NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Week 1: Health and Health Promotion

Much like archaeologists sift through sand to identify artifacts of interest, nurse practitioners must devote time and effort to interviewing patients, sifting through facts to identify relevant information that can be pieced together to create a relevant patient history. These efforts have their own unique challenges and approaches based on the characteristics of the patient, including sex, age, culture, and more.

Female patient interviews have their own unique characteristics. Sensitive matters related to sexual health, physical and/or emotional abuse, pregnancy, menstruation, and other topics may leave patients uncomfortable and create challenges to productive conversations NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

For this week, you will examine the role of the patient interview in health promotion. You also will practice approaches to building a patient history by interviewing a volunteer by creating a script which you use to conduct a mock patient interview with the volunteer.

Learning Objectives

Students will:

• Analyze professional interests of study
• Analyze the different roles related to the a CRNP (certified registered nurse practitioner), a CNM (certified nurse midwife), and a PA (Physician Assistant)
• Create scripts for taking a health history to include difficult questions
• Develop patient health histories related to difficult questions

*These Learning Objectives are introduced this week and assessed in Week 2 NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Optional Resources (click to expand/reduce)

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NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Week 1: Health and Health Promotion

Similar to how archaeologists meticulously sift through sand to uncover significant artifacts, nurse practitioners must invest time and effort in patient interviews, carefully extracting pertinent information to construct a comprehensive patient history. This process presents distinct challenges and strategies contingent upon patient characteristics, encompassing factors like gender, age, culture, and more.

Interviews with female patients entail unique characteristics. Delicate topics concerning sexual health, physical and emotional abuse, pregnancy, menstruation, and related subjects can induce discomfort in patients, posing obstacles to productive discussions in the context of NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

During this week, you will delve into the significance of patient interviews in health promotion. Additionally, you will gain hands-on experience by creating a script for a mock patient interview with a volunteer, honing your skills in building a patient history.

Learning Objectives

Students will:

– Assess professional interests in the field of study.
– Evaluate the different roles associated with CRNPs (Certified Registered Nurse Practitioners), CNMs (Certified Nurse Midwives), and PAs (Physician Assistants).
– Develop scripts for gathering health histories that encompass challenging inquiries.
– Construct patient health histories involving sensitive questions.

Please note that these Learning Objectives are introduced in this week and evaluated in Week 2 of NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Learning Resources

Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Optional Resources (click to expand/reduce)

Discussion: Varied Roles of Nurse Practitioners

The term “history” encompasses a wide spectrum of meanings. In the realm of archaeology, specialists often focus their careers on particular niches or geographical regions of historical significance.

Similarly, within the expansive domain of healthcare, nurse practitioners channel their careers into diverse roles. These roles may be influenced by specific areas of interest, such as women’s health. Additionally, careers may center on particular nursing specialties within the context of NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Photo Credit: Getty Images/Blend Images

For this discussion, you will explore your professional interests and examine how these interests align with established guidelines and competencies. Furthermore, you will investigate the different roles that nurse practitioners assume in the realm of women’s health and consider how these roles might impact your own practice.

To prepare:

– Examine the modular structure of this course and contemplate how each module defines the specific skills required of advanced Nurse Practitioners (NPs).
– Review the ANA guidelines, NP competencies, and Ethical resources featured in this week’s Learning Resources, reflecting on their implications for NP work.
By Day 3

Post a concise explanation regarding the distinctions in roles between a CRNP, a CNM, and a PA, elucidating how each role may influence your practice as a FNP (Family Nurse Practitioner). Be specific, and provide illustrative examples.

Take time to read through the responses of your peers. Healthcare providers possess diverse educational backgrounds, and various credentials are present within women’s healthcare settings, including certified registered nurse practitioner (CRNP) or advanced practice nurse practitioner (APNP), certified nurse midwife (CNM), and physician’s assistant (PA). This discussion explores the multifaceted roles of individuals based on their educational backgrounds within the context of NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

A crucial aspect to consider when examining healthcare providers revolves around the scope of practice. In the United States, nurse practitioners (NPs) are subject to varying state-level practice laws, despite their educational preparation for independent patient care, prescribing practices, and diagnostic procedures (Poghosyan, Liu, & Norful, 2017; Kraus & DuBois, 2017). The scope of practice for NPs in Ohio, for instance, falls under a reduced practice model. Advanced practice nurse practitioners, including CNMs, in Ohio must collaborate with a licensed physician under a written agreement for prescribing practices, as per the Ohio Revised Code (NCSL, 2021; McCleery et al., Freeman, 2019). Limitations on the scope of practice for CNMs are also delineated in state laws; for example, CNMs in Ohio are prohibited from delivering breech babies or performing versions (Legislative Service Commission, 2020). Prescribing practices and scope of practice for PAs also vary under the Ohio Revised Code. An agreement between the PA and an appropriate physician that addresses prescriptive authority for schedule II-V controlled substances, along with a mutually agreed-upon scope of practice, must be submitted to the State Medical Board (NCSL, 2021). As advanced practice providers, it is crucial to be aware of the scope of practice within one’s state, understand facility-specific practice guidelines, and establish agreements with supervising physicians.

Another distinction among these three provider roles is their approach to patient care. Individuals who follow the nursing path, such as CNMs or APNPs, adopt a patient-centered approach focused on disease prevention and patient education. In contrast, individuals with a medical school background, like PAs, tend to adopt a disease-centered approach to healthcare. Clinical approaches to healthcare delivery differ based on scope of practice, educational background, and professional influences (Freeman, 2019). These variances in approach are particularly relevant when considering team-based care coordination within the context of NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

In conclusion, healthcare is rapidly evolving towards a team-based approach to patient management. As a practitioner, it is vital to comprehend the distinctions in roles among various advanced practice providers. Understanding one’s own scope of practice within their state and neighboring states is crucial for providing safe care. Providers must prioritize delivering safe care to all individuals, which necessitates knowledge of other providers’ roles when delegation is required.

References

Freeman, J. (2019). Family Physicians, Nurse Practitioners, Physician Assistants, and Scope of Practice: Who Will Decide? Family Medicine, 51(4), 305-307. doi: 10.22454/FamMed.2019.356702

Kraus, E., & DuBois, J. (2017). Knowing your limits: A qualitative study of physician and nurse practitioner perspectives on NP independence in primary care. Journal of General Internal Medicine, 32(3), 284-290. doi: 10.1007/s11606-016-3896-7

Legislative Service Commission. (2020). Section 4723.43 | Scope of specialized nursing services. Retrieved from https://codes.ohio.gov/ohio-revised-code/section-4723.43.

NCSL. (2021). Scope of Practice Policy. Retrieved from https://scopeofpracticepolicy.org/states/oh/

Poghosyan, L., Liu, J., & Norful, A. (2017). Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study. International Journal of Nursing Studies, 74, 1-7. doi: 10.1016/j.ijnurstu.2017.05.004 NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

By Day 6

Respond to at least two of your colleagues’

posts on two different days, offering additional insights related to the issues and topics they may want to consider. Support your explanations with information from the Learning Resources or current literature.

Please note that for this Discussion, you are required to post your initial response before accessing and responding to your colleagues’ contributions. To post, click on the “Post to Discussion Question” link and select “Create Thread.” Once you’ve submitted your post, you cannot delete or edit it, and anonymous posts are not allowed. Please review your post carefully before clicking “Submit.”

I found your post insightful, particularly in highlighting the nuances in the scope of practice among CRNPs, CNMs, and PAs. Your mention of the varying state-level practice laws for nurse practitioners in the United States is an important point to consider. It emphasizes the importance of being well-informed about the regulations in one’s own state and ensuring compliance with these laws in practice.

The distinction you made regarding the patient-centered approach of nursing-based roles and the disease-centered approach of medical school-trained professionals is also noteworthy. It underscores the diversity in healthcare delivery approaches and the importance of recognizing these differences for effective team-based care.

Additionally, your mention of the evolving nature of advanced practice, with practitioners acquiring new knowledge and skills throughout their careers, highlights the dynamic nature of healthcare. Adapting to these changes and continuously expanding one’s skill set is crucial for providing high-quality care.

Overall, your post provides valuable insights into the complexities of advanced practice roles and the need for practitioners to navigate these complexities effectively. Well done!

Discussion: Different Roles of the Nurse Practitioner

For this Discussion, you will explore your professional interests and those interests are addressed in specific guidelines and competencies. You also examine the different nurse practitioner roles related to women’s health and how these roles might impact the way you work.

To prepare:

• Review the modular structure of this course and reflect on how each module defines the specific skills needed as an advanced Nurse Practitioner (NP).
• Review the ANA guidelines, NP competencies, and the Ethic resources found in this week’s Learning Resources and consider how they impact the work of the NP.

By Day 3

Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as a FNP. Be specific and provide examples.

Read a selection of your colleagues’ responses.

  Providers present with many different education backgrounds. Some credentials one may see within a women’s health care setting include: certified registered nurse practitioner (CRNP) or advanced practice nurse practitioner (APNP), certified nurse midwife (CNM) and physician’s assistant (PA). This discussion will look at the different roles of an individual based on their educational background NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

When looking at providers one area to discuss includes scope of practice. For nurse practitioners (NPs) in the United States, state level practicing laws vary from state to state despite educational preparation for independent patient care, prescribing practices and diagnostic procedures (Poghosyan, Liu, & Norful, 2017, Kraus & DuBois, 2017). The scope of practice for an NP in Ohio falls under a reduced practice. APNPs, including a CNM, in the state of Ohio must collaborate with a licensed physician with a written agreement for prescribing practices per the Ohio Revised Code (NCSL, 2021, McCleery, et al., Freeman, 2019).  Limitations for CNM is also addressed in the state laws.  For example, a CNM in Ohio is unable to deliver breech babies or perform version (Legislative Service Commission, 2020). Prescribing practices and scope of practice for PAs also differs in the Ohio revised Code. A supervision agreement between the PA and an appropriate physician that addresses prescriptive authority for schedule II-V controlled substances along with a scope of practice agreed upon by both parties must be submitted to the State Medical Board (NCSL, 2021). As an advanced practice provider, it is important to know the scope of practice within the state, practicing guidelines within the facility, and the agreement with the supervising physician.

Another difference in these three provider roles includes their approach to care. An individual who takes the nursing path, such as a CNM or APNP, directs care with a patient-centered approach to disease prevention and education. An individual who takes the medical school approach, such as a PA, follows a disease-centered approach to health care. Clinical approaches to healthcare vary based on scope of practice, education, and practice influence (Freeman, 2019). These differences in approaches are important in team management planning NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

In conclusion, healthcare is changing rapidly in how care is provided with an emphasis on a team approach to management. As a practitioner, it is important to know the differences between the roles of different advanced practice providers. Knowing an individual’s own scope of practice within their state and surrounding states is an important aspect of providing safe care. As a provider it is also important to ensure safe care is provided to all individuals. Knowing roles of other providers is important when delegation is required.

References

Freeman, J. (2019). Family Physicians, Nurse Practitioners, Physician Assistants, and Scope of Practice: Who Will Decide? Family Medicine, 51(4): 305-307. doi: 10.22454/FamMed.2019.356702

Kraus, E. & DuBois, J. (2017). Knowing your limits: A qualitative study of physician and nurse practitioner perspectives on NP independence in primary care. Journal of General Internal Medicine, 32(3): 284-290. doi: 10.1007/s11606-016-3896-7

Legislative Service Commission. (2020). Section 4723.43 | Scope of specialized nursing services. Retrieved from https://codes.ohio.gov/ohio-revised-code/section-4723.43.

NCSL. (2021). Scope of Practice Policy. Retrieved from https://scopeofpracticepolicy.org/states/oh/

Poghosyan, L. Liu, J. & Norful, A. (2017). Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study. International Journal of Nursing Studies, 74: 1-7. doi: 10.1016/j.ijnurstu.2017.05.004 NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

By Day 6

Respond to at least two of your colleagues’ posts on two different days andprovide additional insight to your colleagues related to issues and topics they may want to also consider. Use the Learning Resources and/or the best available evidence from current literature to support your explanation.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 1 Discussion NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Module 1 Assignment: Taking a Health History: Building a Health History: Asking Difficult Questions

For this Assignment, you will develop a script to be used to interview a volunteer serving in the role of patient.

To prepare:

• Review the Ewing (2004) questionnaire found in this week’s Learning Resources and consider the difficult questions you might have to ask when you take a patient’s health history.
• Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.
• Review the media programs related to a vaginal exam, pap test, and breast exam.
• Review the health history guide presented in Chapter 7 of the Schuiling & Likis (2022) text and consider how you would create your own script for building a health history. (Note: You will also find the Health History Form in Chapter 7)
• Describe the components of a complete gynecologic health history.  Include  considerations for special populations such as  LGBTQ+ individuals NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.
• What health maintenance guidelines should be  included for initial and follow up  might be needed for follow-up assessments?  (i.e., bone density test, Gardasil vaccine, shingles, etc.)?
• What questions would you consider in your patient’s assessment? For example
  • What is your patient’s living situation?
  • Do they have stairs?
  • Do they live by themselves?
  • Do they have a working refrigerator?
• Create your own script for building a health history and use the Health History Template for guidance (consider the type of language you would use to help your patient be more comfortable). As you create your script, consider the difficult questions you want to include in your script.

Assignment: (1- to 2-page reflection)

• In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:
  • A brief summary of your experiences in developing and implementing your script during your health history.
  • Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

No Assignment submission due this week.

By Day 7 of Week 2

Submit your Module 1 Assignment by Day 7 of Week 2.

What’s Coming Up in Week 2?

Week 2: Knowledge Check

To go to the next week:

Week 2 NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Week 2: Common Health Screenings

Archeologists do not begin their work by simply selecting a site and digging for historical finds. Their initial steps involve laying the groundwork through research to apply expertise in their historical areas of focus, combined with best practices for excavation and analysis.

Similarly, nurse practitioners do not simply develop a treatment plan for patients. They methodically construct a patient’s history and apply best practices to conduct health screenings that help inform treatment. For practitioners of women’s healthcare this means applying expertise in specialized areas such as gynecology and gynecologic history taking and screening.

For this week, you examine the elements that comprise a patient’s gynecologic history.  As part of your Module 1 assignment, you will describe elements of a complete gynecologic history.

Learning Objectives

Students will:

• Analyze the elements of gynecologic history and recommended screenings for individuals (i.e., LGBTQ+)
• Analyze health maintenance guidelines when conducting patient assessments
• Create scripts for taking a health history to include difficult questions
• Develop patient health histories related to difficult questions
• Identify key terms, concepts, and principles related to the primary care of individuals, families, and communities NRNP 6552: Advanced Nurse Practice in Reproductive Health Care
• Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Optional Resource (click to expand/reduce)

Module 1 Assignment: Taking a Health History: Building a Health History: Asking Difficult Questions

For this Assignment, you will develop a script to be used to interview a volunteer serving in the role of patient.

To prepare:

• Review the Ewing (2004) questionnaire found in the Week 1 Learning Resources and consider the difficult questions you might have to ask when you take a patient’s complete health history.
• Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.
• Review the media programs related to a vaginal exam, pap test, and breast exam.
• Review the health history guide presented in Chapter 7 of the Schuiling & Likis (2022) text and consider how you would create your own script for building a complete health history. (Note: You will also find the Health History Form in Chapter 7)
• Include considerations for special populations such as LGBTQ+ individuals.
• What health maintenance guidelines should be included for initial and follow up might be needed for follow-up assessments? (i.e., bone density test, Gardasil vaccine, shingles, etc.)?
• Create your own script for building a health history and use the Health History Template for guidance (consider the type of language you would use to help your patient be more comfortable). As you create your script, consider the difficult questions you want to include in your script. There is no sample template to provide to you. You are the one to develop the script. Think of it as you are writing a movie and you need to write the script for the movie. What lines would you provide for the actor to utilize when sitting down with a patient to perform a COMPLETE Medical History which also entails those DIFFICULT GYN questions. You do not need to provide the answers to the questions however, if you find that beneficial, you may do so NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Assignment: (1- to 2-page reflection)

• In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:
  • A brief summary of your experiences in developing and implementing your script during your health history.
  • Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

By Day 7 of Week 2

Submit your Module 1 Assignment by Day 7 of Week 2.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “M1Assgn+last name+first initial.(extension)” as the name.
• Click the Module 1 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Module 1 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “M1Assignment+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Module 1 Assignment Rubric NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Module 1 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To participate in this Assignment:

Module 1 Assignment

Knowledge Check: Module 1

By Day 7

Complete and submit your Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Module 1 Knowledge Check

What’s Coming Up in Module 2?

Week 5: Knowledge Check

To go to the next module:

Module 2

Week 3: Gynecologic Health

Western movies often portray dusty old towns with limited available resources that include a single general store, a single saloon, and a single sheriff. Within these settings, healthcare is revealed to be the responsibility of the single town doctor.

Unlike these theatrical towns of old, most modern developed communities enjoy the luxury of diverse choices in shopping, entertainment, and more. Thankfully, this includes healthcare options that extend the concept of the “old west” town doctor to diverse specialty areas of practice, including those focused on women’s health care and wellness, such as gynecology.

For this week, you will use a case study to analyze information obtained from well-woman examinations. You also will consider and propose treatment plans for diagnoses.

Learning Objectives

Students will:

• Analyze pertinent patient information obtained from a comprehensive well-woman exam
• Formulate differential diagnoses
• Recommend diagnostics to support differential diagnoses
• Develop treatment and management plans
• Develop additional questions to support patient assessments NRNP 6552: Advanced Nurse Practice in Reproductive Health Care
• Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Optional Resources (click to expand/reduce)

Case Study Discussion: Gynecologic Health

For this Case Study Discussion, you will review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.

To prepare:

• By Day 1 of this week, you will be assigned to a specific case study scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your case study assignment from your Instructor.
• Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
• Carefully review the clinical guideline resources specific to your assigned case study.
• Use the Focused SOAP Note Template found in the Learning Resources to support Discussion. Complete a SOAP note and critically analyze this and focus your attention on the diagnostic tests. You are NOT to post your SOAP note. This is for your information only to help you develop your differential diagnosis and additional questions NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

By Day 3

DO NOT POST A SOAP NOTE. Post your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues’ posts on two different days and explain how you might think differently about the types of tests you might recommend and explain why. Use your Learning Resources and/or evidence from the literature to support your position.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Case Study Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 3 Case Study Discussion NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

What’s Coming Up in Week 4?

To go to the next week:

Week 4