Running head: FINAL REFLECTION 1

Laura Velasquez

Final Reflection

Foundations of Advanced Nursing Practice

University of St Mary
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Final Reflection

As I move on the next phase of my educational endeavors, first I must reflect on the

topics that were learned and how it effects my nursing practice. Some of these topics range from

the Institute of Medicine’s core competencies recommendations to employ evidence-based

practice, quality improvement and safety, and utilizing informatics into nursing practice. Other

topics are the integration of the Complex Adaptive Systems Theory into nursing hospital

organizations and the scope of practice of Nurse Educator or Administrator.

Evidence-based Practice

Evidence-based practice until recently has been a vague topic for me. The concept was

introduced in the baccalaureate educational aspect. My understanding was that it provided the

background work in the development of hospital policies and procedures. I now have a better

understanding of EBP, which is that making decisions about the delivery of care and providing

the best patient outcomes supported by evidence is the quintessence of nursing.

To this day however, nursing research is still not well developed and debates over which

methodology to use are still questionable. Evidence based-practice is generated usually using the

qualitative and quantitative research methods. Nursing scholars debate that the evolving diversity

of nursing is not captured adequately with the quantitative method of research and the qualitative

method of research they feel is more naturalistic and unstructured. Although both approaches are

appropriate and they both complement nursing aspects of practice; to best reflect the uniqueness

of nursing and to ensure better findings applicable to nursing practice scholars suggest multiple

methods of research such as methodological pluralism. McEwan and Wills (2014) state that

“because there is no one best method of developing knowledge, it is important to recognize that

valuing one standard as exclusive or superior restricts the ability to progress” (p. 18). Cowen and
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Moorhead (2011) suggest that EBP provides an important framework for self-directed, lifelong

learning that is essential in an era of rapid clinical advances and the information explosion.

Thereby, patient-care may suffer if nursing practice is not evidenced by nurses informed clinical

judgment.

Quality Improvement and Safety

To ensure quality patient care and safety in errors the IOM suggests focusing on quality

of care in general, not just errors (Finkelnman & Kenner, 2012). It is our role in nursing care to

provide safe care to our patients by constantly changing protocols to benefit the patient. In a

patient-centered philosophy, it gives me great confidence that nurses can continue to change

policies and/or protocols in a “just culture” manner to provide safe error free care. Such

processes as the Root Cause Analysis to identify causal factors associated with adverse events or

close calls. Or the Quality and Safety Education for Nursing (QSEN) project identified

knowledge, skills, and attitudes that nurses must posses to deliver safe, effective care (AACN,

2012). The project ensures nursing professionals are provided with knowledge and tools to

deliver this care throughout their nursing profession from entry-level nurse to advance practice

nurse.

Utilizing Informatics

Information technology has its benefits and challenges in the healthcare system. Some of

its benefits are that patients may carry their information from one provider to another, they can

access their health information online such as lab results, radiology reports, medications list,

among other information. And there are a few challenges. Some of the challenges with

information technology are the nurse-patient relationship, “losing the caring aspects of nursing”

(Finkelman & Kenner, 2012, p. 138). With bedside computer charting nursing-care feels
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fragmented and intrusive. Sister Simone Roach (2012) cites Henri M. J. Nouwen, he defines

compassion, as that, “which it involves us going … where it hurts, to enter into the places of pain

to share the brokenness, fear, confusion, and anguish…” (p. 58). Somehow, the act of

compassionate care may seem clinical and cold with information technology. With an advantage,

there is always a disadvantage. But nurses can continue to work toward a happy medium where

the flow of patient care won’t feel so fragmented.

Complex Adaptive Systems

The Complex Adaptive Systems Theory is a fascinating topic in how nursing and

ancillary can work in Unisom to provide the best patient outcomes. With the evolving

complexities of the healthcare system, in order to make an impact. A solution for biological

organizations are to implement the Complex Adaptive Systems theory. A nonlinear approach

supporting meaningful adaptation interconnectedness and behaviors. Rather than an “inflexible

and predictable machine-like behaviors with cause-and effect relationships (Penprase & Norris,

2005). The organization is viewed as a biological process that allows for concepts of self-

organization and attractors, creativity, and recognizing the fundamentals of interdependence of

all phenomena. Complex Adaptive Systems Theory is a framework concept that may make an

impact in nursing-patient care.

Scope of Practice of Nurse Educator or Administrator

Teaching patients preventive care is essential for nursing care. How many times do we

care for patients with medical problems that could have been prevented? Giving patient health

information is a very important component in providing care of the patient. Another component

of teaching is health literacy. Health literacy is defined as “the degree to which an individual has

the capacity to obtain, communicate, process and understand basic health information and
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services to make appropriate health decisions” (McEwen & Wills, 2014). I am always vigilant of

finding an opportunity to teach and educate my patients in my nursing practice. I have to be

selective of what learning measure is most important at that time, since the ambulatory care unit

patient interaction is very quick.

The concepts of nurse administration are very relatable in the role of a Charge Nurse. The

leadership essentials from Penprase and Norris (2005) article What nurse leaders should know

about complex adaptive systems theory struck a chord with me because I feel this has been my

philosophy all along. When working with the unit team I feel we should work together in a

copasetic manner combining our skills, adequately communicating with each other and the

patient, producing a safe environment.

In conclusion, in reflecting these topics, although all topics were interesting. The most

fascinating topic for me was the Complex Adaptive Systems Theory, with its biological process

theory. Evidence-base practice has been a hazy process but clearer now. At one point in my

nursing-practice I was very interested in specializing in Informatics but realized that human

interaction is what I enjoy most, therefore I have lost interest. Quality Improvement and Safety

has proven to being the most instrumental and educative in nursing practice. Nurse administrator

study was interesting I could relate and apply concepts in my leadership role as Charge Nurse.

The study of the scope of practice of nurse educator seem a bit redundant and boring, I am

hoping it is not the case since it is the specialty I chose and teaching is my passion.
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References

American Association of Colleges of Nursing QSEN (2012). Graduate level QSEN

competencies, Knowledge, skills and attitudes. Education Consortium. Retrieved from

http://www.aacn.nche.edu/faculty/qsen/competencies.pdf

Cowen, S. & Moorhead, S. (2011). Current issues in nursing (8th ed.). St. Louis, MO: Mosby,

Inc.

Finkelman, A. & Kenner, C. (2012). Learning IOM, implications of the Institute of Medicine

reports for nursing education (3rd ed.). Silver Spring, MD: Nursesbooks.org

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

PA: Wolters Kluwer/Lippincott Williams & Wilkins

Penprase, B. & Norris, D. (2005). What nurse leaders should know about complex

adaptive systems theory. Nursing Leadership Forum, 9(3), 127-

132. Retrieved from

http://search.proquest.com/health/docview/207441633/fulltextPDF/1410AE7

07B7E2084C0/1?accountid=45723

Roach, M. S. (2012). Attributes of professional caring. Retrieved from

https://engage.stmary.edu/learn/pluginfile.php/143486/mod_book/chapter/7594/Roa

h_article.pdf