Module 10 Case study- mREEN

Read the following case study and answer the reflective questions.  Please provide evidence-based rationales for your answers.  APA, 7th ed. must be followed. 

aswpos2

Respond to what he wrote, be argumentative with the answers, and polite. References, and at least 2 paragraphs.

 

 

In the last decade, there have been a lot of changes to the model of practice of advanced practice registered nurses (APRNs) in Northern America. During the pandemic, legislative changes enabled nurse practitioners (NPs) in some states to act in the role of medical doctors, thereby empowering them to work to their full scope of practice. This has resulted in a higher quality of care, decreased hospitalization rates, improved access to care, and the creation of an improved working environment for direct care providers (McGilton et al., 2023). For the purpose of this discussion post, the practice agreements, process of certification and licensure as an APRN in North Carolina, the scope of practice of nurse practitioners, how to get Drug Enforcement Administration (DEA) license, and controlled substance prescriptive authority for NPs will be summarized. Also, the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in North Carolina will be explained.

Summary of Findings

Certain criteria need to be met before an individual can be licensed as an Advanced Practice Registered Nurse (APRN) in the state of North Carolina. A lot of information on certification and licensure can be found on 
www.ncbon.com
Links to an external site.
, which is the North Carolina Board of Nursing (NCBON) website. One must hold a North Carolina Registered Nurse license or a compact state license that is valid to practice in North Carolina. A master’s or higher degree in nursing must be completed. Additionally, a national certification as a nurse practitioner must be obtained from one of the nationally accredited credentialling bodies, and a registration with the North Carolina Controlled Substance Reporting System (CSRS) is required for those that have prescriptive authority for controlled substances. The North Carolina CSRS exists through the North Carolina Department of Health and Human Services to collect information on dispensed controlled substance prescriptions and make this information available to prescribers and dispensers (North Carolina Department of Health and Human Services, n.d.).

The scope of practice of an APRN in North Carolina required being educationally prepared, nationally certified, and maintenance of competence. The APRN is required to promote and maintain health; prevent illness and disability; diagnose, treat, and manage acute and chronic illnesses; guide and counsel individuals and their families; prescribe, administer, and dispense therapeutic measures, tests, procedures, and drugs; plan for situations beyond the nurse practitioner's scope of practice and expertise by consulting with and referring to other health care providers as appropriate; and evaluate health outcomes (Office of Administrative Hearing, 2019). According to the North Carolina Board of Nursing (2022), nurse practitioners have the approval to prescribe legend drugs and Controlled Substance Schedules II – V, which is consistent with the scope of practice determined by their educational preparation and national certification. Professionals who prescribe controlled substances must fully comply with both North Carolina’s state and federal rules and regulations. A nurse practitioner who administers, dispenses, or prescribes any controlled substance, must be registered with the federal Drug Enforcement Administration (DEA). In North Carolina, this process requires applying for DEA registration, paying the required fees, completing, and submitting DEA for 106.

In North Carolina, an APRN requires a collaborative practice agreement with a licensed physician. Therefore, upon completing an advanced degree and obtaining licensure, an APRN needs to apply for an ‘Initial Approval to Practice’. What this application entails is an active North Carolina Registered Nurse license; the physician’s name, their license number, or email address; and the practice information. After all these have been submitted and approved, the APRN can begin practicing in North Carolina (North Carolina Board of Nursing, n.d.).

Types of Regulations that Exist and the Barriers that May Impact Nurse Practitioner Independent Practice

From the research findings, there are regulations, and some barriers exist that may impact nurse practitioner independent practice in North Carolina. For instance, the scope of practice laws defines the activities and responsibilities that healthcare professionals are allowed to engage in. In North Carolina, there is a need for physician oversight, and there is a need for physician collaboration. Also, we are required to have collaborative practice agreements with physicians. Collaborative Practice Agreement (CPA) is an agreement between the nurse practitioner (NP) and the primary supervising physician addressing how the NP operates the administrative code or rules in their practice (North Carolina Board of Nursing, 2023). These agreements outline the relationship and level of collaboration between the nurse practitioner and the physician. Components that are included in the collaborative practice agreement are the drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner. Additionally, prescriptive authority is part of the nurse practitioner approval to practice. A nurse practitioner may prescribe controlled substances; however, the supervising physician must have a DEA registration equal to or greater than the DEA registration of the nurse practitioner that he or she supervises. Finally, regulatory bodies exist to set regulations for APRNs. These boards can influence the level of autonomy nurse practitioners have in their practice in North Carolina.

Some of these regulations pose a major barrier that may impact the nurse practitioner’s ability to practice independently. To begin with, the scope of practice restrictions can be very challenging because it limits the ability to provide care independently. Also, due to the collaborative practice agreements that are needed from a physician, we experience a lot of opposition from physician associations and groups. They cite that they have concerns about patient safety and the need for the role of physicians in the health care team. To add to these barriers, there are challenges as to how the public perceives the role and capabilities of nurse practitioners. Patient and public understanding of the role and capabilities of nurse practitioners can influence the acceptance of independent practice. Educating the public about the training and expertise of nurse practitioners is very crucial for acceptance. Nurse practitioners may also face challenges in being recognized by insurance providers and receiving reimbursement for their services at the same rate as physicians. According to Barnes et al. (2017), in a lot of states, nurse practitioners are reimbursed less than the physician rate, varying from 75% to 100% of physician rates. A lot of legislative processes are ongoing to have nurse practitioners receive 100% reimbursement from Medicare. Currently, reimbursement is only provided at about 85% of the physician rate in most states (Bischof & Greenberg, 2021).

All this information did not come as a surprise to me because during this program, we have been required to carry out research findings on related issues. This has enlightened me to the state regulations for the scope of practice of nurse practitioners in my state. I have educated myself on these requirements and learned a lot from my preceptors and senior colleagues in the field of psychiatric mental health. I believe that I am well prepared for all these upon completion of my degree.

Conclusion

The United States is experiencing shortages of primary care providers, and NPs offer the potential to moderate these shortages (Barnes et al., 2017). As advanced practice registered nurses, it is important to stay updated with the latest regulations and developments in our individual states regarding nurse practitioner practice. It is therefore advisable to consult the state Board of Nursing and other relevant authorities for the most current and accurate information for legal practice.

References

Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431–451. 
https://doi.org/10.1177/1077558716649109
Links to an external site.

Bischof, A., & Greenberg, S. A. (2021). Post COVID-19 reimbursement parity for nurse practitioners. Online Journal of Issues in Nursing, 26(2). 
https://doi.org/10.3912/ojin.vol26no02man03
Links to an external site.

McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1). 
https://doi.org/10.1186/s12877-023-03798-1
Links to an external site.

the North Carolina Board of Nursing. (2022). Prescribing. Retrieved August 29, 2023, from https://www.ncbon.com/practice-nurse-practitioner-prescribing#:~:text=Nurse%20Practitioner%20approval%20includes%20prescriptive,educational%20preparation%20and%20national%20certification.

North Carolina Board of Nursing. (2023). Collaborative practice guidelines. Retrieved August 29, 2023 from https://www.ncbon.com/practice-nurse-practitioner-collaborative-practice-guidelines#:~:text=Required%20components%20of%20the%20CPA,performed%20by%20the%20nurse%20practitioner.

North Carolina Board of Nursing. (n.d.). Advanced practice registered nurse. Retrieved August 27, 2023, from 
Advanced Practice Registered Nurse | North Carolina Board of Nursing (ncbon.com)
Links to an external site.

North Carolina Department of Health and Human Services. (n.d.). NC Controlled Substances Reporting System. Retrieved August 29, 2023, from https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/north-carolina-drug-control-unit/nc-controlled-substances-reporting-system

Office of Administrative Hearing. (2019). Scope of practice. Retrieved August 27, 2023, from 
http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0802.html
Links to an external site.

Research work

Research work

AURP

Total points possible: 100 points

Preparing the assignment
1. Research the literature and obtain two to three resources for current,
evidence-based information related to Tapinarof
2. Develop a teaching brochure and one page paper following these guidelines.

a. Brochure for nurses- Focus on nurses for literacy level
• Key/Relevant Drug Information (30 points/30%)

o Drug Class
o Mechanism of Action
o Drug Administration and Dosage
o Drug Interactions
o Lab effects/interference

• Patient Education Considerations (35 points/35%)
o Nursing Management
o Patient Education Considerations (special considerations)- provide examples
specific to client age needs- geriatric, pediatric and pregnant client
o Patient Assessment
o Side Effects/Adverse Effects/Toxicities
o Special considerations- provide examples specific to client age needs-
geriatric, pediatric, and pregnant clients
o Visual Effects/Creativity (10 points/10%)
o Developed per the required standard
o Appropriate for the intended audience (focus on nurses for literacy level)
o Graphics enhance the purpose of the brochure
o Brochure is visually appealing

b. One Page Paper (15 points/15%)
• Describes intended use of brochure (focus on nurses for literacy level)
• Includes:

o Name
o Date
o Class
o Reference page

• Describe how brochure information would be revised if intended brochure
audience had a low health literacy level.

c. APA Format (5 points/5%)
• Includes no more than 3 unique errors with APA format (current ed.)
• At least two (2) scholarly, primary sources from the last 5 years, excluding the
textbook, are provided

d. Writing and Mechanics (5 points/5%)

• Clearly written
• Includes no more than three unique errors of grammar
• Includes no more than three unique errors in writing mechanics
• Paper is one page, excluding references and title page

Please reply to the following discussions

Please see the attachment for the instructions

NUR 445 – Week 3 Discussion: Researching and Recommending Evidence-Based Research Resources

tep 1 Read the case scenario.
You are part of an interprofessional team working on an evidence-based project to look at falls in patients with dementia in the long-term care setting. The team was brought together in response to a noted increase in the incidence of falls in residents with dementia over the past three months. One of the recent changes before the increase in falls was a mandate to no longer use physical restraints on residents. Several staff members feel that the use of restraints is a must, and they do not have time to use the restraint alternatives that have been suggested. They also feel they do not have enough time to continuously check on residents. This has caused major issues of concern and has compromised the quality and safety of the residents.

When the team meets together, one of the first items discussed is the clinical question. The team uses the PICO question format to develop the following question:

In patients with a diagnosis of dementia in the long-term care setting (P), how does the use of a comprehensive falls assessment prevention plan that includes restraint alternatives (I) compare with the use of a fall prevention protocol that includes the use of restraints (C) affect the number of falls that occur (O)?

Step 2 Post to the discussion forum.
In your initial response, address the following questions:

  1. Determine the best resources to use when conducting a search on the topic. Consider these questions: What databases would be most appropriate? Where would you locate clinical practice guidelines that could be used in the EBP process for this issue?
  2. Conduct a search using the resources you identified in Step 2a. What key search terms did you use? What filters did you use?
  3. From your search, identify at least three articles that you would consider using in an EBP project such as the one described in the case scenario. If possible, suggest resources that meet the highest level (Level I) of evidence. Why would these sources be most appropriate in determining best practices and supporting clinical decision-making for this issue?

Replies week 9MSN 5550

  Reply  with a reflection of their response.  

1.Gordon’s functional health patterns are a mechanism adopted by nurses to assess a patient’s overall health status so as to develop individualized care plans since it researches the individual’s patterns of living and functioning (Salvador, 2022). Its component patterns include (Morgan, 2021), Cognition and perception, identity and relationships, sexuality and reproduction, resilience and stress management, ethics and values, and the way one views and handles their own health all play a part.

In contrast between two toddlers of different ages (Morgan, 2021), the conclusions were a toddler of twelve months was picky with the food that he consumed as he could not consume solid foods, still had occasional accidents, could not sit very well, and took several naps in a day, was able to understand and use simple words and phrases, was beginning to develop a sense of self, was shy around strangers, had no perception of his sexuality or gender identity, had difficulty coping with stress and change and had no sense of value and oblivious of any beliefs. While that of two years ate a wider variety of foods, was potty trained, was able to sit for long, stand run, and play with others, took one nap per day, was able to understand and use complex concepts, such as time and space, had a better understanding of self and is developed a unique personality and interests. Was independent, aware of his sex and gender, coping with stress and exchange to some extent, and developed some values and beliefs.

It is without a doubt that such patterns change or evolve with time as the toddler develops and therefore there will always be the need for a nurse to ensure appropriate help is given.

2. Compare and contrast the growth and developmental patterns of two toddlers of different ages using Gordon’s functional health patterns. Describe and apply the components of Gordon’s functional health patterns as it applies to toddlers.

Toddlers of different ages have different growth and functional health patterns according to Gordon’s functional health patterns. On health perception- and health management, a one-year-old child is starting to develop their perception of health, but does not have a well-developed perception of health and ways of improving it (Dannyelle et al., 2023). The child depends on their parents for nutrition, health check-ups, and other health maintenance. On the other hand, a three-year-old toddler has a better understanding of health and control of their bodies; for instance, they can express themselves when sick and make simple health decisions such as wearing warm clothes when feeling cold. On nutrition-metabolic, both one year and three years child have increased appetites and require a balanced diet to support their growth and development (Dannyelle et al., 2023). A year-old toddler is still transitioning to solid foods and relies on breastmilk for proper nutrition. On the other hand, a three-year-old toddler has a more diverse diet that includes a variety of food groups. The child starts making food choices land, preferring some foods to others. 

On elimination, both toddlers are learning to control their bladder and bowel movements; a year-old is still toilet training, while a 3-year-old kid is well trained and can communicate when they want to relieve themselves. On the activity and exercise development functions, a year-old child is learning to crawl, stand, and take their first steps while a child on normal developmental patterns has mastered such skills of standing and even walking and playing with others; they also run, jump, and climb (Dannyelle et al., 2023). The toddler also enjoys participating in organized physical activities like dancing or playing. 

On cognitive-perceptual functions, toddlers have different cognitive and perception abilities; in normal cases, a year-old child has started to understand simple words and can follow simple instructions. The child has, however not fully developed cognitive functions to enable them to fully follow instructions or behave as grown-up children (Vriesman et al., 2020). At 3, the toddler has developed a more advanced vocabulary and can understand and follow more complex instructions. The child is always able to identify shapes, colors, and objects. For test and sleep health functional health patterns, a year-old child requires a lot of sleep for proper growth and development; they may require 12-14 hours of sleep, including naps. On the other hand, a three years old child has gradually reduced their sleeping duration, and they may require about 10 hours of sleep each day and no longer take daytime naps (Vriesman et al., 2020). Concerning Self-perception, a one-year-old child has started to develop a sense of self. They may recognize themselves in the mirror and have a basic understanding of their identity. Three years old, on the other hand, have a more developed sense of self and can express their likes, dislikes, and feelings.

Concerning roles and relationships, both children are learning how to interact with others and establish relationships. A year-old child may be dependent on his parents; they may also show separation anxiety. At three years old, a child is more independent and can interact with peers and build friendships. On coping-Stress Tolerance, both toddlers have not developed good stress coping strategies; they may become fussy or cry when overwhelmed with pressure and stress (Vriesman et al., 2020). However, three a old may show some tolerance to stress and humiliation by parents and strangers. They are generally better at managing their emotions and can express them verbally. On value-belief, both toddlers are in the process of developing their values and beliefs. At one year old, a year’s child is beginning to understand basic moral concepts like sharing and manners. On the other hand, a three-year-old toddler has a better understanding of right and wrong and may have established some personal beliefs.

Laboratory for Diagnosis, Symptom and Illness Management

 

Case Study 3 & 4 (10 Points) 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Nutritional Principles in Nursing

Describing a Nutritional Assessment Tool

Module 05 Content

Find a dietary assessment tool that can be used either generally or for a specific alteration in health.


When you have found your assessment tool, answer the following questions:

What is the purpose of this tool?

Do you believe that the purpose is fulfilled based on the questions being asked? Why?

In what ways does the tool account for the individual perceptions and needs of the client?

Is there a nutritional history included? What does it cover?

Is the tool easy to use? Why or why not?

Does the tool provide enough information to determine next steps or interventions? Explain.

The writing assignment should be no more than 2 pages and APA Editorial Format must be used for citations and references used. Attach a copy of the assessment tool.

Integrative

Week 3: The Integrative Literature Review

1. Perform a literature review using a minimum of seven (7) peer-reviewed articles
and books, as well as non-research literature such as evidence-based guidelines,
toolkits, standardized procedures, etc.

2. Review of areas in relationship to medicine, nursing, public health, etc.
3. The review should be critical and synthesize rather than just being a catalog of

studies.
4. Summarize the key findings of the research and its relevancy to your project that

point out the scientific status of the phenomenon under question. Such a
statement includes:

5. What we know and how well we know it.
6. What we do not know.
7. Describe any gaps in knowledge that you found and the effects this may have on

advanced practice nursing as it relates to your project topic.

Your integrative literature review should be 5–6 pages in length, not including the cover
or reference pages. You must reference a minimum of 7 scholarly articles published within the past 5–7

years. Use current APA format

NURS_691A_DE – NURS 691-A Rubric Week 3: Integrative Literature Review

NURS_691A_DE – NURS 691-A Rubric Week 3: Integrative Literature Review

Criteria Ratings Pts

This criterion is linked to a

Learning Outcome Critical Analysis 44 to >36.08 pts
Meets Expectations

Presents a thorough and insightful analysis of significant

findings related to the change project topic. Ideas are

synthesized and professionally sound and creative.

Insightful and comprehensive conclusions and solutions are

present. Knowledge gaps are identified and the implications

on nursing are expertly explored.

44 pts

This criterion is linked to a

Learning Outcome Content 20 to >16.4 pts
Meets Expectations

A minimum of 7 peer-reviewed articles, books, or limited

non-research literature (tool kits or standardized

procedures) are present. Literature is supported by

scientific evidence that is credible and timely. Subtopics are

used to support the main topic. All in-text citations are

present and correctly formatted.

20 pts

This criterion is linked to a

Learning Outcome Organization 8 to >6.56 pts
Meets Expectations

Content is well written throughout. Information is well

organized and clearly communicated.

8 pts

This criterion is linked to a

Learning Outcome APA

Format/Mechanics
8 to >6.56 pts
Meets Expectations

Follows all the requirements related to format, length,

source citations, and layout. Assignment is free of spelling

and grammatical errors.

8 pts

Total Points: 80

PreviousNext

  • Week 3: The Integrative Literature Review