Discussion: Clinical Challenges for the NP

Each state has laws that differ in regard to the role of the Nurse Practitioner. They also may significantly impact the NP’s practice. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes may significantly impact your scope of practice as a Nurse Practitioner. Remaining current with the laws in your state is essential. For example, the recent change at the federal level changing hydrocodone-containing drugs from a Schedule III drug to a Schedule II drug has impacted NPs in some states. For states that allow for Nurse Practitioners to write Schedule III-V drugs, these NPs are now unable to write for hydrocodone- containing medications, which significantly impacts their ability to provide care for their patients. The Pearson Report, which is updated almost annually, provides a national overview of each state’s current legislature. As a future NP, you should become familiar with The Pearson Report and stay abreast of state and federal legislation.

For this Discussion, you will post an explanation that defines the legal implications for standard of care, the key components of a malpractice policy in regard to a case study. Additionally you will explain the collaborative agreements and rules for your state in regard to your NP practice and the case study you select.

To prepare:

Review the following case studies and select one to research in depth:

Case Study One: Dismissing the non-compliant patient.

Gwen, a 52 year old Caucasian LPN, recently joined your practice as a new patient. She currently has a BMI of 32, B/P of 142/88. Pulse is 89, Respiratory rate is 22, Pulse Ox is 96% on Room Air. She is taking Lisinopril 10mg po daily (when she can remember), Metformin 1000mg po BID and refuses lab work. Her physical exam is unremarkable and foot exam is normal. She refuses all vaccinations including Prevnar and Influenza. Gwen’s last mammogram and pap smear were “years ago.”

Case Study Two: Preventive care, why is it so important to document? 

John, a 62 year old attorney, who has been a long-term patient of yours, comes to you to discuss his erectile dysfunction. You note that he has refused lab work for the past two years. He is a 30 pack/year smoker, and has not had a chest x-ray or ECG in three years. He does take his HCTZ 25 mg po daily. His BMI is 29 and all vital signs are within normal limits. He does agree to his Prevnar Vaccine today.

Case Study Three: Patient and professional relationships.

Jennifer, a 45 year old Caucasian returns to your clinic for a refill of her hydrocodone. She was diagnosed with Ovarian Cancer last year, followed by successful removal and treatment. All vital signs are stable and preventive care is up to date. She wants to discuss filing a lawsuit against the surgeon that initially turned her away and told her she had gastritis and needed to eat healthier.

Review the following articles found in this week’s Learning Resources:

Miller, K. P. (2013). The National Practitioner Data Bank: An Annual Update. The Journal for Nurse Practitioners, (9)9, 576-580.

Stelmach, E. I. (2015). Dismissal of the Noncompliant Patient: Is this What We Have Come to? The Journal for Nurse Practitioners, 11(7), 723-725.

Review endocrine disorders and erectile dysfunction in your Primary Care Medicine text (Gorrol, Ah. & Mulley, A.G., 2009).

Consider strategies and treatment options that would be most effective for these patient scenarios to improve compliance and health outcomes.

Reflect on how to approach the non-compliant patient and the importance of a separate preventive care visit.

By Day 5

Post an explanation that addresses the following for the Case study you selected:

Identify and briefly summarize the case study you selected

Explain any legal implications for standard of care related to the case study you selected

Identify and explain the key components of a malpractice policy related to the case study you selected

Explain the collaborative agreements and knowledge the rules for your state in regards to NP practice the case study you selected

 

Time Management

This assignment is about you. It is an assessment of your abilities and traits.

Every week you will complete a personal assessment–your own personal leadership framework.

This assignment will help you figure out what style of leadership you have been following and whether this style works for you.

Through this assignment, you will find the various approaches of leadership that complement each other. There is no one theory that describes the only way to be an effective leader. Each theory focuses on different issues, but they all help you to better understand how to become a successful leader.

Using the South University Online Library or the Internet, research about Time Management Assessment.

Note: You can also use the following link to access the Time Management Assessment: http://literacynet.org/icans/chapter03/timemgmt.html

Based on your research and understanding, create a paper in a 3- to 4-page Microsoft Word document that:

• Incorporates your time management self-assessment information and the concepts learned this week (leadership theories, leadership versus management, professional nursing organizations, and time management).
• Includes identification of one leadership theory, which you feel best describes your leadership style.
• Includes a comparison between leadership and management.
• Includes a suggestion on how to apply this week’s concepts to the work environment.

Support your responses with examples.

On a separate references page, cite all sources using APA format.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

Discussion: Professional Development and Certification

Consider the following scenario:

Isabel recently earned certifications offered by the American Association of Critical Care Nurses and the American Organization of Nurse Executives for nurse managers and leaders. She was especially proud of this accomplishment and was confident it would serve her well as she continued her career. At a conference last week, she had found herself talking with a colleague about certification. To her surprise, her colleague suggested that she look into certification through the Project Management Institute. It had not occurred to Isabel that she might need or want that type of certification, but upon further reflection she could see how important it was to be able to manage projects effectively. She wondered how pursuing this type of certification might further her professional development and lead to new opportunities down the road. At the very least, she decided it was worth exploring further.

As you are aware, numerous nursing organizations offer opportunities for professional development, community service, and information gathering. There are also many certifications you can obtain through professional societies or organizations. Certifications recognize an individual’s specialty area knowledge and skills and can lead to professional empowerment. By obtaining certifications, you can help improve your quality of practice and increase your earning potential.

In this Discussion, you consider development opportunities afforded through professional associations and examine how earning certifications can advance your career.

To prepare:

Reflect on your professional goals. These goals may relate to the practicum professional development objectives you established in Week 1 (Document Attached), but you are encouraged to take a broader view of what you would like to accomplish in the immediate future, as well as five or 15 years from now. Identify at least one goal that is especially important to you.

Think about the benefits of becoming involved in professional organizations and obtaining certifications.

If you already have a specialty or clinical certification, reflect on how this has impacted the achievement of your professional goals thus far.

Review information about two or more of the professional organizations listed in the Learning Resources. Consider the following questions:

As you explore each organization’s website, review the mission, vision, and value statements. Also examine the strategic plan, if possible. How do these align with your interests and your professional goals?

Investigate whether the organization offers networking opportunities with fellow professionals. Is there a local or regional chapter you could join?

What are the potential benefits of obtaining a certification through each organization? Examine the criteria for certification.

Evaluate your readiness and desire to become certified through each organization. What hesitations, if any, do you have?

How and why might this certification be useful to you and/or enhance your professional development?

Post a description of one or more of your professional goals. Explain a certification provided by a professional organization that would be of interest to you. Explain how and why this additional certification would be useful to you and/or enhance your professional development. Evaluate your readiness to obtain this certification, noting any reservations you may have.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days, using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional research.

Required Readings (Please use all references mentioned below)

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Reminder: Review resources from previous courses as necessary.

Matthews, J. H. (2012). Role of professional organizations in advocating for the nursing profession. Online Journal of Issues in Nursing, 17(1), 1.

Note: Retrieved from the Walden Library databases.

 

The author addresses the importance of involvement in professional organizations for nursing professionals.

Shekleton, M. E., Preston, J. C., & Good, L. E. (2010). Growing leaders in a professional membership organization. Journal of Nursing Management, 18(6), 662–668.

Note: Retrieved from the Walden Library databases.

 

 “In order to grow leaders an organization must make a commitment to develop and maintain an infrastructure that supports leadership development activities” (Shekleton, Preston, & Good, 2010, p. 667). The authors discuss findings from a leadership development program.

 American Association of Critical Care Nurses. (n.d.). Certification for nurse managers and leaders. Retrieved May 20, 2013, from http://www.aacn.org/wd/certifications/content/cnmlhome.pcms?menu=certification

 

The American Association of Critical Care Nurses Certification Corporation, in collaboration with the AONE credentialing center, offers certification for the nurse leader-manager.

 American Medical Informatics Association. (2011). Clinical informatics becomes a board-certified medical subspecialty following ABMS vote. Retrieved from http://www.amia.org/news-and-publications/press-release/ci-is-subspecialty

 

This article addresses the movement to recognize clinical informatics as a subspecialty.

 American Nurses Association. (2013). Leadership. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Leadership

 

The ANA offers a leadership institute for professional development.

 American Nurses Credentialing Center. (2013). ANCC certification center. Retrieved from http://www.nursecredentialing.org/certification.aspx

 

The ANCC is the largest and most prestigious credentialing organization. View the certifications available by specialty area.

 American Organization of Nurse Executives. (2012). AONE credentialing center. Retrieved from http://www.aone.org/resources/certification/about_certifications.shtml

 

The AONE credentialing center, in collaboration with American Association of Critical Care Nurses Certification Corporation, offers certification for the nurse leader-manager.

 Healthcare Information and Management Systems. (2013). Health IT certifications. Retrieved from http://www.himss.org/health-it-certification?navItemNumber=13588

 

The Office of the National Coordinator for Health Information Technology has specified certification criteria for electronic health records.

 NMA. (2012). Welcome to NMA! Retrieved from http://www.nma1.org/

 

This organization promotes the development of leadership competencies and interpersonal skills.

 Project Management Institute. (2013). What are PMI certifications? Retrieved from http://www.pmi.org/Certification/What-are-PMI-Certifications.aspx

 

PMI recognizes that many professionals of varying skill and education levels are or will be involved with projects. The organization offers certification for professionals involved in project management.

  

Question

Question 1

2 / 2 pts

After sexual transmission of HIV, a person can be infected yet seronegative for _____ months.

24 to 36

6 to 14

18 to 20

1 to 2

Question 2

2 / 2 pts

Once they have penetrated the first line of defense, which microorganisms do neutrophils actively attack, engulf, and destroy by phagocytosis?

Mycoplasma

Fungi

Viruses

Bacteria

Question 3

2 / 2 pts

Cells in _____ may act as a reservoir in which HIV can be relatively protected from antiviral drugs.

bone marrow

the lungs

the thymus gland

the central nervous system

HIV may persist in regions where the antiviral drugs are not as effective, such as the

CNS.

Question 4

2 / 2 pts

What of the following remains a significant cause of morbidity and mortality worldwide?

Cardiovascular disease

Starvation

Traumatic injury

Infectious disease

Question 5

2 / 2 pts

Which statement about vaccines is true?

Most viral vaccines are made by using dead organisms.

Vaccines require booster injections to maintain lifelong protection.

Vaccines provide effective protection for all people against viruses, bacteria, and fungal infections.

Most bacterial vaccines contain attenuated organisms.

Question 6

2 / 2 pts

Which statement is true about fungal infections?

They are prevented by vaccines.

They result in release of endotoxins.

They occur only on skin, hair, and nails.

They are controlled by phagocytes and T lymphocytes.

Question 7

2 / 2 pts

What is the mechanism in type III hypersensitivity reactions?

Antibodies bind to the antigen on the cell surface.

Antibodies bind to soluble antigens that were released into body fluids and the immune complexes are deposited in the tissues.

Cytotoxic T lymphocytes or lymphokine-producing Th1 cells attack and destroy cellular targets directly.

Antibodies coat mast cells by binding to receptors that signal its degranulation followed by discharge of preformed mediators.

Question 8

2 / 2 pts

A person with type O blood is likely to have high titers of anti-___ antibodies.

O

B

A

A and B

Question 9

2 / 2 pts

What disease involves the deposition of circulating immune complexes containing an antibody against host DNA, resulting in tissue damage?

Pernicious anemia

Myasthenia gravis

Hemolytic anemia

Systemic lupus erythematosus (SLE)

Question 10

2 / 2 pts

In which primary immune deficiency is there a partial to complete absence of T-cell immunity?

DiGeorge syndrome

Bruton disease

Reticular dysgenesis

Adenosine deaminase (ADA) deficiency

Question 11

2 / 2 pts

Hypersensitivity is best defined as a(n)

disturbance in the immunologic tolerance of self-antigens.

altered immunologic response to an antigen that results in disease.

undetectable immune response in the presence of antigens.

immunologic reaction of one person to the tissue of another person.

Question 12

2 / 2 pts

The class of antibody involved in type I hypersensitivity reactions is

IgE.

IgM.

IgA.

IgG.

Question 13

2 / 2 pts

Deficiencies in which element can produce depression of both B- and T-cell function?

Magnesium

Iron

Iodine

Zinc

Question 14

2 / 2 pts

What effect does estrogen have on lymphocytes?

Enhancement of B cells and T cells

Depression of T cells and enhancement of B cells

Depression of B cells and enhancement of T cells

Depression of B cells and T cells

Question 15

2 / 2 pts

Stress-age syndrome results in decreased

ACTH.

catecholamines.

cortisol.

immune system.

Question 16

2 / 2 pts

Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?

IL-1 and IL-6

TNF-ß and IL-4

IL-2 and TNF-?

IFN and IL-12

Question 17

2 / 2 pts

During a stress response, increased anxiety, vigilance, and arousal is prompted by

ACTH.

norepinephrine.

cortisol.

epinephrine.

Question 18

2 / 2 pts

Cells from a muscle tumor show a reduced ability to form new muscle and appear highly disorganized. This is an example of

anaplasia.

dysplasia.

myoplasia.

hyperplasia.

Question 19

2 / 2 pts

What is the role of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-alpha (TGF-?) in cell metastasis?

To stimulate growth of nearby tumor cells

To develop new blood vessels to feed cancer cells

To prevent cancer cells from escaping apoptosis

To act as a chemical gradient to guide cells to blood vessels

Question 20

2 / 2 pts

Which of the viruses below are oncogenic DNA viruses?

Adenoviruses, herpesviruses, and retroviruses

Herpesviruses, retroviruses, and papovaviruses

Retroviruses, papovaviruses, and adenoviruses

Papovaviruses, adenoviruses, and herpesviruses

Question 21

2 / 2 pts

Which of the following represents the correct nomenclature for benign and malignant tumors of adipose tissue, respectively?

Liposarcoma, lipoma

Adipoma, adisarcoma

Adisarcoma, adipoma

Lipoma, liposarcoma

Question 22

0 / 2 pts

In chronic myeloid leukemia (CML), a piece of chromosome 9 fuses to a piece of chromosome 22. This is an example of which mutation of normal genes to oncogenes?

Chromosome fusion

Chromosome translocation

Gene amplification

Point mutation

Question 23

0 / 2 pts

Inherited mutations that predispose to cancer are almost invariably what kind of gene?

Growth-promoting genes

Oncogenes

Tumor-suppressor genes

Proto-oncogenes

Question 24

2 / 2 pts

Tobacco smoking is associated with cancers of all of the following except

bladder.

kidney.

pancreas.

lung.

skin.

Question 25

2 / 2 pts

What percentage of children with cancer can be cured?

40%

50%

70%

60%

 Details:
The first step of the EBP process is to develop a question from the nursing practice problem of interest.

Select a practice problem of interest to use as the focus of your research.

Start with the patient and identify the clinical problems or issues that arise from clinical care.

Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project.

The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem.

Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts.

Suggestions for locating qualitative and quantitative research articles from credible sources:

1. Use a library database such as CINAHL Complete for your search.
2. Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
3. When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative.

To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods.

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.