Scientific And Mathematical/Analytical Perspectives Of Inquiry Paper

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Compose a focused paper that explains and describes your healthcare issue/topic from the scientific and mathematical/analytical perspectives of inquiry. (You will cover two perspectives in one paper.)

Address your general topic

EVIDENCE- BASED CARE SHEET

ICD-9 V62.29

ICD-10 Z56.6

Authors Mary Woten, RN, BSN

Cinahl Information Systems, Glendale, CA

Nathalie Smith, RN, MSN, CNP Cinahl Information Systems, Glendale, CA

Reviewers Carita Caple, RN, BSN, MSHS

Cinahl Information Systems, Glendale, CA

Nursing Executive Practice Council Glendale Adventist Medical Center,

Glendale, CA

Editor Diane Pravikoff, RN, PhD, FAAN

Cinahl Information Systems, Glendale, CA

July 6, 2018

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206

Nurse Stress Index (NSI)

What We Know › Work-related stress occurs when the abilities, resources, and/or needs of an employee do

not match the requirements of his/her job(16)

• Workplace factors that increase the risk of work-related stress include a heavy workload, shift work (e.g., working evening or night shifts), poor interpersonal interactions, lack of support from colleagues and management, a nonparticipatory management style, unclear job expectations, job insecurity, inadequate training, lack of advancement opportunities, and a dangerous or unpleasant physical environment(6,14,16)

• Work-related stress can place employees at higher risk for cardiovascular disease, musculoskeletal disorders, urinary tract symptoms including overactive bladder, gastrointestinal disorders, sleep disorders, and psychological disorders(2,4,10,16,17)

› Nurses are at high risk for work-related stress(6,9)

• Work-related stress in nurses is a predictor of decreased job satisfaction, burnout (i.e., a syndrome characterized by emotional exhaustion, depersonalization [i.e., feeling withdrawn and disconnected from coworkers], cynicism, reduced perception of ability, and reduced personal accomplishment) and poor performance, and can compromise nursing care and place patients at risk(7,13)

– Healthcare organizations can increase job satisfaction among nurses by reducing sources of work-related stress(3)

– Nurse managers who have a high tolerance for stress may be less susceptible to occupational stress. Researchers performing a cross sectional study in five Brazilian hospitals found an inverse correlation between hardiness (a quality of having a stress resistant personality) and stress among 62 nurses in managerial positions(5)

– Researchers performing a quantitative systematic review of literature examining stress management interventions for nurse leaders found that interventions involving mental exercise components produced the most significant improvements in well-being. The researchers also concluded, however, that existing studies are in general of low quality(8)

– Occupational well-being in first-line nurse managers can be predicted by job demands, job control, and social support of their team and management. Investigators conducting a cross-sectional survey of 318 first-line nurse managers in Belgian hospitals found that these three factors were the top predictors of stress outcomes. The researchers concluded that hospital management should work to influence these aspects to improve working conditions and employee retention for managerial nursing staff(1)

– Researchers conducting an integrative review of 22 articles on stress and ways of coping among nurse managers found that managers generally experienced moderate stress levels, primarily from heavy workloads, lack of resources, and financial responsibilities(11)

• Work situations that nurses often perceive as stressful include(9,15)

– managing the demanding workload – Sources of stress reported by nurses include inadequate time to complete nursing

tasks and being asked to complete non-nursing tasks (e.g., clerical work)

 

 

– interprofessional conflict – Nurses report poor communication, a lack of support from other staff members, and a lack of involvement in decision

making as sources of stress – inadequate preparation for a managerial role – dealing with death and dying – instances in which they lack confidence and/or skills regarding dealing with the emotional needs of patients and family

members › The Nurse Stress Index (NSI) was developed to evaluate perceived sources of work-related stress in nurses with managerial

responsibilities (e.g., charge nurses)(9)

• The NSI is a 30-item self-report instrument consisting of six subscales, each of which measures a different domain of work-relatedstress(3,9)

– The six domains of work-related stress measured are(3,9)

– managing workload 1 (MW1) – Included in this domain are workload issues related to time management, including

– not having enough time to accomplish tasks – having to meet deadlines – staff members who demand time – urgent situations taking time away from planning – having to perform trivial tasks

– managing workload 2 (MW2) – Included in this domain are

– workload issues related to resource shortages – prioritization – interruptions that prevent working on prioritized tasks – fluctuations in workload – conflicts between nursing and managerial roles

– organizational support and involvement (OSI) – Included in this domain are

– a lack of participation in organizational changes – a lack of support from senior managers – unsatisfactory relationships with senior managers – senior managers not understanding the needs of the unit – receiving only negative feedback

– home-work conflict (HWC) – Included in this domain are

– tensions involved in balancing home and work demands – senior managers not understanding demands related to home – home demands interfering with advancement at work – the need to take time off from work to focus on home demands – being too emotionally involved in work

– confidence and competence in role (CCR) – Included in this domain are

– the ability to effect change among staff members or in the organization – having to perform tasks beyond personal skill level – adapting to new technologies – lack of specialized training – uncertainty about role responsibilities

– dealing with patients and relatives (DPR) – Included in this domain are

– dealing with difficult patients – dealing with aggressive persons – dealing with family members

 

 

– dealing with life-or-death situations – providing bereavement counseling

• The NSI is scored using a 1–5 Likert scale in which a score of 1 represents no perceived stress and a score of 5 represents extreme perceived stress(7,9)

• The NSI has been shown to have acceptable concurrent validity, internal reliability, and split-half reliability(3,7,9,14)

– There are weaknesses in the content validity of the NSI, and the NSI has not been appropriately evaluated with regard to test-retest reliability(9)

What We Can Do › Learn about work-related stress and the NSI so you can appropriately assist management personnel in assessing perceived

sources of work-related stress among nurses with managerial responsibilities and in devising strategies to decrease work-related stress; share this information with your colleagues(12)

› Participate in any research initiatives in your facility in which the NSI is used to evaluate perceived stress among nurses with managerial responsibilities

› Collaborate with your facility’s education department to provide continuing medical education on work-related stress for charge nurses and nurse managers

Coding Matrix References are rated using the following codes, listed in order of strength:

M Published meta-analysis

SR Published systematic or integrative literature review

RCT Published research (randomized controlled trial)

R Published research (not randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the literature

RU Published research utilization report

QI Published quality improvement report

L Legislation

PGR Published government report

PFR Published funded report

PP Policies, procedures, protocols

X Practice exemplars, stories, opinions

GI General or background information/texts/reports

U Unpublished research, reviews, poster presentations or other such materials

CP Conference proceedings, abstracts, presentation

References 1. Adriaenssens, J., Hamelink, A., & Bogaert, P. V. (2017). Predictors of occupational stress and well-being in first-line nurse managers: A cross-sectional survey study.

International Journal of Nursing Studies, 73, 85-92. doi:10.1016/j.ijnurstu.2017.05.007 (R)

2. Borchini, R., Bertu, L., Ferrario, M. M., Veronesi, G., Bonzini, M., Dorso, M., & Cesana, G. (2015). Prolonged job strain reduces time-domain heart rate variability on both working and resting days among cardiovascular-susceptible nurses. International Journal of Occupational Medicine and Environmental Health, 28(1), 42-51. doi:10.2478/s13382-014-0289-1 (R)

3. Burgess, L., Irvine, F., & Wallymahmed, A. (2010). Personality, stress and coping in intensive care nurses: A descriptive exploratory study. Nursing in Critical Care, 15(3), 129-140. doi:10.1111/j.1478-5153.2009.00384.x (R)

4. Costa, G., Anelli, M. M., Castellini, G., Fustinoni, S., & Neri, L. (2014). Stress and nurses employed in “3×8” and 2×12” fast rotating shift schedules. Chronobiology International, 31(10), 1169-1178. (R)

5. de Freitas, F. M. B., Vannuchi, M. T. O., Haddad, M. D. C. L., de Carvalho Silva, L. G., & Rossaneis, M. A. (2017). Hardiness and occupational stress in nurse managers of hospital institutions. Journal of Nursing UFPE, 10(11), 4199-4205. doi:10.5205/reuol.10712-95194-3-SM.1110sup201725 (R)

6. Elovainio, M., Kuusio, H., Aalto, A. M., Sinervo, T., & Heponiemi, T. (2010). Insecurity and shiftwork as characteristics of negative work environment: Psychosocial and behavioural mediators. Journal of Advanced Nursing, 66(5), 1080-1091. doi:10.1111/j.1365-2648.2010.05265.x (R)

7. Flanagan, N. A. (2006). Testing the relationship between job stress and satisfaction in correctional nurses. Nursing Research, 55(5), 316-327. (R)

8. Haggman-Laitila, A., & Romppanen, J. (2018). Outcomes of interventions for nurse leaders’ well-being at work: A quantitative systematic review. Journal of Advanced Nursing, 74(1), 34-44. doi:10.1111/jan.13406 (SR)

9. Harris, P. E. (1989). The Nurse Stress Index. Work & Stress, 3(4), 335-346. (R)

10. Koh, S. J., Kim, M., Oh da, Y., Kim, B. G., Lee, K. L., & Kim, J. W. (2014). Psychosocial stress in nurses with shift work is associated with functional gastrointestinal disorders. Journal of Neurogastroenterology and Motility, 20(4), 516-522. doi:10.5056/jnm14034 (R)

11. Labrague, L. J., McEnroe-Petitte, D. M., Leocadio, M. C., Van Bogaert, P., & Cummings, G. C. (2018). Stress and ways of coping among nurse managers: An integrative review. Journal of Clinical Nursing, 27(7-8), 1346-1359. doi:10.1111/jocn.14165 (RV)

12. Middaugh, D., & Willis, A. (2018). Managerial burnout: Putting out the flames. MEDSURG Nursing, 27(2), 121-122. (RV)

13. Nabirye, R. C., Brown, K. C., Pryor, E. R., & Maples, E. H. (2011). Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. Journal of Nursing Management, 19(6), 760-768. doi:10.1111/j.1365-2834.2011.01240.x (R)

14. Rodrigues, V. M. C. P., & Ferreira, A. S. S. (2011). Stressors in nurses working in intensive care units. Revista Latino-Americana de Enfermagem, 19(4), 1025-1032. doi:10.1590/S0104-11692011000400023 (R)

15. Stecker, M., & Stecker, M. M. (2014). Disruptive staff interactions: A serious source of inter-provider conflict and stress in health care settings. Issues in Mental Health Nursing, 35(7), 533-541. doi:10.3109/01612840.2014.891678 (R)

16. United States Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Health and Safety (NIOSH). (2014, June 6). Stress at work (DHHS [NIOSH] Publication No. 99-101. Retrieved June 26, 2018, from http://www.cdc.gov/niosh/docs/99-101/ (GI)

17. Zhang, C., Hai, T., Yu, L., Lui, S., Li, Q., Zhang, X., & Wang, X. (2013). Association between occupational stress and risk of overactive bladder and other lower urinary symptoms: A cross-sectional study of female nurses in China. Neurourology and Urodynamics

by forming and answering two levels of research questions for each inquiry.

  • Choose a “Level 1 Research Question/Writing Prompt” from both of the lists below to answer in the paper.
  • Compose a “Level 2 Research Question/Writing Prompt” for each kind of inquiry that provides detail, specificity, and focus to your inquiry, research, and writing.
  • State your research questions in the introduction of your paper.
  • Answer each research question and support your assertions with evidence (research) to form the body of your paper.
  • In the conclusion of the paper, briefly review the issues, research questions, answers, and insights.

Level 1 Research Questions/Writing Prompts
SCIENTIFIC Perspective of Inquiry
What are the anatomical, physiological, pathological, or epidemiological issues?
Which body systems are affected?
What happens at the cellular or genetic level?
Which chemical or biological issues are most important?
Level 1 Research Questions/Writing Prompts
MATHEMATICAL/ANALYTICAL Perspective of Inquiry
What are the economic issues involved?
Which economic theories or approaches best explain the issue?
What are the statistical facts related to the issue?
Which statistical processes used to study the issue provide for the best explanation or understanding?

Your paper must be five pages in length and reference four to six scholarly, peer-reviewed resources. Be sure to follow current APA Style (e.g., spacing, font, headers, titles, abstracts, page numbering).

Refer to the rubric for evaluation details and to assist in preparing the paper.

Analyzing Forms Of Nursing Inquiry Presentation Part 1

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An analysis of three types of literature on diabetes management

Ginger E. Fidel, MSN, RN, OCN, CNL

 

1

Introduction

There is confusion about how evidence-based practice is different yet similar to quality improvement and research. The overarching goal of this presentation is to evaluate 3 articles based on standards of care in quality improvement, a research article, and an evidence-based publication.

The problem identified was management of diabetes in hospital and as an outpatient while simultaneously using the American Diabetes Association Standards of Care in the forefront. Fundamentally, the problem, according to the Centers for Disease Control and Prevention [CDC] (2017, as cited by Russell, Durham, & Johnson): diabetes is the 7th leading cause of the underlying cause of other co-morbidities in the U.S. management of diabetes a reflection on quality improvement in hospitals, scientific research and evidence based practice. Diabetes related care also utilizes health care resources more and more, particularly as the population ages; further, the American Nurses Association’s social policy indicates that attention to cost containment to be fiscally and morally responsible in the use of resources ((2005). Therefore, this presentation focus on three different approaches: Quality Improvement, Research and Evidence Based Practice and how the DNP practice scholar applies each form of inquiry.

Management of patients both in hospital and as outpatients require that patient safety is the first consideration as these patients are at risk for hyperglycemia as well as hypoglycemia, both of which may be dangerous (American Diabetes Association, 2019 [ADA]). Additionally, the significance and scope of problem is that diabetes is a chronic, lifelong illness that requires ongoing disease management. Russell et al. (2017) indicate that the disease prevalence in the United States is 9% with 1.4 million people annually diagnosed with diabetes. This presentation will take a dive into the methodologies uses to research this costly health problem that annually costs an average of $245 billion (Russell et al.).

 

2

 

Purpose of analysis

 

 

Selected nursing problem: Diabetes management

 

 

Significance and scope of the practice problem

 

 

 

Quality Improvement centered article (QI) (American Diabetes Association [ADA], 2019)

“Diabetes Care in the Hospital: Standards of Medical Care in Diabetes” (ADA, S173)

 

Best practice protocols, evaluations, and guidelines from admission to discharge

 

Report recommendations includes as a last step, a structured discharge information communicated with outpatient providers

 

 

 

 

 

 

 

 

The American Diabetes Association re-evaluates management of patients with diabetes annually to provide current standards of diabetes care, outline treatment and guidelines as well as share tools to use for further document and appraise care provided to patients with diabetes (Pugh). The underlying purpose of this report is patient safety as in the acute care setting, adverse outcomes are associated with hyperglycemia and hypoglycemia.

 

The ADA indicates in their report that “’Best practice’ protocols, reviews, and guidelines are inconsistently implemented within hospitals” (Moghissi et al., as cited by the ADA, p. S173).

 

Included in this, the ADA recommends:

HbA1C testing if the patient has not had this test performed in the last 3 months.

Diabetes self-management and compliance should be evaluated upon admission. If warranted, diabetes education should such that patients have the appropriate skills to manage their health once discharged.

The standards also address using insulin in the acute care setting that includes written/computerized orders that follow protocols based on fluctuations in glycemic levels; recommendations for consults with specialized diabetes teams; insulin therapy that maintains glucose level of 140-180 mg/dL (moderate versus tight control); basal insulin administration plus corrective boluses in critically ill patients as the sole use of sliding scale is not recommended. Nutrition therapy as well as hypoglycemic event management protocols should be in place in the acute care setting, and in the event of a hypoglycemic incident (glucose level of less than 70 mg/dl) with a patient, the treatment regimen should be adjusted; and a tailored discharge plan fits the individual needs of patients with diabetes.

 

 

 

3

 

 

QI

Methods:

Not specifically outlined

Literature review with citations

 

Impact:

Annual report sets national standards of patient care in the management of diabetes

 

 

QI & the doctor of nursing practice (DNP)

Numerous opportunities for the DNP in the acute care setting and beyond (White et al., 2021)

Private practice (nurse practitioner)

Acute care leadership

Risk management in acute care setting

 

DNP role with and in QI

Leadership in diabetes management

Practice review

Policy creation, review and updates

 

 

5

Research constructed article (Whitehead et al., 2016)

A nurse-led education and cognitive behavior therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomized controlled trial

Knowledge gap identified and quest for further knowledge development initiated by study

 

Methodology

Chronic Care Model (CCM) used as framework

Literature review

Study Design: randomized controlled trial

 

 

 

6

 

 

Research constructed article

 

 

 

Study conclusions (Whitehead et al.)

No evidence participants experienced hypoglycemic events

Study did not collect information on experiences of hypoglycemia or fear of hypoglycemia

Individual and group therapy components

Study did not identify which therapy setting was more effective

Inference: nurse-led intervention effective in reducing participants’ HbA1c is cost-effective in primary care setting

 

 

 

Additional areas for study identified were to examine the similarities and differences between group and individual cognitive-behavioral therapies.

 

7

Research & the DNP

The DNP can use research to implement projects (White et al.; Dang & Dearhold, 2018)

Diabetes self-management education (DSME) with goal of minimizing diabetes associated complications

Cognitive-behavioral interventions in group or individual settings

Impact

Foundational science with room for more studies that DNP could participate in

Further studies to confirm findings

 

 

 

 

Evidence Based Practice article (Russell et al., 2019)

Article:

Problem: Diabetes Self Management (DSME)

Framework: Chronic Care Model (CCM)

Literature review

Implementation Project:

Promote DSME to minimize the complications associated with diabetes

Patient education combined with mobile text

messaging to improve diabetes self-management

 

 

9

Evidence Based Practice (Russell et al., 2017)

Process

“Knowledge gap in best available evidence” (p. 5)

Practice Question, Evidence, Translation (PET)

Amalgamation of evidence for practice adoption

 

Impact

Decrease in participants’ average fasting blood glucose level after text messaging that encouraged supportive DSME

 

 

10

 

Evidence Based Practice (Pugh, 2018)

 

 

 

 

11

 

Purpose

 

 

Performance gap identified in primary practice

 

 

Methodology: Plan-Do-Study-Act (PDSA)

 

 

Evidence produced for application

 

 

Impact

 

 

Decrease in participants’ mean fasting blood glucose levels after education and text messaging

 

 

 

Evidence based practice & the DNP

 

As a DNP, utilization of EBP is the fundamental proficiency for professionals (Institute of Medicine, as cited by Dearholt & Allan, 2018)

 

Translation of knowledge gained by literature review to establish and implement care based on patient/family and community goals (White et al., 2021)

 

Further skill and knowledge development with interprofessional collaboration (White et al.)

 

Of the three articles reviewed, ways to the three different articles are below:

 

QI: Based on the Standards of Care in this report (ADA), the DNP could work in a team with nursing leadership, medicine, laboratory and pharmacy leadership to ensure current standards of care are reviewed annually and policy and procedures match with standard of care.

Research: The DNP could use the literature to work with a multidisciplinary team including clinical therapist and/or psychologists, nursing staff and medicine to implement a cognitive behavioral therapy-based intervention program in an outpatient clinic setting. The DNP could also work with other researchers to springboard from this study to research the differences between group therapy compared to individual therapy as suggested by the authors (Whitehead et al.)

Evidence-based practice: In a rural community setting the DNP could use this model to text message patients in a community setting to improve outcomes for patients with diabetes (Russell et al.).

12

 

 

Analysis

Aims

ADA report: Identify best practice guidelines

Research article: Broaden scientific knowledge as foundation to improve patient outcomes

EBP: Improve DSME in outpatients with diabetes

 

Methods

ADA report: Literature review

Research article: Randomized controlled trial

EBP: Implementation of intervention through text messaging patients

 

 

 

 

All of these articles used literature review as a foundation for the creation of standards or the framework for the study performed. While they may differ in approach, the underlying purpose is to improve the care and wellbeing of the patients served. All used teamwork based on the evidence reviewed to create standards of care, develop research between nursing and psychology, or develop a practical and simple intervention to improve DMSE.

 

Overall, the outcomes should be positive based on the streamlining care of patients with diabetes with annual standards, research that can be the catalyst for further research, and innovative practice programs.

13

 

 

Analysis

 

Impact

ADA: Standardized treatment of patients with diabetes

 

Research: Cognitive-behavioral intervention improved patient outcomes; however, more research is needed to tease out if group or individual therapies have a greater influence on improved glycemic control

 

EBP: Improved patient outcomes through implementation of text messaging program

 

 

14

References

American Diabetes Association (2019). Diabetes care in the hospital: Standards of medical

care in diabetes. American Diabetes Association. (2018). doi: 10.2337/dc19-S015

Accessed, 18 September, 2020.

 

American Nurses Association (2005). Nursing’s Social Policy Statement (2nd ed.). nursebooks.org

 

Dearholt, S.L. & Allan, S.H. (2018). The Johns Hopkins nursing evidence-based practice model

and process overview. In D. Dang & S.L. Dearholt (Eds.), Johns Hopkins Nursing Evidence-

Based Practice: Models and Guidelines (3rd ed., pp. 3-13). Sigma Nursing.

 

 

 

15

References

 

 

Pugh, L.C. (2019). Evidence-based practice: Context, concerns and challenges. In D.

Dang & S.L. Dearholt (Eds.), Johns Hopkins Nursing Evidence-Based Practice:

Models and Guidelines (3rd ed., pp. 3-13). Sigma Nursing.

 

Russell, N.M., Durham, C. & Johnson, E. (2017). Text messaging to support diabetes self

management in a rural health clinic: A quality improvement project. Online Journal of Nursing Informatics, 2(2), 9-1. doi: 128848064 Accessed, 18 September, 2020.

 

White, K.M. (2021). Interprofessional collaboration and teamwork for translation. In K.M. White, S. Dudley-Brown, & M.F. Terhaar (Eds.), Translation of Evidence into Nursing and Healthcare (3rd ed., pp. 299-314). Springer Publishing Company.

 

Reference

Whitehead, L.C. Crowe. M.T., Carter, J.D., Maskill, V.R., Carlyle, D., Bugge, C., &

Frampton, C.M.A. (2017). A nurse-led education and cognitive behavior

therapy-based intervention among adults with uncontrolled type 2 diabetes: A

randomized controlled trial. Journal of Eval Clin Practice, 23, p. 821-829. doi:

124315419 Accessed, 18 September 2020.

Comparison of Virginia, Maryland and District of Columbia APRN Regulations

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First

Comparison of Virginia, Maryland and District of Columbia APRN Regulations

     The region of Virginia in which I live is locally known as “the DMV” (the abbreviation for District/Maryland/Virginia). It is common for many practitioners to live in one jurisdiction and practice in another. For this reason, I chose to compare the three jurisdictions.

     According to the American Association of Nurse Practitioners, an APRN’s practice is restricted in Virginia. However, in the District and Maryland, APRNs may practice to their full scope of education and experience. Two differences I noted were in regulating agencies and in prescriptive authority. In Virginia, APRNs are regulated jointly by the Board of Nursing and the Board of Medicine. In contrast, in the District and Maryland, the respective Boards of Nursing are the only regulatory agencies.

     Regarding prescriptive authority, in Virginia, in order for a nurse practitioner (other than a nurse anesthetist or midwife) to have autonomy in practice, one must have practiced in a restricted capacity for at least five years (9000 hours). Also, nurse practitioners may only prescribe Schedule II – V medications in partnership with a physician. In the District, APRNs have full prescriptive authority (DC Health), and in Maryland, full prescriptive authority includes prescribing medical marijuana (Maryland Board of Nursing).

     Loversidge (2019), in addressing the regulation of Advanced Practice Registered Nurses (APRNs), proffered that it “has been inconsistent because…states [have] the right to establish laws governing professions and occupations” (p. 65). As a note of interest regarding practicing

RNs, the District does not participate in the Nursing Licensure Compact either, and an RN that wants to practice in DC must obtain a separate DC-specific license. In a region as geographically close as the DMV, especially during health-related crises, collaboration among the three regions Boards of Nursing could allow for scope expansion of a Virginia-licensed APRN. In the meantime, it is essential for APRNs crossing borders into other jurisdictions to familiarize themselves with the regulations of each in order to adhere to both prescriptive authority and other regulations.

References

American Association of Nurse Practitioners. Retrieved September 28, 2020, from https://www.aanp.org/advocacy/state/state-practice-environment

DC Health, Nursing Regulations, Nurse Practitioners. Retrieved September 28, 2020, from

https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Chapter%2059%20Nurse-Practitioners.pdf

Loversidge, J.M. (2019). Government response: regulation. In J. A.Milstead, & N. M. Short (Eds.), Health policy and politics: A nurse’s guide (6th ed., pp 57-86). Burlington, MA: Jones & Bartlett Learning

Maryland Board of Nursing Scope and Standards of Practice. Retrieved September 28, 2020, from http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm

Virginia Department of Health Professions Board of Nursing. Retrieved September 28, 2020, from https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners.pdf

Second 

APRN Board of Nursing Regulations in Texas and Florida.

Most states in the U.S of America have similar and different regulations to govern APRN in their practice acts because of the complexity of the health care system. According to Milstead & Short (2019), “Regulation means to control over something by rule or restriction, and health professions regulation is needed as a mechanism to protect the interest of the public safety (p. 60). Each states Board of Nursing in the U.S put in place regulations to protect the public of interest because of the potential risk for harm so that APRN can be held accountable and responsible of any rules that are outline in the practice acts. In Texas, to renew APRN license, applicant must completed an APRN educational program, attest to having a minimum of 400 hours of current practice within the preceding biennium, and attest to being in compliance of continuing competency and APRN with prescriptive authority (Office of the Secretary of States, n.d). In Texas, APRN with full valid prescription authorization number can obtain authority to order or prescribe control substance in Schedule II, III through V. Prescription for controlled substance in Scheduled III through V including refill of the prescription shall not exceed 90 days’ supply, beyond the initial 90 days the refill prescription cannot be authorized, and prescription of the controlled substance in Schedule III through V for child less than two years of age can not be authorize prior to consultation with delegating physician and notation of consultation in the patient’s chart (Office of the Secretary of States, n.d). This regulation enables the APRN to follow the guidelines when prescribing certain categories of control substance.

In Florida, to renew APRN license, the applicant must prescribe up to 30 hours of continuing education biennially as a condition for renewal of a license or certificate, must complete at least 3 hours of continuing education on the safe and effective prescription of controlled substances, and complete a 2-hour continuing education course on human trafficking. In Florida, APRN has been granted legal authority to prescribed drugs listed as controlled substance subject to approval by their supervising Practioner, will need mid-level Practioner DEA registration, APRN cannot prescribe more than 7-day supply of Schedule II control substance except the APRN is a psychiatric nurse who only can prescribe 7-day supply of Schedule II controlled substance that is mental health drugs, and ARNPs who are not psychiatric nurses cannot prescribe psychiatric mental health controlled substances for children younger than 18 years of age (Akerman LLP – Health Law Rx, 2016).

Regulations for Advance Practice Registered Nurse (APRNs): Legal Authority to      Practice

American Health care delivery system is face with so many complex issues which requires adequate access to health care for positive health outcome. There is a barrier to health delivery because of shortage of health care providers in the U.S and these are affecting millions of Americans to seek health care at their convenient time. Every year, foreign immigrants, people living in rural areas, lower-middle class citizen find it difficult to access health care due to race, color, ethnicity, nationality, sexual orientation or socioeconomic status. Granting APRN full legal authority to practice without limitation can help resolve the issue of the barriers facing health care delivery system in the U.S. Some states allow APRNs to practice independent without physician supervision to lessen the high demands of their health care delivery system while other states are still deliberately on the issue. In 2017, 15 states report that NPs are regulated solely by a BON and have independent scope of practice and prescriptive authority without physician supervision, delegation, consultation, or collaboration… (Milstead & Short, 2019 p.63). If an APRN with full legal right to practice moved to another states with limitation, the APRN must abide to the regulations of the new states when it comes to renewal of license and prescription of some categories of control substance. For example, Texas regulation requires APRN to obtain authority to prescribe control substance in Schedule II, III through V, the APRN with legal right to practice independently must abide to the rules of Texas with no exception to the law because the APRN is within the jurisdiction of the new states.

References

Akerman LLP – Health Law Rx. (2016). Deciphering Florida’s New Laws on ARNP and PA Controlled Substance Prescribing. Retrieve from: https://www.jdsupra.com/legalnews/deciphering-florida-s-new-laws-on-arnp-25553.

Milstead, J & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide. Government Response: Regulation. p. 60, 63, 6th edition. Burlington. MA. Jones & Bartlett Learning.

Office of Secretary of States. (n.d). Texas Administrative Code. Retrieve from: https://texreg.sos.state.tx.us/public/readta1c$ext.ViewTAC?tac_view=3&ti=22&pt=11

How were data and information about the community incorporated into the work?

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  • As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
    Recall an experience you have had working with a population, or as part of a community health improvement initiative, or a time in your care setting that you observed this type of work within your organization or community.

    • How were data and information about the community incorporated into the work?
      • Was the diversity of culture and beliefs in the community taken into account?
      • Were other, secondary, health concerns of the community also taken into account?
      • Were the economic and daily environmental realities of the community taken into account?
    • What, if any, ethical issues were considered in working with specific groups and stakeholders in the community?
    • What suggestions might you offer for doing things differently, if you could revisit that work?
      • Would you set different goals?
    • What evidence would you present to support your recommendations?
  • Resources Suggested Resources
    The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MSN-FP6011 – Evidence-Based Practice for Patient-Centered Care and Population Health Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
    Evidence-Based Practice

    • Cabassa, L. J., Stefancic, A., O’Hara, K., El-Bassel, N., Lewis-Fernández, R., Luchsinger, J. A., . . . Palinkas, L. A. (2015). Peer-led healthy lifestyle program in supportive housing: Study protocol for a randomized controlled trial. Trials, 16, 388–401.
    • Dombrowski, J. J., Snelling, A. M., & Kalicki, M. (2014). Health promotion overview: Evidence-based strategies for occupational health nursing practice. Workplace Health & Safety, 62(8), 342–9, 350.
    • Evidence-Based Practice in Nursing & Health Sciences.
    • Evidence-Based Practice in Nursing & Health Sciences: Review Levels of Evidence.
    • The Joint Commission. (2016). Health care leaders meet, address health care disparity. Retrieved from www.jointcommission.org/health_care_leaders_meet_address_health_care_disparity_/
    • SHOW LESSTriple Aim
    • American Hospital Association. (2015). Zeroing in on the Triple Aim [PDF]. Retrieved from www.aha.org/content/15/brief-3aim.pdf
    • Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759–769.
    • Institute for Healthcare Improvement. (2016). Triple Aim for populations. Retrieved from http://www.ihi.org/Topics/TripleAim/Pages/default.aspx
    • Research Guides
    • Database Guide: Ovid Nursing Full Text PLUS.
    • Kaplan, L. (n.d.). Framework for how to read and critique a research study. Retrieved from https://www.nursingworld.org/~4afdfd/globalassets/practiceandpolicy/innovation–evidence/framework-for-how-to-read-and-critique-a-research-study.pdf
    • Nursing Masters (MSN) Research Guide.
  • Assessment Instructions: Preparation
    Your organization is undertaking a population health improvement initiative focused on one of the pervasive and chronic health concerns in the local community. Examples of health improvement initiatives include nationwide concerns, such as type 2 diabetes, HIV, obesity, and Zika. However, your organization has asked you to determine which widespread health concern should be addressed in a population health improvement plan for the community in which you practice and has entrusted you with gathering and evaluating the relevant data.
    Requirements
    Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.
    Data Evaluation
    Evaluate community demographic, epidemiological, and environmental data.

    • Identify the relevant data.
    • Describe the major community health concerns suggested by the data.
    • Explain how environmental factors affect the health of community residents.
    • Health Improvement Plan
      Develop an ethical health improvement plan that effectively addresses the population health concern that you identified in your evaluation of the relevant data.
    • Base your plan on the best available evidence from a minimum of 3–5 current scholarly or professional sources.
      • Apply correct APA formatting to all in-text citations and references.
      • Attach a reference list to your plan.
    • Ensure that your plan meets the cultural and environmental needs of your community and will likely lead to some improvement in the community’s health related to this concern.
      • Consider the environmental realities and challenges that exist in the community.
      • Address potential barriers or misunderstandings related to the various cultures prevalent in the community.
    • Justify the value and relevance of the evidence you used as the basis of your plan.
      • Explain why the evidence is valuable and relevant to the community health concern you are addressing.
      • Explain why each piece of evidence is appropriate and informs the goal of improving the health of the community.
    • Propose relevant and measurable criteria for evaluating the outcomes of your plan.
      • Explain why your proposed criteria are appropriate and useful measures of success.
    • Explain how you will communicate with colleagues and members of the community, in an ethical, culturally sensitive, and inclusive way, with regard to the development and implementation of your plan.
      • Develop a clear communications strategy mindful of the cultural and ethical expectations of colleagues and community members regarding data privacy.
      • Ensure that your strategy enables you to make complex medical terms and concepts understandable to members of the community, regardless of language, disabilities, or level of education.
    • Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.