Tag: Clinical-Nursing

Alterations in Cellular Processes

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

by day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

The role genetics plays in the disease.

Why the patient is presenting with the specific symptoms described.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

The cells that are involved in this process.

How another characteristic (e.g., gender, genetics) would change your response.

Read
 a selection of your colleagues’ responses.

by day 6 of Week 1

Respond 
to 
at least two 
of your colleagues on 
2 different days
 and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.

Note: 
For this Discussion, you are required to complete your initial post before you will be able to view and respond to your peers’ posting. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

 

 

This topic is closed for comments.

CS

Cheryl Athurine Spence

Nov 30, 2023 10pm

Reply from Cheryl Athurine Spence

Post Discussion 1
st
 Response

Hi. Rosy,

I agree with your post. The patient assessment may be a genetic predisposition to the patient’s susceptibility to substance abuse. The scenario presented involves several physiological aspects that can be explained in terms of the patient’s history of substance abuse and the subsequent treatment with naloxone. Genetic factors can indeed play a role in the patient’s susceptibility to substance abuse (Van Den Besselaar et al., 2022). Studies suggest that genetic variations can influence an individual’s predisposition to addiction by affecting neurotransmitter pathways, altering drug metabolism, and controlling the reward and pleasure circuits in the brain. Certain genetic variations can increase the likelihood of developing substance use disorders (SUDs) when exposed to drugs or other addictive substances.

I agree with the explanation that the patient’s symptoms, including burning pain and necrotic tissue, are consistent with rhabdomyolysis. The burning pain over the left hip and forearm and necrotic tissue over the greater trochanter and forearm could indicate a condition known as Rhabdomyolysis (Van Den Besselaar et al., 2022). In cases of substance abuse, especially opioids, prolonged immobility and pressure on specific body parts can lead to reduced blood flow, causing ischemia and subsequent tissue necrosis. Rhabdomyolysis involves breaking skeletal muscle tissue and releasing myoglobin and other intracellular contents into the bloodstream, leading to tissue damage and potentially necrotic areas.

I also agree with the analysis of the physiological response involving hyperkalemia, as indicated by the prolonged PR interval and peaked T waves on the EKG, coupled with the elevated serum potassium level. The EKG changes observed (prolonged PR interval and peaked T waves) and the high serum potassium level (6.9 mEq/L) indicate hyperkalemia. In the context of opioid toxicity and naloxone administration, opioid overdose can lead to the inhibition of the sympathetic nervous system. This inhibition can cause excess acetylcholine release, leading to the shift of potassium out of cells and subsequently elevated serum potassium levels (Van Den Besselaar et al., 2022). Hyperkalemia can result in cardiac conduction abnormalities, such as the EKG changes observed. The physiological response to opioid toxicity, compounded by substance abuse history and subsequent naloxone administration, leads to alterations in sympathetic nervous system activity, which in turn affects potassium homeostasis, resulting in the observed EKG changes and hyperkalemia.

 

References:

Kruit, N., van den Besselaar, L. R., Kamsteeg, E. J., Verbeeck, W., Snoek, M. M. J., Everaerd, D. S., … & Voermans, N. C. (2021). The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. 
European Journal of Neurology
, 
28
(2), 647-659. 
https://doi.org/10.1111/ene.14553
Links to an external site.

Van Den Bersselaar, L. R., Hellblom, A., Gashi, M., Kamsteeg, E. J., Voermans, N. C., Jungbluth, H., … & Snoeck, M. M. (2022). Referral indications for malignant hyperthermia susceptibility diagnostics in patients without adverse anesthetic events in the era of next-generation sequencing. 
Anesthesiology
, 
136
(6), 940-953. 
https://doi.org/10.1097/ALN.0000000000004199
Links to an external site.
.

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Patricia Chioma Ayika

Nov 29, 2023 11:52pm
| 
Last reply Dec 1, 2023 7:01pm

Reply from Patricia Chioma Ayika

 

According to this scenario, the patient is probably suffering from rhabdomyolysis, a disorder that causes skeletal muscle tissue to break down and release intracellular components like myoglobin into the bloodstream. Heart problems, renal failure, and electrolyte imbalances are just a few of the consequences that may arise from this.

Genetics’ role

Rhabdomyolysis can be inherited; however, it is most commonly linked to extrinsic factors such trauma, crush injuries, or drug addiction. Certain muscle illnesses might also be predisposed to genetically. Certain individuals may be more prone to muscle breakdown under specific settings due to genetic variables that affect muscle form and function.

. 
Symptom Presentation
: • The searing pain over the left forearm and hip is probably caused by muscle tissue necrosis and ischemia in these locations. The patient’s complaints of discomfort after receiving naloxone in the field raise the possibility that they were the victim of an opioid overdose, which can cause respiratory depression and extended immobility. Pressure on the muscles from prolonged immobility might result in ischemia and rhabdomyolysis.

Physiologic Response
: Hyperkalemia is indicated by a prolonged PR interval, peaked T waves on the EKG, and a high serum potassium level (6.9 mEq/L). Large volumes of intracellular potassium are released into the bloodstream during rhabdomyolysis, overriding the body’s natural regulatory systems. Arrhythmias and cardiac arrest are among the cardiac disorders that can result from hyperkalemia.

In conclusion, the patient’s extended immobility after an opiate overdose most certainly resulted in rhabdomyolysis. Contents may be influenced by genetic characteristics, which could result in problems such acute renal damage and hyperkalemia. Further understanding of the appearance and treatment of rhabdomyolysis in individual cases can be gained by taking into account factors such as gender, heredity, and the particular drug implicated.

 

References

Baltes,A.,Akhtar,W.,&Birstler,.(2020). Predictors of skin and soft tissue infections among sample of rural residents who inject drugs. Harm Reduction Journal 17(96)

https//doi.org10.1186/s12954-020-00447-3

McCaeve, K.L & Huether.S,E,(2019).Pathophysiology: The biologic basic for disease in adults and children (8
th
 ed.).St louis.MO:Mosby/Elsevier

Bigham,B.(2017), Are you considering crush injury in overdoses? Emergency and mobile medicine learning network. Retrieve from

https//www.hmoglobaillearningwork,com site/emsworld/article/12317524/are-you/considering-crush-injury-in-narcotic-overdoses

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Ramandeep Kaur

Nov 29, 2023 11:11pm
| 
Last reply Dec 3, 2023 1:01am

Reply from Ramandeep Kaur

 

1. The role genetics plays in the disease.

The usage and addiction to addictive chemicals are influenced by a combination of genetic and environmental factors. Addictions have been found to have a moderate to high heritability. The risk of substance abuse in an individual is related to the extent of genetic connection to a relative with addiction (McCane & Huether, 2019). Addiction vulnerability is a complex interplay of genetic and life experience factors. One extensively studied gene in terms of genetic vulnerability is the D2 subtype. When drugs or alcohol are consumed, the brain is stimulated to release dopamine, a neurotransmitter responsible for pleasure and reward experiences. The presence of the D2 subtype gene affects the response to dopamine. Individuals lacking this gene tend to have a stronger craving for alcohol and consume larger amounts compared to those who possess the gene. This is because individuals without the D2 gene do not experience the benefits of dopamine as strongly as those with the gene, leading them to drink more in order to achieve the same sensation.

 

 

Why is the patient presenting with the specific symptoms described?

 
Due to an opiate overdose, the patient was initially unresponsive. However, after receiving Naloxone in the field, the patient became responsive again. Naloxone, an opioid antagonist, was administered to counteract the effects of the opiate overdose. Opioids can suppress breathing, and an overdose can lead to respiratory depression. The respiratory center is depressed, and the breathing rate falls gradually until respiratory failure occurs (McCane & Huether, 2019). It is probable that the substantial amount of necrotic tissue present over the greater trochanter of the left hip and forearm is a consequence of physical injury sustained during the fall when the patient became unconscious. (Haikin, Herzberger, Aviner, & Cherniavsky, 2012. Necrosis is the term used to describe cellular death caused by inadequate blood and oxygen supply to the tissue. The patient’s condition may indicate the presence of rhabdomyolysis, which is a condition caused by muscle injury resulting from the accident. The EKG results showed an extended PR interval and elevated T waves. Additionally, the serum potassium level was measured at 6.9 mEq/L, indicating high potassium levels that contribute to the longer PR interval and peaked T waves (Weiss, Qu, & Shivkumar, K. 2017). Elevated levels of creatine kinase, myoglobin in the blood and urine, as well as potassium and creatinine in the blood and urine, are indicative of muscle injury. Further investigation is required to identify the specific genes that may be involved in the development of the disease.

 

The physiologic response to the stimulus presented in the scenario and why you think this response occurred?

 
Immunosuppression refers to a reduction in the activation or efficiency of the immune system. Certain components of the immune system can suppress other aspects of its functioning, and immunosuppression can occur as an unintended consequence of treating other illnesses. Prolonged drug use and dependency can cause significant damage to various bodily systems, particularly the immune system. Intoxicating substances can directly harm the immune system, or the method of drug administration may increase the likelihood of infections, especially among intravenous drug users.

The cells that are involved in this process.

 

According to the National Institute on Drug Abuse, opioids work by binding to specific proteins called opioid receptors that are present on nerve cells in various parts of the body, including the brain, spinal cord, and gastrointestinal tract. By attaching to these receptors, opioids alter the brain’s perception of pain and induce a sense of euphoria. Additionally, they can cause a decrease in heart rate and breathing rate.

How another characteristic (e.g., gender, genetics) would change your response.

 

In general, men have higher rates of illicit drug use compared to women. However, when it comes to opioid use, women tend to be more sensitive to pain and are more likely to experience chronic pain. This higher prevalence of chronic pain among women may contribute to the higher rates of opioid prescriptions among women of reproductive age.

 

References:

McCance, K. L., & Huether, S. E. (2010). 
Pathophysiology: The biologic basis for disease in adults and children
 (6th ed.). Mosby Elsevier.

Haikin Herzberger, E., Aviner, S., & Cherniavsky, E. (2012). Posttraumatic fat necrosis presented as cellulitis of the leg. 
Case reports in pediatrics
, 
2012
.

Weiss, J. N., Qu, Z., & Shivkumar, K. (2017). Electrophysiology of hypokalemia and hyperkalemia. 
Circulation: Arrhythmia and Electrophysiology
, 
10
(3), e004667.

National Institute on Drug Abuse. (2020, May 28). Sex and Gender Differences in Substance Use. Retrieved November 29,2023, from 
https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use
Links to an external site.

 

 

 

 

 

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Ramandeep Kaur

Nov 29, 2023 10:34pm
| 
Last reply Dec 2, 2023 9:23pm

Reply from Ramandeep Kaur

 

 

 

1. The role genetics plays in the disease.

 

Genetics undoubtedly plays a substantial role in the development of heart attacks. Numerous studies have demonstrated that specific genetic variations can heighten the risk of cardiovascular diseases, including heart attacks. For instance, variations in genes responsible for lipid metabolism, blood clotting, and inflammation can contribute to the formation of atherosclerosis, a primary factor underlying heart attacks. Understanding these genetic factors can help identify individuals at higher risk and inform preventative measures and targeted treatments.  In a study conducted by McPherson et al. (2016), it was found that genetic factors accounted for approximately 40-50% of the risk of developing coronary artery disease, which often leads to heart attacks. Consequently, individuals who have a family history of heart attacks or cardiovascular diseases may possess a heightened genetic predisposition to developing the condition. Genetics plays a role in all diseases to an extent. Variations and functions in DNA (alone or in combinations) alongside the environment contribute to disease processes. Still, cellular and bodily responses to the environment may differ according to our DNA (Jackson et al., 2018). The immune system has genetic control factors. Still, it is sensitive to environmental drivers, given that these factors serve as a control mechanism for limiting the impact of transmissible pathogens. Susceptibility or resistance to diseases, such as autoimmunity, allergy, and inflammation, can sometimes be linked to genetic compounds (Soderholm et al., 2018), Soo (2018) discussed that secondary immune deficiencies are related to stress and poor nutrition and can be related to hormone imbalances.

 

Why is the patient presenting with the specific symptoms described?

 

Based on the patient’s specific symptoms, it is possible that they are experiencing a heart attack. Typical signs of a heart attack include chest pain or discomfort, shortness of breath, lightheadedness, nausea, and pain or discomfort in the arms, neck, jaw, or back. These symptoms occur when there is a reduction or blockage in the blood flow to the heart muscle, resulting in insufficient oxygen supply. The patient’s description of symptoms aligns with the common indicators of a heart attack. It is important for them to seek immediate medical attention. According to the American Heart Association (AHA), chest pain or discomfort is the most common symptom experienced by both men and women during a heart attack.

 

The physiologic response to the stimulus presented in the scenario and why you think this response occurred
?

 

The body’s response to the situation described in the scenario, which is a heart attack,        occurs when the flow of blood to the heart muscle is interrupted. This interruption can occur when a blood clot forms in one of the coronary arteries, causing a blockage. The blockage then restricts the delivery of oxygen and nutrients to the heart muscle, leading to ischemia. When there is insufficient oxygen, the cells of the heart muscle undergo anaerobic metabolism, resulting in the production of lactic acid. The buildup of lactic acid is responsible for causing the feeling of chest pain or discomfort. Furthermore, the lack of oxygen causes the heart muscle cells to become electrically unstable, which can lead to irregular heart rhythms.

 

The cells that are involved in this process.

 

During a heart attack, various cells play a role in the process. The main cells affected are known as cardiomyocytes, which are responsible for the muscle function of the heart. These cells rely on a continuous supply of oxygen and nutrients to carry out their functions effectively. However, when there is a disturbance in the blood flow to the heart muscle, the cardiomyocytes are deprived of oxygen, causing them to malfunction. In more severe cases, this lack of oxygen can result in cell death. In addition to cardiomyocytes, other cells that play a role in a heart attack include endothelial cells, which form the lining of blood vessels, and platelets, which are involved in the formation of blood clots. Inflammatory cells, such as macrophages, also contribute to the progression of atherosclerosis, a condition that can eventually lead to a heart attack.

 

How another characteristic (e.g., gender, genetics) would change your response?

 

An individual’s response to a heart attack can be influenced by factors like gender and genetics. Gender differences have been noted in the way heart attacks present and the outcomes that follow. For example, women may experience symptoms that are atypical, such as fatigue, indigestion, or shortness of breath, instead of the typical chest pain commonly associated with heart attacks. The severity and progression of a heart attack can be influenced by genetic factors. Variations in genes related to blood clotting, lipid metabolism, and inflammation can affect an individual’s vulnerability to developing a heart attack. Furthermore, specific genetic variations can impact how an individual responds to medications commonly used in the treatment of heart attacks. Considering gender and genetics can provide valuable information for tailoring personalized treatment and management approaches for heart attacks.

 

Reference:

Soo, P. (2018, July 28) Pathophysiology CH 10 alterations in immune function [Video file]Retrieved from
https://www.youtube.com/watch?v=Jz0wx1-jTd
Links to an external site.

Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcal pharyngitis: Immune responses involved in bacterial clearance and GAS‐associated immunopathologies.Journal of leukocyte biology,103(2), 193-213

Jackson, M., Marks, L., May, G., & Wilson, J. B. (2018).The genetic basis of disease. Essays in biochemistry,62(5), 643-723. 
https://doi.org/10.1042/EBC20170053
Links to an external site.

McPherson, R., Tybjaerg-Hansen, A. (2016). Genetics of Coronary Artery Disease. Circulation Research, 118(4), 564-577. doi: 10.1161/CIRCRESAHA.115.306566

 

 

 

 

 

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Cheryl Athurine Spence

Nov 29, 2023 10:14pm
| 
Last reply Dec 1, 2023 9:17pm

Reply from Cheryl Athurine Spence

    

Alterations In Cellular Processes

The paper focuses on a 27-year-old patient who has a substance abuse history and the use of emergency medical services (EMS). The roommate notified the EMS that the patient was lying on the floor unresponsively. During his medical workup by the EMS, the patient was given Naloxone and then regained consciousness. During the assessment, the patient reported burning pain in the forearm and left hip. This paper will, therefore, assess the genetic role, reason the patient presents the specific symptoms, physiological response towards the stimulus, the cell involved, and ways another characteristic would change the response.

The Role of Genetics

The patient presents Rhabdomyolysis, a condition due to prolonged immobility related to prolonged unresponsiveness that delays blood supply to parts of the body that facilitate autolysis and high potassium serum levels.  (Kruijt et al. (2020). In such a case, genetics has no role in hyperkalemia, and acute Rhabdomyolysis can result from narcotic drug overdose. However, the primary genetic components that may have had a hand in the condition include lactate dehydrogenase, carnitine, and McCardle’s disease, among other factors.

Reasons for the Presenting Symptoms

The case study evidence points towards different facts concerning the patient’s condition. For instance, once the patient is administered Naloxone, which is an opioid antagonist, he responds, proving that he has opioid drug abuse (Rochester & Graboyes, 2020). The main aim of administering the Naloxone medication, which is an opioid antagonist, is due to its efficacy in knocking opioids and allowing the patient to breathe normally. Therefore, the patient’s discomfort of pain in his forearm and the left hip may have been due to decreased opioid pain-relieving effects. However, there is a high possibility of pain in the forearm and left hip caused by the abrupt fall that the patient experienced.

Physiological Response Towards the Stimulus and the Cell Involved

The physiological response to a stimulus reflects an automatic, unlearned, and instinctive reaction. In the case scenario of the patient, the decrease in adenosine triphosphate (ATP) production may have been due to decreased blood supply to the patient’s forearm and greater trochanter (Kruijt et al., 2020). Such ATP decrease led to increased intracellular calcium, which results in potassium exchange, thus raising serum K+ levels. Consequently, due to Rhabdomyolysis, the calcium and sodium pump becomes dysfunctional, with limited capability to regulate these exchanges. According to Kruijt et al. (2020), the calcium and sodium pump dysfunction causes hypercalcemia and hypokalemia in the extracellular fluids (ECF). Also, the rise of potassium levels depresses the impulse conduction velocity, leading to peaked T-waves and PR interval. When reflecting on the case scenario, patients can elaborate hyperkalemia by recording ECF higher than 5.0mEq/L, while severe hyperkalemia can be illustrated when patients possess serum levels higher or equal to 6.0mEq/L (Kruijt et al., 2020).

Ways Another Characteristic Would Change the Response

When assessing the patient’s case scenario, genetics did not play any role in developing Rhabdomyolysis. The same response would be provided for a female patient. The main reason for such an assumption is the effects of hyperkalemia on the patients, considering that the condition interferes with appropriate electrical signaling to the heart muscle, leading to abnormal ECG results (Kruijt et al., 2020). That is particularly true for individuals with Chronic Obstructive Pulmonary Disease and heart conditions, thus increasing their opioid intake.

Conclusion

The case study reflects a 27-year-old case scenario that has a substance use history. The roommate reports to the EMG that he had been lying down for an unknown period. From evaluation, genetics did not have any role in the patient’s case since Rhabdomyolysis is mainly caused by an interference with appropriate electrical signaling to the heart muscle, leading to abnormal ECG results.

                                              

References

Kruijt, N., Bersselaar, L. R., Kamsteeg, E. J., Verbeeck, W., Snoeck, M. M. J., Everaerd, D. S., Abdo, W. F., Jansen, D. R. M., Erasmus, C. E., Jungbluth, H., & Voermans, N. C. (2020). The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. 
European Journal of Neurology
, 
28
(2), 647–659. https://doi.org/10.1111/ene.14553

Rochester, E., & Graboyes, M. (2020). Experiences of people who use drugs with naloxone administration: a qualitative study. 
Drugs: Education, Prevention and Policy
, 1–8. https://doi.org/10.1080/09687637.2020.1855116

                        

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Courtney Rae Sanders

Nov 29, 2023 10:01pm
| 
Last reply Dec 2, 2023 8:55pm

Reply from Courtney Rae Sanders

Week 1 Main Discussion Board Post

 

Purpose Statement

The purpose of this post is to analyze the pathophysiology seen in a case study of tissue necrosis and hyperkalemia resulting from a substance abuse overdose. Key areas covered will include examining how genetics plays a role in addiction, explaining why pressure ulcers formed over areas of prolonged pressure during unresponsiveness, analyzing the electrolyte imbalance occurring at the cellular level, describing the EKG changes secondary to elevated potassium, and considering how age or genetic predisposition for poor wound healing might alter the degree of tissue damage seen. The aim is to synthesize knowledge from the literature on the multi-systemic response in this emergency and discuss the underlying pathophysiology across the multiple body systems involved all the way to the cellular level.

The Role Genetics Plays in the Disease

An individual’s genetic makeup can influence susceptibility to substance abuse disorders. Variations in genes impacting reward pathways, impulse control, and habit formation may predispose certain patients to addictive behaviors and altered neurocircuitry (Volkow & Koob, 2015). However, environmental factors typically interact with genetics in the development of addiction. Studies of twins have shown alcoholism is approximately 50-60% hereditary, indicating a strong interaction between genetics and environment (Edenberg & Foroud, 2013). Exposure to substances is needed to activate genetic tendencies toward addiction. Childhood trauma, peer influence, and stress also help determine if genetic predispositions manifest clinically (Enoch, 2011). In addition to altering baseline addiction vulnerability, genetic and environmental interactions can also influence treatment outcomes (Ray et al., 2017). For example, variations in dopamine pathway genes seem to affect relapse rates when therapy compliance falters. Overall, the progression from recreational use to compulsive behaviors stems from a combination of genetic tendencies and life experiences.

Why the Patient is Presenting with These Symptoms 

 
The patient is exhibiting necrotic skin and muscle tissue over the left hip and forearm likely due to prolonged pressure on these body areas during a prolonged unresponsive state from overdose. Lying perfectly still for an extended period without positional change or weight-shifting leads to localized external compression and restricted blood flow, culminating in ischemic cellular damage and cell death if prolonged (Black et al., 2010). As pressure duration and intensity increase, perfusion to vulnerable areas like bony prominences decreases, initiating inflammation and lesion development risk (The National Pressure Ulcer Advisory Panel, 2014).

In this patient, altered senses and mental status from the substance abuse prevented adequate movement or rolling to relieve pressure on the affected areas. Psychomotor retardation and decreased pain perception related to heroin and other narcotic use allowed tissue ischemia, hypoxia, free radical injury, and necrosis to advance unchecked for hours without the patient consciously shifting position (Dubick et al. 2018). This unrelieved pressure combined with the patient’s inability to perceive and respond to early warning signs of discomfort and blood flow impairment in the compressed areas contributed to extensive necrosis over the greater trochanter and forearm by the time of ED evaluation.

The Physiologic Response and Why It Occurred 

The EKG findings of a prolonged PR interval and peaked T waves indicate hyperkalemia. The patient’s elevated serum potassium stems directly from extensive muscle death in the necrotic tissue. Potassium leaks out of dying muscle cells in the necrotic skin and tissue areas during cellular breakdown (Thompson Bastin & Cook, 2014). The measured serum potassium of 6.9 mEq/L reflects a significant spike from the normal range of 3.5-5.0 mEq/L. This degree of hyperkalemia impacts cardiac cellular depolarization and repolarization by reducing cardiac cell excitability and disrupts coordinated electrical activity causing the EKG changes (Kardalas et al., 2018).

The Cells Involved in This Process

The dying cells in the pressure ulcers include skin cells like keratinocytes and fibroblasts as well as fat cells and vascular cells from the blood vessels. Underlying muscle cells both skeletal and smooth muscle fibers also die as the wounds extend deeper. As all these cells swell and burst, their contents spill out. One vital intracellular component lost is potassium. There are very high levels of potassium inside healthy cells. But once cell membranes rupture, this potassium floods out into the extracellular space and into the bloodstream.

Too much potassium outside cells causes problems. Cardiac muscle cells rely on special pumps in their membranes to carefully control potassium movement in and out. Excess potassium outside heart cells impedes these pumps (Kay & Hoekstra, 2021). This prevents heart cells from passing electrical signals smoothly to contract in sync. Clinically, extra fluid potassium slows electrical conduction through the heart tissue. On EKGs, widened intervals and tall, peaked T waves reflect the underlying cellular issues. If severe and unchecked, deadly heart rhythm issues can occur. So, the dying skin and muscle cells releasing potassium explains the patient’s high blood potassium and corresponding EKG changes.

How Other Characteristics Would Change the Response

The patient’s gender would likely not impact the response and presentation in this scenario. However, if the patient had certain genetic variations associated with an increased risk of pressure ulcers or poor wound healing, the tissue damage may manifest more quickly or severely (Lootens et al., 2009). Additionally, older age leading to decreased skin integrity could have exacerbated the pressure ulcer development.

 

References

Black, J.M., Edsberg, L.E., Baharestani, M.M., Langemo, D., Goldberg, M., McNichol, L., Cuddigan, J. (2011). Pressure ulcers: avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference. Ostomy Wound Management. 57(2):24-37.

Dubick, M.A., Holcomb, J.B., and McManus, J.G. (2018). Unusual Pressure Ulcer Presentations in Military Casualties from Iraq and Afghanistan Wars. Military Medicine, 39(11/12): 683–686.

Edenberg, H. J & Foroud T. (2013). Genetics and alcoholism. Nature Reviews Gastroenterology & Hepatology 10, 487–494. https://doi.org/10.1038/nrgastro.2013.86

Enoch M. A. (2011). The role of early life stress as a predictor for alcohol and drug dependence. Psychopharmacology, 214(1), 17–31. https://doi.org/10.1007/s00213-010-1916-6

Kardalas, E., Paschou, S. A., Anagnostis, P., Muscogiuri, G., Siasos, G., & Vryonidou, A. (2018). Hypokalemia: a clinical update. Endocrine connections, 7(4), R135–R146. https://doi.org/10.1530/EC-18-0109

Kay, J., & Hoekstra, T. (2021). Hyperkalemia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK554500/

Lootens, L., Brassine, L., Geys, H., Pottel, H., Peeraer, L., & Devuyst, O. (2009). Genetic predisposition to pressure ulcers: A case-control study. Journal of Investigative Dermatology, 129(8), 1946-1952. https://doi.org/10.1038/jid.2009.37

Ray, L. A., Bujarski, S., & Roche, D. J. O. (2017). How age of onset influences the risk and recovery for alcohol dependence. Addiction, 112(12), 2118–2130. https://doi.org/10.1111/add.13925

The National Pressure Ulcer Advisory Council (2014). Pressure ulcer stages revised by NPUAP. Washington, D.C.: National Pressure Ulcer Advisory Council.

Thompson Bastin, M. L., & Cook, A. M. (2014). Electrolyte and acid-base disorders in the emergency department. Emergency Medicine Clinics of North America, 32(3), 437–448. https://doi.org/10.1016/j.emc.2014.06.003

Volkow, N. D., & Koob, G. F. (2015). Brain disease model of addiction: Why is it so controversial? The Lancet. Psychiatry, 2(8), 677–679. https://doi.org/10.1016/S2215-0366(15)00236-9

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Gilliatt Gilliatt

Nov 29, 2023 9:40pm
| 
Last reply Nov 30, 2023 2:28am

Reply from Gilliatt Gilliatt

Alterations in Cellular Processes

Understanding and identifying alterations in cellular processes is critical for diagnosing and treating diseases. As an advanced practice nurse, this knowledge is essential for developing targeted interventions and educating and guiding our patients on restoring normal cellular functions and mitigating the impact of these alterations on their overall health as part of the treatment plan.

The Role of Genetics in the Disease

In the case study scenario of a 27-year-old male patient with a history of substance abuse, based on him being found unresponsive until Naloxone was administered by EMS (Emergency Medical Services), responders in the field suggest a likely Opioid overdose. Naloxone is a drug that classifies as an Opioid antagonist. Naloxone binds to Opioid receptors, particularly the mu-opioid receptors that drugs like Heroin or Morphine target in the central nervous system. When Naloxone binds to the Opiate receptors, it blocks the Opioids, preventing them from causing respiratory depression, sedation, hypotension, and analgesia (
Naloxone Hydrochloride- Naloxone Hydrochloride Injection, Solution
, 2019).

Substance abuse disorder is complex because it is not caused by one factor; genetics, environment, and the person’s behavior could all be contributory. In a GWAS (Genome-Wide Association) study in Peking, they found that genes encoding Opioid receptors such as OPRMI (mu opioid receptor) are involved in a person’s response to Opioid drugs. Genetic variations in these receptors can influence an individual’s response to substances (Chang et al., 2022). The young man in this scenario could have the genetic factors plus other environmental influences such as stress, trauma, or social factors that added to his risk of substance abuse disorder.

Patient’s symptoms, physiologic responses, and the cells involved in the process:

The unresponsive 27-year-old male was found lying on the floor for unknown amounts of time and has a history of substance abuse, indicating a possible Opioid drug overdose that was immediately reversed with the administration of Naloxone, a potent Opioid antagonist. Opioids interact with specific Opioid receptors: Mu, Delta, and Kappa opioid receptors that are found in the brain and spinal cord to affect pain (Dezfulian et al., 2021), mood (Banks, 2020), and addiction (Quirion et al., 2020). When these receptors are activated, they promote pain relief and euphoria, making Opioid use highly susceptible to abuse. Opioids also inhibit GABA-mediated ( Gamma-Aminobutyric Acid) neurotransmitters, leading to sedation and decreased alertness (Otsu & Aubrey, 2022), which is evident in this scenario as the patient was found to be unresponsive.

The patient suffered Hypoxia (lack of sufficient oxygen) before resuscitation with Naloxone. Cellular injury due to lack of oxygen affects the Mitochondria’s ability to produce ATP (Adenosine Triphosphate), the primary energy currency of the cell. Eventually, the cells try to adapt by creating ATP through anaerobic means, using up glycogen in place of oxygen (McCance & Huether, 2019a). Still, over time, this decreased ATP causes cell damage and lactic acid production, further disturbing the sodium-potassium pump mechanism. The cells start retaining the sodium inside, not allowing potassium inside, leaving it circulating intracellularly, thus causing the elevated serum K+ level of 6.9 mEq/L. A potassium concentration of 5.0 mEq/L in the blood is Hyperkalemia. Elevated potassium levels affect the electrical conduction of the heart; the tall T waves and prolonged PR interval in the EKG readings are signs of serious disturbance in cardiac depolarization and repolarization that ultimately progresses to ventricular fibrillation or cardiac arrest (McCance & Huether, 2019b).

The burning pain over the left hip where the greater trochanter bone is and his forearm, which upon examination at the ED showed tissue necrosis on those pressure point sites, was now felt because Naloxone has reversed Opioid effects of pain perception inhibition. Pressure injuries that the patient sustained were caused by the compression of the soft tissues between the bony prominences of his hip and forearm against the ground, which is an external hard surface. The pressure injuries, over time, progressed to tissue death or necrosis. The external injury from immobility causes damage to the Mitochondria, resulting in impaired ATP production, eventually causing less and less regeneration of new cells, leading to cell death or necrosis (McCance & Huether, 2019a).

How another characteristic would change your response?

If the age of the patient were changed from 27 to 80 years old, the outcome of the scenario would have resulted in death. With everything that this 27-year-old patient went through: history of substance abuse, receiving Naloxone for reversal, elevated potassium level, abnormal EKG, necrosis of the hip and arm tissues, the likelihood of an 80-year-old man waking up and recovering with a favorable overall prognosis is slim.

As the human body ages, it undergoes a decline in the cellular and molecular processes compared to a young adult. Some of those changes are Telomere shortening, which contributes to cellular aging, less efficiency in DNA repair, leading to genomic instability, and increased levels of Cytokines that cause chronic inflammation that affects the heart and brain. Increased Cytokines are associated with triggering the onset of neurodegenerative diseases such as Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis, and Multiple Sclerosis (McCance & Huether, 2019a). While aging is a natural and unavoidable part of life, the severity of multiple organ damage and skin necrosis from the above scenario changes the trajectory of treatment, including discussion of advanced directive planning as an appropriate part of the treatment goal.

 

 

References

Banks, M. L. (2020). The rise and fall of kappa-opioid receptors in drug abuse research. In 
Substance use disorders
 (pp. 147–165). Springer International Publishing. 
https://doi.org/10.1007/164_2019_268
Links to an external site.

Chang, X., Sun, Y., Muhai, J., Li, Y., Chen, Y., Lu, L., Chang, S., & Shi, J. (2022). Common and distinguishing genetic factors for substance use behavior and disorder: An integrated analysis of genomic and transcriptomic studies from both human and animal studies. 
Addiction
, 
117
(9), 2515–2529. 
https://doi.org/10.1111/add.15908
Links to an external site.

Dezfulian, C., Orkin, A. M., Maron, B. A., Elmer, J., Girotra, S., Gladwin, M. T., Merchant, R. M., Panchal, A. R., Perman, S. M., Starks, M., van Diepen, S., & Lavonas, E. J. (2021). Opioid-associated out-of-hospital cardiac arrest: Distinctive clinical features and implications for health care and public responses: A scientific statement from the american heart association. 
Circulation
, 
143
(16). 
https://doi.org/10.1161/cir.0000000000000958
Links to an external site.

McCance, K. L., & Huether, S. E. (2019a). Altered cellular and tissue biology: Environmental agents. In 
Pathophysiology: The biologic basis for disease in adults and children
 (8th ed., pp. 50–52, 88-94). Elsevier.

McCance, K. L., & Huether, S. E. (2019b). The cellular environment: Fluids and electrolytes, acids and bases. In 
Pathophysiology: The biologic basis for disease in adults and children
 (8th ed., pp. 117–118). Elsevier.

Naloxone Hydrochloride- naloxone hydrochloride injection, solution. (2019, September). Hospira Inc.. 
https://labeling.pfizer.com/ShowLabeling.aspx?id=4541
Links to an external site.

Otsu, Y., & Aubrey, K. R. (2022). Kappa opioids inhibit the gaba/glycine terminals of rostral ventromedial medulla projections in the superficial dorsal horn of the spinal cord. 
The Journal of Physiology
, 
600
(18), 4187–4205. 
https://doi.org/10.1113/jp283021
Links to an external site.

Quirion, B., Bergeron, F., Blais, V., & Gendron, L. (2020). The delta-opioid receptor; a target for the treatment of pain. 
Frontiers in Molecular Neuroscience
, 
13
. 
https://doi.org/10.3389/fnmol.2020.00052
Links to an external site.

 

 

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Noel Floribert

Nov 29, 2023 8:52pm

Reply from Noel Floribert

     The scenario depicts a patient who has a history of substance abuse and was found unconscious. The patient was treated with naloxone, which suggests an opioid overdose. The necrotic tissue in areas of prolonged pressure, such as the hip and forearm, indicates that the patient was immobile for an extended period, resulting in pressure ulcers.

The EKG findings reveal a prolonged PR interval, peaked T waves, and a serum potassium level of 6.9 mEq/L, indicating hyperkalemia. Hyperkalemia is a condition where the potassium level in the blood is higher than average and can be life-threatening. It affects the cardiac function and can lead to arrhythmias.

The most critical condition highlighted in the scenario is hyperkalemia. It is an abnormally high level of potassium in the blood. Potassium is an essential electrolyte required for various bodily functions, particularly in regulating nerve and muscle cell function, including that of the heart. Normal potassium levels range from about 3.5 to 5.0 millimoles per liter (mmol/L), and levels above 5.0 mmol/L are generally hyperkalemic. Furthermore, the patient is experiencing pain, indicating that the patient experienced rhabdomyolysis (Weir & Rolfe, 2010).

What is hyperkalemia?

Hyperkalemia is a medical condition with too much potassium in the blood. Several factors can contribute to the development of hyperkalemia.

Kidney Dysfunction: The kidneys are critical in filtering and excreting potassium. Any kidney function impairment can lead to potassium accumulation in the blood.

Medications: Certain drugs, such as ACE inhibitors, potassium-sparing diuretics, and NSAIDs, can increase potassium levels.

Cellular Destruction: Severe burns, trauma, or rhabdomyolysis can release large amounts of potassium from inside cells into the bloodstream. Metabolic factors of acidosis may cause potassium to shift from cells into the blood.

Excessive Potassium Intake: This is less common but can occur with overuse of potassium supplements or in patients with renal impairment. According to Cabral et al. (2020), the diagnosis is confirmed when the serum creatine kinase (CK) level is > 1000 U/L or at least 5x the upper limit of normal. Other essential tests to request include serum myoglobin, urinalysis to check for myoglobinuria, and a complete metabolic panel, including serum creatinine and electrolytes (Cabral et al., 2020).

Symptoms of Hyperkalemia

The symptoms of hyperkalemia can be nonspecific and vary depending on the level of potassium elevation. Some symptoms of hyperkalemia may include muscle weakness or paralysis, nausea, irregular heartbeats (arrhythmias), and slow, weak, or absent pulse.

Diagnosis and Treatment

Hyperkalemia, characterized by high potassium levels in the blood, is usually diagnosed through blood tests and electrocardiograms (ECGs). The treatment of hyperkalemia depends on the severity of the condition and the underlying cause. Medications such as diuretics, potassium binders, or insulin can be prescribed to treat the condition. In severe cases where the kidney function is impaired, dialysis is recommended.

The patient suffering from hyperkalemia must follow dietary restrictions and avoid consuming potassium-rich foods. If the condition is severe, it can lead to life-threatening heart rhythm problems and requires prompt treatment. Since the patient has abnormal EKG findings and a history of substance abuse, continuous cardiac monitoring is essential. Treatment options include administering calcium gluconate to stabilize the heart’s electrical activity, insulin with glucose to drive potassium back into cells, and potassium-binding agents or diuretics to remove excess potassium from the body.

The necrotic tissue on the hip and forearm requires the attention of a wound care specialist or surgeon. Treatment might include debridement, antibiotics for infection, and appropriate wound care. The patient needs to be evaluated for rhabdomyolysis, which is a condition that occurs when muscle tissue breakdown releases harmful substances into the blood. This can be done through blood tests and urine analysis.

The underlying substance abuse problem needs to be addressed, and the patient must be referred to addiction services, counseling, and support groups. It is crucial to continuously evaluate the patient’s cardiac, renal, and overall health status, as complications can arise from hyperkalemia, substance abuse, and pressure ulcers. Educating the patient about the dangers of substance abuse, the importance of pressure ulcer prevention, and the need for regular medical follow-ups is also vital. A multidisciplinary team, including emergency physicians, cardiologists, surgeons, psychiatrists, and social workers, must address all aspects of the patient’s condition.
 

Role of Genetics in Hyperkalemia

While hyperkalemia can be linked to genetics, it is usually associated with genetic disorders that affect kidney function or potassium regulation. For example, certain genetic conditions like familial hyperkalemic hypertension or inherited forms of renal tubular acidosis can make individuals more susceptible to hyperkalemia. However, in the given scenario, there is no direct indication that genetics play a role. In this case, hyperkalemia is more likely to be related to the patient’s medical condition and history of substance abuse (NIDA, 2019).

 Specific Symptoms Presentation.

The EKG results of the patient indicate that they have hyperkalemia. This condition is caused by an elevated potassium level in the serum, which in this case is 6.9 mEq/L. Hyperkalemia can affect the heart’s conduction system, leading to changes in the EKG. The prolonged PR interval in the EKG shows that the atrial-ventricular conduction is delayed, while the peaked T waves indicate that the potassium directly affects the cardiac myocytes.

Physiologic Response to the Stimulus

Hyperkalemia can cause several physiological responses in the body. These include cardiac effects and impacts on muscle and nerve cells. High potassium levels can directly affect the heart’s electrical activity, resulting in observed EKG changes. Excessive potassium can also disrupt the normal gradient across cell membranes, essential for nerve and muscle function, including cardiac muscle.

The hyperkalemic state in this patient could have been caused by various factors, including kidney dysfunction, tissue breakdown due to prolonged immobility or pressure, leading to the release of intracellular potassium, and metabolic disturbances due to substance abuse.

Three types of cells play a significant role in hyperkalemia: cardiac myocytes, muscle cells, and kidney cells. High potassium levels can negatively affect the cardiac myocytes, leading to EKG changes. In cases of rhabdomyolysis, damaged muscle cells can release potassium into the bloodstream, worsening hyperkalemia. Kidney cells regulate potassium levels, and any dysfunction in this process can lead to hyperkalemia (Weir & Rolfe, 2010).

Impact of Other Characteristics such as Gender and Genetics

Hyperkalemia can affect the electrical activity of the heart and muscles throughout the body. Although gender does not significantly impact the physiological response to hyperkalemia, the underlying causes and risk factors may vary between males and females.

If there is a genetic predisposition to electrolyte imbalances or kidney disorders, it is essential to thoroughly investigate familial diseases and adopt a different approach to long-term management.

In summary, the management and investigation of hyperkalemia may vary based on individual patient characteristics, such as underlying genetic conditions or other health issues.

 

Reference

Cabral, B. M. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis. 
Disease-a-month : DM
, 
66
(8), 101015. Retrieved from 
https://doi.org/10.1016/j.disamonth.2020.101015
Links to an external site.

NIDA. (2019, August 5). Genetics and Epigenetics of Addiction Drug Facts. Retrieved from https://nida.nih.gov/publications/drugfacts/genetics-epigenetics-addiction on 2023, November 29

Weir, M. R., & Rolfe, M. (2010). Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. 
Clinical Journal of the American Society of Nephrology: CJASN
, 
5
(3), 531–548. https://doi.org/10.2215/CJN.07821109

 

 

 

 

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Brittney Muhammad

Nov 29, 2023 8:47pm

Reply from Brittney Muhammad

Week 1 Discussion: 

 

A 27yo patient with a history of substance abuse is found unresponsive by EMS after being called by the patient’s roommate. The roommate states that he does not know how long the patient had been lying there. The patient received naloxone 
in the field and has become responsive. He complains of burning pain over his left hip and forearm. Evaluation in the ED revealed a large amount of necrotic tissue over the greater trochanter as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level is 6.9 
mEq
/L. 

 

The role genetics plays in 
the disease
:

 

Genetics play a major role in any disease process. 
The purpose of understanding how genetics play a role in disease processes helps to understand why certain individuals are more susceptible to certain diseases versus others. 
However, s
tudies 
conducted involving families found that at least half of a person’s risk of becoming addicted to any substance depends on his or her genetic makeup (NIDA, 2019). According to the Oxford English Dictionary (2008), genetics is defined as the scientific study of inherited variations in living organisms, and of the cellular and molecular processes responsible for this. 
Genes are units of DNA that make up the human genome. 
People’s
 individual 
genes
 can either 
increase their risk for or protect them from certain diseases. 

Why is the patient presenting with the specific symptoms described?

 

The patient presented 
as unresponsive, with necrotic tissue on his left hip and forearm, hyperkalemic, and abnormal EKG. The necrosis on his left hip and forearm could possibly be injection sites for the substance the patient is using. Necrotic tissue can cause hyperkalemia, which presents as peaked T waves and prolonged PR interval on an EKG. 

The physiological response to the stimulus presented in the scenario and why you think this response occurred.

 

According to Cleveland Clinic (2022) necrosis is the death of cells in your body tissues. Necrotic skin tissue occurs when blood flow to your body tissue is blocked secondary to injury, infection, or disease. In the case of this patient, his necrotic skin tissue caused intracellular potassium shifts. Cellular 
injury causes a release of large quantities of intracellular potassium to shift into the extracellular space that presents as hyperkalemia
(Simon, et al, 2023)
. 

The cells that are involved in this process.

 

The cells used in the process of necrotic tissue 
are oncotic cells. Oncotic cells turn necrotic through lysis and spillage of cellular contents before cells can be recognized by phagocytes
 (Fink, et al, 2005)
. Necrotic cells release molecules that act as signals to promote inflammation. 

How 
would gender change my response?

 

Gender does play a role in severity of 
necrotic tissue damage. Necrosis in cells from males 
are 
PARP-1 
(recognizes DNA damage and facilitates DNA repair) 
dependent
 (Wang, et al, 2019)
, while 
cells from female’s are PARP-1 independent. Estrogen
 also
 has a survival component in female cells. Estrogen and PARP-1 are determinants in
 gender bias
 to cell death. 

 

References:

 

Wang, Y., Luo, W., & Wang, Y. (2019). PARP-1 and its associated nucleases in DNA damage response.
 
DNA repair
,
 
81
, 102651. 
https://doi.org/10.1016/j.dnarep.2019.102651
Links to an external site.

 

Fink, S. L., & Cookson, B. T. (2005). Apoptosis, 
pyroptosis
, and necrosis: mechanistic description of dead and dying eukaryotic cells.
 
Infection and immunity
,
 
73
(4), 1907–1916. 
https://doi.org/10.1128/IAI.73.4.1907-1916.2005
Links to an external site.

 

Simon, L., Hashmi, M., & Farrell, M. (2023, September 4).
 
Hyperkalemia
. NIH. Retrieved November 29, 2023, from
 
https://www.ncbi.nlm.nih.gov/books/NBK470284/

 

Necrosis
. (2022, August 9). Cleveland Clinic.
 
https://my.clevelandclinic.org/health/diseases/23959-necrosis
Links to an external site.

 

Genetics
. (2008). Oxford English Dictionary.
 
https://www.oed.com/dictionary/genetics_n?tl=true
Links to an external site.

 

NIDA. 2019, August 5. Genetics and Epigenetics of Addiction 
DrugFacts
. Retrieved from https://nida.nih.gov/publications/drugfacts/genetics-epigenetics-addiction on 2023, November 29

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Tricia Loper

Nov 29, 2023 7:43pm

Reply from Tricia Loper

NURS-6501N-41 Week 1 Discussion Initial Post

The Role Genetics Plays in The Disease

            
Genetics can increase the risk of drug addiction. Studies show that about 50% of opioid addiction is genetically related (Deak & Johnson, 2021). The use of opioids can change the chemical makeup of the brain by flooding the brain with dopamine over prolonged period. Another factor that plays a role in the disease is environmental factors such as age of exposure, financial stress, and lifestyle (NIH, June 2018).

Why The Patient Is Presenting with The Specific Symptoms Described

            
The patient was found unresponsive and due to her history, she was suspected of having had an opioid overdose. Opioid toxicity can severely depress the respiratory system and heart rate which can cause loss of consciousness of reduce response to stimuli. Opioid agonist binds to G-protein receptors which then interferes with the production of the enzyme adenylyl cyclase due to reduction in adrenaline production. This leads to a decrease in intracellular cyclic adenosine monophosphate (cAMP) levels due to reduces ATP production (Pathan & Williams, 2012).

The necrosis noted to her greater trochanter and forearm are caused by injury over a prolonged period due to immobility. The continued pressure to those areas with the reduced oxygenation and nutrition to those cells caused cell death by necrosis. Toxin and ischemic injury cause the rupture of the skin cell’s sarcolemma which causes and increase in cytoplasmic calcium that leads to increased mitochondrial calcium that leads to apoptosis and mitochondrial dysfunction reducing ATP and causing rhabdomyolysis (Giannoglou, Chatzizisis, & Misirli, 2007).

Physiologic Response to Stimulus and Why It Occurred

            
Naloxone is an opioid antagonist and when used it broke the opioid bond with the G-protein receptor reversing the effects of the opioid drug allowing for the patient to become responsive. Once responsive the patient was able to feel pain from her injuries due to the pain receptors being blocked by the opioid antagonist. The pain experienced is likely related to the breakdown of the muscular tissue cells. The elevated potassium level could likely relate to the kidney injury from the rhabdomyolysis and opioid toxicity which increased potassium conduction.

How Another Characteristic (e.g., gender, genetics) Would Change Response

            
I do not believe that gender or genetics being different would change the outcome of the disease process. I do think that had the patient been older than there would be the potential that the effects of the disease and resulting outcomes would likely have been exacerbated.

References

Deak, J. D., & Johnson, E. C. (2021). Genetics of substance use disorders: a review. 
Psychological medicine
, 
51
(13), 2189–2200. Retrieved on November 29, 2023, from 
https://doi.org/10.1017/S0033291721000969
Links to an external site.

Giannoglou, G. D., Chatzizisis, Y. S., & Misirli, G. (2007). The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. European Journal of Internal Medicine, 18(2), 90–100. Retrieved on November 29, 2023, from 
https://doi.org/10.1016/j.ejim.2006.09.020
Links to an external site.

NIDA. 2018, June 6. Understanding Drug Use and Addiction DrugFacts. Retrieved on November 29, 2023, from 
https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction
Links to an external site.
.

Pathan, H., & Williams, J. (2012). Basic opioid pharmacology: an update. 
British Journal of Pain
, 
6
(1), 11–16. Retrieved on November 29, 2023, from 
https://doi.org/10.1177/2049463712438493
Links to an external site.

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Nchetaka Okeke

Nov 29, 2023 6:28pm

Reply from Nchetaka Okeke

The role genetics plays in the disease.

The patient in this scenario has a history of drug abuse. Substance use disorders (SUDs) are heritable psychiatric disorders that are influenced by both environmental and genetic factors (Deak & Johnson, 2021). According to Deak and Johnson (2021), studies conducted on twins and families have revealed that approximately 50% of the risk for opioid dependence can be attributed to genetic factors that accumulate over time. Based on the presenting symptoms, it is likely the patient is experiencing rhabdomyolysis, which is a medical condition characterized by the rapid breakdown of skeletal muscle tissue, that a combination of environmental factors such as strenuous exercise and febrile infection and a predisposing genetic makeup can cause. Therefore, an individual may need a combination of external triggers and genetic predisposition to exceed the threshold for developing rhabdomyolysis (Kruijt et al., 2021). In addition, genetic diseases, including disorders of glycolysis or glycogenolysis, lipid metabolism defects, or mitochondrial disorders, can cause rhabdomyolysis (Kodadek et al., 2022).

Why the patient is presenting with the specific symptoms described.

Substance abuse or substance addiction, as described in the scenario provided, can be related to opioid use. This assumption is based on the fact that the patient responded positively to naloxone, a commonly used opioid reversal agent, as he became responsive when it was administered. Necrosis in the greater trochanter and the forearm occurs due to skeletal muscle injury from a possible fall or immobilization with pressure to the tissue for an unknown period, as the roommate did not know how long he had been lying there. Rhabdomyolysis is a medical condition in which the skeletal muscle is destroyed, causing the release of intracellular contents such as electrolytes, enzymes, and myoglobin into the bloodstream. This leads to systemic complications. Muscle necrosis is the common cause of both traumatic and non-traumatic cases of rhabdomyolysis (Kodadek et al., 2022, Lugo-Fagundo et al., 2022). Additionally, decreased blood supply in the tissue and decreased ATP production can cause tissue necrosis (Kodadek et al., 2022). This muscle breakdown can disrupt the body’s electrolytes, like potassium. Increased amounts of serum potassium can cause EKG changes and arrhythmias. This explains the prolonged PR interval and peak T waves on the EKG.

The physiological response to the presented stimulus and its cause.

Physiologically, with rhabdomyolysis, the plasma membrane of the muscle cell, called the sarcolemma, breaks down, leading to a shift in the sodium-potassium gradients. As a result, excess potassium enters the bloodstream, leading to hyperkalemia. Hyperkalemia causes EKG changes in the heart muscle, which becomes hyperexcitable. The persistent depolarization inactivates sodium channels, which creates a prolonged PR interval. Peaked T waves are also a result of hyperkalemia due to the increase in action potential and decreased repolarization, which occurs because the ventricles become sensitive to potassium (McCance & Huether, 2019).  The patient also sustained necrosis. Necrosis is the death of cells that occurs after cell injury becomes irreversible. In the case of gangrenous necrosis, severe hypoxic injury is the cause, commonly from a blockage in blood flow, such as the patient’s weight compressing onto his hip and forearm. Coagulative necrosis is also part of this condition, where protein denaturation leads to albumin in soft tissues changing from a transparent, gelatinous state to firm and opaque. This causes areas of necrosis to appear tight, shiny, and dark. (McCance & Huether, 2019).

The cells that are involved in this process

The cells are myofibers and myoglobin made from protein and can be found in the endoplasmic reticulum (ER) and ribosome, which are the cells’ protein factories (McCance & Huether, 2019).

How another characteristic (e.g., gender, genetics) would change my response
.

If this situation involved a female or an individual with no known medical history, I would still consider the possibility of rhabdomyolysis. Although rhabdomyolysis is more common in males, gender does not impact how pathophysiology changes occur at a cellular level (Cabral et al., 2020).

References

Cabral, B. M. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis. 
Disease-a-Month
, 
66
(8), 101015. https://doi.org/10.1016/j.disamonth.2020.101015

Deak, J. D., & Johnson, E. C. (2021). Genetics of substance use disorders: A review. 
Psychological Medicine
, 
51
(13), 2189–2200. 
https://doi.org/10.1017/S0033291721000969
Links to an external site.

Kodadek, L., Carmichael Ii, S. P., Seshadri, A., Pathak, A., Hoth, J., Appelbaum, R., Michetti, C. P., & Gonzalez, R. P. (2022). Rhabdomyolysis: An American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. 
Trauma surgery & acute care open
, 
7
(1), e000836. https://doi.org/10.1136/tsaco-2021-000836

Kruijt, N., van den Bersselaar, L. R., Kamsteeg, E. J., Verbeeck, W., Snoeck, M. M. J., Everaerd, D. S., Abdo, W. F., Jansen, D. R. M., Erasmus, C. E., Jungbluth, H., & Voermans, N. C. (2021). The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. 
European journal of neurology
, 
28
(2), 647–659. 
https://doi.org/10.1111/ene.14553
Links to an external site.

Lugo-Fagundo, E., Lugo-Fagundo, C., Weisberg, E. M., & Fishman, E. K. (2022). CT of rhabdomyolysis as a sequela of drug abuse. 
Radiology Case Reports
, 
17
(12), 4727–4729. 
https://doi.org/10.1016/j.radcr.2022.09.035
Links to an external site.

McCance, K. L. & Huether, S. E. (2019). 
Pathophysiology: The biologic basis for disease in adults and children
 (8th ed.). St. Louis, MO: Mosby/Elsevier.

 

 

 

 

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Sheila Sargent

Nov 29, 2023 5:26pm
| 
Last reply Dec 1, 2023 5:56pm

Reply from Sheila Sargent

The patient is presenting with symptoms of possible rhabdomyolysis. Due to the unknown length of time he was unconscious and lying in the same position, he may have compartment syndrome. The edema with rhabdomyolysis can cause fascial compartment pressure, which will cause necrotic tissue. There can be a breakdown of the sarcolemma membrane around the fiber of the skeletal muscle cells, releasing the intracellular content into the bloodstream (Lugo-Fagundo et al., 2022). This can include potassium, creatine kinase, phosphate, urate, and myoglobin. The kidneys are responsible for ridding the body of this waste. If the amounts are more than the kidneys can handle, the kidneys can be damaged, which may lead to kidney failure. High serum levels of creatine kinase and potassium can cause damage to the heart and irregular heart rhythm (Clevland Clinic, 2023).

The Role of Genetics

There is evidence to show that some genetic disorders may predispose someone to rhabdomyolysis. These can include some types of muscular dystrophies, fatty acid metabolism disorders, glycogen metabolism disorders, and metabolic and mitochondrial disorders (Kruijt et al., 2020).

People with disorders that cause muscle contraction or increased serum creatine kinase levels have a higher risk of rhabdomyolysis (Carneiro et al., 2021). Damage to the skeletal muscles with severe muscle contraction or prolonged immobility can increase the risk of intracellular content being released into the bloodstream (Paternostro et al., 2021).

With this patient, there is not adequate genetic history information given to know if there could be a genetic component along with the drug use and prolonged immobilization.

Why the Patient is Presenting with the Specific Symptoms and the Physiologic Response

The patient has been lying for an undetermined amount of time. He is found to have necrotic tissue on his left trochanter and forearm, where he has complained of pain. From potentially extended immobility, he may have compartment syndrome with edema causing fascial compartment pressure, which caused the necrotic tissue. The breakdown of the sarcolemma membrane around the fiber of the skeletal muscle releases intracellular content into the bloodstream (Lugo-Fagundo et al., 2022). This caused elevated potassium and possible creatine kinase, which could be affecting his heart rhythm.

Cells Involved

There is damage to the membrane of the skeletal muscle cells, which allows the release of intracellular content into the blood (Lugo-Fagundo et al., 2022). Cardiomyocytes may be damaged from the intracellular content that has been released.

How Another Characteristic Would Change Your Response

There is a higher rate of males that get rhabdomyolysis, possibly due to a higher muscle mass, but females are still affected (Carneiro et al., 2021). Because this is possibly drug-induced, it is unknown if there could be a predisposition. 

Sheila Sargent

 

 

References

Carneiro, A., Viana-Gomes, D., Macedo-da-Silva, J., Lima, G. H. O., Mitri, S., Alves, S. R., Kolliari-Turner, A., Zanoteli, E., Neto, F. R. de A., Palmisano, G., Pesquero, J. B., Moreira, J. C., & Pereira, M. D. (2021). Risk factors and future directions for preventing and diagnosing exertional rhabdomyolysis. 
Neuromuscular Disorders
, 
31
(7), 583–595. https://doi.org/10.1016/j.nmd.2021.04.007

Cleveland Clinic. (2023, February24). 
Rhabdomyolysis: Symptoms, Treatments
. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis

Kruijt, N., Bersselaar, L. R., Kamsteeg, E. J., Verbeeck, W., Snoeck, M. M. J., Everaerd, D. S., Abdo, W. F., Jansen, D. R. M., Erasmus, C. E., Jungbluth, H., & Voermans, N. C. (2020). The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. 
European Journal of Neurology
, 
28
(2), 647–659. https://doi.org/10.1111/ene.14553

Lugo-Fagundo, E., Lugo-Fagundo, C., Weisberg, E. M., & Fishman, E. K. (2022). CT of rhabdomyolysis as a sequela of drug abuse. 
Radiology Case Reports
, 
17
(12), 4727–4729. 
https://doi.org/10.1016/j.radcr.2022.09.035
Links to an external site.

Paternostro, C., Gopp, L., Matthias Tomschik, Krenn, M., Weng, R., Bointner, K., Jäger, F., Zulehner, G., Rath, J., Berger, T. M., Zimprich, F., & Hakan Çetin. (2021). Incidence and clinical spectrum of rhabdomyolysis in general neurology: a retrospective cohort study. 
Neuromuscular Disorders
, 
31
(12), 1227–1234. https://doi.org/10.1016/j.nmd.2021.09.012

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Pamela Lee Salisbury Smith

Nov 29, 2023 4:58pm

Reply from Pamela Lee Salisbury Smith

Main Question

Discussion:  Week I, Case Study

A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services (EMS), after being called by the patient’s roommate. The roommate states that he does not know how long the patient had been lying there. The patient received naloxone in the field and has become responsive. He complains of burning pain over his left hip and forearm. Evaluation in the ED revealed a large amount of necrotic tissue over the greater trochanter, as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level 6.9 mEq/L.

Questions

The role genetics play in the disease.

Opioid addiction is a disease that has a genetic component, and according to Wang, Chen, Lee, and Cheng (2019), there is a relationship between genetic markers and phenotypes. Sperm and egg cells have genetic variation, with varying sequences of DNA among individuals in a population. It is noted by Wang et al. (2019) that the genetic variance of heroin is the greatest at 0.54.  There is a linkage of chromosomes 2, 17, and an area located within chromosome 14q to opioid addition (Wang et al., 2019).

 

Why the patient is presenting with the specific symptoms as described.

The patient has hyperkalemia, as indicated by a 6.9 serum potassium level. This is most likely due to the sustained injury of the patient being unresponsive and lying on one side for an extended amount of time. Cell hypoxia resulted, and intracellular fluid moved into the extracellular fluid space, resulting in decreased absorbency of the cell membrane (McCance & Huether, 2019). The resulting ischemia was induced by decreased oxygen, nutrients, and adenosine triphosphate (ATP) (McCance & Huether, 2019).

 

The Electrocardiogram (EKG) results revealed a prolonged PR interval and peaked T waves, which are related to increased potassium levels (McCance & Huether, 2019). According to McCance and Huether (2019, EKG dysrhythmia is evident in hyperkalemia, resulting in bradycardic arrythmias and conduction delay.

 

The patient has a large amount of necrotic tissue over the greater trochanter and foreare and is complaining of burning pain in these areas. Necrosis arises from cell death and autolysis, that results in cell homicide to the tissues, and the plasma membrane surrounding the cell is not able to perform optimally and wastes are not being expelled from the tissues (McCance & Huether, 2019). Multiple events occurred from this injury, including ATP reduction, sodium and potassium pump failure, cellular edema, ribosome detachment, and mitochondrial edema (McCance & Huether, 2019). The patient’s complaints of burning pain is a result of having continued pressure on his leg obstructing the blood flow and bradykinins release. Bradykinins, as noted by McCance and Huether (2019), are responsible for the dilation of blood vessels, and are aided by prostaglandins that excite the nerve ending that cause pain.

 

 

 

The physiologic response to the stimulus presented in the scenario, and why you think this response occurred.

The physiologic response to the stimulus presented in the scenario is disuse atrophy, due to the patient’s prolonged disuse of the muscle. This resulted from decreased endoplasmic reticulum and myofilaments of the atrophied muscle, due a reduction in oxygen, nerve loss, and amino acid uptake (McCance & Huether, 2019).

 

The cells that are involved in this process.

The eukaryotic cells, which are located within the cytosol and are responsible for the cytoskeleton, are involved in this process.

 

How another characteristic (e.g., gender, genetics) would change your response.

Genetics play an important part in wound stages and healing. Men usually have more muscle mass than women. An older male or female may have presented with more involved symptoms due to skin integrity, decreased nutritional values, and decreased muscle tone.

 

 

 

 

 

References

McCance, K. L., & Huether, S. E. (2019
). Pathophysiology; The biologic basis for disease in adults and

     Children
 (8
th
 ed.). Elsevier.

Wang, S. C., Chen, Y. C., Lee, C. H., & Cheng, C. M. (2019). Opioid addiction, genetic susceptibility, and

medical treatments: A Review. 
International Journal of Molecular Science,
 20(17).

https://doi.org/10.3390/ijms20174294
Links to an external site.

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Willie Schley

Nov 29, 2023 3:17pm
| 
Last reply Dec 3, 2023 12:57am

Reply from Willie Schley

Week 1: Discussion

The case study presents a 27-year-old male with a history of substance abuse found unconscious for an unknown amount of time. After the use of naloxone, the patient awakens in severe pain at the possible site of impact from a fall that presents with necrosis. The patient also presents with prolonged PR intervals and peaked T waves. The purpose of this discussion is to focus on the predisposition this patient may have had to his substance abuse illness and the possible progression of his symptoms post-overdose.

The role genetics plays in this disease.

Substance abuse or substance use disorder has been extensively studied to determine underlying factors that predispose patients to this disease. According to an NIH (2023) study, there are genetic markers that indicate potential substance use disorders. This does not mean that having these markers automatically means a person will develop substance use disorders. But it does mean that they are predisposed and the knowledge of that may allow them to make decisions in life to help prevent that unfortunate disease from taking over their lives. The data for this was collected from a study involving over 1 million people, with the discovery of multiple molecular patterns that show an underlying addiction risk (NIH, 2023).

Why the patient is presenting with the specific symptoms described?

        The reason the patient reacted the way he did in the scenario is that naloxone is an opioid antagonist that binds to opioid receptors, negates, and reverses the effects opioids have on the CNS, allowing for an increase in neural excitability (NIH, 2022). Therefore, the decreased pain effects the patient felt from the opioids wore off and he was able to feel pain from the necrotic tissue.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred. The cells that are involved in this process.

        The response to the stimulus could be due to rhabdomyolysis. With the knowledge that the patient was found unconscious on the floor for an unknown amount of time, and the necrosis was found on his left side, it is reasonable to assume that the patient suffered a muscle injury to both of those sites when falling to his left side. Due to the overdose, the patient may have suffered from hypoxemia which may have increased the speed of muscle death because no oxygenated blood cells were getting to the injured muscle tissue. Furthermore, hypoxia can also cause insufficient ATP production and sarcolemma dysfunction (Qiao, Cheng, Liu, & Yin, 2016). These conditions lead to failed cellular homeostasis, ionic imbalances, and cell death (Galber, Carissimi, Baracca, & Giorgio, 2021). Wrapping this all together, there is hypoxia resulting in impaired gas exchange, increasing CO2, muscle death, decreased ATP resulting in ionic imbalances and cell death, and sarcolemma dysfunction resulting in increased calcium and potassium in the bloodstream. This is the perfect environment for rhabdomyolysis. 

        The finding for the patient also resulted in prolonged PR interval and peaked T waves due to hyperkalemia. With an increase in potassium, the resting potential of the heart is altered, and the cell membranes become depolarized due to the imbalance between sodium and potassium, increasing myocardial excitability (Hunter & Bailey, 2019). The greater the levels of K+, the greater this effect becomes. A higher level of K+ will eventually create PR intervals so long that they may and action potential decreases significantly resulting in peaked T waves (Hunter & Bailey, 2019).

How another characteristic (e.g., gender, genetics) would change your response? 

According to studies, men are more likely to develop rhabdomyolysis than women. This is because men seem to be more prone to exertional rhabdomyolysis than women due to a high increase in creatine kinase after exertion (Clarkson, Rawson, & Tarnopolsky, 2017).

Another factor that could play a role in the response the patient had is genetics. As previously discussed, some patients are predisposed to addictive behavior. If this patient was one of those patients, then that could’ve been the cause leading to the overdose. If the patient did not have those genetics, he may not have been in the situation to have the response in the first place. Or the patient may have had a metabolic myopathy that pushed him into muscle death even faster and increased the rate of cellular death and necrosis (Blueprint Genetics, 2023).

 

References

Blueprint Genetics. (2023). Metabolic Myopathy and Rhabdomyolysis Panel. Retrieved from https://blueprintgenetics.com/tests/panels/neurology/metabolic-myopathy-and-rhabdomyolysis-panel/#:~:text=However%2C%20recurrent%20rhabdomyolysis%20is%20often,mitochondrial%20disorders%20and%20muscular%20dystrophies.

Clarkson, P. M., Rawson, E. S., & Tarnopolsky, M. A. (2017). Perspectives on Exertional Rhabdomyolysis. Sports Med, 47(1), S33-S49. doi:10.1007/s40279-017-0689-z

Galber, C., Carissimi, S., Baracca, A., & Giorgio, V. (2021). The ATP Synthase Deficiency in Human Diseases. Life (Basel), 8(11), 325. doi:10.3390/life11040325

Hunter, R. W., & Bailey, M. A. (2019). Hyperkalemia: pathophysiology, risk factors and consequences. Nephrology Dialysis Transplantation, 34(3), iii2–iii11. doi:10.1093/ndt/gfz206

NIH. (2022). Naloxone DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/naloxone

NIH. (2023). New NIH study reveals shared genetic markers underlying substance use disorders. Retrieved from https://nida.nih.gov/news-events/news-releases/2023/03/new-nih-study-reveals-shared-genetic-markers-underlying-substance-use-disorders

Qiao, H., Cheng, H., Liu, L., & Yin, J. (2016). Potential factors involved in the causation of rhabdomyolysis following status asthmaticus. Allergy, Asthma & Clinical Immunology, 12(43), 2. doi:https://doi.org/10.1186/s13223-016-0149-6

 

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Yasmine Hewitt

Nov 29, 2023 2:45pm
| 
Last reply Dec 3, 2023 12:56am

Reply from Yasmine Hewitt

 

Based on the patients’ complaints, elevated serum potassium level, and EKG results, the disease highlighted in the scenario suggests Rhabdomyolysis. Rhabdomyolysis is the rapid breakdown of muscle that causes the release of intracellular contents, including protein pigment myoglobin, into the extracellular space and bloodstream( McCance et.al,2019)Ingestion of the illicit drugs as suspected can cause rhabdomyolysis. Rhabdomyolysis can be caused by acquired predispositions such as; sepsis, drugs/toxins, crush injuries. In additions, the disease can be by genetic defects such as; metabolic muscle disorders, mitochondrial disorders, muscular dystrophies, and disorders of intramuscular calcium release. Genetic disorders of fatty acid metabolism plays a role “defects in the beta-fatty acid oxidation pathway lead to disorders of fatty acid metabolism, frequently characterized by exercise intolerance, muscle pain and episodes of rhabdomyolysis related to prolonged aerobic exercise and other triggers such as fever, fasting, stress, and drugs (Scalco et. al, 2015).

Muscle injury and necrosis caused by rhabdomyolysis is direct myocyte injury which disrupts the ATP, Ion channels, and plasma membrane resulting in loss of intracellular electrolyte equilibrium. The muscle injury (trauma, exercise, thermal dependent syndromes) or lack of ATP (Medicines, electrolyte, hereditary and metabolic disorders, intense exercise, ischemia) in a muscle cell results in intracellular sodium and calcium influx(Scalco et. al, 2015). Due to the injury water is drawn into the cell with sodium leading to swelling and disruption of intracellular and membranous structures.The presence of excessive intracellular calcium leads to activation of actin-myosin cross-linkage, myofibrillar contraction, and depletion of ATP. (Scalco et. al, 2015). Excessive calcium in the cell promotes cell membrane dissolution and disruption of ion channels. With reperfusion, leukocytes migrate into the damaged muscle and cause an increased number of cytokines, prostaglandins, and free radicals, causing further myolysis, necrosis of muscle fibers, and release muscle breakdown products like potassium and myoglobin, creatine kinase, phosphate, uric acid, and various organic acids into the bloodstream. (Stanley et. al,2023) This in turn leads to the complications of hyperkalemia and hyperphosphatemia.

 

The stimulus in this scenario was caused by opioid overdose. The patient was found unresponsive then became responsive due to naloxone, an opioid antagonist, which suggest the patient overdosed on an opioid, and is very likely due to medical history of substance abuse. Due to the patients last known well time and uncertainty of how, and if the patient fell would suggest that the necrosis is due to the impaired perfusion caused by rhabdomyolysis. The patient could have been lying there for a long period of time before he was noticed which would cause the severe necrosis to the forearm and greater trochanter found in the ED. The serum potassium level of 6.9 would constitute hyperkalemia. Hyperkalemia found in the patient blood work is caused by the release of potassium and phosphorus from the damaged cell, leading to the increase in potassium in the blood level. Progressive hyperkalemia may result in ECG changes, including peaked T wave, flattened P wave, prolonged PR interval, ST depression, and prolonged QRS duration. Besides, hypokalemia may associate with a peaked P wave, prolonged PR interval, prominent U wave, shallow T wave, and ST depression (Teymouri et. al,2022).

 

Reference :

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). Chapter 45. In 
Pathophysiology: The biologic basis for disease in adults and children
. essay, Elsevier.

Scalco, R. S., Gardiner, A. R., Pitceathly, R. D., Zanoteli, E., Becker, J., Holton, J. L., Houlden, H., Jungbluth, H., & Quinlivan, R. (2015). Rhabdomyolysis: a genetic perspective. 
Orphanet journal of rare diseases
, 
10
, 51. 
https://doi.org/10.1186/s13023-015-0264-3
Links to an external site.

Stanley M, Chippa V, Aeddula NR, et al. Rhabdomyolysis. [Updated 2023 Apr 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK448168/
Links to an external site.

Teymouri, N., Mesbah, S., Navabian, S. M. H., Shekouh, D., Najafabadi, M. M., Norouzkhani, N., Poudineh, M., Qadirifard, M. S., Mehrtabar, S., & Deravi, N. (2022). ECG frequency changes in potassium disorders: a narrative review. 
American journal of cardiovascular disease
, 
12
(3), 112–124.

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Rippanjot Kaur

Nov 29, 2023 2:27pm
| 
Last reply Dec 1, 2023 10:24pm

Reply from Rippanjot Kaur

Discussion

Genetics can influence the patient’s presentation, especially if the patient’s genetics are exposed to substance abuse. Some people may develop genetic susceptibility as a result of substance use disorders and may experience variations in genes due to drug metabolism (Sanchez-Roige et al., 2022). Also, genetic factors can affect the individual’s response to specific substances and the complications these substances may cause. Understanding the genetic component can help develop effective measures and treatment plans, considering the patient’s unique genetic elements and potential complications.

The specific symptoms demonstrated by the patient show potential cases of rhabdomyolysis. The use of naloxone indicates the presence of excessive opioid use, which can cause mobility problems, muscle compression, and increased risk of rhabdomyolysis (Jordan & Morrisonponce, 2023). The release of myoglobin may cause symptoms of burning pain. Myoglobin is described as the breakdown of muscle tissue into the bloodstream. The EKG findings are signs of hyperkalemia, a complication caused by rhabdomyolysis. The increased level of serum also shows an increased risk of rhabdomyolysis. The patient’s potassium is 6.9 mEq/L, and the normal range in healthy individuals is 3.5-5.0 mEq/L. With an increase in extracellular potassium, the cell is more irritable due to faster repolarization, and this irritability is exhibited by the peaked T waves and prolonged PR interval (McCannce & Huether, 2019).

Naloxone acts as a reverse mechanism of the opioid-induced drug, which results in the patient becoming responsive (Jordan & Morrisonponce, 2023). However, the patient is likely to experience prolonged symptoms of immobility and muscle tissue breakdown, which can cause rhabdomyolysis. In addition, the continuous release of myoglobin in damaged muscle tissue can result in acute kidney problems. The EKG changes and peaked T waves demonstrate the risk of hyperkalemia, which is highly attributed to arrhythmias. The burning pain may be caused by the effects of myoglobin, which can affect various body organs and tissues.

Rhabdomyolysis is a severe medical issue when damaged muscle tissues produce protein and electrolytes in the blood. In extreme cases, rhabdomyolysis can cause permanent disability (CDC, 2023). Evidence of extensive necrotic tissue on the greater trochanter and forearm indicates the possibility of extensive muscle damage. Damaged muscles produce myoglobin, which can cause renal tubular injury, increasing the risk of acute kidney problems.

Another characteristic that would have influenced my response is the presence of genetic predisposition of a specific opioid receptor. This characteristic can affect the severity of opioid toxicity and complications. Besides, factors such as gender can also play a crucial role in determining the primary diagnoses, as the distribution and elimination of drugs from the body might vary depending on the body’s metabolism and composition.

 

 

 

References

(2023, February 9). 
Rhabdomyolysis
. Centers for Disease Control and Prevention. 
https://www.cdc.gov/niosh/topics/rhabdo/default.html#:~:text=Rhabdomyolysis%20(often%20called%20rhabdo)%20is,permanent%20disability%20or%20even%20death
Links to an external site.

Jordan, M. R., & Morrisonponce, D. (2023). 
Naloxone
. StatPearls Publishing LLC. 
https://www.ncbi.nlm.nih.gov/books/NBK441910/
Links to an external site.

McCance,K.L.& Huether,S.E(2019). Pathophysiology: The biologic basis for disease in adults and children(8
th
 ed.).St Louis,MO:Mosby/Elsevier.

Sanchez-Roige, S., Kember, R. L., & Agrawal, A. (2022). Substance use and common contributors to morbidity: A genetics perspective. 
eBioMedicine
, 
83
, 104212. 
https://doi.org/10.1016/j.ebiom.2022.104212
Links to an external site.

 

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Paige Devecka

Nov 29, 2023 2:12pm
| 
Last reply Dec 3, 2023 12:53am

Reply from Paige Devecka

Initial Discussion Post

After evaluation of the patient and the clinical manifestations provided, I determined the patient is in Rhabdomyolysis from injuries sustained from the fall and the prolonged time he was in the same position while unconscious before his roommate found him. One of the main causes of Rhabdomyolysis is “long-lasting muscle compression such as that caused by prolonged immobilization after a fall or lying unconscious on a hard surface during illness or while under the influence of alcohol or medication” (Stuart, 2023). This current circumstance resulted in the necrosis and breakdown of muscle on this patient’s grater trochanter and forearm on the side he was laying on. This muscle breakdown is causing the pain that the patient is reporting on admission. This muscular deterioration resulted in red and white skeletal muscle cell breakdown and subsequent death, shown by the necrotic tissue. “Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation” (Bhai & Dimachkie, 2023). As the cells become necrotic, the intracellular potassium leaks outside of the cell which is evident by the raised serum potassium level.

Rhabdomyolysis is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and cells and release of their contents into the bloodstream. “Common complications of rhabdomyolysis include very high levels of potassium in the blood, which can lead to an irregular heartbeat or cardiac arrest and kidney damage”. (Stuart, 2023). The clinical manifestation of raised serum potassium is directly resulting the cardiac function of this patient, with the EKG showing prolonged PR interval with peaked T waves as a result of the increased potassium within the blood due to the breakdown of skeletal muscle cells. Evidenced based practice articles, “showed peaked T wave, as well as expanded QRS complex and low P amplitude, are important changes that can guide us to immediate diagnosis” (Teymouri et al., 2022). These clinical manifestations within this 27-year old patient are evidence that he is suffering from complications of Rhabdomyolysis after being incapacitated in the same position for a unknown amount of time resulting in this muscle breakdown from the trauma his muscle cells sustained.

Genetic factors can be referenced for both the patient’s history of substance abuse and susceptibility to Rhabdomyolysis. According to “recent genetic and neuroscience research implicating 
GABRA2 
and the 2 subunit in substance use. The present findings corroborate the current literature that suggests 
GABRA2 
variation may exert effects on illicit drug-seeking behavior, perhaps through substance-related reward pathways” (Mallard et al., 2018). This gene can be a contributing factor to the patient’s history of substance abuse and incapacitation resulting from the use. “a number of Mendelian genetic defects have been identified to increase rhabdomyolysis susceptibility, including a number of genes implicated in muscle metabolism and mitochondrial function (e.g., 
ACADVL
, 
CPT2
, 
PYGM or LPIN1)” 
(Kruijt et al.
,
2020). Although these specific genes would not result in the Rhabdomyolysis, they can be attributed to the increased susceptibility to the disorder after the event trigger.

After a diagnosis occurs, providers are able to begin treatment for this condition such as using IV fluids to dilute the intracellular fluid in the blood stream while continuing to monitor cardiac function and assess for other potential complications such as seizures.

 

References:

Bhai, & Dimachkie. (2023). Rhabdomyolysis: Clinical manifestations and diagnosis. UpToDate. https://www.uptodate.com/contents/rhabdomyolysis-clinical-manifestations-and-diagnosis#:~:text=CLINICAL%20MANIFESTATIONS%20—%20Rhabdomyolysis%20is%20a,and%20myoglobinuria%20may%20be%20present.

Kruijt, N., van den Bersselaar, L. R., Kamsteeg, E. J., Verbeeck, W., Snoeck, M. M. J., Everaerd, D. S., Abdo, W. F., Jansen, D. R. M., Erasmus, C. E., Jungbluth, H., & Voermans, N. C. (2021). The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. European journal of neurology, 28(2), 647–659. https://doi.org/10.1111/ene.14553

Mallard, T. T., Ashenhurst, J. R., Harden, K. P., & Fromme, K. (2018). Gabra2, alcohol, and illicit drug use: An event-level model of genetic risk for polysubstance use. 
Journal of Abnormal Psychology
, 
127
(2), 190–201. https://doi.org/10.1037/abn0000333

Stuart. (2023). Rhabdomyolysis: Symptoms, causes, and treatments. WebMD. https://www.webmd.com/a-to-z-guides/rhabdomyolysis-symptoms-causes-treatments#:~:text=Rhabdomyolysis%20Causes,-There%20are%20many&text=A%20crush%20injury%20such%20as,influence%20of%20alcohol%20or%20medication

Teymouri, N., Mesbah, S., Navabian, S. M. H., Shekouh, D., Najafabadi, M. M., Norouzkhani, N., Poudineh, M., Qadirifard, M. S., Mehrtabar, S., & Deravi, N. (2022). ECG frequency changes in potassium disorders: a narrative review. 
American journal of cardiovascular disease
, 
12
(3), 112–124.

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Nisha Krishnan Rayan
 (She/Her)

Nov 29, 2023 12:52pm
| 
Last reply Dec 3, 2023 12:52am

Reply from Nisha Krishnan Rayan

Substance use disorder (SUD) is strongly influenced by both environmental and hereditary risk factors. Previous molecular genetic studies, such as the genome-wide association study (GWAS), have shown that opioid addiction is not only environmental but also heritable (Wang, S., et al., 2019). Both classical genetic research and molecular genetic research support this. GWAS supports the idea that some genes related to opioid receptors, the dopaminergic system, and the serotonergic system are linked to opioid addiction. As was already noted, the opioid receptor system in the brain is linked to reward circuits in the brain, and opioid addiction is linked to behavioral patterns like tolerance, cravings, and withdrawal symptoms (Wang, S., et al., 2019). The above findings suggest that opioid addiction is a complex disease.

The patient’s roommate discovered him unconscious after an unknown period. He had overdosed on opiates and was treated with naloxone. The opioid antagonist naloxone reversed the depressive effects of opiate overdose on the central nervous system and respiratory system. The patient suddenly complains of severe pain in his left hip and forearm, which he may not have been experiencing previously due to the opiates’ effects. Opiates’ pain-relieving properties are also lost when they are reversed (Vallerand & Sanoski, 2020).

Due to the respiratory-depressive effects of opiate overdose, the patient was most likely in a state of respiratory acidosis resulting from the ineffective gas exchange and retention of CO2. Respiratory acidosis can be subcategorized as acute, chronic, or acute and chronic. In acute respiratory acidosis, there is a sudden elevation of PCO2 because of a failure of ventilation. This could be due to CVA, the use of CNS depressants such as opioids, or the inability to use respiratory muscles due to disorders such as myasthenia gravis, muscular dystrophy, or Guillain-Barre syndrome (Patel & Sharma, 2023).

We must consider the possibility that the patient is suffering from rhabdomyolysis because of the potential hypoxia from respiratory failure while he was unconscious and muscle injuries on the arm and hip. Muscle cell necrosis can result from prolonged periods of oxygen deprivation to muscles, ultimately precipitating rhabdomyolysis. Potential complications of rhabdomyolysis include hyperkalemia, compartment syndrome, and acute kidney injury (Toress, P. et al., 2015).

Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. When skeletal muscle integrity is compromised, intracellular muscle components such as myoglobin, creatine kinase (CK), aldolase, and lactate dehydrogenase, as well as electrolytes, are released directly into the bloodstream and extracellular space. Rhabdomyolysis can present as an asymptomatic illness with elevated CK levels or as a fatal condition with severe electrolyte imbalances (hyperkalemia), acute renal failure (ARF), and disseminated intravascular coagulation. While direct traumatic injury is the most common cause of rhabdomyolysis, other potential causes include drugs, toxins, infections, muscle ischemia, metabolic and electrolyte abnormalities, genetic disorders, prolonged bed rest or exertion, and temperature-induced conditions like neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH).  (Toress et al., 2015).

The tall T wave in the EKG shown was due to the hyperkalemia reported. The T wave on an electrocardiogram (EKG) typically represents ventricular repolarization. Ventricular repolarization is the process by which the ventricular myocytes return to their negative resting potential so they can depolarize again (Levis, J.T. 2013). T-wave changes are secondary to electrolyte abnormalities in the myocardium since the EKG is representative of the electricity of the heart. The outflow of potassium from the myocyte during repolarization is necessary to restore resting membrane potential. When there is hyperkalemia, the electrochemical gradient for potassium to flow out of the cell is skewed, altering the repolarization phase. These changes in the action potential are reflected by abnormalities in the T wave on an EKG.

Substance use disorders (SUD) affect men and women differently. Although men have a higher prevalence, women with addictive disorders have a more vulnerable profile and are less likely to enter treatment than men (Fonseca, F., et al., 2021). The most relevant data show that female substance use is increasing, and the gender gap may be closing. Men and women use drugs for different reasons. Women progress rapidly from drug use to addiction. Females face severe consequences as a result of drug use, including pregnancy complications and more serious medical issues (Fonseca, F., et al., 2021).

References

Fonseca, F., Robles-Martínez, M., Tirado-Muñoz, J. 
et al.
 A Gender Perspective on Addictive Disorders 
Curr Addict Rep
 
8
, 89–99 (2021). https://doi.org/10.1007/s40429-021-00357-9

Levis, J. T. (2013). ECG diagnosis: hyperkalemia. 
The Permanente journal
, 
17
(1), 69 
https://doi.org/10.7812/TPP/12-088
Links to an external site.

Patel S., Sharma S. Respiratory Acidosis [Updated June 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Retrieved from: 
https://www.ncbi.nlm.nih.gov/books/NBK482430/
Links to an external site.

Torres, P. A., Helmstetter, J. A., Kaye, A. M., & Kaye, A. D. (2015). Rhabdomyolysis pathogenesis, diagnosis, and treatment 
Ochsner journal
, 
15
(1), 58–69.

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2020). Naloxone. In Davis’s drug guide for nurses (17th ed.), In Nursing Central for Apple iOS (Version 1.44) [Mobile application software] Retrieved from 
https://nursing.unboundmedicine.com/nursingcentral
Links to an external site.

Wang, S. C., Chen, Y. C., Lee, C. H., & Cheng, C. M. (2019). Opioid Addiction, Genetic Susceptibility, and Medical Treatments: A Review, 
International journal of molecular sciences
, 
20
(17), 4294 https://doi.org/10.3390/ijms20174294

 

Expand discussion thread from Nisha Krishnan Rayan

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MN

Mofo Ngoupaye
 (He/Him)

Nov 29, 2023 6:28am
| 
Last reply Dec 3, 2023 12:51am

Reply from Mofo Ngoupaye

Main post

Substance use disorder is a curable mental illness that alters a person’s brain and behavior, causing them to be unable to manage their consumption of substances such as legal or illicit drugs, alcohol, or prescriptions. (National Institute of Mental Health, n.d.). It is a major health issue that greatly contribute to morbidity and death rate all over the world.  Scientists uncovered genes that are typically inherited throughout addiction problems, independent of the drug consumed, by going through genetic data from over 1 million people. (NIDA, 2023). This research proves that genetics plays a significant role in the occurrence of substance abuse in people who suffer from substance abuse disorders. According to the symptoms described in the scenario, the patient must have swallowed a large amount of heroin, opioids or fentanyl since he became responsive after receiving Naloxone which is an antidote to opioid and other substance such as Fentanyl and heroin overdose.  According to CDC (2023), when administered in time, naloxone is a life-saving medicine that may reverse an overdose from opioids such as heroin, fentanyl, and prescription opioid. (Para.1).  Naloxone is used to treat opioid toxicity, especially to reverse respiratory depression caused by opioid usage. It can help with accidental or purposeful overdoses, as well as acute or chronic toxicity. “Opioid receptors are abundant in the respiratory center in the cerebral cortex, thalamus, peripheral chemo and baroreceptors in the carotid bodies and vagi, and mechanoreceptors of the airways and lungs. Stimulation of these receptors leads to irregular and slow breathing, eventually developing hypercapnia and hypoxia.” (Dhaliwal and Gupta, 2023, Para. 18). Thanks to extensive research and evidence-based practices, scientists were able to create Naloxone which is a drug that helps to quickly reverse the horrible effect of substance overdose.  According to Jordan and Morrisonponce (2023) Naloxone is a pure, competitive opioid antagonist with a high affinity for the mu-opioid receptor, allowing opioid actions to be reversed. The beginning of effect varies depending on the method of administration; however, it can be as quick as one minute when administered intravenously or intraosseously.

The pain to left hip, forearm, and necrotic tissue found in patient in left greater trochanter and forearm is one evidence that patient was using needles to inject himself with illicit substances. By injecting himself with illicit substances, and without proper aseptic techniques, this patient caused his skin to be infected causing the burning pain he is experiencing. People who inject illicit substances usually use the same syringe many times and inject themselves without using alcohol swab to disinfect their skin which make them more at risk to develop soft tissue and skin infection. The entry of pathogens into the skin causes the development of localized skin and soft tissue infection in people who inject drugs. Bacteria can enter the body through the skin, tainted medicines, or injection equipment such as syringes and associated accessories. Foreign materials and substances in the skin and surrounding tissue might hinder blood and lymphatic outflow, further predisposing to localized infections near the injection site. (Saldana et al, 2020). The patient has an abnormal EKG with prolonged PR interval and peaked T waves with an elevated potassium level of 6.9 mEq/L. These abnormalities are evidence that patient must have a bad kidney function or the drugs he used must have caused a metabolic reaction that cause his potassium level to rise. Rhabdomyolysis is a syndrome that can be caused using some prescription medicines as well as in addition to alcohol, heroin, cocaine, amphetamine, methadone, tramadol, and LSD. This syndrome is characterized by muscle cell degeneration and the spread of muscle cellular components throughout the circulation. This condition can cause the discharge of muscle cell chemicals such as potassium, lactate dehydrogenase, uric acid, and myoglobin into extracellular and circulatory fluid. (Bakak, et al. 2017). Since it is unclear how long this patient has been on the floor unconscious, one can assume that his metabolism might have cause a shock. The shock he experienced might have caused rhabdomyolysis and hyperkalemia.

Gender and genetics will not have changed my response; however, age would have changed my response. This case study is about a 27-year-old male; however, if the patient was elderly with many other comorbidities, the prognostic for him to be alive by the time the emergency medical service arrive will have been poor.

 

 

References

Babak, K., Mohammad, A., Mazaher, G., Samaneh, A., & Fatemeh, T. (2017). Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran. 
Epidemiology and health
, 
39
, e2017050. 
https://doi.org/10.4178/epih.e2017050
Links to an external site.

Center of Disease Control and Prevention. (2023). 
Lifesaving Naloxone.
https://www.cdc.gov/stopoverdose/naloxone/index.html
Links to an external site.

Dhaliwal, A., Gupta, M. (2023). 
Physiology, Opioid Receptor. 
National Library of Medicine. 
https://www.ncbi.nlm.nih.gov/books/NBK546642/
Links to an external site.

Jordan, M. R., Morrisonponce, D. (2023). 
Naloxone
. National Library of Medicine. 
https://www.ncbi.nlm.nih.gov/books/NBK441910/
Links to an external site.

National Institute on Drug Abuse. (2023, March 22). 
New NIH study reveals shared genetic markers underlying substance use disorders. 
Retrieved from 
https://nida.nih.gov/news-events/news-releases/2023/03/new-nih-study-reveals-shared-genetic-markers-underlying-substance-use-disorders
Links to an external site.
 on 2023, November 28

National Institute of Mental Health. (n.d.). 
Substance Use and Co-Occurring Mental Disorders. 
https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
Links to an external site.

Saldana, C. S., Vyas, D. A., & Wurcel, A. G. (2020). Soft Tissue, Bone, and Joint Infections in People Who Inject Drugs. 
Infectious disease clinics of North America
, 
34
(3), 495–509. 
https://doi.org/10.1016/j.idc.2020.06.007
Links to an external site.

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Bernadette Flores

Nov 28, 2023 11:51pm
| 
Last reply Dec 2, 2023 4:33pm

Reply from Bernadette Flores

Main Discussion Post

After reading this case study, I will explain three possible diseases that occurred to this patient. Since the patient was found unresponsive due to the use of substance abuse, the patient may have a significant history of drug use. Due to the pain and necrotic tissue, rhabdomyolysis could have occurred and caused these injuries. The abnormal EKG and elevated potassium levels could also indicate rhabdomyolysis and hyperkalemia. In the patient-provided case study scenario, I will explain these diseases in detail and how they all cause rhabdomyolysis.

The Role Ge
netics Plays in the Disease

Rhabdomyolysis is considered acute and often severe skeletal muscle damage resulting in the release of intracellular muscle components into the bloodstream, which can cause cell and tissue death (Scalco, et al, 2015). There are both genetic and acquired causes of rhabdomyolysis in patients, depending on their family history and drug use.  Metabolic muscle disorders and muscular dystrophies can cause patients to develop this disease along with alcohol and drug use.

Why the Patient is Presenting with the Specific Symptoms Described, 
The Physiologic Response to the Stimulus Presented in the Scenario and Why You Think This Response Occurred

Due to the breakdown in skeletal muscle fibers that then leak into the bloodstream, high levels of potassium in the blood can disrupt the heart’s normal rhythm, causing the patient to have a prolonged PR interval and peaked t waves in his EKG (Miller, 2022). This explains why the patient’s potassium was 6.9 mEq/L and shows why he had an abnormal EKG initial reading. A complication known as compartment syndrome can also occur from prolonged immobility. The sustained muscle compression and increased pressure from lying on a hard surface for too long can cause necrotic tissue (Miller, 2022). As the patient in this case study was found to be unconscious for an unknown amount of time, the patient could have developed the complication of compartment syndrome in his left hip and forearm from lying on his left side for an extended period of time. Given the patient’s substance abuse history, Narcan was used to help reverse the effects of the drug used and allowed the patient to become responsive. Naloxone aka Narcan, is a pure opioid antagonist that completely displaces narcotics from the opioid receptor sites in the brain’s central nervous system (Gibson, 2022). As this medication replaces the receptor sites, it allows the patient to regain consciousness and become responsive by eliminating the narcotic.

The Cells That Are Involved in This Process

Different cellular levels are involved in the process of rhabdomyolysis. The skeletal muscle cell is damaged, leading to the release of toxic intracellular material into the blood circulation (Giannoglou, et al, 2007). Rhabdomyolysis causes an increase in intracellular free-ionized calcium due to cellular energy depletion or direct plasma membrane rupture (Giannoglou, et al, 2007). The increased intracellular calcium activates several proteases, intensifies skeletal muscle cell contractility, induces mitochondrial dysfunction, and increases the production of reactive oxygen species, ultimately resulting in skeletal muscle cell death (Giannoglou, et al, 2007). This disease mainly affects muscle cells which can then cause the symptoms provided in this scenario such as hyperkalemia, necrotic tissue, and increased muscle pain.

How Another Characteristic Would Change Your Response

Genetics would change my response in this scenario. In the case study provided, the patient seemed to self-inflict the symptoms of rhabdomyolysis by ingesting an unknown number of narcotics, which is considered an acquired complication. If the patient had specific genetic issues such as inherited metabolic disorders of skeletal muscle, abnormal glycogen storage affecting muscle, and disorders of fatty acid oxidation (Scalco, et al, 2015), the responses and explanations would differ from the current case study being presented.

References

Giannoglou, G. D., Chatzizisis, Y. S., & Misirli, G. (2007). The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. 
European Journal of Internal Medicine
, 
18
(2), 90–100. https://doi.org/10.1016/j.ejim.2006.09.020

Gibson, J. L. . P. (2022). Naloxone. 
Salem Press Encyclopedia of Health
.

Miller, S. P. (2022). Rhabdomyolysis. 
Salem Press Encyclopedia
.

Scalco, R. S., Gardiner, A. R., Pitceathly, R. D. S., Zanoteli, E., Becker, J., Holton, J. L., Houlden, H., Jungbluth, H., & Quinlivan, R. (2015). Rhabdomyolysis: a genetic perspective. 
Orphanet Journal of Rare Diseases
, 
10
(1), 1–15. https://doi.org/10.1186/s13023-015-0264-3

Evidence-Based Practice and the Quadruple Aim

Evidence-based practice is a technique used to aid health providers in meeting the quadruple aim. Accordingly, the quadruple aim focuses on creating better patient outcomes, enhancing their overall patient experience, reducing costs, and improving clinician experiences. Kim et al. (2016) defined quadruple aims as enhancing patient experience, improving population health, cost reduction, and improving the work life of health providers. A significant relationship exists between evidence-based practice and quadruple aim, as explored in this study.

Evidence-based Practice and Quadruple Aim

Evidence-based practice is involved using and applying scientific evidence to guide decision-making abilities. Due to the efficacy of evidence-based practice in improving healthcare, these practices have increasingly gained momentum over the years and have been referred to when forming public policies, improving nursing practice, and leading the role in education across the globe. Typically, Kim et al. (2016) argued that evidence-based practice incorporates the best available scientific evidence and guides clinicians in making critical decisions concerning patients. The primary goal of the quadruple aim is to appreciate the health system’s efforts in improving the population’s health, enhancing patient experience, and reducing healthcare costs to strengthen health professionals’ work lives (Sikka et al., 2015). Evidence-based practice implements four elements within the quadruple aim.

Patient Experience   

Accordingly, patient experience is one of the first points of the quadruple-aim approach. Through patient experience, evidence-based practice plays an integral role in improving the quality of health services and boosting patient outcomes. Crabtree et al. (2016) argued that when evidence-based practice is implemented, it will increase the overall nurse confidence in conducting a literature search and evaluating the results accordingly. The skills obtained after implementing evidence-based practice do not directly affect patient experience or improve nurses’ ability to translate the research to practice. Nonetheless, it signifies and denotes professional development leading to high-quality health services. Evidence-based practice lays the foundation for improving the patient experience by increasing knowledge of cultural competence. The evidence-based practice utilizes an inter-professional model where shared decision-making can advocate to help nurses positively approach evidence-based research. Research is a way that organizations can acquire skills and knowledge for clinical practice to help improve the overall patient experience.

Population Health

Additionally, evidence-based practice significantly affects the quality of healthcare and subsequently impacts the population’s overall health. In evidence-based practices, there are research practices on educating people on individual health determinants, benefits, and limitations of specific treatments. When evidence-based practices are embraced in a nurse setting, one will likely acquire skills that would enhance the equitable distribution of resources and cultural competence that would help educate the population and thus improve their overall health (Kim et al., 2016). Typically, people are categorized based on their needs, precisely socioeconomic status, support acquired from family, and individual health status. Consequently, this leads to equity and improves resource distribution and allocation efficacy to enhance health promotion. According to Sikka et al. (2015), 60% of doctors in healthcare settings are considered to have left their duty and practice, while 70% know of colleagues who left the service due to reduced morale. Implementing evidence-based practice would improve the population’s health and boost the physicians’ confidence to continue resolving for society’s ultimate good and benefit. The evidence-based practice could resolve issues with the turnover of medical personnel, which would directly affect the processes of care provision by ensuring that there are enough skilled persons to address every patient’s needs.

Healthcare Services Costs

The costs of healthcare services remain a challenge for most healthcare facilities. Most healthcare institutions need help providing safe and high-quality health services at a low cost. (Kim et al. (2016) argued that discounts and pricing are the most common techniques for measuring actual expenses. Evidence-based practice is directly linked to healthcare costs since, in research articles, there are strategies for improving different technologies in a health setting to enhance efficiency. With the adoption of these technologies, the costs of healthcare drop eventually. Hence, this shows the correlation between evidence-based practice and healthcare costs.

Work-Life of Health Providers

For a healthcare environment to be suitable and conducive to the employees, there needs to be an environment that supports inter-professional collaboration, and there has to be minimal stress and burnout for health professionals. Collaboration, reduced stress, and burnout are all integral factors that improve health outcomes and lead to health providers’ satisfaction in their different positions (Kim et al., 2016). The evidence-based practice provides solutions that would help prevent stress and burnout in the work care setting. All these factors would improve the motivation of healthcare providers. Eventually, the work-life of health providers improves, thus showing the link between evidence-based practice and the work-life of health providers.

 

References

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice.
Worldviews on Evidence-Based Nursing, 13
(2), 172-175.
https://doi.org/10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants.
Worldviews on Evidence-Based Nursing, 13
(5), 340-348.
https://doi.org/10.1111/wvn.12171

Sikka, R., Morath, J. M., & Leape, L. (2015). The quadruple aims for Care, health, cost, and meaning in work.
BMJ Quality & Safety, 24
(10), 608-610.
https://doi.org/10.1136/bmjqs-2015-004160

 

Evidence-Based Practice and the Quadruple Aim

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.

Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.

Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

Patient experience

Population health

Costs

Work life of healthcare providers

By Day 7 of Week 1

Submit
 your anaylsis.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
MD1Assgn+last name+first initial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NURS_6052_Module01_Week01_Assignment_Rubric

NURS_6052_Module01_Week01_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Write a brief analysis of the connection between evidence-based practice and the Quadruple Aim. Your analysis should address how evidence-based practice might (or might not) help reach the Quadruple Aim, including each of the four measures of:· Patient experience· Population health· Costs· Work life of healthcare providers

85
 
to >
76.0
 pts
Excellent
The analysis clearly and accurately addresses in detail how evidence-based practice either supports or does not support the Quadruple Aim. … The analysis accurately and thoroughly explains in detail how the four measures of patient experience, population health, costs, and work-life of healthcare providers either supports or does not support the Quadruple Aim. … The analysis provides a complete, detailed, and specific synthesis of two outside resources reviewed on the four measures supporting or not supporting the Quadruple Aim. The response fully integrates at least two outside resources and two or three course-specific resources that fully support the analysis provided with credible and detailed examples.

76
 
to >
67.0
 pts
Good
The analysis accurately addresses how evidence-based practice either supports or does not support the Quadruple Aim. … The analysis accurately explains how the four measures of patient experience, population health, and work life of healthcare providers either supports or does not support the Quadruple Aim. … The analysis provides an accurate synthesis of at least one outside resource reviewed on the four measures supporting or not supporting the Quadruple Aim. The response integrates at least 1 outside resource and two or three course-specific resources that may support the analysis provided and may include some detailed examples.

67
 
to >
59.0
 pts
Fair
The analysis inaccurately or vaguely addresses how evidence-based practice either supports or does not support the Quadruple Aim. … The analysis inaccurately or vaguely explains how the four measures of patient experience, population health, and work life of healthcare providers either supports or does not support the Quadruple Aim. … The analysis provides an inaccurate or vague analysis of the four measures supporting or not supporting the Quadruple Aim with a vague or inaccurate analysis of outside resources. The response minimally integrates resources that may support the analysis provided and may include vague or inaccurate examples.

59
 
to >
0
 pts
Poor
The analysis inaccurately and vaguely addresses how evidence-based practice either supports or does not support the Quadruple Aim or is missing. … The analysis inaccurately and vaguely explains how the four measures of patient experience, population health, and work life of healthcare providers either supports or does not support the Quadruple Aim or is missing. … The analysis provides a vague and inaccurate analysis of the four measures supporting or not supporting the Quadruple Aim with a vague and inaccurate analysis of outside resources. The response fails to integrate any resources to support the analysis provided or is missing.

85
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting—Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

5
 
to >
4.0
 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4
 
to >
3.5
 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.

3.5
 
to >
3.0
 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time. … Purpose, introduction, and conclusion of the assignment is vague or off topic.

3
 
to >
0
 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. … No purpose statement, introduction, or conclusion was provided.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting—English Writing Standards:Correct grammar, mechanics, and proper punctuation.

5
 
to >
4.0
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

4
 
to >
3.5
 pts
Good
Contains a few (one or two) grammar, spelling, and punctuation errors.

3.5
 
to >
3.0
 pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors.

3
 
to >
0
 pts
Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting—The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5
 
to >
4.0
 pts
Excellent
Uses correct APA format with no errors.

4
 
to >
3.5
 pts
Good
Contains a few (one or two) APA format errors.

3.5
 
to >
3.0
 pts
Fair
Contains several (three or four) APA format errors.

3
 
to >
0
 pts
Poor
Contains many (five or more) APA format errors.

5
 pts

Total Points: 
100

Where in the World Is Evidence-Based Practice?

March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.

In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To Prepare:

Review the Resources and reflect on the definition and goal of EBP.

Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).

Explore the website to determine where and to what extent EBP is evident.

By Day 3 of Week 1

Post
 a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues
 on two different days
 by visiting the websites they shared and offering additional examples of EBP or alternative views/interpretations to those shared in your colleagues’ posts.

Main Post

Evidence Based Practice is essential for healthcare as it refers to utilizing the most up to date evidence in clinical practices to enhance the quality of healthcare and improve patient outcomes. These qualities, along with reducing costs and empowering clinicians makes up the quadruple aim and is the basis for healthcare systems in the United States (Melnyk & Fineout-Overholt, 2023, p.7). Kim et. al (2016) discusses how implementation of evidence based practices into nursing and healthcare can be a factor in job satisfaction amongst nurses who work in facilities with evidence based practice implementation (Kim et. al, 2016)

While reviewing the hospital I currently am employed ats website, I found several places where the quadruple aim in Evidence Based Practice is mentioned throughout. The first place is directly in the mission statement “We’re committed to delivering exceptional care- every patient, every time” as well as in the discussion regarding new and innovative methods utilized for improving patient outcomes in the surgical center (HCA Health, n.d.). Emphasizing these two qualities, as well as discussions of ensuring financial assistance is provided, and the discussion of ensuring the highest quality clinicians who are trained in the most advanced and up-to-date medical standards, StoneSprings Hospital appears to be grounded in the quadruple aim of evidence based practice. My perception of StoneSprings has not changed my perception of the hospital with which I am employed as I can see physical evidence of the hospital utilizing the quadruple aim and evidence based practice every shift I work.

 

References

HCA Health. (n.d.). 
About us
. StoneSprings Hospital Center. 
https://www.hcavirginia.com/locations/stonesprings-hospital-center/about-us
Links to an external site.

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A., & Davidson, J. E. (2016). Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants. 
Worldviews on Evidence-Based Nursing
, 
13
(5), 340–348. https://doi.org/10.1111/wvn.12171

Melnyk, B. M., & Fineout-Overholt, E. (2023). 
Evidence-based practice in nursing & healthcare: A guide to best practice
 (5th ed.). Wolters Kluwer

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Kimberly Marie Culp

Jun 1, 2023 3:30pm
| 
Last reply Jun 2, 2023 8:01pm

Reply from Kimberly Marie Culp

Main Post

Johns Hopkins Medicine is a healthcare organization I have been a patient of for over a decade, and is of great interest to me. Their organization’s mission is to improve the health of populations worldwide using evidence-based practice (EBP) from biomedical research and the help of expert clinical knowledge (Johns Hopkins Medicine, n.d.). Johns Hopkins Medicine provides optimal patient care using a multidisciplinary approach from those at the Johns Hopkins Health System and the Johns Hopkins University School of Medicine (Johns Hopkins Medicine, n.d.). Their team members include scientists and researchers who carry out clinical trials in the lab to the physicians, nurses, and other healthcare providers taking this data and integrating it into their practice in over fifty of their patient care sites (Johns Hopkins Medicine, n.d.).They have created their own EBP framework called the Johns Hopkins Evidence-Based Practice Model that medical professionals can utilize when making decisions in the clinical setting or needing help with problem-solving (Liu et al., 2021). EBP models are essential for organizations to have in place so that there is a system for appraising research, effectively translating it, and applying it to improve patient experiences (Dusin et al., 2023). These examples I have found on the Johns Hopkins Medicine website have only solidified my decision as to why I think it is a great organization and why I have continually chosen it as a place to receive my medical care.

References

Dusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting: A scoping review. 
BMJ Open, 13
(5), e071188. 
https://doi.org/10.1136/bmjopen-2022-071188
Links to an external site.

Johns Hopkins Medicine. (n.d.). 
About us
. Retrieved May 31, 2022, from 
https://www.hopkinsmedicine.org/johns_hopkins_healthcare/about_us/index.html
Links to an external site.

Liu, M., Lin, Y., Dai, Y., Deng, Y., Chun, X., Lv, Y., Yang, H., & He, F. (2021). A multi-dimensional EBP educational program to improve evidence-based practice and critical thinking of hospital-based nurses: Development, implementation, and preliminary outcomes. 
Nurse Education in Practice, 52
. 
https://doi.org/10.1016/j.nepr.2020.102964
Links to an external site.

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Yvette Stevenson

Jun 1, 2023 10:41am
| 
Last reply Jun 3, 2023 5:20pm

Reply from Yvette Stevenson

    The organization I chose to review is the National Academy of Medicine. This organization is one of three organizations that combined to create the academy. The NAM focuses on engineering, science, and medicine within the United States utilizing research, community, and scientific advisors to aid in decisions, policies, and care of patients around the world. This academy ensures that any challenges that the citizens of the United States may face medically or scientifically are addressed by the backing of tested and tried research including that of gene studies, climate change that affects health, the well-being of clinicians, safety, the future of nursing, emerging science, and technological advancements (NAM, n.d). This organization seeks to ensure that collaborative and interdisciplinary teams provide the best scientific and up-to-date information to shape the future of healthcare globally(NAM, n.d) . The evidence-based practice aspect of this organization also provides direction and leadership on mental health and healthcare team burnout that contribute to the decline of providers, nurses, and other team members. Due to this, they have developed the National Plan for Health Workforce Well-Being to combat this issue. This initiative assists educational institutions, public and private health leaders, policy regulators, IT companies specific to health care, and multiple associations (NAM, n.d) .

Prior to this assignment, I had minimal knowledge of this organization. After researching what they stand for, believe in, and the research associated I do believe that it is grounded in evidence-based practice. It is the foundation on which they were created, and continues to do so as of today. The scientific and professional data to conclude their final determinations are critical to healthcare, as they advise many of the regulators that fuel our society and healthcare infrastructure (Li et al., 2019).

Reference

Li, S., Cao, M., & Zhu, X. (2019, September). 
Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review
. Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775415/

NAM. (n.d.). How the nam can support your work – national academy of medicine. https://nam.edu/wp-content/uploads/2021/07/NAM-Overview-one-pager-2021.pdf

 

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Yenis Elizabeth Pineda

May 31, 2023 10:57pm
| 
Last reply Jun 1, 2023 9:53am

Reply from Yenis Elizabeth Pineda

NIH (National Institute of Health)

The achievement of quality patient care and the safety of patients is attainable via evidenced based practice. Research is performed by healthcare organizations as a way to gather and utilize evidenced-based information to empower their clinicians, improve the quality of care, improve outcomes, and patient safety. Empirical research is provided by evidenced-based data and allows for efficient management of patient care. The National Institute of Health also known as NIH is an organization that provides data that is evidenced based, addresses, explores, and supports health problems via clinical trials. An example of this is NIH conducting research about the coronavirus and its cure/treatment.

NIH is a government agency with its focus being biomedical research that aids and saves patients’ lives (NIH, 2017a). NIH evidenced based practice located in the section for research and training. NIH began with a one-room laboratory during the year 1887 and is now known as a leading medical research center (NIH, 2015). The nation utilizes NIH as a steward of research such as behavioral and medical (NIH, 2015).  The mission of NIH is to explore the fundamental knowledge regarding the behavior and nature of living systems thereby allowing the application of the information to aid in the reduction of illness, enhancement of health, reduction in disability, and lengthening of life (NIH, 2015). The goals of NIH are to cultivate research strategies that are innovative, fundamental creative discoveries, and ultimately apply it as a way to enhance/improve health. Prevention of diseases via the development, maintenance, and renewal of scientific human and physical resources is another goal. Expansion of knowledge in associated and medical sciences as a way of ensuring economic well-being is the third goal (NIH, 2015). The final goal of the agency is to epitomize and promote in the conduction of science the utmost level of scientific integrity, social responsibility, and public accountability (NIH, 2015). By the realization of these goals, it allows NIH to improve health via the conduction and support of research which aids in finding the cause of the disease, diagnosing, curing, and prevention; human growth and development, environmental contaminants biological effects; understanding addictive, mental, and physical disorders; exchange, collection, and dissemination of information (NIH, 2015).  Congress gives funds to NIH to aid with the research regarding the labor and health human services budget bill. NIH has 27 centers and institutes that aid in the conduction and coordination of research throughout different biomedical research.

NIH utilizes clinical trials as a way to study diseases, medication interactions, and evaluation of intervention and their effects on health outcomes. Due to the utilization of clinical trials by NIH the government, policymakers, stakeholders, researchers, and NIH  revisit and review the procedures and policies as a way to protect the participants, ensure effective utilization of resources, and ensure that vital research questions were answered (Vardeny, Hernandez, Cohen, Franklin, Baqai, Palmer, Bierer & Cobb, 2019). Prior to publishing information NIH ensures that the information gathered is grounded in EBP and effectiveness is evaluated. Exacerbation in a patients symptoms can occur if managed with the use of evidenced based practice early on it can worsen the cost for the patient and organization, length of stay is increased, reduction in patient satisfaction, and poor health outcome (Mullings, 2019).

Research outcomes summary is provided by NIH in addition to providing a link that connects you to the research article which in turn aids healthcare providers/clinicians in coming up with a clinical decision. An example would be while researching an article regarding hangovers the website provided a link which I then clicked and lead to the hangover summary and then at the bottom of the NIH website it provided more information related to alcohol hangover and other links. NIH also has the Wellness Toolkits that provide tips that are evidenced based to improve your health and live well (NIH, 2017b). The toolkits are informative and also provide several links to the resources that were utilized in developing the toolkit (NIH, 2017b).

We utilize the NIH website in the work setting as a way to acquire more information about mental health and drug issues to educate families with evidence-based information properly. This organization is a great resource for clinicians and healthcare professionals. I have a change in how I view the healthcare industry due to the NIH website as they provide several clinical trials, and articles that are up to date and provide evidenced-based data to improve outcomes for patients. NIH is a website that patients and family members can utilize free of charge.

References

Mullings, J. (2019). Embedding National Institute for Health and Care Excellence guidance into a leg ulcer pathway. 
British Journal of Community Nursing, 24
(sup9), S6–S11. https://doi-org.ezp.waldenulibrary.org/10.12968/bjcn.2019.24.Sup9.S6

National Institute of Health (2017a). Mission and goals. 
National Institute of health, turning 
discovery into health
. Retrieve from. https://www.nih.gov/about-nih/what-we[1]do/mission-goal

National Institutes of Health. (2017b, June 22). Your healthiest self: Wellness toolkits. National Institutes of Health (NIH). Retrieved June 4, 2021, from https://www.nih.gov/health-information/your-healthiest-self-wellness-toolk

NIH. (2015, July 7). 
About the NIH
. National Institutes of Health (NIH). 
https://www.nih.gov/about-nih/what-we-do/nih-almanac/about-nih#:~:text=NIH%20is%20the%20steward%20of,and%20reduce%20illness%20and%20disability
Links to an external site.
.

Vardeny, O., Hernandez, A. F., Cohen, L. W., Franklin, A., Baqai, M., Palmer, S., Bierer, B. E., & Cobb, N. (2019). Transitioning to the National Institutes of Health single institutional review board model: Piloting the use of the Streamlined, Multi-site, Accelerated Resources for Trials IRB Reliance. 
Clinical Trials
, 16(3), 290–296. https://doi-org.ezp.waldenulibrary.org/10.1177/1740774519832911

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Stella Muneh

May 31, 2023 10:07pm
| 
Last reply Jun 1, 2023 9:52am

Reply from Stella Muneh

Evidence-Based Practice endorsed by American Nursing Association

Evidence-Based Practice (EBP) in care provision is significantly relevant. Healthcare providers need EBP to provide the most effective care that aims to improve the patient’s outcome. It might not be quality care as expected by the nurses, but the fact that it is most effective makes EBP outstandingly relevant. The discussion below illustrates how American Nursing Association (ANA) endorses Evidence-Based Practices (EBP’s) for their members who are nurses.

Description of the selected healthcare organization

The selected website is the American Nursing Association (ANA) website. The American Nursing Association is a healthcare professional organization that advances the needs of nurses and protects the entire profession from possible policy challenges. The ANA endorses EBP as illustrated below.

Sections that EBP appears on the website

On the website of the American Nursing Association (ANA), under head scripts, they illustrate Evidence-Based Practice (EBP) and why nurses need to implement it as part of offering care. ANA considers EBP as making nurses improve their clinical practice and always ceases depending on traditional methods used to offer care (Melnyk &Fine-out-Overholt, 2023). The ANA also encourages nurses to use EBP while discouraging traditional methods that include: focusing on advice from colleagues, depending on vast experience, and committing to other individuals’ personal beliefs. As a healthcare organization, American Nursing Association implements its duties influenced by research.

One of their departments is made up of research personalities that investigate the various nursing and clinical practices. Additionally, the ANA offers a section of nursing research where professional nurses can access articles to review and identify Evidence-Based Practices to better their client’s healthcare outcomes. As a result, the organizations implement EBP and encourage nurses to use EBP to better their performances.

Changed Perception

The information offered on the website regarding EBP offers a new perspective on how EBP is a space where nurses can expand their knowledge and better their perception of the various nursing skills and practices (Melnyk & Fineout-Overholt, 2023). As a result, nurses must focus on something other than mastering traditional clinical practice. However, they must focus on expanding their knowledge of contemporary clinical practices that could help better every patient’s healthcare outcome.

 

References

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer. 

Links to an external site.

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Ursula Kizzee

May 31, 2023 9:59pm
| 
Last reply Jun 2, 2023 7:49pm

Reply from Ursula Kizzee

Main Discussion

Evidence based practice is by definition “ is a lifelong approach to problem solving to deliver healthcare that consolidates the best evidence from a body of research with a clinician’s  expertise and a patient’s preferences and values to make the best decision about patient care (Melnyk & Fineout-Overholt, 2023).  I will discuss the presence of evidence-based practice within the American Society of PeriAnesthesia Nurses.  I currently work in the recovery room, and this is the organization that we utilize to obtain our certification.  The organization utilized an EBP model that serves as a template for guidance of research in this specialty (ASPAN.org, 2006/2023). The organization’s philosophy and vision do not include EBP but it was noted and discussed in the mission statement and in their core values (ASPAN.org, 2023). I do believe the organization is grounded in evidence based practice, the mission of the organization is to ensure that patient care is guided by evidence and to also to continue to improve the quality of patient care through educating and supporting the perianesthesia nurses. (ASPAN.org, 2023)  It is actually the main responsibility of the American Society of Peri-Anesthesia Nurses to establish evidence based standards to guide the practices of peri-anesthesia nurses (Krenzischek, et al., 2019).  This organization has been setting standards since it was founded in 1980 (ASPAN.org, 2023)and continues to set standards and guidelines regarding the care of patients in the post anesthesia care unit.  Their desire to continue to educate nurses using evidence-based practice and continuing to encourage evidence-based research is exactly what I expected from the organization.

 

References

ASPAN.org. (2006/2023, April). 
ASPAN.org
. Retrieved from ASPAN.org.evidence based practice: https://www.aspan.org/Clinical-Inquiry/Evidence-Based-Practice

ASPAN.org. (2023). 
ASPAN.org
. Retrieved from ASPAN.org/clinicalInquiryoverview: https://www.aspan.org/clinicalinquiryoverview

Krenzischek, D., Card, E., Crosson, J., Clifford, T., Russell, S., MAn=cDonald, R., & Wilson, L. (2019). Delphi Study: ASPAN Adult Patient Pain and Comfort Practices. 
Journal of PeriAnesthesia Nursing, 34
(6), 1120-1129. doi:10.1016/j.jopan.2019.06.003

Melnyk, B., & Fineout-Overholt, E. (2023). 
Evidence-BAsed Practice in Nursing and Healthcare A Guide to Best Practice
 (5th ed.). Philadelphia: Wolters Kluwer.

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Mary Therese Sorensen Wiederhold

May 31, 2023 8:58pm
| 
Last reply Jun 3, 2023 7:31am

Reply from Mary Therese Sorensen Wiederhold

The website I reviewed was for the Centers for Disease Control and Prevention (
https://www.cdc.gov/
Links to an external site.
) . The Centers for Disease Control and Prevention (CDC) provide a plethora of information on disease and other public health threats and concerns (e.g. elder abuse, HIV, ADHD, etc.). They also provide updated guidance on seasonal viruses and new viruses causing a threat to human mortality. Many of us turned to the CDC during the COVID-19 pandemic for guidance in preventing serious illness, preventing or slowing spread of disease, and guidance for our daily routines as the pandemic unfolded. All of this information was based on best evidence at the time starting with previous wisdom from dealing with other respiratory viruses that got refined through study and practice to be more specific to COVID-19 in its many mutations. Evidenced-based practice is the bedrock for this organization. The CDC adopts evidence from studies and research conducted and aides in developing guidelines and evidenced-based practice.

The perception of the Centers for Disease Control and Prevention is that it only deals with diseases or ailments, but the CDC provides information regarding other health hazards and ways to prevent them, like their safe swim guidance for summer. They also provide guidance for healthcare providers as well as lay persons. If you peruse the site you can find guidance geared to lay people for health maintenance and separate guidance for us as healthcare providers to help guide practice. Both contain information derived from research and study, but the healthcare provider guidance is the more focused space to give us guidance to practice safely and effectively for our patients. My perception of the site and organization has expanded. I’ve had to look at the CDC for certain topics as needed for my practice (in particular COVID-19) and also for research or answers to different topical concerns, but as I perused this time I recognized that not all the topics were strictly disease or health topics. I saw that there was hazard protection advice in the form of articles like how to swim safely this summer.

Centers for Disease Control and Prevention (2023) 
Centers for disease control and prevention. 
Accessed 5/31/2023 Accessed from: 
https://www.cdc.gov/
Links to an external site.

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Laci Pistole

May 31, 2023 7:53pm
| 
Last reply Jun 2, 2023 1:52pm

Reply from Laci Pistole

Initial Post

Arkansas Blue Cross Blue Shield was founded in 1948 as an independent licensee of Blue Cross Blue Shield. Arkansas Blue Cross Blue shield is a not-for-profit mutual insurance company. Meaning the company collects premiums and pays back nearly 85 cents on the dollar. The other 15 cents are used for operating expenses and reserve funds.

According to Melnyk et al. (2014), Evidence based practice is defined as improving healthcare quality, reliability, and patient outcomes as well as reducing variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe.  Arkansas Blue Cross Blue Shield has taken this definition and turned it into their part of their vision, mission, and values. AR BCBS also has URAC accreditation. URAC Accreditation is another way they are assuring the company is following evidence-based practice. URACs mission is Advancing the quality of health care through leadership, accreditation, measurement, and innovation.

As a case manager, I see the constant changes to case management up the anti in the quality of case management provided at AR Blue Cross Blue Shield. I whole heartedly believe that they use evidence based practice through daily interaction with members.

References:

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The Establishment of Evidence-Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real-World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs. 
Worldviews on Evidence-Based Nursing
, 
11
(1), 5–15. https://doi.org/10.1111/wvn.12021

URAC. (2023). 
Mission
. 
https://www.urac.org/about/mission/
Links to an external site.

Arkansas Blue Cross Blue Shield.(2021-2023). 
Company Overview.
 https://www.arkansasbluecross.com/company/company-overview

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Blair Tomsheck

May 31, 2023 7:39pm
| 
Last reply Jun 2, 2023 11:28am

Reply from Blair Tomsheck

Healthcare Organization Review

The National League for Nursing is an organization that strives to reach higher excellence with nursing education. Their mission statement focuses on advancing the nursing profession through workforce education. Their mission is to affect nurses locally but also globally. Core values promote caring, integrity, diversity and inclusion, and excellence. Their current board of governors and senior management is heavily advanced on their education spectrum.

Their expectation and demonstration of ethics, communication, and humility have created a culture of integrity throughout the organization. Attention to detail of collaborators empowers nurses to include and innovate beyond the ideologies that could create barriers. Finally, the National League for Nursing pushes for continual growth, quality, and education of the nursing profession and culture. (National League for Nursing, 2022)

Evidence-based Practice Praticaed

The work of the National League for Nursing is grounded in evidence-based practice. They work for their members to promote professional development by creating simulation learning. And continue to collaborate to offer expert clinical professionals during education scenarios. NLN pushes through the barriers preventing the use of evidence-based practice. Identifying further training, encouraging staff to continue education, and making resources readily available should help healthcare staff uptake EBP. (Li et al., 2019) Finally, their efforts to promote evidence-based practice include publishing professional health content provided to their members.

Organization Perception

Currently, there are many options for joining associations in the nursing field. The primary benefit of this organization is pushing nurses to further their education. When nurses use evidence-based practice, their career elevates in ways that extend further than usual. They are better able to care for patients, the quality of care improves and outcomes, and they have a higher gratification than nurses who practice by tradition. (Melnyk et al., 2010)

 

References

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice. Medicine, 98(39), e17209. https://doi.org/10.1097/MD.0000000000017209

Melnyk, B.M., Fineout-Overhold, E., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53.

National League for Nursing. (2022). Core Values. National League for Nursing. https://www.nln.org/about/about/core-values

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Blessing Azuka Ojuah

May 31, 2023 1:21pm
| 
Last reply Jun 1, 2023 9:48am

Reply from Blessing Azuka Ojuah

Evidence-Based Practice
.

Virginia Hospital Center Health.org was the website I researched for the healthcare institution. The American Nurses Credentialing Center named the 453-bed VHC Health a Magnet hospital. It is also a proud Mayo Clinic Care Network member, a nationwide alliance of independent healthcare providers. The Hospital was named a 2021 Top Teaching Hospital by The Leapfrog Group. In 2022, it received a 21st consecutive “A” rating from The Leapfrog Group and the 11th consecutive Healthgrades Outstanding Patient Experience Award. VHC Health is dedicated to becoming the top workplace and healthcare provider in the Washington, DC, metropolitan region (VHC Health (n.d)).

Walden University Producer 2018 states, “Evidence practice is finding a way to address a clinical problem, and it is used to inform clinical decision.” I looked everywhere on the organization’s website, including the healthcare organization’s mission and vision statements, but did not locate any references to EBP. I saw an article by the Washington Post on the organization’s website on “One hospital’s evidence-based approach to reducing C-sections.” The World Health Organization (WHO) advises against performing C-sections at a rate higher than 15% since there is no evidence doing so lowers maternal mortality or the hazards associated with delivery (BrandStudio, 2019). Due to this knowledge, VHCHealth intensified its efforts to reduce the national rate of C-sections. In 2014, VHC learned that their C-section rate was 33 percent, much higher than the WHO and American College of Obstetrics and Gynecology (ACOG) suggestion. The leadership, medical, and registered nursing teams created an evidence-based strategy examining every C-section at the Hospital. They collaborate with obstetricians to lower C-section rates if discovered to be greater than the advised norm and to guarantee that patients are always cared for as effectively as possible (BrandStudio, 2019).

The operation of this healthcare institution is based on EBP, even though I could not find it on their website. EBP should be continuously used since it improves patient outcomes, increases care quality and safety, and lowers costs, supporting a practice that satisfies the triple objective of healthcare (Melnyk & Fineout-Overholt, 2023). I work in this Hospital and know that everything we do is an evidence-based practice, including fall prevention, hand washing, catheter-associated urinary tract infections, and various diseases, including diabetes, heart failure, asthma, etc. (Titler, 2008). Additionally, we perform yearly EBP education on HealthStream. At VHCHealth, the clinical nurse director, the patient care director, and the management all highlight the advantages and significance of EBP.

Since this is the most excellent Hospital to work for, the information I saw on the healthcare organization’s website remained the same as how I felt about the Hospital. It is all in their mission and vision statement. The finest clinical judgments that result in favorable patient outcomes are produced when EBP is applied in a context of care, a culture, and an ecosystem or environment that supports it (Melnyk, Fineout-Overholt, et al., 2014). The goal of VHCHealth is to be the finest health system, and part of that goal is to meet the demands of the community’s healthcare needs by offering the highest quality clinical treatment, achieving the highest levels of patient satisfaction, and investing in their staff’s professional growth and development (VHCHealth, (n.d.).

References

BrandStudio, (2019). One Hospital’s evidence-based approach to Reducing C-section Rates. Retrieved from 
https://www.vhchealth.org/news-publications/news/2019/washington-post-one-hospitals-evidence-based-approach-to-reducin/
Links to an external site.
.

Melnyk, B. M., & Fineout-Overholt, E. (2023). 
Evidence-based practice in nursing & healthcare: A guide to best practice
 (5th ed.). Wolters Kluwer.

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. 
Worldviews on Evidence-Based Nursing
, 11(1), 5–15. doi:10.1111/wvn.12021

Titler MG. The Evidence for Evidence-Based Practice Implementation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD):
 
Agency for Healthcare Research and Quality
 
(US); 2008 Apr. Chapter 7. Available from
: 
https://www.ncbi.nlm.nih.gov/books/NBK2659/
Links to an external site.
.

Walden University, LLC. (Producer). (2018). 
Introduction to Evidence-Based Practice and Research
 [Video file]. Baltimore, MD: Author.

VHCHealth (n.d) About Us. 
https://www.vhchealth.org/about-us/
Links to an external site.
.

VHCHealth (n.d). Mission and Vision. (
https://www.vhchealth.org/about-us/mission-vision/
Links to an external site.
).

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Phiona Amankwah

May 31, 2023 1:05pm
| 
Last reply Jun 1, 2023 9:47am

Reply from Phiona Amankwah

Evidence-based practice, also known as EBP, is defined as “a lifelong problem-solving approach to clinical practice that integrates the following: external evidence to a clinical question, internal evidence to achieve desired patient outcomes, and patient/family preferences and values”(Melnyk&Fineout-Overholt,2018, p. 18). The application of a diligent, problem-solving strategy in clinical practice is referred to as evidence-based practice. Evidence-based practice, as defined by Polit & Beck (2020), entails basing clinical judgments on the best available data, with a focus on data from specialized research. The ability to do research, comprehend and assess new knowledge about patient care, and be adaptable to change are all qualities that nurses must possess as lifelong learners (Polit & Beck, 2020). Research evidence can offer useful insights into human health and illness. To promote excellent health or offer treatment, evidence-based practice is essential (laureate Education Producer, 2018).

The World Health agency (often known simply as WHO) is the name of the healthcare agency that I evaluated. The WHO has included EBP into both their vision and mission statements. The mission of this organization is to encourage people all over the world to improve their health and safety by providing the most advanced and comprehensive medical treatment possible. Within a strong healthcare infrastructure, every person on earth will have access to a health care provider who is knowledgeable, enthusiastic, and well-supported. According to the World Health Organization (WHO), the organization’s objective is to “promote health, serve the vulnerable, keep the world safe, advocate and catalyze global and country actions to help resolve health crisis, and support the achievement of health-related millennium development goals” (Magnusson et. al., 2019). Evidence-based practice can provide an amazing chance to maximize patient care and results by developing and utilizing the appropriate tools, culture, education, and patient engagement skills across the entire care process. This can be accomplished by utilizing the potential benefits of evidence-based practice.

Evidence Base Practice is the foundation upon which the work of the globe Health Organization is carried out. This is because the WHO’s primary mission is to promote health by giving individuals all over the globe the ability to have a greater degree of influence over their own medical care with an emphasis on the control and prevention of diseases. This organization has evidence that indicates how health promotion activities have averted common diseases with an emphasis on primary prevention by taking actions before a problem emerges rather than treating the disease or mitigating its consequences (Magnusson et. al.,2019).

The mission and vision statements of the WHO each provide a concrete example of the organization’s fundamental principles. I have always considered the World Health Organization (WHO) and its website to be an excellent source of information since it offers up-to-date reports and evidence-based research on topics such as the promotion of health, the prevention of disease, the protection of wellness, and other related topics. In addition to providing clear policies and improved statistics, this website also makes use of various tools that are based on evidence-based practice to educate medical professionals and so improve global health.

Reference

Laureate Education (Producer). (2018). Introduction to Evidence-Based Practice and Research

[Video file]. Baltimore, MD: Author.

Magnusson, R. S., McGrady, B., Gostin, L., Patterson, D., & Taleb, H. A. (2019). Legal

capacities required for prevention and control of noncommunicable diseases. Bulletin of the World Health Organization, 97(2), 108–117.
https://doi.org/10.24712FBLT.18.213777
Links to an external site.

Melnyk, B. M., & Fineout-Overholt, E. (2018). 
Evidence-based practice in nursing & healthcare: A guide to best practice
. Lippincott Williams & Wilkins.

Polit, D. F., & Beck, C. T. (2020). 
Nursing research: Generating and assessing evidence for nursing practice
. Lippincott Williams &Wilkins.

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Mary Jane Lagayada Andrada

May 31, 2023 12:46pm
| 
Last reply Jun 3, 2023 11:45pm

Reply from Mary Jane Lagayada Andrada

     I chose the American Nurses Association/ ANA organization, which I am a member of. A nationwide membership of registered nurses and a board of directors that makes and implements policies, programs, and practices based on evidence. These evidenced base practices are supported by the standards of care, with objectives that meet patient care goals. American Nurses Association, Practice and Advocacy Section in clinical practice states that the organization is dedicated to sharing pertinent evidence-based practice information implemented in various clinical care settings. American Nurses Association partners with Standards for Excellence Institute. It is the highest standard of ethics, effectiveness, and accountability in nonprofit governance, management, and operations to help nonprofit organizations meet their goals. The goals of ANA and the Standards for Excellence program are to strengthen nonprofits and improve the public’s trust in nonprofit organizations. 

 

     Bachynsky et al. state that Advanced Practice Registered Nurses (APRNs) play a major role in implementing the Affordable Care Act, TripleAim, and Quadruple Aim goals, especially when actively engaged within multidisciplinary teams. The article describes the changes in Healthcare delivery in the United States and that the Patient Protection and Affordable Care Act’s purpose was to provide policy implications that expand access to care and ultimately improve the healthcare system. 

 

The Institute for Healthcare Improvement has launched a major initiative-the Triple Aim-which focuses on the “simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care( Broller, 2017). Improvement outlines a structure for improving population health and healthcare experience, and reducing per capita cost; simultaneously, the Quadruple Aim adds an element designed to focus on policy implications of meeting the healthcare provider’s needs. 

 

  Three Aims and Quadruple Aims inspired health care workers to provide effective and quality care while the Three aims provided the reason health care system, the foundation of care; and the fourth aim focuses on the foundational elements, which are the caregiver, health care providers aiming for high-value care(Shikka, 2015). The fourth aim: create the conditions for the healthcare workforce to find joy, meaning, and fulfillment in their work and, in doing so, improve the experience of providing care.

 

     Nurses, APRNS, and nurses in leadership roles must take part in the opportunity to educate and be involved with policy making and reform, involved in organizations with evidence base models to improve the health of the population and health care system for the workforce members. (Batcheller, 2017)

 

References:

     American Nurses Association https://www.nursingworld.org/practice-policy/scope-of-practice/.

     Bachynsky, N. Implications for policy: The triple aim, quadruple aim, and interprofessional collaboration. 
Nurs Forum
. 2020; 55: 54–64. https://doi.org/10.1111/nuf.12382

     Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot.
 Journal of Nursing Education, 56
(12), 707–708. doi:10.3928/01484834-20171120-01

     Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in workLinks to an external site. 
BMJ Quality & Safety, pp. 24
, 608–610. doi:10.1136/bmjqs-2015-004160

     Joyce Batcheller, Deborah Zimmermann, Sharon Pappas, Jeffrey M. Adams, Nursing’s Leadership Role in Addressing the Quadruple Aim, 
Nurse Leader, Volume 15, Issue 3, 2017, Pages 203-206, 
ISSN 1541-4612, https://doi.org/10.1016/j.mnl.2017.02.007.

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Steven Lopez

May 31, 2023 10:42am
| 
Last reply Jun 3, 2023 9:04am

Reply from Steven Lopez

The American Nurses Association (ANA) was the page that I reviewed. The ANA webpage talks about several initiatives they are pursuing such as Medicare/Medicaid reform, whistle blower protections and more. It also discusses topics like Empowering Nurses and the future of health care. According to their web page, the ANA’s mission is “Lead the profession to shape the future of nursing and health care” (ANA 2017). The ANA page offers accreditations, answers questions related to the practice of different nursing scopes and even lobbies for legal changes to the practice in the different states and even in Washington DC. After reviewing more of this page it is easy to see that the overarching goal of this organization is to mold and shape the future of Nursing and to make sure that Nurses are the center of whatever changes take place in health care. As far as the question, “Is this organization centered on Evidenced Based Practice?” the answer is a resounding yes. According the Johns Hopkins Center for Nursing Inquiry “EBP is a process used to review, analyze, and translate the latest scientific evidence. The goal is to quickly incorporate the best available research, along with clinical experience and patient preference, into clinical practice, so nurses can make informed patient-care decisions (Dang et al., 2022).” (Kelly, R. 2022)  This definition more than fits what the ANA is and does and what is represented on the page. The information listed on the webpage did not change my perception of this healthcare organization because I have always know about this organization and what they stand for. The ANA is a well know advocacy group for the Nursing practice in all scopes. As a Nurse who is passionate about Mental Health and being a Behavioral Health Nurse I have looked into the accreditations they provide for RN/BSN Nurses. Their tests for all certifications are centered on EBP. According to Registered Nursing.ORG “Because of the wide variety of mental health disorders and complex ways they can present, psychiatric nurses must be thoroughly trained and familiar with the care of this patient population to ensure treatment is leading to the best possible outcomes.” (Registered Nursing.org, 2019) This education and advancement in one’s own career is offered through the ANA.

References

About Ana: Ana enterprise
. ANA. (2017, October 14). https://www.nursingworld.org/ana/about-ana/

Kelly, R. (2022, March 21). 
Evidence-based practice
. Evidence-Based Practice. https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/evidence-based-practice.html

Writers, RegisteredNursing. org S. (2023, April 19). Psychiatric/Mental Health Nurse Certification. https://www.registerednursing.org/certification/psychiatric-mental-health-nurse/

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Daniela Donna Villanueva

May 31, 2023 10:07am
| 
Last reply Jun 1, 2023 9:44am

Reply from Daniela Donna Villanueva

Evidence-Based Practice of Presbyterian

 

According to Melnyk and Fineout-Overholt (2023), evidence-based practice (EBP) can be defined as a life-long problem-solving method for clinical decision-making that includes the use of the optimum evidence with clinician expertise and patient values to improve outcomes (Melnyk & Fineout-Overholt, 2023). There are three elements to EBP which include research, patient values and preferences, and the clinician’s expertise. Using EBP will improve patient outcomes. Research fosters the creation of new knowledge (Walden University, 2018).

Presbyterian Health Services Website Review

In a review of the Presbyterian Health Services website, it was found that this organization is committed to supporting evidence-based care for the members it serves. Presbyterian Health Services is a not-for-profit healthcare system. The clinical healthcare guidelines were developed based on evidence-based practice to support the decision-making process in patient and member care (PHP, n.d.).  EBP appears on the healthcare systems’ websites under clinical practice guidelines.

Is the Organization’s Work Based on EBP

In 2019 Presbyterian Health Services was recognized by U.S. News & World Report for its high performance. Presbyterian was recognized as a “BOLD” healthcare organization that uses evidence-based practice to achieve excellence and improve the quality of healthcare in our community (PHP, n.d.). Presbyterian is committed to supporting evidence-based care for the patients it serves.

My Perception of the Organization  

                
In evaluating my healthcare systems website, I will continue to have the same opinion. Since I started working with this company, I have always felt that their values match mine. They are committed to caring for their community using best practices. EBP helps empower healthcare providers to establish the best treatment plans. For example, you can look up clinical practice guidelines for any disease, such as diabetes.  The website will link you to research and standards of care for diabetes. The standards of care are updated annually which includes the most current evidence-based recommendations for diagnosing and treating.

 

References        

About our quality doctors
. About Our Quality Doctors | Presbyterian Healthcare Services. (n.d.). https://www.phs.org/doctors-services/Pages/our-quality-doctors.aspx

Clinical practice guidelines
. Clinical Practice Guidelines | Presbyterian Health Plan, Inc. (n.d.). https://www.phs.org/providers/resources/reference-guides/Pages/clinical-practice-guidelines.aspx

Melnyk, B. M., & Fineout-Overholt, E. (2023). 
Evidence-based practice in nursing & healthcare: A guide to best practice
 (5th ed.). Wolters Kluwer.

 

Walden University, LLC. (Producer). (2018). 
Introduction to Evidence-Based Practice and Research
 [Video file]. Baltimore, MD: Author.

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Solomon Furayi

May 31, 2023 9:24am
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Last reply Jun 3, 2023 8:01pm

Reply from Solomon Furayi

The healthcare organization website I reviewed was the website of the Mayo Clinic. The Mayo Clinic is a nonprofit medical practice and medical research group based in Rochester, Minnesota. It is one of the largest integrated health care systems in the United States, with over 70,000 employees and 67 hospitals and clinics in six states.The Mayo Clinic’s website mentions EBP in several places(Mayo Clinic, n.d). In the “About Us” section, the website states that the Mayo Clinic is “committed to providing high-quality, evidence-based care.” In the “Research” section, the website describes the Mayo Clinic’s research programs, which are focused on “improving patient care through the translation of scientific discovery into clinical practice.” And in the “Patient Care” section, the website provides information about the Mayo Clinic’s approach to patient care, which is based on “the latest medical evidence.”

Based on the information on the Mayo Clinic’s website, it is clear that the organization is committed to EBP. The Mayo Clinic’s research programs are focused on translating scientific discovery into clinical practice, and the organization’s approach to patient care is based on the latest medical evidence. This commitment to EBP is evident in the quality of care that the Mayo Clinic provides. The Mayo Clinic is consistently ranked as one of the best hospitals in the United States, and it has been recognized for its excellence in patient care (Shanafelt et al., 2023).

The information I discovered on the Mayo Clinic’s website has changed my perception of the organization. I was already aware that the Mayo Clinic was a well-respected hospital, but I was not aware of the organization’s commitment to EBP. Learning about the Mayo Clinic’s commitment to EBP has made me more confident in the quality of care that the organization provides. I am now more likely to recommend the Mayo Clinic to my friends and family members who are seeking medical care.

References

Mayo Clinic. (n.d.). About US – Mayo Clinic Value statements. Mayo Clinic. 
https://www.mayoclinic.org/about-mayo-clinic/mission-values
Links to an external site.

Shanafelt, T. D., Larson, D., Bohman, B., Roberts, R., Trockel, M., Weinlander, E., Springer, J., Wang, H., Stolz, S., & Murphy, D. (2023). Organization-wide approaches to foster effective unit-level efforts to improve clinician well-being. Mayo Clinic Proceedings, 98(1), 163–180. 
https://doi.org/10.1016/j.mayocp.2022.10.031
Links to an external site.

 

 

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Cheryl Athurine Spence

May 30, 2023 9:35pm
| 
Last reply May 31, 2023 8:42am

Reply from Cheryl Athurine Spence

Exploring EBP in the American Association of Nurse Practitioners (AANP) Website

Introduction

According to Melnyk et al. (2021), healthcare is dynamic. Employing evidence-based practices may assist in ensuring that high-quality healthcare is accessible generally. Evidence-based practice optimizes healthcare quality while lowering costs, enhancing patient outcomes, and reducing employee burnout among healthcare providers. They ensure that medical professionals can base their judgments on reliable proof of information. EBP integrates the best available evidence into clinical knowledge and patient preferences to inform decision-making and deliver the best possible healthcare outcomes, according to Melnyk et al. (2021). Practitioners should consistently update themselves on the latest and most recent research and technological advancements to stay current with the newest trends and best practices Cleary-Holdt forth et al. (2021). In this assignment, I will evaluate the American Association of Nurse Practitioners (AANP) website to determine whether it promotes evidence-based practice.

Review of the AANP Website

The AANP is a professional healthcare organization that accepts certified nurse practitioners and nurse practitioner trainees as members. According to the AANP (n.d.a), this association has about 104,000 members who work together to enhance patient care and promote the profession. Access to continuing education, networking opportunities, local and federal advocacy, and access to the most recent medical journals are all membership incentives. I identified numerous spots on the AANP website where EBP is ingrained within the organization’s framework.

Mission, Vision, and Philosophy
: AANP’s mission statement emphasizes the promotion of high-quality, cost-effective healthcare for patients. Whereas EBP is not explicitly indicated, the concepts of evidence-based care are implied in the commitment to providing high-quality healthcare. The vision statement of AANP additionally highlights the significance of evidence-based decision-making for enhancing patient outcomes. This suggests that EBP is valued and integrated into the overall philosophy of the AANP (AANP, n.d).

Goals and Initiatives
: The AANP outlines various goals and initiatives on its website, which include advocating for policies that support nurse practitioners, promoting advanced practice nursing, and fostering professional development. While specific references to EBP may not be explicitly stated, these goals indirectly align with EBP principles (AANP, n.d). According to Thomas (2021), incorporating the best available evidence to improve clinical practice is part of advancing the role of nurse practitioners and fostering their professional development.

Educational Resources
: The AANP website incorporates various resources for nurse practitioners. Clinical practice guidelines, continuing education courses, and research articles are examples of such resources. These resources emphasize evidence-based guidelines and recommendations. Healthcare professionals can leverage the resources to update themselves on and implement the most current knowledge into their practice. This indicates the AANP’s dedication to promoting EBP among its members (AANP, n.d).

Research and Publications
: The AANP actively supports and publishes research on nurse practitioners and their role in healthcare. The AANP contributes to integrating EBP into clinical practice by promoting and disseminating research findings. Research articles and publications often employ EBP methodologies and approaches, showcasing the organization’s dedication to advancing nursing knowledge through evidence-based research.

Impact on Perception

Exploring the AANP website has positively influenced my perception of the organization. The alignment of the AANP’s mission, vision, and goals with EBP principles indicates a commitment to delivering high-quality care based on the best and most effective results. Providing educational resources and research support further solidifies the AANP’s dedication to promoting EBP among nurse practitioners. By actively engaging in EBP, the AANP showcases its progressive stance and contributes to advancing nursing practice. Additionally, their support for research and publications further solidifies their stance in promoting evidence-based care. AANP portrays itself as a forward-thinking organization that prioritizes advancing nursing practice by emphasizing EBP. This dedication assists patients in recuperating more quickly and increases the reputation and professionalism of nursing professionals. The American Association of Nurse Practitioners (AANP) is a leader in advocating evidence-based practice. I have also realized that the organization fosters the development of nurse practitioners.

I now understand the value of joining a professional nursing organization that champions evidence-based practice (EBP). I now recognize the significance of being a part of a professional nursing organization that upholds evidence-based practice (EBP). As an advanced practitioner, I aim to positively impact lives while emphasizing EBP adoption. By becoming a member of the AANP, I will have the opportunity to fight for better patient outcomes, more cost-effective healthcare, and high-quality treatment. The AANP unifies like-minded professionals who are dedicated to promoting EBP, aligning our aims, and encouraging the use of evidence-based therapies.

Conclusion

Finally, evidence-based practice is heavily emphasized throughout the organization’s website. Even though there is no mention of EBP, the organization’s purpose, vision, goals, educational resources, and research efforts, all indicate a commitment to integrating EBP concepts into the practice of nurse practitioners. The material gained on the AANP website has positively affected my perception of the organization since it indicates a commitment to developing nursing practice by incorporating high-quality research.

References

American Association of Nurse Practitioners (AANP). (n.d.a). About the American Association of Nurse Practitioners (AANP). Retrieved from 
https://www.aanp.org/membership/why-join.
Links to an external site.

American Association of nurse practitioners. (n.d.). Aanp website. Retrieved from 
http://www.aanp.org/
Links to an external site.

Cleary‐Hold forth, J., O’Mathúna, D., & Fineout‐Overholt, E. (2021). Evidence‐based practice beliefs, implementation, organizational culture and readiness for EBP among nurses, midwives, educators, and students in the Republic of Ireland. Worldviews on Evidence‐Based Nursing, 18(6), 379-388.

Melnyk, B. M., Tan, A., Hsieh, A. P., & Gallagher‐Ford, L. (2021). Evidence‐based practice culture and mentorship predict EBP implementation, nurse job satisfaction, and intent to stay: Support for the ARCC© model. Worldviews on Evidence‐Based Nursing, 18(4), 272-281.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Martha Redd

May 30, 2023 9:06pm
| 
Last reply Jun 2, 2023 3:39pm

Reply from Martha Redd

Evidence-based practice is the idea that occupational practices ought to be based on scientific evidence. EBP is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research”. Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.

Sovah Health’s mission is Making Communities Healthier, with the vision of creating places where people choose to come for healthcare, physicians want to practice, and employees want to work. We are a member of 
LifePoint Health
Links to an external site.
, a for-profit hospital (n.d. 2023). This hospital is perception change not grounded because the extent to which they integrate research evidence into their clinical practices, policies, and procedures. An organization that values EBP will have mechanisms in place to promote the use of current research, support staff in accessing and appraising evidence, and implement evidence-based guidelines and protocols. This includes regularly reviewing and updating clinical practices based on new evidence. There is no information about EBP which may raise questions about the organization’s approach to incorporating the best available evidence into their practice. Findings demonstrate a compelling need for improvement in knowledge and implementation of EBP in this healthcare facility. I now have a clear understanding of my hospital vison and EBP is not mentioned in the mission statement, my perception of the hospital is more on a lower scale of care because there is no mention of EBP.

 

Reference:

What is evidence-based practice in nursing?
 ANA. (2023, May 5). 
https://www.nursingworld.org/practice-policy/nursing-excellence/evidence-based-practicen
Links to an external site.
nursing/#:~:text=Evidence%2Dbased%20practice%20in%20nursing%20involves%20providing%20holistic%2C%20quality%20care,from%20colleagues%2C%20or%20personal%20beliefs.

Li S, Cao M, Zhu X. Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine (Baltimore). 2019 Sep;98(39):e17209. doi: 10.1097/MD.0000000000017209. PMID: 31574830; PMCID: PMC6775415.

Why sovah health?
. Sovah Health. (n.d.). https://www.sovahhealth.com/why-sovah-health

 

 

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Kamaljit Kaur

May 30, 2023 2:16pm
| 
Last reply Jun 3, 2023 5:22am

Reply from Kamaljit Kaur

Evidence-Based Practice (EBP) is an approach to healthcare that involves integrating the best available evidence from scientific research, clinical expertise, and patient values and preferences to guide clinical decision-making and optimize patient care. According to Melnyk and Fineout-Overholt (2018), EBP not only enhances healthcare quality, but also leads to improved patient outcomes, reduces healthcare costs, and leads to less job burnout in healthcare providers. EBP enhances the quality of nursing care, helps improve patient outcomes, reduces medical costs, and strengthens the confidence of individual clinicians.

I chose to research the World Health Organization is committed to promoting evidence-based practice throughout its work. The organization (WHO) is a healthcare-specialized agency of the United Nations (UN) that deals with public health. The organization, whose work is grounded in evidence-based practice, manages, and maintains extensive data relating to global health and brings the world’s scientists together to accelerate research. WHO promotes best practices and standards for emergency operations and public response to public health emergencies. Therefore, the entity works for the greater good of all people across the globe. The WHO’s commitment to healthcare excellence and scientific evidence is continually improving and advancing to reflect the changes in the state of health in the world (WHO values charter, 2020). According to the organization’s website, the WHO’s key values include adhering to professionalism, integrity, and respect for diversity. These values are employed in enhancing the attainment of quality public health on a global scale. The values inspired by WHO have a vision of a world in which all people attain the highest level of quality healthcare, and their mission is to promote health, keep the world safe, and serve the vulnerable globally.

EBP appears throughout the mission and vision of the WHO, such that the entity is focused on the professional commitment to excellence in health, which is guided by the best available science, evidence, and technical expertise (Our values, our DNA, 2020). The WHO’s work is grounded in EBP, considering that it states that its commitment to health excellence reflects scientific evidence and expertise that is continually developing and improving to respond to the changes in the world. The standards that reflect the WHO organization ensure public trust, integrity, professional commitment, and collaboration of the power of diversity to achieve the highest level of public health and well-being. The information on the WHO’s website has changed my perception of the healthcare organization, as it enlightened me on the core values and visions of the organization.

I usually refer to the WHO website when there is a disease outbreak or epidemic to inform myself about the diseases, their locations, and what to look for symptomatically in patients. The site has shown me what the organization stands for and the importance of public health worldwide. The WHO needs to remain a credible organization to ensure the trust of the public. In doing so they will commit to putting their philosophies and values into practice. Reading and learning more about the WHO has changed my perspective on the organization. I never realized how big their commitment is to global health. An example of such commitment is their Thirteenth General Program of Work (GPW 13). It is their 5-year strategy, 2019-2023 that focuses on their triple billion targets to show measurable impacts on people’s health at the country level. The triple billion targets include one billion more people having universal health coverage, one billion more people being protected from health emergencies, and one billion more people having better health and well-being. A measurable impact on global health is at the heart of the WHO’s mission to change and improve the future of public health (World health organization, 2021).

The information obtained on the website has changed my whole perception of how WHO’s work is grounded in EBP, considering that it states that its commitment to health excellence reflects scientific evidence and expertise that is continually developing and improving to respond to the changes in the world. Still, I have learned that EBP is part and parcel of the current healthcare system, which is now patient-centered. For example, if the WHO’s website offers updated guidelines based on rigorous scientific research and systematic reviews, it demonstrates a dedication to using the best available evidence to inform global health policies. Such information can instill confidence in the WHO’s expertise and its ability to address global health challenges effectively. However, it is important to recognize that the perception of any organization is shaped by various factors, including personal experiences, external reviews, and global events. While the information on the WHO’s website can contribute to forming an impression, a comprehensive assessment requires considering multiple sources of information and evaluating the organization’s performance and impact in the global health arena.

REFERENCE

Melnyk, B. M., & Fineout-Overholt, E. (2018). 
Evidence-based practice in nursing & healthcare: A guide to best practice
 (4th ed.). Philadelphia, PA: Wolters Kluwer

Our values, our DNA. (2020). Retrieved February 25, 2020, from the World Health Organizationwebsite: https://www.who.int/about/who-we-are/our-values

Walden University Library. (n.d.-a).Databases A-Z: NursingLinks to an external site.. Retrieved September 6, 2019, from 
https://academicguides.waldenu.edu/az.php?s=1998
Links to an external site.

WHO values charter. (2020). Retrieved February 25, 2020, from World Health Organization website: 
https://www.who.int/docs/default-source/documents/values-charter-en.pdf?Status=Temp&sfvrsn=4ed75cec_1
Links to an external site.

World Health Organization. (n.d.). WHO’s mission and mandate. Retrieved from https://www.who.int/about/who-we-are/our-mission

Assignment: Case Studies –  NURS 6521 Week 7 assignment Case studies answers

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Review the case study posted in “Announcements” by your Instructor for this Assignment

Review the information provided and answer questions posed in the case study

When recommending a medication, write out a complete prescription for the medication

Whenever possible, use clinical practice guidelines in developing your answers when possible

Include at least three references to support your answer and cite them in APA format.

 

Case Study One: Mary, A 35-year-old with Hypothyroidism – NURS 6521 Week 7 assignment Case studies answers

Mary is a 35-year-old woman that has been diagnosed with hypothyroidism. Her
labs today show a TSH of 20, MCV 78, MCHD 26, Ferritin 9, TIBC 418. She has
a history of iron deficiency anemia for 2 months. Current medications include
Kelp tablets daily, ibuprofen 400 mg daily as needed, and ethinyl
estradiol/norgestrel one tablet daily.What medication would you start this patient
on for her hypothyroidism? How would you monitor this patient’s response to the
medication? What education would you provide regarding her medications and
their interactions?

The case presented a 35-year-old Mary with hypothyroidism; her laboratory findings guide the treatment plan that should be formulated. Mary’s level of thyroid stimulating Hormone (TSH) is 20, and the typical ranges between 0.5 to 4.5 Miu/L, thus showing that the patient has severe hypothyroidism. It is essential, therefore, to develop strategies that ensure the restoration of the thyroid hormones. Additionally, the patients’ mean corpuscular volume and mean corpuscular hemoglobin concentration are within the normal ranges, indicating that the thyroid dysfunctions do not directly cause the cause of Mary’s anemia. Mary also has a high total iron binding capacity and a low ferritin, which indicates chronic iron deficiency. Following the lab findings, a care provider must develop a treatment plan to prevent complications and improve the patient’s quality of life.

Management of Hypothyroidism

In this scenario, the patient requires effective treatment options, including synthetic thyroid hormones. The agents will help the patient to have normal TSH levels and achieve the desired outcomes as the physiology of the hormones is maintained (Jansen et al., 2023). Receiving the hormones also helps alleviate the hypothyroidism and allows her to achieve independence. Therefore, Mary’s prescription requires 50mcg of levothyroxine once daily. The instructions are for the patient to take the drug one hour early before taking meals (Kahaly & Gottwald-Hostalek, 2022). Additionally, the patient should avoid taking the drug with calcium or iron supplements as absorption will be impaired. The quantity to be given is 60 tablets.

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 Monitoring Patient’s Response to Medication

It is essential to monitor the levels of free T4 and TSH 6 to 8 weeks after the drug’s initiation. Monitoring the levels helps ensure that the TSH levels are within normal ranges. The health provider’s role is to ensure that the patient understands the importance of adhering to follow-up clinics (Bianco, 2023). This will help the provider assess and monitor labs and the effectiveness of treatment.

Patient Education and Medication Interactions

The patient should understand the importance of adhering to the prescribed medication to improve her health outcomes. The key concepts include stopping the medication abruptly, as has been done with iodine, which may interfere with the functioning of the thyroid glands. The patient should also continue with ibuprofen as needed per MD orders.  However, patients are to be monitored for any adverse effects that interact with levothyroxine and iron absorption (Bianco, 2023). The patient should also seek alternative contraceptives, as estradiol interferes with thyroid functioning. Iron supplements are essential to manage anemia. Therefore, Mary should be instructed to add supplements, such as green leafy vegetables, into her daily diet.

 

Case Study Two: Joe, a 48-year-old with Diabetes and Hypertension – NURS 6521 Week 7 assignment Case studies answers

Joe is a 48-year-old male diagnosed with Type II Diabetes Mellitus for a year
ago. He has controlled his blood glucose through dietary changes. He has
hypertension and is currently on Lisinopril 20 mg po daily. He has no known
allergies. His lab work includes these results: fasting BG is 225 mg/dL; HgA1C =
7.5%. Basic Metabolic Profile (BMP) is normal except for a Cr of 2.0 and eGRF
of 28. What treatment plan would you implement for Joe? What medications
would you prescribe and how would you monitor them? What education would
you provide regarding his treatment plan?

Joe has a history of hypertension and type 2 diabetes, and his lab findings are glycated hemoglobin of 7.5% and blood glucose of 225mg/dl. The lab findings, therefore, indicate that the patient has uncontrolled diabetes. Additionally, the eGFR is 28, and creatinine levels are 2.0, showing that Joe has compromised renal functions. The altered levels result from uncontrolled diabetes and hypertension, therefore requiring effective management.

Joe’s Treatment Plan

Hypertension and diabetes are chronic conditions; therefore, a strategic plan should be drawn to minimize their effects and improve health outcomes. Metformin is an effective agent in managing type 2 diabetes, but since the patient has renal impairments (Przezak et al., 2022). Linagliptin should be opted for effective control of blood glucose and prevent renal injury. The patient should continue with Lisinopril for the management of hypertension as the ACE inhibitor agents are effective in both hypertensive and diabetic cases as they prevent further kidney injury.

Prescription and Treatment Plan

Linagliptin 10mg by mouth once daily in the morning

Supply: 30 tablets with three refills

Instructions: Take the medication as scheduled with food and maintain adequate hydration to prevent GI distress. Keep a diary of symptom management, adverse reactions, hypoglycemia, and hyperglycemia, which will be reviewed in the next visit. The next visit should occur after one month to evaluate adherence and average blood glucose level, and three months should be spent on glycated hemoglobin values (Naseri et al., 2022).

Monitoring

During the follow-up clinics, the nurse practitioner will conduct various tests and physical examinations and collect relevant history to help assess the plan’s effectiveness. The symptom management or adverse reaction diary will help trace the frequency of adverse reactions and determine issues and complications that may indicate the ineffectiveness of the medications or inadequate adherence. Laboratory tests that will be conducted to determine blood glucose control will include glycated hemoglobin levels, as well as an evaluation of blood glucose values and blood pressure records. (Naseri et al., 2022). In addition, the nurse practitioner must assess the baseline knowledge, blood glucose monitoring techniques, and interpretation of the results to allow effective interventions.

Patient Education and Support

Patient education includes critical components that will promote an understanding of the condition and the treatment plan. In addition, the approach will enhance adherence and promote adequate blood glucose control. The approach must begin with assessing the baseline knowledge of diabetes, hypertension, medications, or treatment plans. The approach will enable the nurse practitioner to understand the issues the client needs to understand and adhere to. These strategies include medications’ purpose, mode of action, interactions, and targeted therapeutic effects. (Al Saleh et al., 2023). Moreover, the nurse practitioner must incorporate nutritional and lifestyle modifications into the disease management. Therefore, the primary caregiver may collaborate with other healthcare professionals to ensure the client receives individualized and holistic services that manage his needs and improve his overall health status.

 

Case Study Treey: Jose 55-year-old with Type 2 Diabetes

Jose is a 55-year-old truck driver being evaluated for his commercial driver’s
license. He has a known history of diabetes mellitus type II. Current medications
include Metformin 1000 mg Bid, Glipizide 20 mg po daily. Diltiazem 120 mg po
BID. He is allergic to sulfa. Lab results show a fasting blood glucose of 325
mg/dL, HgA1C = 10.6%. Basic metabolic Profile is normal. What treatment plan
would you implement for Jose? What medications would you prescribe and how
would you monitor them? What education would you provide regarding his
treatment plan?

Jose has impaired blood sugar, which is likely to result in visual disturbances and other safety issues. Therefore, the patient needs to adhere to his drugs. Since Jose is allergic to sulfa, the treatment plan formulated should prevent adverse reactions and enhance safety. As a care provider, I will add GLP-1 receptor agonists to Jose’s treatment plan. The drug is known to have improved outcomes and manage blood glucose effectively (Richardson et al., 2021).

Prescription Liraglutide 0.6mg of Liraglutide once daily; subcutaneous route

Monitor the blood glucose levels, perform rotational injection techniques

The dose can gradually be adjusted to 1.8mg weekly until the targeted glycemic control is achieved.

Monitoring and Patient Education

Monitoring Joe’s condition is vital for determining the progress and identifying the need to review the treatment plan. In this case, Jose requires regular follow-up every three months to evaluate the glycated hemoglobin level, revealing adherence to the treatment plan. In addition, during the follow-up care, the nurse practitioner can determine the side effects, adverse reactions, and hypo or hyperglycemia incidents. One of the side effects that may occur with the new regimen is GI distress, which may wear off with continued therapy. Therefore, the nurse practitioner must provide adequate reassurance for the client to understand the condition and achieve the targeted outcomes (Galicia-Garcia, 2020). Moreover, the patient should adopt a healthy lifestyle, engage in regular physical activities, avoid stress, and understand the measures for preventing complications (Singer et al., 2022).

 

Case Study Four: A 63-year-old Jenny – NURS 6521 Week 7 assignment Case studies answers

Jenny is a 63-year-old woman with complaints of heartburn 4 to 5 times a week
over the past 3 months. Her symptoms are worse at night after going to bed. Her
heartburn is worse, and she coughs a lot at night. She has tried OTC Prevacid 24
hour once daily for the past 2 weeks. This has helped the symptoms some, but
she is still bothered by them. Current medications include Diltiazem CD 120 mg
PO once daily, Hydrochlorothiazide 25 mg PO once daily, Metformin 500 mg PO
twice daily, Aspirin 81 mg PO daily, Fluticasone/salmeterol DPI 100 mcg/50 mcg
one inhalation twice daily. Your working diagnosis for this patient is GERD. What
treatment plan would you implement for Jenny? What medications would you
prescribe and how would you monitor them? What education would you provide
regarding her treatment plan?

The 63-year-old Jenny presents with gastroesophageal reflux disease, which has not improved despite the past measures that have been ineffective in enhancing her comfort. Jenny reports to have been taking OTC Prevacid, which improves is symptoms. However, Jenny is bothered by his symptoms and requires more advanced therapies to achieve optimal health. Therefore, the healthcare provider should formulate a treatment plan that enhances the patient’s well-being, has minimal side effects, and prevents long-term complications. The patient’s prescription will be as follows: Esomeprazole 40 milligrams taken daily for four weeks (Lata et al., 2023). Therefore, 28 capsules should be given without refills. The patient’s instruction would include attending a follow-up clinic after four weeks to review the plan and manage the side effects experienced.

Monitoring

It is crucial to assess the patient’s response to the new drug, including any symptom improvement and side effects with the pharmacotherapy. Expected effects include gastrointestinal disturbances and headaches (Hungin et al., 2024). The care provider should, therefore, reassess the patient’s condition after four weeks, taper the dose, and then discontinue. In addition, long-term monitoring of side effects and a thorough health assessment are essential.

Patient Education

The nurse or health practitioner should teach the patient about medication adherence, the side effects, and food and drug interactions. In case of any side effects, Jenny should report to the provider immediately. Lifestyle medication is also essential in this case. Therefore, the patient should avoid drinks and foods that trigger heartburn, eat small but frequent healthy meals, and avoid lying down immediately after eating. The health provider should also ensure that Jenny understands the long-term effects of using proton pump inhibitors, such as vitamin deficiencies (Antunes et al., 2023). Moreover, encouraging regular follow-up clinics is crucial in monitoring and adjusting the treatment plan for effective management of GERD.

 
References

Al Saleh, Y., Al Busaidi, N., Al Dahi, W., Almajnoni, M., Mohammed, A. S., Alshali, K., Al-Shamiri, M., Al Sifri, S., Arafah, M., Chan, S. P., El-Tamimi, H., Hafidh, K., Hassanein, M., Shaaban, A., Sultan, A., & Grassi, G. (2023). Roadmap for Managing Type 2 Diabetes and Hypertension in the Middle East: Review of the 2022 EVIDENT Summit.
Advances in Therapy
,
40
(7), 2965–2984.
https://doi.org/10.1007/s12325-023-02529-7

Antunes, C., Curtis, S. A., & Aleem, A. (2023, July 3).
Gastroesophageal reflux disease
. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441938/

Bianco, A. C. (2023). Emerging Therapies in Hypothyroidism.
Annual Review of Medicine
,
75
(1).
https://doi.org/10.1146/annurev-med-060622-101007

Galicia-Garcia, U. (2020). Pathophysiology of Type 2 Diabetes Mellitus.
International Journal of Molecular Sciences
,
21
(17), 1–34.
https://doi.org/10.3390/ijms21176275

Hungin, A. P., Yadlapati, R., Anastasiou, F., Bredenoord, A. J., El Serag, H., Fracasso, P., Mendive, J. M., Savarino, E. V., Sifrim, D., Udrescu, M., & Kahrilas, P. J. (2024). Management advice for patients with reflux-like symptoms: an evidence-based consensus.
European Journal of Gastroenterology & Hepatology
,
36
(1), 13.
https://doi.org/10.1097/MEG.0000000000002682

Jansen, H. I., Boelen, A., Heijboer, A. C., Bruinstroop, E., & Fliers, E. (2023). Hypothyroidism: The difficulty in attributing symptoms to their underlying cause.
Frontiers in Endocrinology
,
14
.
https://doi.org/10.3389/fendo.2023.1130661

Kahaly, G. J., & Gottwald-Hostalek, U. (2022). Use of levothyroxine in the management of hypothyroidism: A historical perspective.
Frontiers in Endocrinology
,
13
.
https://doi.org/10.3389/fendo.2022.1054983

Lata, T., Trautman, J., Townend, P., & Wilson, R. B. (2023). Current management of gastro-oesophageal reflux disease—treatment costs, safety profile, and effectiveness: A narrative review.
Gastroenterology Report
,
11
. https://doi.org/10.1093/gastro/goad008

Naseri, M. W., Esmat, H. A., & Bahee, M. D. (2022). Prevalence of hypertension in Type-2 diabetes mellitus.
Annals of Medicine and Surgery
,
78
, 103758.
https://doi.org/10.1016/j.amsu.2022.103758

Przezak, A., Bielka, W., & Pawlik, A. (2022). Hypertension and Type 2 Diabetes—The Novel Treatment Possibilities.
International Journal of Molecular Sciences
,
23
(12), 6500.
https://doi.org/10.3390/ijms23126500

Richardson, C. R., Borgeson, J. R., Van Harrison, R., Wyckoff, J. A., Yoo, A. S., Aikens, J. E., Griauzde, D. H., Tincopa, M. A., Van Harrison, R., Proudlock, A. L., & Rew, K. T. (2021). Management of Type 2 Diabetes Mellitus. In
PubMed
. Michigan Medicine University of Michigan.
https://www.ncbi.nlm.nih.gov/books/NBK579413/

Singer, M. E., Dorrance, K. A., Oxenreiter, M. M., Yan, K. R., & Close, K. L. (2022). The type 2 diabetes “modern preventable pandemic” and replicable lessons from the COVID-19 crisis.
Preventive Medicine Reports
,
25
, 101636.
https://doi.org/10.1016/j.pmedr.2021.101636 
 NURS 6521 Week 7 assignment Case studies answers

NURS_6521_Week7_Assignment_Rubric

NURS_6521_Week7_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate NURS 6521 Week 7 assignment Case studies answers.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 1:
Written medication orders
include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation NURS 6521 Week 7 assignment Case studies answers

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics NURS 6521 Week 7 assignment Case studies answers.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. NURS 6521 Week 7 assignment Case studies answers

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses
correct grammar, spelling, and punctuation with no errors
.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

Total Points: 
100 NURS 6521 Week 7 assignment Case studies answers

The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

Reducing interruptions while administering medication 

Describe the project you propose

The project proposed seeks to utilize the bottom-up approach toward reducing interruptions that usually occur while the medication is being administered to a patient. The specific problem being considered is that these interruptions impact many medical errors in our organization, Kaiser Permanente. Despite having a mission of providing affordable and high-quality patient care, mistakes occur frequently. According to recent research, over 7000 patients die annually due to medical errors that can be easily prevented (Keers et al., 2018). Further research has proposed that reducing the number of interruptions during drug administration would help reduce this number. Moreover, the exercise of administering medication is usually repetitive and skillful based hence attracting more chances of distractions. The project will better address the problem by applying pre-intervention, and post-intervention observational study approaches. The intervention in this project shall be tailored by the bottom-up approach, where it shall be the training tool. The Intervention shall be fully captured through offering adequate training to all nurses when administering medications to patients. The nurse participants will be observed throughout the project while recording the total number of dispensing rounds and pre-intervention and post-intervention periods.

Identify the stakeholders impacted by this project.

The focus of the project is safety during medication administration. The first stakeholder will therefore be patients, who are at risk whenever these errors occur. Patients are more informed nowadays and ask more questions during healthcare delivery. Patients’ consent should therefore be considered before the project. This should be exposed to the complete information concerning the project since they are the consumers of the medications administered—the second set of stakeholders in academia. The obtained results from the project can be added to the current concepts of safety in the training curriculum to ensure that every nurse is equipped with critical thinking skills while administering medication to patients (Schroers et al., 2021). The third set of stakeholders encompasses external healthcare providers such as the regulatory, licensing, and accrediting bodies who would utilize the project results towards developing new safety measures. The healthcare organization and its leaders would also be essential project stakeholders. They would help implement the project’s results in their mission and vision of maximizing patient safety during medication administration. Finally, nurse practitioners would also be an essential set of stakeholders since it is a project that involves the current practices of maximizing patient safety and delivery of care. The project results are also essential since nurse practitioners gain room to maintain competencies and information about patient safety.

 

BUY A HUMAN-WRITTEN, PLAGIARISM-FREE PAPER HERE

Explain the patient outcome(s) or patient-care efficiencies this project aims to improve and how this improvement would occur. Be specific and provide examples.

The project’s main aim is to reduce the interruptions that mainly occur during the administration of medications to patients, which in most cases impact medical errors. Therefore, the project expects to obtain a reduced proportion of medical errors. A selected number of nurses will be included in the project, where they shall receive training on risks related to interruptions while administering medication. The training aims to create awareness among these nurses of the interruptions that occur during medication administration. Moreover, it is expected that after training, these nurses will develop protocols and strategies for eliminating or handling interruptions so that we do not get distracted while administering medication to patients. Additionally, the organization’s leaders can work with the frontline medical personnel to apply the best intervention approach. In general, the mission of the project is to maximize the safety of patients and patient outcomes by eliminating or minimizing the incidences of medical errors.

Identify the technologies required to implement this project and explain why

Various technologies will be required in this project. However, there are three major ones. The first technology is the training material required to inform the medical personnel about related risks of interruptions during medication administration. Among the training materials include trainers, posters, presentations, and notes. A trainer will offer training sessions by collaborating with the selected nurses. It will also involve practical sessions to ensure that all the selected nurses are equipped before the start of the project. The notes, posters, and presentations will summarize what the trainer will offer the nurse participants. Access to electronic medical records (EMR) is the second technology required. EMR facilitates access to medication errors and data concerning other essential variables (Sessions et al., 2019). The final technology is data analysis software such as SPSS, STATA, or python, which will be essential to determine the correlation between variables of interest, which would otherwise provide the most beneficial interventions.

Identify the project team (by roles) and explain how you would incorporate the nurse informaticist into the project team.

The entire project has about three members. The project manager is the first member whose primary role is coaching the team throughout the project period. The manager is also responsible for coordinating with the organization’s management and ensuring the success of all the required implementations in meeting deadlines and other performance and functionality requirements (Schroers et al., 2021). The manager also acts as the link coordinator of all project stages, from the planning, design, development, implementation, and testing stages. The manager will also ensure that every stage is successful before proceeding to the next stage. The training analyst is the second member of the project. The training analyst has a significant role in linking the ideas and concepts proposed in training as part of the requirement (Keers et al., 2018). Technical knowledge, as well as continuous training applications, are the expertise areas of training analysts. The position of a training analyst is essential as it requires quality communication and interpersonal skills to facilitate the conveyance of information to others and elicit the project’s needs and analytical skills. The training analyst should also have a clinical background and an understanding of the need for medication administration. Finally, the other important member is the nurse informaticist. They are responsible for the management of all data needs of the project. For example, they identify the project’s variables that inform medication errors (Mosier, Roberts & Englebright, 2019). The nurse informaticist is therefore entitled to evaluate all the data concerning the project and inform the project leader and other stakeholders of all the project results.

References

Keers, R. N., Placido, M., Bennett, K., Clayton, K., Brown, P., & Ashcroft, D. M. (2018). What

causes medication administration errors in a mental health hospital? A qualitative study

with the nursing staff. 
PloS one
, 
13
(10), e0206233.

https://doi.org/10.1371/journal.pone.0206233

Mosier, S., Roberts, W. D., & Englebright, J. (2019). A systems-level method for developing

nursing informatics solutions: the role of executive leadership. 
JONA: The Journal of

Nursing Administration
, 
49
(11), 543-548.

https://DOI: 
10.1097/NNA.0000000000000815

Schroers, G., Ross, J. G., & Moriarty, H. (2021). Nurses’ perceived causes of medication

administration errors: a systematic qualitative review. 
The Joint Commission Journal on

Quality and Patient Safety
, 
47
(1), 38-53.
https://doi.org/10.1016/j.jcjq.2020.09.010

Sessions, L. C., Nemeth, L. S., Catchpole, K., & Kelechi, T. J. (2019). Nurses’ perceptions of

high‐alert medication administration safety: A qualitative descriptive study. 
Journal of

advanced nursing
, 
75
(12), 3654-3667.
https://doi.org/10.1111/jan.14173

 

The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined?

Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Review the concepts of technology application as presented in the Resources.

Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

Describe the project you propose.

Identify the stakeholders impacted by this project.

Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.

Identify the technologies required to implement this project and explain why.

Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

Use APA format and include a title page and reference page.

Use the Safe Assign Drafts to check your match percentage before submitting your work.

By Day 7 of Week 4

Submit your completed Project Proposal.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK4Assgn_LastName_Firstinitial The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NURS_5051_Module02_Week04_Assignment_Rubric

NURS_5051_Module02_Week04_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient care efficiency. Your project proposal should include the following:· Describe the project you propose.· Identify the stakeholders impacted by this project.

25
 
to >
22.0
 pts
Excellent
The response accurately and thoroughly describes in detail the project proposed….The response accurately and clearly identifies the stakeholders impacted by the project proposed.

22
 
to >
19.0
 pts
Good
The response describes the project proposed….The response identifies the stakeholders impacted by the project proposed.

19
 
to >
17.0
 pts
Fair
The response topics are superficially addressed.

17
 
to >
0
 pts
Poor
The response is very vague or missing.

25
 pts

This criterion is linked to a Learning Outcome
· Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving.· Explain how this improvement would occur. Be specific and provide examples. Use sufficient supporting evidence in your response. The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

25
 
to >
22.0
 pts
Excellent
The response accurately and thoroughly explains in detail the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an accurate and detailed explanation, with sufficient supporting evidence of how this improvement would occur.

22
 
to >
19.0
 pts
Good
The response explains the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an explanation, with some supporting evidence of how this improvement would occur.

19
 
to >
17.0
 pts
Fair
The response is missing one or two of the required elements, contains little supporting evidence or elements are superficially addressed.

17
 
to >
0
 pts
Poor
The response is very vague, lacking examples or supporting evidence, or missing.

25
 pts

This criterion is linked to a Learning Outcome
· Identify the technologies required to implement this project and explain why.· Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

25
 
to >
22.0
 pts
Excellent
The response accurately and clearly identifies the technologies required to implement the project proposed with a detailed explanation why….The response accurately and clearly identifies the project team (by roles) and thoroughly explains in detail how to incorporate the nurse informaticist in the project team.

22
 
to >
19.0
 pts
Good
The response identifies the technologies required to implement the project proposed with an explanation why….The response identifies the project team (by roles) and explains how to incorporate the nurse informaticist in the project team.

19
 
to >
17.0
 pts
Fair
The response is missing one or two of the required elements, or elements are superficially addressed.

17
 
to >
0
 pts
Poor
The response is very vague or missing.

25
 pts

This criterion is linked to a Learning Outcome
Resources

10
 
to >
8.0
 pts
Excellent
Assignment includes: 3 or more peer-reviewed research articles and 2 or more course resources.

8
 
to >
7.0
 pts
Good
Assignment includes: 2 peer-reviewed research articles and 2 course resources.

7
 
to >
6.0
 pts
Fair
Assignment includes: 1 peer-reviewed research article and 1 course resource.

6
 
to >
0
 pts
Poor
Assignment includes: 1 or no resources.

10
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – Paragraph Development and Organization:Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5
 
to >
4.0
 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4
 
to >
3.0
 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3
 
to >
2.0
 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.

2
 
to >
0
 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. 5  pts This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards:Correct grammar, mechanics, and proper punctuation 5   to >
4.0
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

4
 
to >
3.0
 pts
Good
Contains a few (1-2) grammar, spelling, and punctuation errors.

3
 
to >
2.0
 pts
Fair
Contains several (3-4) grammar, spelling, and punctuation errors.

2
 
to >
0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – APA:The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

5
 
to >
4.0
 pts
Excellent
Uses correct APA format with no errors.

4
 
to >
3.0
 pts
Good
Contains a few (1-2) APA format errors.

3
 
to >
2.0
 pts
Fair
Contains several (3-4) APA format errors.

2
 
to >
0
 pts
Poor
Contains many (≥ 5) APA format errors.

5
 pts

Total Points: 
100

Monty is a 52-year-old male following up on his labs that were drawn last week.
He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is
allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL
cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan
would you implement for Monty’s lipid profile? What is the goal Total Cholesterol
(TC), HDL-C, and LDL-C level for Monty? How would you monitor the
effectiveness of your treatment plan? How many risk factors for coronary artery
disease does this patient have? Identify them specifically.

‘

GET A HUMAN-WRITTEN PAPER HERE

Learning Resources

Lecturio Resources

Review the following Video Resources and Content Pages in the Lecturio Platform by clicking button below labeled 
Load Week 4: Learning Resources in a new window
.

Motility Disorder medication

Stomach Ulcer (Peptic Acid Disease) Medication

Nausea Medication: Antiemetics – Gastrointestinal Drugs

Pancreatic Enzyme Replacement Therapy (PERT) and Gallstone Prevention – Gastrointestinal Drugs

Irritable Bowel Syndrome (IBS) Medication

Questions and Case Studies: GERD Medications

Inflammatory Bowel Disease Medication

Questions and Case Studies: Steroids, Cyclosporine and Crohn’s Disease

Hepatitis Treatment – Antiviral Drugs

Overview – Antiviral Agents and Treatment of CMV Retinitis – Antiviral Drugs

Required Readings

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

Chapter 68, “Drugs for Weight Loss” (pp. 627–637)

 

Optional Resources

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

Chapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589a–597)

Chapter 65, “Laxatives” (pp. 598–604)

Chapter 66, “Other Gastrointestinal Drugs” (pp. 605–616)

Monty is a 52-year-old male following up on his labs that were drawn last week.
He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily.

Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.

Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

By Day 3 of Week 3

Post
 a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

By Day 6 of Week 3

Respond
 to at least 
two
 of your colleagues
* on two different days
, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

*Note:
 Throughout this program, your fellow students are referred to as colleagues.

Informaticist interactions with health professionals

Nurse informaticists assumed pivotal roles as technology instruments in healthcare settings. They oversee the general picture of healthcare in the organizational hierarchy and the core of the organization’s information management infrastructure and support (Nagle, L., Sermeus, W., & Junger, A., 2017). The initial encounter with a nurse informaticist begins with an orientation, which involves learning the healthcare software that serves as a clinical platform for electronic health records utilized by the organization’s interdisciplinary professionals. Classroom training, in-person teaching guidance, and surveys of post-in-service education are being conducted to determine the effectiveness of new updates and modifications to the current electronic healthcare platform. Since informatics shapes the integration of technology and healthcare, continuous transformation through updates and education is mandatory for every organization member to achieve a positive health outcome (McGonigle & Mastrian, 2022).

 

Strategy to improve interactions

Due to the complexity of the technology-laden healthcare system in the current era, significant numbers of clinicians have polar acceptance of evidence-based health recommendations leading to the failure of the outcome-oriented health design system. The results-driven professionals utilized the system to improve health outcomes; however, some refused to adopt and adapt to the updated protocols due to the poor usability of the system and unwillingness to learn because of doubt about the effectiveness of health informatics in nursing practice. Alert systems prompting end-users about clinical data integrated with clinical decision support systems are overwhelming. Still, they create awareness of the patient’s clinical status as being evaluated by predictive models supporting increased safety (Nibbelink et al., 2018). Therefore, education programs that improve compliance using the health design significantly contribute to the practical evaluation of the software protocol leading to positive health outcomes (Sipes, C., 2016). Frequent email updates and prompts with guidance on using the EHR design through webinars and online educational resources are paramount to improving usage and interactions among clinicians and nurse informaticists to achieve patient safety (McGonigle & Mastrian, 2022).

 

Impact of nursing informatics on technologies and professional interactions.

            
The evolution of nursing informatics in technologies and professional interactions has significantly improved outcomes through interdisciplinary clinical assessment, formulation of care plans, application of interventions, and data analysis to formulate predictive progress by the healthcare design system. Nursing practice integrated with information science creates a highly specific plan of care that will improve the quality of care outcomes (Darvish et al., 2014). Individualized interventions based on problems are generated, while alert systems prompt clinicians to consult physicians to address life-threatening conditions (McGonigle & Mastrian, 2022). Health informatics also enhances post-discharge monitoring due to its revolutionary ways of healthcare delivery through a mobile device use with a health app or any wearable surveillance devices (Ng, Y., Alexander, S. & Frith, K., 2018).

 

References:

Nagle, L., Sermeus, W., & Junger, A. (2017). In J. Murphy, W. Goosen, &  P. Weber  (Eds.), 
Forecasting Competencies for Nurses in the Future of Connected Health
 (212–221). Clifton, VA: IMIA and IOS Press. Retrieved on March 15, 2023, from 
https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF
Links to an external site.

McGonigle, D., & Mastrian, K. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Nibbelink, C. W., Young, J. R., Carrington, J. M., & Brewer, B. B. (2018). Informatics Solutions for Application of Decision-Making Skills. 
Critical care nursing clinics of North America
, 
30
(2), 237–246. Retrieved on March 15, 2023, from 
https://doi.org/10.1016/j.cnc.2018.02.006
Links to an external site.

Sipes, C. (2016). Project Management: Essential Skill of Nurse Informaticists. 
Studies in Health Technology and Informatics, 225, 252–256. 
Retrieved on March 15, 2023, from

https://eds.s.ebscohost.com/eds/pdfviewer/pdfviewer?vid=3&sid=ed21dc7e-c2d2-4b5d-98d8-24a8e3238854%40redis
Links to an external site.

Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The role of nursing informatics in promoting quality of health care and the need for appropriate education. 
Global journal of health science
, 
6
(6), 11–18. Retrieved on March 15, 2023, from

https://doi.org/10.5539/gjhs.v6n6p11
Links to an external site.

Ng, Y., Alexander, S. & Frith, K. (2018). Integration of Mobile Health Applications in Health Information Technology Initiatives. CIN: Computers, Informatics, Nursing, 36 (5), 209–213. Retrieved on March 16, 2023, from

https://doi:10.1097/CIN.0000000000000445

 

Nursing Informatics Interactions

Nursing informaticists and/or data technology specialists interact with other healthcare professionals on a daily basis. The first hospital that I was employed with had nursing informaticists teach new hires about the charting system that was used. This allowed for staff to experience the charting system prior to starting their first shift. The information technology (IT) team within the hospital system that I’m currently employed with works with staff members during both the day and night shifts to resolve technical and organizational issues (Singh, 2022). For example, the IT team was contacted by a nurse during the day due to the inability to chart within the electric medical record (EMR) system. They worked to resolve this issue to ensure that all patient information was correctly charted.

Strategies to Improve Interactions

  One example of a strategy that could be used to improve the interactions between healthcare professionals and nursing informaticists is by communicating to improve the technology within the hospital system. Clinical staff usually defer to informaticists regarding the use of decision support and the finest way to design inputs and outputs on information. Technical experts usually defer to clinical experts regarding workflow and content. Regulatory experts provide guidance on content and workflow involving the evaluation of final products. This will allow for the improvement of nursing documentation, creating a more useful patient-centered healthcare record, and normalizing data to evaluate nursing care of patients during their hospital stay and their outcome levels (Mosier et al., 2019). By working together, the healthcare professionals and the nursing informaticists will continue to improve patient outcomes.

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Evolution of Nursing Informatics and New Technologies

  The evolution of nursing informatics and new technologies is clear. It’s known that nursing informatics specialists have united analytical sciences and nursing science to define, identify, communicate data, manage data, knowledge, informatics, and wisdom for decades. Now, nurses who work in informatics are advancing towards implementing better EMRs. They also work on improving the knowledge of educators, analysts, policy developers, software engineers, and operational owners to improve patient care. During the COVID-19 pandemic, nursing informaticists, program leaders, clinical services, and information services worked together to implement telehealth programs (Schoenbaum & Carroll, 2022). This was a solution that was implemented to protect the health and safety of patients and healthcare workers throughout the country.
 

References

Mosier, S., Roberts, D., & Englebright, J. (2019, November). 
A Systems-Level Method for Developing Nursing Informatics Solutions: The Role of Executive Leadership
. JONA: The Journal of Nursing Administration. Retrieved March 15, 2023, from https://oce.ovid.com/article/00005110-201911000-00008/HTML
 

Schoenbaum, A. E., & Carroll, W. M. (2022, May 16). 
Nursing informatics key role in defining clinical workflow, increasing efficiency and improving quality
. HIMSS. Retrieved March 15, 2023, from https://www.himss.org/resources/nursing-informatics-key-role-defining-clinical-workflow-increasing-efficiency-and
 

Singh, A. (2022, August 17). 
What does an IT professional do?
 University of the People. Retrieved March 15, 2023, from https://www.uopeople.edu/blog/what-does-an-it-professional-do/#:~:text=IT%20stands%20for%20information%20technology,within%20organizations%20of%20all%20sizes.

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Ketia Sanon

Mar 15, 2023 9:52pm
| 
Last reply Mar 19, 2023 5:28am

Reply from Ketia Sanon

Interaction between Nurse Informaticists and Other Specialists

            
Nursing informatics is integral in helping transform healthcare services’ quality and safety. Nurse informatics is a new specialty in nursing that integrates nursing information and knowledge with technology to manage and integrate healthcare. Nursing informatics has helped transform the healthcare system by helping promote and incorporate evidence-based practices into the clinical decision-making process by providing relevant, practical, and current data and information to support healthcare provision and decision-making (McGonigle & Mastrian, 2022). The role of a nurse informaticist is to collect, analyze, and disseminate data to ensure the delivery of quality and safe care through the utilization of advanced technological resources (Deckro et al., 2020). Nurse informaticists support other healthcare specialists in applying information technology in healthcare and clinical processes.

Interaction between Nurse Informaticists, Data or Technology Specialists, and Other Professionals Within My Healthcare Organization

            
In my healthcare organization, nurse informaticists ensure proper and meaningful utilization of all technological systems. Nurse informaticists offer technical support to other specialists to avoid and avert technological mishaps that could adversely affect the quality and safe care delivery (McGonigle & Mastrian, 2022). In my organization, nurse informaticists work to develop communication and information technologies to enhance the delivery of care. We use mobile devices, social media platforms, and emails to communicate. Nurse informaticists ensure flawless communication within the organization, facilitating the exchange of vital patient information. When new technologies are implemented at the organization, nurse informaticists carry out training to ensure that we all understand the use and application of the new technologies.

Improving Interactions between Clinicians or Other Specialists and Nurse Informacists/
 
Data or Technology Specialists

            
The interactions between technology specialists and other professionals within my healthcare organization help eliminate delays and waste of healthcare resources (Deckro et al., 2020). At the healthcare facility, we use electronic health records to facilitate the delivery of patient-centered interventions. Electronic health records ensure that all specialists at the organization have accurate and complete information about patients and other issues, thus enabling effective and timely decisions. Nurse informaticists ensure that all professionals at the healthcare facility have quick access to patient records for better coordinated and efficient care.

The use of electronic health records at my healthcare organization has improved workflow efficiency leading to better patient experience and healthcare outcomes (McGonigle & Mastrian, 2022). One strategy for improving the interactions between nurse informaticists and other professionals might be enhancing security and privacy. Nurse informaticists should ensure that there is a limited risk of unauthorized persons accessing patient information (Mosier et al., 2019). For instance, using biometrics for verification when prescribing medications or accessing electronic systems in the facility has greatly improved security and eliminated system misuse by professionals. For example, it helps eliminate colleagues misusing other people’s systems to perform tasks such as prescribing medications, which could land others in trouble in case of prescription mistakes or errors.

The Impact of the Continued Evolution of Nursing Informatics on Professional Interactions

            
The continued emergence of new technologies will significantly impact professional interactions. Using new and advanced technologies improves the quality and efficiency of providing health services to patients. Increased efficiency has implications for healthcare professionals because it reduces work-related stress and fosters overall job satisfaction. The continued evolution of nursing informatics and the emergence of new technologies might impact professional interactions because they simplify information acquisition (Mosier et al., 2019). Simplified acquisition of patient information enhances decision-making, which saves the patient time. The continued emergence of new technologies will help improve workflow, quality of care, and patient safety. The evolution of nursing informatics as a specialty will continue to enhance communication and inter-professional collaborations, leading to improved healthcare services.

References

Deckro, J., Phillips, T., Davis, A., Hehr, A. T., & Ochylski, S. (2021). Big data in the veterans health administration: A nursing informatics perspective. 
Journal of Nursing Scholarship, 53
(3), 288-295. 
https://doi.org/10.1111/jnu.12631
Links to an external site.

McGonigle, D., & Mastrian, K. G. (2022). 
Nursing informatics and the foundation of knowledge (5th Ed.).
 Jones & Bartlett Learning.

Mosier, S., Roberts, W. D., & Englebright, J. (2019). A systems-level method for developing nursing informatics solutions: The role of executive leadership. 
The Journal of Nursing Administration
, 
49
(11), 543–548. 
https://doi.org/10.1097/NNA.0000000000000815
Links to an external site.

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Kelly Ann Robertson

Mar 15, 2023 9:06pm
| 
Last reply Mar 19, 2023 5:29am

Reply from Kelly Ann Robertson

Week Three Discussion:

Initial Post

What is a Nursing Informaticist?

As time goes on, technology improves to make our lives as medical providers easier, as well as keeping patients well and safe. Technology has given us the use of electronic health records (EHR), telemedicine, medication dispensing machines, and much more. A Nursing Informaticist is a registered nurse that collects data and applies information to improve nursing systems, nursing care, and improve patient outcomes (HIMSS, 2022,.).

Post
 a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization.

I work for an outpatient psychiatric clinic who primarily handles SMI (Serious Mental Illness) members as well as COT (Court Ordered Treatment) members. Before coming to this clinic, the places I worked had paper charting and that was always a nightmare! We now use an EHR called Axiom, and while it has its flaws it seems to work okay now. When we first launched Axiom, the errors were unbelievable. Charts wouldn’t load right, it would shut down when charting a note, injections wouldn’t show up in the log, medications were incorrect on the reconciliation pages, billing code errors, and the list goes on. According to Dimas, J., Lyons, A., Richardson, S., & Sward, K. (2022), sometimes the EHR’s just simply contain errors that will take time to fix much like the errors I already mentioned. Technology is not perfect, much like we aren’t. While we don’t have a nursing informatics team, we do have a large team of IT specialists, Quality Improvement Specialists and Business Systems Analyst. In order to fix these issues within the company, we use email and phone calls to collaborate with these specialist to try to get this solved quickly and efficiently. But sadly, our IT department can’t always fix everything and then they will have to reach out to the IT department of the EHR. My company does take in a LOT of feedback from the medical staff as we are affected the most, and we have all worked together with Axiom to create a more seamless charting system that is companywide (we have numerous clinics around the state) and we can all see the same notes and documentation and have reduced the errors significantly.

Suggest at least one strategy on how these interactions might be improved
.

There are a couple of ways that this issue could improve. While we do use email as our primary communication within the company, our IT/Specialists can have a difficult time getting a hold of IT for the EHR. Most of the time the error is fixed in a couple of hours, but there are times that the communication just isn’t there and it could be DAYS before an error gets fixed, and you can probably image the pure chaos that stems from that. Ways to improve this of course would be better communication and maybe someone on the receiving end could prioritize phone calls from outside consumers. Within the company where there are problems in the EHR, IT and specialists will come to each clinic and discuss the issues we are having and ways to improve or increase the work flow and relay them to the charting company. Nurses need to have a voice when it comes to flaws in the EHR. Voicing our needs and suggestions are important to create the workflow we desire and can help redesign the health record programs (Kang, J., Lee, S., 2021.).I think discussing with staff first hand and holding meetings and trainings is the best way to start to collect data to discuss with the company.

Explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

Technology is growing and the possibilities are endless within the medical field. I have friends that work in the medical hospitals and the things they tell me that they can do is incredible, like scanning a barcode on the patients wrist to check medications, vitals automatically going into the chart, it’s great. Going from years of paper charting to electronic charting has made a huge improvement in our patient care and our performance as medical professionals. The ability to have the providers, pharmacy, and case management/social workers, see what we are charting and in real time has been amazing. No more waiting for a call back from the on-call provider. No more hoping and praying that the medication order made it to the pharmacy. We can see who the members entire team consists of without having to hunt down staff. That part makes me happy because we can all read each other’s notes and everything is conveniently in a drop down menu to choose the area you want to research or staff you wish to communicate with. Hopefully, things will continue to improve as time goes on.

Resources:

Dimas, J., Lyons, A., Richardson, S., & Sward, K. (2022, June). 
Assessing EHR data for use in clinical improvement and research: Ingenta connect
. American Journal of Nursing. Retrieved on March 14, 2023, from 
https://www.ingentaconnect.com/content/wk/ajn/2022/00000122/00000006/art00021
Links to an external site.

Lee, Seonah PhD, RN; Kang, Ji-Soon PhD, RN. Unintended Consequences and Workarounds of Electronic Medical Record Implementation in Clinical Nursing Practice. CIN: Computers, Informatics, Nursing 39(12):p 898-907, December 2021. | DOI: 10.1097/CIN.0000000000000785

What is nursing informatics?
 (2022, June 29). Retrieved on March 15, 2023, from

HIMSS. https://www.himss.org/resources/what-nursing-informatics

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Dafroza Ikolo Msuya

Mar 15, 2023 8:49pm
| 
Last reply Mar 18, 2023 8:22pm

Reply from Dafroza Ikolo Msuya

Nurse Informaticists Interaction

Nurse informatics are important healthcare team members because they help nurses and other medical staff do their jobs when caring for patients. They use technology to improve patient outcomes and the overall performance of the healthcare system. They ensure that nurses have correct and up-to-date information and advise them on how to use it well. Nurse informatics must also know how to work well with other specialists to give patients the best care possible. The healthcare system’s success depends on the collaboration of nurse informatics and other specialists (Sipes, 2016). By working together, these professionals can ensure that patients receive the best possible care. Furthermore, this collaboration can aid in discovering new ways to improve care delivery (Sipes, 2016).

Nurse informatics is a part of nursing that uses computers, information systems, and nursing to determine what data means (Sipes, 2016). It is also a unique part of nursing that lets nurses work with other professionals as communication and information technology developers. When combined with evidence-based technology, informatics can help patients receive better care and outcomes. The concepts of evidence-based practice (EBP) and the use of workplace technologies demonstrate that the world of healthcare is changing (Abdekhoda & Khezri, 2021). Nurse informatics and information technology teams can help the hospital use the system during care. All healthcare workers in my nursing unit use the Cerner EHR to access, organize, store, and share patient’s electronic medical records (EMR). Since the software was introduced to the hospital a few years ago, nurse informatics have taught older and newer employees how to use it. During software updates and competency reviews, older employees are given refresher courses. Scheduled training days are provided for new team members to learn how to use the software properly. The nurse informatics goal is to ensure everyone is trained well enough to prevent mistakes in patient medical records.

Strategy on how these interactions might be improved.

Interactions between nurse informatics, and other professionals can be improved through communication. For example, when patients are discharged from the hospital, they are given two copies of their medical records—one for themselves and one for their primary care physician. Even though they see hospitalized patients daily, primary care doctors cannot get information about them unless they give it to them during office visits (Theodos & Sittig, 2020). It would be simple for the doctor to continue providing care if he or she could see information about the patient, especially if the person has a long-term illness. The problem with denying access is that the information about the patient is private, and the doctor must use the same system used in acute care facilities (Theodos & Sittig, 2020). Once the patient agrees to share his or her medical record, access to information should be available using a broader system. So, standardizing how the medical system is used will eliminate the problem of being unable to get patient information and give patients the best care possible.

Impact of 
continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

Creating new technology and nursing informatics tools significantly affects how professionals work together. When technology is used, it makes healthcare services better and more efficient for patients. At the management level, healthcare information systems coordinate all activities within a healthcare system (Mosier et al., 2019). Furthermore, obtaining information is simplified and more convenient, patients save time when seeking medical assistance, workflow is improved, and treatment decisions can be made quickly. Most of the time, using technology to manage health information has made patients safer. When the administration and professionals from different fields can access up-to-date, accurate, and relevant information from information management systems, it is easy to find problems and inefficiencies in how healthcare is given (Mosier et al., 2019). Interprofessional communication technology and electronic health records improve collaboration and patient outcomes.

Reference

Abdekhoda, M., & Khezri, H. (2021, August 6). 
Investigating the impact of Health Informatics Literacy on the evidence-based practice of Nursing
. HIMSS. Retrieved March 15, 2023, from 
https://www.himss.org/resources/investigating-impact-health-informatics-literacy-evidence-based-practice-nursing
Links to an external site.

Mosier, S., Roberts, W. D., & Englebright, J. (2019). A Systems-Level Method for Developing Nursing Informatics Solutions: 
The Role of Executive LeadershipLinks to an external site.
Links to an external site.
. 
JONA: The Journal of Nursing Administration
, 
49
(11), 543-548.

Sipes, C. (2016). Project management: 
Essential skill of nurse informaticistsLinks to an external site.
Links to an external site.
. 
Studies in Health Technology and Informatics, 225
, 252-256.

Theodos, K., & Sittig, S. (2020, December 7). 
Health Information Privacy Laws in the digital age: HIPAA doesn’t apply
. Perspectives in health information management. Retrieved March 15, 2023, from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883355/
Links to an external site.

 

 

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Shannon Glasshoff

Mar 15, 2023 8:39pm

Reply from Shannon Glasshoff

Initial Post 

          Nursing Informatics supports the nursing profession through the integration of nursing science and analytical science (Sipes, 2016). Healthcare continues to evolve with the advancement of technology. The role of the nurse informaticists is becoming more prominent across health systems daily. 
 

          Trauma patients, patients with obstetric complications and certain gastrointestinal bleeding can be prevented with blood products in the pre-hospital setting (Shand et al., 2019). In the quest to put blood products on our aircraft and bring this vital lifesaving component to the pre-hospital patient, my department worked alongside the nurse informaticists to collect and interpret data. Some of the most important data collected consisted of the patient’s blood pressure, heart rate, and/or a positive FAST exam. Other information pertinent was whether the patient received tranexamic acid in lieu of blood products being available. It was also important to review the patient’s chart to see if they received any blood products upon immediate arrival at the trauma bay. 
 

          We worked alongside the nurse informaticist on project management. This process included initiation, plan, implementation, monitor, and evaluation (Sipes, 2016). To initiate this process several things needed to be put in place. Those things included a freezer with temperature monitoring, an insulated cooler to carry the blood in the aircraft, and blood specific metrics in the patient’s chart. A plan was formulated to gather equipment, validate equipment, and work with a local blood bank to supply the blood products and monitor temperatures. Education was provided to all staff members. Each quarter the lead nurse on the project, a member of the blood bank, management, and the nurse informaticist would monitor and report all patient cases where blood products were transfused. The nurse informaticist helped in many ways throughout this project. They helped guide data collection and interpretation. 
 

          Nurse informaticists assist in informing and expanding the nurse’s knowledge and use of technology (McGonigle & Mastrian, 2022). There is such a varied age range and work experience when working on this project that the nurse informaticists needed to slow down and or elaborate on their idea of how this project would take shape. It appeared as though the informaticists were sometimes a few steps ahead during this project. However, once this was brought to their attention, they took the time to slow down and be specific with their ideas and formulate the plan in a way all parties could understand. 
 

          It is undeniable that technology is changing the field of nursing. The nursing profession has seen the integration of electronic medical records, robotic surgery, telehealth medicine, evidence-based practice, and implanted monitoring devices for multiple different disease processes just to name a few. Informaticists bring the patient, the care team, the data, and technology together. They assist the bedside nurse in interpreting data and incorporating science to improve patient care. 
 

 

References
 

McGonigle, D., & Mastrian, K. G. (2022). 
Nursing informatics and the foundation of 
knowledge
 (5th ed.). Jones &         Bartlett Learning.
 

Sipes, C. (2016). Project management: 
Essential skill of nurse informaticistsLinks to an external 
site. 
Studies in Health    Technology and Informatics, 225
, 252-256.
 

Shand, S., Curtis, K., Dinh, M., & Burns, B. (February 2019). 
What is the impact of prehospital 
blood product administration for patients with catastrophic haemorrhage: an 
integrative review. 
Injury, 
50(2), 226-234.
 

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Michaela Manney

Mar 15, 2023 8:23pm
| 
Last reply Mar 19, 2023 2:24pm

Reply from Michaela Manney

INITIAL POST

Nurse Informaticists and Their Interactions

Nursing informaticists gather, analyze, and disseminate data, information, and knowledge as it applies to their specific specialty in their healthcare organization. They combine the acquisition of data with nursing expertise and help to implement new processes or refine old processes. They work closely with other nurses, providers, and leadership. Data can be an integral piece of operational and patient care decisions (Mosier, et.al., 2019). Furthermore, nursing informatics helps nurses, patients, consumers, stakeholders, and the whole interdisciplinary team (Sipes, 2016).  Healthcare leadership relies on data to make important decisions in regard to patient care, to staff their healthcare organization, and to integrate the highest functioning technology into the healthcare worker’s day. Nurse informaticists can also help orient new hires on the electronic health record (EHR) that the organization uses. Or, when a facility updates its current EHR, it can help assist in training nurses for the new system. Nursing informaticists can also bring technological concerns to leadership. For example, nurses might have issues with scanning a certain medication during administration, and nursing informaticists can help problem solve and bring the issue to the appropriate person.

 

Strategies to Improve Interactions

Nursing informaticists work closely with nurses and other healthcare professionals. It is important that they keep a good relationship with each other. Nurses should be able to go to nursing informaticists with questions and feel supported. On the other side, nursing informaticists should be able to provide feedback to nurses. It would also be a good idea to educate incoming nurses on the role that nursing informaticists play in keeping a healthcare organization going. Communication is another key to facilitating a good relationship and email can be a good starting point.

 

Impact of Evolution of Nursing Informatics and New Technologies

The medical field in general continues to make fast-paced changes to the nursing workforce. Telehealth is one of the ways it has changed. Telehealth appointments involve a patient having an interaction with a healthcare provider via video call. This can be very convenient, especially during a pandemic, but it can also lead to an impersonal feeling experience as the provider is not there to provide gentle touch and more articulate facial expressions. Nursing meetings can be held over Zoom or Microsoft Teams, which can also lead to less of a personalized experience, but it is much easier and more flexible. More and more bedside technology is advancing. For example, blood pressure cuffs can be set to automatically retake blood pressure every 5, 15, or 30 minutes. This can be very convenient for a busy nurse, but relying on technology can lead to errors and manual blood pressure is always the best bet for accuracy. As technology advances, it is important that healthcare providers remember to treat the whole patient and not be on their devices during time with patients and families. It is so easy to just be charting on your tablet or computer, but this can come off as distant and cold to the patient. The medical advances we have made are tremendous, but we should never forget the human interaction piece of healing.

References:

Mosier, S. , Roberts, W. & Englebright, J. (2019). A Systems-Level Method for Developing Nursing Informatics Solutions. JONA: The Journal of Nursing Administration, 49 (11), 543-548. doi: 10.1097/NNA.0000000000000815.

Sipes, C. (2016). Project Management: Essential Skill of Nurse Informaticists. Studies in Health Technology and Informatics, 225, 252–256.

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Ashley Green

Mar 15, 2023 8:04pm
| 
Last reply Mar 19, 2023 3:38pm

Reply from Ashley Green

Within my workplace trying to reach a technology specialist can be very frustrating. You have two ways to communicate within that department, including sending an email, or sitting on hold for long periods of time. Our organization requires a ticket be placed to log the problem and this keeps track of how and who resolved the problem. There are many challenges when adapting any new technology including staff training, software problems, and lack of engagement from staff (Olayiwola & Magana, 2019). One way to help combat technology problems within the unit is having Superusers. Superusers are specially trained to benefit a unit to provide expertise and the knowledge needed in different situations (Deutsch, 2019). Downfalls to having superusers is always having one available on every shift. Also their can be tension within colleagues due to the demand within this very select few people (Haber & Reichman, 2020).

 

Haber, E., & Reichman, A. (2020). The User, the Superuser, and the Regulator: Functional Separation of Powers and the Plurality of the State in Cyber. 
Berkeley Tech. LJ
, 
35
, 431.

Deutsch, R. (2019). Superusers’ c-factors. 
Superusers
, 15–33. 
https://doi.org/10.4324/9781351138987-2
Links to an external site.

Olayiwola, J. N., & Magaña, C. (2019). Clinical transformation in technology: a fresh change management approach for primary care. 
Harvard Health Pol Rev
.

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Shaquita Blue

Mar 15, 2023 7:18pm
| 
Last reply Mar 20, 2023 8:50pm

Reply from Shaquita Blue

            Nursing informatics combines knowledge, skill, and technology to improve patient care (Kassam et al, 2017). Patient care and outcomes are based off information that is collected and analyzed. Without all necessary information the patient care and outcomes can suffer and make it more difficult to treat the patient. Nurse informatics relates with other healthcare professionals within an organization in different ways. One of the ways this happens at the hospital I work at is in data collection in incident reports. All the occurrences are documented in a system according to the hospitals policies and procedures. For example, one of the biggest issues in the hospital are falls. In the event of a fall, an incident report is completed, and all the managers are notified. With all the information gathered it allows the team to evaluate what could have prevented the fall and set interventions immediately into place. From the information gathered from the system events, trends, and missing information can be seen and healthcare professionals can address the issues and prevent further occurrences.  Another way that nurse informatics interact with the healthcare organization is the safeguards put into place when scanning IV fluids or medications. The medication is scanned and the pump that it is connected to is scanned so that the computer can send the information and it can decrease the instance of medication errors. There is a report that generates and can show if it is being done or if it is entered manually. This ensures a safer and more efficient medication administration.

One strategy to improve this interaction is through conducting research to enhance nursing informatics. There can be improvements by getting feedback from the nurses to make sure some of the implementations of policies are effective. Some of the older nurses are not as comfortable with change when it is integrated, and changes are made so I think it is important to make sure that everybody is on the same page. Data about nursing care has become an integral part of decisions related to patient care and management that can improve the efficiacy of nursing practice (Mosier et al, 2019).

The continuing growth and emergence of new technology and nursing informatics tools have tremendous implications for professional interactions. The use of technology increases the quality and efficiency of providing health services to patients. Technology and EHRs that support inter-professional communication enhance collaboration and improve patient outcomes (McGonigle & Mastrian, 2022).

 

References

Kassam, I., Nagle, L., & Strudwick, G. (2017). Informatics competencies for nurse leaders: protocol for a scoping review. 
BMJ open
, 
7
(12), e018855. https://doi.org/10.1136/bmjopen-2017-018855

McGonigle, D., & Mastrian, K. G. (2022). 
Nursing informatics and the foundation of knowledge
 (5th ed.) Jones & Bartlett Learning

Mosier, S., Roberts, W. D., & Englebright, J. (2019). A System-level Method for Developing Nursing Informatics Solutions: The role of Executive Leadership. The Journal of Nursing Administration, 49(11), 543-548.

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Sherrona D Wiggins

Mar 15, 2023 6:06pm

Reply from Sherrona D Wiggins

MAIN POST: Sherrona Wiggins

 

Nursing informaticists are responsible for assessing and selecting technology. They oversee defining end-user conditions and requirements and customizing functionality. They are also counted on to deploy the technology and get users ready by creating and delivering the required training (Gibson, 2022, p.612). In the organization in which I am employed, there was a recent implementation of tablets for patient documentation, before this, everything was documented manually. The Nursing Informaticist was responsible for putting together an interactive computer-based training tutorial so that all nurses would be prepared to properly use the software on the tablets. The Nursing Informaticist was also responsible for coordinating interactions between clinical nursing staff, management, and IT during this process.

Nurse informaticists play a key role in introducing cutting-edge technology to nurses’ daily work, enhancing workflows, and optimizing documentation. They go beyond providing simple technical support (Kwiatkowski, 2021). Often when rolling out new technology one must be well-prepared. Though it is not a perfect process being prepared shows that Nursing Informaticists are competent in their ability. In the aforementioned scenario, a strategy for improved interactions would have been concerning the interactive tutorial. The tutorial was in very tiny writing, and no one was able to read the directions on the tutorial so completing it was null and void. This left many of the nurses confused and the lack of communication between the Nurse Informaticist, management, clinical nursing staff, and IT became chaotic because no one knew whom to go to for concrete direction. I would have put together a spreadsheet identifying whom to call for specific situations that may have arisen.

Technology is ever-changing and will continue to be an intricate dynamic in healthcare. It is important to have a clear understanding of how technology works to be successful in the healthcare arena. Nursing Informaticists are responsible for bridging these gaps in technological knowledge. Throughout the years their roles have evolved. As healthcare continues to experience rapid change and ambiguity in the creation of cutting-edge emerging technologies, the application of Nursing Informaticist’s priceless informatics skills and capabilities will foster a culture of safety (Whende, 2019).

 

References

Gibson, D. (2022). 
Nursing informatics and the foundation of knowledge
 (5th ed.). Independently published.

Kwiatkoski, T. (2021). Nursing informaticists are the backbone of technology-driven care. 
ONS Voice
, 
36
(8), 13.

Whende, C. (2019). Nursing informaticists safeguarding the use of emerging technologies. 
Online Journal of Nursing Informatics
, 
23
(3), 6.

 

 

 

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Rayanne Abood

Mar 15, 2023 4:50pm

Reply from Rayanne Abood

CONTINUED
 WEEK 3 DISCUSSION POST

 

Impact of Evolution of Nursing Informatics and New Technologies

The new technologies that emerged the past ten years have paved the way for easier access to clinician information which will ultimately improve patient care. Previously, written hand offs were done which led to miscommunication of information and errors. Physicians and nurses need to summarize patient information to be clear, concise and to the point in order to be able to give care in a timely matter. With the evolution of EMR systems, a significant filtering of information, and an improved organization of the way information is displayed such as allergies and medication interactions being the first thing clinicians see, has improved patient health outcomes and reduced errors. Nursing informaticists are constantly improving technology systems to reduce time clinicians spend and potential errors. Through electronic prescriptions, a reduction of medication errors have occurred and patients have become more compliant with care knowing that they no longer can lose a written paper. Clinicians including nurses are able to track drug information and an alert is noted when there can be potential drug-drug interactions ( Berner et al., 2005).

 

References:

Booth, R. G., Strudwick, G., McBride, S., O’Connor, S., & Solano López, A. L. (2021). How the nursing profession should adapt for a digital future. 
The BMJ
, 
p. 373
, n1190. 
https://doi.org/10.1136/bmj.n1190
Links to an external site.

Eta S. Berner, EdD, Jacqueline Moss, PhD, RN, Informatics Challenges for the Impending Patient Information Explosion, 
Journal of the American Medical Informatics Association
, Volume 12, Issue 6, November 2005, Pages 614–617, 
https://doi.org/10.1197/jamia.M1873
Links to an external site.

Khezri H, Abdekhoda M. Assessing nurses’ informatics competency and identifying related factors. 
Journal of Research in Nursing
. 2019;24(7):529-538. doi:
10.1177/1744987119839453
Links to an external site.

Ng, Y. C., Alexander, S., & Frith, K. H. (2018). Integration of Mobile Health Applications in Health Information Technology Initiatives: Expanding Opportunities for Nurse Participation in Population Health. CIN: Computers, Informatics, Nursing, 36(5), 209–213.

 

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Cheryl Athurine Spence

Mar 15, 2023 4:21pm

Reply from Cheryl Athurine Spence

My Colleague

First discussion question response

Oluwakemi,

 

I enjoyed reading your post. I agree. Yes, nurses are the face of the healthcare system. We rely on tools and technology to help us complete our workday.  Informatics is the science and innovation of technology that will help us screen, triage, and treat patients safely and effectively.  Technological advancement has given us the skills and knowledge to perform our job better.  Nursing informatics provides an integration system that can implement various ways to transfer and analyze data to the EHR (Electronic Health Records) for patient-related care that is safe and effective. Using IT technology, nurses, doctors, administrators, and pharmacists can now review, act and work in collaboration with each to reach faster positive outcomes. Nursing informatics technology remains at the forefront with ongoing training, patient focus, and effective results.

 

Another aspect of using technology is during the 2020 COVID pandemic; technology played a vital role throughout the community. The public health department works with the city to implement, collaborate, and organize vaccine centers, such as churches, daycare centers, and schools to vaccinate the community. These sites were equipped for patients to view healthcare records securely.   The HIMSS (HealthCare Information Management Systems Society) Was also an information site that people could use to obtain resources.

 

References:

Anna. E Schoenbaum, DNP, MS, RN-BC, FHIMSS and Whined McCarroll, MS, RN; -BC HIMSSNursing Informatics Committee Members

Nursing Informatics Key Role in Defining Clinical Workflow, Increasing Efficiency, and Improving Quality.

Healthcare Information and Management Systems Society.

https//www.himss.org/resources

 

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Nanette Fernandez
 (She/Her)

Mar 15, 2023 3:47pm
| 
Last reply Mar 17, 2023 11:42pm

Reply from Nanette Fernandez

Main Discussion Post

Interaction Between Nurse Informatics and Other Specialists

Nurse Informatics Interaction

Before I started working at my current job at the Veterans Hospital in Northern California, I had never met or spoken with a nurse informatician. Nonetheless, given that I work the night shift, I am not shocked.  
However, when working the dayshift in the hospital where I had previously worked more than four years earlier in another Veterans Hospital Administration (VHA) in Florida, I had a few interactions with a few nurse informaticians. Most of them had such a technological flare to their speech, and they had already solved several issues with data cross-over from the Spacelab monitor to the PICIS system.  The VHA’s critical care units use the PICIS Critical Care Management software to identify and assess patient patterns and future intensive care unit problems.  This program automates patient data collection and vital signs by connecting to medical monitoring devices and intravenous pumps (United States of Veterans Affairs (n.d.).  

Another instance involved a meeting with the head of bar-coded medication administration (BCMA) and champions from various units.  Following the administration of medications, it was discussed how to conduct a prompt evaluation of one-hour PRN (pro re nata) effectiveness.  The chief explained employing alerts to comply with a one-hour review of efficacy while presenting a compilation of data compliance.

According to Jouparinejad et al. (2020, -a), the growth and development of nursing informatics (NI) and health information technology (HIT) are revolutionizing all facets of nursing practice.  Holden et al. (2017) stated that health informaticians are critical assets of interprofessional teams in all problem-solving aspects, including problem assessment, solution formulation, implementation, and evaluation.  By using their skills in design, development, adoption, and use of information technology (IT)-based innovations, health informaticians bring value in various other situations. Informaticians can design tools and networks to allow interprofessional collaboration and communication, establish methodologies and technologies to advance team research, and create standards and vocabularies to support system interoperability. 

Strategies to Improve Interactions

One strategy to improve the interaction between nursing informatics and other healthcare professionals would be to enhance nurses’ nursing informatics competency, particularly in information management skills.  Managers, decision-makers, educators, and authorities in clinical settings should organize suitable interventions and training programs with the assistance of informatics specialists (Jouparinejad et al., 2020, -b).

Nurse management should also emphasize the significance of highly competent and effective nurses in delivering patient-centered, evidence-based care.  They ought to supply the necessary materials to support nurses’ NI competency.  Jouparinejad et al. (2020, -c) pointed out that in order to create NI competency in future nurses, nursing schools are in the greatest position to do so.  Hence, improving collaboration and engagement between universities and hospitals is crucial.  Future nurses can successfully balance health information technology with clinical needs if NI competency is integrated into nursing education and nursing students’ NI competency is developed through blended courses.

On the other hand, many nurse leaders today must completely grasp the value of informatics competencies for nursing practice.  It has been challenging to persuade nurse leaders that they must develop informatics skills.  After being persuaded of the importance of informatics capabilities, nurse leaders still need help gaining the right kind and level of informatics skills to support technologically advanced healthcare environments. Improved guidance on informatics skills and technology more suited to nursing care should assist direct care nurses in the long run because nurse leaders are better equipped with specialized informatics competencies.  Henceforth, they improved interactions between the nursing informaticians and the clinical nursing teams (Strudwick et al., 2019).

Impact of Evolution of Nursing Informatics and New Technologies

The reduction of medical errors, prompt diagnosis and efficient care delivery, enhanced communication between healthcare providers and patients, motivation for research, and the incorporation of more cutting-edge technologies to improve healthcare quality are just a few examples of how nursing informatics has a significant impact on patient care ( Al Najjar & Shafie, 2022).  A few examples of this nursing technology that the VHA uses are telehealth, EHR, point-of-care technology, electronic lift systems and smart beds, omnicell, vocera communications, and BCMA.  The authors, Al Najjar & Shafie, emphasized that in the Information Age nowadays, where nurses frequently use nursing technology to attend to patients’ medical needs, it is only natural that nurses and other healthcare professionals will continue integrating ever-evolving technology into their daily routines, including using machinery and artificial intelligence technology for the same purpose.

Furthermore, technological advances are occurring more frequently, altering how people are treated for their health and welfare.  Pepito and Locsin (2019) added that the organization and structure of the nursing industry had undergone significant changes due to technological advancements. Technology advancements have enabled nurses to work more effectively and safely while providing patient care.  Modal changes in modern healthcare and its delivery methods, including the adoption of electronic health records and advancements in biomedical and engineering technologies that enable the development of ever more sophisticated technologies in healthcare, robotics technology, and artificial intelligence, have transformed the nursing industry.  When more modern technology becomes available to nurses, they can raise care standards, improve working conditions, and cut expenses.

Again, technology is a key component of nursing practice and education in today’s dynamic health systems.  Because nurses increasingly utilize nursing informatics, they can use technology to improve care results.  Thus, it is important to draw attention to the fact that nurses need the right IT education. An educational setting that prepares nurses at all levels to use IT instruments in all facets of their career and integrates them with the rapidly accelerating pace of technological advancements is advised in order to make use of nursing informatics to improve nursing outcomes and healthcare quality (Park & Park, 2023).   By doing this, nursing informaticians and clinical nurses collaborate and positively engage with one another to accomplish a shared objective.

References

Al Najjar, R. & Shafie, Z. (2022). Impact of Nursing Informatics on the Quality of Patient Care.  
International Journal Of Medical Science And Clinical

            Research Studies
, 
2
(5), 418–421. 
https://doi.org/10.47191/ijmscrs/v2-i5-19
Links to an external site.

Holden, R. J., Binkheder, S., Patel, J., & Viernes, S. H. P. (2018). Best Practices for Health Informatician Involvement in Interprofessional Health Care

Teams.  
Applied clinical informatics
, 
9
(1), 141–148. 
https://doi.org/10.1055/s-0038-1626724
Links to an external site.

Jouparinejad, S., Foroughameri, G., Khajouei, R., & Farokhzadian, J. (2020). Improving the informatics competency of critical care nurses: results of an  

            interventional study in the southeast of Iran. 
BMC medical informatics and decision making, 20
(1), 220. 
https://doi.org/10.1186/s12911-020-
Links to an external site.

01244-5

Park, J. & Park, J. (2023, January). Identifying the Knowledge Structure and Trends of Nursing Informatics: A Text Network Analysis. CIN: Computers,

            Informatics, Nursing, 41(1), 8–17. 
https://doi.org/10.1097/CIN.0000000000000919
Links to an external site.

Pepito, J. A., & Locsin, R. (2019). Can nurses remain relevant in a technologically advanced future?. 
International journal of nursing sciences, 6
(1), 106-

            110. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6608671/
Links to an external site.

Strudwick, G., Nagle, L., Kassam, I., Pahwa, M., & Sequeira, L. (2019). Informatics competencies for nurse leaders: a scoping review.  
JONA: The Journal

            of Nursing Administration
, 
49
(6), 323-330. 
https://pubmed.ncbi.nlm.nih.gov/31135640/
Links to an external site.

United States of Veterans Affairs (n.d.). PICIS Critical Care Manager- Veterans Affairs. 
https://www.oit.va.gov/Services/TRM/ToolPage.aspx?tid=11507
Links to an external site.

 

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Rayanne Abood

Mar 15, 2023 3:20pm
| 
Last reply Mar 19, 2023 10:42pm

Reply from Rayanne Abood

Week 3 Discussion

 

Experiences and observations on interactions between nurse informaticists and data or technology specialists
 

 

Nurse informaticists play a vital role in ensuring the efficacious collection of clinical information and health records to present the information practically to the users. Nurse informaticists are responsible for making clinical decisions through research and theory and applying it to their practice and knowledge (Khezri & Abdekhoda, 2019). Nurse informaticists interact with clinical staff and IT to promote information through technology. We witness more effective and safe quality care outcomes through technology and evidence-based research. Nursing informatics implements value-based care by focusing on department systems, EHR systems, optimal documentation, and care coordination. 

 

Strategies on how professional Interactions between nurse informaticists and technology specialists can be Improved
 

 

During the pandemic, we witnessed a significant shift in the technology world, forcing many individuals to rely heavily on their phones, the internet, and social media, and a significant dependency on tele-health. However, medical professionals still need to gain knowledge of digital technology usage. Firstly, there should be more efforts towards training staff and integrating technological systems within the healthcare system. Additionally, nursing informaticists can enhance the interactions between professionals by analyzing the data in EHRs (Ng et al., 2018). In a previous medical facility, nursing informaticists conducted monthly analyses through a program built within the EMR system that detects CAUTIs, hospital-acquired pneumonia, and patient falls—through this integration, improved. 

 

Through informatics and technology, healthcare is more easily accessible and convenient for practitioners and patients. Healthcare systems rely heavily on technology and the management of healthcare facilities. Furthermore, it is convenient for nurses to track and follow up with patients, specifically on a medication regimen, pain management, and education. Additionally, communication methods within the healthcare system need to be improved or more robust. Working for a tele-health primary care group has opened my eyes to the communication gap between practitioners. When practitioners are hard to reach in time-sensitive cases, systems like Slack have been an excellent method to enable fast notifications with other professionals. Communication systems such as Slack can help practitioners make better healthcare choices for patients and allow asking each other clinical questions, including access to information to ensure quality care (Sipes, 2016).

 

 

 

 

 

 

 

 

 

 

 

 

References:

 

Booth, R. G., Strudwick, G., McBride, S., O’Connor, S., & Solano López, A. L. (2021). How the nursing profession should adapt for a digital future. 
The BMJ
, 
p. 373
, n1190. 
https://doi.org/10.1136/bmj.n1190
Links to an external site.

Khezri H, Abdekhoda M. Assessing nurses’ informatics competency and identifying related factors. 
Journal of Research in Nursing
. 2019;24(7):529-538. doi:
10.1177/1744987119839453
Links to an external site.

Ng, Y. C., Alexander, S., & Frith, K. H. (2018). Integration of Mobile Health Applications in Health Information Technology Initiatives: Expanding Opportunities for Nurse Participation in Population Health. CIN: Computers, Informatics, Nursing, 36(5), 209–213.

 

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Rachael Werner

Mar 15, 2023 3:17pm
| 
Last reply Mar 16, 2023 2:23pm

Reply from Rachael Werner

WEEK 3 Discussion Post

 

Nursing informaticists are essential to the nursing profession. This specialty combines nursing science with analytical science to effectively manage and communicate data for better patient care and outcomes (Admin, 2023). It is imperative that nurse informaticists and/or technology specialists work closely with healthcare professionals such as nurses and physicians to ensure that the patient is receiving the best of care when it comes to quality and safety. In order to minimize adverse events, it’s important that healthcare facilities embrace a safety culture (McGonigle & Mastrian, 2022). Time management is also of the essence when it comes to proper patient care. Time management is imperative in the healthcare setting and utilizing informatics to improve patient care and not create additional barriers is important (Sweeney, 2017). For example, in the facility I work, we have patients who may want to be on hormone replacement therapy (HRT) and/or peptide therapy. For this process, blood work is essential to see what that patient’s body is doing based on their blood results. We use an electronic medical record (EMR) system called Zenoti to update patient information, chart notes, refills, consults, and so forth. Zenoti keeps a record of each time that a patient interacts with staff so that it is easily accessible to the nurse, physician or front desk employee to access and have that data in real-time. If a patient recently had blood work done, that is through another company so those results have to be uploaded to their chart separately. This process can definitely leave room for error, especially if there is a critical lab value that gets overlooked. Myself, the nurse practitioner, or the medical director has to be cautious when refilling and/or ordering medications such as testosterone because we have to make sure we are seeing all the blood results so as to not over or under-medicate a patient.  Although it is great to have a system that all staff can utilize for efficacy, there is definite room for error.

One of the ways to improve informatics with the healthcare team where I work would be possibly reevaluating the EMR system we are currently using. If the EMR system could flag when a patient’s blood results are critical or important so that the healthcare provider isn’t searching all over the electronic chart and potentially overlooking a result. Another important improvement would be receiving a notification to alert staff and the patient when blood re-draws are required. For example, if a patient is receiving HRT, such as testosterone, our protocol is to have that patient have their hormones redrawn every 3 months. The only way to know when they are due for a redraw is by searching the chart for the last time results were noted and dated. This could save the provider as well as the patient time so that there is no delay in therapy.

According to McGonigle and Mastrian (2022), nursing is hard work. There is absolutely no debate about that statement. Nurses are known for multitasking as well as being compassionate to their patients. The continued improvement of technological advances will help those in the healthcare profession to better serve our patients safely and effectively without buring the providers out.

 

References

Admin. (2023, February 27). 
What is Nursing Informatics?
 HIMSS. Retrieved March 15, 2023, from https://www.himss.org/resources/what-nursing-informatics#:~:text=Nursing%20informatics%20%22is%20the%20specialty,and%20wisdom%20in%20nursing%20practice.%22

McGonigle, D. & Garver Mastrian, K. (2022). Nursing informatics and the foundation of knowledge. Jones & Bartlett Learning.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics. Retrieved on March 15, 2023, from https://www.himss.org/ojni

 

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DV

Daniela Donna Villanueva

Mar 15, 2023 11:23am
| 
Last reply Mar 16, 2023 8:46pm

Reply from Daniela Donna Villanueva

Observation of Nurse Informaticist Interaction

In my experience as a nurse at a local hospital, I have observed the informatics clinical nurse provide support for clinical informatics, including planning initiatives to meet clinical needs. The informatics clinical nurse works closely with leadership and the IT department to ensure systems are up-to-date and will assess and troubleshoot issues. I have also observed the informatics clinical nurse train new providers on the hospital’s software and systems to help prioritize and organize charting. The informaticist also sits on hospital committees to help make technology decisions that improve organizational processes, performance, and outcomes.

Strategy to Improve Interaction

The nursing practice depends on information and communication technologies that collect input from other nurses and all the patient care technologies (McGonigle & Mastrian, 2022, p. 607). One strategy to improve interaction is for the floor nurses to communicate better with the informatics nurse. My experience has been that the floor nurse becomes frustrated when computer glitches or problems with a program arise. The time it takes for IT or the informatics nurse to respond is challenging. Effective communication is essential for better outcomes. The team should be encouraged to work toward the same goal and support ideas for the team as a whole (Skoda et al., 2021). For example, you are in a patient’s room administering medication, and the medication scanner is not responding. The nurse must reboot her computer, and if still not working, she will call IT or the informatics nurse. The floor nurse is now late on her medication pass, and patients are angry, making it very frustrating. The lack of communication between the two teams harms patient outcomes and satisfaction.

Impact of Continued Evolution

Nursing informatics is constantly changing beyond its definition (Sipes, 2016). Technology can help transformational outcomes of great-quality and evidence-based care and education (Harerimana et al., 2022). During the COVID-19 pandemic, the role of nursing informatics was forced to change to continue managing operations. The use of telehealth and other means of virtual meetings has rapidly expanded and has taken on a whole new meaning (Garcia-Dia, 2021). This specialty will continue to evolve in moments of need and to keep up with technology to help improve patient satisfaction and outcomes.

 

References

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Garcia-Dia, Mary Joy DNP, RN, FAAN. Nursing informatics: An evolving specialty. Nursing Management (Springhouse) 52(5):p 56, May 2021. | DOI: 10.1097/01.NUMA.0000743444.08164.b4

Harerimana, A., Wicking, K., Biedermann, N., & Yates, K. (2022, August). 
Nursing Informatics in undergraduate nursing education in Australia before COVID-19: A scoping review
. Collegian. Retrieved March 15, 2023, from https://www.sciencedirect.com/science/article/pii/S1322769621001621

Škoda, T. Baksa, L. Luić (2021) Effective Communication Practices in Digital Curriculum, INTED2021 Proceedings, pp. 5995-6002.Sipes, C. (2016). Project management: 
Essential skill of nurse informaticistsLinks to an external site.
Links to an external site.
. 
Studies in Health Technology and Informatics, 225
, 252-256.

Sipes, C. (2016). Project management: 
Essential skill of nurse informaticistsLinks to an external site.
Links to an external site.
. 
Studies in Health Technology and Informatics, 225
, 252-256.

 

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Latisha Hawkins

Mar 15, 2023 8:15am
| 
Last reply Mar 19, 2023 9:26pm

Reply from Latisha Hawkins

Nurse informatics looks different depending on what type of specialty you are in, for example, I have a full-time pediatric private duty nurse job, and I work PRN at a correctional facility. In the previous discussions, I mentioned that there is no nurse informatics in my correctional job, and they do chart auditing. And the majority of the charting on corrections is on paper and transferred to an out-of-date charting system.

In my full-time job, the nurse informaticists we have usually teach our charting classes and keep us up to date with any changes that come with it. They typically look for trends in charting issues amongst then nurses throughout the company that need to be addressed. At the same time, I haven’t had any direct observations of them working, and the direct experience I have had with them is through our charting classes and meetings when they feel that those trends need to be addressed.

One major issue is when a provider adds a new order or changes an existing one. Because no doctor looks at the charting, they can’t put in their orders. So it’s left up to the nurses to do it. And it needs to be clarified because you can’t update a previous nurse’s order. You have to discontinue it and go in to add the updated medication or new medication. And often, they call us to say how it’s done incorrectly or to clarify the order without contacting the provider. They should incorporate the providers to get updates when we place these orders. I was taught to put in my order, take a picture of the label and add it for them to verify. And there have been many times when I have a call a provider directly to question an order. Still, if the provider gets maybe notification to clarify it or fix any confusion, it would cut down on many issues with the nurses. Having a system with care everywhere to help with any barrier preventing medication errors could be very beneficial when a patient has a procedure or a hospital stay.

The nursing informatics specialty would have a positive outlook on the interaction of home health nurses with providers. The trends of how often nurses put in these medication orders and how often there are many questions. It would leave no gray area, allow for open communication, and achieve the goal of improved patient outcomes. And as technology advances, I would be surprised if nurse informaticists can achieve it somehow with the current charting system being used.

References

Bakken, S., & Dreisbach, C. (2022). Informatics and data science perspective on future of nursing 2020–2030: Charting a pathway to health equity. 
Nursing Outlook
, 
70
(6), S77–S87. 
https://doi.org/10.1016/j.outlook.2022.04.004
Links to an external site.

Garcia-Dia, M. (2021). Nursing informatics. 
Nursing Management
, 
52
(5), 56–56. 
https://doi.org/10.1097/01.numa.0000743444.08164.b4
Links to an external site.

Wolter Kluwer. (2018, March 27). 
Nursing informatics: The intersection of technology and clinical practice
 [Wolter Kluwer]. 
https://www.wolterskluwer.com/en/expert-insights/nursing-informatics-the-intersection-of-technology-and-clinical-practice
Links to an external site.

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FI

Francess Ikowe

Mar 15, 2023 1:32am
| 
Last reply Mar 18, 2023 4:04pm

Reply from Francess Ikowe

                                                                                                      
Week 3 discussion

 

                                                                                    Experiences or observations on how  nursing informatics interact 

The American Nurses Association (ANA) defines nursing informatics as a field that combines nursing science and information technology to manage better and communicate data within nursing practice.

I only interact with informatics nurses when there are significant updates in the electronic health system (EHR). My company uses a system called  EPIC documentation system, it is mandatory to get quarterly updates, or the company could lose its contract with EPIC. So, whenever these updates are done, the informatics nurses will be around daily for about a week to answer questions until everyone is comfortable with the new changes. We sometimes must attend in-person classes; for some of these updates, those classes are taught by informatics nurses. The last one I heard was when our IV pump system was integrated into the EHR to calculate all the intravenous fluids the patient received from the Alaris pump.

 Suggest at least one strategy on how these interactions might be improved. 

These interactions could be improved by allowing nurses to give feedback and express their opinions on the changes and how they may improve or impair their ability to provide patient care. The second is by reforming nursing education; Booth et al. 2021 noted that creating opportunities for undergraduates and graduate-level students in informatics and data science to work with some of these professionals will give nurses the skills to evolve and stay relevant in this technology age. Topaz et al. 2016 also noted that making nursing informatics mandatory for all undergraduate nursing programs should be one of the biggest goals for nursing educators.

                                                                                                       The impact of the continued evolution of nursing 

As health technology improves and hospitals invest in technology like AI, drones, and robots, nurses will have no choice but to collaborate with some of these developers to ensure a positive patient outcome (Booth et al.  2021). Some of these technologies will make providing nursing care much easier, especially in the area of documentation.

 

References 

Nursing informatics: Scope and standards of Practice, 2nd ed
. ANA. (2016, December 1). Retrieved March 14, 2023, from
 https://www.nursingworld.org/nurses-books/nursing-informatics-scope-and-standards-of-practice-2nd-ed/#:~:text=Nursing%20informatics%20(NI)%20is%20the,and%20wisdom%20in%20nursing%20practice
Links to an external site.
.

 

Booth, R. G., Strudwick, G., McBride, S., O’Connor, S., & Solano López, A. L. (2021). How the nursing profession should adapt for a digital future. 
BMJ
.
 https://doi.org/10.1136/bmj.n1190
Links to an external site.

 

Peltonen, L. M., Topaz, M., Ronquillo, C., Pruinelli, L., Sarmiento, R. F., Badger, M. K., Ali, S., Lewis, A., Georgsson, M., Jeon, E., Tayaben, J. L., Kuo, C. H., Islam, T., Sommer, J., Jung, H., Eler, G. J., & Alhuwail, D. (2016). Nursing Informatics Research Priorities for the Future: Recommendations from an International Survey. 
Studies in health technology and informatics
, 
225
, 222–226.

1.
 
Sara is a 45-year-old female presenting for her annual exam. Her blood pressure
today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her
last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking
ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal
for her blood pressure? What medication would you prescribe to treat her blood
pressure? What education would you prescribe?

Sara’s problem is uncontrolled hypertension, as evidenced by the current blood pressure reading of 160/90mmHg and supported by the pressure reading of 152/92mmHg. According to The American Heart Association (2023), blood pressure higher than 140/90mmHg indicates stage 2 hypertension. It requires assessing and evaluating the underlying cause with the patient and developing a treatment plan to address the specific needs. Based on the provided history, Sara’s chronic pain and the use of Ibuprofen 600mg 8 hours every day could be significant contributing factors that may cause her high blood pressure. Tabassum et al. (2023) indicate that long-term use of NSAIDs has been
associated with…

Assignment: Case Studies

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Review the case study posted in “Announcements” by your Instructor for this Assignment

Review the information provided and answer questions posed in the case study

When recommending a medication, write out a complete prescription for the medication

Whenever possible, use clinical practice guidelines in developing your answers when possible

Include at least three references to support your answer and cite them in APA format.

By Day 7 of Week 4

Submit the Assignment.

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submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK4Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
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 for review.

Rubric

NURS_6521_Week4_Assignment_Rubric

NURS_6521_Week4_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection Sara is a 45-year-old female presenting for her annual exam

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection Sara is a 45-year-old female presenting for her annual exam.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. 

3
 pts

Total Points: 
100 Sara is a 45-year-old female presenting for her annual exam.
Her blood pressure
today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195

Regulation of Nursing Practice through State Boards of Nursing

In the United States, all states have established boards of nursing for regulating nursing practice. In agreement with Cassiani et al. (2020), the fundamental purpose of regulating nursing practice is to ascertain the provision of safe nursing care to the public. This discussion compares two board of nursing regulations for APRNs in my state (New Jersey), with those of Alaska.

Comparison of APRNs’ Regulations in New Jersey and Arizona States

A relevant regulation is APRN scope of practice, full practice authority (FPA). In New Jersey, the regulatory structure of its board of nursing adopts a reduced practice approach for APRNs (American Association of Nurse Practitioners, 2022). By contrast, the state of Alaska has enacted a full practice regulatory structure for APRNs. An example is that licensed APRNs in Alaska can independently diagnose and treat medical conditions, while those in New Jersey have to collaboratively work with a physician (be delegated) to perform such practices.

The other regulation is continuing education (CE) programs for license renewal. APRNs in New Jersey must complete 30 contact hours in the period preceding mandated biennial renewal (New Jersey Division of Consumer Affairs, 2022). They must also complete one hour of CE on opioid drug prescription with regard to opioid alternatives to manage and treat pain, and risks and signs of opioid abuse, addiction, and diversion. In Alaska, APRNs need to complete 30 contact hours of CE in the period preceding mandated biennial renewal (Department of Commerce, Community, and Economic Development, 2022). Within the same period, APRNs with controlled substance authority and DEA registration are required to two hours of education on pain management and opioid use and addiction.

Impact of Regulations on APRNs with Legal Authority to Practice within Full Scope

As outlined by the American Association of Nurse Practitioners (AANP), FPA allows APRNs independent practice. They have the authority to: evaluate patients; diagnose, order, and interpret diagnostics; and initiate and treat medical problems including prescription of drugs and controlled substances under the state board of nursing’s exclusive licensure authority (DePriest et al., 2020). Since New Jersey adopts reduced practice approach, APRNs in this state have to be supervised, delegated, or managed by a physician while carrying out at least one of the FPA practices such as prescribing drugs (New Jersey Division of Consumer Affairs, 2022).

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In Alaska, licensed APRNs assume FPA to perform board-approved advanced and specialized practices practicing as nurse midwives, nurse practitioners, clinical nurse specialists, or certified registered nurse anesthetists, or in more than one role for which they have received specialized education (Department of Commerce, Community, and Economic Development, 2022). In addition to aforementioned FPA practices, APRNs in Alaska can authorize registered nurses to conduct a determination of death, they can certify the death, and write do not resuscitate orders, and expected death at home forms and death certificates.

Ways APRNs Comply with Selected Regulations

APRNs in New Jersey, prior to prescribing drugs or a medical device, they should attain a joint protocol with a licensed collaborating physician in this state (New Jersey Division of Consumer Affairs, 2022). Those in Alaska practice independently guided by the Scope of Nursing Practice Decision-Making Framework and Scope of Practice for NPs (Department of Commerce, Community, and Economic Development, 2022). APRNs in both states, for example enrolling for May license renewal 2022, can complete 30 hours of instruction from their employer approved by American Nurses Crediting Services (ANCC) between June 1, 2020 and May 31, 2022.

References

American Association of Nurse Practitioners. (2022). 
New Jersey: Information and Resources for New Jersey NPs
. https://www.aanp.org/advocacy/new-jersey

American Association of Nurse Practitioners. (2022). 
Alaska: Information and Resources for Alaska NPs
. Retrieved December 24, 2022, from https://www.aanp.org/advocacy/alaska

Cassiani, S. H. D. B., Lecorps, K., Cañaveral, L. K. R., da Silva, F. A. M., & Fitzgerald, J. (2020). Regulation of nursing practice in the Region of the Americas. 
Revista Panamericana de Salud Pública
, 
44
. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429928/

DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. P. (2020). Nurse practitioners’ workforce outcomes under implementation of full practice authority. 
Nursing outlook
, 
68
(4), 459-467. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581487/

Department of Commerce, Community, and Economic Development. (2022). 
Board of nursing, professional licensing, division of corporations, business and professional licensing
. Retrieved December 24, 2022, from https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/BoardofNursing.aspx

New Jersey Division of Consumer Affairs. (2022, September 12). 
Pages – New Jersey board of nursing
. Retrieved December 24, 2022, from https://www.njconsumeraffairs.gov/nur

 

Professional Nursing and State-Level Regulations

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To Prepare:

Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.

Consider how key regulations may impact nursing practice.

Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.

By Day 3 of Week 5

Post
 a comparison of at least two APRN board of
nursing regulations in your state/region
with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

By Day 6 of Week 5

Respond
 to at least 
two
 of your colleagues
* on two different days
 and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.

*Note:
 Throughout this program, your fellow students are referred to as colleagues.

Initial Post 

The two states I’m comparing APRNs are Texas and California. Texas is where I currently reside and California would be my dream state to live in. The comparison will give me insight into the differences within the state’s scope of practice. California isn’t a compact state but one can apply for endorsement. Texas is one of the compact states for all nurses and APRNs. The two states I’m comparing APRNs are Texas and California. Texas is where I currently reside and California would be my dream state to live in. The comparison will give me insight into the differences within the state’s scope of practice. California isn’t a compact state but one can apply for endorsement. Texas is one of the compact states for all nurses and APRNs.

The scope of practice for APRNs varies widely from one jurisdiction to the next. Some regions and states have stricter regulations than others. For instance, some states and regions need APRNs to have a specific amount of clinical experience before they may be licensed. For instance in California to be a PMHNP, they require a master’s degree along with 2 years of clinical experience (which includes 1 year of supervisory experience) after you obtained your master’s degree. In Texas, that law isn’t required.

There are certain regulations for every state. In California, APRNs are not allowed to work independently. Broadly speaking, NPs are trained to assess, diagnose, order, and interpret medical tests, prescribe medications, and collaborate in the care of patients (Levine, 2019). . The scope of practice for a nurse practitioner varies from state to state, and sometimes even from hospital to hospital. In California, NPs practice in collaboration with a licensed physician (Levine, 2019). In Texas, Nurse Practitioners can exercise the full scope of their training and work autonomously. That means you can own and operate a nurse practitioner private practice without physician oversight (TWU, 2020).

In California, BPC 2836.1 was amended changing furnishing to mean “order” for a controlled substance and can be considered the same as an “order” initiated by the physician. This law requires the NP who has a furnishing number to obtain a DEA number to “order” controlled substances, Schedule II, III, IV, V (DCA, n.d.) The mission of the Texas Board of Nursing (BON) is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely (TBON, n.d.). Acting in accordance with the highest standards of ethics, accountability, efficiency, effectiveness, and openness, the Texas Board of Nursing approaches its mission with a deep sense of purpose and responsibility and affirms that the regulation of nursing is a public and private trust (TBON, n.d.).

References

GENERAL INFORMATION: NURSE PRACTITIONER PRACTICE
. (n.d.). https://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf. Retrieved December 28, 2022, from 
https://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf
Links to an external site.

 

How to Start a Nurse Practitioner Private Practice | Texas Woman’s University Online
. (2020, October 26). 
https://onlinenursing.twu.edu/blog/how-start-nurse-practitioner-private-practice
Links to an external site.

 

Mission and Values
. (n.d.). Texas Board of Nursing. Retrieved December 28, 2022, from 
https://www.bon.texas.gov/about_mission_and_values.asp.html
Links to an external site.

 

What Does a Nurse Practitioner Do?
 (n.d.). Cedars-Sinai. https://www.cedars-sinai.org/blog/nurse-practitioners.html

 

 

 

 

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Nchetaka Okeke

Dec 28, 2022 10:05pm

Reply from Nchetaka Okeke

The nursing profession is controlled by rules and regulations that vary by state and laws that govern them. Most of their rules are related to public safety and licensing. “Health professions regulation is needed as a mechanism to protect the interests of public safety” (Milstead &Short, 2019).  They specify certification criteria as well as the scope of practice in the state. Knowledge of the individual State’s Nurse Practice Act (NPA) is essential to practicing within the expected guidelines by law and ensures the safety of patients. The NPA is set in place by States to detail requirements for nursing education, licensure, and scope of practice (Haddad & Huynh, 2022)

Comparison of Nursing Regulations

I am a registered nurse in Texas; therefore, I will compare the Texas board of nursing regulations to that of the Arizona board of nursing regulations. Texas has a 
“reduced practice”
 policy; this means Texas Nurse Practitioners cannot perform the full scope of practice without a supervising or collaborating physician (Clarke, 2022).  According to the Texas Board of Nursing (2022), “Protocols or other written authorization should be jointly developed by the advanced practice nurse and the appropriate physician(s)” (p.169). The prescriptive authority in Texas requires “an agreement entered into by a physician and an advanced practice registered nurse (APRN) or physician assistance (PA) through which the physician delegates to the APRN or PA the act of prescribing or ordering a drug or device” (Texas Board of Nursing, n.d.). In contrast, APRNs in Arizona have full independent practice authority and do not require a physician’s supervision or collaboration. They can practice unsupervised within the area of their certification only. They can prescribe and dispense drugs and devices within the nurse practitioner’s population focus. They may also prescribe scheduled II-V controlled substances (NCSL, n.d.)

 

Full Practice Authority

According to Bosse et al. (2017), the benefits of having APRNs with full practice authority (FPA) include cost-efficient care, reduced number of prescriptions, decreased emergency room visits, and improved collaboration between clinicians. Hence, in the states where FPA is not in place, there is no opportunity for improvement in the overall healthcare system. For example, if Texas nurse practitioners were granted FPA, they could take care of patients independently and prescribe medications. With this, more patients can receive care, and the cost of healthcare will be reduced for the patient and the healthcare organization. As for APRNs, it is critical to pay close attention to the scope of practice for the state where you work.

                                                             References

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. 
Nursing Outlook
, 
65
(6), 761–765. 
https://doi.org/10.1016/j.outlook.2017.10.002
Links to an external site.

Huynh, A. P., & Haddad, L. M. (2022). Nursing Practice Act. 
StatPearls
. Retrieved December 27, 2022, from 
https://www.ncbi.nlm.nih.gov/books/NBK559012/#article-26029.s1
Links to an external site.

Milstead, J. A., & Short, N. M. (2021). Government Response: Regulation. (pg. 57–84) 
Health 
Policy and Politics: A Nurse’s Guide 6th Edition 
(6th ed.). Jones & Bartlett Learning.

NCSL. (n.d.). Scope of practice policy state overview: Arizona. Retrieved December 27, 2022, from 
https://scopeofpracticepolicy.org/states/az/
Links to an external site.

Nurse Journal. (2022). Nurse practitioner practice authority: A state-by-state guide. Retrieved December 26,, 2022, from 
https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/
Links to an external site.

Texas Board of Nursing. (n. d.). Texas administrative code: chapter 222 advanced practice registered nurse with prescriptive authority. Retrieved December 25, 2022, from 
https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=222&rl=5
Links to an external site.

Texas Board of Nursing. (2022). Texas Board of Nursing: Rules and regulations relating to nurse education, licensure and practice. Retrieved December26, 2022, from  
https://www.bon.texas.gov/pdfs/law_rules_pdfs/rules_regulations_pdfs/October%202022%20Rules%20and%2200Regulations.pdf
Links to an external site.

 

 

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Bonita Leone
 (She/Her)

Dec 28, 2022 9:49pm

Reply from Bonita Leone

Nurs 6050N State Comparison  Discussion Post 1

As someone who has worked in Michigan her whole life and has never contemplated working out of state, I looked to Ohio to compare to my home state of Michigan, which is within an hour’s commute. Keep in mind I have worked with Ohio nurses in Michigan for nearly 20 years.

Ohio currently recognizes the national mandate by the president to acknowledge nurses from outside of the state that want to practice in Ohio during the pandemic under a White House Briefing released in February 2022. Also, per the Nurse License Compact (NLC), Nurses from Ohio can practice in another one of 39  NLC states without applying for a license. Michigan nurses do not have this same luxury.

Also, Michigan is a restricted practice state along with a minority of other states across the US; legislation is currently in Michigan’s state legislature to bring Michigan up to speed to a full practice authority state. This current weakened scope of NP practice contradicts the suggested goals of the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) (IOM & RWJF, 2010) assessment report,  stating the future of nursing was to enhance health care in the United States by optimally utilizing the nursing workforce(Yoon et al., 2018).

References

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765. Retrieved December 26, 2022, from https://doi.org/10.1016/j.outlook.2017.10.002

House, W., & . (2022, February 18). Notice on the continuation of the national emergency concerning the coronavirus disease 2019 (covid-19) pandemic. The White House. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/

Nurse licensure compact (nlc). (n.d.). NCSBN. Retrieved December 27, 2022, from https://www.ncsbn.org/compacts/nurse-licensure-compact.page

Neff, D. F.,Yoon, S.H., Steiner, R. L.,,  Bumbach, M. D. , & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. 
Nursing Outlook, 
66(4), 379-385.

 

 

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Essie Tani Richardson

Dec 28, 2022 9:32pm
| 
Last reply Dec 31, 2022 8:25pm

Reply from Essie Tani Richardson

The key distinction between Texas and Louisiana is that Texas does not need APRNs to have a collaborative agreement with a physician. This means that whereas APRNs in Texas are permitted to practice without a formal, written agreement with a physician, they are not permitted to do so in Louisiana. APRNs must possess a license in order to work in both states. APRNs need to have finished an accredited APRN program and passed a national certification exam in order to obtain a license. Both states permit APRNs to prescribe drugs as part of their scope of practice. APRNs are only permitted to prescribe Schedule II–V controlled medications in Louisiana, but, if they have successfully registered as a controlled substance prescriber with the state’s board of pharmacy.

In Texas, APRNs are permitted to prescribe any controlled substance on Schedules II through V. In order to practice, APRNs must keep their RN licenses up to date in both states. APRNs in Louisiana must also keep their APRN licenses up to date. APRNs must complete continuing education requirements in both states in order to renew their licenses. Every two years, APRNs in Louisiana are required to complete at least 15 contact hours of continuing education. Every two years, APRNs in Texas are required to complete at least 20 contact hours of continuing education. Both states’ APRNs are obligated to follow the rules established by the state in which they are licensed to practice.

This means that in order to prescribe restricted medications in Louisiana, APRNs must have a collaboration agreement with a doctor and be registered with the Louisiana Board of Pharmacy. Although a collaborative agreement is not required in Texas for APRNs to prescribe restricted medications, they must still be registered with the Texas Board of Pharmacy.

Both states demand that APRNs keep their RN licenses up to date and complete continuing education requirements in order to renew their credentials. Each state has its own criteria for continuing education, though. Every two years, APRNs in Louisiana are required to complete at least 15 contact hours of continuing education, while APRNs in Texas are required to complete at least 20 contact hours.

 

References

 

https://www.bon.texas.gov/pdfs/aprn_position_statement.pdf
Links to an external site.

https://www.lsbn.state.la.us/docs/default-source/publications/aprn-practice-guidelines.pdf?sfvrsn=2

https://www.aacnnursing.org/News-Information/Fact-Sheets/Scope-of-Practice-for
Links to an external site.
 Nurses

https://www.ncsbn.org/Aprn_Consensus_Model.pdf

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Kayla Holt

Dec 28, 2022 8:28pm

Reply from Kayla Holt

Regulations (rules) enable reasonable implementation of the law (Milstead & Short, 2019). Note the terms regulation and rule are also used interchangeably (Milstead & Short, 2019). Whereas law is written in broad language, regulations are detailed and specify how the law will be put into practice (Milstead & Short, 2019). APRN practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing, but other laws and regulations may impact practice, and other boards may play a role (American Nurses Association, n.d.).

Arkansas is a reduced practice state which means nurse practitioners can perform some of their scope of practice without physician supervision (NurseJournal, 2022). These restrictions typically involve operating their own practices or prescribing certain types of medications (NurseJournal, 2022). They rarely involve the nurse practitioner’s ability to order tests or diagnose conditions (NurseJournal, 2022). For example, a nurse practitioner might need to be part of a practice that is supervised by a physician, rather than running their own practice, but within that practice, can operate with relative autonomy (NurseJournal, 2022).

South Dakota is a full practice authority state (NurseJournal, 2022). Nurse practitoners can perform the full scope of practice without a supervising or collaborating physician (NurseJournal, 2022). They can diagnose a patient, order tests, prescribe medication, and operate on their own independent practices (NurseJournal, 2022). Nurse practitioner independent practice states may require a certain level of experience working under a physician’s supervision or require additional training before allowing full practice authority (NurseJournal, 2022). Because these requirements are not permanent, these states are still considered full practice authority states (NurseJournal, 2022). If a nurse practitioner practiced under a physician in Arkansas for the required amount of time and then moved to South Dakota, they could open their own practice.

 

References

American Medical Association. (2021). 
State law chart: nurse practitioner practice authority. 
American Medical Association. https://www.ama-assn.org/system/files/2020-02/ama-chart-np-practice-authority.pdf

American Nurses Association. (n.d.). 
State law and regulation
. 
https://www.nursingworld.org/practice-policy/state-law-and-regulation/
Links to an external site.

Milstead, J. A., & Short, N. M. (2019). 
Health policy and politics: A nurse’s guide
 (6th ed.). Jones & Bartlett Learning.

NurseJournal Staff. (2022, November 29). 
Nurse practitioner practice authority: a state-by-state guide. 
NurseJournal. 
https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/#definition
Links to an external site.

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Rachel Butcher

Dec 28, 2022 8:12pm
| 
Last reply Dec 31, 2022 10:31am

Reply from Rachel Butcher

APRN Board Nursing Regulations

The APRN is an organization that is part of the legislation helping make policies to help keep the public safe. Six representatives help lead the organizations, and members, including the NCSBN, have made a toolkit to support the legislators and regulatory bodies in making changes to the healthcare professionals within the scope of practice. Certain states go by state-specific resources to determine the scope of practice. The states are Ohio, Oregon, New York, and Louisiana. (
APRN State Law and Regulation
, n.d.).

The Ohio APRN regulations are Drug Enforcement Administration (DEA). Certain drugs are under section 4723.42, which certifies that nurse practitioners can administer certain medications. Certified nurse practitioners are allowed to prescribe scheduled II controlled substances under specific guidelines.  The guidelines state that the physician initially prescribes the substance when the patient has terminal conditions. There are several other guidelines that the certified nurse practitioner has to follow before administering a schedule II substance. The nurse practitioner can prescribe controlled substances under the direction of the physician of the practice or facility.  (
Section 4723.481 | Authority of A.P.R.N. Designated as a Clinical Nurse Specialist, Certified Nurse-Midwife, or Certified Nurse Practitioner to Prescribe Drugs and Therapeutic Devices.
, 2021). Another regulation that Ohio APRN has to follow is to maintain Standard Care Arrangement by collaborating with specialists such as podiatrists or physicians.  Commonly prescribed medications from certified nurse practitioners are ant-asthmatics, antibiotics, anti-hypertensives, diabetic agents, and cholesterol medication. (
The Authority to Prescribe Medications and Therapeutic Devices
, n.d.). The Standard Care Arrangement is to help make a guide for evaluating and planning patient healthcare.

The Standard Care Arrangement is developed by the general physician, podiatrist, CNP, CNM, and CNS. This regulation must be renewed every two years, and the employer must keep a copy of the SCA in case the board wants to see it. (
What Is a Standard Care Arrangement
, n.d.).

I work in a long-term care facility that also has a skilled unit. The skilled unit is where patients come to get rehab after they have had a knee replacement, hip replacement, open heart surgery, wound care, strokes, etc. The nurse practitioner works under a medical director who is the primary physician. The nurse practitioner addresses the needs and treats the patient, ensuring their pain is controlled. If the nurse practitioner does not treat the patient’s pain properly, then the patient will not be able to do their therapy and get better and go home. The nurse practitioner needs to be able to work under the primary care physician to prescribe the proper medications. Nurse practitioners need to go by specific guidelines to make sure the patients are getting excellent care for better outcomes and return home safely. The Standard Care Act helps nurse practitioners with guidelines on how to treat the patients they see. Each patient is different, so they need to know what direction to go to ensure they receive the proper care.

Different states have different guidelines for APRN regulations. For example, Federal Controlled Substance and State define North Carolina guidelines when prescribing controlled substances. The nurse practitioner must have a DEA number entered when prescribing the controlled substances. The nurse practitioner must follow a primary or backup supervising physician when prescribing the controlled substances. When the nurse practitioner orders the controlled substances, the patient’s name and the nurse practitioner’s name and telephone number have to be on the prescription. (
Prescribing Authority
, 2021).

For instance, NC and Ohio have similar and different controlled substance prescription regulations. Both states have their nurse practitioners working under primary care physicians when prescribed controlled substances. There are differences in that North Carolina’s regulations when prescribing controlled substances are stricter. The nurse practitioner in North Carolina goes by Federal and state guidelines. The NP has to make sure their name, patient’s name, and telephone number are where the NP can be reached by staff and primary physician. The NP must also give their DEA number each time they order a controlled substance. Ohio NP was not as strict on ensuring their DEA number was given each time a controlled substance was prescribed.

Nurse practitioners must be able to prescribe controlled substances, even if under a primary physician. There are more NP available to assess patients. Physicians rely on and trust their NP to help treat their patients. NP should be able to prescribe controlled substances on a limited basis.

 

References

APRN state law and regulation. (n.d.). ANA America nurses association. Retrieved December 27, 2022, from 
https://www.nursingworld.org/practice-policy/advocacy/state/aprn-state-law-and-regulation/
Links to an external site.

Prescribing authority
. (2021, August 1). 21 NCAC 36.0809. Retrieved December 27, 2022, from 
http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0809.html
Links to an external site.

Section 4723.481 | authority of A.P.R.N. designated as a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner to prescribe drugs and therapeutic devices. (2021, July 30). Ohio Laws & administrative rules. Retrieved December 27, 2022, from 
https://codes.ohio.gov/ohio-revised-code/section-4723.481
Links to an external site.

The authority to prescribe medications and therapeutic devices. (n.d.). Ohio ARRNs providing quality, affordable healthcare in a variety of settings.. Retrieved December 28, 2022, from 
http://www.ohioaprn.com/prescriptive-authority.html#:~:text=Learn%20more%20about%20the%20rules%20governing%20APRN%20prescribers,substances%29%20continuing%20education%20on%20a%20regular%20basis%20%28bi-annually%29
Links to an external site.

What is a standard care arrangement
. (n.d.). Ohio APRNs providing quality, affordable healthcare in a variety of settings. Retrieved December 28, 2022, from 
http://www.ohioaprn.com/sca—standard-care-arrangement.html
Links to an external site.

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Amandeep Kaur

Dec 28, 2022 7:22pm
| 
Last reply Dec 30, 2022 10:58pm

Reply from Amandeep Kaur

Main Post:

Professional Nursing and State-Level Regulations

There are more than 50 state board nursing bodies in the country. The Board of Nursing ensures that its nurses have regulation that guides their practice in the State. For instance, in Minnesota, nurse practitioners are allowed to practice independently. The State joined eleven states in January 2015, allowing Nurse Practitioners to prescribe or practice independently (Graziano et al., 2017). The move has contributed to having a state with highly improved healthcare services. For example, the NPs have contributed to improving access to mental health services, helping Minnesota to counteract the ever-increasing primary care gap.

Before practice, the Minnesota Board of Nursing mandates that individuals meet all educational and certification requirements. The State has made numerous adjustments to its policies to ensure that only qualified individuals can handle patients’ issues. For instance, in 2014, the State stipulated that advanced practice nurses must have separate APRN licensing in addition to the Registered Nurse license. All the process and requirement allows the healthcare providers to meet the educational requirement for rendering them competent in rendering effective healthcare services in the State.

Each State may have its regulations and programs on how they want healthcare services to be rendered in their State. It is crucial to compare the Minnesota APRN regulations to those in California. The Nursing Practice Act (NPA) is the organization of the body for California mandating the Board on setting the scope of practice, duties, and responsibilities of Registered nurses (Lin et al., 2018). The State requires all individuals who may want to obtain certification for practicing as nurse practitioners to ensure they have an active license as a registered nurse for California. An additional requirement is that the nurse must also have a master’s degree in nursing or any clinical field that can be equated to nursing. The healthcare provider needs to complete a nurse practitioner education program.

The State requires nurse practitioners to practice within the scope of practice described in the Nursing Practice Act of California. The roles of nurse practitioners, as stipulated by the Nurse Practice Act, are not limited to assessment, ordering, requesting, and interpreting diagnostic tests, diagnosing, treating, and prescribing medications (Smith, 2022). Nurse practitioners have the relevant skills for managing, counseling, and educating patients and their families on their health conditions.

Nurse practitioners working in the State have the mandate of adhering to the provided policies and regulations and ensuring that they render the healthcare services highlighted in the scope of practice. It is relevant to ensure that all the education and certification requirements are met. Nurse practitioners are vital for healthcare providers as they deliver services that primary care physicians could only render. The regulations and accreditations process may be different for the two states described in this document. Still, they all aim to ensure that the public receives competent and safe services.

The Board of Nursing for states ensures the protection and regulation of nurses and nursing practice. It ensures improvement, which contributes to having healthcare facilities that are competent in solving and meeting the patients’ healthcare needs. At times healthcare providers wanting to practice in other states may need to follow the provided requirements in the State before being accredited to practice.

 

Reference
s

Smith L. B. (2022). The effect of nurse practitioner scope of practice laws on primary care delivery. 
Health Economics
, 
31
(1), 21–41. 
https://doi.org/10.1002/hec.4438
Links to an external site.

Graziano, J. A., Uppman, F., Anderson, K., Johnson, L., Frosch-Erickson, S., Hill, D., Eccles, J., Beasley, L., & Kohler, S. (2017). Minnesota Alliance for Nursing Education (MANE): A Unique Multi-institutional Approach to Preparing Nurses for the Future. 
Nursing Education Perspectives
, 
38
(5), E2–E7. 
https://doi.org/10.1097/01.NEP.0000000000000198
Links to an external site.

Lin, V. W., Juraschek, S. P., Xu, L., Jones, D., & Turek, J. (2018). California regional registered nurse workforce forecast. 
Nursing Economic$
, 
26
(2), 85–121. https://pubmed.ncbi.nlm.nih.gov/18524374/

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Rafael Carlos Martinez

Dec 28, 2022 7:20pm

Reply from Rafael Carlos Martinez

For this discussion post, I am comparing the APRN scope of practice regulations between New Hampshire, where I currently live, and Texas, where my extended family lives. New Hampshire is a full independent practice state, meaning that a fully licensed nurse practitioner in the state does not need to practice under the supervision of a physician. As a fully independent practitioner, a nurse practitioner within New Hampshire has full prescriptive ability, can sign POLST forms, and can work as a primary care provider within the state.  In comparison, nurse practitioners within Texas must have a written scope of practice agreement with a physician (that is renewed annually) that dictates what their scope of practice will be, and what medications and medical devices they can prescribe. Nurse practitioners in Texas may work as primary care providers, but they must practice within the scope of the practice agreement between themselves and a physician, and they cannot sign POLST forms.

These scope of practice regulations affect nurse practitioners who have legal authority to practice within their full scope of practice of their education and experience in that Nurse practitioners in Texas, although they may have the knowledge and experience to practice independently, cannot practice as a provider without the supervision of a delegating physician, who is ultimately responsible for all the care that the nurse practitioner provides to patients. Furthermore, a nurse practitioner in Texas, would not be legally able to practice independently, and could not sign any POLST forms for their patients. The same nurse fully licensed practitioner working in New Hampshire, however, would be able to independently see their patients (without a delegating or supervising physician), and would be able to sign the POLST form without having to go to a physician for a signature.

Bin Abdul Baten, R., & Wehby, G. L. (2022). 
Effects of the aca medicaid expansions on access and health by nurse practitioner scope of practice laws. Nursing Outlook, 70(2), 228–237
. https://doi.org/10.1016/j.outlook.2021.12.011

NCSLSOP. (2022). 
Nurse practitioners
: scope of practice policy. Retrieved December 28. 2022, from https://scopeofpracticepolicy.org/practitioners/nurse-practitioners/?

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Holly Anne Mayes

Dec 28, 2022 6:35pm

Reply from Holly Anne Mayes

Discussion 5:

 

Regarding licensure authority for an APRN, each state has its own set of regulations (American Association of Nurse Practitioners, 2022). Two differences between New Mexico and Florida are the ability to practice independently without restrictions or oversight and work in different specialty areas. In all 50 states, APRNs fall into one of three different levels of practice. According to the American Association of Nurse Practitioners, the three different levels are as follows:

Full Practice

State practice and licensure laws permit all NPs to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.

Reduced Practice

State practice and licensure laws reduce the ability of NPS to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider for the NP to provide patient care, or it limits the set of one or more elements of NP practice.

Restricted Practice

State practice and licensure laws restrict the ability of NPS to engage in at least one element of NP practice. State law requires career-long supervision, delegation, or team management by another health provider for the NP to provide patient care (American Association of Nurse Practitioners, 2022).

New Mexico falls under the full practice, while Florida is restricted practice. The New Mexico board of nursing states that an APRN can “practice independently and make decisions regarding healthcare needs of the individual, family or community and carry out all health regimens, including the prescription and distribution of dangerous drugs and controlled substances” (
New Mexico Board of Nursing,
 2022b). Florida is a restricted practice state where the APRN can only work under an approved protocol or a Physician.

To comply with this regulation, the APRN must enter a supervisory protocol with at least one physician within the physician group practice. In Florida, an APRN can apply to become an “Autonomous Advanced Nurse Practitioner,” where they can practice independently but can only engage in autonomous practice in primary care practices, including family medicine, general pediatrics, and general internal medicine, as defined by board rule. They also must have completed a minimum of 3,000 hours in the specialty they are approved to work in before they can be licensed as autonomous and have to apply to the state of Florida for approval and compliance (
Statutes & constitution: view statutes: Online sunshine,
 2022). New Mexico APRNs can work independently as soon as they are licensed and can work in all specialties. Since we are a rural state with limited access to care and specialists, our state would suffer if we had restrictions in a place like Florida. APRNs are vital to our healthcare system in New Mexico; we have a limited number of physicians and need our APRNs’ support to continue caring for our patients.

 

References

American Association of Nurse Practitioners. (2022). 
State practice environment. 
https://www.aanp.org/advocacy/state/state-practice-environment
Links to an external site.

New Mexico Board of Nursing. (n.d.). Retrieved December 28, 2022, from 
https://nmbon.sks.com/nurse-practice-act
Links to an external site.

NursingLicensure.org (2022a). 
Advanced Practice Nurse Requirements in New Mexico
. 
https://www.nursinglicensure.org/np-state/New
Links to an external site.
 Mexico-nurse-practitioner/

Statutes & Constitution: view statutes: Online Sunshine. (2022, December 28). Retrieved December 28, 2022, from 
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499%2F0464%2F0464.html
Links to an external site.

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Lima Vadakkedam

Dec 28, 2022 5:43pm
| 
Last reply Dec 30, 2022 10:48pm

Reply from Lima Vadakkedam

The Board of Nursing varies between each state on how they regulate the APRNs(American Association of Nurse Practitioners, 2022). The New Jersey Board of Nursing was established in 1912 to protect the health, safety and welfare of New Jersey’s residents by ensuring that those who practice nursing are qualified and competent to do so. This board licenses registered nurses and practical nurses, and regulates the nursing profession in New Jersey. The board certifies advanced practice nurses, sexual assault forensic nurses, and certified homemaker-home health aides. The board accredits nursing schools and approves clinical affiliates. (American Association of Nurse Practitioners, 2022). The state of New Jersey has certain regulations that only pertain to the state of New Jersey. I also hold my NLC. An NLC is a nursing compact license that RN can apply for if they live in a compact state. The Nurse Licensure Compact (NLC) allows a nurse to have one multistate license with the ability to practice in the home state and other compact states. (NCBSN, 2022). This allows for nurses who are doing travel nursing to not have to apply for each state separately.

 

APRNs in most states are able to independently treat and diagno patients. For example, in the state where I live and will obtain my license, APRNs still have to practice under the delegation of a physician. On the contrary in the State of Oregon, they have allowed for nurses to have full practice authority. This means that the APRNs in Oregon can diagnose and treat patients independently. (AANP 2022). I understand that each state follows different regulations, but sometimes it makes no sense considering we all take similar NCLEX in the beginning. There should be a standardized practice from state to state for APRNs. I understand Oregon may have more vast rural areas than New Jersey and that is why they may give APRNs more freedom with providing care. New Jersey is a metropolitan area with access to arguably some of the best healthcare in the country, which may be why they have more restrictions on APRNs they do not see the full value they bring to the healthcare system. However, if we all receive the same schooling and take very similar boards, why not just standardize the scope of practice for all APRNs. This would most likely lead to a better continuity of care from state to state. APRNs are a vital and very important part of the healthcare system and letting them work to the full extent of their scope of practice is important.

 

Furthermore, regulations of the different states in the United States work differently between state to state. Some licenses limit nurses in some states, where as other states nurses are able to practice freely.

References: 

American Association of Nurse Practitioners. (2022). New Jersey: Information and Resources for New Jersey NPs. https://www.aanp.org/advocacy/new-jersey

Nurse Licensure Compact (NLC). NCSBN. (n.d.). Retrieved December 28, 2022, from https://www.ncsbn.org/compacts/nurse-licensure-compact.page

American Association of Nurse Practitioners. (2022). Alaska: Information and Resources for Oregon NPs. Retrieved December 28, 2022, from https://www.aanp.org/advocacy/Oregon

 

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Anna Fortenberry Williams

Dec 28, 2022 4:57pm
| 
Last reply Dec 30, 2022 1:32pm

Reply from Anna Fortenberry Williams

In Texas, Nurse practitioners are not allowed to sign death certificates or handicap parking permits.  They are able to sign worker’s compensation claims and be named primary care providers. (
Nurse Practitioner Scope of Practice: Texas | ThriveAP
, n.d.) Texas Nurse Practitioners have a limited scope of practice. Nurse practitioners practicing in Texas have laws requiring physician supervision in prescribing and practice. In Texas, the nurse practitioner must practice within 75 miles of the supervising physician. Physicians cannot supervise greater than four nurse practitioners at one time.  The supervising physician must also review at least 10 percent of the nurse practitioner’s charts each month. In Texas Nurse Practitioners are allowed to prescribe under physician supervision. They can only prescribe a 30 day supply of medications and cannot o prescribe schedule 2 drugs.

In Arkansas unlike Texas Nurse practitioners allow full practice rights. Nurse Practitioners, like in Texas can evaluate and examine patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.

 

The issue with restricting Nurse Practitioner’s right to practice fully is it reduces the amount of providers, especially in rural areas. All states with reduced rights for Nurse Practitioner practice are trying to move towards full authority, but it is a long and tedious process that requires much work.

 

Arkansas
. (n.d.). American Association of Nurse Practitioners. Retrieved December 28, 2022, from https://www.aanp.org/advocacy/arkansas

‌

Important Scope of Practice Information – Texas Nurse Practitioners
. (n.d.). Www.texasnp.org. 

Home

Links to an external site.

 

Milstead, J. A., & Short, N. M. (2019). 
Health policy and politics: A nurse’s guide
 (6th ed.). Jones & Bartlett Learning.

 

American Nurses Association. (n.d.). 
ANA enterprise
 Links to an external site.
Links to an external site.
. Retrieved September 20, 2018, from 
http://www.nursingworld.org
Links to an external site.

 

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). 
Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care Links to an external site.
Links to an external site.
. 
Nursing Outlook, 65
(6), 761–765.

 

Halm, M. A. (2018). 
Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing
 Download Evaluating the impact of EBP education: Development of a modified Fresno test for acute care nursing
. 
Worldviews on Evidence-Based Nursing, 15
(4), 272–280. doi:10.1111/wvn.12291

 

National Council of State Boards of Nursing (NCSBN) Links to an external site.
Links to an external site.
. (n.d.). Retrieved September 20, 2018, from 
https://www.ncsbn.org/index.htm
Links to an external site.

 

Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). 
The impact of nurse practitioner regulations on population access to care Links to an external site.
Links to an external site.
. 
Nursing Outlook, 66
(4), 379–385.

 

Peterson, C., Adams, S. A., & DeMuro, P. R. (2015). 
mHealth: Don’t forget all the stakeholders in the business case Links to an external site.
Links to an external site.
. 
Medicine 2.0, 4
(2), e4.

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Shelly Bailey

Dec 28, 2022 3:11pm
| 
Last reply Dec 29, 2022 10:45pm

Reply from Shelly Bailey

For my discussion, I have chosen to look at the Mississippi Board of Nursing (MSBON) and Tennessee Board of Nursing (TNBON) regulations and requirements for the Advance Practice Registered Nurse (APRN). Both states are Nurse Licensure Compact (NLC). I live in Mississippi (MS) and am licensed through the MSBON, but I currently work in Tennessee (TN). I have worked as a nurse in both states throughout my nursing career.

As an RN or APRN in the State of MS, you must be fingerprinted along with a background check. This background check and fingerprinting must be redone every two years if you change to another employee. In Tennessee, no fingerprinting is required with one’s background check. To practice as an APRN in Mississippi, the RN must have or obtain a Mississippi BON license even though MS is an NCL state. (Mississippi Board of Nursing, n.d.). A licensed MS APRN can apply to work in TN as a practicing APRN without obtaining a TN BON license because Tennessee, as a multi-state compact license state, recognizes the MS APRN license (Tennessee Board of Nursing, n.d.).

In the state of MS, APRNs can only practice independently if they enter into a collaborative agreement with a physician that must be sent to the MSBON (Mississippi Board of Nursing, n.d.). In TN, practicing APRNs can only practice independently in their place as long as a practicing physician represents them. The physician and APRN must have a written practice protocol outlining an acceptable standard of patient care, and a copy must be present at each practice site (Tennessee Board of Nursing, n.d.).

As with all BON, the purpose of regulations is to provide safety for the public and allow nurses to work within their scope of practice to ensure public safety.

 

References

Mississippi Board of Nursing. (n.d.). Advance Practice Registered Nurse. Retrieved

December 27, 2023. 
https://www.msbn.ms.gov/
Links to an external site.

Mississippi Board of Nursing. (n.d.). Advance Practice. Retrieved December 27, 2022

https://www.sos.ms.gov/ACProposed/00022833b.pdf
Links to an external site.

Tennessee Board of Nursing. (n.d.). Rules of the Tennessee Board of Nursing. Retrieved

December 27, 2022. 
https://publications.tnsosfiles.com/rules/1000/1000-04.20190812.pdf
Links to an external site.

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Madeline Reighard

Dec 28, 2022 3:05pm
| 
Last reply Dec 28, 2022 3:34pm

Reply from Madeline Reighard

I will be comparing the regulations for Advanced Practice Registered Nurses (APRNs) in the state of Pennsylvania where I reside and the state of Minnesota. For APRNs in the state of Pennsylvania, 30 hours of continuing education (CE) must be completed every two years for license renewal (Pennsylvania Department of State, n.d.). In Minnesota, CE hours are not needed to renew your APRN license and only 24 hours of CE credits are required within two years to renew your registered nurse (RN) license (Minnesota Board of Nursing, n.d.).

An APRN in Pennsylvania can prescribe and order medications by obtaining approval through collaboration with a physician within their specialty and must complete 45 hours in advanced pharmacology education (Pennsylvania Code, 2022). In comparison, APRNs in Minnesota may prescribe and administer medications independently including controlled substances, but prescribers must complete two hours of CE on best practices for opioid prescribing and alternative treatments for pain (Minnesota Board of Nursing, n.d.).

Both APRNs in Pennsylvania and Minnesota can sign death certificates as well as POLST forms (Wiesen, n.d.). In Minnesota, cause of death can be provided by an APRN; however, in Pennsylvania APRNs cannot report cause of an individual’s death but can only sign the death certificate (Minnesota Board of Nursing, 2020).

In Pennsylvania, APRNS have reduced practice which means that nurse practitioners (NPs) must have a collaborative agreement with a physician to care for patients and to carry out certain orders (American Association of Nurse Practitioners, 2022). Whereas in the state of Minnesota full practice authority (FPA) has been implemented so that Certified Nurse Practitioners (CNP) and Certified Nurse Specialists (CNS) with 2,080 practice hours after the date July 1, 2014, can manage patients independently without a collaborating physician if their previous practice hours were in a collaborative agreement (Minnesota Board of Nursing, n.d.). This significantly effects care as APRNs are trained to independently care for patients and having FPA can improve access to healthcare as well as be more cost effective for patients and hospitals (Bosse et al., 2017).

APRNs who have FPA can manage patient’s medications in their entirety without having to be under a physician contract and research has shown that with the use of APRNs prescribing under their full scope less prescriptions linked to overdose deaths have been given to patients (Bosse et al., 2017). When FPA is in effect across the board this can enable APRNs to sign, and report causes of death without hesitation and in a respectful way for patients’ families and for postmortem care to take place in a timely manner. When APRNs in Pennsylvania, adhere to the CE hours needed for renewal in the coming year they will have to make sure they have obtained 30 hours within two years. Pennsylvania APRNs will also need to have completed their 45 hours of advanced pharmacology along with a collaboration contract with a physician in their practice to prescribe medications for patients.

 

References

American Association of Nurse Practitioners. (2022). Retrieved on December 27, 2022, from https://www.aanp.org/advocacy/state/state-practice-environment

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care
. Nursing Outlook, 65
(6), 761–765.

Minnesota Board of Nursing. (n.d.). Advanced Practice Registered Nurse (APRN) Licensed General Information. Retrieved on December 28, 2022, from https://mn.gov/boards/nursing/advanced-practice/advanced-practice-registered-nurse-(aprn)-licensure-general-information/

Minnesota Board of Nursing. (2020). APRNS and Authority to Pronounce Death and Provide Case of Death. Retrieved December 28, 2022, from https://mn.gov/boards/assets/APRNS_Auth_Pronounce_Death_12-2020_tcm21-37245.pdf

Pennsylvania Code. Title 49. Chapter 21. 49 Pa. Code § 21.283. Authority and qualifications for prescribing, dispensing and ordering drugs.

Pennsylvania Department of State. (n.d.). Retrieved on December 27, 2022, from https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/Certified-Registered-Nurse-Practitioner-Licensure-Requirements-Snapshot.aspx

Wiesen, K. (n.d.). Nurse Practitioner Scope of Practice by State – 2023. Retrieved December 28, 2022, from https://www.nursingprocess.org/nurse-practitioner-scope-of-practice-by-state.html

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Cheryl Athurine Spence

Dec 28, 2022 11:14am
| 
Last reply Jan 1, 2023 4:41pm

Reply from Cheryl Athurine Spence

 

Professional Nursing and State-Level Regulations

Nursing regulations have the fundamental purpose of ensuring that the public is provided with safe nursing care by impacting the quality of nursing education, the relevance of academic programs, and professional practice. Regulations are government oversight measures of professional nursing practice to avoid the risk of harm to the public if they receive nursing care from an incompetent or inexperienced person. Regulations present mechanisms for safeguarding the public including continuing nursing education, competency exams, and seminars to keep up with the ever-changing nursing skills.   The presence of regulations is intended to ensure that the nurses are well-trained, competent, resilient, adaptive, and responsible for population needs (DeNisco, 2021). This paper compares nursing regulations for the State of California and the State of New York.

Practice requirements

Advanced Practice Registered Nurses (APRN) practice in the states of California and New York under the regulations developed by their respective state boards of nursing. In California, APRNs are under the jurisdiction of the California Board of Nursing. To be certified as an APRN, the practitioner must be licensed as a registered nurse in the state and be educated at the graduate level in advanced specialty areas of nurse anesthetist, nurse practitioner, nurse-midwife, clinical nurse specialist, and psychiatric/mental health nurse. APRNs from out of the state must receive a state registered nurse license before being allowed to practice within the state (NursingLicensure.org, 2022a). Like California, the New York Board of Nursing certifies all APRNs seeking to practice in the state, requiring them to hold a state-specific registered nurse license and certification for the specialty after completing a program registered with the New York State Education Department or its equivalent (NursingLicensure.org, 2022b).

Although the APRN practice requirements for the states of California and New York are similar, there are significant differences in prescription authority. In the State of California, APRNs are required to complete a master’s or post-master advanced pharmacology course that meets the state board requirements after which a furnishing number is issued to allow the APRN to have the prescriptive privilege. While the course does not have to be delivered by an institution in California, a nationally accredited program must deliver it. This implies that an APRN would only be eligible for the prescriptive privilege if he/she completes an advanced pharmacology course through an approved program (NursingLicensure.org, 2022a). In contrast, an APRN can enjoy prescriptive privilege in New York State if he/she demonstrates competence in pharmacology. This involves completing a registered nursing program that has pharmacology content. Alternatively, APRNs who do not complete programs with pharmacology content can complete a stand-alone registered program presented as a three-semester course that includes pharmacology content and passes an acceptable pharmacology examination. The pharmacology coursework must follow all the criteria that the New York Board of Nursing requires.  Also, for the   APRN who completes pharmacology coursework within the state of New York, the law requires to complete a complete state-specific legal curriculum delivered by the Nurse Practitioner Association of New York State or the New York State Nurses Association (NursingLicensure.org, 2022b).

Practice Authority

APRNs in New York State have long enjoyed full practice authority. This implies that they are allowed to evaluate patients in terms of diagnosing, ordering, and interpreting diagnostic tests. In addition, APRNs are permitted to initiate and manage treatments including medication and controlled substances prescriptions as authorized by the exclusive licensure authority of the state board of nursing (American Association of Nurse Practitioners, 2022). In contrast, APRNs in California State are subjected to restricted practice authority. The state regulations restrict the ability of APRNs to engage in some elements of practices, requiring that APRNs who seek to provide patient care must be subjected to career-long team management, delegation, or supervision by another health provider (American Association of Nurse Practitioners, 2022).

Still, there have been some changes in the state regulations with the changes expected to take effect on January 1, 2023. The changes allow certified APRNs to practice independently and enjoy full practice authority within the state. Assembly Bill 890 which was signed into law in 2020 by California Governor Gavin Newsom gives certified APRNs a pathway to full-practice authority after going through three years of physician supervision. The regulation clarifies that within three years, APRNs are allowed to practice independently and can consult a physician if needed. After three years of supervised practice, APRNs can gain full practice authority without any restrictions. This regulation implies that the earliest that APRNs in California state can gain full practice authority is in 2026. This will allow APRNs to practice within the complete scope of their license without supervision including performing physical exams, prescribing medication, ordering tests, and diagnosing patients. Besides that, full practice authority would still allow APRNs to collaborate with other health providers but no longer requires other providers to sign off on assessments.  The APRNs will continue to work together with other providers for the best patient outcome.

Conclusion

One must accept that the nursing regulations are developed by state nursing boards and are intended to ensure that the nursing workforce is well-trained, competent, resilient, adaptive, and responsible for population needs. In addition, one must acknowledge that APRNs in the states of California and New York are under the authority of the state board of nursing, educated to the level of APRN, and licensed to practice as APRNs. Besides that, APRNs in California are subjected to restricted practice authority and would begin enjoying full practice authority in 2023, while APRNs in New York enjoy full practice authority.

References

American Association of Nurse Practitioners (2022). 
State Practice Environment
. 
https://www.aanp.org/advocacy/state/state-practice-environment
Links to an external site.

DeNisco, S. M. (2021). 
Advanced Practice Nursing: Essential Knowledge for the Profession
 (4
th
 ed.). Jones & Bartlett Learning, LLC.

Monday, R. (2022, December 7). 
California Expands Nurse Practitioner Practice Authority
. 
https://nursejournal.org/articles/california-expands-nurse-practitioner-practice-authority/
Links to an external site.

NursingLicensure.org (2022a). 
Advanced Practice Nurse Requirements in California
. 
https://www.nursinglicensure.org/np-state/california-nurse-practitioner/
Links to an external site.

NursingLicensure.org (2022b). 
Advanced Practice Nurse Requirements in New York
. 
https://www.nursinglicensure.org/np-state/new-york-nurse-practitioner/
Links to an external site.

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Jestanon Ratunil

Dec 28, 2022 2:14am
| 
Last reply Jan 1, 2023 6:25pm

Reply from Jestanon Ratunil

 

During the COVID-19 pandemic in 2020, the US healthcare system faced an unprecedented challenge in providing healthcare services to its citizens. In response to the urgent need for healthcare providers, state governmental leadership focused on removing barriers for many healthcare professions including Advance Practice Registered Nurses (APRN) (Melander, S., et al 2020).

State Board of Nursing (BON) across the country answered the call during the pandemic. In California, Governor Gavin Newsom signed Assembly Bill 890, Chapter 265 of the CA statutes of 2020 about nurse practitioners (NP) scope of practice. NPs who practiced in licensed healthcare settings as defined in the statute, meet the education requirements, transition to practice experience (3 years full-time equivalent [FTE] or 4,600 hours), and certification requirements are authorized to practice independently under a newly defined scope of practice without standardized procedures and physician supervisions (California Board of Nursing).

However, per the California Board of Registered Nursing, all NPs will meet these provisions outlined in AB 890 on January 1, 2023. It means, California NPs will not be able to see the changes and progress until after January 1, 2023, when NPs and Certified Nurse Midwives included, may be able to practice independently when the above requirements are met. It is funny how this law is being implemented after two years when it is needed the most.

On the other hand, Nevada adopted the Full Practice Authority (FPA) in 2013. Nevada law authorizes NPs to evaluate, diagnose, prescribe medications and provide therapeutic measures and, it saw increased access among patients to healthcare providers especially patients in rural areas (cdc.gov).

I compared Nevada to California for its proximity. While Nevada is also a member of the APRN compact (NCSBN), California is not for several reasons. Nursing interest groups and politicians shaped their argument in favor of FPA around the increasingly insured population because of the Affordable Care Act (ACA), provider shortages, and rural healthcare access (VanBeuge, S.S., & Walker, T. 2014).

NPs have gained a lot recently. Since 2011-2016, 8 states adopted Full Practice Authority (FPA), a twofold increase from the previous 10 years. Institutional challenges do exist. NPs need to educate stakeholders about the value and capacity of their services to address perceptions about parity in payments for similar services by physicians (Phillips S.J., (2021).

 

References:

 

APRN state law and regulation
. ANA. (2017, October 20). Retrieved December 27, 2022, from 
https://www.nursingworld.org/practice-policy/advocacy/state/aprn-state-law-and-regulation/
Links to an external site.

 

How state scope-of-practice policies impact NP care
. NursingCenter. (n.d.). Retrieved December 27, 2022, from 
https://www.nursingcenter.com/journalarticle?Article_ID=5637152
Links to an external site.

 

Susanne J. Phillips is the associate dean of clinical affairs and a practicing family NP at the Sue & Bill Gross School of Nursing. (n.d.). 
33rd annual APRN legislative update: Unprecedented changes…: The nurse practitioner
. LWW. Retrieved December 27, 2022, from 
https://journals.lww.com/tnpj/fulltext/2021/01000/33rd_annual_aprn_legislative_update__unprecedented.6.aspx
Links to an external site.

 

Melander, S., Hardin-Pierce, M., & Howard, P. B. (2020). Meeting the challenges of Expanded Practice Through Postgraduate APRN Certification. 
The Nurse Practitioner
, 
45
(6), 8–10. 
https://doi.org/10.1097/01.npr.0000666212.83911.d3
Links to an external site.

 

T; V. B. S. S. W. (2014, June 26). 
Full Practice Authority–effecting change and improving access to care: The Nevada journey
. Journal of the American Association of Nurse Practitioners. Retrieved December 28, 2022, from 
https://pubmed.ncbi.nlm.nih.gov/24688001/
Links to an external site.

 

 

 

 

 

 

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Sarah E. Tasker

Dec 27, 2022 12:57pm
| 
Last reply Jan 1, 2023 2:10pm

Reply from Sarah E. Tasker

APRN Board of Nursing Regulations

Each state board of nursing regulates specific exclusive licensure authority for their APRNs (American Association of Nurse Practitioners, 2022). While each state board of nursing governs the laws, the state legislature must pass the laws (West Virginia RN Board, 2022b). I have found two differences from state to state: the ability for reduced or restricted practice and the ability to prescribe schedule II narcotics (American Association of Nurse Practitioners, 2022). These differences are shown in West Virginia and Georgia regulations.

West Virginia is a state with reduced practice regulations, and Georgia has restricted practice regulations (American Association of Nurse Practitioners, 2022). Restricted practice guidelines require another health provider to deliver career-long supervision, delegation, or team management (American Association of Nurse Practitioners, 2022). Reduced practice regulations require career-long collaborative agreements with another provider, or it limits the setting of one or more components of nurse practitioner practice (American Association of Nurse Practitioners, 2022). For example, Georgia’s state board of nursing requires a written nurse protocol signed by the nurse and licensed physician. This agreement specifies the delegated medical acts by the physician to the nurse. It provides immediate consultation with that physician or a physician designated in the absence of the delegating physician (Rules and Regulations of the State of Georgia, 2022). However, West Virginia APRNs still need a career-long collaborative agreement with less supervision of periodic evaluation (West Virginia Legislature, 2022). Georgia APRNs must have more direct supervision by a physician, whereas West Virginia APRNs are allowed less physician supervision (West Virginia Legislature, 2022).

Another difference between Georgia and West Virginia APRN laws is the ability to prescribe schedule II narcotics (West Virginia RN Board, 2022a; Rules and Regulations of the State of Georgia, 2022). On May 2, 2022, West Virginia’s governor signed a bill giving APRNs under specific regulations new prescriptive authority for a 3-day supply of schedule II narcotics (West Virginia RN Board, 2022a). These medications include hydromorphone, methadone, oxycodone, fentanyl, morphine, hydrocodone, and codeine (Diversion Control Division, 2022). What stands out most to me is the ability of APRNs to prescribe methadone in an attempt to combat West Virginia’s opioid epidemic. APRNs in Georgia do not have the prescriptive authority to prescribe schedule II drugs (Rules and Regulations of the State of Georgia, 2022). In Georgia, only a physician can prescribe schedule I and II medication when deemed appropriate (Rules and Regulations of the State of Georgia, 2022). These two different laws create a difference in the care APRNs can provide in West Virginia and Georgia.

References

American Association of Nurse Practitioners. (2022). 
State practice environment. 
https://www.aanp.org/advocacy/state/state-practice-environment

Diversion Control Division. (2022). 
Controlled substances schedules. 
https://www.deadiversion.usdoj.gov/schedules/

Rules and Regulations of the State of Georgia. (2022). 
Chapter 410-11 Regulation of advanced 
practice registered nurses.
 https://rules.sos.ga.gov/gac/410

-11

West Virginia Legislature. (2022). 
West Virginia code. 
http://www.wvlegislature.gov/WVCODE/ChapterEntire.cfm?chap=30&art=7&section=

=15B#7

West Virginia RN Board. (2022a). 
Board message regarding APRN prescriptive authority. 
https://wvrnboard.wv.gov/Pages/Board-Message-Regarding

-APRN-Prescriptive-Authority.aspx

West Virginia RN Board. (2022b). 
Law/scope. 
https://wvrnboard.wv.gov/lawandscope/pages/default.aspx#:~:text=The%20laws%20are

%20passed%20by,are%20found%20in%20Chapter%2030

4.
 
Daute is a 56-year-old man seeking evaluation for increasing shortness of
breath. He noticed difficulty catching his breath about 3 years ago. Physical
activity increases his symptoms. He avoids activity as much as possible to
prevent any SOB. His previous physician had placed him on
salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He
thinks his physician initiated the medication for the shortness of breath, but he is
not entirely sure. He did not refill the prescription and has not been taking it.
Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12
months of treatment with oral antibiotics. He has a 40-pack-year smoking history.
What treatment plan would you implement for this patient?
What medication(s)
would you prescribe? How would you monitor the effectiveness of this plan?

GET A HUMAN-WRITTEN PAPER HERE

NURS_6521_Week4_Assignment_Rubric

NURS_6521_Week4_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
Daute is a 56-year-old man seeking evaluation for increasing shortness of
breath. He noticed difficulty catching his breath about 3 years ago

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

Daute is a 56-year-old man seeking evaluation for increasing shortness of
breath. He noticed difficulty catching his breath about 3 years ago

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

Total Points: 
100