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Table of Contents APN Capstone Portfolio Part 2 3 Exemplar #1: NR 500 Evidenced-Based Practice Discussion 3 Exemplar #2: NR512 Wisdom Versus Judgement Discussion 6 Exemplar #3: NR506 RN as Healthcare Policy Leader 9 Exemplar #4: NR510 Advanced Practice Nursing 12 Exemplar #5: NR505 Identification of Area of Interest 16 Exemplar #6: NR503 Healthy People 2020 Impact Paper Excerpt 19 Exemplar #7: NR507 Congestive Heart Failure Discussion 23 Exemplar #8: NR601 Discussion Board-Polypharmacy 26 Exemplar #9: NR602 Evaluation of Marginalized Women Paper Excerpt 30 Exemplar #10: NR603 Mental Health Treatment Plan/Analysis: Adult ADD 34 Conclusion 38 References 39 Appendix A: Concept Map 46

 

 

 

APN Capstone Portfolio Part 2

My goal as a future nurse practitioner is to improve patient health outcomes with the knowledge and materials, I have obtained from the MSN program. This portfolio will display my professional growth and learning through this program from NR500: Foundational Concept and Applications to NR661: APN Capstone Practicum. Each exemplar presented will be accompanied with an explanation and reflection of how Program Outcomes, the National Organization of Nurse Practice Faculties (NONPF) Core Competencies, and the Essentials of Master’s Education in Nursing completed and met these exemplars.

Exemplar #1: NR 500 Evidence-Based Practice Discussion

As a nurse it is our duty to perform evidenced based practice for our patients. The importance of evidenced based practice is to improve patient care and results. (Stevens, 2013) The evidenced based practice process has adapted over the years and around 50 models have been created. (Loversidge, 2016) The evidence-based practice process starts with a question about patient care and from there finding evidence-based research and validating that evidence (Loversidge, 2016). I chose the Nurse Practitioner track because I want to advance my knowledge and be able to have more autonomy in my practice. As a registered nurse it is not in my scope of practice to diagnose and treat. I want to use my knowledge and experience to care for my patients. A topic that has special interest to me is the overuse of antibiotics. In the nurse practitioner setting, many patients will come in for cold symptoms. They are so uncomfortable and miserable and want to speed up the process. They have come to expect an antibiotic to speed everything up. Patients believe that the antibiotics are working when in reality it’s just the virus working its way out of their body. The antibiotic prescription is not harmless though. It can cause antibiotic resistance for the future. Due to the overuse of antibiotics, easy to cure infections are now more difficult to treat than ever and could end in mortality (Barth, 2016). There is a direct link between overprescribing antibiotics and resistant bacterial strains (Fromage, 2018). Providers are still prescribing antibiotics for the common cold despite knowing the problems with antibiotic resistance. Current studies show that “30-50 % of cases, antibiotic therapy has been incorrect, with the indication, choice of agent or duration of treatment being suboptimal” (Fromage, 2018). It is important for providers to educate themselves continuously on what is best practice of antibiotics and when it is appropriate to use them (Fromage, 2018).

Outcomes and Competencies

Program Outcome #4

This exemplar met the Chamberlain Program Outcome #4, which is the incorporation of professional values by services in healthcare and scholarship to develop a professional identity (Chamberlain University, 2019). In this discussion I presented the reasons why I was working to obtain a master’s in nursing and what it means to me. By utilizing evidenced-based practice to better patient outcomes, I am able to build on my professional identity to maximize my services in healthcare.

NONPF #1 Core Competency

This exemplar also met the NONPF #1 which is the Scientific Foundations Competency. NONPF #1 Competency acknowledges the importance and mastery of carefully analyzing all data and evidence to improve patient outcomes (The National Organization of Nurse Practitioner Faculties [NONPF], 2017). This exemplar also discussed the importance of evidence-based practice and its use to the master’s prepared nurse. This exemplar met this competency by the acknowledgement and intention to use evidenced-based practice to improve my advanced nursing practice.

Master’s Essential I

The last competency met by this exemplar is Master’s Essentials I, which is the background for practice from sciences and humanities. Utilizing what was learned as a baccalaureate prepared nurse, I am able to build upon that to develop my knowledge in becoming a master’s prepared nurse. As a master’s prepared nurse, findings from biopsychosocial fields, genetics, public health, health economics, translational science, organizational science, science, humanities, and quality improvement are incorporated together to continually improve patient health (American Association of Colleges or Nursing [AACN], 2011). This exemplar explained the incredible benefits and absolute need for the use of evidenced-based practice as a master’s prepared nurse.

Connect Concepts

Evidenced-Based Practice

A concept presented in this exemplar is evidenced-based practice concept. Evidenced-base practice is utilized in practice to solve problems and perform clinical decisions to improve patient outcomes (Lippincott, 2020).

Health Promotion

Another concept presented by this exemplar is health promotion. Health promotion relies on the actions and behavior of the provider to improve health and well-being (Lippincott, 2020).

Reflection

It is very interesting to look back to the beginning of the program and see how much I’ve grown as a nurse and how I’ve developed my professional identity. This reflection of my previous work has also opened my eyes to how much I have developed my professional writing. Evidenced-based practice is all founded in the competency’s Program Outcome #4, NONPF #1, and Master’s Essential I. As a baccalaureate prepared nurse, I had a good understanding of the importance and use of evidenced-based practice. I will continue to use evidenced-base practice in my daily use as a professional and will stay up to date and current to provide optimal care and treatment to my patients. The MSN program has developed me as a professional and my abilities to utilize evidenced-base practice in the improvement of patient health outcomes. At the end of the MSN program, I now have a greater understanding of the achievement I have made with Program Outcome #4, NONPF #1, and Master’s Essential I Competencies.

Exemplar #2: NR512 Wisdom Versus Judgement Discussion

Wisdom in nursing informatics is utilizing knowledge at the appropriate time when caring for a patient necessity or issue (Ronquillo et al., 2016). “Wisdom” was introduced into the DIK framework to aid in the use of evidenced based practice (Ronquillo et al., 2016). Using evidenced based practice can improve patient outcomes. When using wisdom, knowledge and experience are combined to improve critical thinking and clinician judgement (McGonigle et al., 2014).

During nursing school, lessons on critical thinking and nursing judgement were taught to prepare us for the nursing world. For testing purposes, I always reminded myself to “think like a nurse” to do well on a test. Clinical judgment is an important skill needed when caring and planning interventions for patients, particularly with a rapidly declining patient (van Graan et al., 2016). Using clinical judgement, the nurse would know the appropriate actions when patients display specific symptoms. I feel that wisdom and professional nursing judgement are very similar and nursing judgments aids wisdom in its success.

Nursing informatics provides all the tools required to improve the DIKW route, and actually allows all information to be readily accessible by the nurses (McGonigle et al.,2014). Utilizing nursing informatics can create ease in the profession in all areas. Data is used every day by nurses, such as vital signs from a monitor and lab results (McGonigle et al., 2014). I use data every time I’m at work such as when I am assessing my patients and taking their vitals or reviewing their current or past lab results. The data is used and has meaning as information and can then be transformed into knowledge. My own nursing knowledge grows and improves every time I’m at work caring for my patients. The knowledge that I have obtained so far, I am able to use to make sound judgements and critical thinking when I am caring for my patients. I use wisdom when I apply my knowledge to the care I give to my patients.

Outcomes and Competencies

Master’s Essential V

Exemplar #2 meets the Master’s Essential V which relates to informatics and healthcare technologies. The Master’s Essential V encompasses the utilization of patient care technologies to maximize care, technology communication to integrate and coordinate care, management of data in analysis to improve outcomes, utilization and navigation of electronic health records for improvement of patient care, and health data management for evidence-based care and distribution of health education (AACN, 2011). Exemplar #2 discusses the importance of daily use of informatics and healthcare technologies to improve patient health outcomes. For example, having the ability to navigate through the patient’s electronic health records, the provider can view past lab results and notes to assess the improvement or worsening of the patient’s condition. The more these technologies are used, the better the provider will become in its utilization.

NONPF #5 Core Competency

This exemplar also meets NONPF #5 which is Technology and Information Literacy Competency. This exemplar meets NONPF #5 Competency by the acknowledgment and intent to incorporate the appropriate technologies for knowledge to enhance patient health outcomes (NONPF, 2017). This exemplar also explains the importance of the translation of technical and scientific patient health information to prepare appropriate patient education (NONPF, 2017). This discussion post discussed the importance of information literacy skills in making critical decisions in patient care (NONPF, 2017). Exemplar #2 also discussed the importance of the ability to readily use technology systems to observe and act when appropriate in the presence of variables to ensure safe, quality, and cost-efficient patient care (NONPF, 2017).

Connect Concepts

Communication

An important concept achieved and presented in this exemplar is communication. Communication is the practice of exchanging information by means of verbal and nonverbal messages that are sent and received simultaneously (Lippincott, 2020). Communication is vital when practicing ensuring that a patient’s care and treatment is being performed efficiently and fully. Many times, technological communication is necessary when caring for a patient especially when in collaboration with other professionals.

Informatics

Informatics uses technology information to enhance the effectiveness, quality, or delivery of patient health care (Lippincott, 2020). The concept of informatics was present and acknowledged in exemplar #2 and explained in detail.

Reflection

Before the MSN program I felt very proficient and at times advanced in informatics and healthcare technologies. Completing this program, I feel it has developed me even further in those areas and I have become an expert in some areas such as capturing and updating data, communicating electronically, utilizing appropriate search databases for evidenced-base information, and basic computer competencies. The online studies MSN program has greatly improved my abilities in navigating with ease in technology and informatics.

During clinicals I was able to utilize their electronic medical records systems and I felt at ease with its use and at times would even teach my preceptors how to navigate more easily. I am eager to begin my first year as an APRN and utilize my technology and informatic competencies from this program. With the completion of this program, I feel I have surpassed my abilities in meeting Master’s Essential V and NONPF #5 Competencies.

Exemplar #3: NR506 RN as Healthcare Policy Leader

If a mother is able to breastfeed her newborn and continue doing so for 6 months or longer there are incredible benefits for both mother and baby. Since working in labor and delivery, I am even a bigger advocate for breastfeeding for my patients. I do my best to explain all of the wonderful priceless benefits of breastfeeding and give information on how to receive support while they are in the hospital and when they are discharged and home with their newborn.

Some of the breastfeeding benefits for the baby are fewer infections during infancy, decreased the likelihood of chronic diseases later in life, and increased cognition and IQ (Hamze et al., 2018). The maternal benefits of breastfeeding include quicker restoration to postpartum uterine tone, increased weight loss postpartum, and delayed return of menstruation (Hamze et al., 2018). Data shows that worldwide only 37% of babies that are 6 months old or younger are exclusively breastfed (Hamze et al., 2018). There can be many reasons that women do not exclusively breastfeed for 6 months or longer, such as lack of family support, lack of resources, or return to work with no support for pumping.

To help support breastfeeding, practitioners should discuss the benefits and resources available when mothers come in for their appointments prenatal and postpartum (Louis-Jacques & Stuebe, 2018). Health care providers can advocate for their breastfeeding patients by advocating for policies associated with breastfeeding in the workplace and maternity leave (Louis-Jacques & Stuebe, 2018). Even with the Affordable Care Act implementing a break time and clean private area that is not a bathroom for mothers pumping, there are still barriers to mothers actually being able to pump in the workplace (Kozhimannil et al., 2016). Workplaces should not hide the policies related to pumping but rather let the policies be known and support the mother on when and where she can pump during the workday.

Outcomes and Competencies

Program Outcome #4

Exemplar #3 meets Program Outcome #4 which is based on integration of professional values using scholarship and provision in health care (Chamberlain University, 2019). This exemplar meets this competency by the acknowledgement of an issue and the intent and action to remedy the issue by using the knowledge of policies and problem-solving skills. By utilizing knowledge and growth as a master’s prepared nurse, I am able to educate the patient to the best of my ability in order to empower the patient to also advocate for themselves.

Master’s Essential VI

This exemplar also meets Master’s Essential VI Health Policy and Advocacy. Master’s prepared nurses have the knowledge and skills to promote healthy lifestyles, influence the healthcare system, and promote values such as social justice with policy procedures and advocacy (AACN, 2011). The master’s prepared nurse has the ability to interpret research and advocate for policies that will improve healthcare for the public and in the profession of nursing (AACN, 2011). This exemplar presents that the ability and knowledge of the master’s prepared nurse can promote positive changes in healthcare policy and advocate for healthy patient outcomes (AACN, 2011).

NONPF #6 Core Competency

This exemplar completes NONPF #6 Policy Competency. Exemplar #3 meets this competency by an understanding and utilization of the interdependence of practice and policy (NONPF, 2017). Exemplar #3 discusses the advocacy for patients to have the ability to breastfeed in a comfortable and private area. Many patients are not aware of the policies present to them and the master’s prepared nurse has the ability to educate patients on what is available to them.

Connect Concepts

Advocacy

Advocacy is educating and assisting others to develop and self-actualize by enlightening them of their rights and ensuring they understand the information being presented (Lippincott, 2020). A large part of nursing is being a patient advocate and ensuring the patient has the proper information and education.

Health Policy

Health policy encompasses the laws that a nation determines to oversee how health care is delivered to its people (Lippincott, 2020). Health policy is a very important part of nursing and its importance was presented in this exemplar.

Reflection

As nurses, we have the ability to be the biggest patient advocates and educate our patients to become self-advocates. Reflecting on this exemplar, I see how important policy and patient advocacy is in nursing. Health care policy is an important part of nursing and should be incorporated into practice to produce optimal patient health outcomes. Reflecting more on this exemplar, I feel well equipped to stay up to date with policies especially the policy that ensures that breastfeeding mothers are ensured a break from work in a clean environment to breastfeed or pump. From the completion of this course to now at the end of the MSN program, I have a fuller understanding of the importance and necessity of knowledge in health care policy. This exemplar was able to meet Program Outcome #4, Master’s Essential VI, and NONPF#6 Competencies by acknowledgement and the knowledge of the importance of healthcare policy in nursing.

Exemplar #4: NR510 Advanced Practice Nursing

Advance Practice Nurses (APN) are now allowed to prescribe controlled substances in the state of Florida, which is the last state to join, as of January 2017 (Kellams & Maye, 2017). All APN roles must practice under the supervision of a physician in the state of Florida which includes a written protocol between the physician and APN with the provision of an annual review (Florida Board of Nursing, 2018). The description of the duties of both the APN and the physician are described in the protocol and include the conditions of the specific therapies, treatments, and drug therapies that may be made by the APN (Florida Board of Nursing, 2018).

A Certified Nurse Practitioner (CNP) has the ability to work in many different specialties like family practice, pediatric, geriatric, acute care, emergency, neonatal and women’s health (American Association of Nurse Practitioners, 2018). The CNP may practice in clinics, hospitals, emergency rooms, urgent care sites, private physician practices, nursing homes, schools, colleges, and public health departments (American Association of Nurse Practitioners, 2018). The CNP in Florida has a salary between $92,027 and $107,737 (Salary.com, 2018). A pro for this role is the ability to diagnose, treat and manage patients. A con with the CNP role is the opinions of some patients feeling the CNP is not as competent as the physician.

I chose the role of CNP advanced practice nurse versus the other roles because I like the ability to have a variety of areas I could go into with my degree and the ability to have a following of patients that I am able to manage their healthcare. My entire nursing career has been in labor and delivery, so I am very comfortable with the idea of working in women’s health following obtaining my license. The second area that I would be interested in is the Acute Care Nurse Practitioner in an urgent care center.

My idea of Nurse Practitioner practice in Florida has changed slightly after researching the limitation of the CNP. I have been enlightened by the fact that Florida is still a bit behind other states that allow more autonomy. These limitations do not completely discourage me from practicing in the state of Florida as a CNP. I am excited for what the future brings in changes to the limitations of the CNP in Florida.

Outcomes and Competencies

NONPF #9 Core Competency

The exemplar meets NONPF #9 Independent Practice Competency. Much has changed since I wrote this exemplar in November 2018. APN’s are on their way to independent practice in the state of Florida. As an APN, I will have the ability to practice independently and manage previously diagnosed and undiagnosed patients in my practice (NONPF, 2017). This exemplar meets competency NONPF#9 Competency by the acknowledgement and intention to practice independently, educate other professionals and lay caregivers, collaborate with other professionals or caregivers for optimal patient outcomes, and the use of professional standards and evidenced-based practice (NONPF, 2017).

NONPF #2 Core Competency

NONPF #2 Leadership Competencies were met in this exemplar by intention and acknowledgement to lead and foster collaboration between multiple persons in order to improve patient health care (NONPF, 2017). An APN must possess the abilities and knowledge to perform as a leader to improve patient health outcomes through critical and reflective thinking (NONPF, 2017). As an APN, the provider must be willing and able to meet the challenge of complex and advanced leadership roles in order to provide healthy and necessary changes in healthcare (NONPF, 2017).

Master’s Essential II

This exemplar also meets Master’s Essentials II organizational and systems leadership. High quality and safe patient care depend on organizational and systems leadership (AACN, 2011). The MSN program has been instrumental in preparing graduates to assume a leadership role to provide high quality and efficient patient care (AACN, 2011). This exemplar meets Master’s Essentials II by the acknowledgement and intention to develop a leadership role and use critical thinking and communication skills between professionals and patients to provide high quality patient care (AACN, 2011).

Connect Concepts

Leadership

Leadership is using one’s ability to positively influence and encourage others to meet a goal using noncoercive measures (Lippincott, 2020). A master’s prepared nurse must have the abilities and knowledge to be a positive leader.

Management

Management is the ability to lead and influence an organization through the disposition and guidance of resources (Lippincott, 2020). An excellent leader is able to manage patients and professional relationships carefully to create effective change.

Reflection

It is a big role change to transition from staff nurse to advanced-practice nurse. Reflecting back on this exemplar, it is interesting to see how much I’ve grown and changed during this program. The thought of being a leader was always a daunting task for me since I always felt I was better as a follower. This program and specifically this exemplar have encouraged me and opened my eyes to the fact that I also can be a leader.

The class NR510 Leadership and Role of the APN and this exemplar both meet the NONPF#2, NONPF#9, and Master’s Essentials II competencies by their teaching and aid in development of creating leaders of all MSN graduates despite their very different backgrounds in nursing. During this program I was still hesitant to acknowledge my leadership skills, this exemplar, MSN program, and taking the role of Charge RN in OB triage several shifts have shaped and developed my leadership and management skills further.

Exemplar #5: NR505 Identification of Area of Interest

My EBP interest from NR500 was on the overuse of antibiotics causing antibiotic resistance. As Nurse Practitioners in the office setting, we will come across patients coming in for the common cold and requesting antibiotics. They will push for these medications because it seems like it will make them better because other practitioners have prescribed this for them in the past. It is not a harmless prescription though. Providers should be educated about when and why antibiotics should be prescribed.

My MSN program specialty track is the Family Nurse Practitioner. MY EBP interest is consistent and relevant to my specialty track because I will be working with providers that will be frequently prescribing antibiotics for viral infections. Providers that have this habit will try to teach new providers their methods and the cycle will continue. I would like to keep the same EBP area of interest from NR500 because I feel that it is an important area of research to my future career.

Family nurse practitioners will quite frequently see patients for the common cold or upper respiratory viral infections. In 1962 it was found that antibiotics were not an effective approach to colds or upper respiratory viral infections (Jones & Samore, 2017). Today patients are still being prescribed antibiotics for the common cold or viral infections (Jones & Samore, 2017). Infections are more difficult to treat more than ever due to overuse of antibiotics (Barth, 2016).

There is a direct link between overprescribing antibiotics and bacterial resistant strains (Fromage, 2018). There are not currently enough new antibiotics being produced to prevent antibiotic resistance (Fromage, 2018). The common causes of antibiotic resistance are overuse, improper prescribing, agricultural utilization, failure to make new antibiotics (Fromage, 2018).

The PICO questions I am considering is: In adult patients, how does the use of alternative treatments for the common cold compare to antibiotic prescription in reducing antibiotic resistance?

Outcome and Competencies

Program Outcome #5

Exemplar #5 was met by Program Outcome #5 which is extraordinary nursing through advocacy for improved patient outcomes by collaborative, evidenced-based, and compassionate advanced nursing practice (Chamberlain University, 2019). NR505 tasked students to present an area of interest for the evidenced-based practice proposal with a PICOT question. My area of interest to research more was reducing antibiotic resistance. This exemplar meets Program Outcome #5 by the interest in reducing antibiotic resistance and the plan and intention to always use compassion, evidenced-based, and collaborative advanced nursing practice to improve patient outcomes.

NONPF #3 Core Competency

This exemplar also meets NONPF #3 which is Quality Competencies. NONPF #3 focuses on the use of the best available evidence in order to ensure improvement in quality of clinical practice (NONPF, 2017). Exemplar #5 had a goal of using the best available evidence to reduce antibiotic resistance in practice. Quality competencies looks at the relationship between access, cost, quality, safety, and influence and how it affects health care (NONPF, 2017). This exemplar reviewed how marketing and care processes affect the quality of health care and how it can be improved.

Master’s Essential IV

Lastly, this exemplar meets Master’s Essential IV which is translating and integrating scholarship into practice. The use and understanding of evidenced-base practice are vital to healthy patient outcomes. The APN must use their critical thinking skills, clinician judgement, ability to gather evidence and translate those into practice to improve patient outcomes. This exemplar met this competency by using my resources to gather evidence on antibiotic resistance in order to translate the information to be used into my daily practice.

Connect Concepts

Pharmacology

Pharmacology is the scientific study and understanding of the biological results from chemicals (Lippincott, 2020). This exemplar presents the concept of pharmacology by recognizing the benefits and possible harms of medication.

Quality Improvement

Quality improvement is the practice and process of ensuring that quality exertions are consistent to guarantee that quality will always be improved (Lippincott, 2020). In practice it is important to always practice quality improvement to ensure patients are receiving optimal care.

Reflection

This assignment was interesting and assisted in the further development of my abilities to be vigilant when researching evidenced-based practice information to use in my own practice. During clinical I was able to see how different providers practiced and if they followed the guidelines for antibiotic use. I noticed that the APRN I was following was very careful in her prescriptions of antibiotics and the physician I followed would prescribe antibiotics without thought especially if the patient was asking for a script and didn’t need one.

The EBP proposal in NR505 was helpful in understanding how much work is needed in order to promote and teach evidenced-based practice to other professionals and patients. At the end of this program, I have an even greater appreciation of evidenced-based practice and all the work that goes into it to be put into effect. NONPF#3, Program Outcome #5, and Master’s Essentials IV were clearly met in this exemplar and especially now they have been completed at the end of the MSN program.

Exemplar #6: NR503 Healthy People 2020 Impact Paper Excerpt

According to the data for 2014 in the state of Florida, 2,445 adults aged 64 or older died from falls and more than 200,000 were hospitalized for fall injuries (Florida Department of Health, 2016). Adults aged 85 years and older have a higher risk of death or injuries from falls (Florida Department of Health, 2016). Patients aged 65 and older are at an increased risk of a fall by 8 falls per 1,000 patients after a hospital visit (Demons & Duncan, 2014). Data has found that 1% of falls will result in a hip fracture and 20% to 30% will result in relative to intense injuries (Demons & Duncan, 2014).

Clutter in households can be very hazardous for a person with unsteady gait caused by a chronic health condition. Patients diagnosed with cancer, diabetes, asthma, stroke, obesity, depression, chronic obstructive pulmonary disease, or coronary artery disease are more prone to risks of falling (Paliwal et al., 2017). Persons that do not participate in physical exercise or are a part of the community for mental stimulation are more prone to falls (Morris et al., 2016).

HP2020

The goal of Healthy People (2019) 2020 is to reduce emergency department visits by 10 percent due to falls in adults aged 65 and older. The data in the National Snapshot for the year 2007 shows there were 5,235.1 emergency room trips per 100,000 caused by falls in adults aged 65 and older (Healthy People, 2019). The goal for 2020 is 4,711.6 emergency room trips per 100,000 caused by falls (Healthy People, 2019). In 2015 there were 6,306.2 emergency room trips per 100,000 (Healthy People, 2019). This data was collected from the National Hospital Ambulatory Medical Care Survey from the emergency department for the cause of their visit (Healthy People, 2019).

The Center for Disease Control (CDC) has implemented a program called STEADI (Stopping Elderly Accidents, Deaths, & Injuries) to screen, assess and then intervene in order to reduce fall accidents in the elderly (Lee, 2017). The STEADI screening is less reliable for cognitively impaired individuals so other screenings should be utilized (Renfro et al., 2016). For persons that are cognitively intact, the STEADI screening tool is found to be adequate to excellent for reliability on test-retest and inter-rater (Renfro et al., 2016).

Program Plan

The target population in Broward County is adults aged 65 years and older. Physical therapy and balance classes, handlebars installed in all bathrooms, and instruction on the use of walkers at all times regardless of location could possibly decrease the number of falls in the population of adults aged 65 years and older. There are specific exercise classes aimed at the older adult community, but there are many people that do not know about these classes.

Doctors’ offices and hospitals will provide information on balance and Tai Chi classes to all adults aged 65 years and older. Any patients that are required to use a walker will be given clear and thorough instructions to use the walker at all times regardless of the setting. Data will be collected from hospitals in Broward County of the number of emergency visits for fall-related injuries or deaths. Data will be collected again one year later following the intervention to see the impact of the fall prevention program.

Outcomes and Competencies

Master’s Essential VIII

This exemplar that targets a plan for the prevention of falls is met by Master’s Essential VIII which is the clinical prevention and population health for improving health. The Healthy People Curriculum Task Forced worked to produce the Clinical Prevention and Population Health Curriculum Framework with four main areas (AACN, 2011). Master’s Essential VIII is focused on the implementing clinical prevention and population health activities to accomplish the national goal of improving the all-around health status in the United States (AACN, 2011). This exemplar was able to demonstrate this competency by the presentation of epidemiological data used to design an evidenced-based plan to prevent falls (AACN, 2011). In this exemplar, I designed a plan for the prevention of falls that is patient centered.

Master’s Essential III

This exemplar is also met by Master’s Essential III which is quality improvement and safety. This exemplar was successful in analyzing information on quality initiatives and implementing evidenced-based plans to improve quality of patient care (AACN, 2011). The program plan created to reduce elderly falls was successful in the intention to create safe environments for the elderly.

Program Outcome #2

This exemplar also meets Program Outcome #2 which is care-focused by creating an environment of caring in order to achieve improved patient health outcomes. When creating the program plan to prevent elderly falls, I kept in mind that it should come from center of caring in order to reach patients well. I feel patients and persons in general are able to give their attention more when the person teaching is warm and caring. Nursing should always involve caring and especially when teaching to our patients. I feel it is easier for patients to remember and follow directions when the care plan laid out for them involved a caring nature. This exemplar discusses a program plan to teach patients of their options to prevent falls. One of the options was to have balance classes for patients, which I think is an excellent way to learn and have fun with others. I feel this exemplar and the completion of this program has completed Program Outcome #2 competency.

Connect Concepts

Functional Ability

Functional ability focused on a person’s capability to execute activities of daily living (ADLs) and instrumental activities of daily living (IADLs) (Lippincott, 2020). This exemplar highlights this concept because of its goal to improve ADL’s and IADL’s to prevent patient falls, especially at home.

Safety

Safety entails the act of protecting from possible or real harm and is considered one of the basic human needs (Lippincott, 2020). The goal of this exemplar is safety and to prevent an injury from occurring which could progress to serious harm.

Reflection

I really enjoyed writing this exemplar in creating a program plan to prevent falls in the elderly population, especially since it is a great need. This exemplar and the completion of the MSN program has aided in a better understanding of how important it is to understand the community resources available to share with patients. Being up to date on evidenced-based practices is vital to give optimal patient care.

Reflecting on this exemplar, I have realized that I can make a small impact on the community by teaching patients about all of the possible resources available to them. Any patient teaching that I give I like to keep in mind that it is coming from a center of caring. I have always felt that nursing always involves caring and is one of the many reasons I chose it for a career. I feel that this exemplar and the completion of the program has met Program Outcome #2 and Master’s Essential VIII competencies to completion.

Exemplar #7: NR507 Congestive Heart Failure Discussion

Heart failure is described as a decrease in cardiac output which makes the heart no longer able to meet the needs and demands of the body (Rogers & Bush, 2015). Mitochondrial abnormalities have been found to be involved in heart failure (McCance et al., 2019). A virus, hypertensive disease, or genetic abnormalities can cause an injury to the heart muscles which causes damage to the myocardial cells which in turn reduces the efficiency of pumping (Lodge & Yousef, 2016). The heart might initially try to compensate by increasing in volume and wall thickness (Lodge & Yousef, 2016). Hypertension greatly increases the workload on the heart and over time this workload damages and weakens the heart which leads to heart failure (Rogers & Bush, 2015). In diabetes mellitus, the high blood glucose levels and changes in lipid metabolism results in damage to the vessels that are suppliers of blood to the heart (Rogers & Bush, 2015).

Left heart failure can either be heart failure with reduced ejection fraction, also known as systolic heath failure, or heart failure with preserved ejection fraction, also known as diastolic heart failure (McCance et al., 2019). Systolic heart failure is described as less than 40% ejection fraction and the heart’s incapability to produce an efficient cardiac output to perfuse all vital tissues (McCance et al., 2019). Systolic heart failure is more common in males, the left ventricle chamber is larger, and there is pulmonary congestion with cardiomegaly (McCance et al., 2019). Diastolic heart failure is described as the inability of the left ventricle to relax like normal and pulmonary congestion is present (McCance et al., 2019). Diastolic heart failure is more common in women, the left ventricular chamber is smaller, and there is pulmonary congestion with no cardiomegaly (McCance et al., 2019).

When cardiac output is decreased, the sympathetic nervous system releases epinephrine and norepinephrine which increases peripheral vascular resistance, heart rate, and contractility (Rogers & Bush, 2015). This activates the renin-angiotensin-aldosterone system (Rogers & Bush, 2015). The secretion of aldosterone promotes retention of sodium and fluid which increases preload and afterload (Rogers & Bush, 2015). This results in vascular and pulmonary congestion which leads to the symptoms of shortness of breath and having to prop oneself up to breathe (Rogers & Bush, 2015).  This patient has been increasing her exercise which causes increased cardiac output that results in limited filling reserve which causes shortness of breath (Lodge & Yousef, 2016).

Management of the patient’s diabetes and hypertension is very important to prevent further damage. There was research done to see the long-term effects of liraglutide treatment for type II diabetes mellitus on improving cardiac function (Arturi et al., 2017). Liraglutide was found to improve cardiac function significantly and patients in the study had no hypoglycemic events or worsening heart failure (Arturi et al., 2017). It is very important for this patient to be on an appropriate regimen for her diabetes and she should be checking in with her family healthcare provider regularly. I would remind the patient that if she is feeling short of breath or fatigued that she should see her healthcare provider right away.

Outcomes and Competencies

Program Outcome #1

This exemplar completes Program Outcome #1 which is the holistic health and patient-centered care competency. Program Outcome #1 represents that care is high quality, safe, patient-centered, and centered in holistic health values (Chamberlain University, 2019). It is easy to focus and treat just one body system and feel that your job is complete, when in reality the body has to be viewed as an intertwined process that should be viewed as a whole. In this exemplar I was tasked to review the case study of a 64-year-old woman presenting with congestive heart failure and notable medication history of type 2 diabetes and hypertension. When creating a teaching and treatment plan for this patient I kept in mind that her past medical history also needed to be considered. Exemplar #7 was very successful in completing Program Outcome #7 by a holistic treatment plan for the case study patient.

Master’s Essential I

Master’s Essential I is the background for practice from sciences and humanities. Master’s Essential I was met by this exemplar by the in-depth discussion and explanation of congestive heart failure. This exemplar and class NR507 were essential in completing Master’s Essential I due to its in-depth study of advanced pathophysiology. My background as a baccalaureate nurse was vital and helpful in the learning process for NR507. NR507 was an incredible course that focused on scientific bases of illness prevention and development, health promotion, and wellness (AACN, 2011). With an in-depth understanding of the body processes, it is easier to diagnose and treat patients thoroughly and successfully.

Connect Concepts

Perfusion

Perfusion is the route of oxygenated capillary blood through the body tissues (Lippincott, 2020). This exemplar discusses the process of inadequate perfusion which leads to congestive heart failure.

Assessment

Assessment is the process of continuous compilation, examination, and communication of patient data (Lippincott, 2020). Assessment skills were utilized in this exemplar to compile a plan of care for this patient.

Reflection

Reflecting on this exemplar and the completion of the MSN program, I feel that case studies have been extremely helpful in understanding the correct treatment of patient’s diseases. I also have learned that it is important to know the guidelines for specific treatment of diseases and illnesses in order to provide high quality patient care. I know with repetition and frequency of use of the guidelines it will become memory and I will start to feel more comfort and ease in the treatment of patient’s illnesses and disease. A holistic approach is very beneficial to patient quality of care and will reduce patient concerns and flare ups of chronic diseases.

Program Outcome #1 was met throughout the course and especially in this exemplar and NR507 assignments. NR507 was a very informative course and prepared me well to further my development to complete the MSN program. This course and exemplar were able to meet Program Outcome #1 and MSN Essential I competencies.

Exemplar #8: NR601 Discussion Board-Polypharmacy

Polypharmacy is a harmful happening that currently affects the majority of the geriatric population. Polypharmacy can be defined as the regular use of 5 medications or more and can greatly increase the risks of adverse medical outcomes (Halli-Tierney et al., 2019). Another definition of polypharmacy is the prescribing of potentially inappropriate medications (PIMs) (Kennedy-Malone et al., 2019). PIMs include Timolol, carvedilol, metformin, zolpidem, atorvastatin, ibuprofen, and docusate (Nguyen et al., 2019).

The main reason for its occurrence is the many diseases an older adult may have which can require many different medications (Dunphy et al., 2019). Multiple comorbidities such as diabetes, renal failure, and hypertension in patients can easily result in multiple medications being prescribed. Patients living in long-term facilities are at greater risk for polypharmacy since they are usually on 5 or more medications (Halli-Tierney et al., 2019). Long-term facility patients are at a greater risk of polypharmacy due to the more likely occurrence of cognitive impairment paired with multiple medical issues that require multiple medications (Halli-Tierney et al., 2019). A risk factor at the healthcare level can occur when the patient’s medications are not adequately recorded it can result in discontinued medications being refilled after an automatic refill request was sent (Halli-Tierney et al., 2019).

A way to reduce polypharmacy is to review all medications with the patient on the initial visit, every 6-12 months, and with any medication changes. Collaboration with the pharmacist or other health care providers can assist in deprescribing any PIMs (Nguyen et al., 2019). The provider can request that the patient bring in all of their medications they are currently taking in their original bottles to properly record exactly what the patient is taking (Dunphy et al., 2019).

The clinical preceptor provider uses safety precautions to avoid polypharmacy. She routinely goes through the patient’s medication lists to see if there are any medications that can be discontinued to help reduce polypharmacy. She always lists all of the patient’s other providers so she can collaborate with them on the patient’s care.

Outcomes and Competencies

NONPF #4 Core Competency

NONPF #4 Practice Inquiry competency was able to meet exemplar #8 fully. This exemplar discussed the importance of acknowledging the dangers of polypharmacy which is quite prevalent in the elderly population. With this knowledge and understanding, I developed a plan to reduce polypharmacy in collaboration with the patient and other providers. NONPF #4 practice inquiry competency produces knowledge learned from clinical practice in order to produce high quality patient and practice outcomes (NONPF, 2017).

Meeting NONPF #4 means that the provider is able to apply their clinical investigative skills, lead practice inquiry, analyze clinical guidelines, and disseminate evidence in order to produce high quality patient care and outcomes (NONPF, 2017). Patients that came to the office were asked the names of their providers so it could be recorded, and providers could be contacted to collaborate in the patients care in order to reduce polypharmacy. Teaching other providers and staff of the process of asking the patients for a list of all their medications and providers and to carry it with them at all times is vital in the prevention of polypharmacy.

NONPF #7 Core Competency

NONPF #7 Health Delivery System Competencies was successful in meeting exemplar #8. NONPF #7 applies knowledge of the practices and complex systems to help improve patient health care delivery (NONPF, 2017). NONPF #7 also collaborates with other providers and healthcare teams to create a positive impact on healthcare delivery (NONPF, 2017). This exemplar represents NONPF #7 by the presentation of knowledge of successful ways to reduce polypharmacy with the collaboration of the patient and patient providers.

Connect Concepts

Healthcare Systems

The healthcare system is important to a nation to deliver and pay for health care for its residents (Lippincott, 2020).

Clinical Decision Making

Clinical decision making refers to purposeful, goal-oriented efforts that are used in a methodical way to determine a choice between other alternatives correlated to patient care or other clinical complications (Lippincott, 2020). This exemplar presented clinical decision making by choosing a plan to reduce polypharmacy among patients.

Reflection

As I go through and reflect on my assignments through the MSN program, it is amazing to see how my writing and professionalism advances throughout. Through knowledge and clinical practice, I am more well equipped to care for patients in a high-quality manner and put my critical thinking abilities to proper use. This exemplar was very helpful in understanding that I have the skills and thought process to make a difference in clinical practice and provide improved patient health outcomes. My time during clinical was priceless and so valuable to my growth and development into an APRN.

Clinical practice was vital in gaining the knowledge on how to prevent polypharmacy with patients by the development of a plan. Having the knowledge and understanding of the process and workings of health delivery systems is necessary in order to provide quality health care to patients. NONPF #4 and #7 were successfully met in this exemplar and through the clinical’s that I had the privilege of being a part of.

 

 

Exemplar #9: NR602 Evaluation of Marginalized Women Paper Excerpt

Adequate and affordable care is a human right for women with HIV and is covered under the American with Disabilities Act (ADA) (Crowley et al., 2015). Before the ADA was set in place, persons with HIV were discriminated against when being considered for jobs or their access to health care (Crowley et al., 2015). The ADA allows women with HIV access to affordable health care and protects them from discrimination from being denied health benefits (Crowley et al., 2015).

Women with HIV that have been incarcerated are experiencing discrimination and segregation when their HIV status is discovered (Rice et al., 2018). Women with HIV that have been incarcerated have reported that they were separated to a cell alone and also had their medical needs withheld (Rice et al., 2018). Regardless of where a woman is located or her criminal history, everyone should have the same access to appropriate medical care and treatment.

Ethical Issues

Some women have reported they were not aware they had been tested for HIV when their provider reported their HIV status (Ion & Elston, 2015). Before testing for HIV, a patient must be informed and give consent for HIV testing (Ion & Elston, 2015). Tests should never be performed without the patient being aware, it is a patient right to be aware of what tests are being performed on them.

It is not a healthcare professionals’ role to disclose a patient’s HIV status to the patients partner or family (Ion & Elston, 2015). When discussing the patients’ medical history, family members and visitors should be asked to step outside of the room for patient privacy and protection (Ion & Elston, 2015). Trust between patient and providers can be created when the healthcare provider respects the patient’s privacy by only discussing their medical history with only them with a non-judgmental and caring attitude. Women with HIV may already feel ashamed and uncomfortable, it is the healthcare professionals’ task to create a non-judgmental atmosphere for the patient.

It is unethical to inform a patient they are HIV positive and not properly educate them on what this means and how they should care for themselves (Ion & Elston, 2015). Extensive discussion, support, and education on their status is necessary to reduce the spread of HIV and keep viral load undetectable. Providers should be competent or become competent in their ability to educate patients on self-care and treatment regimen of HIV.

Plan

The first measurable plan of action to address the marginalized women with HIV is to create a collaborative team to care for this group (Cook et al., 2018). Mental health professionals and primary care providers can work together to care for women with HIV both physically and mentally (Cook et al., 2018). HIV does not only take a physical toll on a person, but it can affect a person mentally by inciting shame and fear. To measure this outcome, the primary care provider and mental health professional can evaluate the patients progress both physically and mentally.

The second measurable plan of action will be to address patients that have been diagnosed with an STI and properly counsel and educate them in a nonjudgmental manner to better equip themselves when engaging in any sexual encounters. Women that have been diagnosed with syphilis or gonorrhea should be counseled on the risk of being infected with HIV and how to prevent this occurrence (Peterman et al., 2015). Close follow up with these patients will be a way to measure the outcome of the effectiveness of the education and counseling given.

The third measurable plan of action to reduce stigma and discrimination towards marginalized women with HIV. This can be accomplished by educating other providers on proper body language and attitudes when addressing any patient (Rice et al., 2018). This plan may be measured by the feedback from patients with how they felt their medical history was handled and approached.

Outcomes and Competencies

Program Outcome #3

This exemplar is a great representation of meeting Program Outcome #3 which is cultural humility. Program Outcome #3 refers to the provider engaging in lifetime individual and professional growth by the contemplative practice and appreciation of cultural diversity (Chamberlain University, 2019). As providers, it is important to be aware of the broad cultural diversity in practice and be sensitive to them to show your patients that you care and are willing to learn about them more. This exemplar identified women with HIV as a marginalized group and reviewed the economic aspects, social justice, ethical issues, and formed a plan to address how this marginalized group will be attended in clinical practice. This exemplar was very successful in the completion of Program Outcome #3 by understanding the vast diversity in clinical practice.

NONPF #8 Core Competency

This exemplar met NONPF #8 Ethics Competencies. NONPF #8 integrates ethical principles, evaluates the decisions of ethical consequences, and creates and applies ethically sound solutions to complicated issues (NONPF, 2017). Healthcare is comprised of several issues that need attention in order to improve patient health outcomes. One of those issues is marginalized women with HIV and the poor treatment they received. This exemplar discussed the unethical nature of testing women for HIV without their consent, discussing HIV status around patient’s family without prior consent, not properly educating patients with new HIV status, and patients being segregated in prison once their HIV status was disclosed. Ethics were discussed at length and well understood in this exemplar which was successful in meeting NONPF #8.

Connect Concepts

Ethics

Ethics is the system that agrees on the standards of character and behavior in relation to what is seen as right and wrong (Lippincott, 2020). This exemplar is representative of some ethical standards.

Diversity

Diversity refers to the differences between people in cultural background, origin of race and ethnicity, religion, physical size, sexual orientation, language, gender, age, disability, geographic location, occupational status, and socioeconomic status (Lippincott, 2020). This exemplar presented the importance of being aware of the vast diversity we are surrounded in nursing.

Reflection

This exemplar was a vital portion of my learning process especially in understanding diversity in healthcare and ethical treatment and care. As healthcare providers, we are at risk of performing our jobs void of emotion. It is necessary to continue a human connection with our patients and treat them as individuals in order to give them high quality care. I always like to think about how I would like to be treated by a provider and try to tailor my care and treatment. Getting to know and understand your patients’ culture and needs is a part of meeting Program Outcome #3.

Patient information is private, and it is vital as providers to not share that information to family unless the patient gives prior consent. Ethical standards are necessary to respect patient privacy and inform patients properly of any new diagnosis. This exemplar discussed the cultural diversity and ethical practices that come into play during clinical practice which meets NONPF #8 Core Competency and Program Outcome #3.

Exemplar #10: NR603 Mental Health Treatment Plan/Analysis: Adult ADD

The primary diagnosis presented by CL is Adult Attention Deficit Disorder (ADD). ADD should be diagnosed utilizing the DSM-5 criteria, other testing and studies can be performed to rule out other diagnoses. A referral to psychiatry is essential for CL in the evaluation of severity of ADD, cognitive behavioral therapy (CBT), and appropriate pharmacological regimen (Wolraich et al., 2019).

Many family practice providers do not consider ADHD diagnosis if it was not established during childhood (Post & Kurlansik, 2012). Patients older than 17 years of age must meet four criteria of DSM-IV instead of the six required for patients under the age of 17 (APA, 2013). The DSM-IV criteria have been criticized for the cutoff age and also the fact that the presentation of ADHD differs in adults than children (Post & Kurlansik, 2012). CL meets the criteria of failing to give close attention to detail in work, does not seem to listen when spoken to, avoids activities that require sustained effort mentally, and she is easily distracted by stimuli extraneously (APA, 2013).

Physical and psychiatric conditions to consider as differential diagnoses are thyroid disease, substance use disorders, or mood disorders (Post & Kurlansik, 2012). To rule out these other diagnoses, labs should be drawn such as a thyroid panel and urine drug screen (Post & Kurlansik, 2012). To distinguish between mood disorders and ADD, a mental status exam and screening should be performed with a thorough psychiatric and developmental history (Post & Kurlansik, 2012). The confirmation of ADD can be made by ruling out all other possible diagnoses through lab work, physical and psychiatric exam, and meeting DSM-IV criteria (Post & Kurlansik, 2012).

Follow-up/Referrals

CL will be referred to psychiatry to follow along with new treatment with stimulants and CBT (Wolraich et al., 2019). When CL follows up in the office, she should have established care with the referral to psychiatry and have been on her medication for at least 2 weeks (Post & Kurlansik, 2012). The follow up visit will include assessment of side effects of medications, success of treatment, and urine drug screen for confirmation of medication correct use. Dosing changes to stimulants should be made after four to 6 weeks following initiation of medication (Post & Kurlansik, 2012).

Quality

Family practice providers that are not experienced or trained well in diagnosing and managing comorbid conditions, should refer out to the appropriate specialties (Wolraich et al., 2019). There are limited studies showing the effectiveness of CBT as an adjunct in treatment of ADHD (Post & Kurlansik, 2012). Many patients are not comfortable with admitting to any psychiatric issues, so it is the providers job to achieve a comfortable atmosphere for them to share and reveal what ails them. Patients must be educated on the risks and benefits of the pharmacological and non-pharmacological treatments available to them. In the future, it must be kept in mind that every patient is different and will not tolerate and react the same way to every medication.

Outcomes and Competencies

Master’s Essential VII

Exemplar #10 met Master’s Essential VII Interprofessional Collaboration for Improving Patient and Population Health Outcomes. Master’s Essential VII advocates for the value of the role of the APRN in the interprofessional healthcare team and understands the scope of practice for other health profession’s (AACN, 2011). This exemplar explains that for some practitioners, mental health is not an area of expertise for them, so they prefer to refer to Psychiatry professional providers. Quality patient care requires understanding the importance each professional play in the involvement of the patient’s treatment plan. The MSN prepared nurse is able to professionally communicate with the healthcare team to design and coordinate evidenced-based practice care.

Master’s Essential IX

This exemplar was able to meet Master’s Essential IX Master’s-Level Nursing Practice. Master’s Essential IX prepares the APRN to perform a comprehensive and systematic assessment to then apply evidenced-based practice to provide quality patient care (AACN, 2011). The assessment of the patient, CL, in exemplar #10 concludes that she presents with Adult ADD and requires a treatment plan. This treatment plan includes a referral to psychiatry for treat with CBT and the management of stimulants prescribed. The patient, CL, will be able to see the family practice provider for the stimulant refills once it becomes maintenance and no longer needs titration. At completion of the MSN program the master’s prepared nurse is able to advocate for their patients and use their knowledge of illness and disease management to prepare evidence-based care plans to patients (AACN, 2011). The master prepared nurse uses their advanced knowledge in science, ethics, and patient care to perform quality patient care (AACN, 2011).

Connect Concepts

Collaboration

Collaboration is the functioning and open communication between nursing and interprofessional teams to achieve high quality patient care (Lippincott, 2020). Collaboration is evident in this exemplar because the APRN and Psychiatry providers are necessary in the treatment and care of the patient in question.

Development

Development is the organized pattern of the changes in arrangement, feelings, outlooks, or behaviors due to growth, experiences, and knowledge (Lippincott, 2020). The patient presented in this exemplar has developed ADD over her lifetime and requires treatment both pharmacologically and behavioral therapy.

Reflection

Psychology has always been an area of interest for me. As healthcare providers for patients across the lifespan, the understanding of the body and possible diagnoses are very broad so the APRN must have a good understanding of each possibility. Anytime the provider is unsure of their care or diagnosis it is appropriate to refer to other healthcare professionals to collaborate and discover the appropriate diagnosis and treatment plan for that patient. This exemplar played an important role in the preparation and understanding of the professional relationships that must be initiated and developed.

This exemplar and the completion of the MSN program prepared me to conduct a proper assessment, apply evidenced-base practice, be a patient advocate, teach patients, and form therapeutic relationships (AACN, 2011). This exemplar was vital in meeting Master’s Essential VII and IX by the development of the Master’s-Level nurse to perform to their full potential in collaboration between the healthcare interprofessional team.

Conclusion

This well-rounded MSN program greatly prepared me to meet Program Outcomes 1-5, Master’s Essential Competencies I-IX, and NONPF Core Competencies 1-9. To stay up to date on best practice several resources can be used such as clinical guidelines, most appropriate diagnostic and screening tools, and evidence-based practice. Healthy and professional relationships will be created with patients, healthcare professionals, and patient families. Learning and growth will not cease at the completion of the MSN program. I will strive to incorporate all that I have learned from the MSN program, outcomes, and competencies.

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E., Porter, B.O.  & Thomas, D.J. (2019). Primary Care-The art and science of Advanced Practice Nursing-An interprofessional approach. (5th ed.) Philadelphia: F.A. Davis Company. Florida Board of Nursing. (2018). Advance Practice Registered Nurse. https://floridasnursing.gov/licensing/advanced-practice-registered-nurse/ Florida Department of Health. (2016). Special emphasis report: Fall injuries among older adults 2005-2014. http://www.floridahealth.gov/statistics-and-data/florida-injury-surveillance-system/_documents/older-adult-falls-emphasis-report-2014.pdf Fromage, G. (2018). Antibiotic resistance: an exploration of its causes and management strategies. Journal of Aesthetic Nursing, 7(1), 18-23. https://doi.org/10.12968/joan.2018.7.1.18 Halli-Tierney, A. D., Scarbrough, C., & Carroll, D. (2019). Polypharmacy: Evaluating risks and deprescribing. American Family Physician, 100(1), 32–38. http://www.afp-digital.org/afp/july_1__2019/MobilePagedArticle.action?articleId=1501446#articleId1501446 Hamze, L., Carrick-Sen, D., Zhang, Z., Liu, Y., & Mao, J. (2018). Maternal attitude towards breastfeeding: A concept analysis. British Journal of Midwifery, 26(7), 462–469. https://doi.org/10.12968/bjom.2018.26.7.462 Healthy People. (2019). Older adults. https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults Ion, A., & Elston, D. (2015). Examining the health care experiences of women living with human immunodeficiency virus (HIV) and perceived HIV-related stigma. Women’s Health Issues. https://doi.org/10.1016/j.whi.2015.03.012 Jones, B. E., & Samore, M. H. (2017). Antibiotic overuse: Clinicians are the solution. Annals of Internal Medicine, 166(11), 844-845. https://doi.org/10.7326/M17-1061 Kellams, J. R., & Maye, J. P. (2017). 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Risk for HIV following a diagnosis of syphilis, gonorrhea or chlamydia: 328,456 women in Florida, 2000-2011. International Journal of STD & AIDS, 26(2), 113-119. https://doi.org/10.1177/0956462414531243 Post, R. E., & Kurlansik, S. L. (2012). Diagnosis and management of attention-deficit/hyperactivity disorder in adults. American Family Physician, 85(9), 890-896. https://www.aafp.org/afp/2012/0501/p890.html Renfro, M., Maring, J., Bainbridge, D., & Blair, M. (2016). Fall risk among older adult high-risk populations: A review of current screening and assessment tools. Current Geriatrics Reports, 5(3), 160-171. https://doi.org/10.1007/s13670-016-0181-x Rice, W., Logie, C. H., Napoles, T. M., Walcott, M., Batchelder, A. W., Kempf, M. C., Wingood, G. M., Konkle-Parker, D. J., Turan, B., Wilson, T. E., Johnson, M. O., Weiser, S. D., & Turan, J. M. (2018). 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Appendix A

Concept Map

 

 

Chamberlain Program Outcomes, NONPF Core Competencies, Master’s Essentials

 

 

Evidenced-based Practice

 

 

Advocacy

 

 

Leadership

 

 

Collaboration

 

 

Functional Ability

 

 

Communication

 

 

Informatics

 

 

Health Policy

 

 

Healthcare Systems

 

 

Management

 

 

Quality Improvement

 

 

Perfusion

 

 

Ethics

 

 

Development

 

 

Diversity

 

 

Assessment

 

 

Clinical Decision Making

 

 

Pharmacology

 

 

Health Promotion

 

 

Safety