In your initial post, consider the Four Prototypic Dimensions of Parenting and address the following:

1. Which style best describes the approach used by your parents/guardians when you were growing up?
2. Which style do you (or would you) use with your children?
3. What impact do you think the parenting-style you experienced growing up has had on you? Has it influenced (or would it influence) your style as a parent?

Be sure to support your responses and give examples.

Discussion 1

In today’s society, certain types of cultural barriers in healthcare have the power to negatively impact outcomes and can lead to expensive consequences for health systems. Cultural competency refers to the ability to interact with people across cultures. When used in healthcare, it focuses on being able to care for patients with diverse values, beliefs, and behaviors. Today, the delivery of healthcare needs to be tailored to patients’ social, cultural and linguistic needs. According to the health care service company Cigna, cultural competency in healthcare can overcome health disparities. Some of these disparities include language barriers, cultural beliefs and practices, medical bias, variations in care access and quality, and low health literacy (Husson University, 2019).

The Purnell Model of Clinical Competence is a mid-range theory that is used for the research examining culture and within the context of culture and values. This theory was created by Larry Purnell and it was developed based on his observations of undergraduate nursing students and how they would interact with patients that are from different cultural backgrounds. In the United States, culturally competency is a key area for nurses and advanced practitioners (Marzilli, 2017).

Having the ability to communicate effectively with patients and their families is key for good patient care. The importance of communicating effectively in cross-cultural encounters is necessary. Cultural competence includes providing effective health care across diverse cultures by working collaboratively and communicating effectively. Advanced practice nurses and physicians who are aware of their own and their patients’ cultural backgrounds, along with the values that are often implicit in current medical models, are better able to achieve mutual understanding within the patient encounter and to focus on culturally appropriate health care interventions (Ladha et al., 2018)

With the Purnell Model, all aspects and domains of this model work by affecting one another, rather than standing alone. With this model there are specific cultural domains that include, heritage, communication, family roles and organization, workforce issues, bicultural ecology, high risk behaviors, nutrition, childbearing, death rituals, spirituality, health care practices and the healthcare practitioner (National Association for School Nurses, 2019).

As nurse practitioners, understanding the impact that cultural competence and interaction with your patients are key in quality patient care and trust. Cultural competency is relevant to healthcare education due to the fact that minorities will constitute 54% of the total United States population by 2050. The Purnell Model helps by evaluating the impact of interventions such as service learning and the change on cultural competence following the specific intervention. Research involving the Purnell Model is used as the theoretical framework for determining the healthcare providers role and responsibilities in caring for particularly vulnerable populations of patients (Marzilli, 2017).

Cultural competence in healthcare is continuing to become more essential to the list of necessary skills that a healthcare provider must utilize and become familiar with when caring for patients (Marzilli, 2017). By taking some of the previously done research and building onto this, advanced healthcare providers can continue to to work on and become more culturally competent individuals. By doing so, this will help them care for their patients and give them a better patient outcome.

References

Husson University. (2019, September 3). The Need for Cultural Competence in Healthcare. MedCity News. https://medcitynews.com/?sponsored_content=the-need-for-cultural-competence-in-healthcare&rf=1.

Ladha, T., Zubairi, M., Hunter, A., Audcent, T., & Johnstone, J. (2018, February). Cross-cultural communication: Tools for working with families and children. Paediatrics & child health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815116/.

Marzilli, C. (2017). A Review of the Theoretical Framework of Culture and Value Applied to Nursing. International Journal of Nursing. https://www.ijnonline.com/index.php/ijn/article/view/380.

National Association for School Nurses. (2019). Purnell Model. Purnell Model – National Association of School Nurses. https://www.nasn.org/nasn-resources/practice-topics/cultural-competency/cultural-competency-purnell-model.

Roles and Responsibilities of the Advanced Nurse Practitioner in Prescribing

The roles and responsibilities of the advanced nurse practitioners in prescribing medications to patients are to obtain as much information from the patient by a verbal history and through a hands on physical examination in order to diagnose and then establish a course of treatment for the patient, (Arcangelo et al., 2017, p. 7).  In order to do no harm and provide for the best outcome for the patient, the advanced nurse practitioner must consider many things when choosing which medication to treat the patient with.

When making the drug choice, the advanced nurse practitioner should ask themselves if the drug is required, and if so, what will be the effect on the patient?  Side effects should be reviewed with the patient.  The nurse practitioner should also consider if the regimen is one the patient can abide by.  Other concerns would be is this the most effective medication for the patient, and if the cost is a barrier to compliance for the patient, (Arcangelo et al., 2017, p. 7). Also, does the patient agree with the course of treatment?  If the patient agrees, they will more likely be compliant with the medication regimen.

Another aspect the advanced nurse practitioner should consider is if the medication is truly needed for the illness.  A patient that is ill may come in and specifically request a medication.  In this case, the advanced nurse practitioner should not be influenced by the patient’s request, but should weigh all aspects of the patient illness presentation before a decision is made.  One common example of this is a patient request for an antibiotic.  Antibiotics have been noted to be prescribed by advanced nurse practitioners at a higher rate than physicians. Therefore, the advanced nurse practitioner should be judicious in their decision to prescribe an antibiotic in order to prevent antibiotic resistance, (Sanchez et al., 2016).   

The next important responsibility of the advanced nurse practitioner in regards to prescribing medication would be to consider the drug that is chosen for the illness.  The advanced nurse practitioner should review if the patient has any allergies to the medication.  Another consideration is if the medication will interact with a medication the patient is currently prescribed.  For example, if a patient is receiving Methadone therapy for opioid use disorder (OUD), the prescriber should not consider Azithromycin as a treatment for infection as this can lead to increased prolongation of the QT interval and result in the possible fatal condition of Torsades de Pointes, (Sunilkumar & Lockman, 2018).

Lastly, the legal and regulatory aspects of prescribing medication should be considered by the advanced nurse practitioner.  One important example of this would be an advanced nurse practitioner prescribing Suboxone to a patient with OUD in their primary care practice.  The advanced nurse practitioner can legally prescribe this Schedule III medication if they have received their Drug Addiction Treatment Act (DATA) 2000 waiver and are legally able to prescribe this under their state’s regulatory body, (Frank et al., 2018).

References

Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics

            for Advanced Practice: A Practical Approach (4th Ed.). Philadelphia, PA: Wolters

            Kluwer/Lippincott Williams & Wilkins American

Frank, J. W., Wakeman, S. E., & Gordon, A. J. (2018). No end to the crisis without an end to the

            waiver. Substance Abuse, 39(3), 263-265, DOI: 10.1080/08897077.2018.1543382

Guillermo V. Sanchez, Adam L. Hersh, Daniel J. Shapiro, James F. Cawley, Lauri A. Hicks,

            Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician

            Assistants, Open Forum Infectious Diseases, Volume 3, Issue 3, Summer 2016, ofw168,

            https://doi.org/10.1093/ofid/ofw168

Sunilkumar, M. M., & Lockman, K. (2018). Practical Pharmacology of Methadone: A Long-

            acting Opioid. Indian journal of palliative care, 24(Suppl 1), S10–S14.

            https://doi.org/10.4103/IJPC.IJPC_180_17

Case Study One – Bad Fish: A Case on Nervous Tissue

One evening during a recent trip to Indonesia, Dr. Marshall Westwood sat down to a meal of puffer fish and rice. Within an hour of returning to his hotel room, Dr. Westwood felt numbness in his lips and tongue, which quickly spread to his face and neck. Before he could call the front desk, he began to feel pains in his stomach and throat, which produced feelings of nausea and eventually severe vomiting.

Fearing that he had eaten some “bad fish” for dinner, Dr. Westwood called a local hospital to describe his condition.  The numbness in his lips and face made it almost impossible for him to communicate, but the hospital staff managed to at least understand the address he gave them and they sent an ambulance. As Dr. Westwood was rushed to the hospital, his breathing became increasingly labored.

The patient presented in the ED with diaphoresis, motor dysfunction, paresthesias, nausea, and an ascending paralysis that started in his legs and spread to the upper body, arms, face, and head. The patient was cyanotic and hypoventilating. Within 30 minutes of presenting in the ED, Dr. Westwood developed bradycardia with a BP of 90/50 mmHg. Atropine was administered in response to the bradycardia. Intravenous hydration, gastric lavage, and activated charcoal followed a presumptive diagnosis of tetrodotoxin poisoning that was based on the clinical presentation in the ED. Five hours after treatment, the following vital signs were noted:

•        BP 125/79 mmHg

•        HR 78 bpm

•        Oxygen saturation: 97% on room air

After discussing his case with his physician, he learned that he had probably been the victim of puffer fish poisoning. The active toxin in the tissues of this fish is a chemical called tetrodotoxin (TTX). Tetrodotoxin is in a class of chemicals known as neurotoxins because it exerts its effects on neurons. The specific action of tetrodotoxin is that it blocks voltage-gated sodium ion channels.

1. Define the following phrases and terms associated with the signs and symptoms of Dr. Westwood’s TTX poisoning:
   1. diaphoresis
   2. motor dysfunction
   3. paresthesias
   4. cyanotic
   5. hypoventilating 
   6. bradycardia
   7. gastric lavage
   8. oxygen saturation
2. As mentioned in the case description, tetrodotoxin is a molecule that blocks voltage-gated sodium ion channels. What is a voltage-gated sodium ion channel and what is its function?
3. When nerve cells are at rest, there is an unequal amount of positive and negative charges on either side of a nerve cell membrane. This charge difference creates an electrical potential. Describe how the resting membrane potential (resting potential) is generated.
4. What is happening to the electrical potential of a neuron when it generates an action potential? What is the function of the action potential in neurons?
5. Describe the role of sodium ions and sodium channels in generating an action potential.
6. What would happen to a neuron if it was exposed to tetrodotoxin? Be specific regarding its effect on the ability of a neuron to communicate.
7. Now that you have addressed some of the basic biology of this case, explain why Dr. Westwood experienced numbness after eating the puffer fish meal.
8. Paralysis is a term used to describe the loss of muscle function. If tetrodotoxin’s effect is on neurons, why did Dr. Westwood experience paralysis?

Length: 1500-2000 words

Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

Week 2 Discussion

Based on last week’s reading, you now have an idea of the role of the APRN, and legal/professional issues in prescribing. As a future nurse practitioner, you have the authority, based on your state nurse practice act, to prescribe medications for the patients for whom you will provide care, and the responsibility of prescriptive authority is more than just simply writing a prescription correctly. 250 words APA Format

Important Links:

• https://www.flsenate.gov/Committees/BillSummaries/2016/html/1424
• http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html
• https://floridasnursing.gov/new-legislation-impacting-your-profession/
• https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-prescriptive-privilege

Discuss the role of advanced practice nursing in safe prescribing and 3 prescribing barriers for APRNs:

1. You need 1 initial post, and 2 replies to 2 different students.

2. A minimum of 2 paragraphs is required for all posts (initials and replies).

3. Support all posts with at least 2 cited peer review references within 5 years of publication (references cannot be older than 5 years).

4. All posts are to be written in APA 6th edition format as required by the university.