Discussion 1 Based on Module 1: Lecture Materials & Resources and experience, what are the roles and responsibilities of the advanced nurse practitioners in prescribing? Peer 1: 1 response  1 paragrah short with  refrences The Purnell Model for Cultural Competence and its relevance for advanced practice nurse.Cultural competence is one of the principal foundations of clinical nursing. There are different perspectives regarding this issue as it has not yet been clearly defined and analyzed. Nurses are required to understand the distinct cultures and behaviors of their patients and to provide the appropriate services for their needs, and in order to achieve it, we first need to understand our own beliefs, values, behaviors, and customs, otherwise, cultural diversity becomes a significant barrier to the delivery of effective health care.The Purnell Model for Cultural Competence can effectively be used in the advanced nursing practice because it delivers the groundwork to understand in a better way the different cultural aspects, such as opinions about different illnesses, the healthcare system, experiences, and motivation. This model includes twelve domains that are important in evaluating the traits and characteristics of different ethnic groups. The twelve domains comprise an overview of heritage, communication, family roles and organization, workforce issues, bio-cultural ecology, high-risk behaviors, nutrition, pregnancy, death rituals, spirituality, healthcare practices, and healthcare professionals. The model uses a scheme of parallel circles that represent the elements of global society, community, family, and the individual itself. Finally, the cultural awareness of the health care provider ranges from unconsciously incompetent, where the person is unaware of the lack of knowledge about other cultures, to unconsciously competent, where the person automatically already delivers culturally competent care to patients from diverse cultures. (Albougami, Pounds & Alotaibi, 2016).The Purnell Model can be used for all healthcare professionals both in clinical practice and academic development, and according to Albougami, Pounds & Alotaibi, (2016) it is often being used in undergraduate communication and health assessment programs. This model has the powerful element of being flexible which gives it increased applicability in diverse healthcare circumstances. There are several studies showing the unique role of Advanced Registered Nurse Practitioners in delivery culturally competent care to diverse and underserved populations, where they have had to demonstrate compassion and understanding to be able to build a trustful patient-caregiver relationship. An example is this study by Carpenter & Theeke (2018) where they used the Purnell model to recruit a sample of adults with type 2 diabetes from the rural Appalachia. In this study, the health care providers used eight of the twelve domains of the Purnell model as a guide to understand and work effectively in their project while respecting their cultural beliefs, emphasizing in the concepts of trust and communication.Because of the current and anticipated growth of demographic variations, resulting from global geographic migrations, the importance of addressing cultural, ethnic, linguistic, racial, and spiritual health disparities is a must for healthcare organizations. The relevance of using the Purnell model for Advanced Nursing Practice is significant, due to the increased multi-cultural characteristic of our patients’ communities. Paying especial attention to the United States and its unique diverse population, facing a constant challenge of preventing health care disparities. Culturally competent healthcare organizations must ensure the delivery of adequate services for the diverse consumers by using evidence-based frameworks of organization, such as the Purnell Model for Cultural Competence.ReferencesAlbougami, A. S., Pounds, K. G., & Alotaibi, J. S. (2016). Comparison of four cultural competence models in transcultural nursing: A discussion paper. International Archives of Nursing and Health Care, 2(3), 1-5. Retrieved from https://pdfs.semanticscholar.org/f1b7/48b664e1236fc0841a6c33259403e3f4f5e9.pdf (Links to an external site.)Carpenter, R., & Theeke, L. A. (2018). Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence. International journal of nursing sciences, 5(3), 230-237.Purnell, L. D. (2013). Transcultural Health Care: A Culturally Competent Approach (4th ed.). F.A. Davis.  Peer 2: Roles and Responsibilities of Advanced Nurse PractitionerThe health sector and nursing professional practice has improved greatly due to constant advancement in education, research, practice, and incorporation of technology in health. Nurse practitioners are more experienced, skilled and knowledgeable to provide high-quality care in most critical cases and to participate in research teams with highly qualified medical professionals. Though nurse practitioners have bridged the healthcare gap created by the shortage of doctors, they are on the receiving end of a lot of criticism and opposition from legislators, stakeholders, and other professional organizations (Hooker, Brock & Cook, 2016). Despite the American Nurses Association and other nursing associations and agencies promise to represent the nursing professionals, nurse practitioners still find themselves advocating and fighting for full autonomy to practice.Several states in the US have implemented policies allowing full autonomy of practice. These professionals provide physician services and nursing services to health consumers and perform according to the state guidelines of practice, ethical principles of practice, and standard of professional practice. According to Park et al, (2018), NPs are expected to provide the best quality, safe, effective, and culturally appropriate care. Nurse practitioners with full autonomy practice independently and provide services ranging from health assessment, formulating a diagnosis, and interpreting test results. They also prescribe medications, educate patients or clients, formulate discharge plans, and refer patients to other health institutions or specialists. The District of Columbia, Alaska, and other 21 states allow full autonomy to nurse practitioners. These professionals offer medical consultation services, teach in institutions of medical sciences and work in critical care settings. However such autonomy comes with a lot of responsibility and repercussions. They must be accountable for all medical errors and mistakes that may arise. These challenge them to research, learn further and guide their practice with experience, scientific information, and critical thinking. Such autonomy comes with accountability and adherence to codes of conduct, ethics, and state policies. In Michigan and Virginia, nurse practitioners must work under a physician who constantly evaluates competency and quality of services. Restricted autonomy undermines the full potential of nurses. It undermines personal and professional development.Nurse practitioners also offer mental health and psychosocial health services. Depending on their area of specialization, NPs offer counseling services to individuals, families, and the community.  Mental health and psychiatric nurses consult mental health evaluation, diagnose mental problems, and create treatment and management plans. They address the psychosocial need of the patients and communities. To promote community health and prevent diseases, these professionals conduct health education and offer health promotion services. They are highly regarded by organizations and agencies. As a result, they participate in research, policy formulation, and implementation. It is their responsibility to ensure their consumers receive high-quality, safe, and effective medical attention. They are responsible for their actions, and as a result, use evidence-based practice and guide their practice with laws and guidelines to prevent the most common medical errors and negligence. Regardless of such benefits and positive impact NPs bring to the community, some states still deny them full autonomy to practice independently (Valentine, 2016). In efforts to give full autonomy to NPs, the American Medical Association has been against such policies and initiatives.  ReferencesHooker, R. S., Brock, D. M., & Cook, M. L. (2016). Characteristics of nurse practitioners and physician assistants in the United States. Journal of the American Association of Nurse Practitioners, 28(1), 39-46.Park, J., Athey, E., Pericak, A., Pulcini, J., & Greene, J. (2018). To what extent are state scope of practice laws related to nurse practitioners’ day-to-day practice autonomy?. Medical Care Research and Review, 75(1), 66-87.Valentine, N. M., 2016. Advancing Advanced Practice Nurses in Illinois: Challenges in the Land of the American Medical Association.Module1_Roles and Responsibilities of Advanced Nurse Practitioner_Myra Rico.docx ReplyReply to CommentCollapse SubdiscussionSill, ChristineSill, ChristineWednesdayJan 12 at 1:32pmManage Discussion EntryNur 600 Discussion 1The advanced practice nurse has great responsibility when it comes to prescribing medications. Before prescribing any therapy, a practitioner is responsible for gathering a thorough medical history and performing a physical assessment. Once the data is collected and evaluated, a diagnosis is made, and a treatment plan is established. Most treatment plans include medication therapy, usually a prescription medication or an OTC drug.In order to determine which drug would best fit the patient's needs, a risk-benefit analysis should be considered. The practitioner should weigh each drug's possible risks and side effects and choose the appropriate medication to prescribe that will give the best therapeutic effect. There are several factors to consider when prescribing medications. For example, the practitioner should consider differences in action, side effects, interactions, convenience, storage needs, route of administration, efficacy, and cost (Arcangelo et al., 2017).Prescriptive authority is regulated by the state in which the FNP practices. In 22 states and the District of Columbia, FNPs have full legal practice authority, including prescriptive authority. In the remaining states, FNPs must either work collaboratively with a physician or pass a probationary period before earning practice and prescriptive authority (Duquesne University, 2020). In states where FNPs have prescriptive authority, many are legally authorized to prescribe controlled substances, including opioid painkillers.Opioids were once a cornerstone for treating chronic and disabling pain. Now, they have driven a drug-addiction epidemic that claims the lives of 115 people in the United States every day. In many cases, the use of opioids leads to heroin, fentanyl, and other narcotics (Duquesne University, 2020).Patients may put pressure on the practitioner to prescribe a specific medication. It is up to the practitioner to decide if that medication, another medication, or maybe none at all is what is appropriate for that patient. They have a responsibility to prescribe something only if it is necessary for the patient's well-being and will be effective in treating the problem. Inversely, the practitioner must also explain why they will not prescribe the requested medication if it is not in the patient's best interest. This is just one example of why nurse practitioners need to understand the responsibility of becoming a medical provider.Education plays a significant role in prescribing medication. We need to educate our patients on what and why we prescribe certain medications, potential side effects to look out for, and ways to deal with possible adverse effects. Educating our patients on possible side effects may help prevent them from suddenly discontinuing a medication before discussing it with the practitioner.Studies show nearly one-third of adults in the United States take five or more medications daily. Unfortunately, the more medications a person takes, the greater the chance of adverse drug events.The World Health Organization suggests a multi-step approach to prescribing that may help providers better focus the intent for the treatment. The guidelines were established in 2007 and are still applicable today (Duquesne University, 2020).Evaluate and define the patient's problem.Determine the therapeutic objective of drug therapy.Select an appropriate medication.Provide patients with information, warnings, and instructions.Monitor the patient regularly.Consider drug costs when prescribing.Use appropriate tools, such as prescribing software and electronic drug references to reduce prescription errors.              When prescribing medication, there are many responsibilities, and serious consequences may result if these responsibilities are not taken seriously. Our common goal is to help our patients feel better and to do so safely and effectively.                                                                                       ReferencesArcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice (4th ed.). Lippincott Williams and Wilkins.Duquesne University. (2020, May 20). The APRN's Role and Responsibility in Ethical Prescribing. Duquesne University School of Nursing. Retrieved January 12, 2022, from https://onlinenursing.duq.edu/blog/aprns-role-resp...

Develop a 4-5 page quality/performance improvement framework for your doctoral project.Quality/performance improvement (QI/PI) frameworks are used to establish and evaluate processes in practice. The most common models for such a framework are Plan-Do-Study-Act (PDSA) and Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC). The purpose of this assessment is to use key information from your project charter to develop a QI/PI framework from which you will begin developing a project implementation plan and logic model in the next assessment.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Competency 1: Align the project charter with a continuous improvement model.Describe the current practice needing improvement.Explain how QI/PI data will be collected and analyzed.Describe the proposed QI/PI changes and expected outcomes.Explain how changes in quality or performance will be evaluated.Competency 6: Address assessment purpose in a well-organized text, incorporating appropriate evidence and tone in grammatically sound sentences.Write clearly and concisely in a logically coherent and appropriate form and style.Apply APA style and formatting to scholarly writing.PreparationNote: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page. InstructionsNote: The assessments in this course must be completed in the order presented; subsequent assessments should be built on both your earlier work and your instructor’s feedback on earlier assessments. If you choose to submit assessments prematurely, without considering and integrating your instructor’s feedback, your assessment may be returned ungraded, resulting in your loss of an assessment attempt.Develop a quality/performance improvement (QI/PI) framework for your project, aligned with your project charter. Choose a model for your framework, using the PDCA or DMAIC model, a model used in your organization, or another familiar reputable model that is suitable for your project. PDCA or DMAIC model information and examples are included in Resources.Provide a succinct, scholarly narrative that reflects the content of your model and addresses the key points outlined below:Graded RequirementsEach of the main tasks corresponds to scoring guide criteria. Read the performance-level descriptions in the scoring guide for each criterion to see how your work will be assessed.Describe the current practice needing improvement.What is the problem and its root cause?What is the gap between what is and what should be?What evidence supports your assertions and conclusions?Explain how QI/PI data will be collected and analyzed.What data is needed?How will you record and organize collected data?What are appropriate data analysis methods for the type of data you will be collecting?Describe proposed QI/PI changes and expected outcomes.What are appropriate measures for determining actual improvement?How feasible are the proposed changes and what are the relevant contextual factors that can affect expected outcomes?Explain how changes in quality or performance will be evaluated.What evaluation tools or methods will you use?What criteria will you use to evaluate outcomes?Write clearly and concisely in a logically coherent and appropriate form and style.Write with a specific purpose and audience in mind.Adhere to scholarly and disciplinary writing standards.Proofread your writing to minimize errors that could distract readers and make it difficult for them to focus on the substance of your introduction.Apply APA style and formatting to scholarly writing.Document Format and LengthFormat your QI/PI framework narrative using current APA style.An APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your narrative. Be sure to include:A title page and references page. An abstract is not required.Appropriate section headings.Your paper should comprise 4–5 pages of narrative plus title and references pages.Include your framework model as an appendix.Additional RequirementsBefore submitting your assessment, proofread it to minimize errors that could distract readers and make it difficult for them to focus on the substance of your QI/PI framework.