ReflectionAdvanced Roles in Nursing Primary role of a nurse practitioner is to: • Establish relationships which foster trust and respect • Provide cost effective care, appropriate to the needs of the patient • Deliver care in accordance with patient goals and beliefs • Support the maximal level of health and functioning • To manage conditions with competence and in accordance with state defined scope

Professional Goals • Commitment to provide comprehensive, evidence-based care to patients and community members. • Develop a system of personal and professional accountability. • Participate in professional practice and research activities. • Through volunteerism, administer care and services to diverse patient populations during times of disaster/need.

MSN Objectives 1. Integrate knowledge, theory, research & skills in the delivery of comprehensive care & services MSN 510, Theories for advanced Nursing Roles Provided theoretical foundation for nursing practice Bandura’s Social Learning Theory (SLT) offers insight into factors that motivate behavior (Bandura, 2001) Exploration of values placed on current behaviors can assist providers to remodel behaviors through education and enlightenment Neuman’s Systems Model (NSM) considers the effect of environmental stressors on health and wellness and the practitioners role in strengthening and maintaining a patient’s line of defense (Memmott, et al, 2000) 6 (continued)

MSN Objectives 1. Integrate knowledge, theory, research & skills in the delivery of comprehensive care & services MSN Role Performance & Role Specific Coursework: • Provided the foundation for an organized approach to comprehensive patient-centered care • Skill: psychosocial, physical assessments, utilization of resources • Research: utilization of evidence-based (EB) guidelines of care • Delivery: • Establish relationships; consider patient needs & perceptions • Systematically approach & prioritize care • Provide cost effective care • Identify & eliminate barriers; support self-efficacy & autonomy

MSN Objectives 2. Design culturally sensitive programs & systems of care & services that meet the needs of diverse & vulnerable populations. MSN 514, Health Promotion and Disease Prevention • Developed a health promotion & disease prevention plan for adolescents & young adults • Vulnerable population: • Adolescents & young adults • Program focus: • Sexual health & disease prevention • Considerations: • Local resource availability • Laws, public education & funding • Professional guidelines of care & FNP role (continued)

MSN Objectives 2. Design culturally sensitive programs & systems of care & services that meet the needs of diverse & vulnerable populations. FNP Role Performance Courses Clinical Application Managed care of vulnerable patient populations Infant-elderly, ethnic minorities & immigrants, underfunded, uneducated, lacking intact support systems, multiple medical & psychiatric comorbidities Provided cost-effective care appropriate to needs/beliefs of patient Refer to social security office / state welfare Cost conscious diagnostics & treatments Medication samples or low-cost prescriptions Listened to the patient, utilized SLT & NSM principles 9 (continued)

MSN Objectives 2. Design culturally sensitive programs & systems of care & services that meet the needs of diverse & vulnerable populations. FNP Role Performance Courses Clinical application Educate, promote self-responsibility & self-efficacious behavior Health promotion & disease prevention Education & empowerment Encourage follow-up Accountability Evaluate progress Institute additional management strategies Offer encouragement 10

MSN Objectives 3. Provide evidence-based, clinically proficient care & services using critical thinking skills in advanced nursing roles. MSN 528, Advanced Pathophysiology • In-depth case review of patient with COPD • Pathophysiology & risks assoc with development of disease • Demonstrated use of advanced assessment • Accessed & utilized EB guidelines to manage various aspects of care (continued)

MSN Objectives 3. Provide evidence-based, clinically proficient care & services using critical thinking skills in advanced nursing roles. FNP Role PerformanceI-IV Provided opportunity to utilize: Critical thinking & clinical reasoning Integrate experience & knowledge Advanced assessment skills Psychosocial, physical, risk factors, wellness/preventatives Professional guidelines of care Diagnostics, diagnoses, pharmacotherapy, health promotion, disease prevention, education & self-efficacy Research activities To assist in development of EB professional practice 12

MSN Objectives 4. Apply oral, written & technological communication skills in clinical, educational, & professional contexts & systems. MSN 502, Advanced Nursing Roles & FNPRole Performance Electronic and web based systems utilized in practice: • Medical records, evidence-based guidelines, standardized procedures • Continuity of care, communication with patients/providers • Self-efficacy, self-responsibility, autonomy • Research Education: • Patient education materials from professional sources • Use of PowerPoint during MSN courses & to educate staff & students • Delivery of EBP information

MSN Objectives 5. Integrate ethical principles into theories, research and practice in advanced nursing roles. MSN 531, Nursing Ethics • Ethical theories, principles and standards intermingle and influence day-to-day decision-making • Virtue Ethics, Ethics of Care • Autonomy, respect, justice, beneficence, nonmaleficence • Nurses are trusted to be ethical, honest, compassionate & to protect patient interests (ANA, 2001) • Ethical dilemmas: end-of-life decisions & provider resources • Do Not Resuscitate & Compassionate Choices Act • Bioethics committee

MSN Objectives 6. Advocate for healthcare policies & financing that promote, preserve & restore public health. MSN 513, Health Care Policy and Economics: • Understanding the legislative process • Paper examining the process • AB 394: Nurse-Patient Ratios • Legislator interview – Assemblywoman Patty Berg • Compassionate Choices Act: AB 374 • Advocating for a patient’s right to choose • Professional considerations • Lobbying efforts & the united front, nurses seldom involved • Understand motives of opposition, plan to counteract by informing the end receiver (continued)

MSN Objectives 6. Advocate for healthcare policies & financing that promote, preserve & restore public health. MSN 513, Health Care Policy and Economics: Professional involvement Understanding legislative process, build relationships Nurses commonly lack knowledge of health care policy/legislation (Spenceley, et al, 2006) Professional affiliation & activity Facilitates participation Supports collective efforts to achieve goals Healthcare Reform and FNP role Advocacy Primary role in patient-centered care Scope of practice 16

MSN Objectives 7. Provide leadership in collaborative efforts with other disciplines to influence improvement in healthcare systems. MSN 502, Advanced Nursing Roles, FNP Role Performance Courses & Professional Roles • To manage complex patient populations requires advocacy, leadership, effective communication, and collaboration. • Influence improvement in healthcare systems by: • Collaborating with care providers & community health care partners (AHRQ, 2008) • Developing future care providers • Communicating organizational & professional goals • Role modeling

MSN Objectives 8. Demonstrate commitment to lifelong learning for continued professional growth. MSN 502, MSN 566, FNP Role Performance II-III • Lifelong learning is a commitment each practitioner must make to ensure care provided is consistent with current guidelines and within designated scope and skill level. • Assignments provided opportunity to examine: • State defined scope & laws governing practice • Standardized procedures • Nursing vs the practice of medicine • Legislation & the opposition • Ethical & professional responsibilities for providing competent care • Future Sources of Continuing Education • AANP: CE Center, conferences • CANP: meetings, conferences • Society of Trauma Nurses: meetings, conferences • Professional journals/websites, EB guidelines of care

This has been an incredible journey, humbling and rewarding. Thank you to those who have taken the time to enhance my learning experience and in turn, the lives of my future patients. Leslie Eldridge

References AHRQ Publication No. 08-0043. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved October 2, 2010, from http://www.ahrq.gov/qual/nurseshdbk/ American Nurses Association (ANA) (2001). Code of ethics for nurses with interpretive statements. Silver Spring: American Nurses Association. Bandura, A. (2001). Guide for constructing self-efficacy scales (Revised). Retrieved September 2, 2010, from http://www.des.emory.edu/mfp/014-BanduraGuide2006.pdf Memmott, R., Marett, K., Bott, R., and Duke, L., (2000). Use of the Neuman systems model for interdisciplinary teams. Online Journal of Rural Nursing and Health Care,1(2). Retrieved June 13, 2006, from, http://www.rno.org/journal/issues/Vol-1/issue-2/Memmott.htm Spenceley, S., Reutter, L. & Allen, M. (2006). The road less traveled: Nursing advocacy at the policy level. Policy, Politics, & Nursing Practice. 7(3), 180-94. Retrieved January 26, 2008, from Sage Publications. Zandra, D. (2005). Because you care: Celebrating Nurses, caregivers and other everyday heroes. WA: Compendium. 20

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