Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

1. New practice approaches
2. Interprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Practices of culturally sensitive care
6. Ensuring the integrity of human dignity in the care of all patients
7. Population health concerns
8. The role of technology in improving health care outcomes
9. Health policy
10. Leadership and economic models
11. Health disparities

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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

Answer the 3 Questions

EBOOK:  Potter, P.A., Perry, A. G., Stockert, P. & Hall, A. (2021). Fundamentals of Nursing (10th ed.). Elsevier.

Student Instructions for Standardized Simulation

NR 224 Maria Hernandez

PURPOSE: The following information is to be used in guiding your preparation and participation in the scenario for this

course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW: Maria Hernandez is an 80-year-old Hispanic female. She is widowed and lives alone in a senior housing

apartment. Her two children live out of state. She spends most days watching television, rarely leaving her

apartment. Mrs. Hernandez was admitted for surgical debridement of a non-healing sacral ulcer, which has been

present for several months.

APA Format

Purpose

The purpose of this activity is to deepen learning through reflective inquiry. It will allow for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals.

Preparing the assessment

Follow these guidelines when completing this assignment. Contact your course faculty if you have questions.

1.  Write a brief 1-2 paragraph weekly reflection addressing the questions posed in the Reflect section of each weekly module. Edit your Reflection to include each weekly reflection.

2.  Include the following sections in your Reflection.

Week 1

·  As you assess your learning, provide one specific example of how you achieved the weekly objective(s):

·  What strategies will you use to lead culturally and linguistically appropriate healthcare?

·  What do you value most about your learning this week?

Week 2

·  As you assess your learning, provide one specific example of how you achieved the weekly objective(s):

·  Share one example of descriptive or analytic epidemiology that you see applied in your practice setting.

·  What do you value most about your learning this week?

Week 3

·  As you assess your learning, provide one specific example of how you achieved the weekly objective(s):

·  Professionally, what doubts do you have about the security of health data?

·  What do you value most about your learning this week?

Week 4

·  As you assess your learning, provide one specific example of how you achieved the weekly objective(s):

·  Which population health interventions did you find the most valuable and why?

·  What do you value most about your learning this week?

Week 5

·  As you assess your learning, provide one specific example of how you achieved the weekly objective(s):

·  How can you amplify the effectiveness of your decision-making and empower your teams to advance health outcomes?

·  What do you value most about your learning this week?

Week 6

·  As you assess your learning, provide one specific example of how you achieved the weekly objective(s):

·  In and after a disaster, what ethical questions arise regarding the fair allocation of relief funds to help with recovery?

·  What do you value most about your learning this week?

Week 7

·  As you assess your learning, provide one specific example of how you achieved the weekly objective(s):

·  Why is causation so difficult to prove and how does it define outcomes?

·  What do you value most about your learning this week?

Writing Organization and Mechanics

·  Grammar and mechanics are free of errors.

Reflective Inquiry

Requirements:

·  1. Addresses all aspects of the weekly reflection 

·  2. Assesses own learning 

·  3. Assesses value of the learning experience

Includes no fewer than 3 requirements for weekly reflection.

I ATTACHED EVERY DISCUSSION BOARD OF EACH WEEK. YOU HAVE TO RESUME THESE QUESTIONS ABOVE IN EACH DISCUSSION BOARD OF EACH WEEK IN ONE OR TWO PARAGRAPHS. EACH WEEK ANSWER SEPARATED AND USE AT LEAST 3 SOURCES NO LATER THAN 5 YEARS.

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.  

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

• Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs,      disclosure, and nondisclosure.
• Review the scenario assigned by your Instructor for this Assignment.
• Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your      Instructor.
• Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber,      pharmacist, patient, and patient’s family.
• Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

Write a 3- to 4-page paper that addresses the following:

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision-making in this scenario, including whether you would disclose your error. Be sure to justify your explanation. 
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

· Chapter 1, “Prescriptive Authority” (pp. 1–3)

· Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)

· Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)

· Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)

· Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)

· Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of nurse practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

 As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult. 

State of Florida