This competency portfolio aims to track my progress to advanced practice nursing (APN) concerning the nine MSN Essentials set by the American Association of Colleges of Nursing (2006). 

 

Essential I Background for Practice: NURS 709 DB #1   

            All clinical problems can be answered by applying nursing theory or conducting research. I learned that nursing theory and evidence-based research are the foundation for advanced nursing practice (APN) from the NURS 709 discussion board (DB). From the NURS 715 DB, how to review and apply knowledge about health literacy, vulnerable populations, and ethical/legal protections. Synthesizing three assigned was the foundation of knowledge gained from this assignment. I learned that my three most essential views about the value of nursing theory and research were: (1) delivery of nursing care, (2) delineating the role of an APN, and (3) APN as a change agent. Translating research findings into improvement in practice is a nurse practitioner (NP) competency about Essential I that was fulfilled in my DB for end-of-life care for the homeless population by addressing the health literacy challenges of this vulnerable population. An example of integrating nursing and related sciences into my care was addressing nursing shortages. Integration was done by reviewing the literature and incorporating proven interventions to address time management problems faced in nursing. This skill will be invaluable in future practice because there will be many opportunities to research to ensure I am delivering the best care. 

Essential II Leadership: NURS 802 DB #1; NURS 802 Business Plan; NURS 715 DB #4

            I learned how important it is to include a cost-effective study in all proposed health programs or changes to be made by an APN. I focused on a cost-effective study to provide research evidence to support my proposed business venture and business plan. My DB centered on a workplace smoking cessation program to support the effectiveness of company-sponsored employee health and wellness programs. The cost-effectiveness DB and the development of a business plan helped me understand how healthcare delivery systems are organized and financed. I also learned how to apply budgeting, market analysis, and advertising in developing a comprehensive business plan focused on the health promotion of individuals, families, and communities. My business venture was centered on designing and implementing a workplace health program, focusing on a new care delivery model and coordination. I will use this knowledge of business and economic strategies in my future as I look to open a private practice one day and will need to develop a business plan for that venture. 

            In my DB for NURS 715, I explain how I once made a homeless man take a shower and took that choice from him. I stood there and helped him. I did not realize how this population often feels invisible, fearful, and undignified. Working with this homeless man was a learning experience I have not forgotten for over 20+ years. Applying the research from this assignment helped me apply ethical analysis and clinical reasoning in my assessment and interventions of this vulnerable population. The research into the homeless population I did has already helped me as I was at PiN ministries during my clinical rotation this semester and will continue to guide me in my future everyday practice. The peer response aspect helps engage in discussion with other APNs in a constructive scholarly way. 

Essential III Quality Improvement: NURS 763 Group Project; NURS 802 DB #2; NURS 802 Business Plan; NURS 715 DB #4

            The group project from NURS 763 taught us how to work within different schedules and overcome this barrier by coming up with alternative ways to communicate, complete our portion of the project, and edit the paper. We also had the unique opportunity to learn about each other's healthcare roles and services. As physical therapists (PTs) and APNs, we developed a physical activity brochure for older adults that incorporated views from both professions. A safe and effective plan was provided to this population. The NURS 802 DB used a research article's measurements and evaluation of a smoking cessation program and its cost-effectiveness to employees, the company, and its insurance provider, demonstrating competency in comparing appropriate quality improvement models. Applying the results of the research supported my business venture. My business plan outlined quality improvement measures addressing health promotion, prevention, and cost savings. The business plan and evaluation process demonstrated the integration of healthcare services within systems to improve patient outcomes and provide continuity of care. In the homeless population NURS 715 DB, research led to direct quality improvement methods promoting culturally responsive, safe, timely, and equitable patient-centered care. I was able to apply this to my clinical rotation at PiN and, in the future, to any vulnerable population facing numerous SDOHs. I have and will be able to work successfully with an interprofessional team in my role as an APN. I can apply quality measures to evaluate interventions used in caring for my patients and adjust my plan accordingly.  

Essential IV Scholarship into Practice: NURS 709 Critique I, II; NURS 709 Group Project 

            I learned how to analyze specific sections of a research article and compare/contrast with critique guidelines to assess the credibility of data gathered in support of Enhancing Migraine Self-efficacy and Reducing Disability Through a Self-management Program. Competencies met with critiquing research were how to analyze ethical practice within nursing research and present the credibility of sources of information and their relevance to the practice problem presented. Identifying the contents of specific sections of a research article plus verbiage used to identify topics such as hypothesis/research question, concepts, and ethical/legal considerations is especially helpful for current and future research into a clinical question or problem. Measurement and evaluation of outcomes is an additional skill studied for this assignment. The group project for NURS 709 applied Orem's Self-Care Nursing Theory to clinical practice. We learned how to take care of a pediatric patient encountering many social determinants of health (SDOH) and barriers to care such as poverty and parental non-compliance. This group project demonstrates competency in integrating theory, evidence, clinical judgment, research, and interprofessional perspectives into care delivery and improvement. When I identify a clinical question or concern, I will be able to conduct a literature review for research evidence, apply theory-based care, and be confident that I am providing the most current care for patients in my future practice. 

Essential V Informatics and Healthcare Technologies: Telehealth Course Certificate 

            Telehealth has exploded since the onset of COVID 19. I learned how to conduct a telehealth patient visit and work collaboratively with an interprofessional group. Knowledge gained was telehealth technologies, delivery models, legal considerations, billing/coding, data measurements, consent, conducting visits and physical exams, and follow-up. Our group video project was between three of us, where we each had the opportunity to be a telehealth provider, patient, and evaluator. NP competencies met were current and emerging technologies (home monitoring systems) supporting safe practice environments, evaluating outcome data using statistical principles for health improvement, and using technologies and resources to teach patients (group members during visits). This class was vital to my clinical rotations during school and for my future practice, as I am now able to conduct a telehealth visit that is systematic, effective, and convenient for patients and providers. These visits are HIPAA compliant, safe, and secure. 

Essential VI Health Policy/Advocacy: NURS 800 DB #1; NURS 802 DB #2

            In the DB for NURS 800, I learned how an APN could be involved in health care design and policy specific to genetic cancers. Incorporating reading materials, patient materials, and in-person training programs was identified as a potential for change in formal education offerings. This change demonstrates how an APN can participate in developing, implementing, and advocating for policies to improve public health and the nursing profession. In the DB for NURS 802, I learned that federal laws govern healthcare concerning privacy, confidentiality, discrimination, and disabled persons. Bringing a nursing perspective to a clinical concern will assist me in the future if I see any deficit regarding a specific problem/population. I have the knowledge base to create a policy addressing an issue. This knowledge will be helpful in my future practice as I plan to be an APN who opens her practice. Change and knowledge of the city, state, and federal laws are critical in healthcare and business ownership.

Essential VII Interprofessional Collaboration: NURS 763 and Telehealth Group Projects 

            The NURS 763 interdisciplinary group project and telehealth group projects covered health promotion theory, interventions, delineating provider roles, and overcoming barriers. As APNs, we advocated leading the inter-professional group, facilitating understanding of other provider roles, and collaborating in designing, coordinating, and evaluating patient care. Effective communication strategies like zoom meetings, phone calls, emails, and texting were used. I functioned as an effective team member in my responsibility to cover Healthy People 2030 objectives and apply Pender's Health Promotion Model to engage older adults in healthy behaviors supported by research evidence to affect health outcomes positively. I will be able to use my role as an APN in future practice for interprofessional healthcare teams and patient-centered care and collaboration to deliver high-quality health care to patients.

Essential VIII Clinical Prevention and Population Health: NURS 800 Group Project 

            The project was on the human immunodeficiency virus (HIV) within the prison population. I learned of this population's unique needs and learned more about identifying, assessing, planning and treating HIV within the prison population. I learned how to work together with other healthcare professionals in identifying a vulnerable population and their susceptibility to a specific disease process. Working together, we fulfilled NP competencies related to Essential VIII by synthesizing social determinants of health (SDOH) and applying epidemiologic data to design and implement prevention strategies specific to HIV in the prison population. Focusing on primary, secondary, and tertiary prevention, we were able to design a cultural, patient-centered plan of action with a needle exchange program, HIV screenings, and providing adequate medical care in the U.S. prison system. I will use these competencies plus prevention and population health concepts when I develop culturally relevant health education, communication, and interventions. Knowledge of population health and prevention strategies is integral to caring for individual patients and their caregivers. It will allow me to apply evidence-based care and provide the most current guidelines proven successful in treating many acute and chronic conditions. 

Essential IX Master's Level Nursing Practice: SOAP Notes; EXXAT Patient Log 

            I learned a systematic approach to my patient visits and charting in the SOAP note format. With the various SOAP note assignments, I moved from subjective to objective, then to assessment and plan. This format is helpful in recall and reflection, so I can apply any necessary changes to make sure my care is proper and within guidelines. Seeing the numerous patients throughout my clinical allowed me to learn, grow, see what worked and did not, and apply the newest evidence-based clinical care possible for my patients. The SOAP notes and my EXXAT patient log demonstrated NP competencies about Essential IX, such as conducting comprehensive and systematic assessments as a foundation for decision making and applying the most current evidence-based care to my patients. In my encounter with EVMS patient 1, I incorporated the Alzheimer's Foundation, their website, and their services to advance patient education, enhance the accessibility of care, and improve health care outcomes. This valuable service will help this patient best care for her mother and herself as she fulfills the role of caregiver in the home. The knowledge I gained from seeing patients during clinical and writing SOAP notes is vital to my future nursing practice. This systematic format will ensure a patient visit and organized documentation addressing patient concerns, assessment, and appropriate planning within appropriate clinical care guidelines. This experience has been vital to my competence as a future APN.

 

References

American Association of College of Nursing. (2006). The essentials of doctoral education for advanced practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf