Advocating for patients means you are keeping their best interest in mind. As nurses, we have a duty to protect their information, rights, dignity, and act as a voice for them when they aren’t able to speak up or advocate for themselves. Having the courage to say something when certain aspects of care are missed or the best interest of the patient is overlooked is another role nurse’s play in patient advocacy. Patients may need you to speak up for them regarding family members who may not have the patient’s best interest in mind as well. “Advocates become facilitators when patients and family members need to discuss uncomfortable information or explore its implications. Nurses may sometimes need to advocate for patients against their families” (Gerber, 2018).

Patient safety is a huge goal for advocating for patients. For example, if a doctor makes a mistake and prescribes a certain drug dose that doesn’t seem right for that patient, it is important to question that and verify it with the provider, even though you may feel uncomfortable doing it. The patient’s safety and health are at risk and it is up to us to be the final check for those circumstances.

A situation I can recall occurred during one of my clinical rotations. A patient I was assigned to with my nurse was homeless and spent a few days on the med/surg unit recovering from pneumonia. The patient was sheduled to be discharged and both myself and the nurse didn’t feel right about the situation. The patient had no where to go and was still recovering. We wanted to make sure the patient could transfer herself from her wheelchair to the bathroom so she didn’t soil herself and contacted a social worker to help find a place for her to go. Once she had a place set up, we bathed her before leaving and made sure she was able to transfer herself before discharging her. If she didn’t have an advocate, she could have not recovered and healed appropriately in addition to being at risk for falling and harming herself. This would have resulted in a worse condition than she came in to begin with. It was a wonderful learning experience to witness.

Reference:

Gerber, L. (2018). Understanding the nurse’s role as a patient advocate. Retrieved from https://journals.lww.com/nursing/Fulltext/2018/04000/Understanding_the_nurse_s_role_as_a_patient.15.aspx

Nursing is a very highly regulated profession. There are over 100 boards of nursing and national nursing associations throughout the United States and its territories. Their existence helps regulate, inform, and promote the nursing profession. With such numbers, it can be difficult to distinguish between BONs and nursing associations, and overwhelming to consider various benefits and options offered by each.

Both boards of nursing and national nursing associations have significant impacts on the nurse practitioner profession and scope of practice. Understanding these differences helps lend credence to your expertise as a professional. In this Assignment, you will practice the application of such expertise by communicating a comparison of boards of nursing and professional nurse associations. You will also share an analysis of your state board of nursing.

To Prepare:

• Assume that you are leading a staff development meeting on regulation for nursing practice at your healthcare organization or agency.
• Review the NCSBN and ANA websites to prepare for your presentation.

The Assignment: (9- to 10-slide PowerPoint presentation)

Develop a 9- to 10-slide PowerPoint Presentation that addresses the following:

• Describe the differences between a board of nursing and a professional nurse association.
• Describe the geographic distribution, academic credentials, practice positions, and licensure status of members of the board for your specific region/area.
  • Who is on the board?
  • How does one become a member of the board?
• Describe at least one federal regulation for healthcare.
  • How does this regulation influence delivery, cost, and access to healthcare (e.g., CMS, OSHA, and EPA)?
  • Has there been any change to the regulation within the past 5 years? Explain.
• Describe at least one state regulation related to general nurse scope of practice.
  • How does this regulation influence the nurse’s role?
  • How does this regulation influence delivery, cost, and access to healthcare?
• Describe at least one state regulation related to Advanced Practice Registered Nurses (APRNs).
  • How does this regulation influence the nurse’s role?
  • How does this regulation influence delivery, cost, and access to healthcare?

Problem Identification for a Planned Change Practicum Project

Selecting a problem to address through a planned change project will require careful consideration of many variables. Here are a few suggestions to help you identify a problem that is relevant, feasible, and appropriate for a planned change practicum project:

• In collaboration with your faculty and/or mentor, brainstorm problems, concerns, or opportunities for improvement which you could address by leading a planned change project.
• Consider the overall scope of the project, realizing that it should fit into the timeframe of the practicum, be feasible, and be something for which you have the power to facilitate change.
• Remember that in order to secure support, most organizations will want validation that a project is worthwhile and necessary. Toward that end, be sure to identify the potential value added to the organization through the project:
  • Improved health outcomes for patients
  • Improved compliance with regulatory guidelines
  • Improved fiscal outcomes (the financial bottom line)
  • Improved health care delivery methods or practices (to enhance quality, safety, or best practices)
• Review current scholarly literature and professional publications regarding the problem to make sure you have a clear understanding of the facts, relevant health policy compliance, and evidence-based practice.
• Obtain feedback and insights from key leaders and experts within the organization, and within the field, as you identify a problem to address.

Make the Connection

Here are a few examples that may serve as a springboard for additional ideas. As always, remember that the scope of your project and available timeframe must be considered as you identify a problem or opportunity for improvement:

• Reduce 30-day readmission rates as mandated by the Hospital Readmissions Reduction Program (through the ACA)
• Improve compliance with National Patient Safety Goals (or other standards of care)
• Improve HCHAPS scores
• Reduce rates of infection
• Increase compliance with core measure indicators (or other standards of care)
• Reduce the patient safety risks
• Implement nurse peer-review program in your agency (just one example of performance improvement)
• Coordinate transition to patient bedside reporting (just one example to enhance communication)
• Initiate patient navigation of CHF patients to improve health outcomes and decrease readmissions

Think About It

As you think about next steps and identifying a problem of interest or need, ask yourself:

• Is there a problem or need that I can address?
• Is there an opportunity for quality improvement that I could lead?
• Are there specific best practice standards of care that need to be instituted?
• Are there specific regulatory guidelines for which compliance must be assured?
• Are there expenses that could be diminished or contained?
• Is there a health outcome that needs to be improved?
• Is there a healthcare delivery process that needs to be enhanced?

Often these items are prime targets for planned change initiatives that will benefit the patient and the organization.  Contact your mentor to discuss ideas you have, and they may have additional ideas to share.  Collaborating with your course instructor, mentor, and the organization to determine the focus of your project creates a win-win situation for you, the organization, and all involved stakeholders.

How will you make a difference?  How will you lead change in your corner of the world?

Assessment of the Problem

In order to investigate the organizational context and external factors impacting your selected problem, you will need to intentionally examine the following:

• SWOT analysis of the organization (strengths, weaknesses, opportunities, and threats relevant to your planned change project)
• Stakeholder involvement and support (identification of who is impacted by the problem, who will be impacted by the planned change, and strategies to engage these stakeholders to garner their input and support)
• Financial implications of the problem and proposed planned change (present financial impact of the problem or need, cost of the change initiative, anticipated cost savings realized through the planned change, etc.)
• External factors which drive or impact the problem (i.e., legislative mandates, health policy compliance, national quality directives, evidence-based standards of practice, accreditation requirements, external benchmarking, reimbursement guidelines, etc.) Note: Support from current professional publications and scholarly literature will be required to validate the external influencing factors.

As you consider each influencing factor, it is helpful to also consider the necessary assessment strategies for each element. Additionally, please note that the process of assessing internal and external influencing factors is iterative, rather than a ‘one-time’ task. As new evidence unfolds, or as stakeholder agendas change it is important to stay abreast of the elements, and relationships, which impact your project. There may be financial implications, regulatory, compliance, reimbursement, or accreditation factors relevant to your project that emerge over time. It will be important to maintain an ongoing assessment of these factors throughout your journey.

Strategies for Data Collection

Take a look at the data collection methods described below. How might you use these strategies to assess internal and external factors impacting the problem?

Influencing Factor

Strategies for Data Collection

SWOT Analysis

• Internal assessment of the organization to determine the strengths, weaknesses, opportunities, and threats relevant to the problem and the planned change project
• Review of organizational documentation regarding the problem
• Key informant interviews with organizational leaders, team players, and other experts when necessary to define the SWOT

Stakeholder Involvement

• Identification of all stakeholders who are affected by this problem or will be impacted by your planned change project
• Consider stakeholders both internal and external to the organization (i.e., organizational departments, health care professionals from other disciplines, community members, patients, families, administration, etc.)
• Develop strategies to engage stakeholders in order to solicit their feedback and perspective regarding the problem, and to garner their support of the planned change

Financial Implications

• Information regarding this element will likely require discussion with the appropriate leader or health care administrator. Information to discover includes:
  • What is the present financial impact of the problem?
  • What are the anticipated costs involved with the planned change project?
  • What are the anticipated cost savings realized through the planned change?

External Factors

• This element will likely require review of the literature, current best practices, related policies, etc. relevant to the problem or problem:
  • Legislative mandates
  • Health policy compliance
  • National quality or patient safety directives
  • Evidence-based standards of practice
  • Accreditation requirements
  • External benchmarking (such as HCAHPS, core measures, accountable care organizational practices, CMS guidelines, value-based purchasing, etc.)
  • Reimbursement guidelines
• Be sure to cite and reference sources as you validate these external factors within the literature
• Make sure that your literature support is current within five years, and that it is from credible scholarly sources
• Key informant interviews may also provide insight to additional external factors within the community

Practicum Application and Activities

Earlier in your MSN coursework, you may have identified a problem and initiated a SWOT analysis, as well as investigation of influencing factors that shape this problem. Take time to revisit any previous work and take the necessary ‘next steps’ to complete an actual or hypothetical SWOT analysis, and an actual investigation of the external variables that shape the problem. Review the Johns Hopkins Appendix G and the SWOT Analysis and Assessment of Influencing Factors Worksheet located in the MSN Toolbox area of the course. Proceed with the following activities. Document your practicum-related activities on the Practicum Log:

• Prepare a plan with specific talking points to meet with your faculty (and practicum mentor if available) regarding the implementation and evaluation of your planned change project.
• Meet by phone with faculty (and practicum mentor if available) to discuss assessment of the problem and influencing factors.
• Revisit current, scholarly publications that support the identified problem. Document your findings using a literature review tool or the Johns Hopkins Appendix G document, located in the MSN Toolbox for this activity.
• Complete the SWOT Analysis and Assessment of Influencing Factors Worksheet located in the MSN Toolbox.
• Validate your work on Phase 1 with your faculty (and practicum mentor if available) as needed.
• Revise your work as necessary.
• Submit the following with your time log, once Phase 1 is completed:
  • Submit your literature review tool that supports the identified problem or the John Hopkins Appendix G
  • SWOT Analysis and Assessment of Influencing Factors Worksheet

Professional Practice Paper

Based on the AP role of the person that you interviewed in W1 Project, in a 3- to 5-page paper (excluding the title page, references, and appendices) describe the role, the type of organization, and address all the interview questions, and include:

• List the type of organization. For example: Primary care office, ED, Specialty, cardiology GI etc.
• List the type of and how many clients it serves. FP would see all ages. Research in your area the number of visits in a local office per year or # of visits seen local ED, specialty office etc. 
• the professional fit for advanced nursing role. “Fit” refers to the Qualifications in order to be an AP provider at that agency/organization. What license, credentialing (accrediting agency, and other expectations NPI, CMS)?
• Include a brief job description
• Discuss board of nursing NPA or scope of practice of the state. Include what the NPA in the state allows and restrictions.

The learning activity and corresponding assignment in this topic  requires students to perform a heritage assessment with families  selected by students from their local communities.

Click on http://wps.prenhall.com/wps/media/objects/663/679611/box_6_1.pdf  in order to access the “Heritage Assessment Tool.”

Interview three families from different cultures. One family should  be from your own culture. Compare the differences in health traditions  between these cultures.

Assess the three families using the “Heritage Assessment  Tool.” In 1,000-1,500 words, discuss the usefulness of applying a  heritage assessment to evaluate the needs of families and develop  plans for health maintenance, health protection, and health  restoration. Include the following:

1. Perform a heritage assessment on three families. One of these    families should be from your own culture.
2. Identify common health    traditions based on cultural heritage. Evaluate and discuss how the    families subscribe to these traditions and practices. Address health    maintenance, health protection, and health restoration as they    relate to your assessment.

Prepare this assignment according to the guidelines found in the APA  Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to  beginning the assignment to become familiar with the expectations for  successful completion.

You are required to submit this assignment to Turnitin.