Chamberlain college of nursing program outcome 5

Running head: MAIKEL MITCHEL PORTFOLIO PART II 1

MAIKEL MITCHEL PORTFOLIO PART II 4

Portfolio Part II

NAME

Chamberlain University

NR661 APN Capstone

Contents Background 4 Exemplar I: NR503 Population Health, Epidemiology & Statistical Principles 4 Identify and Explain 11 Chamberlain Program Outcomes 11 Connect 13 Reflection 13 Exemplar II: NR 505 Advance Research Methods Week 3 15 Identify and Explain 23 Connect 24 Reflection 25 Exemplar III: NR 507 Advanced Pathophysiology 26 Identify and Explain 27 Connect 29 Reflection 29 Exemplar IV: NR 508 Advanced Pharmacology 30 Identify and Explain 32 Connect 34 Reflection 34 Exemplar V: NR 509 Advanced Physical Assessments 35 Identify and Explain 36 Connect 37 Reflection 38 Exemplar VI: NR510: Leadership and Role of the Advanced Practice Nurse 39 Identify and Explain 45 Connect 46 Reflection 46 Exemplar VII NR 511 Differential Diagnoses and Primary Care 48 Identify and Explain 50 Reflection 52 Exemplar VIII: NR 601 Primary Care of the Maturing and Ageing Family 53 Identify and Explain 57 Connect 58 Reflection 58 Exemplar IX: NR 602 Primary Care of the Childbearing and Childbearing Family 59 Identify and Explain 62  Ethics Competencies 63 Connect 64 Reflection 64 Exemplar X: NR 602 Advanced Clinical Care and Practice Across the Lifespan of Practinum 65 Identify and Explain 67 Connect 69 Reflection 69 Appendix A: Mind Concept 71 Appendix B: Tabulation of outcome, Essentials and Competencies achieved 72

Background
As a result of the comprehensive and intense nursing education program at Chamberlain cumulating into an award of Masters of Science in Nursing, the following is a documention of the journey through the Program Outcomes, Master’s Education Essentials as well as the National Organization of Nurse Practioner Faculties Core Competencies all of which bear the abbrevations PO, MSN Essentials, and NONPF. Correspondingly, this documentation will cover all of the ten exemplars and give an assessment on views of the right argument that all of the above requirements have been covered.

Exemplar I: NR503 Population Health, Epidemiology & Statistical Principles
Introduction

The high number of HIV cases, especially the newly diagnosed cases of the disease constitutes a major health problem in South Florida and the entire country. Although, the preventive efforts for HIV have led to a considerable reduction in the number of new diagnoses, some populations and regions are disproportionately affected by the disease. As such, the proportion of individuals living with the disease is considerable higher in some regions and populations, and this could largely be attributed to high-risk behaviors, economic and social factors that place these groups at a higher risk for infection. This has created a huge concern especially among the healthcare professionals due to the consequences and health risks associated with the disease.

The Centers for Disease Control and Prevention (2016), estimates that about 1.2 million individuals in the US have HIV. Moreover, a considerable proportion of these individuals are not aware of their HIV status. In regard to transmission category, majority of the new cases of HIV are recorded among MSM (men who have sex with men) across all the ethnic and racial groups. On the other hand, African-Americans constitute the high affected group with the highest prevalence followed by the Hispanics.

In regard to South Florida, HIV constitutes the major health problem in the region that affects a substantial proportion of the population. According to AIDSVu (2016), about 25,669 individuals living in Miami-Dade County were found to have HIV in 2013. In addition, about seventy-two percent of individuals living with the disease were men while the rest were women. As such, this indicates that the rate of HIV within the region is higher among men as compared to women. HIV is usually associated with numerous consequences including reduced productivity and increased cases of hospitalization that have a huge economic burden on patients, families, employers and the entire healthcare system. Furthermore, HIV usually weakens an individual’s immune system whereby this predisposes one to various infections like tuberculosis and candidiasis as well as other health complications including kidney disease and certain forms of cancer. Hence, this stresses the urgent need to effectively assess the problem of HIV in the region, identify the contributing factors to these problems and subsequently develop efficient strategies for addressing this problem. As such, the purpose of this paper is to assess the problem of HIV, particularly in South Florida and develop suitable strategies for addressing this problem in order to enhance the community’s health.

Background of the disease

HIV (Human immunodeficiency virus) is a virus that weakens an individual’s immune system and interferes with the ability of the body to fight various disease causing organisms. The virus may lead to the development of AIDS (Acquired immunodeficiency syndrome) especially if it is not treated. However, even with the treatments, it is impossible for the human body to effectively fight off HIV and get rid of the virus completely; hence it is a life-time disease.

HIV usually attacks the immune system, particularly the CD4 cells whereby this weakens the system and subsequently the body’s ability to fight off various disease causing organisms (Bradley et al., 2014). Lack of treatment for HIV decreases the number the number of T-cells whereby this increases the vulnerability of an individual to various opportunistic infections as well as cancers. Ultimately, the virus destroys most of the CD4 cells, hence affecting the body’s ability to fight off diseases as well as infections and progression of the disease to the last stage that is known as AIDS. During the last state, the immune system is severely weakened and this leads to an increase in various opportunistic illnesses that ultimately lead to death. HIV is associated with various symptoms, though they usually vary based on the stage of infection. Acute HIV is the initial stage of the disease and is usually characterized by a variety of symptoms that include; headaches, rashes, fever, swellings in the lymph glands, muscle aches and sore throat (Bradley et al., 2014). In most cases, these symptoms develop two months after one is infected. Lack of treatment causes multiplication of the virus leading to destruction of the immune cells whereby this leads to the development of chronic symptoms including; fatigue, diarrhea, fever, weight loss, shingles and thrust. Ultimately, lack of treatment causes severe weakening of the immune systems and leads to the progression of the disease to AIDS. Some of the symptoms associated with this stage include; recurrent fever, persistent fatigue, skin rashes, unusual lesions in the mouth, weight loss and chronic diarrhea. HIV is transmitted in various ways that include; engaging in sexual intercourse with a partner who is infected with the disease, blood transfusion, sharing of contaminated needles, breast feeding or during pregnancy. However, the treatment of HIV mother and screening of blood during transfusion usually lowers the chances of transmission (Bradley et al., 2014).

Although HIV is incurable, the disease is controllable through proper treatments or medical care. Typically, antiretroviral therapy is the recognized treatment for HIV and when they are taken appropriately these medications usually help in prolonging the lives of infected individual and enables them to enjoy an active and healthy life (World Health Organization, 2014).

HIV constitutes one of the major health problems in South Florida, and statistics provided by various departments indicate that the rate of HIV has dramatically increased in the recent years and is currently higher than the national average. According to a survey carried out by the Centers for Disease Control and Prevention in 2015, the number of individuals diagnosed with HIV was about 38.8 per 100,000 individuals in Miami-Fort Lauderdale-West Palm Beach. In addition, the survey indicated that about 51.2 cases per 100,000 individuals were diagnosed with the disease within the same year in Miami-Dade County (CDC, 2015). This shows that the rate of HIV new infections is higher than the national average that was about 12.3 cases per 100,000 individuals within the same year. On the other hand, the survey showed that the highest number of cases was recorded among MSM (men who have sex with men). For instance, in Miami-Dade County, there were about 8,293 cases recorded among this group. Similarly, according to AIDSVu (2016), in 2013 about 25,669 individuals were found to have HIV in Miami-Dade County and men comprised the highest percentage (72%) of this population. In regard to ethnicity, the percentage of individuals who were diagnosed with the disease within the same years was 45%, 42% and 12% among Blacks, Hispanics and Whites respectively. Moreover, about four-hundred and fifty nine individuals died as a result of this disease in the county and about 2,274 of HIV-related deaths were recorded in 2013 in Florida. Similarly, according to the Health Communities Institute (2017), Non-Hispanic Blacks constitute the highest percentage of HIV cases while non-Hispanic Whites have the least number of cases, and the MSM group, specifically those aged between twenty and twenty-nine years constitute the highest percentage of new infections.

Overall, these statistics indicate that the rate of HIV in Miami is higher than state as well as national rate. This emphasizes the urgent need to undertake the appropriate actions to prevent new infections and foster optimal control of the disease among those who are already infected. The table below shows the differences in the rate of HIV in Miami, Florida and at the national level.

Prevalence rates of HIV

Geographical area

Year (2015)

Miami

51.2 cases per 100,000 individuals

Florida

24.5 cases per 100,000 individuals

United states

12.3 cases per 100,000 individuals

Surveillance methods for reporting the disease to providers

Surveillance and reporting of HIV to providers is an essential aspect that helps the healthcare providers to understand the extent of the problem and subsequently come up with relevant interventions for preventing and controlling the disease. As such, there are numerous surveillance methods utilized in the region that enable the provider to acquire the correct information pertaining to the disease. Some of the surveillance methods utilized in the region include; surveying and analyzing of the clinical records on the diagnosed cases and incidences of HIV, morbidity as well as the mortality rates. In regard to this, there are various agencies that are involved in the collection of data related to HIV, analysis and interpretation of HIV care practices, morbidity rates, risks factors and mortality rates in the region. These agencies report their findings to the relevant healthcare departments and providers and usually offer recommendations on the on the community’s health status and the improvements that can be made to enhance the community’s health. Among the key agencies or organizations involved in HIV surveillance include, the Centers for Disease Control and Prevention, the Health Council of South Florida and Florida Department of Health. These agencies usually collect accurate as well as complete data relating to HIV and analyze the trends of the disease. This information helps healthcare providers in developing appropriate interventions to curb the disease.

Epidemiology analysis of the disease

HIV is one of the most widespread disease is South Florida and accounts for a large percentage of deaths as well as hospitalization cases within the region. According to CDC (2016), about 51.2 cases per 100,000 individuals were diagnosed with the disease in 2015 in Miami-Dade County. In addition, South Florida is ranked among the top regions with the highest number of newly diagnosed cases of the disease and the rate is about three times higher than the national rate. In relation to ethnicity, the Non-Hispanic Blacks constitute the highest percentage of HIV cases while non-Hispanic Whites have the least number of cases while the MSM group constitutes the highest percentage of HIV infections (CDC, 2016). For instance, blacks constitute about 45% of individuals suffering from this disease in Miami-Dade County. Moreover, HIV accounts for a great percentage of the hospitalizations and is among the major reasons for hospital visits. This increase the healthcare costs incurred by the healthcare organizations, patients and families. For instance, the average annual cost of treating an individual patient suffering from HIV is about $ 25,000. Overall, the disease is associated with numerous consequences including reduced productivity and increased cases of hospitalization that have a huge economic burden on patients, families, employers and the entire healthcare system.

Diagnosis of the disease and standards for screening and prevention

Diagnosis of HIV is a key aspect that helps in early identification of this disease and consequently enables individuals diagnosed with the disease to start treatments during the initial stages of the disease whereby this prevent the progressions and foster optimal management of the disease. As such, numerous guidelines on screening of HIV have been developed so as to promote early detection and treatment of the disease. Some of the screening test used in the diagnosis of HIV includes; the CD4 count test and viral load test (Bradley et al., 2014). The CD4 test is used in measuring the number of the CD4 cells in an individual’s blood sample and the normal CD4 count for a healthy person is between 500–1,600 cells/mm3. The USPSTF (US Preventive Services Task Force) recommends that screening for HIV should be performed in all individuals aged between fifteen and sixty –five years.

Plan

Based on the increased prevalence and the high number of new HIV cases in the region, there is an urgent need to come up with a comprehensive action plan for addressing this problem in order to enhance the community’s health. As such, I plan on increasing HIV awareness within the community though educating the community members on the risks as well as consequences associated with HIV and the need to minimize the high-risk behaviors like engaging in sexual intercourse with multiple partners. Moreover, I will endeavor to educate the population on safe sex practices like the use of condoms and the importance of regular screening and encourage the community members and the benefits of screening. Additionally, I will closely work with the relevant stakeholders as well as the policy makers to promote HIV screening within the community and minimize stigmatization of individuals suffering from the disease, since this is one of the key factors that hinder optimal screening of the disease.

Conclusion

HIV is a major health problem in Miami, Florida that is associated with numerous consequences and health risks. Lack of treatment of the disease usually increases one’s vulnerability to various infectious diseases and increases the risk of developing other related complications. The disease presents a huge economic burden on the healthcare system, families, employers and patients due to the associated health expenditures as well as indirect costs. As such, there is an urgent need to develop and implement effective measures to prevent the spread of this disease.

Identify and Explain
Chamberlain Program Outcomes
· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

AACN MSN Essentials

· Essential I: Background for Practice from Sciences and Humanities

NONPF Core Competencies

· Scientific Foundation Competencies

· Technology and Information Literacy Competencies

The course Program Outcome #1 largely applied to the study I carried on HIV in South Florida in the United States. The Program Outcome #1 was realized by calculating HIV prevalence in various areas in the State of Florida. The prevalence was broken down to address specific populations of interest. Surveillance methods for HIV were discussed and this is an application of techniques to ensure high quality community intervention plan. The intervention plan to increase health awareness on HIV is prioritizing the patients which mean it is patient centric. I have systematically applied analysis of the HIV prevalence in South Florida and suggested an intervention plan.

The MSN Essential I that captures the need to develop competencies of understanding and using the background for practice in humanities and sciences informed the systematic approach to understanding prevalence of HIV in the target community. As demonstrated in studying prevalence of HIV and designing a community intervention for Miami, I relied on scientific findings from the field of nursing, quality improvement, public health as well as organizational sciences to advocate for continual improvement of health outcomes of the target community. For instance, I invoked scientific findings to understand how widespread HIV is in Miami. The concepts of prevalence and incidence are borrowed from statistics. I had to rely on organizational concepts to understand ways of interacting with the community in my intervention plan.

I also demonstrated NONPF Core Competencies and in particular the scientific foundation competencies by thinking critically concerning data on HIV and applying evidence based practice to design a health intervention plan for the target population. I went further and included research outcomes to improve practice approaches and outcomes of HIV patient. I have also included knowledge from other disciplines to arrive at a conclusion that is highly applicable. The Technology and Information Literacy Competencies as a NONPF competence was accomplished by using a spreadsheet application to determine prevalence of HIV from the data collected.

Connect
Screening: In nursing context, health screening refers to a test carried out to determine a condition prior to symptoms manifestation. Health screening is used to help detect conditions and diseases early enough to make it easier to treat. In this manner, screening is part of preventive care. Adequate health awareness is needed to encourage health screening (Porter et al., 2016).

Surveillance: Disease surveillance refers to information-oriented activity that entails gathering, analyzing and interpreting large volumes of relevant health data from different sources. Technology and informatics can be used to enhance disease surveillance by enabling real time analysis. Disease surveillance should lead to effective management and enhanced preventive health measures. Surveillance of diseases is normally a continuing process and demands systematic gathering of data and information relevant to tracking the incidence rate and prevalence of the disease (Porter et al., 2016).

Reflection
This course has allowed me to test scientific foundations in realizing Program Outcome #1 to promote safe and high quality patient-driven care anchored in holistic health tenets. I had to invoke several scientific studies on prevalence of HIV in Miami to fully understand the status of the disease in this target population. I had to compare several studies to conclude on the prevalence of HIV in Miami as well as determining the incident rate in Miami. Dividing the study into smaller segments allowed me to fully address every aspects of the study including determing the potentially responsive plan. For instance I went further to analyze prevalence rates in men having sex with men.

By having a background in humanities and sciences, it become easier to understand evidence based research articles on HIV prevalence and intervention plans in Miami. The MSN Essential I informed my competencies of understanding and using the background for practice in humanities and sciences informed the systematic approach to understanding prevalence of HIV in the target community. Through having a background in humanities, I understood the factors given for the vulnerability of the target population in Miami and this informed the treatment plan. A nurse should also possess NONPF core competencies such as scientific foundation competencies. I managed to include research outcomes to enhance practice approaches to managing HIV. By using a spreadsheet application to compute prevalence of HIV from the data given I had operationalized Technology and Information Literacy Competencies, a NONPF core competency.

References

AIDSVu. (2017). Miami (Miami-Dade County) - AIDSVu. Retrieved from https://aidsvu.org/state/florida/miami/

Bradley, H., Hall, H. I., Wolitski, R. J., Van Handel, M. M., Stone, A. E., LaFlam, M., ... & Patel, R. (2014). Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR Morb Mortal Wkly Rep, 63(47), 1113-7.

Centers for Disease Control and Prevention. (2015). HIV Surveillance | Reports| Resource Library | HIV/AIDS | CDC. Retrieved from https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

Centers for Disease Control and Prevention. (2016). Today’s HIV/AIDS Epidemic. Retrieved from https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf

Health Communities Institute. (2017). Miami-Dade Matters:: Indicators :: HIV Incidence Rate :: County : Miami-Dade. Retrieved from http://www.miamidadematters.org/index.php?module=indicators&controller=index&action=view&indicatorId=263&localeId=414

Porter, S., Qureshi, R., Caldwell, B. A., Echevarria, M., Dubbs, W. B., & Sullivan, M. W. (2016). Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers. Infants & Young Children, 29(2), 91-101.

World Health Organization. (2014). Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations.

Exemplar II: NR 505 Advance Research Methods Week 3
Author, Year of Publication

Purpose

Sample

Design

Level of Evidence

Findings

Limitations

Gupta, Shukla, & Tyagi (2016)

To evaluate the degree of know-how and practice of bio-hazardous waste management among the health care fraternity

Convenience sample of 89 health care personnel encompassing doctors, laboratory technicians, health workers, nurses, pharmacists and also class IV workers

Cross-Sectional Study aimed at investigating the degree of awareness on infectious waste in each identified category of health care personnel

VI: evidence from a single descriptive study

15 doctors, 22 class IV, 32 laboratory technicians, and 20 nurses responded. 93% of medical officers had remarkable awareness on medical waste generation and legislation as compared to 100% doctors, 95% nurses, 90% lab technicians, and 0%to 4.6% among class IV workers

The findings cannot be generalized due to small sample size

Das, S. K., & Biswas, R (2016)

Assessing the knowledge and practice regarding biomedical waste management of health care providers in a tertiary facility

The study deployed a convenience sample of 198 hospital staff working in different capacities but within the departments of obstetrics, surgery, general medicine, and gynecology.

Descriptive study of staff awareness and practice with regards to medical waste management

VI: evidence from a single descriptive study

All subjects had heard about biomedical waste, 1.5% had formal training on the same, 6.6% had know-how on the use of five-color coding, 31% understood correct disposal of sharps, 70.2% knew the use of masks and gloves, and 41.4% knew there is a risk of HIV/AIDS transmission through bio-medical waste

The study’s main drawback was its small sample size thus affecting the generalizability of findings.

Njiru, M.W., Mutai, C., & Gikunju, J (2013)

Assess both the extent of awareness and practice regarding bio-medical waste management among health care personnel in one Kenyatta National Hospital, Kenya.

A convenience sample of 244 healthcare personnel comprising 17 doctors, 129 nurse, and 98 support staff was used.

A Cross-Sectional study design

VI evidence from a single descriptive study

The overall awareness level stood at 60%. In terms of categories, doctors scored 51%, nurses 65%, and support staff 55%.

The study is overly generalized as it does not explain in which areas the said personnel score exemplary and in which areas they require training.

Sharma (2010)

Assess the awareness of bio-medical waste management rules among health care personnel in Agra

A convenience sample of 1972 participants was selected. The subjects came from three strata namely: apex government hospitals; government and non-government FRU; and private healthcare facilities

Descriptive Study design was used.

VI evidence from a single descriptive study

Only 33.21% of the personnel in apex government hospitals knew about the rules governing the management of bio-medical waste as compared to 29.09% and 17.07% in government and non-government hospitals and private hospitals respectively.

Relying explicitly on questionnaire technique of gathering data, this study suffers three main shortcomings. First, it lacks the validity of data. Second, there is no sure way of eliminating interviewee bias in answering the questions. Third, the formulation of questionnaires is vulnerable to subjectivity of the researcher.

Summary

The research concern or question addressed in the research summary table is: “What is the degree of awareness and practice of bio-medical waste management among health-care personnel?” All of the samples were convenience samples of healthcare personnel ranging from doctors, nurses, laboratory technicians, and support staff. The use of convenience sampling could have been necessitated by several factors such as cost effectiveness. Since this method does not require an elaborate setup, overhead costs are maintained at minimal levels and this frees funds for use in other aspects of the research. It should also be noted that most research studies that use convenience sampling collect their data from the populations at hand. Sample groups are therefore readily available when using this method and this enhances ease of study as researchers need not travel long distances to collect data.

Three of the studies investigate the extent to which health care personnel ranging from medical doctors, nurses, laboratory practitioners, and support staff are aware of the existent of both bio-medical wastes and management practices of these wastes. The fourth study takes a twist from the awareness of infectious waste and management practices to the awareness of the bio-medical waste management rules. Hence, all the studies answer the research question in remarkable uniformity; the extent to which the healthcare personnel is aware of bio-medical waste management practices is very wanting.

Turning to the selection of the sample and the number of subjects selected for the investigations, these studies score quite low. Beginning with the selection of the samples, convenience sampling negatively affects the validity of research findings in various ways. Firstly, convenience sampling relies heavily on the judgment of the researcher especially with regards to the number of subjects. Hence, the technique can easily lead to either over-representation or under-representation of certain groups within the sample. Secondly, the sampling frame is unknown and the sample is not realized randomly. Consequently, it is highly unlikely that the sample will be an accurate subset of the population. In cases of unrepresentative sample, the ability to generalize findings for the entire population is greatly hampered. Besides the use of convenience sampling, these studies also utilized very small numbers except in the case of Sharma (2010). These small sample sizes also affect the researchers’ ability to generalize findings.

Having identified the major limitations of these studies as small sample sizes and the sampling technique, future researchers can remedy them by increasing the sample size and using a purposive sampling technique. Widening the sample sizes would move a long in enhancing the generalizability of findings. As a result, findings in bio-medical waste awareness will have the required authority to drive policy formulations and implementations. Most importantly, future researchers should direct their energies towards investigation of the health risks associated with improper management of bio-medical wastes to both healthcare personnel and the general public. Empirical research findings showing the existence of evidence-based connections between bio-medical wastes and susceptibility to some diseases would move a long way in invoking the health care practitioners to embrace the already existing rules with regards to infectious waste management.

Despite the above highlighted limitations, the evidence that these studies unveil is strong enough to suggest change in practice. There are two primary rationales why these findings are enough to trigger change in the management of bio-medical wastes. First and foremost, bio-medical wastes contravene the culture of safety in healthcare facilities both for the practitioners and the patients. One way of cultivating and maintaining a culture of safety is failing to tolerate egregious behavior such as improper management of infectious wastes. Secondly, professional codes of conduct, Code of ethics, and competency set by healthcare regulatory bodies require healthcare facilities and personnel to practice with accordance to rules. In this light, there are a host of rules established with regards to appropriate management of biomedical wastes. Hence, healthcare personnel have an obligation not only to orient themselves on existing legislations with regards to bio-medical wastes but also to practice them. In addition, professional standards require that practicing individuals always engage in self-evaluation on their practice and improve where need be.