Advanced practice nurses must be equipped with an in-depth understanding of pathophysiological disease processes across the lifespan. In this course, students focus on understanding the biophysiological processes, the deviations from these processes, and an in-depth examination of the scientific concepts related to the biology of disease processes. Advanced practice nursing students learn how normal organ systems function and how organ systems are interrelated to help the body maintain homeostasis. Through knowledge of pathophysiological disease processes, students gain the information needed to develop appropriate treatment plans for patients across the lifespan. Students explore a variety of topics, such as immunity, inflammation, cancer genetics, and cardiovascular disease. They also examine a range of disease processes, including hematologic, renal, neurologic, gastrointestinal, and reproductive disorders.
ORDER A CUSTOM-WRITTEN PAPER NOW
Walden University practices a policy of nondiscrimination in admission to, access to, and employment in its programs and activities. Walden does not discriminate on the basis of race, color, sex, age, religion or creed, marital status, disability, national or ethnic origin, socioeconomic status, sexual orientation, or other legally protected status.
Walden is committed to providing barrier-free access to its educational services and makes appropriate and reasonable accommodations when necessary. Students requesting accommodations per the Americans with Disabilities Act (ADA) must contact the Office of Disability Services at disability@mail.waldenu.edu. NURS 6501 – Advanced Pathophysiology Essay Assignment papers
Walden University publications, including the Catalog and Student Handbook, represent current curricula, educational plans, offerings, requirements, tuition, and fees. These may be modified or discontinued from time to time in the university’s sole discretion to carry out the university’s purposes and objectives. Neither the provisions of this document, nor the acceptance of students through registration and enrollment in the university constitutes a contract or an offer of a contract.
Information in this version of the Walden University Catalog and Student Handbook are effective as of August 24, 2017.
Catalog
Looking for information on programs and courses? The 2017–2018
Walden University Catalog
is the primary resource for academic information, including official curricular requirements, for Walden University graduate and undergraduate students. Students who are admitted for, and enrolled during, the 2017–2018 academic year are subject to the degree requirements described in this
Walden University Catalog
.
Catalog:
To access the catalog, select from the topics listed on the left navigation pane. For more information, click the “Help” button (upper right) or select the “Catalog Features” link.
Handbook
The
Walden University Student Handbook
offers convenient tools to help undergraduate and graduate students quickly locate and search university policies, procedures, and resources.
Student Handbook:
To access the student handbook, select “2017–2018 Walden University Handbook (September, 2017),” from the drop-down menu in the upper-right corner of this page and then click “Enter.” NURS 6501 – Advanced Pathophysiology Essay Assignment papers.
University Guidebooks
Interested in published resources to help you through your program? See the University Guidebooks posted on this site for information about KAM learning and how to prepare a dissertation, a doctoral study, or a thesis. NURS 6501 – Advanced Pathophysiology Essay Assignment papers
University Guidebooks:
On the drop-down menu in the upper-right corner of this page, select “University Guidebooks” and then click “Enter.”
NURS 6501 – Advanced Pathophysiology Quiz Questions and Answers and Discussion Assignment Essays
Question 1
1 out of 1 points
A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect?
Selected Answer:
d.
Peripheral vasoconstriction
Correct Answer:
d.
Peripheral vasoconstriction
Question 2
1 out of 1 points
A 58-year-old female presents in the clinic presenting with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia?
Selected Answer:
b.
Pernicious anemia
Correct Answer:
b.
Pernicious anemia
Question 3
ORDER A CUSTOM-WRITTEN PAPER NOW
1 out of 1 points
A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart?
Selected Answer:
b.
Pernicious anemia
Correct Answer:
b.
Pernicious anemia
Question 4
1 out of 1 points
A group of cells isolated in the laboratory have membrane-bound granules in their cytoplasm and they show phagocytic activity. Which of the following cells is most similar?
Selected Answer:
d.
Eosinophils
Correct Answer:
d.
Eosinophils
Question 5
1 out of 1 points
A nurse is caring for a patient who cannot clot. Which end product of the clotting cascade is this patient unable to make?
Selected Answer:
d.
Fibrin
Correct Answer:
d.
Fibrin
Question 6
1 out of 1 points
A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease?
Selected Answer:
b.
Being alcoholic
Correct Answer:
b.
Being alcoholic
Question 7
1 out of 1 points
A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit?
Selected Answer:
b.
Spoon-shaped nails
Correct Answer:
b.
Spoon-shaped nails
Question 8
1 out of 1 points
A 60-year-old female emphysema patient experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which of the following respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand?
Selected Answer:
b.
Increased rate and depth of breathing
Correct Answer:
b.
Increased rate and depth of breathing
Question 9
1 out of 1 points
A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia?
Selected Answer:
d.
Hemolytic anemia
Correct Answer:
d.
Hemolytic anemia
Question 10
1 out of 1 points
A 10-year-old male is diagnosed with leukemia. The nurse assesses for which other condition that could be associated with his disease?
Selected Answer:
a.
Down syndrome
Correct Answer:
a.
Down syndrome
Question 11
1 out of 1 points
Which of the following individuals should the nurse assess first for a vitamin B12 deficiency anemia?
Selected Answer:
c.
47-year-old male who had a gastrectomy procedure (removal of the stomach)
Correct Answer:
c.
47-year-old male who had a gastrectomy procedure (removal of the stomach)
Question 12
1 out of 1 points
A 5-year-old female is diagnosed with acute leukemia. The nurse will most likely treat this patient with:
Selected Answer:
c.
Chemotherapy
Correct Answer:
c.
Chemotherapy
Question 13
0 out of 1 points
A staff member wants to know where the greatest proportion of iron is located. How should the nurse respond? The greatest proportion of total body iron is located in the:
Selected Answer:
c.
Bone marrow
Correct Answer:
a.
Erythrocytes
Question 14
1 out of 1 points
A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?
Selected Answer:
b.
Hemolytic anemia
Correct Answer:
b.
Hemolytic anemia
Question 15
1 out of 1 points
While checking lab results, the nurse remembers the normal leukocyte count is:
Selected Answer:
b.
5,000-10,000/mm
3
Correct Answer:
b.
5,000-10,000/mm
3
Question 16
1 out of 1 points
A 62-year-old female tells her health care provider she has been experiencing regular night sweats that cause her to wake up drenched. She also remarks that she has been unintentionally losing weight. Physical exam reveals enlarged lymph nodes on her neck that do not appear to be painful. She should be screened for which of the following cancers?
Selected Answer:
b.
Hodgkin lymphoma
Correct Answer:
b.
Hodgkin lymphoma
Question 17
1 out of 1 points
When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes:
Selected Answer:
b.
Hypochromic
Correct Answer:
b.
Hypochromic
Question 18
1 out of 1 points
A 10-year-old male is diagnosed with sickle cell anemia. When the parents ask who is responsible for this disease, what is the nurse’s best response? He most likely inherited it from:
Selected Answer:
c.
Both his mother and father
Correct Answer:
c.
Both his mother and father
Question 19
NURS 6501 – Advanced Pathophysiology Quiz Questions and Answers and Discussion Assignment Essays
0 out of 1 points
A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis to be documented on the chart?
Selected Answer:
d.
Sideroblastic anemia
Correct Answer:
a.
Pernicious anemia
Question 20
1 out of 1 points
A 45-year-old female undergoes a splenectomy to remove a tumor. Which of the following assessment finding is most likely to occur following surgery?
Selected Answer:
a.
Leukocytosis
Correct Answer:
a.
Leukocytosis
Question 21
0 out of 1 points
A hematologist is discussing hematopoiesis. Which information should be included? ________ participate in hematopoiesis.
Selected Answer:
d.
Neutrophils
Correct Answer:
a.
Colony-stimulating factors (CSFs)
Question 22
1 out of 1 points
In disseminated intravascular coagulation (DIC), the nurse assesses for active bleeding after intravascular clotting because:
Selected Answer:
b.
Clotting factors are depleted.
Correct Answer:
b.
Clotting factors are depleted.
Question 23
1 out of 1 points
During an infection, the nurse assesses the lymph nodes. Lymph nodes enlarge and become tender because:
Selected Answer:
a.
Lymphocytes are rapidly dividing.
Correct Answer:
a.
Lymphocytes are rapidly dividing.
Question 24
1 out of 1 points
A 52-year-old male IV drug user was diagnosed with hepatitis C 5 years ago. He is now experiencing impaired blood clotting. The nurse suspects a decrease in which of the following vitamins?
Selected Answer:
a.
K
Correct Answer:
a.
K
Question 25
0 out of 1 points
A 65-year-old male experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before his death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal:
Selected Answer:
b.
Liver hypoxia
Correct Answer:
c.
Heart failure
Question 26
1 out of 1 points
For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be:
Selected Answer:
c.
Sequestered
Correct Answer:
c.
Sequestered
Question 27
1 out of 1 points
A 10-year-old male presents with abdominal swelling, night sweats, fever, and weight loss. He is diagnosed with Burkitt lymphoma. Upon obtaining the history, which of the following is the most likely cause?
Selected Answer:
d.
Epstein-Barr virus (EBV)
Correct Answer:
d.
Epstein-Barr virus (EBV)
Question 28
1 out of 1 points
The people from which country have the lowest risk for Hodgkin lymphoma?
Selected Answer:
b.
Japan
Correct Answer:
b.
Japan
Question 29
1 out of 1 points
A 50-year-old female is diagnosed with primary thrombocythemia. A nurse would expect the blood smear to reveal _____ platelets.
Selected Answer:
d.
Overproduced
Correct Answer:
d.
Overproduced
Question 30
1 out of 1 points
A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is:
Selected Answer:
a.
Defective DNA synthesis
Correct Answer:
a.
Defective DNA synthesis
Question 31
1 out of 1 points
A 15-year-old male with infectious mononucleosis is being given instructions on how to prevent the spread of this infection to others. Which statement represents a correct instruction?
Selected Answer:
b.
Do not share drinking glasses or eating utensils.
Correct Answer:
b.
Do not share drinking glasses or eating utensils.
Question 32
1 out of 1 points
A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in ______ is the most likely cause.
Selected Answer:
c.
Intrinsic factor
Correct Answer:
c.
Intrinsic factor
Question 33
0 out of 1 points
A nurse is teaching the staff about platelets. Which information should the nurse include? In addition to playing a role in hemostasis, platelets have the ability to:
Selected Answer:
c.
Undergo cell division in response to bleeding
Correct Answer:
b.
Release biochemical mediators of inflammation
Question 34
1 out of 1 points
A newborn baby is diagnosed with a blood disorder in which her platelet count is low. Which of the following does the nurse suspect could be the reason?
Selected Answer:
c.
Decreased thrombopoietin
Correct Answer:
c.
Decreased thrombopoietin
Question 35
0 out of 1 points
A 67-year-old female has chronic gastrointestinal bleeding. A nurse recalls the primary cause of her anemia is:
Selected Answer:
a.
Vitamin B
12
deficiency
Correct Answer:
b.
Iron deficiency
NURS 6501 – Advanced Pathophysiology Quiz Questions and Answers and Discussion Assignment Essays
NURS 6620 Family Nurse Practitioner (FNP) Diagnosis and Management for Aging Families Essay Assignments and Exam Questions and Answers
NURS 6620-001 Family Nurse Practitioner (FNP) Diagnosis and Management for Aging Families: Clinical Application
All students are responsible for checking their UTHSCSA Livemail account regularly (i.e., daily or several times every week) to obtain Official University Communication regarding their courses, program and student status.
Clinical Orientation will take place on Tuesday, May 12, 2015 from 2:00 PM – 4:00 PM. Room TBA.
Tuesday, August 4, 2015 (2:00 PM – 5:00 PM) Patient Management Case Presentations
Clinical hours may begin on May 11, 2015 as long as an IOR has been completed. All clinical hours must be completed by Friday, August 14, 2015.
ORDER A CUSTOM-WRITTEN PAPER NOW
FACULTY CONTACT INFORMATION
John B. Chavez, DNP, RN, APRN, FNP-BC (Course Coordinator)
E-Mail: chavezj2@uthscsa.edu
Phone: 210-567-5885
Office: 2.374
Office Hours: By Appointment
Family & Community Health Systems
Rebecca Rokosky, MSN, RN, FNP-BC
E-mail: Rokosky@uthscsa.edu
Office Phone:
Office: TBA
Office Hours: By Appointment
Family & Community Health Systems
Tamika Sanchez-Jones, PhD, RN, FNP-BC
E-mail: SanchezJones@uthscsa.edu
Office Phone: (210) 567-5785
Office: NS 2.
Office Hours: By Appointment
Family & Community Health Systems
Cristina Winters, DNP, RN,FNP-C
E-mail: winterscl@uthscsa.edu
Phone: (210) 567-5848
Office: 2.366
Office Hours: By Appointment
Family & Community Health Systems
TBA
COURSE DESCRIPTION
The focus of this course is integration of the Family Nurse Practitioner’s (FNP) core knowledge in health promotion and diagnosis and management in the care of the mature and aging patient and families in the primary healthcare setting. Emphasis is placed on the care of mature and aging patients and families with acute and chronic complex health problems. In addition, the family nurse practitioner as a collaborative member of the interprofessional team will be emphasized.
NURS 6451 FNP Diagnosis and Management of Young Families: Concepts and Theory
NURS 6452 FNP Diagnosis and Management of Aging Families: Concepts and Theory
PROGRAM OUTCOMES
Upon completion of the Master of Science in Nursing Program (MSN) students will:
Integrate scientific findings from nursing and related sciences, including genetics and genomics, into the delivery of advanced nursing care to populations in diverse settings.
Demonstrate organizational and systems leadership to assure ethical and critical decision-making at all systems’ levels for quality and patient safety.
Incorporate performance improvement strategies for quality, safety, and patient-centered care delivery.
Use improvement science to achieve optimal patient care and care environment outcomes.
Integrate meaningful and usable information systems and healthcare technologies to support safe, quality patient care and healthcare systems effectiveness.
Advocate for policy changes that influence healthcare at appropriate levels.
Lead interprofessional teams using collaborative strategies to effect quality patient care and population health outcomes.
Analyze and incorporate broad ecological and social health determinants to design and deliver evidence-based clinical prevention and population healthcare and services to individuals, families, and aggregates/identified populations.
Integrate the advanced competencies expected of a master’s prepared nurse to design, deliver, and evaluate outcomes of systems of care for individuals, families, and diverse populations.
CLINICAL OUTCOMES
Provide patient-centered care with emphasis on health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, and palliative care to mature and aging patients and families during transitions and life-style adjustments as an integral member of the interprofessional team (
Essentials I, VIII, IX).
Apply knowledge of acute and chronic illnesses to diagnose and manage mature and aging patients and families as health status varies (
Essentials I, IV, IX).
Use evidenced-based guidelines related to patient health, disease management and prevention to impact health outcomes in this diverse population (Essentials I, IV, IX).
Use advanced diagnostic reasoning and differential diagnosis for disease management of the mature and aging patients and family (Essentials I, IV, IX).
Integrate history and physical exam data with the knowledge of pathophysiology of acute and chronic diseases to develop appropriate differential diagnoses and initiate appropriate patient-centered interventions in this diverse population (Essentials I, IX).
Incorporate traditional and complementary pharmacological interventions into the treatment and management of illnesses (
Essentials I, IX).
Integrate social, cultural, explanatory models and spiritual components in patient-centered plans of care for mature and aging patients and families (Essentials I, IX).
Integrate ethical principles in decision-making and demonstrate core professional values in the implementation of the nurse practitioner role (Essentials I, VIII, IX).
Create a climate of patient-centered care to include confidentiality, privacy, comfort, emotional support, education, mutual trust and respect (Essentials II, IX).
Use self-reflection to evaluate progress in professional development as an integral member of the interprofessional team (Essential II, VII, IX).
CRITERIA FOR EVALUATION / GRADES
NURS 6620 Family Nurse Practitioner (FNP) Diagnosis and Management of Aging Families: Clinical Application
Course Description:
This course focuses on the primary care experience in health promotion, disease prevention, and diagnosis and management of acute and chronic illness in patients across the reproductive continuum and the health and illness from birth to adolescents. Additionally, this course emphasizes collaborative partnership development among patients, families, and interprofessional teams.
Credit Hour Allocation Clock Hour Allocation:
6 semester hours-
300 clock hours clinical practicum
15 clock hours seminar
Pre-requisites:
NURS 6451 FNP Diagnosis and Management of Young Families: Concepts and Theory
NURS 6452 FNP Diagnosis and Management of Aging Families: Concepts and Theory
Course Outcomes:
1.Provide patient-centered care with emphasis on health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, and palliative care to patients across the reproductive continuum and from birth to adolescents during developmental transitions and life-style adjustments as an integral member of the interprofessional team. (Essentials I, VIII, IX).
2.Apply knowledge of acute and chronic illness to diagnose and manage patients across the reproductive continuum and from birth to adolescents as health status varies. (Essentials I, IV, IX)
3.Integrate anticipatory guidance into the comprehensive treatment plans for both primary and secondary prevention for patients across the reproductive continuum and from birth to adolescents. (Essentials I, VIII and IX).
4.Integrate history and physical examination data with the knowledge of pathophysiology of acute and chronic diseases to develop appropriate differential diagnoses, and initiate appropriate customized interventions for this diverse population (Essentials I, IX).
5.Incorporate traditional and complementary pharmacological interventions into the treatment and management of illness for this diverse population. (Essentials I, IX).
6.Integrate social, cultural, explanatory models, and spiritual components in patient-centered plans of care for patients across the reproductive continuum and from birth to adolescents. (Essentials I, IX)
7.Evaluate the relationships among access, cost, quality, and safety and their influence on health care.(Essentials I, III).
8.Integrate ethical principles in decision-making and demonstrate core professional values in the implementation of the nurse practitioner role.(Essentials I, VIII, IX).
9.Create a climate of patient-centered care to include confidentiality, privacy, comfort, emotional support, education, mutual trust and respect. (Essential II, IX)
10.Use self-reflection to evaluate progress in professional development as an integral member of the interprofessional team. (Essential II, VII, VIII, IX)
Clinical:
100 hours Adult Primary Care
100 hours Geriatric Care
100 hours Sub-specialty Care and/or Family Practice
300 Clinical Hours Total
Criteria for Evaluation/Grades
Component/Item – Weighting Percent of Final Grade – Due Date & Time
Reflective Journal Entries (3) – Pass/Fail – Three Entries Total
(Due dates will be listed on course calendar)
SOAP Notes (3) – Pass/Fail – Three Notes Total
(Due dates will be listed on course calendar)
Patient Management Paper – Pass/Fail – Must earn 80% or better on Paper to pass
Preceptor Evaluation(s) (One to be completed by each Preceptor at the end of each rotation. If you have only one preceptor the whole semester, then have the preceptor do a Midterm & Final Evaluation) – Pass/Fail – To be submitted by the Preceptor through Project Concert.
Faculty Evaluation(s) – Pass/Fail – One clinical site visit will be conducted during the semester. An additional site visit may be conducted if the need is determined by the clinical faculty.
Patient Management Presentation – Pass/Fail – Presentation is on Patient used for Patient Management Paper
Final Grade -Pass/Fail
Clinical Experience is Pass/Fail
No clinical can be started at any clinical site until an Intent of Relationship (IOR) is completed, submitted to the course coordinator in hand, email or fax, and approved by the faculty. Clinical practicum may start on May 11,2015 if the IOR is completed, submitted and approved but not before. All clinical practicum hours must be completed by August 14, 2015. The student must pass the clinical experience in order to pass the course regardless of the numeric grade earned.
Clinical Practicum
The student will complete 300 hours of clinical practicum with their assigned preceptor(s) once the Intent of Relationship (IOR) agreement is completed by the student and preceptor, signed, faxed to the School of Nursing, and approved by the graduate faculty. Students are expected to dress in business casual and present a professional appearance while in the clinical setting. The clinical practicum must be completed no later than the end of the course. There are no extensions for completing hours therefore the student must plan ahead when negotiating clinical hours with the preceptor.
Clinical Site Visits:
Students will have one to two scheduled site visits by their assigned faculty.
Preceptor and Faculty Evaluation (pass/fail):
Students must pass clinical to pass the course. A written evaluation from the student’s preceptor(s) is/are required at the end of the rotation with the preceptor.Each preceptor is required to sit down with the student to go over the evaluation. At least one written evaluation will also be completed by the faculty for each student during the semester.
Class Attendance:
Students are required to attend all clinical experiences. Students are to be prompt, prepared,and appropriately attired. A student who is unable to attend a clinical experience must contact the clinical faculty personally prior to the beginning of the clinical experience. Leaving a message or e-mail for the faculty is not acceptable. Professional role behavior is expected. The graduate student will notify the clinical agency and preceptor that she/he is unable to attend.
Practicum Course Policies:
Students are encouraged to have a variety of clinical experiences that will encompass all aspects of their advanced practice role and expose them to patients within different clinic settings.
1. Students may not have a clinical preceptorships at a practice setting where he/she is currently employed, nor may they be paid for clinical as part of their working hours.
2. Students may not have a clinical preceptorship with a provider with whom they are a patient of that provider.
3. The majority of clinical experiences during the clinical preceptorship must be at the participation level or higher. Total observation is not acceptable at this level in the program.
4. Students must receive “Passing” on all clinical evaluations from faculty during clinical site visits (Standardized Patient observation may serve as a clinical site visit.)
5. The preceptorship component must be successfully completed in order to pass the course, regardless of grades received on the didactic components. The preceptorship component consists of:
A. One clinical evaluation through observation by the clinical course faculty and additional clinical evaluations by each preceptor, with each documenting on the clinical evaluation form, and;
B. Clinical log documentation of student’s experiences.
C. Students who are deemed unsafe or fail to meet the expected clinical course outcomes and clinical competencies in any clinical course in the required program of study will receive a course grade of “F”. Behaviors constituting clinical failure include, but are not limited to, the following:
a. Request for removal from clinical site for cause by a clinical agency
b. Demonstrates unsafe performance and makes questionable decisions
c. Lacks insight and understanding of own behaviors and behavior of others
d. Needs continuous specific and detailed supervision
e. Has difficulty in adapting to new ideas and roles
f. Fails to submit required written clinical assignments
g. Falsifies documents
D. Procedure: A student who fails a clinical course maybe placed on probation or be dismissed from the program in accordance with set criteria.
6. There are NO in completes for clinical courses except for a major health problem. All clinical hours must be completed by the last official class day of the semester. NO extensions for unmet clinical hours will be granted. Failure to complete all clinical hours or falsification of clinical hours will result in failure of the course.
7.It is expected that all scholarly papers will be written using APA Format 6thEdition.
Practicum:
300 clock hour practicum in a community-based, preferably medically underserved, clinic will be selected, working with a clinical preceptor on site. The focus is the health of populations across the lifespan. The practicum will be supervised by a faculty member.
The 300 clock hour practicum will be coordinated by and under the supervision of the UT Health Science Center School of Nursing Clinical Liaison with physicians, physician assistants and nurse practitioner preceptors.
Project Concert Tracking:
Each student is required to maintain an electronic record of patient encounters using Project Concert. The student will document patient encounters in Project Concert in a timely fashion, and as soon as feasible following the clinical experience, but no less than once per week. The student is responsible for accurate and complete records in Project Concert. The student is required to submit Project Concert tracking reports at regular intervals during the semester. The clinical log must be submitted in order to pass the clinical practicum.
Written Assignments:
1.If written assignments are made in a course they are required.
2.Students are expected to submit written work on the scheduled date and time.
3.The student must notify the course coordinator prior to the scheduled due date and time if they are unable to submit the written work as scheduled. Failure to make this notification in advance will result in a “zero” for that written work.
4.If the excuse is accepted as reasonable and necessary, arrangements will be made for an alternative due date and time.
5.Each student is responsible for making sure that he or she has completed the written work prior to submission.
6.Late work will be accepted up to 72 hours after the due date with consequences. Five percent will be deducted for each day an assignment is late (up to 15%). After 72 hours, late assignments will not be accepted.
7.Students must earn an 80% or better on all written assignments.
APA Guidelines:
Effective Fall 2010, the APA Publication Manual 6th edition is required for use in all nursing school programs.
Scholastic Dishonesty:
Students are expected to be above reproach in all scholastic activities. Students who engage in scholastic dishonesty are subject to disciplinary penalties, including the possibility of failure in the course and dismissal from the university. “Scholastic dishonesty includes but is not limited to cheating, plagiarism, collusion, and submission for credit of any work or materials that are attributable in whole or in part to another person, taking an examination for another person, any act designed to give unfair advantage to a student or the attempt to commit such acts.” Regents Rules and Regulations, Part One, Chapter VI, Section 3, Subsection 3.2, Subdivision 3.22.
ADA Accommodations
Any student seeking ADA Accommodations under the American with Disabilities Act should contact the Associate Dean for Admissions and Student Services within the first week of the semester so that appropriate accommodations may be arranged. A Request for Accommodations (Form 100) must be completed. These forms are available in the Office for Students Room: NS 1.106.
CLASSROOM ATTENDANCE
Attendance in class is an expectation of each student.
WRITTEN ASSIGNMENTS
If written assignments are made in a course they are required.
Students are expected to submit written work on the scheduled date and time.
The student must notify the course coordinator prior to the scheduled due date and time if they are unable to submit the written work as scheduled. Failure to make this notification in advance will result in a “zero” for that written work.
If the excuse is accepted as reasonable and necessary, arrangements will be made for an alternative due date and time.
Each student is responsible for making sure that he or she has completed the written work prior to submission.
Late work will be accepted with consequences as outlined per course syllabi.
APA GUIDELINES
The APA Publication Manual 6th edition is required for use in all nursing school programs.
SCHOLASTIC DISHONESTY
Students are expected to be above reproach in all scholastic activities. Students who engage in scholastic dishonesty are subject to disciplinary penalties, including the possibility of failure in the course and dismissal from the university. “Scholastic dishonesty includes but is not limited to cheating, plagiarism, collusion, and submission for credit of any work or materials that are attributable in whole or in part to another person, taking an examination for another person, any act designed to give unfair advantage to a student or the attempt to commit such acts.”
Regents Rules and Regulations
, Part One, Chapter VI, Section 3, Subsection 3.2, Subdivision 3.22.
ADA ACCOMMODATIONS
Any student seeking reasonable accommodations through the Americans with Disabilities Act (ADA) should contact either the Associate Dean for Admissions and Student Services within the first week of the semester or schedule a meeting with the UTHSCSA ADA Compliance Office so that appropriate accommodations may be arranged. A request for accommodations (Form ADA-100: http://uthscsa.edu/eeo/form100-Faculty-student-resident.pdf) must be completed and submitted to the Executive Director of the ADA Compliance Office before accommodations can be provided. Additional information can be provided in the Student Success Center, Room 1.118 or through the ADA Compliance Office website: http://uthscsa.edu/eeo/request.asp.
REQUIRED TEXT / REFERENCE
Text books from previous semesters may be used as references during your clinical practicum.
RECOMMENDED (OPTIONAL) TEXT / REFERENCE
Text books from previous semesters may be used as references during your clinical practicum.
CONTENT OUTLINE
Clinical:
100 hours Adult Primary Care
100 hours Geriatric Care
100 hours Sub-specialty Care and/or Family Practice
300 Clinical Hours Total
NURS 6620 Family Nurse Practitioner (FNP) Diagnosis and Management for Aging Families Essay Assignments and Exam Questions and Answers
APA Referencing and Citation Style Format Example Nursing Paper Template Doc and Pdf
APA Referencing and Citation Style Template with Explanations
The above template in word has the explanations below or APA referencing, paper structure and all that you need to know about APA referencing style.
Cover Paper – See attached document
ORDER A PLAGIARISM-FREE PAPER NOW
Abstract
This is the abstract, which is typed in block format with no indentation. The abstract briefly summarizes your paper in 120 words or less. Through your abstract, your readers should be able to fully understand the content and the implications of the paper. Also, note that writing this section after the paper itself may be helpful. See section 2.04 APA for tips and more information on writing abstracts. This template was updated April 25, 2016.
Title of the Paper
This template’s margins, page numbers, and page breaks are set for you, and you do not need to change them. Do not add any extra spaces between the heading and the text (you may want to check
Spacing
under
Format
,
Paragraph
in your word processor, and make sure that it is set to 0”). Instead, just double space as usual, indent a full ½ inch (preferably using the tab button), and start typing. The introduction should receive no specific heading because readers assume that the first section functions as your paper’s introduction.
After considering these formatting issues, you will need to construct a thesis statement, which lets readers know how you synthesized the literature into a treatise that is capable of advancing a new point of view. This statement provides readers with a lens for understanding the forthcoming research presented in the body of your essay (after all, each piece of literature should support and apply to this thesis statement).
Once you have established your thesis, begin constructing the introduction. An easy template for writing an introduction follows:
Start with what has been said or done regarding the topic.
Explain the problem with what has been said or done.
Offer a solution in a concise thesis statement that can be supported by the literature.
Explain how the thesis brings about social change.
Level 1 Heading
This text will be the beginning of the body of the essay. Even though this section has a new heading, make sure to connect this section to the previous one so readers can follow along with the ideas and research presented. The first sentence in each paragraph should transition from the previous paragraph and summarize the main point in the paragraph. Make sure each paragraph contains only one topic, and when you see yourself drifting to another idea, make sure you break into a new paragraph. Also, avoid long paragraphs (more than three-fourths of a page) to help hold readers’ attention; many shorter paragraphs are better than a few long ones. In short, think this: new idea, new paragraph.
Another Level 1 Heading
Here is another Level 1 heading. Note that, when you add additional headings, you should use the APA levels available in the Styles area of your toolbar. If you enter them manually instead, you may need to delete the automatic indent that appears because Word thinks you are beginning a new paragraph. Again, the topic sentence of this section should explain how this paragraph is related or a result of what you discussed in the previous section. Consider using transitions between sentences to help readers see the connections between ideas. Below are a few examples of how to transition from one statement to another (or in some cases, one piece of literature to another):
Many music teachers at Olson Junior High are concerned about losing their jobs (J. Thompson, personal communication, July 3, 2013), largely due to the state’s recent financial cutbacks of fine arts programs (Babar, 2007).
Obesity affects as much as 17% of the total population of children, an increase which may lead to other chronic health problems (Hera, 2008; Sinatra, 2008).
For more examples, see some of the transitions handouts on the Writing Center’s website.
Level 2 Heading
The Level 2 heading designates a subsection of the previous section. Using headings is a great way to organize a paper and increase its readability, so be sure to review heading rules on APA 3.02 and 3.03 in order to format them correctly. For shorter papers, using one or two levels is all that is needed. You would use Level 1 (centered, bold font with both uppercase and lowercase) and Level 2 (left aligned, bold, both uppercase and lowercase). This template provides examples of APA’s four heading levels, but remember that at least two headings on the same level are needed before the next heading level. For example, a paper must have at least two level 3 headings before a level 4 heading.
Level 3 heading.
Note that you should write Level 3 and 4 headings in sentence case, meaning that only the first word and any proper nouns are capitalized. The number of headings needed in a particular paper is not set, but longer papers may benefit from another heading level, such as this Level 3 heading (which is an indented, bold, lowercase paragraph heading).
Level 4 heading.
One crucial area in APA is learning how to cite in academic work. Make sure to cite source information throughout your paper to avoid plagiarism. This practice is critical: you need to give credit to your sources and avoid copying others’ work at all costs. Look at APA starting at 6.01 for guidelines on citing source information in your text.
Level 4 heading.
You will want to include at least two of each kind of heading in your paper, hence this additional paragraph modeling effective heading usage. See below for further tips on using headings effectively.
Level 3 heading.
Again, if you choose to use Level 3 or 4 headings, at least two of each heading level should appear in the paper. Otherwise, if only one heading appears, your readers may question the need for a heading at all. If you find yourself questioning whether or how to use headings, consider consulting your instructor or committee chair for his or her input.
Level 1 Heading
APA can seem difficult to master, but following the general rules becomes easier with use. The Writing Center also offers numerous resources on its website and by email to help.
And so forth until the conclusion…..
Level 1 Heading
The conclusion section should recap the major points of your paper. However, perhaps more importantly, the conclusion should also interpret what you have written and what it means in the bigger picture. To help write your concluding remarks, consider asking yourself these questions: What do you want to happen with the information you have provided? What do you want to change? What is your ultimate goal in using this information? What would it mean if the suggestions in your paper were taken and used?
References
(Please note that the following references are intended as examples only. Also, these illustrate different types of references but are not all cited in the text. In your paper, be sure every reference entry matches a citation, and every citation refers to an item in the reference list.)
Alexander, G., & Bonaparte, N. (2008). My way or the highway that I built.
Ancient Dictators
,
25
(7), 14–31. doi:10.8220/CTCE.52.1.23-91
Babar, E. (2007). The art of being a French elephant.
Adventurous Cartoon Animals,
19
, 4319–4392. Retrieved from http://www.elephants104.ace.org
Bumstead, D. (2009). The essentials: Sandwiches and sleep.
Journals of Famous Loafers
,
5
, 565–582. doi:12.2847/CEDG.39.2.51-71
Hansel, G., & Gretel, D. (1973).
Candied houses and unfriendly occupants.
Thousand Oaks, CA: Fairy Tale Publishing.
Hera, J. (2008). Why Paris was wrong.
Journal of Greek Goddess Sore Spots
,
20
(4), 19-21. doi: 15.555/GGE.64.1.76-82
Laureate Education, Inc. (Producer). (2007).
How to cite a video: The city is always Baltimore
[DVD]. Baltimore, MD: Author.
Laureate Education, Inc. (Producer). (2010).
Name of program
[Video webcast]. Retrieved from http://www.courseurl.com
Sinatra, F. (2008). Zing! Went the strings of my heart.
Making Good Songs Great, 18
(3), 31–22. Retrieved from http://articlesextollingrecordingsofyore.192/fs.com
Smasfaldi, H., Wareumph, I., Aeoli, Q., Rickies, F., Furoush, P., Aaegrade, V., … Fiiel, B. (2005).
The art of correcting surname mispronunciation.
New York, NY: Supportive Publisher Press. Retrieved from http://www.onewaytociteelectronicbooksperAPA7.02.com
White, S., & Red, R. (2001).
Stop and smell the what now? Floral arranging for beginners
(Research Report No. 40-921). Retrieved from University of Wooded Glen, Center for Aesthetic Improvements in Fairy Tales website: http://www.uwg.caift/~40_921.pdf
APA Referencing and Citation Style Format Example Nursing Paper Template Doc and Pdf
Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Are you looking for Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers or someone to handle any of the following for you?
ORDER A PLAGIARISM-FREE PAPER OR SITING ONLINE EXAM
Discussions
– initial posting and/or response postings to colleagues?
Assignments
– someone to handle your weekly assignments and guarantee you quality and plagiarism free papers?
Midterm and final exams
– Someone to handle the online exams?
Practicum Journal Entries and assignments
– Who do you trust to write your papers?
We can handle, just
place your order
with us.
NURS 6650 MIDTERM EXAM STUDY GUIDE
The mid-term exam will cover the following topics, which relate to psychotherapy with groups and families:
• Introductory concepts related to group and family therapy
• Family assessment and phases of family therapy
• Experiential and narrative family therapy
• Structural and strategic family therapy
• Solution-focused and cognitive behavioral family therapy
Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer Publishing Company.
• Chapter 11, “Group Therapy” (pp. 407-428)
• Chapter 12, “Family Therapy” (pp. 429-468)
Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.
• Chapter 1, “The Foundations of Family Therapy” (pp. 1-6)
• Chapter 2, “The Evolution of Family Therapy” (pp. 7-28)
• Chapter 3, “Basic Techniques of Family Therapy” (pp. 29-48)
• Chapter 4, “The Fundamental Concepts of Family Therapy” (pp. 49- 68)
• Chapter 5, “Bowen Family Systems Therapy” (pp. 69-88)
• Chapter 6, “Strategic Family Therapy” (pp. 89-109)
• Chapter 7, “Structural Family Therapy” (pp. 110-128)
• Chapter 8, “Experiential Family Therapy” (pp. 129-147)
• Chapter 10, “Cognitive-Behavior Family Therapy” (pp. 166-189)
The final exam will cover the following topics, which relate to psychotherapy with groups and families:
Foundations of Group Work and Types of Groups
Group Processes
Cognitive Behavioral Therapy for Groups
Group Therapy for Addiction
Group Therapy with Children and Adolescents
Group Therapy with Older Adults
LET’S SIT YOUR ONLINE EXAM – ORDER NOW
Wheeler, K. (Eds.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
. New York, NY: Springer Publishing Company.
Chapter 11, “Group Therapy” (pp. 407-428)
Chapter 12, “Family Therapy” (pp. 429-468)
Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565-596)
Chapter 17, “Psychotherapy with Children” (pp. 597-624)
Chapter 18, “Psychotherapy with Older Adults” (pp. 625-660)
Yalom, I. D., & Leszcz, M. (2005).
The theory and practice of group psychotherapy
(5th ed.). New York, NY: Basic Books.
Chapter 1, “The Therapeutic Factors” (pp. 1-18)
Chapter 2, “Interpersonal Learning” (pp. 19-52)
Chapter 3, “Group Cohesiveness” (pp. 53-76)
Chapter 5, “The Therapist: Basic Tasks” (pp. 117-140)
Chapter 8, “The Selection of Clients” (pp. 231-258)
Chapter 9, “The Composition of Therapy Groups” (pp. 259-280)
Chapter 11, “In the Beginning” (pp. 309-344)
Chapter 12, “The Advanced Group” (pp. 345-390)
Chapter 13, “Problem Group Members” (pp. 391-428)
Video
Leading Groups with Adolescents
by Janice DeLucia-Waack, PhD & Allen Segrist, PhD
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bélanger, C., Laporte, L., Sabourin, S., & Wright, J. (2015). The effect of cognitive-behavioral group marital therapy on marital happiness and problem solving self-appraisal. American Journal of Family Therapy, 43(2), 103-118. doi:10.1080/01926187.2014.956614
Bjornsson, A. S., Bidwell, L. C., Brosse, A. L., Carey, G., Hauser, M., Mackiewicz Seghete, K. L., & … Craighead, W. E. (2011). Cognitive-behavioral group therapy versus group psychotherapy for social anxiety disorder among college students: A randomized controlled trial. Depression and Anxiety, 28(11), 1034-1042. doi:10.1002/da.20877
Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990-2010. Journal of Child Psychology & Psychiatry, 54(7), 707-723. doi:10.1111/jcpp.12058
Bonhote, K., Romano-Egan, J., & Cornwell, C. (1999). Altruism and creative expressions in a long-term older adult psychotherapy group. Issues in Mental Health Nursing, 20(6), 603-617. doi:10.1080/016128499248394
Cheston, R., & Jones, R. (2009). A small-scale study comparing the impact of psycho-education and exploratory psychotherapy groups on newcomers to a group for people with dementia. Aging & Mental Health, 13(3), 420-425. doi:10.1080/13607860902879409
Cohn, A. S. (2014). Romeo and Julius: A narrative therapy intervention for sexual-minority couples. Journal of Family Psychotherapy, 25(1), 73-77. doi:10.1080/08975353.2014.881696
Conoley, C., Graham, J., Neu, T., Craig, M., O’Pry, A., Cardin, S., & … Parker, R. (2003). Solution-focused family therapy with three aggressive and oppositional-acting children: An N=1 empirical study. Family Process, 42(3), 361-374. PMID: 14606200
Crane-Okada, R. (2012). The concept of presence in group psychotherapy: An operational definition. Perspectives in Psychiatric Care, 48(3), 156-164. doi:10.1111/j.1744-6163.2011.00320.x
de Castro, S., & Guterman, J. (2008). Solution-focused therapy for families coping with suicide. Journal of Marital & Family Therapy, 34(1), 93-106. doi: 10.111/j.1752-0606.2008.00055.x.
Escudero, V., Friedlander, M. L., Boogmans, E., & Loots, G. (2012). Alliance rupture and repair in conjoint family therapy: An exploratory study. Psychotherapy, 49(1), 26-37. doi:10.1037/a0026747
Freedman, J. (2014). Witnessing and positioning: Structuring narrative therapy with families and couples. Australian & New Zealand Journal of Family Therapy, 35(1), 20-30. doi:10.1002/anzf.104
Freedman, J. (2014). Witnessing and positioning: Structuring narrative therapy with families and couples. Australian & New Zealand Journal of Family Therapy, 35(1), 20-30. doi:10.1002/anzf.1043
Gamble, J., & O’ Lawrence, H. (2016). An overview of the efficacy of the 12-step group therapy for substance abuse treatment. Journal of Health & Human Services Administration, 39(1), 142-160.
Governors State University (Producer). (2009). Emotionally focused couples therapy [Video file]. Chicago, IL: Author.
Himelhoch, S., Medoff, D., & Oyeniyi, G. (2007). Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: A systematic review and meta-analysis. AIDS Patient Care & Stds, 21(10), 732-739.
Khawaja, I. S., Pollock, K., & Westermeyer, J. J. (2011). The diminishing role of psychiatry in group psychotherapy: A commentary and recommendations for change. Innovations in Clinical Neuroscience, 8(11), 20-23.
Kim, J. W., Choi, Y. S., Shin, K. C., Kim, O. H., Lee, D. Y., Jung, M. H., & … Choi, I. (2012). The effectiveness of continuing group psychotherapy for outpatients with alcohol dependence: 77-month outcomes. Alcoholism: Clinical & Experimental Research, 36(4), 686-692. doi:10.1111/j.1530-0277.2011.01643.x
Koukourikos, K., & Pasmatzi, E. (2014). Group therapy in psychotic inpatients. Health Science Journal, 8(3), 400-408.
Krishna, M., Honagodu, A., Rajendra, R., Sundarachar, R., Lane, S., & Lepping, P. (2013). A systematic review and meta-analysis of group psychotherapy for sub-clinical depression in older adults. International Journal of Geriatric Psychiatry, 28(9), 881-888. doi:10.1002/gps.3905
Krishna, M., Jauhari, A., Lepping, P., Turner, J., Crossley, D., & Krishnamoorthy, A. (2011). Is group psychotherapy effective in older adults with depression? A systematic review. International Journal of Geriatric Psychiatry, 26(4), 331-340. doi:10.1002/gps.2546
L’Abate, L. (2015). Highlights from 60 years of practice, research, and teaching in family therapy. American Journal of Family Therapy, 43(2), 180-196. doi:10.1080/01926187.2014.100236
Lego, S. (1998). The application of Peplau’s theory to group psychotherapy. Journal of Psychiatric and Mental Health Nursing, 5(3), 193-196. doi:10.1046/j.1365-2850.1998.00129.x
Lerner, M. D., McLeod, B. D., & Mikami, A. Y. (2013). Preliminary evaluation of an observational measure of group cohesion for group psychotherapy. Journal of Clinical Psychology, 69(3), 191-208. doi:10.1002/jclp.21933
Leszcz, M., & Kobos, J. C. (2008). Evidence-based group psychotherapy: Using AGPA’s practice guidelines to enhance clinical effectiveness. Journal of Clinical Psychology, 64(11), 1238-1260. doi:10.1002/jclp.2053
Marmarosh, C. L. (2014). Empirical research on attachment in group psychotherapy: Moving the field forward. Psychotherapy, 51(1), 88-92. doi:10.1037/a003252
McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism and Developmental Disorders, 44(8), 2041-2051. doi:10.1007/s10803-014-2087-9. Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
McNeil, S. N., Herschberger, J. K., & Nedela, M. N. (2013). Low-income families with potential adolescent gang involvement: A structural community family therapy integration model. American Journal of Family Therapy, 41(2), 110-120. doi:10.1080/01926187.2011.649110
Méndez, N. A., Qureshi, M. E., Carnerio, R., & Hort, F. (2014). The intersection of Facebook and structural family therapy volume 1. American Journal of Family Therapy, 42(2), 167-174. doi:10.1080/01926187.2013.794046
Microtraining Associates (Producer). (2009). Leading groups with adolescents [Video file]. Alexandria, VA: Author.
Mojta, C., Falconier, M. K., & Huebner, A. J. (2014). Fostering self-awareness in novice therapists using internal family systems therapy. American Journal of Family Therapy, 42(1), 67-78. doi:10.1080/01926187.2013.772870. Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207-215. doi:10.1111/famp.12025
Papero, D. V. (2014). Assisting the two-person system: An approach based on the Bowen theory. Australian & New Zealand Journal of Family Therapy, 35(4), 386-397. doi:10.1002/anzf.1079
Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of Family Psychotherapy, 25(2), 132-144. doi:10.1080/08975353.2014.910023. Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Perry, A. (2014). Cognitive behavioral therapy with couples and families. Sexual & Relationship Therapy, 29(3), 366-367. doi:10.1080/14681994.2014.909024
Pessagno, R. A., & Hunker, D. (2013). Using short-term group psychotherapy as an evidence-based intervention for first-time mothers at risk for postpartum depression. Perspectives in Psychiatric Care, 49(3), 202-209. doi:10.1111/j.1744-6163.2012.00350.x
Phipps, W. D., & Vorster, C. (2011). Narrative therapy: A return to the intrapsychic perspective. Journal of Family Psychotherapy, 22(2), 128-147. doi:10.1080/08975353.2011.578036. Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Psychotherapy.net (Producer). (1998). Narrative family therapy [Video file]. San Francisco, CA: Author.
Psychotherapy.net (Producer). (2006). Tools and techniques for family therapy. [Video file]. Mill Valley, CA: Author.
Psychotherapy.net (Producer). (2010). Bowenian family therapy [Video file]. Mill Valley, CA: Author .
Psychotherapy.net (Producer). (2011a). Group therapy: A live demonstration. [Video file]. Mill Valley, CA: Author.
Psychotherapy.net (Producer). (2015). Group therapy for addictions: An interpersonal relapse prevention approach [Video file]. Mill Valley, CA: Author. Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Ramisch, J., McVicker, M., & Sahin, Z. (2009). Helping low-conflict divorced parents establish appropriate boundaries using a variation of the miracle question: An integration of solution-focused therapy and structural family therapy. Journal of Divorce & Remarriage, 50(7), 481-495. doi:10.1080/10502550902970587
Restek-Petrović, B., Bogović, A., Mihanović, M., Grah, M., Mayer, N., & Ivezić, E. (2014). Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: A preliminary study. Nordic Journal of Psychiatry, 68(5), 333-340. doi:10.3109/08039488.2013.839738
Rice, A. (2015). Common therapeutic factors in bereavement groups. Death Studies, 39(3), 165-172. doi:10.1080/07481187.2014.946627
Ryan, W. J., Conti, R. P., & Simon, G. M. (2013). Presupposition compatibility facilitates treatment fidelity in therapists learning structural family therapy. American Journal of Family Therapy, 41(5), 403-414. doi:10.1080/01926187.2012.727673
Safak, Y., Karadere, M. E., Ozdel, K., Ozcan, T., Türkçapar, M. H., Kuru, E., & Yücens, B. (2014). The effectiveness of cognitive behavioral group psychotherapy for obsessive-compulsive disorder. Turkish Journal of Psychiatry, 25(4), 225-233.
Saltzman, W. R., Pynoos, R. S., Lester, P., Layne, C. M., & Beardslee, W. R. (2013). Enhancing family resilience through family narrative co-construction. Clinical Child and Family Psychology Review, 16(3), 294-310. doi:10.1007/s10567-013-0142-2. Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Sayın, A., Candansayar, S., & Welkin, L. (2013). Group psychotherapy in women with a history of sexual abuse: What did they find helpful? Journal of Clinical Nursing, 22(23/24), 3249-3258. doi:10.1111/jocn.1216
Sheehan, A. H., & Friedlander, M. L. (2015). Therapeutic alliance and retention in brief strategic family therapy: A mixed-methods study. Journal of Marital and Family Therapy, 41(4), 415-427. doi:10.1111/jmft.12113
Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008a). Legal and ethical issues for mental health professionals, volume 1: Confidentiality, privilege, reporting, and duty to warn [Video file]. Mill Valley, CA: Psychotherapy.net.
Szapocznik, J., Muir, J. A., Duff, J. H., Schwartz, S. J., & Brown, C. H. (2015). Brief strategic family therapy: Implementing evidence-based models in community settings. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 25(1), 121-133. doi:10.1080/10503307.2013.856044
Tasca, G. A. (2014). Attachment and group psychotherapy: Introduction to a special section. Psychotherapy, 51(1), 53-56. doi:10.1037/a0033015 Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Tasca, G. A., Francis, K., & Balfour, L. (2014). Group psychotherapy levels of interventions: A clinical process commentary. Psychotherapy, 51(1), 25-29. doi:10.1037/a0032520
Triangle Productions (Producer). (2001). Brief strategic therapy with couples [Video file]. La Jolla, CA: Author.
ORDER A CUSTOM-WRITTEN PAPER NOW
Wang, C., Tzeng, D., & Chung, W. (2014). The effect of early group psychotherapy on depressive symptoms and quality of life among residents of an apartment building for seniors. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 14(1), 38-46. doi:10.1111/psyg.12037
Washington, K. T., Wittenberg-Lyles, E., Parker Oliver, D., Baldwin, P. K., Tappana, J., Wright, J. H., & Demiris, G. (2014). Rethinking family caregiving: Tailoring cognitive–behavioral therapies to the hospice experience. Health & Social Work, 39(4), 244-250. doi:hsw/hlu031. Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Watkins, R., Cheston, R., Jones, K., & Gilliard, J. (2006). ‘Coming out’ with Alzheimer’s disease: Changes in awareness during a psychotherapy group for people with dementia. Aging & Mental Health, 10(2), 166-176. PMID: 16517492
Yildiran, H., & Holt, R. R. (2015). Thematic analysis of the effectiveness of an inpatient mindfulness group for adults with intellectual disabilities. British Journal of Learning Disabilities, 43(1), 49-54. doi:10.1111/bld.12085
Psychotherapy with Groups and Families – NURS 6650 Walden University – Exam Questions and Answers
Adult/Gerontology Primary Care Nurse Practitioner – Master of Science in Nursing (MSN) Essay Papers and Exams
The advanced practice registered nurse role in the healthcare system is becoming increasingly critical—and specialized—as the healthcare industry undergoes myriad changes. Adult/Gerontology Primary Care Nurse Practitioners (AGNPs) are advanced practice nurses who hold a Master of Science in Nursing (MSN) and who have advanced clinical training. AGNPs are trained to assess, diagnose, treat, and manage a variety of health issues among adult patients, ages 18 years and older. This specialization explores strategies for improving health outcomes through effective communication and collaboration. Students have the opportunity to explore current health topics through a curriculum developed in collaboration with experts who serve in leading healthcare systems and institutions. Courses are rooted in evidence-based practice so that students can gain knowledge in providing quality, comprehensive, accessible, and cost-effective care.
ORDER A PLAGIARISM-FREE PAPER
This specialization can prepare students to make a positive difference in today’s dynamic and ever-changing healthcare environment, whether in clinical practice or a related health professional role. Students can gain responsibility in their current role or prepare to advance their career. Walden practicum coordinators are available to assist students in meeting their practicum requirements. Graduates can pursue national adult nurse practitioner certification and state credentialing.
Specialization Courses – Adult/Gerontology Primary Care Nurse Practitioner – Master of Science in Nursing (MSN) Essay Papers and Exams
NURS 6501 – Advanced Pathophysiology♦
NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning♦
NURS 6521 – Advanced Pharmacology♦
NURS 6531 – Advanced Practice Care of Adults Across the Lifespan
NURS 6540 – Advanced Practice Care of Frail Elders
NURS 6551 – Primary Care of Women
NURS 6565 – Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings
Note on Certification – Adult/Gerontology Primary Care Nurse Practitioner – Master of Science in Nursing (MSN) Essay Papers and Exams
The MSN nurse practitioner specializations are designed to prepare graduates to qualify to sit for national nurse practitioner certification exams, which are required for practice as a nurse practitioner in most states. Because no graduate program can guarantee that graduates will be permitted to practice as a nurse practitioner upon graduation, we encourage students to consult the appropriate Board of Nursing or state agency to determine specific certification exam requirements. Walden enrollment advisors can provide information relating to national certification exams; however, it remains the individual’s responsibility to understand, evaluate, and comply with all requirements relating to national certification exams for the state in which he or she intends to practice as requirements vary widely. Walden makes no representations or guarantee that completion of Walden coursework or programs will permit an individual to obtain national certification. For more information about nurse practitioner certification exams, students should visit the American Academy of Nurse Practitioners at
www.aanpcertification.org
, American Nurses Credentialing Center at
www.nursecredentialing.org
, or other nurse practitioner certification exam websites.
Adult/Gerontology Primary Care Nurse Practitioner – Master of Science in Nursing (MSN) Essay Papers and Exams Note on Licensure
The MSN nurse practitioner specializations are designed to prepare graduates with an active registered nurse (RN) license to practice as nurse practitioners. However, each state Board of Nursing has its own academic and certification requirements and issues its own credential for an RN to be permitted to practice as a nurse practitioner in that state. Because no graduate program can guarantee that graduates will be permitted to practice as a nurse practitioner upon graduation, we encourage students to consult the appropriate Board of Nursing or state agency in the state in which he or she wishes to practice to determine specific requirements. Walden enrollment advisors can provide guidance relating to the state-by-state requirements for practice as a nurse practitioner; however, it remains the individual’s responsibility to understand, evaluate, and comply with all requirements relating to the practice as a nurse practitioner in the state in which he or she intends to practice as requirements vary widely. Walden makes no representations or guarantee that completion of Walden coursework or programs will permit an individual to obtain state licensure, authorization, endorsement, or other state credential. For more information about the requirements to practice as a nurse practitioner, students should contact the appropriate Board of Nursing or state agency.
Adult/Gerontology Primary Care Nurse Practitioner – Master of Science in Nursing (MSN) Essay Papers and Exams
NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers
NURS 6650 MIDTERM EXAM STUDY GUIDE
The mid-term exam will cover the following topics, which relate to psychotherapy with groups and families:
• Introductory concepts related to group and family therapy
• Family assessment and phases of family therapy
• Experiential and narrative family therapy
• Structural and strategic family therapy
• Solution-focused and cognitive behavioral family therapy
NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers
Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer Publishing Company.
• Chapter 11, “Group Therapy” (pp. 407-428)
• Chapter 12, “Family Therapy” (pp. 429-468)
ORDER A PLAGIARISM-FREE PAPER OR ONLINE EXAM HERE
Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.
• Chapter 1, “The Foundations of Family Therapy” (pp. 1-6)
• Chapter 2, “The Evolution of Family Therapy” (pp. 7-28)
• Chapter 3, “Basic Techniques of Family Therapy” (pp. 29-48)
• Chapter 4, “The Fundamental Concepts of Family Therapy” (pp. 49- 68)
• Chapter 5, “Bowen Family Systems Therapy” (pp. 69-88)
• Chapter 6, “Strategic Family Therapy” (pp. 89-109)
• Chapter 7, “Structural Family Therapy” (pp. 110-128)
• Chapter 8, “Experiential Family Therapy” (pp. 129-147)
• Chapter 10, “Cognitive-Behavior Family Therapy” (pp. 166-189)
NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers
The Psychiatric and Mental Health Nurse Practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders, or substance abuse problems. They are licensed to provide emergency psychiatric services, conduct psychosocial and physical assessment of their patients, develop and manage treatment plans, and provide ongoing manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on making a psychiatric diagnosis, differentiates between medical disorders with psychiatric symptoms, and orders appropriate medications to treat various psychiatric disorders. A PMHNP can often practice autonomously, depending on state licensure laws.
University Outcomes – NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers
1. Facilitate positive social change where they work, in their communities, and in
society.
2. Use their knowledge to positively impact their profession, communities, and
society.
3. Demonstrate a commitment to lifelong learning.
4. Apply their learning to specific problems and challenges in their workplace and
professional settings.
5. Demonstrate information literacy.*
*Information literacy is defined as the ability to know when there is a need for information, and
being able to identify, locate, evaluate, and effectively use that information for the issue or
problem at hand.
6. Demonstrate an understanding of the methods of inquiry used in their
professional or academic field.
7. Practice legal and ethical integrity in their professional work.
8. Effectively communicate their ideas and the rationale behind them to others.
9. Support diversity and multiculturalism within their profession, communities, and
society.
NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers
Program Outcomes – NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers
1. Synthesize organizational/systems leadership for cost-effective specialist nursing
practice that contributes to high-quality healthcare delivery, advancement of the
nursing profession, and social change.
2. Critique evidence-based literature drawing from diverse theoretical perspectives
and pertinent research to guide decision making that demonstrates best
practices for specialist nursing practice in a global society.
3. Integratively assess, diagnose, plan, implement, and evaluate cost-effective
healthcare strategies that reduce health disparities by patient/population
advocacy for access to specialist nursing care.
4. Demonstrate the ability to effectively communicate using audience-specific oral,
written, and information technology for professional delivery of specialist nursing
care.
ORDER A PLAGIARISM-FREE PAPER NOW
5. Evaluate health needs of diverse populations for necessary teaching/coaching
functions based on specialist nursing knowledge to restore/promote health and
prevent illness/injury.
6. Exhibit ongoing commitment to professional development and value of nursing
theories/ethical principles (altruism, autonomy, human dignity, integrity, social
justice) in accordance with ethically responsible, legally accountable, specialist
nursing practice.
7. Implement specialist nursing roles to promote quality improvement of patientcentered
care in accordance with professional practice standards that transform
health outcomes for diverse populations.
Course Outcomes
1. Evaluate evidence-based psychotherapeutic counseling theories for groups and
families
2. Apply psychotherapeutic counseling techniques and methods for groups and
families
3. Assess clients presenting for group and family psychotherapy
4. Develop psychiatric diagnoses for clients across the lifespan
5. Analyze ethical and legal implications of counseling clients presenting for group
and family psychotherapy. NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers.
NURS 6650 Psychotherapy with Groups and Families Exam Questions and Answers
NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers
Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized.
(Prerequisite(s):
NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.)
Note:
This course requires a minimum of 160 practicum hours.
ORDER A CUSTOM-WRITTEN PAPER NOW
NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers
NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Course Readings
Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long?”
OJIN: The Online Journal of Issues in Nursing, 19
(1).
Christensen, C. M., Bohmer, R. M. J., & Kenagy, J. (2000). Will disruptive innovations cure health care?
Harvard Business Review, 78
(5), 102-112, 199.
Ford, L. C.. & Gardenier, D. (2015). Fasten your seat belts – it’s going to be a bumpy ride.
The Journal for Nurse Practitioners, 11
(6), 575-577.
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign.
OJIN: The Online Journal of Issues in Nursing, 19
(2).
Hayes, E., Chandler, G., Merriam, D., & King, M. C. (2002). The master’s portfolio: Validating a career in advanced practice nursing.
Journal of the American Academy of Nurse Practitioners, 14
(3), 119.
Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners -risks and rewards. New England Journal of Medicine, 368(20), 1935-1941.
Jordan, L. M., Quraishi, J. A., & Liao, J. (2013). The national practitioner data bank and CRNA anesthesia-related malpractice payments.
American Association of Nurse Anesthetists Journal, 81
(3), 178-182.
Kooienga, S.A. & Carryer, J.B. (2015). Globalization and advancing primary care health care nurse practitioner practice.
The Journal for Nurse Practitioners, 11
(8), 804–811.
Miller, K. P. (2013). The national practitioner data bank: An annual update.
The Journal for Nurse Practitioners, 9
(9), 576-580.
O’Connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: Using a capability framework in developing practice standards for advanced practice nursing.
Journal of Advanced Nursing, 70
(12), 2728-2735.
Reinisch, C. E. (2014). Loretta Ford: Envisioning the future.
Clinical Scholars Review, 7
(1), 82-84.
Rhodes, C. A., Bechtle, M., & McNett, M. (2015). An incentive plan for advanced practice registered nurses: Impact on provider and organizational outcomes.
Nursing Economics, 33
(3), 125-131.
Silver, H. K,. Ford, L. C., & Day, L. R. (1968). The pediatric nurse-practitioner program: Expanding the role of the nurse to provide increased health care for children.
JAMA, 204
(4), 298-302.
Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . . Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners.
Journal for Nurse Practitioners, 9
(8), 492-500.
Stelmach, E. I. (2015). Dismissal of the noncompliant patient: Is this what we have come to?
The Journal for Nurse Practitioners, 11
(7), 723-725.
Watson, E. (2014). Nursing malpractice: Costs, trends and issues.
Journal of Legal Nurse Consulting, 25
(1), 26-31.
Weber, S. (2006). Developing nurse practitioner student portfolios.
Journal of the American Academy of Nurse Practitioners, 18
(7), 301-302.
Westrick, Susan J., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics.
The Journal for Nurse Practitioners, 12
(2), 120-126.
NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers
NURS 6565 Week 2 Discussion: Ethical Challenges in Health Care for Practicing NPs
Consider the following case study:
Mrs. ABC is a 35 year old woman who has a scheduled business trip today. It is currently 8 am, and her plan is to leave at 6 pm. Mrs. ABC has a sore throat and she thinks it is strep because her 5 year old daughter was recently treated for strep. Mrs. ABC calls her physician for an appointment, but there are no appointments available until next week. She has a mother who is a nurse practitioner and her office is 5 minutes away from where she lives. She calls and schedules an appointment with her mother. Her mother was surprised to see her daughter at the office. Mrs. ABC is frantic and begs her mother for an antibiotic. Her mother tests her and the rapid strep test is negative in office. Her mother (NP) sends out a strep DNA probe. Her mother prescribes an antibiotic and the patient (her daughter) is very satisfied. The results returned for the DNA probe 48 hours later and it confirmed negative for strep. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
By Day 3 OF NURS 6565 Week 2 Discussion
Post
an explanation of whether NPs should treat family members. What are the ethical dilemmas in this situation? What are the laws in your state for NPs treating themselves, family, or friends? NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
****I live in Texas**** but you can choose any state in the US
CHAPTER CONTENTS Characteristics of Ethical Dilemmas in Nursing, 328
Communication Problems, 329 Interdisciplinary Conflict, 329 Multiple Commitments, 330
Ethical Issues Affecting Advanced Practice Nurses, 330
Primary Care Issues, 330 Acute and Chronic Care, 330 Societal Issues, 331 Access to Resources and Issues of Justice, 332 Legal Issues, 333
Changes in interprofessional roles, advances in medical technology, privacy issues, revisions in patient care delivery systems, and heightened economic constraints have increased the complexity of ethical issues in the health care setting. Nurses in all areas of health care routinely encounter disturbing moral issues, yet the success with which these dilemmas are resolved varies significantly. Because nurses have a unique relationship with the patient and family, the moral position of nursing in the health care arena is distinct. As the complexity of issues intensifies, the role of the advanced practice nurse (APN) becomes particularly important in the identification, deliberation, and resolution of complicated and difficult moral problems. Although all nurses are moral agents, APNs are expected to be leaders in rec- ognizing and resolving moral problems, creating ethical practice environments, and promoting social justice in the larger health care system. It is a basic tenet of the central definition of advanced practice nursing (see Chapter 3) that skill in ethical decision making is one of the core competencies of all APNs. In addition, the Doctor of Nursing Practice {DNP) essential competencies emphasize leadership in developing and evaluating strate- gies to manage ethical dilemmas in patient care and organizational arenas (American Association of Colleges of Nursing [AACN], 2006). This chapter explores the distinctive ethical decision-making competency of advanced practice nursing, the process of developing and evaluating this competency, and barriers to ethical prac- tice that APNs can expect to confront. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
328
Ethical Decision Making
Ann B. Hamric • Sarah A. Delgado
Ethical Decision Making Competency of Advanced Practice Nurses, 333
Phases of Core Competency Development, 333 Evaluation of the Ethical Decision Making Competency, 349 Barriers to Ethical Practice and Potential Solutions, 350
Barriers Internal to the Advanced Practice Nurse, 350 lnterprofessional Barriers, 351 Patient-Provider Barriers, 351 Organizational and Environmental Barriers, 352
Conclusion, 354
Characteristics of Ethical Dilemmas
lll~l12:’:1’Si~ ~~·-· ~ -······· …. ···~ ·-· In this chapter, the terms ethics and morality or morals are used interchangeably (see Beauchamp & Childress, 2009, for a discussion of the distinctions between these terms). A problem becomes an ethical or moral problem when issues of core values or fundamental obligations are present. An ethical or moral dilemma occurs when obliga- tions require or appear to require that a person adopt two (or more) alternative actions, but the person cannot carry out all the required alternatives. The agent experiences tension because the moral obligations resulting from the dilemma create differing and opposing demands (Beauchamp & Childress, 2009; Purtilo & Doherty, 2011). In some moral dilemmas, the agent must choose between equally unacceptable alternatives; that is, both may have elements that are morally unsatisfactory. For example, based on her evaluation, a family nurse practitioner (FNP) may suspect that a patient is a victim of domestic violence, although the patient denies it. The FNP is faced with two options that are both ethically troubling-connect the patient with existing social services, possibly straining the family and jeopardizing the FNP-patient relationship, or avoid intervention and potentially allow the violence to continue. As described by Silva and Ludwick (2002), hon- oring the FNP’s desire to prevent harm (the principle of beneficence) justifies reporting the suspicion, whereas respect for the patient’s autonomy justifies the opposite course of action. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Jameton (1984, 1993) has distinguished two additional types of moral problems from the classic moral dilemma, which he termed moral uncertainty and moral distress. In situations of moral uncertainty, the nurse experiences unease and questions the right course of action. In moral distress, nurses believe that they know the ethically appro- priate action but feel constrained from carrying out that action because of institutional obstacles (e.g., lack of time or supervisory support, physician power, institutional policies, legal constraints). Noting that nurses and others often take varied actions in response to moral distress, Varcoe and colleagues (2012) have proposed a revision to Jameton’s definition: “moral distress is the experience of being seriously compromised as a moral agent in prac- ticing in accordance with accepted professional values and standards. It is a relational experience shaped by multiple contexts, including the socio-political and cul- tural context of the workplace environment” (p. 60). The phenomenon of moral distress has received increasing national and international attention in nursing and medical literature. Studies have reported that moral dis- tress is significantly related to unit-level ethical climate and to health care professionals’ decisions to leave clinical practice (Corley, Minick, Elswick, et al., 2005; Epstein & Hamric, 2009; Hamric, Borchers, & Epstein, 2012; Hamric, Davis, & Childress, 2006; Pauly, Varcoe, Storch, et al., 2009; Schluter, Winch, Hozhauser, et al., 2008; Varcoe, Pauly, Webster, & Storch, 2012). APNs work to decrease the incidence of moral uncertainty and moral distress for themselves and their colleagues through edu- cation, empowerment, and problem solving. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Although the scope and nature of moral problems experienced by nurses and, more specifically APNs, reflect the varied clinical settings in which they practice, three general themes emerge when ethical issues in nursing practice are examined. These are problems with commu- nication, the presence of interdisciplinary conflict, and nurses’ difficulties with managing multiple commitments and obligations.
Communication Problems
The first theme encountered in many ethical dilemmas is the erosion of open and honest communication. Clear communication is an essential prerequisite for informed and responsible decision making. Some ethical disputes reflect inadequate communication rather than a difference in values (Hamric & Blackball, 2007; Ulrich, 2012). The APN’s communication skills are applied in several arenas. Within the health care team, discussions are most effective when members are accountable for presenting informa- tion in a precise and succinct manner. In patient encoun- ters, disagreements between the patient and a family
C HAP T E R 13 Ethical Decision Making
member or within the family can be rooted in faulty com- munication, which then leads to ethical conflict. The skill of listening is just as crucial in effective communication as having proficient verbal skills. Listening involves recog- nizing and appreciating various perspectives and showing respect to individuals with differing ideas. To listen well is to allow others the necessary time to form and present their thoughts and ideas.
Understanding the language used in ethical delibera- tions (e.g., terms such as beneficence, autonomy, and utili- tarian justice) helps the APN frame the concern. This can help those involved to see the components of the ethical problem rather than be mired in their own emotional responses. When ethical dilemmas arise, effective com- munication is the first key to negotiating and facilitating a resolution. Jameson (2003) has noted that the long history of conflict between certified registered nurse anes- thetists (CRNAs) and anesthesiologists influences how these providers communicate in practice settings. In inter- views with members of both groups, she found that some transcended role-based conflict whereas others became mired in it, particularly in the emotions around perceived threats to role fulfillment. She recommended enhancing communication through focus on the common goal of patient care, rather than on the conflicting opinions about supervision and autonomous practice. In other words, focusing on shared values rather than the values in conflict can promote effective communication. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Interdisciplinary Conflict
The second theme encountered is that most ethical dilemmas that occur in the health care setting are multidisciplinary in nature. Issues such as refusal of treatment, end-of-life decision making, cost containment, and confidentiality all have interprofessional elements interwoven in the dilemmas, so an interprofessional approach is nec- essary for successful resolution of the issue. Health care professionals bring varied viewpoints and perspectives into discussions of ethical issues (Hamric & Blackball, 2007; Piers, Azoulay, Ricou, et al., 2011; Shannon, Mitchell, & Cain, 2002). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.These differing positions can lead to creative and collaborative decision making or to a breakdown in communication and lack of problem solving. Thus, an interdisciplinary theme is prevalent in the presentation and resolution of ethical problems.
For example, a clinical nurse specialist (CNS) is writing discharge orders for an older woman who is terminally ill with heart failure. The plan of care, agreed on by the inter- professional team, patient, and family, is to continue oral medications but discontinue IV inotropic support and all other aggressive measures. Just prior to discharge, the social worker informs the CNS that medical coverage for. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
330 PART ll Competencies of Advanced Practice Nursing
the patient’s care in the skilled nursing facility will only be covered by the insurer if the patient has an IV in place. The attending cardiologist determines that the patient can be discharged to her daughter’s home because she no longer requires skilled care and the social worker agrees to proceed with this plan. However, the CNS is concerned that the patient’s need for physical assistance will over- whelm her daughter and believes that the patient is better off returning to the sldlled nursing facility. Although each team member shares responsibility to ensure that the plan of care is consistent with the patient’s wishes and mini- mizes the cost burden to the patient, they differ in how to achieve these goals. Such legitimate but differing perspec- tives from various team members can lead to ethical conflict. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Multiple Commitments
The third theme that frequently arises when ethical issues in nursing practice are examined is the issue of balancing commitments to multiple parties. Nurses have numerous and, at times, competing fidelity obligations to various stakeholders in the health care and legal systems (Chambliss, 1996; Hamric, 2001). Fidelity is an ethical concept that requires persons to be faithful to their com- mitments and promises. For the APN, these obligations start with the patient and family but also include physi- cians and other colleagues, the institution or employer, the larger profession, and oneself. Ethical deliberation involves analyzing and dealing with the differing and opposing demands that occur as a result of these commitments. An APN may face a dilemma if encouraged by a specialist consultant to pursue a costly intervention on behalf of a patient, whereas the APN’s hiring organization has estab- lished cost containment as a key objective and does not support use of this intervention (Donagrandi & Eddy, 2000). In this and other situations, APNs are faced with an ethical dilemma created by multiple commitments and the need to balance obligations to all parties.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
The general themes of communication, interdisciplin- ary conflict, and balancing multiple commitments are prevalent in most ethical dilemmas. Specific ethical issues may be Wlique to the specialty area and clinical setting in which the APN practices.
Ethical Issues Affecting Advanced Practice Nurses
Primary Care Issues
Situations in which personal values contradict professional responsibilities often confront NPs in a primary care setting. Issues such as abortion, teen pregnancy, patient
nonadherence to treatment, childhood immunizations, regulations and laws, and financial constraints that inter- fere with care were cited in one older study as frequently encountered ethical issues (Turner, Marquis, & Burman, 1996). Ethical problems related to insurance reimburse- ment, such as when implementation of a desired plan of care is delayed by the insurance authorization process or restrictive prescription plans, are an issue for APNs. The problem of inadequate reimbursement can also arise when there is a lack of transparency regarding the specifics of services covered by an insurance plan. For example, a patient who has undergone diagnostic testing during an inpatient stay may later be informed that the test is not covered by insurance because it was done on the day of discharge. Had the patient and nurse practitioner (NP) known of this policy, the testing could have been sched- uled on an outpatient basis with prior authorization from the insurance company and thus be a covered expense. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Viens {1994) found that primary care NPs interpret their moral responsibilities as balancing obligations to the patient, family, colleagues, employer, and society. More recently, Laabs (2005) has found that the issues most often noted by NP respondents as causing moral dilemmas are those of being required to follow policies and procedures that infringe on personal values, needing to bend the rules to ensure appropriate patient care, and dealing with patients who have refused appropriate care. Issues leading to moral distress included pressure to see an excessive number of patients, clinical decisions being made by others, and a lack of power to effect change (Laabs, 2005). Increasing expectations to care for more patients in less time are routine in all types of health care settings as pressures to contain costs escalate. APNs in rural settings may have fewer resources than their col- leagues working in or near academic centers in which ethics committees, ethics consultants, and educational opportunities are more accessible.
Issues of quality of life and symptom management tra- verse primary and acute health care settings. Pain relief and symptom management can be problematic for nurses and physicians (Oberle & Hughes, 2001). APNs must con- front the various and sometimes conflicting goals of the patient, family, and other health care providers regarding the plans for treatment, symptom management, and quality of life. The APN is often the individual who coor- dinates the plan of care and thus is faced with clinical and ethical concerns when participants’ goals are not consis- tent or appropriate. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Acute and Chronic Care
In the acute care setting, APNs struggle with dilemmas involving pain management, end-of-life decision making,
advance directives, assisted suicide, and medical errors (Shannon, Foglia, Hardy, & Gallagher; 2009). Rajput and Bekes (2002) identified ethical issues faced by hospital- based physicians, including obtaining informed consent, establishing a patient’s competence to make decisions, maintaining confidentiality, and transmitting health information electronically. APNs in acute care settings may experience similar ethical dilemmas. Recent studies of moral distress have revealed that feeling pressured to continue aggressive treatments that respondents thought were not in the patients’ best interest or in situations in which the patient was dying, working with physicians or nurses who were not fully competent, giving false hope to patients and families, poor team communication, and lack of provider continuity were all issues that engen- dered moral distress (Hamric & Blackball, 2007; Hamric, Borchers, & Epstein, 2012).
APNs bring a distinct perspective to collaborative decision making and often find themselves bridging com- munication between the medical team and patient or family. For example, the neonatal nurse practitioner (NNP) is responsible for the day-to-day medical manage- ment of the critically ill neonate and may be the first provider to respond in emergency situations (Juretschke, 2001). The NNP establishes a trusting relationship with the family and becomes aware of the values, beliefs, and attitudes that shape the family’s decisions. Thus, the NNP has insight into the perspectives of the health care team and family. This “in-the-middle” position, however, can be accompanied by moral distress (Hamric, 2001), particu- larly when the team’s treatment decision carried out by the NNP is not congruent with the NNP’s professional judg- ment or values. Botwinski (2010) conducted a needs assessment ofNNPs and found that most had not received formal ethics content in their education and desired more education on the management of end-of-life situations, such as delivery room resuscitation of a child on the edge of viability. Knowing the best interests of the infant and balancing those obligations to the infant with the emo- tional, cognitive, financial, and moral concerns that face the family struggling with a critically ill neonate is a complex undertaking. Care must be guided by an NNP and health care team who understand the ethical princi- ples and decision making related to issues confronted in neonatal intensive care unit (NICU) practice. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Societal Issues
Ongoing cost containment pressures in the health care sect01· have significantly changed the traditional practice of delivering health care. Goals of reduced expenditures and services and increased efficiency, although important, may compete with enhanced quality oflife for patients and. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
cHAPTER 13 Ethical Decision Making
improved treatment and care, creating tension between providers and administrators, particularly in managed care systems in which providers find that their clinical decisions are subject to outside review before they can be reimbursed. Ulrich and associates (2006) surveyed NPs and physician assistants to identify their ethical concerns in relation to cost containment efforts, including managed care. They found that 72% of respondents reported ethical concerns related to limited access to appropriate care and more than 50% reported concerns related to the quality of care. An earlier study of 254 NPs revealed that 80% of the sample perceived that to help patients, it was sometimes necessary to bend managed care guidelines to provide appropriate care (Ulrich, Soeken, & Miller, 2003). Most respondents in this study reported being moderately to extremely ethically concerned with managed care; more than 50% said that they were concerned that business decisions took priority over patient welfare and more than 75% stated that their primary obligation was shifting from the patient to the insurance plan. Although the passage of the Patient Protection and Affordable Care Act (PPACA; U.S. Department of Health & Human Services fHHSJ, 2011) may help with these concerns to some extent, the ethical tensions that underlie cost containment pressures and the business model orientation of health care delivery may continue.
An example of how cost containment goals can create conflict is a situation in which a NP wishes to order a computed tomography (CT) scan to evaluate a patient complaining of abdominal pain. The NP knows that the patient has a history of diverticulosis resulting in abscess formation and the current pres·entation with fever and abdominal tenderness justifies this testing; however, the insurance approval process takes a minimum of 24 hours. By sending the patient to the emergency room, the test can be done more quickly, but the patient will also face a long wait and a high copay if she does not require subse- quent hospital admission. Limiting access to CT scans is based on containing costs and avoiding unnecessary testing, which are two laudable goals. However, in this situation, the lengthy approval process means that the NP does not have needed information to direct the treatment plan and alleviate the patient’s suffering in a timely manner. The use of the emergency room to obtain essen- tial clinical information is a greater burden on the patient and may ultimately prove more expensive to the system. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Technologic advances, such as the rapidly expanding :field of genetics, are also challenging APNs (Caulfield, 2012; Harris, Winship, & Spriggs, 2005; Horner, 2004; Pullman & Hodgkinson, 2006). As Hopldnson and Mackay (2002) have noted, although the potential impact of mapping the human genome is immense, the challenge of how to translate genetic data rapidly into improvements
331
332 PART IT Competencies of Advanced Practice Nursing
in the prevention, diagnosis, and treatment of disease remains. To counsel patients effectively on the risks and benefits of genetic testing, APNs need to stay current in this rapidly changing field (a helpful resource for this and other issues is the text by Steinbock, Arras, and London, 2012), As one example, genetic testing poses a unique challenge to the informed consent process. Patients may feel pressured by family members to undergo or refuse testing, and may require intensive counseling to under- stand the complex implications of such testing; APNs are also involved in post-test counseling, which raises ethical concerns regarding the disclosure of test results to other family members (Eden, 2006). Because genetic information is crucially linked to the concepts of privacy and confidentiality, and the availability of this information is increasing, it is inevitable that APNs will encounter legal issues and ethical dilemmas related to the use of genetic data. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
APNs may engage in research as principal investiga- tors, co-investigators, or data collectors for clinical studies and trials. In addition, leading quality improvement (QI) initiatives is a key expectation of the DNP-prepared APN (AACN, 2006). Ethical issues abound in clinical research, including recruiting and retaining patients in studies, pro- tecting vulnerable populations from undue risk, and ensuring informed consent, fair access to research, and study subjects’ privacy. As APNs move into QI and research initiatives, they may experience the conflict between the clinician role, in which the focus is on the best interests of an individual patient, and that of the researcher, in which the focus is on ensuring the integrity of the study (Edwards & Chalmers, 2002).
Access to Resources and Issues of Justice
Issues of access to and distribution of resources create powerful dilemmas for APNs, many of whom care for underserved populations. Issues of social justice and equi- table access to resources present formidable challenges in clinical practice. Trotochard (2006) noted that a growing number of uninsured individuals lack access to routine health care; they experience worse outcomes from acute and chronic diseases and face higher mortality rates than those with insurance. McWilliams and colleagues (2007) found that previously uninsured Medicare beneficiaries require significantly more hospitalizations and office visits when compared with those with similar health problems who, prior to Medicare eligibility, had private insurance. The PPACA, when fully enacted, will help improve access to quality care and decrease the incidence of these dilem- mas. However, as noted, the escalating costs of health care represent ethical challenges to providers and systems alike, regardless of the population’s insurance status. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
The allocation of scarce health care resources also creates ethical conflicts for providers; regardless of pay- ment mechanisms, there are insufficient resources to meet all societal needs (Bodenheimer & Grumbach, 2012; Trotochard, 2006). Scarcity of resources is more severe in developing areas of the world and justice issues of fair and equitable distribution of health care services present serious ethical dilemmas for nurses in these regions (Harrowing & Mill, 2010). A further international issue is the “brain drain” of nurses and other health professionals who leave underdeveloped countries to take jobs in developed countries (Chaguturu & Vallabhaneni, 2007; Dwyer, 2007). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Allocation issues have been described in the area of organ transplantation but dilemmas related to scarce resources also arise in regard to daily decision maldng, for example, with a CNS guiding the assignment of patients in a staffing shortage, or an FNP finding that a specialty consultation for a patient is not available for several months. Whether in community or acute care settings, APNs must, on a daily basis, balance their obligation to provide holistic, evidence-based care with the necessity to contain costs and the reality that some patients will not receive needed health care. As Bodenheimer and Grumbach (2012) have noted, “Perhaps no tension within the U.S. health care system is as far from reaching a satis- factory equilibrium as the achievement of a basic level of fairness in the distribution of health care services and the burden of paying for those services” (p. 215).
One of the value-added components that APNs bring to any practice setting is creativity and a wide range of patient management strategies, which are crucial in caring for large numbers of uninsured and underinsured persons. It is not uncommon for an APN to encounter a patient who has been forced to stop taking certain medications for financial reasons. Although many practitioners pre- scribe generic forms of medications, if available, some patients still have to pay an exorbitant price for their medi- cations. For example, an acute care nurse practitioner (ACNP) managing an underinsured patient with chronic lung disease and heart failure discovers that the patient is unable to pay for all the medications prescribed and has elected to forego the diuretic and an angiotensin- converting enzyme inhibitor (ACE-I). Because the ACNP knows that ACE-Is are associated with reduced morbidity and mortality rates, and that diuretics control symptoms and prevent rehospitalization, these changes are discour- aged. Instead, the ACNP helps the patient make more suitable choices when altering medications, such as dosing some medications on an every-other-day basis. The ACNP has helped the patient cope with the situation but must face the morally unsettling fact that this plan of care is medically inferior. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Finally, as APNs broaden their perspectives to encom- pass population health and increased policy activities, both essential competencies of the DNP-prepared APN (AACN, 2006), they will experience the tension between caring for the individual patient and the larger population (Emanuel, 2002). Caregivers are increasingly being asked to incorporate population-based cost considerations into individualized clinical decision making (Bodenheimer & Grumbach, 2012). Population-based considerations pre- sent a challenge to the moral agency of APNs, who have been educated to privilege the individual clinical decision.
Legal Issues
Over the last 30 years, the complexity of ethical issues in the health care environment and the inability to reach agreement among parties has resulted in participants turning to the legal system for resolution. A body of legal precedent has emerged, reflecting changes in society’s moral consensus. Ideally, moral rights are upheld or protected by the law. For example, the Culturally and Linguistically Appropriate Services (CLAS) Standards established by the HHS mandate that health care institu- tions receiving federal funds provide services that are accessible to patients regardless of their cultural back- ground (HHS, Office of Minority Health, 2001). These standards provide a legislative voice for the ethical obliga- tion to respect all persons, regardless of their cultural background and primary language. In a different voice, the PPACA (HHS, 20ll) has mandated that persons who can afford health insurance purchase it or pay a penalty, starting in 2014. According to this law, societal benefi- cence, in the form of limiting high expenditures on the care of uninsured persons, is preferred over individual autonomy (Trautman, 2011). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
APNs must use caution and not conflate legal perspec- tives with ethical decision making. In many cases, there is no relevant law and thoughtful deliberation of the ethical issues offers the best hope of resolution. In addition, looking to the judicial system for guidance in ethical deci- sion making is troubling because the judicial aim is to interpret the law, not to satisfy the ethical concerns of all parties involved. In addition, clinical understanding may be absent from the judicial perspective. Involvement of the media may further confuse the situation, as was evident in the Schiavo case (Gostin, 2005). The legal guidelines in that case were dear; the Florida court system repeatedly upheld the right of Ms. Schiavo’s spouse to refuse nutrition and hydration on her behalf However, advocacy groups, politicians, and Ms. Schiavo’s parents used the media to offer a variety of interpretations of the case and wielded political power to prevent removal of the feeding tube and to have it replaced twice after it was removed. Clearly, the
CHAPTER 13 Ethical Decision Making
legal perspective did not satisfy the moral concerns of all involved. Unfortunately, much of the publicity focused on the emotional experience of the parents fearing the loss ,of their daughter and not on careful consideration of the ethical elements. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Sometimes, the law not only falls short of resolving ethical concerns, but contributes to the creation of new dilemmas. Changes in the Medicare hospice benefit under the PPACA (HHS, 2011) offer a dear example. Designed to prevent hospice agencies from enrolling and re-enrolling patients who do not meet criteria, the new regulations require a face-to-face assessment by a health care provider to recertify hospice eligibility at set intervals after the initial enrollment (Kennedy, 2012). Often, patients with dementia or another slowly progressive disease state who enroll in hospice experience an initial period of stability, likely because they have improved symptom management and access to comprehensive services. If this stability extends to the next certification period, the patient may face disenrollment. For the practitioner conducting the assessment, this creates the ethical dilemma of wanting to be truthful regarding the patient’s status and at the same time avoid removing a service that is benefiting the patient and family. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Ethical Decision Making Competency of Advanced Practice Nurses
There are a number of reasons why ethical decision maldng is a core competency of advanced practice nursing. As noted, clinical practice gives rise to numerous ethical concerns and APNs must be able to address these con- cerns. Also, ethical involvement follows and evolves from clinical expertise (Benner, Tanner, & Chesla, 2009). Another reason why ethical decision malting is a core competency can be seen in the expanded collaborative skills that APNs develop (see Chapter 12). APNs practice in a variety of settings and positions but, in most cases, the APN is part of an interprofessional team of caregivers. The team may be loosely defined and structured, as in a rural setting, or more definitive, as in the acute care setting. The recent re-emergence of an interprofes- sional care model is changing practice for all providers (Interprofessional Collaborative Initiative [IPECJ, 2011). Regardless of the structure, APNs need the knowledge and skills to avoid power struggles, broker and lead interdis- ciplinary communication, and facilitate consensus among team members in ethically difficult situations. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Phases of Core Competency Development
The core competency of ethical decision making for APNs can be organized into four phases. Each phase depends on
333
334 PART Il Competencies of Advanced Practice Nursing
Phases of
1. Knowledge Development-Moral Sensitivity
2. Knowledge Application-Moral Action
3. Creating an Ethical Environment
4. Promoting Social Justice Within the Health Care System
of Core
Ethical theories
Ethical issues in specialty
Professional code
Professional standards
Legal precedent
Moral distress
Ethical decision-making frameworks
Mediation and facilitation strategies
Preventive ethics
Awareness of environmental barriers to ethical practice
Concepts of justice
Health policies affecting a specialty population
the acquisition of the lmowledge and skills embedded in the previous level. Thus, the competency of ethical deci- sion making is understood as an evolutionary process in an APN’s development. Phase 1 and beginning exposure to Phase 2 should be explicitly taught in the APN’s gradu- ate education. Phases 3 and 4 evolve as APNs mature in their roles and become comfortable in the practice setting; these phases represent leadership behavior and the full enactment of the ethical decision maldng competency. Phase 4 relies on competencies required of DNP-prepared APNs; the knowledge and sldlls needed for Phases 3 and 4 should be incorporated into DNP programs. Although an expectation of the practice doctorate, all APNs should develop their ethical knowledge and sldlls to include ele- ments of all four phases of this competency. The essential elements of each phase are described in Table 13-1.
Phase 1: Knowledge Development The first phase in the ethical decision making competency is developing core lmowledge in ethical theories and prin- ciples and the ethical issues common to specific patient
for Ethical Decision
Sensitivity to ethical dimensions of clinical practice — — — —- —– — – —
Values clarification
Sensitivity to fidelity conflicts
Gather relevant literature related to problems identified
Evaluate practice setting for congruence with literature
Identify ethical issues in the practice setting and bring to the attention of other team members
Apply ethical decision making models to clinical problems
Use skilled communication regarding ethical issues
Facilitate decision making by using select strategies
Recognize and manage moral distress in self and others
Role model collaborative problem solving
Mentor others to develop ethical practice
Address barriers to ethical practice through system changes
Use preventive ethics to decrease unit-level mor~l distress
Ability to analyze the policy process
Advocacy, communication, and leadership skills
Involvement in health policy initiatives supporting social justice
populations or clinical settings. This dual knowledge enables the APN student to integrate philosophical con- cepts with contemporary clinical issues. The emphasis in this initial stage is on learning the language of ethical discourse and achieving cognitive mastery. The APN learns the theories, principles, codes, paradigm cases, and relevant laws that influence ethical decision making. With this knowledge, the APN begins to compare current prac- tices in the clinical setting with the ethical standards desctibed in the literature.
Phase 1 is the beginning of the APN’s personal journey toward developing a distinct and individualized ethical framework. The work of this phase includes developing sensitivity to the moral dimensions of clinical practice (Weaver, 2007). A helpful initial step in building moral sensitivity is understanding one’s values, in which students clarify the personal and professional values that inform their care (Fry & Johnstone, 2008). Engaging in this work uncovers personal values that may have been internalized and not openly aclmowledged, and is particularly impor- tant in our multicultural world. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answersm
Another key aspect of this phase is developing the ability to distinguish a true ethical dilemma from a situa- tion of moral distress or other clinically problematic situ- ation. This requires a general understanding of ethical theories, principles, and standards that help the APN define and discern the essential elements of an ethical dilemma. Novice APNs should be able to recognize a moral problem and seek clarification and illumination of the concern. The APN identifies ethical issues and formu- lates the concerns about which others are uneasy. This step earns credibility and enables the APN to gain self- confidence by bringing the issue to the awareness and attention of others. If the issue remains a moral concern after clarification, the APN should pursue resolution, seeking additional help if needed.
Formal education in ethical theories and concepts should be included in graduate education programs for APNs. Although some beginning graduate students will have had significant exposure to ethical issues in their undergraduate programs, most have not. A 2008 U.S. survey of nurses and social workers found that only 51% of the nurse respondents had formal ethics education in their undergraduate or graduate education; 23% had no ethics training at all (Grady, Danis, Soeken, et al., 2008). APN students with no ethics education will be at a disad- vantage in developing this competency because graduate education builds on the ethical foundation of professional practice. The current master’s essentials (AACN, 2011) do not address ethics education directly but include compe- tencies in the use of ethical theories and principles. The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006) contains explicit ethical content in five of the eight major categories (Box 13-1). Even catego- ries that do not explicitly list necessary ethical content imply it in referring to issues such as improving access to health care, addressing gaps in care, and using conceptual and analytic skills to address links between practice and organizational and policy issues.
Exposure to ethical theories, principles, and concepts allows the APN to develop the language necessary to articulate ethical concerns in an interprofessional envi- ronment. It is important, however, that lmowledge devel- opment extend beyond classroom discussions. Clinical practicum experiences also need to build in discussions of ethical dimensions of practice explicitly rather than assume that these discussions will naturally occur. In one study of the clinical experiences of graduate students from four graduate programs, only 4 of20 students were identi- fied as having experience with an ethical dilemma and only 2 of 22 preceptors noted any exposure to ethical dilemmas for students (Howard & Steinberg, 2002). The authors concluded that this apparent void in clinical edu- cation may have been a function oflimited recognition of. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
CHAPTER 13 Ethical Decision Maldng 335
Ethical Competencies in the DNP Essentials*
Integrate nursing scierice with· knowledge: froin ethiCs .and biophysiCal •. psychoS()Ci~l~ analytic, ahd organizational sciences as the basis for the highest level’ Of nurSing practice. (I) Develop and/or eValuate etfective.stfategies for· man·aging the ethical dilemmas inherent in patient care, the health.~are orgimizatiOn; and research. (II) Desigll, direct, .arid evaluate qualitY: ImProv:eme.~t methodologies to promote safe, timely, effective, efficient, equitable (emphasis added), and patierit-centered care.·(I!I) Piovide’leadership i.n the ev~luation.and reSolution of ethical and legal issue’s within health care systems relating to ‘the use of inform·ation, inforrilatio·n technology, conirhunication netWorks; ‘arid ·patient care technology. (IV) Advocate for social justice, equity; .a~d ethi~al
within. all health care arenas. (V)
‘Essential number in parentheses. From American Association of Colleges of Nursing. (2006). Tile essentials of doctoral education for advanced nursing practice. Washington, DC: Author.
ethical decision making processes by APN students and preceptors. In another study, Laabs (2005) noted that 67% of NP respondents claimed that they never or rarely encountered ethical issues. Some respondents showed confusion regarding the language of ethics and related principles. In a later study, Laabs (2012) found that APN graduates, most of whom had had an ethics course in their graduate curriculum, indicated a fairly high level of con- fidence in their ability to manage ethical problems, but their overall ethics knowledge was low. These three studies provide compelling commentary on the need for Phase 1 activity in graduate curricula.
The core knowledge of ethical theories should be sup- plemented with an understanding of issues central to the patient populations with whom the APN works. As APNs assume positions in specific clinical areas or with particu- lar patient populations, it is incumbent upon them to gain an understanding of the applicable laws, standards, and regulations in their specialty, as well as relevant paradigm cases. This information may be garnered from current literature in the field, continuing education programs, or discussions with colleagues. Information on legal and policy guidelines should be offered during graduate pract- icum experiences in the area of clinical concentration. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
336 PART II Competencies of Advanced Practice Nursing
Although Phase 1 is the building block for the other phases of this competency, it is also an ongoing process. APNs will gain core knowledge in graduate education but, as societal issues change and new technologies emerge, new dilemmas and ethical problems arise. The ability to be a leader in creating ethical environments involves a commitment to lifelong learning about ethical issues, of which professional education is just the beginning.
Developing an Educational Foundation As noted, education in ethical theories, principles, rules, and moral concepts provides the foundation for develop- ing skills in ethical reasoning. Because the APN will apply these theoretical p1inciples in actual encounters with patients, it is imperative that consideration of the context in specific situations be strengthened. A portion of gradu- ate ethics education should involve discussion of typical issues encountered by APNs, rather than issues that receive extensive media attention but occur infrequently. Howard and Steinberg (2002) maintained that graduate curricula need to go beyond traditional ethical issues to encompass building trust in the APN -patient relationship, professionalism and patient advocacy, resource allocation decisions, individual versus population-based responsi- bilities, and managing tensions between business ethics and professional ethics. The latter three areas are crucial for developing the Phase 4 level of the ethical decision malting competency.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Continuing education programs are also effective and necessary forums in which current information can be provided in a rapidly changing health care environment. As technology changes and new dilemmas confront prac- titioners, the APN must be prepared to anticipate condi- tions that erode an ethical environment. Knowledge and skills in all phases of this competency depend on the appli- cation of current ethical knowledge in the clinical setting; ethical reasoning and clinical judgment share a common process and each serves to teach and inform the other (Dreyfus, Dreyfus, & Benner, 2009). Therefore, the impor- tance of clinical practice cannot be overemphasized.
Overview ofEthkal11wories Prillciple-Based ll1odel. Although ethical decision
making in health care is extensively discussed in the bio- ethics literature, two dominant models are most often applied in the clinical setting. The first model of decision maldng is a principle-based model (Box 13-2), in which ethical decision maldng is guided by principles and rules (Beauchamp & Childress, 2009). In cases of conflict, the principles or rules in contention are balanced and inter- preted with the contextual elements of the situation. However, the final decision and moral justification for actions are based on an appeal to principles. In this way NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Principles and Rules Important to Professional Practice
Principle’ofrespect,for autonomy: The duty to respect_othe1:s’ personal liberty and individual values, beliefs, and choices Principle-of ilorunaleficence: The duty not to inflict harm or evil Principle of beneficence: The duty to do good and pfevent or remove harm Principle of formal justice: The duty to treat equals equally and treat those who are_ t.lnequal according to their ne_eds Rule of veracity: The duty to tell the truth and not to deceive others Rukof fidelity: The duty to honor commitments Rule of confidentiality: The duty not to. disclose, information shared in ‘an intimate and tmSted manner Rule of privacy: The duty to respect limite<:l access to a_person
Adapted from Beauct1amp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.
the principles are binding and tolerant of the particulari- ties of specific cases (Beauchamp & Childress). The prin- ciples of respect for persons, autonomy, beneficence, nonmaleficence, and justice are commonly applied in the analysis of ethical issues in nursing. The American Nurses Association (ANA) Code of Ethics for Nurses (2001) has endorsed the principle of respect for persons and under- scores the profession’s commitment to serving individuals, families, and groups or communities. The emphasis on respect for persons throughout the code implies that it is not only a philosophical value of nursing, but also a binding principle within the profession.
Although ethical principles and rules are the corner- stone of most ethical decisions, the principle-based approach has been criticized as being too formalistic for many clinicians and lacldng in moral substance ( Gert, Culver, & Clouser, 2006). Other critics have argued that a principle-based approach conceals the particular person and relationships and reduces the resolution of a clinical case simply to balancing principles (Rushton & Penticuff, 2007). Because all the principles are considered of equal moral weight, this approach has been seen as inadequate to provide guidance for moral action ( Gett et al., 2006; Strong, 2007). In spite of these critiques, bioethical prin- ciples remain the most common ethical language used in clinical practice settings. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answersm
Casuistry. The second common approach to ethical decision maldng is the casuistic model (Box 13-3), in
Alternative Ethical
Casuistry Direct analysis of particular cases Uses previous paradigm cases to infer ethical action in a current case Analogues in common law and case law Values practical knowledge’ rather than theory (pretheoretical) Privileges experience
Narrative Ethics Supplements principles by emphasizing importance of full context Gathers views of all parties to provide more complete baSis for moral justification Story and narrator substitute for ethical justification, which emerges naturally Privileges stories
Virtue-Based Ethics Emphasizes the moral agent, not the situation or the action Right motives and character reveal more about moral worth than right actions Character more important than conformity to rules
which current cases are compared with paradigm cases (Beauchamp & Childress, 2009; Jonsen & Toulmin, 1988; Toulmin, 1994). The strength of this approach is that a dilemma is examined in a context -specific manner and then compared with an analogous earlier case. The funda- mental philosophical assumption of this model is that ethics emerges from human moral experiences. Casuists approach dilemmas from an inductive position and work from the specific case to generalizations, rather than from generalizations to specific cases (Beauchamp & Childress, 2009). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Concerns have also been raised regarding the use of a casuistic model for ethical decision making. As a moral dilemma arises, the selection of the paradigm case may differ among the decision makers and thus the interpreta- tion of the appropriate course of action will vary. In nursing, there are few paradigm cases of ethical issues on which to construct a decision making process. Further- more, other than the reliance on previous cases, casuists have no mechanisms to justify their actions. The possibil- ity that previous cases were reasoned in a faulty or inac- curate manner may not be fully considered or evaluated (Beauchamp & Childress, 2009). In spite of these con- cerns, the case-based moral reasoning used in casuistry appeals to clinicians because it mimics clinical reasoning, in which providers often appeal to earlier similar cases to
CHAPTER 13 Ethical Decision Making
“‘ Righ~ motives make for right actions Privileges actor’s values and motives
Feminist Ethics Views women as embodied, fully rational, and having experiences relevant to moralt’easoning Emphasizes view of the disadvantaged-women and other underrepresented groups Emphasizes importance and value of openness to different perspectives Concerned with power differentials that create oppression Emphasizes importance of attention to the vulnerable and to resulting inequalities Privileges power imbalancesCare-Based Ethics Emphasizes creating and sustaiining responsive connection with others Emphasizes importance of context and subjectivity in discerning ethical action Sees individuals as interdependent rather than independent; focuses on parties in a relationship Privileges relationships.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
make clinical judgments. Artnak and Dimmitt (1996) applied the casuistic model to an analysis of a complex case, concluding that the use of this approach allows fuller consideration of the contextual particulars ofthe case and provides a systematic approach for organizing and analyz- ing the facts of the case. An adaptation of this approach has been developed by Jansen and colleagues (2010), sometimes referred to as the “four box” approach. These authors have advocated clustering patient information according to four key topics-medical indications, patient preferences, quality of life, and contextual features-and then using that information to resolve a dilemma. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Narrative Ethics. Because neither of these theoretical approaches have been seen as fully satisfactory, altern a- tives have emerged (see Box 13-3). Narrative approaches to ethical deliberation have evoked considerable interest (Charon & Montello, 2002; Nelson, 2004; Rorty, Werhane, & Mills, 2004). Narrative ethics emphasizes the particulars of a case or story as a vehicle for discerning the meaning and values embedded in ethical decision making. The argument is that all knowing is bound up in a narrative tradition and that all participants in ethical deliberations need the coherence and singular meaning given to a particular situation that only narrative knowledge can provide. Narrative ethics begins with a patient’s story and has some similarities with casuistry in its inductive
337
338 PART II Competencies of Advanced Practice Nursing
particularistic approach. Critics of this approach have argued that although narrative is a necessary element in ethical analysis, it cannot supplant principle- or theory- based ethics (Arras, 1997; Childress, 1997). There is, howevet~ recognition that careful consideration of patient’s stories can enlarge and enrich ethical delibera- tions. In commenting on narrative versus principle-based approaches, Childress (1997) noted that “We need both in any adequate ethics” (p. 268). As with casuistry, narrative-based approaches appeal to nurses, who find much of the meaning in their work through entering into the stories of their patient’s lives.
Care-Based Ethics. Other approaches, such as virtue- based ethics, feminist ethics, and care-based ethics, provide alternative processes for moral reflection and argument (Beauchamp & Childress, 2009; Wolf, 1996), Historically, nursing ethics was virtue-based, with an emphasis on qualities necessary to be a virtuous nurse. Although this is no longer a dominant theme in nursing literature, it can still be seen. For example, Gallagher and Tschudin (2010) based their understanding of ethical leadership in professional values and virtues.
The ethics of care has emerged as relevant to nursing (Cooper, 1991; Edwards, 2009; Lachman, 2012). The care perspective constructs the central moral problem as
Clinical Situation
To illustrate the different ethical approaches, consider the case of a 64-year-old man, GB, who is unable to speak for himself because of an aggressive brain tumor. He had seen a neurosurgeon 1 month prior to the current hospital adillission and was told that the tumor was inoperable. He has been undergoing outpatient radiation treatment and is now taken to his local hospital because of altered mental status. In the emergency room, his condition worsens; he is unable to communicate or breathe so he is started on mechanical ventilation and transferred to the ICU. Imaging shows that the tumor has continued to progress, despite radiation. The patient’s daughter requests that the patient be transferred to another facility for a second opinion from a different neurosurgeon. The social worker has a copy of the patient’s advance directive, completed prior to starting radiation, which states that he does not desire aggressive medical treatment if there is little hope of recovery. The team caring for the patient, including a staff nurse, resi- dent, attending physician, social worker, and CNS apply different ethical theories when they approach this case. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
The nurse adopts a principle-based approach, favor- ing patient autonomy and respect for persons, as empha- sized in the Code of Ethics for Nurses (ANA, 2001). He
sustaining responsive connections and relationships with important others, and consequently focuses on issues sur- rounding the intrinsic needs and corresponding responsi- bilities that occur in relationships (Gilligan, 1982; Little, 1998). In this approach, moral reasoning requires empathy and emphasizes responsibilities rather than rights. The response of an individual to a moral dilemma emerges from important relationship considerations and the norms of friendship, care, and love. Viens (1995) reported that NPs she interviewed used a moral reasoning process that mirrored Gilligan’s model in the major themes of caring and responsibility.
Although every ethical theory has some limitations and problems, an understanding of contemporary approaches to bioethics enables the APN to appeal to a variety of perspectives in achieving a moral resolution. In the clinical setting, ethical decision making most often reflects a blend of the various approaches rather than the application of a single approach. Although there is some danger in oversimplifying these rich and complex approaches, Exemplar 13-1 shows how they can be reflected in ethical decision making. A more thorough discussion of ethical theory is beyond the scope of this chapter, but the reader is referred to the references cited for more detail.
Ethical
recognizes the daughter’s distress but believes that her desire to seek a second opinion comes from her own fear of losing her father and is not based on her knowledge of the patient’s wishes. Because the patient should be respected as a person, keeping him on life support or transferring him to another institution as a means to alleviate his daughter’s fears is unethical. The nurse believes that the daughter’s inability to support her father’s advanced directive renders her an inappropriate decision maker. The advance directive, as an indication of the patient’s autonomous wishes, should guide care. Because it clearly states the patient that does not wish to be kept alive with little hope of recovery, he favors withdrawal of ventilator support and institution of comfort measures only. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
The resident had a case a year ago, when she was still a medical student, in which a patient’s cancer was thought to be inoperable but a second opinion was sought and the patient went on to survive surgical inter- vention. This case, occurring early in her career in health care, profoundly influences her to support second opin- ions on complicated surgical cases. Applying a casuistry- based approach, the resident supports the daughter’s request and agrees to help her explore avenues for
CHAPTER 13 Ethical Decision Maldng
Clinical Situation Demonstrating Differing Ethical
transferring the patient for consultation with a different neurosurgeon on the slim chance that he may be eligible for additional treatment to prolong his life. She consults the social worker to assist in investigating the feasibility of transferring the patient.
The attending physician adopts a care-based approach, privileging the relationships within the patient’s family. He himself has a long-standing relation- ship with the neurosurgeon who was previously con- sulted, and he trusts that a second opinion at an outside facility will not yield a different prognosis. He favors keeping the patient in his current setting, because transferring him to a distant facility will take him far from his family, and their time with him is essential He does not see any reason to withdraw mechanical ventilation but he also believes that initiating cardiopulmonary resuscitation (CPR) would be futile and would disrupt the peaceful atmosphere his family deserves as they struggle with the loss of their father and grandfather. He there- fore convinces the patient’s daughter to agree to a do not resuscitate (DNR) order, and closes the discussion by encouraging her and the rest of the family to stay with the patient and to “be together at this crucial time:’ He also asks the ICU staff to relax the regulations regarding family visitation so that the daughter and her children can spend more time at GB’s bedside.
The social worker completes a lengthy assessment of the patient and family in response to the consult requested by the resident. In the process, she learns that the family has limited financial resources and that the patient’s daughter has a lOth-grade education. Prior to GB’s diagnosis, her only interactions with the health care system were the births of her three children. Her mother died when she was teenager and, for the past few years, her father has assisted her in the care of her children. The social worker views the attending physi- cian as condescending, and she hears one of the ICU nurses describe the daughter as “totally clueless:’ Inter- preting the case from a feminist viewpoint, she worries that the family’s socioeconomic status and the daughter’s educational background are creating a bias against hon- oring the request for transfer. She is determined to advocate for the patient’s daughter to correct this power imbalance. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
The CNS’s involvement in the case begins when the nurse consults her because his appeals to the resident and attending physician have failed to result in what he
believes is the right course of action-namely with- drawal of the ventilator. The CNS listens to the nurse’s story and attends carefully to the details he gives. She then seeks out the resident) attending physician, and social worker to hear their perspectives. She adopts a narrative-based approach and wants to hear all the con- textual features of the case before coming to a conclusion about the best course of action. When she speaks to GB’s daughter, she learns about the conversation that she had with her father shortly before he became unresponsive, in which he expressed a desire to attend her oldest child’s high school graduation. It is this conversation that led the patient’s daughter tO request a transfer for a second opinion: “I know he wants to Jive;’ she explains, “no matter what it says on that paper:’
Resolution of the Case The CNS calls a team meeting. She asks the members to work toward a consistent message that can be given to GB’s family because the contrasting views are dearly creating confusion. This request results in careful review of the clinical aspects of the case, including the most recent magnetic resonance imaging (MRI) scan, and brings the team to an agreement that the patient’s prog- nosis is poor and a second opinion from an outside neurosurgeon is not necessary to confirm this. The social worker has an opportunity to ask questions and is thus assured that the team was unaware of the daughter’s educational background and economic status and are not basing their care on these factors. The CNS then moves forward to establish a mutually acceptable plan of care. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers
In a subsequent family meeting, the team explains the patient’s prognosis to the patient’s daughter using layman’s terms and simple pictures to clarify the growth of the tumor and its position. After addressing the family’s questions, the CNS presents two options- withdt•awing intensive care interventions or continuing to provide this care with the DNR order in place. She explains that the team has met separately to consider carefully the daughter’s request for transfer GB and determined that the risks of such a plan outweigh poten- tial benefits. The CNS ends the meeting with the family by offering them additional time to discuss their options and ask any further questions. After several days, the family elects to withdraw the ventilator and initiate comfort measures.
339
34D PART II Competencies of Advanced Practice Nursing
Professional Codes and Guidelines
The ANA’s Code of Ethics for Nurses (2001) describes the profession’s philosophy and general ethical obligations of the professional nurse. It describes broad guidelines that more reflect the profession’s conscience than provide specific directions for pa1ticular clinical situations. It provides a framework that delineates the nurse’s overriding moral obligations to the patient, family, community, and profession.
Professional organizations delineate standards of performance that reflect the responsibilities, obligations, duties, and rights of the members. These standards also can serve as guidelines for professional behavior and define desired conduct. Although the general principles are relatively stable, professional organizations often reflect on specific or contemporary issues and take a proactive position on pivotal concerns. For example, the American Association of Critical-Care Nurses (2008) has issued a position paper on moral distress, acknowledging that it negatively affects quality of care and influences nurses who are considering leaving the profession. The paper then lists the responsibilities of nurses to address moral distress, some resources that can be helpful to them, and the obligations of nurses’ employers to offer support, such as employee assistance programs and ethics committees, to assist with managing moral distress. An additional example is the International Association of Forensic Nurses’ position paper (2009) supporting the use of emergency contraception for victims of sexual assault. This document provides ethical and clinical rationales for policies that permit dispensing of these medications. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Personal a11d Professional Values Individuals’ interpretations and positions on issues are a reflection of their underlying value system. Value systems are enduring beliefs that guide life choices and decisions in conflict resolution (Ludwick & Silva, 2000). Viens (1995) found that values were an essential feature of the everyday practice of the 10 primary care NPs she inter- viewed. Values of caring, responsibility, trust, justice, honesty, sanctity and quality of life, empathy, and religious beliefs were articulated by the study participants, often as ideals that motivated their actions. An awareness of per- sonal values generates more consistent choices and behav- iors; it can also assist APNs to be aware of the boundaries of their personal and professional values so that they can recognize when their own positions may be unduly influ- encing patient and family decision making.
Values awareness should include an understanding of the complex interplay between cultural values and ethical decision making (Buryska, 2001; Ludwig & Silva, 2000). When patient and family decisions contradict traditional.
Western medical practice, health care providers may resort to coercive or paternalistic measures to influence patient’s choices to be more consistent with the provider’s values. APNs and other health care providers must under- stand that the assumptions they make may be based on their own cultural values and biases and understand how these assumptions may influence their recommendations of particular treatments. As health care professionals gain an understanding of factors that guide a person’s decisions, treatment plans that reflect the patient’s value preferences are more easily developed. for example, a patient from a Southeast Asian culture may show respect to authority figures by obeying the APN’s treatment suggestions, even if he or she disagrees with the plan. In this situation, the APN could assure the patient that questions about the plan of care are welcomed and are not disrespectful.
.
By the same token, claims made in the name of reli- gious and cultural beliefs are not absolute. Buryska (2001) offered helpful guidelines for clinicians to assess the defensibility of patient and family claims made in the name of cultural or religious considerations. For example, he maintained that spiritual or cultural claims grounded in an identifiable and established community are more defensible than those that are idiosyncratic to the person malting the claim. Although it is critical for caregivers to respond with respectful dialogue, support, and compas- sionate care, patient and family demands for treatment must be considered in relation to other claims that also have ethical weight-the professional integrity of provid- ers, legal considerations, economic realities, and issues of distributive justice.
Professional Bou1utaries In their professional capacity, APNs have access to per- sonal and private patient information and may develop long-term therapeutic relationships with many of their patients. The atmosphere of intimacy in the nurse-patient relationship, coupled with the need to touch the patient during a physical examination, sets up a power differential that accentuates the patient’s vulnerability (Holder & Schenthal, 2007). Boundaries must be established that acknowledge the appropriate and necessary use of this patient information and intimacy to meet the patient’s needs and provide care. The obligation to maintain profes- sional boundaries within a therapeutic relationship is shared with all nurses (ANA, 2001), but APNs are also in a position to observe for boundary violations by others and to intervene when they occur.
Boundary violations, in which the APN or another health care professional inadvertently or purposely breaches the limits and expectations of the relationship, may profoundly alter the foundation of a therapeutic
relationship. Such transgressions may be subtle, such as the APN sharing excessive personal information, or blatant, as in sexually seductive behavior. Regardless of the magnitude of the violation, the behavior must be con- fronted immediately and the culpable individual must be removed from interaction with the patient. Other members of the health care team should strive to restore the patient’s integrity and trust, involving the help of others as necessary (National Council of State Boards of Nursing, 2009). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Phase 2: Knowledge Application The second phase of the core competency is applying the knowledge developed in the first level to the clinical practice arena. Phase 2 continues the APN’s journey in assessing ethical problems and being actively involved in the process of resolving ethical dilemmas. As APNs acquire core ethical decision making knowledge, the responsibility to take moral action becomes more compel- ling. Rather than retrospectively analyzing ethical dilem- mas, the APN takes moral action, which implies that the APN recognizes, pursues, and responds to ethical issues. Often, the inequities toward or infringements on other persons are enough to motivate moral action and a timely response can change the course in present and future situations. 1herefore, moral action should not be under- estimated as a core APN skill and should be recognized, fostered, and valued by others. Once an advanced nursing role is assumed, the APN accepts the responsibility to be a fUll participant in the resolution of moral dilemmas rather than simply an interested observer or one of many parties in conflict.
Although the core knowledge of ethical concepts pro- vides the foundation for moral reasoning, the application of these concepts enables the APN to develop the practical wisdom of moral reasoning. It is the experience in the practice setting and the courage of the APN to discuss sensitive issues openly that enable the APN to assume an active role in dispute resolution. The success and speed with which the APN gains these behavioral skills is related to the presence of mentors in the clinical setting and the willingness of the APN to become immersed in ethical discussions. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Institutional resources, such as ethics committees and institutional review boards, provide valuable opportunities for APNs to participate in the discussion of ethical issues. Typically, hospital ethics committees serve three functions-policy formation, case review, and education. As a member of the ethics committee, the APN exchanges ideas with colleagues and gains an understanding of ethical dilemmas from a variety of perspectives. In addition, the APN is informed of current legislation, regulations, and hospital policies that have ethical implications.
CHAP T E R 13 Ethical Decision Making
This is an extremely valuable experience that can accelerate the development of ethical decision making skills.
Unfortunately, most APNs do not have the opportunity to serve on interdisciplinary ethics committees and, in some cases, may have few professional colleagues avail- able to mentor and develop the skills of ethical decision making. 1hus, the APN must advance this phase by actively seeking opportunities to engage in ethical dia- logue with professional colleagues. Professional organiza- tions offer materials such as The 4 AS to Rise Above Moral Distress (American Association of Critical Care Nurses, 2004) and workshops in which case studies are discussed and analyzed. This format is helpful to the inexperienced APN who needs guidance in applying knowledge to clini- cal cases.
Ethical Decision Making Frameworks Several authors have proposed a stepwise approach to ethical decision making (McCormick-Gendzel & Jurchek, 2006; Purtilo & Doherty, 2011; Rushton & Penticuff, 2007; Spencer, 2005; Weuste, 2005). In Box 13-4, the steps sug- gested by Purtilo and Doherty (2011) are listed as an example. The reader will note that this framework uses many elements of the various ethical approaches dis- cussed earlier in considering contextual factors, seeking full information on a case, and specifying a step that explicitly appeals to ethical theory. This framework for ethical decision making is intended for all health profes- sionals and therefore is applicable to a wide variety of situations.
Most frameworks for ethical decision malting include information gathering as a key step. Generally, informa- tion about the clinical situation, the parties involved, their obligations and values, and legal, cultural, and religious factors are needed. However, this factual information is not sufficient unless tempered with the contextual features of each case. Identifying the cause of the problem and determining why, where, and when it occurred, and who or what was affected, will help clarify the nature of the problem.
Problem identification is also a common step in most frameworks. Strong emotional responses to a situation can be the first signal that ethical conflict exists. However, many conflicts that arise in the clinical setting generate powerful emotional responses but may not be ethical issues. Ethical issues are those that involve some form of controversy about conflicting moral values and/or fundamental duties or obligations. The APN must distinguish and separate moral dilemmas from other issues, such as administrative concerns, communication problems, and lack of clinical knowledge. For example, a communication problem between a staff· nurse and physician may be resolved if an APN acts as a facilitator, ensuring that each. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Psychotherapy With Individuals – NURS 6640 – Exam Questions and Answers
Question 33
During a therapy session the patient is asked how she currently deals with stress, and she says, “Well, I don’t. I just let it build and build.” The PMHNP responds by asking how well this has been working out for her. The patient states, “Well, to be honest, it just feels like I’m drowning, you know what I mean.” Illustrating idiosyncratic meaning, the PMHNP responds with:
A.
“Would you say you feel like you are suffocating?”
B.
“No, I am not sure what you are saying. Can you please explain?”
C.
“Sort of like a fish out of water?”
D.
“When you say, ‘I just can’t breathe,’ you do understand, that is a form of anxiety?”
ORDER A PLAGIARISM-FREE PAPER OR ONLINE EXAM SITTING HERE
Question 34
The PMHNP is having a therapy session with Charlotte, a 20-year-old victim of date rape. The patient states, “I shouldn’t have been there; I should have just gone home. This was all my fault; how could I have been so stupid?” Using the Socratic method, what is the PMHNP’s best response?
A.
“If this had happened to someone else with the exact same circumstances, would you say this was her fault?”
B.
“Can you recall exactly what stopped you from going home when you originally wanted to go home?”
C.
”Have you shared these thoughts about what you should have done with anybody other than me?”
D.
“Do you understand that there is absolutely nothing that you could ever do to deserve to be treated the way you were treated?”
Question 35
At the initial interview with a patient, the PMHNP reviews the condition of receiving services, including limits that will be imposed on confidentiality. During the discussion, the patient shares information that the PMHNP is legally required to report.
True or false: If the PMHNP does not report information that s/he is legally required to report, state laws govern the consequences which include penalties for not reporting, especially child and elder abuse.
True
False
Psychotherapy With Individuals – NURS 6640 – Exam Questions and Answers
Question 37
The PMHNP is meeting with a 42-year-old man with depression brought on by the recent passing of his wife. As he describes the circumstances surrounding his late wife’s death, the PMHNP begins to feel sad. The sadness lingers for several hours, and the PMHNP finds it difficult to focus on other patients for the rest of the day. What is the most appropriate explanation for the reaction that the PMHNP is experiencing?
A.
Autognosis
B.
Complementary identification
C.
Concordant identification
D.
Self-disclosure
Question 40
A new patient has been informed of the limits of confidentiality, and has signed informed consent forms. No consent, however, has been obtained for voluntary “Release of Information.” The patient is 20 years old and still lives at home with his parents. He is being treated for depression, which he attributes to the trouble he’s had finding employment.
True or false: If the patient’s mother calls the PMHNP to check up on her son to see how he is doing, the therapist is required to protect patient confidentiality and not disclose information.
True
False
Question 41
A PMHNP is treating a 45-year-old female patient who is upset that her brother has not been calling since his divorce. When asked to describe her brother and what prompts him not to call as frequently, she says, “Everything is about him, not me. I think he’s jealous that I have a good marriage and he wants me to be unhappy, too. So he doesn’t call to upset me and ruin my relationships.” Based on this information, the PMHNP can conclude that the patient _________.
A.
may lack ability to see independent motivations
B.
has an insistent emphasis on the feelings of others
C.
has an intrusive interpersonal relationship
D.
all of the above
Psychotherapy With Individuals – NURS 6640 – Exam Questions and Answers
Question 42
The PMHNP is assessing a patient who grew up in a foster home because she was neglected and abused by her birth parents at a young age. The patient admits to having difficulty forming and maintaining relationships throughout her life. Understanding maladaptive schemas, which statement does the PMHNP predict that the patient is likely to make?
A.
“I deserve the utmost respect from everyone who meets me.”
B.
“I prefer doing everything on my own.”
C.
“It takes me a while to warm up to people; people often wear masks.”
D.
“I can’t seem to do anything on my own.”
Question 43
A patient who has borderline personality disorder is meeting with the PMHNP. When asked about future goals, the patient responds, “I’d like to go back to school to do what
you
do. You know, talk to people all day about their problems. It seems pretty easy.” How does the PHMNP respond to the client in a way that is free from any stigmatizing beliefs or judgments?
A.
“It is dangerous to fantasize about the future.”
B.
“I think that’s an excellent idea! I can help you review the prerequisites!”
C.
“You may want to explore the requirements for becoming a PMNHP.”
D.
None of the above.
STUDY GUIDE
This quiz (Psychotherapy With Individuals – NURS 6640 – Exam Questions and Answers) will cover the following topics, which relate to psychotherapy with individuals in the Wheeler textbook and the Fisher textbook excerpts:
Topics
The Nurse Psychotherapist and a Framework for Practice
Confidentiality Limits in Psychotherapy: Ethics Checklists for Mental Health Professionals
Assessment and Diagnosis
The Initial Contact and Maintaining the Frame
Cognitive Behavioral Therapy
Supportive and Psychodynamic Psychotherapy
Stabilization for Trauma and Dissociation
Motivational Interviewing
Psychotherapeutic Approaches for Addictions and Related Disorders
ORDER A PLAGIARISM-FREE NURSING PAPER NOW
Wheeler, K. (Eds.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(2nd ed.). New York, NY: Springer Publishing Company.
Chapter 1, “The Nurse Psychotherapist and a Framework for Practice”
Chapter 3, “Assessment and Diagnosis”
Chapter 4, “The Initial Contact and Maintaining the Frame”
Chapter 5, “Supportive and Psychodynamic Psychotherapy”
Chapter 13, “Stabilization for Trauma and Dissociation”
Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders”
Fisher, M. A. (2016). Introduction. In
Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals
(pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001. Psychotherapy With Individuals – NURS 6640 – Exam Questions and Answers
Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In
Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals
(pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002
Psychotherapy With Individuals – NURS 6640 – Exam Questions and Answers
NURS 6551 – Primary Care of Women Essay Assignment Papers and Exam Questions and Answers
How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes.
Note:
This course requires a minimum of 144 practicum hours
.
ORDER A PLAGIARISM-FREE PAPER NOW
NURS 6551 – Primary Care of Women Essay Assignment Papers and Exam Questions and Answers
NURS 6551 – Primary Care of Women Required Course Readings
Dragoman, M., Davis, A., & Banks, E. (2010). Contraceptive options for women with preexisting medical conditions.
Journal of Women’s Health, 19
(3), 575–580.
Fitzgerald, C. (2010). Improving nurse practitioner assessment of woman veterans.
Journal of the American Academy of Nurse Practitioners, 22
(7), 339–345.
Gagan, M. J. (2009). The SOAP format enhances communication.
Kai Tiaki Nursing New Zealand, 15
(5), 15.
Kelley, S. J., Whitley, D. M., & Campos, P. E. (2010). Grandmothers raising grandchildren: Results of an intervention to improve health outcomes.
Journal of Nursing Scholarship, 42
(4), 379–386.
Loeb, S. J., Penrod, J., Hollenbeak, C. S., & Smith, C. A. (2011). End-of-life care and barriers for female inmates.
Journal of Obstetric, Gynecologic & Neonatal Nursing, 40
(4), 477–485.
NURS 6551 – Primary Care of Women Essay Assignment Papers and Exam Questions and Answers