Participation Responses: No later than the due date assigned, review and comment on the discussion question responses posted by at least two of your peers and faculty. Continue to monitor your question and responses until the end of the week.

Peer 1 

An ethical dilemma that was experienced by the NP was when she was encouraging the 30 year old patient to transition to hospice care. End of life discussions are always tough conversations to have. This was considered an ethical issue to me because at the beginning, the patient stated he wanted to do whatever he could do in order to prolong his life expectancy and the NP was in a way, coercing him to make the decision to transition from his home to a hospice center. Though the patient was bed bound, he was still coherent and should be able to make his own decisions without the encouragement of others to do otherwise. If I was the NP in this scenario, I would allow the patient and his mother to come to the decision at their own timing. I would still provide honest, realistic answers, but still give them the opportunity and time to make their own decision. Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them (Haddad, 2020). A mechanism to overcome this ethical dilemma would be to just take in account each patient scenario and continue to gain experience in this realm. Learning ways to navigate through these types of scenarios would make it more comfortable for the patient and the provider. 

The NP in the documentary is noted as a disruptive innovator because she provides primary care to patients in their own homes. Traditional visits to a primary care clinic are often wrought with friction-inducing barriers such as scheduling, commutes, and long wait times for a condensed provider visit that carries a high price tag. Now, health care consumers can have their provider visit them for their primary care needs in the comforts of their own homes where they will experience primary care in a very different way (Fuller, 2019). The need for primary care providers is at an all time high with the population across the nation increasing and primary care physicians not being available, makes a need for NP’s to provide the primary care for these patients in an affordable fashion. 

References: 

Fuller, Ryan MSN, RN, CNML; Hansen, April MSN, RN Disruption Ahead, Nursing Administration Quarterly: July/September 2019 – Volume 43 – Issue 3 – p 212-221 doi: 10.1097/NAQ.0000000000000354

Haddad LM, Geiger RA. Nursing Ethical Considerations. [Updated 2020 Sep 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526054/

Peer 2

• How is the NP in the documentary a Disruptive Innovator?

A Disruptive Innovator is described as someone that meets the needs of the undeserved, unserved population. In the documentary The Invisible Patients, Jessica, NP goes to four homebound patients and provides them with care. “Changes to medical models are generally regarded with reticence, but we have been proving our worth by silently meeting the health care needs of underserved populations or special medically complex patients for decades. Disruptive innovation in nursing does not happen overnight or without a strategy, but it does happen, and it is powerful” (Journal of Pediatric Surgical Nursing, 2016). Jessica goes above and beyond to bridge disparities for these patients. 

Jessica faces an ethical dilemma when Ron’s brother, Louie, ask her for a prescription. The brothers clearly do not have a lot of resources. It unlikely they have a vehicle or other supporting family members. She could have possibly written Louie a prescription just to help him out. Jessica chose to have the honest response of she can only do that for her established patients. “The first theme encountered in many ethical dilemmas is the erosion of open and honest communication. The erosion begins when clinicians fail to speak up in crucial situations” (Tracy & O’Grady, 2018). It may have been less awkward for Jessica to just write the prescription, but she handled the situation correctly by directly telling the family member no. Not only can it be an ethical problem, writing prescriptions and providing care to individuals that are not established patients, can cost the Nurse Practitioner and company money. 

America Reframed. (2018, March 20). America Reframed: The Invisible Patients. Retrieved January 28, 2021, from https://www.bing.com/videos/search?q=how can i watch the invivisble patients&docid=607999196040858628

Journal of pediatric surgical nursing. (2016, October 12). LWW. Retrieved January 28, 2021, from https://journals.lww.com/journalofpediatricsurgicalnursing/Fulltext/2016/10000/Disruptive_Innovators__Are_We_Ready_.2.aspx

Tracy, E.O.M. F. Hamric and Hanson’s Advanced Practice Nursing. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323447751/

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

You are required to cite to a minimum of five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, 

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

Assignment: Off-Label Drug Use in Pediatrics

Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?

This assignment, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings.

Effective Communication

The Joint Commission reported that [poor] communication was the root cause of 66% of Sentinel Events between 1995-2005. Examine the communication and collaboration in your workplace. Include these aspects:

• The components necessary for effective interpersonal communication.
• Discuss the importance of interprofessional collaboration.
• Apply components of interpersonal communication to interprofessional collaboration.
• Discuss strategies to promote interprofessional collaboration.
• Describe effective strategies to build interprofessional teams.
• Cultural competence

Assignment Expectations:

Length: Between 1500 and 2000 words

Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

CASE STUDY

 Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had been suffering from emphysema for several years and had had frequent hospitalizations for respiratory problems. On the last hospital admission, her pneumonia quickly progressed to organ failure. Death appeared to be imminent, and she went in and out of consciousness, alone in her hospital room. The medical-surgical nursing staff and the nurse manager focused on making Mrs. Smith’s end-of-life period as comfortable as possible. Upon consultation with the vice president for nursing, the nurse manager and the unit staff nurses decided against moving Mrs. Smith to the palliative care unit, although considered more economical, because of the need to protect and nurture her because she was already experiencing signs and symptoms of the dying process. Nurses were prompted by an article they read on human caring as the “language of nursing practice” (Turkel, Ray, & Kornblatt, 2012) in their weekly caring practice meetings.

The nurse manager reorganized patient assignments. She felt that the newly assigned clinical nurse leader who was working between both the medical and surgical units could provide direct nurse caring and coordination at the point of care (Sherman, 2012). Over the next few hours, the clinical nurse leader and a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The clinical nurse leader asked the nurse manager whether there was a possibility that Mrs. Smith had any close friends who could “be there” for her in her final moments. One friend was discovered and came to say goodbye to Mrs. Smith. With help from her team, the clinical nurse leader turned, bathed, and suctioned Mrs. Smith. She spoke quietly, prayed, and sang hymns softly in Mrs. Smith’s room, creating a peaceful environment that expressed compassion and a deep sense of caring for her. The nurse manager and nursing unit staff were calmed and their “hearts awakened” by the personal caring that the clinical nurse leader and the volunteer nurse provided. Mrs. Smith died with caring persons at her bedside, and all members of the unit staff felt comforted that she had not died alone.

Davidson, Ray, and Turkel (2011) note that caring is complex, and caring science includes the art of practice, “an aesthetic which illuminates the beauty of the dynamic nurse-patient relationship, that makes possible authentic spiritual-ethical choices for transformation—healing, health, well-being, and a peaceful death” (p. xxiv). As the clinical nurse leader and the nursing staff in this situation engaged in caring practice that focused on the well-being of the patient, they simultaneously created a caring-healing environment that contributed to the well-being of the whole—the emotional atmosphere of the unit, the ability of the clinical nurse leader and staff nurses to practice caringly and competently, and the quality of care the staff were able to provide to other patients. The bureaucratic nature of the hospital included leadership and management systems that conferred power, authority, and control to the nurse manager, the clinical nurse leader, and the nursing staff in partnership with the vice president for nursing. The actions of the nursing administration, clinical nurse leader, and staff reflected values and beliefs, attitudes, and behaviors about the nursing care they would provide, how they would use technology, and how they would deal with human relationships. The ethical and spiritual choice making of the whole staff and the way they communicated their values both reflected and created a caring community in the workplace culture of the hospital unit.

Critical thinking activities

Based on this case study,  please answer the consider the following questions, apa format, more thatn 300 words and NO PLAGIARISM. Thank you in advance.

1. What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.
2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.
3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?
4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring