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NR 667 narrative template.doc

NR 667 narrative template.doc

Narrative Analysis Chamberlain College of Nursing NR 667: FNP Capstone Practicum and Intensive

NR 667 narrative template.doc

MSN Essential I asserts that the masters-prepared nurse have a background for practice grounded in sciences and humanities and integrates those scientific findings from the fields of nursing, biopsychosocial, genetics, public health, quality improvement, and organizational sciences so that there is continuous improvement in the various diverse settings involving nursing care (AACN, 2011). Essential II declares that the masters-prepared nurse understands that organizations and systems leadership that are rooted in ethical decision making, efficient interprofessional relationships, and a systems-perspective are important in the delivery of high- quality-safe patient care (AACN, 2011). Essential III establishes that the masters-prepared nurse should be well-versed in the methods, tools, performance measures, and standards that yield quality improvement and be inclined to use quality principles within an organization (AACN, 2011). Essential IV declares that the master’s prepared nurse executes outcomes from research in their practice setting, finds solutions for practice problems by working as a change agent, and disseminates results to the healthcare community (AACN, 2011) Essential V ensures that the masters-prepared nurse utilizes technology in patient care and communication that will transform the integration and coordination of care (AACN, 2011). Essential VI requires the masters- prepared nurse to arbitrate at the system level through involvement in policy development while advocating to influence health and health care (AACN, 2011). Essential VII encourages the masters-prepared nurse to work as a member and leader of interprofessional teams by communicating, collaborating, and consulting with other healthcare professionals to effectively manage and coordinate care (AACN, 2011). Essential VIII recognizes that the masters-prepared nurse should integrate concepts that are broad, organizational, client-centered, and culturally appropriate to plan, deliver, manage, and evaluate evidence-based clinical prevention and population care not only to individuals, but also to their families and the community as well

NR 667 narrative template.doc

(AACN, 2011). Essential IX defines masters-level nursing practice as any form of nursing intervention that elicits a change in the healthcare outcomes of individuals, populations, or systems and declares that the masters-prepared nurse possess an advanced level of understanding in nursing and other sciences and simultaneously understand how to integrate the knowledge into clinical practice through direct and indirect interventions (AACN, 2011). NONPF Core Competencies NONPF core competency number one involves the scientific foundation competencies and identifies that the masters-prepared nurse can critically analyze data and evidence that will improve the advanced nursing practice, integrate knowledge from humanities and sciences and apply it to the nursing profession, translate research and other knowledge in a manner that improves the processes and outcomes of practice, and develops new approaches to practice that is based on research, theory, and practice knowledge (NONPF, 2017). Core competency number two incorporates the leadership competencies and asserts that the masters-prepared nurse initiates and guides changes through involvement in complex and advanced leadership roles, fosters collaboration with a number of stakeholders through leadership to improve health care, incorporates leadership that utilizes critical and reflective thinking, strives for improved access to quality and cost-effective healthcare, participates in advancement of practice through developing and implementing innovations that promote principles of change, effectively communicates knowledge in writing and through oral communication, and involves themselves in professional organizations and activities that will positively influence the profession and health outcomes for a population (NONPF, 2017). Core competency number three is the quality competency and requires the masters-prepared nurse to use the best available evidence that will improve the quality of practice, consider the relationship between access, cost, quality, and safety to

NR 667 narrative template.doc

includes the ethics competencies and challenges the masters-prepared nurse to involve ethical principles during decision making, examine their decisions for ethical consequences, apply solutions that are ethically sounds when faced with complex issues related to individuals, populations, and systems of care (NONPF, 2017). Core competency nine incorporates the independent practice competencies and charges the masters-prepared nurse to function as a licensed independent practitioner while demonstrating the greatest level of accountability during professional practice and practice independently while managing patients previously diagnosed or undiagnosed using health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end of life care principles (NONPF, 2017). Additionally the masters-prepared nurse should be equipped to employ advanced health assessment skills to determine normal, variations of normal, and abnormal findings, utilize screening and diagnostic testing to develop diagnoses, prescribe medications within the scope of practice, manage health/ illness status of patients and families, provide patient-centered care that considers cultural diversity and includes the patient as an active member in the decision-making process (NONPF, 2017). Furthermore, the masters-prepared nurse embarks on a relationship with patients that is based on mutual respect, empathy, and collaboration to promote confidentiality, privacy, comfort, emotional support, trust, and respect (NONPF, 2017). Decisions should be made according to the patients cultural and spiritual preferences, values, and beliefs (NONPF, 2017). The masters-prepared nurse should recognize and develop strategies to prevent their own personal biases from interfering with delivery of high-quality, patient-centered care (NONPF, 2017). Additionally, the masters-prepared nurse is expected to actively participate in the development, implementation, and evaluation of professional standards and evidence- based care (NONPF, 2017).

NR 667 narrative template.doc

Course Artifacts NR 500: NP Role The Area of Interest PowerPoint assignment encouraged students to identify and discuss an area of interest pertinent to his or her specialty track. The student was to expand by identifying a common practice problem and recommend a way to positively affect change in their specialty track. I chose to address the challenges associated with the vaccination of children in the 21st^ century. This assignment shows evidence that I have met PO numbers two, three, four, and five, MSN Essentials I, II, IV, VI, and VIII, and NONPF core competency numbers one, two, three, four, seven, eight, and nine. The Addressing Bias assignment educated the student regarding the increasing diversity, globalization, and expanding technologies present in the healthcare system. It encouraged introspection to identify any personal biases. Students were challenged to create a plan to combat bias to promote not only professional growth but also personal growth. I expressed a personal bias that is implicit, or unintentional, to alcoholism and/or substance abuse due to a personal experience with a former spouse abusing alcohol. This assignment shows evidence that I have met PO numbers one, two, three, and five, MSN Essentials II and VIII, and NONPF core competency numbers two, eight, and nine. The Week Four Leadership: Establishing Relationships and Influencing Change Discussion encouraged development of interpersonal skills to prepare the student to become a leader and a change agent. This discussion asks the student how they plan to influence change and to identify two strengths possessed by the student that promotes leadership. The student was also to identify two areas of improvement as well as two strategies that will enhance leadership

NR 667 narrative template.doc

respond by making our nurses feel recognized and valued in order to maintain their professional integrity and drive (McIntosh & Sheppy, 2013). This will work to increase autonomous behaviors and improve self-image (McIntosh & Sheppy, 2013). We cannot expect to provide high-quality, holistic healthcare if we are not treated in the same fashion by our leaders. I plan to model these behaviors and actively use coping strategies to combat the stressors of the workplace to provide the best care for my patients. This assignment shows evidence that I have met PO numbers one, two, three, four, and five, MSN Essentials I, III, IV, VI, VII, and IX, and NONPF core competency number one, three, four, seven, eight, and nine. NR 503: Population Health The Evaluation of an Epidemiological Disease or Problem assignment calls for the student to incorporate knowledge and skills obtained during this course in order to practice problem solving with chronic population health issues and apply them to their current geographic area. I chose to discuss schizophrenia. Mental health illnesses are serious, chronic disorders that deserve the same attention and prompt intervention and follow-up as those chronic diseases like diabetes and heart disease. Schizophrenia, although rare, is a life-altering, chronic disease that can be identified, treated, and managed with careful consideration and attention from primary care providers. As stewards of the community, healthcare providers owe it to the aggregates of their community to be actively involved in the identification, treatment, and rehabilitation of those suffering from schizophrenia. Those suffering from mental health illnesses are members of a severely underserved population and when left untreated often result in severe financial, emotional, social, and environmental burden. This paper has sought to provide a background of the disease of schizophrenia, discuss any surveillance or reporting methods, provide a descriptive epidemiology analysis, analyze diagnostic and screening tools that are used, and provide a plan

NR 667 narrative template.doc

of action to address patients that are suffering from schizophrenia in an attempt to serve as advocates for this underserved and often stigmatized population. This assignment shows evidence that I have met PO numbers one and three, MSN Essentials I, IV, VI, VIII, and IX, and NONPF core competency numbers one, three, six, seven, eight, and nine. The Infectious Disease paper encouraged the exploration of communicable diseases to include epidemiology and the implications of the disease. I chose to cover varicella. According the American Association of Nurse Practitioners (2019), the nurse practitioner can uniquely provide management of healthcare needs while keeping the whole individual in mind. They believe that the nurse practitioner has a main focus of health promotion and prevention with an emphasis on education and counseling in order to empower patients to make healthier choices all while lowering the cost of healthcare (AANP, 2019). Nurse practitioners must be knowledgeable in the pathophysiology, treatment, and management of infectious diseases. He or she must also be up to date on those diseases that are reportable due to their infectious nature. The nurse practitioner must be diligent in providing primary prevention by initiating education to the public regarding communicable diseases, secondary prevention measures by screening high risk individuals for communicable diseases, and tertiary prevention by restoring the health of those affected by communicable diseases. It is also important that the nurse practitioner stay current on the epidemiological dynamics of communicable diseases in his or her area by using the most up- to-date research to provide evidence-based practice. This assignment shows evidence that I have met PO numbers one, two, and five, MSN Essentials I, IV, VI, and VIII, and NONPF core competency numbers one, three, seven, and nine. The Week Eight Health Policy and Ethics Discussion charged the student to navigate their state government web page to identify a health policy enacted in the last two years and

NR 667 narrative template.doc

measures (Adams, Hall, & Fulghum, 2014). Concurrently, the higher the perceived likelihood of contracting the disease or illness, the more likely they will engage in preventative care (Adams, Hall, & Fulghum, 2014). This assignment shows evidence that I have met PO numbers one, two, three, four, and five, MSN Essentials I, II, III, IV, VI, and VIII, and NONPF core competency numbers one, three, four, six, eight, and nine. The Research Literature, Design, Sampling, and Implementation assignment expands on the EBP proposal project that began in week two of the course. This assignment calls for the discussion of the research needed to support the concern, the identification of the research design, explanation of the sample method, and implementation through a change model. The process of reviewing literature in nursing research provides alignment of available research information with the goal of improving patient outcomes (Baker, 2016). The information reviewed provides foundational information about what is known and identifies any gaps in knowledge (Baker, 2016). The literature review for this EBP project will provide a basis and allow for expansion and understanding of the impact of individualized education regarding the concerns of parents of children aged birth to six months and the decision to accept, delay, or refuse vaccinations. Ten research articles were analyzed for the purpose, research approach, data collection methods, results, strengths, and limitations. This EBP project will make use of a qualitative research approach using a phenomenological design. Qualitative research approaches study individuals in their natural environment and seek to find meaning in their lived experiences and perceptions. In particular, the phenomenological design is used to evaluate the experiences of individuals as they are actively living and in their natural settings. The researcher using this design has a desire to understand why the participants feels a certain way or choose a certain choice (Farghaly, 2018). The sampling method that will be used is a non-probability sampling

NR 667 narrative template.doc

method meaning that it is not randomized. Edward Deming produces the PDSA change model to enable knowledge development and implement a change in behavior (Donnelly & Kirk, 2015). PDSA is an acronym for plan, do, study, and act (Donnelly & Kirk, 2015). Using the PDSA change model for this EBP project is appropriate because the problem of vaccination delay or refusal is increasing with no proven method of changing the minds of parents. This assignment shows evidence that I have met PO number four, MSN Essentials I, III, IV, VI, and VIII, and NONPF core competency numbers one, two, three, four, six, and nine. The Data Collection, Analysis, Evaluation, Dissemination of Results, and Conclusion assignment serves as the completion of the EBP proposal project which began in week two of this course. It is in this assignment that the student focused on data collection, analysis, evaluation, dissemination of results, and the conclusion. For this evidence-based practice (EBP) proposal project, a qualitative design is used with a PICo question to assess the impact of education that is tailored to the concerns and needs of the parent affect the parent’s decision to accept, delay, or refuse vaccinations. The data will be collected with a pre-visit survey to assess concerns regarding vaccination and intent to vaccinate along with a post-visit telephone interview to assess effectiveness of the individualized education. The telephone interviews will also assess for any remaining concerns or teachable moments as well as intent to vaccinate. Records will also be analyzed to monitor for adherence to suggested vaccination schedules. In this qualitative EBP proposal project, data is analyzed by the use of coding to identify themes among parents regarding what drives their hesitancy toward childhood vaccinations and the impact that educational interventions have on their intent to vaccinate. Codes will be formed after analyzing the follow-up telephone interviews by identifying similar words or thoughts. Themes will emerge after evaluation of relationships during coding. Codes will be sorted into

NR 667 narrative template.doc

assignment shows evidence that I have met PO numbers one and five, MSN Essentials I and III, and NONPF core competency numbers one and three. The Week One Shadow Health assignment involved the interview and comprehensive health history of Ms. Jones’ recent right foot injury. The student was provided the opportunity to practice effective therapeutic communication skills to educate and empathize with Ms. Jones. The student was to create a problem list from the data collected during the interview and prioritize the data into immediate and non-immediate care while planning the best way to address the most important issue through assessment, intervention, and education. The information was documented using the SOAP note template. This assignment shows evidence that I have met PO numbers one, two, and five, MSN Essentials I, IV, V, VII, and IX, and NONPF core competency numbers one, five, and nine. The Week Six Shadow Health assignment allowed the student to encounter Daniel Rivera, an 8-year-old boy with the chief complaint of a cough. The student was to determine if the patient was in any distress, explore the underlying cause, and investigate for related symptoms in other body systems. It challenged the student to differentiate the presenting symptoms as well as perform a physical exam. The visit was to be documented using the SOAP note template. In this assignment, the student was also tasked with identifying three differential diagnoses with ICD-10 codes as well as pertinent positives and negatives for each diagnosis. The student was also to produce a comprehensive treatment plan including diagnostics, medications, education, referral/consultation, and follow-up. This assignment shows evidence that I have met PO numbers one, two, and five, MSN Essentials I, IV, V, VII, and IX, and NONPF core competency numbers one, five, and nine. NR 510: Leadership and Policy

NR 667 narrative template.doc

The APN Professional Development paper provided the student with the opportunity to research the role of the APN and develop and professional plan. This assignment discussed the goals and purpose of the APN professional development plan, the APN scope of practice in the student’s state, a personal assessment of Benner’s Self-Assessment Tool, strategies for networking and marketing, and completion of a CV/resume. This assignment shows evidence that I have met PO number three, MSN Essentials II, III, IV, V, and IX, and NONPF core competency numbers five, seven, and nine. The Recorded LACE presentation challenged the student to investigate how licensure, accreditation, certification, and education (LACE) differ for all four APN clinical roles in California, Washington, and Illinois. Additionally, the student was to share the evidence-based strategies that could be implemented to foster continuity between state regulatory boards. The student was to identify if independent NP practice was allowed in their state and to share their opinions in relation to independent practice in their state. This assignment was completed via PowerPoint with a visual and audio presentation in Kaltura. This assignment shows evidence that I have met PO number four, MSN Essentials II, III, IV, V, and IX, and NONPF core competency numbers two, four, five, six, seven, and nine. In the Health Policy Concern assignment, the student was able to select a healthcare policy concern that can be improved if changed with the potential of improvement as an outcome for a population group. Students were asked to present the change proposal to an elected official and then analyze the project. I spoke with the head of the school board about reports of sexual misconduct of teachers with students and proposed a change in policy that would teach susceptible students how to recognize inappropriate behaviors and how to seek help. This assignment shows evidence that I have met PO numbers two, three, and five, MSN Essentials I,

NR 667 narrative template.doc

how practice would be impacted by the topic, and the informatic skills used during the development process of the assignment in a visual and audio presentation using PowerPoint and Kaltura. This assignment shows evidence that I have met PO numbers four and five, MSN Essentials I, III, IV, and V, and NONPF core competency numbers one, three, five, six, and nine. The Week Two Wisdom Versus Judgement Discussion asks the student how the concept of wisdom in nursing informatics compares to the concept of professional nursing judgement. The student was asked to define DIKW and discuss how it is used in practice. As stated by McGonigle and Mastrian (2018), the concept of wisdom to the DIKW Paradigm was added in

2008. Wisdom occurs when a nurse learns to apply knowledge learned through the information obtained by collecting data specific to a patient (McGonigle & Mastrian, 2018). The nurse accomplishes this through learned knowledge and experience which, in turn, boosts the common sense allowing him or her consider the values of the patient and exercise appropriate judgment to provide high-quality, safe care to patients and their families (McGonigle & Mastrian, 2018). I view professional nursing judgment as the ability of the nurse to provide appropriate ethical care to patients in the most prudent manner while considering the individual needs of the patient to provide holistic care in a cost-effective manner. The difference between wisdom and professional nursing judgment is that wisdom can only be achieved through the application of knowledge and experience, while a novice nurse can apply the information obtained through nursing education to come to sound professional nursing judgment. The DIKW framework was conducted by Graves and Cocoran and incorporates the central concepts of data, information, knowledge, and wisdom (Ronquillo, Currie, & Rodney, 2016). Data are separate items observed objectively without the use of interpretation (Ronquillo, Currie, & Rodney, 2016). Information is obtained when data organized and interpreted (Ronquillo, Currie, & Rodney, 2016). Once

NR 667 narrative template.doc

information is integrated and established, knowledge occurs (Ronquillo, Currie, & Rodney, 2016). Wisdom is the result of knowing when and how to apply knowledge for the benefit of patient outcomes (Ronquillo, Currie, & Rodney, 2016). Nurses use the DIKW framework without knowing that they use it. For example, in my work as a cardiac nurse on a progressive cardiac unit I assess my patients to arbitrate their needs. I do this by collecting data to evaluate and understand the situation at hand to make an informed decision about the interventions that will be used while considering my experience with similar cases and the individual values of the patients themselves. This assignment shows evidence that I have met PO numbers one, two, three, and five, MSN Essentials V and IX, and NONPF core competency numbers two, five, and nine. NR 601: Aging The Case Study assignment challenged the student to evaluate subjective and objective data to diagnose and develop a treatment plan for the case study patient. The student was directed to use the national diabetes guidelines as well as other national guidelines to manage secondary diagnoses. This assignment challenged the student to analyze data to diagnose, treat, and manage the health of a 55-year old Hispanic female with a chief complaint of fatigue and decreased level of energy. The primary diagnosis for Mrs. G is type 2 diabetes mellitus (ICD- E11.9) (Type 2 diabetes mellitus, 2016). A secondary diagnosis for Mrs. G is hyperlipidemia (ICD-10 E78.5) (Hyperlipidemia, 2016). Diabetes is a chronic disorder that can result in multiple complications and comorbidities that could extensively decrease quality of life and length of life. However, these complications can be decreased very easily with the introduction of medications and lifestyle modifications that will also work to decrease the secondary diagnosis of hyperlipemia. If Mrs. G were not treated promptly, she could very easily lose life or limb. This