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DISCUSSION POST # 1 Julie

One of the Fifteen Ethical Principles of the Universal Declaration on Bioethics and Human Rights I picked is number five: persons without the capacity to consent. The ethical principle of increasing benefit and reducing harm promotes safety. The ethical principle of human dignity promotes patient centeredness and equality. Thus, promotion of healthcare quality can be seen as ethical enterprise. However, that does not mean that every approach to improving quality is necessarily ethical (Melnyk, et al, 2019).

Understanding that some patients are not able to give their consent depending on the situation. It’s up to the doctors to make ethical decisions on the patient’s behalf if no relative is there to make those decisions. An ethical question you must ask yourself “is it not fair to ask others what you are unwilling to do yourself”. It’s putting yourself in their shoes. You need to ask yourself if this is in the best interest of the patient. As medical professionals we want to put our patient’s well-being first.

DISCUSSION POST # 2 Nozomi

One of the fifteen ethical principles in Bioethics is the principle of benefit and harm. Benefit, or beneficence, refers to acting in ways that benefit others while promoting their safety and well-being (Barrow et al., 2021). Examples of the benefit of a research study are potentially valuable information in medicine, an improved understanding of a medical condition, or the possibility of helping other people with the same condition. On the other hand, the principle of “harm” means to do no harm, or non-maleficence (Barrow et al., 2021). This is important in research because it means that research subjects will be kept free from harm and discomfort, and that they will be protected against abuse and exploitation.

In conducting a research using human subjects, researchers need to ensure that the principle of benefit and harm is upheld to the highest standards. One way this can be achieved is through the effort of researchers and clinicians to continually improve skills, knowledge, and training, in order to provide the best possible treatment and research methods that they can provide to patients and subjects (Ahluwalia, 2020). Additionally, researchers must consider the individual circumstances of the patients, and provide the best treatment for their well-being (Ahluwalia, 2020). Also, researchers can protect the beneficence and non-maleficence by partnering with bioethicists and investigators prior to research approval (Lapid et al., 2021). Furthermore, members of institutional review boards should devise study protocols that balance the needs of biomedical research and the need to preserve the rights of research participants (Lapid et al., 2021). At times, beneficence may conflict with the other principles in bioethics. For instance, what the clinician knows is best for the patient may be against what the patient wishes to do, according to their autonomy. In such cases, institutional review boards and ethics professionals should work in collaboration with clinicians and patients in order to find a solution.

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DISCUSSION POST # 1 Trang

The four metaparadigms of nursing include person, environment, health, and nursing (Utley, 2018). According to Utley (2018), “the metaparadigm concepts of person, environment, health, and nursing grounds the theories and provides a common structure” (p. 20). The metaparadigm concepts provide a framework for nursing as a discipline. Taking into consideration the person, their environment, their health, and the practice of nursing itself, the metaparadigm considers everything that goes into caring for a patient. It provides a foundation for applying the essential skills nurses must possess.

The personal theory I have developed in weeks 2 and 5 is aromatherapy (concept A) reduces (proposition) chemotherapy-induced nausea and vomiting (CINV) (concept B). My personal theory has all four components of the metaparadigm of nursing. The theory has the components of environment and health as it involves changing the environment for the patient by using aromatherapy, which directly leads to better health outcomes. This is evident because a systemic review by Dilek and Necmiye (2020) suggested that inhalation of aromatherapy reduced the severity of CINV. Moreover, aromatherapy also “stimulates the central nervous system through inhalation and helps the formation of positive emotions or elimination of negative emotions” (Dilek & Necmiye, 2020, p. 1). The theory also includes the component of the nursing aspect because the nurse is actively in touch with the patient’s condition and needs by eliminating the patient’s uncomfortable feelings of nausea using aromatherapy. This also demonstrates that the theory has the human or person component as well because the nurse listens, understands, and respects the patient’s needs. According to Leslie & Lonneman (2016), to establish a trusting relationship between the nurse and patient, the nurse must meet the needs of the patient, respects the patient, and be a reliable person to the patient.

DISCUSSION POST # 2 Cherrylee

Metaparadigm concepts comprise the central issues in a discipline. Fawcett has named person, health, environment, and nursing as the four main concepts of nursing that need to be comprehensively defined. The Human Caring Theory is significant because of its focus on the spiritual dimension of human beings. The aim of this study was to comparatively explain three of the main metaparadigm concepts of nursing in the Human Caring Theory and Persian mysticism, and find the similarities and differences that can help develop the theory and its application in societies with the atheistic point of view. This comparative documentary study was done in two phases. First, a concept analysis was performed to find the attributes, antecedents, and consequences of the concepts of human beings, environment, and health in the two fields of Persian mysticism and Jean Watson’s Human Caring Theory. Then they were apparently and deductively compared with each other. In spite of some similarities between the two perspectives, Persian mysticism was found to provide more comprehensive conceptualizations of the three main concepts of nursing (Nikfarid et al., 2018).

As I link the theory I developed in Weeks 2 and 5 in our short-term rehab unit, we were able to implement our definitions of the four metaparadigms of nursing throughout our interactions with Covid-19 positive patients and their families. Our definition of
person
was illustrated by treating our patients equally and recognizing each of our patient’s cultural differences as well as accepting and valuing them without judgment. Good listening skills were applied when communicating and interacting with our patients, especially during those times when visitations were restricted per CDC guidelines for infection control practices. The red zone covid nurses were able to demonstrate the metaparadigm
health
by using the holistic approach to patient caretaking. Rather than solely focusing on treating Covid-19, we realized that patients’ mental and spiritual health also needed to be assessed. We realized that our patients were mentally distraught and felt isolated and like a burden to us. Our entire
nursing team was able to demonstrate the metaparadigm of nursing. The nurse was able to exemplify the metaparadigm of the
environment
through customized care. By utilizing our definitions of the four metaparadigms of nursing, our exemplary team was able to provide exceptional care for our well-deserved patients (Branch et al., n.d.).

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DISCUSSION POST # 1 Trang

According to Utley (2018), “conceptual models represent relationships between abstract concepts and are more general or broad in scope than grand, middle range, and practice theories” (p. 7). In other words, conceptual models are too broad and abstract to be applied to specific nursing practice situations. However, conceptual models are used to develop theories by providing useful frameworks (Utley, 2018). In order to apply conceptual models into practice, the general framework needs to be broken down to mid-range theories and supported by measurement of outcome (Utley, 2018). The Conceptual-Theoretical-Empirical (CTE) model can help narrow down these components to demonstrate how the conceptual model can be used in real-life practice.

The personal theory I have developed in week 2 is that aromatherapy (concept A) reduces (proposition) chemotherapy-induced nausea and vomiting (CINV) (concept B). CINV is among the most feared side effects of cancer treatments that affect up to 40% of cancer patients (Gupta et al., 2021). Nausea and vomiting in cancer patients lead to detrimental problems such as dehydration, malnourishment, and electrolyte imbalances (Dilek & Necmiye, 2020). Aromatherapy is a non-pharmacological method that utilizes essential oils to “stimulate the central nervous system through inhalation and help the formation of positive emotions or elimination of negative emotions” (Dilek & Necmiye, 2020, p. 1). A systemic review by Dilek and Necmiye (2020) suggested that inhalation of aromatherapy reduced the severity of CINV, and it is a cost-effective and applicable intervention for cancer patients.

By utilizing Jean Watson’s conceptual framework of the Theory of Human Caring and some of the middle-range theories, the CTE model will help demonstrate how this theory can apply to practice and measure outcomes to examine the effectiveness of the intervention. The middle-range theories that apply to this situation are Caritas Processes four and eight (Watson, 2021). Caritas four involves “developing and sustaining loving, trusting-caring relationships” (Watson, 2021, p. 1). Trying to help the patients eliminate the feelings of nausea and vomiting, shows that the nurse is in touch with the patient’s condition and needs. The nurse’s action may lead to the patient’s development of trust and rapport. According to Leslie & Lonneman (2016), to establish a trusting relationship between the nurse and patient, the nurse must meet the needs of the patient, respects the patient, and be a reliable person to the patient. Caritas eight involves “creating a healing environment at all levels; subtle environment for energetic authentic caring presence” (Watson, 2021, p. 1). The act of utilizing scent by the nurse directly creates a new healing environment for the patients. This physical change of the environment stimulates the central nervous system, creates positive emotions, and eliminates negative emotions (Dilek & Necmiye, 2020).

To measure the effectiveness of aromatherapy, there are two things to measure. The first measure is the utilization of aromatherapy and the positive acceptance of the smells in patients experiencing nausea and vomiting. The nurse needs to have a list of patients with nausea and vomiting symptoms and ask them if they use aromatherapy in their room, what kinds of aromatherapy they are using, and if there are reactions to the smells. The second measure is to measure the effectiveness of aromatherapy in reducing the symptom of nausea and vomiting. This can be measured by using the Rhodes Index of nausea, vomiting, and retching (INVR) before and after the use of aromatherapy to measure the incidence and severity of nausea and vomiting (Ahmad et al., 2016).

DISCUSSION POST # 2 Nozomi

I have worked in the Medical-Surgical/Telemetry unit for a few years now, and one of the most common cardiac diseases that I have seen in patients is Congestive Heart Failure (CHF). In fact, CHF affects about 26 million people worldwide, and 800,000 new cases are diagnosed every year (Wang & Li, 2021). Furthermore, the incidence rate is expected to increase every year due to the rising number of people with risk factors for CHF, such as hypertension and diabetes (Wang & Li, 2021). CHF is very debilitating; not only can the disease lower the quality of life for patients, but it can be very costly to public health due to the poor outcomes and high cost of treatment (Wang & Li, 2021). Therefore, prevention of CHF and better management of the disease are beneficial to individual patients and for society as a whole.

One way to develop a practice theory is by utilizing the Conceptual-Theoretical-Empirical model, or the CTE. According to Utley et al. (2018), conceptual models illustrate relationships between abstract concepts and they are broader in scope than grand, middle, and practice theories. Although they may not be clearly useful in practice settings, conceptual models are very important in setting the framework for practice (Utley et al., 2018). After identifying the conceptual model, one can move on to propose a theory. Lastly, the empirical stage will describe how the theory will be measured and evaluated.

I would like to propose a theory that the provision of self-care education (concept A) will lead to (proposition) increased quality of life for CHF patients (concept B). For this theory, I will be applying Orem’s Self-Care Deficit Theory. Self-care is defined as “a human regulatory function that individuals have to perform to achieve health and well-being” (Attaallah et al., 2018). Orem’s theory maintains that the ability of individuals to care for themselves is affected by various internal and external factors, such as age, prior health history, family system, socioeconomic status, culture, and educational level (Attaallah et al., 2018). Thus, in order to help patients improve their self-care abilities, it is crucial for nurses to understand the individual factors. Additionally, self-care education methods need to address those factors and tailor them to the needs of CHF patients.

For example, in their study, Wang & Li (2021) used a CHF education tool in which patients were given a two-day classroom education from experienced nurses after discharge, in addition to the routine discharge education using pamphlets. The classroom education consisted of PowerPoint slides that covered topics such as cardiac anatomy, CHF risk factors, diet management, exercise, monitoring BP, and exacerbation symptoms (Wang & Li, 2021). As a result, patients who received additional classroom education had decreased re-admissions due to CHF compared to the control group who only received routine educational methods. In another study that focused on geriatric patients with CHF, regular verbal and written education from nurses about CHF, in combination with video educational materials, improved patient knowledge about the disease, compared to those patients who only received routine primary care visits (Attaallah et al., 2018). For their study, Attaallah et al. (2018) also conducted cognitive assessment tests prior to conducting education in order to make sure that patients are able to comprehend the educational materials. As a result, Attaallah et al. (2018) found that patients who received frequent follow-up appointments reported increased knowledge about the disease, were better able to manage CHF, and experienced fewer hospitalizations due to CHF.

In order to test my theory, the outcome, which is “improved quality of life for CHF patients,” needs to be measured. One way this can be measured is the 30-day CHF readmission rate, which is also a tool used by CMS to evaluate hospitals on how well CHF patients are managed (Attaallah et al., 2018). Another useful tool is the Minnesota Living with Heart Failure Questionnaire (MLHFQ), which is a 21-item questionnaire that uses a six-point Likert scale, from 0, which is none, to 5, which represents “very much” (Bilbao et al., 2018). The MLHFQ is one of the most commonly used tools to evaluate the quality of life for patients with CHF. Furthermore, the six-minute walking distance (6MWD) tool is another important indicator to measure heart function (Bilbao et al., 2018). Instead of relying on just one tool, several different methods can be used to measure the quality of life for CHF patients in relation to patient education.

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DISCUSSION POST #1 Kathleen

This discussion surprised me on how ordinary people and colleagues view the purpose of nursing. When I asked 5 laypersons about the question, “What is the purpose of nursing?”, Person 1 answers that “nurses make sure that patient receives the direct care they need”. Person 2 defines the purpose of nursing is to “identifying patient’s needs and monitor and implement the medical plan and treatment”. Person 3 says “nurses are a caregiver that manages the physical needs of patients”. Person 4 says that the purpose of nursing is to “observe and monitor the patient and record any relevant information to aid in treatment and decision making”. Person 5 says” nurse is a multi-purpose profession that links between patient, doctors and other branches of the healthcare system.”

5 nurses were asked the same question. Nurse 1 answers the purpose of nursing is to “care for the ill, disabled & dying”. Nurse 2 says “to give care to the patient in need while providing competent skills as a nurse”. Nurse 3 said, “nursing is caring for individuals who are sick, promote health and prevent illness through patient education”. Nurse 4 is a PACU nurse for 20 yrs. and she says” nursing involves a lot of critical thinking skills and professionalism since nurses deal with human lives and nurses are expected to provide the highest quality of patient care.” Nurse 5 stated that the purpose of nursing is to “be knowledgeable and to know that every patient has different needs and give patient care to all types of people, that requires emotional, physical and spiritual aspects of care”.

Caring is one thing in common among their answers as caring has been defined as the essence and core of nursing (Watson, 2022) Based on their answers, laypersons value the aspect of caring more than the technicality of being a nurse. On the other hand, nurses perceived the value of competence through critical thinking and problem-solving skills to address the wholeness of the patient, and not just focus on the disease itself. According to Watson (2022), creating a solution-seeking through the caring process contributes to the health and wellness of the patient. Touching their mind, body, and spirit by being physically present and active listening to their concern as well as offering self for their basic needs will create a connection by both nurse and patient leading to a transpersonal caring relationship (Watson, 2022).

DISCUSSION POST #2 Betsy

Nursing is an integral part of the health care system, and this knowledge is shared by individuals in the nursing profession and laypeople. In this discussion, laypeople will encompass all individuals that do not have certification, licensure, or specific health training. According to Garfield et al. (2016), there is consensus that nurses, patients, and the public should be involved in research in a meaningful way. In this case, five nurses were asked the following question, “what is the purpose of nursing?” It is interesting to note that in all these cases, the nurses had the following response. Nurse 1: the role of nursing is to advocate and care for individuals while they are through illness and health. Nurses 2: the purpose of nursing is to promote health while preventing illness and injury. Nurse 3: the purpose of nursing is the alleviation of suffering through proper diagnosis of illness affecting patients. Nurse 4: the purpose of nursing is the creation of a standard of care where the nurse develops the care plan for the patient. Nurse 5: the purpose of nursing is advocacy for health promotion and educating the public on means of disease prevention.

Certainly, in all these cases, there was a similarity in the nurses’ responses since they showed that nurses are the patient care, and they achieve that through advocacy, educating the public, creating standards of care, and caring for the sick individuals. The same question was asked to five laypersons, and some of the responses included the following. Layperson 1: the purpose of nursing is caring for sick people. Layperson 2: the purpose of nursing is to take care of the older people in the population. Layperson 3: the purpose of nursing is to provide education among the marginalized communities. Layperson 4: the purpose of nursing is caring for individuals, either sick or healthy. Layperson 5: the purpose of nursing is the provision of knowledge about the role of nurses in the community. In all these instances, it showed that the laypeople had a small understanding of the purpose of nursing in their communities and the role of nurses in education and advocacy.

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DISCUSSION POST #1 Helena

An advanced practice registered nurse (APRN) is also a registered nurse (RN), but their scope of practice is different. Both provide patient care by various methods, but the main dissimilarity between them is the degree of patient care provided. APRNs have advanced training and education, usually a master’s or doctoral degree in nursing, and they are able to assess, diagnose, prescribe, and provide medical treatments to their patients (Schirle et al., 2020). The United States only acknowledges four APRN roles, such as nurse practitioners (NP), certified registered nurse anesthetists (CRNA), certified nurse-midwives (CNM), and clinical nurse specialists (CNS) (Schirle et al., 2020).

One of the existing nursing theories that can be applied to advanced practice nursing is Orem’s self-care deficit nursing theory (SCDNT). Orem developed this theory in order to promote better health outcomes through nursing interventions (Yip, 2021). When SCDNT is applied to the APRNs’ primary healthcare settings, it can provide a theoretical framework for how APRNs perform diagnostic, prescriptive, treatment, and case management interventions (Yip, 2021).

The role of the APRN in the primary care setting is to administer practicable nursing and medical interventions to promote the best possible self-care of the patient, and this is considered as case management (Yip, 2021). Prior to prescribing appropriate treatments, APRNs need to assess how the patient can manage self-care within the given circumstances (Yip, 2021). Thus, evaluations must consider the patient’s current situation, and possible newly arranged living places or nursing facilities, and this is diagnostic (Yip, 2021). In addition, Orem’s theory provides guidance to APRNs on how they can understand their patient as an agent who can grow, develop, and be an active participant in the self-care process (Yip, 2021).

DISCUSSION POST #2 Nozomi

According to Joel (2018), an advanced practice nurse, or APRN, is defined as an RN who has completed a graduate degree or postgraduate program that has prepared him or her to practice in one of the four roles: Certified Nurse Midwife (CNM), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), or Certified Nurse Practitioners (CNP). Furthermore, APRNs will have to have received advanced education in at least one of the six population areas: family, adult-gerontology, pediatrics, neonatal, women’s health, or psychiatric/mental health (Partin, 2019). Additionally, the difference between RN and APRNs can also be found in their roles and expectations. Stanley et al. (2019) describe APRNs as “highly qualified clinicians who provide cost-effective, accessible, patient-centered care and have the education to provide the range of services at the heart of the reform movement, including care coordination, chronic care management, and wellness and preventive care.” In other words, APRNs are not only expected to provide high-quality patient care, but they are also responsible for being at the forefront of the healthcare reform and devising new ways to effectively provide patient care. They are leaders and educators, as well as researchers. Thus, the role of the APRN is wider and more advanced than the RN role. In summary, APRNs are nurses with advanced degrees and have a broader perspective on the nursing profession and healthcare as a whole (Partin, 2019).

Even if an RN is an expert in his or her field, that individual can become a novice once again when they begin their journey as an NP. Thus, it is clear that one to transition from the RN to the APRN role, he or she must go through major changes not only in the form of education but also through a shift in perspectives and attitudes. When individuals experience changes, they often go through a transition period that may at times be difficult or uncomfortable. One nursing theory that illustrates this transition process is Meleis’s Transitions Theory. This theory claims that there are certain personal or community-level conditions that either enhance or inhibit the process of transition (Barnes, 2017). In her study, Barnes (2017) sought to find out if receiving formal orientation (a community-level condition) will assist RNs in transitioning successfully into the NP role. For the study, a successful transition was defined as competence, mastery of skills, and autonomous practice (Barnes, 2017). Conversely, an unsuccessful transition was characterized by negative emotions, lack of confidence, high turnover, and limited support (Barnes, 2017). As a result, Barnes (2017) found that the provision of formal orientation for new NPs led to a better transition into the role. Interestingly, Barnes (2017) also found that prior nursing experience did not affect the transition process. Thus, community-level conditions, such as formal orientation, could enhance the transition process from the RN to the NP role.

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DISCUSSION POST # 1 Nozomi

I would like to utilize this information regarding CHF to devise a clinical question in the PICOT format. According to Melnyk and Fineout-Overholt (2019), a PICOT question consists of Patient population, Intervention or Issue, Comparison intervention, Outcome, and Time. My PICOT question is as follows: “In CHF patients (P), how does follow-up education after discharge (I) compared with CHF education during hospitalization (C) affect the rate of re-hospitalization due to CHF exacerbation (O) within six months?”

This PICOT question is relevant and important because of how prevalent CHF is. As stated earlier, CHF affects many people worldwide. As nurses and advanced practice nurses, we are likely to come across many patients who suffer from CHF. Furthermore, some studies have shown that the provision of individualized education to CHF patients after discharge can lead to decreased re-admission due to CHF (Wang & Li, 2021). As educators, nurses can empower patients by providing them with the knowledge and means to maintain optimal health and minimize the negative effects of the disease.

DISCUSSION POST # 2 Elaine

PICOT questions are important for focusing the search for evidence in the introductory process of evidence-based practice. Without properly constructed PICOT questions, research pertinent to the issue at hand may be difficult to locate, or results found may be lacking the necessary evidentiary support to provide the best clinical outcomes (Melnyk & Fineout-Overholt, 2019). According to Dr. Fineout-Overholt, “the purpose of PICOT questions is to guide the systematic search of healthcare databases to find the best available evidence to answer the question” (Melnyk & Fineout-Overholt, 2019, p.72). Therefore, PICOT questions must be properly constructed with all the essential elements to maximize the search for evidence in the literature.

The PICOT question I have constructed is: How does the incorporation of testosterone in bioidentical hormone replacement for perimenopausal and postmenopausal women affect the symptoms of hormone deficiency (e.g. sleeplessness, fatigue, lack of energy, decreased libido, weight gain) compared to the use of estrogen and/or progesterone alone? I came up with this question dealing with my health journey and struggle to find adequate and reliable information on the subject. There is a significant amount of bioidentical hormone replacement options on the market, but some are not recognized by the general medical community, specifically the use of testosterone replacement in women. However, there a many doctors that tout its positive benefits for women and promote its use. I am searching for evidence in the literature that either confirms or contradicts this claim. The journey through perimenopause and menopause can be a difficult process for women and include horrible symptoms that affect a woman’s sleep, energy, exercise, sexual relationship, temperature control, and weight gain for several years. If there is a better way to counteract these symptoms and provide improved patient outcomes then they need to be recognized by the medical community as a whole and incorporated into practice guidelines. My one fear in selecting this question is that there will not be a significant amount of research in which to write my paper or qualify the outcome.

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DISCUSSION POST # 1 Ashlesha

Evidence-based practice refers to using the best available evidence for decision-making and scientifically providing efficient and effective patient care. However, it is widely known that evidence-based practice improves healthcare quality, reliability, and patient outcomes and reduces variations in care and costs. It is still not the standard of care delivered by practicing clinicians across the globe. Nurses still struggle to get evidence into practice. One of the barriers is a lack of understanding about what EBP means or time to apply and relate the evidence into practice and inadequate resources (Li et al., 2019).

According to Melnyk et al. (2014), the Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost, evidence-based health care. To evolve more quickly, the EBP in nursing and system must commit to advancing in EBP and allocate resources in Basic and graduate nursing programs must begin to teach the value and foundations of EBP if nursing is to create a culture where EBP is the “norm” and not the rarity (Melnyk, 2002). Moreover, develop Critical appraisal tools and reporting guidelines to practice registered nurses and advanced practice nurses to disseminate evidence to meet EBP competencies (Buccheri et al., 2017).

An example of a compelling clinical question that piques my interest is the latest change in our mother-baby unit for newborns. It involves antibiotics and the way of delivery of the antibiotics. For years when a mother spikes a fever within the two hours of postpartum, she is immediately given ampicillin, and Gentamycin IV piggyback. The baby is given IM Gentamycin and ampicillin for chorioamnionitis protocol for 24 hours. Recently we have switched from IM antibiotics for babies to IV antibiotics. My question is, “Do IV antibiotics have a better outcome for baby than IM?” or “Are IV antibiotics less traumatic than IM antibiotics?”

DISCUSSION POST # 2 Reesha

Evidence Based Practice (EBP)simply put is the solution to a problem-based in research developed by credible healthcare professionals to improve patient outcomes. Evidence-based practice as we know it consists of three principles “Integration of best available evidence, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision-making” (AAPTA, 2021). In regards to nursing, EBP has come a long way in terms of improving practice and as the nature of EBP, it will always continue to evolve as the medical field is always striving for ways to improve. For example, preventive hospital falls, the way nurses implement strategies to prevent falls differs from the way it was done 20 years ago. This was done through evidenced-based practice and medical/technological advances the way nurses know to combat this issue with an effective prevention rate. “To advance nursing science, enhance practice for future nurses, and improve patient outcomes, it is critical to teach nursing students not only the value of evidence-based knowledge, but also how to access this knowledge, appraise it, and apply it correctly as needed” (Abu-Baker, 2021). A clinical question that piques my interest is how to increase medical regimen compliance among patients who have low literacy. Hopefully, within the oncoming weeks, I will find EBP to aid in my research on this topic.

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DISCUSSION POST # 1 Dianne

Nursing is definitely a unique profession due to its wide scope of practice and approach to patient care. Nurses have the ability to play many roles in order to ensure the provision of quality care. For instance, the different roles include patient advocate, caregiver, manager of care, teacher, and decision-maker. In addition, patient care is being provided 24 hours a day. As I’ve noticed in the previous discussion, many people who are not in the nursing profession view the role as only providing physical care towards patients who are ill. However, the role of nurses is much deeper than just caring for physical needs. Nurses play such an integral role in the healthcare system as this profession carries out many responsibilities to promote positive patient outcomes. Instead of only focusing on the physical needs of patients, nurses must treat each patient as a whole person, which includes their emotional, mental, and spiritual needs. Jean Watson’s theory of caring focuses on the importance of providing holistic care to improve the patient’s health and healing process (Denipote et al, 2017). Nurses have the ability to provide attentive, authentic, and personal interactions with patients in order to provide quality outcomes for their patients.

DISCUSSION POST # 2 Cherrylee

Nursing is unique in its ways of promoting patient advocacy. The role of patient advocate has been mandated by a recommendation in some North American states and is supported by the American Nurses Association (2016) and by nursing theorists (Corley, 2002; Watson, 1999). As practicing nurse professionals in any society, we not only have a responsibility to know what we need to know to practice nursing but also a responsibility to act as advocates for those who cannot speak for themselves, our patients. As professional nurses, we carry a commitment and responsibility to all people in the community in which we practice. That’s what makes our profession unique. Second, nurses are different from other healthcare providers by our approach to patient care. Nursing stands apart from all other healthcare professions because of the healing relationships nurses can cultivate with their patients. Nursing is about the intensity in the relation to the person that they care for. The person-centeredness is there, but the uniqueness of nursing is the intenseness in person-centered care. We are constantly present. We are the only professionals that are present with the unique human being from birth to the very ending of life, like no other profession in our healthcare services. We are the navigator of health and wellbeing. Most of the real work of nursing is intangible. Our profession involves much more than just the ability to perform practical tasks. We help people to find the quality of life amid life as it happens; the skill and finesse by which we do this expose the beauty of our profession. And that is the art of nursing and the very heart of nursing!

The unique purpose of nursing as it’s linked to Henderson’s Nursing Theory implies that it is the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. The idea was that nurses devote themselves to patients and help them learn to care for themselves once again (Nursing Theory, n.d.).

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DISCUSSION POST # 1 Elaine

Research studies can be challenging and time-consuming, and one of the most complex elements in the process is determining how to analyze the data. Choosing the right statistical method is essential and the first step to data analysis. According to McKechnie & Fisher (2019) particular aspects of the research study including the research design, hypothesis, and data collected need to be considered when choosing a statistical method. The researcher needs to consider the data collected, the categories, scales, variables, and their relationships (McKechnie & Fisher, 2019).

There are many statistical tests used in nursing research including the Pearson’s Chi-squared test, Student’s t-test, Analysis of Variance (ANOVA), and Analysis of Covariance (ANCOVA) to name a few. One statistical analysis method commonly used in nursing research is the Pearson’s chi-squared test. The chi-squared test is utilized to test assumptions concerning proportional differences in categorical variables (Polit & Beck, 2018). These tests require nominal or dichotomous levels of measurement (McKechnie & Fisher, 2019). For example, let’s say we do a study to test whether a hypertensive medication helps patients with high blood pressure. In this study, we will have two groups, the patients who do not get the medication (control), and the patients who do get the medication (experimental). The data will be categorized into a crosstab and be generalized, positive effect (helps to lower BP) or null effect (no change in blood pressure). The data evaluation in this scenario will not look at specific blood pressure numbers or ranges but instead the overall positive or neutral effect of the medication. If the research study required further evaluation of the extent of positive or negative effects of the medication in numerical value, another statistical method would need to be used. Therefore, knowing what type of data you have and how you want to evaluate it is important when determining what statistical method to use.

DISCUSSION POST # 2 Gema

There are many statistical tests used in nursing, ranging from Pearson correlation, Chi-square, Paired T-test, ANOVA, Independent T-test, and the list goes on. When deciding on what statistical test to use in nursing research one must determine the research design is used, the distribution of data, and the type of variable in question. For example, Inferential statistics allows one to make predictions based on a sample and apply it to a population. In other words, you can make a population generalization based on data sample outcomes. “Inferential statistics can help researchers draw conclusions from a sample to a population” (Gueterman, 2019). Inferential statistics is a broad category of describing data. T-test and ANOVA, along with Analysis of variant, Correlation and Regression they fall under the broad category of Inferential statistics.

The type of statistical test that I would use, given the following research study:

The effectiveness of implementing the [Geriatric Depression Scale or standardized assessment instrument] for the treatment and management of [depression or disease] in primary care- would be a Correlation Statistical test to examine whether there is a relationship between two or more variables; the implementation of the GDS (Geriatric Depression Screening) scale, the elderly population and its correlation to treatment and management of the disease: depression. However, I can easily use the T-test as well to determine if the process of implementing GDS has an effect on the treatment and management of the geriatric population. Both options are suitable; nonetheless, analysis of these groups will result in an association or difference between variables.

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DISCUSSION POST # 1 Reesha

The PICOT question I have selected to conduct a systematic review and search of is; The Effect of Culture and Eating Habits on Childhood obesity in the United States. In terms of how I will go about researching the topic, I would find reputable search engines to maintain data that is accurate and official. Then when finding articles and journals that provide evidence on my topic I would make sure the references I picked were neutral and unbiased. I would pull from multiple sources to prove that my research is the most current evidence to support my solutions for my PICOT question. According to an article published by PubMed, the steps in conducting a systematic review are as follows. “Step 1: Framing questions for a review, Step 2: Identifying relevant work, Step 3: Assessing the quality of studies, Step 4: Summarizing the evidence, and Step 5: Interpreting the findings” (Khan, 2003). An important factor to note is that when I am analyzing my research I have to make sure the interpretation of the results is accurate instead of representing the stance I am stating. When pondering on how the research study would be set up for my question I would make sure to use the right study format and variables are used to further ensure my data is accurately reflecting the population. Then after the study has been conducted the next steps following are extracting the data, analyzing the findings, and interpreting the results. This is the same format I would use when it comes to doing a meta-analysis. If I were not to conduct my own personal research. Using these same principles from both I am sure I will find sufficient evidence to link American culture and eating habits that cause childhood obesity.

DISCUSSION POST # 2 Nozomi

According to Melnyk and Fineout-Overholt (2019), the first step in answering a PICOT question is to gather reliable and accurate evidence. Thus, finding credible sources of evidence and methods to obtain them is crucial in order to answer a PICOT question. There are mainly two sources of information that can be used to answer clinical questions: practice-based evidence (PBE) and research (Melnyk & Fineout-Overholt, 2019). PBE is considered to be internal evidence, and it is usually produced through quality improvement and outcome management projects within the local setting. Although expertise and clinician observation may vary from place to place, an accumulation of small studies can lead to broad research and evidence (Melnyk & Fineout-Overholt, 2019). Unlike PBE, research evidence is obtained through the systematic investigation into a question, and it is considered to be a strong source of knowledge for clinicians (Melnyk & Fineout-Overholt, 2019). Research evidence goes through procedures and reviews in order to make sure that the findings are reliable and accurate.

Research evidence can be obtained through various sources. Two electronic sources that are especially useful are CINAHL and MEDLINE (Polit & Beck, 2018). CINAHL provides information for locating references, and it even provides links to actual research articles as well (Polit & Beck, 2018). MEDLINE is developed by the U.S. National Library of Medicine, and it covers approximately 5600 medical, nursing, and health journals (Polit & Beck, 2018). Another important source is the school and institution library, as well as the health librarians, who may be able to assist in searching for appropriate information.

After identifying research articles, several questions need to be asked in order to appraise the information that is obtained. The clinician should look for substantive themes, or patterns in the evidence collected (Polit & Beck, 2018). Additionally, methodologic themes observe the methods that were used to obtain data, and the strengths and weaknesses of those methods (Polit & Beck, 2018). For instance, participant selection criteria and data analysis methods are both considered to fall under the methodologic category (Baumgart et al., 2021). Finally, the transferability theme asks if the evidence applies differently to various populations and settings (Polit & Beck, 2018).

Another way to appraise research data is to ask about their “credibility (can the findings be trusted?), dependability (is the process logical and transparent?), confirmability (can the findings and interpretations linked to the data?), and transferability (are the findings relevant to other contexts and settings?)” (Baumgart et al., 2021). By observing research data from various angles, one can gain a deeper insight into the reliability of those sources.

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Law and Legislation

DISCUSSION POST #1 Baljeet

Assembly Bill 2537 (AB 2537), Personal Protective Equipment: Health Care Employees is created to protect staff from COVID-19 exposures in the workplace. Starting on April 1, 2021, employers in hospital settings are required to maintain a three-month supply of new and un-expired personal protective equipment (PPE). In addition, the bill requires employers to create and execute effective written procedures for periodically determining the amount and types of equipment used in its normal consumption. The bill classifies seven specific types of PPE that must be maintained in an amount equal to three months of normal consumption: “N95 filtering facepiece respirators, powered air-purifying respirators with high-efficiency particulate air filters, elastomeric air-purifying respirators and appropriate particulate filters or cartridges, surgical masks, isolation gowns, eye protection, and shoe coverings” (Bill Text – AB-2537 Personal protective equipment: health care employees., 2020). In addition, hospitals must be ready to verify their respirator fit testing program up to date and compliant with the Occupational Safety and Health Administration (OSHA) Respiratory Protection Standard. Employers should provide training for PPE donning and doffing procedures to minimize the risk of exposure to the employee or contamination of the transport vehicle or health care facility environment.  Ensure all PPE is disposed of after use and kept separate for waste disposal, minimizing the risk for exposure to housekeeping and waste disposal workers and for contamination of other environments. The California Occupational Safety and Health Act of 1973 states that the legal obligation of the employer is to provide and maintain a safe and healthful workplace for employees. Nurses and health care workers should be protected while doing their jobs to impact our health care system’s ability to respond to pandemics.

DISCUSSION POST # 2 Cherrylee

A healthcare initiative or legislative statute that is currently underway in California is the AB 890. It updated the Nursing Practice Act (in the state Professions Code) to allow NPs who meet specific criteria to practice without physician supervision. AB 852 would update these other sections of California law, which govern health care providers, to also include nurse practitioners. Clarifying that NPs are included in these existing laws is critical to ensuring that NPs can practice to the full extent of their education and training. AB 852 passed the full Assembly on a bipartisan 75-3 vote in May 2021. In June 2021, Assemblymember Wood made AB 852 a two-year bill, meaning that the bill can still move forward in 2022 as a vehicle for allowing NPs to practice without physician supervision. The extended timeline gives advocates and legislators additional time for key conversations around AB 890 implementation. In order to implement the provisions of AB 890, the
Board of Registered Nursing (BRN)
will follow state law for outlining, editing, and finalizing regulations. CANP is actively engaged in ongoing discussions regarding AB 890 implementation occurring at the BRN and at the BRN’s
Nurse Practitioner Advisory Committee
(NPAC). NPAC was established by AB 890 and will to the BRN Practice Committee, which will then to the full Board. BRN staff are in the process of drafting AB 890 regulations, as is NPAC, and are prioritizing transition to practice regulations. Additionally, the BRN has had a preliminary presentation by the Office of Professional Examination Services to investigate whether NPs will need a supplemental examination. No determination has been made yet.

In conclusion, AB 890 passed out of the California Legislature on August 31, 2020. The great news is that the measure was signed into law by Governor Gavin Newsom on September 29, 2020 (California Association for Nurse Practitioners, 2022).

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DISCUSSION POST # 1 Gita

There are lots of things to be considered when seeking employment as an APRN. I will be excited to be practicing as APRN however, lots of things come up to mind when transitioning from RN to APRN. It can be overwhelming to make decisions and write an order when I am used to following orders. Of course, the compensation, location, and benefits come first, but I want to make sure, the job is right for me so that I could provide safe care to my patients. I do consider their benefits like 401K, federal taxes, tuition reimbursement, malpractice insurance, collaboration agreement, continuing education credits, sick leave, vacation, and travel allowance, etc. For me, salary should be negotiable with bonuses with certain raise every year. I will determine if the position is salaried or is per hour, per day, or per–patient contract. If it’s salaried, what are the on-call and weekend policies? Another thing I would consider will be if I will be able to practice to the full extent of my scope of practice. I would check for barriers that are more stringent than those in place in state law or regulation, I will make sure to know what is expected to practice beyond the scope of my practice (AANP, 2022) . Besides, the organization’s culture, vision, and values are equally important to me. I will look for a position that best fits my skills, interests, and experience. I will familiarize myself with the regulation pertaining to advanced practice in the state. For example, I need to understand what authority I have for prescribing medications and other medical interventions, and I must be aware of any requirements for collaboration with a doctor. It’s equally important for me to know what type of patients that particular organization treats, whether an APN has the autonomy needed to practice up to the full scope of practice, how the APN’s time will be allocated and if the APNs will be a primary care provider who can treat patients independently.

DISCUSSION POST # 2 Kathryn

As I think about the future and my career as an APN there are several non-negotiables when it comes to employment. The work environment is super important to me. A positive supportive culture to learn and grow is on the top of the list for me when finding the right fit. Transitioning from student to provider of care can cause feelings of stress, isolation, self-doubt, frustration, and uncertainty about clinical knowledge. Having someone to rely on to alleviate some of these stresses is very important (Erickson et al., 2021). Having a benefited position that gives access to a 401k and healthcare access is also a contributing factor.

After interviewing and being offered a new place, a crucial part of the job-seeking process begins nurse practitioner negotiation (Hicks & Hennessy, 2016). Negotiables when starting as a new nurse practitioner for me are things like vacation time and compensation. My primary goal as a new nurse practitioner will be to provide my patients with the best safest care. In order to do this, I am willing to take a job that is the best fit for me, not simply the highest paying position available.

Some benefits of formal employment include health insurance and reimbursement of licensure. Organizations will often pay or reimburse for continuing education requirements. These continuing education classes can be pricey and are often required to remain licensed in different states (Childress, 2021).

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DISCUSSION POST # 1 Ann

Jehovah’s witness and blood transfusion

According to the article of (Rashid et al., 2021) More than 8.5 million people in the world observe the Jehovah’s Witness faith and require unique consideration for perioperative blood management as they generally refuse transfusion of blood and blood products.

Managing anemia and acute blood loss in critical patients has long been reliant on the judicious use of red blood cell transfusions. The primary goal of blood transfusion is the efficient delivery of oxygen to end organs, especially the brain. Provided that appropriate guidelines are followed, allogenic blood transfusions are considered a safe and effective therapeutic option. Some patients refuse or decline blood transfusions due to cultural and/or religious beliefs, with the most well-known being followers of Jehovah’s Witnesses (Sticco et al., 2019).

Jehovah’s witnesses oppose receiving blood transfusions based on religious grounds. This refusal raises complex medical, legal and ethical issues for the treating medical staff. In the past physicians attempted to force patients and children to accept transfusions when deemed medically necessary through the use of court orders. However, in recent years the threshold for blood transfusion has been gradually raised by medical experts as expressed in consensus guidelines, which means that Jehovah’s witnesses’ aversion to transfusion would have been partially justified medically (Sagy et al., 2017).

Although the courts have ruled that the decisions of competent adults must be respected, and healthcare providers have come to appreciate the need to care for the whole person-including respecting beliefs that may appear irrational or harmful-dealing with individual believers can still be a source of moral distress. The Watch Tower Society has done an admirable job of establishing hospital liaison committees to educate healthcare providers about its beliefs with regard to alternative, bloodless surgical procedures, and to support Jehovah’s Witness believers in navigating the healthcare system (Pullman, 2019).

Conflicts arise between cultural beliefs and delivering competent medical care which makes it challenging for the healthcare providers. In my opinion, as a healthcare provider, it is imperative to respect a person’s belief in their care. It is paramount that we acknowledge and accommodate their culture and beliefs.

Discussion post # 2 Kelly

Cultural Competence: as Simple as the Food We Eat

“Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and is transmitted intergenerationally” (Stanhope p. 141 para 4). In order to practice as an APRN, we need to be aware of the distinct cultural needs of others. We need to be able to view the patient separate from the culture we live in and be able to recognize the importance of what they require in order to accept our care. This goes beyond ethnicity, religion, or race. We also cannot make assumptions about someone’s culture. By failing to recognize the cultural differences in our patients, we may be undermining their healthcare unknowingly (Black 2017).

“APN’s frequently face a dual challenge: to provide high-quality, evidence-based care to culturally diverse populations and to do so in communities that are often socially and economically challenged” (Joel p. 300 para 6). If a patient in a care center is losing weight due to malnutrition or refuses to eat the food in a hospital due to cultural beliefs, the APN needs to view those beliefs and not judge the patient for choosing not to eat the food. Food can connect us across cultures, and generations. Food can connect us to our heritage and ethnicity but is not limited by it.

I was reminded of this for the last several months. A co-worker brought food every day for a church friend that was hospitalized because they believe the food prepared by strangers will not heal the body. A healthcare provider may interpret this as the refusal of care, or non-compliance. Recently during Hanukkah, my grandmother insisted on taking a brisket and potatoes latkes to her friend at the care center who refused to eat anything that was set before her. Her friend was losing weight and had stopped speaking English. When we went to visit, she ate well and conversed with my grandmother. The staff asked, “How did you get her to eat?” My grandmother stated, “I gave her what she needed.” Cultural competence requires systems that can personalize the needs of the population they serve. Being able to apply cultural knowledge is also being aware of how culture influences our health practices, dietary needs, our beliefs about food, and how we communicate our health belief needs (Marion 2017).

As nurses, and especially as APNs we will face challenges as our population continues to evolve and change. According to Leininger’s theory, we need to view the patient in the context of their culture, respect the culture of the patient and recognize the importance of its relationship of the culture within the nursing care we deliver (Joel 2018). She encouraged us to use creativity and find the cultural path that works best for our patients, while still being able to deliver care. Sometimes, all we have to do is make minor changes in the delivery to make major changes in the outcome.