Advanced Practice Nurse Assignment Papers.

Advanced Practice Nurse Assignment Papers.

Advanced Practice Nurse Assignment Papers.

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Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses.Advanced Practice Nurse Assignment Papers.

Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system.Advanced Practice Nurse Assignment Papers. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours.Advanced Practice Nurse Assignment Papers.

According to Antonelli (2017), ‘self-assessment of knowledge and accuracy of skill performance is essential to the practice of healthcare and self-directed life-long learning’. The emphasis on life-long learning is important. Sullivan and Hall (2017) suggest that a self-assessment can promote reflection on personal performance as well as to identify reasons for discrepancies between scores of assessors and assesse. Self-assessment is ‘the act of judging ourselves and making decisions about the next step.’(Boud.,2015). An important principle is that assessment must be followed by action.Advanced Practice Nurse Assignment Papers.

The three strengths that I possess include; ability to complete accurately and thoroughly any physical exam that encompasses the patients using appropriate techniques as provisioned for in the diagnosis chart. I am also able to effectively communicate verbally as well as establish interpersonal communication with the patients and other staff within the healthcare facility, which is crucial in establishing a collaborative working relationship and a calm environment in which the patients can feel comfortable to articulate what they might be experiencing. The third strength is that I am a strong believer in patient education. All these three strengths complement each other and play a crucial role in ensuring that I am effective in patient handling as well as establishing close relationship with them. For example, the ability to carry out thorough and accurate physical exams and diagnosis on patients ensures that I am able to focus on the patient symptoms with more ease as well as effectively diagnose their condition. The effective verbal communication as well as interpersonal communication helps ensure that I can create a comfortable environment through which the patients can be able to narrate their medical history thus gives me an opportunity to effectively analyze their condition. The provision of patient education about the patient medication or examination helps ensures they gain autonomy and self-empowerment to control and manage their condition.Advanced Practice Nurse Assignment Papers.

The three weaknesses that I have include; the lack of an understanding of the state’s nursing practice act, inability to add all differential patient diagnosis in my the patient assessment although I might carry out accurate assessments, as well as the need to improve on the use of medical literature and thus be able to plan treatment appropriately. I am currently working on gaining a better understanding of the nursing legal compliance within the state as well as ensuring that each day I undertake patient assessments and fill in the differential diagnosis to ensure that the assessments are not only accurate but also comprehensive (Schober, 2016). I am currently working on improving my understanding of medical literature as well as taking time to research and understand more on the pathology of diseases and their treatment plans.Advanced Practice Nurse Assignment Papers.

The clinical skills that I intent to acquire before exiting the program include; cultural competency skills, critical thinking skills as well as decision making skills, all which will help ensure that I am able to expedite my duties as a nurse better. The acquisition of the cultural competency skills will help ensure that I am able to not only communicate but also understand information from patients drawn from diverse backgrounds (Buppert, 2015). This will be achieved by ensuring that I spend time with colleagues drawn from different backgrounds as well as read widely on the various cultures and their practices. The critical thinking and decision-making skills will be honed through active practice, in which I will ensure that in every engagement I am involved try to critically think before making the decision as well as evaluating the various scenarios and circumstances at hand before making the final decision.Advanced Practice Nurse Assignment Papers.

Advanced practice nurses have evolved widely through the years as technology has become integrated into the nursing profession, with the intent of realizing new cost-effective methods of delivering care as well as increasing the ratio of practitioners to patients. The advanced practice nurses are expected to not only obtain health histories of the patients but also perform comprehensive examinations on the patients, develop differential diagnostics, evaluate the response of the patients to treatment as well as engage in research studies (Schober, 2016). As an advanced practice nurse, I will play a crucial role developing therapeutic plan of care, provide patient education and counseling as well as participate in research studies aimed at improving the nature of care that is available for the patients.Advanced Practice Nurse Assignment Papers.

This power point will discuss highlights of our clinical courses and will provide a quick access guide , with classroom requirements and reminders. Nurse Practitioner (NP) student clinical orientation.Advanced Practice Nurse Assignment Papers.

Dr. Jennifer Stone – Clinical Supervisor, jennifer.stone2@mail.waldenu.edu

Dr. Tara Harris – PT Clinical Supervisor, tara.harris4@mail.waldenu.edu

Welcome to NP Program

Dr. Linda Steele – NP Program Director

Dr. Timothy Legg – PMHNP Coordinator

Dr. Salma Hernandez – AGACNP & AGPCNP Coordinator

Dr. Phyllis Morgan – FNP Coordinator

Dr. Stefanie Gatica – FNP Coordinator

Dr. Jennifer Stone – Clinical Supervisor

Dr. Tara Harris – Clinical Supervisor

NP Full time faculty

Dr. Rachel Carlton

Dr. Eva Hvingelby

Dr. Mahaman Moussa

Dr. Erica Sciarra

Dr. Jeani Thomas

Dr. Cindy Trent

Dr. Gretchen Zunkel

Chain of Command
and
Course Coordinator Support

Any questions or concerns about your clinical course:

First point of contact is the Clinical faculty

Didactic faculty – clinical faculty will contact if help is needed.

Lead faculty – didactic faculty will contact if help is needed.

Course coordinator – lead faculty will contact if help is needed

Clinical Supervisors – faculty will contact for specific clinical issues or questions

Course Coordinators

Timothy Legg – 6512, 6630, 6640

Salma Hernandez – 6501, 6540, 6550, 6560

Phyllis Morgan – 6521, 6551, 6565

Stefanie Gatica – 6531, 6541

Student resources

Student Assistance Program – Students, and anyone in their households, who want to use this service or are referred for assistance should be encouraged to call 1-866-465-8942 (TDD: 1-800-697-0353) or visit http://inside.WaldenU.edu/sap for more information. When students request services from the program, they will be asked for a Walden ID. That ID is SAP4EDU. Nurse Practitioner (NP) student clinical orientation..Advanced Practice Nurse Assignment Papers.

Writing Center – http://academicguides.waldenu.edu/writingcenter/home

Walden library – http://academicguides.waldenu.edu/library

Technical support – 800-925-3368

PRE-CLINICAL INFORMATION

Students are to create a schedule for clinical hours that the student and preceptor have agreed upon and email it to your clinical faculty

Please save it in a calendar format and include your contact information as well as preceptor’s contact information on the schedule

Save the file name and “clinical schedule”

You must email the schedule to Clinical Faculty

Clinical faculty will call or email student and preceptor to set up a minimum of 1 phone conference and 2 email contacts during the quarter

PRECLINICAL INFORMATION FOR STUDENTS

You should reflect and prepare learning goals and objectives for the course

Review the course objectives

Review SOAP notes article. Nurse Practitioner (NP) student clinical orientation.

Review the preceptor evaluation of student

Review the Competencies for your specialty (AGACNP, AGPCNP, FNP, PMHNP) by visiting the following sites:

Core Competencies for nurse practitioners http://nonpf.com/associations/10789/files/NPCoreCompetenciesFinal2012.pdf

AGPCNP Competencies http://nonpf.com/associations/10789/files/Adult-GeroPCComps2010.pdf

FNP Competencies http://www.nonpf.org/associations/10789/files/PopulationFocusNPComps2013.pdf

AGACNP Competencies http://www.aacn.nche.edu/geriatric-nursing/Adult-Gero-ACNP-Competencies.pdf

PMHNP Competencies: http://www.aacn.nche.edu/education-resources/PopulationFocusNPComps2013.pdf

CLINICAL ATTIRE

STUDENTS MUST WEAR APPROPRIATE ATTIRE

Name Tag

Instructions for making your name tag

Students go to myWalden Portal

Welcome Center tab

Get Prepared tab

Scroll to bottom of page #7

Print ID badge

If your clinical site requires a photo ID, please add a passport photo (scan your photo with name tag)

Resources STUDENTS should take to CLINICAL

Practice guidelines for your specialty program: FNP, AGACNP, AGPCNP, and PMHNP

Ask preceptor if acceptable to use smartphones, etc. while in the setting

Pharmacology applications on your smartphone or iPad, etc.

Ask preceptor what resources they use most often

STUDENT Expectations

Print the Syllabus for the Course and hand deliver to your preceptor and review the objectives for the course. Nurse Practitioner (NP) student clinical orientation.

Students should see the minimum number of patients outlined in this presentation.

Generally you should:

Ask the patient if they mind if you see them in combination with your preceptor

Perform your assessment: Subjective, Objective Data

Make a list of differential diagnoses

Form a tentative plan of care – look for teaching opportunities – look for evidence to back your plan

Consult with your preceptor and revise your assessment, diagnoses and plan

STUDENTS First Day

Students should be oriented to the clinical site by preceptor or office personnel for a maximum of 8 hours

The lay out of the office

Office procedures

Lunch

Restroom locations

Other

Orientation/observation to the site

**NEW **Requirements for patient encounters per course

Consensus of patient numbers by course. These are MINIMUM numbers of patients:

NURS 6531 – 144 patients in 144 hours

NURS 6540 – 100 patients in 144 hours

NURS 6541 – 144 patients in 144 hours

NURS 6550 – 75 patients in 144 hours

NURS 6551 – 100 GYN patients; 25 OB patients in 144 required hours

NURS 6560 – 75 patients in 144 hours

NURS 6565 – 144 patients in 144 hours

PMHNP Courses: NURS 6640, NURS 6650, NURS 6660, NURS 6670:

“Students in the PMHNP program will need to complete 144 hours of practicum in EACH of the four practicum courses. It is acknowledged that a variety of factors will influence the number of clients seen, but students should strive to see as many clients possible each clinical day.”Advanced Practice Nurse Assignment Papers.

*A minimum of 144 clinical hours are required in each practicum course. More hours can be completed but cannot transfer to another clinical course.

Meditrek

Students are to upload their information on the time log and patients log every 48 hours.

Midterm and final evals by preceptor need to be completed in Meditrek.

Midterm eval should be completed prior to midterm conference call, then reviewed.

Didactic faculty are responsible to ensure ALL clinical students have their time logs signed and final evals completed prior to entering final grade. Nurse Practitioner (NP) student clinical orientation.

Meditrek Contact Information

If the preceptor does not receive an email with login information, the student or the preceptor should email the preceptor’s name and email, along with the student’s name and Walden ID number to SONPreceptor@waldenu.edu and the login information will be sent to the preceptor directly.Advanced Practice Nurse Assignment Papers.

How do STUDENTS document patient encounters at clinical site?

This will be up to the preceptor and clinical faculty

It is a good idea to learn from each site as many have electronic medical records

The preceptor may want you to hand write your SOAP note

Documenting Clinical Experiences for the Course

To prepare for this course’s Practicum Experience, address the following in Practicum Journal (AGPCNP and FNP students ONLY):

Select and describe a nursing theory to guide your practice.

Develop goals and objectives for your Practicum Experience in this course. When developing r goals and objectives, students are to be sure to keep the competency domains of practice in mind.

Create a timeline of practicum activities based on your practicum requirements.

Documenting Clinical Experiences for the Course

All patients must be entered on the NP Patient Log within 48 hours of each clinic day.

All clinic hours must be entered on the Time log within 48 hours of each clinic day.

Clinical faculty will review all NP patient logs and Time logs periodically throughout the course. Students are to keep them up-to-date at all times. Nurse Practitioner (NP) student clinical orientation.Advanced Practice Nurse Assignment Papers.

Weekly Journal Entries are required but only submitted Weeks 3, 7 and 10 (or as directed in clinical course).

Grading CLINICAL JOURNALS and Time Logs

Midterm and Final Evaluations

All students are required to have their preceptor complete a midterm and final evaluation in order to pass the course

Midterm evaluation is done through Meditrek and should be completed by the preceptor during weeks 4-6; the preceptor will receive login credentials to Meditrek beginning in week 3.Advanced Practice Nurse Assignment Papers.

Students must have a satisfactory final evaluation by preceptor in Meditrek by end of week 10.

All students are required to have their preceptor and practicum site evaluation in Meditrek by end of week 10.

What happens if…

Student or preceptor is ill or has an emergency

Students are to notify their clinical faculty and make plans to obtain the missed hours

If student is ill, please make sure you notify your preceptor

If student and/or preceptor terminate the agreement

Students are to notify clinical faculty immediately and be proactive in securing another preceptor

Clinical Failure

Behaviors constituting clinical failure include, however are not limited to, the following:

Demonstration of unsafe performance and/or decision-making skills. Nurse Practitioner (NP) student clinical orientation.

Failure to complete clinically related class assignments and/or clinical log.

Failure to complete the required clinical hours and patients numbers

Falsification of clinical hours, records, or documentation.

Failure to complete clinical hours with approved preceptor. All preceptors must be approved or clinical hours will not count.Advanced Practice Nurse Assignment Papers.

Students Must Remember…

Students are a guest in the clinical setting and should act politely at all times

Students are not make personal phone calls. Turn your phones on vibrate and take calls only during breaks

Always thank the patient and preceptor and office staff

Be active in the learning process

You are there to learn to be a health care provider. You are not a nurse in the clinic.

It is ok to be wrong. We expect that as part of the learning process.

Ask questions!

IF YOU DON’T KNOW…

Ask preceptor

Ask clinical faculty

Ask didactic faculty

We all want students to learn and be successful

Nurse Practitioner (NP) student clinical orientation.

Specialty Coordinators

Dr. Salma Hernandez AGACNP and AGPCNP salma.hernandez@mail. waldenu.edu

Dr. Phyllis Morgan FNP phyllis.morgan@mail.waldenu.edu

Dr. Stefanie Gatica FNP stefanie.gatica@mail.waldenu.edu

Dr. Timothy Legg Coordinator PMHNP timothy.legg@mail.waldenu.edu

Clinical Supervisors

Dr. Jennifer Stone – Full time Clinical Supervisor for FNP, AGACNP, AGPCNP, PMHNP

jennifer.stone2@mail.waldenu.edu

Dr. Tara Harris – Part time Clinical Supervisor for FNP, AGACNP, AGPCNP, PMHNP

tara.harris4@mail.waldenu.edu

Field Office Contacts

Preceptors – sonpreceptor@mail.waldenu.edu

Field Sites for Affiliation Agreements – sonaffiliation@mail.waldenu.edu

Students – nursefieldtraining@mailwaldenu.edu

Onboarding Questions – sononboarding@mail.waldenu.edu

THANK YOU!

MUCH SUCCESS!

Nurse Practitioner (NP) student clinical orientation.

During NP clinical practicum experiences, we identify, as nurses, many health care issues that need to be addressed at the local, state, or national level. Addressing the need for change in health care policy is now an intricate part of your role as a social change agent.
For this Discussion, you will identify a change needed in your community and what your nursing legacy for positive social change will be.Advanced Practice Nurse Assignment Papers.
To prepare:
Consider the health care issues and deficits you have recognized in your professional practice.
Identify a change needed in your community in health care policy and discuss how you could impart change during your career as an NP.
Consider your future as a NP and what your nursing legacy will be. How will you impart Social Change?
By Day 3
Post a change needed in your community and an explanation for how you will begin to implement that change. Then, share with your colleagues a brief explanation of what your nursing legacy will be and how will you impart Social Change.Advanced Practice Nurse Assignment Papers.

Enrollment is open for our new accelerated summer nursing transfer program, designed for students who have already completed 70-80 course credits. Qualified applicants may reduce up to a year off of graduation time, and competitive scholarships are available to qualifying transfers!

Call our admissions team at 414-382-610 or email a copy of your transcripts to our admissions department.

Apply by May 14 for your chance to fast track your future.

Alverno guarantees clinical placements and features an on-campus, state-of-the-art Clinical Learning Center and Clinical Simulation Center to mimic real-life health care environments. And our ability-based curriculum will equip you with the career-readiness skills you need to become a leader in today’s rapidly changing health care field.Advanced Practice Nurse Assignment Papers.

Here at CHLA, we believe every child deserves to enjoy all those special moments that childhood has to offer, free from pain and suffering. This is what inspires our staff to be their best—and they’re equipped with everything they need to succeed. If you want to help create more special moments for children where you’re empowered to deliver the highest quality of care, this is the place to do it.Advanced Practice Nurse Assignment Papers.

Founded in 1901, Children’s Hospital Los Angeles is one of the nation’s leading children’s hospitals and is acknowledged worldwide for its leadership in pediatric and adolescent health. Children’s Hospital Los Angeles is one of only 10 children’s hospitals in the nation—and the only children’s hospital on the West Coast—ranked in all 10 pediatric specialties by U.S. News & World Report and named to the magazine’s Honor Roll of children’s hospitals.

Children’s Hospital Los Angeles is a premier teaching hospital and has been affiliated with the Keck School of Medicine of the University of Southern California since 1932.Advanced Practice Nurse Assignment Papers.

Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours.Advanced Practice Nurse Assignment Papers.

According to Antonelli (2017), ‘self-assessment of knowledge and accuracy of skill performance is essential to the practice of healthcare and self-directed life-long learning’. The emphasis on life-long learning is important. Sullivan and Hall (2017) suggest that a self-assessment can promote reflection on personal performance as well as to identify reasons for discrepancies between scores of assessors and assesse. Self-assessment is ‘the act of judging ourselves and making decisions about the next step.’(Boud.,2015). An important principle is that assessment must be followed by action.Advanced Practice Nurse Assignment Papers.

The three strengths that I possess include; ability to complete accurately and thoroughly any physical exam that encompasses the patients using appropriate techniques as provisioned for in the diagnosis chart. I am also able to effectively communicate verbally as well as establish interpersonal communication with the patients and other staff within the healthcare facility, which is crucial in establishing a collaborative working relationship and a calm environment in which the patients can feel comfortable to articulate what they might be experiencing. Advanced Practice Nurse Assignment Papers. The third strength is that I am a strong believer in patient education. All these three strengths complement each other and play a crucial role in ensuring that I am effective in patient handling as well as establishing close relationship with them. For example, the ability to carry out thorough and accurate physical exams and diagnosis on patients ensures that I am able to focus on the patient symptoms with more ease as well as effectively diagnose their condition. The effective verbal communication as well as interpersonal communication helps ensure that I can create a comfortable environment through which the patients can be able to narrate their medical history thus gives me an opportunity to effectively analyze their condition. The provision of patient education about the patient medication or examination helps ensures they gain autonomy and self-empowerment to control and manage their condition.Advanced Practice Nurse Assignment Papers.

The three weaknesses that I have include; the lack of an understanding of the state’s nursing practice act, inability to add all differential patient diagnosis in my the patient assessment although I might carry out accurate assessments, as well as the need to improve on the use of medical literature and thus be able to plan treatment appropriately.Advanced Practice Nurse Assignment Papers. I am currently working on gaining a better understanding of the nursing legal compliance within the state as well as ensuring that each day I undertake patient assessments and fill in the differential diagnosis to ensure that the assessments are not only accurate but also comprehensive (Schober, 2016). I am currently working on improving my understanding of medical literature as well as taking time to research and understand more on the pathology of diseases and their treatment plans.Advanced Practice Nurse Assignment Papers.

The clinical skills that I intent to acquire before exiting the program include; cultural competency skills, critical thinking skills as well as decision making skills, all which will help ensure that I am able to expedite my duties as a nurse better.Advanced Practice Nurse Assignment Papers. The acquisition of the cultural competency skills will help ensure that I am able to not only communicate but also understand information from patients drawn from diverse backgrounds (Buppert, 2015). This will be achieved by ensuring that I spend time with colleagues drawn from different backgrounds as well as read widely on the various cultures and their practices. The critical thinking and decision-making skills will be honed through active practice, in which I will ensure that in every engagement I am involved try to critically think before making the decision as well as evaluating the various scenarios and circumstances at hand before making the final decision.Advanced Practice Nurse Assignment Papers.

Advanced practice nurses have evolved widely through the years as technology has become integrated into the nursing profession, with the intent of realizing new cost-effective methods of delivering care as well as increasing the ratio of practitioners to patients.Advanced Practice Nurse Assignment Papers. The advanced practice nurses are expected to not only obtain health histories of the patients but also perform comprehensive examinations on the patients, develop differential diagnostics, evaluate the response of the patients to treatment as well as engage in research studies (Schober, 2016). As an advanced practice nurse, I will play a crucial role developing therapeutic plan of care, provide patient education and counseling as well as participate in research studies aimed at improving the nature of care that is available for the patients.Advanced Practice Nurse Assignment Papers.

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers

Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Advanced Practice Nurse Assignment Papers. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours.Advanced Practice Nurse Assignment Papers.

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NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Course Readings

Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long?” OJIN: The Online Journal of Issues in Nursing, 19(1).Advanced Practice Nurse Assignment Papers.

Christensen, C. M., Bohmer, R. M. J., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102-112, 199.

Ford, L. C.. & Gardenier, D. (2015). Fasten your seat belts – it’s going to be a bumpy ride. The Journal for Nurse Practitioners, 11(6), 575-577.

Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Hayes, E., Chandler, G., Merriam, D., & King, M. C. (2002). The master’s portfolio: Validating a career in advanced practice nursing. Journal of the American Academy of Nurse Practitioners, 14(3), 119.

Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners -risks and rewards. New England Journal of Medicine, 368(20), 1935-1941.

Jordan, L. M., Quraishi, J. A., & Liao, J. (2013). The national practitioner data bank and CRNA anesthesia-related malpractice payments. American Association of Nurse Anesthetists Journal, 81(3), 178-182.

Kooienga, S.A. & Carryer, J.B. (2015). Globalization and advancing primary care health care nurse practitioner practice. The Journal for Nurse Practitioners, 11(8), 804–811.

Miller, K. P. (2013). The national practitioner data bank: An annual update. The Journal for Nurse Practitioners, 9(9), 576-580.

O’Connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: Using a capability framework in developing practice standards for advanced practice nursing. Journal of Advanced Nursing, 70(12), 2728-2735.

Reinisch, C. E. (2014). Loretta Ford: Envisioning the future. Clinical Scholars Review, 7(1), 82-84.

Rhodes, C. A., Bechtle, M., & McNett, M. (2015). An incentive plan for advanced practice registered nurses: Impact on provider and organizational outcomes. Nursing Economics, 33(3), 125-131.

Silver, H. K,. Ford, L. C., & Day, L. R. (1968). The pediatric nurse-practitioner program: Expanding the role of the nurse to provide increased health care for children. JAMA, 204(4), 298-302.

Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . . Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500.

Stelmach, E. I. (2015). Dismissal of the noncompliant patient: Is this what we have come to? The Journal for Nurse Practitioners, 11(7), 723-725.

Watson, E. (2014). Nursing malpractice: Costs, trends and issues. Journal of Legal Nurse Consulting, 25(1), 26-31.

Weber, S. (2006). Developing nurse practitioner student portfolios. Journal of the American Academy of Nurse Practitioners, 18(7), 301-302.

Westrick, Susan J., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics. The Journal for Nurse Practitioners, 12(2), 120-126.

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers

NURS 6565 Week 2 Discussion: Ethical Challenges in Health Care for Practicing NPs

Consider the following case study:

Mrs. ABC is a 35 year old woman who has a scheduled business trip today. It is currently 8 am, and her plan is to leave at 6 pm. Mrs. ABC has a sore throat and she thinks it is strep because her 5 year old daughter was recently treated for strep. Mrs. ABC calls her physician for an appointment, but there are no appointments available until next week. Advanced Practice Nurse Assignment Papers. She has a mother who is a nurse practitioner and her office is 5 minutes away from where she lives. She calls and schedules an appointment with her mother. Her mother was surprised to see her daughter at the office. Mrs. ABC is frantic and begs her mother for an antibiotic. Her mother tests her and the rapid strep test is negative in office. Her mother (NP) sends out a strep DNA probe. Her mother prescribes an antibiotic and the patient (her daughter) is very satisfied. The results returned for the DNA probe 48 hours later and it confirmed negative for strep. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

By Day 3 OF NURS 6565 Week 2 Discussion
Post an explanation of whether NPs should treat family members. What are the ethical dilemmas in this situation? What are the laws in your state for NPs treating themselves, family, or friends? NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.

****I live in Texas**** but you can choose any state in the US

NURS 6565 Week 2 Discussion Resources
http://midlevelu.com/blog/should-providers-treat-their-friends-and-family

http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx

NURS 6565 Week 2 Discussion
CHAPTER CONTENTS Characteristics of Ethical Dilemmas in Nursing, 328
Communication Problems, 329 Interdisciplinary Conflict, 329 Multiple Commitments, 330

Ethical Issues Affecting Advanced Practice Nurses, 330

Primary Care Issues, 330 Acute and Chronic Care, 330 Societal Issues, 331 Access to Resources and Issues of Justice, 332 Legal Issues, 333

Changes in interprofessional roles, advances in medical technology, privacy issues, revisions in patient care delivery systems, and heightened economic constraints have increased the complexity of ethical issues in the health care setting.Advanced Practice Nurse Assignment Papers. Nurses in all areas of health care routinely encounter disturbing moral issues, yet the success with which these dilemmas are resolved varies significantly. Because nurses have a unique relationship with the patient and family, the moral position of nursing in the health care arena is distinct. As the complexity of issues intensifies, the role of the advanced practice nurse (APN) becomes particularly important in the identification, deliberation, and resolution of complicated and difficult moral problems. Although all nurses are moral agents, APNs are expected to be leaders in rec- ognizing and resolving moral problems, creating ethical practice environments, and promoting social justice in the larger health care system. It is a basic tenet of the central definition of advanced practice nursing (see Chapter 3) that skill in ethical decision making is one of the core competencies of all APNs. In addition, the Doctor of Nursing Practice {DNP) essential competencies emphasize leadership in developing and evaluating strate- gies to manage ethical dilemmas in patient care and organizational arenas (American Association of Colleges of Nursing [AACN], 2006). This chapter explores the distinctive ethical decision-making competency of advanced practice nursing, the process of developing and evaluating this competency, and barriers to ethical prac- tice that APNs can expect to confront. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.

328

Ethical Decision Making

Ann B. Hamric • Sarah A. Delgado

Ethical Decision Making Competency of Advanced Practice Nurses, 333

Phases of Core Competency Development, 333 Evaluation of the Ethical Decision Making Competency, 349 Barriers to Ethical Practice and Potential Solutions, 350

Barriers Internal to the Advanced Practice Nurse, 350 lnterprofessional Barriers, 351 Patient-Provider Barriers, 351 Organizational and Environmental Barriers, 352

Conclusion, 354

Characteristics of Ethical Dilemmas

lll~l\12:’:1’Si~ ~~·-· ~ -······· …. ···~ ·-· In this chapter, the terms ethics and morality or morals are used interchangeably (see Beauchamp & Childress, 2009, for a discussion of the distinctions between these terms).Advanced Practice Nurse Assignment Papers. A problem becomes an ethical or moral problem when issues of core values or fundamental obligations are present. An ethical or moral dilemma occurs when obliga- tions require or appear to require that a person adopt two (or more) alternative actions, but the person cannot carry out all the required alternatives. The agent experiences tension because the moral obligations resulting from the dilemma create differing and opposing demands (Beauchamp & Childress, 2009; Purtilo & Doherty, 2011). In some moral dilemmas, the agent must choose between equally unacceptable alternatives; that is, both may have elements that are morally unsatisfactory. For example, based on her evaluation, a family nurse practitioner (FNP) may suspect that a patient is a victim of domestic violence, although the patient denies it.Advanced Practice Nurse Assignment Papers. The FNP is faced with two options that are both ethically troubling-connect the patient with existing social services, possibly straining the family and jeopardizing the FNP-patient relationship, or avoid intervention and potentially allow the violence to continue. As described by Silva and Ludwick (2002), hon- oring the FNP’s desire to prevent harm (the principle of beneficence) justifies reporting the suspicion, whereas respect for the patient’s autonomy justifies the opposite course of action. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.

Jameton (1984, 1993) has distinguished two additional types of moral problems from the classic moral dilemma, which he termed moral uncertainty and moral distress. In situations of moral uncertainty, the nurse experiences unease and questions the right course of action. In moral distress, nurses believe that they know the ethically appro- priate action but feel constrained from carrying out that action because of institutional obstacles (e.g., lack of time or supervisory support, physician power, institutional policies, legal constraints). Advanced Practice Nurse Assignment Papers. Noting that nurses and others often take varied actions in response to moral distress, Varcoe and colleagues (2012) have proposed a revision to Jameton’s definition: “moral distress is the experience of being seriously compromised as a moral agent in prac- ticing in accordance with accepted professional values and standards. It is a relational experience shaped by multiple contexts, including the socio-political and cul- tural context of the workplace environment” (p. 60). The phenomenon of moral distress has received increasing national and international attention in nursing and medical literature. Studies have reported that moral dis- tress is significantly related to unit-level ethical climate and to health care professionals’ decisions to leave clinical practice (Corley, Minick, Elswick, et al., 2005; Epstein & Hamric, 2009; Hamric, Borchers, & Epstein, 2012; Hamric, Davis, & Childress, 2006; Pauly, Varcoe, Storch, et al., 2009; Schluter, Winch, Hozhauser, et al., 2008; Varcoe, Pauly, Webster, & Storch, 2012). APNs work to decrease the incidence of moral uncertainty and moral distress for themselves and their colleagues through edu- cation, empowerment, and problem solving. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.

Although the scope and nature of moral problems experienced by nurses and, more specifically APNs, reflect the varied clinical settings in which they practice, three general themes emerge when ethical issues in nursing practice are examined. These are problems with commu- nication, the presence of interdisciplinary conflict, and nurses’ difficulties with managing multiple commitments and obligations.Advanced Practice Nurse Assignment Papers.

Communication Problems

The first theme encountered in many ethical dilemmas is the erosion of open and honest communication. Clear communication is an essential prerequisite for informed and responsible decision making. Some ethical disputes reflect inadequate communication rather than a difference in values (Hamric & Blackball, 2007; Ulrich, 2012). The APN’s communication skills are applied in several arenas. Within the health care team, discussions are most effective when members are accountable for presenting informa- tion in a precise and succinct manner. In patient encoun- ters, disagreements between the patient and a family

C HAP T E R 13 Ethical Decision Making

member or within the family can be rooted in faulty com- munication, which then leads to ethical conflict. The skill of listening is just as crucial in effective communication as having proficient verbal skills. Listening involves recog- nizing and appreciating various perspectives and showing respect to individuals with differing ideas. To listen well is to allow others the necessary time to form and present their thoughts and ideas.Advanced Practice Nurse Assignment Papers.

Understanding the language used in ethical delibera- tions (e.g., terms such as beneficence, autonomy, and utili- tarian justice) helps the APN frame the concern. This can help those involved to see the components of the ethical problem rather than be mired in their own emotional responses. When ethical dilemmas arise, effective com- munication is the first key to negotiating and facilitating a resolution. Jameson (2003) has noted that the long history of conflict between certified registered nurse anes- thetists (CRNAs) and anesthesiologists influences how these providers communicate in practice settings. In inter- views with members of both groups, she found that some transcended role-based conflict whereas others became mired in it, particularly in the emotions around perceived threats to role fulfillment.Advanced Practice Nurse Assignment Papers. She recommended enhancing communication through focus on the common goal of patient care, rather than on the conflicting opinions about supervision and autonomous practice. In other words, focusing on shared values rather than the values in conflict can promote effective communication. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Interdisciplinary Conflict

The second theme encountered is that most ethical dilemmas that occur in the health care setting are multidisciplinary in nature. Issues such as refusal of treatment, end-of-life decision making, cost containment, and confidentiality all have interprofessional elements interwoven in the dilemmas, so an interprofessional approach is nec- essary for successful resolution of the issue. Health care professionals bring varied viewpoints and perspectives into discussions of ethical issues (Hamric & Blackball, 2007; Piers, Azoulay, Ricou, et al., 2011; Shannon, Mitchell, & Cain, 2002). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.These differing positions can lead to creative and collaborative decision making or to a breakdown in communication and lack of problem solving. Thus, an interdisciplinary theme is prevalent in the presentation and resolution of ethical problems.Advanced Practice Nurse Assignment Papers.

For example, a clinical nurse specialist (CNS) is writing discharge orders for an older woman who is terminally ill with heart failure. The plan of care, agreed on by the inter- professional team, patient, and family, is to continue oral medications but discontinue IV inotropic support and all other aggressive measures. Just prior to discharge, the social worker informs the CNS that medical coverage for. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

330 PART ll Competencies of Advanced Practice Nursing

the patient’s care in the skilled nursing facility will only be covered by the insurer if the patient has an IV in place. The attending cardiologist determines that the patient can be discharged to her daughter’s home because she no longer requires skilled care and the social worker agrees to proceed with this plan.Advanced Practice Nurse Assignment Papers. However, the CNS is concerned that the patient’s need for physical assistance will over- whelm her daughter and believes that the patient is better off returning to the sldlled nursing facility. Although each team member shares responsibility to ensure that the plan of care is consistent with the patient’s wishes and mini- mizes the cost burden to the patient, they differ in how to achieve these goals. Such legitimate but differing perspec- tives from various team members can lead to ethical conflict. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.

Multiple Commitments

The third theme that frequently arises when ethical issues in nursing practice are examined is the issue of balancing commitments to multiple parties. Nurses have numerous and, at times, competing fidelity obligations to various stakeholders in the health care and legal systems (Chambliss, 1996; Hamric, 2001). Fidelity is an ethical concept that requires persons to be faithful to their com- mitments and promises. For the APN, these obligations start with the patient and family but also include physi- cians and other colleagues, the institution or employer, the larger profession, and oneself. Ethical deliberation involves analyzing and dealing with the differing and opposing demands that occur as a result of these commitments. An APN may face a dilemma if encouraged by a specialist consultant to pursue a costly intervention on behalf of a patient, whereas the APN’s hiring organization has estab- lished cost containment as a key objective and does not support use of this intervention (Donagrandi & Eddy, 2000). In this and other situations, APNs are faced with an ethical dilemma created by multiple commitments and the need to balance obligations to all parties.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

The general themes of communication, interdisciplin- ary conflict, and balancing multiple commitments are prevalent in most ethical dilemmas. Specific ethical issues may be Wlique to the specialty area and clinical setting in which the APN practices.Advanced Practice Nurse Assignment Papers.

Ethical Issues Affecting Advanced Practice Nurses

Primary Care Issues

Situations in which personal values contradict professional responsibilities often confront NPs in a primary care setting. Issues such as abortion, teen pregnancy, patient

nonadherence to treatment, childhood immunizations, regulations and laws, and financial constraints that inter- fere with care were cited in one older study as frequently encountered ethical issues (Turner, Marquis, & Burman, 1996). Ethical problems related to insurance reimburse- ment, such as when implementation of a desired plan of care is delayed by the insurance authorization process or restrictive prescription plans, are an issue for APNs. The problem of inadequate reimbursement can also arise when there is a lack of transparency regarding the specifics of services covered by an insurance plan. Advanced Practice Nurse Assignment Papers. For example, a patient who has undergone diagnostic testing during an inpatient stay may later be informed that the test is not covered by insurance because it was done on the day of discharge. Had the patient and nurse practitioner (NP) known of this policy, the testing could have been sched- uled on an outpatient basis with prior authorization from the insurance company and thus be a covered expense. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Viens {1994) found that primary care NPs interpret their moral responsibilities as balancing obligations to the patient, family, colleagues, employer, and society. More recently, Laabs (2005) has found that the issues most often noted by NP respondents as causing moral dilemmas are those of being required to follow policies and procedures that infringe on personal values, needing to bend the rules to ensure appropriate patient care, and dealing with patients who have refused appropriate care.Advanced Practice Nurse Assignment Papers. Issues leading to moral distress included pressure to see an excessive number of patients, clinical decisions being made by others, and a lack of power to effect change (Laabs, 2005). Increasing expectations to care for more patients in less time are routine in all types of health care settings as pressures to contain costs escalate. APNs in rural settings may have fewer resources than their col- leagues working in or near academic centers in which ethics committees, ethics consultants, and educational opportunities are more accessible.Advanced Practice Nurse Assignment Papers.

Issues of quality of life and symptom management tra- verse primary and acute health care settings. Pain relief and symptom management can be problematic for nurses and physicians (Oberle & Hughes, 2001). APNs must con- front the various and sometimes conflicting goals of the patient, family, and other health care providers regarding the plans for treatment, symptom management, and quality of life. The APN is often the individual who coor- dinates the plan of care and thus is faced with clinical and ethical concerns when participants’ goals are not consis- tent or appropriate. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Acute and Chronic Care

In the acute care setting, APNs struggle with dilemmas involving pain management, end-of-life decision making,

advance directives, assisted suicide, and medical errors (Shannon, Foglia, Hardy, & Gallagher; 2009). Rajput and Bekes (2002) identified ethical issues faced by hospital- based physicians, including obtaining informed consent, establishing a patient’s competence to make decisions, maintaining confidentiality, and transmitting health information electronically. APNs in acute care settings may experience similar ethical dilemmas. Advanced Practice Nurse Assignment Papers. Recent studies of moral distress have revealed that feeling pressured to continue aggressive treatments that respondents thought were not in the patients’ best interest or in situations in which the patient was dying, working with physicians or nurses who were not fully competent, giving false hope to patients and families, poor team communication, and lack of provider continuity were all issues that engen- dered moral distress (Hamric & Blackball, 2007; Hamric, Borchers, & Epstein, 2012).Advanced Practice Nurse Assignment Papers.

APNs bring a distinct perspective to collaborative decision making and often find themselves bridging com- munication between the medical team and patient or family. For example, the neonatal nurse practitioner (NNP) is responsible for the day-to-day medical manage- ment of the critically ill neonate and may be the first provider to respond in emergency situations (Juretschke, 2001). The NNP establishes a trusting relationship with the family and becomes aware of the values, beliefs, and attitudes that shape the family’s decisions. Thus, the NNP has insight into the perspectives of the health care team and family. This “in-the-middle” position, however, can be accompanied by moral distress (Hamric, 2001), particu- larly when the team’s treatment decision carried out by the NNP is not congruent with the NNP’s professional judg- ment or values. Botwinski (2010) conducted a needs assessment ofNNPs and found that most had not received formal ethics content in their education and desired more education on the management of end-of-life situations, such as delivery room resuscitation of a child on the edge of viability.Advanced Practice Nurse Assignment Papers. Knowing the best interests of the infant and balancing those obligations to the infant with the emo- tional, cognitive, financial, and moral concerns that face the family struggling with a critically ill neonate is a complex undertaking. Care must be guided by an NNP and health care team who understand the ethical princi- ples and decision making related to issues confronted in neonatal intensive care unit (NICU) practice. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Societal Issues

Ongoing cost containment pressures in the health care sect01· have significantly changed the traditional practice of delivering health care. Goals of reduced expenditures and services and increased efficiency, although important, may compete with enhanced quality oflife for patients and. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

cHAPTER 13 Ethical Decision Making

improved treatment and care, creating tension between providers and administrators, particularly in managed care systems in which providers find that their clinical decisions are subject to outside review before they can be reimbursed. Ulrich and associates (2006) surveyed NPs and physician assistants to identify their ethical concerns in relation to cost containment efforts, including managed care. They found that 72% of respondents reported ethical concerns related to limited access to appropriate care and more than 50% reported concerns related to the quality of care. An earlier study of 254 NPs revealed that 80% of the sample perceived that to help patients, it was sometimes necessary to bend managed care guidelines to provide appropriate care (Ulrich, Soeken, & Miller, 2003). Advanced Practice Nurse Assignment Papers. Most respondents in this study reported being moderately to extremely ethically concerned with managed care; more than 50% said that they were concerned that business decisions took priority over patient welfare and more than 75% stated that their primary obligation was shifting from the patient to the insurance plan. Although the passage of the Patient Protection and Affordable Care Act (PPACA; U.S. Department of Health & Human Services fHHSJ, 2011) may help with these concerns to some extent, the ethical tensions that underlie cost containment pressures and the business model orientation of health care delivery may continue.Advanced Practice Nurse Assignment Papers.

An example of how cost containment goals can create conflict is a situation in which a NP wishes to order a computed tomography (CT) scan to evaluate a patient complaining of abdominal pain. The NP knows that the patient has a history of diverticulosis resulting in abscess formation and the current pres·entation with fever and abdominal tenderness justifies this testing; however, the insurance approval process takes a minimum of 24 hours. By sending the patient to the emergency room, the test can be done more quickly, but the patient will also face a long wait and a high copay if she does not require subse- quent hospital admission. Limiting access to CT scans is based on containing costs and avoiding unnecessary testing, which are two laudable goals.Advanced Practice Nurse Assignment Papers. However, in this situation, the lengthy approval process means that the NP does not have needed information to direct the treatment plan and alleviate the patient’s suffering in a timely manner. The use of the emergency room to obtain essen- tial clinical information is a greater burden on the patient and may ultimately prove more expensive to the system. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Technologic advances, such as the rapidly expanding :field of genetics, are also challenging APNs (Caulfield, 2012; Harris, Winship, & Spriggs, 2005; Horner, 2004; Pullman & Hodgkinson, 2006). As Hopldnson and Mackay (2002) have noted, although the potential impact of mapping the human genome is immense, the challenge of how to translate genetic data rapidly into improvements

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332 PART IT Competencies of Advanced Practice Nursing

in the prevention, diagnosis, and treatment of disease remains. To counsel patients effectively on the risks and benefits of genetic testing, APNs need to stay current in this rapidly changing field (a helpful resource for this and other issues is the text by Steinbock, Arras, and London, 2012), As one example, genetic testing poses a unique challenge to the informed consent process. Patients may feel pressured by family members to undergo or refuse testing, and may require intensive counseling to under- stand the complex implications of such testing; APNs are also involved in post-test counseling, which raises ethical concerns regarding the disclosure of test results to other family members (Eden, 2006). Because genetic information is crucially linked to the concepts of privacy and confidentiality, and the availability of this information is increasing, it is inevitable that APNs will encounter legal issues and ethical dilemmas related to the use of genetic data. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

APNs may engage in research as principal investiga- tors, co-investigators, or data collectors for clinical studies and trials. In addition, leading quality improvement (QI) initiatives is a key expectation of the DNP-prepared APN (AACN, 2006). Ethical issues abound in clinical research, including recruiting and retaining patients in studies, pro- tecting vulnerable populations from undue risk, and ensuring informed consent, fair access to research, and study subjects’ privacy. As APNs move into QI and research initiatives, they may experience the conflict between the clinician role, in which the focus is on the best interests of an individual patient, and that of the researcher, in which the focus is on ensuring the integrity of the study (Edwards & Chalmers, 2002).Advanced Practice Nurse Assignment Papers.

Access to Resources and Issues of Justice

Issues of access to and distribution of resources create powerful dilemmas for APNs, many of whom care for underserved populations. Issues of social justice and equi- table access to resources present formidable challenges in clinical practice. Trotochard (2006) noted that a growing number of uninsured individuals lack access to routine health care; they experience worse outcomes from acute and chronic diseases and face higher mortality rates than those with insurance. McWilliams and colleagues (2007) found that previously uninsured Medicare beneficiaries require significantly more hospitalizations and office visits when compared with those with similar health problems who, prior to Medicare eligibility, had private insurance.Advanced Practice Nurse Assignment Papers. The PPACA, when fully enacted, will help improve access to quality care and decrease the incidence of these dilem- mas. However, as noted, the escalating costs of health care represent ethical challenges to providers and systems alike, regardless of the population’s insurance status. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.

The allocation of scarce health care resources also creates ethical conflicts for providers; regardless of pay- ment mechanisms, there are insufficient resources to meet all societal needs (Bodenheimer & Grumbach, 2012; Trotochard, 2006). Scarcity of resources is more severe in developing areas of the world and justice issues of fair and equitable distribution of health care services present serious ethical dilemmas for nurses in these regions (Harrowing & Mill, 2010). A further international issue is the “brain drain” of nurses and other health professionals who leave underdeveloped countries to take jobs in developed countries (Chaguturu & Vallabhaneni, 2007; Dwyer, 2007). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Allocation issues have been described in the area of organ transplantation but dilemmas related to scarce resources also arise in regard to daily decision maldng, for example, with a CNS guiding the assignment of patients in a staffing shortage, or an FNP finding that a specialty consultation for a patient is not available for several months. Whether in community or acute care settings, APNs must, on a daily basis, balance their obligation to provide holistic, evidence-based care with the necessity to contain costs and the reality that some patients will not receive needed health care. As Bodenheimer and Grumbach (2012) have noted, “Perhaps no tension within the U.S. health care system is as far from reaching a satis- factory equilibrium as the achievement of a basic level of fairness in the distribution of health care services and the burden of paying for those services” (p. 215).Advanced Practice Nurse Assignment Papers.

One of the value-added components that APNs bring to any practice setting is creativity and a wide range of patient management strategies, which are crucial in caring for large numbers of uninsured and underinsured persons. It is not uncommon for an APN to encounter a patient who has been forced to stop taking certain medications for financial reasons. Although many practitioners pre- scribe generic forms of medications, if available, some patients still have to pay an exorbitant price for their medi- cations. For example, an acute care nurse practitioner (ACNP) managing an underinsured patient with chronic lung disease and heart failure discovers that the patient is unable to pay for all the medications prescribed and has elected to forego the diuretic and an angiotensin- converting enzyme inhibitor (ACE-I). Because the ACNP knows that ACE-Is are associated with reduced morbidity and mortality rates, and that diuretics control symptoms and prevent rehospitalization, these changes are discour- aged. Instead, the ACNP helps the patient make more suitable choices when altering medications, such as dosing some medications on an every-other-day basis. The ACNP has helped the patient cope with the situation but must face the morally unsettling fact that this plan of care is medically inferior. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Finally, as APNs broaden their perspectives to encom- pass population health and increased policy activities, both essential competencies of the DNP-prepared APN (AACN, 2006), they will experience the tension between caring for the individual patient and the larger population (Emanuel, 2002). Caregivers are increasingly being asked to incorporate population-based cost considerations into individualized clinical decision making (Bodenheimer & Grumbach, 2012). Population-based considerations pre- sent a challenge to the moral agency of APNs, who have been educated to privilege the individual clinical decision.Advanced Practice Nurse Assignment Papers.

Legal Issues

Over the last 30 years, the complexity of ethical issues in the health care environment and the inability to reach agreement among parties has resulted in participants turning to the legal system for resolution. A body of legal precedent has emerged, reflecting changes in society’s moral consensus. Ideally, moral rights are upheld or protected by the law.Advanced Practice Nurse Assignment Papers. For example, the Culturally and Linguistically Appropriate Services (CLAS) Standards established by the HHS mandate that health care institu- tions receiving federal funds provide services that are accessible to patients regardless of their cultural back- ground (HHS, Office of Minority Health, 2001). These standards provide a legislative voice for the ethical obliga- tion to respect all persons, regardless of their cultural background and primary language. In a different voice, the PPACA (HHS, 20ll) has mandated that persons who can afford health insurance purchase it or pay a penalty, starting in 2014. According to this law, societal benefi- cence, in the form of limiting high expenditures on the care of uninsured persons, is preferred over individual autonomy (Trautman, 2011). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

APNs must use caution and not conflate legal perspec- tives with ethical decision making. In many cases, there is no relevant law and thoughtful deliberation of the ethical issues offers the best hope of resolution. In addition, looking to the judicial system for guidance in ethical deci- sion making is troubling because the judicial aim is to interpret the law, not to satisfy the ethical concerns of all parties involved. In addition, clinical understanding may be absent from the judicial perspective. Involvement of the media may further confuse the situation, as was evident in the Schiavo case (Gostin, 2005). Advanced Practice Nurse Assignment Papers. The legal guidelines in that case were dear; the Florida court system repeatedly upheld the right of Ms. Schiavo’s spouse to refuse nutrition and hydration on her behalf However, advocacy groups, politicians, and Ms. Schiavo’s parents used the media to offer a variety of interpretations of the case and wielded political power to prevent removal of the feeding tube and to have it replaced twice after it was removed. Clearly, the

CHAPTER 13 Ethical Decision Making

legal perspective did not satisfy the moral concerns of all involved. Unfortunately, much of the publicity focused on the emotional experience of the parents fearing the loss ,of their daughter and not on careful consideration of the ethical elements. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Sometimes, the law not only falls short of resolving ethical concerns, but contributes to the creation of new dilemmas. Changes in the Medicare hospice benefit under the PPACA (HHS, 2011) offer a dear example. Designed to prevent hospice agencies from enrolling and re-enrolling patients who do not meet criteria, the new regulations require a face-to-face assessment by a health care provider to recertify hospice eligibility at set intervals after the initial enrollment (Kennedy, 2012). Advanced Practice Nurse Assignment Papers. Often, patients with dementia or another slowly progressive disease state who enroll in hospice experience an initial period of stability, likely because they have improved symptom management and access to comprehensive services. If this stability extends to the next certification period, the patient may face disenrollment. For the practitioner conducting the assessment, this creates the ethical dilemma of wanting to be truthful regarding the patient’s status and at the same time avoid removing a service that is benefiting the patient and family. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Ethical Decision Making Competency of Advanced Practice Nurses

There are a number of reasons why ethical decision maldng is a core competency of advanced practice nursing. As noted, clinical practice gives rise to numerous ethical concerns and APNs must be able to address these con- cerns. Also, ethical involvement follows and evolves from clinical expertise (Benner, Tanner, & Chesla, 2009). Another reason why ethical decision malting is a core competency can be seen in the expanded collaborative skills that APNs develop (see Chapter 12). APNs practice in a variety of settings and positions but, in most cases, the APN is part of an interprofessional team of caregivers. The team may be loosely defined and structured, as in a rural setting, or more definitive, as in the acute care setting. The recent re-emergence of an interprofes- sional care model is changing practice for all providers (Interprofessional Collaborative Initiative [IPECJ, 2011). Regardless of the structure, APNs need the knowledge and skills to avoid power struggles, broker and lead interdis- ciplinary communication, and facilitate consensus among team members in ethically difficult situations. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Phases of Core Competency Development

The core competency of ethical decision making for APNs can be organized into four phases. Each phase depends on

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334 PART Il Competencies of Advanced Practice Nursing

Phases of

1. Knowledge Development-Moral Sensitivity

2. Knowledge Application-Moral Action

3. Creating an Ethical Environment

4. Promoting Social Justice Within the Health Care System

of Core

Ethical theories

Ethical issues in specialty

Professional code

Professional standards

Legal precedent

Moral distress

Ethical decision-making frameworks

Mediation and facilitation strategies

Preventive ethics

Awareness of environmental barriers to ethical practice

Concepts of justice

Health policies affecting a specialty population

the acquisition of the lmowledge and skills embedded in the previous level. Thus, the competency of ethical deci- sion making is understood as an evolutionary process in an APN’s development. Phase 1 and beginning exposure to Phase 2 should be explicitly taught in the APN’s gradu- ate education. Phases 3 and 4 evolve as APNs mature in their roles and become comfortable in the practice setting; these phases represent leadership behavior and the full enactment of the ethical decision maldng competency. Phase 4 relies on competencies required of DNP-prepared APNs; the knowledge and sldlls needed for Phases 3 and 4 should be incorporated into DNP programs. Although an expectation of the practice doctorate, all APNs should develop their ethical knowledge and sldlls to include ele- ments of all four phases of this competency. The essential elements of each phase are described in Table 13-1.Advanced Practice Nurse Assignment Papers.

Phase 1: Knowledge Development The first phase in the ethical decision making competency is developing core lmowledge in ethical theories and prin- ciples and the ethical issues common to specific patient

for Ethical Decision

Sensitivity to ethical dimensions of clinical practice — — — —- —– — – —

Values clarification

Sensitivity to fidelity conflicts

Gather relevant literature related to problems identified

Evaluate practice setting for congruence with literature

Identify ethical issues in the practice setting and bring to the attention of other team members

Apply ethical decision making models to clinical problems

Use skilled communication regarding ethical issues

Facilitate decision making by using select strategies

Recognize and manage moral distress in self and others

Role model collaborative problem solving

Mentor others to develop ethical practice

Address barriers to ethical practice through system changes

Use preventive ethics to decrease unit-level mor~l distress

Ability to analyze the policy process

Advocacy, communication, and leadership skills

Involvement in health policy initiatives supporting social justice

populations or clinical settings. This dual knowledge enables the APN student to integrate philosophical con- cepts with contemporary clinical issues. The emphasis in this initial stage is on learning the language of ethical discourse and achieving cognitive mastery. The APN learns the theories, principles, codes, paradigm cases, and relevant laws that influence ethical decision making. With this knowledge, the APN begins to compare current prac- tices in the clinical setting with the ethical standards desctibed in the literature.Advanced Practice Nurse Assignment Papers.

Phase 1 is the beginning of the APN’s personal journey toward developing a distinct and individualized ethical framework. The work of this phase includes developing sensitivity to the moral dimensions of clinical practice (Weaver, 2007). A helpful initial step in building moral sensitivity is understanding one’s values, in which students clarify the personal and professional values that inform their care (Fry & Johnstone, 2008). Engaging in this work uncovers personal values that may have been internalized and not openly aclmowledged, and is particularly impor- tant in our multicultural world. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answersm

Another key aspect of this phase is developing the ability to distinguish a true ethical dilemma from a situa- tion of moral distress or other clinically problematic situ- ation. This requires a general understanding of ethical theories, principles, and standards that help the APN define and discern the essential elements of an ethical dilemma. Novice APNs should be able to recognize a moral problem and seek clarification and illumination of the concern. The APN identifies ethical issues and formu- lates the concerns about which others are uneasy. This step earns credibility and enables the APN to gain self- confidence by bringing the issue to the awareness and attention of others. If the issue remains a moral concern after clarification, the APN should pursue resolution, seeking additional help if needed.Advanced Practice Nurse Assignment Papers.

Formal education in ethical theories and concepts should be included in graduate education programs for APNs. Although some beginning graduate students will have had significant exposure to ethical issues in their undergraduate programs, most have not. A 2008 U.S. survey of nurses and social workers found that only 51% of the nurse respondents had formal ethics education in their undergraduate or graduate education; 23% had no ethics training at all (Grady, Danis, Soeken, et al., 2008). APN students with no ethics education will be at a disad- vantage in developing this competency because graduate education builds on the ethical foundation of professional practice.Advanced Practice Nurse Assignment Papers. The current master’s essentials (AACN, 2011) do not address ethics education directly but include compe- tencies in the use of ethical theories and principles. The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006) contains explicit ethical content in five of the eight major categories (Box 13-1). Even catego- ries that do not explicitly list necessary ethical content imply it in referring to issues such as improving access to health care, addressing gaps in care, and using conceptual and analytic skills to address links between practice and organizational and policy issues.Advanced Practice Nurse Assignment Papers.

Exposure to ethical theories, principles, and concepts allows the APN to develop the language necessary to articulate ethical concerns in an interprofessional envi- ronment. It is important, however, that lmowledge devel- opment extend beyond classroom discussions. Clinical practicum experiences also need to build in discussions of ethical dimensions of practice explicitly rather than assume that these discussions will naturally occur. In one study of the clinical experiences of graduate students from four graduate programs, only 4 of20 students were identi- fied as having experience with an ethical dilemma and only 2 of 22 preceptors noted any exposure to ethical dilemmas for students (Howard & Steinberg, 2002). The authors concluded that this apparent void in clinical edu- cation may have been a function oflimited recognition of. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

CHAPTER 13 Ethical Decision Maldng 335

Ethical Competencies in the DNP Essentials*

Integrate nursing scierice with· knowledge: froin ethiCs .and biophysiCal •. psychoS()Ci~l~ analytic, ahd organizational sciences as the basis for the highest level’ Of nurSing practice. (I) Develop and/or eValuate etfective.stfategies for· man·aging the ethical dilemmas inherent in patient care, the health.~are orgimizatiOn; and research. (II) Desigll, direct, .arid evaluate qualitY: ImProv:eme.~t methodologies to promote safe, timely, effective, efficient, equitable (emphasis added), and patierit-centered care.·(I!I) Piovide’leadership i.n the ev~luation.and reSolution of ethical and legal issue’s within health care systems relating to ‘the use of inform·ation, inforrilatio·n technology, conirhunication netWorks; ‘arid ·patient care technology. (IV) Advocate for social justice, equity; .a~d ethi~al

within. all health care arenas. (V)

‘Essential number in parentheses. From American Association of Colleges of Nursing. (2006). Tile essentials of doctoral education for advanced nursing practice. Washington, DC: Author.Advanced Practice Nurse Assignment Papers.

ethical decision making processes by APN students and preceptors. In another study, Laabs (2005) noted that 67% of NP respondents claimed that they never or rarely encountered ethical issues. Some respondents showed confusion regarding the language of ethics and related principles. In a later study, Laabs (2012) found that APN graduates, most of whom had had an ethics course in their graduate curriculum, indicated a fairly high level of con- fidence in their ability to manage ethical problems, but their overall ethics knowledge was low. These three studies provide compelling commentary on the need for Phase 1 activity in graduate curricula.

The core knowledge of ethical theories should be sup- plemented with an understanding of issues central to the patient populations with whom the APN works. As APNs assume positions in specific clinical areas or with particu- lar patient populations, it is incumbent upon them to gain an understanding of the applicable laws, standards, and regulations in their specialty, as well as relevant paradigm cases. This information may be garnered from current literature in the field, continuing education programs, or discussions with colleagues. Information on legal and policy guidelines should be offered during graduate pract- icum experiences in the area of clinical concentration. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

336 PART II Competencies of Advanced Practice Nursing

Although Phase 1 is the building block for the other phases of this competency, it is also an ongoing process. APNs will gain core knowledge in graduate education but, as societal issues change and new technologies emerge, new dilemmas and ethical problems arise. The ability to be a leader in creating ethical environments involves a commitment to lifelong learning about ethical issues, of which professional education is just the beginning.Advanced Practice Nurse Assignment Papers.

Developing an Educational Foundation As noted, education in ethical theories, principles, rules, and moral concepts provides the foundation for develop- ing skills in ethical reasoning. Because the APN will apply these theoretical p1inciples in actual encounters with patients, it is imperative that consideration of the context in specific situations be strengthened. A portion of gradu- ate ethics education should involve discussion of typical issues encountered by APNs, rather than issues that receive extensive media attention but occur infrequently. Howard and Steinberg (2002) maintained that graduate curricula need to go beyond traditional ethical issues to encompass building trust in the APN -patient relationship, professionalism and patient advocacy, resource allocation decisions, individual versus population-based responsi- bilities, and managing tensions between business ethics and professional ethics. The latter three areas are crucial for developing the Phase 4 level of the ethical decision malting competency.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Continuing education programs are also effective and necessary forums in which current information can be provided in a rapidly changing health care environment. As technology changes and new dilemmas confront prac- titioners, the APN must be prepared to anticipate condi- tions that erode an ethical environment. Knowledge and skills in all phases of this competency depend on the appli- cation of current ethical knowledge in the clinical setting; ethical reasoning and clinical judgment share a common process and each serves to teach and inform the other (Dreyfus, Dreyfus, & Benner, 2009). Therefore, the impor- tance of clinical practice cannot be overemphasized.Advanced Practice Nurse Assignment Papers.

Overview ofEthkal11wories Prillciple-Based ll1odel. Although ethical decision

making in health care is extensively discussed in the bio- ethics literature, two dominant models are most often applied in the clinical setting. The first model of decision maldng is a principle-based model (Box 13-2), in which ethical decision maldng is guided by principles and rules (Beauchamp & Childress, 2009). In cases of conflict, the principles or rules in contention are balanced and inter- preted with the contextual elements of the situation. However, the final decision and moral justification for actions are based on an appeal to principles. In this way NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.

Principles and Rules Important to Professional Practice

Principle’ofrespect,for autonomy: The duty to respect_othe1:s’ personal liberty and individual values, beliefs, and choices Principle-of ilorunaleficence: The duty not to inflict harm or evil Principle of beneficence: The duty to do good and pfevent or remove harm Principle of formal justice: The duty to treat equals equally and treat those who are_ t.lnequal according to their ne_eds Rule of veracity: The duty to tell the truth and not to deceive others Rukof fidelity: The duty to honor commitments Rule of confidentiality: The duty not to. disclose, information shared in ‘an intimate and tmSted manner Rule of privacy: The duty to respect limite<:l access to a_person

Adapted from Beauct1amp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.

the principles are binding and tolerant of the particulari- ties of specific cases (Beauchamp & Childress). The prin- ciples of respect for persons, autonomy, beneficence, nonmaleficence, and justice are commonly applied in the analysis of ethical issues in nursing. The American Nurses Association (ANA) Code of Ethics for Nurses (2001) has endorsed the principle of respect for persons and under- scores the profession’s commitment to serving individuals, families, and groups or communities. The emphasis on respect for persons throughout the code implies that it is not only a philosophical value of nursing, but also a binding principle within the profession.Advanced Practice Nurse Assignment Papers.

Although ethical principles and rules are the corner- stone of most ethical decisions, the principle-based approach has been criticized as being too formalistic for many clinicians and lacldng in moral substance ( Gert, Culver, & Clouser, 2006). Other critics have argued that a principle-based approach conceals the particular person and relationships and reduces the resolution of a clinical case simply to balancing principles (Rushton & Penticuff, 2007). Because all the principles are considered of equal moral weight, this approach has been seen as inadequate to provide guidance for moral action ( Gett et al., 2006; Strong, 2007). In spite of these critiques, bioethical prin- ciples remain the most common ethical language used in clinical practice settings. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answersm

Casuistry. The second common approach to ethical decision maldng is the casuistic model (Box 13-3), in

Alternative Ethical

Casuistry Direct analysis of particular cases Uses previous paradigm cases to infer ethical action in a current case Analogues in common law and case law Values practical knowledge’ rather than theory (pretheoretical) Privileges experience

Narrative Ethics Supplements principles by emphasizing importance of full context Gathers views of all parties to provide more complete baSis for moral justification Story and narrator substitute for ethical justification, which emerges naturally Privileges stories

Virtue-Based Ethics Emphasizes the moral agent, not the situation or the action Right motives and character reveal more about moral worth than right actions Character more important than conformity to rules.Advanced Practice Nurse Assignment Papers.

which current cases are compared with paradigm cases (Beauchamp & Childress, 2009; Jonsen & Toulmin, 1988; Toulmin, 1994). The strength of this approach is that a dilemma is examined in a context -specific manner and then compared with an analogous earlier case. The funda- mental philosophical assumption of this model is that ethics emerges from human moral experiences. Casuists approach dilemmas from an inductive position and work from the specific case to generalizations, rather than from generalizations to specific cases (Beauchamp & Childress, 2009). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Concerns have also been raised regarding the use of a casuistic model for ethical decision making. As a moral dilemma arises, the selection of the paradigm case may differ among the decision makers and thus the interpreta- tion of the appropriate course of action will vary. In nursing, there are few paradigm cases of ethical issues on which to construct a decision making process. Further- more, other than the reliance on previous cases, casuists have no mechanisms to justify their actions. The possibil- ity that previous cases were reasoned in a faulty or inac- curate manner may not be fully considered or evaluated (Beauchamp & Childress, 2009). In spite of these con- cerns, the case-based moral reasoning used in casuistry appeals to clinicians because it mimics clinical reasoning, in which providers often appeal to earlier similar cases to

CHAPTER 13 Ethical Decision Making

“‘ Righ~ motives make for right actions Privileges actor’s values and motives

Feminist Ethics Views women as embodied, fully rational, and having experiences relevant to moralt’easoning Emphasizes view of the disadvantaged-women and other underrepresented groups Emphasizes importance and value of openness to different perspectives Concerned with power differentials that create oppression Emphasizes importance of attention to the vulnerable and to resulting inequalities Privileges power imbalancesCare-Based Ethics Emphasizes creating and sustaiining responsive connection with others Emphasizes importance of context and subjectivity in discerning ethical action Sees individuals as interdependent rather than independent; focuses on parties in a relationship Privileges relationships.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

make clinical judgments. Artnak and Dimmitt (1996) applied the casuistic model to an analysis of a complex case, concluding that the use of this approach allows fuller consideration of the contextual particulars ofthe case and provides a systematic approach for organizing and analyz- ing the facts of the case. An adaptation of this approach has been developed by Jansen and colleagues (2010), sometimes referred to as the “four box” approach. These authors have advocated clustering patient information according to four key topics-medical indications, patient preferences, quality of life, and contextual features-and then using that information to resolve a dilemma. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Narrative Ethics. Because neither of these theoretical approaches have been seen as fully satisfactory, altern a- tives have emerged (see Box 13-3). Narrative approaches to ethical deliberation have evoked considerable interest (Charon & Montello, 2002; Nelson, 2004; Rorty, Werhane, & Mills, 2004). Narrative ethics emphasizes the particulars of a case or story as a vehicle for discerning the meaning and values embedded in ethical decision making. The argument is that all knowing is bound up in a narrative tradition and that all participants in ethical deliberations need the coherence and singular meaning given to a particular situation that only narrative knowledge can provide. Narrative ethics begins with a patient’s story and has some similarities with casuistry in its inductive.Advanced Practice Nurse Assignment Papers.

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338 PART II Competencies of Advanced Practice Nursing

particularistic approach. Critics of this approach have argued that although narrative is a necessary element in ethical analysis, it cannot supplant principle- or theory- based ethics (Arras, 1997; Childress, 1997). There is, howevet~ recognition that careful consideration of patient’s stories can enlarge and enrich ethical delibera- tions. In commenting on narrative versus principle-based approaches, Childress (1997) noted that “We need both in any adequate ethics” (p. 268). As with casuistry, narrative-based approaches appeal to nurses, who find much of the meaning in their work through entering into the stories of their patient’s lives.Advanced Practice Nurse Assignment Papers.

Care-Based Ethics. Other approaches, such as virtue- based ethics, feminist ethics, and care-based ethics, provide alternative processes for moral reflection and argument (Beauchamp & Childress, 2009; Wolf, 1996), Historically, nursing ethics was virtue-based, with an emphasis on qualities necessary to be a virtuous nurse. Although this is no longer a dominant theme in nursing literature, it can still be seen. For example, Gallagher and Tschudin (2010) based their understanding of ethical leadership in professional values and virtues.Advanced Practice Nurse Assignment Papers.

The ethics of care has emerged as relevant to nursing (Cooper, 1991; Edwards, 2009; Lachman, 2012). The care perspective constructs the central moral problem as

Clinical Situation

To illustrate the different ethical approaches, consider the case of a 64-year-old man, GB, who is unable to speak for himself because of an aggressive brain tumor. He had seen a neurosurgeon 1 month prior to the current hospital adillission and was told that the tumor was inoperable.Advanced Practice Nurse Assignment Papers. He has been undergoing outpatient radiation treatment and is now taken to his local hospital because of altered mental status. In the emergency room, his condition worsens; he is unable to communicate or breathe so he is started on mechanical ventilation and transferred to the ICU. Imaging shows that the tumor has continued to progress, despite radiation. The patient’s daughter requests that the patient be transferred to another facility for a second opinion from a different neurosurgeon. The social worker has a copy of the patient’s advance directive, completed prior to starting radiation, which states that he does not desire aggressive medical treatment if there is little hope of recovery. The team caring for the patient, including a staff nurse, resi- dent, attending physician, social worker, and CNS apply different ethical theories when they approach this case. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

The nurse adopts a principle-based approach, favor- ing patient autonomy and respect for persons, as empha- sized in the Code of Ethics for Nurses (ANA, 2001). He

sustaining responsive connections and relationships with important others, and consequently focuses on issues sur- rounding the intrinsic needs and corresponding responsi- bilities that occur in relationships (Gilligan, 1982; Little, 1998). In this approach, moral reasoning requires empathy and emphasizes responsibilities rather than rights. The response of an individual to a moral dilemma emerges from important relationship considerations and the norms of friendship, care, and love. Viens (1995) reported that NPs she interviewed used a moral reasoning process that mirrored Gilligan’s model in the major themes of caring and responsibility.Advanced Practice Nurse Assignment Papers.

Although every ethical theory has some limitations and problems, an understanding of contemporary approaches to bioethics enables the APN to appeal to a variety of perspectives in achieving a moral resolution. In the clinical setting, ethical decision making most often reflects a blend of the various approaches rather than the application of a single approach. Although there is some danger in oversimplifying these rich and complex approaches, Exemplar 13-1 shows how they can be reflected in ethical decision making. A more thorough discussion of ethical theory is beyond the scope of this chapter, but the reader is referred to the references cited for more detail.Advanced Practice Nurse Assignment Papers.

Ethical

recognizes the daughter’s distress but believes that her desire to seek a second opinion comes from her own fear of losing her father and is not based on her knowledge of the patient’s wishes. Because the patient should be respected as a person, keeping him on life support or transferring him to another institution as a means to alleviate his daughter’s fears is unethical.Advanced Practice Nurse Assignment Papers. The nurse believes that the daughter’s inability to support her father’s advanced directive renders her an inappropriate decision maker. The advance directive, as an indication of the patient’s autonomous wishes, should guide care. Because it clearly states the patient that does not wish to be kept alive with little hope of recovery, he favors withdrawal of ventilator support and institution of comfort measures only. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

The resident had a case a year ago, when she was still a medical student, in which a patient’s cancer was thought to be inoperable but a second opinion was sought and the patient went on to survive surgical inter- vention. This case, occurring early in her career in health care, profoundly influences her to support second opin- ions on complicated surgical cases. Applying a casuistry- based approach, the resident supports the daughter’s request and agrees to help her explore avenues for

CHAPTER 13 Ethical Decision Maldng

Clinical Situation Demonstrating Differing Ethical

transferring the patient for consultation with a different neurosurgeon on the slim chance that he may be eligible for additional treatment to prolong his life. She consults the social worker to assist in investigating the feasibility of transferring the patient.Advanced Practice Nurse Assignment Papers.

The attending physician adopts a care-based approach, privileging the relationships within the patient’s family. He himself has a long-standing relation- ship with the neurosurgeon who was previously con- sulted, and he trusts that a second opinion at an outside facility will not yield a different prognosis.Advanced Practice Nurse Assignment Papers. He favors keeping the patient in his current setting, because transferring him to a distant facility will take him far from his family, and their time with him is essential He does not see any reason to withdraw mechanical ventilation but he also believes that initiating cardiopulmonary resuscitation (CPR) would be futile and would disrupt the peaceful atmosphere his family deserves as they struggle with the loss of their father and grandfather. He there- fore convinces the patient’s daughter to agree to a do not resuscitate (DNR) order, and closes the discussion by encouraging her and the rest of the family to stay with the patient and to “be together at this crucial time:’ He also asks the ICU staff to relax the regulations regarding family visitation so that the daughter and her children can spend more time at GB’s bedside.

The social worker completes a lengthy assessment of the patient and family in response to the consult requested by the resident. In the process, she learns that the family has limited financial resources and that the patient’s daughter has a lOth-grade education. Prior to GB’s diagnosis, her only interactions with the health care system were the births of her three children. Her mother died when she was teenager and, for the past few years, her father has assisted her in the care of her children. The social worker views the attending physi- cian as condescending, and she hears one of the ICU nurses describe the daughter as “totally clueless:’ Inter- preting the case from a feminist viewpoint, she worries that the family’s socioeconomic status and the daughter’s educational background are creating a bias against hon- oring the request for transfer. She is determined to advocate for the patient’s daughter to correct this power imbalance. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

The CNS’s involvement in the case begins when the nurse consults her because his appeals to the resident and attending physician have failed to result in what he

believes is the right course of action-namely with- drawal of the ventilator. The CNS listens to the nurse’s story and attends carefully to the details he gives. She then seeks out the resident) attending physician, and social worker to hear their perspectives. She adopts a narrative-based approach and wants to hear all the con- textual features of the case before coming to a conclusion about the best course of action. When she speaks to GB’s daughter, she learns about the conversation that she had with her father shortly before he became unresponsive, in which he expressed a desire to attend her oldest child’s high school graduation. It is this conversation that led the patient’s daughter tO request a transfer for a second opinion: “I know he wants to Jive;’ she explains, “no matter what it says on that paper:’Advanced Practice Nurse Assignment Papers.

Resolution of the Case The CNS calls a team meeting. She asks the members to work toward a consistent message that can be given to GB’s family because the contrasting views are dearly creating confusion. This request results in careful review of the clinical aspects of the case, including the most recent magnetic resonance imaging (MRI) scan, and brings the team to an agreement that the patient’s prog- nosis is poor and a second opinion from an outside neurosurgeon is not necessary to confirm this.Advanced Practice Nurse Assignment Papers. The social worker has an opportunity to ask questions and is thus assured that the team was unaware of the daughter’s educational background and economic status and are not basing their care on these factors. The CNS then moves forward to establish a mutually acceptable plan of care. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers

In a subsequent family meeting, the team explains the patient’s prognosis to the patient’s daughter using layman’s terms and simple pictures to clarify the growth of the tumor and its position. After addressing the family’s questions, the CNS presents two options- withdt•awing intensive care interventions or continuing to provide this care with the DNR order in place. She explains that the team has met separately to consider carefully the daughter’s request for transfer GB and determined that the risks of such a plan outweigh poten- tial benefits. The CNS ends the meeting with the family by offering them additional time to discuss their options and ask any further questions. After several days, the family elects to withdraw the ventilator and initiate comfort measures.Advanced Practice Nurse Assignment Papers.

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34D PART II Competencies of Advanced Practice Nursing

Professional Codes and Guidelines

The ANA’s Code of Ethics for Nurses (2001) describes the profession’s philosophy and general ethical obligations of the professional nurse. It describes broad guidelines that more reflect the profession’s conscience than provide specific directions for pa1ticular clinical situations. It provides a framework that delineates the nurse’s overriding moral obligations to the patient, family, community, and profession.Advanced Practice Nurse Assignment Papers.

Professional organizations delineate standards of performance that reflect the responsibilities, obligations, duties, and rights of the members. These standards also can serve as guidelines for professional behavior and define desired conduct. Although the general principles are relatively stable, professional organizations often reflect on specific or contemporary issues and take a proactive position on pivotal concerns.Advanced Practice Nurse Assignment Papers. For example, the American Association of Critical-Care Nurses (2008) has issued a position paper on moral distress, acknowledging that it negatively affects quality of care and influences nurses who are considering leaving the profession. The paper then lists the responsibilities of nurses to address moral distress, some resources that can be helpful to them, and the obligations of nurses’ employers to offer support, such as employee assistance programs and ethics committees, to assist with managing moral distress. An additional example is the International Association of Forensic Nurses’ position paper (2009) supporting the use of emergency contraception for victims of sexual assault. This document provides ethical and clinical rationales for policies that permit dispensing of these medications. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Personal a11d Professional Values Individuals’ interpretations and positions on issues are a reflection of their underlying value system. Value systems are enduring beliefs that guide life choices and decisions in conflict resolution (Ludwick & Silva, 2000). Viens (1995) found that values were an essential feature of the everyday practice of the 10 primary care NPs she inter- viewed. Values of caring, responsibility, trust, justice, honesty, sanctity and quality of life, empathy, and religious beliefs were articulated by the study participants, often as ideals that motivated their actions. An awareness of per- sonal values generates more consistent choices and behav- iors; it can also assist APNs to be aware of the boundaries of their personal and professional values so that they can recognize when their own positions may be unduly influ- encing patient and family decision making.Advanced Practice Nurse Assignment Papers.

Values awareness should include an understanding of the complex interplay between cultural values and ethical decision making (Buryska, 2001; Ludwig & Silva, 2000). When patient and family decisions contradict traditional.

Western medical practice, health care providers may resort to coercive or paternalistic measures to influence patient’s choices to be more consistent with the provider’s values. APNs and other health care providers must under- stand that the assumptions they make may be based on their own cultural values and biases and understand how these assumptions may influence their recommendations of particular treatments. As health care professionals gain an understanding of factors that guide a person’s decisions, treatment plans that reflect the patient’s value preferences are more easily developed. for example, a patient from a Southeast Asian culture may show respect to authority figures by obeying the APN’s treatment suggestions, even if he or she disagrees with the plan. In this situation, the APN could assure the patient that questions about the plan of care are welcomed and are not disrespectful. .Advanced Practice Nurse Assignment Papers.

By the same token, claims made in the name of reli- gious and cultural beliefs are not absolute. Buryska (2001) offered helpful guidelines for clinicians to assess the defensibility of patient and family claims made in the name of cultural or religious considerations. For example, he maintained that spiritual or cultural claims grounded in an identifiable and established community are more defensible than those that are idiosyncratic to the person malting the claim. Although it is critical for caregivers to respond with respectful dialogue, support, and compas- sionate care, patient and family demands for treatment must be considered in relation to other claims that also have ethical weight-the professional integrity of provid- ers, legal considerations, economic realities, and issues of distributive justice.Advanced Practice Nurse Assignment Papers.

Professional Bou1utaries In their professional capacity, APNs have access to per- sonal and private patient information and may develop long-term therapeutic relationships with many of their patients. The atmosphere of intimacy in the nurse-patient relationship, coupled with the need to touch the patient during a physical examination, sets up a power differential that accentuates the patient’s vulnerability (Holder & Schenthal, 2007). Boundaries must be established that acknowledge the appropriate and necessary use of this patient information and intimacy to meet the patient’s needs and provide care. The obligation to maintain profes- sional boundaries within a therapeutic relationship is shared with all nurses (ANA, 2001), but APNs are also in a position to observe for boundary violations by others and to intervene when they occur.

Boundary violations, in which the APN or another health care professional inadvertently or purposely breaches the limits and expectations of the relationship, may profoundly alter the foundation of a therapeutic.Advanced Practice Nurse Assignment Papers.

relationship. Such transgressions may be subtle, such as the APN sharing excessive personal information, or blatant, as in sexually seductive behavior. Regardless of the magnitude of the violation, the behavior must be con- fronted immediately and the culpable individual must be removed from interaction with the patient. Other members of the health care team should strive to restore the patient’s integrity and trust, involving the help of others as necessary (National Council of State Boards of Nursing, 2009). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Phase 2: Knowledge Application The second phase of the core competency is applying the knowledge developed in the first level to the clinical practice arena. Phase 2 continues the APN’s journey in assessing ethical problems and being actively involved in the process of resolving ethical dilemmas. As APNs acquire core ethical decision making knowledge, the responsibility to take moral action becomes more compel- ling. Rather than retrospectively analyzing ethical dilem- mas, the APN takes moral action, which implies that the APN recognizes, pursues, and responds to ethical issues. Often, the inequities toward or infringements on other persons are enough to motivate moral action and a timely response can change the course in present and future situations. 1herefore, moral action should not be under- estimated as a core APN skill and should be recognized, fostered, and valued by others. Once an advanced nursing role is assumed, the APN accepts the responsibility to be a fUll participant in the resolution of moral dilemmas rather than simply an interested observer or one of many parties in conflict.Advanced Practice Nurse Assignment Papers.

Although the core knowledge of ethical concepts pro- vides the foundation for moral reasoning, the application of these concepts enables the APN to develop the practical wisdom of moral reasoning. It is the experience in the practice setting and the courage of the APN to discuss sensitive issues openly that enable the APN to assume an active role in dispute resolution. The success and speed with which the APN gains these behavioral skills is related to the presence of mentors in the clinical setting and the willingness of the APN to become immersed in ethical discussions. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

Institutional resources, such as ethics committees and institutional review boards, provide valuable opportunities for APNs to participate in the discussion of ethical issues. Typically, hospital ethics committees serve three functions-policy formation, case review, and education. As a member of the ethics committee, the APN exchanges ideas with colleagues and gains an understanding of ethical dilemmas from a variety of perspectives. In addition, the APN is informed of current legislation, regulations, and hospital policies that have ethical implications.Advanced Practice Nurse Assignment Papers.

CHAP T E R 13 Ethical Decision Making

This is an extremely valuable experience that can accelerate the development of ethical decision making skills.

Unfortunately, most APNs do not have the opportunity to serve on interdisciplinary ethics committees and, in some cases, may have few professional colleagues avail- able to mentor and develop the skills of ethical decision making. 1hus, the APN must advance this phase by actively seeking opportunities to engage in ethical dia- logue with professional colleagues. Professional organiza- tions offer materials such as The 4 AS to Rise Above Moral Distress (American Association of Critical Care Nurses, 2004) and workshops in which case studies are discussed and analyzed. This format is helpful to the inexperienced APN who needs guidance in applying knowledge to clini- cal cases.Advanced Practice Nurse Assignment Papers.

Ethical Decision Making Frameworks Several authors have proposed a stepwise approach to ethical decision making (McCormick-Gendzel & Jurchek, 2006; Purtilo & Doherty, 2011; Rushton & Penticuff, 2007; Spencer, 2005; Weuste, 2005). In Box 13-4, the steps sug- gested by Purtilo and Doherty (2011) are listed as an example. The reader will note that this framework uses many elements of the various ethical approaches dis- cussed earlier in considering contextual factors, seeking full information on a case, and specifying a step that explicitly appeals to ethical theory. This framework for ethical decision making is intended for all health profes- sionals and therefore is applicable to a wide variety of situations.Advanced Practice Nurse Assignment Papers.

Most frameworks for ethical decision malting include information gathering as a key step. Generally, informa- tion about the clinical situation, the parties involved, their obligations and values, and legal, cultural, and religious factors are needed. However, this factual information is not sufficient unless tempered with the contextual features of each case. Identifying the cause of the problem and determining why, where, and when it occurred, and who or what was affected, will help clarify the nature of the problem.Advanced Practice Nurse Assignment Papers.

Problem identification is also a common step in most frameworks. Strong emotional responses to a situation can be the first signal that ethical conflict exists. However, many conflicts that arise in the clinical setting generate powerful emotional responses but may not be ethical issues. Ethical issues are those that involve some form of controversy about conflicting moral values and/or fundamental duties or obligations. The APN must distinguish and separate moral dilemmas from other issues, such as administrative concerns, communication problems, and lack of clinical knowledge. For example, a communication problem between a staff· nurse and physician may be resolved if an APN acts as a facilitator, ensuring that each. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.Advanced Practice Nurse Assignment Papers.

5095. Prespecialty Clinical Directed Study [Formerly NURS 262] This clinical course is designed to facilitate prespecialty student maintenance of clinical competencies in the event the student is unable to progress as planned in the clinical course curriculum of the prespecialty level. Students enrolled in this course will complete independent review of prior clinical and non-clinical course content, supervised laboratory practice, and facilitated clinical experience as directed by the faculty to demonstrate maintenance of clinical competency at the level of the last successfully completed prespecialty course. Prerequisite: Successful completion of at least one prespecialty clinical course. [1]
5101. Legal and Ethical Accountability in Professional Nursing Practice [Formerly NURS 215] This course provides an opportunity for the student to explore current legal and ethical issues in health care. Students will gain understanding of legal and ethical concepts, applying them in identification and analysis of complex scenarios affecting professional nursing practice. Legal principles, nursing liability, ethical theories, and decision-making are discussed as foundational concepts for professional nursing practice.Advanced Practice Nurse Assignment Papers. Corequisites: 5103, 5105, 5106, 5115. [2] Fall
5103. Human Experience of Health and Illness Across the Lifespan I [Formerly NURS 235] Nursing 5103 is the first of three didactic courses examining the human experience of health and illness across the lifespan from infancy through senescence. The framework incorporates the following concepts and their influence on health and response to illness: growth and development, mental health, gender, lifestyle, value systems, spirituality, ethnicity, environment, and psychosocial, economic, and cultural issues. The impact of these factors on individuals, families, and aggregates will be explored. Basic concepts/knowledge of selected interventions will be introduced. Selected health problems involving the sensory, hematological, endocrine, renal/urinary, cardiovascular, and respiratory systems will be presented; the epidemiology, pathophysiology, medical management (select pharmacologic, non-pharmacologic, and surgical), and nursing management will be addressed. Advanced Practice Nurse Assignment Papers. Health promotion, including primary, secondary, and tertiary, anticipatory guidance, and patient education will be discussed. Corequisite: 5101, 5105, 5106, 5115. [4] Fall
5105. Enhancement of Community and Population Health I [Formerly NURS 225] This course is the first in a sequence of three clinical practice courses designed to provide the student with an opportunity to explore population and community-based health care principles that impact the client. Healthy People 2020 will be used as a framework to determine the health status of the community. Notably, the course will provide the student knowledge on how the social determinants of health impact the health of the community. In addition, resources will be discussed in relation to the availability, barriers,and access in the community. The community clinical experience is designed to provide the student the opportunity to work within a community organization or agency to assess and identify specific challenges to maximizing the health of persons in communities and populations. Corequisite: 5101, 5103, 5106, 5115. [3] Fall
5106. Pharmacology for Nursing Care I [Formerly NURS 255A] This course presents an introduction to pharmacologic knowledge, the clinical indications for drug use as a treatment modality, and the role of the nurse in drug therapy. The course will present content on the prototype drug from major drug classifications that serves as a framework for continued self-study of new drug information. Advanced Practice Nurse Assignment Papers. Emphasis will be placed on major drug classifications and their respective prototype drug(s) that are more commonly encountered in drug therapy. Corequisite: 5101, 5103, 5105, 5115. [2] Fall
5115. Fundamentals of Clinical Practice [Formerly NURS 245] This course is the first in a sequence of three clinical practice courses. The course is designed to provide the student with the opportunity to acquire the knowledge, skills, and attitudes required to apply the nursing process (assessment, analysis, planning, intervention, and evaluation) in the delivery of client-centered nursing care. Students will learn and practice assessment and intervention skills in a didactic classroom setting and in a simulated laboratory setting and progress to full application of the nursing process in an adult medical/surgical clinical setting with maximum faculty guidance. Corequisite: 5101, 5103, 5105, 5106. [5] Fall
5201. Inquiry and Evidence in Professional Nursing Practice [Formerly NURS 216] This course provides an introduction to nursing research and the evidence based practice process. Special emphasis is placed on integration of nursing science with clinical judgment and patient preferences for care. Students gain knowledge of the contributions of qualitative and quantitative research to clinical practice.Advanced Practice Nurse Assignment Papers. Knowledge development and the interrelationships among theory, practice and research are discussed. The nurse’s role as advocate for human subjects in research is presented. Students identify clinical problems, search scholarly literature for information related to those problems, and critically appraise the scholarly information for application to clinical practice. The course culminates with the presentation of an evidence based nursing project addressing a selected clinical problem for the purpose of improving patient outcomes. Prerequisites: 5101, 5102, 5103, 5105, 5106, 5115; corequisites: 5203, 5205, 5206, 5215. [2] Spring
5203. Human Experience of Health and Illness Across the Lifespan II [Formerly NURS 236] Nursing 5203 is the second of three didactic courses examining the human experience of health and illness across the lifespan from infancy through senescence, including the childbearing cycle.Advanced Practice Nurse Assignment Papers. The framework incorporates the following concepts and their influence on health and response to illness: growth and development, mental health, gender, lifestyle, value systems, spirituality, ethnicity, environment, and psychosocial, economic, and cultural issues. The impact of these factors on individuals, families, and aggregates will be explored. Basic concepts/knowledge of selected interventions will be introduced. Selected health problems involving mental health disorders with appropriate treatment modalities and settings, gastrointestinal, reproductive (including maternity focus) systems, and care of the client with cancer will be presented.Advanced Practice Nurse Assignment Papers. The epidemiology, pathophysiology, medical management (non-pharmacologic, and surgical), and nursing management will be addressed. Health promotion, including primary, secondary, and tertiary, anticipatory guidance, and patient education will be discussed. Prerequisite: 5101, 5102, 5105, 5103, 5115, 5106. Corequisite: 5201, 5205, 5215, 5206. [5] Spring
5205. Enhancement of Community and Population Health II [Formerly NURS 226] This course is the second in a sequence of three clinical practice courses designed to provide the student with an opportunity to explore population and community based health care principles that impact the client. Advanced Practice Nurse Assignment Papers. This course will provide the student with an opportunity to use evidence-based practice to enhance the knowledge base regarding factors that impact the client’s health status within the community and population. This course will focus on how evidence-based practice may be used to increase healthy lifespans, decrease discrepancies in health status and improve health outcomes. The course explores population-based care models and environments in which health care is delivered: community agencies, clinics, neighborhoods/communities, schools, the family, and the workplace. Prerequisite: 5101, 5102, 5105, 5103, 5115, 5106. Corequisite: 5201, 5203, 5215, 5206. [3] Spring
5206. Pharmacology for Nursing Care II [Formerly NURS 255B] This course extends and builds upon pharmacological knowledge from earlier pharmacology courses and the Health and Illness Across the Lifespan series. The focus of the course is drug therapy most commonly seen in specific clinical settings and specific patient situations.Advanced Practice Nurse Assignment Papers. The course presents a context for safe drug administration and for continued self-study of new drug information. Emphasis is placed on pharmacological interventions to achieve safe and optimal patient outcomes. Prerequisite: 5101, 5102, 5105, 5103, 5115, 5106. Corequisite: 5201, 5205, 5203, 5215. [2] Spring
5215. Integration of Theoretical and Clinical Aspects of Nursing I [Formerly NURS 246] This course is the second of a sequence of three clinical practice courses. It is designed to provide the student with the opportunity to integrate theory, practice, and evidence in the application of the nursing process in a clinical setting for diverse client aggregate populations across the lifespan (child-bearing families/newborn health, pediatric and adolescent health, adult and older adult health, and psychiatric/mental health). Students will analyze and integrate aggregate specific concepts in the provision of client-centered care in a variety of health care settings with moderate faculty guidance.Advanced Practice Nurse Assignment Papers. Prerequisite: 5101, 5102, 5105, 5103, 5115, 5106. Corequisite: 5201, 5205, 5203, 5206. [3] Spring
5301. Leadership and Management in Professional Nursing Practice [Formerly NURS 217] This course provides an introduction to leadership and management in nursing. Course content focuses on leadership and decision-making theories, power and influence, team building, communication, and problem solving skills. The course is designed to facilitate transition to practice and management of professional issues that reflect the current complexity in provision of care with respect to patient, organizational, and professional advocacy. Quality improvement and management skills will be emphasized including delegation and assignment, managed care, outcomes management, resource allocation, conflict resolution, and economic principles pertinent to the efficient and effective delivery of health care services. Prerequisite: 5101, 5201; corequisite: 5303, 5305, 5306, 5315, 5325. [2] Summer
5303. Human Experience of Health and Illness Across the Lifespan III [Formerly NURS 237] This is the third of three didactic courses examining the human experience of health and illness across the lifespan – from infancy through senescence – with an emphasis on increasing complex acute and chronic issues. The course provides the student with the theoretical basis to apply principles of chronic illness, including assessment and intervention skills, to at-risk populations.Advanced Practice Nurse Assignment Papers. The impact of multi-system factors on individuals, families, and aggregates or populations/communities will be explored.Advanced Practice Nurse Assignment Papers. The epidemiology, pathophysiology, medical management (pharmacologic, non-pharmacologic, and surgical), and nursing management for selected health problems will be addressed. Health promotion, anticipatory guidance, and patient education will be discussed. Prerequisite: 5101, 5201, 5102, 5105, 5205, 5103, 5203, 5115, 5215, 5106, 5206. Corequisite: 5301, 5305, 5315, 5325, 5306. [Prerequisites and corequisites apply to non-R.N. students only.] [4] Fall, Summer
5305. Enhancement of Community and Population Health III [Formerly NURS 227] This course is the third in a sequence of three clinical practice courses designed to provide the student with an opportunity to explore population and community-based health care principles that impact the client. This course addresses healthcare systems related issues that impact the client’s ability to maintain and maximize health. Students will have the opportunity to build on their knowledge of clients within communities and populations, collaborate to synthesize and evaluate data, identify appropriate programs, and disseminate findings. Advanced Practice Nurse Assignment Papers. Prerequisite: 5101, 5201, 5102, 5105, 5205, 5103, 5203, 5115, 5215, 5106, 5206. Corequisite: 5301, 5303, 5315, 5325, 5306. [2] Summer
5306. Pharmacology for Nursing Care III [Formerly NURS 256] This course presents pharmacologic knowledge, the clinical indications for medication use as a treatment modality, and the role of the nurse in medication therapy. Emphasis is placed on the variations of pharmacologic therapy in critical and complex situations with the goal of achieving safe and optimal client outcomes in specific situations. Major medication classifications and commonly encountered prototype(s) within specialty areas will serve as a framework for continued learning of new pharmacologic information.Advanced Practice Nurse Assignment Papers. Additionally, this course engages students in group activities which require collaboration, negotiation, and rationalizations of decisions essential for client centered care.. Prerequisite: 5101, 5201, 5102, 5105, 5205, 5103, 5203, 5115, 5215, 5106, 5206. Corequisite: 5301, 5305, 5303, 5315, 5325. [1] Summer
5315. Integration of Theoretical and Clinical Aspects of Nursing II [Formerly NURS 247A] This course is the final rotation of the second in the sequence of three clinical practice courses.Advanced Practice Nurse Assignment Papers. This course is designed to provide the student with the opportunity to integrate theory, practice, and evidence in the application of the nursing process in a clinical setting for diverse client aggregate populations across the life span (child-bearing families/newborn health, pediatric and adolescent health, adult and older adult health, and psychiatric/mental health). Students will analyze and integrate aggregate specific concepts in the provision of client-centered care in variety of health care settings with moderate faculty guidance. Prerequisite: 5101, 5201, 5102, 5105, 5205, 5103, 5203, 5115, 5215, 5106, 5206. Corequisite: 5301, 5305, 5303, 5325, 5306. [1] Summer
5325. Capstone Clinical Practicum [Formerly NURS 247B] This course is the third in a sequence of three clinical practice courses.Advanced Practice Nurse Assignment Papers. This course is designed to provide the student with the opportunity to synthesize theory, practice, and evidence in the application of the nursing process for multiple complex adult medical-surgical clients. Students will synthesize acquired knowledge, skills, and attitudes to prevent illness and promote health, prioritize and delegate nursing care, and engage as leaders within the inter-professional health care team to meet the needs of clients on the continuum of health. Prerequisite: 5101, 5201, 5102, 5105, 5205, 5103, 5203, 5115, 5215, 5106, 5206. Corequisite: 5301, 5305, 5303, 5315, 5306. [2] Summer
5401. Critical Thinking, Supporting Evidence and Communication, Part 1 [Formerly NURS 218A] This course focuses on identification of the unique strengths/perceptions of each RN student and a development of an individualized plan for learning. The course assists RN students in identifying and developing strategies to foster critical thinking, lifelong learning, and nursing practice role development. Advanced Practice Nurse Assignment Papers. Theory development and research are introduced as processes essential to the organization and development of nursing knowledge. Limited to RN students. [3] Fall
5402. Epidemiology and Population-Based Nursing [Formerly NURS 228] This course provides the student with an opportunity to explore population-based health care principles of prevention, health maintenance and health promotion within the context of Healthy People 2010.Advanced Practice Nurse Assignment Papers. Notably, the course will focus on how these principles are used to increase healthy lifespan, decrease discrepancies in health status and health outcomes for different populations and assure access to preventive services for all. It emphasizes epidemiologic principles and population-based holistic health promotion/disease prevention as an integral part of populations at risk for illness, disability, or premature death. Further, the course explores population-based care models and environments in which health care is delivered: community agencies, neighborhoods/communities, schools, the family, and the workplace. Legislation and policy implications for primary, secondary, and tertiary care will be discussed. [3] Fall
5403. Health Care Systems and the Role of the Nurse as Facilitator of Learning [Formerly NURS 238] This course addresses health care systems and the role of the nurse as teacher and facilitator of learning in health care. Course content focuses on leadership concepts, decision-making, team building, communication, managerial skills, and integrates the foundational concepts of teaching and counseling patients and families. The course also provides information on contemporary trends in the organization and delivery of health care to individuals, families and populations to include quality improvement and legal/regulatory issues. In addition, course content will include the impact of managed care and financial pressures on health care providers along with outcomes management, financial management, conflict resolution and economic principles pertinent to the delivery of health care services. Advanced Practice Nurse Assignment Papers. The course provides concepts related to change management and the teaching and learning processes. Corequisites: 5401, 5402, 5303. [3] Fall
5501. Critical Thinking, Supporting Evidence and Communication, Part 2 [Formerly NURS 218B] This course is the second of a two course sequence addressing critical thinking, research utilization, and communication. Students in this course will identify, evaluate, and engage the various steps of scholarly inquiry in order to address research problems related to professional nursing practice. Students also will explore the theoretical and research foundations for evidence-based practice in nursing. Prerequisite: 5401. [2] Spring
5502. Advanced Practice Nurse Assignment Papers. Ethics in Nursing Practice [Formerly NURS 219] This didactic and seminar course addresses basic ethical principles and special problems/issues as sources for ethical reflection. Ethical dilemmas in health care are discussed using professional and analytical methods of investigation. Students are expected to reflect on their personal values and beliefs, ethical principles, clinical experiences, and literature sources while engaging in all assignments. Prerequisite: 5401. [2] Spring
5505. Health Assessment for the Registered Nurse [Formerly NURS 248] This course is designed to provide the RN student the opportunity to learn and practice the skills of assessment in a classroom, laboratory setting, and then in a clinical area for a variety of client populations across the life span. The student’s specialty population will be considered in the choice of health care setting utilized for practice. Prerequisite: 5303, 5402. Corequisite: 5506. [3] Spring
5506. Pharmacology for the Registered Nurse [Formerly NURS 259] This course extends and builds upon pharmacological knowledge from foundational pharmacology courses and pathophysiology courses. The focus of the course is the variations of drug therapy in complex situations. The course presents cases of complex drug regimens for analysis and evaluation by the student. Emphasis will be placed on pharmacological interventions to achieve safe and optimal patient outcomes in specific situations. [3] Spring
5515. Providing Care at the Community Level [Formerly NURS 249] This course is an introduction to the scope and practice of family and community health nursing.Advanced Practice Nurse Assignment Papers. It emphasizes, through didactic and community practice, the promotion and maintenance of the health of diverse populations across the lifespan. The epidemiological process and the nursing process serve as the organizing framework for didactic content and clinical interventions to support family and community health. Social, cultural, economic, environmental, and ethical issues related to specific populations will be explored. Limited to RN students. Prerequisite: 5402; or with permission of instructor. [3] Spring
5598. Independent Study – Non Clinical [Formerly NURS 251] Ind Study – Non Clinical [1-6]
5999. [Clinical Continuation] [Formerly NURS 3000] MSN, post-master’s certificate, or DNP students enroll in this course to resolve an incomplete grade in a prior semester’s clinical course. Enrollment in the course is considered to carry at least half-time status.Advanced Practice Nurse Assignment Papers. Tuition is charged at a flat rate of $200. Students may enroll in this course no more than twice. Offered as needed. [0] Fall, Spring, Summer
Specialty Nursing Courses and Electives
6010. Advanced Pathophysiology [Formerly NURS 308] This is a graduate level, advanced pathophysiology course designed to meet the educational needs of those pursuing certification as advanced practice nurses. The course builds on pre-acquired knowledge of normal human anatomy and physiology. Classic and current research findings form the basis for analysis of pathophysiologic processes and their effect on individual and multiple body systems. Students analyze the effect and progression of selected disease entities in diverse populations across the lifespan. Advanced Practice Nurse Assignment Papers. The course provides a foundation for clinical assessment, diagnosis and management of clients experiencing alterations or risks of alterations in their health status. Pre/corequisite: Courses in normal human anatomy and physiology. [3] Fall, Spring
6011. Advanced Health Assessment and Clinical Reasoning [Formerly NURS 305A] This course is the foundational didactic course for advanced nursing practice. Students differentiate abnormal from normal findings using advanced assessment techniques, interpret diagnostic study results and use clinical reasoning to formulate diagnoses for culturally diverse individuals. Health promotion and disease prevention strategies are discussed. Prerequisite: Admission to specialty and graduate level standing. [2] Fall
6011L. Advanced Health Assessment Lab This course is the foundational physical exam and health assessment lab companion course for Advanced Health Assessment, N6011 for advanced nursing practice.Advanced Practice Nurse Assignment Papers. Students differentiate abnormal from normal findings using advanced assessment techniques, interpret diagnostic study results and use clinical reasoning to formulate diagnoses for culturally diverse individuals. Students interpret data and problem-solve utilizing case studies and standardized patients. Prerequisite: Admission to specialty and graduate level standing. [1] Fall
6020. Advanced Pharmacotherapeutics [Formerly NURS 307] This course is designed to provide students with the knowledge of pharmacokinetics that will enable the student to safely and appropriately select pharmacologic agents for the management of common acute and chronic health problems of diverse populations.Advanced Practice Nurse Assignment Papers. Specific content of the course covers representative drugs of a pharmacologic group, indications for use, drug selection, titration of dose, key adverse effects, and monitoring of therapy and alternative therapy. [3] Fall, Spring
6025. Applied Quality Improvement and Patient Safety [Formerly NURS 383A] This course focuses on the application of quality improvement methodology and measurement of outcomes across a broad range of health care settings. Students learn the systematic methods of continuous quality improvement, based on the work of Deming and others. The use of various outcome measurement instruments and data collection tools are explored. Prerequisite: 6065. [2-3] Spring
6030. Advanced Practice Nursing in Primary Care of the Adult [Formerly NURS 309A] This course is designed to provide students with knowledge needed to assess and manage common acute and chronic health problems in the adult population. Multidimensional interventions are discussed (e.g., culturally and environmentally sensitive; health promoting). Pre/corequisite: 6101 or 6011. [3] Fall, Spring
6031. Advanced Practice Nursing in Primary Care of the Adolescent [Formerly NURS 309C] This didactic course presents knowledge that is necessary for the practice of primary health care nursing of adolescents. Course content includes the principles of health promotion, disease prevention and assessment, and management of common primary health care problems in diverse adolescent populations. Emphasis is placed on developmental needs and the pathophysiologic processes underlying certain conditions. The impact of the family on the health of the adolescent is explored. Students are introduced to the dynamics of the managed care environment. Pre/corequisite: 6011 or 6101. [1] Fall, Summer
6032. Advanced Practice Nursing in the Primary Care of the Woman [Formerly NURS 309E] This didactic course presents the knowledge that is necessary for the practice of primary care of the female patient by advanced practice nurses. Course content includes the principles of health promotion, disease prevention and assessment, and the management of common primary health care problems in the female population. Emphasis is placed on management of women’s health issues in a general, primary care setting.Advanced Practice Nurse Assignment Papers. Pre/corequisite: 6011. [1] Spring
6034. Adult Gerontology Primary Care I [Formerly NURS 310A] This course is designed to provide students with knowledge needed to assess and manage common acute and chronic health problems in the adult population.Advanced Practice Nurse Assignment Papers. Multidimensional interventions are discussed (e.g., culturally and environmentally sensitive, health promoting). Pre/corequisite: 6011. [3] Fall
6036. Advanced Practice Nursing in Primary Care of the Child and Adolescent This course presents knowledge necessary for the practice of primary health care of children and adolescents. Course content includes the principles of health promotion, disease prevention, and assessment and management of common primary health care problems in diverse pediatric and adolescent populations ages 0-21 years. Emphasis is placed on developmental needs and the pathophysiologic processes underlying certain conditions. The impact of the family on the health of the child/adolescent is explored. This course builds on pre-requisite knowledge by exploring the pathophysiologic disease processes underlying certain conditions that are specific to the pediatric and adolescent population as well as exploring treatment of these processes. Pre/corequisite: 6011. [3] Spring
6040. Introduction to Health Informatics [Formerly NURS 381A] Health informatics is the management and transformation of health data into information and knowledge to improve aspects of health outcomes such as cost, quality, safety, and/or satisfaction. This survey course focuses on information systems in clinical settings and the use of information for health systems management.Advanced Practice Nurse Assignment Papers. The recent emphasis on the National Health Information Infrastructure at the Federal level will be used to frame the topics. Examples include organizing information pertinent to individual patient care, analyzing data to determine clinical effectiveness, retrieving needed information or knowledge at the point of care, using data to improve management of health care enterprises, and assessing the health patterns of populations and aggregates. Pre/corequisite: Basic competency in using word processing, electronic mail, bibliographic or library retrieval systems, presentation graphics, spreadsheets, and databases. These skills are not taught in the course, but students may be required to apply them to carry out course assignments. [3] Fall
6041. Principles of Health Care Finance [Formerly NURS 385A] In this course, students learn to apply accounting and economic principles, and financial management strategies to effectively manage health care resources in health care organizations. Students acquire the knowledge and skills to utilize computer software for conducting efficient financial analysis. [3] Spring
6045. Professional Formation 1: Roles and Contexts for Advanced Nursing Practice This course offers an introduction to the principles, concepts, and frameworks for advanced nursing practice. Students will integrate principles of evidence-based practice, quality and safety, leadership, ethics, policy, and role development. Students will identify the role of advanced nursing practice in the healthcare environment with emphasis on leadership in quality and safety as a part of interprofessional teams. [2] Fall
6055. Professional Formation 2: Application of Evidence in Healthcare Environments This course is the second in a series of courses facilitating Professional Formation in the Advanced Nursing Practice role.Advanced Practice Nurse Assignment Papers. Students will develop skills to evaluate and synthesize supporting evidence and examine ethical dilemmas of implementation, to develop and articulate innovative solutions. Advanced Practice Nurse Assignment Papers. Students will learn how to assess clinical processes, identify advanced nursing practice problems, and determine how to address problems. Prerequisite: 6045. [3] Spring
6060. Conceptualization and Integration of Evidence for Advanced Nursing Practice [Formerly NURS 399B] This course provides the student with the opportunity to explore a relevant problem in advanced nursing practice. Concepts related to the selected problem are identified and critically appraised. Methodologies to generate evidence will be presented to examine knowledge related to the selected problem and make practice recommendations. This course builds upon prerequisite knowledge. Prerequisite: 6050. [3] Summer
6065. PF 3: Leading Collaborative Change: Improving Delivery of Healthcare to Patients and Populations This course is the third in a series building Professional Formation in an advanced nursing practice role.Advanced Practice Nurse Assignment Papers. Students will develop leadership skills for participation in interprofessional teams to address practice problems and improve care delivery. Students will plan evidence-based solutions that meet the six aims for healthcare quality from the Institute for Healthcare Improvement. Students will be prepared to advocate for policy change at the institutional, state, and federal level to improve the health of populations. Prequisite: 6055. [4] Summer
6070. APN Role Within the U.S. Healthcare Delivery System [Formerly NURS 395] This course provides students with an understanding of how the U.S. healthcare system works, including major components of both service delivery and financing of care. Students analyze and evaluate the healthcare delivery system, focusing on the role of the Advanced Practice Nurse within the system. The relationships between and among the various stakeholders, including consumers, providers, payers, regulatory agencies, and policy makers, are explored as well as their impact on healthcare delivery. The focus is on economic implications of health planning, organization of personnel and resources, design of payment systems, and cost effectiveness of healthcare delivery. [3] Fall, Summer
6075. Professional Formation 4: Transition to Advanced Nursing Practice This course facilitates professional formation through transition to the advanced nursing practice role. Students will evaluate practice settings appropriate for their scope and navigate the employment search and hiring process.Advanced Practice Nurse Assignment Papers. Students will also explore the credentialing/privileging process and will discuss strategies for continued professional development. [1] Summer
6080. Local Applications of Global Health This is a 1 credit hour elective course designed for graduate students interested in the local context of global health applications. This course will consist of weekly discussions led by interdisciplinary experts in global health, within and outside of VU. Topics will focus on interdisciplinary innovations that alleviate health disparities in diverse settings locally and abroad. Students will engage in learning through readings, attendance and participation in discussion and debates at weekly seminars and assignments.Advanced Practice Nurse Assignment Papers. This course is designed for students interested in reciprocity in global health and caring for underserved populations locally and abroad, and builds on a diverse base of prerequisite knowledge in interdisciplinary fields pertaining to health, social justice, sustainable development, and working in interdisciplinary teams. [1] Spring
6084. Planetary Health, Policy and Social Justice This is a 3 credit hour elective course designed for students interested in exploring the intersections between primary care, planetary health and climate change (according to WHO, currently the greatest threat to global health), social justice and policy. The causes of climate change and the resulting primary, secondary and tertiary impacts on people and communities will be examined through the lens of global health and policy.Advanced Practice Nurse Assignment Papers. Students will work with local agencies to develop evidence-based and targeted adaptation and mitigation strategies as well as policy-based solutions, all incorporating science and engineering, political science and policy, law and economics as well as nursing and medicine to address healthspan disparities related to climate change and social vulnerability. [3] Spring
6085. Professional Formation 5: Role of the APN in Improving Delivery of Healthcare – Indiv. & Populations Students will identify the role of advanced nursing practice in the healthcare environment with emphasis on leadership in quality and safety as a part of interprofessional teams. Students will incorporate ethical principles in clinical scenarios and in the use of current and emerging technologies. Advanced Practice Nurse Assignment Papers. Students will develop plans for system change to deliver high quality care to patients and populations. [2] Summer
6090. JOINT STUDIES MED SCHOOL
6091. LGBTI Health in Inter-professional Practice Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Health in Inter-professional Practice is a course focusing on specific healthcare needs (from the perspective of many health-related professions) of people who identify as a sexual or gender minority. Guidance for self-exploration of biases, discomforts, strengths and talents that may impede or restore the provision of equitable healthcare delivery for LGBTI people will be provided. Language, sexual development, disease prevention, health risks and legal and ethical issues related to gender identity and sexual orientation will be defined and explored within the context of different healthcare environments. Additionally, specific healthcare concerns for patients with disorders of sexual development (DSD) or intersex will be explored. Students will interact with inter-professional and -disciplinary team members while developing knowledge and skills to provide expert and equitable care for LGBTI people. Advanced Practice Nurse Assignment Papers. Students will engage in learning through readings, synchronous and asynchronous discussions, written assignments and a discipline-specific project. Pre/corequisite: Admission to any graduate or professional degree program across the Vanderbilt campus. [2] Summer
6098. Independent Study, Non-Clinical [Formerly NURS 370] Content varies according to individual needs and interest. A contract is made between the student and the faculty sponsor, with copies for the student, the sponsor, the program director, and the student’s record. [Variable credit 1-6] Fall, Spring, Summer
6099. Independent Study: Clinical [Formerly NURS 371] A program of independent study in a selected area of nursing practice under the direction of a faculty sponsor. A contract is made between the student and the faculty sponsor, with copies for the student, the sponsor, the program director, and the student’s record. [Variable credit 1-6] Fall, Spring, Summer
6101. Advanced Health Assessment and Clinical Reasoning [Formerly NURS 305F] Students differentiate abnormal from normal findings using advanced assessment techniques, interpret diagnostic study results, and use clinical reasoning to formulate diagnoses for culturally diverse adults and older adults. Students interpret data and problem solve utilizing case studies and surrogate patients.Advanced Practice Nurse Assignment Papers. Health promotion and disease prevention strategies are discussed. Prerequisite: Admission to specialty and graduate level standing. [3] Fall
6102. Advanced Physiology and Pathophysiology [Formerly NURS 306A] This course provides in-depth discussion of complex physiologic and pathophysiologic concepts across the lifespan essential for advanced practice nursing of adult and geriatric patient populations in acute care settings. Physiology of each organ system is discussed from the cellular level to the function of organ systems. Emphasis is placed on integrating physiologic concepts to predict, evaluate, and manage pathologic processes. Prerequisite: Courses in undergraduate level human anatomy and physiology. [4] Fall
6103. Advanced Pharmacotherapeutics [Formerly NURS 307C] This course builds on knowledge of the basic principles of pharmacology to establish a knowledge base for clinical judgments in the pharmacologic management and evaluation of adults and older adults as related to the role of Adult-Gerontology Acute Care Nurse Practitioners.Advanced Practice Nurse Assignment Papers. Drug interactions, incompatibilities, side effects, and contraindications are discussed. Appropriate patient education is integrated. Pre/corequisite: 6102. [3] Fall
6105. Advanced Health Assessment Applications for the Adult-Gerontology Acute Care Nurse Practitioner [Formerly NURS 305B] This course builds on knowledge of advanced health assessment with a focus on clients commonly seen in the acute care practice setting. Advanced health assessment skills include obtaining appropriate health histories and performing physical examinations on adult patients with complex problems in a variety of acute and chronic health care settings, as well as participating in direct patient care.Advanced Practice Nurse Assignment Papers. In addition, the course emphasizes proper documentation of data obtained from the history and physical exams and the development of appropriate differential diagnoses, problem lists, and therapeutic plans of care. Pre/corequisite: 6101, graduate-level standing, admission to the specialty. [1] Fall
6114. Pathophysiology and Collaborative Management in Acute Care for the Adult-Gerontology ACNP I NURS 6114 is the first of a three-course series that explores, at an advanced level, pathophysiology, assessment, diagnoses, and collaborative management of adults and older adults with selected episodic/chronic health problems in acute/critical care. Each student demonstrates in writing his or her ability to analyze, integrate, and synthesize pathophysiologic concepts and current research findings for collaborative management of adult health problems. The course goals are met through didactic content and case study analyses. Pre/corequisite: 6102, 6103. [2]
6115. Adult-Gerontology Acute Care Nurse Practitioner Practicum [Formerly NURS 342A] This course is designed to provide clinical experience in development and application of the roles of the acute care nurse practitioner.Advanced Practice Nurse Assignment Papers. The students apply and evaluate nursing theory and pathophysiologic and psychosocial concepts in planning and delivery of care in clinical settings. The student practices in clinical settings for a total of 280 hours. Clinical conferences are held weekly and focus on pathophysiology, diagnoses, and therapeutic management related to episodic/chronic problems in acute/critical care in the adult population. Prerequisite: 6101, 6102, 6103, 6105, 6114; corequisite: 6124. [4] Spring
6123. Pathophysiology and Collaborative Management in Acute Care for the Adult-Gerontology ACNP II [Formerly NURS 340B] This course explores, at an advanced level, the pathophysiology, assessment, diagnosis, and collaborative management of adults and older adults with selected episodic/chronic health problems in acute/critical care, including oncology and renal and fluid and electrolyte disorders.Advanced Practice Nurse Assignment Papers. Each student demonstrates his/her ability to analyze, integrate, and synthesize pathophysiologic concepts for collaborative management of adult health problems. The course goals are met through didactic content and case study analyses. Pre/corequisite: 6050. Prerequisite: 6102, 6103, 6113. [3] Spring
6124. Pathophysiology and Collaborative Management in Acute Care for the Adult-Gerontology ACNP II NURS 6124 is the second of a three-course series that explores, at an advanced level, pathophysiology, assessment, diagnoses, and collaborative management of adults and older adults with selected episodic/chronic health problems in acute/critical care. Each student demonstrates in writing his or her ability to analyze, integrate, and synthesize pathophysiologic concepts and current research findings for collaborative management of adult health problems. Advanced Practice Nurse Assignment Papers. The course goals are met through didactic content and case study analyses. Prerequisite: 6045, 6102, 6103, 6114. Pre/corequisite: 6055. [4] Spring
6125. Adult-Gerontology Acute Care Nurse Practitioner Practicum [Formerly NURS 342B] This course is designed to provide clinical experience in development and application of the roles of the acute care adult nurse practitioner.Advanced Practice Nurse Assignment Papers. The clinical setting will be used for application and evaluation of nursing theory and pathophysiologic and psychosocial concepts in planning and developing care for culturally diverse adults and older adults in the clinical setting. The student will practice in clinical settings for a total of 140 hours. Clinical conferences will be held weekly and will focus on pathophysiology, diagnoses, and therapeutic management related to episodic/chronic problems in acute/critical care in the adult population. Pre/corequisite: 6011 or 6101, 6102, 6103, 6114, 6305. [2] Spring
6133. Pathophysiology and Collaborative Management in Acute Care for the Adult-Gerontology ACNP III [Formerly NURS 340C] This course is third in a sequence of courses that explores, at an advanced level, the pathophysiology, assessment, diagnosis, and collaborative management of adults and older adults with selected episodic/chronic health problems in acute/critical care, including hematologic, hepatic, endocrine, and gastrointestinal disorders as well as psychosocial needs. Each student demonstrates his or her ability to analyze, integrate, and synthesize pathophysiologic concepts for collaborative management of adult health problems. The course goals are met through didactic content and case study analyses. Prerequisite: 6050, 6102, 6103, 6113 & 6123. Corequisite: 6060 & 6070. [3] Summer
6134. Pathophysiology and Collaborative Management in Acute Care for the Adult-Gerontology ACNP III This course is third in a sequence of courses that explores, at an advanced level, the pathophysiology, assessment, diagnosis, and collaborative management of adults and older adults with selected episodic/chronic health problems in acute/critical care, including hematologic, hepatic, endocrine, and gastrointestinal disorders as well as psychosocial needs.Advanced Practice Nurse Assignment Papers. Each student demonstrates his or her ability to analyze, integrate, and synthesize pathophysiologic concepts for collaborative management of adult health problems. The course goals are met through didactic content and case study analyses. Prerequisite: 6045, 6055, 6102, 6103, 6114, 6124. Pre/corequisite: 6065, 6075. [3] Summer
6135. Adult-Gerontology Acute Care Nurse Practitioner Practicum in Intensive Care [Formerly NURS 342C] This course is designed to provide clinical experience in development and application of the roles of the acute care adult nurse practitioner with an intensivist focus.Advanced Practice Nurse Assignment Papers. The clinical setting will be used for application and evaluation of pathophysiologic and psychosocial concepts in planning and developing care in the clinical setting. Student will be assigned to multidisciplinary critical care teams and will rotate through these teams during the course. The student will practice in clinical settings for a total of 210 hours. Clinical conferences will be held weekly and will focus on pathophysiology, diagnoses, and therapeutic management related to episodic/chronic problems in critical care in the adult population. Prerequisites: 6101, 6102, 6103, 6105, 6114; Pre/corequisite: 6124. [4] Spring
6140. Introduction to Transplantation [Formerly NURS 345] This elective course consists of didactic content related to the care of adults undergoing transplantation with emphasis on immunology, immunosuppression, and criteria for transplantation, as well as complications related to transplantation and immunosuppression. An overview of transplantation of the heart, lung, liver, kidney, pancreas, and bone marrow is presented. Ethical, psychosocial, and donor selection/management issues are discussed. [2] Spring
6141.Advanced Practice Nurse Assignment Papers. Introduction to Neurocritical Care and Management of Neurological Disease This course provides an introduction into the subspecialty field of neurocritical care and management of neurological disease across care settings (i.e. outpatient specialty clinic to intensive care). This course will build upon a foundational understanding of neurocritical care and management of neurological disease specific to the role of the AGACNP or ENP. Prerequisite: 6101, 6102, 6103, 6114. [2] Summer
6142. Concepts in Advanced Trauma Nursing [Formerly NURS 396G] This course explores, at an advanced practice level, pathophysiology, assessment and diagnosis and collaborative management of adults who have experienced a severe trauma. Each student will demonstrate in writing his or her ability to analyze, integrate, and synthesize pathophysiologic concepts and current research findings for the collaborative management of trauma patients. Pre/corequisite: 6101, 6105 and 6114. [2] Spring
6143. Fundamentals of Point of Care Ultrasound for the Advanced Practice Provider This course introduces advanced practice students to the utilization of point of care ultrasound (POCUS) in clinical practice.Advanced Practice Nurse Assignment Papers. Course concepts include basic ultrasound physics and mechanics, anatomical landmarks in the context of pathophysiology, ultrasound exam types, and ultrasound methods for diagnostic, procedural and therapeutic applications of the technology in patient care. Students will participate in module-based didactics and apply course concepts during hands on simulation experiences. Pre/corequisite: 6102. [2] Summer
6147. Advanced Concepts in Cardiovascular Nursing [Formerly NURS 347] This course is designed to provide a conceptual basis for the diagnosis and treatment of human response to actual and/or potential cardiovascular health problems. The concomitant influence of physical, psychological, social, cultural, and environmental variables will also be explored. Emphasis is placed on acute and/or critically ill adult and older-adult patients with alterations in cardiovascular health states, as well as on the selection and application of concepts and theories relevant to advanced cardiovascular nursing. N347 is an elective support course for students within the Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) Program who wish to develop a foundation for advanced practice in the management of cardiovascular disease. Learning experiences focus on management of cardiovascular disease in acute and critically ill adult and older-adult patient populations. Prerequisite: 6102, 6103 or with permission of course coordinator. [3] Spring
6148. Concepts of Diagnostics and Care for the Hospitalist Acute Care Nurse Practitioner [Formerly NURS 348] The course introduces basic concepts of hospital practice used by adult-gerontology acute care nurse practitioners. The Hospitalist manages care from admission of the adult and older adult patient from admission to discharge, in a variety of hospital settings and situations. Advanced Practice Nurse Assignment Papers. A variety of hospital topics will be covered in this course to include infectious disease, dermatology, wound care and hospital specific pulmonary and cardiac situations. Lab and diagnostic testing during all phases of the hospitalization process, consultation practice, working with ancillary services, including physical occupation and speech therapists and case management issues are also included in the course content. Concurrent enrollment in 6165 is strongly recommended but not required for enrollment in the course. Pre/corequisite: 6102. [2] Spring
6149. Advanced Critical Care Concepts for the ACNP Intensivist [Formerly NURS 396D] This course assists students in developing the competence to evaluate, diagnose and treat patients with a variety of complex critical illnesses. Students will be educated on a variety of advanced intensive care topics. The primary focus is on evidence-based practice diagnostics and treatment of the critically ill patient. This course builds on previous coursework, including the Acute Care Nurse Practitioner core courses. Prerequisite: 6102, and Fundamental Critical Care Support Provider Certification through the Society of Critical Care Medicine’s Course. [3] Spring
6155. Adult Gerontology Acute Care Nurse Practitioner Intensivist Practicum This course is designed to provide clinical experience in and application and integration of the roles of the adult gerontology acute care nurse practitioner as an intensivist. The clinical setting will be used for application, synthesis, and evaluation of nursing theory and pathophysiologic and psychosocial concepts.Advanced Practice Nurse Assignment Papers. The student will practice in clinical settings for a total of 280 hours and will focus on working with complex patients in a variety of intensive care units. Clinical conference will be held every week and will focus on pathophysiology, diagnoses, and therapeutic management related to critical care and acute care problems for the adult population in an intensive care setting or step down unit. Prerequisite: 6101, 6102, 6103, 6105, 6114, 6124, 6135, 6149. Pre/corequisite: 6134. [4] Summer
6165. Advanced Clinical Skills for the AG-ACNP Hospitalist The course engages the Hospitalist student in simulation geared toward diagnostic techniques and patient management strategies utilized by the adult-gerontology acute care nurse practitioner for hospitalized patients. Additional diagnostic skills and documentation techniques such as assessment note dictation will be introduced in this course. Procedures include I&D of an abscess and skin biopsy. Prerequisite: 6102. Advanced Practice Nurse Assignment Papers. Completion or current enrollment in 6148 is required for enrollment in the course. No exceptions will be made. [1] Spring
6170. Advanced Critical Care Simulation [Formerly NURS 396E] This course is designed to provide advanced cognitive and procedural experience in the critical care simulator at the Center for Experimental Learning and Assessment at the Vanderbilt School of Medicine.Advanced Practice Nurse Assignment Papers. Simulations are designed to provide clinical content surrounding the management of complex patients in the ICU setting. These class sessions provide an opportunity for students to integrate complex diagnostics and therapeutics with communication and team management skills. Sessions focus on clinical situations that student NPs are unlikely to directly manage during their clinical rotation where more experienced providers are available. Prerequisite: 6101, 6105, 6102, 6103, 6114, 6135, 6149. Pre/corequisite: 6134. [1] Summer
6185. Adult-Gerontology Acute Care Nurse Practitioner Preceptorship [Formerly NURS 343B] N6185 is the final acute care nurse practitioner clinical preceptorship, and is designed to provide clinical experience, application and integration of the roles of the acute care nurse practitioner for students in the dual AG-ACNP/FNP – Emergency Care program.Advanced Practice Nurse Assignment Papers. The emergency clinical setting will be used for application, synthesis, and evaluation of nursing theory, pathophysiologic and psychosocial concepts in planning and developing care for culturally diverse adults and older adults. The student will practice in clinical settings for a total of 280 hours, and will focus on working with complex patients. Clinical conference will be held weekly and will focus on pathophysiology, diagnoses, and therapeutic management related to episodic/chronic problems in adult acute/critical care. Pre-requisite: 6101, 6102, 6103, 6114, 6124, 6125, 6301, 6305 Pre/corequisite: 6134, 6385. [4] Summer
6195. Adult-Gerontology Acute Care Nurse Practitioner Preceptorship [Formerly NURS 343] This course is the final clinical preceptorship, and it is designed to provide clinical experience in and application and integration of the roles of the acute care nurse practitioner. The clinical setting will be used for application, synthesis, and evaluation of nursing theory and pathophysiologic and psychosocial concepts. The students practice in clinical settings for a total of 280 hours, and will focus on working with complex adult and older adult patients.Advanced Practice Nurse Assignment Papers. Clinical conference will be held every week and will focus on pathophysiology, diagnoses, and therapeutic management related to episodic/chronic problems in acute/critical care in the adult population. Prerequisite: 6101, 6102, 6103, 6105, 6114, 6115, 6124, RN licensure; Pre/corequisite: 6134. [4] Summer
6205. Advanced Health Assessment Applications for the Adult-Gerontology Primary Care Nurse Practitioner [Formerly NURS 305B] This course builds on knowledge of advanced health assessment with a focus on clients commonly seen in the adult practice setting. Advanced health assessment techniques are emphasized. Diverse approaches are used in expanding proficiency in conducting histories and physical examinations in clinical laboratory settings with adult clients. Pre/corequisite: 6011, graduate-level standing, admission to the specialty. [1] Fall
6215. Adult Gerontology Primary Care Nurse Practitioner Clinical I [Formerly NURS 365A] This course is a clinical practicum focusing on adult health care with emphasis on health promotion, management of common acute and chronic health problems, and client education. Advanced Practice Nurse Assignment Papers. Students participate in a clinical rotation in adult health care settings which provide the opportunity for health assessment of the adult and the development of a comprehensive plan of care. Clinical conferences highlight pathophysiological processes and psychological needs of the adults and their families. The role of the nurse practitioner as a primary health care provider in a variety of adult settings will be examined. Students explore relevant resources related to adult health care and apply findings to client situations. Pre/corequisite: 6011/6105, 6020, 6010, 6034. [4] Fall, Spring
6231. Essential Procedures for the Primary Care Provider [Formerly NURS 368] This course builds on knowledge of advanced health assessment and primary care of the adult with a focus on procedures commonly performed in the adult practice setting. Using principles of universal precautions and infection control as a foundation, students will learn invasive procedures related to different body systems. Pre/corequisite: 6011. [2] Summer
6234. Adult Gerontology Primary Care II [Formerly NURS 310B] This course is designed to provide students with knowledge needed to assess and manage less common acute and chronic diseases and health problems in the adult and geriatric population. Multidimensional interventions are discussed (e.g., culturally and environmentally sensitive care, health promotion, symptom palliation). Prerequisite: 6011, 6034; Pre/corequisite: 6010. [3] Spring
6236. Advanced Concepts in the Care of the Elderly [Formerly NURS 310C] This didactic course presents the advanced concepts in the care of the elderly patient. Students examine selected age/related changes, disease processes and comorbidities. Pathophysiology, clinical presentations, interventions, and outcomes are identified. Advanced Practice Nurse Assignment Papers. This course integrates the principles of health promotion, disease prevention and rehabilitation. Emphasis is placed on developmental needs and the pathophysiologic processed underlying certain conditions. The impact of the family on the health of the elderly is explored. Students are introduced to the dynamics of the managed care environment. [2] Spring, Summer
6237. Concepts of Mental Health for Adults [Formerly NURS 310D] This didactic course presents common mental health disorders seen in primary care settings within the scope of practice of the AGNP. This course identifies pathophysiology, clinical presentations, interventions, and outcomes of common mental health disorders in adult and geriatric patients.Advanced Practice Nurse Assignment Papers. Importance is placed on early screening, diagnosis, treatment and referrals. The reciprocal relationship of mental and physical health is emphasized. Pre/corequisite: 6010, 6020, 6034. [1] Fall, Summer
6295. Adult Gerontology Primary Care Nurse Practitioner Clinical II [Formerly NURS 365B] In this clinical course, the student implements the role of the Adult-Gerontology Primary Care Nurse Practitioner working with patients in the primary care setting. The focus is on the synthesis of theory, knowledge and skills from previous courses for the Adult Nurse Practitioner scope of practice. Pre/corequisites: 6010, 6011, 6020, 6031, 6034, 6045, 6055, 6065, 6205, 6215, 6234, 6236. [4] Fall
6301. Concepts of Advanced Emergency Nursing [Formerly NURS 396F] This course provides students with the knowledge base and skills necessary to render emergency and trauma care. This will provide a foundation for future ACNP role development. The essential evaluation, stabilization and critical time management techniques will be discussed. It is essential that the ACNP functioning in the ER be experienced in the assessment of non-urgent, urgent and emergent conditions.Advanced Practice Nurse Assignment Papers. In this course, the ACNP student will learn the techniques, physiology, and clinical skills necessary to care for adult patients in an emergency setting. Prerequisite: 6011 or 6101. [Variable 2-3] Spring
6305. Advanced Health Assessment Applications for the Dual Adult-Gerontology Acute Care NP/Family NP [Formerly NURS 305B] This course builds on knowledge of advanced health assessment with a focus on clients commonly seen in the family practice setting. Advanced health assessment techniques are emphasized. Diverse types of approaches are used in expanding proficiency in conducting histories and physical examinations in laboratory and clinical settings.Advanced Practice Nurse Assignment Papers. Communication techniques unique to the specialty population are emphasized. Systematic and organized health assessments that are sensitive to cultural and developmental needs are explored. Students are introduced to the dynamics of the managed health care environment. Experienced nurse practitioners serve as role models in clinical practice. Pre/corequisite: 6101, graduate-level standing, admission to the specialty. [1] Fall
6361. Pathophysiology & Collaborative Management in Emergent & Critical Care This didactic course is designed to provide ENP postmasters students an exploration of the pathophysiology, assessment, diagnosis, and collaborative management of selected urgent and emergent health problems across the lifespan. Students will demonstrate the ability to analyze, integrate, and synthesize pathophysiologic concepts and current research findings for collaborative management of commonly encountered conditions within emergency care settings. Prerequisite: Enrollment in ENP Specialty Program. Co-requisite: NURS 6365. [3] Fall
6365. Trauma, Emergency & Critical Care Clinical I N6365 is the first in a 2-part clinical sequence designed to provide the FNP with clinical experience in development and application of the roles of the emergency nurse practitioner.Advanced Practice Nurse Assignment Papers. Emergency Department settings allow the student to apply management skills, nursing theory, pathophysiologic and psychosocial concepts in planning care for patients across the lifespan. The student will practice in clinical settings for a total of 210 hours. Clinical conferences will be held weekly and will focus on pathophysiology, diagnoses, and collaborative therapeutic management related to emergency care. Prerequisite: Enrollment in ENP Specialty Program. Co-requisite: NURS 6361. [3] Fall
6375. Trauma, Emergency & Critical Care Clinical II N6375 is the second in a 2-part clinical sequence designed to provide the FNP with clinical experience in development and application of the roles of the acute care emergency nurse practitioner.Advanced Practice Nurse Assignment Papers. Emergency Department settings allow the student to apply management skills, nursing theory, pathophysiologic and psychosocial concepts in planning care for patients across the lifespan. The student will practice in clinical settings for a total of 210 hours. Clinical conferences will be held weekly and will focus on pathophysiology, diagnoses, and collaborative and therapeutic management related to emergency care. Prerequisites: Enrollment in ENP Specialty Program, NURS 6365. Co-requisite: NURS 6301. [3] Spring
6385. Practicum in Emergency Care I [Formerly NURS 397A] This course is designed to provide clinical experience in development and application of the roles of the acute care emergency nurse practitioner.Advanced Practice Nurse Assignment Papers. Emergency Department settings will allow the student to apply management skills and evaluate nursing theory, pathophysiologic and psychosocial concepts in planning care for adult patients. The student will practice in clinical settings for a total of 70 hours. Clinical conferences will be held weekly and will focus on pathophysiology, diagnoses, and therapeutic management related to emergency care of adults. Prerequisites: 6102, 6103, 6305, 6114. Corequisites: 6124, 6125, 6301. [1] Summer
6395. Practicum in Emergency Care II [Formerly NURS 397B] This course is designed to provide a capstone clinical experience in development and application of the roles of the dual Acute Care and Family NP for ED practice. Emergency Department settings will allow the student to apply management skills and evaluate nursing theory, pathophysiologic and psychosocial concepts in planning. The student will practice in clinical settings for a total of 70 hours. Clinical conferences will be held weekly and will focus on pathophysiology, diagnoses, and therapeutic management related to emergency care across the lifespan. Pre/corequisites: 6030, 6031, 6032, 6102, 6103, 6114, 6124, 6125, 6134, 6301, 6305, 6385, 6531, 6532, 6525. [1] Spring
6401. Organizational Behavior [Formerly NURS 380] Integral to management practice is the acquisition of theoretical frameworks that explain organizational theories, management models and decision-making strategies related to health care systems and care delivery. In addition to providing a conceptual understanding of management practice, this course focuses on the development of interpersonal skills and effective leadership styles through role preparation, communication theories and the application of change strategies. Pre/corequisite: Specialty level status. [3] Fall
6402. Leadership [Formerly NURS 382] Theories and models of leadership are explored and students assess their personal leadership styles.Advanced Practice Nurse Assignment Papers. Application of leadership theory in complex organization is explored. [3] Spring
6404. Directed Reading [Formerly NURS 384] This directed reading course introduces students to contemporary issues that influence society and healthcare. Students explore the socio-political and ethical environments in which advanced practice nurse leadership takes place. Students demonstrate critical thinking and analysis in the course assignments and discussions. [2] Summer
6408. Strategic Planning [Formerly NURS 388] This course focuses on short- and long-term strategic issues that affect the financing, organization, and delivery of health care services.Advanced Practice Nurse Assignment Papers. Market driven organizations and services are the core of the course, with emphasis placed on designing and operationalizing strategy as an individual or a member of teams at the middle and executive management levels. Students develop competency in strategic planning and apply these skills to complex health care organizations. [2] Summer
6409. Health Care Management of Populations [Formerly NURS 389] This course provides a framework for students to develop and apply both an ethical and a theoretical framework for population-based care management. Students develop a framework for measuring client satisfaction, quality of care, resource efficiency and explore principles of multidisciplinary collaboration. [3] Fall, Summer
6411. Foundations of Leadership The call for nurses to advance and assume leadership positions within their organizations is a current imperative.Advanced Practice Nurse Assignment Papers. Amid the complex nature of leadership within health care, this course provides students with a foundation in the many aspects of leadership ranging from an understanding of personal attributes, strengths, and challenges to a review of contemporary leadership theories and conflict management. This introductory course provides practical application of leadership principles. [3] Fall
6414. Organizational Behavior in Complex Health Care Systems The current healthcare environment challenges leaders to think and lead in new ways. Nurse leaders are at the forefront of change, patient safety, and population outcomes. Complexity science influences leadership behavioral models that drive reform, efficiencies, and outcomes.Advanced Practice Nurse Assignment Papers. Fundamental to these new ways of leading change is the emphasis on the quality of relationships, the ability to lead teams, and the ability to inspire others. This course offers students a paradigm shift in thinking from a focus on linear or hierarchical traditional models to a transformational, collaborative, and relationship-based leadership approach. [3] Fall
6417. Advanced Leadership and Human Capital This course focuses on the art and science of leading and managing people.Advanced Practice Nurse Assignment Papers. The course guides students in their quest to become resonant leaders, coaches, and mentors, and to embrace diversity in the teams they lead. Reality based decision making is explored as an approach to support high quality and safe patient care. [3] Spring
6485. Practicum I [Formerly NURS 386] This course is a leadership/management practicum experience in which students apply models of quality improvement, informatics, leadership and organizational behavior, outcome measurement, and financial management in a selected health care setting. This practicum provides students with an opportunity to work closely with a leader in a variety of health care settings.Advanced Practice Nurse Assignment Papers. Students contribute to the functioning of the health care agency and complete an agency designated project(s) during the practicum. All specialty courses (except 6404) are pre- or co-requisites for the practicum courses. [3] Spring
6495. Practicum II [Formerly NURS 387] This course provides students with an opportunity to work closely with a leader in a formal mentorship arrangement in a health care setting. Students observe and practice management and leadership skills in a health care organization.Advanced Practice Nurse Assignment Papers. The role of a leader is explored in the context of the changing health care environment. This practicum builds on skills and experiences obtained in Practicum I. In this second practicum, students are mentored by a senior leader with increased complexity of course deliverables. In addition to the agency designated practicum project, students will complete a population health project related to the agency’s population, needs, and priorities. All specialty courses (except 6404 & 6495) are pre- or co-requisites for the practicum courses. [4] Summer
6505. Advanced Health Assessment Applications for the Family Nurse Practitioner [Formerly NURS 305B] This course builds on knowledge of advanced health assessment with a focus on clients commonly seen in the family practice setting. Advanced health assessment techniques are emphasized.Advanced Practice Nurse Assignment Papers. Diverse types of approaches are used in expanding proficiency in conducting histories and physical examinations in laboratory and clinical settings. Communication techniques unique to the specialty population are emphasized. Systematic and organized health assessments that are sensitive to cultural and developmental needs are explored. Pre/corequisite: 6011, graduate-level standing, admission to the specialty. [1] Fall
6521. The Context of Primary Care: Family Nurse Practitioner Domains and Core Competencies for Practice [Formerly NURS 361A] This course is designed to provide Family Nurse Practitioner (FNP) students with the knowledge of the context of primary care and related domains and core competencies of family nurse practitioner practice identified by the National Organization of Nurse Practitioner Faculties (NONPF). Advanced Practice Nurse Assignment Papers. Specific content of the course covers the hallmarks of primary care and the seven domains and focuses on operationalizing competencies into practice. Competencies needed to promote and protect health and prevent disease are emphasized. Pre-requisite knowledge: This course builds on previous course work involving the assessment, diagnosis, and management of common and chronic conditions seen in the primary care setting. Graduate status and FNP specialty student required. [2] Spring
6525. Practicum in Primary Health Care of the Child and Adolescent [Formerly NURS 362] This course is a clinical practicum focusing on child and adolescent health care with an emphasis on health promotion, management of common health problems, and client education.Advanced Practice Nurse Assignment Papers. A developmental approach across the lifespan is used in assessing the client and family in formulating the treatment plan. Students participate in a clinical rotation in a pediatric health care setting which provides the opportunity for health assessment of the child and adolescent and formulation of a comprehensive plan of care. Clinical conferences highlight various pathophysiological and psychological processes encountered with children and their families. The role of the nurse practitioner as a primary health care provider in a variety of pediatric settings is examined. Relevant resources and research related to the child and adolescent are explored with the application of findings to the care of clients. Pre/Corequisites: 6305 or 6505, 6010, 6020, 6531, 6031. [2] Spring
6531. Advanced Practice Nursing in Primary Care of the Child [Formerly NURS 309B] This course presents knowledge necessary for the practice of primary health care of children.Advanced Practice Nurse Assignment Papers. Course content includes the principles of health promotion, disease prevention and assessment, and management of common primary health care problems in diverse pediatric populations. Emphasis is placed on developmental needs and the pathophysiologic processes underlying certain conditions. The impact of the family on the health of the child is explored. Students are introduced to the dynamics of the managed care environment. Prerequisite: 6011. [2] Spring
6532. Advanced Practice Nursing in the Primary Care of the Elderly [Formerly NURS 309D] In this didactic course, knowledge is presented that is necessary for the practice of primary health care nursing of the elderly.Advanced Practice Nurse Assignment Papers. Course content includes the principles of health promotion, disease prevention and assessment, and management of common primary health care problems in diverse elderly populations. Emphasis is placed on developmental needs and the pathophysiologic processes underlying certain conditions. The impact of the family on the health of the elderly is explored. Students are introduced to the dynamics of the managed care environment. Prerequisite: 6011. [1] Spring
6535. Practicum in Primary Health Care of the Adult for Dual Specialty [Formerly NURS 363A] This course is a clinical practicum focusing on adult health care with an emphasis on health promotion, management of common acute and chronic health problems, and client education. A developmental approach across the lifespan is used in assessing the client and family in formulating the treatment plan.Advanced Practice Nurse Assignment Papers. Students participate in a clinical rotation in adult health care settings which provide the opportunity for health assessment of the adult and the development of a comprehensive plan of care. Clinical conferences highlight pathophysiological processes and psychological needs of the adults and their families. The role of the nurse practitioner as a primary health care provider in a variety of adult settings will be examined. Students explore relevant resources related to adult health care and apply findings to client situations. This course is for Adult-Gerontology/Family Nurse Practitioner: Emergency Care Focus students. Prerequisites: 6305. Corequisites: 6010, 6020, 6030. [3] Fall, Summer
6545. Practicum in Primary Health Care of the Adult [Formerly NURS 363C] This course is a clinical practicum focusing on adult health care with emphasis on health promotion, management of common acute and chronic health problems, and client education. Students participate in a clinical rotation in adult health care settings which provide the opportunity for health assessment of the adult and the development of a comprehensive plan of care. Clinical conferences highlight pathophysiological processes and psychological needs of the adults and their families. The role of the nurse practitioner as a primary health care provider in a variety of adult settings will be examined. Students explore relevant resources related to adult health care and apply findings to client situations. This course is for NMW and NMW/FNP students. Prerequisite: 6805, 6810; Pre/Corequisite: 6020, 6821. [2] Spring
6555. Practicum in Primary Health Care of the Family [Formerly NURS 360A] This course is a clinical practicum focusing on child, adolescent and adult health care with an emphasis on health promotion, management of common health problems, and client education. Advanced Practice Nurse Assignment Papers. A developmental approach across the lifespan is used in assessing the client and family in formulating the treatment plan. Students participate in a clinical rotation in a primary care setting which provides the opportunity for health assessment of clients of all ages and the formulation of a comprehensive plan of care. Clinical conferences highlight various pathophysiological and psychological processes encountered with clients and their families. The role of the nurse practitioner as a primary health care provider in a variety of primary health care settings will be examined. Relevant resources/research related to health is explored with the application of findings to the care of clients. Prerequisite: 6505; Corequisite: 6010, 6020, 6031, 6531. [Variable credit – 4 for FNP; 2 for NMW/FNP] Spring
6565. Practicum in Primary Health Care of the Family [Formerly NURS 360B] This course is a clinical practicum focusing on child, adolescent and adult health care with an emphasis on health promotion, management of common health problems, and client education. A developmental approach across the lifespan is used in assessing the client and family in formulating the treatment plan. Students participate in a clinical rotation in a primary care setting which provides the opportunity for heal assessment of clients of all ages and the formulation of a comprehensive plan of care. Clinical conferences highlight various pathophysiological and psychological processes encountered with clients and their families.Advanced Practice Nurse Assignment Papers. The role of the nurse practitioner as a primary health care provider in a variety of primary health care settings will be examined. Relevant resources/research related to health is explored with the application of findings to the care of clients. Prerequisite: 6505, 6532, 6555. [1] Summer
6575. Clinical Decision Making for the Family Nurse Practitioner [Formerly NURS 360C] This clinical course builds on knowledge and skills developed in previous didactic courses and implemented in the first practicum. Emphasis is on utilization of evidence-based practice and the integration of technology into primary care. This course focuses on management of the patient with complex acute or chronic illness.Advanced Practice Nurse Assignment Papers. The purpose of the course is to enable the student to enter practice with the ability to independently manage patients across the lifespan. Prerequisite: 6032, 6521. Corequisite: 6565, 6585. [1] Summer
6585. Family Nurse Practitioner Preceptorship [Formerly NURS 364] In this clinical course, the student implements the role of the family nurse practitioner working with clients across the lifespan and their families in urban and/or rural primary care settings. The focus is on the integration of theory, knowledge, and skills from previous courses within the family nurse practitioner scope of practice. Pre/corequisite for FNP students: 6555, 6565; pre/corequisite for NMW/FNP students: 6545, 6555. [4] Spring, Summer
6595. Family Nurse Practitioner Preceptorship for AG-ACNP/FNP Dual Specialty [Formerly NURS 364A] In this clinical course, the student implements the role of the family nurse practitioner working with clients across the lifespan and their families in urban and/or rural primary care settings.Advanced Practice Nurse Assignment Papers. The focus is on the integration of theory, knowledge, and skills from previous courses within the family nurse practitioner scope of practice for students who are pursuing dual preparation. Pre- or co-requisites: 6030, 6031, 6032, 6525, 6531, 6532, 6535, all core courses. [3] Spring, Summer
6602. Developmental/Neonatal Physiology [Formerly NURS 306C] This course provides an in-depth examination of human genetics, embryologic development and normal physiologic functioning of developing body systems. Mechanisms involved in cell division, gametogenesis, and inheritance patterns are addressed. The structural and functional development of fetal systems, during critical periods, is emphasized. Abnormalities and alterations in fetal development are explored. Environmental factors that influence the structural and functional development of fetal systems are discussed. Long-term clinical implications of alterations in structure and physiologic functioning are also addressed. [2] Fall. Fall
6605. Advanced Neonatal Health Assessment [Formerly NURS 305C] This core course provides opportunities for NNP students to develop the knowledge and skills needed to perform a comprehensive health and gestational age assessment.Advanced Practice Nurse Assignment Papers. Data to collect when eliciting a health history, principles of performing a physical and gestational age assessment, diagnostic study interpretations, and examination techniques are stressed in the didactic portion of the course. Critical thinking is emphasized as the basis for synthesis of knowledge regarding the performance of health histories, physical assessments and identification of potential diagnostic tests for alterations in clinical findings. Emphasis is placed on the recognition of assessment findings that deviate from normal. 56 hours of supervised clinical experience in the regular newborn nursery and/or Level II Neonatal Intensive Care Unit provides students with opportunities to perform health histories, health assessments and gestational age assessments with both normal and late preterm infants. [3] Fall
6610. Neonatal Nursing Birth Through 2 Years of Age [Formerly NURS 316] This course focuses on the health status and care of the neonates and infants through 2 years of age. Emphasis is placed on theories of attachment, growth and development through 2 years of age. This course is designed to help students in the use of critical thinking to foster health promotion, primary prevention of illness and management of common older infant medical conditions. Physical, social, cognitive and emotional growth will be addressed as well as issues associated with the development of sleep/wake cycles, infant behavior, newborn laboratory screening, feeding, infant and childhood immunizations, safety, and common parental concerns. Normal variations and minor disruptions in aspects of newborn and infant health are emphasized. Knowledge synthesized from this course provides an essential working foundation for future neonatal/infant course work. Clinical practice in the role of the NNP related to infant outcomes and ethical dilemmas are discussed. Corequisite: 6602. [2] Fall
6614. Neonatal Pathophysiology and Management I [Formerly NURS 317A] This is the first of two sequential courses in which students examine the pathophysiology and management of ill neonates/infants and their families. Advanced Practice Nurse Assignment Papers. Theory and research form the basis for discussions of clinical assessment and restorative care. This course emphasizes the role of the advanced practice nurse in the care of high-risk neonates/infants. Perinatal risk factors associated with variations in neonatal health and functioning are also examined. Issues, trends and legal issues of the NNP role are addressed. Corequisite: 6602, 6605, 6610. [3] Fall
6615. Neonatal Practicum [Formerly NURS 318] Clinical practicum and seminars provide opportunities for developing advanced skills in the nursing care of level II neonates and infants through 2 years of age. Experiences in facilitating and evaluating continuity of care across several settings are a major thrust. Students may work collaboratively with NNPs on unit-based projects as part of the practicum. Advanced practice nursing roles and expert skills are critically examined in clinical and individual conferences. RN licensure is required prior to beginning clinical hours. This course builds on the knowledge obtained during the fall and early part of the spring semesters.Advanced Practice Nurse Assignment Papers. Students are expected to attend deliveries and provide complete care to neonates/infants in a level II nursery. Experiences will also occur in the newborn follow-up clinic or pediatrician office to care for older infants through 2 years of age if available. Prerequisite: 6602, 6605, 6610, 6614; corequisite: 6620, 6624; successful completion of Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) is required prior to clinical. [3] Spring
6620. Introduction to Advanced Procedures for Neonatal Nurse Practitioners [Formerly NURS 315] This course provides students with an introduction to the advanced practice skills commonly performed by neonatal nurse practitioners. A step-by-step practical approach is taken to describe the procedures. Students demonstrate an understanding of essential intensive care nursery concepts, skill, and equipment necessary for completing direct bedside assessment and care of neonates in a safe manner.Advanced Practice Nurse Assignment Papers. The theoretical basis, indications and complications for these skills are emphasized. Students have the opportunity to practice the skills presented in the course under the supervision of experienced Advanced Practice Neonatal Nurses. The differentiation between normal and abnormal lab values are also emphasized. Prerequisite: 6602, 6605, 6610, 6614. Corequisite: 6621, 6624. [3] Spring
6621. Advanced Neonatal Pharmacotherapeutics [Formerly NURS 307D] This course provides students preparing for roles within the Neonatal Nurse Practitioner specialty with knowledge of the pharmacotherapeutics for common classifications of drugs used to care for neonates and infants.Advanced Practice Nurse Assignment Papers. The physiologic action of selected prescription drugs, unexpected client responses and major untoward effects encountered in diseases of the neonates are discussed. Pharmacokinetic and pharmacodynamic principles, their clinical application and the use of pharmacologic agents in the prevention of illness and the restoration and maintenance of health are emphasized. Emphasis is placed on indications for correct drug choice, usual dose, routes of administration, pharmacological mechanisms in association with drug interactions, adverse effects; and contraindications for use are included. Discussions of clinical judgments in the management and evaluation of pharmacologic therapeutic agents for neonatal use are emphasized. Prerequisite: Graduate level standing and admission to the NNP specialty. Can be taken as a special student with permission of the instructor. [3] Spring
6624. Neonatal Pathophysiology and Management II [Formerly NURS 317B] This is the second of two sequential courses in which students examine the pathophysiology and management of ill neonates/infants and their families.Advanced Practice Nurse Assignment Papers. Theory and research form the basis for discussions of clinical assessment and restorative care. This course continues to emphasize the role of the advanced practice nurse in the care of high-risk neonates/infants. Integration of previous knowledge of embryology, physiology, pathophysiology, interpretation of lab data, radiologic findings and collaboration with other health professionals are emphasized. Prerequisite: 6602, 6605, 6610, 6614; Corequisite: 6620, 6621. [3] Spring
6695. Neonatal Preceptorship [Formerly NURS 319] Students synthesize theory, knowledge, and skills from previous courses within the neonatal nurse practitioner scope of practice. Clinical preceptorships provide students with opportunities to further develop expertise relevant to the assessment and management of groups of neonates and infants through 2 years of age. Prerequisite: 6602, 6605, 6610, 6614, 6615, 6620, 6624; all core courses. [6] Summer
6710. Fundamentals of Nursing Informatics-NI Professional Formation 1 This course provides an overview of informatics and the role it plays in the delivery of evidence based care. With a focus on healthcare information technology’s contribution to data acquisition, this course will enhance the learner’s understanding of the transformation of data into information and knowledge. A practical approach is taken to ensure learners understand essential elements of informatics practice such as the system development lifecycle, the electronic health record, national health policy, patient quality, and the safe use of technology. This course prepares the learner to optimize the use of clinical systems and technology tools to continue to advance practice and drive clinical transformation. [3] Fall
6711. Technology Components of Informatics [Formerly NURS 381B] This course explores the structure and function of networks and network based applications as they relate to their use within healthcare and healthcare education. Topics covered include basic concepts of infrastructure (IP addressing, routing and networks), the basic technology behind medical recording, BYOD (bring your own device) such as Cell Phones and Tablets, data collection and analysis tools, social networking including synchronous communication applications, and educational applications including asynchronous screen narration applications and Learning Management Systems. [2] Fall
6712. Desktop Maintenance [Formerly NURS 381D] The purpose of this course is to teach how to properly maintain your computer to minimize problems that may occur and handle simple issues and problems with your computer.Advanced Practice Nurse Assignment Papers. The course will also cover how to properly install and uninstall hardware and software, how and when to rebuild your system, how to protect your system from worms and viruses, and the hows and whys of creating a home network connected to a broadband environment such as cable or DSL. [1] Fall
6715. Nursing Informatic Practicum I [Formerly NURS 392B] In this course, the learner implements the role of the informatics nurse specialist in a health care setting. The focus is on the integration and application of theory, knowledge, and skills from previous courses within the various roles open to an informatics nurse specialist. Learners are provided an opportunity to work closely with a preceptor to observe and participate in real world informatics activities. Under the guidance of the preceptor, learners will have the opportunity to use current informatics evidence and research from the literature, collect and analyze data, demonstrate critical thinking skills, identify researchable clinical informatics problems, and identify and evaluate various informatics roles. Prerequisite: 6723 [3] Spring
6720. Theories, Frameworks and Models Supporting Informatics Practice-NI Professional Formation 2 This course is the second in a series of courses facilitating professional formation for the informatics nurse specialist. Building on content from NI Professional Formation 1, learners will develop knowledge and skills in the concepts, theories, models, and frameworks that support informatics practice. Topics include evidence-based practice, organizational theories, systems thinking, the socio-technical model, human factors engineering principles, and information science theories.Advanced Practice Nurse Assignment Papers. The application of ethical principles and systematic change processes will be emphasized throughout the course. Prerequisite: 6710. [3] Spring
6722. Consumer Health Care Informatics [Formerly NURS 381G] This course addresses the consumer’s use of electronic information systems and applications to improve their medical outcomes and their health care decisions.Advanced Practice Nurse Assignment Papers. How informatics solutions impact the health care partnership of provider and patient is explored. Various technology and applications that empower consumers are reviewed. Studies that evaluate the effectiveness of health care informatics in patient outcomes are included. [2] Spring
6723. Informatics of Clinical Practice [Formerly NURS 392A] This course focuses on a structured approach to methods, techniques, and tools for information system development and implementation used by informatics nurse specialists. The information system life cycle approach incorporates the following phases: planning, analysis, design, implementation, and evaluation. Planning and management of disaster recovery, business continuity, and methods of evaluating effectiveness and return on investment are included. Prerequisite: 6710, 6720, 6732. [3] Summer
6724. Leveraging Technology for Learning and Teaching in Healthcare Informatics nurse specialists have the responsibility to teach their professional colleagues how to use the latest information technology applications. This course will expose learners to adult learning principles that translate into evidence-based, technology-facilitated learning activities. Technology enhanced instructional tools for professional development and patient education will be covered. [3] Summer
6725. Web Development for Health Care Applications Informaticists spend a significant amount of their time dealing with technology implementation, rollout, and training. In this course, students will learn how to create eLearning modules designed to train their staff or students how to perform a specific task, such as how to use a new or modified feature in a HER environment.Advanced Practice Nurse Assignment Papers. The course covers the basics of ADDIE (Analysis, Design, Development, Implementation, Evaluation) instructional design, hoe to create a module in an eLearning product, and how to mount it on a webserver or Learning Management System (LMS). Along the way the course will have to cover the role of a VPN environment and how to mount a shared drive to a server. [3] Spring
6727. Data to Information I Given the explosion of data generation and availability in recent years, skills for managing large amounts of data and gaining insights from these data are essential for informatics nurse specialists.Advanced Practice Nurse Assignment Papers. This first of two courses focuses on extracting information from data and will emphasize data collection, database design, data querying, and descriptive analysis. Learners will gain practical experience and skills in creating a database application and then retrieving and analyzing data found in their database. [3] Fall
6728. Data to Information II Building upon Data to Information I, this course focuses on the use of rapidly growing clinical data to support continuous learning in healthcare.Advanced Practice Nurse Assignment Papers. Learners will be exposed to key concepts in Learning Health Systems, data science, machine learning, “big data,” and the application of diverse methods to improve the quality of healthcare outside of traditional clinical trials and related approaches. The course will emphasize data science studies in biomedical literature, clinical prediction models, and collaboration with data scientists.Advanced Practice Nurse Assignment Papers. Prerequisite: 6727. [3] Spring
6730. Advanced Concepts of Informatics-NI Professional Formation 3 This course is the third in a series of courses facilitating professional formation in the informatics nurse specialist role. Building on content from NI Professional Formation 2, learners will acquire advanced knowledge in contemporary health informatics topics applicable to local, national, and global environments. Ranging from interoperability to knowledge representation to genetics/genomics to health policy to healthcare delivery outside the clinical environment, this survey course will cover a large breadth of topics and facilitate learners’ ability to acquire greater content depth in a self-directed manner.Advanced Practice Nurse Assignment Papers. Learners will also be exposed to professional development and career planning resources. Prerequisite: 6720. [3] Summer
6731. Informatics of Evidence-Based Practice [Formerly NURS 392C] This course addresses informatics techniques to bring the best available evidence about nursing to the point of care to support the patient’s health and decision making. The relationship between standardized languages, electronic documentation systems, and evidence-based nursing practice are explored. Use of the Internet to select and customize nursing interventions, point of care devices, and Web-based diagnostic decision support systems are examined. [3]. Summer
6732. Designing, Planning and Managing Scalable Projects [Formerly NURS 381W] Regardless of size or scope, all new and existing projects within a healthcare setting can benefit from leaders able to execute successful project management skills. Project management skills covered in this course include determining project scope, time, cost, quality, human resource, communications, risk, and procurement management.Advanced Practice Nurse Assignment Papers. This course will expose learners to the tools and skills required to successfully manage complex informatics projects within healthcare settings. Learners will be exposed to tools and frameworks found in business and management environments. Practical skills that leverage software will be acquired through hands-on application. Prerequisite: 6710. [3] Spring
6735. Database Design for Health Care Applications [Formerly NURS 381E] The purpose of this course is to teach how to create online database applications in the health care field. While it is not the goal of this course to train the participants how to create full-fledged hospital management systems and electronic medical record systems, students will develop an understanding of the basic concepts underlying these systems by creating simple database applications on the Web. Advanced Practice Nurse Assignment Papers. Database concepts including user interface design, table design, normalization, password protection, and data queries are basically the same regardless of the purpose of the application. Upon completion of this course, the students will have an appreciation and understanding of large scale database environments in their field and be able to communicate effectively with management system software developers using the appropriate terminology. Prerequisite: Knowledge of Web design and HTML. [2] Summer
6795. Nursing Informatics Practicum II [Formerly NURS 392D] This practicum builds on skills and experiences obtained in Nursing Informatics Practicum I. The learner will continue to be mentored by a preceptor in a healthcare setting. The focus is on the integration and application of theory, knowledge, and skills from previous courses with increasing complexity and advanced critical thinking. Under the guidance of the preceptor, learners will have the opportunity to grow their informatics knowledge and further evaluate their role as an informatics nurse specialist. In this second practicum, students will complete an informatics related project pertinent to a healthcare organization using evidence and data to address a real world problem. Prerequisite: 6715. [3] Summer
6805. Advanced Health Assessment Applications for Nurse-Midwifery [Formerly NURS 305B] This course builds on knowledge of advanced health assessment with a focus on clients commonly seen in the nurse-midwifery practice setting. Techniques, including communication skills, used in assessment of the health status of women and the fetus are developed and refined in laboratory and clinical settings.Advanced Practice Nurse Assignment Papers. Congruence of philosophical concepts among the profession, school, and the program is introduced. The American College of Nurse-Midwives (ACNM) Core Competencies for Basic Midwifery Practice (including Hallmarks of Midwifery and Midwifery Management Process), Standards for Midwifery Practice, and Code of Ethics provide the basis for clinical actions.Advanced Practice Nurse Assignment Papers. This course builds on knowledge of advanced health assessment with a focus on clients commonly seen in the nurse-midwifery practice setting. Pre/corequisite: 6011, graduate-level standing, admission to the specialty. [1] Fall
6810. Women’s Health for Nurse-Midwifery [Formerly NURS 327A] Consistent with the emerging definitions of women’s health and women’s health practice, this course examines a full range of health issues unique to women. Women’s health specialization includes prevention, the societal and political determinants of health, patient education, and reconceptualization of women’s relationships with health care providers. Health assessment and maintenance as well as disease identification and treatment will be presented on a wellness to illness continuum. Students utilize current research in women’s health and identify potential research opportunities.Advanced Practice Nurse Assignment Papers. This course builds on knowledge of basic reproductive anatomy and physiology as well as techniques of assessment to facilitate student’s ability to translate knowledge into clinical application. Students synthesize knowledge of organic processes, normal and abnormal, to learn assessment, management, diagnosis, and treatment of conditions encountered by the clinician whose scope is the care of women. Pre/corequisite: 6011. [3] Fall
6811. Reproductive Anatomy and Physiology [Formerly NURS 306B] Normal anatomy and physiologic processes of reproduction, including changes during the maternity cycle, are studied. Selected physiologic processes associated with healthy women across the lifespan, human genetics, development of the products of conception, the maternity cycle and the implications for client adaptations are examined. [2] Fall
6812. Evolution of Midwifery in America [Formerly NURS 333] This course surveys the historical and social literature of midwifery nursing and medicine in the context of the care of women and infants. Development of midwifery and the professional organization are analyzed and interpreted. Development of the midwife and nurse-midwife are examined in relation to societal, economic, and political issues involved in health care systems from the 18th century to present. Dynamics that affect the medical and midwifery models of care will be discussed to provide critical understanding of women’s health care in America. Prerequisite: none. [2] Fall
6815. Nurse-Midwifery Practicum I [Formerly NURS 331] Students apply advanced knowledge of normal physiology, pathophysiology and psychosocial concepts to nurse-midwifery care of women from premenarche through post-menopause. Students apply specific components of the American College of Nurse-Midwives (ACNM) Philosophy, Core Competencies for Basic Midwifery Practice (including the Hallmarks of Midwifery and Midwifery Management Process), Standards for the Practice of Midwifery, and the Code of Ethics to women from peri-menarche through post-menopause including primary care, preconception, antepartal, and interconceptional periods.Advanced Practice Nurse Assignment Papers. Clinical experience is under the supervision of nurse-midwifery, nurse practitioner, or physician preceptors in a variety of settings. Students have the opportunity to identify and discuss risk management and ethical issues inherent in clinical practice. This course uses content on women’s health and preconception from N6810 and physiology of pregnancy from N6811. This course will address the clinical application of gynecologic care, both normal and pathology, over the lifetime, as well as maternal changes and fetal development in pregnancy building on content from these courses. Prerequisites: 6011, 6805, 6810; corequisites: 6020, 6821. [2] Spring
6821. Antepartal Care for Nurse-Midwifery [Formerly NURS 330] This course provides the theoretical basis of individualized family-centered management of pregnancy for women of diverse cultural and socioeconomic backgrounds. Pregnancy is viewed as a normal physiologic and developmental process that affects and is affected by a variety of factors, including psychosocial, epidemiologic, legal and ethical issues.Advanced Practice Nurse Assignment Papers. Strategies are presented for health promotion and disease prevention, including preconception and prenatal screening, health education, empowerment of women, and collaboration with other health care providers. Selected complications of pregnancy are addressed, and appropriate applications of technology, pharmacologic, non-pharmacologic, and common complementary and alternative therapies are considered. A variety of evidence supporting management decisions is critically examined, including published research, standards of care, and risk management principles. The American College of Nurse-Midwives (ACNM) Philosophy, Code of Ethics, ACNM Core Competencies for Basic Midwifery Practice (including Hallmarks of Midwifery and Midwifery Management Process), and the Standards for Midwifery Practice provide the framework of the course. Prerequisite: 6810. Pre/corequisite: 6811 [3] Spring
6831. Skills for Nurse-Midwifery [Formerly NURS 334] This course provides nurse-midwifery students with clinical and laboratory experiences needed to develop skills necessary during uncomplicated birth and specific complicated or emergency situations in the intrapartum and postpartum periods. Prerequisite: 6805, 6810. Pre/Corequisite: 6821. [1] Summer
6835. Practicum in Intrapartum/Postpartum/Neonatal Nurse-Midwifery Care [Formerly NURS 335] Students will integrate principles, current literature, theory and research findings into the management of the care of women during the intrapartum and postpartum periods, and management of the newborn from birth to 28 days of life. Methods of screening for abnormalities, supporting healthy adaptation to extrauterine life, and facilitating healthy parental-newborn family relationships are applied.Advanced Practice Nurse Assignment Papers. Students have the opportunity to apply components of the American College of Nurse-Midwives (ACNM) Philosophy, Core Competencies for Basic Midwifery Practice (including the Hallmarks of Midwifery and Midwifery Management Process), and Standards for the Practice of Midwifery, and the Code of Ethics in the management of labor, birth, and the puerperium, as well as in management of the newborn through 28 days of life. Clinical objectives are achieved in a variety of settings under the preceptorship of experienced certified nurse-midwives and physicians. Prerequisite: 6011, 6020, 6805, 6811, 6815. Pre/Corequisite: 6831, 6836, 6838. [4] Summer
6836. Intrapartum Care for Nurse-Midwifery [Formerly NURS 336] This course examines the theoretical basis of intrapartum nurse-midwifery management. Multidisciplinary theories, concepts, and research are synthesized to develop safe management plans that are culturally and ethically appropriate and applicable to the physical, emotional, and educational needs of the childbearing woman and her family. Nurse-midwifery management recognizes pregnancy and birth as a normal physiologic and developmental process. Advanced Practice Nurse Assignment Papers. Management includes non-intervention in the absence of complications as well as selected intrapartum complications and emergencies. A variety of evidence supporting management decisions is critically examined, including published research, standards of care, and risk management principles. The American College of Nurse-Midwives (ACNM) Philosophy, Code of Ethics, ACNM Core Competencies for Basic Midwifery Practice (including Hallmarks of Midwifery and Midwifery Management Process), and the Standards for Midwifery Practice provide the framework of the course. Prerequisite: 6011, 6020, 6805, 6810, 6811, 6815, 6821. [3] Summer
6838. Nurse-Midwifery Care of the Mother-Baby Dyad [Formerly NURS 338] This course examines theory and research related to nurse-midwifery management of the maternal/newborn dyad during the post-partum period, and strategies for facilitating healthy physiological adaptation and parental-family-newborn relationships.Advanced Practice Nurse Assignment Papers. Methods of screening for and collaborative management of common abnormalities are discussed. Management includes non-intervention in the absence of complications as well as selected postpartum complications and emergencies. The American College of Nurse-Midwives (ACNM) Core Competencies for Basic Midwifery Practice (including Hallmarks of Midwifery and Midwifery Management Process), Standards of Midwifery Practice and Code of Ethics provide the framework for the course. Prerequisite: 6010 and 6020. Corequisite: NRP. [2] Summer
6841. Nurse-Midwifery Role Synthesis, Exploration, and Analysis [Formerly NURS 304B] This course is designed to prepare the nurse-midwifery student for entry into professional practice.Advanced Practice Nurse Assignment Papers. In addition, concepts related to leadership, reimbursement and quality principles to continually improve healthcare are applied. The course builds on information initially discussed in NURS 6812 Evolution of Midwifery in America. Pre-requisites: 6812. Co-requisites: 6895 or permission of instructor. [2] Fall
6895. Advanced Clinical Integration Experience for Nurse-Midwifery [Formerly NURS 339] The final nurse-midwifery practicum allows the student to practice full scope nurse-midwifery under the supervision of experienced Certified Nurse-Midwife preceptors, managing women’s health care from perimenarche through the postmenopausal periods and newborn health care from birth through the first month of life.Advanced Practice Nurse Assignment Papers. Full scope nurse-midwifery care includes the areas of gynecology, family planning, preconception, antepartum, intrapartum, postpartum, newborn, breast-feeding support, common health problems in the pregnant and non-pregnant woman, and the peri and postmenopausal periods. Students immerse themselves in the clinical practice to which they are assigned and reside in the community in which it is located, providing for continuity of care. Practice is in collaboration with the client and other health care providers, consulting and referring according to the nurse-midwifery management process. Academic faculty are closely involved with the selection of appropriate clinical sites and ongoing advisement and evaluation of the student during the practicum. A written comprehensive exam is taken after the practicum is completed. By the end of the course, the graduate is prepared to assume the role of the beginning professional nurse-midwife and to sit for the American Midwifery Certification Board (AMCB) certification examination. Advanced Practice Nurse Assignment Papers. The AMCB Philosophy, Code of Ethics, and Core Competencies for Basic Midwifery Practice (including Hallmarks of Midwifery and Midwifery Management Process), and the Standards for Midwifery Practice provide the framework of the course. Prerequisite: 6810, 6815, 6821, 6831, 6835, 6836, 6838. Corequisite: 6841. [5] Fall
7011. Health Promotion of Behavior Development: Birth through Adolescence [Formerly NURS 311] This course focuses on the theoretical basis for pediatric advanced nursing practice emphasizing the development of the child and adolescent as an individual within the context of family and society.Advanced Practice Nurse Assignment Papers. Using a family-centered approach, this course considers factors, techniques and research which facilitate or interfere with healthy development. Emphasis is placed on developing strategies for providing appropriate anticipatory guidance, health promotion, and disease prevention interventions within the life course. Pre/corequisite: None. [3] Fall
7012. Advanced Practice Nursing in Pediatric Primary Care-Part I [Formerly NURS 312A] This is the first course in a two-part pediatric primary care didactic course sequence. Information is presented that is necessary for the practice of primary health care nursing of children and adolescents. Advanced Practice Nurse Assignment Papers. Course content includes information related to the principles of health promotion, disease prevention, and assessment and management of common primary health care problems in children and adolescents by pediatric nurse practitioners. Content is presented within a family-centered and developmental perspective and includes content related to advanced pathophysiology, research, psychosocial factors, and ethical considerations. Prerequisite: Graduate level standing, admission to the Pediatric Nurse Practitioner Program; Corequisite: 7011, 7013, 7015 or 7025, 6010. [3] Fall
7013. Advanced Health Assessment and Clinical Reasoning [Formerly NURS 305D] Students differentiate abnormal from normal findings using advanced assessment techniques, interpret diagnostic study results and use clinical reasoning to formulate diagnoses for culturally diverse pediatric patients.Advanced Practice Nurse Assignment Papers. Synthesizing a systematic, organized, family-centered health assessment that is sensitive to growth and development needs is emphasized. Health promotion and disease prevention strategies are discussed. Pre/corequisite: 6010, 7015 or 7025. [2] Fall
7015. Advanced Health Assessment Applications for the Primary Care Pediatric Nurse Practitioner [Formerly NURS 305E] This course builds on knowledge of advanced health assessment with focus on clients commonly seen in the pediatric practice setting.Advanced Practice Nurse Assignment Papers. Techniques, including communication skills, used to assess the health status of children and adolescents are enhanced and refined. Diverse clinical experiences are used to develop proficiency in history taking and health assessment techniques with infants, children, and adolescents within the context of family-centered care. Synthesizing a systematic and organized health assessment that is sensitive to growth and developmental needs and which will provide the most pertinent data with the least risk to the infant and child-adolescent is emphasized. Corequisite: 7013. [1] Fall
7021. Advanced Practice Nursing in Pediatric Primary Care-Part II [Formerly NURS 312B] In this second part of the pediatric primary care didactic course sequence, information is presented that is necessary for the practice of primary health care nursing of children and adolescents.Advanced Practice Nurse Assignment Papers. Course content builds upon the information presented in Part I related to the principles of health promotion, disease prevention, and assessment and management of common primary health care problems in children and adolescents. Using a family-centered and developmental perspective, related advanced pathophysiology, research, psychosocial factors, and ethical considerations are explored. Prerequisite: 6010, 7011, 7012, 7013/7015; Pre/corequisite: 7023. [3] Spring
7022. Advanced Practice Nursing in Pediatric Acute Care-Part I [Formerly NURS 312C] In this first part of the pediatric acute care didactic course sequence, information is presented that is necessary for the practice and management of acutely ill, critically ill, and chronically ill children and adolescents.Advanced Practice Nurse Assignment Papers. Course content relates to the principles of assessment and management of common health care problems in children and adolescents. A portion of the course includes information necessary for PNPs to care for pediatric clients with special needs and their families. Using a family-centered and developmental perspective, related advanced pathophysiology, research, psychosocial factors, and ethical considerations are explored. Prerequisite: 6010, 7011, 7013, 7012, 7025; corequisite: 7024, 7045. [3] Spring
7023. Advanced Pharmacotherapeutics [Formerly NURS 307E] This course is designed to provide students with the knowledge of pharmacokinetics that will enable the student to safely and appropriately select pharmacologic agents (prescription and over the counter) for the management of common acute and chronic health problems of pediatric clients.Advanced Practice Nurse Assignment Papers. Specific content of the course covers representative drugs of a pharmacologic group, indications for use, drug selection, titration of dose, key adverse effects, and monitoring of therapy and alternative therapy. Prerequisite: Graduate level standing; admission to the Pediatric Nurse Practitioner program; Corequisites: 6010, 7011. [3] Spring
7024. Advanced Pharmacotherapeutics This course is designed to provide students with the knowledge of pharmacodynamics and pharmacokinetics which will enable the student to safely and appropriately select pharmacologic agents for the management of acute and chronic health problems of pediatric clients in the acute care setting. Specific content of the course covers representative drugs of pharmacologic groups, indications for use, drug selection, titration of dose, key adverse effects, drug to drug interactions and monitoring of therapy.Advanced Practice Nurse Assignment Papers. Legal and ethical considerations in pediatric pharmacotherapy are discussed. Pre/co-requisites: 6010, 7011, 7012, 7013, 7025. [3] Spring
7025. Advanced Health Assessment Applications for the Acute Care Pediatric Nurse Practitioner [Formerly NURS 305G] This clinical course builds on content presented in NUR 7013. Laboratory and clinical experiences are provided to develop techniques of advanced physical and developmental assessment of the well child. Oral and written communication skills necessary for effective history taking and inter-professional collaboration are refined. The clinical experience in pediatric primary care provides an opportunity for the student to apply principles of family-centered care. Pre/corequisite: 6010, 7011, 7013. [1] Fall
7031. Advanced Practice Nursing in Pediatric Acute Care-Part II This course is the second part of the acute care content designed to provide students with the knowledge necessary for the management of acutely ill, chronically ill, and critically ill children and adolescents. Course content builds upon the illness management presented in NURS 7022, and that of NURS 7025 related to the principles of assessment and management of common health care problems and developmental issues in children and adolescents. A portion of the course includes information necessary for PNP-ACs to care for pediatric clients with special needs and their families. Using a family-centered and developmental perspective, related advanced pathophysiology, research, psychosocial factors, and ethical considerations are explored. Prerequisites: 6010, 7011, 7013, 7022, 7025, 7045. Corequisite: 7095. [3] Summer
7032. Current Issues in the Delivery of Advanced Pediatric Care [Formerly NURS 313] The focus of this course is on the pediatric nurse practitioner role in developing, implementing, and evaluating comprehensive care with pediatric clients. Applications of effective strategies with selected families and populations are emphasized.Advanced Practice Nurse Assignment Papers. The course provides an opportunity for synthesis of knowledge and skills, including management and communication strategies, health policies and trends, appropriate theories, and ethical principles. Pre/corequisite: None. [3] Summer
7035. Practicum in Primary Health Care of Children [Formerly NURS 314A] This course is a precepted clinical practicum focusing on pediatric health care in the primary care setting with an emphasis on health promotion, management of common health problems, and client education. A developmental approach is used in assessing the child and adolescent and formulating the treatment plan. Nursing strategies to educate and assist children and families in adaptation to special health needs will be discussed and implemented. Learners also participate in clinical conferences where various pathophysiological and psychological processes encountered with the child and his/her family will be discussed. The role of the nurse practitioner as a primary health care provider in a variety of pediatric settings is examined. Learners explore relevant resources/research related to pediatric health care and apply findings to the care of clients. Advanced Practice Nurse Assignment Papers. Prerequisite: 6010, 7011, 7012, 7013, 7015; Pre/corequisite: 7021, 7023. [4] Spring
7045. Advanced Practice Nursing in Pediatric Acute Care Practicum – I [Formerly NURS 314C] This course is a precepted clinical practicum focusing on inpatient management of acutely ill, chronically ill, and critically ill pediatric patients. A developmental approach is used to assess hospitalized pediatric patients and formulate a comprehensive plan of care. Precepted clinical rotations in acute pediatric health-care settings provide the opportunity for advanced health assessment of the child, interdisciplinary collaboration, and comprehensive patient care management. All clinical experiences must occur in the acute care setting. Integrated principles of advanced pathophysiologic and psychosocial concepts will be applied to the care of acutely ill pediatric patients and their families.Advanced Practice Nurse Assignment Papers. Emphasis will be placed on evidence-based, family-centered, culturally-competent pediatric health care. The role of the pediatric nurse practitioner as an acute care provider in a variety of pediatric settings will be examined. Prerequisite: 6010, 7012, 7013, 7025, 311. Corequisite: 7022 and 7024. [4] Spring
7085. Advanced Pediatric Primary Care Preceptorship [Formerly NURS 314B] The focus of this clinical practicum is on implementation of the pediatric nurse practitioner role in delivering primary care to pediatric clients. The preceptorship provides a broad practice experience which allows for synthesis of knowledge and skills acquired in prerequisite and corequisite coursework. Emphasis is on providing comprehensive care to pediatric clients and families across a variety of practice settings in collaboration with other health professionals.Advanced Practice Nurse Assignment Papers. At least 240 of the total clinical hours will be in primary care settings. Clinical seminars will focus on professional role issues for pediatric nurse practitioners and case presentations. Prerequisite: 6010, 7011, 7012, 7013, 7015, 7021, 7023, 7035. [5] Summer
7095. Advanced Practice Nursing in Pediatric Acute Care Practicum – II [Formerly NURS 314D] This course is a precepted clinical practicum focusing on the management of acutely ill, chronically ill, and critically ill pediatric patients and building upon the knowledge and experience gained in N314C. A developmental approach is used to assess hospitalized pediatric patients and formulate a comprehensive plan of care. Precepted clinical rotations in acute pediatric health-care settings provide the opportunity for advanced health assessment of the child, interdisciplinary collaboration, and comprehensive patient care management. All clinical experiences must occur in the acute care setting. Integrated principles of advanced pathophysiologic and psychosocial concepts will be applied to the care of acutely ill pediatric patients and their families. Emphasis will be placed on evidence-based, family-centered, culturally-competent pediatric health care.Advanced Practice Nurse Assignment Papers. The role of the pediatric nurse practitioner as an acute care provider in a variety of pediatric settings will be examined. Prerequisite: 6010, 7011, 7012, 7013, 7022, 7025, and 7045. Corequisite: 7031. [5] Summer
7205. Advanced Health Assessment Applications for the Psychiatric-Mental Health Nurse Practitioner [Formerly NURS 305B] This course builds on knowledge of advanced health assessment with a focus on co-morbid physical and psychiatric conditions commonly seen in psychiatric/mental health settings, with an emphasis on expanding proficiency in conducting histories and physical examinations.Advanced Practice Nurse Assignment Papers. Communication techniques unique to the specialty population are emphasized. Systematic and organized health assessments related to identification of co-morbidity and interrelationship of physical and psychiatric conditions and treatments are explored. Experienced psychiatric mental health practitioners, psychiatrists and other related providers serve as role models in clinical practice.Advanced Practice Nurse Assignment Papers. The course emphasizes the integration of health assessment strategies that are sensitive to the psychosocial needs of mental health clients. Pre/corequisite: 6010, 6011, graduate-level standing, admission to the Psychiatric-Mental Health Nurse Practitioner program. [1] Spring
7212. Theories of Individual and Family Psychotherapy This course introduces a variety of conceptual models and theories related to the practice of individual psychotherapy and family therapy. Models of personality development and family dynamics provide a theoretical basis for understanding the development of psychopathology and selection of appropriate therapeutic strategies. Students will apply selected theories to case study material and evaluate the utility of theory-based research findings for specific client populations. [2] Fall
7215. Theoretical Foundations and Practicum for Psychiatric-Mental Health Nursing Across the Lifespan [Formerly NURS 351] This course provides the theoretical content and clinical practice for assessing, diagnosing, and intervening in dysfunctional coping patterns and psychiatric disorders of individuals across the lifespan.Advanced Practice Nurse Assignment Papers. The DSM5 (Diagnostic Statistical Manual of Mental Disorders) will be used as the basis for diagnostic nomenclature across the lifespan. Emphasis will be placed on the assessment, diagnosis and evidence-based treatment of mental health disorders. Laboratory time concentrates on case-based simulation of initial diagnostic interviews, formulation of differential diagnoses and initial treatment plans. Clinical practicum provides students the opportunity to integrate theory and practice in supervised clinical experiences. Analysis of process dynamics and nursing interventions occurs during supervision. Pre/corequisite: 6011, 7211 or 7212. [3] Fall
7216. Child and Adolescent Psychopathology [Formerly NURS 355] This course builds on prerequisite knowledge of theoretical foundations of advanced nursing practice, mental health assessment, group and family therapy, models and theories of psychiatric nursing, neurobiology, psychopharmacology, research methods, pathophysiology, and clinical practicum with psychiatric patients. This two-credit course for post-master’s Adult PMHNP or Adult PMHCNS students reviews the major childhood disorders; looking at epidemiology, health and mental health promotion and prevention, risk factors, taxonomy, cultural factors, assessment issues specific to children and adolescents, use of rating scales, as well as evidence-based child and adolescent specific treatments. Individual therapy, cognitive-behavioral therapy, family-based interventions, psychopharmacological interventions, trauma-based interventions and combinations of these treatments will all be presented. Pre/corequisite: Admission to the PMHNP specialty level as a post-master’s student who holds current ANCC certification as an Adult Psychiatric Mental Health Nurse Practitioner (PMHNP) or Adult Psychiatric Mental Health Clinical Nurse Specialist (PMHCNS), has a master’s degree or a post-master’s certificate in psychiatric mental health nursing from an NLNAC or CCNE accredited program documented by official transcripts, holds a nursing license in an eligible state, and receives approval from the PMHNP Program Director to be eligible to take this course. [2] Summer
7221. Neuroscience for Mental Health Practitioners [Formerly NURS 352] This course presents advanced concepts in neuroscience and the clinical management of targeted psychiatric symptoms, related to the treatment of various psychiatric disorders.Advanced Practice Nurse Assignment Papers. The course reflects current scientific knowledge of neuroanatomy, neurophysiology, and neurochemistry, and its application to clinical problems seen in a variety of settings. This course complements diagnostic and psychopharmacology content from 7222 to provide the advanced practitioner with knowledge related to clinical management of psychiatric illnesses. Pre/corequisite: 6010 and 7222 or permission of faculty. [3] Spring
7222. Psychopharmacology [Formerly NURS 353] This course presents advanced concepts in neuroscience, pharmacokinetics and pharmacodynamics and the clinical management of targeted psychiatric symptoms, related to the psychopharmacologic treatment of various psychiatric disorders across the lifespan. The course reflects current scientific knowledge of psychopharmacology and its application to clinical problems seen in a variety of settings.Advanced Practice Nurse Assignment Papers. This course builds on diagnostic and neuroscience content from 7221 to provide the advanced practitioner with knowledge related to clinical management of psychotropic medications. Pre/corequisite: 6010, and 7221 or permission of faculty. [2] Spring
7225. Practicum in Psychiatric-Mental Health Nursing with Individuals, Groups and Families [Formerly NURS 356] This course builds on the first advanced practicum course by expanding the student’s ability to identify and apply concepts, theories, and principles to complex groups.Advanced Practice Nurse Assignment Papers. The student gains skill in implementing evidence-based practice interventions, case load management, and analyzing process dynamics with individuals, families, and groups so that patterns in self and others are identified accurately and with regularity. Students will explore the PMHNP scope of practice through exposure to multiple roles and models. They will continue to refine diagnostic skills, pharmacological management, non-pharmacological management, and clinical reasoning. A focused needs assessment at clinical site will form the basis for implementation and evaluation of summer clinical project to improve some aspect of patient care or agency services. Advanced Practice Nurse Assignment Papers. Prerequisites: 6011, 7205 and 7215; corequisites: 7221 and 7222. [4] Spring
7231. Population-based Mental Health Care Across the Lifespan [Formerly NURS 357] This course focuses on systems issues affecting clients across the lifespan who require special attention from the advanced practice psychiatric nursing role. Emphasis is placed on effective management of current practice issues without compromising the special needs of these populations. These issues deal with the areas of effective evidence-based treatments, interface with families, developmental task resolution, legal/ethical decision-making, socialization, placements, co-morbidities in care and finances. This content is then conceptualized and operationalized relative to the advanced practice psychiatric nursing role and its interface with both the interdisciplinary psychiatric team of care and other health care professionals involved in the holistic treatment of the patient. Pre/corequisite: Admission to the PMHNP specialty level. Successful completion of 7215, 7225 clinical coursework. [2] Summer
7232. Advanced Psychopharmacology Explores advanced concepts related to the targeted clinical management of psychiatric symptoms and disorders across the lifespan. Applies knowledge of pharmacokinetics and pharmacodynamics and evidence-based practices to the management of complex patients with psychiatric disorders across the lifespan.Advanced Practice Nurse Assignment Papers. Prepares the advanced practice registered nurse to evaluate available evidence to manage psychiatric disorders in persons with complex multimorbid psychiatric and physical health conditions. [2] Summer
7275. Psychiatric-Mental Health Nurse Practitioner Preceptorship with Child and Adolescent Focus [Formerly N358C] This clinical course builds on prerequisite knowledge of theoretical foundations and provides a synthesis experience during which the student implements the role of the psychiatric-mental health nurse practitioner applying current evidence-based practice focusing on children and adolescent clients and their families. Additional prerequisite knowledge includes mental health assessment and differential diagnosis, group and family therapy, models and theories of psychiatric nursing, neurobiology, psychopharmacology, research methods, pathophysiology, and previous psychiatric-mental health nursing experience. The clinical emphasis is on assessment, diagnosis, and both pharmacologic and non-pharmacologic intervention with children and adolescents with behavioral, developmental, and mental health disorders or at risk for mental illness within the context of their families and communities. Both direct (assessment, diagnosis, intervention) and indirect (consultation, case management, supervision) roles will be implemented.Advanced Practice Nurse Assignment Papers. This preceptorship is designed for ANCC Certified Adult PMH-CNSs or Adult PMHNPs seeking post-master’s certificate as Psychiatric Mental Health Nurse Practitioner prepared across the lifespan. Pre/Co-requisite: Admission to the PMHNP specialty level as a post-master’s student who holds one or more of the following current ANCC certification(s): Clinical Nurse Specialist in Adult Psychiatric Mental Health Nursing (Adult PMH-CNS) or Adult Psychiatric Mental Health Nurse Practitioner (Adult PMHNP); has a master’s degree or post-master’s certificate in psychiatric mental health nursing from an NLNAC or CCNE accredited program documented by official transcripts, hold a nursing license in an eligible state, and receives approval from the PMHNP Program Director to be eligible to take this course based on Gap Analysis of transcripts. Gap Analysis of transcripts documents completion of equivalent content and clinical for 6010, 6011, 6020, 6050, 6060, 6070, 7205, 7211 or 7212, 7215, 7221, 7222, 7225, 7231. N7216 Child/Adolescent Psychopathology is required co/pre-requisite. [3] Spring, Summer
7285. Psychiatric-Mental Health Nurse Practitioner Preceptorship with Adult and Geriatric Focus [Formerly NURS 358B] This clinical course builds on prerequisite knowledge of theoretical foundations of advanced practice mental health nursing and provides a synthesis experience during which the student implements the role of the psychiatric-mental health nurse practitioner applying current evidence-based practice focusing on adult and geriatric clients and their families. Additional prerequisite knowledge includes mental health assessment, group and family therapy, models and theories of psychiatric nursing, neurobiology, psychopharmacology, research methods, pathophysiology, and previous psychiatric-mental health nursing experience.Advanced Practice Nurse Assignment Papers. The clinical emphasis is on assessment, diagnosis, pharmacologic and non-pharmacologic interventions with adults and geriatric clients with mental illness and for persons/populations at risk for mental illness, as well as primary prevention in mental health. Both direct (assessment and intervention) and indirect (consultation, case management, supervision) roles will be implemented. This preceptorship is designed for ANCC Certified Adult Psychiatric-Mental Health Clinical Nurse Specialists and Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialists seeking post-master’s certificate as a Psychiatric Mental Health Nurse Practitioner prepared across the lifespan. Pre/corequisite: Admission to the PMHNP specialty level as a post-master’s student who holds one or both of the following current ANCC certification(s): Clinical Nurse Specialist in Adult Psychiatric Mental Health Nursing (Adult PMH-CNS) or Clinical Nurse Specialist in Child and Adolescent Psychiatric Mental Health Nursing (Child/Adolescent PMH-CNS); has a master’s degree or post-master’s certificate in psychiatric mental health nursing from an NLNAC or CCNE accredited program documented by official transcripts, holds a nursing license in an eligible state, and receives approval from the PMHNP Program Director to be eligible to take this course; 6011, 6020, 6010, 7221, and 7222; Gap analysis of graduate transcripts for completion of equivalent content and clinical for 7211 or 7212, 7215, 7225, 7231, 6070, 6050. [3] Spring, Summer
7295. Psychiatric-Mental Health Nurse Practitioner Preceptorship [Formerly NURS 358A] This clinical course provides a synthesis experience during which students implement the role of the psychiatric-mental health nurse practitioner.Advanced Practice Nurse Assignment Papers. The focus is on assessment and intervention with persons with mental illness and persons/populations at risk for mental illness, and primary prevention in mental health. In addition to expanding on clinical aspects of the PMHNP role, the course introduces professional aspects including legal issues and mental health policy. Interprofessional collaboration with other health care providers is emphasized. Prerequisite: 7225. [4] Summer
7305. Advanced Health Assessment Applications for the Women’s Health Nurse Practitioner [Formerly NURS 305B] Advanced techniques used in assessment of the health status of women are taught. Students in the course have the opportunity to enhance and refine their assessment and diagnostic skills in a laboratory setting.Advanced Practice Nurse Assignment Papers. Diverse applications are used to expand proficiency in history taking and health assessment techniques specifically directed at the health care of women. Pre/corequisite: 6011, graduate-level standing, admission to the specialty. [1] Fall
7310. Women’s Health for Advanced Practice Nursing I [Formerly NURS 327A] Consistent with the emerging definitions of women’s health and women’s health practice, this course examines a full range of health issues unique to women, focusing on obstetric and gynecologic issues.Advanced Practice Nurse Assignment Papers. Women’s health specialization includes prevention across the lifespan, societal and political determinants of health, patient education, culturally competent care, and reconceptualization of women’s relationships with healthcare providers. This course will focus on the health assessment and maintenance of wellness including normal gynecologic issues, the childbearing family, and the low-risk pregnancy.Advanced Practice Nurse Assignment Papers. Students utilize current research in women’s health and identify potential research opportunities in obstetrics and gynecology. Corequisite: 6011. [3] Fall
7315. Practicum in Women’s Health [Formerly NURS 328] This practicum offers opportunities for students to engage in specific components of advanced nursing practice during self-directed clinical experiences in collaboration with preceptors. Students will apply advanced knowledge of normal physiology, pathophysiology and psychosocial concepts to nursing care of women across the lifespan. Pre/corequisite: 6011, 6020, 7305, 7310, 7320. [4] Spring, Summer
7320. Women’s Health for Advanced Practice Nursing II [Formerly NURS 327B] Building on prior knowledge of experience with women’s health emphasizing wellness, students will begin to critically examine and evaluate evidence regarding deviations from normal gynecology and low-risk pregnancy. This course focuses on advanced nursing practice through the comprehensive assessment and management of disease processes and treatment of obstetric-gynecologic abnormalities.Advanced Practice Nurse Assignment Papers. Concepts include disease and risk identification, culturally competent care, management, treatment, risk reduction, patient education, consultations and referrals. Pre/corequisite: 6010, 7310. [3] Spring
7330. Women’s Health Issues [Formerly NURS 326] In this course, students examine major historical, political and cultural influences on the health and health care of women in the United States. Students develop a woman-centered holistic approach to care, which is the central concept in their women’s health nursing practice. Enrollment limited to WHNP and WH/AGPCNP students. [1] Summer
7395. Preceptorship in Women’s Health [Formerly NURS 329] The Women’s Health Nurse Practitioner specialty begins with the study of healthy childbearing women and gynecologic, well-woman care then continues with the study of high-risk obstetrics and deviations from normal gynecology. Emphasis is on health maintenance of women throughout the life span. This course prepares students for entry-level advanced practice as a Women’s Health Nurse Practitioner. Pre/corequisite: 7315, all core courses. [5] Fall, Summer
7999. THESIS [Formerly NURS 379] THESIS
Dcotorate of Nursing Practice Courses
8010. Evidence-Based Practice I: The Nature of Evidence [Formerly NURS 410] This course explores the philosophical underpinnings for nursing knowledge relevant to advanced nursing practice at the doctoral level.Advanced Practice Nurse Assignment Papers. Methods by which nursing knowledge is generated, levels of evidence, nursing theories and theories from other disciplines informing nursing practice will be investigated. Students will identify and analyze concepts relevant to their topic of interest. Admission to the DNP Program or permission of instructors required. [2] Fall
8012. Informatics for Scholarly Practice [Formerly NURS 412] This course provides an overview of informatics and the role it plays in the delivery of evidence based care. With a focus on healthcare information technology’s (IT) contribution to data acquisition, this course will enhance the student’s understanding of the transformation of data into information and knowledge for scholarly practice and inquiry. A practical approach is taken to ensure students understand and can synthesize evidence based aspects of informatics practice including evolving trends such as the use of social media in health care, use of remote monitoring systems, simulation strategies, patient portals and patient generated health data.Advanced Practice Nurse Assignment Papers. Driving this evolution is the involvement of the federal government via healthcare reform policies. This course prepares the student to optimize the use of clinical systems and technology tools to continue to advance practice and drive clinical transformation. [2] Fall
8014. Statistics in Health Sciences [Formerly NURS 414] This course provides the foundation for the critical evaluation and synthesis of published health sciences evidence including an overview of the appropriate use and interpretation of commonly used statistical techniques for generating that evidence. Students will analyze the research methods and reported statistical results in published literature with an emphasis on implications for advanced nursing practice decisions.Advanced Practice Nurse Assignment Papers. Students will develop plans for analysis of data collected with consideration of the alignment of project purpose with methods. Students will develop skills necessary to translate the statistical findings for stakeholders. Prerequisite: Admission to the DNP program or permission of instructors. [3] Spring
8015. Integrative Application of Evidence-Based Practice I [Formerly NURS 420] NURS 8015 is the first of the three integrative application courses that provides a progressive sequence to advance and develop the student into a practice scholar. This course offers the student mentored opportunities to initiate the development of the DNP scholarly project proposal and apply clinical scholarship to improve patient and population health outcomes.Advanced Practice Nurse Assignment Papers. The student is expected to accrue a minimum of 125 hours in an area related to their practice inquiry to achieve the Essentials of Doctoral Education for Advanced Nursing Practice competencies. The student will integrate the academic achievements and evidence in a portfolio to reflect the application of advanced empirical, theoretical, leadership, and specialty knowledge and skills to clinical practice and systems level experiences. Prerequisite: 8010 (or seamless transition student). Corequisite: 8014 & 8042. [1] Fall, Spring
8022. Evidence-Based Practice II: Evaluating and Applying Evidence [Formerly NURS 422] This course will build on Evidence-Based Practice I by preparing DNP students to evaluate evidence designed to improve clinical outcomes related to their identified topic of interest, and to translate the evidence into practice environments. Prerequisite: 8010 (or seamless transition student). [3] Spring
8024. Epidemiology [Formerly NURS 424] Epidemiology focuses on the distribution and determinants of disease frequency in human populations.Advanced Practice Nurse Assignment Papers. This course introduces concepts of population, incidence, bias, and disease causality. Implications for program evaluation will be discussed. Upon completion, the student will be able to apply epidemiologic concepts and methods to examine patterns of system, population, and/or individual health outcomes or indicators and to evaluate published studies of these outcomes. Pre/Corequisite: 8014. [3] Spring, Summer
8025. Integrative Application of Evidence-Based Practice II [Formerly NURS 430] NURS 8025 is the second of the three integrative application courses that provides a progressive sequence to advance and develop the student into a practice scholar.Advanced Practice Nurse Assignment Papers. This course offers the student mentored opportunities to complete the DNP scholarly project proposal and apply clinical scholarship to improve patient and population health outcomes. The student is expected to accrue a minimum of 250 practice hours in an area related to their practice inquiry to achieve the Essentials of Doctoral Education for Advanced Nursing Practice competencies. Advanced Practice Nurse Assignment Papers. The student will integrate the academic achievements and evidence in a portfolio to reflect the application of advanced empirical, theoretical, leadership, and specialty knowledge and skills to clinical practice and systems level experiences. Prerequisite: 8015; pre/corequisite: 8032 or 8034. [1] Spring, Summer
8032. Health Care Economics and Finance [Formerly NURS 432] This course covers basic economic theory, market drivers and restraints, health care finance and reimbursement, cost-benefit analysis and health care entrepreneurism.Advanced Practice Nurse Assignment Papers. Theory and application are integrated throughout the course with a particular focus on the clinical role of the DNP within the contemporary health care environment. Students take either 8032 or 8034. [3] Summer
8034. Advanced Health Care Economics and Finance [Formerly NURS 434] This course addresses advanced application of economic theory, financial principles and financial modeling in the health care market. Theory and application are integrated and aimed at preparing the student to assume an executive-level DNP role in large and complex health care organizations. [3] Summer
8042. Quality Improvement and Patient Safety [Formerly NURS 442] This course introduces students to improvement science and prepares them to design, implement and evaluate evidence-based quality health care practices for patient populations (individuals and aggregates) in acute, home and community settings. Working as partners in interdisciplinary teams, students will assess organizational culture, gather safety information, analyze data and translate findings into systems changes through action learning experiences within their own organizations. [3] Fall
8044. Management of Organizations and Systems [Formerly NURS 444] This course synthesizes leadership theory and organizational models within the context of the health care industry. Models of human resource management, change management, strategic planning, program development and implementation will be explored and applied. Based on these theories and models, the student will derive the DNP’s role in complex health care organizations. [3] Fall
8045. Evidence Based Leadership in Healthcare Organizations: Creating sustainable value in Health Care [Formerly NURS 445] This course is specifically designed for DNP students with demonstrated leadership competencies in organizational theory and behavior, leadership principles and practices, and organizational structure and culture through prior graduate education and career history. These experienced nurse leaders will apply evidence based leadership methodology towards creating sustainable value within their own health care environments. The DNP Leadership role is explored as an important catalyst for transforming traditional organizational decision-making and policy development to an evidence based approach. Prerequisite: 8010, 8032 or 8034. Corequisite: 8012 or permission of instructor. [3] Fall
8052. Health Policy [Formerly NURS 452] This course addresses health policy from the perspectives of evidence development, analysis and economic impact within a socio-political context. There is a secondary focus on the role of regulation within the U.S. health care system. The DNP contribution to health policy development is explored. [2] Spring
8054. Legal and Ethical Environment [Formerly NURS 454] This course provides a comprehensive analysis of the legal, regulatory and ethical environments that impact DNP practice. [3] Spring
8060. Obesity and Weight Control Part 1: Biology, Physiology and Epidemiology [Formerly NURS 460A] Nationwide and worldwide the obesity epidemic is growing, and this has led to a significant number of adults and children with obesity-related comorbidities such as hypertension, dyslipidemia, type 2 diabetes and cardiovascular disease. Awareness of this trend necessitates greater understanding of the link between adiposity and metabolic disease.Advanced Practice Nurse Assignment Papers. This course will review the biological and physiological control of food intake and energy balance. The course will evaluate the metabolic pathways in which food and macronutrient intakes are utilized to provide energy and mechanisms by which body weight and health are influenced. Public health issues associated with obesity, energy and macronutrient intakes will be discussed as well as the adequacy of intakes in meeting recommended requirements at various life stages. Critical evaluation of peer-reviewed literature will be used to study prevention and risk factors of overweight and obesity, consequences with regard to metabolic syndrome and other chronic disease states, and public health issues. This course builds on undergraduate/graduate preparation in anatomy, physiology and biochemistry. [2] Fall
8062. Management of Psychiatric Issues for the Non-Psychiatric-Mental Health Advanced Practice Nurse [Formerly NURS 462] Expand clinical competencies of Non-Psychiatric Mental Health Advanced Practice Nurses in assessing, evaluating, diagnosing, and treating mental health problems. This course will identify common mental health disorders seen in the primary and acute care settings including the epidemiology, etiology, risk factors and diagnostic signs/symptoms of these disorders. It will also provide clinical practice guidelines, screening tools and evidenced based treatment approaches to provide a foundation for the clinician to identify and manage common disorders within their scope of practice and setting.Advanced Practice Nurse Assignment Papers. Students will also recognize when psychiatric consultation or specialty care is indicated. The course is designed for the non-mental health provider and builds on undergraduate/graduate preparation in anatomy, physiology, biochemistry within a cultural context. Prerequisite: Specialization in a non-Psychiatric-Mental Health Advanced Practice Nurse role. [2] Not Currently Offered
8064. Scholarly Writing This course is designed to prepare students to be disciplined thinkers and effective communicators. The course explores general principles of analytical, expository, and argumentative writing and provides opportunity to review elements of the scholarly writing process; implement strategies to compose, review and proofread composition; critique one’s own work; and evaluate the writing of others. [1] Fall
8066. Curriculum Strategies for Health Professionals Education [Formerly NURS 466] (Required course for students who have received a Nurse Faculty Loan) This course introduces the student to the foundations of learning theory and learning styles. The impact of technology on learning practices and the appropriate use of technology to facilitate learning is emphasized.Advanced Practice Nurse Assignment Papers. Students will create course units for effective learning and use a course management system. Overall curriculum strategies that integrate content, organization, informatics and sequencing of courses are discussed. Prerequisite: Graduate-level standing. [3] Fall
8067. Educational Evaluation for Learning in the Health Professions [Formerly NURS 467] (Required course for students who have received a Nurse Faculty Loan) This course provides an introduction to theoretical foundations and evidence-based strategies for assessment, measurement, and evaluation in nursing education. Course participants explore assessment of clinical and didactic learning across cognitive, psychomotor, and affective domains for diverse learners, and are introduced to strategies for curriculum and program evaluation.Advanced Practice Nurse Assignment Papers. Emphasis is placed on development of test items, interpretation of test results, evaluation of written assignments, and assessment of clinical skill performance. Discussion of legal, ethical, and social issues related to evaluation is included. Prerequisite: None, although completion of 8066 is strongly recommended. [3] Spring
8068. Online Methodologies for Nursing Education [Formerly NURS 468] This course prepares nurse educators to teach in blended, hybrid, and online environments. Students will learn effective course design and teaching/learning strategies for students in the online setting, including pedagogical approaches to facilitate social processes of online learning, collaboration, and engagement. Moving from theoretical to practical application, students will create an online learning module and evaluate a sample course for quality. Prerequisites: None, although completion of N8066 and N8067 is recommended. [3] Summer
8069. Lean Methodology in Healthcare [Formerly NURS 469] This course focuses on the analysis and application of Lean principles to improve a process or system. This course builds on basic quality improvement principles. Topics include a history of the Toyota production system including how to identify the eight wastes in health care, how to implement 5S, A3 concepts, data collection, and value stream mapping of current state and future state processes. [2] Spring, Summer
8070. Obesity and Weight Control Part 2: Management and Practice [Formerly NURS 460B] Weight management and treatment of overweight, obesity, metabolic syndrome and other obesity related comorbidities requires multidisciplinary efforts.Advanced Practice Nurse Assignment Papers. This course will build on the knowledge obtained in 8060 to provide the student with a comprehensive understanding of national and organizational guidelines as well as current evidence based standards of care. The course will review the role of various health care providers in screening and assessment of body weight and energy balance. Patient management issues specific to age groups across the life cycle will be discussed as well as differences in practice and management by health care setting. The course content will include use of the scientific evidence to evaluate current dietary, pharmaceutical and surgical treatment models, strategies to optimize outcomes as well as identification and management of adverse outcomes. [2] Summer
8071. Leadership in Interprofessional Practice: Critical Issues for Promoting a Culture of Safety [Formerly NURS 471] This course is designed to enhance students’ understanding of the management of unprofessional behavior, difficult interpersonal interactions, disclosure of medical errors and the role of each in building a culture of safety in the clinical practice environment. Using a case-based format, students will explore critical incidents, gain expertise in recognizing impediments to patient safety, and develop skills to rectify situations resulting in poor clinical outcomes. Students participate in faculty-guided, case-based group exercises emphasizing inter-professional team dynamics and emerge prepared to serve in leadership roles to create safer practice environments.Advanced Practice Nurse Assignment Papers. The course builds on undergraduate and graduate preparation by engaging the student to gain new perspectives on how to expertly handle inter-professional discord, disclosure of medical errors, and improve communication in the healthcare team. Prerequisite: Graduate level standing. MSN students may enroll in the course with permission of the instructors. [2] Summer
8072. Fundamentals of Global Health: Addressing Global Health Disparities [Formerly NURS 470] This is a 3 credit hour elective course designed for graduate students interested in global health and will consist of seven units: Introduction to Global Health, Health Disparities, Health Care Delivery Systems, Evidence-based Practice, Non-communicable and Communicable illnesses, Trauma and Violence and Effective, Ethical Models for Global Health Engagement. The course will focus on best practices for allocating scarce resources and engaging in interdisciplinary global health work with diverse communities from a cultural, ethical and clinical perspective. Students will engage in learning through readings, synchronous and asynchronous discussions, case studies and written assignments. This course is designed for students interested in caring for and empowering underserved populations locally and abroad. [3] Fall, Spring
8073. Genetics in Clinical Practice This is an elective course which focuses on the genetic basis of disease, genetic risk assessment and counseling, clinical genetics and management guidelines. The course will serve as the basis for the healthcare professional to holistically integrate genetic/genomics, epigenetics, and scientific concepts into personalized health care. This course is provided for doctoral and graduate students and offered during the spring, summer, and fall semesters. Students outside the School of Nursing should contact the instructor for permission to enroll. [2] Fall, Spring, Summer.Advanced Practice Nurse Assignment Papers.
8074. Foundations of Genetics/Genomics in Healthcare This is an elective course which focuses on the molecular basis of genetic disease, inheritance of disease and distribution of genetic diseases in populations. The course aims to expose students in the health sciences to genetic/genomic concepts for integration in clinical care and research endeavors. The ethical, legal and social implications of genetic testing will be addressed along with the available technology and applications of data science. This course is provided for doctoral and graduate students and offered during the fall and spring semesters. Students outside the School of Nursing should contact the instructor for permission to enroll. [3] Fall, Spring
8076. Building a Professional Scholarship Trajectory This is an elective course for the Vanderbilt University School of Nursing Doctorate of Nursing Practice Program focused on building a professional scholarship trajectory. Students will develop a plan for pursuing scholarship initiatives. Pre-requisite: admission to the DNP program or permission of faculty. [1] Spring
8080. Independent Study [Formerly NURS 464] Individualized study with content related to the student’s practice and scholarly project.Advanced Practice Nurse Assignment Papers. A contract is made between the student and faculty adviser with copies for the student, faculty adviser, program director, and student’s academic record. With the adviser’s guidance, the student is responsible for identifying study objectives and DNP competencies that are addressed within the course, and for specifying the primary DNP competency related to this study and learning activities and evaluation method. In addition, the student must complete the independent study agreement form that is available on the School of Nursing website. Prerequisite: Consent of faculty adviser. [Variable credit 1-4] Fall, Spring, Summer
8090. Palliative Care for Adults: Advanced Pain and Symptom Management [Formerly NURS 465A] This course provides a foundation for graduate level nurses to deliver effective pain and symptom management for adults living with a complex serious illness and/or terminal disease. The paradigm shift from traditional models of health care to models of palliative and hospice care, and the resultant impact on care in this population and their families are explored. Advanced Practice Nurse Assignment Papers. The complexity of serious illnesses and terminal diseases and challenges and barriers to effective pain and symptom management are examined.Advanced Practice Nurse Assignment Papers. Evidence-based pain and symptom management by the advanced practice nurse are emphasized. Prerequisite: Admission to graduate program or permission by faculty. Must be APRN or APRN student and completed Pathophysiology, Pharmacology and Assessment courses. [2] Spring
8091. Palliative Care for Adults: Psychosocial, Spiritual and Cultural Aspects [Formerly NURS 465B] This course provides a foundation for understanding the relationships among individual and family psychosocial, spiritual and cultural dimensions, ethical issues and client-family-provider communication when providing palliative and end-of-life care to adults and their families. Selected theory and practice components of loss, grief, death and bereavement for patients, families, and professional caregivers are examined. Prerequisite: Admission to graduate program or permission by faculty. [2] Summer
8092. Palliative Care III: Palliative Care in Specialized Populations [Formerly NURS 465C] Palliative Care in Specialized Populations. [Formerly NURS 465C] This is one of three didactic palliative care courses. This course is designed to provide graduate level nurses with the knowledge and skills important to provide clinical care for clients of all ages living with advanced complex illness and their families.Advanced Practice Nurse Assignment Papers. In particular, this course presents selected theory and practice components of palliative care in specialized populations, such as children, homeless, home bound, Veterans and older adults. The course is designed to continue to develop the knowledge and skills necessary for therapeutic and compassionate interactions with specific populations facing advanced illness and death. In addition, this course focuses on development of the APRN in leadership and education. Specifically, topics discussed are aspects of starting a palliative care service, measuring quality indicators, educating staff in caring for patients receiving palliative care and developing leadership qualities to guide the health care system to improve care to patients and families with advanced illness. Prerequisite: admission to post-master’s or DNP program or permission of faculty. [2] Fall
8095. Integrative Application of Evidence-Based Practice III [Formerly NURS 440] NURS 8095 is the third of three integrative application courses that provides a progressive sequence to advance and develop the student into a practice scholar. This course offers the student mentored opportunities to implement their DNP scholarly project and disseminate the findings to improve patient and population health outcomes. Advanced Practice Nurse Assignment Papers. The student is expected to accrue a minimum of 500 practice hours in an area related to their practice inquiry to achieve the Essentials of Doctoral Education for Advanced Nursing Practice competencies. The student integrates the academic achievements and evidence in a portfolio to reflect the application of advanced empirical, theoretical, leadership, and specialty knowledge and skills to clinical practice and systems level experiences. Prerequisite: 8025. [2] Fall, Summer
8105. DNP Integrative Application of Evidence-Based Practice NURS 8105 is an integrative application course that provides a progressive sequence to advance and develop the student into a practice scholar.Advanced Practice Nurse Assignment Papers. This course offers the student mentored opportunities to develop and implement the DNP project and apply scholarship to improve healthcare system, patient, and/or population health outcomes. The student is expected to accrue a minimum of 500 practice hours to achieve the Essentials of Doctoral Education for Advanced Nursing Practice competencies. Pre-requisites: 8010 and 8042. Co-requisite: 8022. This course is designed to be repeated for at least four terms. Students will earn zero credit hours in all but the final term of enrollment for the series, at which time students will be awarded four credit hours upon successful completion of the sequence.Advanced Practice Nurse Assignment Papers. For the purposes of billing, academic load determination, and financial aid, this course will count for one credit hour in all terms of enrollment. [4] Fall, Spring, Summer
PhD in Nursing Science Courses
8302. Advanced Doctoral Seminar I [Formerly NRSC 302] This course consists of a series of seminars focusing on issues related to qualifying examinations, the dissertation, and continued development of a program of research. The topics are selected by course faculty and the students who plan to take the comprehensive examinations withing the next 9-12 months. Topics and experiences may include proposal development, grant applications, mock proposal reviews, qualifying examination situations, and dissemination of research findings. The seminar is required for two consecutive semesters.Advanced Practice Nurse Assignment Papers. Prerequisite: Core Ph.D. course completion consistent with ability to complete the qualifying examination within 9-12 months after registration. [1] SPRING Spring
8303. Advanced Doctoral Seminar II [Formerly NRSC 303] This is the second seminar course in this series. Prerequisite: completion of NRSC 8302: Advanced Doctoral Seminar I. [1] SUMMER Summer
8304. Ethical And Legal Issues In Research [Formerly NRSC 304] This course provides an overview of issues related to the responsible conduct of research, including data management, vulnerable populations, authorship and publication, conflicts of interest and collaboration. Federal and institutional guidelines are included. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [2] SPRING Spring
8305. Informatics And Scholarly Inquiry [Formerly NRSC 305] This course provides an overview of informatics, a specialty that joins nursing science with information and analytical sciences throughout the data, information, knowledge, wisdom continuum. To take advantage of the current data-rich healthcare environment, scholars need to understand core informatics principles in order to use data for knowledge generation.Advanced Practice Nurse Assignment Papers. In addition, this course familiarizes the student with technology tools to organize, interpret, and present data. [2 credits]. FALL
8306. Research Design And Statistics I [Formerly NRSC 306] This course focuses on understanding and applying the basic concepts of descriptive and relational research design and statistics. Students will be introduced to the full range of designs available to address research aims, moving from descriptive to experimental and quasi-experimental. Advanced Practice Nurse Assignment Papers. After examining the relationship of research aims to research design, the nature of measurement, and causal inference, relevant statistical methods for visualizing, describing, and making inferences from data will be introduced. The focus will be on univariate and bivariate descriptive methods. Statistical computing packages will be used. Published research will be used to develop the student’s ability to evaluate the design and statistical methods used to describe health care phenomena as well as relationships among them. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [3] FALL
8307. Research Design And Statistics II [Formerly NRSC 307] The course expands the concepts and applications of RD&S I including an introduction to longitudinal and randomized control design issues.Advanced Practice Nurse Assignment Papers. Topics related to internal validity, experimental designs, and issues in comparing individuals and groups cross-sectionally and longitudinally will be detailed.Advanced Practice Nurse Assignment Papers. Students will be introduced to issues in external validity and the relationships between internal and external validities. Parametric and non-parametric univariate comparative statistical methods used to analyze data resulting from cross-sectional and randomized controlled designs will be included. Students will be expected to generate and interpret results from statistical software and present relevant information in figures, tables, and text. Concepts will be studied within the context of evaluating published research. Prerequisite: completion of Research Design and Statistics I or consent of faculty. [3] SPRING
8308. Research Design And Statistics III [Formerly NRSC 308] This course is focused on advanced designs and multivariate statistical techniques.Advanced Practice Nurse Assignment Papers. Design topics include advanced issues in external validity, field experimentation versus laboratory experiments, quasi-experimental and blended designs as well as special considerations for nested and complex longitudinal designs. Related statistical topics include advanced multiple linear regression methods (e.g. path and structural equation modeling), log-linear models and advanced techniques in survival and longitudinal data analysis. These methods and concepts will be discussed and evaluated through educational resources and published research using them. Students will have the opportunity to develop advanced skills in statistical applications most commonly used in their respective areas of interest. Prerequisite: completion of Research Design and Statistics II or consent of faculty. [3] SUMMER
8309. Special Topics In Quantitative Methods [Formerly NRSC 309] This course provides an overview of varied and timely topics in the field of quantitative methods.Advanced Practice Nurse Assignment Papers. Exemplar topics may include issues in data collection methods such as using online or other resources, an examination of how quantitative data collection methods influence data management and analytic approaches, collection methods for physiological or psycho-social outcomes, and the benefits and drawbacks of using public data sets, conventional and new analytic techniques, as well as broader issues in the evolution of quantitative methods. Prerequisites: NRSC 8308, NRSC 8313; NRSC 8352 or NRSC 8382; or with permission from instructor(s). [2] FALL Fall
8310. Health, Health Care, Research, And Public Policy [Formerly NRSC 310] This course explores and critically analyzes theoretical and empirical approaches to understanding dynamic synergies between research, nursing practice, health care organization, and public policy and their impact on health. Strategies for dissemination, translation, and evaluation of evidence-based research findings to support health care practices and public policies to measurably improve health outcomes for selected populations and the student’s phenomenon of interest will be discussed.Advanced Practice Nurse Assignment Papers. Local, national, and global implications will be explored. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [2] SPRING
8311. Role of Scientist In Academe, Community, And World [Formerly NRSC 311] This seminar course assists the student to develop a personal framework for behavior within academe, the scientific community, and the world beyond. Through readings and discussions, the student will explore a variety of viewpoints about the duties and responsibilities of an educated citizen scientist in an interdependent world. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [1] SPRING
8312.Advanced Practice Nurse Assignment Papers. Programs of Research And Grantsmanship [Formerly NRSC 312] This course provides the foundational information necessary for developing a program of research. Focus is placed on acquiring practical skills necessary to develop a program of research, narrowing the focus of student’s area of research, and for basic grantsmanship. Focus is placed upon developing the knowledge and practical skills necessary to investigate an area of research interest and draft a research proposal appropriate to current level of career development needs and/or phenomenon of interest. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [2] FALL
8313. Theories of Science [Formerly NRSC 313] This course provides students with an introduction to the central theoretical and philosophical issues concerning the nature of science, the patterns of knowing and knowledge development, criteria for evaluating knowledge claims, and philosophy of science.Advanced Practice Nurse Assignment Papers. The course will enable students to become knowledgeable about the forces affecting the development of knowledge and critical analyses of theories commonly used in nursing research. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [2] FALL
8350. Conceptual Foundations For Clinical Research [Formerly NRSC 350] Critical analysis of theories, concepts, and research related to the promotion, protection, and restoration of health across the lifespan at individual, family, and community levels. Emphasis will be on the individual level. Students conduct a critical analysis of existing and emerging scientific knowledge in a chosen field of study. Advanced Practice Nurse Assignment Papers. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [3] SPRING
8352. Measurement In Clinical Research [Formerly NRSC 352] This course examines the principles of measurement, sources of measurement error, and procedures used for critical evaluation of the psychometric properties of clinical measures including techniques for assessing validity and reliability. Selected measures, commonly used in clinical research and specific to student research interests, will be evaluated for psychometric properties and fit with a proposed focus of study. Prerequisite: enrollment in the Ph.D. program and completion of NRSC 8307 and NRSC 8350; or consent of faculty. [3] SUMMER Summer
8353. Designing And Testing Clinical Interventions [Formerly NRSC 353] Analysis of methodological, ethical, and practical issues related to the design and implementation of theory-based intervention studies. Advanced Practice Nurse Assignment Papers. Students conduct a critical analysis of existing and emerging interventions related to their chosen field of study. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [3]
8366. Curriculum Strategies For Health Professional Education [Formerly NRSC 366] This course introduces the student to the foundations of learning theory and learning styles. The impact of technology on learning practices and the appropriate use of technology to facilitate learning is emphasized. Students will create electronic elements for effective learning and use a course management system. Advanced Practice Nurse Assignment Papers. Copyright and fair use issues are discussed. Overall curriculum strategies that integrate content, organization, informatics, and sequencing of courses are discussed. Students will design a learning program that integrates learning styles, technology use, and a course management system. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [3]
8368. Contextual Nature Of Health And Health Behaviors [Formerly NRSC 368] This course explores and critically analyzes theoretical and empirical approaches to understanding the interaction of health and environment in affecting health by examining contextual factors that impact health and health behaviors of various system levels. Examines disparity (e.g., social and economic) as a determinant of health among individuals and sub-populations. Critique selected models of health, health behavior, community organization, and health care delivery and their usefulness to understand and impact selected health phenomena and various ethno-cultural populations and communities.Advanced Practice Nurse Assignment Papers. Students critically analyze and synthesize the literature related to a selected phenomenon of interest. Prerequisite: enrollment in the Ph.D. program or consent of faculty.
8371. Advanced Concepts in Nursing Education This course is designed to facilitate expertise in the application of advanced educational concepts, principles, and theories related to nursing education in the academic setting. The underlying premise for the value of such knowledge is that nurse educators encounter situations and issues that warrant systematic consideration, and reflection. Moreover, students will acquire competence in facilitating learner development and role socialization, review accreditation parameters for nursing programs, and explore various aspects and topics such as legal, ethical and socio-cultural factors related tot he role of the nurse educator. Prerequisites: 366, 367 [3] FALL
8377. Special Topics In Nursing Science Students will discuss research and current developments of special interest to faculty and students (may be repeated for credit). Prerequisite: enrollment in the Ph.D. program or consent of faculty. [Variable credit: 1-3]
8380. Knowledge Synthesis In Nursing Science [Formerly NRSC 380] This course provides a critical appraisal of the theoretical and empirical basis of nursing science.Advanced Practice Nurse Assignment Papers. Theories and research generated to study phenomena related to nursing are evaluated and synthesized. Strategies for synthesizing extant knowledge in nursing are discussed. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [3] SPRING
8381. Current Topics In Health Services Research [Formerly NRSC 381] This course assists the student’s development of expertise in knowing and applying resources (scholarly, organization, theoretical and methodological) to her/his health services research (HSR) foci as well as the position of her/his research interest within the current HSR environment. [3 credits]. SPRING. Prerequisite: enrollment in the PhD program or consent of faculty.Advanced Practice Nurse Assignment Papers.
8382. Measuring Outcomes: Issues In Health Service Research Designs [Formerly NRSC 382] In this course, the student will develop expertise in the design, measurement, and analysis of studies employing the five generic outcomes of greatest interest in outcomes studies: satisfaction, cost-effectiveness, mortality, health-related quality of life, and morbidity. The student will also be expected to develop an overview including measurement and analysis plans for a condition-specific outcome. The impact of the researcher’s decisions regarding conceptual models, treatment definition, risk adjustment strategies, and the application of statistical techniques will be explored. At least one controversy attendant to each of the five generic outcomes will be debated in class. Prerequisite: completion of Research Design and Statistics I and II. [3] Summer
8383. Issues in Health Services Research Intervention Studies [Formerly NRSC 383] The student will develop expertise in the design and execution of intervention studies in health services research. Emphasis will be placed on the selection of interventions and the valid and reliable execution of the interventions through examination of issues such as treatment fidelity, intervention duration, location and interventionist expertise. Advanced Practice Nurse Assignment Papers. The intervention categories studied include: labor, capital and processes (e.g., working conditions and work design.) Strategies of attending to the execution and analysis of multilevel, multi-organizational studies will be addressed. [3] Fall. Fall
8390. Independent Study In Nursing Science [Formerly NRSC 390] Individualized study and reading in areas of mutual interest to the student and faculty member. Prerequisite: consent of instructor. [Variable credit: 1-3] Fall, Spring, Summer
8394. Qualitative Research Methods [Formerly NRSC 394] This course introduces and explores qualitative research methods, including their theoretical and methodological foundations, and practical applications. Course participants will explore and pilot test one method in the context of their topic of interest.Advanced Practice Nurse Assignment Papers. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [3] Summer
8395. Research Practicum [Formerly NRSC 395] This course provides students with exposure to and involvement in the research process. Learning activities are based on student need and interest and determined according to best fit with available faculty research programs. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [Variable credit: 1-3]
8999. Non-Candidate Research [Formerly NRSC 379] Research prior to entry into candidacy (completion of qualifying examination) and for special non-degree students. Prerequisite: enrollment in the Ph.D. program or consent of faculty. [Variable credit: 0-6] Fall, Spring, Summer
9999. Ph.D. Dissertation Research [Formerly NRSC 399] Prerequisite: Enrollment in the Ph.D. program and consent of faculty. [Variable credit: 0-6] Fall, Spring, Summer

Quality Enhancement Research Initiative’s (QUERI) Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to Veterans Affairs (VA) managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports throughout VA.Advanced Practice Nurse Assignment Papers.

QUERI provides funding for 4 ESP Centers and each Center has an active VA affiliation. The ESP Centers generate evidence syntheses on important clinical practice topics, and these reports help:

develop clinical policies informed by evidence,
guide the implementation of effective services to improve patient outcomes and to support VA clinical practice guidelines and performance measures, and
set the direction for future research to address gaps in clinical knowledge.
In 2009, the ESP Coordinating Center was created to expand the capacity of QUERI Central Office and the 4 ESP sites by developing and maintaining program processes. In addition, the Center established a Steering Committee comprised of QUERI field-based investigators, VA Patient Care Services, Office of Quality and Performance, and Veterans Integrated Service Networks (VISN) Clinical Management Officers. The Steering Committee provides program oversight, guides strategic planning, coordinates dissemination activities, and develops collaborations with VA leadership to identify new ESP topics of importance to Veterans and the VA healthcare system.Advanced Practice Nurse Assignment Papers.

Comments on this evidence brief are welcome and can be sent to Nicole Floyd, ESP Coordinating Center Program Manager, at vog.av@dyolf.elocin.

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EXECUTIVE SUMMARY
This evidence brief discovered little new evidence regarding health outcomes of patients receiving care from an independent advanced practice nurse (APRN) or physician. In primary and urgent care settings, there was no difference in health status, quality or life, mortality, or hospitalizations favoring either APRN or physician care, although the strength of evidence was generally low (see Table 1).Advanced Practice Nurse Assignment Papers.

Table 1. Evidence Summary.
Table 1
Evidence Summary.

Recent publications promoting over-riding state scope-of-practice laws argue that a large body of evidence shows APRNs working independently provide the same quality of care as medical doctors. We found scarce long-term evidence to justify this position.

The generally low strength of evidence outlined in this brief does not necessarily mean that additional randomized trials are necessary to prove comparable health outcomes among patients cared for by APRNs and physicians. Data on performance measures and provider errors, which is routinely collected by the VA, may be a better source of information on the actual quality of care provided by independent VA APRNs.Advanced Practice Nurse Assignment Papers.

Strong conclusions or policy changes relating to extension of autonomous APRN practice cannot be based solely on the evidence reviewed here. Although no differences in 4 outcome measures (health status, quality of life, mortality, hospitalizations) were detected, the evidence cannot rule out such differences. Published evidence about performance measures, satisfaction, resource use, and considerations of access to care—as well as the track record of VA facilities that use this model—should be considered.Advanced Practice Nurse Assignment Papers.

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INTRODUCTION
The term “Advanced Practice Registered Nurse” (APRN) encompasses the Nurse Practitioner (NP), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), and Nurse Midwife (NM).1

Today, most NPs practice in primary care. Autonomy or independence has always been central to the concept of a nurse practitioner as a primary care provider.2 The National Council of State Boards of Nursing defines “independence” as practicing with “no requirement for a written collaborative agreement, no supervision, [and] no conditions for practice.”3 Although the authority to diagnose and prescribe are the most frequently mentioned aspects of independence, the concept encompasses other dimensions including entry into practice; authority to bill for services independently; access to diagnostic services and hospital admitting privileges; and recognition as primary care providers.4

Medical licensing is a state function and APRN scope-of-practice (SOP) laws vary from state to state. 5 In 16 states, APRNs have the authority to practice without a written agreement with a supervising physician, 9 states require physician involvement to prescribe but not to diagnose and treat, and in 24 states physician oversight is required to prescribe, diagnose, and treat.6 The definition of “oversight,” however, varies by state, and most states allow collaboration or supervision to occur remotely.7 There is also variation in SOP laws regarding APRNs’ authority to supervise clinical staff. For example, one article notes a requirement in sections 2069–71 of the California Business and Professions Code that doctors and selected other professions— but not registered nurses—may supervise California medical assistants.8

While there is disagreement about whether APRNs should practice independently, the seemingly arbitrary variation in SOP laws among the states is nearly universally criticized. As an editorial from the Commonwealth Fund put it, “objectively interpreted data on the competencies of professionals should guide policy, not rigid, often antiquated state laws.”9

The National Governors Association10 and the Institute of Medicine (IOM)11 have criticized variation in SOP regulations among the states, and both argue that nurses should be able to practice to the “full extent of their education and training” in order to adapt to the changing health care system after the implementation of the Affordable Care Act (ACA), which authorizes nurse-managed health clinics and other innovations.Advanced Practice Nurse Assignment Papers. In March, 2014, a report from the Federal Trade Commission, relying in large part on the IOM report, argued that physician supervision or collaborative practice agreement requirements “may sometimes restrict competition unnecessarily, which can be detrimental to health care consumers and have broader public health consequence,” that is, “decreased access to health care services, higher health care costs, reduced quality of care, and less innovation in health care delivery.”12 In the context of the ACA, one emergent issue is whether some patient care teams should be led by a nurse practitioner instead of only a medical doctor. Other advocates for change argue that, nationally, removing restrictions on NP practice would improve access to primary care and allow NPs to emerge as leaders of the integrated teams that are an important component of new models for delivering primary care.8,13,14

THE IMPACT OF STATE SOP REGULATION
Despite the strong statements from multiple groups, there has been very little formal study of the impact of SOP laws on access to and quality of care. The National Governors Association report, supporting the elimination of most SOP restrictions for APRNs, notes:

Although there is a growing body of evidence from health services research that suggests that NPs can deliver certain elements of primary care as well as physicians, there is a dearth of rigorous research that isolates the effect of NP scope of practice rules on health care quality, cost, and access at the state level.10

More restrictive SOP rules are probably associated with slower growth in the number of NPs15 and in the number of Medicare patients cared for by NPs.16 In both 2006 and 2010, the odds of having an NP as a primary care provider were 2.5 times higher in the least restrictive states compared to the most restrictive states.16 These findings have not been directly associated with overall access to primary care, and it is unclear whether SOP rules exert this effect directly, or indirectly via the policies of state and private payers. In an extensive provider survey, “at the point of care, scope-of-practice laws were not found to have substantial impact across the study states on what services NPs can deliver, despite significant differences across states in the level of NP autonomy…”17 Rather, the study found that payer policies had more impact than SOP laws on how and where NPs can practice.17 Payers in states with restrictive SOP laws often add additional restrictions, such as not recognizing NPs as primary care providers, that make independent NP practice difficult. In addition, Medicare policies do not permit a NP to order home health care or durable medical equipment, even in states in which NPs practice independently.Advanced Practice Nurse Assignment Papers.

Other arguments made by advocates for APRNs about the adverse effects of SOP restrictions are based on hypothetical reasoning or on anecdotes concerning inefficient use of time and, in some cases, delay in needed care because a physician’s approval was required to prescribe, order equipment, or admit a patient to the hospital.Advanced Practice Nurse Assignment Papers.

PHYSICIAN GROUP PERSPECTIVES
Physician groups that support SOP restrictions envision a system in which physicians delegate the care of less complex patients to (supervised) nurse practitioners; one physician advocacy group has estimated that “nurse practitioners and physician assistants are capable of providing 70% or more of the care required for adults and 90% in pediatrics.”18 According to J.K. Iglehart, the AMA supports team-based care but argues that teams should be led by medical doctors, as integrated systems such as Geisinger, Kaiser Permanente, and the VA have done. 5

These groups also argue that physicians may be better able to manage complicated diagnostic problems, patients with multiple chronic conditions, and unstable patients. These claims are plausible—as Blumenthal and Abrams note, “[p]hysicians and nurse practitioners receive very different training, and it would be surprising if their competencies were identical.”9 However, no studies have been done to examine the validity of these beliefs.Advanced Practice Nurse Assignment Papers.

Physician groups also argue that policymakers should take into account that patients prefer having a medical doctor as a primary care provider and that use of the title “doctor” by APRNs who have completed doctoral training could confuse patients about the training of their provider.19 Evidence about patients’ preferences regarding the type of provider is conflicting.Advanced Practice Nurse Assignment Papers.

VETERANS HEALTH ADMINISTRATION PRACTICE ENVIRONMENT AND PREVIOUS RESEARCH
In the Veterans Health Administration (VHA), the use of APRNs in the delivery of health care, including primary, specialty, acute, and home health care, expanded greatly after the implementation of the Veterans Integrated Service Network (VISN) structure in October 1995 and the Veterans Health Care Eligibility Reform Act in 1996 (Public Law 104-262).20 These changes resulted in a shift to local and regional networks grounded in ambulatory and primary care,21 an increase in the number of patients served by the VHA, and an increase in the percentage of patients seeking primary care services: 20% in fiscal year 1994 to 76% in fiscal year 1996. In 1996, 75% of VHA primary care practices reported using NPs and by 1999, this proportion had risen to 90%.22 Today the VHA employs over 4,700 nurse practitioner full time equivalents, 786 CRNAs, and 482 CNSs.23

Currently, although a single unrestricted license allows APRNs to work at any VA facility, the VHA observes state-by-state rules regarding prescribing and admission privileges and physician supervision for APRNs. Each VA institution establishes its own policies regarding all other aspects of scope of practice.Advanced Practice Nurse Assignment Papers. Advocates for “federal supremacy” argue that overriding state laws would “increase access to health care services, reduce costs and improve the quality and availability of health care” for Veterans by eliminating bureaucratic complexity and “artificial barriers” such as supervisory requirements.23,24 They note that varying regulations for diagnosing and prescribing can delay appropriate care and waste time and resources, particularly for CNSs in cardiology and other specialties working in VA facilities that serve patients from more than one state.

Research on APRNs in the VHA has been sporadic, and has focused on NPs rather than CRNAs or CNSs. From 1995 to 1999, the VHA HSR&D conducted one single-center RCT25 and several observational studies of the impact of NPs on access to specialty care, continuity of care, and resource use.26-29 Some studies demonstrated improved continuity of and access to care after implementation of an interdisciplinary firm system,27-29 however, little research was conducted in the 2000s.20,30 The best recent data are from a 2011 cross-sectional study of all VISN 11 primary care patients who had hypertension and/or diabetes.20 VISN 11 includes 2 states (Illinois, Michigan) with very restrictive scope of practice laws and 2 states (Ohio, Indiana) with moderately restrictive laws. The main findings were:Advanced Practice Nurse Assignment Papers.

On average, primary care NPs cared for less complicated patients than primary care physicians. MDs were caring for the more complex patients within the study sites.
Provider type was not significantly associated with an elevated blood pressure or creatinine level in either diabetic or hypertensive patients nor with an elevated HbA1c in diabetics.
Increased use of resources by NPs was not demonstrated. NPs were less likely than physicians to obtain psychiatric referrals.
A survey of VISN 11 NPs and MD providers was also part of this study. The main findings were:Advanced Practice Nurse Assignment Papers.

Over 80% of NPs said they assess acutely ill/unstable patients on their own, and about 70% said they also plan care and make medication changes on their own.
VHA NPs and physicians reported a high degree of collegiality.
Nevertheless, there were “striking differences” between physicians’ and nurses’ beliefs about the NPs’ scope of practice. About 50% of physicians (vs 21% of NPs) were apprehensive about the fact that NPs function on their own, particularly for acute/unstable patients.
A 2012 ESP report reviewed the evidence on the role of primary care providers’ skill level (MD vs NP/PA) in ambulatory care settings in influencing patient outcomes from a VHA perspective.31 The authors of the ESP report stated that they “did not review studies that examined the effect of skill levels on patient quality of care or patient safety as it is widely accepted that medical school or more training increases quality of care.” The best evidence the ESP identified came from 2 randomized controlled trials which consistently found no difference in patient satisfaction with provider interaction when seeing a NP/PA instead of an MD. The ESP report also noted that a large VA study of patient satisfaction among 1.6 million veterans seen in 21 VISNs provided some limited information about impact of skill level: patient satisfaction increased in 3 VISNs that hired more NP/PAs.Advanced Practice Nurse Assignment Papers.

USE OF EVIDENCE IN POLICY DEBATES
In a policy paper, Newhouse and colleagues state “[o]nce the issue of comparability between APRN care and that delivered by physicians is set aside in favor of an integrated team concept, disciplines can focus on…overarching goals” such as developing patient-centered team care, reducing quality gaps, and educating an interprofessional workforce.Advanced Practice Nurse Assignment Papers. 32 Their recent systematic review of RCTs and observational studies supports the emphasis on team care outlined in their policy paper. Including all types of APRNs, intermediate and health outcomes, and various patient populations and settings, Newhouse et al concluded that the outcomes of care provided by APRNs in collaboration with specialist or primary care physicians are similar to, or in some cases better than, the outcomes of care provided by a physician alone.33

Although Newhouse et al’s emphasis on the role of APRNs in integrated teams is more relevant to the current organization of primary care services in VHA, policy discussions about over-riding state SOP laws invoke the argument that APRNs working independently provide the same quality of care as medical doctors.11,24,34 The Institute of Medicine, for example, claims that a large body of evidence “does not support the conclusion that APRNs are less able than physicians to provide safe, effective, and efficient care.”11 Similarly, a publication from the Robert Wood Johnson Foundation (RWJF) asserts that “health outcomes are comparable for patients treated by primary care NPs and MDs.”24

Most articles about the role of APRNs do not explicitly define the autonomy of the nurses, compare non-autonomous nurses with physicians, or evaluate nurse-direct protocol-driven care for patients with specific conditions.35 However, studies like these are often cited in support of the claim that APRNs practicing autonomously provide the same quality of primary care as medical doctors. For example, the RWJF publication quoted above refers to a review by Naylor and Kurtzman14 that relied on 2 systematic reviews published in 2002 and 200536,37 and 2additional randomized trials published in 2009. Many of the trials included in 2 older systematic reviews were considered by Naylor and Kurtzman.36,37

The first additional trial comparing NP and general physician care was conducted 2 months after the NPs successfully completed a Masters-level training program. As nurses were not permitted to prescribe independently, physicians were “always available for consultation and to validate prescriptions and referrals.”38 The second randomized trial included in the Naylor and Kurtzman review evaluated a 4-visit, computer-guided, nurse-led intervention for overweight and obese patients conducted in 11 general practice (GP) locations.39

Most research on APRNs has evaluated team models of care or interventions designed to enhance care for patients with specific conditions (eg, incontinence, bronchiectasis, heart failure, etc.).36,37,40,41 The evidence supporting the contributions of APRNs in team models of care, protocol-driven care and nurse-led intervention focusing on a specific patient population is relevant to VHA and reasonably up-to-date.33,35 VA-ESP recently published a report that concluded there is strong evidence that nurse-managed protocols help to improve health outcomes among patients with moderate severity of diabetes, hypertension, hyperlipidemia, and chronic heart failure.42

Nevertheless, the issue of the comparability of health outcomes of autonomous APRNs and physicians continues to be a cornerstone of the debate regarding state SOP rules. Because no previous systematic review has focused on this issue, the VHA Office of Quality, Safety and Value commissioned the VA Evidence-based Synthesis Program (ESP) Coordinating Center to reevaluate recent, original studies that reported health outcomes.

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SCOPE
The objective of this evidence brief is to assess the strength and relevance of studies comparing autonomous APRNs with physicians in primary care, urgent care, and anesthesia settings for 4 important outcomes: health status, quality of life, hospitalizations, and mortality. Advanced Practice Nurse Assignment Papers. We did not include process of care measures (such as access to care or resource use), performance measures (eg, blood pressure or glucose control), or patient satisfaction. We did not include studies of the work of APRNs (primarily CNSs) in team-based care or in interventions designed to augment usual care, nor care provided by nurse midwives.

The ESP Coordinating Center investigators and representatives of the Office of Quality, Safety and Value worked together to identify the population, intervention, comparator, outcome, timing, setting, and study design characteristics of interest. The Office of Quality, Safety and Value approved the following key questions and eligibility criteria to guide this review:

KEY QUESTIONS
Key Question 1. Do independent advanced practice nurses and physicians provide comparable quality of care?
Key Question 2. Does the quality of care provided by advanced practice nurses vary by the type of care (eg, primary or specialized care) being provided or by the setting of practice?
Key Questions 3. Does the quality of care provided by advanced practice nurses vary by their degree of autonomy?
INCLUSION CRITERIA
Population: adults.
Intervention: A nurse or nurses practicing primary care, urgent care, or anesthesia with a high degree of autonomy. We included advanced practice nurses (including nurse practitioners (NP), clinical nurse specialists (CNS), specially-trained nurses, and certified registered nurse anesthetists (CRNA)). We did not include studies of Nurse Midwife (NM) care since the VA does not employ these providers.Advanced Practice Nurse Assignment Papers.
Comparator: a physician providing patient care.
Outcomes: hospitalizations, mortality, health status (resolution of symptoms, overall improvement, or functional status), quality of life.
Timing: no restriction on minimum study duration.
Setting: both inpatient and outpatient care.
Study design: randomized controlled trials and comparative observational studies.
To address Key Question 1, we searched for evidence for the direct comparison between care provided by an advanced practice nurse and care provided by a physician. In Key Questions 2 and 3, we sought to identify the factors that mediate the relationship between type of provider (advanced practice nurse or physician) and quality of care. Potential factors that might influence this relationship include the type of care being provided, the setting of practice, or the degree of autonomy of the advanced practice nurse.Advanced Practice Nurse Assignment Papers.

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METHODS
Brief or rapid review methodology is still developing and there is not yet consensus on what represents best practice. For example, limiting the number of electronic databases, excluding studies published in languages other than English, and forgoing a specific search for gray literature could introduce bias. An evidence brief differs from a full systematic review in that the scope is narrowly defined and the traditional review methods are streamlined in order to synthesize evidence within a shortened timeframe. An evidence brief does not outline the context in which the information is to be used and does not present a comprehensive assessment of knowledge on the topic.Advanced Practice Nurse Assignment Papers.

Reference lists from existing systematic reviews and meta-analyses provided literature dating from 1969 to 2009. Additionally, we searched PubMed and CINAHL (2008-November 2013) using terms for advanced practice nurse and quality of care (see Supplemental Materials for complete search strategies). Additional citations were identified from hand searching reference lists, and consultation with content experts. We limited the search to published and indexed articles involving human subjects available in the English language. Study selection was based on the eligibility criteria described above. Titles, abstracts, and full-text articles were reviewed by one investigator and checked by another. All disagreements were resolved by consensus.Advanced Practice Nurse Assignment Papers.

We rated the internal validity (quality) of controlled trials using methods from the Agency for Healthcare Research and Quality (AHRQ).43 We abstracted data from all included studies on intervention and patient characteristics and results for each included outcome. All data abstraction and internal validity ratings were first completed by one reviewer and then checked by another. All disagreements were resolved by consensus.Advanced Practice Nurse Assignment Papers.

We graded the strength of the evidence based on the AHRQ version of the GRADE working group system.44 This approach incorporates 4 key domains: risk of bias (includes study design and aggregate quality), consistency, directness, and precision of the evidence. It also considers other optional domains that may be relevant for some scenarios, such as a dose-response association, plausible confounding that would decrease the observed effect, strength of association (magnitude of effect), and publication bias. Strength of evidence is graded for each key outcome measure and ratings range from high to insufficient, reflecting our confidence that the evidence reflects the true effect. For example, “low” strength of evidence means “[o]ur confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.”45

A previous version was reviewed by 4 invited peer reviewers. Reviewer comments and author responses can be found in the Supplemental Materials.Advanced Practice Nurse Assignment Papers.

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AALNC’s Subject Matter Experts
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