NR 667 Assignment: Capstone Narrative Analysis
NR 667 Assignment: Capstone Narrative Analysis
Artifacts/Assignment per CLASS:
Choose any three assignments from each core course and clinical course that you consider your best work in the program and connect/relate to our Program Outcomes.
INSTRUCTIONS
Submit a scholarly reflective narrative analysis & synthesis that demonstrates how each of the artifacts submitted, and the course in which the artifacts were produced, meet each MSN program outcome. How you meet MSN program outcome on each of the class artifacts submitted.
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Narrative Analysis
1. Using synthesis and evaluation, the student authors a 3,000-4,500-word scholarly reflective narrative that demonstrates how all of the artifacts submitted, and the course in which the artifacts were produced, meet each MSN/FNP Program Outcome; AND
2. The student provides summative evaluation of own professional growth and development as a graduate student in the COGNITIVE, PSYCHOMOTOR, and AFFECTIVE domains as it pertains to the FNP Program; AND
3. The student provides summative evaluation of own professional growth and development as a graduate student as it pertains to AACN’s MSN Essentials for Graduate Education; AND
4. The student provides summative evaluation of own professional growth and development as a graduate student as it pertains to the National Organization of Nurse Practitioner Faculties (NONPF) Competencies; AND
5. The student reflects how own cultural competence has been transformed.
example :
• Goal of the paper in few sentences.
• Narrative analysis of each submitted artifacts/assignment in every class on how you meet MSN program outcome.
• summative evaluation of their own professional growth and development as a graduate student in the COGNITIVE, PSYCHOMOTOR, and AFFECTIVE domains as it pertains to the FNP Program
• provides summative evaluation of own professional growth and development as a graduate student as it pertains to AACN’s MSN Essentials for Graduate Education;
• provides summative evaluation of own professional growth and development as a graduate student as it pertains to the National Organization of Nurse Practitioner Faculties (NONPF) Competencies
• reflects how own cultural competence has been transformed
• Conclusion
Please use “I” for more personalized statement in analysis and reflection.
This Narrative Analysis format should use APA7 format, to include a cover page, running head, headings, and a reference list. Other elements, such as an APA formatted table, may also be included. Strict adherence to APA7 format is required. Examples of references that would support this Narrative Analysis might include a required journal reading from a course, material from a nurse practitioner professional web site to include a board of nursing site, or other peer-reviewed scholarly articles. Course textbooks may be used.
MSN Program Outcomes (PO):
PO1. Provide high quality, safe, patient, centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care).
PO2. Create a caring environment for achieving quality health outcomes (Care-Focused).
PO3. Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility).
PO4. Integrate professional values through scholarship and service in health care (Professional Identity).
PO5. Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary Nursing).
Course Outcomes
The COs define the learning objectives that the student will be required to comprehend and demonstrate by course completion. The COs that will be covered in detail each week can be found in the Overview page in that week. Whenever possible, a reference will be made from a particular assignment or discussion back to the CO that it emphasizes.
CLASS WEEK (artifacts) COURSE OUTCOMES (COs)
Class 1
Foundational
Concept and
Application • Week 1 The Value of a Master’s-Prepared Nurse (PO 2,3,4,5)
• Week 6 Area of interest powerpoint presentation regarding teenage depression (PO 2,3,4,5)
• Week 7 Incivility and Healthful Environment (PO 1,2,3,5) Course outcome: Upon completion of this course, the student will be able to do the following.
1. Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care. (PO 5) Week 1, 2, 3, 4, 5, 6, 7, 8
2. Apply concepts of person-centered care to nursing practice situations. (PO1, PO2) Week 3, 4, 7, 8
3. Analyze essential skills needed to lead within the context of complex systems. (PO2, PO3) Week 1, 4, 5, 6, 7, 8
4. Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings. (PO3, PO4)Week 1, 2, 4,6,8
Class 2
Theoretical
Basis for Advanced Nursing Practice • Week 3: Steps of Concept Analysis (PO 1,2,5)
• Week 4: Nursing Theory (PO 1,2)
• Week 5: Application of Theory Assignment (PO 1,2,5)
Course outcome: Upon completion of this course, the student will be able to do the following.
1. Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO 2 and 5) Week 2, 3, 5, 6, 8
2. Apply nursing theory as a framework to guide the development of new knowledge and implementation of evidence-based practice in future professional settings. (PO 1 and 4) Week 2, 7
3. Examine broad theoretical concepts as foundational to advanced nursing practice roles. (PO 1 and 2) Week 1, 3, 4
4. Analyze theories from nursing and relevant fields with respect to the components, relationship among the components, and application to advanced nursing practice. (PO 1) Week 4, 5, 6
Class 3
Population Health, Epidemiology,
and Statistical Principles • Week 1: Discussion – Exercise and Discussion Questions from Curley Text Book (PO 2)
• Week 2: Discussion – Epidemiological Methods (PO 2,3)
• Week 6: Epidemiological Analysis: Chronic Health Problem (PO 2) Course Outcome: Upon completion of this course, the student will be able to do the following.
1. Define key terms in epidemiology, community health, and population-based research. (PO 2) Week 1, 2, 4
2. Compare study designs used for obtaining population health information from surveillance, observation, community, and control trial based research. (PO 2) Week 2, 3, 4, 5
3. Identify appropriate outcome measures and study designs applicable to epidemiological subfields such as infectious disease, chronic disease, environmental exposures, reproductive health, and genetics. (PO 2, 3) Week 2, 4
4. Apply commonly used measures of health risk. (PO 2) Week 6, 7
5. Examine current ethical/legal issues in epidemiology. (PO 2, 3) Week 7, 8
6. Identify important sources of epidemiological data. (PO 2) Week 3, 5, 6
7. Evaluate a public health problem in terms of magnitude, person, time, and place. (PO 2, 3) Week 8
Class 4
Advanced Research Methods • Week 1: Evidence-Based Practice, Quality-Improvement and Research Methodology (PO 1,2,5)
• Week 2: Writing a PICO Question (PO 1)
• Week 4: State of the Science Quality Improvement Paper Part 1 (PO 1,2)
Upon completion of this course, the student will be able to do the following.
1. Integrate evidence-based practice and research to support advancement of holistic nursing care in diverse healthcare settings. (PO 1) Week 1, 6, 7, 8
2. Integrate knowledge related to evidence-based practice and person-centered care to improve healthcare outcome. (PO 1,2) Week 1, 6, 7, 8
3. Demonstrate professional and personal growth through a spirit of inquiry, scholarship, and service in diverse healthcare settings. (PO 1,5) Week 1, 7, 8
4. Develop knowledge related to research and evidence-based practice as a basis for designing and critiquing research studies. (PO 1, 6) Week 1, 2, 3, 4, 5, 6, 7
5. Analyze research findings and evidence-based practice to advance holistic nursing care initiatives that promote positive healthcare outcomes. (PO 1) Week 1, 2, 3, 6, 7
Class 5
Healthcare Policy and Leadership • Week 1: Barriers to Practice (PO 1,4)
• Week 5: Ethical and Legal Implications (PO 2 3,4)
• Week7: APNs as Healthcare Policy Leaders (PO 1,3,4
Upon completion of this course, the student will be able to do the following.
1. Employ strategies to impact the development, implementation, and consequences of holistic healthcare policies using evidence-based
Practice principles. (PO1) Week 1, 3, 4
2. Critically analyze how healthcare systems and APRN practice are organized and influenced by ethical, legal, economic and political factors. (PO4) Week 1, 2, 3, 4, 5, 6, 7, 8
3. Demonstrate professional and personal growth concerning the advocacy role of the advanced practice nursing in fostering policy within diverse healthcare settings. (PO3) Week 2, 3, 5, 7
4. Analyze social, historical, ethical and political contexts of healthcare policies and advanced practice leadership. (PO4) Week 2, 3, 4, 5
5. Advocate for institutional, local, national and international policies that fosters person-centered healthcare and nursing practice. (PO1) Week 3, 4, 6, 7, 8
Class 6
Advanced Physical Assessment • Week 1: Shadow Health Assessment Assignment (patient with fever, diabetes, foot wound, etc) (PO1,2)
• Week 2: Shadow Health Assessment Assignment (patient with asthma) (PO 1,2)
• Week 5: Shadow Health Assessment Assignment (constipated patient) (PO 1,2)
Upon completion of this course, the student will be able to do the following.
1. Complete a focused health history and examination for various patient populations. (PO 1,2) Week 1, 2, 3, 4, 5, 6
2. Differentiate normal from abnormal physical examination findings. (PO 1, 2) Week 2, 3, 4, 5, 6, 7, 8
3. Document findings of the history and physical examination in a logical and organized sequence. (PO 1, 2) Week 1, 2, 3, 4, 5, 6
4. Adapt history and physical examination to the needs of the patient, i.e., male versus female patient. (PO 1, 2) Week 2, 3, 4, 5, 6
5. Demonstrate knowledge required to perform a comprehensive health history and examination for developmental, gender-related, age-specific, and special populations. (PO 1, 2) Week 2, 3, 4, 5, 6, 7, 8
Class 7
Nursing Informatics for Advanced Practice • Week 3: EHRs Benefits and Drawbacks (PO 3,4,5)
• Week 5: Clinical Decision Support Systems (PO 3, 5)
• Week 6: Medical Application Critical Appraisal Guidelines (PO 3, 5)
Upon completion of this course, the student will be able to do the following.
1. Define key terms in informatics, healthcare informatics, and nursing informatics to achieve quality health outcomes. (PO 1) Week 1
2. Demonstrate synthesis of nursing and non-nursing science with information and computer technologies through collaborative advanced nursing practice (PO 3) Week 1, 2, 3, 4, 5, 6, 8
3. Examine the ethical/legal issues arising in NI relating to the advanced practice nurses’ use of information systems to promote quality health outcomes (PO 3, 5) Week 7
4. Exemplify professional values and scholarship to support professional and personal development. (PO 5) Week 2, 3, 4, 5, 6
5. Demonstrate the ability to properly document all patient health data needed for the role of advanced practice nurse (PO 4) Week 3
Class 8
Primary Care of the Maturing and Aged Family • Week 3: Psychiatric Disorders and Screening
• Week 5: Case Study Assignment
• Week 6: Post-Menopausal and Sexuality Issues in the Maturing and Older Adult Upon completion of this course, the student will be able to do the following.
1. Employ appropriate health promotion guidelines and disease prevention strategies in the management of mature and aging individuals and families. Week 1, 3, 5, 7
2. Formulate appropriate diagnoses and evidence-based management plans for mature and aging individuals and families. Week 2, 3, 4, 5, 7, 8
3. Incorporate cultural preferences, values, and health beliefs in the care of mature and aging individuals and families. Week 2, 5, 6, 7, 8
4. Integrate theory and evidence-based practice in the care of mature and aging individuals and their families. Week 1, 2, 3, 4, 5, 7, 8
5. Assess and manage risk factors for common conditions prevalent in mature and aging individuals and families. Week 1, 2, 3, 4, 5, 6, 7, 8
6. Conduct pharmacologic assessment addressing polypharmacy, drug interactions and other adverse events in the care of mature and aging individuals and their families. Week 1, 2, 5, 7
7. Apply appropriate evidence-based screening tools in the functional assessments of mature and aging individuals and their families. Week 1, 2, 7
Class 9
Primary Care of the Childbearing Family • Week 3: Immunization Case Study Assignment (PO 5)
• Week 4: Pediatric Clinical Pearl Case Study Assignment (PO 5)
• Week 8: Marginalized Women and Childbearing Families (PO 5) Upon completion of this course, the student will be able to do the following.
1. Integrate current evidence based clinical practice guidelines in the care of childbearing and childrearing families (PO 5). Week 1, 2, 3, 4, 5, 6, 7, 8
2. Appropriately apply anticipatory guidance and health promotion in the care of childbearing and childrearing families (PO 5). Week 1, 3, 4, 5, 6, 7, 8
3. Assess growth and developmental milestones in the care of childbearing and childrearing families (PO 5). Week 1, 3, 4
4. Construct an evidence based reproductive health management plan (PO 5). Week 1, 2
5. Identify and address healthcare needs of marginalized childbearing and childrearing families (PO 5) Week 8
Class 10
Advanced Clinical Diagnosis and Practice Across the Lifespan • Week 2: Case Discussion Pulmonary – Part 1 (PO 5)
• Week 6: Mental Health Final Treatment Plan/Analysis – Part 2 (PO 5)
• Week 7: Case Study Discussion (PO 5) Upon completion of this course, the student will be able to do the following.
CO: 1. Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan. (PO 5)
Week(s): 1, 4, 7
CO: 2. Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
Week(s): 2, 3
CO: 3. Involve the patient and family in the formulation of management plans that align with their goals and perspectives of health and wellness. (PO 5)
Week(s): 3
CO: 4. Develop management plans based on current scientific evidence and national guidelines. (PO 5)
Week(s): 1, 2, 5, 6
CO: 5. Incorporate cultural preferences, values, health beliefs, and behaviors into the care of patients and families with complex or multiple diagnoses across the lifespan. (PO 5)
Week(s): 3, 7, 8
CO: 6. Prioritize treatment based on relevant clinical presentation.
Week(s): 4, 5, 6
Class 11
FNP Capstone Week 1: Discussion
Week 5: Grand Rounds Presentation about major depression
Upon completion of this course, the student will be able to do the following.
CO: 1. Independently formulate a management plan addressing health promotion, disease prevention and health protection for patients and families across the lifespan using evidence-based guidelines. (PO 5)
Week(s): 2, 3, 4, 5, 6, 7
CO: 2. Collaborate with interdisciplinary team members to improve the quality of healthcare. (PO 5)
Week(s): 1
CO: 3. Appraise personal and professional growth toward achieving mastery of the NONPF competencies and the Essentials for Master’s Education in Nursing. (PO 5)
Week(s): 8
CO: 4. Demonstrate a command of essential knowledge needed for safe, quality primary care practice as a family nurse practitioner. (PO 5)
Week(s): 1, 2, 3, 4, 5, 6, 7
CO: 5. Demonstrate competencies essential of the family nurse practitioner role as leaders and advocates of holistic, safe, and quality care. (PO 5)
Week(s): 1, 3, 8
National Organization of Nurse Practitioner Faculties (2017). Nurse practitioner core competencies content.https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf?fbclid=IwAR1Gast9jCv2DNGPH4DUdkCXnmKa7ioZgPDSQn-xy8PGn51LmfSSklximDA
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Capstone Narrative Analysis
The aim of any nursing course is to equip the student nurse with the necessary knowledge in all three domains of learning. These are the cognitive domain, the affective domain, and the psychomotor domain. Also, for the advanced practice nurse (APN) the course is usually designed so that it can transfer specific competencies to the prospective advanced practice nurse to enable them discharge their clinical responsibilities competently. Examples of these competencies are those advanced by the National Organization of Nurse Practitioner Faculties or NONPF (Nurse Journal, 2022). These particular competencies are nine in total and apply to all advanced practice nurses regardless of their specialty or population focus. The competencies are scientific foundations, leadership, investigative skills, quality care, policy capabilities, technology and information literacy, the healthcare system, ethics, and independent practice. The purpose of this paper is to present a reflective narrative analysis of the course content and how they have enabled me to achieve the core competencies as well as course and professional objectives.
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The MSN Program Outcomes (PO)
The MSN program outcomes for the family nurse practitioner (FNP) program are as follows:
- Provision of high quality, safe, patient, centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care).
- Creation of a caring environment for achieving quality health outcomes (Care-Focused).
- Engaging in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility).
- Integrating professional values through scholarship and service in health care (Professional Identity).
- Advocating for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary Nursing).
The artifacts that I submitted throughout the course and that I have chosen for this narrative analysis fulfil these outcomes in more ways than one.
Value of a Masters Prepared Nurse
The artifact in class 1 on the value of a Master’s-prepared nurse helped me address and meet the MSN program outcome of engaging in lifelong personal and professional growth. It is clear to me that as a master’s-prepared nurse; I am better placed to deliver the best evidence-based care to my population focus as a family nurse practitioner (FNP). This will especially be important for me since I intend to practice in a state with full practice authority or FPA. This means that I will be autonomous without the need for physician oversight and supervision (Harkey et al., 2017). In such a scenario, I need to have knowledge and competence in all the areas of my practice at a higher level. That is what the master’s program brings on board for me.
Incivility and Healthful Environments
Still in class 1, the artifact on incivility and healthful environments was instrumental in assisting me achieve the MSN program outcome of provision of high quality, safe, timely, effective, efficient, patient-centered, and equitable care. It also helped me realise the MSN program outcome of integrating professional values through scholarship and service in health care. Professionalism is a very integral part of an advanced practice nurse’s day to day routine. One must be civil with colleagues and always practice interprofessional collaboration and effective communication during consultations. Incivility will ruin the care atmosphere and the workplace will have no psychological safety at all. This is an environment in which care cannot be offered in a safe and efficient manner and errors are bound to occur.
Concept Analysis and Nursing Theory
In class 2, concept analysis and nursing theory were both instrumental artifacts that addressed the MSN competencies of providing high quality, safe, patient-centered care grounded in holistic health principles. This is because I am aware that quality care that is based on evidence-based practice or EBP is underpinned by strong conceptual frameworks drawn from nursing theories. An example is the theory of Human Caring by Jean Watson that underpins compassionate, selfless, and loving holistic care provided in a caring environment and guided by the carative factors (Pajnkihar et al., 2017). I am now having a better understanding of the role of theoretical frameworks and nursing theories in guiding evidence-based nursing practice thanks to these articular artifacts done and submitted during the course.
Epidemiological Methods
In class 3, the artifact on epidemiological methods helped me address and achieve the MSN outcome of advocating for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice. I have come to appreciate because of this artifact that knowledge of epidemiological patterns of disease is essential for better planning on primary and secondary prevention activities by the advanced nurse in the community. These are usually educational in nature and must be backed by disease statistics and facts that will form the basis for asking the community to change.
Evidence-Based Practice and Quality Improvement (QI)
Lastly but not least, the artifact in class 4 on evidence-based practice (EBP), quality improvement (QI), and clinical inquiry was an eye-opener for me and enabled me achieve the MSN program outcome of advocating for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice. It also helped me achieve the MSN program outcome of providing high quality, safe, patient-centered care grounded in holistic health principles. During the course, I have come to better appreciate the role that EBP plays in the realization of desired patient outcomes. I have also come to be even more competent in clinical inquiry and questioning common practice. Through this, I am now comfortable in managing change at the place where I will go to practice so that care quality can be improved. Indeed, quality improvement (QI) ensures that EB always remains the only choice for administering interventions to patients in order to get the desired outcomes.
The Domains of Learning
There are three domains of learning that are applicable to any pedagogical activity, including learning the art and science of nursing. These three domains are the cognitive domain, the affective domain, and the psychomotor domain (McDonald, 2018; Oermann & Gaberson, 2019). Throughout my baccalaureate degree and now the MSN degree, I have come to appreciate the role that each of these domains of learning plays in making me a knowledgeable and competent family nurse practitioner. In the cognitive domain, I am expected to acquire the most theoretical knowledge that I can and recall facts and figures of disease and treatment.
In the psychomotor domain of learning, I am expected to be good in practical application of concepts. In other words, I am supposed to be good in carrying out procedures that require practical manipulation. Lastly, in the affective domain of learning, the expectation on me as an advanced practice nursing student is that I have to be emotionally appropriate when dealing with patents and clients. The way that I feel about patients and the way that I look at them have a bearing on the speed with which they will get better. In other words, as a nurse I have to love what I do and also show my patients love.
The Artifacts with Regard to Bloom’s Taxonomy
- Cognitive Domain
The cognitive domain of learning is addressed by the artifacts that I presented in all the classes. For instance, in class 4 the artifact was about EBP, clinical inquiry, and quality improvement (QI). What this means is that I acquired theoretical knowledge on what I need to do in order to find out the best intervention that I can use that is backed by scientific, scholarly, peer-reviewed and published literature. Before applying this knowledge practically in the field, the first step is of course to attain the knowledge and this only comes through the cognitive domain of learning as taught in the classroom (real or virtual).
Theory on Technology in Healthcare
In class 7, I also learnt the theory about how technology is incorporated in healthcare. This is a very important aspect as I came to realize because acquiring the practical competence in the use of the innovative healthcare technologies requires that one first grasps the theory behind the technologies and how they are used. This can only be taught in class via the cognitive domain of learning. Testing whether one has understood the concepts will then take the form of formative and summative assessments (McDonald, 2018; Oermann & Gaberson, 2019). In my case, I am proud to state that I have passed with flying colors in all of these formative and summative assessments so far.
Electronic health records or EHRs came into use after the signing of the Health Information and Technology for Economic and Clinical Health (HITECH) Act as well as the American Recovery and Reinvestment Act or ARRA into law (Sweeney, 2017). These two legislative policies came up with the provision known as the Meaningful Use (MU) Program. This program provided incentives to healthcare organizations that implemented EHR technologies in their settings. This was at a time that the adoption of technology into healthcare was just beginning. However, the legislative policies mandated every healthcare setting to have an EHR system to capture, document, store, and retrieve sensitive patient information and data (McGonigle & Mastrian, 2017). In my case and that of all the other MSN nursing students, all this had to be learnt in class through the cognitive domain of learning.
- Affective Domain
As stated earlier, the affective domain of learning is concerned with how as a nurse one feels when handling a patient. It is all about one’s demeanor and the way that they carry themselves in front of the patient. Ideally, training in acquiring the correct attitude and behavior as a nurse in the affective domain of learning emphasizes compassion, empathy, understanding, caring, and selflessness. For me, I already understood much earlier that the patient sees and knows what we feel about them and their condition just by looking at how we behave and how we treat them. Assessment of the affective domain can only be made in a practical setting as a student nurse interacts with a patient. In my case, I am grateful that I really wanted to become a nurse way before I even got a chance to enrol for my basic nursing course. Because of this, I do not struggle to put on a false face so that I can be seen to feel and care for a patient. Mine is natural and spontaneous because I have passion for what I do.
Shadow Health
For me the artifacts that addressed for me the affective domain of learning are those I did in classes 6, 8, and 10. In class 6 the exercise was that of Shadow Health. This involves the evaluation, assessment, investigation, treatment, and follow-up of a hypothetical patient in an interactive manner such that the patient appears to be real. All this is enabled by technology. Here, I had to apply my affective skills as learnt in the affective domain of learning to make the patient feel comfortable and willing to share subjective information. It had to begin by establishing a good rapport and creating a trusting nurse-patient therapeutic relationship.
Psychometric and Nonpsychometric Tests
In class 8, there was an exercise of using psychometric and non-psychometric tests on mental health clients being assessed for treatment. As is known, a family nurse practitioner sees patients across the lifespan and treats all conditions after which they may then decide to refer such as to the psychiatric-mental health nurse practitioner or PMHNP. In administering these mental health tests, the FNP as I realized also has to have the correct observable affect or emotions. I knew that under no circumstance should the patient feel or see that they are bothering us and that we want to quickly finish up with them. This is not the correct outlook taught to MSN students in the affective domain of learning. As such, I discovered that I had to have the right comportment if the tests were to turn out to be valid and reliable. Lastly in class 10, the artifact was a case discussion and this meant that I had to show the correct and appropriate affect with regard to the patient whose case I was discussing.
- Psychomotor Domain
As I have already mentioned above, the psychomotor domain of learning is concerned with what the MSN nurse can do with their hands. It is all about the practical aspects of the advanced practice nurse. As for me and the other colleagues, I found that competency in this was best assessed during my practicum course placement. It is during practicum that one gets the chance to practice what they learnt in class in the cognitive domain of learning. It is also during practicum that the affective domain of learning can be assessed as the student nurse has the opportunity to now interact directly with the patient and show real emotions. I feel that the psychomotor domain of learning was well addressed in my case with the artifacts in classes 6 and 8.
In class 6, the exercise was that of the patient in the Shadow Health module. Even though the patient was not real, the interaction was realistic as facilitated by technology. For this reason, when it came to doing physical examination for instance I had to repeat the very same movements that I would have done with a real physical patient. There is nothing more appropriate for teaching and assessing the psychomotor domain of learning. Personally, I really enjoyed this class as I found that I could practice what I had learnt in the cognitive domain thoroughly without worrying about offending the patient when mistakes occur.
It is in class 8 that we had the performance of the psychometric and non-psychometric tests on patients with mental health conditions. As I have already elaborated, this is a practical thing that the APN has to do repeatedly if they have to develop the experience and competence. In my case, I realized the importance of this early and made sure that I administered the tests appropriately and interpreted the results correctly. Apart from the above, the rest of the psychomotor domain training I completed during my practicum placement. At this time, I had to see a specified number of patients by the end of the practicum placement. This offered me a rare chance to perfect what I had learnt in terms of the psychomotor domain of learning.
The AACN’s (American Association of Colleges of Nursing’s) MSN Essentials for Graduate Education
The AACN MSN Essentials are a set of abilities that every MSN-prepared advanced practice nurse like the FNP must possess in order to perform their APN jobs effectively. As a result, their consequences for practice are enormous. The Essentials and their implications for APNs are as follows (AACN, 2011):
Essential I
This necessitates that the MSN-prepared nurse practitioner have a good grounding in the humanities and sciences in order to practice effectively. In practice, this means that the NP will be able to combine varied information from all of these domains in order to solve clinical issues that will be presented to them. The artifact that I feel helped me meet this AACN MSN practice Essential is that I did in class 2 on concepts and theories. This is because nursing theories (grand theories, middle range theories, and practice-level theories) cut across all humanities and sciences in a bid to cover all human healthcare needs.
Essential II
This second MSN Essential is on the necessity for MSN-prepared nurse practitioners to develop leadership abilities. In terms of practice, this means that excellent organizational leadership, as well as leadership in terms of practice systems, is critical in providing high-quality patient care and treatment. The present compensation approach is to reimburse treatment and services based on their quality. The Patient Protection and Affordable Care Act of 2010 mandates pay-for-performance. The Institute of Medicine (IOM) defines excellent health care as being safe, effective, efficient, timely, patient-centered, and equitable, among other things (AHRQ, 2018). These are the five domains of healthcare quality.
The artifacts that helped me address the leadership abilities that I have include those in classes 1 and 4. The artifact on incivility in class 1 is especially instructive in that I am now aware that transformational leadership is the best style that is recommended for success in healthcare organizations. A transformational leader such as a nurse leader motivates, empowers, communicates, inspires, and facilitates subordinates to achieve organizational objectives beyond expectations (Asiri et al., 2016; Choi et al., 2016). As a matter of fact, they create a welcoming workplace environment that discourages incivility and encourages love and harmony at the workplace. This is what spurs productivity, prevents errors, improves patient safety, and generally changes patient outcomes for the better.
Essential III
This fundamental is all about ensuring patient safety and continuous process improvement. It means that an MSN-prepared nurse practitioner must always strive to offer safe, effective, efficient, timely, patient-centered, and equitable care and interventions. In the same breath, she must be willing to participate in quality improvement initiatives if any of these characteristics are missing. The artifacts that I found to be addressing patient safety and quality improvement are in classes 4 and 7.
In class 4 the artifact was about EBP, clinical inquiry, and QI. These are the tools with which best practice is installed and maintained. Common practice is disregarded in favor of best practice by questioning current practice in the form of clinical inquiry. When the evidence leads to recommendations for change, the translation into practice serves as a quality improvement initiative. In the same way, the artifact in class 7 on technology (EHRs and clinical decision support systems or CDSS) has the singular intention of improving patient safety by reducing human errors in practice. The 1999 report by the Institute of Medicine (IOM) titled To Err Is Human (Palatnik, 2016) revealed that human errors were responsible for up to 98,000 preventable patient deaths annually in hospitals in the United States at that time. The report recommended technology as the best solution to mitigate that problem. At a personal professional level, I have come to be proficient in the use of both the EHRs and CDSS in discharging my clinical duties.
Essential IV
Converting research information into safe and effective practice treatments is the fourth essential. In practice, this means that the MSN-prepared NP should only apply evidence-based interventions that are backed up by scholarly research. In other words, she should always go from common to best practice, led by clinical inquiry. AACN MSN Essential IV is aptly addressed by the artifact in class 4. In this I learnt about clinical inquiry, formation of a PICOT question, search of evidence in research databases, critical appraisal of evidence, and implementation of recommendations for practice (Melnyk & Fineout-Overholt, 2019). This is how the body of EBP is grown and I have become part and parcel of it thanks to my fourth class artifact.
Essential V
The AACN’s essential five for MSN-prepared APRNs is healthcare informatics and technologies. In order to provide effective healthcare services in an increasingly technological world, the MSN prepared NP must be technologically savvy and proficient in the use of healthcare systems. Without doubt, the artifacts that impacted me on the matter of healthcare informatics and technology in healthcare was that in class 7 on EHRs as well as CDSS. In have since come to terms with the fact that technology is a tool for ensuring that patient safety is protected.
Essential VI
This is a discussion on healthcare policy and activism. The MSN-prepared NP is expected to be a strong advocate for patients. The practice implication is that she is expected to be at the frontline of protecting the patient’s rights at all times. She should also be a member of a professional association, since this will put her in an excellent position to influence state and federal healthcare policy choices. I learnt about healthcare policy and advocacy in this program in class 5. I have always known that the nurse is the frontline advocate for the patient and as such must militate against any measure, policy, or recommendation that oppresses and disadvantages the patient. I am now aware that as an APN, I also have tremendous influence in shaping healthcare policy, including that which affects fellow nurses such as the practice environment.
Essential VII
The MSN-prepared NP is expected to work as part of a team in the clinical setting. The practical implication is that if she is to provide high-quality care and treatment, she must embrace interdisciplinary teamwork. This is due to the fact that a patient’s needs are varied, demanding tight collaboration within professions to address them all. In class 1, the artifacts on higher education and incivility helped me in appreciating teamwork and interprofessional collaboration. I have now known that no single person can satisfy the needs of a single patient. Rather, an interdisciplinary team has to work collaboratively to achieve this goal.
Essential VIII
The eighth AACN essential is all about employing culturally sensitive measures to help establish a disease-prevention environment in the community. The implication for practice is that the NP is first and foremost a primary health care provider who must place a greater emphasis on illness prevention at both the primary and secondary levels. The NP’s strategies, on the other hand, must be culturally suitable and diversity-friendly. I feel that cultural sensitivity for me was addressed in classes 5 and 6. The artifact in class 5 on ethical and legal implications of practice, barriers to practice, and policy considerations prepared me to be culturally sensitive and competent. Then the Shadow Health artifact reinforced this when I practically applied multiculturalism in handling the case.
Essential IX
The ninth fundamental Essential encapsulates the other eight essentials in that it expects MSN-prepared APRNs to be highly educated and trained, making them immediately distinct from other nurses who lack MSN training and education. The clinical effect is that, because SN prepared NPs are authorized to operate independently in many states, they must be highly talented, highly educated, and extremely capable in assessing, diagnosing, treating, and evaluating patients with a wide range of health problems throughout their lives. Pursuing higher education (postgraduate in my case) was aptly and abundantly tackled in the artifact in class 1. Individually, I am on course to achieving this because after this MSN I intend to enrol for my doctorate degree.
The National Organization of Nurse Practitioner Faculties (NONPF) Competencies
The NONPF competencies are expected to be possessed by all nurses in healthcare and they are nine in total. The first one is competency in scientific foundations that I feel I achieved and is now competent in. Class 7 artifact on technology addressed for me this competency adequately. This is because it gave me the opportunity to learn and apply knowledge of EHRs and CDSSs. The second NONPF competency to be addressed is leadership ability. In class 1, the artifact on incivility played this role and helped me perfect my skills on transformational leadership in practice.
Competency in matters quality and quality improvement is the other NONPF competency nurses are expected to acquire. I achieved this in this program through the artifact in class 4 on EBP, QI, and clinical inquiry. Competence in investigative skills is a NONPF competency that was also addressed in my case by the same class 4. This is because clinical inquiry is basically detective work channelled to finding the most appropriate intervention that is backed by evidence for specific patient problems.
Competency in technology and information literacy for me was addressed in class 7 when I did and submitted artifacts on EHRS and CDSSs. Competence in policy was addressed for me in class 5 in the artifact on policy together with ethics, legal implications, and barriers to practice. I feel extremely professionally competent at this juncture as I have now mastered these competencies very well. The remaining NNPF competencies in healthcare delivery systems, ethical behavior, and independent practice for me were addressed in the artifacts in classes 7, 5, and 6 respectively. In all, I feel well-rounded now on matters NONPF competencies and I feel more than ready to practice autonomously in a free practice authority state.
A Reflection on the Transformation of My Own Cultural Competence
Looking back on my MSN program and the way I was coming from the baccalaureate degree position, I am happy that I feel I am more culturally competent now than ever before. It is now clear to me that my understanding of cultural competence had been narrow previously until I enrolled for the MSN course. I have now come to know and appreciate that cultural competence is not only about respecting the ethnicity or race of someone. The concept goes much deeper and further. It is also about inclusion and respect for ideas and beliefs. As an advanced practice nurse, I feel I am now better able to discharge my duties after this improvement in my understanding of multiculturalism. Professionally, I feel that I am now more tolerant, more understanding, and more empathetic just because my cultural competence has changed for the better.
Conclusion
This has been an honest assessment and reflection of my MSN program and the way I think that I have achieved program objectives or outcomes, AACN MCN Essentials, NONF competencies, and success in the three domains of learning. My honest opinion is that I have excelled and matured professionally including that I have now become even more competent on matters multiculturalism. In all, this is an honest treatise on what I have achieved and what I will hopefully continue to achieve as an advanced practice nurse with a family nurse practitioner specialty.
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