GCU Health & Medical Advanced Registered Nurse Specialty Questions

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Week 1 DQ 1 Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes? We are leap years ahead of what was even imagined in the days of Florence Nightingale. From simply learning washing your hands saves lives and wooden legs as prosthetics to medical technology that is so advanced that a robot can independently complete surgery while the surgeon watches from a screen. Nurses in the 20th century were the first nurses to have formal nursing education after Florence Nightingale pioneered the opening of formalized school for nurses. Soon after that nursing schools were popping up across the US. Most schools were run by nuns and local hospitals were operated by the student nurses themselves. Advanced nurses have really blossomed over the last several decades compared to when they never over spoke a physician’s word or possible reprimand would surely ensue in the early years of their practice. Today we have valued opinions, more autonomy, better focused education and specialty practices. Though we have come a long way in earning our place within the medical world there is still much to be done. Such as, obtain equally liberties of overseeing total care for patients and prescribing medicines across the US independently. Many states have granted these liberties most have not. According to a study conducted by the RWJF, nurses are at a position to bridge the gap that the United States is facing with coverage and access to quality patient care by fulfilling their potential as primary care providers. Let’s face it without nurses, who make up most of the medical profession, we would be in a crisis because there is not enough Doctors to cover the amount of people living within the US. The AACN projects a nursing shortage by 2030 when baby boomers need for frequent healthcare increases, which would be a perfect opportunity to focus on increasing education and autonomy of the advance practice registered nurses. I believe in the near future advance practice nurses will have a wider scope of practice to include independent practice, prescribing and diagnosing across the entire United States of America. DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124 Week 1 DQ 2 Refer to the consensus report of the National Academies of Sciences, Engineering, and Medicine, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, provided in the topic Resources. Identify recommendations for nursing education you believe will be most effective or radical in creating change within the industry. Provide rationale based on your experience in practice. Do you agree or disagree with how the report describes the evolution of the advanced practice registered nurse role? Why or why not? I do agree in some respects to advanced practice nurses assuming more responsibilities in certain capacities. Though, I am hesitant to link them equivalent with DO/MDs as our (Masters) in school education and residency time does not equally match their level of expert. It is one recommendation by the National Academies of Sciences, Engineering, and Medicine, to implement nurse residency programs and add to the APRNs education base and this is something that can further the possibly of someday being more independent in all states. A thought that comes to mind is that at that point are APRNs or doctors? A few strong points of the report are to allow the APRN scope of practice be reformed that they can practice in all states equally. “Reform scope-of-practice regulations to conform to the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules” (Article XVIII, Chapter 18). They proposed a way to gain this agreement is to limit funding to the states that do not comply with these new regulations. I do not agree with this approach. For the simple fact that there may not be enough practicing APRNs in that state and secondly the patients then suffer with lack of health funding from federal levels and usually these patients are the underserved population. I believe there is a better way and in time these states will need to change the scope of practice to accommodate the ever-rising baby boomer population. Intimidation is to make someone fearful, forcing their victims into doing what they want the person to do. This extends to the masses. Clearly, we are seeing this more prevalent today. When it comes to mass populations the situation can give the oppressor power, this is the case here. Intimidation is not godly and cannot be good. We can do better as an organized government and give the reasons why it needs to be done, educate, and vote these changes into place. A full scope of practice reform for the APRN is warranted and for all the states of the US. I strongly agree with Medicare reform to accommodate proper pay scale for the APRNs in and out of the hospitals. They are pulling a workload of, at times, of two doctors in some cases. They should be paid a fair wage. Like MD/DOs they give up personal time, vacations, ability to have a family, children’s events, and much more to the job. This many times is overlooked because they do not bare a different title. If the job that is being carried out, whether it be a MD or an APRN, is the same in respect to education and scope of practice then the pay should be the same. Mary K. Wakefield, David R. Williams (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982. Week 2 DQ 1 Two regulatory bodies for the state of Arizona include AZ State Board of Nursing and AZ State Legislature. When the AZ State board of Nursing sets scope of practice for nurses and advanced practice nurses this document must then be sign and approved by the governor of AZ. Within the scope of practice for the APRN its states that, “Nurse practitioner scope of practice is derived from their educational preparation, the validation of their education through the attainment of board certification, and licensure that grants the legal authority to practice. Scope of practice is further delineated by the patient’s needs and is not setting specific” (AZBN.gov, 2022). I find this vague and somewhat concerning. When practicing independently with prescribing authority having a straightforward guide or scope of practice is a safeguard in a sense. Arizona allows NP/ACNP to practice independently. The question at this point is, should they then be governed by the medical board? Interesting to think about. Another interesting advisement within the scope of practice document states that the Board doesn’t regulate the procedures that a practitioner performs and the only regulation they must adhere to is to have official training with certifications to perform additional to that in which they learned during school (AZBN, 2021) This broad spectrum of unknown scope could potentially allow the practitioner to cross a line in their daily practice and cause risk for liability if then deemed he/she was practicing outside the scope of practice. Moving forward to allow states to adopt and follow the APRN Consensus Model would than allow for precise or close to practicing regulations and scope. Having uniformity is a must and the faster all states and regulatory bodies come together we than can start to see better patient outcomes and more well-rounded advanced practice nurses NCSBN, 2022). Arizona State Board of Nursing. (2018). Arizona State Board of Nursing. Nurse Practice Act | Arizona State Board of Nursing. Retrieved September 10, 2022, from https://www.azbn.gov/education/nursepractice-act Arizona. American Association of Nurse Practitioners. (n.d.). Retrieved September 10, 2022, from https://www.aanp.org/advocacy/arizona National Council of State Boards of Nursing, Inc. (2022). APRN Consensus model. NCSBN. Retrieved September 10, 2022, from https://ncsbn.org/aprn-consensus.htm Arizona Board of Nursing. (2021, July). APRN scope of Practice Q&A final – AZBN. APRN Questions & Answers SCOPE OF PRACTICE: Nurse Practitioners. Retrieved September 10, 2022, from https://www.azbn.gov/sites/default/files/202107/APRN%20Scope%20of%20Practice%20Q%26A%20FINAL%205-2021.pdf Week 2 DQ 2 Comparing the ethical guidelines between a FNP and a ACNP is a simple one. According to the American Nurses Association there are four main guidelines an NP needs to adhere to which include autonomy, beneficence, justice and non-maleficence (ana.org, 2022). These guidelines extend to the ACNP as well. All clinicians must uphold an ethical guideline and self-compass the, at times in cloudy, ethical dilemma situations. As providers we are held to an ethical code of conduct and when we miss the mark there can be devastating consequences. Not only does these broken codes leave us open to legal troubles but can send practitioners into a mental health breakdown. Humans hold themselves personally responsible for these gone wrong situations even when they are unintentionally or intentionally produced. An ethical situation that can arise in the hospital setting can look very different than in a visit to a PCP. Delivering excellent patient care can be challenging in a hospital setting when the patient’s level of acuity, family dynamics and what the hospital can deliver fall short, and this can be frustrating when the patient care is compromised. The ACNP can then struggle with setting personal-professional boundaries. Patients have high expectations when placed in the hospital that they will receive great patient care and as they should. This pressure may cause the ACNP to promise outcomes that may not be tangible. This level of care is very different compared to receiving preventative and or health management. There is more time and a different level of expectation for a primary care provider. On the other hand, the patient-PCP relationship can be challenging as well. The relationship between the patient an NP can be many years and when a provider becomes comfortable, they may allow the relationship to move from professional to personal. This can cause an ethical dilemma and the reputation of the provider and care of the patient is then compromised. American Nurses Association Code of Ethics for Nurses with Interpretive Statements. http://www.nursingworld.org/code-of-ethics. Accessed February 8, 2018. Week 3 DQ 1 Personal worldview is, for me, ever evolving to be the best human being and lover of other people possible. I am always learning and changing the meaning of what I consider my worldview. I have deep and meaningful conversations on this subject and yet I find it difficult to put my personal views into words on a paper. As a woman of a tragic past, fulfilling present and bright future I shy from letting others into what I consider a personal worldview. This must be a protection mechanism that is put in place to stare away from rejection, ridicule and disappointment. I am a glass half full kind of person and I let the guidance of God directed my paths whether it be how I am professionally, as mother, as friend and as a wife. My nursing worldview philosophy is one of complete care, delivering compassionate and culturally sensitive care to patients and their families. To me nursing is about compassion and trying to understand human beings on all emotional, spiritual and physical levels. It is a profession which uses evidence-based practices yet displays a comprehensive understanding of human beings. As a professional nurse, I feel a personal commitment toward lifelong learning, through education and hands-on experience to better myself and my nursing knowledge. I take a slight pause to say the most important worldview I carry most dear is that of faith in my Lord Jesus Christ and to let his commandments be an ever strong, precise guide in my life. I find when my life is surrendered to Him that the pieces align to His will for my worldly path. Every decision I make for my patients is always in goodness and will be blessed by God. In Philippian’s 2:13 Apostle Paul writes, “for it is God who works in you to will and to act in orders to fulfill His good purpose” (Holy Bible, AD 61). I believe taking a holistic approach when caring for my patients and their families is of highest importance. I believe that nursing is an occupation consisting of professional individuals that exhibit and express compassion, respect, dignity, and integrity to their patients and fellow coworkers. My personal philosophy is to first and foremost be a patient advocate, through clear communication, education, and applying critical thinking, and decision-making skills to help better the patients’ outcome. As a Family Nurse Practitioner, it is important to me to provide the highest quality of nursing care possible to achieve excellence in patient results, while simultaneously, providing a safe healing environment. I believe that it is imperative to consider the economics of clinical practice. I believe the fiscal responsibility is equally part of the nursing profession and can be seen as a way of also caring for your patient. I believe that nursing care is a profession that comes straight from the heart. It is a calling on one’s life. Providing protection from harm and putting our patients’ well-being first. I believe that nursing is an occupation consisting of professional individuals that exhibit and express compassion, respect, dignity, and integrity to their patients and fellow coworkers. I believe wholeheartedly in providing quality patient centered care with dedication to my colleagues, patients and families in and around my community. From paper: My personal worldview is characterized by a desire for consistent evolution towards being a lover of other human beings and being the best in my endeavors. Consequently, my worldview is based on an intent to offer complete care while providing empathetic and culturally sensitive care to individuals and families. I consider nursing to be largely based on compassion and the desire to understand human beings on the physical, spiritual, and emotional levels. Even though the profession of nursing is guided by evidence-based interventions, it is rightly anchored in human understanding and compassion (Durkin, Gurbutt, and Carson, 2018). As a professional in the healthcare sector, I harbor a personal commitment to consistent learning through hands-on experience and formal training. In so doing, I will realize the personal objective of imparting significant impacts on individuals and families and improving my nursing knowledge. In turn, my personal worldview inclines towards the provision of safe healing environments for patients. Personal Worldview My personal worldview is shaped by my religious faith in the Lord Jesus Christ and His salvation. Consequently, I am largely influenced by the commandments of Christ, which impart a strong and precise influence over my life. Through my association with the Christian faith, I have observed that my undertakings have aligned with God’s will for my worldly path. As such, I strive to make all decisions about my patients with the hope of achieving goodness and pleasing my God. As noted in Philippians 2: 13, “it is God who works in us to will and to act in orders that fulfill His good purpose.” My understanding of cultural diversity has also affected my personal philosophy of practice and attitude towards patient care. Indeed, I strive to first be an advocate for my patients in ways that facilitates the improvement of their lives through critical thinking and decision-making. Based on the need to provide the best care, I have committed towards lifelong education and clear communication with patients. Personal Philosophy My personal philosophy of practice is best understood through the theory of human caring as advanced by Jean Watson. According to the theory of human caring, the department of care regenerates new energies and elicits new capabilities in both the patients and the caregivers (Wei et al., 2019). This theory is consistent with my worldview regarding the universal and mutually beneficial experiences of providing care to the sick. My spiritual and personal attitude towards care for patients is anchored on the notion of care being a service to God. Even though I have not been engaged in direct service to God through evangelism, the expectation for service to God can be achieved through nursing practice. The theory of human caring promotes the centrality of care in helping nurses to affirm concern and kindness for patients. The provision of care to vulnerable patients is also guided by the consideration of the patient’s best interests. This theory motivates me to provide the best possible care to my patients in consistency with my personal worldview. Tarsus, P. (n.d.). Holy Bible (KJV) – philippians 2. Philippians 2. Retrieved September 20, 2022, from https://genius.com/Holy-bible-kjv-philippians-2 Week 7 DQ1 The seven steps that produce EBP changes include the following, first asking a clinical PICOT question, this involves a patient population (P), a subject wanting investigated or interested in(I), comparison intervention or group being studied (C), the outcomes that took place (O), and time for the study and time to implement the change into practice (T). This provides a framework for research and the medical community to thoroughly conduct and carry out a successful evidence-based study and implement it into practice. Steps two through seven include searching for evidence, appraisal of the evidence, integrate the evidence, evaluate the changes that integrated into practice, chare the information within the medical community so it is not duplicated. Within perioperative nursing it can be hard for nurses to utilize EBP and implement it into practice (Stucky et al., 2020). I find this to be correct. In the surgery setting when are nurse has been doing the same procedures for years and the outcomes are always good it can be hard to adopt a new protocol when they feel the protocol, they have used for years works. This results in slowed integration of EBP. Stucky, C. H., De Jong, M. J., & Rodriguez, J. A. (2020). A Five‐Step Evidence‐Based Practice Primer for Perioperative RNs. AORN Journal, 112(5), 506–515. https://doiorg.lopes.idm.oclc.org/10.1002/aorn.13220 Melnyk, B. M., & Fineout-Overhold, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins. Week 7 DQ 2 This can be a topic that may stir much controversy, especially in today’s healthcare system since the pandemic of COVID19 began. Some nurses would argue, myself included, they have seen ethics fall by the wayside to usher in more policy and protocol without backed sound research. What is policy and protocol without a code of ethics? Some would say the foundations of trust and the lives of patients are in great danger when ethical and moral decision making is taken out of the process of implementing new research into practice while making of policy and protocol. For example, I personally witnessed both PCPs and hospital doctors refusing to provide care to unvaccinated patients…this is an ethical line that was crossed and now patients are reaping the consequences. I have treated patients from all walks of life from drug addicted, child sex rapist to gang members and never did I witness a doctor refuse care to any of them despite their differing opinions on lifestyle or criminal behavior. Have nurses and doctors forgotten their code of ethics for fear of what may ensue if they go against the narrative? I don’t know that answer, but it seems this subject needs some tending to. This type of movement we are seeing affects healthcare workers across the world and in every setting. Many conversations with patients have been discussed and pondered as to why a family NP refused care to their patient for fear of retaliation of doing the right thing. The question remains, does this violate the oat they took to do no harm? Moving forward as a FNP these are some of the issues we must face and resolve to deliver safe and effective care to our patients daily. As a FNP I will always treat my patients regardless of my personal beliefs on a medications, religion or vaccination because it is my duty to treat and care for all Gods people the way I would want to be treated. According to Jodi O’Malley MSN, RN, things would be very different “If we had only adhered to the best available science, which is evidence-based practice to guide our decisions, the effects wouldn’t have been so catastrophic” and I would have to agree with this statement. She further goes on to list the 4 principles of the nursing code of ethics. which are listed below: “4 main principles are part of the nursing code of ethics. In short, they are, 1-Autonomy- is recognizing the patient’s right to self-determination and decision-making. The nurse’s duty is to ensure that patients receive all medical information, education, and options in order to choose the option that is best for them. This includes all potential risks, benefits, and complications to make well-informed decisions. Once they have all the relevant information, the medical and nursing team can make a plan of care in compliance with the medical wishes of the patient. A nurse’s duty and ethical obligation are to the patient first and foremost. If the medical team does not agree with the patient’s decision, it is the nurse’s duty to advocate for the patient, despite their disagreement. 2-Beneficence- Simply stated, compassion involves empathy or genuine concern for patients while waiting to take steps to alleviate a patient’s need or suffering. 3-Justice- regardless of the individual’s financial abilities, race, religion, gender, and/or sexual orientation (vaccination status), there should always be a fair distribution of resources and provision of individuals’ equal treatment and care. 4-non-maleficence- the most well-known of all the principles is “Do No Harm.” More specifically, it is selecting interventions and care that will cause the least amount of harm to achieve a beneficial outcome. The principle of nonmaleficence ensures the safety of the patient and community in all aspects of healthcare delivery. Nurses are also responsible for reporting treatment options that are causing significant harm to a patient, which may include vaccine adverse events” (O’Malley, 2022). This is a reminder to us all to not forget that EBP and ethics play a major role in the service to our patients. O’Malley, J. (2022, October 1). Why did nurses and physicians forget their oaths? Retrieved October 17, 2022, from https://www.americaoutloud.com/ethics-in-healthcare-why-did-nurses-and-physiciansforget-their-oaths/ Kelly, R. (2022, March 21). Evidence-based practice. Evidence-Based Practice. Retrieved October 17, 2022, from https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/evidencebased-practice.html APA Writing Checklist Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center. ☐ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout. ☐ The title page is present. APA format is applied correctly. There are no errors. ☐ The introduction is present. APA format is applied correctly. There are no errors. ☐ Topic is well defined. ☐ Strong thesis statement is included in the introduction of the paper. ☐ The thesis statement is consistently threaded throughout the paper and included in the conclusion. ☐ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors. ☐ All sources are cited. APA style and format are correctly applied and are free from error. ☐ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error. Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience. Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries. Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline. Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion. Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library. ☐ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing. © 2022. Grand Canyon University. All Rights Reserved.

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