Embracing the role of a nurse practitioner with a doctorate in nursing practice (DNP) requires taking on the additional challenge of acting as an effective change agent. A DNP’s primary role is to act as a bridge between research and the bedside nurse. A strong clinical background assists in translating research findings into realistic evidence-based practices that nurses can readily incorporate into their daily routines. Nurses needed to learn what resources were available to meet the specific needs of the dying and how to promote a peaceful death. The CARES tool attempts to give some sense of order and structure to the care of the dying. The CARES tool is based on the immense educational resources provided by experts from the End-of-Life National Education Consortium (ELNEC), the National Consensus Project for Quality Palliative Care, and from evidence-based literature reviews.
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The author, Arthur G. Cosby speaks about his mother, Lillie Mae Mclntire Cosby; a nurse who led him to understand what constitutes leadership, his responsibilities to others, and the role of women in the modern world. In his mother’s mind, discipline was a critical aspect of good health care. As head nurse, she supervised large number of junior nurses, aids and orderlies, many of whom had limited formal health care training. It was very important to him that he had a mother who could do so many things and do them well. Not only was she a mother and nurturer, she was also a woman who was the breadwinner, who could successfully carry out most any job even the most difficult. Over the course of her career, she actively carried out the health care responsibilities of head nurse, hospital administrator, emergency room nurse, obstetrics nurse, public health nurse and nurse practitioner.
Barry H. Smith’s opening is significant: that nursing care is at the core of humanity. He recounts his own experiences with nurses, when as a surgical resident he learned the value of team work, and developed a respect for the nurses who were so tuned in to the needs of the patients and families. Smith asserts that nurses must be the central point of any health care system, and yet many factors have converged to keep nurses in a subservient role within health care. Today, there are Nurses Aides, Licensed Practical Nurses, Registered Nurses, Nurse Practitioners, and those with doctorates in nursing, with an increasing premium being placed on advanced nursing clinical practice, as well as research. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
This introduction presents an overview of key concepts covered in the subsequent chapters of this book. The book explains how to write proposals. One’s immediate goal in writing a proposal is either to meet a requirement for graduation or to seek funding for his/her project. Some people move on to exploratory or developmental projects that will allow them to finish the preliminary work they need to accomplish before conducting definitive studies. Foundations and health organizations typically fund projects in their interest areas, which might be obvious from their titles or may require one to learn their current interests. The Internet is rife with advice on writing proposals for PhD and Doctor of Nursing Practice (DNP) work, postdoctoral fellowships, traineeships, and research and educational projects.
This chapter presents a case study to demonstrate what can go right and what can go terribly wrong when caring for the dying. The use of the same scenario is intentional, so the differences in care can be more readily understood and the effective use of the CARES tool can be accentuated. Mr. F was a 78-year-old gentleman with a history of uncontrolled type 1 diabetes, end-stage cardiomyopathy, and acute renal insufficiency. The chapter discusses five scenarios that are intended to demonstrate the impact good communication skills, an understanding of basic palliative care and end-of-life training, and establishing individualized goals of care can have on patient outcomes. The scenarios also demonstrate how the CARES tool can be used to prompt the nurse, and to help anticipate the commonly needed orders to more effectively support the dying and their families.
Nurse practitioner (NP) instructors are finding it increasingly challenging to evaluate students in the clinical area because of an increase in nursing school enrollment, nursing faculty shortage, and difficulty in evaluating students in the clinical setting because of the Health Insurance Portability and Accountability Act’s (HIPAA) privacy rules. Simulation-based pedagogy has been implemented in the Common Health Problems of Adults and Older Adults course as a method of teaching/learning to prepare NP students for their first clinical rotation. This course is designed to enable students to develop the necessary knowledge base and problem-solving skills for practice as an NP in the management of common health problems such as hypertension and diabetes. The goal of the diabetes management scenario is to allow students an opportunity to complete a comprehensive patient encounter in the context of a modified objective structured clinical examination (OSCE) format.
This chapter explores how to analyse a review of a PhD proposal or a Doctor of Nursing Practice (DNP) proposal. It shows National Institutes of Health (NIH) proposal as a model for dealing with reviews. The NIH requires a summary statement in electronic Research Administration (eRA) Commons, changes in the application, and a one-page introduction responding to issues raised in the reviews and summarizing the changes made. For those doing a PhD or DNP project, typically the “reporting” required involves regular meetings with the committee chair or advisor and then reporting the final outcomes via the dissertation or capstone project report. For those who have obtained funding, some agencies only fund for short periods of time and only require a final report from the researchers. Others, such as the NIH, require annual reports for most multi-year projects.
- Go to chapter: Primary Care Patients With Gastrointestinal Problems: Graduate Program Advanced Physiology and Pathophysiology
Primary Care Patients With Gastrointestinal Problems: Graduate Program Advanced Physiology and Pathophysiology
This three-credit course is mandatory for all graduates of accredited master’s programs in nursing. It is commonly referred to as one of the “three Ps” (physical assessment, physiology and pathophysiology, and pharmacology). The course is a prerequisite for any of the specialty track courses for nurse practitioners (NPs), midwives, and nurse anesthetists. Analysis of physiologic responses and implications of the genome model to illness are included. Interpretation of laboratory data for patient management of acute and chronic disease is discussed. Students analyze case studies of hospitalized and primary care patient scenarios. This scenario is focused on gaining experience with analyzing patients’ differential diagnoses and explaining the etiology for each diagnosis. In identifying patient signs and symptoms to determine three differential diagnoses, the students gain much confidence in their reasoning skills. Also, the case provides some application of assessment skills for students to collect data regarding this patient’s Gastrointestinal (GI) complaints.
Advanced practice registered nurses (APRNs) are nurses with a master’s, post-master’s, or doctorate level of education. Four roles encompassed under the definition of the APRN are certified nurse practitioners (CNPs), certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs). Each has its own context, but all share the commonality of nursing, especially advanced practice nursing. Although education similarities as well as accreditation and certification exist, uniform state regulations for APRN practice do not. States, with their governing licensing boards and statutes, provide state practice authority. The legal scope of the APRN is individually and independently determined by each state. The educational programs that APRNs graduate from are nationally accredited; therefore, their graduates are eligible for national certification and state licensure. APRNs provide professional care across the health spectrum based on individual patient needs and educational experiences.
The CARES tool assists in the promotion of individualized care for dying patients and utilizes a stronger focus on spirituality and employing compassion and humanity. The focus on self-care as part of the CARES tool has resulted in the development of a monthly support group meeting held on an intensive care unit (ICU), called grieving rounds. Professional grief was often explored with the help of a social worker; a psychologist, a spiritual care counselor, and a palliative care nurse practitioner that routinely attend the monthly sessions. Another creative benefit of providing training for care of the dying utilizing the CARES tool resulted in a type of group therapy. A final suggested use for the CARES tool was to incorporate it with the teaching provided to staff and volunteer personnel participating in the No One Dies Alone (NODA) program.