APN Interview

The scope of advanced nursing practice, the required qualifications, and the competencies needed to be met by advanced practice nurses differ from state to state. To enhance the knowledge of the scope of practice for nurse practitioners and the required competencies and regulations to be adhered to within the state of Alabama, Lori Mosley, a family nurse practitioner working at Coosa Valley Medical Center in Sylacauga, Alabama, was selected for the interview.

The Organization and Setting, Population, And Colleagues

Coosa Valley Medical Center is an independent, non-profit hospital in Sylacauga, Alabama. It is focused on delivering high-quality healthcare to the residents of Sylacauga and its surrounding communities. With a 168-bed capacity, it represents 19 areas of medical specialization with 40 active medical professionals and over 100 courtesy, consulting, and emergency department staff members. It is governed by the Sylacauga Health Care Authority and operates under the Healthcare Authority Act of Alabama.

Lori Mosley works as a family nurse practitioner, so the population under focus is the family. The nurse practitioner plays a vital role in delivering family-centered care with a holistic approach that considers the social relationships, needs, and any ongoing changes and challenges within the patient’s family. She works with several interprofessional team members, ensuring team effort in delivering quality care to patients and their families. She points out that some of her colleagues within the interprofessional team include physicians, floor nurses, nutritionists, pharmacists, physiotherapists, and pediatricians, among many others. They all collaborate to ensure that patients get the best possible experience and receive high-quality medical and nursing services at the hospital. They also conduct community outreach services to provide health teaching and medical advice to the residents of Sylacauga and its surroundings.

The Regulatory and Legal Requirements

The area of practice is within the state of Alabama, which is the same state in which the interviewee, Lori Mosley, practices. The Alabama Board of Nursing establishes qualifications for advanced practice nurses, sets rules and regulations, and establishes the procedures for certification as an advanced practice nurse (NursingLicensure.org, 2020). Advanced practice nurses who wish to practice in Alabama must be registered by the Alabama Board of Nursing and meet the certification requirements as licensed nurse practitioner. The rules and regulations governing collaborative practice in Alabama allow advanced nurse practitioners to own independent practice. However, they must enter into a collaborative agreement with a licensed physician in Alabama with more than one year of medical experience. One physician should not collaborate with more than three full-time nurse practitioners, and the physician should be readily available to the nurse practitioner for consultation, either in person or by phone.

Scope Of Practice for My State of Practice and That of The Interviewee

            As stated above, nurse practitioners in Alabama can practice independently in collaboration with a physician. Alabama rules and regulations give nurse practitioners limited prescription authority (ThriveAP, 2022). They can only prescribe in collaboration with a physician. They are prohibited from making self-prescriptions for immediate family members or individuals who are not their patients. The Alabama State Laws allow NPs to prescribe medications in schedule III, IV, and V but cannot prescribe drugs in schedule II, including narcotics for pain management. Other restrictions include the inability to sign sports physicals, death certificates, and parking permits for the disabled. In addition, NPs in Alabama are not formally recognized as primary care providers.

Professional Organizations Available for Membership Based on My Selected Role

The Nurse Practitioner Alliance of Alabama is an example of a professional organization for a family nurse practitioner in Alabama. It represents advanced practice nurses, and students enrolled in nurse practitioner programs within the state of Alabama. The organization ensures full utilization of the scope of practice for nurses, advocates for professional privileges consistent with the educational preparation for nurse practitioners, and advocates for issues of significant importance to the welfare of nurse practitioners (The Nurse Practitioner Alliance of Alabama, 2022). It improves the health and welfare of the citizens of Alabama by improving the healthcare delivery system in the State. Another professional organization is the Central Alabama Nurse Practitioner Association which also provides NPs with opportunities for networking, legislative updates, and timely updates on continuing education programs (The Central Alabama Nurse Practitioner Association website, 2020).

Required Competencies and Certification Requirements

To be certified as a family nurse practitioner in Alabama, one must first earn a Bachelor’s degree in nursing, take and pass the NCLEX-RN examination, and become a registered nurse in Alabama (Registered Nursing.org). They must then complete a Master’s Degree program for FNPs before being licensed as an FNP by the Alabama Board of Nursing. The American Association of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC) offer certification credentials, which give tests on various medical topics. After passing these tests, the nurse is awarded the credential of a Family Nurse Practitioner-Board Certified (FNP-BC).  According to Fraze et al. (2020), the required competencies for nurse practitioners include experience with handling electronic health records, the ability to work effectively within a team setting to provide relationship-based care, high critical thinking skills and emotional intelligence, ability to establish and maintain proper working relationships with patients, co-workers, and the public, effective oral and written communication skills with appropriate interpersonal relationships and a high level of knowledge on basic life and emergency response.

References

Fraze, T. K., Briggs, A. D. M., Whitcomb, E. K., Peck, K. A., & Meara, E. (2020). Role of Nurse Practitioners in Caring for Patients With Complex Health Needs. Medical Care, 58(10), 853–860. https://doi.org/10.1097/MLR.0000000000001364

Nurse Practitioner Alliance of Alabama. (2022). NPAA - About Us. Npalliancealabama.org. https://npalliancealabama.org/aboutnpaa

NursingLicensure.org. (2020, November 4). How to Become a Nurse Practitioner in Alabama | APN Requirements in AL - NursingLicensure.org. NursingLicensure.org. https://www.nursinglicensure.org/np-state/alabama-nurse-practitioner/#:~:text=They%20must%20hold%20both%20their

Registered Nursing.org. (2020). Becoming a Family Nurse Practitioner (FNP). Www.registerednursing.org. https://www.registerednursing.org/nurse-practitioner/fnp/#:~:text=What%20Are%20the%20Education%20Requirements

The Central Alabama Nurse Practitioner Association. (2020). The Central Alabama Nurse Practitioner Association | ENP Network. The Central Alabama Nurse Practitioner Association | ENP Network. https://canpa.enpnetwork.com/

Thrive AP. (2022). Nurse Practitioner Scope of Practice: Alabama | ThriveAP. Www.thriveap.com. https://www.thriveap.com/blog/nurse-practitioner-scope-practice-alabama

APN Practice

Advanced practice nurses (APNs) have advanced training at the Masters or Doctoral level. They can diagnose and manage patients with different conditions by performing physical assessments, ordering and interpreting diagnostic tests, giving medication prescriptions and treatment, and providing adequate patient education (Abraham et al., 2019). Globally, the roles of APNs have been expanded, and they have been increasingly involved in the active management of patients with different health conditions as primary care providers.

Cost-Effectiveness Of APN Practice

The services provided by advanced practice nurses have been associated with an improvement in quality outcomes of patients at a relatively affordable cost. This has enabled patients to have increased access to quality care and improved quality of life and patient experience. Nurse practitioners offer holistic patient care, which means they treat patients as a whole and do not merely concentrate on the disease. They go beyond diagnosing and treating the conditions afflicting patients to encompass other sensitive factors, such as social, economic, and cultural factors that may affect their health. They also provide counselling on diet and exercise, which prevent future illnesses and reduce treatment costs.

Nurse practitioners spend much time with their patients, which makes it easier for them to establish a therapeutic relationship with the patients to know what is ailing them. Razavi et al. (2020) noted that as opposed to physicians who may not have enough time to take a comprehensive patient history due to productivity pressure, nurse practitioners spend more time taking the history of patients, which helps them in making diagnoses and ruling out conditions responsible for the patient’s health problems without necessarily relying on diagnostic tests and procedures which may incur additional costs to the patients. This results in the cost-effectiveness of treatments and improves quality outcomes.

Research has shown that APNs can relay comparable levels of services and attain similar or even better results than physicians with respect to patient satisfaction, waiting time, the control of serious illnesses, and cost-effectiveness (Woo et al., 2017). The services provided by advanced nurse practitioners enhance the quality of care and minimize the costs associated with providing primary care services. They keep patients out of hospitals and reduce cases of re-admission, which ensures the cost-effectiveness of care.

Influence Of APN Practice on Reduction of Errors

            Errors in healthcare can be fatal and costly to both patients and healthcare institutions as well as healthcare providers. Advanced practice nursing education prepares nurses with adequate skills and competencies to reduce errors in their practice. For instance, advanced practice nurses are equipped with adequate communication skills that enable them to have a good relationship with their patients and other healthcare providers to enhance effective practice and reduce errors of omission and commission, which are common in clinical practice.

            Advanced practice nurses are also equipped with competencies in incorporating evidence-based practice in nursing care. This promotes a more collaborative approach to care, allowing them to incorporate the latest research-based evidence in care and adopt innovative interventions for quality and improved patient safety. They also research to develop better techniques in care provision and prevent errors related to outdated practices.

            With their advanced knowledge to diagnose and prescribe medications, advanced practice nurses can quickly identify errors in medication dosages and prescriptions, ensuring prompt action is taken to prevent an error in medication administration. Being patient advocates, they strive to defend and promote patients’ rights, preventing them from harm. They provide patients with empowerment through adequate patient education to ensure that the patients know their rights and prevent them from errors and abuse (Rodziewicz et al., 2022). To safeguard patients against medication errors, advanced practice nurses implement proper procedures for administering medications, strictly adhering to the five rights of medication administration, including the right patient, drug, dose, route, and time.

            In addition, the holistic approach to care offered by advanced practice nurses focuses on addressing the leading causes of the patient’s problems rather than treating the disease. This helps the patients take charge of their health, prevent illnesses, and find long-lasting solutions for existing conditions. This prevents errors from occurring as the nurses will provide healthcare focusing on all the aspects of the patient’s life which may affect their health.

Effects Of APN Services on Misuse or Overuse of Healthcare Services

            Some gaps exist between the healthcare services people should receive and what they actually receive. These gaps may have significant human and monetary implications regarding morbidity and mortality. The services offered by advanced practice nurses have significantly affected the misuse or overuse of services in healthcare. Overuse occurs when a drug or treatment is prescribed and administered without medical justification. The scope of practice of APNs allows them to prescribe medications to patients, and sometimes, medication prescriptions can be made when they are unnecessary. An example is when antibiotic drugs are made to treat viral infections. In children, antibiotics have been incorrectly prescribed to treat ear infections, even though most of these infections clear up in three days without them. This demonstrates a significant overuse of treatment. However, with the entry of APN services into healthcare, more research has been conducted, and an action plan has been developed to incorporate measures that will minimize the misuse of antibiotics and reduce antibiotic resistance cases.

            In healthcare, providing unnecessary care is not better. It can result in significant damage and may have more implications in terms of cost to the patient and healthcare organizations (Ellen et al., 2018). Diagnostic tests such as MRIs and other imaging tests are useful when used correctly. However, it has been established that frequent use of these services has no effect on the treatment plan or patient outcome and may result in a significant waste of resources and time. Therefore, advanced practice nurses need to consider other alternatives to ensure that patients are not put under long-term exposure to radiological rays that may harm their health.

            Misuse is another term that can be used to refer to malpractice. It occurs when the patient does not receive the full effect of treatment or when treatment causes harm to the patient due to a preventable error (Eaton Business School, 2019). An example is when a patient is given a drug containing ingredients to which the patient is allergic. Advanced practicing nurses have the competency in comprehensive history-taking, making it easier to identify loopholes in healthcare and take measures to prevent such misuse.

            In conclusion, APNs play a vital role in care provision and are at the forefront of providing preventive care services to the public. With a wealth of knowledge and experience, they provide quality, affordable, and patient-centered care, ensuring adequate improvement in patient outcomes and preventing medical errors. Therefore, state legislation should give APNs more opportunities to treat patients on a larger scale and expand their scope of practice to enhance medical care in rural areas and underserved communities.

References

Abraham, C. M., Norful, A. A., Stone, P. W., & Poghosyan, L. (2019). Cost-Effectiveness of Advanced Practice Nurses Compared to Physician-Led Care for Chronic Diseases: A Systematic Review. Nursing Economic$, 37(6), 293–305. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491992/

Eaton Business School. (2019). Overuse, Underuse and Misuse of Healthcare Quality (With Example). EBS. https://ebsedu.org/blog/healthcare-quality-conceptual-note/

Ellen, M. E., Wilson, M. G., Vélez, M., Shach, R., Lavis, J. N., Grimshaw, J. M., & Moat, K. A. (2018). Addressing overuse of health services in health systems: a critical interpretive synthesis. Health Research Policy and Systems, 16(1). https://doi.org/10.1186/s12961-018-0325-x

Razavi, M., O’Reilly-Jacob, M., Perloff, J., & Buerhaus, P. (2020). Drivers of Cost Differences Between Nurse Practitioner and Physician Attributed Medicare Beneficiaries. Medical Care, 59(2), 177–184. https://doi.org/10.1097/mlr.0000000000001477

Rodziewicz, T. L., Hipskind, J. E., & Houseman, B. (2022, May 1). Medical error prevention. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499956/

Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on the quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15(1), 1–22. https://doi.org/10.1186/s12960-017-0237-9

Application Essay- WGU PMNHP Program

Beginning the transformative journey from a seasoned registered nurse to a Psychiatric Mental Health Nurse Practitioner (PMHNP) through the esteemed WGU PMHNP program is both a personal and professional milestone for me. A report by the National Institute of Mental Health (2023) notes that more than one in five US adults live with mental illness. This calls for an increased demand for skilled and compassionate practitioners, which has never been more critical. In writing this application essay, I aim to articulate not only the depth of my life and professional experiences that uniquely prepare me for the challenges of the PMHNP role but also to demonstrate a keen understanding of the societal, health, and economic dimensions associated with PMHNP practice in the United States. Drawing insights from relevant peer-reviewed resources, this essay seeks to convey how the WGU PMHNP program aligns with my aspirations, equipping me with the knowledge and skills to contribute meaningfully to the mental health care needs of my local community.

My life and Professional Experience in Preparation for the WGU PMHNP program

My journey as a registered nurse working on the medical-surgical floor since 2014 has been instrumental in cultivating a clear foundation that uniquely positions me for the WGU PMHNP program. The challenges and diverse patient interactions I have had in the medical-surgical environment have honed my clinical skills, ensuring a deep understanding of the interconnectedness between physical and mental health. I have witnessed the impact of mental health on patient well-being during my tenure, which has fueled my commitment to pursue advanced education in psychiatric mental health. My nursing experience has also instilled in me a holistic approach to patient care, emphasizing empathy and a comprehensive understanding of individuals' needs. I have rich exposure to a diverse patient population, which has enriched my cultural competence, a crucial factor in psychiatric care where the intersection of cultural backgrounds and mental health is critical (Nair & Adetayo, 2019). Interacting with individuals facing mental health challenges on the medical-surgical floor has fueled my passion to make a more direct impact on their lives, propelling me toward the specialized knowledge and skills offered by the WGU PMHNP program. This foundation, together with my unwavering dedication to enhancing mental health outcomes, propels me towards the PMHNP program with a genuine eagerness to expand my knowledge, refine my clinical expertise, and contribute meaningfully to mental health care delivery.

How the WGU Program will Prepare me to Deliver Mental Healthcare in my Community

The WGU PMHNP program holds immense promise in equipping me with the comprehensive skill set and knowledge required to deliver impactful mental health care to my community. One of the program's notable strengths is its emphasis on evidence-based practice and cutting-edge research, ensuring that I am well-versed in the latest advancements in psychiatric nursing. This focus on evidence-based care aligns with my commitment to providing the highest quality of mental health services to my community. The program's curriculum, guided by the latest research and evidence-based practice, involves a wide range of topics, including psychopharmacology, psychotherapy, and diagnostic reasoning. A study by Fraino and Selix (2021) notes that a comprehensive and well-rounded education guided by evidence-based practice is essential for a PMHNP, as it ensures competence in addressing the needs of individuals with mental health issues. The clinical rotations and practical experiences, designed to simulate real-world scenarios, will also be instrumental in refining my clinical skills and enhancing my ability to apply theoretical knowledge to real-life patient scenarios. I anticipate gaining valuable insights into collaborative and interdisciplinary approaches to mental health care, which will help me establish partnerships within the community, forge alliances with other healthcare providers, and advocate for holistic mental health services.

Clinical Practice Specialization Upon Graduation

Upon completing the WGU PMHNP program, I aim to engage in an outpatient psychiatric practice that offers a comprehensive array of mental health services to individuals within my community. This will strive to create a therapeutic environment that fosters healing and support for individuals with mental health challenges. The outpatient setting allows for personalized and continuous care, ensuring that patients receive ongoing treatment, counseling, and medication management as needed. With a focus on holistic wellness, my practice will emphasize preventive strategies, psychoeducation, and evidence-based interventions to empower individuals in their mental health journey. Through this outpatient psychiatric practice, I aspire to be a compassionate advocate, providing accessible and inclusive care that addresses the diverse needs of my community.

Reducing Costs of Care for Patients and their Families

My future clinical practice as a PMHNP holds the potential to significantly enhance the quality and cost-effectiveness of mental health care for my patients and their families. Implementing a patient-centered approach emphasizing preventive measures, early intervention, and holistic well-being will contribute to improved mental health outcomes. Through comprehensive assessments and personalized treatment plans, I aim to address underlying issues efficiently, minimizing the need for prolonged and costly interventions. In addition, I aspire to enhance the health literacy of patients and their families, enabling them to participate in their care and make informed decisions by promoting mental health education and collaborating with interdisciplinary teams. This proactive and collaborative model can potentially reduce emergency room visits, hospitalizations, and other high-cost interventions, fostering a more sustainable and accessible mental health care system.

Conclusion

As I work towards enhancing my knowledge and skills in mental healthcare, I believe my experience as a registered nurse on the medical-surgical floor has prepared me for the more comprehensive and challenging roles of a psychiatric mental health nurse practitioner. I aim to provide holistic, culturally sensitive, and patient-centered care, which are all part of the WGU PMHNP program outlined in the course. It, therefore, serves as the ideal institution for me to further cultivate the expertise necessary to address the mental health needs of the diverse populations in my community, and I hope to secure a chance at this prestigious institution. I am hoping to hear from you soon.

I have reviewed and understand the scope of practice of the Psychiatric Mental Health Nurse Practitioner role in my state of ____.
Signature Line: __________________________

References

Fraino, J., & Selix, N. (2021). Facilitating well-rounded clinical experience for psychiatric nurse practitioner students. The Journal for Nurse Practitioners, 17(8), 1004–1009. https://doi.org/10.1016/j.nurpra.2021.05.015

Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. Plastic and Reconstructive Surgery - Global Open, 7(5). ncbi. https://doi.org/10.1097/gox.0000000000002219

National Institute of Mental Health. (2023, March). Mental illness. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness

Article

U.S. citizenship is tied to the Constitution in several ways. Many of these attributes are freedom of speech, punishment for crime, searches, and confiscation. The U.S. Constitution was drafted in 1787, ensuring citizens amend the law, allowing them the right to vote, own property, or seek elective office, and more. Many of these modifications we use today. For example, women and men over the age of 18 are allowed to vote. Also, people have the right to have any kind of religion they want. U.S. citizenship is tied to the Constitution in some ways. The first reason why American citizenship is tied to the Constitution is that people have the right to be punished for their crimes.

References

1. U.S. Constitution of 1787, United States Constitution. National Archives. https://www.archives.gov/founding-docs/constitution

2. The Eighth Amendment of the U.S. Constitution, “Eighth Amendment.” Legal Information Institute. Cornell Law School. https://www.law.cornell.edu/constitution/eighth_amendment

3. The British Bill of Rights, “Bill of Rights 1689.” The National Archives. http://www.legislation.gov.uk/aep/WillandMarSess2/1/2/introduction

4. “Two Treatises of Government” by John Locke, Locke, John. “Two Treatises of Government.” Project Gutenberg. [Online]. https://www.gutenberg.org/ebooks/7370 Cit

Capstone Assessment 4- Patient, Family, or Population Health Problem Solution

Addressing hypertension management requires a comprehensive approach that extends beyond individual medical interventions. The solution lies not only in medical treatments but also in fostering a holistic framework that involves patients, their families, and the broader population. A comprehensive solution can be crafted to elevate hypertension management by developing targeted strategies to enhance patient education, improve family engagement, and implement community-wide initiatives. This approach recognizes the interconnected nature of health. It aims to empower individuals, strengthen familial support structures, and leverage community resources to create an environment conducive to effective hypertension prevention and control. My Capstone project focused on the management of hypertension, working in collaboration with my grandmother, Mrs. Jones, who has been battling hypertension for over twenty years. To enhance the understanding of hypertension management and its impact on her well-being, a brochure was selected as an effective education tool and has been attached to this assessment.

Role of Leadership and Change Management in Addressing the Problem

Leadership and change management play crucial roles in addressing the problem of hypertension and guiding the development and implementation of effective interventions. According to Weintraub and McKee (2019), leadership involves inspiring and influencing individuals and groups to achieve common goals, fostering innovation, and promoting positive change within healthcare systems. In hypertension management, effective leadership is essential for creating a vision of improved patient outcomes, mobilizing resources, and aligning the healthcare team toward a shared goal (Kho et al., 2020). Change management strategies, on the other hand, are vital for navigating the complexities associated with introducing and sustaining transformative initiatives. This involves assessing organizational readiness, engaging stakeholders, communicating effectively, and addressing resistance to change.

Leadership and change management strategies played critical roles in developing the proposed intervention focused on targeted education using an educational brochure for Mrs. Jones. Leadership was instrumental in articulating a vision where patient education becomes a cornerstone in hypertension management. It facilitated collaboration among healthcare professionals, educators, and Mrs. Jones herself to design an evidence-based, patient-centered, and culturally sensitive intervention. Change management strategies were employed to assess the organization's readiness for this educational intervention, addressing potential challenges and resistance through transparent communication and stakeholder engagement.  This promoted buy-in from Mrs. Jones, aligning her preferences and needs with the intervention's goals. Fostering a culture that embraces continuous learning and improvement, leadership, and change management supported the seamless integration of the educational brochure into the hypertension management framework, ensuring adequate management and better outcomes for the patient.

Nursing ethics served as a guiding principle throughout the development of the proposed intervention. The intervention aimed to empower Mrs. Jones with knowledge and resources to actively participate in her hypertension management, aligning with ethical principles of autonomy and beneficence. The educational brochure was patient-centric, respecting individual values, beliefs, and cultural considerations. In addition, the intervention addressed health disparities by ensuring that educational materials were accessible and inclusive. Ethical considerations were also crucial in maintaining the privacy and confidentiality of patient information throughout the educational process, preventing the breach of any identifiable patient data. This intervention not only aimed for improved health outcomes but also promoted a sense of respect, dignity, and shared decision-making in hypertension management.

Patient Communication and Collaboration Strategy

The patient I am working with in this capstone project is my grandmother, Mrs. Jones, a 72-year-old retired school teacher who has been managing hypertension for the past twenty years through antihypertensive medications. Mrs. Jones and her 75-year-old husband, Mr. Robert Jones, lead an active life and share a profound bond cultivated over 50 years of marriage. The couple is integral to a closely-knit family with two children and four grandchildren. To improve outcomes associated with her hypertension, effective communication and collaboration with her and her family are critical aspects of care that must be explored. Involving Mrs. Jones and her husband in decision-making processes regarding her care, treatment plans, and lifestyle modifications ensures that interventions align with their values, preferences, and daily routines. Considering their significant role in a larger family unit, engaging them in the care process can create a ripple effect, influencing the entire family to adopt heart-healthy behaviors and supporting her management of hypertension.

There are several benefits of gathering input from Mrs. Jones and her family. For instance, it promotes patient-centered care, enhancing the likelihood of treatment adherence and successful hypertension management. It also fosters a supportive environment, reinforcing the importance of lifestyle modifications, medication adherence, and regular check-ups (Robinson et al., 2021). This collaborative approach acknowledges the interdependence of health within familial relationships, contributing to a holistic and sustainable management strategy.

Best-practice strategies from the literature for effective communication and collaboration in hypertension management emphasize a patient and family-centered approach. Utilizing shared decision-making models ensures that Mrs. Jones and her husband actively participate in determining the course of her care. A study by Kwame and Petrucka (2021) notes that regular and clear communication about treatment plans, potential side effects, and lifestyle modifications is essential for fostering understanding and compliance. Additionally, leveraging technology, such as telehealth or secure messaging, can facilitate ongoing communication and monitoring of Mrs. Jones's blood pressure between appointments. Cultivating a partnership between the patient, her family, and the healthcare team promotes a collaborative atmosphere where everyone works together toward optimal hypertension management and improved well-being (Rosen et al., 2019).

State Board Nursing Practice Standards and Organizational or Governmental Policies

The development of the proposed intervention for Mrs. Jones's hypertension was guided by state board nursing practice standards as well as organizational policies focusing on patient education and chronic disease management. The Alabama State Board of Nursing standards emphasize the importance of evidence-based practice, patient-centered care, and patient education, all of which informed the creation of a targeted educational brochure tailored to Mrs. Jones's needs (Alabama Board of Nursing, 2020). Our healthcare organization also has policies highlighting the significance of empowering patients through education and facilitating shared decision-making, which influenced the intervention's design. According to Engle et al. (2019), effective patient education, adherence to evidence-based practice, and a patient-centered approach positively impact hypertension outcomes. Hannan et al. (2022) also demonstrate that comprehensive patient education and involvement in care decisions contribute to improved blood pressure control and overall health outcomes in individuals with hypertension. Therefore, aligning the intervention with established nursing practice standards and organizational policies ensures a foundation rooted in evidence and best practices, contributing to enhanced outcomes in hypertension management.

Improving the Quality of Care, Enhancing Patient Safety, and Reducing Costs

The proposed intervention, involving developing and implementing an educational brochure for Mrs. Jones's hypertension management, is expected to significantly improve the quality of care, enhance patient safety, and reduce costs for the healthcare system and Mrs. Jones individually. Providing targeted education, the intervention aims to empower Mrs. Jones with the knowledge and tools necessary for effective self-management, promoting adherence to medication regimens and lifestyle modifications. This increased adherence can lead to better blood pressure control, improving the quality of care and reducing the risk of hypertension-related complications. In addition, enhanced patient education contributes to increased awareness of potential adverse effects and the importance of regular monitoring, improving patient safety. From a cost perspective, studies by Miller et al. (2020) have demonstrated that patient education interventions in hypertension management result in cost savings by reducing hospital admissions and emergency department visits. Benchmark data on care quality, patient safety, and costs can be sourced from reputable databases such as the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS), and studies published in peer-reviewed journals on hypertension management outcomes. These sources provide valuable benchmarks for evaluating the effectiveness and efficiency of interventions, guiding continuous improvement efforts in healthcare delivery.

Technology, Care Coordination, and Community Resources

Utilizing technology, care coordination, and community resources is instrumental in addressing hypertension. Wearable devices and mobile applications enable real-time monitoring, empowering patients in self-management (Khoong et al., 2021). Coordinated care efforts among healthcare providers enhance proactive and patient-centered approaches, improving overall outcomes. Community resources, such as lifestyle programs and educational initiatives, contribute to preventive care. A study by Carey et al. (2019) indicates that community resources positively impact hypertension control by making more resources and support available to hypertensive patients. Integrating these approaches aligns with evidence-based practices, fostering a comprehensive strategy for hypertension management that extends beyond medical interventions, promoting patient engagement, and addressing social determinants of health.

Conclusion

The health problem solution, centered around using an educational brochure for hypertension management, highlights the significance of patient-centered approaches. The development and implementation of such interventions rely on comprehensive strategies involving technology, care coordination, and community resources. Healthcare professionals can foster informed decision-making and active engagement in their care by empowering patients with knowledge and resources through targeted educational materials. This approach improves health outcomes and promotes a collaborative environment where patients, families, and healthcare providers work together to achieve optimal health and well-being.

References

Alabama Board of Nursing. (2020). Section 610-X-6-.10 - Patient Care Orders, Ala. Admin. Code r. 610-X-6-.10 | Casetext Search + Citator. Casetext.com. https://casetext.com/regulation/alabama-administrative-code/title-610-alabama-board-of-nursing/chapter-610-x-6-standards-of-nursing-practice/section-610-x-6-10-patient-care-orders

Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2019). Prevention and control of hypertension. Journal of the American College of Cardiology, 72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008

Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2019). Evidence-based practice and patient-centered care: Doing both well. Health Care Management Review, 46(3), 174–184. https://doi.org/10.1097/HMR.0000000000000254

Hannan, J. A., Commodore‐Mensah, Y., Tokieda, N., Smith, A. P., Gawlik, K. S., Murakami, L., Cooper, J., Koob, S., Wright, K. D., Cassarino, D., Arslanian‐Engoren, C., & Melnyk, B. M. (2022). Improving hypertension control and cardiovascular health: An urgent call to action for nursing. Worldviews on Evidence-Based Nursing, 19(1), 6–15. https://doi.org/10.1111/wvn.12560

Kho, J., Gillespie, N., & Martin-Khan, M. (2020). A systematic scoping review of change management practices used for telemedicine service implementations. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05657-w

Khoong, E. C., Olazo, K., Rivadeneira, N. A., Thatipelli, S., Barr-Walker, J., Fontil, V., Lyles, C. R., & Sarkar, U. (2021). Mobile health strategies for blood pressure self-management in urban populations with digital barriers: Systematic review and meta-analyses. Npj Digital Medicine, 4(1), 1–12. https://doi.org/10.1038/s41746-021-00486-5

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(158), 1–10. https://doi.org/10.1186/s12912-021-00684-2

Miller, J., McNaughton, C., Joyce, K., Binz, S., & Levy, P. (2020). Hypertension management in emergency departments. American Journal of Hypertension, 33(10). https://doi.org/10.1093/ajh/hpaa068

Robinson, S. K., Meisner, M., Robert L., Phillips, J., & McCauley, L. (2021). Person-centered, family-centered, and community-oriented primary care. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK571814/

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2019). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433–450. NCBI. https://doi.org/10.1037/amp0000298

Weintraub, P., & McKee, M. (2019). Leadership for innovation in healthcare: An exploration. International Journal of Health Policy and Management, 8(3), 138–144. NCBI. https://doi.org/10.15171/ijhpm.2018.122

Capstone Project Assessment 3-Assessing the Problem: Technology, Care Coordination, and Community Resource Considerations

Effective hypertension management involves a comprehensive approach integrating technology, care coordination, and community resources. In modern healthcare, technology offers innovative tools for monitoring, tracking, and managing blood pressure levels. From wearable devices that provide real-time data on vital signs to telemedicine platforms facilitating remote consultations, technological advancements empower both healthcare professionals and patients in the proactive management of this prevalent condition. Concurrently, care coordination among healthcare providers ensures a comprehensive and synchronized approach to treatment. Recognizing and leveraging community resources are also integral in supporting patients, addressing socio-economic determinants, and promoting lifestyle modifications essential for hypertension management. The convergence of these elements forms a robust framework for holistic care and improved outcomes in combating hypertension. This paper assesses hypertension management, considering the impact of technology, care coordination, and community resources in improving care and patient outcomes.

Impact of Healthcare Technology on Hypertension Management

The impact of healthcare technology on the management of hypertension has been profound, affecting patients, their families, and the broader population. One significant advantage lies in the invention of wearable devices and mobile health applications designed to monitor and manage blood pressure. According to Awad et al. (2021), these technologies enable real-time monitoring, empowering patients to actively participate in their care and providing healthcare professionals with valuable data for timely interventions. Telemedicine platforms have also emerged as a convenient means of remote consultation, enhancing accessibility to healthcare services for individuals managing hypertension (Haleem et al., 2021). However, it is crucial to acknowledge the potential disadvantages and disparities associated with technology use. Saeed and Masters (2021) suggest that certain populations, particularly those with lower socioeconomic status, may face challenges in accessing and utilizing health technologies, exacerbating existing health disparities.

In my nursing practice, the consistent integration of technology aligns with the evidence presented in the literature. The use of mobile applications for blood pressure monitoring and telehealth consultations has become commonplace, facilitating more proactive and patient-centered care. Patients are often provided with tools that enable self-management, fostering a sense of empowerment and engagement in their treatment plans. However, it is essential to recognize potential barriers to technology adoption. Some patients, especially older adults or those with limited technological literacy, may struggle to navigate these tools effectively, making it challenging to apply and obtain reliable data (Finkelstein et al., 2023). In addition, data security and privacy issues remain concerns that healthcare professionals must address to ensure the ethical and secure use of technology in hypertension management.

The implementation of healthcare technology is not without associated costs and barriers. While the initial investment in technology may be substantial, Gentili et al. (2022) emphasize the potential cost-effectiveness of digital health interventions for hypertension management over the long term. However, financial constraints, both at the individual and healthcare system levels, can pose significant barriers to widespread adoption. Infrastructure challenges, such as inadequate internet access in certain communities, may also limit the reach and effectiveness of technology-based interventions. Addressing these barriers is crucial to ensuring equitable access to technological solutions for hypertension management.

Care Coordination and the Utilization of Community Resources

Care coordination and the strategic utilization of community resources are critical in addressing the challenges associated with hypertension in patients, their families, and the broader population. According to Schot et al. (2019), the integration of various healthcare providers, such as physicians, nurses, pharmacists, and community health workers, promotes a collaborative and holistic approach to patient care. This collaborative model is consistent with the principles of the Chronic Care Model, which emphasizes the importance of an organized, proactive, and patient-centered approach to managing chronic conditions like hypertension. However, despite the evident benefits and alignment with established models, there are challenges and opposing views on the application of care coordination and community resource utilization in hypertension management. For instance, a study by Karam et al. (2021) suggests that while care coordination may improve certain aspects of patient care, it might not always result in significant cost savings or better health outcomes. The complexity of coordinating care across diverse healthcare settings and the associated administrative burdens can be substantial barriers.

In my nursing practice, I observe the positive effects of care coordination in hypertension management. Multidisciplinary teams collaborate to develop comprehensive care plans tailored to individual patient needs. Regular communication among healthcare professionals ensures a unified approach, facilitating timely adjustments to treatment plans based on patient progress and changing health conditions. This coordinated effort contributes to improved patient satisfaction and outcomes.

The utilization of community resources further enhances the effectiveness of hypertension management. Community-based interventions, such as lifestyle modification programs, support groups, and health education initiatives, have been shown to impact blood pressure control positively. According to Still et al. (2020), community resources, including access to healthy food options and recreational facilities, contribute to the prevention and control of hypertension. These resources not only address the medical aspects of hypertension but also target social determinants of health, such as socioeconomic status and neighborhood environments. While the literature supports the benefits of care coordination and community resources, barriers to their effective implementation exist. Challenges in communication and information sharing among healthcare providers, especially in fragmented healthcare systems, can impede care coordination efforts. In addition, resource constraints may limit the scope and reach of community-based interventions, affecting care coordination efforts (Kwame & Petrucka, 2021). Disparities in access to community resources may also exist, disproportionately affecting vulnerable populations.

State Board Nursing Practice Standards

In the state of Alabama, the Alabama Board of Nursing (ABN) provides practice standards that guide nursing professionals in the application of technology, care coordination, and community resources in managing chronic conditions such as hypertension. The ABN emphasizes the importance of evidence-based practice and staying current with technological advancements to ensure the delivery of safe and effective patient care. For instance, the ABN recognizes the use of electronic health records (EHRs) as a valuable tool for organizing patient information and facilitating communication among healthcare providers (Alabama Board of Nursing, 2020). It also supports the collaborative nature of care coordination, encouraging nurses to work with interdisciplinary teams to meet the diverse needs of patients. This is consistent with the ABN's commitment to promoting the health and well-being of the public. For instance, nurses in Alabama are expected to actively engage in care coordination efforts, ensuring that patients with hypertension receive comprehensive and integrated care that addresses both medical and social determinants of health. Nurses are encouraged to collaborate with community organizations, educational institutions, and public health agencies to promote preventive care and health education, aligning with the broader goal of enhancing community resources to address health disparities and improve population health.

These standards will guide my actions in applying technology, care coordination, and community resources to hypertension management by ensuring that I stay informed about technological advancements relevant to patient care. For example, I would utilize EHRs to document and monitor hypertension-related data efficiently. Care coordination efforts would involve active collaboration with healthcare professionals from different disciplines, aligning with the ASBN's emphasis on interdisciplinary teamwork. In addition, I would work to connect patients with community resources such as support groups, educational programs, and local services to enhance their overall well-being.

Local, state, and federal policies and legislation also play a crucial role in shaping nursing practice in applying technology, care coordination, and community resources. For instance, the Health Information Portability and Accountability Act (HIPAA) mandates strict standards for protecting patient privacy and the security of health information at the federal level (Edemekong et al., 2022). In the state of Alabama, the Nurse Practice Act outlines the scope of nursing practice and the legal requirements for nursing licensure. Awareness and adherence to these policies are essential to ensure that nursing actions related to technology use, care coordination, and community resource utilization align with legal and ethical standards. Nursing ethics will inform my approach to addressing hypertension by observing principles such as autonomy, beneficence, and justice, which will guide decisions about the use of technology to respect patient autonomy, coordinate care in the best interest of patients, and promote equitable access to community resources. This will also guide the responsible and ethical use of patient data in technological applications, ensuring the confidentiality and security of sensitive health information.

Conclusion

The integration of technology, care coordination, and community resources in hypertension management is guided by state nursing practice standards, organizational policies, and ethical principles. These guidelines emphasize the importance of evidence-based and patient-centered care, urging nursing professionals to leverage technology for efficient healthcare delivery, foster interdisciplinary collaboration in care coordination, and tap into community resources to address social determinants of health. Adherence to these guidelines ensures a patient-centered, evidence-based approach that addresses care quality, patient safety, and system costs, reflecting the commitment of nursing professionals to provide effective and ethical care.

References

Alabama Board of Nursing. (2020). EHR | Alabama department of public health (ADPH). Www.alabamapublichealth.gov. https://www.alabamapublichealth.gov/ehr/

Awad, A., Trenfield, S. J., Pollard, T. D., Ong, J. J., Elbadawi, M., McCoubrey, L. E., Goyanes, A., Gaisford, S., & Basit, A. W. (2021). Connected healthcare: Improving patient care using digital health technologies. Advanced Drug Delivery Reviews, 178(1), 113958. https://doi.org/10.1016/j.addr.2021.113958

Edemekong, P. F., Haydel, M. J., & Annamaraju, P. (2022, February 3). Health insurance portability and accountability act (HIPAA). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500019/

Finkelstein, R., Wu, Y., & Brennan-Ing, M. (2023). Older adults’ experiences with using information and communication technology and tech support services in New York City: Findings and recommendations for post-pandemic digital pedagogy for older adults. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1129512

Gentili, A., Failla, G., Melnyk, A., Puleo, V., Tanna, G. L. D., Ricciardi, W., & Cascini, F. (2022). The cost-effectiveness of digital health interventions: A systematic review of the literature. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.787135

Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2(2). https://doi.org/10.1016/j.sintl.2021.100117

Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing care coordination for patients with complex needs in primary healthcare: A scoping review. International Journal of Integrated Care, 21(1), 1–21. https://doi.org/10.5334/ijic.5518

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(158), 1–10. https://doi.org/10.1186/s12912-021-00684-2

Saeed, S. A., & Masters, R. M. (2021). Disparities in health care and the digital divide. Current Psychiatry Reports, 23(9). https://doi.org/10.1007/s11920-021-01274-4

Schot, E., Tummers, L., & Noordegraaf, M. (2019). Working on working together: A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care, 34(3), 1–11. https://doi.org/10.1080/13561820.2019.1636007

Still, C. H., Margevicius, S., Harwell, C., Huang, M.-C., Martin, L., Dang, P. B., & Wright Jnr, J. T. (2020). A community and technology-based approach for hypertension self-management (COACHMAN) to improve blood pressure control in African Americans: results from a pilot study. Patient Preference and Adherence, 14, 2301–2313. https://doi.org/10.2147/PPA.S283086

Capstone Project- 4900 Assessment 1: Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Nurses play a critical role in healthcare leadership, demonstrating proficiency in guiding and coordinating patient care. Their expertise extends to effective collaboration with interdisciplinary teams, fostering open communication channels crucial for optimal patient outcomes. In healthcare, nurses exhibit adequate knowledge in change management, adapting to innovations, and implementing best practices. In addition, their involvement in policy considerations ensures that patient care aligns with evolving healthcare policies and standards. This paper will focus on identifying a patient health problem that will be the focus of my capstone project and assess the problem in relation to the role of nurses in leadership, collaboration, change management, and policy consideration.

Patient Health Problem

Hypertension, commonly known as high blood pressure, emerges as a significant patient health problem, especially in the aging population. It is a pervasive health concern, often asymptomatic but posing severe risks such as heart disease and stroke (Oliveros et al., 2019). According to the World Health Organization (WHO) (2020), hypertension affects nearly 1.13 billion people globally, contributing to 9.4 million deaths each year. Data reveals that the prevalence of hypertension increases with age, affecting approximately 65% of individuals aged 60 and above (Oliveros et al., 2019). In this capstone project, I will be working with Ms. Jones, my 72-year-old grandmother, who was diagnosed with hypertension twenty years ago and has been on antihypertensive medications since then. As a retired school teacher, she leads an active life alongside her 75-year-old husband, Mr. Robert Jones, with whom she shares a strong bond cultivated over 50 years of marriage. The couple is an integral part of a closely-knit family with two children and four grandchildren. Personally invested in Ms. Jones's well-being, I have observed the daily challenges associated with managing hypertension, witnessing the impact it has on her lifestyle and overall quality of life. This project offers a unique opportunity to examine the complexities of hypertension within a familial context, allowing for a comprehensive exploration of evidence-based interventions tailored to Ms. Jones's specific health needs.

As a baccalaureate-prepared nurse, addressing hypertension aligns with the holistic care approach emphasized in my practice, focusing not only on treatment but also on preventive strategies and patient education to mitigate long-term complications. This health problem is particularly relevant to my nursing practice as it highlights the necessity for comprehensive patient-centered care, incorporating evidence-based interventions, regular monitoring, and tailored lifestyle adjustments. Collaborating with Mrs. Jones and her family to develop a personalized care plan will involve education on dietary modifications, stress management techniques, and consistent medication adherence. In addition, as a nurse, advocating for routine blood pressure screenings, promoting healthy behaviors, and offering ongoing support to empower patients and families in managing hypertension aligns with the preventive care approach integral to nursing practice.

Evidence that Describes and Guides Nursing Actions

Evidence from peer-reviewed literature consistently emphasizes the significance of nursing interventions in managing hypertension. Ojangba et al. (2023) highlight lifestyle modifications, including dietary changes, regular exercise, and stress reduction techniques, as pivotal in controlling blood pressure. Medication adherence and close monitoring also play crucial roles in achieving optimal outcomes. The literature echoes the importance of patient education in understanding the condition, its implications, and adherence to prescribed treatment regimens (Asgedom et al., 2018). These findings align closely with what I observe in my nursing practice, emphasizing the holistic approach to hypertension management.

Unreliable data in hypertension literature might surface in studies lacking rigorous methodology, small sample sizes, or biased conclusions. Studies with inadequate control groups or those heavily reliant on self-reported data could present less reliable findings. Discrepancies between studies or contradictory results across literature may also signal a need for further investigation into the validity of the data. Barriers to implementing evidence-based practice in hypertension care often include healthcare system constraints, resistance to change, and inadequate resources for patient education and monitoring (McArthur et al., 2021). Additionally, patient-related factors like non-adherence to treatment plans or reluctance to adopt lifestyle modifications can hinder the effective implementation of evidence-based interventions.

Recent research explores the effectiveness of nursing standards and policies in improving hypertension outcomes. Studies showcase the positive impact of standardized care protocols, emphasizing regular blood pressure monitoring, medication adherence, and lifestyle modifications, ultimately leading to better patient outcomes and reduced cardiovascular risks (Tam et al., 2020). Nurses are increasingly involved in policy-making initiatives aimed at improving outcomes, preventing illnesses, and reducing hospital readmissions related to hypertension. Their roles include advocating for community-based programs promoting healthy lifestyles, participating in policy development for better access to healthcare resources, and contributing to initiatives focusing on early detection and management.

Nursing theories or frameworks like the Health Promotion Model (HPM) or the Self-Care Deficit Nursing Theory (SCDNT) guide in understanding patient behaviors and formulating interventions for hypertension management. The HPM emphasizes individual behaviors and motivations, guiding nurses in designing tailored health promotion strategies. Meanwhile, the self-care deficit theory focuses on patients' abilities for self-care and the nurse's role in bridging the deficit, offering insights into empowering patients to manage their hypertension effectively (Khademian et al., 2020). Integrating these theories into practice during my practicum will aid in comprehensive patient-centered care delivery.

State Board Nursing Practice Standards

In Alabama, the state board of nursing practice standards outlined by the Alabama Board of Nursing significantly impact the approach to hypertension management. Nurses, including registered nurses (RNs) and licensed practical nurses (LPNs), are expected to practice within their legal scope as defined by the Alabama Nurse Practice Act and the Board's Administrative Code, (2020). Standards highlight the importance of maintaining competence through ongoing learning, executing medical regimens within approved protocols, and identifying changes in patient health status promptly.  Research supporting the effectiveness of these standards in improving patient outcomes for hypertension involves evaluating healthcare facilities' adherence to these guidelines. For example, examining the impact of regular blood pressure monitoring, timely documentation, and collaborative care on hypertension management outcomes can provide insights into the practical application of these standards.

The role of nurses in policy-making to improve outcomes, prevent illness, and reduce hospital readmissions involves advocating for evidence-based practices and actively participating in healthcare policy development. In hypertension management, nurses play a critical role in shaping policies related to preventive care, community health initiatives, and patient education programs. Their involvement in policy-making aligns with the state standards, encouraging nurses to collaborate on the planning and care of patients, including health maintenance, patient teaching, and prevention of illness (Hajizadeh et al., 2021).

Local, state, and federal policies or legislation can significantly influence the nursing scope of practice in hypertension management. For instance, policies promoting access to healthcare resources, reimbursement for preventive services, and support for community-based interventions can enhance nurses' ability to provide comprehensive care. On the contrary, restrictive policies or lack of resources may pose challenges in delivering optimal hypertension management. Therefore, nurses must be aware of and actively engage in advocating for policies that support evidence-based practices and improve patient outcomes in hypertension care.

Leadership Strategies

To improve outcomes, patient-centered care, and patient experience in hypertension management, leadership strategies must prioritize a patient-centered approach. Effective leadership involves creating a supportive environment that fosters collaboration and open communication among healthcare professionals, patients, and their families. Leaders should advocate for the implementation of evidence-based practices, emphasizing regular blood pressure monitoring, individualized care plans, and patient education on lifestyle modifications. Research suggests that leadership engagement in promoting a culture of continuous improvement and adherence to guidelines positively impacts hypertension outcomes (Engle et al., 2019). The role of leadership in addressing hypertension involves inspiring a shared vision for comprehensive care, aligning team goals with patient needs, and fostering a culture of accountability. Collaboration and communication strategies should include regular interdisciplinary team meetings, involving patients and their families in care planning, and leveraging technology for effective communication. Change management strategies such as the Kurt Lewin Forcefield model should focus on educating healthcare teams on updated guidelines, facilitating training programs for skill development, and implementing feedback loops to ensure continuous improvement in hypertension care delivery.

Conclusion

Addressing hypertension requires a comprehensive approach grounded in evidence-based nursing practices, state standards, and effective leadership strategies. The integration of patient-centered care, collaboration, and communication, guided by the State Board Nursing Practice standards, is essential for optimal outcomes. Leadership plays a crucial role in inspiring a shared vision, fostering a culture of continuous improvement, and ensuring accountability in hypertension management. Leveraging research-backed strategies and emphasizing change management can contribute to enhancing patient experiences, improving outcomes, and effectively addressing the challenges posed by hypertension in healthcare.

References

Alabama Board of Nursing. (2020). Nurse practice act – Alabama board of nursing. Www.abn.alabama.gov. https://www.abn.alabama.gov/legal/laws/nurse-practice-act/

Asgedom, S. W., Atey, T. M., & Desse, T. A. (2018). Antihypertensive medication adherence and associated factors among adult hypertensive patients at Jimma University Specialized Hospital, southwest Ethiopia. BMC Research Notes, 11(1). https://doi.org/10.1186/s13104-018-3139-6

Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2019). Evidence-based practice and patient-centered care: Doing both well. Health Care Management Review, 46(3), 174–184. https://doi.org/10.1097/HMR.0000000000000254

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00648-6

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study. International Journal of Community Based Nursing & Midwifery, 8(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0

McArthur, C., Bai, Y., Hewston, P., Giangregorio, L., Straus, S., & Papaioannou, A. (2021). Barriers and facilitators to implementing evidence-based guidelines in long-term care: A qualitative evidence synthesis. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01140-0

Ojangba, T., Boamah, S., Miao, Y., Guo, X., Yifei Fen, Agboyibor, C., Yuan, J., & Dong, W. (2023). Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review. https://doi.org/10.1111/jch.14653

Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, K. A. (2019). Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology, 43(2), 99–107. https://doi.org/10.1002/clc.23303

Tam, H. L., Wong, E. M. L., & Cheung, K. (2020). Effectiveness of educational interventions on adherence to lifestyle modifications among hypertensive patients: An integrative review. International Journal of Environmental Research and Public Health, 17(7), 2513. https://doi.org/10.3390/ijerph17072513

World Health Organization. (2020). First WHO report details devastating impact of hypertension and ways to stop it. Www.who.int. https://www.who.int/news/item/19-09-2023-first-who-report-details-devastating-impact-of-hypertension-and-ways-to-stop-it#:~:text=This%20common%2C%20deadly%20condition%20leads

Capstone Project- 4900 Assessment 2: Assessing the Problem: Quality, Safety, and Cost Considerations

In the management of hypertension, quality, safety, and cost considerations are critical in delivering effective and efficient healthcare. Achieving optimal outcomes in hypertension care necessitates a commitment to the highest standards of quality, ensuring that evidence-based practices are consistently applied. Patient safety is equally crucial, demanding considerable attention to medication management, regular monitoring, and preventive measures to avert complications. The economic implications of hypertension management also highlight the importance of cost-effective interventions that maximize healthcare resources without compromising quality or safety. Balancing these three pillars—quality, safety, and cost—requires a comprehensive approach, where healthcare providers must continually assess, adapt, and implement strategies that not only improve patient outcomes but also contribute to the sustainability of healthcare delivery systems. This assessment examines the impact of hypertension on quality, safety, and cost considerations, working in collaboration with my grandmother, Ms. Jones, who has been battling hypertension for the past twenty years.

Impact of Hypertension on the Quality of Care, Patient Safety, and Costs

Hypertension significantly impacts the quality of care, patient safety, and costs within healthcare systems and for individuals. The quality of care for patients with hypertension is influenced by the degree of adherence to evidence-based guidelines, timely monitoring, and personalized management strategies. Uncontrolled hypertension increases the risk of cardiovascular events, stroke, and kidney disease, impacting the overall quality of life for affected individuals (Masenga & Kirabo, 2023). It may also contribute to complications such as vision impairment, cognitive decline, and a heightened susceptibility to other chronic conditions.  Uncontrolled hypertension not only poses immediate threats to cardiovascular health but can have cascading effects on various organ systems, causing memory and vision impairment and even erectile dysfunction, diminishing the well-being and functional capacity of individuals (Carey et al., 2019). These studies highlight the correlation between elevated blood pressure and adverse outcomes, emphasizing the importance of patient safety measures such as accurate medication administration, regular blood pressure monitoring, and patient education to prevent complications. In my nursing practice, I've witnessed the impact of poorly managed hypertension on patient well-being, where patients present with kidney damage requiring frequent dialysis for sustainability. This reinforces the critical need for stringent monitoring and adherence to treatment protocols to prevent such complications.

The economic burden of hypertension is also substantial, affecting both healthcare systems and individuals. Wierzejska et al. (2020) note that the costs associated with hypertension stem from medication expenses, hospitalizations due to complications, and productivity loss. A review by Kirkland et al. (2018) on the trends in healthcare expenditure among hypertensive individuals in the United States between 2003 and 2014 indicates an annual healthcare cost of about $131 billion. According to this study, indirect costs related to reduced productivity and absenteeism significantly impact individuals' financial well-being. In addition, healthcare systems face increased financial strain due to the demand for resources in managing hypertension-related complications. This evidence aligns closely with my nursing practice, where I've observed firsthand the economic challenges individuals face in managing hypertension and the strain on healthcare resources to provide comprehensive care. Addressing hypertension comprehensively not only improves patient outcomes but also mitigates the economic burden on individuals and healthcare systems, underlining the significance of effective hypertension management strategies.

State Board Nursing Practice Standards and Organizational/Governmental Policies

State board nursing practice standards and organizational policies significantly influence the impact of hypertension on care quality, patient safety, and costs. According to the Alabama Board of Nursing Practice Standards (2020), nurses are required to maintain competence through ongoing learning and application of knowledge, execute medical regimens according to approved protocols, and identify changes in patient health status to take appropriate action. These standards directly affect the quality of care for hypertensive patients by ensuring that nurses stay informed about evidence-based practices, administer medications safely, and promptly respond to changes in health status. According to Vaismoradi et al. (2020), standards emphasizing collaboration in planning and care and conducting comprehensive assessments contribute to quality care and patient safety by fostering a team-based approach and thorough understanding of individual patient needs. This reduces healthcare costs through preventive measures and early interventions.

In addressing hypertension, these standards will guide my actions by promoting a holistic approach that includes ongoing learning to stay updated on hypertension management strategies. Ensuring compliance with approved medical protocols and standing orders, such as those outlined in the Alabama Board of Nursing standards, will be crucial in maintaining patient safety and preventing adverse events. Collaborative planning and comprehensive assessments will also guide my interventions tailored to individual patient needs, contributing to improved care quality. The focus on preventive measures and efficient resource utilization outlined in the standards aligns with my organization’s goal of minimizing the economic burden of hypertension-related complications and enhancing cost management.

Local, state, and federal policies also shape nursing practice in hypertension management. For example, federal policies such as the Affordable Care Act emphasize preventive care, impacting nursing practice by encouraging early detection and management of hypertension to reduce long-term costs (Angier et al., 2020). State policies, including those addressing Medicaid and insurance coverage, influence the accessibility of care for hypertensive individuals. The Alabama Board of Nursing's emphasis on practicing within the legal scope, maintaining professional boundaries, and respecting patients' rights aligns with broader policies promoting patient-centered care, confidentiality, and ethical conduct.

Strategies to Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs

A comprehensive approach is needed to enhance the quality of care, promote patient safety, and reduce costs in hypertension management. For instance, implementing evidence-based practice guidelines and clinical protocols for hypertension diagnosis and management can standardize care, ensuring that healthcare providers adhere to best practices. This can be achieved through continuous training and education programs for healthcare professionals on the latest advancements and guidelines in hypertension management, contributing to ongoing competence and improved care quality. Collaborative care models involving interdisciplinary teams, including nurses, physicians, dietitians, and pharmacists, can also streamline communication and enhance patient care through a holistic approach. Additionally, leveraging technology such as remote monitoring devices and telehealth services enables real-time data collection, facilitating proactive interventions and reducing the risk of complications.

Several studies support the implementation of these strategies in improving hypertension management. According to Schmidt et al. (2020), adherence to evidence-based guidelines in hypertension management leads to better patient outcomes, decreased morbidity, and reduced healthcare costs associated with hospitalizations and complications. Collaborative care models have demonstrated improved patient adherence to treatment plans, resulting in better blood pressure control and overall health outcomes (Dixon et al., 2021). In addition, the integration of telehealth and remote monitoring technologies has shown promise in enhancing patient safety by enabling timely interventions, reducing the frequency of emergency visits, and minimizing healthcare costs associated with preventable complications.

There are various benchmark data on care quality, patient safety, and costs, which are crucial for continuous improvement in hypertension management. National healthcare databases, such as those provided by the Centers for Disease Control and Prevention (CDC) or the National Center for Health Statistics (NCHS), offer valuable insights into population-level health outcomes and can serve as benchmarks for evaluating hypertension management programs. Healthcare organizations can also leverage electronic health records (EHRs) and quality improvement databases to track and compare key performance indicators related to hypertension care, patient safety metrics, and associated costs. Collaborative initiatives, such as those led by professional organizations or quality improvement agencies, also provide benchmarking opportunities by sharing best practices and performance data across healthcare settings. Utilizing these sources of benchmark data enables healthcare providers to assess their performance, identify areas for improvement, and implement targeted strategies to enhance care quality, patient safety, and cost-effectiveness in hypertension management.

Conclusion

The integration of strategies targeting quality, safety, and cost considerations forms a vital framework for improving patient outcomes and optimizing healthcare delivery in addressing hypertension management. Embracing evidence-based practices, collaborative care models, and technological innovations not only enhances care quality and patient safety but also fosters cost-effective approaches. The integration of technology, such as telehealth and remote monitoring, also facilitates proactive interventions and contributes to cost reduction by preventing complications and emergency visits. Leveraging benchmark data sources enables continual assessment and refinement of care practices. This comprehensive approach serves to address the immediate needs of hypertensive individuals and sets a foundation for sustainable and patient-centered care, ensuring that healthcare delivery remains efficient, safe, and high-quality in the management of hypertension.

References

Alabama Board of Nursing Practice Standards. (2020). Section 610-X-6-.02 - Standards Of Practice, Ala. Admin. Code r. 610-X-6-.02 | Casetext Search + Citator. Casetext.com. https://casetext.com/regulation/alabama-administrative-code/title-610-alabama-board-of-nursing/chapter-610-x-6-standards-of-nursing-practice/section-610-x-6-02-standards-of-practice

Angier, H., Huguet, N., Ezekiel-Herrera, D., Marino, M., Schmidt, T., Green, B. B., & DeVoe, J. E. (2020). New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion. Family Medicine and Community Health, 8(4), e000607. https://doi.org/10.1136/fmch-2020-000607

Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2019). Prevention and control of hypertension. Journal of the American College of Cardiology, 72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008

Dixon, D. L., Baker, W. L., Buckley, L. F., Salgado, T. M., Benjamin Van Tassell, & Carter, B. L. (2021). Effect of a physician/pharmacist collaborative care model on time in target range for systolic blood pressure: Post hoc analysis of the CAPTION trial. Hypertension, 78(4), 966–972. https://doi.org/10.1161/hypertensionaha.121.17873

Kirkland, E. B., Heincelman, M., Bishu, K. G., Schumann, S. O., Schreiner, A., Axon, R. N., Mauldin, P. D., & Moran, W. P. (2018). Trends in healthcare expenditures among US adults with hypertension: National estimates, 2003–2014. Journal of the American Heart Association, 7(11). https://doi.org/10.1161/jaha.118.008731

Masenga, S. K., & Kirabo, A. (2023). Hypertensive heart disease: Risk factors, complications, and mechanisms. 10. https://doi.org/10.3389/fcvm.2023.1205475

Schmidt, B.-M., Durao, S., Toews, I., Bavuma, C. M., Hohlfeld, A., Nury, E., Meerpohl, J. J., & Kredo, T. (2020). Screening strategies for hypertension. Cochrane Database of Systematic Reviews, 5. https://doi.org/10.1002/14651858.cd013212.pub2

Vaismoradi, M., Tella, S., A. Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 1–15. https://doi.org/10.3390/ijerph17062028

Wierzejska, E., Giernaś, B., Lipiak, A., Karasiewicz, M., Cofta, M., & Staszewski, R. (2020). A global perspective on the costs of hypertension: A systematic review. Archives of Medical Science: AMS, 16(5), 1078–1091. https://doi.org/10.5114/aoms.2020.92689

Capstone Project- 4900 Assessment 4: Assessing the Problem: Technology, Care Coordination, and Community Resource Considerations

Effective hypertension management involves a comprehensive approach integrating technology, care coordination, and community resources. In modern healthcare, technology offers innovative tools for monitoring, tracking, and managing blood pressure levels. From wearable devices that provide real-time data on vital signs to telemedicine platforms facilitating remote consultations, technological advancements empower both healthcare professionals and patients in the proactive management of this prevalent condition. Concurrently, care coordination among healthcare providers ensures a comprehensive and synchronized approach to treatment. Recognizing and leveraging community resources are also integral in supporting patients, addressing socio-economic determinants, and promoting lifestyle modifications essential for hypertension management. The convergence of these elements forms a robust framework for holistic care and improved outcomes in combating hypertension. This paper assesses hypertension management, considering the impact of technology, care coordination, and community resources in improving care and patient outcomes.

Impact of Healthcare Technology on Hypertension Management

The impact of healthcare technology on the management of hypertension has been profound, affecting patients, their families, and the broader population. One significant advantage lies in the invention of wearable devices and mobile health applications designed to monitor and manage blood pressure. According to Awad et al. (2021), these technologies enable real-time monitoring, empowering patients to actively participate in their care and providing healthcare professionals with valuable data for timely interventions. Telemedicine platforms have also emerged as a convenient means of remote consultation, enhancing accessibility to healthcare services for individuals managing hypertension (Haleem et al., 2021). However, it is crucial to acknowledge the potential disadvantages and disparities associated with technology use. Saeed and Masters (2021) suggest that certain populations, particularly those with lower socioeconomic status, may face challenges in accessing and utilizing health technologies, exacerbating existing health disparities.

In my nursing practice, the consistent integration of technology aligns with the evidence presented in the literature. The use of mobile applications for blood pressure monitoring and telehealth consultations has become commonplace, facilitating more proactive and patient-centered care. Patients are often provided with tools that enable self-management, fostering a sense of empowerment and engagement in their treatment plans. However, it is essential to recognize potential barriers to technology adoption. Some patients, especially older adults or those with limited technological literacy, may struggle to navigate these tools effectively, making it challenging to apply and obtain reliable data (Finkelstein et al., 2023). In addition, data security and privacy issues remain concerns that healthcare professionals must address to ensure the ethical and secure use of technology in hypertension management.

The implementation of healthcare technology is not without associated costs and barriers. While the initial investment in technology may be substantial, Gentili et al. (2022) emphasize the potential cost-effectiveness of digital health interventions for hypertension management over the long term. However, financial constraints, both at the individual and healthcare system levels, can pose significant barriers to widespread adoption. Infrastructure challenges, such as inadequate internet access in certain communities, may also limit the reach and effectiveness of technology-based interventions. Addressing these barriers is crucial to ensuring equitable access to technological solutions for hypertension management.

Care Coordination and the Utilization of Community Resources

Care coordination and the strategic utilization of community resources are critical in addressing the challenges associated with hypertension in patients, their families, and the broader population. According to Schot et al. (2019), the integration of various healthcare providers, such as physicians, nurses, pharmacists, and community health workers, promotes a collaborative and holistic approach to patient care. This collaborative model is consistent with the principles of the Chronic Care Model, which emphasizes the importance of an organized, proactive, and patient-centered approach to managing chronic conditions like hypertension. However, despite the evident benefits and alignment with established models, there are challenges and opposing views on the application of care coordination and community resource utilization in hypertension management. For instance, a study by Karam et al. (2021) suggests that while care coordination may improve certain aspects of patient care, it might not always result in significant cost savings or better health outcomes. The complexity of coordinating care across diverse healthcare settings and the associated administrative burdens can be substantial barriers.

In my nursing practice, I observe the positive effects of care coordination in hypertension management. Multidisciplinary teams collaborate to develop comprehensive care plans tailored to individual patient needs. Regular communication among healthcare professionals ensures a unified approach, facilitating timely adjustments to treatment plans based on patient progress and changing health conditions. This coordinated effort contributes to improved patient satisfaction and outcomes.

The utilization of community resources further enhances the effectiveness of hypertension management. Community-based interventions, such as lifestyle modification programs, support groups, and health education initiatives, have been shown to impact blood pressure control positively. According to Still et al. (2020), community resources, including access to healthy food options and recreational facilities, contribute to the prevention and control of hypertension. These resources not only address the medical aspects of hypertension but also target social determinants of health, such as socioeconomic status and neighborhood environments. While the literature supports the benefits of care coordination and community resources, barriers to their effective implementation exist. Challenges in communication and information sharing among healthcare providers, especially in fragmented healthcare systems, can impede care coordination efforts. In addition, resource constraints may limit the scope and reach of community-based interventions, affecting care coordination efforts (Kwame & Petrucka, 2021). Disparities in access to community resources may also exist, disproportionately affecting vulnerable populations.

State Board Nursing Practice Standards

In the state of Alabama, the Alabama Board of Nursing (ABN) provides practice standards that guide nursing professionals in the application of technology, care coordination, and community resources in managing chronic conditions such as hypertension. The ABN emphasizes the importance of evidence-based practice and staying current with technological advancements to ensure the delivery of safe and effective patient care. For instance, the ABN recognizes the use of electronic health records (EHRs) as a valuable tool for organizing patient information and facilitating communication among healthcare providers (Alabama Board of Nursing, 2020). It also supports the collaborative nature of care coordination, encouraging nurses to work with interdisciplinary teams to meet the diverse needs of patients. This is consistent with the ABN's commitment to promoting the health and well-being of the public. For instance, nurses in Alabama are expected to actively engage in care coordination efforts, ensuring that patients with hypertension receive comprehensive and integrated care that addresses both medical and social determinants of health. Nurses are encouraged to collaborate with community organizations, educational institutions, and public health agencies to promote preventive care and health education, aligning with the broader goal of enhancing community resources to address health disparities and improve population health.

These standards will guide my actions in applying technology, care coordination, and community resources to hypertension management by ensuring that I stay informed about technological advancements relevant to patient care. For example, I would utilize EHRs to document and monitor hypertension-related data efficiently. Care coordination efforts would involve active collaboration with healthcare professionals from different disciplines, aligning with the ASBN's emphasis on interdisciplinary teamwork. In addition, I would work to connect patients with community resources such as support groups, educational programs, and local services to enhance their overall well-being.

Local, state, and federal policies and legislation also play a crucial role in shaping nursing practice in applying technology, care coordination, and community resources. For instance, the Health Information Portability and Accountability Act (HIPAA) mandates strict standards for protecting patient privacy and the security of health information at the federal level (Edemekong et al., 2022). In the state of Alabama, the Nurse Practice Act outlines the scope of nursing practice and the legal requirements for nursing licensure. Awareness and adherence to these policies are essential to ensure that nursing actions related to technology use, care coordination, and community resource utilization align with legal and ethical standards. Nursing ethics will inform my approach to addressing hypertension by observing principles such as autonomy, beneficence, and justice, which will guide decisions about the use of technology to respect patient autonomy, coordinate care in the best interest of patients, and promote equitable access to community resources. This will also guide the responsible and ethical use of patient data in technological applications, ensuring the confidentiality and security of sensitive health information.

Conclusion

The integration of technology, care coordination, and community resources in hypertension management is guided by state nursing practice standards, organizational policies, and ethical principles. These guidelines emphasize the importance of evidence-based and patient-centered care, urging nursing professionals to leverage technology for efficient healthcare delivery, foster interdisciplinary collaboration in care coordination, and tap into community resources to address social determinants of health. Adherence to these guidelines ensures a patient-centered, evidence-based approach that addresses care quality, patient safety, and system costs, reflecting the commitment of nursing professionals to provide effective and ethical care.

References

Alabama Board of Nursing. (2020). EHR | Alabama department of public health (ADPH). Www.alabamapublichealth.gov. https://www.alabamapublichealth.gov/ehr/

Awad, A., Trenfield, S. J., Pollard, T. D., Ong, J. J., Elbadawi, M., McCoubrey, L. E., Goyanes, A., Gaisford, S., & Basit, A. W. (2021). Connected healthcare: Improving patient care using digital health technologies. Advanced Drug Delivery Reviews, 178(1), 113958. https://doi.org/10.1016/j.addr.2021.113958

Edemekong, P. F., Haydel, M. J., & Annamaraju, P. (2022, February 3). Health insurance portability and accountability act (HIPAA). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500019/

Finkelstein, R., Wu, Y., & Brennan-Ing, M. (2023). Older adults’ experiences with using information and communication technology and tech support services in New York City: Findings and recommendations for post-pandemic digital pedagogy for older adults. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1129512

Gentili, A., Failla, G., Melnyk, A., Puleo, V., Tanna, G. L. D., Ricciardi, W., & Cascini, F. (2022). The cost-effectiveness of digital health interventions: A systematic review of the literature. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.787135

Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2(2). https://doi.org/10.1016/j.sintl.2021.100117

Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing care coordination for patients with complex needs in primary healthcare: A scoping review. International Journal of Integrated Care, 21(1), 1–21. https://doi.org/10.5334/ijic.5518

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(158), 1–10. https://doi.org/10.1186/s12912-021-00684-2

Saeed, S. A., & Masters, R. M. (2021). Disparities in health care and the digital divide. Current Psychiatry Reports, 23(9). https://doi.org/10.1007/s11920-021-01274-4

Schot, E., Tummers, L., & Noordegraaf, M. (2019). Working on working together: A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care, 34(3), 1–11. https://doi.org/10.1080/13561820.2019.1636007

Still, C. H., Margevicius, S., Harwell, C., Huang, M.-C., Martin, L., Dang, P. B., & Wright Jnr, J. T. (2020). A community and technology-based approach for hypertension self-management (COACHMAN) to improve blood pressure control in African Americans: results from a pilot study. Patient Preference and Adherence, 14, 2301–2313. https://doi.org/10.2147/PPA.S283086

Capstone Project-4900 Assessment 5: Intervention Presentation and Capstone Video Reflection

Hello everyone. Welcome to this video reflection on my capstone project. The project focused on the management of hypertension, working together with my grandmother, Mrs. Jones, who has been battling the condition for over twenty years now. This video provides an opportunity to share insights from the experience, reflecting on the project's impact on the affected individual and the support system while developing and implementing interventions to enhance hypertension management. As we delve into this reflection, I hope to provide a glimpse into the various aspects of hypertension management, exploring the role of technology, the significance of patient and family engagement, and the impact of community resources on effective healthcare strategies.

I will begin by assessing the impact of my intervention on Mrs. Jones and her support system. The intervention implemented, which involved developing and utilizing an educational brochure for Mrs. Jones in managing her hypertension, has positively impacted the patient and her family, contributing to an improved quality of life. Mrs. Jones and her husband provided valuable feedback, expressing a sense of empowerment and increased confidence in managing her hypertension. The educational brochure served as a comprehensive resource, addressing the medical aspects of hypertension and providing practical guidance on lifestyle modifications, dietary choices, and the importance of regular monitoring. The feedback highlighted a heightened awareness of the significance of adherence to medication and the integration of healthier habits into daily life. This increased understanding translated into a more engaged and collaborative relationship between Mrs. Jones, her family, and the healthcare team. It enhanced Mrs. Jones's knowledge and fostered a sense of control and agency in managing her health, positively influencing her and her family's satisfaction and quality of life.

Mrs. Jones’s feedback also emphasized the convenience and accessibility of the intervention. She found the brochure easy to use and appreciated a tangible resource she could refer to regularly. The clarity of information and the inclusion of practical tips tailored to her lifestyle were particularly well-received. The family also expressed gratitude for being involved in the educational process, as they saw it as an opportunity to support Mrs. Jones in her hypertension management journey collectively. This collaborative approach, facilitated by the intervention, created a more positive and inclusive experience for the entire family, fostering a supportive environment beyond the conventional scope of medical care.

The planning and implementation of my capstone project were heavily guided by evidence-based practice, and peer-reviewed literature was utilized to inform every aspect. A thorough exploration of peer-reviewed literature was the cornerstone for understanding the latest research findings, best practices, and effective interventions related to hypertension education and medication adherence. The systematic review of evidence allowed for the identification of proven strategies, ensuring that the intervention was not only theoretically grounded but also aligned with the most current and robust evidence in the field. This evidence-based approach informed the selection of educational content, the design of the intervention, and the overall strategy for improving outcomes in hypertension management. It provided a solid foundation to justify and optimize the effectiveness of the project, ensuring that interventions were not only innovative but also rooted in the best available evidence to enhance patient and family experiences in managing chronic conditions. I examined studies in reputable journals, such as the American Journal of Hypertension and the Journal of Nursing Education and Practice, to understand best practices, effective educational tools, and the impact of patient-centered interventions on hypertension outcomes. This evidence-based approach ensured that the intervention was grounded in the latest research findings and aligned with proven strategies for chronic disease management.

Healthcare technology played a significant role in enhancing communication and outcomes in my capstone project. Utilizing electronic health records (EHRs) facilitated an organized approach to patient data management. In addition, leveraging telehealth technologies allowed for remote monitoring, enabling timely interventions and reducing barriers to healthcare access. Developing a mobile app for patient education and reminders enhanced communication and engagement. These technologies improved communication within the healthcare team and provided efficient means for patient education, monitoring, and follow-up.

While the project successfully leveraged healthcare technology, opportunities for improvement exist for future practice. For instance, incorporating more advanced data analytics and machine learning algorithms could enhance the predictive analysis of patient adherence patterns, allowing for more personalized interventions (Kanyongo & Ezugwu, 2023). In addition, exploring virtual reality or augmented reality applications could provide innovative ways to engage patients in educational experiences, making health information more immersive and memorable (Pottle, 2019). Integrating wearable devices with more advanced features like real-time feedback and personalized health insights could further enhance patient empowerment and self-management, promoting better outcomes for hypertensive patients (Kang & Exworthy, 2022).

Health policy played a significant role in the project implementation. This ensured that the educational intervention for hypertension management met clinical effectiveness and aligned with regulatory requirements. For instance, the Alabama Board of Nursing’s emphasis on patient education and advocacy influenced the inclusion of comprehensive educational content in the intervention, ensuring that it empowered patients with the necessary knowledge and skills for self-management. In addition, the state's telehealth and electronic health record policies informed the incorporation of technology in the project, allowing for remote monitoring and enhancing communication with healthcare providers, addressing access barriers, and improving patient care. The intervention's focus on patient engagement and collaborative care also resonates with broader healthcare policies aiming for patient-centered approaches and shared decision-making, contributing to the ongoing shift towards value-based care (Engle et al., 2019).

The project contributed to policy development by highlighting the effectiveness of patient-centered educational interventions in hypertension management. The successful implementation and positive outcomes observed in the project provided evidence for the potential impact of such interventions in improving patient adherence, outcomes, and healthcare quality. This contribution could inform future policy considerations for incorporating patient education strategies in chronic disease management programs. As a baccalaureate-prepared nurse, my role in policy implementation involved ensuring that the project adhered to established guidelines and advocating for policies prioritizing patient education and empowerment in chronic disease management. I also recognized the importance of staying informed about evolving health policies, as they directly influence the scope of nursing practice and the delivery of patient-centered care. Therefore, the project served as a product of existing policies and a potential influencer of future policies, emphasizing the role of baccalaureate-prepared nurses in policy implementation and development within the healthcare system.

The outcomes of my capstone project closely aligned with my initial predictions, demonstrating positive impacts on hypertension management. The intervention, involving an educational brochure, not only met but exceeded expectations in enhancing patient knowledge, adherence, and engagement in managing hypertension. The feedback from Mrs. Jones and her husband surpassed my anticipated satisfaction levels, indicating the intervention's effectiveness in empowering patients to get actively involved in their care. While the project was successful within this setting, its adoption as a best practice could be feasible given its evidence-based approach and patient-centered design. The generalizability of the intervention to other settings depends on factors such as patient demographics, healthcare infrastructure, and cultural considerations (Schloemer & Schröder-Bäck, 2019). However, the core principles of the intervention, rooted in evidence-based practice and involving technology for patient education, offer a promising foundation for adaptation and implementation in diverse healthcare environments.

The journey through my capstone project and the RN-to-BSN program has been transformative, marking significant personal and professional growth. As I navigated the capstone project, I honed my skills in evidence-based practice, integrating research findings into practical solutions for hypertension management. My commitment to ethical care and professional standards was evident in the patient-centered approach, ensuring Mrs. Jones received personalized and dignified care throughout the intervention. Reflecting on my growth, I am most proud of my enhanced critical thinking skills, which were evident in the strategic planning and implementation of the educational intervention. This experience deepened my understanding of the baccalaureate-prepared nurse's role in influencing positive health outcomes and advocating for evidence-based, ethical care. The RN-to-BSN program has not only enriched my theoretical knowledge but has provided a platform to translate this knowledge into meaningful, patient-centered interventions, fostering a sense of confidence and competence in my nursing practice. Thank you.

References

Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2019). Evidence-based practice and patient-centered care: Doing both well. Health Care Management Review, 46(3), 174–184. https://doi.org/10.1097/HMR.0000000000000254

Kang, H. S., & Exworthy, M. (2022). Wearing the future—Wearables to empower users to take greater responsibility for their health and care: A scoping review. JMIR MHealth and UHealth, 10(7), e35684. https://doi.org/10.2196/35684

Kanyongo, W., & Ezugwu, A. E. (2023). Machine learning approaches to medication adherence amongst NCD patients: A systematic literature review. Informatics in Medicine Unlocked, 38, 101210. https://doi.org/10.1016/j.imu.2023.101210

Pottle, J. (2019). Virtual reality and the transformation of medical education. Future Healthcare Journal, 6(3), 181–185. https://doi.org/10.7861/fhj.2019-0036

Schloemer, T., & Schröder-Bäck, P. (2019). Criteria for evaluating transferability of health interventions: A systematic review and thematic synthesis. Implementation Science: IS, 13(88).

Dashboard Metrics Evaluation

Performance indicators in healthcare are measurable and quantifiable metrics that assess the effectiveness, efficiency, and quality of healthcare processes, services, and outcomes. The evaluation of dashboard metrics serves as a critical tool for understanding and enhancing the effectiveness of medical institutions in healthcare management and performance assessment. The provided case study in the Villa Health Scenario examines the Public Health Dashboard - Diabetes of Mercy Medical Center in Shakopee, MN. The dashboard presents crucial information regarding new diabetes patients, categorized by race, gender, and age, alongside data on eye exams, foot exams, and HgbA1c tests. The demographic details of the Shakopee population and accolades received by the medical center are also included. This analysis aims to identify and prioritize areas for improvement and emphasize the significance of these metrics in contributing to the overall success of Mercy Medical Center.

Evaluation for Mercy Medical Center

Mercy Medical Center provides comprehensive healthcare services catering to diverse patient populations, offering reproductive health, emergency, critical care, and outpatient services. The medical facility serves a community of approximately 20,000 individuals spanning all age groups. The most significant demographic segment falls within the 21-44 age range, comprising 14,732 individuals, while the smallest demographic consists of adults aged 65 and above, with a population of 2,371 (Capella University Villa Health, n.d). In terms of racial distribution, the health center predominantly serves a white population, accounting for 28,537 patients, while individuals of interracial backgrounds constitute the minority group, totaling 1,016. The gender distribution indicates 17,597 male and 18,235 female patients within the served population.

The Public Health Dashboard - Diabetes of Mercy Medical Center provides valuable insights into the institution's performance related to diabetes care. However, certain organizational performance shortfalls become evident when evaluating the dashboard metrics against benchmarks set forth by local, state, or federal healthcare laws or policies. For instance, the declining trend in HgbA1c exams raises concerns. The data reveals a decrease in the number of HgbA1c tests conducted over the quarters, with Q4 2020 recording only 64 tests compared to 78 in Q3 2020. This decline may signify a gap in meeting recommended screening frequencies for monitoring glycemic control in diabetic patients. The low rate of foot exams is another notable area of concern. The data indicates inconsistent performance in this category, with only 48 foot exams conducted in Q3 2020 compared to 75 in Q1 2020. According to Pérez-Panero et al. (2019), routine foot exams are crucial for identifying early signs of neuropathy or vascular issues and preventing diabetes-related complications.

While the dashboard provides data on new patients by race, gender, and age, it lacks information on the total number of new patients in previous quarters. Without this information, it becomes challenging to assess whether the reported numbers represent a significant deviation from historical trends or if there is a notable increase in diabetes incidence within the community. This gap in information hinders a comprehensive evaluation of new patient metrics against some recommended benchmarks.

The Set Benchmarks for Diabetes by Local, State, & Federal Laws

Set benchmarks for diabetes care are established by local, state, and federal health authorities to ensure standardized and effective management of the condition. For instance, the American Diabetes Association (ADA) recommends regular monitoring of Hemoglobin A1c (HbA1c) levels at least twice a year for patients with stable glycemic control (HbA1C <7%) and quarterly for those not meeting treatment goals until the target level is achieved (Eyth & Naik, 2023). Federal guidelines, such as those from the Centers for Medicare & Medicaid Services (CMS), emphasize regular foot exams at least annually and more frequently for high-risk patients (Cooksey, 2020). State-level health departments may specify targets for annual eye exams, as routine screenings can help prevent and manage diabetic retinopathy. These benchmarks aim to enhance the quality of diabetes care, promoting timely interventions and reducing the risk of complications.

Consequences of not Meeting the Benchmarks

Failing to meet prescribed benchmarks in diabetes care can have significant consequences for healthcare organizations and teams. Inadequate adherence to HbA1c monitoring frequency can result in delayed detection of poorly controlled blood sugar levels, leading to increased risks of complications such as cardiovascular disease and diabetic nephropathy (Davies et al., 2022). In addition, failure to conduct regular foot exams, as recommended, may result in the oversight of potential issues like peripheral neuropathy, putting patients at risk of foot ulcers and amputations. Inadequate compliance with benchmarks for eye exams can lead to undetected diabetic retinopathy, contributing to irreversible vision impairment. These consequences compromise patient outcomes and pose financial burdens on healthcare organizations as increased hospitalizations and interventions become necessary. Non-compliance with benchmarks may also negatively impact the reputation of healthcare teams and institutions, eroding patient trust and satisfaction. Assumptions underlying this analysis include the assumption that benchmarks are evidence-based and reflect optimal diabetes care. Failure to meet these benchmarks correlates with suboptimal patient outcomes and increased healthcare costs.

Evaluating Benchmark Underperformance

One benchmark in Mercy Medical Center that holds significant potential for greatly improving overall performance is the HgbA1c monitoring frequency. The declining trend in HgbA1c exams, as evidenced by the decreasing numbers over consecutive quarters, raises concerns about the medical center's adherence to recommended diabetes care practices. Improving the frequency of HgbA1c tests is critical as it is a key indicator of long-term blood sugar control. Enhancing compliance with established benchmarks for HgbA1c monitoring, such as ensuring biannual testing for stable patients and quarterly for those not meeting treatment goals, can lead to early identification of patients at risk of complications. This proactive approach enables timely interventions to optimize glycemic control, reducing the incidence of diabetes-related complications like cardiovascular diseases and nephropathy (Imai et al., 2021). In addition, meeting or exceeding HgbA1c monitoring benchmarks aligns with evidence-based diabetes care standards, enhancing the overall quality of performance and promoting positive patient outcomes. When prioritized and achieved, this benchmark can significantly elevate the standard of diabetes care at Mercy Medical Center.

Ethical Intervention for the Underperforming Benchmark

Addressing the benchmark underperformance in HgbA1c monitoring at Mercy Medical Center requires a collaborative approach involving healthcare providers, administrators, and patients. Ethical considerations dictate transparent communication with patients about the importance of regular HgbA1c tests and their role in preventing diabetes-related complications (Mužik et al., 2023). Sustainability goals can be realized by establishing an educational outreach program to raise awareness about the significance of consistent monitoring. This program should emphasize shared decision-making between healthcare professionals and patients, promoting autonomy and informed choices. Healthcare providers must also ensure equitable access to testing resources, aligning with ethical principles of justice and fairness. Fostering a patient-centered, ethically sound, and sustainable approach to HgbA1c monitoring, Mercy Medical Center can enhance diabetes care, ensuring the well-being of patients while upholding ethical standards and contributing to the longevity and effectiveness of healthcare practices.

Conclusion

The analysis of benchmark underperformance at Mercy Medical Center, particularly in addressing HgbA1c monitoring, highlights the critical need for ethical, sustainable, and collaborative interventions. The healthcare organization can enhance its commitment to optimal diabetes care by focusing on transparent communication, patient education, and equitable resource access. Adhering to evidence-based benchmarks aligns with ethical principles such as patient autonomy and justice and contributes to the sustainability of healthcare practices. As a result, prioritizing the recommended actions will address the identified performance gaps and fortify the institution's dedication to providing high-quality, patient-centered care that is ethically responsible and environmentally sustainable.

References

Cooksey, C. (2020). Strategies to improve annual diabetic foot screening compliance at a family clinic. Clinical Diabetes, 38(4), 386–389. https://doi.org/10.2337/cd20-0030

Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., Rossing, P., Tankova, T., Tsapas, A., & Buse, J. B. (2022). Management of hyperglycemia in type 2 diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 45(11). https://doi.org/10.2337/dci22-0034

Eyth, E., & Naik, R. (2023, March 13). Hemoglobin A1C. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549816/

Imai, C., Li, L., Hardie, R.-A., & Georgiou, A. (2021). Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: A 5-year retrospective cohort study in Australian general practice. BMJ Quality & Safety, 30(9), bmjqs-2020-012026. https://doi.org/10.1136/bmjqs-2020-012026

Mužik, R., Knapčoková, V., Saal, B., & Tkáč, I. (2023). Effect of a disease management program on the adherence to guideline-recommended HbA1c monitoring in patients with diabetes in Slovakia. Diabetes Therapy, 14(10), 1685–1694. https://doi.org/10.1007/s13300-023-01447-9

Pérez-Panero, A. J., Ruiz-Muñoz, M., Cuesta-Vargas, A. I., & Gónzalez-Sánchez, M. (2019). Prevention, assessment, diagnosis, and management of diabetic foot based on clinical practice guidelines. Medicine, 98(35), e16877. https://doi.org/10.1097/md.0000000000016877

Discussion Reflection Response - Health Policy

In my area of specialization as a family nurse practitioner (FNP), the three most important trends are the mounting debates on the changes in the FNP’s full practice authority, discrepancies over reimbursement, and the FNP’s trend of taking over more roles of a primary care provider. The roles of advanced nurse practitioners (APRNs) are determined at the state level; therefore, they may vary from state to state. However, there have been several attempts to harmonize regulations among the states and ensure that each state recognizes APRNs as licensed practitioners with the full authority of practice, which includes prescribing medications. The full practice authority of nurse practitioners includes independent practice and the ability to prescribe medications without the oversight of another profession.

There has also been a raging debate on the reimbursement to nurse practitioners for providing the same services as physicians. Nurse practitioners are usually reimbursed less than physicians for these same services. The training for physicians is more rigorous and expensive, with more demanding educational requirements. In some states, nurse practitioners have to work under physicians’ oversight, which may also lead to discrepancies in pay. Seemingly, this reimbursement policy may not change any time soon. However, providers must be compensated appropriately for the services they offer. There are more people residing in areas with primary provider shortages, and narrowing this gap requires NPs to be allowed to practice to the full scope of their education.

References

No References

Discussion Reflection Response- Ethical Dilemma

How the NP in the Documentary is A Disruptive Innovator

Over the past few decades, nurse practitioners have changed their practice into a more evolving and innovative form. An example of disruptive innovation is shown in the invisible patient’s documentary, where Jessica, a nurse practitioner, took care of a young patient with muscular dystrophy through end-of-life care, changing the scenario from working in a hospital to a home-bound setting. In the documentary, the NP battles with an ethical dilemma of managing Roger Brown, a 30-year-old patient, on end-of-life care and telling him and his family the truth about his condition. The patient issues a “Do Not Resuscitate” order in case his heart stops. In this case, Jessica, the NP, tries to prepare the client and his mother for the eventuality of death, however difficult it is. He tells the client that he is only 30 and should not be talking about death, but they must.

The Relationship Between My Personal Beliefs and Values and This Ethical Dilemma/Barrier

As a future nurse practitioner, I firmly believe that no matter how difficult the situation is, it is important to tell the patient and the family the truth about their condition and prepare them to make difficult decisions professionally. I would have similarly managed this condition as Jessica did. She managed this end-of-life care as best as possible and made the patient and his family feel the compassion and empathy she had for them.

One mechanism to manage the barrier discussed

Managing this barrier requires the NP to be honest and truthful to the clients and their families. Offering compassionate care and support to the clients and their families go a long way in helping them make critical decisions that will ensure overall patient satisfaction and improve their quality of life. The families also prepare early enough for eventualities, such as the death of their loved ones, and undergo the normal grief process.

The potential cost/benefits of the barrier

Giving patients and their families false hopes may be costly as they will tend to seek curative means to a life-terminating condition. They may deplete all their resources during treatment, yet their loved ones will not recover. Honesty, in this case, will help the client and his family make an informed decision on the process of care and save on the available resources.

References

No References

Discussion- Reflection

As I transition from the role of a registered nurse (RN) with an undergraduate degree to the role of a Nurse Practitioner (NP) specializing in the specialty of a family nurse practitioner, the competency of independent practice is one that will be key in ensuring effectiveness in my practice. This competency ensures that nurse practitioners have the necessary academic and professional training to be able to provide all services to patients as required by law. During my past experience working as an RN, most of the decisions on patient diagnosis and treatment were made by physicians.  My new role as a nurse practitioner challenges my knowledge as the role will require me to be more analytical and utilize my knowledge of critical thinking to be able to make independent decisions on patient diagnosis and plan of care in collaboration with my patients.

Some expectations in independent practice that I believe I have met, especially with the knowledge I acquired at my undergraduate level include the basic fundamental knowledge on health promotion, disease prevention, and management of illnesses to ensure optimum health. Through the basic pathophysiological knowledge of different illnesses that I acquired during my undergraduate studies, I am able to employ screening and diagnostic techniques to diagnose illnesses. I should work more on my interpersonal techniques and communication skills to be able to develop a trusting, mutual and empathetic relationship with my patients to be able to create a therapeutic relationship and enhance patient-centered care. To improve these skills, I will ensure I have proper mentorship by certified family nurse practitioners and enhance my knowledge and skills by participating in the development, use, and evaluation of professional standards and evidence-based care.

References

No References

Dissertation paper

Climate change

   Climate change has been affecting society, especially nowadays. Humans have been affected by climate change in recent years, and many things have happened to communities and society. New things are happening, and hopefully, the new generations can help solve and stop climate change. People have been affected by changes in the weather and have been worrying more about their health. Many home and army bases are being destroyed.

Work Cited

UCSUSA. Global warming increases the frequency of dangerously hot days. Union of Concerned Scientists. Global Change. Sea level rise impacts on coastal communities.

CBS Chicago. (2019, January 31). Chicago’s historic cold snap breaks record for the coldest temperature ever recorded.

ENG Week 2 Discussion- Mary Oliver, Philip Levine, and Robert Frost Poem Analysis

Mary Oliver, Philip Levine, and Robert Frost contemplate the notions of work, freedom, and life in their poems, developing their unique viewpoints on the nature of existence, daily routines, and opportunities. Each poet employs imagery and tone to expound on the nature of human life, providing interpretations that likely speak to each reader in more ways than one.

In the poem ‘Singapore,’ Oliver contrasts the aesthetics of nature with the reality of human labor. The poem describes the dignity of work, while the speaker initially reacts with disgust when encountering a woman scrubbing a public restroom. The first contemplation of the speaker is, “A poem should always have birds in it,” which suggests that poetry should be a way to flee from reality and embrace lightness and divinity (line 8). Nevertheless, as the poem progresses, the speaker seems to adopt a different perspective. Despite the woman’s humble occupation as a janitor and her work deemed as “dull enough” (Oliver, line 21), the poem shows that there is “light that can shine out of a life” (Oliver, line 36), representing a symbol of beauty and resilience. The poem portrays the routine as something poetic, which means that even in monotonous labor work, there is beauty in it, implying respect towards work and the latent beauty in it.

Levine’s poem “What Work Is” presents a more melancholic and straightforward reflection of work. In the poem, work is interpreted as the physical exertion and the weight on the heart and soul it entails. The speaker describes waiting in line for a job, feeling the weight of rejection and longing: “A man is waiting who will say, no, we’re not hiring today.” (Levine, line 15). The poem paints the gloom and hopelessness characteristic of the working class. Although the poem is relatively simple, the series of images and emotions peak when the speaker reflects on his brother’s night shift and he is suddenly overwhelmed with love. The poem brilliantly intertwines work with emotional strain, noting that work is deeper than a simple motion; it has to do with the sacrifices made for the family and the self-sacrificing love of the speaker with his brother. The poem ends with an appreciation that while knowing what work is, it is not merely employment, but embracing the cost it extracts from life.

The poem “The Road Not Taken,” by Robert Frost, deals with the theme of decisions and their implications. While Oliver and Levine are concerned with the idea of work, Frost explores the philosophical concept of choice. The speaker reflects on two diverging paths in the woods, noting that taking the road less traveled “has made all the difference” (Frost, lines 19-20). This poem is based on the principles of free will and the fact that with any decision made, risks are always involved. Hence, the tone adopted by Frost is one of tributary contemplation of the path not taken, as the speaker accepts that a choice determines the course of one’s life in ways that may not be fully comprehended. It echoes the fact that many decisions in life are inconsequential until one looks back at them later in life.

It is apparent that each of the three poets featured in this discussion employs human experience as their subject matter, yet they do so differently. Oliver brings worth into what people do for a living, Levine portrays feelings of jobs, and Frost focuses on decision-making outcomes. Altogether, the above poems depict the small moments in life that are often overlooked, such as a worker toiling away, standing in line for a job, or reflecting on a decision in the woods. With distinct points of view, Oliver, Levine, and Frost raise awareness of the complexities of life’s tasks, decisions, and existence.

References

Frost, R. (1915). The Road Not Taken. Poetry Foundation. https://www.poetryfoundation.org/poems/44272/the-road-not-taken

Levin, P. (1991). What work is – A poem by Philip Levine. What Work Is – a Poem by Philip Levine. https://sergiocaredda.eu/inspiration/what-work-is-a-poem-by-philip-levine

Oliver, M. (1988, August 28). Singapore- The Poetry Foundation. SALT Project. https://www.saltproject.org/progressive-christian-blog/2019/8/28/singapore-by-mary-oliver

ENGL 147: Argument Research Essay Proposal

I. Based on our Week 1 Discussion and your current favorite choice for a topic/debate within the course theme announcement, answer the following:

A. State your stance within the debate you chose, without using “I.” (1 sentence)

Incorporating Medication-Assisted Treatment (MAT) in managing opioid dependence is effective and should be encouraged in addition to behavioral therapy.

B. Why is your stance a good one for an argument research essay? (at least three sentences)

This is a reasonable stance for an argument because there are two possible views: whether medication-assisted treatment should be incorporated in the management of opioid dependence or not. I am also proposing an issue of concern to the general public, looking into the effectiveness of MAT therapy, which will combat misinformation on the topic. Finally, there is a lot of evidence-based research available on this topic, and I can effectively address my stance and, at the same time, identify and address the opposing views.

C. Who might disagree with your stance and why? (at least three sentences)

Some organizations are against the use of MAT therapy in managing opioid addiction. They base their arguments on the fact that some medications used in MAT therapy may also cause addiction, which may precipitate the problem rather than provide a solution. In addition, the drugs may have severe side effects; therefore, these organizations call for the exploration of other alternatives, such as behavioral therapy, to manage the problem. I will need to address this issue by giving significant benefits of combining MAT and behavioral therapy to improve health outcomes in opioid dependence.

D. Who do you imagine your audience will be? (at least two sentences)

I imagine that my audience will consist of the general public, those with opioid use disorder who are undergoing treatment or about to start treatment, and even members of the healthcare team in rehabilitation centers. These people may be interested in knowing the best management practices for opioid dependence and opioid use disorder.

II. In a whole paragraph of 7-9 sentences, and without performing any research, please note what you already understand about the debate and what you do not already understand about the debate:

            I understand that the opioid crisis is an issue of public health concern. Since opioid-based medications are usually prescribed for managing severe acute pain, the case may remain for a long time. Strict measures have been put in place to regulate unnecessary prescriptions of opioids, but complete control is still a problem. Once a person develops opioid dependence, compulsive use of opioids may lead to adverse effects on the individual, affecting their physical, emotional, and social well-being. Medication-Assisted Treatment (MAT) incorporates the use of drugs, in addition to other treatment methods, to manage the problem of opioid dependence. However, being that these are drugs, they may alter certain body functions, which may result in adverse effects. I believe these effects can be counteracted, and I will incorporate the evidence from literature and scientific research to determine how and explain why the therapy is effective.

III. Possible Search Phrases

• What is opioid dependence?
• Effectiveness of MAT therapy in managing opioid dependence
• What are the side effects of MAT therapy in managing opioid dependence?
• Managing the side effects of MAT therapy in opioid dependence.
• Barriers to the use of MAT therapy in opioid dependence.

References

No References

Essay

There are no results for Rising Waters,

1. Lost Homes Climate change has been affecting society, especially nowadays.

2. Humans have been affected by climate change in recent years,

3. and many things have happened to communities and society. New things are happening, and hopefully, the new generations can help solve and stop climate change.

    People have been affected by changes in the weather and have been worrying more about their health. Many home and army bases are being destroyed. Changes in weather have been a huge part of society’s worries; changes are drastic and so severe that some states and places in the world can’t handle them. Some places along the northern and midwestern regions show that spring may be arriving sooner; hot weather is happening more and more often. UCSUSA states, “Dangerously hot weather is occurring more frequently than it did 60 years ago.” The heat may be increasing by dangerous amounts that may result in catastrophic events for many places, especially the Arctic area. In places such as California, wildfires are occurring more often, too. As a result of having many wildfires, the air quality lessens. If wildfires keep on happening, the air will be contaminated with harmful chemicals. These chemicals can lead to sickness and more contamination; these hugely affect people, and kids with asthma could be in grave danger. Use original sources only. Order your custom essay on The Growing Threat of Climate Change: Impact on Society and Urgent Solutions Get Custom Essay Reviews.io 4.7/5 Homes are also being destroyed as a result of climate change. The main thing is flooding and fires. Flooding has caused many places to be evacuated, and homes have to be left behind to be destroyed. Forest fires have also burned down not only homes but entire communities. Many people and families have been left homeless, and they have to start over again. Families have to leave their homes behind because sometimes the conditions may be too brutal to return to. Global Change says that “…communities that live by the water, sea level rise, combined with coastal storm increase the risk of erosion and storm surges.” Places near waters Where they are a danger to communities and are no longer safe to live in. people have lost their lives because of flooding, and some have moved out of 

References

There are no results for Rising Waters, Lost Homes Climate change has been affecting society, especially nowadays. Humans have been affected by climate change in recent years, and many things have happened to communities and society. New things are happening, and hopefully, the new generations can help solve and stop climate change. People have been affected by changes in the weather and have been worrying more about their health. Many home and army bases are being destroyed. Changes in weather have been a huge part of society’s worries; changes are drastic and so severe that some states and places in the world can’t handle them. Some places along the northern and midwestern regions show that spring may be arriving sooner; hot weather is happening more and more often. UCSUSA states, “Dangerously hot 

Essay

In response to the pressing issue of patient overcrowding in the emergency department of our Upstate New York healthcare facility, the implementation of a nurse-led triage system stands as a crucial and innovative solution. The escalating demand for emergency medical services has led to significant challenges in delivering timely and efficient care to patients in need. Recognizing the urgency of this matter, our healthcare facility has devised a comprehensive plan to alleviate the strain on resources and enhance the overall patient experience. The plan aims to streamline the patient flow, prioritize cases effectively, and optimize resource utilization by entrusting experienced and skilled nurses with the responsibility of triage. This implementation design outlines the processes, protocols, and training initiatives necessary to establish a nurse-led triage system to mitigate patient overcrowding and ensure prompt, high-quality care for all individuals seeking medical attention at our facility.

Interprofessional Collaboration Strategies

To successfully lead, manage, and implement professional nursing practices while ensuring interprofessional collaboration during the implementation of the nurse-led triage system, several key strategies must be employed. Effective leadership is essential, encompassing clear communication of the intervention plan's objectives, benefits, and expected outcomes to all stakeholders, including nurses, physicians, administrative staff, and support personnel (Sfantou et al., 2018). It is imperative to foster a culture of open dialogue where conflicting data and diverse perspectives are acknowledged and valued. Regular interdisciplinary team meetings and forums should be organized to encourage collaborative problem-solving and consensus-building.

Robust management strategies are also crucial, involving establishing standardized protocols and guidelines for triage procedures that are evidence-based and continually updated based on emerging research and best practices. Nursing staff should receive comprehensive training and ongoing education to ensure competency and adherence to these protocols. Additionally, implementing a system for continuous data collection and analysis can provide valuable insights into the effectiveness of the nurse-led triage system, enabling timely adjustments to enhance its efficiency (Harrison et al., 2021). It is also critical to create a supportive environment for interprofessional collaboration, which requires recognizing and appreciating the unique contributions of each team member. Nurses, physicians, and other healthcare professionals should be encouraged to share their perspectives and insights, fostering a collaborative atmosphere where the strengths of each discipline are harnessed to optimize patient care. Embracing diverse viewpoints, addressing conflicting data impartially, and promoting open communication will enable the nurse-led triage system to benefit from the collective expertise of the entire healthcare team, improving patient outcomes and satisfaction.

Change Implications Associated with the Proposed Strategy

The proposed strategies for improving the quality and experience of care by implementing the nurse-led triage system while controlling costs carry significant implications for the healthcare facility. One of the critical implications is the potential improvement in patient outcomes and satisfaction. According to Harding et al. (2019), the streamlined triage process can lead to quicker access to appropriate care, reducing wait times and enhancing overall patient experience. In addition, the intervention has the potential to control costs, contributing to long-term financial sustainability by optimizing resource utilization and ensuring efficient allocation of staff. However, there are several knowledge gaps and areas of uncertainty that need to be addressed for a comprehensive analysis. For instance, the long-term impact of the nurse-led triage system on patient outcomes, readmission rates, and healthcare costs needs to be thoroughly studied to assess its sustainability and effectiveness over time.

Additionally, understanding the potential resistance to change among healthcare professionals and patients is crucial, as it can influence the successful implementation of the new system (Nilsen et al., 2020). A detailed cost-benefit analysis is also necessary to evaluate the financial implications accurately, considering initial implementation costs, ongoing training expenses, and potential savings from improved efficiency. Research on the optimal nurse-to-patient ratio, training requirements, and necessary support systems is essential to ensure the effectiveness and sustainability of the proposed strategies. Addressing these knowledge gaps and uncertainties is vital to making well-informed decisions, maximizing the benefits of the nurse-led triage system, and ensuring the overall success of the intervention in improving healthcare quality, patient experience, and cost-effectiveness.

Delivery Methods to Improve Project Quality

The successful implementation of the nurse-led triage system to improve the quality of care relies on a carefully planned delivery strategy. To begin, a phased approach should be adopted, starting with a pilot program in a specific area of the emergency department, allowing for testing, refinement, and identification of potential challenges. Comprehensive training programs and workshops should be developed for nursing staff, and a robust communication plan should be implemented to ensure that all stakeholders are well-informed and engaged throughout the process. Additionally, leveraging technology, such as electronic health records and data analytics, can enhance the efficiency and accuracy of the triage system (Xiao et al., 2023). Assumptions underlying this proposal include the readiness and willingness of the nursing staff to adapt to the new system, the availability of necessary resources for training and technology integration, and the support of leadership in promoting a culture of interprofessional collaboration. In addition, it is assumed that a pilot program will reveal valuable insights and allow for necessary adjustments before full-scale implementation. Effective communication and ongoing feedback will also be instrumental in addressing any unforeseen challenges that may arise during the execution of this intervention.

Current and Emerging Technological Options for the Proposed Delivery Methods

The proposed delivery methods for implementing the nurse-led triage system entail integrating technology to enhance efficiency and accuracy. Currently, there are several technological options available, such as electronic health records (EHRs), telemedicine tools, and data analytics platforms, which can aid in the systematic triage process, data collection, and real-time decision support (Papadopoulos et al., 2022). However, knowledge gaps and uncertainties exist in several areas. For instance, the interoperability and compatibility of existing EHR systems with the new triage protocols may require further investigation to ensure seamless data exchange and prevent potential disruptions in patient care. Additionally, while telemedicine tools can assist in remote consultation, the effectiveness and security of these platforms need to be rigorously assessed, especially considering patient privacy and data protection concerns. Data analytics tools can help monitor and improve the triage system, but it's unclear how frequently and in what format this data should be collected and analyzed to maximize its impact. There is also a need to determine the cost-effectiveness of these technologies, considering initial investments, ongoing maintenance, and potential long-term savings.

Stakeholder Regulatory Implications

Implementing the nurse-led triage system is contingent upon a nuanced analysis of stakeholders, regulatory implications, and potential sources of support. Stakeholders in this context encompass healthcare professionals, patients, administrative staff, and regulatory bodies. Nurses and physicians are pivotal stakeholders whose acceptance and engagement are crucial for successfully integrating the new system. Patients' perspectives and experiences also hold significant weight, influencing overall satisfaction. Administrative staff plays a pivotal role in facilitating the logistical aspects of implementation. Regulatory implications involve adherence to healthcare standards, privacy regulations, and licensing requirements, necessitating meticulous compliance to avoid legal complications. Additionally, garnering support from hospital leadership, regulatory agencies, and professional nursing associations is pivotal. Assumptions underlying this analysis include the stakeholders' willingness to adapt to change and engage collaboratively, compliance with existing regulations and standards, and the availability of necessary resources and support from regulatory bodies and hospital administration (Petkovic et al., 2020). It is also assumed that clear communication and education initiatives will address potential concerns among stakeholders and garner their support, ensuring the successful implementation of the nurse-led triage system.

Policy Considerations Supporting the Implementation of the Intervention Plan

An existing policy in New York that can significantly support the implementation of the nurse-led triage system is the "Nurse Practice Act." This policy governs the scope of practice and responsibilities of registered nurses within the state, and it could be leveraged to expand the roles and responsibilities of nurses in triage, allowing them to lead the process effectively (New York State Education Department, 2022). In addition, promoting policies that incentivize healthcare facilities to adopt technology for efficient triage, such as the promotion of telehealth reimbursement, could enhance the adoption of technological tools within the system. Conversely, any policy that restricts or overly complicates the expansion of nursing roles or imposes excessive regulatory burdens on healthcare facilities could impair the implementation of the nurse-led triage system. Therefore, it is imperative to engage with policymakers to ensure that existing and new policies align with the objectives of the intervention plan rather than hinder its progress.

Timelines for Implementing the Proposed Strategy

The timeline for implementing the nurse-led triage system should be designed carefully, considering various factors. Initially, a preparatory phase of approximately 3-6 months is necessary to develop standardized protocols, establish training programs, and conduct pilot testing. This phase allows for addressing any unforeseen challenges. The subsequent roll-out to the entire emergency department can occur over 6-12 months, allowing time for comprehensive staff training and workflow adjustments. Factors influencing the timing include the readiness of nursing staff and available resources for training, the integration of technology, and the alignment with regulatory requirements. Regular assessments and feedback mechanisms should be implemented to monitor progress and make any necessary revisions to the timeline, considering unexpected issues, such as staff resistance or technical complications, which may require adaptations to ensure a smooth and successful implementation.

Conclusion

Implementing a nurse-led triage system in the Upstate New York healthcare facility to alleviate patient overcrowding in the emergency department is a complex endeavor that requires careful planning, interprofessional collaboration, and a mindful approach to technology integration. The strategies proposed, focusing on leadership, management, and professional nursing practices, provide a comprehensive framework for success, while the analysis of implications highlights the need for further research and data-driven decision-making. In addition, considerations of stakeholders, regulatory factors, and policy support underscore the importance of aligning external factors with the intervention plan's objectives. A well-structured timeline allows for systematic implementation while accounting for potential challenges and revisions. Addressing these various facets and staying adaptable enables healthcare facilities to aim to enhance patient care quality and experiences while effectively controlling costs improving the overall healthcare landscape in the region.

References

Harding, K. E., Snowdon, D. A., Lewis, A. K., Leggat, S. G., Kent, B., Watts, J. J., & Taylor, N. F. (2019). Staff perspectives of a model of access and triage for reducing waiting time in ambulatory services: A qualitative study. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4123-0

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of Healthcare Leadership, Volume 13(13), 85–108. NCBI. https://doi.org/10.2147/JHL.S289176

New York State Education Department. (2022). NYS Nursing:Practice Information:FAQ. Www.op.nysed.gov. https://www.op.nysed.gov/professions/registered-professional-nursing/practice-information-for-nursing#:~:text=You%20are%20not%20legally%20allowed

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses, and assistant nurses. BMC Health Services Research, 20(1), 1–8. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4999-8

Papadopoulos, P., Soflano, M., Chaudy, Y., Adejo, W., & Connolly, T. M. (2022). A systematic review of technologies and standards used in the development of rule-based clinical decision support systems. Health and Technology, 12(4), 713–727. https://doi.org/10.1007/s12553-022-00672-9

Petkovic, J., Riddle, A., Akl, E. A., Khabsa, J., Lytvyn, L., Atwere, P., Campbell, P., Chalkidou, K., Chang, S. M., Crowe, S., Dans, L., Jardali, F. E., Ghersi, D., Graham, I. D., Grant, S., Greer-Smith, R., Guise, J.-M., Hazlewood, G., Jull, J., & Katikireddi, S. V. (2020). Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation. Systematic Reviews, 9(21), 1–11. https://doi.org/10.1186/s13643-020-1272-5

Sfantou, D., Laliotis, A., Patelarou, A., Sifaki- Pistolla, D., Matalliotakis, M., & Patelarou, E. (2018). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5(4), 73. NCBI. https://doi.org/10.3390/healthcare5040073

Xiao, Y., Zhang, J., Chi, C., Ma, Y., & Song, A. (2023). Criticality and clinical department prediction of ED patients using machine learning based on heterogeneous medical data. Computers in Biology and Medicine, 165, 107390. https://doi.org/10.1016/j.compbiomed.2023.107390

Essay

Your Name:

1. Description of Issue, Indicator, and Focus

1. Approved transcultural nursing issue from the course project

The approved transcultural nursing issue from my course project is suicide among Hispanic adolescents. Suicide is described as the act of deliberately killing oneself. It is a tragic event for families, communities, and societies at large with long-lasting effects on the people left behind, especially the immediate family members. Throughout the ages, suicide has been a subject of taboo and frequent stigmatization with several cultural and religious norms depicting it as unacceptable and sinful. As a result, social sanctions are possible consequences (Geddes, et al., 2020). Suicide prevention is, therefore, an important mental health issue of concern in Nursing that should be addressed to reduce case fatalities.

1. Approved Healthy People 2030 Leading Health Indicator

Leading Health Indicators (LHI) are a select subset of important factors with great health impacts and are major causes of morbidity and mortality across the United States. In the LHI, suicide is listed under the topic of mental health. According to the Centers for Disease Control and Prevention (CDC), health statistics place suicide as the tenth leading cause of death in the United States and the second leading cause of death for people between the ages of 10-14 and 25-34 (CDC, 2022). It is estimated that in every 11 minutes, 1 death occurs by suicide and the numbers vary by race and ethnicity (Perry, et al., 2022). Several factors such as unemployment, fear of poverty, food insecurity, social isolation, and lack of access to health and mental health services have been identified as some of the major causes of suicide.

1. Approved cultural focus

The approved cultural focus is the Hispanic culture. Cultural factors have a great impact on health-seeking behavior and utilization of mental health services among Hispanic people. For instance, the cultural norms of Hispanic families dictate that mental health problems should be dealt with by members of the family or faith-based communities rather than specialized mental health personnel and institutions. This may make them fail to seek formal mental health-related services due to stigma and concerns that seeking these services may go against the approved cultural norms of the community. Suicide prevention measures among this population should, therefore, be culturally- tailored so that the efforts are suitable and acceptable for the community.

1. References with permalink

The two peer-reviewed scholarly professional journal articles that I selected for my topic include:

López, D., Ochoa, D., Romero, M., & Parr, K. (2020). Integrating Latinx/Hispanic culture, traditions, and beliefs into effective school psychology practice. Communiqué, 49(4), 16-18. https://www.researchgate.net/publication/348309418_Integrating_LatinxHispanic_culture_traditions_and_beliefs_into_effective_school_psychology_practice

Silva, C., & Van Orden, K. A. (2018). Suicide among Hispanics in the United States. Current opinion in psychology, 22, 44–49. https://doi.org/10.1016/j.copsyc.2017.07.013

1. Summary

The first article by Lopez, et al (2020) examines the importance of integrating Latinx/Hispanic culture, traditions, and beliefs into effective school psychology practice to reduce cases of suicide among Hispanic adolescents. The journal provides several recommendations to improve the overall mental health outcome for children, youth and families. These recommendations include addressing mental health stigma by offering explanations about the symptoms of the child and the process of counseling in a culturally acceptable manner.

The idioms of distress, that is, the different unique ways in which distress is expressed by different people such as nervousness among Hispanic people need to be identified and addressed. Cultural values such as el respeto (respect), personalismo (personal, caring relationships), machismo, and marianismo (the cultural norms governing gender-based behaviors), among many others, also need to be put into consideration when providing suicide risk prevention interventions.

The second article by Silva & Van Orden (2018) looks at the suicide rates among Hispanics in the United States. They make a special observation on the considerable increase in suicide rates among Hispanic youths in the last decade with different demographic, cultural, and economic characteristics influencing suicide tendencies among the population. The article also addresses suicide prevention interventions such as improving mental health literacy among Hispanics and offering culturally-tailored prevention interventions such as Familias Unidas (Family unity) to prevent risky behaviors.

1. Educational Plan

Some key points that I would share with fellow nurses when educating them about suicide risks and prevention among Hispanic youths include the importance of incorporating culturally- appropriate interventions in suicide prevention, addressing mental health stigma, and relaying facts on myths related to suicide. I will also address the importance of creating mental health awareness among Hispanic youths to reduce suicidal tendencies.

Some suggestions on the best practices that I would recommend include the adoption of a family-oriented approach (familismo) in managing acculturation stress. It will also be important to incorporate religion, spirituality, and traditional healing practices in the provision of mental health services. In helping the youth deal with stressors such as death, nurses should consider culturally adopted coping mechanisms and strategies for Hispanic adolescents. The suicide risks should be assessed among all individuals presenting with mental health conditions and a safety plan implemented to prevent case fatalities.

Ethical issues and conflicts of care may arise when individuals are not open to the care being provided due to cultural beliefs. As mentioned earlier, Hispanics may not appreciate formal mental health care and they may not readily seek mental health care in hospitals and mental health institutions due to their cultural beliefs (Silva, & Van Orden, 2018).  It is therefore important to provide care that is appropriate to their cultural belief and incorporate this in counseling to promote acceptability.

Your Name:

1. Description of Issue, Indicator, and Focus

1. Approved transcultural nursing issue from the course project

The approved transcultural nursing issue from my course project is suicide among Hispanic adolescents. Suicide is described as the act of deliberately killing oneself. It is a tragic event for families, communities, and societies at large with long-lasting effects on the people left behind, especially the immediate family members. Throughout the ages, suicide has been a subject of taboo and frequent stigmatization with several cultural and religious norms depicting it as unacceptable and sinful. As a result, social sanctions are possible consequences (Geddes, et al., 2020). Suicide prevention is, therefore, an important mental health issue of concern in Nursing that should be addressed to reduce case fatalities.

1. Approved Healthy People 2030 Leading Health Indicator

Leading Health Indicators (LHI) are a select subset of important factors with great health impacts and are major causes of morbidity and mortality across the United States. In the LHI, suicide is listed under the topic of mental health. According to the Centers for Disease Control and Prevention (CDC), health statistics place suicide as the tenth leading cause of death in the United States and the second leading cause of death for people between the ages of 10-14 and 25-34 (CDC, 2022). It is estimated that in every 11 minutes, 1 death occurs by suicide and the numbers vary by race and ethnicity (Perry, et al., 2022). Several factors such as unemployment, fear of poverty, food insecurity, social isolation, and lack of access to health and mental health services have been identified as some of the major causes of suicide.

1. Approved cultural focus

The approved cultural focus is the Hispanic culture. Cultural factors have a great impact on health-seeking behavior and utilization of mental health services among Hispanic people. For instance, the cultural norms of Hispanic families dictate that mental health problems should be dealt with by members of the family or faith-based communities rather than specialized mental health personnel and institutions. This may make them fail to seek formal mental health-related services due to stigma and concerns that seeking these services may go against the approved cultural norms of the community. Suicide prevention measures among this population should, therefore, be culturally- tailored so that the efforts are suitable and acceptable for the community.

1. References with permalink

The two peer-reviewed scholarly professional journal articles that I selected for my topic include:

López, D., Ochoa, D., Romero, M., & Parr, K. (2020). Integrating Latinx/Hispanic culture, traditions, and beliefs into effective school psychology practice. Communiqué, 49(4), 16-18. https://www.researchgate.net/publication/348309418_Integrating_LatinxHispanic_culture_traditions_and_beliefs_into_effective_school_psychology_practice

Silva, C., & Van Orden, K. A. (2018). Suicide among Hispanics in the United States. Current opinion in psychology, 22, 44–49. https://doi.org/10.1016/j.copsyc.2017.07.013

1. Summary

The first article by Lopez, et al (2020) examines the importance of integrating Latinx/Hispanic culture, traditions, and beliefs into effective school psychology practice to reduce cases of suicide among Hispanic adolescents. The journal provides several recommendations to improve the overall mental health outcome for children, youth and families. These recommendations include addressing mental health stigma by offering explanations about the symptoms of the child and the process of counseling in a culturally acceptable manner.

The idioms of distress, that is, the different unique ways in which distress is expressed by different people such as nervousness among Hispanic people need to be identified and addressed. Cultural values such as el respeto (respect), personalismo (personal, caring relationships), machismo, and marianismo (the cultural norms governing gender-based behaviors), among many others, also need to be put into consideration when providing suicide risk prevention interventions.

The second article by Silva & Van Orden (2018) looks at the suicide rates among Hispanics in the United States. They make a special observation on the considerable increase in suicide rates among Hispanic youths in the last decade with different demographic, cultural, and economic characteristics influencing suicide tendencies among the population. The article also addresses suicide prevention interventions such as improving mental health literacy among Hispanics and offering culturally-tailored prevention interventions such as Familias Unidas (Family unity) to prevent risky behaviors.

1. Educational Plan

Some key points that I would share with fellow nurses when educating them about suicide risks and prevention among Hispanic youths include the importance of incorporating culturally- appropriate interventions in suicide prevention, addressing mental health stigma, and relaying facts on myths related to suicide. I will also address the importance of creating mental health awareness among Hispanic youths to reduce suicidal tendencies.

Some suggestions on the best practices that I would recommend include the adoption of a family-oriented approach (familismo) in managing acculturation stress. It will also be important to incorporate religion, spirituality, and traditional healing practices in the provision of mental health services. In helping the youth deal with stressors such as death, nurses should consider culturally adopted coping mechanisms and strategies for Hispanic adolescents. The suicide risks should be assessed among all individuals presenting with mental health conditions and a safety plan implemented to prevent case fatalities.

Ethical issues and conflicts of care may arise when individuals are not open to the care being provided due to cultural beliefs. As mentioned earlier, Hispanics may not appreciate formal mental health care and they may not readily seek mental health care in hospitals and mental health institutions due to their cultural beliefs (Silva, & Van Orden, 2018).  It is therefore important to provide care that is appropriate to their cultural belief and incorporate this in counseling to promote acceptability.

References

Geddes, J., Andreasen, N. C., & Goodwin, G. (2020). New Oxford textbook of psychiatry. Oxford University Press.

López, D., Ochoa, D., Romero, M., & Parr, K. (2020). Integrating Latinx/Hispanic culture, traditions, and beliefs into effective school psychology practice. Communiqué, 49(4), 16-18. https://www.researchgate.net/publication/348309418_Integrating_LatinxHispanic_culture_traditions_and_beliefs_into_effective_school_psychology_practice

Silva, C., & Van Orden, K. A. (2018). Suicide among Hispanics in the United States. Current opinion in psychology, 22, 44–49. https://doi.org/10.1016/j.copsyc.2017.07.013

Perry, S. W., Rainey, J. C., Allison, S., Bastiampillai, T., Wong, M.-L., Licinio, J., Sharfstein, S. S., & Wilcox, H. C. (2022). Achieving health equity in US suicides: a narrative review and commentary. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13596-w

Centers for Disease Control and Prevention (CDC). (2022). Facts about suicide. https://www.cdc.gov/suicide/facts/index.html

Essay

Over the years, Nursing education has undergone significant evolution from the time the training for nursing education was started. Nursing programs were not undertaken in educational training institutions such as colleges during the early days. Alternatively, there were temporary continuing education plans for the program. However, with more research on the need for proper nursing education training, it has advanced to the present training for the doctorate in nursing. From these humble beginnings, evolution in nursing education has enabled nurses to diagnose and treat illnesses in patients, adhering to practices that were initially reserved for physicians alone.

Difference between Advanced Nursing Practice (ANP) and the Advanced Practice Nurse (APN)

An advanced practice nurse (APN) is a practicing caregiver with training to offer patient care in a medical role. They may take up different roles, including adult nurse practitioners, pediatric nurses, family nurse consultants, and geriatric caregivers. An Advanced practice nursing program requires a nurse to have post-graduate education where nurses are equipped with superior instructive and medical knowledge, more medical and nursing proficiencies, and a wider scope of practice (American Nurses Association, 2022). They have a more expanded task in managing individual patients and groups of patients. They may also perform duties initially reserved for physicians, such as making diagnoses, ordering laboratory tests, and prescribing medications to patients (Fealy et al.,2018). Advanced practice nurses may take up one of the four roles for advanced practice which include certified nurse midwife, certified registered nurse anesthetist, certified nurse practitioner, and clinical nurse specialist.

On the contrary, any nurse with a master's degree in nursing may be qualified to be in advanced nursing practice but may not necessarily be an advanced practice nurse. Advanced nursing practitioners are not necessarily authorized or trained to take on medical roles (Cooper et al., 2019). They need only some set policies and guidelines with basic educational training to be able to practice. The program is just concerned with improving the nurse's knowledge beyond the conventional limits and may include some short continuous education courses beyond the basic nursing education training program. Advanced nursing practitioners possess competencies such as critical thinking, rational judgment, and transformation of clinical practice (Bauer & Bodenheimer, 2017). They may take up roles in nursing leadership, research, and expert coaching

Advanced practice nursing and the four roles in advanced practice pertaining to clinical practice, primary care, education, administration, and health information

Advanced nursing practice is a higher level of nursing practice utilizing comprehensive skills, knowledge, and a wide range of experience in offering nursing care. The roles in advanced nursing practice include clinical nurse leadership and advanced practice registered nursing (APRN). As mentioned earlier, the four advanced nursing roles include nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetics.

Nurse practitioners provide primary, specialized, and acute care across the lifespan by assessing, diagnosing, and treating illnesses and injuries (McComiskey et al., 2018). Certified nurse midwives provide specialized care for primary reproductive and gynecological concerns. Clinical nurse specialists facilitate patient management by driving changes in nursing practice and ensuring the provision of care based on evidence-based scientific research. Certified registered nurse anesthetists provide pain management services for patients requiring anesthetic procedures and pain management.

To enter into advanced practice nursing roles, nurses need post-graduate and specialization training to handle patients with different health conditions. They are the most highly trained nurses of all the registered nurses and should hold either a master’s degree or a doctorate in nursing (American Nurses Association, 2022). In the South University program, they are trained to be able to treat and diagnose illnesses, advise the public on issues related to health, get involved in the management of chronic diseases, and undergo a continuous education program to be able to remain ahead in any technological, methodological, or other new developments in the medical and nursing field. As much as these nurses may be required to practice under physicians, they fulfill duties initially reserved for doctors, such as ordering laboratory investigations, diagnosing patients, and prescribing medication. In some states, APNs are allowed to work independently without the supervision of physicians.

The role I intend to acquire through SUO, experiences that influenced my decision, and my personal philosophy

The advanced nursing practice role that I intend to acquire is the role of a family nurse practitioner. Family nurse practitioners collaborate with other healthcare professionals to provide family-centered care. They offer health services such as health promotion, disease prevention, direct patient care, and health-related counseling services across the lifespan (Mounayar & Cox, 2021). A personal experience inspired this choice as I saw my dad battle with diabetes and hypertension for several years, develop a diabetic foot on his left foot, and was amputated. These are lifestyle diseases that can be prevented, and I believe that if my father had adequate support from a family nurse practitioner, he would not have developed the complications that led to the amputation of his foot. I believe in working with the patients together with their families as early as possible to increase the level of impact on the development and adoption of long-term healthy behaviors.

My personal nursing philosophy is founded on individual-based nursing care and focuses on providing compassionate, empathetic, quality nursing care to all my patients and their families. I will focus on providing individual care based on my patients' personal preferences, values, and beliefs to facilitate quality care and encourage better health outcomes. I also believe in involving patients in developing their plan of care so that the care provided is individualized, more patient-centered, and acceptable to the patient. Personal competencies that will help me facilitate my philosophy include encouraging team-oriented nursing care and having excellent communication and interpersonal skills. In addition, compassion and empathy for my patients will help me identify with my patients and enhance the delivery of quality care.

Questions I would like to ask the advanced practice clinician chosen for the interview

Some of the questions that I would like to ask the advanced practice clinician that I have chosen for my interview include:

1. What motivated you to become a nurse practitioner?
2. How do you handle stress in healthcare provision to ensure maximum performance?
3. Does the inadequate rate of the healthcare provider-to-patient ratio affect your morale and performance in healthcare provision?
4. What significant challenge have you experienced working as a nurse practitioner?
5. How do you avoid unethical practices in healthcare and solve unethical decisions witnessed within your healthcare team?
6. How do you solve ethical dilemmas witnessed in the provision of healthcare?
7. How can you describe your contribution to the patient care experience?
8. How would you react if a patient requests you for an unnecessary treatment procedure?
9. Suppose a patient’s pain medication isn’t helping in relieving the pain. How would you react if the patient asks you for an additional dose higher than the prescribed amount?
10. Have you ever disagreed with a doctor on the diagnosis and management of a patient? How did you deal with the situation?

In conclusion, advanced nurse practitioners significantly reduce the burden of disease in patients through involvement in the proper diagnosis and treatment of patients. In addition, they undergo advanced training that equips them with the knowledge to adequately manage patients with different health conditions. This helps bridge the gap in patient care, ensuring patients have easy access to quality medical and nursing care services.

References

American Nurses Association (ANA). (2022). Advanced practice registered nurses (APRNs). Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Bauer, L., & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery of the future. Nursing Outlook, 65(5), 624-632. https://doi.org/10.1016/j.outlook.2017.03.011

Cooper, M. A., McDowell, J., Raeside, L., & ANP–CNS Group. (2019). The similarities and differences between advanced nurse practitioners and clinical nurse specialists. British Journal of Nursing, 28(20), 1308-1314. https://doi.org/10.12968/bjon.2019.28.20.1308

Fealy, G. M., Casey, M., O'Leary, D. F., McNamara, M. S., O'Brien, D., O'Connor, L., ... & Stokes, D. (2018). Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers. Journal of Clinical Nursing, 27(19-20), 3797-3809. https://doi.org/10.1111/jocn.14550

McComiskey, C., Simone, S., Schofield, D., McQuillan, K., Andersen, B., Johannes, S., & Weichold, A. (2018). Professional advancement for advanced practice clinicians. The Journal for Nurse Practitioners, 14(1), 12-17. https://doi.org/10.1016/j.nurpra.2017.09.018

Mounayar, J., & Cox, M. (2021). Nurse practitioner post-graduate residency program: Best practice. The Journal for Nurse Practitioners, 17(4), 453-457. https://doi.org/10.1016/j.nurpra.2020.10.023

Essay

The cardiovascular and the respiratory systems work together in a symbiosis-like relationship to maintain homeostasis. An imbalance in one system puts pressure on the other to work harder to offset the imbalance. With time, the overworked system weakens and begins to go into failure. It is, therefore, important to ensure that both systems are in proper working condition, as they play a significant role in maintaining body functions. This paper aims to describe the pathophysiological reason as to why the patient described in the case study might be experiencing the symptoms listed, discuss some specific variables that might have an impact on the proper functioning of the body, and explain why dysfunction in the two systems produced the patient’s symptoms as provided in the case study.

Cardiovascular and cardiopulmonary pathophysiologic process

Heart failure is a condition that occurs when the heart is incapable of pumping enough blood throughout the body to maintain normal physiologic processes (Dumitru, 2022). Most heart failures occur due to a malfunction in the left side of the heart, resulting in left-sided heart failure. It is a principal reason for morbidity and mortality in old age worldwide. During the initial stages of congestive heart failure, several compensatory mechanisms are initiated to maintain the cardiac output and meet systemic demands. These may include myocardial hypertrophy, myocardial hypercontractility, and the Frank-Sterling mechanism, which changes the generation of myocytes (Malik, Brito & Chhabra, 2022). Over time, the functions of the heart decline.

The heart usually pumps blood to the lungs for oxygenation. When the heart muscles are weakened, it becomes difficult to pump out all the blood it receives from the lungs. A decline in heart functioning causes fluid build-up in the lungs, causing congestion. This interferes with the normal gaseous exchange, leading to shortness of breath. Decreased cardiac output also stimulates the renin-angiotensin-aldosterone system (RAAS), which leads to increased salt and water retention, along with an increase in vasoconstriction causing fluid build-up in the interstitial space (Malik, Brito & Chhabra, 2022). This results in increased weight and peripheral edema.

In right-sided cardiac failure, blood backs up in the venous system, causing a build-up of fluids in the liver. This results in hepatomegaly, and the patient presents with a swollen abdomen. Orthopnea, which refers to shortness of breath while lying down, is experienced because while lying flat, more blood is pulled from the veins into the heart, increasing hydrostatic pressure within the pulmonary capillaries, making it difficult for the patient to breathe in this position. Lying on two pillows relieves this pressure and makes breathing easier for the patient. Diuretics are usually the first-line medications considered in treating heart failure (McDonagh et al., 2021). Since diuretics help eliminate excess fluids, the decision to stop the diuretics was ill-informed, perhaps due to a knowledge deficit on the patient’s part. Traditional cardiovascular risk factors in Black and Hispanic adults make them more vulnerable to heart failure as they are more predisposed to heart conditions such as hypertension, which may worsen the prognosis of heart failure (Pina et al., 2021).

In conclusion, heart failure affects the heart's function in pumping blood to different body organs and systems. This may result from weakening the heart muscles or stiffening the muscles, blocking or reducing blood flow to the heart and other body organs. It can affect the right and the left side of the heart or both sides simultaneously and can either be acute or chronic. Different ethnic or racial variables have been associated with an increased risk of congestive heart failure. Adherence to medication prescription is vital in relieving symptoms.

References

References

Dumitru, I. (2022). Heart failure: Practice essentials. Medscape. Retrieved from https://emedicine.medscape.com/article/163062-overview

Malik, A., Brito, D., Vaqar, S., & Chhabra, L. (2022). Congestive heart failure. https://www.ncbi.nlm.nih.gov/books/NBK430873/

McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., ... & Kathrine Skibelund, A. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal, 42(36), 3599-3726. https://doi.org/10.1093/eurheartj/ehab670

Piña, I. L., Jimenez, S., Lewis, E. F., Morris, A. A., Onwuanyi, A., Tam, E., & Ventura, H. O. (2021). Race and ethnicity in heart failure: JACC focus seminar 8/9. Journal of the American College of Cardiology, 78(25), 2589-2598. https://doi.org/10.1016/j.jacc.2021.06.058

Essay

Advanced practice nurses have various advanced roles such as treating and diagnosing illnesses, advising the public on health issues, managing chronic diseases, and engaging in continuous education programs to ensure that they are ahead of any technological methodological, and any other advancements in the field of healthcare (American Nurses Association, 2022). For a successful practice in these roles, advanced practice nurses need to meet some basic competencies. I am currently on the track of nurse practitioner (NP), specializing in the Family Nurse Practitioner (FNP) program.

The nursing practitioner’s core competencies aim at ensuring that the required standards of patient care are effectively met by the governing bodies in the nation and state that a nurse practitioner practices (Tracy & O’Grady, 2019). The National Organization for Nurse Practitioner Faculties (NONPF) lists nine categorical competencies that meet the requirements for effective service delivery by a nurse practitioner (NP). The core competencies for a family nurse practitioner include scientific foundation, leadership, quality, practice inquiry, technology and information literacy, policy, health delivery system, ethics, and independent practice. With these competencies, family nurse practitioners (FNPs) can have a holistic view of a patient’s situation, considering their physical and emotional well-being as well as the sociocultural context of the patient (Schlunegger et al., 2022).

Practice inquiry entails an analytical application of leadership and clinical application of previous experience to improve nursing practice and enhance change. The nurse practitioner should have basic knowledge in the application of technology to improve the delivery of quality healthcare, expand knowledge, and evaluate the effectiveness of care. It is also important for the nurse practitioner to understand different healthcare policies and how they impact clinical practice. The nurse practitioner should have proper analytical and evaluative skills for policy advocacy and the development of new policies (Thomas et al., 2017). Competency in the healthcare delivery system involves applying knowledge to practice within the organizational systems to enhance change promotion, minimize health risks to the patient, provide culturally diverse and appropriate care, and evaluate patient outcomes.

A nurse practitioner should be able to utilize ethical principles in delivering care to patients. They should employ these ethical principles and use critical thinking and problem-solving skills to solve ethical dilemmas. Independent practice involves practicing with no supervision. Nurse practitioners should be able to diagnose, treat and order prescriptions for patients. They should be able to initiate health promotion and disease prevention activities, educate and counsel patients, develop and maintain a therapeutic, trusting, and respectful relationship with patients, as well as offer palliative care to patients. All these should be carried out while integrating the culture, diversity, and spirituality of the patient into care and involving them in decision-making for their treatment and care plan. All these competencies focus on the provision of patient-centered care to improve healthcare quality and promote positive patient outcomes.

Methods of attaining these competencies

There are several methods I can use to master these competencies. For instance, I can combine the knowledge I gained in my basic undergraduate program which serves as the basic foundation for my advanced role as a family nurse practitioner with that gained in the APN nursing theories to deliver care to patients requiring complex analytical care capabilities. This will prepare me to deliver care that requires advanced thinking techniques and incorporate this knowledge into practice. I will analyze different assessment data and evidence-based research to be able to provide competent, quality patient care.

Proper guidance within the faculty together with mentorship throughout the program, combined with the leadership theories learned in the program will help me attain my best potential as a leader by acting as an agent of change and as a patient advocate. Using peer-reviewed evidence-based research articles and serving on the peer review committee will help me deliver quality patient care and facilitate continuous quality improvement. Through continuous education training on the current technological trends in healthcare, I can be able to keep up to date with the current technological advancements and this will help me attain technological competency.

To enhance my competency in policy advocacy, I can register for membership in a national nurse practitioner organization that will increase my proactivity in policy advocacy. I can also inquire and learn about various organizational systems and how they operate to gain competency in healthcare systems so that I can be able to effectively deliver quality patient care according to the healthcare delivery system used within the organization where I work.

Leadership competency

Leadership is one of a nurse practitioner’s core competencies as identified by NONPF (Thomas et al., 2017). Advanced practice nurses utilize complex systems in care provision and leadership is, therefore, important in ensuring efficient care delivery. The leadership competency that I most identify with is transformational leadership. This type of leadership is defined as a leadership style that transforms vision into action and assists others to attain their best potential. This leadership style inspires positive growth and loyalty and it instills confidence in members of the healthcare team (Cherry, 2022). Through this type of leadership, I can act as an agent of change through a proactive approach in the healthcare organization (Pearson, 2020).

I have worked under supervisors with various leadership styles. During this time, I observed that leaders who were not involved, or engaging with team members led to a decrease in the overall morale of the team members, making it difficult to meet organizational targets. This has always sparked a desire in me to be more of a transformational leader, always available and engaging with the members of my team to improve organizational outcomes and improve the quality of care to my patients.

Additional competencies

Some additional core competencies that I will discuss are scientific foundation and ethics. Scientific foundation as a core competency involves the ability to critically analyze data and evidence, incorporate scientific-based evidence in nursing practice, and formulate new ways of patient care by combining research, theoretical framework, and practice information to come up with better methods of care. I can achieve this competency by acquiring advanced skills in research to promote change, collaborate with other members of the healthcare team and stakeholders, and have skills of critical and reflective thinking that will enable me to incorporate scientific-based evidence to improve the quality of care I offer to my patients.

Ethics is also another key competency that I will need to have as a family nurse practitioner. Ethical practice is a foundation for all nurses and this helps in ensuring proper, efficient, and quality care to all patients. The four main principles of nursing ethics include autonomy, beneficence, justice, and non-maleficence. Autonomy enables patients to make their own decisions regarding their care based on their personal beliefs and values (Haddad & Geiger, 2021). The ethical principle of non-maleficence prevents providers from causing harm to patients and beneficence ensures that healthcare workers do everything to the benefit of the patient, avoiding maltreatment, minimizing harm, and promoting good toward the patient. I will achieve this competency by learning these various ethical principles and applying them in my day-to-day encounter with patients and utilizing my critical thinking and problem-solving skills to handle ethical dilemmas.

References

American Nurses Association (ANA). 2022. Advanced practice registered nurse (APRN). Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Cherry, K. (2022). What is transformational leadership? Transformational leaders can inspire and empower members of a group. Retrieved from: https://www.verywellmind.com/what-is-transformational-leadership-2795313

Haddad, L.M. & Geiger, R.A. (2021). Nursing ethical considerations. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK526054/

Pearson, M. M. (2020). Transformational leadership principles and tactics for the nurse executive to shift nursing culture. JONA: The Journal of Nursing Administration, 50(3), 142-151.

Schlunegger, M. C., Aeschlimann, S., Palm, R., & Zumstein‐Shaha, M (2022). Competencies of nurse practitioners in family practices: A scoping review. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.16382

Thomas, A., Crabtree, M. K., Delaney, K., Dumas, M. A., Kleinpell, R., Marfell, J., & Wolf, A. (2017). Nurse practitioner core competencies content. The National Organization of Nurse Practitioner Faculties. https://online2.marianuniversity.edu/pluginfile.php/677348/mod_resource/content/1/2017_NPCoreComps_with_Curric%281%29.pdf

Tracy, M. F., & O’Grady, E. T. (2019). Hamric and Hanson’s: Advanced Practice Nursing. An integrative approach (6th ed.). St. Louis: Elsevier.

Executive Summary Report

Effective communication is critical in providing safe and quality care in any healthcare institution. Communication breakdowns, especially during shift handover, can lead to increased risk to patient safety and can result in unfortunate consequences such as medical mishaps, omitted treatments, and interrupted care coordination (Raeisi et al., 2020). This executive summary report evaluates ineffective communication in my current organization, determining areas where communication can be improved, and suggests practice changes focusing on improving the clarity and frequency of cross-departmental handoffs. These communication breakdowns could be effectively eliminated to enhance the organizational commitment towards patient safety and a culture of enhancement.

The Key Quality and Safety Outcome Measures.

Some of the quality and safety initiatives in the healthcare sector include minimizing medical errors, patient falls, and adverse outcomes during the transfer of care from one provider to another, which is vital for the patient's welfare and the healthcare organization’s overall image (Rodziewicz et al., 2024). These outcomes relate to patient safety, care coordination, and clinical outcomes. Evaluation of the outcomes helps the organization determine the effectiveness of communication practices in relation to patient care and determine areas of focus for interventions. The current transfer interfaces show many errors and communication breakdowns that result in adverse events during shift and departmental handoffs. The organization must track the progress made in the handoff communication regarding the proposed change by assessing the effectiveness of structured tools like SBAR to enhance safer and more reliable care delivery. The effectiveness of these outcomes is based directly on enhancements in patient safety and minimizing avoidable errors due to available quantitative enhancements in communication. However, a shortcoming of such outcome measures is that they depend highly on staff compliance with the new practices and can be challenging to achieve and maintain without reinforcement and constant training.

The Strategic Value of Specific Outcome Measures to the Organization.

Outcome measures like reduction in medical errors, effective handoff communication, and minimizing adverse events are significant as they relate closely to patient care by ensuring that important information is consistently passed from one caregiver to another to reduce harm. These measures foster a culture of quality and safety by expanding accountability and sustaining enhancement, helping staff emphasize patient safety within every interaction (Singh et al., 2024). It is essential to measure the outcomes regularly since it offers constant data on the efficacy of the interventions so that any interruptions of communication can be rectified without delay. Failure to monitor the outcomes may lead to reduced care delivery, decreased quality of care, and a heightened possibility of patient harm. In addition, focusing on existing outcome measures can help the organization to analyze general trends and allocate resources more effectively while improving collaboration between departments and improving quality improvement efforts and operational efficiency.

Relationship Between the Organizational Systemic Problem and Specific Quality and Safety Outcomes.

Lack of effective communication during handoffs in my organization is a systemic issue that affects several quality and safety outcomes, such as increased medical errors, reduction in staff response time to clients’ needs, and high cases of patients’ falls, among others. Descriptive measures on the time miscommunications occurred, the incidence of adverse events after handoff, and patient injury rates all paint a picture of a lapse in the proper transfer of information during shift handoff. These outcomes are closely linked to the identified problem because handoff shifts may be incomplete, and critical details such as medication adjustments, changes in patient status, or pending procedures may be missed, negatively impacting patient care (Blazin et al., 2020). The relationship spans widely as communication breakdown during handoffs has been identified as the root of many avoidable adverse events. More data that might be collected to develop an even more comprehensive view of the problem may include the nature of information most commonly miscommunicated during handoffs, how well employees, practitioners and other stakeholders follow existing handoff communication standards, and the perceptions of healthcare providers regarding the challenges of effective communication. This information would help better understand the causes of unsuccessful communications and identify areas that need enhancement.

How The Specific Outcome Measures Support Strategic Initiatives Related to a Quality and Safety Culture.

Measurable outcomes like decreased medical errors and compliance in handoff communication align with our organization’s strategic plan of elevating patient safety and quality of care. These outcome measures directly correspond to the specific organizational priorities of reducing avoidable adverse events and improving care coordination, which are part of the organization’s strategies. Monitoring these indicators and related trends helps foster an organizational safety culture and translates evidence-supported practices, such as standardized communication, into routine rather than episodic practice (Mistri et al., 2023). The constant emphasis on outcome measures, aiming to improve overall performance to meet strategic goals, goes hand in hand with organizational targets and creates an accountable and transparent culture of managing risks that is crucial in the ever-changing dynamics of the healthcare sector. This is particularly important considering the current shift towards value-based care, where safety and quality impact patient experience and the organization’s performance.

The Role of Leadership in Supporting the Implementation and Adoption of Proposed Practice Changes Affecting Specific Outcomes

The leadership team, especially the nurse leaders, can facilitate implementing and adopting the proposed practice changes by culturally eradicating the non-standardized handoff practice, providing the required training on the new handoff practice, and engaging the staff continuously. The first step for the nurse leaders would be to guarantee that all the staff has been trained on the said protocol, the importance of the new protocol to be observed, and further develop standards that should be set to implement the protocol across the different departments. They can also develop mechanisms for interprofessional collaboration based on regular meetings with the clinical teams to address identified problems, provide feedback, and discuss positive changes in communication (McLaney et al., 2022). Additional and constant reminders through performance appraisal and quality reporting would also help supplement the need to adhere to the measures. This approach is effective because it leads to accountability, an increased sense of ownership from the team, and change based on feedback from staff, leading to a culture of quality improvement that addresses patient safety and care quality.

Conclusion

Establishing and integrating a standardized SBAR protocol into the EHR is crucial to managing inherent communication problems and improving patient care gaps and safety results. These changes are strategic because they align with the organization’s strategic mission by directly addressing areas of interest to the organization, including medical errors and care continuity. Organizational support is vital as nurse leaders are responsible for initiating the technology by communicating the organization’s expectations and collaborating across departments. The continuous measurement of specific outcomes will yield usable data, leaving no doubt that the changes positively impact the quality and safety of services delivered. With the focus on these measures and the involvement of leadership and the staff, the organization can cultivate a strong sense of quality and safety, improving patient care and the healthcare system.

References

Blazin, L. J., Sitthi-Amorn, J., Hoffman, J. M., & Burlison, J. D. (2020). Improving patient handoffs and transitions through adaptation and implementation of I-PASS across multiple handoff settings. Pediatric Quality & Safety, 5(4), e323. https://doi.org/10.1097/pq9.0000000000000323

McLaney, E., Morassaei, S., Hughes, L., Davies, R., Campbell, M., & Prospero, L. D. (2022). A framework for interprofessional collaboration in a hospital setting: Advancing team competencies and behaviours. Healthcare Management Forum, 35(2), 112–117. https://doi.org/10.1177/08404704211063584

Mistri, I. U., Badge, A., Shahu, S., Mistri, I. U., Badge, A., & Shahu, S. (2023). Enhancing patient safety culture in hospitals. Cureus, 15(12), 1–7. https://doi.org/10.7759/cureus.51159

Raeisi, A., Rarani, M. A., & Soltani, F. (2020). Challenges of patient handover process in healthcare services: A systematic review. Journal of Education and Health Promotion, 8(173). https://doi.org/10.4103/jehp.jehp_460_18

Rodziewicz, T. L., Houseman, B., Vaqar, S., & Hipskind, J. E. (2024, February 12). Medical error reduction and prevention. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499956/

Singh, G., Patel, R. H., & Boster, J. (2024). Root cause analysis and medical error prevention. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570638/

Informatics and Nursing-Sensitive Quality Indicators

Hello everyone. Welcome to my informatics and nursing-sensitive quality indicator presentation. Informatics has had a profound impact on nursing practice, especially in terms of quality care indicators. According to Oner et al. (2020), nursing-sensitive quality indicators measure the care nurses provide and how it affects patient outcomes. These indicators are often used to identify improvement areas and support evidence-based practice. Informatics has allowed nurses to access and analyze data in real-time, providing them with the improvement areas and information they need to make effective decisions to improve quality and safety (Moore et al., 2020). By using informatics, nurses can better assess their performance, as well as that of their colleagues, and use this data to inform their practice and make informed decisions.

The National Database of Nursing-Sensitive Quality Indicators

The National Database of Nursing-Sensitive Quality Indicators (NDNQI) is a web-based tool developed by the American Nurses Association (ANA) and the Centers for Medicare & Medicaid Services (CMS). This database contains a set of indicators that measure the quality of nursing care and its impact on patient outcomes. According to Barchielli et al. (2022), these indicators include nurse staffing levels, patient falls, pressure ulcer incidence, working hours, job satisfaction, and care coordination, among others. The NDNSQI is used to identify areas of improvement in nursing care and to monitor patient outcomes.

Selected Nursing-Sensitive Quality Indicator

This tutorial will address pressure ulcer incidences as a nursing quality indicator. Pressure ulcer incidences are an important nursing quality indicator as they directly reflect the quality of care provided. They result from prolonged pressure on a specific body area, such as the heel, elbow, or other bony parts. They are most common among bedridden patients or those who are unable to reposition themselves on their own. Therefore, nurses must regularly assess patients for any signs of ulcers and take measures to prevent them. The incidences measure how well nurses monitor and address the risk of pressure ulcers and can be used to assess the quality of care in a healthcare setting.

New nurses must be familiar with pressure ulcer incidences as a quality indicator. High incidences can signify inadequate care and lead to various adverse outcomes, including increased length of hospital stay, increased infection risks, and death in extreme cases. Pressure ulcer incidences are preventable, and nurses should be aware of the risk factors associated with their development and implement preventative measures to reduce the occurrence. As such, familiarity with the incidences and their impacts on patient outcomes is essential for all nurses to enhance quality care.

Collection and Distribution of Quality Indicator Data

Healthcare organizations collect and distribute quality indicator data related to pressure ulcers using various methods such as surveys, interviews, and medical records (Rios-Zertuche et al., 2018). The data is then disseminated through reports and presentations to stakeholders, such as healthcare professionals and policymakers. The nurse’s role in supporting accurate reporting and high-quality results is essential. Nurses are responsible for accurately entering data regarding nursing interventions to reduce pressure ulcer incidences and for recognizing potential changes that could lead to risk for pressure ulcers. Nurses must also be aware of changes in the patient's condition to provide appropriate and timely interventions. By ensuring accurate and thorough data collection and analysis, nurses can support the healthcare organization in successfully reducing pressure ulcer incidences.

Role of the Interdisciplinary Team in Collecting Quality Indicator Data

The multidisciplinary approach is highly valued in healthcare settings as it helps improve patient outcomes, reduce costs, and increase efficiency. By working together, healthcare professionals can help to reduce the workload and focus on documentation and data collection. This approach allows for better monitoring of service delivery and makes it easier to report any limits or problems with healthcare services to provide better care.

The interdisciplinary team plays a vital role in collecting and reporting quality indicator data related to pressure ulcer incidences. The team works together to ensure that quality data is collected accurately and timely for use in organizational performance reports. The data collected by the interdisciplinary team helps identify potential risk factors, evaluate current practices, and track patient care outcomes to promote patient safety (Haugum et al., 2019). By collecting quality data, the multidisciplinary team helps ensure that organizations can provide the best possible care to patients. The team's efforts to collect quality data directly impact patient care outcomes, organizational performance, and the overall quality of care. The team works collaboratively to develop, implement, and monitor quality indicators and ensure the accuracy of data collection. They analyze data to identify areas that need improvement and develop strategies to improve the quality of care. Adequate feedback from the team members to clinicians and other stakeholders helps ensure that quality indicators are consistently met and that the pressure ulcer incidence rates are significantly reduced.

Impact of Patient Care Technologies on Desired Outcomes

Care technologies have had a significant impact in reducing pressure ulcer incidences as a quality indicator. Technologies such as patient monitoring systems, pressure mapping systems, and advanced bed alarms provide healthcare providers with more accurate and detailed data to track and monitor the condition of patients (Baernholdt et al., 2020). This information can be used to identify and address the risk factors associated with the development of pressure ulcers and provide more effective preventative care. In addition, these technologies can alert healthcare staff of changes in patient conditions and facilitate timely interventions, which can help reduce the incidence of pressure ulcers.

As a nursing-sensitive quality indicator (NSQI), pressure ulcer incidences can help healthcare organizations identify areas for improvement, identify trends in patient care, and provide a means for comparing the performance of different nursing units. Additionally, it can generate performance reports that help healthcare organizations assess their effectiveness in delivering quality care. By using NSQIs, healthcare organizations can improve patient safety, patient care outcomes, and organizational performance.

Evidence-Based Practice Guidelines

One technological application of evidence-based care guidelines to reduce pressure ulcers is implementing an electronic medical record (EMR) system. According to Andersson et al. (2022), the EMR provides caregivers with an easy-to-access source of up-to-date information on pressure ulcer prevention and management. Through the EMR, clinicians can quickly access evidence-based care guidelines, view patient history, and create treatment plans tailored to each patient. For instance, clinicians can order pre-printed orders for standard pressure ulcer prevention interventions or create customized orders for patients with specialized needs. Furthermore, the EMR can track interventions' effectiveness and provide clinicians feedback to inform future practice. This technology can help ensure that our caregivers are providing evidence-based care to reduce the incidence of pressure ulcers in our organization.

Implementing evidence-based strategies to reduce pressure ulcers, such as repositioning patients at least every two hours, using specialized mattresses and cushions to redistribute pressure, keeping skin clean and dry, and providing adequate nutrition and hydration, will significantly improve quality care. Other strategies include monitoring skin for signs of pressure ulcers, providing skin care and preventive measures, and assessing risk factors. Most importantly, educating patients and their caregivers on the importance of pressure ulcer prevention effectively reduces the risk of developing pressure ulcers.

Nurses play a vital role in pressure ulcer reduction through frequent turning, medication evaluation, instruction, and communication. They are at the forefront to guarantee that the patient and their family comprehend the need for constant care to help avert pressure ulcer incidences. They are also the primary source to ensure that all pressure ulcer incidents are accurately documented and reported by the facility's guidelines for what is classified as a pressure ulcer. This enables easier progress monitoring and quality evaluation to improve nursing care and enhance outcomes.

Conclusion

In conclusion, informatics and nursing-sensitive quality indicators are essential tools for nurses to assess and improve the quality of care they provide. Pressure ulcer incidences are an important nursing quality indicator that affects patient outcomes. The interdisciplinary team plays a vital role in collecting and reporting quality indicator data. At the same time, technologies such as EMRs can help ensure that evidence-based care guidelines are being followed to reduce the incidence of pressure ulcers. Nurses must be familiar with the risks associated with pressure ulcers and take measures to prevent them. By understanding the importance of these indicators and taking the necessary steps to reduce the incidence of pressure ulcers, nurses can ensure that patients receive the highest quality of care.

References

Andersson, J., Imberg, S., & Rosengren, K. (2022). Documentation of pressure ulcers in medical records at an internal medicine ward in university hospital in western Sweden. Nursing Open. https://doi.org/10.1002/nop2.1439

Baernholdt, M., Yan, G., Hinton, I. D., Cramer, E., & Dunton, N. (2020). Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: Longitudinal associations over 4 years. International Journal of Nursing Studies, 105, 103455. https://doi.org/10.1016/j.ijnurstu.2019.103455

Barchielli, C., Rafferty, A. M., & Vainieri, M. (2022). Integrating key nursing measures into a comprehensive healthcare performance management system: A Tuscan experience. International Journal of Environmental Research and Public Health, 19(3), 1373. https://doi.org/10.3390/ijerph19031373

Haugum, M., Iversen, H. H., Helgeland, J., Lindahl, A. K., & Bjertnaes, O. (2019). Patient experiences with interdisciplinary treatment for substance dependence: An assessment of quality indicators based on two national surveys in Norway. Patient Preference and Adherence, Volume 13, 453–464. https://doi.org/10.2147/ppa.s194925

Moore, E. C., Tolley, C. L., Bates, D. W., & Slight, S. P. (2020). A systematic review of the impact of health information technology on nurses’ time. Journal of the American Medical Informatics Association, 27(5). https://doi.org/10.1093/jamia/ocz231

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2020). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3). https://doi.org/10.1002/nop2.654

Rios-Zertuche, D., Zúñiga-Brenes, P., Palmisano, E., Hernández, B., Schaefer, A., Johanns, C. K., Gonzalez-Marmol, A., Mokdad, A. H., & Iriarte, E. (2018). Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries. International Journal for Quality in Health Care, 31(3), 183–190. https://doi.org/10.1093/intqhc/mzy136

NR 443 Week 8 Social Media Discussion: Past, Present, and Future

One of the most recent devastating pandemics that has hit the world on a global scale is the coronavirus disease 2019 (COVID-19). This disease started as an epidemic in Wuhan, China, and has since become a pandemic, affecting millions of people worldwide and claiming millions of lives globally. The virus responsible for COVID-19 symptoms was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and it was determined that it shared a high sequence identity with bat and pangolin-derived SARS-like coronaviruses, which suggests a zoonotic origin (Asselah et al., 2021). Patients with this disease experience symptoms such as fever, cough, tiredness, sore throat, headache, and loss of taste and smell, among others. More severe symptoms include difficulty breathing, loss of speech or mobility, confusion, and chest pain. Since nurses and other healthcare providers are at the forefront of the fight against this disease, most have been infected and even died from the virus. Therefore, strict adherence to the stipulated policies and extra vigilance are required to lower infection rates.

            The electronic health record I currently use in my nursing practice is Epic. Using this EHR enables a connection of global health issues and concerns concerning the rates of new infections, deaths, and re-infections faster and with minimum costs. As a result, it is easier to trace the global trends in infection rates and develop new mechanisms to combat the spread of the virus. In addition, it enables easier tracing of vaccination rates against the virus. Some surveillance data that can be pulled from this record include the number of people admitted to the hospital with the disease, the number of people identified to be having the disease as well as those who have succumbed to the disease. Data pulled from the worldometer report on coronavirus infection puts the global coronavirus death toll at 6, 572, 104 and the infection rate at 630, 067, 357 confirmed cases (Worldometer, 2022).

            I pulled this tweet from the World Health Organization: “Hand Hygiene is one of the most important measures to prevent the spread of infectious diseases including bacterial, diarrhoeal and respiratory diseases such as #COVID19.” This tweet has a significant impact on the control of COVID-19 as hand washing is one of the proven ways that can be used to reduce the spread of infectious diseases and avoid transmission of the virus via contact. Therefore, collaborative efforts are necessary to ensure that everyone in the community has access to appropriate hand-washing facilities and supplies, ensuring the availability of affordable products that can be used by the most vulnerable in the community to combat the spread of the virus. People should also be taught the appropriate handwashing techniques to ensure that all the germs responsible for causing diseases are efficiently washed off to reduce the transmission from one person to another. Hand washing should be done after coughing or sneezing, when caring for the sick, before, during, and after food is prepared, before eating, after using the toilet, and after handling animals or animal waste, among other instances.

            On my Twitter handle, I would encourage people to take the COVID-19 vaccine by tweeting that “The eradication of poliomyelitis through vaccination is enough proof that vaccines work. Let us take the COVID-19 vaccine to eradicate #COVID19. #COVID19prevention #TaketheVaccineShots.”

References

Asselah, T., Durantel, D., Pasmant, E., Lau, G., & Schinazi, R. F. (2021). COVID-19: Discovery, diagnostics and drug development. Journal of Hepatology, 74(1), 168–184. https://doi.org/10.1016/j.jhep.2020.09.031

https://twitter.com/who/status/1581177931144908800. (n.d.). Twitter. Retrieved October 17, 2022, from https://twitter.com/WHO/status/1581177931144908800?s=20&t=wWER78QmrjvPWlczRPY63g

WorldOMeter. (2022). Coronavirus Death Toll Update - Worldometer. Worldometers.info; Worldometer. https://www.worldometers.info/coronavirus/coronavirus-death-toll/

NSG 500 Week 5 Final Paper: Advanced Nursing Practice Roles in Nursing

The roles and responsibilities of advanced practice nurses (APNs) have changed considerably over the past several years following the revision and expansion of their scope of practice in different states within the United States. This has also been coupled with significant evolution in nursing education, which has seen significant changes since the training for nursing education began. Today, the nursing curriculum allows nurses to be trained to the doctorate level, which gives them a broader scope of practice compared to the earlier days when nursing education was not taken in formal education settings such as colleges. With the expansion of their scope of practice, APNs provide various services, ranging from primary and preventive care to mental health, birthing, and anesthesia.

Difference between Advanced Nursing Practice (ANP) and the Advanced Practice Nurse (APN)

Advanced practice nurses (APNs) are practicing caregivers with special training that enables them to offer medical care. Their roles in their practice include offering specialized care to adults, pediatric patients, families, and the geriatric population. They may take over some aspects of physician duties, including making diagnoses, ordering diagnostic tests in the laboratory, and giving medication prescriptions (Fealy et al.,2018). Some of the roles that advanced practice nurses may take include the roles of a certified nurse midwife, clinical nurse specialist, nurse anesthetist, and certified nurse practitioner. On the other hand, the advanced nursing practice involves advanced nursing roles taken by any nurse who has successfully completed a Master’s degree in Nursing. These nurses may not be authorized or trained to carry out medical duties but may take up other roles (Cooper et al., 2019). The program for advanced nursing practice is concerned with improving nurses’ knowledge beyond conventional limits. It equips them with competencies in critical thinking and rational judgment to enable them to transform clinical practice (Bauer & Bodenheimer, 2017). Some advanced nursing roles they may take include leadership, research, and nursing education.

Definition of advanced nursing practice and the roles in advanced practice pertaining to clinical practice, primary care, education, administration, and health information

            Advanced nursing practice refers to a high level of nursing practice where nurses utilize advanced knowledge and skills and apply a wide range of experience to offer nursing care. Advanced practice nurses treat and diagnose illnesses, give advice to the public on issues related to health, and manage chronic diseases. In primary care, they provide specialized and acute care through the assessment, diagnosis, and treatment of injuries (McComiskey et al., 2018). They develop the plan of care for individuals and groups of patients to enhance quality care.

As nurse educators, advanced practice nurses aim to teach and advocate for nurses. They provide instructions to aspiring nurses and offer guidance in both practical and educational settings. As administrators, they take up managerial positions in healthcare organizations and guide other nurses and healthcare providers in achieving the organizational objectives. In nursing informatics, APNs aims to translate the virtual care, technical and operational requirements, evaluate the core tools, develop project plans and implement them. Through nursing informatics, APNs can implement evidence-based practice in clinical settings.

The Advanced Nursing Practice Role That I Aspire to and The Experiences/ Qualities That Influenced My Decision

            The role I aspire to acquire is that of a family nurse practitioner (FNP). This is an advanced practice registered nurse (APRN) providing a wide range of family-focused healthcare services to patients of all ages. The services they provide include health promotion, disease prevention, direct care to patients, and health counseling for patients across all lifespans (Mounayar & Cox, 2021). The personal experience that influenced my choice was when I saw my father battle hypertension and diabetes for many years. He developed complications, which I believe would have been avoided with adequate management.

With the wide range of knowledge gained from the program, I believe I can better help families deal with chronic illnesses effectively without developing severe complications. I will also be able to engage them and provide them with appropriate health education services to ensure health promotion and disease prevention. I believe in collaborating with my patients and their families to develop an effective care plan and improve the likelihood of adopting healthier, long-lasting behaviors to improve health and prevent diseases.

My Personal Nursing Philosophy and The Model That Helped Me Describe It

My personal philosophy is based on the individualized patient care model. It aims to provide compassionate, empathetic, patient-centered quality nursing care to all my patients and their families to improve their quality of life. Based on the individualized care model, I will focus on involving my patients in developing their plan of care to promote acceptability and identify the needs and preferences of the patients. With excellent interpersonal and communication skills, I believe I will be able to collaborate with other members of the healthcare team to ensure quality patient care.

Regulatory And Legal Requirements for The State I Wish to Practice

I wish to practice within the state of Alabama. In this State, the Alabama Board of Nursing is responsible for establishing the laws and regulations for the certification requirements of an advanced practice nurse (NursingLicensure.org, 2020). In order to practice as an advanced practice nurse in Alabama, nurses need to be registered and certified by the board. APNs who wish to own independent practice must collaborate with a physician with more than one year of practice experience and be licensed in Alabama.  The regulations prohibit one physician from collaborating with more than three full-time, independent nurse practitioners. The nurse practitioners should be able to access the physician for consultation in person or by phone.

The prescription authority for Alabama nurse practitioners is quite limited (ThriveAP, 2022). They are only allowed to prescribe with the collaborative agreement of a physician. The regulations also prohibit them from making self-prescriptions or prescribing for those who are not directly under their care. Prescriptions of narcotics for pain management are also prohibited for APNs. In addition, there is no formal recognition of nurse practitioners as primary care providers.

Required Competencies and Certification Requirements for My Selected Role

Core competencies for nurse practitioners aim to ensure that the required patient care standards are met effectively (Tracy & O’Grady, 2019). These competencies are listed by The National Organization for Nurse Practitioner Faculties (NONPF) to meet the requirements for effective service delivery by nurse practitioners. Family nurse practitioners must have competencies in the scientific foundation, quality care, information literacy, independent practice, ethical care, leadership, technology, health delivery systems, and practice inquiry. They should have a basic scientific foundation to have a scientific rationale for each nursing intervention. In addition, They need to have adequate skills for analyzing and evaluating new policies and advocating for policy change in existing and outdated policies (Thomas et al., 2017). Healthcare delivery system competency enables FNPs to apply knowledge to practice within the organizational systems and enhance the promotion of change, minimize risks to patients, and provide diverse care which is culturally appropriate.

As independent practitioners, they should be able to practice with no supervision and apply ethical principles in solving the day-to-day ethical dilemmas they encounter in their practice. With these competencies, family nurse practitioners can provide holistic, quality care to patients and improve their health outcomes. They must be able to use electronic health records, work effectively with a multidisciplinary team to provide relationship-based care, be able to think critically, and have the ability to establish and maintain an effective relationship with patients, the public, and the multidisciplinary team.

The certification requirement for FNPs

In the State of Alabama, nurses must earn a Bachelor’s degree in Nursing, take the NCLEX-RN examination and pass and then be registered as a nurse before being allowed to practice as a certified nurse practitioner (Registered Nursing.org, 2020). Afterward, they must complete a Master’s degree program for FNPs and be registered by the Alabama Board of Nursing. The American Association of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC) offer certification tests on different medical topics. After passing the tests, Family Nurse Practitioner-Board Certified (FNP-BC) credentials are awarded to the nurses to begin their practice in Alabama effectively.

Transformational Leadership and How It Relates to My Identified Leadership Attributes and Those That I Need to Develop

Transformational leadership is a leadership approach that encourages, inspires, and motivates employees to be innovative and create the change necessary to ensure the company's future success (Pearson, 2020). Transformational leaders act as change agents, identifying the innovative and shifting trends in technology and helping the organization to embrace change. From my previous experience working under supervisors with different leadership styles, I developed an interest in being an agent of change and championing for the improvement in quality care. As a result, I developed an urge to engage more with the members of my healthcare team to improve the quality of care for patients in my unit. Some attributes I need to develop include improving my communication and interpersonal skills, which will enable me to have a better relationship with other healthcare team members to be an effective transformational leader.

Application Of The Leadership Style I Would Develop as An APN in Primary Care

In primary care, I would apply transformational leadership to improve patient care as it promotes a better working environment to ensure professionalism and enhance performance.  For example, when taking care of a patient with a sexually transmitted infection, transformational leadership will enable appropriate counseling of the patient on safe sex practices to prevent the recurrence of the infections and promote the patient’s health.

Current Trends Related to APN Roles

The current trends in my practice as a family nurse practitioner are the increasingly mounting debates on the changes in the FNP’s full practice authority, discrepancies over reimbursement, and the FNP’s trend of taking over more roles of a primary care provider. In as much as the practice authority for FNPs is determined by the states and may therefore vary from state to state, several efforts have been made to harmonize state regulations so that each state can recognize APNs are licensed practitioners with full practice authority. Discussions of reimbursement of nurse practitioners are also a challenge as nurse practitioners have repeatedly been compensated less for performing the same job as a physician with a similar or even better outcome. It has also been argued that since more people reside in areas with primary provider shortages, it is essential to allow nurse practitioners to practice to the full range of their training. There should be a general change in the view of APNs, and they should therefore be allowed to practice within the full scope of their education because they are competent and skilled to take up these roles and get adequately reimbursed for the work they do as it achieves a similar or even better outcome as that of a physician.

How APNs Can Lead Changes

Although Advanced practice nurses are highly trained and equipped with competencies to deliver various services, they are usually restricted from doing so due to barriers such as federal and state regulations, outdated models of insurance and reimbursement, and the general culture in healthcare (Wood, 2019). APNs can lead the change in these trends by championing for their rights through professional organizations to help them speak in one voice. These organizations should negotiate for better reimbursement of the nurses for their work and encourage the expansion of the scope of practice for APNs by abolishing outdated state and federal regulations. Advanced practice nurses should also be at the forefront in formulating healthcare practice policies to ensure they get a broader scope of practice with expanded roles. The use of evidence-based scientific evidence in clinical practice should also be encouraged to enhance quality nursing care and promote the fight for expanded scope of APN practice.

In conclusion, the role played by APNs is vital in providing quality care, and they need to be at the forefront in ensuring the provision of preventive care services to the public. APNs have the knowledge and experience to be able to provide affordable, quality and patient-centered care that will ensure patient outcomes are improved and reduce the occurrence of medical errors. Therefore, state policies and legislative processes need to allow them to practice the full range of their education to improve primary care in rural and underserved communities. As a family nurse practitioner, applying transformational leadership will help me bring about change in the process of care and facilitate quality improvement.

References

Bauer, L., & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery of the future. Nursing Outlook, 65(5), 624-632. https://doi.org/10.1016/j.outlook.2017.03.011

Cooper, M. A., McDowell, J., Raeside, L., & ANP–CNS Group. (2019). The similarities and differences between advanced nurse practitioners and clinical nurse specialists. British Journal of Nursing, 28(20), 1308–1314. https://doi.org/10.12968/bjon.2019.28.20.1308

Fealy, G. M., Casey, M., O'Leary, D. F., McNamara, M. S., O'Brien, D., O'Connor, L., ... & Stokes, D. (2018). Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers. Journal of Clinical Nursing, 27(19-20), 3797–3809. https://doi.org/10.1111/jocn.14550

McComiskey, C., Simone, S., Schofield, D., McQuillan, K., Andersen, B., Johannes, S., & Weichold, A. (2018). Professional advancement for advanced practice clinicians. The Journal for Nurse Practitioners, 14(1), 12–17. https://doi.org/10.1016/j.nurpra.2017.09.018

Mounayar, J., & Cox, M. (2021). Nurse practitioner post-graduate residency program: Best practice. The Journal for Nurse Practitioners, 17(4), 453-457. https://doi.org/10.1016/j.nurpra.2020.10.023

NursingLicensure.org. (2020, November 4). How to Become a Nurse Practitioner in Alabama | APN Requirements in AL - NursingLicensure.org. NursingLicensure.org. https://www.nursinglicensure.org/np-state/alabama-nurse-practitioner/#:~:text=They%20must%20hold%20both%20their

Pearson, M. M. (2020). Transformational leadership principles and tactics for the nurse executive to shift nursing culture. JONA: The Journal of Nursing Administration, 50(3), 142–151.

Registered Nursing.org. (2020). Becoming a Family Nurse Practitioner (FNP). Www.registerednursing.org. https://www.registerednursing.org/nurse-practitioner/fnp/#:~:text=What%20Are%20the%20Education%20Requirements

Thomas, A., Crabtree, M. K., Delaney, K., Dumas, M. A., Kleinpell, R., Marfell, J., & Wolf, A. (2017). Nurse practitioner core competencies content. The National Organization of Nurse Practitioner Faculties. https://online2.marianuniversity.edu/pluginfile.php/677348/mod_resource/content/1/2017_NPCoreComps_with_Curric%281%29.pdf

Thrive AP. (2022). Nurse Practitioner Scope of Practice: Alabama | ThriveAP. Www.thriveap.com. https://www.thriveap.com/blog/nurse-practitioner-scope-practice-alabama

Tracy, M. F., & O’Grady, E. T. (2019). Hamric and Hanson’s: Advanced Practice Nursing. An integrative approach (6th ed.). St. Louis: Elsevier.

Wood, R. (2019). Transforming Practice. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK209871/

NSG 5002 Week 1 Discussion Responses

1. Estrella

This is an informative discussion because it explains how the four metaparadigms of nursing: the patient, nurse, health, and environment enable practitioners to apply a holistic care approach to patients. The metaparadigms enable providers to provide individualized patient care, ensuring that the patient’s physical, emotional, spiritual, and social needs are met (Nikfarid et al., 2018). It addresses the patient’s approach to their health-illness continuum as their health and wellness fluctuate throughout their lifetime. Through the application of these paradigms, patients get empowered to take charge of their health and well-being and holistically protect their health by ensuring proper interaction with their surroundings to improve their overall health and well-being. The AACN synergy model nursing theory, a mid-range nursing theory, enables nurses to align their competencies with the patient’s needs to achieve quality outcomes.

References

Nikfarid, L., Hekmat, N., Vedad, A., & Rajabi, A. (2018). The main nursing metaparadigm concepts in human caring theory and Persian mysticism: a comparative study. Journal of Medical Ethics and History of Medicine, 11(6), 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150916/

1. Jodie

This discussion explains the importance of nursing theories and their application in research, education, management, nursing practice, and administration. The classification of nursing theories depends on their function, abstraction levels, or goal orientation. According to the level of abstraction, nursing theories are classified into grand, middle-range, and practice-level theories (Wayne, 2021). Grand theories are usually broad and complex, requiring further research for better clarification. They provide general nursing ideas and frameworks rather than specific interventions. Middle-range nursing theories address specific nursing phenomena and are usually based on the works of a grand theorist. Practice-level theories have a narrower scope, focusing on a specific patient population. As a result, they provide frameworks for nursing interventions and predict the outcomes of the interventions. According to goal orientation, descriptive theories describe nursing phenomena, while prescriptive theories provide interventions for the phenomena.

References

Wayne, G. (2021, July 8). Nursing theories and theorists: An ultimate guide for nurses. Nurseslabs. https://nurseslabs.com/nursing-theories/

References

References Included in the Body

NSG 500: Discussion Reflection Response: Role Transition

The advanced practice nurse has a more expanded scope of practice with more professional independence than the professional registered nurse (RN). Several factors affect the transition process from a registered nurse to the more advanced role of the advanced practice nurse. For instance, developing professional relationships is vital in ensuring adequate transition. Advanced practice nurses must have excellent interpersonal and communication skills to form professional relationships with healthcare team members, patients, and their families. In addition, the perceived level of support offered to the new APNs is a major factor in the role transition process. A solid support system, including mentors and senior APNs, is vital in providing adequate orientation to enable proper transitioning.

            With the new roles and responsibilities in advanced practice and a change in professional identity, novice APNs may face anxiety, tension, fear, and panic. They should understand that transitioning may take time, and patience is required to enhance adequate transition. With a proper transition plan in place, including identifying a support system and mentorship programs to provide adequate orientation to the new roles and responsibilities, nurses should be able to develop comfort and build competence in their new role. Nursing managers and policymakers should be able to identify factors that may affect role transitioning and develop effective coping strategies. A factor such as staff shortages may have a significant impact on the process of transitioning, and this may lead to inadequate coping. Managers should be able to address this issue to avoid putting strain on novice APNs.

References

No References

NSG6101 Discussion Response

1. Alionis

This is an interesting discussion as it probes into the various ways through which substance use disorder can be reduced among teenagers. It identifies substance use as the most common disorder affecting teenagers and has become an issue of public health interest that requires special attention. Teenagers and adolescents are at high risk of substance use because they are at a stage of experimentation, curiosity, formation of personal identity, risk-taking, and the need to exert some level of independence in their lives (Schepis et al.,2018). Health education programs on the effects of substance abuse are critical in the prevention process as it allows teenagers to acquire knowledge on the topic and understand how this may potentially affect their lives. The programs should be school-based to enable more teenagers to gain knowledge and avoid negative pressure that may direct them into drug and substance use.

References

Schepis, T. S., Teter, C. J., & McCabe, S. E. (2018). Prescription drug use, misuse, and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults. Drug and Alcohol Dependence, 189, 172–177. https://doi.org/10.1016/j.drugalcdep.2018.05.017

1. Ana

This discussion is very informative as it examines how language barriers affect healthcare quality and patient outcomes. It further provides a personal experience that motivates the debate and makes it even more enjoyable. Due to the diversity of healthcare and that of patients seeking care, a barrier in language presents an obstacle to accessing quality healthcare because it makes it difficult to obtain proper history for accurate diagnosis and patient involvement in the treatment plan. This may lead to poor quality care, lower patient satisfaction, and poor patient outcomes (Al Shamsi et al., 2020). Healthcare providers should strive to provide high-quality services to all patients regardless of the language they speak. With the increase in technology, they should utilize the available resources to empower their patients and allow families, friends, and even other healthcare providers who understand the patient’s language to translate for them for easier understanding.

References

Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of Language Barriers for Healthcare: A Systematic Review. Oman Medical Journal, 35(2). https://doi.org/10.5001/omj.2020.40

References

References Included in the Body

Option 1: Effects of Bureaucracy

Bureaucracy is a system of governance or management in which an organization comprises several departments, each with policy and decision-making authority. It is characterized by the specialization of functions, adherence to a fixed set of rules, and a hierarchical system of authority and governance (Banton, 2020). It ensures procedures are done correctly to achieve a common goal irrespective of circumstances. Bureaucracy affects our lives and freedoms as ordinary citizens in several ways. For instance, it establishes an authoritative system of decision-making, a predictable set of rules and regulations with fixed areas of jurisdiction, and a technical division of labor, which makes it possible to assemble relevant expertise necessary for solving complex social and technological problems. As a result, addressing the different needs of citizens become easier, improving the quality of life since each agency of bureaucratic governance specializes in providing solutions to particular needs of citizens, such as food security, disaster management, and the improvement of the economic status of citizens.

            In as much as bureaucracy is beneficial, in some instances, it may deny people fundamental freedoms of decision-making and free choice because, in this system, people are expected to follow the rules established by the executives in governance, which they took no part in formulating. They are also expected to accept tasks established by these executives, failing to which they will experience bureaucratic sanctions imposed by those in control (Roskin et al., 2017). These established rules and regulations may be outdated and frustrating and may not effectively address emerging problems.

            Bureaucracy helps my life in several ways. For instance, the set rules and regulations ensure safety, especially in critical areas such as the food and drug administration. It ensures that appropriate precautions are taken to safeguard the health of citizens before a new medication is approved. If a problem arises during the process, the red tape effect documents processes so that data is available for analysis and correction (Monteiro & Adler, 2021). In addition, it ensures that everyone is treated equally, no matter the circumstances. It discourages favoritism, ensuring friendships and political clout does not affect access to critical government infrastructure, funding, and service delivery. Another significant benefit that bureaucracy has on my life is job security. With the established rules and regulations governing the employee and employer terms, I am assured of job security, a steady salary, and other employment benefits, such as medical and disability coverage and a retirement pension.

            However, it also hinders some aspects of my life. For instance, the mountains of papers and rules that must be worked on in a bureaucratic system may hinder adequate response to a crisis (Cornel et al., 2020). This slows an organization’s capacity to achieve desired goals and objectives. The availability of several red tapes imposed by the government is also costly, and as a taxpayer, I feel that these hindrances may be costly and sometimes unnecessary.

            As it stands, I believe the bureaucracy is an effective aspect of my life because the set rules and regulations are important in ensuring that I am treated equally and that some of my fundamental rights are observed. It prevents mismanagement of office and the advances of corrupt individuals from following unconstitutional means to benefit themselves at taxpayers’ expense.

            One issue of the bureaucracy I would like to change is the rigidity of the observance of rules and regulations that may sometimes be outdated and unhelpful.  I would change this by implementing a policy for periodic review of the rules to ensure that they are current and updated so that they can solve current issues and trends to avoid frustrations and hindrances to service delivery.

References

Banton, C. (2020). Learn about the complex nature of a bureaucracy. Investopedia. https://www.investopedia.com/terms/b/bureaucracy.asp

Cornell, A., Knutsen, C. H., & Teorell, J. (2020). Bureaucracy and Growth. Comparative Political Studies, 53(14), 2246–2282. https://doi.org/10.1177/0010414020912262

Roskin Michael, G., Cord, R. L., Medeiros, J. A., & Walter, S. J. (2017). Political science: An introduction. Pearson Higher Education. PDF.

Monteiro, P., & Adler, P. S. (2021). Bureaucracy for the 21st Century: Clarifying and Expanding Our View of Bureaucratic Organization. Academy of Management Annals. https://doi.org/10.5465/annals.2019.0059

Outcome Measures, Issues, and Opportunities

Outcome measures are fundamental to assessing the efficiency of healthcare practices and determining where changes are needed, especially in handling communication and safety. These measures offer an actionable approach to convey how institutions improve care delivery processes and reduce adverse outcomes in unidirectional handoffs and other system flaws (Pantaleon, 2019). Actionable outcomes such as decreased medical errors, enhanced communication, and patient safety are some areas that healthcare organizations can focus on to identify critical concerns and new areas of improvement. Committing these outcome measures to the organization’s strategic plan and integrating leadership support to encompass new practice changes will allow for successful implementation and build a culture of quality and safety in the healthcare environment. This report seeks to understand these outcome indicators, their associated challenges, and their potential for enhancing healthcare delivery.

Organizational Functions, Processes, and Behaviors in High-Performing Organizations

Outstanding healthcare organizations are characterized by effective leadership and communication, focusing on timely and reliable improvement initiatives in quality and safety domains. Such organizations focus on evidence-based practice, advocacy of organizational transparency, and organizational planning that can address the goals and priorities of patient care (Bhati, 2023). Standard procedures for risk management are well implemented and strengthened by interprofessional cooperation integrated into the daily practice, making the decision-making process efficient and continuously developing. Financial processes are also aligned so that resources are used prudently to support care quality, with leadership embracing the challenge of the existing processes. Conversely, organizations that can be considered less successful will likely face issues such as a hierarchical system that hinders the employees, inadequate levels of communication promoting the best practices, and no one to be held responsible for the lack of progress (Vo et al., 2022). Despite my organization’s push to attain these rigorous performance standards, deficiencies continue to be observed in leadership involvement, communication during handoff, and interprofessional collaboration. More information on staff perceptions and patient experiences may provide a more significant distinction between these gaps and help identify specific approaches to enhance practice.

Impact of Organizational Functions, Processes, and Behaviors on the Outcome Measures

Organizational functions, processes, and behaviors influence the outcome measures and shape organizational performance, both positively and negatively. According to Kwame and Petrucka (2021), positive outcomes are observed when leadership encourages accountability, responsibility, transparency, and best practices to improve patient outcomes and safety and decrease medical errors, focusing on the continuity of care. For instance, when interprofessional collaboration is promoted, and efficient communication protocols such as SBAR are used effectively, factors such as patient satisfaction, number of patients’ falls, and rate of adverse events improve exponentially.

On the other hand, poor leadership, communication, and failure to follow procedural measures result in negative impacts on the results, which include a high incidence of errors, long duration of stay, and decreased patient satisfaction. These effects are usually contributed by systematic factors such as inflexible structures, intolerance to innovation, or the lack of adherence to innovation that supports quality and safe culture (Zajac et al., 2021). The rationale for this determination is based on two assumptions: Organizational behavior affects the performance of the staff and patient outcomes, and organizational continuity and clarity are vital in achieving the intended performance standards. Recognizing these relationships highlights the importance of ongoing assessment and strengthening organizational processes to improve outcome indicators.

Typical Quality and Safety Outcomes and the Associated Measures

The quality and safety outcomes related to the performance gap I seek to address—ineffective communication processes during handoffs— include decreased medical error rates, fewer patient falls, continuity of care, and patient satisfaction. The measures related to these outcomes include the incidence of identified communication-related adverse events, the rate of falls, patient harm due to communication breakdown, and patient satisfaction with care during shift handover. These outcomes are subsequent to failure in communication throughout handover between departments or shifts where gaps in passing over data and information can result in catastrophic repercussions (Raeisi et al., 2019). For instance, omitting critical facts concerning a patient’s medication or care plan during handoff will likely lead to the patient not receiving the necessary care at the right time, exposing them to avoidable risks. With this view, the goal is to quantify the decrease in the above-mentioned errors and adverse events, besides evaluating enhancements in clinical performance indicators such as low readmission rates and short hospital stays after the realization of structured communication techniques like the SBAR. These outcome measures provide a clear picture of patient safety quality following communication enhancements.

The effectiveness of data concerning these measures can be assessed using methods such as tracking reported incidents, patient safety dashboards, and patient satisfaction ratings. Although the data collected from such sources is relatively accurate, the completeness and validity are determined by enhanced reporting, staff participation, and precise documentation. There may be blind spots in the data-gathering process; for example, communication breakdowns may not be well reported, emphasizing the need for a clear, accurate, and comprehensive data-collection system (Kuske et al., 2022). The above outcomes should be assessed frequently to identify the actual degree of the performance difference and the available measures to address it effectively.

Performance Issues or Opportunities Associated with Organizational Functions, Processes and Behaviors

The primary communication problem linked to the systematic problem of improper communication of patient details during patient handoffs emanates from variability in information transfer from one provider to another. The problem manifests in a mismatch of organizational functions, poor leadership engagement, improper communication procedures, and inadequate staff development, implying a fragmented information dissemination system (Cortellazzo et al., 2019). The information inaccuracy is mainly pronounced during shift handoff or transfer between care settings, departments, or facilities, where important patient details may go unnoticed or be relayed wrongly, resulting in mishaps, delayed treatment, or patient harm. The lack of a consistent protocol for communication during handoffs across all units should be recognized as an opportunity for improvement, using a protocol like SBAR to harmonize the standard for such transitions (Ruhomauly et al., 2019). The possible reasons that may lead to these sorts of compromises in performance might include different levels of communication, poor staff compliance to the set protocols, poor training, and inadequate constant leadership supervision to ensure compliance. These gaps consequently limit and vary access to care, which puts patient safety and quality outcomes at risk.

The potential impacts of resolving these performance concerns are significant. Through the established protocol for communication, the organization can help transmit information in a structured and more efficient manner to avoid errors, thus promoting patient safety, increasing the quality of patient care and patient satisfaction, and reducing the number of readmissions and adverse effects (Sharkiya, 2023). However, some aspects remain ambiguous or require more detailed investigation, such as the nature of the challenges staff experience in maintaining the constancy of protocol-driven communication and the best ways for leaders to enhance practice improvements. In addition, there are gaps in how communication breakdown can be quantified, as evidenced by the need to improve the methods of data collection that precisely measure problematic outcomes. Further research and evaluation of these two areas of knowledge deficit will help point to a more precise course on reforming communication processes and enhancing safety and quality standards across the organization.

Strategies for Patient Care Measurement and Knowledge Sharing

To ensure that all aspects of patient care are measured and that knowledge is shared effectively with the staff, we will employ Kurt Lewin's Change Management Model, which includes three stages: Unfreezing, change, and refreezing (Burnes, 2020). Initially, the unfreezing stage will involve creating consciousness and understanding of the need to implement the identified change by measuring broader patient care and sharing the knowledge. The process will include communicating the change to be implemented to acquire staff support through meetings, emails, and materials on current gaps in patient care and the value of improvement. The leadership will deal with resistance from the staff through listening to their complaints and engaging in conversation. Ensuring a sense of urgency is crucial to building a solid coalition to support organizational change initiatives.

We will initiate new communication practices during the changing stage using the SBAR tool for patient assessment and knowledge transfer. Some of the critical steps will include using checklists and increasing the functionality of the electronic health record system to incorporate the SBAR tool for reporting patient’s core measurements (Shahid & Thomas, 2020). Education sessions will be conducted to familiarize staff with these new tools and the need to input accurate data. To increase awareness about the outcomes of the change, we will convene regular interprofessional team meetings where staff members of different disciplines will analyze patient outcomes, describe and disseminate knowledge about recent high-quality care practices, and address concerns about potential gaps in care that may require attention. This stage will focus on engaging and involving all the team members to incorporate the necessary changes.

Finally, in the refreezing stage of the process, we will ensure that the changes made are instituted in the new organizational culture. The processes will include regular follow-up using newsletters, intranet sites, and workshops to share relevant information and good practices. Leadership will support the new norm by ensuring the SBAR tool is incorporated into the Electronic Health Records system and by reviewing and acknowledging the outstanding performing teams with additional emphasis on measuring patient care and knowledge sharing (Rabkin & Frein, 2021). Proper monitoring and evaluation will be incorporated to assess and gather feedback. To maintain consolidation, we will integrate these practices into the working processes and share the positive effects of the change processes on patient results. The change is expected to strengthen personal responsibility and positively affect the cooperation between professionals, creating a more efficient and integrated healthcare system.

Conclusion

A systematic approach to capturing patient care and disseminating information is vital to enhance healthcare organizations’ quality and safety results. Applying Kurt Lewin’s Change Management Model will enable the organization to systematically fill the communication gaps, create a unified measurement system, and promote a collaborative and accountable culture. Interprofessional cooperation, staff continual evaluation, and training will guarantee that all aspects of patient care are quantified and the best practices are implemented and followed universally by the healthcare workers. Over time, such activities shall elevate customized outcomes with patients and bolster organizational commitment to quality and safety.

References

Bhati, D. (2023). Improving patient outcomes through effective hospital administration: A comprehensive review. Cureus, 15(10), 1–12. https://doi.org/10.7759/cureus.47731

Burnes, B. (2020). The origins of Lewin’s three-step model of change. The Journal of Applied Behavioral Science, 56(1), 32–59. https://doi.org/10.1177/0021886319892685

Cortellazzo, L., Bruni, E., & Zampieri, R. (2019). The role of leadership in a digitalized world: A review. Frontiers in Psychology, 10(1), 1–21. Frontiersin. https://doi.org/10.3389/fpsyg.2019.01938

Kuske, S., Willmeroth, T., Schneider, J., Belibasakis, S., Roes, M., Borgmann, S. O., & Cartes Febrero, M. I. (2022). Indicators for implementation outcome monitoring of reporting and learning systems in hospitals: An underestimated need for patient safety. BMJ Open Quality, 11(2), e001741. https://doi.org/10.1136/bmjoq-2021-001741

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(158), 1–10. https://doi.org/10.1186/s12912-021-00684-2

Pantaleon, L. (2019). Why measuring outcomes is important in health care. Journal of Veterinary Internal Medicine, 33(2), 356–362. https://doi.org/10.1111/jvim.15458

Rabkin, S. W., & Frein, M. (2021). Overcoming obstacles to developing high-performance teams involving physicians in health care organizations. Healthcare, 9(9), 1136.

Raeisi, A., Rarani, M. A., & Soltani, F. (2019). Challenges of patient handover process in healthcare services: A systematic review. Journal of Education and Health Promotion, 8(173). https://doi.org/10.4103/jehp.jehp_460_18

Ruhomauly, Z., Betts, K., Jayne-Coupe, K., Karanfilian, L., Szekely, M., Relwani, A., McCay, J., & Jaffry, Z. (2019). Improving the quality of handover: Implementing SBAR. Future Healthcare Journal, 6(2), 54. https://doi.org/10.7861/futurehosp.6-2s-s54

Shahid, S., & Thomas, S. (2020). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care – A narrative review. Safety in Health, 4(1), 1–9. https://safetyinhealth.biomedcentral.com/articles/10.1186/s40886-018-0073-1

Sharkiya, S. H. (2023). Quality communication can improve patient-centered health outcomes among older patients: A rapid review. BMC Health Services Research, 23(1), 1–14. https://doi.org/10.1186/s12913-023-09869-8

Vo, T. T. D., Tuliao, K. V., & Chen, C.-W. (2022). Work motivation: The roles of individual needs and social conditions. Behavioral Sciences, 12(2), 49. ncbi. https://doi.org/10.3390/bs12020049

Zajac, S., Woods, A., Tannenbaum, S., Salas, E., & Holladay, C. L. (2021). Overcoming challenges to teamwork in healthcare: A team effectiveness framework and evidence-based guidance. Frontiers in Communication, 6(1). https://doi.org/10.3389/fcomm.2021.606445

Quality Gap Analysis

Meeting the challenges for quality and safety in patient care is essential in the complex and rapidly evolving healthcare environment for organizational and patient outcomes. Quality and safety gap analysis can be a necessary method of establishing the difference between the current practices and an organization’s quality and safety standards. It thoroughly examines current activities, protocols, and results to identify gaps in implementing safety procedures and quality assurance (Manzanera et al., 2020). With awareness of these gaps, improvement initiatives implemented by healthcare organizations can be focused on areas most likely to reduce risk and increase safety, efficiency, and staff engagement in the care of patients. This paper highlights specific practice areas in my healthcare organization and indicates where change is needed to improve patient safety, quality of care, and organizational effectiveness.

Systemic Organizations in the Healthcare Organization

One major systemic issue in my healthcare organization requiring change for improvement is poor communication during shifts or department hand-off, with substantial negative consequences on quality and safety. This problem presents itself through illegible communication, where there is a transmission of incorrect, insufficient or untimely information that leads to misconceptions, failure to notice significant issues and possible adverse outcomes for the patient. The issue is widespread and runs deep through different levels of the healthcare system and results in weak monitoring of patients, delays in treatment, and increased risk of preventable complications. The potential adverse effects, if not solved, are increased medical errors, jeopardized patient safety, patient dissatisfaction, and perhaps increased healthcare costs arising from longer hospitalization or the need for further procedures (Tsegaye et al., 2020). However, knowledge gaps exist on how technology, staff training, and organizational culture relate to these communication breakdowns. In addition, there are questions regarding best practices and strategies that should be implemented to change transition processes within the network, requiring more research to develop specific interventions.

Practice Changes to Bridge the Gap and Promote Better Infection Prevention Measures

To address the gap between current and desired communication performance during handoffs, I suggest using a structured handoff protocol incorporating the SBAR (Situation, Background, Assessment, Recommendation) communication tool into the organization’s electronic health record system and staff training on the SBAR system (Coolen et al., 2020). The current state of the performance gap can be attributed to the variability and lack of standardized patient handoffs, which reflects issues relating to quality and safety, such as information omissions, misunderstandings, missing patient information, and inaccuracy that affects the delivery of patient care. These proposed changes will ensure that all vital information is passed from one shift to another by standardizing the handoff process. The changes are expected to lead to better patient health outcomes due to better organization of care and decreased medical errors because they contribute to the development of organizational safety culture in the framework of healthcare organizations.

Prioritizing Practice Interventions

Out of the proposed practice changes, the most critical change is developing a coherent handoff report generated using the SBAR communication tool in the EHR. This change is essential because it directly targets the issue with handoffs, where errors in communication lead to reduced quality and safety of patient care, inpatient adverse events like medication errors, and patient falls (Tiwary et al., 2019). The justification for prioritizing this change is based on its ability to ensure increased patient safety and care continuity, reduced errors, and enhanced patient satisfaction, all of which will address the organization’s strategic goals in delivering efficient and safe patient care. The implementation of SBAR into the EHR standardizes the protocol’s use across all departments, reducing the variability in the handoff process. This corresponds with the organization's strategic plan to embrace technology in making proper clinical variations and enhance smooth, safe and efficient handling of patient care.

The Impact of the Proposed Changes in Fostering a Culture of Quality and Safety

Introducing a seamless SBAR handoff process contained in an EHR will precipitate a change of attitude and behavior to reflect a paradigm shift of accountability, communication and patient safety within the practice setting. Over time, staff members will better appreciate the significance of correct and thorough information handover as they internalize the techniques of the standardized approach and gain greater control over their communication. The change is expected to promote interdisciplinary cooperation, suppress communication apprehension on potential safety issues, and renew commitment to quality for healthcare professionals (Müller et al., 2020). However, there is potential resistance to the standardized handoff process because staff may be hesitant about the longer time investment. This is why education and constant reinforcement of the long-term positive effects are essential. To assess the effectiveness of promoting such culture, characteristics such as enhanced practice on SBAR, decreased communication breakdowns, and shift in staff attitude toward teamwork and safety culture may be compared with future assessments.

The Impact of Organizational Culture and Hierarchy on the Quality and Safety Outcomes

In an organization with a bureaucratic culture, highly centralized decision-making process, and formal organizational structures, quality and safety results may decline due to the lack of helpful communication and non-contribution by subordinates for fear of punishment when they admit to mistakes (Cuervo-Cazurra et al., 2021). It might affect communication and the overall decision-making process, leading to potential safety problems not being identified or addressed promptly. On the other hand, if the organization cultivates an open culture, where leaders are easily approachable and receptive to new ideas from subordinates, it can lead to favorable outcomes since active communication and quick solutions to emerging issues are attained in such scenarios, with monitoring of patient care being the duty of all members. The organizational structure within such an environment relieves each team member from waiting to be told when to contribute to quality and safety improvements. This analysis assumes that hierarchical structures inherently discourage open communication and that a collaborative, inclusive culture is essential for improving quality and safety outcomes.

Justification for the Necessary Changes in the Organization

The changes are deemed relevant and necessary due to the critical communication breakdowns that hinder patient safety and quality of care delivery, particularly the failure to follow the adverse event report policy, lack of SBAR utilization during handoffs, and absence of SBAR incorporation into EHR. According to Fernández et al. (2022), using communication templates such as SBAR can minimize conveyance mistakes and optimize care transitions, as it guarantees standard communication of relevant information. These modifications are necessary to facilitate the present inadequacies in the handoff process, which are significant sources of misunderstanding and avoidable complications. Implementing handoff protocols will enable the organization to reduce the gaps and omissions due to disruptions in patient care, achieve better coordination among the interprofessional team, and observe improved identification of patients’ needs for effective, efficient, and coordinated care.

Conclusion

Adopting the standardized SBAR communication tool to address the systematic problem of handoff communication and its integration as a part of the EHR is a significant effort towards improving quality and safety outcomes in the organization. These changes in communication practices will close existing gaps by enhancing accountability and collaboration, thereby minimizing risks and enhancing the efficiency and reliability of the care delivery system. Implementing these changes and continued assessment will result in long-term enhanced patient safety, nursing care quality, and organizational performance.

References

Coolen, E., Engbers, R., Draaisma, J., Heinen, M., & Fluit, C. (2020). The use of SBAR as a structured communication tool in the pediatric non-acute care setting: Bridge or barrier for interprofessional collaboration? Journal of Interprofessional Care, 1–10. https://doi.org/10.1080/13561820.2020.1816936

Cuervo-Cazurra, A., Dieleman, M., Hirsch, P., Rodrigues, S. B., & Zyglidopoulos, S. (2021). Multinationals’ misbehavior. Journal of World Business, 56(5), 101244. https://doi.org/10.1016/j.jwb.2021.101244

Fernández, M. C. M., Martín, S. C., Presa, C. L., Martínez, E. F., Gomes, L., & Sanchez, P. M. (2022). SBAR method for improving well-being in the internal medicine unit: Quasi-experimental research. International Journal of Environmental Research and Public Health, 19(24), 16813. https://doi.org/10.3390/ijerph192416813

Manzanera, R., Moya, D., Guilabert, M., Plana, M., Gálvez, G., Ortner, J., & Mira, J. (2020). Quality assurance and patient safety measures: A comparative longitudinal analysis. International Journal of Environmental Research and Public Health, 15(8), 1568. https://doi.org/10.3390/ijerph15081568

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2020). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), 1–10. https://doi.org/10.1136/bmjopen-2018-022202

Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019). Poor communication by health care professionals may lead to life-threatening complications: Examples from two case reports. Wellcome Open Research, 4(1), 1–8. https://doi.org/10.12688/wellcomeopenres.15042.1

Tsegaye, D., Alem, G., Tessema, Z., & Alebachew, W. (2020). Medication administration errors and associated factors among nurses. International Journal of General Medicine, 13(13), 1621–1632. https://doi.org/10.2147/ijgm.s289452

Week 1 Discussion: Basic Statistics Data Used in Everyday Life

The two types of data I would like to present are blood pressure and gender because these are two common measurements and demographics we obtain from patients daily. Blood pressure is a quantitative variable because it is data measured numerically. According to Holmes et al. (2018), quantitative data results from counting or measuring certain population attributes. The second variable is gender which is categorical data because we can classify or categorize it into male and female depending on the unique characteristics and qualities of each gender. Therefore, this is an example of a qualitative variable because it is a descriptive variable using concept words rather than numbers.

            Gender is an example of a nominal variable, also called a categorical variable, because it can be classified into two categories; male or female. However, there is no specific ordering for the categories. Blood pressure, on the other hand, is an example of a continuous variable. It can be measured to as many decimals as the measurement instrument allows. Since the variable uses two values with the difference telling us whether there is normal, high, or low blood pressure, systolic blood pressure is classified as an interval variable (Ranganathan, 2019). For example, someone with a blood pressure of 120/80 is considered healthy, while someone with a blood pressure of 180/90 is considered hypertensive.

            I would use stratified sampling to gather data on gender because I would stratify them into either male or female and then take an equal sample size from each stratum to ensure equal representation of both genders. I may use convenience sampling for blood pressure measurement because the data is readily available and cost-effective (Buang et al., 2019). Other sampling techniques can also be used to take blood pressure measurements depending on the population size and the purpose of the study.

References

Buang, N. F. B., Rahman, N. A. A., & Haque, M. (2019). Knowledge, attitude, and practice regarding hypertension among residents in a housing area in Selangor, Malaysia. Medicine and Pharmacy Reports. https://doi.org/10.15386/mpr-1227

Holmes, A., Illowsky, B., Dean, S., & Openstax College. (2018). Introductory business statistics. Openstax College, Rice University.

Ranganathan, P. (2019). An Introduction to Statistics – Data Types, Distributions and Summarizing Data. Indian Journal of Critical Care Medicine, 23(S2), 169–170. https://doi.org/10.5005/jp-journals-10071-23198

Week 1 Discussion: Diversity in Nursing

Transcultural nursing is a nursing specialty focusing on global cultures to ensure the provision of culturally congruent nursing care. It enables nurses to recognize cultural differences in healthcare values, customs, and beliefs for different communities worldwide to incorporate these differences in providing culturally acceptable care. Transcultural nurses focus not only on a patient’s cultural beliefs, religion, and values but also on how their way of life, thoughts, and unique customs affect their response to illness, disease, healing, and death (Kacan, 2021). Acquiring culturally competent knowledge and skills in nursing ensures that patients receive quality care, increases their satisfaction, and improves their health outcomes.

            I decided to take this course because of the challenges experienced in providing individualized nursing care to patients based on the increasing number of multicultural populations in the country. I believe that transcultural nursing will help solve these challenges as it will help identify various factors affecting the health of individuals from different cultures and analyze ways to promote their health in a culturally appropriate manner (Tosun et al., 2021). As a result, it will be possible to bridge the transcultural gaps in healthcare as nurses will be able to work with cultural contrast to provide clients and families with meaningful care and improve their way of life.

            In the next eight weeks, I would like to learn the different aspects of cultural diversity that significantly impact a patient’s health. I would like to know the diverse cultures and cultural heritage of different communities to communicate effectively with patients and their families so that I can deliver culturally appropriate nursing care. I would also like to learn how I can relate various aspects of a patient’s health beliefs and cultural values to the cause of their illnesses so that I can act as a bridge between the patient’s culture and appropriate health practice. Therefore, I will be able to understand how culture, ethnicity, and race influence the development of a patient’s social and emotional relationships, their practices of child-rearing, and the attitude they have toward health.

            This course will significantly help my nursing practice as it will help me incorporate different aspects of patients’ cultural values and beliefs in developing individualized care for patients. With the knowledge of cultural diversity, I will be able to offer quality care to my patients in a culturally appropriate manner, improving the patient’s satisfaction and health outcomes. In addition, I will gain knowledge and skills in communicating with patients and families from different cultural, ethnic, and racial backgrounds to identify factors influencing their health and how to improve health and bridge the cultural gaps in health determination (Narayan, 2021). This will enhance holistic and creative care, ensuring that all aspects of a patient’s life are considered while offering care and enhancing cultural sensitivity.

References

Narayan, M. C., & Mallinson, R. K. (2021). Transcultural Nurse Views on Culture-Sensitive/Patient-Centered Assessment and Care Planning: A Descriptive Study. Journal of Transcultural Nursing, 33(2), 104365962110469. https://doi.org/10.1177/10436596211046986

Tosun, B., Yava, A., Dirgar, E., Şahin, E. B., Yılmaz, E. B., Papp, K., Tóthova, V., Hellerova, V., Prosen, M., Licen, S., Karnjus, I., Tamayo, M. D. B., Leyva-Moral, J. M., Claeys, A., & Tricas-Sauras, S. (2021). Addressing the effects of transcultural nursing education on nursing students’ cultural competence: A systematic review. Nurse Education in Practice, 55, 103171. https://doi.org/10.1016/j.nepr.2021.103171

Kaçan, C.Y (2021). The Effect of Transcultural Nursing Course on Students’ Moral Sensitivity: A Quasi-Experimental Study. Journal of Transcultural Nursing, 104365962110638. https://doi.org/10.1177/10436596211063813

Week 1 Discussion: Topic Exploration and Viewpoint

The course theme, Opioid Addiction Treatment Controversies, is an open-ended topic that can be discussed from different angles. The opioid crisis is a global concern, especially among people with chronic pain (Johns Hopkins Medicine, 2022). Although it is a common prescription for pain management, chronic use of opioids can lead to the development of opioid use disorder, a condition in which a person becomes a compulsive opioid user. This can negatively affect the physical and emotional well-being of the person.

From the course theme, some of the debates that interest me the most are the effectiveness of Medication Assisted Treatment (MAT) on the management of opioid addiction and the significance of prescribing opioids for pain management, yet it has been established that it can lead to addiction.  For the debate on the effectiveness of Medication-Assisted Treatment in managing opioid addiction, I believe that managing opioid addiction is a complex process, and medications and behavioral therapy should be incorporated into the treatment process (Hatfield, 2022). In as much as opioid use can lead to addiction, I believe prescriptions for pain management are significant as some pain symptoms associated with chronic conditions, such as cancer, among others, may be unbearable, and opioids provide a strong analgesic effect to curb the pain.

I am more likely to discuss the effectiveness of medication-assisted treatment in managing opioid addiction. This is because, as much as these medications may be effective in managing addiction, they may pose significant risks to patients and cause unanticipated additional problems (Mancher & Leshner, 2022). This topic provides a wide range of controversies as the drugs used in managing opioid addiction may also be abused, prompting an anti-MAT debate with a significant focus on behavioral therapy.

References

Hatfield, R. C. (2022). Medication-Assisted Treatment (MAT) for Opioid Dependence. Recovery.org. https://recovery.org/treatment-medication/opioid/

Johns Hopkins Medicine. (2022, October 19). Opioid Use Disorder. Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/opioid-use-disorder

Mancher, M., & Leshner, A. I. (2019). Barriers to Broader Use of Medications to Treat Opioid Use Disorder. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK541389/

Week 2 Discussion: Reflection on Cultural Awareness

Nurses must understand the dynamic values and beliefs of different cultures. Understanding and respecting other cultures is essential in care provision and patient interaction. Effective interaction between nurses and patients enhances patient satisfaction and trust. It also improves their willingness to follow the treatment procedures, which improves their health outcomes and quality of life. Cultural awareness in communication entails understanding that different cultures may perceive verbal and non-verbal cues differently. Applying cultural awareness in my current practice involves learning more about other cultures, communicating in a culturally sensitive manner, and avoiding judging my patients based on their cultural values, beliefs, or language. Practicing active listening is essential to gain an understanding of patients’ problems and to develop solutions to the problems.

An example of miscommunication that occurred at my workplace was when I received a medication order from a doctor with a heavy Russian accent. I could not clearly understand the order, so I kept asking for clarification. This went back and forth until I suggested that he writes the order down. As much as this miscommunication did not result in any form of harm or adverse event to the patient, it can lead to a potential danger because if I didn’t ask for clarification, I would have assumed and given the patient a different medication which would have resulted in severe harm or adverse effects.

Preventing this form of miscommunication should include actively listening to the order and seeking clarification, just as I did. In addition, protocols should be put in place to ensure that medication orders are written and not just verbally stated to prevent any confusion that may result. Administering a medication order that one is unsure about can potentially harm the patient and cause severe effects.

References

No References

Week 2 Project: Core Competencies

Advanced practice nurses have various roles, such as treating and diagnosing illnesses, advising the public on health issues, managing chronic diseases, and engaging in continuous education programs (American Nurses Association, 2018). I am currently on the track of the family nurse practitioner (FNP) program. Nurse practitioners must meet some core competencies to practice successfully in these roles. Tracy & O’Grady (2019) documented that nursing practitioners’ core competencies aim to ensure that the standards of patient care are met by the governing bodies in the nation and state that a nurse practitioner practices.

The National Organization for Nurse Practitioner Faculties (NONPF) lists nine categorical competencies that meet the requirements for effective service delivery by a nurse practitioner (NP). The core competencies of a family nurse practitioner include scientific foundation, leadership, quality, practice inquiry, technology & information literacy, policy, health delivery system, ethics, and independent practice. With these competencies, family nurse practitioners (FNPs) can have a holistic view of a patient’s situation, considering their physical and emotional well-being and the sociocultural context of the patient (Schlunegger et al., 2022).

Practice inquiry entails an analytical application of leadership and clinical application of previous experience to improve nursing practice and enhance change. The nurse practitioner should have basic knowledge in the application of technology to enhance the delivery of quality healthcare, expand knowledge, and evaluate the effectiveness of care. It is also essential for the nurse practitioner to understand different healthcare policies and how they impact clinical practice. The nurse practitioner should have proper analytical and evaluative skills for policy advocacy and developing new policies (Thomas et al., 2017). Competency in the healthcare delivery system involves applying knowledge to practice within the organizational systems to enhance change promotion, minimize health risks to the patient, provide culturally diverse and appropriate care, and evaluate patient outcomes.

A nurse practitioner should be able to utilize ethical principles in delivering care to patients. They should employ these ethical principles and use critical thinking and problem-solving skills to solve ethical dilemmas. Independent practice involves practicing with no supervision. Nurse practitioners should be able to diagnose, treat and order prescriptions for patients. They should be able to initiate health promotion and disease prevention activities, educate and counsel patients, develop and maintain a therapeutic, trusting, and respectful relationship with patients, and offer palliative care. All these should be carried out while integrating the patient’s culture, diversity, and spirituality into care and involving them in their treatment and care plan decision-making. All these competencies focus on providing patient-centered care to improve healthcare quality and promote positive patient outcomes.

Attaining the Basic Mastery of Core Competencies

There are several methods I can use to master these competencies. For instance, I can combine the knowledge I gained in my basic undergraduate program, which serves as the foundation for my advanced role as a family nurse practitioner, with that gained in the APN nursing theories to deliver care to patients requiring complex analytical care capabilities. This will prepare me to deliver care that requires advanced thinking techniques and incorporate this knowledge into practice. In addition, I will analyze different assessment data and evidence-based research to provide competent, quality patient care.

Proper guidance within the faculty, mentorship throughout the program, and the leadership theories learned will help me attain my best potential as a leader by acting as an agent of change and as a patient advocate. Using peer-reviewed evidence-based research articles and serving on the peer review committee will help me deliver quality patient care and facilitate continuous improvement. Through continuous training on the current technological trends in healthcare, I can keep up to date with the recent technological advancements, which will help me attain technological and information literacy competency.

To enhance my competency in policy advocacy, I can register for membership in a national nurse practitioner organization that will increase my proactivity in policy advocacy. I can also learn about various organizational systems and how they operate to gain competency in healthcare systems so that I can effectively deliver quality patient care according to the healthcare delivery system used within the organization where I work.

Leadership Competency

Leadership is one of a nurse practitioner’s core competencies, as identified by NONPF (Thomas et al., 2017). Advanced practice nurses utilize complex systems in care provision, and leadership is important in ensuring efficient care delivery. The leadership competency that I most identify with is transformational leadership. This type of leadership is defined as a leadership style that transforms vision into action and assists others in attaining their best potential. This leadership style inspires positive growth and loyalty and instills confidence in healthcare team members (Cherry, 2022). Through this type of leadership, I can act as an agent of change through a proactive approach in the healthcare organization (Pearson, 2020).

I have worked under supervisors with various leadership styles. During this time, I observed that leaders who were not involved or engaging with team members led to a decrease in the overall morale of the team members, making it difficult to meet organizational targets. This has always sparked a desire in me to be more of a transformational leader, always available and engaging with my team members to improve organizational outcomes and the quality of care for my patients.

Additional Competencies

Some additional core competencies that I will discuss are scientific foundation and ethics. Scientific foundation as a core competency involves the ability to critically analyze data and evidence, incorporate scientific-based evidence in nursing practice, and formulate new ways of patient care by combining research, theoretical framework, and practice information to develop better care methods. I can achieve this competency by acquiring advanced skills in research to promote change, collaborate with other members of the healthcare team and stakeholders, and have critical and reflective thinking skills that will enable me to incorporate scientific-based evidence to improve the quality of care I offer to my patients.

Ethics is another key competency I will need as a family nurse practitioner. Ethical practice is a foundation for all nurses, which helps ensure proper, efficient, and quality care for all patients. The four main principles of nursing ethics include autonomy, beneficence, justice, and non-maleficence. Autonomy enables patients to make their own decisions regarding their care based on their personal beliefs and values (Haddad & Geiger, 2021). The ethical principle of non-maleficence prevents providers from causing harm to patients, and beneficence ensures that healthcare workers do everything to the patient’s benefit, avoiding maltreatment, minimizing harm, and promoting good toward the patient. I will achieve this competency by learning these various ethical principles, applying them in my daily encounters with patients, and utilizing my critical thinking and problem-solving skills to handle ethical dilemmas.

References

American Nurses Association. (2018). Advanced Practice Registered Nurses (APRN) | American Nurses Association. ANA. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Cherry, K. (2022, May 23). Transformational leadership. Verywell Mind. https://www.verywellmind.com/what-is-transformational-leadership-2795313

Haddad, L. M., & Geiger, R. A. (2021, August 30). Nursing ethical considerations. NCBI; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Pearson, M. M. (2020). Transformational Leadership Principles and Tactics for the Nurse Executive to Shift Nursing Culture. JONA: The Journal of Nursing Administration, 50(3), 142–151. https://doi.org/10.1097/nna.0000000000000858

Schlunegger, M. C., Aeschlimann, S., Palm, R., & Zumstein‐Shaha, M. (2022). Competencies of nurse practitioners in family practices: A scoping review. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.16382

Thomas, A., Gnp, A.-B., Crabtree, F., Apn-Bc, K., Delaney, M., Dumas, Gnp-Bc, R., Kleinpell, J., Marfell, Fnp-Bc, D., Nativio, Buchholz, S., Dileo, H., Dontje, K., Haber, J., Hart, A., Reeve, K., Ruppert, S., & Schaffer, S. (2017). Nurse Practitioner Core Competencies Content A delineation of suggested content specific to the NP core competencies 2017 NP Core Competencies Content Work Group. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf

Tracy, M. F., & O’Grady, E. T. (2019). Advanced practice nursing: An integrative approach (6th ed.). Elsevier Saunders.

Week 5 Assignment: Full Draft of the Argument Research Essay

Over the years, the United States has witnessed a significant increase in the use of different mental health applications in diagnosing, educating, and treating patients. These applications should be embraced by including telehealth programs to help solve mental health issues in the community. The applications provide a unique opportunity to expand the quality and availability of mental health assessments and interventions to improve patients’ quality of care and significantly improve health outcomes. Mobile health applications installed on smartphones are easily accessible and can be used by patients to evaluate and assess their mental well-being. However, the rate of entry of mental health applications into the market is higher than the evaluation rate for their effectiveness. As a result, some applications may not be effective in the management of mental health issues. Scientific assessment of the applications is vital in strengthening their effectiveness and usefulness.

Various reasons support the use of mental health applications in managing mental health issues. For instance, smartphone applications are easily accessible and user-friendly. They have been widely used to monitor, assess, and treat physical and mental health conditions. Patients suffering from mental health problems may be on different medications that require taking at varying intervals with different dosages. These applications can be vital in setting reminders for the appropriate dosages and timing of the drugs to avoid non-adherence and inappropriate dosing. In addition, they can perform complex tasks such as monitoring blood sugar and patients’ heart rates. Society should, therefore, have confidence in the use of mobile health applications in the delivery of quality healthcare.

Mobile apps for mental health can effectively monitor or improve symptoms of certain mental disorders, such as anxiety, stress, alcohol disorder, sleep disorder, depression, suicidal behaviors, and PTSD. In a systematic review of mobile apps' effectiveness for monitoring and managing mental health symptoms or disorders, Wang et al. (2018) noted that fourteen out of 100 studies reported that utilizing an app had clinically validated evidence of effectiveness. Even though most mental apps currently available lack clinically validated evidence of their efficacy, the technology offers enormous potential to be an effective tool in delivering mental health care with advancing research.

Despite the availability of effective pharmacologic and pharmacotherapeutic treatment modalities for common mental health conditions, their burden on the community is still significant. According to Marshall et al. (2019), only approximately 30% of people with a probable clinical diagnosis of anxiety or depression receive appropriate treatment for their diagnoses. This is attributed to limited resources, which make it difficult to effectively manage these conditions, especially in rural areas and other underserved communities where obtaining expert face-to-face services may be challenging. In such circumstances, mental health apps can be vital in bridging the gap to counter the barriers to accessing mental health services.

In addition, mental health apps can track users in ways that are wholly inaccessible to physicians. They can collect operational data, for example, self-reported data, as well as passive data, including how often the app is used, timestamps on when various interventions are implemented, and searches within the app for some otherwise unreported symptoms in a self-report (Ahmed et al., 2021). This allows for timely, relevant interventions that would not otherwise be implemented without prompting the data obtained from these apps. Effective management and treatment of mental health conditions depend highly on the data obtained during physical and mental status examinations. These apps provide an opportunity to get accurate and reliable data that can be used in formulating a patient’s diagnosis and during the formulation of the patient’s care plan. This information is recorded and can be used for future reference.

Mental health apps have a significant potential to deliver high-efficacy mental health interventions. They are a good choice for psychological treatment delivery compared to other platforms due to ease of use, low effort expectancy, and high hedonic motivation. A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (Chandrashekar, 2018). Similar studies on the efficacy of mobile apps on patients with anxiety and schizophrenia have reported positive results. 

There are circumstances where mental health services are required on a large scale, for example, in cases of a natural disaster or terror attacks. During these circumstances, offering quality services to individual patients by the few available mental health specialists may not be possible. Mental health applications can serve as an invaluable tool for these patients and the concerned healthcare personnel as the technology will assist in reaching out to more people at a lower cost.

Mental health apps target various psychological disorders, varying in design and functionality. The National Institute for Mental Health (NIMH) provides a six-category classification of mental health apps based on their functionality. These include self-management, cognition improvement, skills training, social support, symptom tracking, and passive collection of data. They span all stages of the provision of clinical care, including immediate crisis intervention, disease, prevention, the process of diagnosis, provision of primary treatment, supplementation to in-person therapy, and the management of post-treatment conditions (Chandrashekar, 2018). Compared to other traditional platforms of care provision, mental health apps provide an excellent choice for the delivery of psychological treatment because of ease of habit, lower effort expectancy, and high hedonic motivation.

It is also important to note that the apps provide high patient-engagement opportunities since they can use them during their own time without necessarily having a clinical oversight. This means that the patients are intrinsically motivated to engage with the app. With an improvement in in-app features such as real-time engagements, reminders of usage, and gamified interactions, patients can have an increased interest in using the apps, making it easier to collect more relevant data concerning the patient’s diagnosis, track symptoms, and monitor for improvements.

On the contrary, some evidence suggests that engagement with mobile apps may be particularly problematic in people with mental health conditions with unique barriers arising from symptoms associated with their condition and privacy concerns (Chan & Honey, 2021). For example, some symptoms of mental health conditions, such as depression and schizophrenia, include the lack of motivation to engage in everyday activities. Therefore, recommending mobile mental health apps is not likely to yield positive clinical outcomes in patients with significant impairment.

The data shared in mobile mental health apps include information about a patient’s behavior based on the details of daily activities, thoughts, and personal connections. Much of this data is sensitive information that puts the patient at risk for third-party misuse of their personal information. In addition, mental health workers are trained to follow evidence-based practice. They may therefore be reluctant to use mental health apps without adequate evidence for their effectiveness. Marshall et al. (2019) noted that mental health clinicians grapple with the ever-changing landscape of reviews on the effectiveness of apps and may avoid them. 

Some mental health apps lack vital features and may suffer from inconsistent patient engagement. This may make it difficult for patients to voluntarily access these apps, reducing the quality of care offered as they will not be able to provide adequate, reliable information concerning their health and symptoms progression. In addition, some mental health apps are driven more by commercial gains than scientific motivations. This makes them unreliable in managing patients’ symptoms and tracking the progression of their illnesses.

It is worth noting that mental health apps can also promote the medicalization of symptoms by patients instead of promoting access to care in the circumstances of stigma or medical mistrust. It is recommended that the value of flexibility when providing care and the need for privacy should be balanced with benefits and risks, clinical explanations of the evidence-based outcomes for the technology use, simplicity, and other alternative treatments to enhance the effectiveness of care.

In as much as mental health apps have gone a long way in reducing the stigma associated with mental health conditions, some of these apps may not address the issue of overdiagnosis and overtreatment, which may be detrimental to the physical, emotional, and mental well-being of the patient. They may delay early interventions and pose a privacy threat to the users. Therefore, even though these mental health apps may appear compelling and appealing, careful considerations should be made to avoid enhancing the problem rather than mitigating it.

An appraisal of the available research evidence for the efficacy and acceptability of mobile apps to support the management of mental health in adolescents by Grist et al. (2017) identified 24 papers describing 15 apps or prototypes, two of which were available for download. The authors only identified two small randomized controlled trials, one of which was a laboratory-based experimental study. Both studies failed to demonstrate a significant effect of their intended consequences. The authors concluded that there is currently insufficient research evidence to support the effectiveness of mental health apps among adolescents with mental health problems. They cautioned clinicians against recommending mobile apps until sufficient evidence supports their safety and efficacy.

Despite the above opposing arguments, patients still have a positive view of mental health apps. The apps are usually recommended as an adjunct to treatment. Thus, they can still be used safely, even in patients with depression and schizophrenia, once they show clinical improvement. Careful selection of candidates for mental health app users can also optimize the technology’s benefits. Clinicians should use the same. Even though the effectiveness of mental health apps in some conditions is still debatable, there are other conditions in which their use is supported by substantial evidence. The ongoing research on the effectiveness of mental health apps will ensure evidence-based data support their use. Lastly, privacy concerns are currently being addressed by technology vendors. The encryption of data shared by patients and hospital policies that guide the utilization of patient data will ensure that patient privacy concerns are addressed.

References

Wang, K., Varma, D. S., & Prosperi, M. (2018). A systematic review of the effectiveness of mobile apps for monitoring and management of mental health symptoms or disorders. Journal of Psychiatric Research, 107, 73–78. https://doi.org/10.1016/j.jpsychires.2018.10.006

Marshall, J. M., Dunstan, D. A., & Bartik, W. (2019). Clinical or gimmickal: The use and effectiveness of mobile mental health apps for treating anxiety and depression. Australian & New Zealand Journal of Psychiatry, 54(1), 20–28. https://doi.org/10.1177/0004867419876700

Ahmed, A., Ali, N., Giannicchi, A., Abd-alrazaq, A. A., Ahmed, M. A. S., Aziz, S., & Househ, M. (2021). Mobile applications for mental health self-care: A scoping review. Computer Methods and Programs in Biomedicine Update, 1, 100041. https://doi.org/10.1016/j.cmpbup.2021.100041

Chandrashekar, P. (2018). Do mental health mobile apps work: evidence and recommendations for designing high-efficacy mental health mobile apps. MHealth, 4(6), 6–6. https://doi.org/10.21037/mhealth.2018.03.02

Chan, A. H. Y., & Honey, M. L. L. (2021). User perceptions of mobile digital apps for mental health: Acceptability and usability ‐ An integrative review. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.12744

Grist, R., Porter, J., & Stallard, P. (2017). Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review. Journal of Medical Internet Research, 19(5), e176. https://doi.org/10.2196/jmir.7332

Week 7 Discussion: Communities and Disaster Preparedness

A pandemic or an epidemic is classified as a form of disaster. As the fight against the Covid-19 pandemic continues, several measures have been taken to ensure adequate preparedness to combat the effects of the infection and prevent further deaths. Vaccination against the virus is one such measure to combat its effects by activating the immune system against the weakened form of the virus, which will help the body respond adequately against future infections. Covid-19 vaccination has been met with resistance from the general population. This billboard erected along the road around my community encourages people to accept and take the vaccine. It reminds people that since vaccination against polio has been a success, there is enough proof that vaccination works in fighting diseases; hence they should get out and take the vaccine against covid-19 to stop the spread.

            One setting within the community impacted by this billboard is schools, but it also impacts all the other settings in the community. Schools are one of the places where people meet regularly and may sometimes be crowded, making it easy to spread the covid-19 virus from one person to another (World Health Organization, 2020). This billboard provides more information about the effectiveness of vaccines by comparing them to the polio vaccine, which has effectively eradicated poliomyelitis. It encourages people to get out and take the vaccine to enhance the fight against the pandemic. Its location is strategic as students and workers travelling from schools and their respective work environments can see the message and act appropriately.

            In schools, one nursing role related to the preparedness for the fight against covid-19 is as an educator (McIntosh et al., 2022). Nurses can educate students and teachers on the importance of the covid-19 vaccine, its side effects and the dangers of not being vaccinated. They can also provide information on how the vaccine works in activating immunity and preventing future infections, promoting acceptance and uptake of the vaccines among the students. One key stakeholder the nurse needs to collaborate with in school is the principal. This collaboration is important because, as the head of administrative functions in the school, the principal will facilitate the smooth running of the health education activities in the school and provide the necessary resources required for health education. The collaboration will also ensure that the students are organized and adequately prepared to learn.

Attachments

References

McIntosh, C. E., Brelage, P. K., Thomas, C. M., Wendel, J. M., & Phelps, B. E. (2022). The school nurse and COVID‐19 response. Psychology in the Schools. https://doi.org/10.1002/pits.22708

World Health Organization. (2020, September 18). Coronavirus disease (COVID-19): Schools. Www.who.int. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-schools