NR 602 Week 8 Reflection Paper

NR 602 Week 8 Reflection Paper

NR 602 Week 8 Reflection Paper

Dr. Griffin and Class,

In NR602: Primary Care of the Childbearing and Childrearing Family, I was provided the opportunity to expand my knowledge in regards to pediatrics and women’s health over the past eight weeks of this course. The knowledge gained during this course came from my fellow classmates, professor, and clinical preceptor. Overall, this course has allowed for me to meet MSN program outcome #1, MSN essential VII, and Nurse Practitioner Core Competency #8.

The MSN program outcome #1: provide high-quality, safe, patient-centered care grounded in holistic health principles (holistic health & patient-centered care)

As a future nurse practitioner (NP), I have learned not only in this course, but in all my previous courses that providing high-quality, safe, patient-centered care allows the patient to reach their optimal health, which ultimately is the goal of the NP–patient relationship. The various assignments throughout the course and my time spent in the clinical setting, both exposed me to, or allowed me to achieve the MSN program outcome #1. One example of how I was exposed to the program outcome involves a patient I had during this rotation. A 45-year-old male patient came in for a follow-up appointment for an elevated hemoglobin A1C that he was trying to manage with diet and exercise alone. At his follow-up appointment his hemoglobin A1C was re-checked with a result of 7.9, which was slightly lower than his previous result of 8.1.

My preceptor wanted to start him on metformin, but the patient was reluctant and wanted to continue with diet and exercise before starting the medication. Holistic medicine was the primary focus of treatment for this patient, which included a discussion on lifestyle modifications, diet, and exercise in order for the patient to attain the goal of reducing his hemoglobin A1C. According to Fan (2017), holistic medicine is about lifestyle changes, noninvasive remedies and improving the flow of a person’s life-force energy, along with enhancing the body’s own ability to heal itself. Holistic, patient-centered care is respectful and takes into account the patient’s preferences, values and needs; promotes flexibility in the delivery of health care, and ensures that the patient’s values guide the clinical decisions (Kuipers, Cramm, & Nieboer, 2019).

A second example of how I was exposed to the MSN program outcome #1 was through completion of the various assignments throughout the course, therefore, allowing me to utilize clinical practice guidelines (CPGs). As we are all aware, CPGs are evidence-based recommendations that offer health care providers with a framework by which to evaluate, treat, and manage the individual needs and preferences of patients who have various medical conditions, thus leading to improved patient outcomes. As a future NP, individualizing treatment plans for my patients will be a crucial component of my practicing capabilities so that I can deliver high-quality, safe, patient-center care.

MSN Essential VII: Interprofessional Collaboration for Improving Patient and
Population Health Outcomes

As a future NP, especially working in the primary care setting, interprofessional collaboration is pertinent to the overall improvement of patient outcomes. For health care providers to deliver appropriate, efficient care focused on improving patient and population health outcomes, all health care disciplines must collaborate in order to achieve this goal. One example of how I achieved the MSN Essential VII involved a 2-year-old patient that was diagnosed with recurrent otitis media of both ears. This particular visit had been his third visit in the past two months for otitis media. The patient was referred to a local otolaryngologist (ENT) and had myringotomy and tympanostomy tube surgery. The child was one-month post-op at his follow-up appointment at my practicum site, which the mother had stated that the child was feeling better and has had no issues since the surgery.

A second example of how I achieved the MSN Essential VII was through the various assignments within the course, specifically the Week 5 paper on marginalized women and the Week 7 discussion on Health People 2020 STD standards. As registered nurses transitioning to becoming future NPs, we all have acknowledged the fact that health disparities are prevalent in the United States. The two aforementioned assignments provided me with advanced knowledge pertaining to the huge gap within the health care system related to health disparities that are associated with a variety of factors, such as socioeconomic status, race/ethnic group, sex, and geographic location. I have learned that health disparities can negatively impact subsets of the population who have steadily experienced greater socioeconomic problems to health. For the Week 7 discussion, I was able to develop an evidence-based action plan for reducing primary and secondary syphilis, which allowed me to integrate interprofessional collaboration into my interventions. Interprofessional collaboration is the foundation needed for health care providers to support patient needs and reduce health disparities in public health (Vanderbilt, Dail, & Jaberi, 2015).

Nurse Practitioner Core Competencies # 8 Ethics Competencies

• Integrates ethical principles in decision making.
• Evaluates the ethical consequences of decisions.
• Applies ethically sound solutions to complex issues related to individuals, populations and systems of care.

The first example of how the Nurse Practitioner Ethics Competencies were achieved was by completing the Week 5 assignment on marginalized women. Prior to completing this assignment, I did not take into account, or think about ethical issues that surround the population of women who are sexually assaulted. When providing medical care or treatment for this particular population, it is the duty and obligation as health care providers to respect the four ethical principles: autonomy, beneficence, non-malfeasance, and justice. One ethical dilemma that can arise from a sexual assault is termination of pregnancy. In terms of both ethics and legality, the dilemmas encompassing the concept of pregnancy termination or abortion has been a longstanding debate among the public, health care industry, and lawmakers. As future NP, we may practice conscientiously by refusing treatment if we feel ethically opposed to a patient’s decision, such as abortion; but it is also our duty and responsibility to provide the patient with the appropriate follow-up and referral.

Regarding the topic of reproductive decisions, a health care provider should not be obligated to perform any act that violates their good judgment or moral principles if it is consistent with standard medical practices (Moss, Snyder, & Lu Lin, 2015). The principle of autonomy encompasses the right of the sexually assaulted victim to make their own decisions; and to respect this principle, the health care provider needs to be cognizant of the desires of the patient. Health care providers should practice without prejudice or preconceptions and uphold the highest ethical values in the delivery of their services (Moss et al., 2015).

Lastly, a second example of how I was exposed to the Nurse Practitioner Ethics Competencies was during a patient encounter at my practicum site. An elderly woman was in for a routine check-up and to get medications refilled, and as I was reviewing her chart, I notice that she had been diagnosed with stage 3 lung cancer a couple months prior. During the examination I had briefly inquired about how she was feeling in regards to her current health and if she had any questions or concerns that needed to be addressed. She responds by stating that she has not fully accepted the fact that she has cancer and wishes to not have any treatment at this present time. She was willing to discuss the matter further, therefore, I educated her as fully as possible about the benefits of treatment recommendations and the risks of no treatment. I also pursued reasons for the patient’s refusal and used beneficent persuasion to determine if the patient might rethink her initial decision and agree to having treatment. The core of patient autonomy allows the patient the freedom of choice and action; therefore, allowing my patient to make her own decision on whether or not she wanted treatment and to act on her own values.

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References

Fan, D. (2017). Holistic integrative medicine: toward a new era of medical advancement. Frontiers of Medicine, 11(1), 152–159. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.1007/s11684-017-0499-6

Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, (1), 1-9. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.1186/s12913-018-3818-y

Vanderbilt, A. A., Dail, M. D., & Jaberi, P. (2015). Reducing health disparities in underserved communities via interprofessional collaboration across health care professions. Journal of Multidisciplinary Healthcare, 8(1), 205–208. doi:10.2147/JMDH.S74129