NSG 517 Week 3 Discussion Board

Please answer the following questions on discussion board this week. Your initial response should be substantiative.  Please post your initial post by midnight Sunday. Please respond to 2 of your peers by midnight the following Tuesday. Please refer to the rubric for this assignment to be sure you are clear on the assignment expectations Through this discussion board interaction I hope to see how what you have learned so far in this course will impact you professionally in regards to your immediate clinical practice.  I have outlined a suggested model for paragraph organization for this assignment.

Don’t forget to cite your references.

This week we learned about the systems and Integral Theory along with many other theories mentioned in Hamric and Hanson’s readings for this week. According to NSG 517 Week 3 Discussion Board concepts you read about- Growth mindset/Fixed mindset, culturally competent care, individualized care, patient autonomy, advanced practice coaching and guidance skills, ethical autonomy, diverse approaches to individualized care, boundary and somatic awareness….There are so many options for you to choose from to highlight in your DB post for this week.

After reviewing the materials for this week, choose the one that resonated with you the most. Please answer the following:

• First Paragraph: What is the significance of your chosen topic in the field of advanced practice nursing? Why did you choose this topic? How does it tie in with one of the theories your learned about this week? Which NONPF competency do you feel the topic you chose supports and briefly explain why.
• Second Paragraph: Do some self reflection and think about characteristics and attributes that you already possess that would support any of the 6 characteristics of direct APN care.  Identify the characteristics and attributes that you would like to strengthen.
• Third Paragraph: How will what you have learned this week impact your personal and professional work?

Discussion Board #3

The significance of individualized care in the field of advanced practice nursing is knowing that not all patients are the same. according to NSG 517 Week 3, Discussion Board what works for some patients may not be the best option for another. I chose this topic because in the ER right now we are becoming overwhelmed with patients requiring a mental health evaluation. Unfortunately, the small critical access hospital I work at is going through a change in hospital security. We have no sheriffs or security most days and never 11 pm to 7 am.

as stated NSG 517 Week 3 Discussion Board it is the mentality of some of the nurses I work with to “pick our battles” as to not anger a patient to the point where security is needed. In the same breath, we are also obligated to follow the policies set out by the hospital requiring safety paper scrubs, handing over electronic devices, etc. I believe that this situation directly ties in with an individualized care plan. Many times, we see a generic care plan written by a social worker, and the care plan may not be appropriate for all patients.

According to some of the patients we encounter are violent, some are children under 10 years old. What applies to a violent patient in the ER, rarely applies to a child in the ER. As stated in our text “one goal of treatment decision making is to choose from among several possible interventions and to use the on that will have the highest probability of achieving the outcomes the patient most desires” (Tracy & O’Grady 2019). It is our job as providers to “tailor care to the unique characteristics of the person and his or her situation (Tracy & O’Grady, 2019).

I feel that the NONPF competency discussed in this situation relates to that of Quality. It is important that our quality of care is based on the most up to date evidence. We want to ensure safety of all of patients.

When it comes to scientific foundations, I would say that I am more than willing to admit my short comings and find better evidence and data to support a decision. As far as leadership goes, I feel as though I can step up in some rough situations and many of my peers admire me for that. I am a charge RN at night in the ER when I work and enjoy that role, but also know when to ask for help. as stated in NSG 517 Week 3 Discussion Board in the area of quality, it is all about how I effect patient care. It is my job to make sure they are safe and being taken care of properly.

Practice Inquiry is an area that I am still working on. I have been a RN now for 4 years and am still learning being confident with presentations of my findings. I do, however, gain my knowledge from previous experiences. In the technology field, I like to think that we already know how to be nurses, it is learning the various computer systems at hospitals that can become overwhelming. according to NSG 517 Week 3 Discussion BoardTailoring conversations to a patient’s literary level, is something we do daily in the ER. We communicate with patients and families in various situations, and I like to think we do it well.

I just recently became involved in helping our administration re-write policies. Some of the policies set fourth by the hospital no longer apply or need re-working to fit today’s scenarios. In the are of ethics, it is our job to make the best decisions possible for our patients. Our healthcare delivery is that we are always discussing ways to do things better. We utilize our resources and can have patients care transferred effectively if needed.

What I have learned this week will allow me different ways to look at situations. Although I agree with the individualized care planning, it may not be as easy as it appears. I can utilize what I learned in the coaching section of our text to investigate “different approaches, philosophies, techniques and disciplines” (Tracy, & O’Grady, 2019) for caring for our population. Using the theory of well-being, it allows me to visualize each step of positive psychology when dealing with patient in mental crisis.

References:

Tracy, M. F., OGrady, E. T., Hamric, A. B., & Hanson, C. M. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier.

I thought your focus on individualized care is certainly an important one in today’s healthcare. I touched upon the same thing in my discussion post this week, but my focus was a little more geared to coaching as it applies to individualized care. I agree that individualized care can certainly be viewed as a component of overall quality of care, and therefore fits into the quality category of the NONPF competencies. According to Thomas et al. (2012), the advanced practice nurse achieves this competency as he/she “evaluates how organizational structure, care processes, financing, marketing, and policy decisions impact the quality of care” (p. 2). In your case, you have determined that applying one general and nonspecific care plan to both violent patients and children with psychiatric issues is inappropriate, and ultimately impacts the quality of care delivered. According to the competency put forth by Thomas et al. (2012), when practicing as an advanced practice nurse, it would be our job to then take this a step further and be “proactive in implementing interventions to ensure quality” (p. 2). For instance, we may need to step in and meet with social work to discuss our concerns and advocate for more individualized plans of care for this vulnerable patient population.

I think another competency met by providing individualized care plans for patients is that of independent practice. According to Thomas et al. (2012), the independent practice competency focuses not only on the practitioner’s ability to diagnose and treat patients as an independent provider, but also puts a heavy focus on patient-centered care. Although this competency specifies including the patient as a “full partner in decision making” (Thomas et al, 2012, p. 5), we know this cannot always be possible with psychiatric patients who may lack capacity. However, I think we can still do our best to fulfill this effort at patient centered care by actively involving the patient whenever possible and tailoring plans for the best possible outcome, as you have mentioned.

Lastly, I would be remiss if I did not touch upon the safety situation you have mentioned with your current position. I can’t imagine what you are dealing with in your emergency room without proper security in place. We often utilize outside companies for more dangerous patients because our security cannot sit with every patient that becomes threatening or assaults a staff member. Although it is not often that we don’t have an immediate presence at the bedside for these patients, I have certainly also been in similarly frightening situations. My heart goes out to you dealing with that situation on the regular at present. I pray that you and your coworkers are kept safe, and keep advocating for what you need to remain that way. No one should be made to feel unsafe at work.

Thanks for your post, and stay safe!

References

Thomas, A. C., Crabtree, M. K., Delaney, K. R., Dumas, M. A., Kleinpell, R. Logsdon, M. C. … Nativio, D. G. (2012). Nurse practitioner core competencies. The National Organization of Nurse Practitioner Faculties. Retrieved from Rivier University Canvas course page.