Role of Nurse Practitioner while caring for Patients with Chronic Illness

A nurse practitioner is a specialized advanced practice registered nurse (Norful, de Jacq Carlino, & Poghosyan, 2018). These nurses are relatively more learned and experienced than the normal nurses. They are equipped with better skills, knowledge, mental strength and expertise that allow them to offer better services to patients with chronic illnesses. They teach patients about their conditions, especially those that require long-term treatment and constant check-ups. This ensures that the disease does not progress to become life-threatening. They have a role in provision of and leadership of advanced clinical care for patients that are chronically ill.

Read also National Organization of Nurse Practitioner Faculties (NONPF) Competencies

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Nurse practitioners perform physical exams and patient observations, record patients’ medical histories and symptoms, create patient care plans and contribute to the existing ones (Torrens, Campbell, Hoskins, Strachan, Wells, Cunningham, & Maxwell, 2020). They also order, administer, and analyze diagnostic tests. In chronic illnesses, they diagnose health issues, detect changes in the patients’ health and thus modify treatment plans as needed. They work in collaboration with other healthcare professions to provide better outcomes and minimize errors in treatment. NPs have a role in training patients and their families on how to manage and prevent illnesses and injury (Norful, de Jacq Carlino, & Poghosyan, 2018). They are responsible for introducing habits for health promotion.

Read also Differences between a Primary Care Nurse Practitioner and an Acute Care Nurse Practitioner

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A good nurse practitioner needs to be attentive when assessing a patient’s condition and go out of their way to ensure that the patient’s needs are met. They take responsibility of their patients, are competent, responsive to the patient, empathic and show compassion (Torrens, Campbell, Hoskins, Strachan, Wells, Cunningham, & Maxwell, 2020). They treat each case differently and offer individualized and specialized healthcare. However, the work can be physically and emotionally draining especially when patients do not follow sound medical guidance. On the upside, nurse practitioners have greater control over their professional practice and patient outcomes.

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Remote Patient Monitoring – Technologies Supporting Applied Practice and Optimal Patient Outcomes

Healthcare Information Technology Trends

The healthcare sector has, over the past two decade, witnessed a gradual surge in the integration and implementation of technological innovations in practice. Today, developments of this kind are commonplace within standard nurse practice environments. They are embraced with the main aim of improving conditions for healthcare providers; often anticipated to promote the provision of high-quality care and the attainment of patients’ goals (McGonigle & Mastrian, 2017). Among the most common trends apparent today is a drive towards informatics and emphasizing on the conceivable benefits of evaluating patient data to improve overall care outcomes. 

Read also Workflow, Data Mining and Advancing Patient Outcomes – Annotated Bibliography

Since the outbreak of the COVID-19 pandemic, I have observed an increase in the adoption of telehealth-type trends and their subsequent use within my healthcare organization. For instance, Remote Patient Monitoring (RPM) is common aspect of care provision and is now generally regarded as a valuable tool in collecting healthcare data. RPM is currently recommended for chronic disease management and feted for its ability to promote self-management healthcare skills (Bhatia et al., 2021). Yet, one must also consider potential challenges, risks, and benefits posed by RPM integration and other future prospects relating to the overall improvement of patient care outcomes, efficiencies, and data management.

Remote Patient Monitoring (RPM)

Potential Challenges                       

            At the present moment, a major challenge preventing the widespread adoption of Remote Patient Monitoring technology revolves around cost implications of software and hardware infrastructure. Operationalization of RPM technology typically requires the creation of a robust digital framework to host a database, middleware, and interface (Singh & Mittal, 2016). The sensitive nature of patient data often requires high-end security algorithms to monitor large volumes of data in real-time and, eventually, relaying this data to respective healthcare providers. Furthermore, a team of skilled professionals is also required to set up RPM systems and, more often than not, exceeds the budget and financial capability of most healthcare facilities.

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Potential Risks

            Confidentilaity remains a major concern in the implementation of Remote Patient Monitoring platforms since they are primarily based on the electronic exchange of private health data between clients and healthcare providers. For instance cameras and sensors, strategically positioned in a patient’s home, may inadvertently transmit sensitive information related to personal activities posing a real privacy concern. Additionally, a possible risk of healthcare providers sharing patient data with third-partly advertisers also exists and may hinder efforts to keep such information private. The possible benefits of RPM could, therefore, be undermined in case privacy and confidentiality issues are not addressed promptly.

Potential Benefits

            Remote Patient Monitoring is a highly beneficial technological trend in healthcare today. Its presence within a healthcare facility reduces the possibility of adverse health events and increases the likelihood of a positive outcome in the long haul. Patients with chronic diseases, such type 2 diabetes, benefit greatly from the daily transmission of data from insulin pumps to their care providers (Salehi et al., 2020).  This type of information is routinely assessed to determine whether patients are meeting set records and adhering to physician’s recommendations. Inferences made from evaluations of this kind then guide healthcare provider’s decision on whether further intervention is warranted.

Read also National Database of Nursing Quality Indicators, Patient Quality and Patient Safety

Future Prospects

            RPM is a revolutionary trend capable of piloting improvements in patient care outcomes and efficacies.  Monitoring of patients while conducting routine follow-ups will improve patient care outcomes by improving care-seeking behave and attitudes towards healthcare providers (Rao-Gupta et al., 2018). Similarly, Remote Patient Monitoring also provides a unique platform for relaying health promotion and disease prevention information to improve compliance in the long haul.  Care provider’s efficiency will also profit from RPM since it promotes productivity through remote scheduling, resulting in an overall reduction in the overall risk of burnout (Firanek 2017). Apart from reducing the cost of care, RPM also improves the direct role of healthcare provider’s in client’s lives by providing a level of assurance and comfort.

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National Database of Nursing Quality Indicators, Patient Quality and Patient Safety


            Hello everyone. I welcome you all at the Coliseum Northside to the Medical-Surgical Unit, where our mission is to offer exceptional and compassionate service care to our clients every day. At this facility, I am a board member of the Quality Improvement Council. This presentation will explore how the National Database of Nursing Quality Indicators (NDQI) can improve patient quality and patient safety.

How a Health Care Organization Uses Nursing Sensitive Quality Indicators

            Zadvinskis et al. (2019) indicate that NDQI was developed in 1998 by the ANA to integrate nursing knowledge and particular information to improve the quality of care and patient safety. Data-centered research is gathered from the nationwide facilities, and they are compared to assess the nursing care quality. It affects patient outcomes at different levels of the healthcare system. The NDQI houses the nursing-sensitive indicators, which the ANA refers to as the documentation standards. These are the components of nursing care that directly impact patient outcomes. According to ANA documentation standards, there are three nursing-sensitive indicators, namely structure, process, and outcomes. Structure talks about the nursing skills and the nursing staff, and the level of education. Process delineates nursing interventions and patient assessment alongside nursing job satisfaction. Outcome sensitive indicator refers to meeting expected patient outcomes.

            The nursing quality indicator chosen for analysis in this assessment is the patient fall.  Zhao et al. (2018) coincide that the amount and the quality of nursing care given to patients directly impacts the probability of these patients experiencing a fall. The NDQI shares data which healthcare organizations use to compare in-house fall rates. In simple terms, the NDQI provides a measuring tool for healthcare organizations regarding how good or not present standards, policies, and procedures are documented, implemented, and maintained. As nurses, we must prevent falls within our facilities to continue building trust in the community, improve the organization’s financial viability, and satisfying the ANA documentation standards. Nurses play a significant role in the prevention of falls and fostering patient safety. Coliseum Northside is mainly a medical-surgical facility. Studies like those by Tsuda (2017) indicate that falls have a higher tendency to occur in medical surgical sections than in other hospital units.

            Multiple studies have shown that thousands of patients experience falls in different hospitals throughout the country each year. Consequentially, it has led to a financial burden for both the patients and healthcare organizations. Kobayashi et al. (2017) mention loss of income, litigation expenses, and temporary placement in rehabilitation centers as examples of financial obstacles clients may incur after a nasty fall. For the healthcare organization, repairing patient harm experienced during the fall becomes a huge burden because reimbursement is no longer provided. Moreover, Medicaid and Medicare services believe that falls occurring due to injuries in hospitals are avoidable incidences, and they no longer cover such costs.

Justification Of How a Nursing-Sensitive Quality Indicator Establishes Evidence-Based Practice Guidelines for Nurses

            As noted earlier, nurses play a pivotal role in preventing the occurrence of patient falls in hospitals. Since the nurses are the frontline soldiers in avoiding falls, they should implement interventions like examining patients for fall risks, setting bed alarms, creating awareness about falls to the patients and their families, and ascertaining that bed wheels are locked; nurses can effectively prevent falls. Michalcova et al. (2020) show that highly engaged nurses have a higher probability of integrating best practices, which have proven to reduce fall rates and boost family and patient satisfaction, positively impacting patient safety.

            I interviewed one of the Quality Improvement Practitioners at Coliseum Northside to better understand how data is used and transmitted to help advance patient safety. The practitioner said that when patients face a fall in the hospital, the assigned RN submits a report via an online reporting database known as the safety portal. Such information helps the quality improvement practitioner identify a problem at hand, leading to a comprehensive analysis of the patient chart.

            Coliseum Northside uses MEDITECH, an electronic medical record for documenting patient interventions. Certified Nursing Aids, registered nurses, Licensed Practice Nurses like the MORSE Fall Scale for assessing fall risks, ambulation abilities, hourly rounding, assistance needs, patient orientation, and the utilization of bedside sitters in the MEDITECH, which is then made available when required for analysis. After the practitioner has analyzed the data in the chart and MEDITECH, the fall is transferred to New York State Database. The interdisciplinary meeting is organized every Monday by the Quality Improvement Practitioner to explore the quality indicators and root cause analysis to create a solution to what is causing the fall or to mitigate the falls that have been occurring. Moreover, assessing pertinent findings in the client’s chart, including communication between physicians and nurses, happens.

            For example, suppose a nurse communicated concern to the doctors regarding the side effects of medications such as lethargy or dizziness. In that case, we want to know if these side effects can increase the probability of a patient experiencing a fall. On the physician’s side, the advantage versus the danger of prescribing medication is assessed. At the same time, additional or new approaches must be implemented on the nurse’s end to ensure the patient’s safety. As nurses, adequate documentation and assessment ascertain that our patients are given the best quality care that meets their satisfaction.

            The meeting findings directly show what new mandates or education and policies need to get implemented to prevent further patient falls. When inquired about the challenges encountered during the execution of quality improvement meetings, the quality improvement practitioner fostering change within the nursing staff said that giving direct patient care was the most challenging task. No person likes change; however, sometimes change is inevitable to grow patient safety, especially in avoiding patient falls positively.

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             I want to emphasize the importance of nurses communicating through shift reports, documentation, and assessments. Besides being a requirement by the Joint Commission responsible for accrediting hospitals that every facility must perform a fall risk assessment, nurses also take oaths to safeguard those in care facilities. Prevention of falls is among the approaches nurses are using to bring changes to the safety of patients. I urge my fellow nurses to expand the scope of their education to gain knowledge about nursing-sensitive indicators and how we can bring change to the healthcare system. Once more, I welcome you to the Coliseum Northside team. I look forward to working with you.

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Workflow, Data Mining and Advancing Patient Outcomes – Annotated Bibliography


At the center of hospital bustle, overwhelmed staff scramble to remain on top of the paperwork cycle. Miscommunication and frequent errors frustrate nurses and inhibit the delivery of healthcare. Approvals are delayed, patients are left waiting for long hours, and information is misplaced – proving a critical challenge for a healthcare facility. While most hospitals have already adopted EHRs, and medical software, other fundamental processes like patient transfers to other facilities remain disorganized.  Omitting a single step in hospital workflows can create detrimental impacts for patients and hospitals alike. Managing different types of patient workflow in a facility is key to smooth operations. Patient workflow management refers to streamlining various tasks needed to process information by automating predictable and repetitive procedures. Patient workflow solutions assist in minimizing human errors, improve compliance to rules and regulations, reduce redundancies, oversights and ensure patients receive quality treatments. Data mining is a potential approach for building knowledge obtained from practice data in decision making. This annotated bibliography demonstrates how workflow and data mining helps in advancing patient outcomes.

Annotated Bibliography

Baek, H., Cho, M., Kim, S., Hwang, H., Song, M., & Yoo, S. (2018). Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. PLoS ONE, 13(4), 1–16.

            In this article, the authors presented the factors related to the hospital’s length of stay (LOS). The article notes that LOS is an essential measure of the effective utilization of medical practices to examine the effectiveness of patient quality care, functional evaluation, and hospital management. The authors of this article argue that a reduction in the LOS rate has been associated with a decrease in the risks of causing opportunistic ailments and side effects of medication. Furthermore, the article adds that a drop in LOS is linked to lower mortality rates and improved health outcomes. Moreover, the article notes that shorter stay in hospital facilities lowers the burden of increased cost and a high turnover in beds, increasing profit margins for the hospitals and reducing social costs. EHRs processes and data mining techniques are integral factors in assessing the impact of LOS in hospitals.   

de Leoni, M., van der Aalst, W. M. P., & Dees, M. (2016). A general process mining framework for correlating, predicting and clustering dynamic behavior based on event logs. Information Systems, 56, 235–257.

            This article explored various processes of mining study approaches and suggested a new model that hospitals can use in data mining. The study showed that process mining research usually starts by discovering the process that constitutes automatic learning of raw data through process models. According to the authors, during this learning process, uncovering and conformance of constrictions occur. The article highlights that a person would want to understand why things exist at such a juncture. However, this can only be attained through the correlation of various elements assembled in the research processes. These elements are usually based on effective workflow management, which explains the next stage to be implemented. The conformance perspective, data flow, the organization perspective and the time perspective are among the characteristics that determine the following action to be executed. However, this source also argues that data components could feature fixed and variable operating costs during the implementation procedure. This leads to confusion and critical challenges. To mitigate these challenges and confusion, this article proposes a model comprising a broad and extendable series of elements related to data flow, organization management, control flow, time resources, and conformance in future nursing studies. Moreover, the article also proposes that researchers utilize a generic model designed with dependent variables comprehensively explained using correlating independent variables.

Heath, S. (2017). E-consent forms useful for patient data sharing in research. Retrieved from

            This article explores different studies discussing e-consent tools and how they determine the sharing of patient information. The author highlights that using e-consent to access patient’s data needs maximum assurance of data security. Furthermore, the author shows that facilitating patient consent to share their information is essential with the growing need for patient data in quality healthcare delivery. The article adds that many research teams have shown that medical findings mainly utilize social determinants, genomic information and biospecimens to perform scientific solutions. Unfortunately, these researchers require the patient’s consent to use their data in advancing research in the clinical environment. The author notes that patients have always supported using their data to research in the medical fields with the condition that their privacy and confidentiality will be provided to their information. In addition, the author argues that he decided to use e-consent tools to obtain the patient’s data because there are numerous ways researchers get patient data. Each of them presents different characteristics and level of satisfaction to patients. But with e-consent tools, patients have a better understanding of how they can share their data via EHRs, learn about various research avenues and give permission for their data to be used on electronic machines such as computers and tablets. The author finishes by commenting that the assurance of the researcher should serve as the standard rule that creates ethical and clinical policies for collecting consent from patients.

Heath, S. (2018). AMIA outlines data use guideline for patient-centred care, PGHD. Retrieved from

            This resource delineates that AMIA is an excellent tool for delivering patient-centred care, especially when looking into healthcare providers can evaluate the social determinants of health. The article coincides that better governance of information leads to constructing seamless data applicable in inpatient settings. The author adds that social factors of health are at the center stage of healthcare. Therefore, this can be achieved by encouraging community care collaborations and integrating social health factors. Nevertheless, collaboration and integration alone are not enough as they need a skeleton of guidelines for obtaining data for quality care to become a reality in communities. To substantiate the presented arguments, this article relied on various pieces of research from other resources to show that patient-based care can be attained from external sources within the community. According to the author, the social determinants of care include sociodemographic status, environment, and educational accomplishments. These social determinants of health, if not well curbed, can impact the delivery of care. But the author shows that with the growing technology, social determinants can be handled differently. Adoption of EHRs and strict data governance will help in eradicating the limitations of care. AMIA acknowledges that the patient is the pillar in the development and refinement of nurse informatics.

USF Health. (n.d.). Data mining in healthcare. Retrieved from

            This study assessed the steps in a workflow process in an actual clinical setting to examine precise departmental information systems that addressed patient flow. The authors note that nursing departments that want to mitigate contemporary challenges and bring care reform should begin with getting access to operational and clinical data and establishing and maintaining goals towards improving the quality of care. Additionally, the authors argue that implementing electronic medical record (EMR) is key to understanding the level of performance in different healthcare organizations. This is because EMR assists in streamlining workflow and data mining. Finally, the article quotes that the Society for Imaging Informatics in Medicine (SIIM) acknowledged that quality data standards and better performance are significant indicators of improved workflow.


            Workflow management is associated with the effective handling of patient’s data. A streamlined workflow has been shown to minimize medication errors, improve the quality of care delivered, and increase HIPAA policies’ compliance. Even though the healthcare industry has gone through numerous struggles to design and redesign a robust workflow system, it should invest more funds in building an effective workflow structure and adopt modern data mining techniques to boost efficiency, minimize the cost of running hospitals, and eradicate unwanted pressure increase patient flow.

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Social Media, A Societal Trend Affecting Patient Education

Over the past five decades, numerous rapid technological changes have been recorded globally and currently impact nearly all spheres of modern life. In particular, the introduction of the internet and related services is among one of the most notable changes witnessed today. According to Carroll, Bruno & Vontschudi (2015), the internet has greatly transformed the process of communication, sharing of important messages, and peer-to-peer interaction within a relatively short period (p. 95). Today, it is more prevalent than ever; especially as a constant presence in our homes and within the workplace environment.  As a communication medium, the internet has also morphed from simple messaging and chatting services to sophisticated social media applications such as Instagram, Facebook, and Twitter. The widespread use of social media today has revolutionized remote interactions and resulted in the “online community” phenomenon where likeminded persons or individuals with similar interests associate on a continual basis. Yet, it remains imperative to consider the implications of such technological changes in nursing. Perhaps one of the most striking aspects of the Information Age is the ever-increasing population of individuals relying on the wide range of services on offer. A future consequence of this current state of affairs is an overall increase in the number of patients and nurses interacting in social media signifying an elevation in basic engagement capabilities. Millennials in the nursing profession grapple with the idea of promoting such changes in a profession with a sizeable older generation which is generally conservative.  Nursing in the Information Age, therefore, represents a yardstick with far reaching consequences for the medical professions the provision of care, and mainly in patient education.

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Fundamentals of Social Media    

            The initial introduction of social media as a major element of the Information Age prompted pundits versed in society’s transformation to posit a future focused on interactions, communication, and education.  Initial speculations were subsequently realized when social media emerged as a key tool in learning and communication owing to the relative ease of access and overall affordability. Today, the permeation of the Telehealth portent, as a product of social media, has seen a considerable improvement in nursing frameworks on patient education (Moorhea, Hazlett, Harrison, Irwin, & Hoving, 2017). Messages transmitted through social media platforms reach the intended target within a relatively shorter period and serves as the epitome of speedy communication. Web platforms and e-mails provide a unique opportunity to relay important information within a relatively short period, allowing nurses to communicate with patients intending to share crucial information regarding their wellbeing. If any of the questions posed remain unanswered, patients are often referred to a specialist versed in the medical field specified to guarantee access to accurately specified information.

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 Furthermore, the internet is seemingly bottomless repository of information and data which can be harnessed to improve individual’s overall wellbeing. Patient education today may also involve actively searching for healthcare information from credible peer-reviewed journal articles and online textbooks. The emergence of this trend is part of a new wave of ideas which underscore the significance of individuals being cognizant of information relevant to their health any given period (Ventola, 2018). For instance, patients today supplement instructions offered during the initial assessment with useful instructional material from government agencies such as the United States Food and Drugs Administration (FDA) and the Centers for Disease Control (CDC).  This relative ease of access to information through social media ensures a greater population, ranging from health science students, nurse practitioners, and educators, gain succinct comprehension of best practices applied today within the healthcare sector (Sinclair, Mcloughlin, & Warne, 2015).

Read also NR360 – Smartphone and Social Media Use in Healthcare

The internet, through social media platforms and applications, has recently enabled healthcare practitioners to offer consultations, evaluations, therapy, and patient education remotely through innovative technology. Efforts to increase the number of platforms offering such services are informed by the essential nature of health promotion today. The initial discharge of patients and subsequent expectations placed on them represents some of the most precarious phases in healthcare. Patients are known to experience a great deal of difficulty sticking to a treatment plan which would otherwise improve their wellbeing (Ventola, 2018). Failure to adhere to available treatment options may be a sign of patient’s reservations to a particular treatment option due to insufficient information regarding its actual significance. Social media offers a unique opportunity for patients to ask pertinent questions about medication management in a bid to improve healthcare outcomes. Additionally, innovative technologies such as video conferencing promote direct correspondence between patients and healthcare providers for the purpose of clarification or further directions on a treatment plan.

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The introduction of this new subset of healthcare has significantly improved its quality by now allowing primary care providers to liaise with specialists who provide crucial care information to promote care delivery. Proponents of using social media in care provision view current trends as a major revolution in the definition of the most appropriate conduits of pertinent healthcare information while particularly aspiring to foster health promotion. Such efforts are likely to address healthcare disparities recorded in the United States today by guaranteeing unlimited access to information capable of promoting care-seeking behavior, ultimately reducing major emergency room cases. The presence of support groups in social media platform has played an invaluable role in offering a sense of community in a manner bound to improve patient outcomes by sticking to the treatment plans provided and in reducing stigma. Innovations such as telepsychiatry apply social media to engage directly with patients. Pertinent questions posed during the course of routine consultations are explored extensively in a manner that explores the behavioral and primary care aspects to guarantee comprehensive coverage.

Read also Patient Safety and Quality Improvement Act of 2005

Professional Standards

While social media is commonly hailed as a positive development today, it remains crucial to acknowledge its drawbacks. The prevalence of social media use within the workplace environment for the purpose of patient education today is also associated with misuse. Evidence of blatant misuse of social media within professional settings is prohibited, with offenders risking stern legal and disciplinary action (Grajales , Sheps, Ho, Novak-Lauscher, & Eysenbach, 2016).  The aforementioned standard is also applicable within a clinical setting and may result in lawsuits for periodic offenders.  Healthcare facilities are, therefore, advised to develop and maintain an elaborate code to ensure ethical considerations are upheld and cases of malpractice accorded the appropriate punitive action.

Read also Personal Communication Devices Use In Nursing Practice


Recent technological advances, such as the internet and social media, have by far transformed healthcare and patient education today. The Information Age provides patients with a wide range of options, ranging from online consultations, telemedicine and even to Telepsychiatry. The common thread among these transformations is the application of social media to eventually improve patient outcomes. With the application of professional standards, patients are bound to expect the highest standards of care within a new dispensation.

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Will Telepsychiatry Affect the Quality of Patient Care?

 Telepsychiatry is a relatively nascent subset of telemedicine which seeks to remotely providing a wide array of psychiatric evaluations and therapy using innovative technology. Apart from the aforementioned services, telemedicine has also emerged as a significant force in health promotion through medication management and patient education ({ConferennceSeries, 2017).

Telepsychiatry is, thus, bound to have a direct impact on the quality of care offered to psychiatric patients.  This is primarily due to its ability to foster direct correspondence between psychiatrists and patients through video conferencing. Furthermore, it also bolsters the capability of primary care providers by liaising with mental health care experts for consultations to aid in care delivery. Telepsychiatry has been hailed by most of its proponents as a practical, yet affordable healthcare option that can now be provided conveniently to mental health patients. This may, inadvertently, address health disparities by ensuring that access to mental health care is improved in remote inaccessible areas such as the mountainous rural expanse around Appalachia in West Virginia.

Additionally, its application is bound to ultimately improve care outcomes by combining the provision of primary and behavioral care. This will be particularly effective in reducing the emergency room cases and any accompanying delays commonly associated with such scenarios. The introduction of telepsychiatry also promises to address the stigma associated with mental healthcare by offering a discrete option for vulnerable sections of society (Maeder & Marcelo, 2016). Yet, one still has to consider the ethical dilemmas associated with recording and storing sessions. For instance, patient data may be compromised by malicious hackers known to target key medical data. Telepsychiatry also presents a rarely explored complication in relation to the duty of care during consultation since they may avoid assuming direct responsibility in case of an emergency.

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Caring for Pediatric Patients – Reflection

The recent transition from my former role as a Registered Nurse (RN to a Family Nurse Practitioner (FNP) represents one of my most significant moves yet. In particular, I was curious to discover the overall impact this would have on my competence and whether I was adequately prepared for my new role.  Felsenstein et al., (2015) notes that budding FNPs are expected to take on a different set of responsibilities which vary significantly from previous role; typically occasioning apprehension regarding suitability for this new responsibilities. Similarly, I was anxious about my new role as an FNP for I knew a lot was expected of me and the fact that I had to ensure the needs of my pediatric patients were met and addressed appropriately to increase the frequency of positive outcomes. Caring for pediatric patients has always been my passion. The opportunity afforded in this new role would, therefore, provided a unique opportunity to execute my mandate as required today.

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In caring for pediatric patients, I was exposed to the significance of persons in this category within a typical family set up; hence the reason why FNPs should always strive to provide the highest quality of care with such patients. One of the most important lessons from this experience was the fact that the review and management of pediatric health conditions was a staid responsibility involving both the pediatric patient in question and their entire family. I was previously oblivious to this fact during my former role as a RN and had only focused on the clinical management of health complications afflicting a patent at any given point without considering the repercussions of this current state. For instance, I became aware of the central role played by the patient’s family and how they seemingly influenced the outcome of each scenario. 

Read also Reflection on Nursing Informatics Competencies

My appreciation for responsiveness was also irradiated in my new role as an FNP.  Tobias (2019) observes that advanced practice nurses should ensure they hone their situational awareness during their practice and remain cognizant of various dynamics within the family unit during treatment. I was always keen in observing the type of family structure from which my pediatric patients hailed from to gain a deeper understanding of the role of each member and their influence on this process. According to Lestishock et al. (2018), FNPs with an eye for key family aspects such as the type of household the patients are from, religion or background are likely to succeed in efforts to tailor care plans to meet the individual needs. Offering my expertise as an FNP was, therefore, a fulfilling experience which allowed me to tap into my altruistic disposition.

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My recent stint as an FNP also allowed me to appreciate the inherent differences in bodily functions among pediatric patients compared to adults and the influence of this awareness on patient outcomes. According to Betz (2018), awareness of variations between adults and children should always take precedence during care due to the presence of clear differences in the manner in which medications are absorbed, basic bodily function, and the basic thought process. I was, therefore, able to appreciate these differences when providing treatment while acknowledging their impact on the efficiency of identified interventions. During one such scenario, I was able to develop a practical healthcare regimen for a pediatric patient in the early stages of childhood obesity and later satisfied by the progress made during a routine evaluation 4 weeks later. FNPs with an in-depth understanding of differences present between pediatric and adult patients eventually promote safety while reducing the frequency of adverse medical events (Scott, 2017, p. 764). My experience as an FNP was fulfilling, especially since my efforts went a long in improving the quality of life for my pediatric patient.

Read also Understanding of Primary and Tertiary Health Care Management by Registered Nurses

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Politics and the Patient Protection and Affordable Care Act

The Affordable Care Act (ACA) is among one of the most impactful healthcare legislations in the history of the state. Yet, numerous efforts have been made to either repeal or replace it by challenging its constitutionality in federal courts. Among the most notable lawsuits challenging ACA was the National Federation of Independent Business v. Sebelius which initially sought to restrict the act’s influence through its individual mandate (Kinney, 2016). Similarly, state governments opposed to the legislation have expressed concern over regional sovereignty and subsequent future implications stemming from its operationalization. Others have responded by proposing that certain sections of the legislation be nullified or amended to avoid a scenario where the legislation infringes upon citizen’s human rights and the possibility of an unfair financial burden on the taxpayers. The individual mandate requiring eligible adults to be insured or else face penalties has been strongly criticized by ACA detractors. In particular, this clause is regarded as a precarious precedent likely to set the stage for similar violations in coming years analogous with the one currently involving the Original Clause. Two major perspectives stand out in relation to repealing or replacing ACA;   the emerging cost-benefit analysis  of legislators being reelected and the impact of voter’s views on decisions made by leaders when proposing and positioning national policies.

Read also The Patient Protection and Affordable Care Act (PPACA) And How It has Impacted American Government and Society

Legislators are essentially charged with the critical task of making prudent choices, mostly from an egalitarian standpoint. Such decisions, therefore, rely greatly on their ability to conduct an in-depth and accurate cost-benefit analysis with the intention of evaluating the suitability of any proposed change (Selker, 2013, p.5). In this regard, they would focus on ensuring that the public get the deserved legislative benefits from the ACA but still focusing on ensuring they remain popular among the electorate. However, the reality today is that a sizeable majority of legislators are mainly interested in maintaining their elective seats through re-election; a complex process that often requires a great deal of political support to achieve political support. The cost-benefit calculations may, therefore, become a priority for legislators when confronted with demands from the electorate (Job, 2018, p. 150). However, demands made by the public may be unmet resulting in the introduction of changes implemented without thoroughly considering the implications of failing to conduct an elaborate cost-benefit analysis. Political leaders who choose to conduct cost-benefit analyses before the final implementation of changes to the ACA provisions are also likely to enjoy renewed political support from the populace based on the perception that they are the embodiment competence.

Read also Individual Mandate Included in the Patient Protection and Affordable Care Act

Voter’s views on matters of national interest have a direct impact on the decision making process, especially when proposing and positioning national policies. The initial introduction of ACA back in 2010 was a carefully orchestrated strategy to provide affordable care to all Americans while garnering a level of political support from this particular legislation (Nowak et al., 2017). Its enactment was soon hailed by political pundits as a milestone in policymaking since it sought to directly address healthcare concerns raised by the public. Healthcare is an issue of great significance for American voters today.  President Obama’s aim of expanding healthcare coverage to all citizens, reducing healthcare disparities, and focusing on affordable healthcare coverage influenced public opinion, influencing his successful bid for re-election.

Read also Public Opinion And The Affordable Care Act

Recent calls to repeal the Affordable Care Act (ACA) may have far-reaching implications for its future primarily since such proposals have been made by voters. Although liberal have proposed repealing contentious sections in the legislation, replacing the legislation altogether cannot be ruled out. Voters are quite capable of voting for legislators promising to institute change through the introduction of new policies which seemingly serve the interests of the majority. Nevertheless, it will also be noteworthy to still note that such a change would require between $90.9 and $927 billion to fully implemented (Cutler, 2015, p. 337). Voters should, therefore, consider the financial cost monumental undertakings and changes in policy to determine whether commensurate benefits will be realized.

Read also Want To Know More About Affordable Care Act – Must Read Resources

The ACA remains one of the most divisive and controversial pieces of legislation enacted in the United States. Local, state, and federal governments were all expected to participate directly in the scheme to guarantee Americans of the level of healthcare deserves while paying less on Medicaid. However, the overall implementation of ACA has proved problematic given an increase in dissenting voices calling for its replacement or the repealing of certain identified sections. Yet, this has been overshadowed by claims that the act infringes upon the fundamental rights held by American citizens and should, therefore, be removed. Nevertheless, instituting such actions first require a thorough cost-benefit analysis to ascertain whether proposed changes are warranted. Such actions will also be informed by voter’s sentiments since they are often considered necessary during the decision-making process.

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A Critique of Nursing Article about Quality Improvement Intervention to Prevent Patient Falls

Morgan, L., Flynn, L., Robertson, E., New, S., Forde-Johnston, C., & McCulloch, P. (2016). Intentional rounding: A staff-led quality improvement intervention in the prevention of patient falls. Journal of Clinical Nursing26(1-2), 115-124.

Critique for Research Problem, Research Questions, and Hypotheses

            The research study was designed to solve nursing problem of patient falls, which is easy to locate and is clearly stated in the study in its aims and objectives section located at the first page of the report. The report built a persuasive and cogent argument for the study. The authors highlighted the significance of the problem in the nursing setting and indicated that Intentional Rounding (IR) as a strategy that has been regarded as remedy. The problem has significance in nursing since patient falling during treatment in hospitals is associated with reduced healthcare outcomes and increase in treatment costs (Hirose et al., 2018).

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            There is a good fit between the research problem and the paradigm within which the study was conducted. The incidences of patient falls have been widely documented in nursing care settings especially among men, which can aggravate symptoms or even cause disability (Lerdal, Sigurdsen, Hammerstad, Granheim & Gay, 2018). Therefore the report provides a good fit between the problem and the paradigm within which it was conducted.  However, the report did not provide a formal research purpose, research questions and research hypothesis. Instead, the researchers provided the research aims and objectives and other parts of the report such as setting, methods, observations, and conclusion. There was no logical placement of the information in a clear way typical of a peer-reviewed nursing research article.

Read also Appropriate Strategies for Administering the Quality Improvement and Risk-Management Processes within a Healthcare Delivery System

            There are no purpose statements, research questions or statement of research concepts and the variables of the study, though the report specifies that the study was carried out on a 75-bed neuro-science ward of a tertiary referral hospital (Morgan et al., 2016). Although there were no formal hypotheses, their exclusion was not justified. Despite the absence of hypotheses, there were statistical analysis performed as the report provided, for example an analysis of the mean visits was done.

Critique for Literature Review

            The article employed researches that were recent considered within the period that was published. Since the article was published in 2016, the review of the literature section indicates that the authors used researches that were latest during that period. Although there are some references used that were published as far as 2006, they were mainly used to provide similar evidence as research that were published using recent evidence. For example, in showing the historical use of intentional rounding (IR), the author indicated that it has been employed for long, and this was backed by literature that showed evidence of IR use, thus the use of studies dated 2008 (Morgan et al., 2016). The authors employed major studies and recent research in the study. For example, the authors employed recent research done on IR in the United States and the pilot studies in the UK.

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            In its review, the authors used mainly primary resources that included research done on the research topic in the primary setting. However, the authors did not provide a critical analysis, appraisal and comparison of the key studies. Although the authors identify the gap in the literature, the conclusion is based on a narrow analysis, evaluation and comparison of few studies. The authors provided an introduction, which include the origins of IR, the problem of patient falls, its implications, and approaches. This is later followed by the background research, where researchers provide a minimal background research before making conclusion on IR.

            The review is well organized, starting with historical development of IR, then the importance, analysis, appraisal, and comparison to the studies to draw the conclusion. The ideas were developed in a short and clear manner. In addition, appropriate language was employed by the researchers, with a suggestion of the tentative nature of prior findings. The review was objectives as the researchers performed an evaluation of prior research and pointed the gap in the transferability of the IR findings in the US in the NHS context. This provided an objective review though the literature review is not as detailed as expected of a good review.            

The review was in the introduction of a new study and the authors indicated the need for the study. The authors reviewed literature on the historical developments of IR and other studies that have been done on its implementation and use in the nursing setting. This allowed the authors to identify the research gap and support the need for the study. The review designed and evaluated a clinical intervention of reducing patient falls using IR. The report drew appropriate implications about the implications of the new intervention to the nursing practice

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Management of Patients with Chronic Kidney Diseases – A Systematic Review of Literature


            Kidneys function so as to keep the metabolic balance in the human body. According to (Norton et al., 2017) kidneys helps in maintenance of stable concentrations of inorganic anions through the control of blood composition and volume. In addition, they maintain stable acid-base balance and waste removal for excretion through the urethra and bladder. Also, kidneys play vital metabolic and endocrine functions. Kidneys produce rennin that helps in maintenance of erythropoietin and vascular volume. Other functions of kidneys include gluconeogenesis, metabolism of endogenous substances like insulin and drugs and conversion of 25-hydroxyvitamin D to active vitamin D.

Read also Pathophysiology of Chronic Kidney Disease

            The research over the past decade has helped in creation of awareness on the great risk factor of chronic kidney disease for cardiovascular diseases. According to (Segall, Nistor, & Covic, 2014) the prevalence of cardiovascular diseases among patients with chronic kidney disease in the United States, reached an astonishing 68% compared to 6% among those without the disease. In end stage renal disease that is common among dialysis dependent patients, the risk of cardiovascular mortality is estimated at 10-20 times higher than in age and gender matched patients.  The remarkable mortality and risk of cardiovascular diseases among patients with chronic kidney disease (CKD) requires effective management of such patients.

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            This paper offers a literature review on the management of patients with chronic kidney disease. The literature search involved the use of keywords to locate scholarly materials from PubMed, Google scholar and university library database. The references of the articles included in this review were also examined to determine the authenticity of the sources.


CKD Management Interventions

According to (Tawfic & Bellingham, 2015) chronic kidney disease has become a worldwide healthcare problem. (Murphree & Thelen, 2010) points that about 13% of adult population suffers from chronic kidney disease (CKD). The knowledge of the therapeutic interventions for chronic kidney disease is important for reduction of morbidity among the patients. Chronic kidney is defined as decline in glomerular filtration rate to less than 60mL/min/1.73m2 or kidney damage of at least three months (Murphree & Thelen, 2010). The disease is common and has high morbidity rates among the patients.  The common sings of kidney damage are proteinuria, persistent glomerulonephritis or structural damage resulting from polycystic kidney disease.  

Regardless of the cause of the disease, the main objective of treatment of CKD is the prevention of occurrence of cardiovascular events, which are responsible for high morbidity rates among the patients. Among the management strategies that were common in the literature, most involved the management of diet, avoiding acute kidney injury, diabetes and pain management.

Management of Diet

The major role of nutrition and food is complex and does not only dwell on the combination of nutrients that the food provides. According to (Campbell & Carrero, 2016) food determines who we are, controlling our health and diseases. The most important aspect of food is quality rather than quantity. The authors further points in their study the increasing public health recommendations for prevention of chronic diseases through good dietary patterns.

The focus of primary prevention of chronic diseases have evolved and shifted its focus on single-nutrient to dietary patterns and whole foods. (Campbell & Carrero, 2016) notes that traditional dietary management of chronic kidney diseases have often focused on the quantity within the diet of protein, energy and restriction of single macronutrient, with recommendation of plant-based patterns. The little focus on quality of diet for CKD patients makes quality of such patients suboptimal. According to the authors, this can be attributed to many factors, which includes restriction on consumption of phosphorus, potassium and sodium and social and financial barriers.

In their study that involved over half a million U.S community dwellers (Campbell & Carrero, 2016) found that individuals who consistently adhered to quality dietary patterns experienced less composite outcomes. The authors noted that the composition of the desirable diet patters included whole grains, legumes, vegetables and high volumes of fruits. The undesirable diet patterns included taking of processed foods that were high in sodium and sugars, red meat and saturated fats.

The management of diet for patients with chronic kidney disease is a complex task (Murphree & Thelen, 2010). According to the authors, it is recommended that as CKD progress, there is need for medical nutrition therapy from a qualified dietician. The authors recommend reduction of excessive protein and sodium intake among the patients with CKD. They argue that protein from the animal source have the potential to increase the renal blood flow rate and glomerular filtration rate (GFR). For sodium intake, the authors argue that reducing sodium intake offers the potential of improving blood pressure control; it lowers the albumin levels in urine and increases the efficacy of RAAS bloggers that manage albuminuria and hypertension.

Management of Diabetes

            Although there is little evidence that a tighter control of CKD compared to poor control slows the progress of CKD. However, (Murphree & Thelen, 2010) points that keeping good blood glucose control lowers albuminuria among patients with diabetes and this reduces the risks that are associated with the declining CFR among the CKD and diabetic patients. Moreover, (Hahr & Molitch, 2015) asserts that diabetes mellitus is the common cause of kidney failure and CKD. According to the authors, those patients who suffer from stage 4-5 CKD and those undergoing dialysis have delayed gastric emptying. This may significantly affect blood sugar levels. Given that patients with CKD are more likely to suffer from CKD, the management of diabetes provides a good intervention for the management of CKD.

Avoiding Acute Kidney Injury

            Acute kidney failure refers to the loss of kidney function, which is defined by increase in serum creatinine <0.3 mg/dL, reduction in urine output by about 0.5 mL/kg/hr for more than six hours or a 50 or more percentage increase in serum creatinine (Murphree & Thelen, 2010). Patients who suffer from CKD are highly susceptible to nephrotoxic medications, which predispose them to acute kidney injury. Kidney injuries have the potential of accelerating progression of CKD. In addition to provision of education to CKD patients on way of lowering acute kidney injuries, such patients must be advised to avoid medications such as β-lactam antibiotics, no steroidal anti-inflammatory drugs (NSAIDs), quinolones and sulfonamides. Moreover, the intravascular administration of iodinated agents must be administered by physicians with caution.

Pain Management

            The most significant element that influences the quality of life of patients with CKD is pain (Zyga et al., 2015). CKD patients undergo pain during the hospital dialysis process. According to the authors, self-efficacy in pain and quality of life can play a significant role in CKD and treatment outcomes. According to (Tawfic & Bellingham, 2015) postoperative pain management issues could include one or a combination of dose adjustment, prevention of further renal damage, the presence of chronic pain and the use of peripheral nerve blocks. The authors further categorize pain management into the various stages of CKD.

            Patients with CKD in stage one have normal renal function but with a structural abnormality diagnosed incidentally during radiological examination, such as presence of kidney cysts. Posttraumatic and postoperative pain management with this group of patients should include neuraxial or peripheral nerve blockade. In stage 2, CKD patients suffer from mild impairment of renal function. The sufficient level of renal functions CKD stage two demands no adjustment for pain medications. CKD in 3rd and 4th stages should be managed through regional techniques as they can be effective in reducing exposure to analgesics.


Based on the findings above, it can be concluded that management of patients with chronic kidney disease involves limited interventions that include control of diabetes, pain management, avoidance of acute kidney injury and management of diet. The focus of the therapeutic interventions is the management of underlying complications and illnesses of chronic kidney disease. It is advisable that CKD is prevented before its offset through radiological screening and quality diet.

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