Evidence Based Practice in Nursing

Answer

The NONPF Core Competencies

The criteria for nurse practitioner programs evaluation provides a significant resource for persons taking part in educational preparations, credentialing, and licensing for nurse practitioners. In combination with the accreditation standards for programs at graduate level in advanced practice nursing, an evaluation basis for all NP programs is realized. The main identified core competencies for NONPF include independent practice, scientific foundations, technology and information literacy, quality, ethics, health delivery system, policy, leadership and practice inquiry.

The Consensus Model Evidence Based Practice

The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education (APRN Consensus Model) refers to an even regulation model for the future of advanced practice nursing. It is planned to support and align the existing interrelationships between certification, licensure, accreditation and education (Bacon et al., 2018). According to the American Nurses Credentialing Center (ANCC), it is anticipated that such clarity and consistency resulting from the execution of the new regulatory model is purposed to benefit all round nurses and facilitate patient care. 

Role of the NP in Providing Transitional Care

Transitional care refers to the delivery of healthcare services purposely to enhance healthcare continuity, limit the possibility of poor patient outcomes, and facilitate safe and timely transfer of patients from a healthcare setting to community following the escalating pressure from payers for hospitals to reduce the length of hospital stays. As highly educated and experienced providers, nurse practitioners assess, analyze, diagnose and prescribe (Barnes, 2015). As esteemed clinical leaders, NPs contain the freedom to work and accept responsibility as well as accountability for all actions. Therefore, they must exercise a unique level of autonomous decision making, for care services to patients having complex multi-dimensional problems.

A Brief Review of Literature on NP Providing Quality, Safe, Cost Effective Care

Evidence regarding the effect of NPs on healthcare safety, quality and cost effectiveness was carefully reviewed. Information from 37 of 27,993 articles in book dating from 1990 till 2009 was systematically analyzed and documented into eleven different aggregate outcomes. The reviews regarding the relevance of NPs was comparable and good for all the 11 outcomes under review (Stanik et al., 2013). A high evidence level indicated that patient satisfaction was heavily dependent on quality of care, status of health, functional status, and the frequency of emergency department visits. If NPs take care provision seriously, then quality of patient outcomes can never be compromised.

Role of the NP Related to use of EBP Guidelines

Nurse practitioners must appreciate the importance of EBP to their clinical practice. NP should incorporate evidence-based interventions learnt to enhance desirable patient outcomes, facilitate the provision of high quality care, cut down on costs and completely eliminate ineffective or obsolete practices (Marshall, 2016). A vital factor during the delivery of high-quality patient care depends on the flexibility of an NP to implement evidence based practice procedures. It is in the position of NPs to use evidence based guidelines and policies to inform practice, and make sound heath care decisions based on findings from rigorous and high-quality research reports, patient perspectives and clinical expertise due to their dynamic roles.

Examples of EBP Guidelines used to Guide Care of Patients

With regards to EBP guidelines in patient care, a practitioner must convert the relevance of the information (regarding prevention, disease diagnosis, causation, therapy or prognosis etc.) into a question that can be comprehensively answered. One must therefore allocate information or practical evidence to answer the stated medical enquiry by tracking down any relevant evidence with which to approach the question. Therefore, critically appraise the found information or evidence for its validity, truth and applicability to the clinical practice. A nurse practitioner can thereafter integrate the appraised critical evidence with clinical expertise as well as a patient’s preferences, unique values, biology and underlying conditions (Dang & Dearholt, 2017). Lastly, the effectiveness and efficiency must be evaluated for all the afore-mentioned steps to find strategies for improvement.

Impact of the IOM Report on Future Practice/Role of the NP

The IOM Report impacts on future practice/role of the NP by largely transforming practice. Nurses are required to practice to their maximum extent of their education and training. By giving in to the recommendations, NP will attain a fundamental rethinking of their roles as healthcare professionals that will establish a firm foundation for their future practices (Clayton, 2015). They will be in a position to create broader healthcare opportunities for both patients and their families due to the exposure to a wider base of knowledge, to create a more accessible, sustainable, and value-driven and high-quality environment for patients. Moreover, such advancements will come with better opportunities for new roles.

Role of the NP in Clinical Resource Management and Reimbursement

NPs may be assigned to bill Medicare using the physician payment system on condition that the professional holds a legal authority under the state law to facilitate healthcare service billing. Basing on the complexity of the regulatory environment, the NPs are required to understand the underlying regulations and maximize on healthcare reimbursement opportunities and make investigations on billing opportunities available. Of significance to note, in addition to the guidelines for federal billing, every state contains a licensing authority for NPs, which might vary depending on the state of practice. Therefore, practitioners have a role to review the state based licensing regulations, and confer the billing experts upon the interpretation of billing regulations. NPs can bill time spent attending to patients, preventive medicine, level and quality of care, diagnosis, and patient counselling (Maier, Aiken, & Busse, 2017).

Common Issues Related to Billing for Nurse Practitioner Services

Some common issues related to billing for nurse practitioner services include billing complications which necessitates resource input and education in order to maximize reimbursement and limit inefficient billing practices. Therefore, it is an expensive process that requires training, failure which may create discrepancies. Moreover, there are wide variances in state laws and significant differences in the third-party payer’s policies on reimbursement which may bring inequalities in the quest for payments.

Legal Requirements of the NP Related to Billing and Fraud Prevention

There are various legal requirements of the NP related to billing and fraud Prevention. The nurse practitioners have a legal responsibility to billing and fraud prevention, and must be accountable for any misappropriations caused. Nurse practitioners are required to provide patients with appropriate care. Healthcare related fraud is a critical issue within the healthcare department that negatively affects clients. It involves filing claims for unnecessary procedures and fraudulent with a desire to make illegal money.

Role of the NP using HIT and protecting PHI

NPs should use patient health information exclusively for procedures pertaining care delivery. The information can be used to establish a diagnosis, treatment option or healthcare counselling and recommendations upon hospital assessment. Health information must only be accessed when need be, and not out of any undesirable motives that might impact on the patient’s safety, privacy, health care outcome and general wellbeing. With regards to protecting PHI, nurse practitioners are required to implement safety measures, procedures and guiding policies to guard access to electronic information systems with patient information by unauthorized intrusion (Maier, Aiken, & Busse, 2017). They can as well validate an individual’s need to access given information, or introduce privacy filters to protect sensitive patient data from side-angle views.

Role/Responsibility of the NP in Caring for Vulnerable Populations

The vulnerable populations, including the immigrants, uninsured and underinsured, and the working poor, are exposed to higher risks of developing health issues. Over time, the nurse practitioners have taken care of this growing population. Taking care of such vulnerable patients need a unique set of skills to achieve optimum effectiveness. NPs hold a vital role in the delivery of primary healthcare to the vulnerable group (Maier, Aiken, & Busse, 2017). NPs reach out to such marginalized group to undertake screening programs, advice on lifestyle choices, enrollment into Medicare and Medicaid programs, facilitate supply of healthcare resources to the marginalized regions, and engage in service practices that improve the quality of care for the group. They act as key providers in safety-net primary care settings which operate as the main source of primary care and interventions for close to 23 million minority and low-income patients.

Role/Responsibility of the NP in Addressing Health Disparities

The NPs hold a vital role in addressing health disparities. Normally, health-related disparities are as a result of lack of societal care. Central to nursing, care provision makes the entire profession suited for leadership towards elimination of the health disparities (Alicea, Pose & Smith, 2016). Nurse practitioners are required to rebuild a greater capacity for social care while enhancing a relational practice. Practitioners are required to promote nurse-oriented primary care and emphasize on changing local, state and national policy programs to enhance access, equity as well as health protection (Alicea, Pose, & Smith, 2016).

Rural Healthcare Issues and Challenges

Mostly, underserved communities suffer a lower socioeconomic status that is associated with lower education levels and inadequate understanding of disease processes. Some beliefs and societal values do not permit some medical procedures like vaccination which limit nurse providers from fully providing medical services as required of them. Poverty is another challenge which makes it almost impossible to take good care of the chronically ill patients with cancer or diabetes, or management of mental illness. Moreover, issues of language barriers and communication patterns may possibly limit a provider from understanding what a patient is actually suffering. When this happens, providers may treat a condition they know nothing about, or it becomes hard to explain a prescription to the patient. Sometimes it is hard to keep up with medical technology due to poor internet connectivity hence, rendering it hard for a provider to use technology to engage patients. Among the main care issues in a rural health include workforce shortage issues, economic issues, cultural and social differences, education-based challenges, limited legislator recognition as well as isolation of staying in marginalized areas, which create health care disparities.

Summary

Nursing is a dynamic profession that suffers from different challenges that if not properly monitored can compromise the quality of care provided. Policy programs should be executed to increase efficiency in operation and ensure patient safety and care quality is not compromised at any given point.

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