Discussion 2 – End of Life Care
Eduardo Roqueso
Florida National University
Advanced Family Practicum III
Jacqueline Alonso DNP, Family ARNP
The ability to provide primary palliative care is a skill set that nurse practitioners should acquire, develop, and refine. Primary palliative care skills include thorough and effective symptom assessment and management, initiating and guiding conversations around advance care planning, and completing medical directives that guide care with life-limiting/life-threatening illness (Wheeler, 2016). Although sometimes confused with hospice, it’s important to remember hospice is a specific type of palliative care designed to address the needs of those who have 6 months or less to live. In other words, hospice care is always palliative, but not all palliative care is hospice care. (IPC, 2018).
As frontline clinicians, APRNs, along with their RN colleagues, spend the most time with patients at their bedside. All APRNs must have fundamental palliative care skills. This includes understanding illness trajectories from diagnosis to death, appropriate assessment and management of pain, particularly in the current opioid misuse epidemic b (Dahlin & Coyne, 2019).
The most recognized area of leadership for APRNs is Clinical Care. To be successful, APRNs must understand the diagnosis and the natural course of illnesses and diseases along with the critical decision-making points to manage and treat these conditions from diagnosis to end-of-life care, based on best available evidence. APRNs are in a key position to deliver collaborative interdisciplinary palliative care for patients with serious illness and move palliative care upstream to caring for populations across the lifespan and across the health care continuum (Dahlin & Coyne, 2019).
In palliative care, when presenting with a symptom complaint, disease progression must always be considered. Disease progression needs to be identified to help with the ongoing goals-of-care discussions. Often-cited symptoms include pain, breathlessness, fatigue, anorexia, nausea/vomiting, constipation, depression, dry mouth, and sleep disturbance (Wheeler, 2016)
In a perfect palliative care world, advance directives for care at end of life would be documented, medical powers of attorney would be named, and these documents would be shared with all health care providers. The reality is that this does not happen, and many hospitalizations are for a crisis when decisions need to be made and there has not been an open and honest discussion of the illness trajectory. NPs enter into these discussions without an agenda for what are the “correct” decisions. The desired outcome is to have the patient understand the issues and make informed choices based on their goals and their definition of quality of life. NPs need to be prepared to discuss disease trajectory, realistic interventions, and prognosis. Palliative care advocates that advance care planning be documented and revisited with subsequent changes in health status (Wheeler, 2016).
References:
Dahlin, C., & Coyne, P. (2019). The palliative APRN leader. Annals of Palliative Medicine, 8(1), S30-S38. doi:10.21037/apm.2018.06.03
IPC. (2018). Palliative Care: The Next Frontier for APRNs? Retrieved from CSU Institute of Palliative Care: https://csupalliativecare.org/palliative-care-aprns/
Wheeler, M. (2016). Primary Palliative Care for Every Nurse Practitioner. The Journal for Nurse Practitioners, 12(10), 647-653. Retrieved from https://www.npjournal.org/article/S1555-4155(16)30503-7/pdf
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Week 2 Discussion Nurs 6001 18769889
/in Uncategorized /by developerOnline Learning Strategies: Completing courses in the absence of a physical classroom and frequent face-to-face contact can be challenging, even for those who are comfortable with technology and the online environment. You need to be able to plan and manage your time well, particularly since there is no structured “class time”; communicate clearly and effectively where there is no visual or nonverbal feedback; and use technology effectively.
This Discussion provides you with an opportunity to think about your skills in the above areas, to explore strategies for successful online learning, and exchange strategies with your colleagues.
To prepare:
•Review this Week’s assigned readings from the Walden e-Guide and the document, “Technical Tips for Learning at Walden,” in the Learning Resources. •Review this week’s media program, “Tips for Effective Online Composition and Communication.”
•Think about some strategies you have used, or read about, that may be beneficial for effective planning, time management, communication, and technology use. •Consider how the strategies you have identified can contribute to being a successful online learner.
Post a description of at least one strategy for each of the following areas related to online success: planning, time management, communication, and technology use.
Explain how/why you think use of each strategy will contribute to your success as an online learner. Support your Discussion assignment with specific resources used in its preparation using APA formatting. You are asked to provide a reference for all resources, including those in the Learning Resources for this course.
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Week 2 Discussion Nurs 6001 18769895
/in Uncategorized /by developerOnline Learning Strategies: Completing courses in the absence of a physical classroom and frequent face-to-face contact can be challenging, even for those who are comfortable with technology and the online environment. You need to be able to plan and manage your time well, particularly since there is no structured “class time”; communicate clearly and effectively where there is no visual or nonverbal feedback; and use technology effectively.
This Discussion provides you with an opportunity to think about your skills in the above areas, to explore strategies for successful online learning, and exchange strategies with your colleagues.
To prepare:
•Review this Week’s assigned readings from the Walden e-Guide and the document, “Technical Tips for Learning at Walden,” in the Learning Resources. •Review this week’s media program, “Tips for Effective Online Composition and Communication.”
•Think about some strategies you have used, or read about, that may be beneficial for effective planning, time management, communication, and technology use. •Consider how the strategies you have identified can contribute to being a successful online learner.
Post a description of at least one strategy for each of the following areas related to online success: planning, time management, communication, and technology use.
Explain how/why you think use of each strategy will contribute to your success as an online learner. Support your Discussion assignment with specific resources used in its preparation using APA formatting. You are asked to provide a reference for all resources, including those in the Learning Resources for this course.
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Week 2 Discussion Pharmacology
/in Uncategorized /by developerComment using your own words but please provide at least one reference for each comment.
Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.
Provide the comment for each discussion separate.
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Week 2 Discussion Prompt Community Practice
/in Uncategorized /by developerDiscuss two areas of difficulty you encountered or two new nursing interventions you learned this week at your clinical site as a Case Manager. You may also choose to share one of each.
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Week 2 Discussion Reply 19464077
/in Uncategorized /by developerPlease reply to this discussion with one reference.
The theory-practice gap is something that nurses encounter as they enter practice. A way that graduate education is working to bridge this gap is through middle-range theories and the doctor of nursing practice degree (Butts & Rich, 2017). Middle range theories and doctorate level nursing practice are attempting to cover the components missing from theory but used in everyday nursing practice. Since doctorate level nurses are very familiar with theory and have clinical expertise to understand the missing parts from theory needed for practice (Butts & Rich, 2017). Doctorate prepared nurses are also able to assist other nurses with this gap in knowledge to improve their practice (Butts & Rich, 2017).
I believe that the gap between theory and clinical practice is there and that it is the duty of practicing nurse clinicians to help bridge this gap. In a study by the International Journal of Caring Sciences, it was found one way to help close this gap was by the use of nursing clinical instructors (Akram, Mohamad, & Akram, 2018). These clinical instructors help students in clinical rotations understand the differences between theory and everyday practice (Akram, Mohamad, & Akram, 2018). It is important while nurses are in a student role to differentiate between theory that exists in a perfect world and actual real-world practice. Another important aspect is to ensure that these clinical instructors create an environment conducive to learning and stay up-to-date with the latest in policy and healthcare trends (Akram, Mohamad, & Akram, 2018).
Understanding theory and the impact it has on the nursing discipline is imperative in advancing nursing practice. Theory gives the basis for nursing practice and for nurses to be able to have a solid basis of practice they should understand theory (Butts & Rich, 2017). Nursing theory also helps nurses understand their assumptions, develop critical thinking skills and improve the ability to analyze complex situations (Ahtisham, & Jacoline, 2015). I believe that although many of the theories we study were formed in the past, they still have relevance to nursing practice today and help nurses advance their practice and develop the skills needed to thrive in the nursing profession.
References
Ahtisham, Y., & Jacoline, S. (2015). Integrating Nursing Theory and Process into Practice; Virginia’s Henderson Need Theory. International Journal of Caring Sciences, 8(2), 443–450. Retrieved from https://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=rzh&AN=102972280&site=eds-live
Akram, A. S., Mohamad, A., & Akram, S. (2018). The Role of Clinical Instructor in Bridging the Gap between Theory and Practice in Nursing Education. International Journal of Caring Sciences, 11(2), 876–882. Retrieved from https://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=rzh&AN=131851628&site=eds-live
Butts, J. B. & Rich, K. (2017). Philosophies and Theories for Advanced Nursing Practice, Third Edition. [VitalSource Bookshelf version]. Retrieved from vbk://9781284143010
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Week 2 Discussion Response
/in Uncategorized /by developerComment using your own words but please provide at least one reference for each comment.
Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.
Provide the comment for each discussion separate.
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Week 2 Diss
/in Uncategorized /by developerDiscuss how genogram and ecomaps are used in nursing. Why and how would they incorporate these tools into their care of families? How does the use of these tools affect family risk appraisal?
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Week 2 End Of Life
/in Uncategorized /by developerDiscussion 2 – End of Life Care
Eduardo Roqueso
Florida National University
Advanced Family Practicum III
Jacqueline Alonso DNP, Family ARNP
The ability to provide primary palliative care is a skill set that nurse practitioners should acquire, develop, and refine. Primary palliative care skills include thorough and effective symptom assessment and management, initiating and guiding conversations around advance care planning, and completing medical directives that guide care with life-limiting/life-threatening illness (Wheeler, 2016). Although sometimes confused with hospice, it’s important to remember hospice is a specific type of palliative care designed to address the needs of those who have 6 months or less to live. In other words, hospice care is always palliative, but not all palliative care is hospice care. (IPC, 2018).
As frontline clinicians, APRNs, along with their RN colleagues, spend the most time with patients at their bedside. All APRNs must have fundamental palliative care skills. This includes understanding illness trajectories from diagnosis to death, appropriate assessment and management of pain, particularly in the current opioid misuse epidemic b (Dahlin & Coyne, 2019).
The most recognized area of leadership for APRNs is Clinical Care. To be successful, APRNs must understand the diagnosis and the natural course of illnesses and diseases along with the critical decision-making points to manage and treat these conditions from diagnosis to end-of-life care, based on best available evidence. APRNs are in a key position to deliver collaborative interdisciplinary palliative care for patients with serious illness and move palliative care upstream to caring for populations across the lifespan and across the health care continuum (Dahlin & Coyne, 2019).
In palliative care, when presenting with a symptom complaint, disease progression must always be considered. Disease progression needs to be identified to help with the ongoing goals-of-care discussions. Often-cited symptoms include pain, breathlessness, fatigue, anorexia, nausea/vomiting, constipation, depression, dry mouth, and sleep disturbance (Wheeler, 2016)
In a perfect palliative care world, advance directives for care at end of life would be documented, medical powers of attorney would be named, and these documents would be shared with all health care providers. The reality is that this does not happen, and many hospitalizations are for a crisis when decisions need to be made and there has not been an open and honest discussion of the illness trajectory. NPs enter into these discussions without an agenda for what are the “correct” decisions. The desired outcome is to have the patient understand the issues and make informed choices based on their goals and their definition of quality of life. NPs need to be prepared to discuss disease trajectory, realistic interventions, and prognosis. Palliative care advocates that advance care planning be documented and revisited with subsequent changes in health status (Wheeler, 2016).
References:
Dahlin, C., & Coyne, P. (2019). The palliative APRN leader. Annals of Palliative Medicine, 8(1), S30-S38. doi:10.21037/apm.2018.06.03
IPC. (2018). Palliative Care: The Next Frontier for APRNs? Retrieved from CSU Institute of Palliative Care: https://csupalliativecare.org/palliative-care-aprns/
Wheeler, M. (2016). Primary Palliative Care for Every Nurse Practitioner. The Journal for Nurse Practitioners, 12(10), 647-653. Retrieved from https://www.npjournal.org/article/S1555-4155(16)30503-7/pdf
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Week 2 Ethical Frameworks Essay Ethics
/in Uncategorized /by developerConsider the “Four Topics Approach” (or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
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Week 2 Evolving Practice Of Nursing And Patient Care Delivery Models
/in Uncategorized /by developerAs the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and fewer will be available in acute care hospitals.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines.
This assignment uses a rubric.
You are required to submit this assignment to LopesWrite.
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