In this assignment you will review a case that deals with a client who has GERD.

Clinical Case:

Mrs. G. is a 45-year-old female arrives at the emergency department where you are working with complaints of burning pain in her chest and throat and a sour taste in her mouth. She states this pain has been going on for years after she eats certain foods. She has a large, extended family and does all of the cooking. She is Hispanic and likes to cook her special recipes because she believes that “these foods are good for herself and her family.” She is very proud of her cooking and believes that is one of her main contributions to her family. She has never been sick and does not like to take pills.

She is examined by the emergency room doctor and diagnosed with Gastroesophageal Reflux Disease (GERD). The doctor has ordered medication for you to administer. These medications include a proton pump inhibitor (Prilosec), and a Histamine 2 blocker (Pepcid). He also prescribes the proton pump inhibitor to be taken at home for the next two weeks. Mrs. G. starts to feel better and is ready for discharge. You will be providing the client teaching and discharge instructions about GERD.

In your discussion include:

• Dietary suggestions you would make
• What foods and liquids she should avoid
• What changes she should make
• Barriers she will face in making these changes and how they can be overcome

Include APA formatted references if used.

Topic 1 DQ 1

“Variant characteristics of culture” include nationality, race, age, color, religious affiliation, educational status, socioeconomic status, occupation, military experience, political beliefs, urban versus rural residence, enclave identity, marital status, parental status, sexual orientation, gender issues, physical characteristics, immigration status, and length of time away from the country of origin.

Which characteristics can change, and which cannot? Discuss how these, whether changing or stable, can influence one’s worldview.

Topic 1 DQ 2

How does cultural competency occur? What can one do to become culturally aware? Describe an effective approach to using The Purnell Model when working with subcultures (immigration status, gender, political beliefs, socioeconomic status, sexual orientation, educational status, etc.).

Topic 2 DQ 1

From your readings, which cultural difference would be most challenging for you to understand? Why? How would you prepare to work with individuals from this culture in order to respect their culture?

Topic 2 DQ 2

If health care practitioners cannot communicate to the patients in their language, how important is it to find a translator? Whose problem is it, the health care provider’s or the patient’s? Why?

Case

Sometimes It Works, Sometimes It Doesn’t

Jim Beaufort was appointed as the administrator of Marshall Nursing Center, a 230-bed skilled nursing facility located in a large metropolitan area. The facility’s occupancy rate had gradually declined from 82% (188 residents) a year ago to 74% (170 residents). Three months ago when Jim was hired for the job, the company’s vice president of operations, Ronald Ortner, was upfront about the declining census. Ortner was particularly impressed with Jim’s business degree in marketing, and how Jim had enthusiastically talked about using a “mystery shopper”* to get information on the competitors of a nursing home he had previously managed. Jim knew that his work was cut out for him. When offering the job, Ortner had said, “I am giving you a 20% raise over what you were making at your old job; I want this facility turned around in a year’s time.” To that Jim had confidently responded, “Oh, you will see a trend change much before that.”

Jim spent the first 3 months on the job getting to know the staff, residents, and some of the family members. He made written notes on some of his observations:

• The certification survey 6 months ago was satisfactory. There were no serious deficiencies.
• Some issues with building cleanliness have been addressed with the housekeeping supervisor.
• Department head meetings had been sparse and irregular.
• Food was the most common complaint from residents and family members, but so it is at every other facility.
• The licensed nursing staff is stable, but high turnover of certified nursing assistants creates some staffing shortages. Overtime is high, and the director of nursing says that there is some burnout among both nurses and CNAs.
• The facility’s expenses are below budget; the previous administrator must have been a “penny pincher.”
• Patients are scattered throughout the building. Many of them are occupying private rooms, whereas Medicaid pays only for semiprivate accommodations.

Jim thinks that he has just 9 months left to increase the census and keep his job. So, he embarks on formulating a marketing plan:

• Free up as many patient rooms as possible in one section of the building by moving patients to other occupied parts of the facility. Start an adult day care center by using some of the empty rooms.
• Hire one additional RN and one LPN to alleviate the feelings of burnout among the staff. Start a CNA training program at the facility.
• Send a mystery shopper to the three main competitors to evaluate how they handle the inquiry process. Have the mystery shopper evaluate Marshall’s inquiry process as well. Improve the admission coordinator’s personal selling skills.
• Purchase advertising at the local newspaper, radio station, and TV station that would say:

Marshall Nursing Center has excelled in providing high-quality nursing and rehabilitation care in this community for more than 20 years. Our staff’s caring is like a healing touch. We are accepting new patients. Bring your loved one here and see the results for yourself.

“That will get people’s attention,” Jim thought to himself.

• Discard the black and white brochures and replace them with a four-color brochure with some pictures and the same message used in advertising. Place these brochures in hospital waiting rooms and doctors’ clinics.
• Invite the hospital’s discharge planners to dinner at a fine restaurant. Explain to them the facility’s new marketing plan and ask for their help in referring patients.
• While the marketing plan is being implemented, Jim will personally handle all preadmission inquiries, using the admission’s coordinator for backup.

Jim was confident that in another 6 months the facility’s census would start turning around, but it only deteriorated further. Frustrated, he starts looking for another job. Sitting in his office, he moans, “Marketing is just a theory: sometimes it works, sometimes it doesn’t.”

* A mystery shopper, also referred to as a “secret shopper,” is a marketing professional who specializes in visiting and evaluating business practices, posing as a potential client.

Questions

1.  How should Jim have handled his job interview with regard to the declining census?

2.  Do you agree with Jim’s statement: Marketing is just a theory: sometimes it works, sometimes it doesn’t? Explain why marketing may not work.

3.  Evaluate Jim’s marketing plan. What main improvements would you make?

4.  Critically evaluate the promotional message.

Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

ASSIGNMENT:

The scenario for this week’s assignment is below:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Write a 2- to 3-page paper that addresses the following:

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.

Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.

Explain the process of writing prescriptions, including strategies to minimize medication errors

REQUIRED READINGS;

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Chapter 1, “Prescriptive Authority” (pp. 1–3)

Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 5–9)

Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 11–16)

Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)

Chapter 5, “Adverse Drug Reactions and Medical Errors” (pp. 41–49)

Chapter 6, “Individual Variation in Drug Response” (pp. 51–56)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

his article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html

This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. Silver Spring, Maryland: American Nurses Association, 2015.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.