delivering health care. Goals of reduced expenditures and services and increased efficiency, although important, may compete with enhanced quality oflife for patients and improved treatment and care, creating tension between providers and administrators, particularly in managed care systems in which providers find that their clinical decisions are subject to outside review before they can be reimbursed. Ulrich and associates (2006) surveyed NPs and physician assistants to identify their ethical concerns in relation to cost containment efforts, including managed care. They found that 72% of respondents reported ethical concerns related to limited access to appropriate care and more than 50% reported concerns related to the quality of care. An earlier study of 254 NPs revealed that 80% of the sample perceived that to help patients, it was sometimes necessary to bend managed care guidelines to provide appropriate care (Ulrich, Soeken, & Miller, 2003).

Most respondents in this study reported being moderately to extremely ethically concerned with managed care; more than 50% said that they were concerned that business decisions took priority over patient welfare and more than 75% stated that their primary obligation was shifting from the patient to the insurance plan. Although the passage of the Patient Protection and Affordable Care Act (PPACA; U.S. Department of Health & Human Services fHHSJ, 2011) may help with these concerns to some extent, the ethical tensions that underlie cost containment pressures and the business model orientation of health care delivery may continue.Advanced Practice Nurse Assignment Papers. An example of how cost containment goals can create conflict is a situation in which a NP wishes to order a computed tomography (CT) scan to evaluate a patient complaining of abdominal pain. The NP knows that the patient has a history of diverticulosis resulting in abscess formation and the current pres·entation with fever and abdominal tenderness justifies this testing; however, the insurance approval process takes a minimum of 24 hours. By sending the patient to the emergency room, the test can be done more quickly, but the patient will also face a long wait and a high copay if she does not require subsequent hospital admission.

Limiting access to CT scans is based on containing costs and avoiding unnecessary testing, which are two laudable goals.Advanced Practice Nurse Assignment Papers. However, in this situation, the lengthy approval process means that the NP does not have needed information to direct the treatment plan and alleviate the patient’s suffering in a timely manner. The use of the emergency room to obtain essential clinical information is a greater burden on the patient and may ultimately prove more expensive to the system. Technologic advances, such as the rapidly expanding field of genetics, are also challenging APNs (Caulfield, 2012; Harris, Winship, & Spriggs, 2005; Horner, 2004; Pullman & Hodgkinson, 2006). As Hopldnson and Mackay (2002) have noted, although the potential impact of mapping the human genome is immense, the challenge of how to translate genetic data rapidly into improvements in the prevention, diagnosis, and treatment of disease remains.

To counsel patients effectively on the risks and benefits of genetic testing, APNs need to stay current in this rapidly changing field (a helpful resource for this and other issues is the text by Steinbock, Arras, and London, 2012), As one example, genetic testing poses a unique challenge to the informed consent process. Patients may feel pressured by family members to undergo or refuse testing, and may require intensive counseling to under- stand the complex implications of such testing; APNs are also involved in post-test counseling, which raises ethical concerns regarding the disclosure of test results to other family members (Eden, 2006). Because genetic information is crucially linked to the concepts of privacy and confidentiality, and the availability of this information is increasing, it is inevitable that APNs will encounter legal issues and ethical dilemmas related to the use of genetic data.

APNs may engage in research as principal investigators, co-investigators, or data collectors for clinical studies and trials. In addition, leading quality improvement (QI) initiatives is a key expectation of the DNP-prepared APN (AACN, 2006). Ethical issues abound in clinical research, including recruiting and retaining patients in studies, protecting vulnerable populations from undue risk, and ensuring informed consent, fair access to research, and study subjects’ privacy. As APNs move into QI and research initiatives, they may experience the conflict between the clinician role, in which the focus is on the best interests of an individual patient, and that of the researcher, in which the focus is on ensuring the integrity of the study (Edwards & Chalmers, 2002).Advanced Practice Nurse Assignment Papers. Acute and Chronic Care Access to Resources and Issues of Justice Issues of access to and distribution of resources create powerful dilemmas for APNs, many of whom care for underserved populations. Issues of social justice and equitable access to resources present formidable challenges in clinical practice.

Trotochard (2006) noted that a growing number of uninsured individuals lack access to routine health care; they experience worse outcomes from acute and chronic diseases and face higher mortality rates than those with insurance. McWilliams and colleagues (2007) found that previously uninsured Medicare beneficiaries require significantly more hospitalizations and office visits when compared with those with similar health problems who, prior to Medicare eligibility, had private insurance.Advanced Practice Nurse Assignment Papers. The PPACA, when fully enacted, will help improve access to quality care and decrease the incidence of these dilem- mas. However, as noted, the escalating costs of health care represent ethical challenges to providers and systems alike, regardless of the population’s insurance status. The allocation of scarce health care resources also creates ethical conflicts for providers; regardless of pay- ment mechanisms, there are insufficient resources to meet all societal needs (Bodenheimer & Grumbach, 2012; Trotochard, 2006). Scarcity of resources is more severe in developing areas of the world and justice issues of fair and equitable distribution of health care services present serious ethical dilemmas for nurses in these regions (Harrowing & Mill, 2010). A further international issue is the “brain drain” of nurses and other health professionals who leave underdeveloped countries to take jobs in developed countries (Chaguturu & Vallabhaneni, 2007; Dwyer, 2007).

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Allocation issues have been described in the area of organ transplantation but dilemmas related to scarce resources also arise in regard to daily decision maldng, for example, with a CNS guiding the assignment of patients in a staffing shortage, or an FNP finding that a specialty consultation for a patient is not available for several months. Whether in community or acute care settings, APNs must, on a daily basis, balance their obligation to provide holistic, evidence-based care with the necessity to contain costs and the reality that some patients will not receive needed health care. As Bodenheimer and Grumbach (2012) have noted, “Perhaps no tension within the U.S. health care system is as far from reaching a satis- factory equilibrium as the achievement of a basic level of fairness in the distribution of health care services and the burden of paying for those services” (p. 215). One of the value-added components that APNs bring to any practice setting is creativity and a wide range of patient management strategies, which are crucial in caring for large numbers of uninsured and underinsured persons. It is not uncommon for an APN to encounter a patient who has been forced to stop taking certain medications for financial reasons. Although many practitioners pre- scribe generic forms of medications, if available, some patients still have to pay an exorbitant price for their medications.

For example, an acute care nurse practitioner (ACNP) managing an underinsured patient with chronic lung disease and heart failure discovers that the patient is unable to pay for all the medications prescribed and has elected to forego the diuretic and an angiotens in converting enzyme inhibitor (ACE-I). Because the ACNP knows that ACE-Is are associated with reduced morbidity and mortality rates, and that diuretics control symptoms and prevent rehospitalization, these changes are discouraged. Instead, the ACNP helps the patient make more suitable choices when altering medications, such as dosing some medications on an every-other-day basis. The ACNP has helped the patient cope with the situation but must face the morally unsettling fact that this plan of care is medically inferior. Finally, as APNs broaden their perspectives to encompass population health and increased policy activities, both essential competencies of the DNP-prepared APN (AACN, 2006), they will experience the tension between caring for the individual patient and the larger population (Emanuel, 2002). Caregivers are increasingly being asked to incorporate population-based cost considerations into individualized clinical decision making (Bodenheimer & Grumbach, 2012). Population-based considerations present a challenge to the moral agency of APNs, who have been educated to privilege the individual clinical decision.

Phases of Core Competency Development

Phases of Core Competency Development The core competency of ethical decision making for APNs can be organized into four phases. Each phase depends on Phases of 1. Knowledge Development-Moral Sensitivity 2. Knowledge Application-Moral Action 3. Creating an Ethical Environment 4. Promoting Social Justice Within the Health Care System of Core Ethical theories Ethical issues in specialty Professional code Professional standards Legal precedent Moral distress Ethical decision-making frameworks Mediation and facilitation strategies Preventive ethics Awareness of environmental barriers to ethical practice Concepts of justice

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Health policies affecting a specialty population the acquisition of the knowledge and skills embedded in the previous level. Thus, the competency of ethical decision making is understood as an evolutionary process in an APN’s development. Phase 1 and beginning exposure to Phase 2 should be explicitly taught in the APN’s gradu- ate education. Phases 3 and 4 evolve as APNs mature in their roles and become comfortable in the practice setting; these phases represent leadership behavior and the full enactment of the ethical decision making competency. Phase 4 relies on competencies required of DNP-prepared APNs; the knowledge and skills needed for Phases 3 and 4 should be incorporated into DNP programs. Although an expectation of the practice doctorate, all APNs should develop their ethical knowledge and sldlls to include elements of all four phases of this competency. The essential elements of each phase are described in Table 13-1. Phase 1: Knowledge Development The first phase in the ethical decision making competency is developing core knowledge in ethical theories and principles and the ethical issues common to specific patient for Ethical Decision Sensitivity to ethical dimensions of clinical practice — — — —- —– — – —

Values clarification Sensitivity to fidelity conflicts Gather relevant literature related to problems identified Evaluate practice setting for congruence with literature Identify ethical issues in the practice setting and bring to the attention of other team members Apply ethical decision making models to clinical problems Use skilled communication regarding ethical issues Facilitate decision making by using select strategies Recognize and manage moral distress in self and others Role model collaborative problem solving Mentor others to develop ethical practice Address barriers to ethical practice through system changes Use preventive ethics to decrease unit-level moral distress Ability to analyze the policy process Advocacy, communication, and leadership skills Involvement in health policy initiatives supporting social justice populations or clinical settings. This dual knowledge enables the APN student to integrate philosophical concepts with contemporary clinical issues. The emphasis in this initial stage is on learning the language of ethical discourse and achieving cognitive mastery. The APN learns the theories, principles, codes, paradigm cases, and relevant laws that influence ethical decision making. With this knowledge, the APN begins to compare current practices in the clinical setting with the ethical standards desctibed in the literature.

Phase 1 is the beginning of the APN’s personal journey toward developing a distinct and individualized ethical framework. The work of this phase includes developing sensitivity to the moral dimensions of clinical practice (Weaver, 2007). A helpful initial step in building moral sensitivity is understanding one’s values, in which students clarify the personal and professional values that inform their care (Fry & Johnstone, 2008). Engaging in this work uncovers personal values that may have been internalized and not openly acknowledged, and is particularly important in our multicultural world. Another key aspect of this phase is developing the ability to distinguish a true ethical dilemma from a situation of moral distress or other clinically problematic situation. This requires a general understanding of ethical theories, principles, and standards that help the APN define and discern the essential elements of an ethical dilemma. Novice APNs should be able to recognize a moral problem and seek clarification and illumination of the concern.

The APN identifies ethical issues and formulates the concerns about which others are uneasy. This step earns credibility and enables the APN to gain self- confidence by bringing the issue to the awareness and attention of others. If the issue remains a moral concern after clarification, the APN should pursue resolution, seeking additional help if needed. Formal education in ethical theories and concepts should be included in graduate education programs for APNs. Although some beginning graduate students will have had significant exposure to ethical issues in their undergraduate programs, most have not. A 2008 U.S. survey of nurses and social workers found that only 51% of the nurse respondents had formal ethics education in their undergraduate or graduate education; 23% had no ethics training at all (Grady, Danis, Soeken, et al., 2008). APN students with no ethics education will be at a disadvantage in developing this competency because graduate education builds on the ethical foundation of professional practice. The current master’s essentials (AACN, 2011) do not address ethics education directly but include compe- tencies in the use of ethical theories and principles.

The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006) contains explicit ethical content in five of the eight major categories (Box 13-1). Even categories that do not explicitly list necessary ethical content imply it in referring to issues such as improving access to health care, addressing gaps in care, and using conceptual and analytic skills to address links between practice and organizational and policy issues. Exposure to ethical theories, principles, and concepts allows the APN to develop the language necessary to articulate ethical concerns in an interprofessional environment. It is important, however, that knowledge development extend beyond classroom discussions. Clinical practicum experiences also need to build in discussions of ethical dimensions of practice explicitly rather than assume that these discussions will naturally occur. In one study of the clinical experiences of graduate students from four graduate programs, only 4 of 20 students were identified as having experience with an ethical dilemma and only 2 of 22 preceptors noted any exposure to ethical dilemmas for students (Howard & Steinberg, 2002). The authors concluded that this apparent void in clinical education may have been a function of limited recognition.

Ethical Competencies in the DNP Essentials

Ethical Competencies in the DNP Essentials Integrate nursing science with knowledge: from ethics and biophysical psychosocial analytic, and organizational sciences as the basis for the highest level’ Of nursing practice. (I) Develop and/or evaluate effective strategies for· managing the ethical dilemmas inherent in patient care, the healthcare organization; and research. (II) Design, direct, and evaluate quality: Improvement methodologies to promote safe, timely, effective, efficient, equitable (emphasis added), and patient-centered care.· (I!I) Provide’leadership in the evaluation and resolution of ethical and legal issue’s within health care systems relating to ‘the use of information, information technology, communication networks; ‘and patient care technology. (IV) Advocate for social justice, equity; within all health care arenas. (V) Ethical decision making processes by APN students and preceptors.

In another study, Laabs (2005) noted that 67% of NP respondents claimed that they never or rarely encountered ethical issues. Some respondents showed confusion regarding the language of ethics and related principles. In a later study, Laabs (2012) found that APN graduates, most of whom had had an ethics course in their graduate curriculum, indicated a fairly high level of confidence in their ability to manage ethical problems, but their overall ethics knowledge was low. These three studies provide compelling commentary on the need for Phase 1 activity in graduate curricula.

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The core knowledge of ethical theories should be supplemented with an understanding of issues central to the patient populations with whom the APN works. As APNs assume positions in specific clinical areas or with particular patient populations, it is incumbent upon them to gain an understanding of the applicable laws, standards, and regulations in their specialty, as well as relevant paradigm cases. This information may be garnered from current literature in the field, continuing education programs, or discussions with colleagues. Information on legal and policy guidelines should be offered during graduate pract- icum experiences in the area of clinical concentration. Although Phase 1 is the building block for the other phases of this competency, it is also an ongoing process. APNs will gain core knowledge in graduate education but, as societal issues change and new technologies emerge, new dilemmas and ethical problems arise.

The ability to be a leader in creating ethical environments involves a commitment to lifelong learning about ethical issues, of which professional education is just the beginning. Developing an Educational Foundation As noted, education in ethical theories, principles, rules, and moral concepts provides the foundation for developing skills in ethical reasoning. Because the APN will apply these theoretical principles in actual encounters with patients, it is imperative that consideration of the context in specific situations be strengthened. A portion of graduate ethics education should involve discussion of typical issues encountered by APNs, rather than issues that receive extensive media attention but occur infrequently. Howard and Steinberg (2002) maintained that graduate curricula need to go beyond traditional ethical issues to encompass building trust in the APN -patient relationship, professionalism and patient advocacy, resource allocation decisions, individual versus population-based responsibilities, and managing tensions between business ethics and professional ethics.

The latter three areas are crucial for developing the Phase 4 level of the ethical decision malting competency. Continuing education programs are also effective and necessary forums in which current information can be provided in a rapidly changing health care environment. As technology changes and new dilemmas confront practitioners, the APN must be prepared to anticipate conditions that erode an ethical environment. Knowledge and skills in all phases of this competency depend on the appli- cation of current ethical knowledge in the clinical setting; ethical reasoning and clinical judgment share a common process and each serves to teach and inform the other (Dreyfus, Dreyfus, & Benner, 2009).

Therefore, the importance of clinical practice cannot be overemphasized. Overview of Principle-Based model. Although ethical decision making in health care is extensively discussed in the bio- ethics literature, two dominant models are most often applied in the clinical setting. The first model of decision making is a principle-based model (Box 13-2), in which ethical decision making is guided by principles and rules (Beauchamp & Childress, 2009). In cases of conflict, the principles or rules in contention are balanced and interpreted with the contextual elements of the situation. However, the final decision and moral justification for actions are based on an appeal to principles.

NURS 6565 Week 2 Discussion

NURS 6565 Week 2 Discussion: Ethical Challenges in Health Care for Practicing NPs

NURS 6565 Week 2 Discussion: Ethical Challenges in Health Care for Practicing NPs Consider the following case study: Mrs. ABC is a 35 year old woman who has a scheduled business trip today. It is currently 8 am, and her plan is to leave at 6 pm. Mrs. ABC has a sore throat and she thinks it is strep because her 5 year old daughter was recently treated for strep. Mrs. ABC calls her physician for an appointment, but there are no appointments available until next week. Advanced Practice Nurse Assignment Papers. She has a mother who is a nurse practitioner and her office is 5 minutes away from where she lives. She calls and schedules an appointment with her mother. Her mother was surprised to see her daughter at the office. Mrs. ABC is frantic and begs her mother for an antibiotic. Her mother tests her and the rapid strep test is negative in office. Her mother (NP) sends out a strep DNA probe. Her mother prescribes an antibiotic and the patient (her daughter) is very satisfied. The results returned for the DNA probe 48 hours later and it confirmed negative for strep.

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers. By Day 3 OF NURS 6565 Week 2 Discussion Post an explanation of whether NPs should treat family members. What are the ethical dilemmas in this situation? What are the laws in your state for NPs treating themselves, family, or friends? NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. ****I live in Texas**** but you can choose any state in the US NURS 6565 Week 2 Discussion Resources

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http://midlevelu.com/blog/should-providers-treat-their-friends-and-family http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx NURS 6565 Week 2 Discussion CHAPTER CONTENTS Characteristics of Ethical Dilemmas in Nursing, 328 Communication Problems, 329 Interdisciplinary Conflict, 329 Multiple Commitments, 330 Ethical Issues Affecting Advanced Practice Nurses, 330 Primary Care Issues, 330 Acute and Chronic Care, 330 Societal Issues, 331 Access to Resources and Issues of Justice, 332 Legal Issues, 333 Changes in interprofessional roles, advances in medical technology, privacy issues, revisions in patient care delivery systems, and heightened economic constraints have increased the complexity of ethical issues in the health care setting. Nurses in all areas of health care routinely encounter disturbing moral issues, yet the success with which these dilemmas are resolved varies significantly. Because nurses have a unique relationship with the patient and family, the moral position of nursing in the health care arena is distinct.

As the complexity of issues intensifies, the role of the advanced practice nurse (APN) becomes particularly important in the identification, deliberation, and resolution of complicated and difficult moral problems. Although all nurses are moral agents, APNs are expected to be leaders in rec- ognizing and resolving moral problems, creating ethical practice environments, and promoting social justice in the larger health care system. It is a basic tenet of the central definition of advanced practice nursing (see Chapter 3) that skill in ethical decision making is one of the core competencies of all APNs. In addition, the Doctor of Nursing Practice {DNP) essential competencies emphasize leadership in developing and evaluating strate- gies to manage ethical dilemmas in patient care and organizational arenas (American Association of Colleges of Nursing [AACN], 2006). This chapter explores the distinctive ethical decision-making competency of advanced practice nursing, the process of developing and evaluating this competency, and barriers to ethical practice that APNs can expect to confront.

DNP 820 Week 8 Assignment: Reflective Journal

Details: Learners are required to maintain a reflective journal integrating leadership and inquiry into current practice. In your journal, reflect on the personal knowledge and skills gained in the this course and address a variable combination of the following: new practice approaches, intraprofessional collaboration, health care delivery and clinical systems, ethical considerations in health care, population health concerns, the role of technology in improving health care outcomes, health policy, leadership and economic models, and/or health disparities.

Outline what you have discovered about your professional practice, personal strengths and weaknesses that have surfaced, what additional resources and abilities could be introduced to a given situation to influence optimal outcomes, and finally how you met the competencies aligned to this course. Additional information regarding your reflective journal is found in the DC Network. Submit your reflective journal both to the instructor and in the Typhon Tracking System under the corresponding course section. Failure to submit your journal in both the course room and Typhon systems may result in a grade of Incomplete for the course. You are not required to submit this assignment to LopesWrite.

We can also assist you with: DNP 820 Week 8 Scholarly Activities

Details: Throughout the DNP program, learners are required to provide a report documenting participation in a minimum of four scholarly activities outside of clinical or professional practice. These reports will be due in specific courses throughout the program, as described below, and must be documented in your Practice Portfolio by the end of each course in which an activity report is due. Examples of scholarly activities include attending conferences, seminars, grand rounds, participating in policy and quality improvement committees, writing scholarly publications, participating in community planning, serving as a guest lecturer, etc. Involvement in and contribution to interdisciplinary initiatives are also acceptable scholarly activities.

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Documentation of these activities is required in DNP-810, DNP-820, DNP-830, and DNP-840. A summary report of the scholarly activity, including who, what, where, when and take home points, will be submitted as the assignment. Include the appropriate program competencies associated with the scholarly activity and future professional goals related to this activity. You may use the “Scholarly Activity Summary” template to help guide this assignment. Scholarly_ Activity_Summary_Template.doc

DNP 820 Week 8 Assignment: Scholarly Activities

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DNP 820 Week 8 Practice Hours Portfolio

Details: The Typhon Tracking System will be used to document and follow the status of your practice immersion hours throughout this and every subsequent course. Learners must be able to document a minimum of 50 concurrently or previously logged practice hours in association with this course, which will contribute to fulfillment of the total required 1,000 post-baccalaureate practice hours by the conclusion of the program. Review the Practice Hours Portfolio Required Elements below, then review the Guidelines for Graduate Field Experiences located in the GCU Student Success Center for details on what may/may not qualify as practice hours.

Practice Hours Portfolio Required Elements The Practice Hours Portfolio (using the Typhon Student Tracking System) will include all of the following elements:

Individual Success Plan signed off by mentor.
Comprehensive clinical log of hours applied to doctoral level learning outcomes.
Learner evaluations (final).
Practice mentor evaluations (final).
Current and updated CV (update each course as necessary).
Faculty approvals of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)
Practice mentor’s approval of the Individual Success Plan and documented practice immersion hours. (Learner is responsible for obtaining approvals.)

Practice Hours Completion Statement Learners will track their practice hours within the Typhon Tracking System throughout each course and via the Practice Hours Completion Statement provided in this assignment. Complete the following statement in a Word document, submit it to the instructor, and complete the Typhon Tracking System entries appropriate for this course.

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