Write a 250- to 300-word journal entry (identified as Journal Entry 2) in which you do the following:

• Describe a problem, issue, or situation that you have observed during your Practicum Experience (no more than a half page).
• Using no fewer than three peer-reviewed sources of evidence, analyze what you have observed within the context of your specialty using appropriate concepts, principles, and theories. Give special attention to observed events that vary from scholarly literature.
• Explain how the problem, situation, or issue was handled in a manner that is consistent and a manner that is inconsistent with the theory, concepts, and principles detailed in the evidence.
• Given the various evidence-based approaches that can be used in handling the problem, situation, or issue, formulate a plan for approaching the matter differently.
• Include references immediately following the content.
• Use APA style for your journal entry and references.

CS/SB 614 authorizes  an ARNP to prescribe, dispense, administer, or order any drug, which would include controlled substances.

ARNP disciplinary sanctions are added to the bill in s. 456.072, F.S., (Section 5) to mirror a physician’s sanctions for prescribing or dispensing a controlled substance other in the course of professional practice or failing to meet practice standards. Additional acts for which discipline may be taken against an ARNP relating to practicing with controlled substances that are added to the Nurse Practice Act (Section 10) include:

 Presigning blank prescription forms.

 Prescribing a Schedule II for office use.

 Prescribing, dispensing, or administering an amphetamine or sympathomimetic amine drug, except for specified conditions.

 Prescribing, dispensing, or administering certain hormones for muscle-building or athletic performance.

 Promoting or advertising a pharmacy on a prescription form unless the form also states that the prescription may be filled at the pharmacy of your choice.

 Prescribing, dispensing, or administering drugs, including controlled substances, other than in the course of his or her professional practice.

 Prescribing, dispensing, or administering a controlled substance to himself or herself.

 Prescribing, dispensing, or administering laetrile.

 Dispensing a controlled substance listed in Schedule II or Schedule III in violation of the requirements for dispensing practitioners in the Pharmacy Practice Act.

 Promoting or advertising controlled substances.

After reading the following news article http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/

Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations? 

Reply Hollie

Case study:

Health disparities a 32-year-old African American woman may experience related to her pregnancy, such as the risk for preterm labor and the high rate of infant mortality in low-income women.

           This is a timely topic as this year the CDC pointed out that the risk of black* women dying in pregnancy is three to four times that of white women (CDC, 2019). ACOG (2015) discusses the consistent and prevalent disparities in obstetrics and gynecology. Healthcare access is one of the documented issues. ACOG reminds us that the United States is the only country that has a market driven health care system rather than the view that healthcare is a right that every citizen should have (ACOG, 2015). In 2013, 59% of black women lived in areas where Medicaid was not going to be expanded (ACOG, 2015). Also documented is the biases and stereotyping from a provider point of view (ACOG, 2015). Demographic and social biases have been shown to influence clinican’s decisions regarding contraception and pre-natal care (ACOG, 2015). Could the mistrust of many black women with the healthcare system have anything to do with forced sterilization in the past? (ACOG, 2015).

These disparities are nothing new. In 2011, Cox, Zhang, Zotti, and Graham discussed racial disparities and unfavorable birth outcomes. The study referenced that fact that black women consistency received less than adequate pre-natal care from providers. In addition black women had a greater chance of premature babies, babies with low birth weight, and babies who die in childbirth (Cox, Zhang, Zotti, & Graham, 2011). We have the power, as Nurse Practitioners to encourage and provider early and consistent pre-natal care free of bias and judgment. With consistent care, we can assist with nutritional and psychosocial counseling as well as assisting with modifiable risk factors such as alcohol, drug use, or cigarette smoking in pregnancy (Cox, Zhang, Zotti, & Graham, 2011).

*I am African Canadian so prefer to use the word black rather than African American

References

American College of Obstetrics and Gynecology (ACOG). (2015). Women’s Health Care Physicians. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Racial-and-Ethnic-Disparities-in-Obstetrics-and-Gynecology

Centers for Disease Control (CDC). (2019). Pregnancy-Related Deaths | CDC. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm

Cox, R. G., Zhang, L., Zotti, M. E., & Graham, J. (2011). Prenatal care utilization in mississippi: Racial disparities and implications for unfavorable birth outcomes.Maternal and Child Health Journal, 15(7), 931-42. doi:http://dx.doi.org/10.1007/s10995-009-0542-6

Reply Gina

Given the United States’ climate of racial inequality and health disparities, our patient, which is an African American woman is more likely to be exposed to stress and complications such as preterm labor, preeclampsia, depression, fetal demise or fetal growth restriction during the pregnancy. A healthy environment, financial stability, healthcare, education, and social community context are essential during pregnancy (Mohamed et al., 2014). In this case study, the patient is a 32-years-old, African American single mother, has three children from previous relationships, is financially unstable, overweight, with preexisting conditions such as hypertension and at risk for gestational diabetes. She has two jobs that probably does not offer benefits or insurance coverage. The patient is more likely to experience hypertensive disorders of pregnancy that may be attributable to pre-pregnancy hypertension. Her BMI is already elevated, which may lead to complications, including preterm birth, fetal death, macrosomia, gestational diabetes, and cesarean delivery.

According to Mohamed et al. (2014), women of color are less likely to have access to vital reproductive health services including screening for sexually transmitted infections and cervical cancer, family planning; and abortion, when compared with non-Hispanic white women. Although socioeconomic status is considered the main leading factor in health disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women’s health outcomes (Mohamed et al., 2014). In this case, I would inquire on factors that contributed to her delay in OB care and lack of follow-up visits. What determined the patient to have all this gap in care? Was it the lack of financial resources or other factors such as domestic violence? Based on the screening results, the patient should be screened for domestic violence and guided in the process of care based on her needs and beliefs.

 Unfortunately, African American women receive lower-quality health care related to inequities in income, housing, education and job opportunities, which results in higher risk for mortality across the life span for this population (Bryant, 2010). This contributes to racial disparities in pregnancy-related risk factors such as hypertension, anemia, gestational diabetes, and obesity and other conditions such as heart disease, HIV, AIDS, and cancer (Bryant, 2010).

Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Studies showed that infants of African American mothers are more likely to be born preterm than infants of white mothers (Mohamed et al., 2014). But, why is preterm birth rate higher in African-Americans?

Women of color are 49 percent more likely than whites to deliver prematurely, and black infants are twice as likely as white babies to die before their first birthday (Mohamed et al., 2014). In this case, the stress, financial instability, lack of nutritional food, and comorbidities may put in jeopardy the patient and infant’s life. Although the Affordable Care Act (ACA) created historical advances in health insurance coverage, millions still go without health insurance each year, many of the people of color (Mohamed et al., 2014).

Low-income, lack of financial resources, maternal pre-pregnancy weight, exposure to stress, and maternal health status prior to pregnancy may lead to fetal growth restriction. Research showed that African American women are more likely to experience fetal growth restriction (FGR), a significant contributor to neonatal morbidity and mortality, than are women of other races and ethnicities (Bryant, 2010). The patient has to be enrolled in public programs such as the Special Supplemental Food Program for Women, Infants, and Children, to avoid food insecurity during pregnancy that may have a beneficial effect on FGR risk among women (Bryant, 2010).

According to Bryant (2010), there are multiple disparities in obstetrical outcomes between women of different race or ethnicities. The author suggests that stress induced by racial and gender discrimination plays a significant role in maternal and infant mortality. According to Kliff (2018), infants in the United States have a 76 percent higher risk of death compared with infants in other wealthy nations and African American women experience the most elevated rates of maternal and infant death. This inequity in health status can be reduced by properly addressing the social determinants of health and advocating for a system of more culturally and linguistically appropriate care for all. (Kliff, 2018).

In this case, it will be our responsibility as health care providers to encourage that all care is patient-centered, culturally appropriate, and listens to women’s needs. This new visit at the office represents a good opportunity for screening and education of the patient in a culturally sensitive manner about steps she can take to prevent disease conditions and any negative birth outcomes.

                                                         References

Bryant, A. S., Worjoloh, A., Caughey, A. B., & Washington, A. E. (2010). Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American journal of obstetrics and gynecology, 202(4), 335-43.

Center for Reproductive Rights (2018). Addressing Disparities in Reproductive and Sexual Health Care in the U.S. Retrieved from https://www.reproductiverights.org/node/861

Mohamed, S. A., Thota, C., Browne, P. C., Diamond, M. P., & Al-Hendy, A. (2014). Why is Preterm Birth Stubbornly Higher in African-Americans? Obstetrics & gynecology international journal, 1(3), 00019.

Sarah Kliff (2018), American kids are 70 percent more likely to die before adulthood than kids in other rich countries, Retrieved from https://www.vox.com/health-care/2018/1/8/16863656/childhood-mortality-united-states.

I graduated from my ADN program in 2014, and since then I have had some great career opportunities. However, my goal and passion has always been working as an L&D nurse. I found it challenging to fulfill my passion and goal since the hospitals I was looking to work at required a BSN. I have had many co-workers and former classmates complete their RN-BSN program through GCU; all have had wonderful things to say about the program and saw their careers soar. With their encouragement and time needed to save financially, I have decided that I needed to take the next steps in obtaining my BSN.

This is my first online class/program, so I am a little worried and concern about the structure of the program and expectations. I am also concerned with my ability to stay on task and complete everything I need to be successful in a timely fashion. But after reading 7 Habits of Highly Effective Nursing Students (Moore, 2015) and Balancing Work and Nursing School (All Nursing Schools, n.d.), I will create a working space for me to complete my school work, a calendar for assignments and proactively stay ahead of schedule.

I know that as long as follow Strategy #8-Focus on Your Nursing Career Goal (All Nursing Schools, n.d.) and have my goal and passion align, I will stay on track and be successful.