NURS 8002 The DNP-Prepared Nurse and Their Community
NURS 8002 The DNP-Prepared Nurse and Their Community

NURS 8002 The DNP-Prepared Nurse and Their Community

RE: Blog – Week 7
COLLAPSE

Increasing access to care can feel like a constant battle for Veterans and the Veterans Health Administration (VHA).  As we see more and more initiatives opened, we also see more and more applications for VHA benefits.  Within the VHA, notably the primary care setting, I have witnessed many significant accomplishments and solutions to everyday problems, only to open the door to more problems.  For this discussion, I have found two challenges within the VA system; however, both are regarding access to care and two different programs.

In the VHA, we have what is called the Mission Act.  The Mission Act allows Veterans to go to urgent care or the emergency room for urgent or emergent treatment (Veterans Affairs [VA], 2017).  Disseminated information since 2018, many veterans do not know of this increased access to care initiative.  Is it because information overload from the complex VA is constantly bombarding their mailboxes and telephone?

In addition to the Mission Act, we also have the Clinical Contact Center that offers virtual urgent care visits for Veterans here in Florida (US Department of Veterans Affairs, 2019).  This has also been around for about two years now, and I’m surprised I still must teach Veterans about it daily.  This center also offers Pharmacy services.

With this situation, it’s not a matter of not having access to care, and it’s more of a case of not knowing access to care exists.  So, my solution would be to provide flyers to patients at every visit for a quarter or six months until most patients receive the information and can be familiar with it.  Another way to get the information out is to educate with each call made or in-person visit constantly.  I thought a mass mailing of the services would work, but I believe the Veterans are already over-bombarded with VA mailings, and it would be overlooked and not financially wise.  It will take time for this information to get to all the Veterans, and it is going to be a matter of continuity of providing the information and education.  I have also witnessed a lot of patients who do not feel comfortable using this method and never take advantage of it.  This is primarily the older generations, challenged by modern technology, that still see the value in a face-to-face visit with their provider.

Another problem with access to care is in the community care program that enables qualified Veterans to see providers, specialists, and diagnostics in the community approved by the VA (US Department of Veteran Affairs, 2013).  As an RN, I have seen numerous consults go in for these visits only to see the consults discontinued and the patient calling me wanting an explanation for why it was discontinued.

With community care consults, the primary care provider must first enter a consult for the appropriate specialty at the main VA building.  At that point, the specialty scheduler will then reach out to the patient.  One of three things will happen.  One, the patient doesn’t answer the phone, and after trying one time to contact, a generic letter is sent (adding to the mail bombarding mentioned earlier). After so many days, the consult is discontinued.  The second thing that can happen is the patient doesn’t realize they must ask for community care because only the specialist can order community care (not the primary care doctor). The scheduler doesn’t take the time to educate the patient on how the system works.  The consult then gets discontinued, and the patient starts over from ground zero, going back to the primary care physician for another consult to be written.  The third scenario is everything goes as planned, and the patient requests community care services from the specialty scheduler.  The scheduler then checks for eligibility, and if approved, the specialist will then place a consult for community care.  The community care office receives the consult and then plans with the community provider to set up appointment times and services covered.  The patient must wait for the community provider to reach out to them to inform them of their appointment time.  Community care is designed to save the patient travel time or wait time.

By the time consults finally go through, they could have seen the VA specialist most of the time.  This system frustrates the patients and the doctors.  A practice I would add to this process is changing the number of times required to attempt phone contact before sending a letter.  One attempt is simply not enough.  Patients call me furious at how their consult was handled, and even though I’m not involved, I must sort it out for them and try to restore trust once again.  Another change I would do regarding practice is if a consult is discontinued for inability to make a connection with the patient when the patient calls the specialty clinic, the specialist should be able to pick up at the point of the discontinued consult and push it through to community care with a new consult that they write, and not rely on the primary care doctor to re-do the consult.  Doctors do not have enough time to get to every concern and question patients have daily, which only adds to the time the Veteran must wait.

Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking V (American Association of College of Nursing [AACN], n.d.).  This essential reflects on the actual process of change under the direction of leadership to improve patient outcomes.  In this case, it would be increasing access to care in both scenarios.

 

The two essentials in the AACN Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care (AACN, n.d.).  This essential involves the use and knowledge of technology to improve patient outcomes.

 

References:

American Association of College of Nursing [AACN]. (n.d.). Doctor of nursing practice. American Association of Colleges of Nursing: The Voice of Academic Nursing. Retrieved October 12, 2021, from https://www.aacnnursing.org/DNP/DNP-Essentials.

US Department of Veteran Affairs. (2013, December 2). Veterans Affairs. Community Care. Retrieved October 12, 2021, from https://www.va.gov/communitycare/.

 

US Department of Veterans Affairs. (2019, May 22). VISN 8 Clinical Contact Center – 24/7 Virtual Urgent Care. Retrieved October 12, 2021, from https://www.visn8.va.gov/ccc.asp.

 

Veterans Affairs. (2017, August 22). Veterans Affairs. Go to VA.gov. Retrieved October 12, 2021, from https://www.va.gov/communitycare/programs/veterans/Urgent_Care.asp.

 

NURS 8002 The DNP-Prepared Nurse and Their Community

Vaccine and immunization legislation.

Nutritional assistance programs for school youths.

Diabetes education for elderly outpatients in a community health clinic.

Reducing the number of re-admits of patients who have had outpatient procedures.

Reducing the number of patient falls on a medical/surgical hospital floor.

Photo Credit: Getty Images/iStockphoto

These represent a few community and organizational needs, challenges, and issues that may require and merit the advocacy, skill set, and knowledge of the DNP-prepared nurse. In your role as a DNP-prepared nurse, you may find yourself the champion and advocate for improved health outcomes both at a local and individual patient level to one of a national or global and population-based level. The DNP-prepared nurse is well poised to address and advocate changes not only in a healthcare setting but in a community context to promote positive social change and positive health-based outcomes.

For this Discussion, reflect on those needs, challenges, and issues that may be most important for your community or organization. Why do these needs, challenges, and issues merit the attention of a DNP-prepared nurse?

To prepare:

Review the Learning Resources for this week and consider those local issues/topics that are most important for your community or organization. Find articles about your community or organization that reflect the need for intervention by a doctorally prepared nurse.
Reflect on why these local issues/topics merit addressing from your perspective as a DNP-prepared nurse.
Reflect on your role as the DNP-prepared nurse to address these local issues/topics and consider what type of practice changes or interventions you might recommend to bring about needed change for your community or organization.

By Day 3 of Week 7

Post a response to your Blog in which you describe at least two of the most important needs/challenges/issues in your community or organization. Why are these needs/challenges/issues important? Be specific. Then, recommend at least two practice changes or interventions you would suggest to address these needs/challenges/issues in your community or organization. Be sure to align your role as the DNP-prepared nurse to the competencies identified in the AACN Essentials.

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NURS 8002 The DNP-Prepared Nurse and Their Community

By Day 5 of Week 7

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional strategies your colleague could implement to bring about needed change in their community.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 7 Blog Rubric

 

Post by Day 3 of Week 7 and Respond by Day 5 of Week 7

To Participate in this Blog:

Week 7 Blog

 

What’s Coming Up in Module 4?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will explore and analyze approaches for summarizing peer-reviewed research. You will also contrast which approaches are most helpful in summarizing peer-reviewed research.

Next Module

To go to the next module:

Module 4

 

Week 7: The Doctorally Prepared Nurse: Community of Practice

What is meant by a community of practice?

A community of practice represents a group of individuals who share a common purpose and desire to positively impact their practice and share ideas, perspectives, and lessons learned to enhance the proficiency with which to engage in practice.

Not surprisingly, as a profession, nursing already represents a critical community of practice. Moreover, DNP-prepared nurses are uniquely poised to lead and install changes of a transformative capacity within a community of practice due to their skill set of understanding and engaging in evidence-based practice. As a future DNP-prepared nurse, how do you see yourself engaging with or leading a community of practice?

This week, you will examine community and organizational needs, challenges, and issues. You will analyze the role of the DNP-prepared nurse in addressing these needs, challenges, and issues in your Blog Assignment. You will also consider and recommend practice changes that will meet community and organizational needs, challenges, and issues.

Learning Objectives

Students will:

Evaluate community and organization needs, challenges, and issues
Analyze the role of the DNP-prepared nurse in addressing community and organization needs, challenges, and issues
Recommend practice changes and interventions that address community and organization needs, challenges, and issues

Learning Resources

Required Readings (click to expand/reduce)

 

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

 

Andrew, N., Tolson, D., & Ferguson, D. (2008). Building on Wenger: Communities of practice in nursing. Nurse Education Today, 28(2), 246–252. https://doi.org/10.1016/j.nedt.2007.05.002

 

Cook, D. A., Pencille, L. J., Dupras, D. M., Linderbaum, J. A., Pankratz, V. S., & Wilkinson, J. M. (2018). Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants. PLOS ONE, 13(1), e0191943. https://doi.org/10.1371/journal.pone.0191943

 

Fukuda, T., Sakurai, H., & Kashiwagi, M. (2020). Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists. PLOS ONE, 15(6), e0234879. https://doi.org/10.1371/journal.pone.0234879

 

Kislov, R., Walshe, K., & Harvey, G. (2012). Managing boundaries in primary care service improvement: A developmental approach to communities of practice. Implementation Science, 7(97), 97–110. https://doi.org/10.1186/1748-5908-7-97

 

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Name: NURS_8002_Week7_Blog_Rubric

Grid View
List View
  Excellent

90%–100%

Good

80%–89%

Fair

70%–79%

Poor

0%–69%

Main Posting:

Response to the Blog prompt is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

18 (30%) – 20 (33.33%)

Thoroughly responds to the Blog prompt(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and/or current practice experiences.

No less than 75% of post has exceptional depth and breadth.

16 (26.67%) – 17 (28.33%)

Responds to most of the Blog prompt(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and/or current practice experiences.

50% of the post has exceptional depth and breadth.

14 (23.33%) – 15 (25%)

Responds to some of the Blog prompt(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

0 (0%) – 13 (21.67%)

Does not respond to the Blog prompt(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Main Posting:

Writing

5 (8.33%) – 5 (8.33%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

4 (6.67%) – 4 (6.67%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

3 (5%) – 3 (5%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 2 (3.33%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

5 (8.33%) – 5 (8.33%)

Meets requirements for timely, full, and active participation.

Posts main Blog post by due date.

4 (6.67%) – 4 (6.67%)

Posts main Discussion by due date.

Meets requirements for full participation.

3 (5%) – 3 (5%)

Posts main Blog post by due date.

0 (0%) – 2 (3.33%)

Does not meet requirements for full participation.

Does not post main Blog post by due date.

First Response:

Post to colleague’s main post that is reflective.

5 (8.33%) – 5 (8.33%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

4 (6.67%) – 4 (6.67%)

Response has some depth and may exhibit critical thinking or application to practice setting.

3 (5%) – 3 (5%)

Response is on topic and may have some depth.

0 (0%) – 2 (3.33%)

Response may not be on topic and lacks depth.

First Response:
Writing 5 (8.33%) – 5 (8.33%)

Communication is professional and respectful to colleagues.

Response fully answers faculty questions, if posed.

Provides clear, concise opinions and ideas.

Response is effectively written in standard, edited English.

4 (6.67%) – 4 (6.67%)

Communication is mostly professional and respectful to colleagues.

Response mostly answers faculty questions, if posed.

Provides opinions and ideas.

Response is written in standard, edited English.

3 (5%) – 3 (5%)

Response posed in the Blog may lack effective professional communication.

Response somewhat answers faculty questions, if posed.

0 (0%) – 2 (3.33%)

Responses posted in the Blog lack effective communication.

Response to faculty questions is missing.

First Response:
Timely and full participation 5 (8.33%) – 5 (8.33%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (6.67%) – 4 (6.67%)

Meets requirements for full participation.

Posts by due date.

3 (5%) – 3 (5%)

Posts by due date.

0 (0%) – 2 (3.33%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective. 5 (8.33%) – 5 (8.33%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

4 (6.67%) – 4 (6.67%)

Response has some depth and may exhibit critical thinking or application to practice setting.

3 (5%) – 3 (5%)

Response is on topic and may have some depth.

0 (0%) – 2 (3.33%)

Response may not be on topic and lacks depth.

Second Response:
Writing 5 (8.33%) – 5 (8.33%)

Communication is professional and respectful to colleagues.

Response fully answers faculty questions, if posed.

Provides clear, concise opinions and ideas.

Response is effectively written in standard, edited English.

4 (6.67%) – 4 (6.67%)

Communication is mostly professional and respectful to colleagues.

Response mostly answers faculty questions, if posed.

Provides opinions and ideas.

Response is written in standard, edited English.

3 (5%) – 3 (5%)

Response posed in the Blog may lack effective professional communication.

Response somewhat answers faculty questions, if posed.

0 (0%) – 2 (3.33%)

Responses posted in the Blog lack effective communication.

Response to faculty questions is missing.

Second Response:
Timely and full participation 5 (8.33%) – 5 (8.33%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (6.67%) – 4 (6.67%)

Meets requirements for full participation.

Posts by due date.

3 (5%) – 3 (5%)

Posts by due date.

0 (0%) – 2 (3.33%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 60

Name: NURS_8002_Week7_Blog_Rubric

 

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