research paper week 7 capstone

Running head: NARRATIVE ANALYSIS 1

Narrative Analysis

Chamberlain College of Nursing

NR 667: FNP Capstone Practicum and Intensive

NARRATIVE ANALYSIS 2

Narrative Analysis

This paper is a narrative analysis to exhibit how the Chamberlain University Masters of

Science in Nursing (MSN) program Family Nurse Practitioner (FNP) track prepares the graduate

nurse to meet the university’s program outcomes (PO), the American Association of Colleges of

Nursing (AACN) Essentials of Master’s Education (MSN Essentials), and the National

Organization of Nurse Practitioner Faculties (NONPF) Core Competencies. This paper will

identify and explain how I have reached each of theses objectives by providing artifacts from my

graduate course work and reflect on how meeting these objectives have transformed me into a

prospective masters-prepared nurse.

Chamberlain University’s MSN/FNP Program Outcomes

Chamberlain University’s PO number one asserts that the masters-prepared nurse will

provide high-quality, safe patient-centered care that is grounded in holistic principles

(Chamberlain University, 2020). PO number two charges the maters-prepared nurse to provide a

caring environment that allows for the achievement of quality health outcomes (Chamberlain

University, 2020). The third PO encourages the masters-prepared nurse to engage in a reflective

practice and appreciate cultural diversity while participating in a lifelong pursuit of professional

growth and development (Chamberlain University, 2020). PO number four requires the masters-

prepared nurse to utilize professional values by continued scholarship and service in healthcare

(Chamberlain University, 2020). The final, fifth, PO challenges the masters-prepared nurse to

advocate for the positive health outcomes for patient through the practice of compassionate care

that is evidence-based and collaborative to exhibit advanced nursing practice (Chamberlain

University, 2020).

AACN’s MSN Essentials

NARRATIVE ANALYSIS 3

MSN Essential I asserts that the masters-prepared nurse have a background for practice

grounded in sciences and humanities and integrates those scientific findings from the fields of

nursing, biopsychosocial, genetics, public health, quality improvement, and organizational

sciences so that there is continuous improvement in the various diverse settings involving

nursing care (AACN, 2011). Essential II declares that the masters-prepared nurse understands

that organizations and systems leadership that are rooted in ethical decision making, efficient

interprofessional relationships, and a systems-perspective are important in the delivery of high-

quality-safe patient care (AACN, 2011). Essential III establishes that the masters-prepared nurse

should be well-versed in the methods, tools, performance measures, and standards that yield

quality improvement and be inclined to use quality principles within an organization (AACN,

2011). Essential IV declares that the master’s prepared nurse executes outcomes from research in

their practice setting, finds solutions for practice problems by working as a change agent, and

disseminates results to the healthcare community (AACN, 2011) Essential V ensures that the

masters-prepared nurse utilizes technology in patient care and communication that will transform

the integration and coordination of care (AACN, 2011). Essential VI requires the masters-

prepared nurse to arbitrate at the system level through involvement in policy development while

advocating to influence health and health care (AACN, 2011). Essential VII encourages the

masters-prepared nurse to work as a member and leader of interprofessional teams by

communicating, collaborating, and consulting with other healthcare professionals to effectively

manage and coordinate care (AACN, 2011). Essential VIII recognizes that the masters-prepared

nurse should integrate concepts that are broad, organizational, client-centered, and culturally

appropriate to plan, deliver, manage, and evaluate evidence-based clinical prevention and

population care not only to individuals, but also to their families and the community as well

NARRATIVE ANALYSIS 4

(AACN, 2011). Essential IX defines masters-level nursing practice as any form of nursing

intervention that elicits a change in the healthcare outcomes of individuals, populations, or

systems and declares that the masters-prepared nurse possess an advanced level of understanding

in nursing and other sciences and simultaneously understand how to integrate the knowledge into

clinical practice through direct and indirect interventions (AACN, 2011).

NONPF Core Competencies

NONPF core competency number one involves the scientific foundation competencies

and identifies that the masters-prepared nurse can critically analyze data and evidence that will

improve the advanced nursing practice, integrate knowledge from humanities and sciences and

apply it to the nursing profession, translate research and other knowledge in a manner that

improves the processes and outcomes of practice, and develops new approaches to practice that

is based on research, theory, and practice knowledge (NONPF, 2017). Core competency number

two incorporates the leadership competencies and asserts that the masters-prepared nurse

initiates and guides changes through involvement in complex and advanced leadership roles,

fosters collaboration with a number of stakeholders through leadership to improve health care,

incorporates leadership that utilizes critical and reflective thinking, strives for improved access to

quality and cost-effective healthcare, participates in advancement of practice through developing

and implementing innovations that promote principles of change, effectively communicates

knowledge in writing and through oral communication, and involves themselves in professional

organizations and activities that will positively influence the profession and health outcomes for

a population (NONPF, 2017). Core competency number three is the quality competency and

requires the masters-prepared nurse to use the best available evidence that will improve the

quality of practice, consider the relationship between access, cost, quality, and safety to

NARRATIVE ANALYSIS 5

healthcare, assess the impact that organizational structure, care processes, financing, marketing,

and policy has on the quality of health care, promote a culture of excellence by applying skills in

peer review, and implement proactive interventions in anticipation of variations in practice to

ensure quality (NONPF, 2017). Core competency number four incorporates the practice inquiry

competencies and challenges the masers-prepared nurse to be a leader by translating new

knowledge into practice, develop knowledge during clinical practice that will improve patient

outcomes, implement clinical investigative skills that will improve outcomes, lead by either

individually or in partnership with others questioning current practice, disseminate findings using

multiple modalities to diverse audiences, and critically analyze clinical guidelines and

individualize their recommendations in their practice (NONPF, 2017). Core competency number

five integrates the technology and information literacy competencies and suggests that the

masters-prepared nurse utilize appropriate technologies to improve health care and translate

information according to the audience’s needs (NONPF, 2017). Core competency number six

involves policy and requires the masters-prepared nurse to demonstrate an understanding of the

relationship between policy and practice, advocate for policies that are ethical to promote access,

equity, quality, and cost, and evaluate ethical, legal, and social factors that influence the

development of policy (NONPF, 2017). Core competency number seven, the health delivery

system competencies, endorse masters-prepared nurses that apply knowledge of organizational

practices and complex systems to improve the delivery of health care, initiate change in

healthcare by using skills in negotiation, consensus-building, and partnership, minimize risk to

patients as well as providers at the individual and systems level, scrutinize the structure,

function, and resources of an organization to improve the delivery of care while collaborating in

the planning of transitions across the continuum of care (NONPF, 2017). Core competency eight

NARRATIVE ANALYSIS 6

includes the ethics competencies and challenges the masters-prepared nurse to involve ethical

principles during decision making, examine their decisions for ethical consequences, apply

solutions that are ethically sounds when faced with complex issues related to individuals,

populations, and systems of care (NONPF, 2017). Core competency nine incorporates the

independent practice competencies and charges the masters-prepared nurse to function as a

licensed independent practitioner while demonstrating the greatest level of accountability during

professional practice and practice independently while managing patients previously diagnosed

or undiagnosed using health promotion, disease prevention, health protection, anticipatory

guidance, counseling, disease management, palliative, and end of life care principles (NONPF,

2017). Additionally the masters-prepared nurse should be equipped to employ advanced health

assessment skills to determine normal, variations of normal, and abnormal findings, utilize

screening and diagnostic testing to develop diagnoses, prescribe medications within the scope of

practice, manage health/ illness status of patients and families, provide patient-centered care that

considers cultural diversity and includes the patient as an active member in the decision-making

process (NONPF, 2017). Furthermore, the masters-prepared nurse embarks on a relationship

with patients that is based on mutual respect, empathy, and collaboration to promote

confidentiality, privacy, comfort, emotional support, trust, and respect (NONPF, 2017).

Decisions should be made according to the patients cultural and spiritual preferences, values, and

beliefs (NONPF, 2017). The masters-prepared nurse should recognize and develop strategies to

prevent their own personal biases from interfering with delivery of high-quality, patient-centered

care (NONPF, 2017). Additionally, the masters-prepared nurse is expected to actively participate

in the development, implementation, and evaluation of professional standards and evidence-

based care (NONPF, 2017).

NARRATIVE ANALYSIS 7

Course Artifacts

NR 500: NP Role

The Area of Interest PowerPoint assignment encouraged students to identify and discuss

an area of interest pertinent to his or her specialty track. The student was to expand by

identifying a common practice problem and recommend a way to positively affect change in

their specialty track. I chose to address the challenges associated with the vaccination of

children in the 21st century. This assignment shows evidence that I have met PO numbers two,

three, four, and five, MSN Essentials I, II, IV, VI, and VIII, and NONPF core competency

numbers one, two, three, four, seven, eight, and nine.

The Addressing Bias assignment educated the student regarding the increasing diversity,

globalization, and expanding technologies present in the healthcare system. It encouraged

introspection to identify any personal biases. Students were challenged to create a plan to

combat bias to promote not only professional growth but also personal growth. I expressed a

personal bias that is implicit, or unintentional, to alcoholism and/or substance abuse due to a

personal experience with a former spouse abusing alcohol. This assignment shows evidence that

I have met PO numbers one, two, three, and five, MSN Essentials II and VIII, and NONPF core

competency numbers two, eight, and nine.

The Week Four Leadership: Establishing Relationships and Influencing Change

Discussion encouraged development of interpersonal skills to prepare the student to become a

leader and a change agent. This discussion asks the student how they plan to influence change

and to identify two strengths possessed by the student that promotes leadership. The student was

also to identify two areas of improvement as well as two strategies that will enhance leadership

NARRATIVE ANALYSIS 8

abilities. This assignment shows evidence that I have met PO numbers three and four, MSN

Essentials I, II, IV, and VII, and NONPF core competencies number two and nine.

NR 501: NP Theory

The Application of Theory paper challenges the student to choose a nursing model and

apply it to their specialty track by appraising the value of the model as a theoretical framework.

The model that I selected was the Person-Centered Nursing (PCN) Care Framework. I plan to

utilize the constructs of this framework in my practice as a family nurse practitioner by being

actively involved in professional development and looking at every opportunity as a chance to

learn. This assignment has served as a reminder that the true essence of nursing is being

authentically and actively involved in the act of caring. This assignment shows evidence that I

have met PO numbers two, three, and four, MSN Essentials I, II, and IV, and NONPF core

competency numbers one and nine.

The Concept Analysis assignment encourages analytical thinking in regard to a nursing

theory with an application of a concept to the profession of nursing. I chose to analyze the

concept of compassion fatigue and to discuss the application of this concept to Watson’s Theory

of Caring. This assignment shows evidence that I have met PO numbers one, two, three, four,

and five, MSN Essentials I, III, VIII, and IX, and NONPF core competency numbers one, three,

seven, eight, and nine.

The Week Six Borrowed (non-nursing) Theories Applied to the Nursing Profession

Discussion asked the student to incorporate a non-nursing theory and discuss how it has been

applied or could be applied to their specialty track. I chose to incorporate Hans Selye’s

framework regarding the body’s response to stress called general adaptation syndrome (McEwen

& Willis, 2014). It is important that as leaders we recognize these responses to stress and, first,

NARRATIVE ANALYSIS 9

respond by making our nurses feel recognized and valued in order to maintain their professional

integrity and drive (McIntosh & Sheppy, 2013). This will work to increase autonomous

behaviors and improve self-image (McIntosh & Sheppy, 2013). We cannot expect to provide

high-quality, holistic healthcare if we are not treated in the same fashion by our leaders. I plan to

model these behaviors and actively use coping strategies to combat the stressors of the workplace

to provide the best care for my patients. This assignment shows evidence that I have met PO

numbers one, two, three, four, and five, MSN Essentials I, III, IV, VI, VII, and IX, and NONPF

core competency number one, three, four, seven, eight, and nine.

NR 503: Population Health

The Evaluation of an Epidemiological Disease or Problem assignment calls for the

student to incorporate knowledge and skills obtained during this course in order to practice

problem solving with chronic population health issues and apply them to their current geographic

area. I chose to discuss schizophrenia. Mental health illnesses are serious, chronic disorders that

deserve the same attention and prompt intervention and follow-up as those chronic diseases like

diabetes and heart disease. Schizophrenia, although rare, is a life-altering, chronic disease that

can be identified, treated, and managed with careful consideration and attention from primary

care providers. As stewards of the community, healthcare providers owe it to the aggregates of

their community to be actively involved in the identification, treatment, and rehabilitation of

those suffering from schizophrenia. Those suffering from mental health illnesses are members of

a severely underserved population and when left untreated often result in severe financial,

emotional, social, and environmental burden. This paper has sought to provide a background of

the disease of schizophrenia, discuss any surveillance or reporting methods, provide a descriptive

epidemiology analysis, analyze diagnostic and screening tools that are used, and provide a plan

NARRATIVE ANALYSIS 10

of action to address patients that are suffering from schizophrenia in an attempt to serve as

advocates for this underserved and often stigmatized population. This assignment shows

evidence that I have met PO numbers one and three, MSN Essentials I, IV, VI, VIII, and IX, and

NONPF core competency numbers one, three, six, seven, eight, and nine.

The Infectious Disease paper encouraged the exploration of communicable diseases to

include epidemiology and the implications of the disease. I chose to cover varicella. According

the American Association of Nurse Practitioners (2019), the nurse practitioner can uniquely

provide management of healthcare needs while keeping the whole individual in mind. They

believe that the nurse practitioner has a main focus of health promotion and prevention with an

emphasis on education and counseling in order to empower patients to make healthier choices all

while lowering the cost of healthcare (AANP, 2019). Nurse practitioners must be knowledgeable

in the pathophysiology, treatment, and management of infectious diseases. He or she must also

be up to date on those diseases that are reportable due to their infectious nature. The nurse

practitioner must be diligent in providing primary prevention by initiating education to the public

regarding communicable diseases, secondary prevention measures by screening high risk

individuals for communicable diseases, and tertiary prevention by restoring the health of those

affected by communicable diseases. It is also important that the nurse practitioner stay current on

the epidemiological dynamics of communicable diseases in his or her area by using the most up-

to-date research to provide evidence-based practice. This assignment shows evidence that I have

met PO numbers one, two, and five, MSN Essentials I, IV, VI, and VIII, and NONPF core

competency numbers one, three, seven, and nine.

The Week Eight Health Policy and Ethics Discussion charged the student to navigate

their state government web page to identify a health policy enacted in the last two years and

NARRATIVE ANALYSIS 11

report the bill number as well as the sponsors of the bill. Next, the student was to write a

summary of the policy while including the concepts of advocacy, population health, and the ANA

ethical statements. I chose the Tennessee house bill number 0744 (HB0744) and Senate bill

0281 (SB0281) since they endorse and execute the Chronic Disease Prevention Act (Tennessee

General Assembly, 2019). This assignment shows evidence that I have met PO numbers three

and four, MSN Essentials I, II, III, IV, VI, and VII, and NONPF core competency numbers one,

three, six, seven, eight, and nine.

NR 505: NP Advanced Research and Evidence-Based Practice

The Refinement of Nursing Concern into an Evidence-Based Practice Proposal

assignment allows the student to revisit the area of interest assignment completed in NR 500.

The student was asked to produce an overview of the evidence-based practice (EBP) project

along with the PICOT/PICo question. This assignment was the beginning of the EBP proposal

project that was followed throughout the course. After discussing the history and present state of

EBP, I returned to my original area of interest and discussed the hesitancy of parents toward the

use of vaccinations. Next, I introduced the process of formulating the PICOT/PICo question

along with the process of searching for literature. I chose to incorporate the Health Belief Model

(HBM) for guidance on the solution of the problem. The Health Belief Model (HBM) provides a

rare understanding of the refusal or hesitation of childhood vaccination by parents and provides

insight to the steps that a practitioner must take to change the behaviors of these parents. The

HBM works under two assumptions: people place a conscious value upon avoiding disease and

illness, and they have expectations that certain actions will prevent the attainment of the disease

or illness (Adams, Hall, & Fulghum, 2014). In other words, the higher the individual’s

perception of threat by the illness, the more likely they are to participate in preventative

NARRATIVE ANALYSIS 12

measures (Adams, Hall, & Fulghum, 2014). Concurrently, the higher the perceived likelihood of

contracting the disease or illness, the more likely they will engage in preventative care (Adams,

Hall, & Fulghum, 2014). This assignment shows evidence that I have met PO numbers one, two,

three, four, and five, MSN Essentials I, II, III, IV, VI, and VIII, and NONPF core competency

numbers one, three, four, six, eight, and nine.

The Research Literature, Design, Sampling, and Implementation assignment expands on

the EBP proposal project that began in week two of the course. This assignment calls for the

discussion of the research needed to support the concern, the identification of the research

design, explanation of the sample method, and implementation through a change model. The

process of reviewing literature in nursing research provides alignment of available research

information with the goal of improving patient outcomes (Baker, 2016). The information

reviewed provides foundational information about what is known and identifies any gaps in

knowledge (Baker, 2016). The literature review for this EBP project will provide a basis and

allow for expansion and understanding of the impact of individualized education regarding the

concerns of parents of children aged birth to six months and the decision to accept, delay, or

refuse vaccinations. Ten research articles were analyzed for the purpose, research approach, data

collection methods, results, strengths, and limitations. This EBP project will make use of a

qualitative research approach using a phenomenological design. Qualitative research approaches

study individuals in their natural environment and seek to find meaning in their lived experiences

and perceptions. In particular, the phenomenological design is used to evaluate the experiences

of individuals as they are actively living and in their natural settings. The researcher using this

design has a desire to understand why the participants feels a certain way or choose a certain

choice (Farghaly, 2018). The sampling method that will be used is a non-probability sampling

NARRATIVE ANALYSIS 13

method meaning that it is not randomized. Edward Deming produces the PDSA change model to

enable knowledge development and implement a change in behavior (Donnelly & Kirk, 2015).

PDSA is an acronym for plan, do, study, and act (Donnelly & Kirk, 2015). Using the PDSA

change model for this EBP project is appropriate because the problem of vaccination delay or

refusal is increasing with no proven method of changing the minds of parents. This assignment

shows evidence that I have met PO number four, MSN Essentials I, III, IV, VI, and VIII, and

NONPF core competency numbers one, two, three, four, six, and nine.

The Data Collection, Analysis, Evaluation, Dissemination of Results, and Conclusion

assignment serves as the completion of the EBP proposal project which began in week two of

this course. It is in this assignment that the student focused on data collection, analysis,

evaluation, dissemination of results, and the conclusion. For this evidence-based practice (EBP)

proposal project, a qualitative design is used with a PICo question to assess the impact of

education that is tailored to the concerns and needs of the parent affect the parent’s decision to

accept, delay, or refuse vaccinations. The data will be collected with a pre-visit survey to assess

concerns regarding vaccination and intent to vaccinate along with a post-visit telephone

interview to assess effectiveness of the individualized education. The telephone interviews will

also assess for any remaining concerns or teachable moments as well as intent to vaccinate.

Records will also be analyzed to monitor for adherence to suggested vaccination schedules. In

this qualitative EBP proposal project, data is analyzed by the use of coding to identify themes

among parents regarding what drives their hesitancy toward childhood vaccinations and the

impact that educational interventions have on their intent to vaccinate. Codes will be formed

after analyzing the follow-up telephone interviews by identifying similar words or thoughts.

Themes will emerge after evaluation of relationships during coding. Codes will be sorted into

NARRATIVE ANALYSIS 14

concerns, impact of education on the concerns, and intent to vaccinate. The use of triangulation,

or peer debriefing, allows for expression of reliability. Triangulation is important to qualitative

research as it provides opportunity for multiple reviews by multiple researchers proving that the

results are able to be replicated (Belotto, 2018). The results of this EBP proposal project could be

shared with the stakeholders through a PowerPoint presentation at a staff meeting aimed at

improving patient outcomes. The results could be shared within a facility through the use of e-

mail, in-services, or screen savers on computers. The community could be provided with the

information through the use of articles shared via social media or interviews with local media

outlets. Results of the project could be shared at the state level by contacting a representative of

the state board of nursing and requesting to be added to the agenda at the next meeting and

presenting the findings via PowerPoint presentation. Dissemination of results nationally could be

accomplished through involvement in political activism. This assignment shows evidence that I

have met PO number four, MSN Essentials III, IV, and VIII, and NONPF core competency

numbers one, three, four, six, and nine.

NR 509: Advanced Physical Assessment

The Week Eight Reflection Post highlights quality improvement strategies. The student

was to reflect upon PO number one stating what the outcome means to them. The student was to

cite two examples of how he or she achieved or had exposure to this outcome. In addition, the

student was to review the results of the APEA 3P exam and identify three domains that

represented the lowest percentage in relation to the national average. I was very excited to see

that I only had one area that fell below the national average, which was Urology. My other two

lowest domains were Women’s Health and Psychiatry. Furthermore, the student was to research

topics related to those domains and develop a self-guided quality improvement plan. This

NARRATIVE ANALYSIS 15

assignment shows evidence that I have met PO numbers one and five, MSN Essentials I and III,

and NONPF core competency numbers one and three.

The Week One Shadow Health assignment involved the interview and comprehensive

health history of Ms. Jones’ recent right foot injury. The student was provided the opportunity to

practice effective therapeutic communication skills to educate and empathize with Ms. Jones.

The student was to create a problem list from the data collected during the interview and

prioritize the data into immediate and non-immediate care while planning the best way to address

the most important issue through assessment, intervention, and education. The information was

documented using the SOAP note template. This assignment shows evidence that I have met PO

numbers one, two, and five, MSN Essentials I, IV, V, VII, and IX, and NONPF core competency

numbers one, five, and nine.

The Week Six Shadow Health assignment allowed the student to encounter Daniel

Rivera, an 8-year-old boy with the chief complaint of a cough. The student was to determine if

the patient was in any distress, explore the underlying cause, and investigate for related

symptoms in other body systems. It challenged the student to differentiate the presenting

symptoms as well as perform a physical exam. The visit was to be documented using the SOAP

note template. In this assignment, the student was also tasked with identifying three differential

diagnoses with ICD-10 codes as well as pertinent positives and negatives for each diagnosis.

The student was also to produce a comprehensive treatment plan including diagnostics,

medications, education, referral/consultation, and follow-up. This assignment shows evidence

that I have met PO numbers one, two, and five, MSN Essentials I, IV, V, VII, and IX, and

NONPF core competency numbers one, five, and nine.

NR 510: Leadership and Policy

NARRATIVE ANALYSIS 16

The APN Professional Development paper provided the student with the opportunity to

research the role of the APN and develop and professional plan. This assignment discussed the

goals and purpose of the APN professional development plan, the APN scope of practice in the

student’s state, a personal assessment of Benner’s Self-Assessment Tool, strategies for

networking and marketing, and completion of a CV/resume. This assignment shows evidence

that I have met PO number three, MSN Essentials II, III, IV, V, and IX, and NONPF core

competency numbers five, seven, and nine.

The Recorded LACE presentation challenged the student to investigate how licensure,

accreditation, certification, and education (LACE) differ for all four APN clinical roles in

California, Washington, and Illinois. Additionally, the student was to share the evidence-based

strategies that could be implemented to foster continuity between state regulatory boards. The

student was to identify if independent NP practice was allowed in their state and to share their

opinions in relation to independent practice in their state. This assignment was completed via

PowerPoint with a visual and audio presentation in Kaltura. This assignment shows evidence that

I have met PO number four, MSN Essentials II, III, IV, V, and IX, and NONPF core competency

numbers two, four, five, six, seven, and nine.

In the Health Policy Concern assignment, the student was able to select a healthcare

policy concern that can be improved if changed with the potential of improvement as an outcome

for a population group. Students were asked to present the change proposal to an elected official

and then analyze the project. I spoke with the head of the school board about reports of sexual

misconduct of teachers with students and proposed a change in policy that would teach

susceptible students how to recognize inappropriate behaviors and how to seek help. This

assignment shows evidence that I have met PO numbers two, three, and five, MSN Essentials I,

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III, IV, VI, VII, VIII, and IX, and NONPF core competency numbers one, two, three, four, six,

seven, eight, and nine.

NR 599: Informatics

For the HealthIT Topic of the Week assignment, the student was asked to select a popular

topic from FierceEMR or FierceHealthIT and write a scholarly paper on how the topic will

impact practice whether it be positively or negatively. The student was also required to share

what skills or knowledge related to informatics were used in the development process of the

assignment. This assignment asked students to address popular health information technology

topics and their impact on current practice. Patient engagement is an extremely important topic

because patients are the health consumers. As in any public service, the customer, or patient,

should be the focus of practitioners. Clients that are well informed and engaged in their own

health care are more likely to experience satisfactory outcomes. No matter the education or

experienced possessed, providers should continually learn and grow by improving competencies,

especially those related to the use of technology in patient and family engagement to foster

relationships that are mutually respectful and honest. This assignment has provided me with

many examples on how to actively engage my patients in participating in their own health care. I

would recommend including patients in the design, development, and implementation of

technologies to best meet their needs. Future research regarding the use of virtual clinic visits is

warranted to continue to increase accessibility of health care. This assignment shows evidence

that I have met PO numbers one and five, MSN Essentials I, III, IV, and V, and NONPF core

competency numbers one, three, five, six and nine.

The Narrated PowerPoint presentation was an extension of the HealthIT Topic of the

Week assignment. Students were asked to summarize their explanation for selecting the topic,

NARRATIVE ANALYSIS 18

how practice would be impacted by the topic, and the informatic skills used during the

development process of the assignment in a visual and audio presentation using PowerPoint and

Kaltura. This assignment shows evidence that I have met PO numbers four and five, MSN

Essentials I, III, IV, and V, and NONPF core competency numbers one, three, five, six, and nine.

The Week Two Wisdom Versus Judgement Discussion asks the student how the concept of

wisdom in nursing informatics compares to the concept of professional nursing judgement. The

student was asked to define DIKW and discuss how it is used in practice. As stated by

McGonigle and Mastrian (2018), the concept of wisdom to the DIKW Paradigm was added in

2008. Wisdom occurs when a nurse learns to apply knowledge learned through the information

obtained by collecting data specific to a patient (McGonigle & Mastrian, 2018). The nurse

accomplishes this through learned knowledge and experience which, in turn, boosts the common

sense allowing him or her consider the values of the patient and exercise appropriate judgment to

provide high-quality, safe care to patients and their families (McGonigle & Mastrian, 2018). I

view professional nursing judgment as the ability of the nurse to provide appropriate ethical care

to patients in the most prudent manner while considering the individual needs of the patient to

provide holistic care in a cost-effective manner. The difference between wisdom and

professional nursing judgment is that wisdom can only be achieved through the application of

knowledge and experience, while a novice nurse can apply the information obtained through

nursing education to come to sound professional nursing judgment. The DIKW framework was

conducted by Graves and Cocoran and incorporates the central concepts of data, information,

knowledge, and wisdom (Ronquillo, Currie, & Rodney, 2016). Data are separate items observed

objectively without the use of interpretation (Ronquillo, Currie, & Rodney, 2016). Information

is obtained when data organized and interpreted (Ronquillo, Currie, & Rodney, 2016). Once

NARRATIVE ANALYSIS 19

information is integrated and established, knowledge occurs (Ronquillo, Currie, & Rodney,

2016). Wisdom is the result of knowing when and how to apply knowledge for the benefit of

patient outcomes (Ronquillo, Currie, & Rodney, 2016). Nurses use the DIKW framework

without knowing that they use it. For example, in my work as a cardiac nurse on a progressive

cardiac unit I assess my patients to arbitrate their needs. I do this by collecting data to evaluate

and understand the situation at hand to make an informed decision about the interventions that

will be used while considering my experience with similar cases and the individual values of the

patients themselves. This assignment shows evidence that I have met PO numbers one, two,

three, and five, MSN Essentials V and IX, and NONPF core competency numbers two, five, and

nine.

NR 601: Aging

The Case Study assignment challenged the student to evaluate subjective and objective

data to diagnose and develop a treatment plan for the case study patient. The student was

directed to use the national diabetes guidelines as well as other national guidelines to manage

secondary diagnoses. This assignment challenged the student to analyze data to diagnose, treat,

and manage the health of a 55-year old Hispanic female with a chief complaint of fatigue and

decreased level of energy. The primary diagnosis for Mrs. G is type 2 diabetes mellitus (ICD-10

E11.9) (Type 2 diabetes mellitus, 2016). A secondary diagnosis for Mrs. G is hyperlipidemia

(ICD-10 E78.5) (Hyperlipidemia, 2016). Diabetes is a chronic disorder that can result in multiple

complications and comorbidities that could extensively decrease quality of life and length of life.

However, these complications can be decreased very easily with the introduction of medications

and lifestyle modifications that will also work to decrease the secondary diagnosis of

hyperlipemia. If Mrs. G were not treated promptly, she could very easily lose life or limb. This

NARRATIVE ANALYSIS 20

case study has been extremely informative in learning how one chronic disease can affect the

entire body. This assignment shows evidence that I have met PO number five, MSN Essentials

I, IV, VI, VII, VIII and IX, and NONPF core competency numbers one, six, and nine.

The Week One Polypharmacy Discussion encouraged the student to obtain a deeper

understanding of polypharmacy to include risk factors as well as three interventions to prevent

polypharmacy and the complications associated with polypharmacy. The student was also asked

to give an example of how their preceptor has addressed polypharmacy. This assignment shows

evidence I have met PO numbers one and five, MSN essentials I, III, IV, VI, VIII, and IX, and

NONPF core competency numbers one, two, three, six, eight, and nine.

The purpose of the Week Six Post-Menopausal and Sexuality Issues in the Maturing and

Older Adult Discussion was to explore post-menopausal and sexuality issues in the maturing and

older adult. Specifically, the student was to discuss the symptoms of genitourinary syndrome of

menopause (GSM). The student was expected to reflect on their individual comfort level

associated with the sexual history interviewing of the maturing or older adult. This assignment

shows evidence I have met PO numbers one, two, three, and five, MSN essentials I, III, IV, VI,

VIII, and IX, and NONPF core competency numbers one, two, three, six, eight, and nine.

NR 602: Care of the Childbearing Family

In the Marginalized Women Health paper the student was required to choose a topic from

the list and then identify the disease or population health problem that was an issue in his or her

geographic area that he or she will serve following graduation. The student was asked to discuss

social justice and how it is related to health disparities and health care of the marginalized group.

A plan was to be included with three actions the student would use during their practice. The

student was to discuss how her, or she will measure the outcomes of those actions. The group of

NARRATIVE ANALYSIS 21

marginalized women that I chose for this assignment was female veterans. This assignment

shows evidence that I have met PO numbers one, three, and five, MSN essentials I, III, IV, VI,

VIII, and IX, and NONPF core competency numbers one, two, three, six, eight, and nine.

In the Pediatric Grand Rounds Presentation and Discussion, the student was asked to

create a video PowerPoint presentation in Kaltura on an assigned topic picked by the professor.

This presentation was required to discuss pathophysiology, epidemiology, risk factors, and

clinical assessment findings. There should have been three differential diagnoses, as well as any

diagnostic studies to confirm diagnosis, prevention, treatment, patient education, and follow-up.

The student also discussed the best practices for optimal outcomes. I was assigned

gynecomastia. This assignment shows evidence that I have met PO numbers one, two, four, and

five, MSN Essentials I, IV, V, VI, VIII, and IX, and NONPF core competency numbers one, five,

six, and nine.

The Women’s Health Grand Rounds Presentation and Discussion involved a recorded

PowerPoint presentation in Kaltura on a topic assigned to the student by the professor. The

student was asked to discuss the pathophysiology, epidemiology, risk factors, and clinical

assessment findings. There was to be at least three differential diagnoses along with applicable

diagnostics, prevention, treatment, education, and the best practices for optimal outcomes. I was

assigned human papillomavirus. This assignment shows evidence that I have met PO numbers

one, two, four, and five, MSN Essentials I, IV, V, VI, VIII, and IX, and NONPF core competency

numbers one, five, six, and nine.

NR 603: Clinical Diagnosis

In Part One of the Mental Health Clinical Presentation the student was assigned a mental

health disorder commonly seen in primary care. I was assigned the topic of delayed grief. This

NARRATIVE ANALYSIS 22

study could mirror a patient seen in practicum or be completely fabricated. The case study

should not be overly simple and in part one should include the chief complaint, HPI,

demographic data, past medical history, subjective and objective findings. This assignment

shows evidence that I have met PO number five, MSN Essentials I, IV, V, VI, VIII, and IX, and

NONPF core competency numbers one, five, six, and nine.

The Part Two Mental Health Final Treatment Plan/Analysis assignment was the

completion of the mental health part one assignment. This final treatment plan asked the student

to present a primary diagnosis, any diagnostic testing recommended by national guidelines,

medications, interventions, education, labs, follow-up, or referral if needed. There was also an

analysis section to which the student was asked to provide a brief pathophysiology and

pharmacology summary along with any pertinent national guidelines, follow-up, referral, quality

improvement measures, coding, and billing information. This assignment shows evidence that I

have met PO number five, MSN Essentials I, III, IV, V, VI, VIII, and IX, and NONPF core

competency numbers one, three, five, six, and nine.

The Week Eight Reflection post asked the student to identify how they were able to

achieve the objective of PO number four and how that prepared him or her to meet the MSN

essential IV and the nurse practitioner core competency number seven. I used two examples

from practicum to establish that I had met PO number 4. I mentioned the other two artifacts

presented above as proof of meeting MSN Essential IV and NONPF core competency number

seven. This assignment shows evidence that I have met PO numbers four, MSN Essential IV, and

NONPF core competency number seven.

NR 667: Capstone

NARRATIVE ANALYSIS 23

The narrative analysis is a 3,000 to 4,500-word reflective narrative that requires the

student to explain how each artifact from the various courses meet each MSN/FNP PO with an

evaluation of professional growth and development in the cognitive, psychomotor, and affective

domains. Additionally, there is an evaluation of professional growth and development in relation

to the MSN Essentials and the NONPF competencies. The student is also asked to reflect upon

how their cultural competence has been transformed. This assignment shows evidence that I

have met PO numbers one thru five, MSN Essentials I-IX, and NONPF core competency

numbers 1-9.

The Certification Review Plan assignment asked the student to identify strengths and

weaknesses that will better prepare the student for the APEA post-predictor exam, the national

certification exam, and the first year of FNP clinical practice. The student will identify

opportunities for improvement as well. This assignment shows evidence that I have met PO

number four, MSN Essentials III and IX, and NONPF core competency numbers two, three, five,

and nine.

The Grand Rounds Presentation was intended for the student to gain knowledge

regarding a chronic health condition commonly seen in primary care. The student was to choose

from a weak area identified by the APEA pre-predictor exam in NR 603. I scored the lowest in

the pulmonary section, so I chose to present an infographic of obstructive sleep apnea. This

assignment shows evidence that I have met PO numbers one, two, four, and five, MSN Essentials

I, IV, V, VI, VII, and IX, and NONPF core competency numbers one, five, six, and nine.

Cognitive, Psychomotor, and Affective Professional Growth and Development

A highly accepted learning framework is Bloom’s taxonomy, which involves three

learning domains: cognitive, affective, and psychomotor (Muzyk et al., 2018). Within the

NARRATIVE ANALYSIS 24

cognitive domain there are six categories of learning: remembering, comprehending, applying,

analyzing, evaluating, and creating (Muzyk et al., 2018). I began this program by doing a lot of

memorization work, but quickly realized that in order to be successful I had to actually

comprehend the information that I was reviewing. I think the most effective retention, for

myself, occurred once I began practicum courses and had the opportunity to put it all together.

The affective domain connects the learner to emotions in regard to people and situations (Muzyk

et al., 2018). Characteristics associated with this domain are the receiving phenomena,

responding phenomena, internalizing values, valuing, and organization (Muzyk et al., 2018). I

feel as though I have always had a pretty good grasp on this domain, but practicum definitely

gave me a new perspective on how to engage in therapeutic relationships with patients to reach

optimal outcomes. Finally, the psychomotor domain is related to the learner’s response to cues,

both verbal and non-verbal, as well as performance, imitation, and trial and error (Muzyk et al.,

2018). The characteristics associated with this domain are perception, set, guided response,

mechanism, complex overt response, adaptation, and origination (Muzyk et al., 2018). I

comprehend this domain as the ability to combine both the cognitive and affective domains and

bring it all together to see the whole picture. I have found a greater success with this through my

study in the MSN/FNP coursework at Chamberlain University.

Transformation of Cultural Competence

Cultural competency is a combination of behaviors, attitudes, and policies that function

congruently in a system or among professionals to yield an environment that is conducive among

cross-cultural situations (Young & Guo, 2020). In our present day, it is of utmost importance to

consider cultural aspects and involve yourself, as a provider, in social justice reform. Prior to

becoming involved in this program, I must say I was quite naïve to the overwhelming inequities

NARRATIVE ANALYSIS 25

experienced by minority groups. This program and the coursework involved has greatly evolved

my cultural competence as well as my emotional intelligence.

Conclusion

The masters-prepared nurse is expected to complete an education program that is

comprised of coursework that aligns with the MSN Essentials and NONPF core competencies to

prepare him or her to enter into practice as an advance practice nurse. In addition to the

acquisition of these objectives, the advanced practice nurse must participate in learning activities

that challenge his or her professional growth and development to provide culturally competent

health care across the lifespan. This narrative analysis exhibits how the Chamberlain University

MSN/FNP program prepares the masters-prepared nurse to enter into the nursing profession as a

culturally competent advanced practice provider.

NARRATIVE ANALYSIS 26

References

Adams, A., Hall, M., & Fulghum, J. (2014). Utilizing the health belief model to assess vaccine

acceptance of patients on hemodialysis. Nephrology Nursing Journal, 41(4), 393-407.

American Association of Colleges or Nursing (AACN). (2011). The essentials of master’s

education in nursing. Retrieved from

http://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf.

American Association of Nurse Practitioners. (2019). What’s a nurse practitioner? Retrieved

from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner.

Baker, J.D. (2016). The purpose, process, and methods of writing a literature review. AORN

Journal, 103(3), 265-269. doi: 10.1016/j.aorn.2016.01.016.

Belotto, M.J. (2018). Data analysis methods for qualitative research: Managing the challenges of

coding, interrater reliability, and thematic analysis. The Qualitative Report 2018, 23(11),

2622-2633.

Chamberlain University. (2020). Academic catalog 2020-2021, Vol.13: Graduate program

outcomes. https://www.chamberlain.edu/media/3371/catalog.pdf.

Donnelly, P & Kirk, P. (2015). Use the PDSA model for effective change management.

Education for Primary Care, 26(4), 279-281.

Farghaly, A. (2018). Comparing and contrasting quantitative and qualitative research approaches

in education: The peculiar situation of medical education. Education in Medicine Journal,

10(1), 3-11. doi: 10.21315/eimj2018.10.1.2.

NARRATIVE ANALYSIS 27

Hyperlipidemia. (2016). In Epocrates Plus for Apple iOs. (Version 19.12). [mobile application

software]. Retrieved from https://epocrates.com/movile/iphone/plus.

McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA:

Wolters Kluwer/Lippincott Williams & Wilkins.

McGonigle, D. & Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th

ed.). Burlington, MA: Jones and Bartlett.

McIntosh, B. & Sheppy, B. (2013). Effects of stress on nursing integrity. Nursing Standard,

27(25), 35-39.

Muzyk, A.J., Tew, C., Thomas-Fannin, A., Dayal, S., Maeda, R., Schramm-Saptya, N., Andolsek,

K., & Holmer, S. (2018). Utilizing Bloom’s taxonomy to design a substance use disorders

course for health professions students. Substance Abuse, 39(3), 348-353. doi:

10.1080/08897077.2018.1436634.

Ronquillo, C., Currie, L.M., & Rodney, P. (2016). The evolution of data-information-knowledge-

wisdom in nursing informatics. Advances in Nursing Science, 39(1), E1-E18. Retrieved

from https://ovidsp-tx-ovid-com.chamberlainuniversity.idm.oclc.org/sp-

3.31.lb/ovidweb.cgi?

WebLinkFrameset=1&S=OPNPFPCCHBDDGGGMNCEKLCGMHB00&pdf_index=/fs

046/ovft/live/gv023/000122722/000122722-201601000-00010.

Tennessee General Assembly. (2019). HB0774. Retrieved from

wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB0774&GA=111.

NARRATIVE ANALYSIS 28

The National Organization of Nurse Practitioner Faculties (NONPF). (2017). Nurse practitioner

core competencies content.

https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/20170516_NPCor

eCompsContentF.pdf.

Type 2 diabetes. (2016). In Epocrates Plus for Apple iOs. (Version 19.12). [mobile application

software]. Retrieved from https://epocrates.com/movile/iphone/plus.

Young, S. & Guo, K.L. Cultural diversity training: The necessity of cultural competence for

health care providers and in nursing practice. The Health Care Manager, 39(2), 100-108.

doi: 10.1097/0000000000000294.