NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers
Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours.
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NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers
NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Course Readings

 
Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long?” OJIN: The Online Journal of Issues in Nursing, 19(1).
Christensen, C. M., Bohmer, R. M. J., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5),  102-112, 199.
Ford, L. C.. & Gardenier, D. (2015). Fasten your seat belts – it’s going to be a bumpy ride. The Journal for Nurse Practitioners, 11(6), 575-577.
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).
Hayes, E., Chandler, G., Merriam, D., & King, M. C. (2002). The master’s portfolio: Validating a career in advanced practice nursing. Journal of the American Academy of Nurse Practitioners, 14(3), 119.
Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners -risks and rewards. New England Journal of Medicine, 368(20), 1935-1941.
Jordan, L. M., Quraishi, J. A., & Liao, J. (2013). The national practitioner data bank and CRNA anesthesia-related malpractice payments. American Association of Nurse Anesthetists Journal, 81(3), 178-182.
Kooienga, S.A. & Carryer, J.B. (2015). Globalization and advancing primary care health care nurse practitioner practice. The Journal for Nurse Practitioners, 11(8), 804–811.
Miller, K. P. (2013). The national practitioner data bank: An annual update. The Journal for Nurse Practitioners, 9(9), 576-580.
O’Connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: Using a capability framework in developing practice standards for advanced practice nursing. Journal of Advanced Nursing, 70(12), 2728-2735.
Reinisch, C. E. (2014).  Loretta Ford:  Envisioning the future. Clinical Scholars Review, 7(1), 82-84.
Rhodes, C. A., Bechtle, M., & McNett, M.  (2015). An incentive plan for advanced practice registered nurses: Impact on provider and organizational outcomes.  Nursing Economics, 33(3), 125-131.
Silver, H. K,. Ford, L. C., & Day, L. R. (1968). The pediatric nurse-practitioner program: Expanding the role of the nurse to provide increased health care for children. JAMA, 204(4), 298-302.
Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . . Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500.
Stelmach, E. I. (2015). Dismissal of the noncompliant patient: Is this what we have come to? The Journal for Nurse Practitioners, 11(7), 723-725.
Watson, E. (2014). Nursing malpractice: Costs, trends and issues. Journal of Legal Nurse Consulting, 25(1), 26-31.
Weber, S. (2006). Developing nurse practitioner student portfolios. Journal of the American Academy of Nurse Practitioners, 18(7), 301-302.
Westrick, Susan J., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics. The Journal for Nurse Practitioners, 12(2), 120-126.

NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers
 
 
NURS 6565 Week 2 Discussion: Ethical Challenges in Health Care for Practicing NPs
Consider the following case study:
Mrs. ABC is a 35 year old woman who has a scheduled business trip today. It is currently 8 am, and her plan is to leave at 6 pm. Mrs. ABC has a sore throat and she thinks it is strep because her 5 year old daughter was recently treated for strep. Mrs. ABC calls her physician for an appointment, but there are no appointments available until next week. She has a mother who is a nurse practitioner and her office is 5 minutes away from where she lives. She calls and schedules an appointment with her mother. Her mother was surprised to see her daughter at the office. Mrs. ABC is frantic and begs her mother for an antibiotic. Her mother tests her and the rapid strep test is negative in office. Her mother (NP) sends out a strep DNA probe. Her mother prescribes an antibiotic and the patient (her daughter) is very satisfied. The results returned for the DNA probe 48 hours later and it confirmed negative for strep. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
By Day 3 OF NURS 6565 Week 2 Discussion
Post an explanation of whether NPs should treat family members. What are the ethical dilemmas in this situation? What are the laws in your state for NPs treating themselves, family, or friends? NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
****I live in Texas**** but you can choose any state in the US
NURS 6565 Week 2 Discussion Resources
http://midlevelu.com/blog/should-providers-treat-their-friends-and-family

http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx
NURS 6565 Week 2 Discussion
CHAPTER CONTENTS Characteristics of Ethical Dilemmas in Nursing, 328
Communication Problems, 329 Interdisciplinary Conflict, 329 Multiple Commitments, 330
Ethical Issues Affecting Advanced Practice Nurses, 330
Primary Care Issues, 330 Acute and Chronic Care, 330 Societal Issues, 331 Access to Resources and Issues of Justice, 332 Legal Issues, 333
Changes in interprofessional roles, advances in medical technology, privacy issues, revisions in patient care delivery systems, and heightened economic constraints have increased the complexity of ethical issues in the health care setting. Nurses in all areas of health care routinely encounter disturbing moral issues, yet the success with which these dilemmas are resolved varies significantly. Because nurses have a unique relationship with the patient and family, the moral position of nursing in the health care arena is distinct. As the complexity of issues intensifies, the role of the advanced practice nurse (APN) becomes particularly important in the identification, deliberation, and resolution of complicated and difficult moral problems. Although all nurses are moral agents, APNs are expected to be leaders in rec- ognizing and resolving moral problems, creating ethical practice environments, and promoting social justice in the larger health care system. It is a basic tenet of the central definition of advanced practice nursing (see Chapter 3) that skill in ethical decision making is one of the core competencies of all APNs. In addition, the Doctor of Nursing Practice {DNP) essential competencies emphasize leadership in developing and evaluating strate- gies to manage ethical dilemmas in patient care and organizational arenas (American Association of Colleges of Nursing [AACN], 2006). This chapter explores the distinctive ethical decision-making competency of advanced practice nursing, the process of developing and evaluating this competency, and barriers to ethical prac- tice that APNs can expect to confront. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
328
Ethical Decision Making
Ann B. Hamric • Sarah A. Delgado
Ethical Decision Making Competency of Advanced Practice Nurses, 333
Phases of Core Competency Development, 333 Evaluation of the Ethical Decision Making Competency, 349 Barriers to Ethical Practice and Potential Solutions, 350
Barriers Internal to the Advanced Practice Nurse, 350 lnterprofessional Barriers, 351 Patient-Provider Barriers, 351 Organizational and Environmental Barriers, 352
Conclusion, 354
Characteristics of Ethical Dilemmas
lll~l12:’:1’Si~ ~~·-· ~ -······· …. ···~ ·-· In this chapter, the terms ethics and morality or morals are used interchangeably (see Beauchamp & Childress, 2009, for a discussion of the distinctions between these terms). A problem becomes an ethical or moral problem when issues of core values or fundamental obligations are present. An ethical or moral dilemma occurs when obliga- tions require or appear to require that a person adopt two (or more) alternative actions, but the person cannot carry out all the required alternatives. The agent experiences tension because the moral obligations resulting from the dilemma create differing and opposing demands (Beauchamp & Childress, 2009; Purtilo & Doherty, 2011). In some moral dilemmas, the agent must choose between equally unacceptable alternatives; that is, both may have elements that are morally unsatisfactory. For example, based on her evaluation, a family nurse practitioner (FNP) may suspect that a patient is a victim of domestic violence, although the patient denies it. The FNP is faced with two options that are both ethically troubling-connect the patient with existing social services, possibly straining the family and jeopardizing the FNP-patient relationship, or avoid intervention and potentially allow the violence to continue. As described by Silva and Ludwick (2002), hon- oring the FNP’s desire to prevent harm (the principle of beneficence) justifies reporting the suspicion, whereas respect for the patient’s autonomy justifies the opposite course of action. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Jameton (1984, 1993) has distinguished two additional types of moral problems from the classic moral dilemma, which he termed moral uncertainty and moral distress. In situations of moral uncertainty, the nurse experiences unease and questions the right course of action. In moral distress, nurses believe that they know the ethically appro- priate action but feel constrained from carrying out that action because of institutional obstacles (e.g., lack of time or supervisory support, physician power, institutional policies, legal constraints). Noting that nurses and others often take varied actions in response to moral distress, Varcoe and colleagues (2012) have proposed a revision to Jameton’s definition: “moral distress is the experience of being seriously compromised as a moral agent in prac- ticing in accordance with accepted professional values and standards. It is a relational experience shaped by multiple contexts, including the socio-political and cul- tural context of the workplace environment” (p. 60). The phenomenon of moral distress has received increasing national and international attention in nursing and medical literature. Studies have reported that moral dis- tress is significantly related to unit-level ethical climate and to health care professionals’ decisions to leave clinical practice (Corley, Minick, Elswick, et al., 2005; Epstein & Hamric, 2009; Hamric, Borchers, & Epstein, 2012; Hamric, Davis, & Childress, 2006; Pauly, Varcoe, Storch, et al., 2009; Schluter, Winch, Hozhauser, et al., 2008; Varcoe, Pauly, Webster, & Storch, 2012). APNs work to decrease the incidence of moral uncertainty and moral distress for themselves and their colleagues through edu- cation, empowerment, and problem solving. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Although the scope and nature of moral problems experienced by nurses and, more specifically APNs, reflect the varied clinical settings in which they practice, three general themes emerge when ethical issues in nursing practice are examined. These are problems with commu- nication, the presence of interdisciplinary conflict, and nurses’ difficulties with managing multiple commitments and obligations.
Communication Problems
The first theme encountered in many ethical dilemmas is the erosion of open and honest communication. Clear communication is an essential prerequisite for informed and responsible decision making. Some ethical disputes reflect inadequate communication rather than a difference in values (Hamric & Blackball, 2007; Ulrich, 2012). The APN’s communication skills are applied in several arenas. Within the health care team, discussions are most effective when members are accountable for presenting informa- tion in a precise and succinct manner. In patient encoun- ters, disagreements between the patient and a family
C HAP T E R 13 Ethical Decision Making
member or within the family can be rooted in faulty com- munication, which then leads to ethical conflict. The skill of listening is just as crucial in effective communication as having proficient verbal skills. Listening involves recog- nizing and appreciating various perspectives and showing respect to individuals with differing ideas. To listen well is to allow others the necessary time to form and present their thoughts and ideas.
Understanding the language used in ethical delibera- tions (e.g., terms such as beneficence, autonomy, and utili- tarian justice) helps the APN frame the concern. This can help those involved to see the components of the ethical problem rather than be mired in their own emotional responses. When ethical dilemmas arise, effective com- munication is the first key to negotiating and facilitating a resolution. Jameson (2003) has noted that the long history of conflict between certified registered nurse anes- thetists (CRNAs) and anesthesiologists influences how these providers communicate in practice settings. In inter- views with members of both groups, she found that some transcended role-based conflict whereas others became mired in it, particularly in the emotions around perceived threats to role fulfillment. She recommended enhancing communication through focus on the common goal of patient care, rather than on the conflicting opinions about supervision and autonomous practice. In other words, focusing on shared values rather than the values in conflict can promote effective communication. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Interdisciplinary Conflict
The second theme encountered is that most ethical dilemmas that occur in the health care setting are multidisciplinary in nature. Issues such as refusal of treatment, end-of-life decision making, cost containment, and confidentiality all have interprofessional elements interwoven in the dilemmas, so an interprofessional approach is nec- essary for successful resolution of the issue. Health care professionals bring varied viewpoints and perspectives into discussions of ethical issues (Hamric & Blackball, 2007; Piers, Azoulay, Ricou, et al., 2011; Shannon, Mitchell, & Cain, 2002). NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.These differing positions can lead to creative and collaborative decision making or to a breakdown in communication and lack of problem solving. Thus, an interdisciplinary theme is prevalent in the presentation and resolution of ethical problems.
For example, a clinical nurse specialist (CNS) is writing discharge orders for an older woman who is terminally ill with heart failure. The plan of care, agreed on by the inter- professional team, patient, and family, is to continue oral medications but discontinue IV inotropic support and all other aggressive measures. Just prior to discharge, the social worker informs the CNS that medical coverage for. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
 
330 PART ll Competencies of Advanced Practice Nursing
the patient’s care in the skilled nursing facility will only be covered by the insurer if the patient has an IV in place. The attending cardiologist determines that the patient can be discharged to her daughter’s home because she no longer requires skilled care and the social worker agrees to proceed with this plan. However, the CNS is concerned that the patient’s need for physical assistance will over- whelm her daughter and believes that the patient is better off returning to the sldlled nursing facility. Although each team member shares responsibility to ensure that the plan of care is consistent with the patient’s wishes and mini- mizes the cost burden to the patient, they differ in how to achieve these goals. Such legitimate but differing perspec- tives from various team members can lead to ethical conflict. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Multiple Commitments
The third theme that frequently arises when ethical issues in nursing practice are examined is the issue of balancing commitments to multiple parties. Nurses have numerous and, at times, competing fidelity obligations to various stakeholders in the health care and legal systems (Chambliss, 1996; Hamric, 2001). Fidelity is an ethical concept that requires persons to be faithful to their com- mitments and promises. For the APN, these obligations start with the patient and family but also include physi- cians and other colleagues, the institution or employer, the larger profession, and oneself. Ethical deliberation involves analyzing and dealing with the differing and opposing demands that occur as a result of these commitments. An APN may face a dilemma if encouraged by a specialist consultant to pursue a costly intervention on behalf of a patient, whereas the APN’s hiring organization has estab- lished cost containment as a key objective and does not support use of this intervention (Donagrandi & Eddy, 2000). In this and other situations, APNs are faced with an ethical dilemma created by multiple commitments and the need to balance obligations to all parties.NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
The general themes of communication, interdisciplin- ary conflict, and balancing multiple commitments are prevalent in most ethical dilemmas. Specific ethical issues may be Wlique to the specialty area and clinical setting in which the APN practices.
Ethical Issues Affecting Advanced Practice Nurses
Primary Care Issues
Situations in which personal values contradict professional responsibilities often confront NPs in a primary care setting. Issues such as abortion, teen pregnancy, patient
nonadherence to treatment, childhood immunizations, regulations and laws, and financial constraints that inter- fere with care were cited in one older study as frequently encountered ethical issues (Turner, Marquis, & Burman, 1996). Ethical problems related to insurance reimburse- ment, such as when implementation of a desired plan of care is delayed by the insurance authorization process or restrictive prescription plans, are an issue for APNs. The problem of inadequate reimbursement can also arise when there is a lack of transparency regarding the specifics of services covered by an insurance plan. For example, a patient who has undergone diagnostic testing during an inpatient stay may later be informed that the test is not covered by insurance because it was done on the day of discharge. Had the patient and nurse practitioner (NP) known of this policy, the testing could have been sched- uled on an outpatient basis with prior authorization from the insurance company and thus be a covered expense. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Viens {1994) found that primary care NPs interpret their moral responsibilities as balancing obligations to the patient, family, colleagues, employer, and society. More recently, Laabs (2005) has found that the issues most often noted by NP respondents as causing moral dilemmas are those of being required to follow policies and procedures that infringe on personal values, needing to bend the rules to ensure appropriate patient care, and dealing with patients who have refused appropriate care. Issues leading to moral distress included pressure to see an excessive number of patients, clinical decisions being made by others, and a lack of power to effect change (Laabs, 2005). Increasing expectations to care for more patients in less time are routine in all types of health care settings as pressures to contain costs escalate. APNs in rural settings may have fewer resources than their col- leagues working in or near academic centers in which ethics committees, ethics consultants, and educational opportunities are more accessible.
Issues of quality of life and symptom management tra- verse primary and acute health care settings. Pain relief and symptom management can be problematic for nurses and physicians (Oberle & Hughes, 2001). APNs must con- front the various and sometimes conflicting goals of the patient, family, and other health care providers regarding the plans for treatment, symptom management, and quality of life. The APN is often the individual who coor- dinates the plan of care and thus is faced with clinical and ethical concerns when participants’ goals are not consis- tent or appropriate. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Acute and Chronic Care
In the acute care setting, APNs struggle with dilemmas involving pain management, end-of-life decision making,
advance directives, assisted suicide, and medical errors (Shannon, Foglia, Hardy, & Gallagher; 2009). Rajput and Bekes (2002) identified ethical issues faced by hospital- based physicians, including obtaining informed consent, establishing a patient’s competence to make decisions, maintaining confidentiality, and transmitting health information electronically. APNs in acute care settings may experience similar ethical dilemmas. Recent studies of moral distress have revealed that feeling pressured to continue aggressive treatments that respondents thought were not in the patients’ best interest or in situations in which the patient was dying, working with physicians or nurses who were not fully competent, giving false hope to patients and families, poor team communication, and lack of provider continuity were all issues that engen- dered moral distress (Hamric & Blackball, 2007; Hamric, Borchers, & Epstein, 2012).
APNs bring a distinct perspective to collaborative decision making and often find themselves bridging com- munication between the medical team and patient or family. For example, the neonatal nurse practitioner (NNP) is responsible for the day-to-day medical manage- ment of the critically ill neonate and may be the first provider to respond in emergency situations (Juretschke, 2001). The NNP establishes a trusting relationship with the family and becomes aware of the values, beliefs, and attitudes that shape the family’s decisions. Thus, the NNP has insight into the perspectives of the health care team and family. This “in-the-middle” position, however, can be accompanied by moral distress (Hamric, 2001), particu- larly when the team’s treatment decision carried out by the NNP is not congruent with the NNP’s professional judg- ment or values. Botwinski (2010) conducted a needs assessment ofNNPs and found that most had not received formal ethics content in their education and desired more education on the management of end-of-life situations, such as delivery room resuscitation of a child on the edge of viability. Knowing the best interests of the infant and balancing those obligations to the infant with the emo- tional, cognitive, financial, and moral concerns that face the family struggling with a critically ill neonate is a complex undertaking. Care must be guided by an NNP and health care team who understand the ethical princi- ples and decision making related to issues confronted in neonatal intensive care unit (NICU) practice. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Societal Issues
Ongoing cost containment pressures in the health care sect01· have significantly changed the traditional practice of delivering health care. Goals of reduced expenditures and services and increased efficiency, although important, may compete with enhanced quality oflife for patients and. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
cHAPTER 13 Ethical Decision Making
improved treatment and care, creating tension between providers and administrators, particularly in managed care systems in which providers find that their clinical decisions are subject to outside review before they can be reimbursed. Ulrich and associates (2006) surveyed NPs and physician assistants to identify their ethical concerns in relation to cost containment efforts, including managed care. They found that 72% of respondents reported ethical concerns related to limited access to appropriate care and more than 50% reported concerns related to the quality of care. An earlier study of 254 NPs revealed that 80% of the sample perceived that to help patients, it was sometimes necessary to bend managed care guidelines to provide appropriate care (Ulrich, Soeken, & Miller, 2003). Most respondents in this study reported being moderately to extremely ethically concerned with managed care; more than 50% said that they were concerned that business decisions took priority over patient welfare and more than 75% stated that their primary obligation was shifting from the patient to the insurance plan. Although the passage of the Patient Protection and Affordable Care Act (PPACA; U.S. Department of Health & Human Services fHHSJ, 2011) may help with these concerns to some extent, the ethical tensions that underlie cost containment pressures and the business model orientation of health care delivery may continue.
An example of how cost containment goals can create conflict is a situation in which a NP wishes to order a computed tomography (CT) scan to evaluate a patient complaining of abdominal pain. The NP knows that the patient has a history of diverticulosis resulting in abscess formation and the current pres·entation with fever and abdominal tenderness justifies this testing; however, the insurance approval process takes a minimum of 24 hours. By sending the patient to the emergency room, the test can be done more quickly, but the patient will also face a long wait and a high copay if she does not require subse- quent hospital admission. Limiting access to CT scans is based on containing costs and avoiding unnecessary testing, which are two laudable goals. However, in this situation, the lengthy approval process means that the NP does not have needed information to direct the treatment plan and alleviate the patient’s suffering in a timely manner. The use of the emergency room to obtain essen- tial clinical information is a greater burden on the patient and may ultimately prove more expensive to the system. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
Technologic advances, such as the rapidly expanding :field of genetics, are also challenging APNs (Caulfield, 2012; Harris, Winship, & Spriggs, 2005; Horner, 2004; Pullman & Hodgkinson, 2006). As Hopldnson and Mackay (2002) have noted, although the potential impact of mapping the human genome is immense, the challenge of how to translate genetic data rapidly into improvements
331
332 PART IT Competencies of Advanced Practice Nursing
in the prevention, diagnosis, and treatment of disease remains. To counsel patients effectively on the risks and benefits of genetic testing, APNs need to stay current in this rapidly changing field (a helpful resource for this and other issues is the text by Steinbock, Arras, and London, 2012), As one example, genetic testing poses a unique challenge to the informed consent process. Patients may feel pressured by family members to undergo or refuse testing, and may require intensive counseling to under- stand the complex implications of such testing; APNs are also involved in post-test counseling, which raises ethical concerns regarding the disclosure of test results to other family members (Eden, 2006). Because genetic information is crucially linked to the concepts of privacy and confidentiality, and the availability of this information is increasing, it is inevitable that APNs will encounter legal issues and ethical dilemmas related to the use of genetic data. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
APNs may engage in research as principal investiga- tors, co-investigators, or data collectors for clinical studies and trials. In addition, leading quality improvement (QI) initiatives is a key expectation of the DNP-prepared APN (AACN, 2006). Ethical issues abound in clinical research, including recruiting and retaining patients in studies, pro- tecting vulnerable populations from undue risk, and ensuring informed consent, fair access to research, and study subjects’ privacy. As APNs move into QI and research initiatives, they may experience the conflict between the clinician role, in which the focus is on the best interests of an individual patient, and that of the researcher, in which the focus is on ensuring the integrity of the study (Edwards & Chalmers, 2002).
Access to Resources and Issues of Justice
Issues of access to and distribution of resources create powerful dilemmas for APNs, many of whom care for underserved populations. Issues of social justice and equi- table access to resources present formidable challenges in clinical practice. Trotochard (2006) noted that a growing number of uninsured individuals lack access to routine health care; they experience worse outcomes from acute and chronic diseases and face higher mortality rates than those with insurance. McWilliams and colleagues (2007) found that previously uninsured Medicare beneficiaries require significantly more hospitalizations and office visits when compared with those with similar health problems who, prior to Medicare eligibility, had private insurance. The PPACA, when fully enacted, will help improve access to quality care and decrease the incidence of these dilem- mas. However, as noted, the escalating costs of health care represent ethical challenges to providers and systems alike, regardless of the population’s insurance status. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers.
The allocation of scarce health care resources also creates ethical conflicts for providers; regardless of pay- ment mechanisms, there are insufficient resources to meet a

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