EVIDENCE-BASED PRACTICE
Step 5: Evaluate the Practice Change
6.1 CUSN DNP Competencies for Direct Patient Care Residency Case Narrative Log (Continued)
Evaluate and direct care during hospitalization, and design a comprehensive discharge plan for patients from an acute care setting.
A.
A. Assess the acuity of patient’s condition and determine the most appropriate inpatient treatment setting based on level of acuity.
B.
B. Actively participate in the admission process to the appropriate inpatient treatment setting.
C.
C. Actively co-manage patient care during hospitalization.
D.
D. Formulate plan for ongoing care to be provided in a subacute setting, such as a long-term care facility, rehabilitation facility, or home or community setting.
E.
E. Coordinate ongoing comprehensive care to be provided in a subacute setting, such as a long-term care facility, rehabilitation facility, or home or community setting.
Competency (C) 6
Direct
comprehensive care for patient in a subacute setting to maximize quality of life and functional status.
Performance Objective (PO)
A.
A. Assess the acuity of the patient’s condition to determine the need for sub- acute, long-term care.
B.
B. Determine the most appropriate subacute or chronic care treatment setting based on level of acuity, functional status, and availability of formal and informal caregiver resources.
Domain (D) 1. Comprehensive Clinical Care
Competency Competency
Demonstrated Performance Objectives
(PO) PO
Demonstrated Competency
(C) 5 Performance Objective
(PO)
6.1 (Continued)
(continued)
Chapter 6 Evaluating DNP Clinical Case Narratives
65
(continued)
C.
C. Coordinate ongoing
comprehensive care provided in a subacute setting.
D.
D. Initiate referral to other health care professionals while maintaining primary responsibility for patient care in a subacute setting.
E.
E. Utilize consultant recommendations for decision-making while maintaining primary responsibility for care in a subacute setting.
Competency (C) 7
Facilitate and guide the process of palliative care and/or planning end-of-life care by discussing diagnoses and prognosis, clarifying and validating patient desires and priorities, and promoting informed choices and shared decision-making by patient, family, and members of the health care team.
Performance Objective (PO)
A.
A. Facilitate and guide the palliative care process by discussing diagnoses and prognosis, clarifying and validating patient desires and priorities, and promoting informed choices and shared decision-making by the patient, family, and members of the health care team.
B.
B. Facilitate and guide planning of end-of-life care by discussing diagnoses and prognosis, clarifying and validating patient desires and priorities, and promoting informed choices and shared decision- making by the patient, family, and members of the health care team.
Domain (D) 1. Comprehensive Clinical Care
Competency Competency
Demonstrated Performance Objectives
(PO) PO
Demonstrated Competency
(C) 6 Performance Objective
(PO)
6.1 CUSN DNP Competencies for Direct Patient Care
Residency Case Narrative Log (Continued)
Assemble a collaborative interdisciplinary network, refer and consult appropriately while maintaining primary
responsibility for comprehensive patient care.
A.
A. Initiate referral to other health care professionals while maintaining primary responsibility for patient care.
B.
B. Accept referrals from other health care professionals and communicate consultation fi ndings and recommendations to the referring provider and collaborative network.
C.
C. Utilize consultation recommendations for decision-making while maintaining primary responsibility for care.
D.
D. Evaluate outcomes of interventions.
E.
E. Provide ongoing patient follow-up and monitor outcomes of collaborative network interventions.
Competency
(C) 2 Performance Objective
(PO)
Coordinate and manage the care of patients with chronic illness utilizing specialists, other disciplines, community resources, and family, while maintaining
A.
A. Coordinate care for a patient with chronic illness as the focus of care transitions across ambulatory, acute, subacute, and/or community settings.
B.
B. Co-manage care for a patient with chronic illness as the focus of care transitions across ambulatory, acute, sub- acute, and/or community settings.
Domain (D) 2. Interdisciplinary and Patient-Centered Communication
Competency Competency
Demonstrated Performance Objectives
(PO) PO
Demonstrated Competency
(C) 1 Performance Objective
(PO)
6.1 (Continued)
(continued)
Chapter 6 Evaluating DNP Clinical Case Narratives
67
(continued)
primary responsibility for direction of patient care and ensuring the seamless fl ow of information among providers as the focus of care transitions across ambulatory to acute, sub- acute settings, and community settings.
C.
C. Coordinate care for a patient with chronic illness utilizing specialists, other disciplines, community resources, and family.
D.
D. Direct care for patient with chronic illness and ensure the seamless fl ow of information among providers as the focus of care transitions across settings.
E.
E. Co-manage care for a patient with chronic illness utilizing shared decision- making and teaching.
F.
F. Co-manage care for a patient with chronic pain as the focus of care transitions across ambulatory, acute, subacute, and/or community settings.
Domain (D) 3. Systems and Context of Care Competency
(C) 1
Construct and evaluate outcomes of a culturally sensitive, individualized intervention that incorporates shared decision- making and addresses the specifi c needs of a patient in context of family and community.
Performance Objective (PO)
A.
A. Assess culturally specifi c needs of patient in the context of family and community.
B.
B. Construct a culturally sensitive intervention to address the needs of the patient in the context of family and community.
C.
C. Evaluate outcomes of the intervention.
Domain (D) 2. Interdisciplinary and Patient-Centered Communication
Competency Competency
Demonstrated Performance Objectives
(PO) PO
Demonstrated Competency
(C) 2 Performance Objective
(PO)
6.1 CUSN DNP Competencies for Direct Patient Care
Residency Case Narrative Log (Continued)
Evaluate gaps in health care access that compromise optimal patient outcomes, and apply current knowledge of the organization and fi nancing of health care systems to advocate for the patient and to ameliorate negative impact.
A.
A. Identify gaps in access that compromise patient’s optimum care.
B.
B. Identify gaps in reimbursement that compromise patient’s optimum care.
C.
C. Demonstrate patient advocacy in the provision of continuous and comprehensive care.
D.
D. Apply current knowledge of the organization to ameliorate negative impact.
E.
E. Apply current knowledge of health care systems to ameliorate negative impact.
Competency (C) 3
Synthesize the principles of legal and ethical decision-making and analyze dilemmas that arise in patient care, interprofessional relationships, research, or practice management to improve outcomes.
Performance Objective (PO)
A.
A. Synthesize ethical principles to address a complex practice dilemma.
B.
B. Apply ethical principles to resolve the dilemma.
C.
C. Synthesize legal principles to address a complex practice dilemma.
D.
D. Apply legal principles to resolve the dilemma.
Domain (D) 3. Systems and Context of Care
Competency Competency
Demonstrated Performance Objectives
(PO) PO
Demonstrated Competency
(C) 2 Performance Objective
(PO)
6.1 (Continued)
Chapter 6 Evaluating DNP Clinical Case Narratives
69
References
American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved August 31, 2009, from http://www/aacn.nche.edu/DNP/pdf/
Essentials.pdf
Carraccio, C., Wolfsthal, S.D., Englander, R., Ferentz, K., & Martin, C. (2002). Shifting paradigms: From Flex- ner to competencies. Academic Medicine, 77(5), 361–367.
Cook, S.S., Kase, R., Middelton, L., & Monsen, R.B. (2003). Portfolio evaluation for professional competence:
Credentialing in genetics for nurses. Journal of Professional Nursing, 19(2), 85–90.
Council for the Advancement of Comprehensive Care (CACC). (2003). Competencies of a clinical nursing doctorate. New York: Columbia University School of Nursing.
Dannefer, E.F., & Henson, L.C. (2007). The portfolio approach to competency-based assessment at the Cleveland Clinic Lerner College of Medicine. Academic Medicine, 82(5), 493–502.
Fabrizio, S. (2003). Machine learning in automated text categorization: Advancements in information retrieval.
Paper presented at the 25th European Conference, Pisa, Italy.
Hanson, C.W., & Marshall, B.E. (2001). Artifi cial intelligence applications in the intensive care unit. Critical Care Medicine, 29(2), 427–435.
Holmes, D., McAlpine, R., & Russell, J. (2005). Use of neural net technology to quantify portfolio evaluations.
InGenetics nursing portfolios: A new model for the profession (pp. 79–90). Washington, DC: American Nurses Association.
National Organization of Nurse Practitioner Faculties (NONPF) National Panel for NP Practice Doctorate Competencies. (2006). Practice doctoral nurse practitioner entry-level competencies. Retrieved August 31, 2009, from http://www.nonpf.com/NONPF2005/PracticeDoctorateResourceCenter/Competency- DraftFinalApril2006.pdf
II
DNP Approach and Clinical Case Narratives in the
Pediatric and
Adolescent
Population
73
DNP Approach to Providing Pediatric and Adolescent Care
The DNP who cares for a pediatric patient (DNP/PNP) assumes responsibility for the child’s comprehensive care across settings and over time. As the complexity and chronicity of pediatric care issues increase and the settings in which care is delivered become more diverse, there is an acute need to provide families with coordinated, comprehensive, evidence-based, expert care. The DNP/PNP is educated to provide comprehensive family-centered evidence-based care to the pediatric patient. Building on the foundation of ambulatory pediatric primary care, the DNP in pediatrics expands the contextual boundaries and is accountable for the child’s care in all set- tings, including the home, offi ce, acute, and subacute settings. The DNP/PNP appraises the acuity of the patient’s conditions and determines the setting that best optimizes the care.
The expanded DNP accountability is fostered during the DNP residency and is refl ected in the case narratives. DNP/PNP clinical decision-making is refl ective and deliberative. Clinical skills are enhanced by the broad under- pinning of doctoral education. The support coursework includes ethical decision-making, epidemiology and environmental health, advances in clinical science, critical appraisal and application of research to practice, information
7
Rita Marie John Judy Honigtechnology for data retrieval, and decision support. The case narratives are the DNP’s demonstration of this multifaceted, cognitive process.
This chapter focuses on the components of the comprehensive and interval history and complete physical examination needed to develop a differential diagnosis, assessment, and plan of care for pediatric patients. Comprehensive, family-centered, continuous care of pediatric patients is challenging and utilizes multiple skill sets. Pediatric patients are evaluated in the context of the family. The age and developmental status of the child, family history, and individual risks based on genetic profi le are important components that need to be considered when providing care to children. The DNP/PNP formulates differential diagnoses and develops diagnostic strategies using evidence-based guidelines. The DNP/PNP communicates with the family in an open forum using shared decision-making.