NR 500NP Week 5: Systems Theory and Practice Issues

Sample Answer for NR 500NP Week 5: Systems Theory and Practice Issues Included After Question

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. 

Activity Learning Outcomes 

Through this discussion, the student will demonstrate the ability to: 

Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care (CO1)

Apply concepts of person-centered care to nursing practice situations (CO2)

Analyze essential skills needed to lead within the context of complex systems (CO3)

Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings (CO4)

Due Date

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0 for any portion of the discussion not posted by that time). Week 8 discussion closes on Saturday at 11:59pm MT. 

 NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Saturday. 

A zero is the lowest score that a student can be assigned. 

Faculty may submit any collaborative discussion posting to Turnitin in order to verify originality. 

Total Points Possible:  75 

A Sample Answer For the Assignment: NR 500NP Week 5: Systems Theory and Practice Issues

Title: NR 500NP Week 5: Systems Theory and Practice Issues

Requirements: 

Discussion Criteria

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I.   Application of Course Knowledge: of Course Knowledge: 

The student post contributes unique perspectives or insights gleaned from personal experience or examples from the healthcare field. The student must accurately and fully discuss the topic for the week in addition to providing personal or professional examples. The student must completely answer the entire initial question. 

II.  Engagement in Meaningful Dialogue: I. The student responds to a student peer and course faculty to further dialogue.

Peer Response: The student responds substantively to at least one topic-related post by a student peer. A substantive post adds content or insights or asks a question that will add to the learning experience and/or generate discussion.

A post of “I agree” with a repeat of the other student’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
The peer response must occur on a separate day from the initial posting.
The peer response must occur before Sunday, 11:59 p.m. MT.
The peer response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.

Faculty Response: The student responds substantively to at least one question by course faculty. The faculty question may be directed to the student, to another student, or to the entire class.

A post of “I agree” with a repeat of the faculty’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
The faculty response must occur on a separate day from the initial posting.
Responses to the faculty member must occur by Sunday, 11:59 p.m. MT.
This response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.

III.  Integration of Evidence: The student post provides support from a minimum of one scholarly in-text citation with a matching reference AND assigned readings OR online lessons, per discussion topic per week.

What is a scholarly resource? A scholarly resource is one that comes from a professional, peer-reviewed publication (e.g., journals and government reports such as those from the FDA or CDC).
NR 500NP Week 5: Systems Theory and Practice Issues

Contains references for sources cited
Written by a professional or scholar in the field and indicates credentials of the author(s)
Is no more than 5 years old for clinical or research article

What is not considered a scholarly resource?

Newspaper articles and layperson literature (e.g., Readers Digest, Healthy Life Magazine, Food, and Fitness)
Information from Wikipedia or any wiki
Textbooks
Website homepages
The weekly lesson

Articles in healthcare and nursing-oriented trade magazines, such as Nursing Made Incredibly Easy and RNMagazine (Source: What is a scholarly article.docx; Created 06/09 CK/CL Revised: 02/17/11, 09/02/11 nlh/clm)

Can the lesson for the week be used as a scholarly source?

Information from the weekly lesson can be cited in a posting; however, it is not to be the sole source used in the post.

Are resources provided from CU acceptable sources (e.g., the readings for the week)?

Not as a sole source within the post. The textbook and/or assigned (required) articles for the week can be used, but another outside source must be cited for full credit. Textbooks are not considered scholarly sources for the purpose of discussions.

Are websites acceptable as scholarly resources for discussions?

Yes, if they are documents or data cited from credible websites. Credible websites usually end in .gov or .edu; however, some .org sites that belong to professional associations (e.g., American Heart Association, National League for Nursing, American Diabetes Association) are also considered credible websites. Websites ending with .com are not to be used as scholarly resources

IV.  Professionalism in Communication: The post presents information in logical, meaningful, and understandable sequence, and is clearly relevant to the discussion topic. Grammar, spelling, and/or punctuation are accurate.

V.  Wednesday Participation Requirement: The student provides a substantive response to the graded discussion question(s) or topic(s), posted by the course faculty (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.

VI.  Total Participation Requirement: The student provides at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

DISCUSSION CONTENT
Category	Points	%	Description
Application of Course Knowledge	20	27	Answers the initial discussion question(s)/topic(s), demonstrating knowledge and understanding of the concepts for the week.
Engagement in Meaningful Dialogue With Peers and Faculty	20	27	Responds to a student peer AND course faculty furthering the dialogue by providing more information and clarification, adding depth to the conversation
Integration of Evidence	20	27	Assigned readings OR online lesson AND at least one outside scholarly source are included. The scholarly source is:  1) evidence-based, 2) scholarly in nature, 3) published within the last 5 years
	60	81%	Total CONTENT Points= 60 pts
DISCUSSION FORMAT
Category	Points	%	Description
Grammar and Communication	8	10	Presents information using clear and concise language in an organized manner
Reference Citation	7	9	References have complete information as required by APA    In-text citations included for all references  AND references included for all in-text citation
	15	19%	Total FORMAT Points= 15 pts
			DISCUSSION TOTAL=75 points

Preparing the Assignment

Introduction

This graded discussion will explore the impact of systems theory on a practice problem or issue. Please provide an initial response to the discussion question by Wednesday at 11:59pm MT and two interactive dialogue responses no later than Sunday 11:59 PM MT at the end of WEEK 5. The discussion is worth 75 points. Please refer to the discussion grading rubric for additional criteria.

Discussion Question:

Many of you have experience in complex adaptive systems whether you realize it or not. Thinking about your current or future practice area, identify an issue or concern. In your initial response, please describe the concern. Does the concern primarily occur at the micro, meso, or macro level? How would you address this issue? What impact might your solution have on the other levels of the system? In what ways could interprofessional collaboration be used to resolve the issue?

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

NR500NP Week 5: Discussion

My experience as a RN is in the ED and ICU. The ED in itself can be considered as a complex adaptive system, because of the constantly changing dynamics and boundaries set by the staff as well as coordinating with the outside units and integrating the best plan of care for the patients. I have worked beside many great FNPs in the ED that assist doctors and lighten their patient load as well as make the turnover more efficient and smoother.  Many of the patients that come through ED are not always as simple as just writing a prescription and seeing them on their way.  Many patients have adaptive challenges in place that can pose as barriers to the Nurse Practitioners and doctors. 

Lateef et al. (2022) stated that, “adaptive challenges, on the other hand, are less obvious and, thus, not so easy to identify”. “An example would be, attempting to change a negative behavior in a patient who presents with frequent giddiness and has not been taking his antihypertensive medication” (Lateef et al., 2022).  Let’s also say this patient is a frequent flyer and continues to show up in the ED with noncompliance of taking meds causing hypertensive issues and is uninsured.  The first step in the care for this patient would be at the micro- level.  The micro- level focuses on the subjective and objective data obtained from the NP and doctor to better help them make clinical decisions about this patient’s care such as treatment, goals of care, and or supportive services needed after discharge (Sawatzky et al., 2021). 

Sawatzky et al. (2021) mentions that at the meso-level, “healthcare managers and leaders of quality improvement, performance monitoring, and accreditation of different healthcare services and organizations” monitor data for better patient outcomes.  This patient’s noncompliance and frequency of visits to ED, has now integrated the meso- level of care to intervene.  For example, at the meso-level the managers and the leaders of the ED will find ways of quality improvement and performance monitoring, as to why the frequency of visits are occurring.  

As a NP I could coordinate with these managers to find and try to resolve what can we do to better educate this patient or what services can we offer to help with the noncompliance and frequency of visits.  Because of all of this the macro- level of the hospital is now affected in this patient’s care.  Related to the patient being noninsured and the resources used to help this patient now affects the overall healthcare system and reimbursement of healthcare services that the hospital won’t receive because he is unfunded.  

References:

Lateef, Kiat, K., Yunus, M., Rahman, M., Galwankar, S., Al Thani, H., & Agrawal, A. (2022). BRAVE: A point of care adaptive leadership approach to providing patient-centric care in the emergency department. Journal of Emergencies, Trauma and Shock, 15(1), 47–52. https://doi.org/10.4103/jets.jets_138_21Links to an external site.

Sawatzky, Kwon, J.-Y., Barclay, R., Chauhan, C., Frank, L., van den Hout, W. B., Nielsen, L. K., Nolte, S., & Sprangers, M. A. G. (2021). Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures. Quality of Life Research, 30(12), 3343–3357. https://doi.org/10.1007/s11136-021-02766-9Links to an external site.

Week 5 discussion

The healthcare system is complex, diverse,  and evolving every day. Each organization is different and has its flaws. The healthcare system I work for is a big teaching hospital. However, everything is not peachy. Every day is a challenge to face even though healthcare professionals are doing their best to provide the best care they can offer. After Covid19 I noticed that we have a nursing shortage because many nurses went to do travel nursing, some are burned out, and others are dissatisfied with management. Additionally, the institution I work for is a magnet hospital which makes it difficult to hire Associates prepared nurses because they have found bachelor’s prepared nurses have higher positive patient outcomes.

According to the American Association of Colleges of Nursing (2022), having many BSN nurses in the hospital equals have less mortality rate which is the reason for encouraging BSN-prepared nurses. The staffing shortage we have is impacting us because sometimes we have to be on call in case some nurses don’t show up and sometimes we have to stay an extra four hours until the oncoming nurse can make it. Additionally, I noticed the nurse educators rushing the new grad to get off orientation because they need nurses which is not safe.

I believe this issue originates at the macro level because the lower management follows the directions given to them about the budget. If they don’t pay their nurses well those nurses may end up leaving the institution. I will address this issue by attending committees and advocating for the patients and my colleagues. Additionally, respectfully communicate the issue with my managers even though they know the issue might help.

If they decided not to cooperate with us and make a positive change, the next step will be not to agree to pick up extra shifts. According to DeNisco and Barker (2015), “this first step has been referred to as unfreezing, creating dissatisfaction, creating a sense of urgency, and sense-making”. My solution might affect the other levels because the hospital needs nurses to run it effectively. The patients are paying so much money and they deserve the best care they can get.

Interprofessional collaboration can be used to resolve the issue by making the upper management understand that the nurses’ mindset affects patient care. If the nurses are satisfied and happy, they will be there and give all they have to the patients. It won’t be easy but communication and collaboration may have an impact on the issue.

References:

Association of Colleges of Nursing. (2022). Nursing shortage. https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortageLinks to an external site.

DeNisco, S.M. & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning.

Fatta Mento

Oct 2, 2023Oct 2 at 11:09am

Manage Discussion Entry

Hi Everyone,

In my current or future practice area, one of the concerns I’ve identified is the fragmented communication and coordination between various healthcare providers involved in patient care. This issue primarily occurs at the meso level, involving healthcare organizations and their departments (Tadros et al., 2023). Often, different departments within a hospital or clinic work in silos, leading to inefficiencies, delayed care, and sometimes even errors in patient management.

To address this concern, I would propose the implementation of an integrated electronic health record (EHR) system that connects all departments within the healthcare organization (Dornan et al., 2019). This EHR system would allow seamless sharing of patient information, test results, and treatment plans among different healthcare professionals. It would also facilitate real-time communication and collaboration.

The impact of this solution would extend across all levels of the healthcare system. At the micro level, individual healthcare providers would have access to comprehensive patient data, enabling them to make well-informed decisions. At the meso level, the organization would benefit from improved efficiency, reduced duplication of tests, and enhanced patient satisfaction (Dornan et al., 2019). At the macro level, this system could contribute to better population health outcomes and cost savings within the healthcare system.

Interprofessional collaboration would play a crucial role in implementing this solution. It would involve IT specialists to set up the EHR system, clinicians to provide input on its design and functionality, and administrators to ensure organizational buy-in and resource allocation (Tadros et al., 2023). Additionally, ongoing collaboration among healthcare professionals from different disciplines would be essential for adapting to the new system and continuously improving patient care processes.

References

Tadros, E., Barbini, M., & Kaur, L. (2023). Collaborative healthcare in incarcerated settings. International Journal of Offender Therapy and Comparative Criminology, 67(9), 910-929. https://doi.org/10.1177/0306624X211058952

Dornan, L., Pinyopornpanish, K., Jiraporncharoen, W., Hashmi, A., Dejkriengkraikul, N., & Angkurawaranon, C. (2019). Utilisation of electronic health records for public health in Asia: a review of success factors and potential challenges. BioMed research international, 2019. https://doi.org/10.1155/2019/7341841

Natalie Markham

Oct 2, 2023Oct 2 at 7:16pm

Manage Discussion Entry

I currently work in the emergency department of a level two trauma center as a registered nurse. This is a very complex system. This hospital is complex in many ways, including the number of units, job titles, different treatments and diagnoses, the number of people we see in the emergency department, and so on. One primary concern and frustration I have working in the emergency department is the overcrowding of patients, specifically the overflow into the hallways. These are considered “hallway patients” and are labeled “hallway 11” and frequently turn into “hallway 11-a, b, c, and d”. This concerns patient safety, as most patients are not on a cardiac monitor, nor do they have a call light system to reach us in times of need. Another concern for safety is the lack of time we have as ED nurses to care for all these patients. This is a concern for a HIPAA violation as none of these patients have any privacy. The number of hallway patients continues to grow and grow as we lack the ability to transfer these patients to a unit.

To break down the levels in this scenario, we can see patients and their ED nurses at the micro level, the emergency department as a whole on the meso level, and the hospital as a whole on the macro level. I wish it were as easy as hiring more nurses to staff the beds upstairs in the units, building more ER rooms, or sending patients somewhere else that is not there for emergency treatment. Still, these are problems on the macro level and things this hospital cannot finance. Therefore, we can look at this scenario from a meso level (emergency department as a whole). One study looked at overcrowding, specifically in the emergency department, and ways to reduce this (Valipoor et al., 2020). One solution that was developed included establishing an EMS triage area (Valipoor et al., 2020). The idea was to use all ED exam rooms for ED patients only, provide care and treatment, and once the patient was decided to need boarding in the hospital, they would be moved to the hallway (Valipoor et al., 2020). Ultimately, this would lead to a decreased level of care in hallways, less equipment use and clutter, and the full utilization of exam rooms for improvement in the flow rates of the ER (Valipoor et al., 2020). Interprofessional collaboration can be used in this plan by first bringing the idea to the ED director. Interprofessional collaboration is defined as the communication and interactions between the healthcare team as a whole, using each of their advanced knowledge base to facilitate a process (DeNisco & Barker, 2015). The ED director can help facilitate the model in the department; next would include the ED charge nurse who would direct the EMS into the exam rooms; next would be the ED nurse taking reports and settling each rescue. Finally, this would include prompt exams and treatment plans from the provider to allow quick turnover between patients in each exam room.

References

DeNisco, S.M. & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning.

Valipoor, S., Hatami, M., Hakimjavadi, H., Akçalı, E., Swan, W. A., & De Portu, G. (2020). Data-driven design strategies to address crowding and boarding in an emergency department: A discrete-event simulation study. HERD: Health Environments Research & Design Journal, 14(2), 161–177. doi: 10.1177/1937586720969933