Advanced Practice Registered Nurses (APRN) perform numerous roles in clinical settings, including conducting physical examinations, diagnosing patients, ordering lab tests, inferring results, and assessing the progress of patients and their response to treatment. APRN also interact with the public, frequently acting as link between a physician and the patient’s families. The advanced training implies that APRNs have increased levels of knowledge, and therefore, demonstrate expertise in areas such as assessment and diagnosis, planning, enactment, and evaluation of healthcare plans.

My philosophy of advanced practice nurse is an extension of Florence Nightingale’s pioneering efforts of turning nursing into a profession that incorporates education and responsibilities into the job. Though the practice is guided by empirical evidence and scientific theory, it also derives numerous concepts from abstract knowledge such as models and theories of caring and empathy. In effect, I don’t perceive patients a physical illness, but in the context of a whole person, i.e., body, mind, and spirit. I understand that caring for patients implies acknowledging the individuality of each person while delivering compassionate care, educating patients and their families, and striving to create a healthcare setting that is therapeutic and accords respect to all human beings. This philosophy coincides with the Code of Ethics as prescribed by the American Nurses Association, wherein patients should be treated as individuals. I believe that patients should be partners in their care plan, and therefore, any wishes must be respected. As a subscriber of the cognitive model of learning, I believe that active learning occurs when knowledge is shared or presented to patients in a way that they can easily apply it.

As an APRN guided by a holistic approach in nursing, I focus on delivering care that meets the needs of a patient as a whole. This approach of wholeness, peace, and healing by values the mental, physical, and emotional needs of a patient. The philosophy is also guided by the metaphysical underpinning of comfort in care. Influenced by Katherine Kolcaba’s theory of comfort, I assess the comfort needs of a patient, develop and implement appropriate nursing care plans that empower patients to transition seamlessly from admission to discharge. The philosophical footings also enable me to advance opportunities and services that meet health needs through the concepts of nursing metaparadigm: person, environment, health, and nursing. I consider a patient as an individual, family, or community that needs primary, tertiary, and preventing care. I regard health as the optimal functioning of people and communities as facilitated by the provision of comfort needs. Lastly, the environment is any variable in a healthcare setting or of a patient that I can manipulate to improve the comfort needs of a patient.

The philosophical concepts of the theory allow me to identify the needs of patients and families that have been met and modify intervening variables (factors that I cannot change, such as diagnosis and poverty). Using these concepts, I develop a comfort care plan to enhance comfort over an assessment of baseline comfort. After improving the comfort needs of patients or their families, I engage them consciously to develop health-seeking behaviors that are agreed upon treatment goals. When patients and their families do better, institutional integrity increases, and this can be considered as a measure of patient satisfaction (Ferrandiz & Martín-Baena, 2015).

In conclusion, my philosophy of nursing is to offer care in a setting that promotes respect, compassion, and integrity. In the future, I look forward to more responsibilities that will afford me a more significant role in the improvement of skills. This role will allow educating patients and the community on measures to improve health and prevent transmission. I seek to embrace this challenge and commit to keep the community free of illness.

In the United States, NPs are the primary group of advanced-practice nurses that deliver primary care, placed at the first point of patient contact in numerous healthcare setups. They work in both collaborative and independent practices organizations, leading in roles such as management and medical in primary care system. The contemporary American healthcare system is afflicted by a convergence of issues that affect the primary care model. The increase in elderly and chronically ill populations has compounded concerns about the workforce's adequacy in meeting quality. Gaps in quality, complemented by the shortage of nurses, have threatened the delivery of services. Nonetheless, America is benefitting from the increase in the number of nurse practitioners since the per capita supply is estimated to increase yearly by an average of 9% (Naylor & Kurtzman, 2010).

As an NP with a Bachelor of Science in Nursing, my role includes disease diagnosis, treating conditions, and delivering evidence-based education to patients. I assess patients by examining medical history, conducting physical examinations, maintain detailed records, and developing individualized care plans. I also collaborate with other healthcare practitioners to ensure the continuation of education and keep updated on the methodological and technological developments in the healthcare field. Despite making essential contributions to the valued primary care, significant obstacles prevent me from practicing to my full abilities. Various state laws are significant barriers that limit the NP scope practice since some laws restrict us from delivering comprehensive primary care services as regulated by licensure and educational preparation. The state to state disparities in practice scope has resulted in NPs migrating from highly limiting to lesser restrictive states (Naylor & Kurtzman, 2010).

Another barrier is professional tension. The healthcare system has resisted the expansion of the NP's practice of scope, and as a result, NPs lack the independence to operate autonomously. Some states require NPs to practice alongside physicians, instead of collaborating as members of the healthcare team. Besides the extensive medical expertise, NPs have a unique scope of practice, holistic patient advocacy focus, and expertise in areas such as pain management and patient education. Additionally, nursing is a distinct scientific field where nursing scholars train nurses in degree programs that last 2-4 years in colleges and universities.

Despite these obstacles, the unique scope of nursing ha began gaining recognition from various state agencies. Numerous state nurse practice acts define the practice in broad and independent terms that do not rely on doctors and other practitioners. For instance, the Massachusetts law describes nursing as a service to help people and groups attain optimal health (Naylor & Kurtzman, 2010). NPs in the state can administer procedures, make clinical decisions based on theories, enact care strategies, evaluate responses to care and management, coordinate care deliveries, and collaborate with members of the healthcare team. As the Institute of Medicine suggests, fostering teamwork eliminates tension and creates effective interdisciplinary care team models.

John Doe

3300 W Camelback d Phoenix, AZ 85017

818-330-6310

[email protected]

Professional Statement

Dedicated RN with more than 15 years of experience providing care to broad variety of patient populations, assessing patient health conditions, implementing nursing care plans, and maintaining medical records. As I advance my career, I seek to leverage established nursing skills in your organization. Licensed to practice in Maryland and Florida.

Core Qualifications

Highly experienced nursing professional with more than 10 years’ experience in the ward.

Outstanding computer skills.

Proficient in using modern technology to deliver care.

Skilled in creating and implementing care plans.

Knowledge of primary functions in healthcare settings such as infection control, administration of medications, and care plans.

Experience

Holy Cross Hospital, Silver Spring, Maryland 2003-2009

Provided critical care to diverse patient populations

Maintained a hygienic, sterile, and safe environment.

Managed patients’ medical records and evaluated their progress.

Regularly interacted with the patients and their families to meet their mental, social and physical needs.

Supervised licensed NPs.

Attended educational workshops, thus increasing practical and professional knowledge.

Interacted and coordinated with the interdisciplinary teams, thereby upholding pleasant relationships.

Howard University Hospital 2009-2011

Collaborated with members of the interdisciplinary team to formulate treatment plans for chronic illnesses such as cancer, diabetes mellitus, and stroke.

Offered patient education on lifestyle changes and management of chronic conditions.

Organized monthly patient education events in the community for various health conditions such as diabetes, sexually transmitted diseases, and nutrition.

Reviewed patient chart to gain a comprehension of treatment protocols and health history.

Supervised a group nursing interns and volunteers by helping them create schedules.

Handled patent cases to guarantee a continuum of care between members of the interdisciplinary team.

Florida Hospital East, Orlando, Florida 2015-present

Meaningfully enhanced the facility’s public image by guaranteeing outstanding patient satisfaction.

Involved in performance improvement activities in core measures and enhancing clinical outcome in nurse-sensitive indicators

Performed clinical assessments, screening evaluations, vital signs, ECGs, blood sampling as scheduled & per protocol.

Reviewed patient's medical history, health status, and medications.

Mentored nursing interns by offering support, leadership, and assistance as required

Periodically performed the role of Charge Nurse where I delegated duties, allocated nurses, and ensured compliance with rules, procedures, and regulations.

Professional Goals

Achieve core features that define an experienced and successful nurse.

Dedicate myself to all-time learning.

A nurse educator to impart knowledge and skills to nursing students.

Deliver ongoing community services to patients and communities in need of healthcare services.

Skills

Capability maintain calmness during emergency situations.

Flexible to the ever-changing environment of the healthcare sector.

Crucial skills- team player, compassionate, tolerance, and kindness.

Outstanding interpersonal and communication skills.

Education

Bachelor of Science in Nursing, BSN

NP student 2017- Present

Licensure & Certification

RN License

Achievements and Recognition

Attained “Management Recognition Award” for excellent nursing skills.

Certificate of Excellence

Star of the quarter award

My ideal NP position is a holistic NP, characterized by duties and responsibilities that include disease diagnosis, patient assessment by examining medical histories, performance of diagnostic tests, administer medicines and treatment, maintaining patient records, and train patients and families on ways to manage and illnesses and disease prevention (Raftery, 2016). This position will enable me to work in a conventional medicine primary care practice in an outpatient clinic. The patient population will be adult-gerontology, where I can apply both traditional and complementary healing practices. An essential modality that I will specialize in is mind-body medicine that includes hypnotherapy, art therapy, and meditation.

This position will enable me to work with an interdisciplinary team made of case managers, physicians from different fields, pharmacists, and respiratory technicians. This interdisciplinary approach will involve members of the team working collaboratively with common goals and sharing resources and responsibilities. The significance of the approach is that it will benefit the growing number of older people needing healthcare in the U.S. This population requires numerous different diagnoses. Therefore, the approach will deal with complex comorbidities and psychological issues. The approach is effective in improving patient outcomes, level of satisfaction, and healthcare processes. It also prevents duplication of assessment, resulting in more inclusive and holistic records of care. This position will allow me to earn a median pay of $107,030. I will also be entitled to a range of benefits that include health insurance, vacation pay, onsite childcare, tuition reimbursement, and professional liability coverage.

My ideal scope of practice is collaboration that involves combining nurses to work as a team to develop patient care. The approach leverages the diversity of experience, skills, and education levels. Nurses work collaboratively and share responsibilities. Benefits associated with the model include increased nurse satisfaction and morale as the entire staff feel supported. For instance, when an experienced nurse is paired with a novice nurse, the former will assist the latter through sharing essential skills and observation. Staff communication also improves, thereby improving quality and patient safety since timely communication reduces the occurrence of adverse events. Lastly, the ideal shift is an 8-hour shift as compared to a 12-hour shift or longer shifts. Longer shifts are detrimental to the nurse as they are associated with burnouts and reduced job satisfaction. They also affect patient outcomes since a person is likely to make medical errors due to exhaustion.

John Doe

3300 W Camelback d Phoenix,

AZ 85017

818-330-6310

March 30, 2020

Jane Doe

Director of Human Resource

AON Healthcare Group

125 Main Street

3466 NY

Dear Miss Doe:

I am delighted to express my interest in a holistic NP position available at AON Healthcare Group. As a Registered Nurse, I am licensed to practice in Maryland and Florida and with more than 10 years of experience. I have been impressed by the AON Healthcare Group' reputation as a top emergency care center in the city, and I believe that my professional experience would add value to your team of nurse practitioners.

In my role as an NP, I have proved to be an efficient and reliable holistic nurse practitioner. In the course of caring for various patient populations, I have become proficient in diagnosing diseases and formulating and implementing care plans. At my previous place of work, I have also had a chance to:

Meaningfully enhanced the facility’s public image by guaranteeing outstanding patient satisfaction.

Performed improvement activities in core measures and enhance clinical outcomes in nurse-sensitive indicators.

Performed clinical assessments, screening evaluations, vital signs, ECGs, blood sampling as scheduled & per protocol.

Reviewed the patient's medical history, health status, and medications.

Mentored nursing interns by offering support, leadership, and assistance as required

Periodically performed the role of Charge Nurse where I delegated duties, allocated nurses, and ensured compliance with rules, procedures, and regulations.

Additionally, I have strong interpersonal and interaction skills, possess the capability to maintain calmness during emergency situations, and flexible to the ever-changing healthcare sector. Having attained a Bachelor of Science in Nursing, BSN at the university level, I possess the proficiency and skills to provide holistic care since my philosophy is guided by pioneers such as Florence Nightingale and Katherine Kolcaba.

I strive to achieve core features that define a knowledgeable and positive nurse to facilitate the best effective long-term care plans that will help patients transition to community care as they get discharged. I also commit myself to lifelong learning since nursing is an ever-evolving profession. Lastly, I intend to deliver ongoing community services to patients and communities in need of healthcare services since I believe that solving healthcare problems at the community level is the best preventive strategy.

Attached is my resume and list of references. Please feel free to contact me to discuss the position in detail. Thanks in advance.

Sincerely

John Doe.

Michael Tasman

1244 Forest Glen Road

Silver Spring

Holy Cross Hospital

1500 Forest Glen Rd,

Silver Spring, MD 20910, United States

+1 301-754-7000

To Whom It May Concern:

It is my pleasure to recommend John Doe for the position of a nurse practitioner at your organization. I have worked with Doe for 12 years as his nurse manager at Holy Cross Hospital, where he exhibited excellent nursing skills in primary care. I am confident that Mr. Doe's personal qualities, professional experience will make him a dedicated and skilled nurse at your organization.

Doe joined Holy Cross Hospital after graduating from nursing school, and for the period he has been with us, he has gained extensive knowledge of medical procedures. Physicians and surgeons have enjoyed working with him due to his professionalism and efficiency. He has also worked with diverse patient populations, where he often forged therapeutic relationships with them. Doe has a strong work ethic, responsibility, sense of duty, emotional flexibility, and stamina. He is flexible when it comes to working late due to changing shifts or an emergency.

Doe has my highest recommendation for NP position in any hospital because he is the most reliable NP I have had the privilege of supervising. I do not doubt that he will make a quality addition to your interdisciplinary team. Please feel free to reach for if you have any questions regarding his candidacy or past performance.

Sincerely

Michael Tasman

Nurse Manager

Holy Cross Hospital

Jamie Pennyworth

8383 N Davis Hwy,

Pensacola

West Florida Hospital

8383 N Davis Hwy,

Pensacola, FL 32514, United States

+1 850-494-3212

To Whom It May Concern:

John Doe worked for five years in the pediatric ward at West Florida Hospital, where I was the supervisor. In the entire time in the ward, he was a dependable nurse who was committed to provide patients with comfort care.

Doe was an asset in this hospital. He was always committed to tasks and willing to offer assistance in any department of the hospital. He displayed vital skills such as tolerance, team player, kindness, and compassion in his roles and duties. Doe was also interested in learning and often led other nurses in CEUs.

Doe has my highest recommendation for the position of an RN in your hospital. I have no doubt that he will be an asset to your team. Please feel free to contact me if you need more information regarding his performance.

Sincerely,

Jamie Pennyworth

Head Nurse, Pediatric Department

West Florida Hospital

Joe Baldwin

2041 Georgia Ave NW,

Washington

Howard University Hospital

2041 Georgia Ave NW,

Washington, DC 20060, United States

+1 202-865-6100

To Whom It Might Concern:

I am writing to recommend John Doe for the position of a registered nurse in your healthcare organization. I have known Mr. Doe for four years in my capacity as a nurse manager at Howard University Hospital. He worked with our pediatric department as an RN from May 2015 to December 2019.

Mr. Doe has plentiful strengths to offer. For example, he is a professional, accountable, well-organized, committed, and understanding. For the time Mr. Doe has worked at Howard University Hospital, he has distinguished himself as an exceptional nurse who is ready to go ahead of what is expected of him, and as a result, he formed many connections with our patients and their families. With a superb attendance record, Mr. Doe has always maintained a strong professional relationship with other members of the healthcare team.

To summarize, I highly recommended Mr. Doe for an RN position in your hospital. Based on performance at Howard University Hospital, I guarantee that Mr. Doe would be a quality addition to your team of nurses.

I wish him all the best in future endeavors, and in case of additional information, feel free to contact me.

Sincerely,

Joe Baldwin

Nurse Manager

Howard University Hospital

As I complete my Nurse Practitioner program and plan to join the workforce, I need to achieve a national certification from an accredited certifying body. The selected certifying body is AANP, where I will apply for national certification as a Family Nurse Practitioner (FNP). FNP certification examination is a competency-based examination that tests clinical knowledge in individuals/family across the life span. The program has 150 questions, and the score of the candidate is based on 135 questions. The remaining 15 are pretest questions that are utilized in examination to get statistical data for establishing the proficiency of a candidate before vetting.

The first step to become a nationally certified FNP is to create an online profile account at the AANP website. During the period of certification, I will notify AANPCB of any changes in contact formation. The application process should be completed within 30 days once started. As an applicant, I will be notified by email once a week of any additional information is required. These applications are reviewed to establish the qualifications to take the examination and for completeness to undergo professional review by qualified NPs. For a candidate to take the examination, he or she must meet the required qualifications and eligibility. First, one must meet given education that prepares graduate students in national proficiencies of family/across lifespans. The second requirement is that one must complete the APRN core courses as well as complete all educational and clinical NP program coursework, which entail all faculty-supervised clinical clock hours as specified in the NP program. Thirdly, a current U.S. or Canadian RN licensure is needed, and lastly, a person’s educational preparedness must be consistent with the conforming national certification process. It should also be noted that the examination cannot be completed twice in a calendar year.

I will prepare for this examination by utilizing review books and completing the Fitzgerald course review online. Fitzgerald Faculty has courses that meet the needs of practicing NPs in three formats: live, online, or recorded. Additionally, the Fitzgerald Bookstore will provide resources that will help me prep review for all examinations. Therefore, I will enroll in a Fitzgerald online course to prepare myself for the exams.

Scholarly Work

Evidence-Based Management of Hypertension

Hypertension is a major risk factor of cardiovascular diseases that can lead to premature death. Evidence suggests that controlling hypertension diminishes the risk of heart diseases, risk of stroke, and related medical costs. Agarwal (2011) indicates that treatment of hypertension can follow a multi-pronged approach, including medication, changes in diet, and exercise. The objective of management is to lessen the blood pressure to less than 140/90 mm Hg. Various drugs of treating hypertension are available whereby a particular drug may be suitable or a combination of two contingents on the risk factors of patients. Hypertension medications include thiazide diuretics, angiotensin-converting enzyme inhibitors (ACE), Beta-blockers and long-acting calcium channel blockers, short-acting calcium channel blockers, and short-acting Alpha antagonists. Among this category of drugs, short-acting calcium channel blockers and short-acting Alpha antagonists should not be used as first choice of antihypertensive medications.

Evidence from randomized placebo-controlled trials indicates that benefits of antihypertensive drug treatment are to lessen the threat of cardiac events, deadly and non-fatal stroke, premature deaths in people with systolic or diastolic hypertension, and improve the quality of life (Agarwal, 2011). However, it is not apparent whether specific drugs when used as first-line agents, have direct pharmacological effects that increase the blood pressure or if they perform by other numerous secondary actions. Since most of the research studies have utilized a stepped care framework in which different drugs are used to complement first-line agents to decrease blood pressure to targeted levels, it is difficult to evaluate the impact of specific agents (Agarwal, 2011). This study hypothesizes that thiazides diuretics can be used as first-line medications while long-acting calcium channel blockers, ACE inhibitors and Beta-blockers as effective alternatives, short-acting calcium channel blockers, and short-acting Alpha antagonists should not be used as first choice antihypertensive medications.

Numerous hypertension trials have equated chlorthalidone, hydrochlorothiazide, or an aggregate of thiazide and triamterene or amiloride (potassium-sparing agents) with no drug or placebo treatment. Flack (2007) showed that dosages like thiazides lessen the risk of stroke; however, low dosage treatments decrease rates of coronary artery diseases. The study also confirmed that various types of thiazides are effective in managing hypertension. Systematic meta-analyses and reviews of randomized controls compared Beta-blockers as first-line agents and a placebo in the treatment of hypertension. The findings of one of the studies by Wright (2000) revealed that Beta-blockers reduced strokes but not blockage of coronary arteries or mortality. The study also showed that Beta-blockers are a different category of medications with fluctuating levels of sympathomimetic activity and cardioselectivity. Therefore, it was uncertain if the cardiovascular significance of various Beta-blockers represented a class effect.

A randomized placebo-controlled trial by Yusuf et al. (2000) demonstrated that ACE Ramipril was effective since it reduced cardiovascular events by 22% and mortality by 16% in patients at high risk. In this study, half of the sample was hypertensive and had myocardial infarction in the past. Additionally, 40% of the trial participants were taking Beta-blockers. When it comes to calcium channel blockers, a large randomized trial by Thakkar and Oparil (2001) likened calcium channel blocker with a no drug treatment in systolic hypertensive elderly patients aged 60 years and above. The trial revealed reduced proportions of heart disease events with active therapy by 31% equated to a control. Therefore, calcium channel blockers fall under the different categories of antihypertensive treatment agents with numerous hypothesized action mechanisms and may not have a class effect in hypertensive patients. Lastly, no major randomized trial has investigated the clinical outcomes of Alpha-agonist and Alpha-blockers such as clonidine and doxazosin, respectively, as a first-line treatment agent, with a placebo.

Various studies have also compared different antihypertensive agents. A study by UK Prospective Diabetes Study Group (1998) found that calcium channel blockers and ACE inhibitors showed high efficacy in decreasing blood pressure, but calcium channel blockers were likely to increase cardiovascular events up to five times when compared with ACE inhibitors. Another randomized trial by the ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2000) found that when Alpha-blockers were compared with diuretic chlorthalidone, the former was found to increase cardiovascular events, especially congestive heart failure than the latter. When it comes to tolerability, a study by Hansson et al. (2000) showed that low dosage of diuretics, Beta-blockers, ACE inhibitor, and calcium channel blockers were more tolerable and enhanced the quality of life than new drugs in the market.

The study also examined pharmacologic agents with minor side effects and revealed that drugs varied by class and agents within the classes. For instance, a trial study involving a sample of 6600 participants in the age of between 70 and 84 revealed that 26% of patients who received calcium channel blockers experienced minor side effects such as ankle edema and 30% of those who received ACE inhibitors reported coughing. 9% of patients who received diuretics showed effects of cold hands and feet (Hansson et al., 2000). When it comes to the drugs with fatal adverse effects, diuretics showed life-threatening side effects that resulted in hospital admissions and disabling. However, trials that compared Beta-blockers with thiazides showed that the latter was associated with low rates of side effects.

This evidence confirms the hypothesis that thiazides diuretics can be used as first-line medications and long-acting calcium channel blockers, Beta-blockers, and ACE inhibitors as effective alternatives. This is due to the high tolerability and lessened side effects when compared to other classes of drugs. Short-acting calcium blockers should be avoided because they increase cardiovascular events.

Clinical Judgement

An Evidence-Based Management Plan for The Frail Elderly Patients

Patient Description

The patient is a 72-year-old Hispanic male diagnosed with nosocomial pneumonia, hypertension, and hepatitis C. The patient’s allergies include penicillin, sulfa, and iodine.

Medication for Nosocomial Pneumonia

Chloramphenicol 1g every 6 hours for 7 days

gentamicin 5 mg/kg daily in divided doses

Ceftriaxone 1g every 12 - 24 hours for 7 days.

Medication for Chronic obstructive pulmonary disorder

Carbinoxamine 4mg taken orally once a day

Triprolidine 1.25 mg taken daily once a day

Medication for Hepatitis C:

Daclatasvir 60mg taken orally once a day

Sofosbuvir 400mg taken orally once a day

Velpatasvir 100mg taken orally once a day

Glecaprevir 40mg taken orally once a day

Age-Related Changes Pharmacokinetics and Pharmacodynamics

Advancing age results in significant changes in body composition. Progressive reduction occurs in lean body mass and total water body, causing an increase in body fat (Mangoni & Jackson, 2003). Age-related pharmacokinetics changes that are present in this patient's clinical situations include congestive heart failure, ACE inhibitors, and diuretics. Studies exploring potential age-related differences in cardiac functions in patients with heart failure display an increase in systematic vascular and decrease in heart rate in elderly patients (Mangoni & Jackson, 2003). These effects are related to increased concentrations of plasma noradrenaline and serum creatinine.

Some drugs in the category of ACE inhibitors are active compounds (lisinopril), but they are pro-drugs that undergo activation in the liver. In patients with hepatic congestion or severe heart failure, this biotransformation might be impaired (Mangoni & Jackson, 2003). ACE inhibitors are excreted from the body via the kidney through glomerular filtration and tubular secretion. In patients with renal impairments, the plasma concentration increases, and thus, the dose a patient receives must be adjusted accordingly.

In pharmacodynamics, significant age-related changes include an increase in acute and chronic antihypertensive effects with calcium channel blockers, a decrease in peak diuretic responses with a drug such as Furosemide, and no significant change with heparin drug. Other age-related changes include anticoagulant effect, chronotropic effect, analgesic effects, and cognitive functions (Mangoni & Jackson, 2003).

The American Geriatrics Society Beer’s Criteria

The AGS Beer Criteria is a tool that reduces the elderly's drug-related problems since the elderly population experience the highest occurrence of adverse drug events, yet many of these events are preventable (American Geriatrics Society 2015 updated Beers Criteria, n.d.). Based on the AGS Beer criteria, drugs that should be discontinued in this patient’s treatment regime are carbinoxamine and triprolidine. Carbinoxamine is an anticholinergic that should be avoided since its use leads to dry mouth, constipation, and toxicity. On the other hand, triprolidine causes severe allergic reactions. Other drugs listed can be continued. In place of carbinoxamine, Loratadine may be used, and an alternative to triprolidine is pseudoephedrine.

Challenges Faced by Nurse Practitioners (NP)

As a nurse practitioner, two challenges regarding the regulation of complementary and alternative medications in the care of the frail elderly are toxicity and adulterants (Broom & Adams, 2007). Many consumers of complementary and alternative medications assume that these drug products are safe because they are regarded as natural. However, these medications can cause toxicity through drug interactions or by delaying the traditional care that is proven effective. Determining the safety of these medications has been hindered by a lack of scientifically collected data on adverse reactions since the evaluation of the safety and efficacy of these drugs has been significantly anecdotal (Broom & Adams, 2007). There is also the risk of adulteration or contamination of dietary supplements with toxic substances such as carcinogens in some imported products.

Specific Strategy to Assess Reconciliation

Complementary and alternative medications lack reliable scientific data concerning their safety and efficacy. As an NP, a particular strategy that I will consider is the use of reputable informational sources and efficacy to determine the safety and efficacy of these products. The first source that I will use is the U.S. Food and Drug Administration. This is a significant source that provides information about the regulation of CAM and other drug products (Broom & Adams, 2007). The U.S. Pharmacopoeia is another source that I will consider because it is a public standard-setting authority for over-the-counter, prescription, and other health care products that are produced and used in the U.S. The source also describes quality standards of CAM and other dietary products (Broom & Adams, 2007).

Plan for Lifelong Learning

The nursing field is broad, ever-expanding, and dynamic. As a result, nurses have an opportunity to advance the profession, increases knowledge, and improve patient care. Florence Nightingale, a pioneer in nursing, also indicated that people should never consider themselves as finished nurses, they must be learning all their lives (Kroning, 2016). As a nurse practitioner, I will continue to learn throughout my career to acquire knowledge so that I can proficiently achieve the nursing scope and standards of care. My lifelong learning plan is to collaborate with other healthcare professions. Collaboration with physicians, case managers, and other healthcare professionals will allow me to increase the awareness of other members' types of skills and knowledge, resulting in improved decision-making. Collaboration would also lead to increased utilization of standardized communication tools that allow practitioners to create an environment where they can speak up and express concerns. Additionally, studies show the use of standardized tools improves teamwork and reduces medical errors.

I also plan to attend national seminars and conferences. Nursing conferences will allow me to continue with education, network, and receive the latest updates about the nursing practice. Conferences will contribute to my educational development by the accumulation of educational units. Another benefit associated with meetings is that I will be able to explore new information about the practice through the study of abstracts and presentations made by speakers. Such presentations will be vital to allowing me to discuss ideas with presenters and authors directly, generating nursing forums (Kroning, 2016). This will help me see a broader world view of the profession, rather than in the context of the hospital and community in which I practice. Lastly, I will increase the community of contact across the nation or the globe. For example, attending the Magnet Conference will allow me to learn from nurses around the world.

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American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults Clinical Practice Guidelines. Retrieved 4 February 2020, from https://www.guidelinecentral.com/summaries/american-geriatrics-society-2015-updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults/#section-date

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