Nurs 6565 Week 1 Assignment Paper.

Nurs 6565 Week 1 Assignment Paper. Nurs 6565 Week 1 Assignment Paper. Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Nurs 6565 Week 1 Assignment Paper. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours. Permalink: https://nursingpaperessays.com/ nurs-6565-week-1-assignment-paper / According to Antonelli (2017), ‘self-assessment of knowledge and accuracy of skill performance is essential to the practice of healthcare and self-directed life-long learning’. The emphasis on life-long learning is important. Sullivan and Hall (2017) suggest that a self-assessment can promote reflection on personal performance as well as to identify reasons for discrepancies between scores of assessors and assesse. Self-assessment is ‘the act of judging ourselves and making decisions about the next step.’(Boud.,2015). An important principle is that assessment must be followed by action. Nurs 6565 Week 1 Assignment Paper. The three strengths that I possess include; ability to complete accurately and thoroughly any physical exam that encompasses the patients using appropriate techniques as provisioned for in the diagnosis chart. I am also able to effectively communicate verbally as well as establish interpersonal communication with the patients and other staff within the healthcare facility, which is crucial in establishing a collaborative working relationship and a calm environment in which the patients can feel comfortable to articulate what they might be experiencing. Nurs 6565 Week 1 Assignment Paper. The third strength is that I am a strong believer in patient education. All these three strengths complement each other and play a crucial role in ensuring that I am effective in patient handling as well as establishing close relationship with them. For example, the ability to carry out thorough and accurate physical exams and diagnosis on patients ensures that I am able to focus on the patient symptoms with more ease as well as effectively diagnose their condition. The effective verbal communication as well as interpersonal communication helps ensure that I can create a comfortable environment through which the patients can be able to narrate their medical history thus gives me an opportunity to effectively analyze their condition. The provision of patient education about the patient medication or examination helps ensures they gain autonomy and self-empowerment to control and manage their condition. Nurs 6565 Week 1 Assignment Paper. The three weaknesses that I have include; the lack of an understanding of the state’s nursing practice act, inability to add all differential patient diagnosis in my the patient assessment although I might carry out accurate assessments, as well as the need to improve on the use of medical literature and thus be able to plan treatment appropriately. I am currently working on gaining a better understanding of the nursing legal compliance within the state as well as ensuring that each day I undertake patient assessments and fill in the differential diagnosis to ensure that the assessments are not only accurate but also comprehensive (Schober, 2016). I am currently working on improving my understanding of medical literature as well as taking time to research and understand more on the pathology of diseases and their treatment plans. Nurs 6565 Week 1 Assignment Paper. The clinical skills that I intent to acquire before exiting the program include; cultural competency skills, critical thinking skills as well as decision making skills, all which will help ensure that I am able to expedite my duties as a nurse better. The acquisition of the cultural competency skills will help ensure that I am able to not only communicate but also understand information from patients drawn from diverse backgrounds (Buppert, 2015). This will be achieved by ensuring that I spend time with colleagues drawn from different backgrounds as well as read widely on the various cultures and their practices. Nurs 6565 Week 1 Assignment Paper. The critical thinking and decision-making skills will be honed through active practice, in which I will ensure that in every engagement I am involved try to critically think before making the decision as well as evaluating the various scenarios and circumstances at hand before making the final decision. Nurs 6565 Week 1 Assignment Paper. Advanced practice nurses have evolved widely through the years as technology has become integrated into the nursing profession, with the intent of realizing new cost-effective methods of delivering care as well as increasing the ratio of practitioners to patients. The advanced practice nurses are expected to not only obtain health histories of the patients but also perform comprehensive examinations on the patients, develop differential diagnostics, evaluate the response of the patients to treatment as well as engage in research studies (Schober, 2016). As an advanced practice nurse, I will play a crucial role developing therapeutic plan of care, provide patient education and counseling as well as participate in research studies aimed at improving the nature of care that is available for the patients. Nurs 6565 Week 1 Assignment Paper. Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Nurs 6565 Week 1 Assignment Paper. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours. Nurs 6565 Week 1 Assignment Paper. ORDER A CUSTOM-WRITTEN PAPER NOW NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Course Readings Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long?” OJIN: The Online Journal of Issues in Nursing, 19(1). Christensen, C. M., Bohmer, R. M. J., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102-112, 199. Ford, L. C.. & Gardenier, D. (2015). Fasten your seat belts – it’s going to be a bumpy ride. The Journal for Nurse Practitioners, 11(6), 575-577. Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). Nurs 6565 Week 1 Assignment Paper. Hayes, E., Chandler, G., Merriam, D., & King, M. C. (2002). The master’s portfolio: Validating a career in advanced practice nursing. Journal of the American Academy of Nurse Practitioners, 14(3), 119. Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners -risks and rewards. New England Journal of Medicine, 368(20), 1935-1941. Jordan, L. M., Quraishi, J. A., & Liao, J. (2013). The national practitioner data bank and CRNA anesthesia-related malpractice payments. American Association of Nurse Anesthetists Journal, 81(3), 178-182. Nurs 6565 Week 1 Assignment Paper. Kooienga, S.A. & Carryer, J.B. (2015). Globalization and advancing primary care health care nurse practitioner practice. The Journal for Nurse Practitioners, 11(8), 804–811. Miller, K. P. (2013). The national practitioner data bank: An annual update. The Journal for Nurse Practitioners, 9(9), 576-580. O’Connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: Using a capability framework in developing practice standards for advanced practice nursing. Journal of Advanced Nursing, 70(12), 2728-2735. Nurs 6565 Week 1 Assignment Paper. Reinisch, C. E. (2014). Loretta Ford: Envisioning the future. Clinical Scholars Review, 7(1), 82-84. Rhodes, C. A., Bechtle, M., & McNett, M. (2015). An incentive plan for advanced practice registered nurses: Impact on provider and organizational outcomes. Nursing Economics, 33(3), 125-131. Silver, H. K,. Ford, L. C., & Day, L. R. (1968). The pediatric nurse-practitioner program: Expanding the role of the nurse to provide increased health care for children. JAMA, 204(4), 298-302. Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . . Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500. Nurs 6565 Week 1 Assignment Paper. Stelmach, E. I. (2015). Dismissal of the noncompliant patient: Is this what we have come to? The Journal for Nurse Practitioners, 11(7), 723-725. Watson, E. (2014). Nursing malpractice: Costs, trends and issues. Journal of Legal Nurse Consulting, 25(1), 26-31. Weber, S. (2006). Developing nurse practitioner student portfolios. Journal of the American Academy of Nurse Practitioners, 18(7), 301-302. Nurs 6565 Week 1 Assignment Paper. Westrick, Susan J., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics. The Journal for Nurse Practitioners, 12(2), 120-126. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers NURS 6565 Week 2 Discussion: Ethical Challenges in Health Care for Practicing NPs Consider the following case study: Mrs. ABC is a 35 year old woman who has a scheduled business trip today. It is currently 8 am, and her plan is to leave at 6 pm. Mrs. ABC has a sore throat and she thinks it is strep because her 5 year old daughter was recently treated for strep. Mrs. ABC calls her physician for an appointment, but there are no appointments available until next week. Nurs 6565 Week 1 Assignment Paper.She has a mother who is a nurse practitioner and her office is 5 minutes away from where she lives. She calls and schedules an appointment with her mother. Her mother was surprised to see her daughter at the office. Mrs. ABC is frantic and begs her mother for an antibiotic. Her mother tests her and the rapid strep test is negative in office. Her mother (NP) sends out a strep DNA probe. Her mother prescribes an antibiotic and the patient (her daughter) is very satisfied. The results returned for the DNA probe 48 hours later and it confirmed negative for strep. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. By Day 3 OF NURS 6565 Week 2 Discussion Post an explanation of whether NPs should treat family members. What are the ethical dilemmas in this situation? What are the laws in your state for NPs treating themselves, family, or friends? NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Nurs 6565 Week 1 Assignment Paper. ****I live in Texas**** but you can choose any state in the US NURS 6565 Week 2 Discussion Resources http://midlevelu.com/blog/should-providers-treat-their-friends-and-family http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx NURS 6565 Week 2 Discussion CHAPTER CONTENTS Characteristics of Ethical Dilemmas in Nursing, 328 Communication Problems, 329 Interdisciplinary Conflict, 329 Multiple Commitments, 330 Ethical Issues Affecting Advanced Practice Nurses, 330 Primary Care Issues, 330 Acute and Chronic Care, 330 Societal Issues, 331 Access to Resources and Issues of Justice, 332 Legal Issues, 333 Changes in interprofessional roles, advances in medical technology, privacy issues, revisions in patient care delivery systems, and heightened economic constraints have increased the complexity of ethical issues in the health care setting. Nurses in all areas of health care routinely encounter disturbing moral issues, yet the success with which these dilemmas are resolved varies significantly. Because nurses have a unique relationship with the patient and family, the moral position of nursing in the health care arena is distinct. As the complexity of issues intensifies, the role of the advanced practice nurse (APN) becomes particularly important in the identification, deliberation, and resolution of complicated and difficult moral problems. Nurs 6565 Week 1 Assignment Paper. Although all nurses are moral agents, APNs are expected to be leaders in rec- ognizing and resolving moral problems, creating ethical practice environments, and promoting social justice in the larger health care system. It is a basic tenet of the central definition of advanced practice nursing (see Chapter 3) that skill in ethical decision making is one of the core competencies of all APNs. In addition, the Doctor of Nursing Practice {DNP) essential competencies emphasize leadership in developing and evaluating strate- gies to manage ethical dilemmas in patient care and organizational arenas (American Association of Colleges of Nursing [AACN], 2006). This chapter explores the distinctive ethical decision-making competency of advanced practice nursing, the process of developing and evaluating this competency, and barriers to ethical prac- tice that APNs can expect to confront. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Nurs 6565 Week 1 Assignment Paper. 328 Ethical Decision Making Ann B. Hamric • Sarah A. Delgado Ethical Decision Making Competency of Advanced Practice Nurses, 333 Phases of Core Competency Development, 333 Evaluation of the Ethical Decision Making Competency, 349 Barriers to Ethical Practice and Potential Solutions, 350 Barriers Internal to the Advanced Practice Nurse, 350 lnterprofessional Barriers, 351 Patient-Provider Barriers, 351 Organizational and Environmental Barriers, 352 Conclusion, 354 Characteristics of Ethical Dilemmas lll~l12:’:1’Si~ ~~·-· ~ -······· …. ···~ ·-· In this chapter, the terms ethics and morality or morals are used interchangeably (see Beauchamp & Childress, 2009, for a discussion of the distinctions between these terms). A problem becomes an ethical or moral problem when issues of core values or fundamental obligations are present. Nurs 6565 Week 1 Assignment Paper.An ethical or moral dilemma occurs when obliga- tions require or appear to require that a person adopt two (or more) alternative actions, but the person cannot carry out all the required alternatives. The agent experiences tension because the moral obligations resulting from the dilemma create differing and opposing demands (Beauchamp & Childress, 2009; Purtilo & Doherty, 2011). In some moral dilemmas, the agent must choose between equally unacceptable alternatives; that is, both may have elements that are morally unsatisfactory. For example, based on her evaluation, a family nurse practitioner (FNP) may suspect that a patient is a victim of domestic violence, although the patient denies it. Nurs 6565 Week 1 Assignment Paper. The FNP is faced with two options that are both ethically troubling-connect the patient with existing social services, possibly straining the family and jeopardizing the FNP-patient relationship, or avoid intervention and potentially allow the violence to continue. As described by Silva and Ludwick (2002), hon- oring the FNP’s desire to prevent harm (the principle of beneficence) justifies reporting the suspicion, whereas respect for the patient’s autonomy justifies the opposite course of action. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Jameton (1984, 1993) has distinguished two additional types of moral problems from the classic moral dilemma, which he termed moral uncertainty and moral distress. In situations of moral uncertainty, the nurse experiences unease and questions the right course of action. In moral distress, nurses believe that they know the ethically appro- priate action but feel constrained from carrying out that action because of institutional obstacles (e.g., lack of time or supervisory support, physician power, institutional policies, legal constraints). Nurs 6565 Week 1 Assignment Paper.Noting that nurses and others often take varied actions in response to moral distress, Varcoe and colleagues (2012) have proposed a revision to Jameton’s definition: “moral distress is the experience of being seriously compromised as a moral agent in prac- ticing in accordance with accepted professional values and standards. It is a relational experience shaped by multiple contexts, including the socio-political and cul- tural context of the workplace environment” (p. 60). The phenomenon of moral distress has received increasing national and international attention in nursing and medical literature. Studies have reported that moral dis- tress is significantly related to unit-level ethical climate and to health care professionals’ decisions to leave clinical practice (Corley, Minick, Elswick, et al., 2005; Epstein & Hamric, 2009; Hamric, Borchers, & Epstein, 2012; Hamric, Davis, & Childress, 2006; Pauly, Varcoe, Storch, et al., 2009; Schluter, Winch, Hozhauser, et al., 2008; Varcoe, Pauly, Webster, & Storch, 2012). APNs work to decrease the incidence of moral uncertainty and moral distress for themselves and their colleagues through edu- cation, empowerment, and problem solving. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Nurs 6565 Week 1 Assignment Paper. Although the scope and nature of moral problems experienced by nurses and, more specifically APNs, reflect the varied clinical settings in which they practice, three general themes emerge when ethical issues in nursing practice are examined. These are problems with commu- nication, the presence of interdisciplinary conflict, and nurses’ difficulties with managing multiple commitments and obligations. Communication Problems The first theme encountered in many ethical dilemmas is the erosion of open and honest communication. Clear communication is an essential prerequisite for informed and responsible decision making. Some ethical disputes reflect inadequate communication rather than a difference in values (Hamric & Blackball, 2007; Ulrich, 2012). The APN’s communication skills are applied in several arenas. Within the health care team, discussions are most effective when members are accountable for presenting informa- tion in a precise and succinct manner. In patient encoun- ters, disagreements between the patient and a family. Nurs 6565 Week 1 Assignment Paper. C HAP T E R 13 Ethical Decision Making member or within the family can be rooted in faulty com- munication, which then leads to ethical conflict. The skill of listening is just as crucial in effective communication as having proficient verbal skills. Listening involves recog- nizing and appreciating various perspectives and showing respect to individuals with differing ideas. To listen well is to allow others the necessary time to form and present their thoughts and ideas. Nurs 6565 Week 1 Assignment Paper. Understanding the language used in ethical delibera- tions (e.g., terms such as beneficence, autonomy, and utili- tarian justice) helps the APN frame the concern. This can help those involved to see the components of the ethical problem rather than be mired in their own emotional responses. When ethical dilemmas arise, effective com- munication is the first key to negotiating and facilitating a resolution. Jameson (2003) has noted that the long history of conflict between certified registered nurse anes- thetists (CRNAs) and anesthesiologists influences how these providers communicate in practice settings. In inter- views with members of both groups, she found that some transcended role-based conflict whereas others became mired in it, particularly in the emotions around perceived threats to role fulfillment. Nurs 6565 Week 1 Assignment Paper. She recommended enhancing communication through focus on the common goal of patient care, rather than on the conflicting opinions about supervision and autonomous practice. In other words, focusing on shared values rather than the values in conflict can promote effective communication. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Interdisciplinary Conflict The second theme encountered is that most ethical dilemmas that occur in the health care setting are multidisciplinary in nature. Issues such as refusal of treatment, end-of-life decision making, cost containment, and confidentiality all have interprofessional elements interwoven in the dilemmas, so an interprofessional approach is nec- essary for successful resolution of the issue. Health care professionals bring varied viewpoints and perspectives into discussions of ethical issues (Hamric & Blackball, 2007; Piers, Azoulay, Ricou, et al., 2011; Shannon, Mitchell, & Cain, 2002). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.These differing positions can lead to creative and collaborative decision making or to a breakdown in communication and lack of problem solving. Thus, an interdisciplinary theme is prevalent in the presentation and resolution of ethical problems. Nurs 6565 Week 1 Assignment Paper. For example, a clinical nurse specialist (CNS) is writing discharge orders for an older woman who is terminally ill with heart failure. The plan of care, agreed on by the inter- professional team, patient, and family, is to continue oral medications but discontinue IV inotropic support and all other aggressive measures. Just prior to discharge, the social worker informs the CNS that medical coverage for. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. 330 PART ll Competencies of Advanced Practice Nursing the patient’s care in the skilled nursing facility will only be covered by the insurer if the patient has an IV in place. The attending cardiologist determines that the patient can be discharged to her daughter’s home because she no longer requires skilled care and the social worker agrees to proceed with this plan. However, the CNS is concerned that the patient’s need for physical assistance will over- whelm her daughter and believes that the patient is better off returning to the sldlled nursing facility. Although each team member shares responsibility to ensure that the plan of care is consistent with the patient’s wishes and mini- mizes the cost burden to the patient, they differ in how to achieve these goals. Such legitimate but differing perspec- tives from various team members can lead to ethical conflict. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Multiple Commitments The third theme that frequently arises when ethical issues in nursing practice are examined is the issue of balancing commitments to multiple parties. Nurses have numerous and, at times, competing fidelity obligations to various stakeholders in the health care and legal systems (Chambliss, 1996; Hamric, 2001). Fidelity is an ethical concept that requires persons to be faithful to their com- mitments and promises. For the APN, these obligations start with the patient and family but also include physi- cians and other colleagues, the institution or employer, the larger profession, and oneself. Ethical deliberation involves analyzing and dealing with the differing and opposing demands that occur as a result of these commitments. An APN may face a dilemma if encouraged by a specialist consultant to pursue a costly intervention on behalf of a patient, whereas the APN’s hiring organization has estab- lished cost containment as a key objective and does not support use of this intervention (Donagrandi & Eddy, 2000). In this and other situations, APNs are faced with an ethical dilemma created by multiple commitments and the need to balance obligations to all parties.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. The general themes of communication, interdisciplin- ary conflict, and balancing multiple commitments are prevalent in most ethical dilemmas. Specific ethical issues may be Wlique to the specialty area and clinical setting in which the APN practices. Ethical Issues Affecting Advanced Practice Nurses Primary Care Issues Situations in which personal values contradict professional responsibilities often confront NPs in a primary care setting. Issues such as abortion, teen pregnancy, patient nonadherence to treatment, childhood immunizations, regulations and laws, and financial constraints that inter- fere with care were cited in one older study as frequently encountered ethical issues (Turner, Marquis, & Burman, 1996). Ethical problems related to insurance reimburse- ment, such as when implementation of a desired plan of care is delayed by the insurance authorization process or restrictive prescription plans, are an issue for APNs. The problem of inadequate reimbursement can also arise when there is a lack of transparency regarding the specifics of services covered by an insurance plan. For example, a patient who has undergone diagnostic testing during an inpatient stay may later be informed that the test is not covered by insurance because it was done on the day of discharge. Had the patient and nurse practitioner (NP) known of this policy, the testing could have been sched- uled on an outpatient basis with prior authorization from the insurance company and thus be a covered expense. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Nurs 6565 Week 1 Assignment Paper. Viens {1994) found that primary care NPs interpret their moral responsibilities as balancing obligations to the patient, family, colleagues, employer, and society. More recently, Laabs (2005) has found that the issues most often noted by NP respondents as causing moral dilemmas are those of being required to follow policies and procedures that infringe on personal values, needing to bend the rules to ensure appropriate patient care, and dealing with patients who have refused appropriate care. Issues leading to moral distress included pressure to see an excessive number of patients, clinical decisions being made by others, and a lack of power to effect change (Laabs, 2005). Increasing expectations to care for more patients in less time are routine in all types of health care settings as pressures to contain costs escalate. APNs in rural settings may have fewer resources than their col- leagues working in or near academic centers in which ethics committees, ethics consultants, and educational opportunities are more accessible. Nurs 6565 Week 1 Assignment Paper. Issues of quality of life and symptom management tra- verse primary and acute health care settings. Pain relief and symptom management can be problematic for nurses and physicians (Oberle & Hughes, 2001). APNs must con- front the various and sometimes conflicting goals of the patient, family, and other health care providers regarding the plans for treatment, symptom management, and quality of life. The APN is often the individual who coor- dinates the plan of care and thus is faced with clinical and ethical concerns when participants’ goals are not consis- tent or appropriate. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Acute and Chronic Care In the acute care setting, APNs struggle with dilemmas involving pain management, end-of-life decision making, advance directives, assisted suicide, and medical errors (Shannon, Foglia, Hardy, & Gallagher; 2009). Rajput and Bekes (2002) identified ethical issues faced by hospital- based physicians, including obtaining informed consent, establishing a patient’s competence to make decisions, maintaining confidentiality, and transmitting health information electronically. APNs in acute care settings may experience similar ethical dilemmas. Recent studies of moral distress have revealed that feeling pressured to continue aggressive treatments that respondents thought were not in the patients’ best interest or in situations in which the patient was dying, working with physicians or nurses who were not fully competent, giving false hope to patients and families, poor team communication, and lack of provider continuity were all issues that engen- dered moral distress (Hamric & Blackball, 2007; Hamric, Borchers, & Epstein, 2012). Nurs 6565 Week 1 Assignment Paper. APNs bring a distinct perspective to collaborative decision making and often find themselves bridging com- munication between the medical team and patient or family. For example, the neonatal nurse practitioner (NNP) is responsible for the day-to-day medical manage- ment of the critically ill neonate and may be the first provider to respond in emergency situations (Juretschke, 2001). The NNP establishes a trusting relationship with the family and becomes aware of the values, beliefs, and attitudes that shape the family’s decisions. Thus, the NNP has insight into the perspectives of the health care team and family. This “in-the-middle” position, however, can be accompanied by moral distress (Hamric, 2001), particu- larly when the team’s treatment decision carried out by the NNP is not congruent with the NNP’s professional judg- ment or values. Botwinski (2010) conducted a needs assessment ofNNPs and found that most had not received formal ethics content in their education and desired more education on the management of end-of-life situations, such as delivery room resuscitation of a child on the edge of viability. Nurs 6565 Week 1 Assignment Paper. Knowing the best interests of the infant and balancing those obligations to the infant with the emo- tional, cognitive, financial, and moral concerns that face the family struggling with a critically ill neonate is a complex undertaking. Care must be guided by an NNP and health care team who understand the ethical princi- ples and decision making related to issues confronted in neonatal intensive care unit (NICU) practice. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers. Nurs 6565 Week 1 Assignment Paper. Societal Issues Ongoing cost containment pressures in the health care sect01· have significantly changed the traditional practice of delivering health ca