Advanced Practice Leadership Paper

Advanced Practice Leadership Paper

Advanced practice nurses (APNs) must have the knowledge and skills to serve as leaders in their practice setting, promoting patient interests. The current paper’s practice setting is a hospital inpatient care unit that provides transitional care to adult patients who have been hospitalized for congestive heart failure (CHF), a condition that is widespread, affecting up to 2% of American adults; high risk, with six-month re-hospitalization and cardiac mortality rates of 50% and 5.2%, respectively; and costly, with annual direct care expenses in the United States estimated to be close to $32 billion (Chuang et al., 2017; Lenzi et al., 2016; Whitaker-Brown et al., 2017). In this practice setting, APNs play critical leadership roles consistent with best practices in nurse leadership. The goal of this paper is to examine the advanced nursing practice leadership application from an ethics of care standpoint within the context of a hospital inpatient care practice setting to demonstrate how the ethic of care ultimately contributes to the advanced nursing practice role. The analysis in this paper is essential to conduct because applying ethics of care in advanced nursing practice can improve patient health, quality of life, and satisfaction outcomes by facilitating more personalized care while encouraging better treatment adherence (Shapiro et al., 2017). APNs working in a hospital setting focusing on improving CHF patient outcomes can improve their practice by incorporating this ethical approach into their leadership practices and perspectives. The remainder of this section will first provide a brief overview of the advanced nursing practice leadership dynamic. The following section of this paper defines and evaluates the ethics of care and ethics of justice perspectives in nursing practice using examples. The following section discusses the application of advanced nursing practice leadership. It reflects on using the ethics of care perspective, including the process of use and its outcomes, using examples from the practice setting. At the end of the paper, a brief conclusion summarizes the main points raised in the paper.

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Dynamic Leadership in Advanced Nursing Practice

In the CHF care delivery practice setting, the advanced nursing practice leadership dynamic is multifaceted and consistent with best leadership practices. The role of APNs in providing care to CHF patients includes tasks such as care and patient education delivery, as well as ensuring patients receive the appropriate post-discharge care to follow up. However, much of the advanced nursing practice role entails APN supervision, such as overseeing interdisciplinary care for CHF patients and leading teams to translate transitional care interventions, develop patient education messages, and create protocols to tailor interventions to the needs of CHF patients and their families (Boykin et al., 2014). The APN leadership role has been linked to increased nurse satisfaction, retention, and performance, which leads to better patient care outcomes (Metzger & Rivers, 2014). CHF care provided by nurse-led teams has been linked to lower re-hospitalization risks and improved health outcomes, supporting the application of advanced nursing practice leadership to this practice setting (Shapiro et al., 2017; Stamp et al., 2014). Confusion over ethical demands, on the other hand, can jeopardize nurses’ leadership quality, highlighting the need to carefully examine the ethical perspectives that may be applied in these leadership roles (Elliott et al., 2016). The following section contrasts two major ethical perspectives in nursing: ethical care and ethical justice.

Ethical Concern vs. Ethical Justice

Both the ethics of care and the ethics of justice perspectives in nursing are core ethical frameworks that can guide APN leadership in the CHF care practice setting. It is critical to compare and contrast these approaches to nursing ethics to determine which perspective is more applicable to this practice setting. The two subsections that follow each discuss the ethical care and ethical justice perspectives, using an example to illustrate each approach to ethics.

Ethical Care Perspective

The ethical care perspective has characteristics that make it a sound, ethical framework to use in the practice setting, and these characteristics can be demonstrated using examples. The ethics of care, according to Botes (2000, p.1072), is “an ethical approach in terms of which involvement, harmonious relations” with all stakeholders, as well as “considering the needs of others play an important part in ethical decisionmaking in each ethical situation.” The characteristics used in the ethics of care perspective are, first and foremost, care, which is a transpersonal, expressive set of behaviors that includes communication practices, resource investment, and the use of personal skills, as well as beneficence values and emotions of compassion and love (Sargent, 2012). Care can be demonstrated through nursing actions that are not directly related to patient care, such as taking into account patients’ needs, beliefs, resources, and input when defining a practice problem to improve the CHF care process or developing care guidelines for nurses providing care services to patients and their families. Empathy, emotional and mental involvement in one’s actions, and a desire to promote interpersonal harmony are also essential characteristics. Interpersonal harmony is more than a nicety; a nurse may try to persuade a CHF patient who does not want to change their diet, despite familial pressure, to do so to reap the benefits of the new diet while also avoiding a source of stress in the patient’s household.

The need for the patient to avoid stress is also related to another aspect of care ethics: care is provided based on each patient’s holistic needs and the context of the care relationship and setting (Norvedt & Vosman, 2014). Finally, extensive communication with this viewpoint facilitates rational decision-making. To develop a personalized intervention, a nurse may assess a patient’s social environment, lifestyle habits, home life, health beliefs and behaviors, family history, psychological state, and physical health (Hamar et al., 2016). From the standpoint of ethical justice, some of these factors would be avoided because they would be seen as having no meaningful influence on the success of evidence-based, standardized care. Because of the high rate of non-adherence patients have with many standardized care regimens, which raises readmission, complication, and mortality risks, the ethics of care perspective is helpful for CHF care (Bayati et al., 2014). Patient non-adherence to CHF care regimens can sometimes be attributed to the patient viewing the care recommendations as lacking consideration of their health beliefs or resources used to access care or because formal patient education did not take patient health literacy or other factors into account (Bayati et al., 2014; Plotka et al., 2017).

Ethical Justice Perspective

While the ethical justice perspective is not necessarily opposed to the ethics of care regarding its characteristics, there is enough difference between the two to distinguish them when applied in practice settings. The ethics of justice has been defined as “an ethical perspective in which ethical decisions are made on the basis of universal principles and rules, and in an impartial and verifiable manner.” The goal of making such decisions with the ethics of justice is “to ensure the fair and equitable treatment of all people” (Botes, 2000, p. 1072). The characteristics of this perspective demonstrate these factors.

This viewpoint seeks to encourage the autonomous decision-making of staff and stakeholders in an unbiased manner, with decisions based on rational, logical positivist approaches to knowledge (Norvedt & Vosman, 2014). Because decision-makers use logical positivism and universal rules of ethical reasoning, decision-making must be reliable regarding replicability and standardization. These characteristics imply that if an APN had a hunch that a CHF patient would adhere to care better by going to a specialist weekly for outpatient visits rather than receiving home health visits, the latter being more common for CHF patients in the practice setting’s program, the APN would need empirical evidence to back up the reasoning for recommending outpatient care before doing so (Hamar et al., 2016). Furthermore, APNs would create standardized patient education tools based on the most recent, valid research with the largest sample sizes for staff, patients, and patients’ families. However, many studies with high levels of evidence have not demonstrated the effectiveness of culturally tailored education compared to more generalized approaches. In that case, these tools are unlikely to make much allowance for cultural differences in care preferences or lifestyle habits. As a result, an advanced nursing practice approach based on care ethics would be more appropriate for use in the CHF transitional care practice setting. The following section reflects on how the ethics of care perspective is applied in practice settings.

Reflection on the Application from the Perspective of Care Ethics

The ethical care perspective can be applied in various ways, as evidenced by the various ways APNs have incorporated it not only into their direct interactions with patients and patients’ family members but also into the framework of their leadership activities. APNs use quantitative patient and facility data, as well as mixed-methods patient feedback surveys and qualitative interviews, to thoroughly understand patient experiences and needs, as well as how those needs may vary by culture, income, gender, and other factors, to identify problems for quality improvement and subsequent interventions, as well as the creation of patient educational materials. Furthermore, advanced nursing practice leaders’ care guidelines emphasize the importance of meeting holistic patient needs and provide guidance for nurses on tailoring care regimens to meet patients’ individual needs and resources, thereby promoting compliance. For members of interdisciplinary care teams, decision-making consensus is also emphasized as an aspect of harmony (Botes, 2000).

Conclusion

Well-defined advanced nursing practice leadership roles and APNs’ success in filling these roles are critical components of a practice setting involving developing and delivering transitional care programs to CHF inpatients in a large, urban hospital. The ability of APNs as a group to promote improved patient health outcomes and care regimen compliance while reducing hospitalizations and lengths of stay is due, in part, to the use of the ethics of care perspective, which informs APN decision-making in the practice setting. The ethical care and ethical justice perspectives were discussed in this paper by describing their characteristics, identifying examples, and analyzing their ability to be applied in the CHF care delivery setting. The analysis revealed that, while the ethics of justice perspective has valuable benefits in health care delivery, the ethics of care perspective is better suited to meeting patients’ highly individual needs in a personalized manner, making the ethics of care perspective more appropriate for use in the CHF transitional care environment that serves as the practice setting. The examples of how APNs use the ethics of care perspective in the CHF transitional care practice setting highlight another benefit of that ethical perspective: its versatility, which allows it to be applied in a wide variety of ways, allowing advanced nursing practice leaders to use the ethics of care perspective flexibly, depending on patient needs and practice setting demands.

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References

Bayati, M., Braverman, M., Gillam, M., Mack, K. M., Ruiz, G., Smith, M. S., & Horvitz, E. (2014). Data-driven decisions for reducing readmissions for heart failure: General methodology and case study. PLoS ONE, 9(10), 1–9.

Botes, A. (2000). A comparison between the ethics of justice and care. Journal of Advanced Nursing, 32(5), 1071–1075.

Chuang, E., Kim, G., Blank, A. E., Southern, W., & Fausto, J. (2017). 30-day readmission rates in patients admitted for heart failure exacerbation with and without palliative care consultation: A retrospective cohort study. Journal of Palliative Medicine, 20(2), 163–169.

Hamar, B., Rula, E. Y., Wells, A. R., Coberley, C., Pope, J. E., & Varga, D. (2016). Impact of a scalable care transitions program for readmission avoidance. American Journal of Managed Care, 22(1), 28–34.

Lenzi, J., Avaldi, V. M., Hernandez-Boussard, T., Descovich, C., Castaldini, I., Urbinati, S., & … Fantini, M. P. (2016). Risk-adjustment models for heart failure patients’ 30-day mortality and readmission rates: The incremental value of clinical data abstracted from medical charts beyond hospital discharge record. BMC Health Services Research, 16, 1-12.

Metzger, R., & Rivers, C. (2014). Advanced practice nursing organizational leadership model. Journal for Nurse Practitioners, 10(5), 337–343.

Nortvedt, P., & Vosman, F. (2014). An ethics of care: New perspectives, both theoretically and empirically? Nursing Ethics, 21(7), 753–754.

Plotka, A., Prokop, E., Migaj, J., Straburzynska-Migaj, E., & Grajek, S. (2017). Patients’ knowledge of heart failure and their perception of the disease. Patient Preference and Adherence, 11, 1459-1467.

Sargent, A. (2012). Reframing caring as discursive practice: a critical review of conceptual analyses of caring in nursing. Nursing Inquiry, 19(2), 134–143.

Whitaker-Brown, C. D., Woods, S. J., Cornelius, J. B., Southard, E., & Gulati, S. K. (2017). Improving the quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-to-care clinic. Heart & Lung, 46(2), 79–84.

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TOPIC: DPI Project Budget and Timeline

Assessment Description

Please use the attached document to complete this assignment

Creating a timeline and budget for your project is an often underestimated core skill. Projects often have hidden time commitments and costs that lead to unexpected expenses, which creates unintended barriers to project completion and sustainability. In collaboration with your mentor and senior leadership at your project site, create a timeline and budget for your DPI Project. This timeline and budget will be embedded in your final manuscript.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Review the attached resource, “DPI Project Management Timeline and Budget Template,” which will be used to complete this assignment.
• Doctoral learners are required to use APA style for their writing assignments.

Directions:

Part 1:

1. Create a detailed project timeline using the “DPI Project Management Timeline” section of the “DPI Project Management Timeline and Budget Template.”
2. Review each activity in the timeline.
3. Identify the course that each activity was completed.
4. Document the start date, the number of days required to complete the activity, and the end date.
5. For activities that have not yet been achieved, document an estimated start date, the number of days required to complete the activity, and the end date.

Part 2:

1. Create a detailed project budget using the “DPI Project Budget” section of the “DPI Project Management Timeline and Budget Template.”
2. Include anticipated direct and indirect costs, fixed and variable costs, labor and materials, travel, equipment and space, and license and miscellaneous expense.
3. Justify the total anticipated costs in 50-150 words per section.
4. Each section must be answered. If one section does not apply to your DPI Project, include an explanation as to why.

 

Resources

Advanced Practice Nursing: Essential Knowledge for the Profession

Read Chapters 10 and 23 in Advanced Practice Nursing: Essential Knowledge for the Profession.

Sommers, B. D., & Gruber, J. (2017). Federal funding insulated state budgets from increased spending related to Medicaid expansion. Health Affairs, 36(5), 938-944. https//doi.org/10.1377/hlthaff.2016.1666 https://www.proquest.com/healthcomplete/docview/1905634017/FE0AA7E7EEB34AA6PQ/3?accountid=7374&parentSessionId=YhvDBJA5av3Y0yX3GtrlZRi5%2BKPf%2BBFxUxEa3M6gRJc%3D

Balcazar, H., M. S., & George, S. (2018). Community health workers: Bringing a new era of systems change to stimulate investments in health care for vulnerable US populations. American Journal of Public Health, 108(6), 720-721. https//doi.org/10.2105/AJPH.2018.304427 https://www.proquest.com/healthcomplete/docview/2089757682/2B0AB6CAF4CA451EPQ/10?accountid=7374&parentSessionId=J2ItNaTaUh%2BTPwHMbaybX0wQoyiJWmNNVMsWgAkzw4g%3D

Beauvais, B., Richter, J. P., & Kim, F. S. (2019). Doing well by doing good: Evaluating the influence of patient safety performance on hospital financial outcomes. Health Care Management Review, 44(1), 2-9. https//doi.org/10.1097/HMR.0000000000000163 https://journals.lww.com/hcmrjournal/Abstract/2019/01000/Doing_well_by_doing_good__Evaluating_the_influence.2.aspx

Petrou, P., Samoutis, G., & Lionis, C. (2018). Single-payer or a multipayer health system: A systematic literature review. Public Health, 163, 141-152. https//doi.org/10.1016/j.puhe.2018.07.006

Institute for Healthcare Improvement. (2018, April 11). Providing better care for less [Video]. YouTube. https://www.youtube.com/watch?v=dxOJIZJtpQ0&feature=youtu.be

Kaiser, B. (Host). (2021, November 4). What mission-driven valued-based care looks like (No. 78) [Audio podcast episode]. In The Business of Healthcare podcast. YouTube. Kaiser, B. (Host). (2021, November 4). What mission-driven valued-based care looks like (No. 78) [Audio podcast episode]. In The Business of Healthcare podcast. YouTube. https://www.youtube.com/watch?v=59VvmWTqE4s