Read the following article and view the video on the same case. How can this example be used as an illustration of maintaining patient safety and providing safe, effective care? Identify some of the possible barriers that nurses face when acting on what they believe to be the morally correct action in this particular case. 

https://www.cpr.org/2015/02/17/for-colorado-mom-story-of-daughters-hospital-death-is-key-to-others-safety/

Respond to what he wrote, be argumentative with the answers, and polite. References, and at least 2 paragraphs.

 

 

In the last decade, there have been a lot of changes to the model of practice of advanced practice registered nurses (APRNs) in Northern America. During the pandemic, legislative changes enabled nurse practitioners (NPs) in some states to act in the role of medical doctors, thereby empowering them to work to their full scope of practice. This has resulted in a higher quality of care, decreased hospitalization rates, improved access to care, and the creation of an improved working environment for direct care providers (McGilton et al., 2023). For the purpose of this discussion post, the practice agreements, process of certification and licensure as an APRN in North Carolina, the scope of practice of nurse practitioners, how to get Drug Enforcement Administration (DEA) license, and controlled substance prescriptive authority for NPs will be summarized. Also, the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in North Carolina will be explained.

Summary of Findings

Certain criteria need to be met before an individual can be licensed as an Advanced Practice Registered Nurse (APRN) in the state of North Carolina. A lot of information on certification and licensure can be found on 
www.ncbon.com
Links to an external site.
, which is the North Carolina Board of Nursing (NCBON) website. One must hold a North Carolina Registered Nurse license or a compact state license that is valid to practice in North Carolina. A master’s or higher degree in nursing must be completed. Additionally, a national certification as a nurse practitioner must be obtained from one of the nationally accredited credentialling bodies, and a registration with the North Carolina Controlled Substance Reporting System (CSRS) is required for those that have prescriptive authority for controlled substances. The North Carolina CSRS exists through the North Carolina Department of Health and Human Services to collect information on dispensed controlled substance prescriptions and make this information available to prescribers and dispensers (North Carolina Department of Health and Human Services, n.d.).

The scope of practice of an APRN in North Carolina required being educationally prepared, nationally certified, and maintenance of competence. The APRN is required to promote and maintain health; prevent illness and disability; diagnose, treat, and manage acute and chronic illnesses; guide and counsel individuals and their families; prescribe, administer, and dispense therapeutic measures, tests, procedures, and drugs; plan for situations beyond the nurse practitioner's scope of practice and expertise by consulting with and referring to other health care providers as appropriate; and evaluate health outcomes (Office of Administrative Hearing, 2019). According to the North Carolina Board of Nursing (2022), nurse practitioners have the approval to prescribe legend drugs and Controlled Substance Schedules II – V, which is consistent with the scope of practice determined by their educational preparation and national certification. Professionals who prescribe controlled substances must fully comply with both North Carolina’s state and federal rules and regulations. A nurse practitioner who administers, dispenses, or prescribes any controlled substance, must be registered with the federal Drug Enforcement Administration (DEA). In North Carolina, this process requires applying for DEA registration, paying the required fees, completing, and submitting DEA for 106.

In North Carolina, an APRN requires a collaborative practice agreement with a licensed physician. Therefore, upon completing an advanced degree and obtaining licensure, an APRN needs to apply for an ‘Initial Approval to Practice’. What this application entails is an active North Carolina Registered Nurse license; the physician’s name, their license number, or email address; and the practice information. After all these have been submitted and approved, the APRN can begin practicing in North Carolina (North Carolina Board of Nursing, n.d.).

Types of Regulations that Exist and the Barriers that May Impact Nurse Practitioner Independent Practice

From the research findings, there are regulations, and some barriers exist that may impact nurse practitioner independent practice in North Carolina. For instance, the scope of practice laws defines the activities and responsibilities that healthcare professionals are allowed to engage in. In North Carolina, there is a need for physician oversight, and there is a need for physician collaboration. Also, we are required to have collaborative practice agreements with physicians. Collaborative Practice Agreement (CPA) is an agreement between the nurse practitioner (NP) and the primary supervising physician addressing how the NP operates the administrative code or rules in their practice (North Carolina Board of Nursing, 2023). These agreements outline the relationship and level of collaboration between the nurse practitioner and the physician. Components that are included in the collaborative practice agreement are the drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner. Additionally, prescriptive authority is part of the nurse practitioner approval to practice. A nurse practitioner may prescribe controlled substances; however, the supervising physician must have a DEA registration equal to or greater than the DEA registration of the nurse practitioner that he or she supervises. Finally, regulatory bodies exist to set regulations for APRNs. These boards can influence the level of autonomy nurse practitioners have in their practice in North Carolina.

Some of these regulations pose a major barrier that may impact the nurse practitioner’s ability to practice independently. To begin with, the scope of practice restrictions can be very challenging because it limits the ability to provide care independently. Also, due to the collaborative practice agreements that are needed from a physician, we experience a lot of opposition from physician associations and groups. They cite that they have concerns about patient safety and the need for the role of physicians in the health care team. To add to these barriers, there are challenges as to how the public perceives the role and capabilities of nurse practitioners. Patient and public understanding of the role and capabilities of nurse practitioners can influence the acceptance of independent practice. Educating the public about the training and expertise of nurse practitioners is very crucial for acceptance. Nurse practitioners may also face challenges in being recognized by insurance providers and receiving reimbursement for their services at the same rate as physicians. According to Barnes et al. (2017), in a lot of states, nurse practitioners are reimbursed less than the physician rate, varying from 75% to 100% of physician rates. A lot of legislative processes are ongoing to have nurse practitioners receive 100% reimbursement from Medicare. Currently, reimbursement is only provided at about 85% of the physician rate in most states (Bischof & Greenberg, 2021).

All this information did not come as a surprise to me because during this program, we have been required to carry out research findings on related issues. This has enlightened me to the state regulations for the scope of practice of nurse practitioners in my state. I have educated myself on these requirements and learned a lot from my preceptors and senior colleagues in the field of psychiatric mental health. I believe that I am well prepared for all these upon completion of my degree.

Conclusion

The United States is experiencing shortages of primary care providers, and NPs offer the potential to moderate these shortages (Barnes et al., 2017). As advanced practice registered nurses, it is important to stay updated with the latest regulations and developments in our individual states regarding nurse practitioner practice. It is therefore advisable to consult the state Board of Nursing and other relevant authorities for the most current and accurate information for legal practice.

References

Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431–451. 
https://doi.org/10.1177/1077558716649109
Links to an external site.

Bischof, A., & Greenberg, S. A. (2021). Post COVID-19 reimbursement parity for nurse practitioners. Online Journal of Issues in Nursing, 26(2). 
https://doi.org/10.3912/ojin.vol26no02man03
Links to an external site.

McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1). 
https://doi.org/10.1186/s12877-023-03798-1
Links to an external site.

the North Carolina Board of Nursing. (2022). Prescribing. Retrieved August 29, 2023, from https://www.ncbon.com/practice-nurse-practitioner-prescribing#:~:text=Nurse%20Practitioner%20approval%20includes%20prescriptive,educational%20preparation%20and%20national%20certification.

North Carolina Board of Nursing. (2023). Collaborative practice guidelines. Retrieved August 29, 2023 from https://www.ncbon.com/practice-nurse-practitioner-collaborative-practice-guidelines#:~:text=Required%20components%20of%20the%20CPA,performed%20by%20the%20nurse%20practitioner.

North Carolina Board of Nursing. (n.d.). Advanced practice registered nurse. Retrieved August 27, 2023, from 
Advanced Practice Registered Nurse | North Carolina Board of Nursing (ncbon.com)
Links to an external site.

North Carolina Department of Health and Human Services. (n.d.). NC Controlled Substances Reporting System. Retrieved August 29, 2023, from https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/north-carolina-drug-control-unit/nc-controlled-substances-reporting-system

Office of Administrative Hearing. (2019). Scope of practice. Retrieved August 27, 2023, from 
http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0802.html
Links to an external site.

 

Identifying and justifying appropriate Study Designs · 

Step 1:  A not-for-profit organization called Epidemiologists Without Borders has reached out to student researchers studying epidemiology at Florida National University. The organization has asked for support in the design of three research projects they plan to carry-out in several of the communities where they currently work. Read these three case studies summarized below.

NOTE: You may substitute one of the case-studies outlined below for a case study that is relevant to your own community. If you choose to do so, generate a case-study regarding a public health problem that is relevant and requires epidemiological research. Include the case study when you submit your assignment.

Case study 1:

Vaginal cancer is a rare disease that can often be cured when detected in its early stages. Vaginal cancer occurs more often in women over the age of 50 but can occur at any age. There are usually no symptoms for vaginal cancer. Epidemiologists Without Borders has been awarded a large grant to study the relationship between vaginal cancer and prior exposures to any risk factor among women in a South African city.  

Case study 2:

Epidemiologists Without Borders has learned that a large group of employees who have worked in a specific building (building A) of a very large corporation for more than 25 years appear to have high cancer incidence rates. The corporation has a total of 3 office buildings (buildings A, B, and C). Epidemiologists Without Borders would like to conduct research to determine if the rates of cancer incidence among those workers from building A are in fact higher than expected.

Case study 3:

Epidemiologists Without Borders supports the rights to life, health, and dignity for people who use illicit drugs. The organization is concerned about the high rates of HIV infection it has observed in one particular community and suspects that there are many risk factors possibly contributing to this high HIV risk. Currently, the data in this community with respect to the exact HIV incidence rate among injection drug users is of poor quality but estimates indicate that the prevalence is as high as 10-20%. Access to HIV testing is also low in this population. Additional challenges include limited resources, and the difficulty in recruiting people for testing due to their high mobility and hidden social networks. 

Epidemiologists without Borders would like to identify potential risk factors for contracting HIV among injection drug users in this community so that it can develop appropriate interventions.

Step 2: Select the most appropriate study design for each of the three case-studies proposed by Epidemiologists Without Borders (or for the one relevant in your community) based on what you have learned in this Week’s Lectures, Readings, PPT’s and modules. 

Step 3: Write a letter responding to Epidemiologists Without Borders outlining the study designs that you recommend. Justify why the study designs you selected are appropriate for each of the three case-studies. Your response must also outline at least one benefit and one limitation for each of the study designs you have recommended for each case-study. Your letter to Epidemiologist Without Borders should be clear and concise and contain no more than 450-550 words.  

Please be sure to adhere to the following when posting your weekly discussions:

1. Students are to write their name and the appropriate discussion number/discussion title in the title bar for each discussion. For example, Discussion 1: Micheal Cabrera or Discussion 3: Sheila Smith. This is important in identifying that students are submitting original posts as well as response posts as required.

2. Students are to submit their discussions directly onto Blackboard Discussion Board Attachments submitted as discussion board posts will not be graded.

3.  As a reminder, all discussion posts must be minimum 350-550 words, references must be cited in APA format 7th Edition, and must include minimum of 3 scholarly resources published within the past 5-7 years (not part of the classroom coursework).  

Assessment 3-4040

Evidence-Based Proposal and Annotated Bibliography on Technology in Nursing

INSTRUCTIONS- Write a 4–6 page annotated bibliography where you identify peer-reviewed publications that promote the use of a selected technology to enhance quality and safety standards in nursing.

INTRODUCTIONS- This assessment will give you the opportunity to deepen your knowledge of how technology can enhance quality and safety standards in nursing. You will prepare an annotated bibliography on technology in nursing. A well-prepared annotated bibliography is a comprehensive commentary on the content of scholarly publications and other sources of evidence about a selected nursing-related technology. A bibliography of this type provides a vehicle for workplace discussion to address gaps in nursing practice and to improve patient care outcomes. As nurses become more accountable in their practice, they are being called upon to expand their role of caregiver and advocate to include fostering research and scholarship to advance nursing practice. An annotated bibliography stimulates innovative thinking to find solutions and approaches to effectively and efficiently address these issues.

PREPARATION- Before you begin to develop the assessment, you are encouraged to complete the Annotated Bibliography Formative Assessment. Completing this activity will help you succeed with the assessment and counts towards course engagement.

To successfully complete this assessment, perform the following preparatory activities:

· Select a SINGLE direct or indirect patient care technology that is relevant to your current practice or of interest to you. 
Direct patient care technologies require an interaction, or direct contact, between the nurse and patient. Nurses use direct patient care technologies every day when delivering care to patients. Electronic thermometers or pulse oximeters are examples of direct patient care technologies. 
Indirect patient care technologies, on the other hand, are those employed on behalf of the patient. They do not require interaction, or direct contact, between the nurse and patient. A handheld device for patient documentation is an example of an indirect patient care technology. Examples of topics to consider for your annotated bibliography include:

· Delivery robots.

· Electronic medication administration with barcoding.

· Electronic clinical documentation with clinical decision support.

· Patient sensor devices/wireless communication solutions.

· Real-time location systems.

· Remote patient monitoring.

· Artificial intelligence.

· Telehealth.

· Telestroke.

· Tele-icu.

· Tele-psychiatry.

· Tele-genetics.

· Workflow management systems.

· Conduct a library search using the various electronic databases available through the Capella University Library.

· Consult the 

BSN Program Library Research Guide
 for help in identifying scholarly and/or authoritative sources.

· Access the NHS Learner Success Lab, linked in the courseroom navigation menu, for additional resources.

· Scan the search results related to your chosen technology.

· Select 
four peer-reviewed publications focused on your selected topic that are the most interesting to you.

· Evaluate the impact of patient care technologies on desired outcomes.

· Analyze current evidence on the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team.

· Integrate current evidence about the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team into a recommendation.

Notes

· Publications may be research studies or review articles from a professional source. Newspapers, magazines, and blogs are not considered professional sources.

· Your selections need to be current—within the last five years.

An Evidence-based Recommendation for Selected Technology Implementation

Prepare a 4–6 page paper in which you introduce your selected technology and describe at least four peer-reviewed publications that promote the use of your selected technology to enhance quality and safety standards in nursing. You will conclude your paper by summarizing why you recommend a particular technology by underscoring the evidence-based resources you presented. Be sure that your paper includes all of the following elements:

· Introduction to the Selected Technology Topic

· What is your rationale for selecting this particular technology topic? Why are you interested in this?

· What research process did you employ?

· Which databases did you use?

· Which search terms did you use?

· Note: In this section of your bibliography, you may use first-person since you are asked to describe your rationale for selecting the topic and the research strategies you employed. Use third person in the rest of the bibliography, however.

· Annotation Elements

· For each resource, include the full reference followed by the annotation.

· Explain the focus of the research or review article you chose.

· Provide a summary overview of the publication.

· According to this source, what is the impact of this technology on patient safety and quality of care?

· According to this source, what is the relevance of this technology to nursing practice and the work of the interdisciplinary health care team?

· Why did you select this publication to write about out of the many possible options? In other words, make the case as to why this resource is important for health care practitioners to read.

· Summary of Recommendation

· How would you tie together the key learnings from each of the four publications you examined?

· What organizational factors influence the selection of a technology in a health care setting? Consider such factors as organizational policies, resources, culture/social norms, commitment, training programs, and/or employee empowerment.

· How would you justify the implementation and use of the technology in a health care setting? This is the section where you will justify (prove) that the implementation of the
patient care technology is appropriate or not. The evidence should be cited from the literature that was noted in the annotated bibliography.

· Consider the impact of the technology on the health care organization, patientcare/satisfaction, and interdisciplinary team productivity, satisfaction, and retention.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

·
Assessment 3 Example [PDF].

· Additional Requirements-
Written communication: Ensure written communication is free of errors that detract from the overall message.

·
Length: 4–6-typed, double-spaced pages.

·
Number of resources: Cite a 
minimum of four peer-reviewed publications, not websites.

·
Font and font size: Use Times New Roman, 12 point.

·
APA: Follow APA style and formatting guidelines for all bibliographic entries
. Refer to 

Evidence and APA
 as needed.

Context- Rapid changes in information technology go hand-in-hand with progress in quality health care delivery, nursing practice, and interdisciplinary team collaboration. The following are only a few examples of how the health care field uses technology to provide care to patients across multiple settings:

· Patient monitoring devices.

· Robotics.

· Electronic medical records.

· Data management resources.

· Ready access to current science.

Technology is essential to the advancement of the nursing profession, maintaining quality care outcomes, patient safety, and research.

Competencies Measured- By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

· Competency 3: Evaluate the impact of patient care technologies on desired outcomes.

· Analyze current evidence on the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team.

· Integrate current evidence about the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team into a recommendation.

· Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.

· Describe organizational factors influencing the selection of a technology in the health care setting.

· Justify the implementation and use of a selected technology in a health care setting.

· Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.

· Create a clear, well-organized, and professional annotated bibliography that is generally free from errors in grammar, punctuation, and spelling.

· Follow APA style and formatting guidelines for all bibliographic entries.

Scoring Guide

Use the scoring guide to understand how your assessment will be evaluated.

View Scoring Guide

Evidence-Based Proposal and Annotated Bibliography on Technology in Nursing Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Analyze current evidence on the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team.

Integrate current evidence about the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team into a recommendation.

Describe organizational factors influencing the selection of a technology in the health care setting.

Justify the implementation and use of a selected technology in a health care setting.

Create a clear, well-organized, and professional annotated bibliography that is generally free from errors in grammar, punctuation, and spelling.

Follow APA style and formatting guidelines for all bibliographic entries.

Please see the attachment for the instructions