AGACNP – ANP 650 topic 1 dq 1
AGACNP – ANP 650 topic 1 dq 1
Document clear and concise SOAP notes for all populations.
I will admit that transitioning from emergency nursing back to intensive care nursing has been challenging. In the emergency department, we chart by exception, meaning that although we can perform an across-the-room assessment, our documentation focuses on the chief complaint of the patient. As many of you know, the intensive care unit (ICU) is quite different in that it is more comprehensive. I am grateful for that. My role in continues to allow me to create new neural pathways which will be beneficial in my future role as a provider. In my clinical experience, my plan is to request and receive feedback on my SOAP notes and supporting documentation. I hope to learn to be thorough in my notes with documentation that supports decisions made and provides an accurate depiction of the status of patients I will be seeing.
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Recommend options for treatment and management of care for patients according to evidence-based guidelines.
Designing evidence-based treatments for patients comes with so much responsibility that we in this class may have never had to deal with. Our training, however, along with our experience as registered nurses, may prove to be beneficial not only to us, but to the facilities in which we will work. One study by Kleinpell et al. (2019) noted increased use of clinical practice guidelines, improved patient outcomes, reduced complications, and improved patient care management with advanced practice providers in the ICU setting. As RN’s we naturally want what is best for our patients and sometimes must deal with many barriers to achieving our goals. As Adult-Gerontology Acute Care Nurse Practitioner (AGANCP) students, we can learn from our faculty and preceptors the many ways we can manage and treat our patients to achieve the best possible outcomes. Evidence-based medicine uses the most up-to-date, relevant clinical research that can assist with determining if a medical intervention alters the disease process and improves quality of life, or if it does not (Jameson et al., p. 20). We must ask the right questions, seek to understand, and when in doubt, ask again. There is zero room for arrogance and/or complacency. My goal is to provide care that is necessary, accurate, evidence-based, and cost efficient AGACNP – ANP 650 topic 1 dq 1 .
Exhibit professional behaviors within scope of practice in interactions with patients and the interdisciplinary team.
This will take some adjustment, but not in the way one would automatically think. Moving from a staff role to a provider role will have its challenges. For me as a staff nurse, I am a helper. If I see someone needing assistance, I am the first to volunteer. As a provider, it will be challenging to remain in a provider role and not assist with cleaning a patient. I imagine it will be awkward, especially on my current unit. I will be seeking guidance from my preceptors on how to handle those situations. My goal is to move my mind from staff RN to provider by this time next year.
Order laboratory and imaging tests and analyze results for subacute and complex chronic patients.
According to Jameson et al. (2018, p. 16), clinicians can be more efficient users of diagnostic data if we understand the nature of test information. I truly hope to become more proficient at not only ordering the necessary labs and imaging needed to support my diagnosis and decision-making, but thoroughly understanding what the information means for my patients. My fear is that I will try to order more than what is necessary and cloud my judgement with too much information. My goal is to leverage my preceptors’ knowledge to help me navigate this new (to me) concept and learn the “who”, “what”, “when”, “where”, “how”, and “why” for each diagnostic for each patient case I can participate in.
References:
Jameson, J., Fauci, A., Kasper, D., Hauser, S., Longo, D., & Loscalzo, J. (2018). Harrison’s principals of internal medicine (20th ed.). McGraw-Hill Education.
Kleinpell, R. M., Grabenkort, W. R., Kapu, A. N., Constantine, R., & Sicoutris, C. (2019). Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018. Critical care medicine, 47(10), 1442–1449. https://doi.org/10.1097/CCM.0000000000003925
AGACNP – ANP 650 topic 1 dq 1 sample 2
As I read through the course objectives there were many different topics to consider that are all important and beneficial as AGACNP students in providing patient care and learning how to be NPs in a clinical setting. Clinical practice guidelines (CPGs) help to support various interrelationships among critical contributors to clinical decision-making. There is no one-size-fits-all approach when it comes to patient care, so CPGs can elevate the decisions a clinician makes by describing and appraising the evidence and reasoning behind certain recommendations which allow for them to show relevance to each patient at the individual level (U.S. Department of Health and Human Services, n.d.). I have selected three objectives that I feel are of great value for me personally in that I want to expand my current knowledge of them.
The first objective I will incorporate into my clinical rotations is clinical documentation and how it affects patient care, patient outcomes, and reimbursement. I know that documentation on the provider level is much different than that of an RN and what I am used to doing daily so learning and mastering this is something I feel is valuable and I would like to establish this skill early on in my clinical rotations so that I can build on it with each additional rotation and course. Documentation for the patient at the inpatient level should follow the general principles of Professional Billing and Coding, according to our textbook, as it is considered a record of the patient’s clinical experience. The documentation must follow certain regulatory requirements to ensure adequate and full reimbursement for services rendered (McKean et al., 2016).
The second objective I feel is important and I will be incorporating is the use of diagnostic testing and interpretation of these tests to properly diagnose, treat, and manage the conditions of the patients I will be caring for. I am familiar with diagnostic testing in diagnosing patients with various conditions. However, I am no expert and have much to still learn as I know this is a vital aspect of any provider’s ability to properly care for their patients. I hope to gain more knowledge and experience in this area to be confident at what I am ordering for a patient is the right test or study and not wasting time or money in ordering them AGACNP – ANP 650 topic 1 dq 1 . This also can be related to the clinical documentation discussed above as what I am ordering and why will need to be put in my documentation for the patient so that it is understood and supported as to what decisions are made.
The third objective I will be incorporating in my rotations is the use of clinical judgment with evidence-based medicine guidelines supporting this judgment. Our text discusses this at length and discusses that clinical judgment and expertise are vital in the practice of EBM (McKean et al., 2016). As a learner in this field, I am hoping to gain insight from my preceptor and others I will work with to be able to learn and better my clinical judgment skills. What I know now will only grow with each clinical rotation and I hope to improve my clinical judgment skills more and more each day.
References:
McKean, S. C., Ross, J. J., Dressler, D. D., & Scheurer, D. (2016). Principles and practice of hospital medicine, (2nd ed.). McGraw Hill LLC.
U.S. Department of Health and Human Services. (n.d.). Clinical practice guidelines. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/clinicalpractice AGACNP – ANP 650 topic 1 dq 1
