Provide a substantive response to a peers discussion post. included below
Initial discussion post instructions.
- Identify a time in which collaboration was not used and that led to negative consequences for the patient. Discuss the responsibility of the APRN as a patient advocate.
- Review the example Standard Care Arrangement provided in the module. Discuss the positive and negative aspects of this agreement in the discussion board.
- Identify which of the Domains from the AACN Essentials this assignment meets.
****Peer’s discussion board post that requires a response.****
- Identify a time in which collaboration was not used and that led to negative consequences for the patient. Discuss the responsibility of the APRN as a patient advocate.
I currently work as a rapid response nurse at my hospital. Like most facilities, resources are scarce at night, and collaboration is nonnegotiable in order to provide safe, high-quality care to our patients under such conditions. There is one particular intensivist who can sometimes make transferring critical patients from the floor to the intensive care unit (ICU) difficult. About six months ago, I responded to a rapid response on our ICU step-down floor. Upon arrival, the patients systolic blood pressure was in the lower sixties. She had just returned from a thrombectomy after discovering a pulmonary embolism had been causing the shortness of breath she presented to the emergency department for. The patient was in obvious distress- tachycardic, dyspneic, anxious, hypotensive, and out-right scared (and rightfully so). As I began to assess the situation and ask the appropriate questions, the resident team arrived to help coordinate obtaining appropriate orders. After intervening as we could with fluid boluses and working through differentials on the floor, we all agreed on the inevitable- this patient needed pressors and a swift transfer to the ICU. Unfortunately, because of the previous relationship that the residents had with the particular doctor covering the ICU, they were hesitant to do what they knew was needed for this patient. Care was delayed by calling the intensivist who ultimately ended up requesting not to start pressors and insisted on attempting further interventions before accepting this patient as a transfer. Thanks to the strong advocacy skills of my favorite advanced practice registered nurse (APRN) and her untimely expertise, she spoke to the ICU physician and insisted this patient needed transferred at this very moment, there was no time to waste. Unfortunately, despite our best efforts, the patient ended up losing a pulse before we could transfer them. Luckily for the patient, the patients family, and the staff working the code, the APRN stayed to run it (though traditionally this would have been the job of the intensivist in most circumstances). The patient ultimately did not survive, but the staff could breathe a little easier knowing we had this particular APRN in the room to advocate for not only the family, but also the staff and their uneasiness in being forced to care for high-acuity patients often outside of their comfort zone. While this was not the outcome I wanted in any way at all, the patients family had the best possible provider advocating for their loved one and she so amazingly handled ensuring they were informed of what was going on at all times. Furthermore, this APRN has a certain way of respecting patients who have died under her care in truly inspiring ways. In fact, shes a large reason I chose to transition from family practice to an acute care track.
This example provides great insight into the advocacy role that many APRNs will find themselves in. Despite the ease she brings to patients, families, and nurses, she was recently let go from her position as night-time coverage in our ICU, which is the only reason she was serving as a hospitalist at this time. This scenario is one that largely opened my eyes to the challenges that interprofessional collaboration can sometimes bring, despite its glaringly apparent pertinence. Samuriwo (2022) briefly discusses the challenges of interprofessional collaboration (IPC) despite the integral role it plays in patient safety. Samuriwo (2022) cites differing opinions of professional boundaries and jurisdiction conflicts as key aspects to the shortcoming of IPC. Increases in education and hands-on training through interprofessional development education programs have showed limited effectiveness (Samuriwo, 2022). How do we improve this? Samuriwo (2022) suggests a system-thinking approach. I wasnt entirely familiar with how a system-thinking approach could help solve the challenges of IPC, but Khalil and Lakhani (2022) discuss this extensively. For example, a key aspect of a system-thinking approach revolves around ensuring that those affected by an issue have a seat at the table when it comes to solving it (Khalil & Lakhani, 2022). In other words, this approach recognizes the different perspectives that each professional experiences based on their background, thus highlighting the unique approaches to solving problems that each can offer. Khalil and Lakhani (2022) state that a system-thinking model recognizes three important factors: interrelationships, perspectives, and boundaries. The fact that this model specifically calls out the exact concerns that Samuriwo (2022) highlighted begs the valid question- is it time for a new theory? What do you guys think? Does it sound like its time to reconsider our current system? Could it bring benefit to our patients?
Finally, Khalil and Lakhani (2022) argue that while traditionally, a system-thinking approach has been used to tackle challenges of specific patient populations, it could be more widely employed to help address the way we deliver care as a healthcare team. Ultimately, safe, professional, and appropriate teamwork is my goal, and I think this goal could align with most other healthcare professionals. In my opinion, it may be time to reconsider our current way of doing things.
2. Review the example Standard Care Arrangement provided in the module. Discuss the positive and negative aspects of this agreement in the discussion board.
The Standard Care Arrangement provided in this module is the first such arrangement Ive had the opportunity to review. Ive always been a bit on the fence regarding where I stand on full practice authority for APRNs, but this example document has helped me identify a few key points to either side of the argument.
First and foremost, I am of the opinion that Im okay with not having full practice authority if it means Im not under the same liability/responsibility of a physician. However, this document has encouraged me to do a deeper reflection of what that really means. If the expectation is for me to work independently of a physician performing a majority of the same tasks and being held to the same standard, maybe its time to rethink my opinion. Furthermore, if a collaborative agreements stipulations include review of patient charts to discuss rationales, diagnoses, prescriptions, and general patient management only once a year, I fear this is less collaboration than I wanted. I worry that this retrospective reviewing could fall short of meeting patients needs in real time, and would therefore consider this a negative aspect. While the collaborative agreement does however mention a physician being readily available at all times, Ive worked the bedside long enough to understand that this realistically looks better on paper than it does in the real world. While this at first seems like a positive side to the collaborative agreement, it might not be as positive in practice.
The part of me that second-guesses whether APRNs should hold full practice authority is the part that recognizes the strenuous residency rotations that physicians undergo and that APRNs lack. While Im a firm believer in the benefit of bedside nursing experience, I do recognize that its a different way of thinking and each perspective holds benefit as part of the healthcare team. As part of a team, it not only works, but the differing views are essential. Does it make sense to practice independently paying little to no attention to other perspectives of the healthcare team? Im not sure that it does, but I would say the same thing about physicians- APRNs and physicians working together as a team makes healthcare safer and more efficient. Bouton et al. (2022) discusses this in their study on how interprofessional collaboration has shown to improve patients outcomes in certain populations through primary care initiatives. Working together can lead to more meaningful lives with a higher quality of life (Bouton et al., 2022). The two professions coming together is what makes the most sense.
Overall, this particular agreement is a bit too vague for my liking as a new APRN starting out. While eventually, as I gain experience and start to feel more comfortable I may appreciate the independence, initially it would be nice to have someone more available to be a resource to me. This could help to ease my anxiety during my transition from RN to APRN in ways that the current collaborative agreement presented in this module does not.
3. Identify which of the Domains from the AACN Essentials this assignment meets.
While there is not specifically a domain of the American Association of Colleges of Nursing (AACN) Essentials that addresses a system-thinking approach, I find the move towards competency-based education very similar to the thinking of this model (American Association of Colleges of Nursing [AACN], 2021). Both encourage the nursing professional to employ critical thinking/reasoning and see beyond the problem obviously presented. This way of thinking transcends the old way of practice, which focused on one specific problem, and works towards a model where nurses become equipped with the tools to conquer other similar problems through clinical judgement and experiential reasoning. I think this is the future of nursing- we can be task doers, or we can be professionals able to adapt, comprehend, figure out, and successfully navigate. Id rather be the latter, and I think AACN agrees (AACN, 2021). Specifically, this assignment most obviously meets Domain six: Interprofessional Collaboration. AACN (2021) highlights the role-model behavior that should be demonstrated by a nursing professional to help lead the way in patient care. Domain nine: Professionalism and Domain ten: Personal, Professional, and Leadership development are also highlighted through this assignment in the way that nurses conduct themselves in difficult situations that collaboration can sometimes bring about (AACN, 2021). Part of professionalism is the ability to reflect on ones actions and the role they play in conflict that inevitably arises from time to time. Accordingly, nurses must be able to rise to the occasion as leaders of care in whatever scenario they find themselves a part of. Lastly, Domain seven: Systems-based Practice is discussed in my interpretation of this assignment (AACN, 2021). Nurses must be willing to come to the table to help address complex health issues, which is part of evaluating current processes and a part of systems-based practice (AACN, 2021).
References
American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education.
Bouton, C., Journeaux, M., Jourdain, M., Angibaud, M., Huon, J. F., & Rat, C. (2023). Interprofessional collaboration in primary care: What effect on patient health? A systematic literature review. BMC Prim. Care, 24(253).
Khalil, H., & Lakhani, A. (2022) Using systems thinking methodologies to address healthcare complexities and evidence implementation. JBI Evidence Implementation, 20(1), 3-9.
Samuriwo, R. (2022). Interprofessional collaboration- Time for a new theory of action? Frontiers in Medicine, 9, 1-4.
***Include 3 references from scholarly sources published within the last 5 years
***Rubric***
nitial Discussion
Student thoroughly addresses required content and all questions posed in the discussion prompt. The post demonstrates a solid understanding of the topic, incorporates supporting information from the assigned readings and other outside research.
50 pts
Exceptional
The submitted work demonstrates a comprehensive understanding of the discussion topic. The information provided is accurate, in-depth, meets word number requirements, synthesizes information from the course materials and includes a minimum of three scholarly references.
40 pts
Proficient
The submitted work demonstrates an adequate understanding of the discussion topic. The information provided is adequate, meets word number requirement, synthesizes information from the course materials and includes a minimum of two scholarly references; however, all concepts of the discussion may not be fully developed.
30 pts
Developing
The submitted work demonstrates a basic or incomplete understanding of the discussion topic. The information provided is inadequate, does not meet word number requirement, does not focus on the assignments topic, and insufficient number of references to support content of discussion (30 points)
0 pts
Not Met
Either no work was submitted (0 points) or the submitted work does not meet any of the minimum criteria and demonstrates no understanding of the material; no supporting references provided.
50 pts
This criterion is linked to a Learning Outcome
Peer Response
Student responds to at least two of their peers initial discussion posts; posts build upon
The ideas and information posed with supporting scholarly references
25 pts
Exceptional
Responds to two or more peers initial posts; responds to instructor’s comments (if applicable); responses demonstrate an analysis of the peers comments that extend and deepen the conversation, supported by a minimum of two scholarly references.
20 pts
Proficient
Responds to two or more peers initial posts; responds to instructor’s comments (if applicable); responses provide reflection and insight into the posts, supported by a minimum of one scholarly reference.
15 pts
Developing
Responds to peers initial posts; responses lack clarification or addition of new information into the posts; insufficient scholarly references to support content of discussion.
0 pts
Not Met
Either no peer responses were submitted (0 points) or the responses do not meet any of the minimum criteria; no supporting references provided.
25 pts
This criterion is linked to a Learning Outcome
Frequency of Distribution of Posts
Students are active in the weekly discussion forum by posting on at least two separate days.
10 pts
Exceptional
Participation in the discussion forum on two separate days of the week; peer responses made on two separate days.
5 pts
Proficient
Participation in the discussion forum on one day of the week
0 pts
Not Met
No participation in the discussion forum
10 pts
This criterion is linked to a Learning Outcome
Academic Writing and Format
Posts are organized in a logical, clear, and concise manner. Writing is free of spelling and grammatical errors. All references are correctly cited in APA format
15 pts
Exceptional
Posts are very organized, well written, and references are correctly cited; no errors in spelling or grammar. knowledge, identifying relevant arguments, evaluating alternative points of view, justifying key results, explaining assumptions, and/or drawing upon reasonable and thoughtful conclusions.
10 pts
Proficient
Posts are adequately organized and satisfactorily written; contains one to two errors in spelling, grammar, or APA formatting of references.
5 pts
Developing
Posts are inadequately organized and poorly written; contains three to four errors in spelling, grammar, or APA formatting of references.
0 pts
Not Met
Either no posts were submitted for evaluation (0 points) or posts are unorganized, poorly written, and contain a substantial number of errors in spelling, grammar, or APA formatting of references.
15 pts
Total Points: 100