19Table of ContentsAPN Capstone Portfolio Part 23Exempl

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Table of Contents
APN Capstone Portfolio Part 2 3
Exemplar #1: NR 500 Evidenced-Based Practice Discussion 3
Exemplar #2: NR512 Wisdom Versus Judgement Discussion 6
Exemplar #3: NR506 RN as Healthcare Policy Leader 9
Exemplar #4: NR510 Advanced Practice Nursing 12
Exemplar #5: NR505 Identification of Area of Interest 16
Exemplar #6: NR503 Healthy People 2020 Impact Paper Excerpt
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Exemplar #7: NR507 Congestive Heart Failure Discussion 23
Exemplar #8: NR601 Discussion Board-Polypharmacy 26
Exemplar #9: NR602 Evaluation of Marginalized Women Paper
Excerpt 30
Exemplar #10: NR603 Mental Health Treatment Plan/Analysis:
Adult ADD 34
Conclusion 38
References 39
Appendix A: Concept Map 46
APN Capstone Portfolio Part 2
My goal as a future nurse practitioner is to improve patient
health outcomes with the knowledge and materials, I have
obtained from the MSN program. This portfolio will display my
professional growth and learning through this program from
NR500: Foundational Concept and Applications to NR661: APN
Capstone Practicum. Each exemplar presented will be
accompanied with an explanation and reflection of how Program

Outcomes, the National Organization of Nurse Practice
Faculties (NONPF) Core Competencies, and the Essentials of
Master’s Education in Nursing completed and met these
exemplars.
Exemplar #1: NR 500 Evidence-Based Practice Discussion
As a nurse it is our duty to perform evidenced based practice for
our patients. The importance of evidenced based practi ce is to
improve patient care and results. (Stevens, 2013) The evidenced
based practice process has adapted over the years and around 50
models have been created. (Loversidge, 2016) The evidence-
based practice process starts with a question about patient care
and from there finding evidence-based research and validating
that evidence (Loversidge, 2016).
I chose the Nurse Practitioner track because I want to
advance my knowledge and be able to have more autonomy in
my practice. As a registered nurse it is not in my scope of
practice to diagnose and treat. I want to use my knowledge and
experience to care for my patients.
A topic that has special interest to me is the overuse of
antibiotics. In the nurse practitioner setting, many patients will
come in for cold symptoms. They are so uncomfortable and
miserable and want to speed up the process. They have come to
expect an antibiotic to speed everything up. Patients believe
that the antibiotics are working when in reality it’s just the
virus working its way out of their body. The antibiotic
prescription is not harmless though. It can cause antibiotic
resistance for the future.
Due to the overuse of antibiotics, easy to cure
infections are now more difficult to treat than ever and could
end in mortality (Barth, 2016). There is a direct link between
overprescribing antibiotics and resistant bacterial strains
(Fromage, 2018). Providers are still prescribing antibiotics for
the common cold despite knowing the problems with antibiotic
resistance. Current studies show that “30-50 % of cases,
antibiotic therapy has been incorrect, with the indication, choice

of agent or duration of treatment being suboptimal” (Fromage,
2018). It is important for providers to educate themsel ves
continuously on what is best practice of antibiotics and when it
is appropriate to use them (Fromage, 2018).Outcomes and
Competencies
Program Outcome #4
This exemplar met the Chamberlain Program Outcome #4,
which is the incorporation of professional values by services in
healthcare and scholarship to develop a professional identity
(Chamberlain University, 2019). In this discussion I presented
the reasons why I was working to obtain a master’s in nursing
and what it means to me. By utilizing evidenced-based practice
to better patient outcomes, I am able to build on my
professional identity to maximize my services in healthcare.
NONPF #1 Core Competency
This exemplar also met the NONPF #1 which is the Scientific
Foundations Competency. NONPF #1 Competency
acknowledges the importance and mastery of carefully
analyzing all data and evidence to improve patient outcomes
(The National Organization of Nurse Practitioner Faculties
[NONPF], 2017). This exemplar also discussed the importance
of evidence-based practice and its use to the master’s prepared
nurse. This exemplar met this competency by the
acknowledgement and intention to use evidenced-based practice
to improve my advanced nursing practice.
Master’s Essential I
The last competency met by this exemplar is Master’s Essentials
I, which is the background for practice from sciences and
humanities. Utilizing what was learned as a baccalaureate
prepared nurse, I am able to build upon that to develop my
knowledge in becoming a master’s prepared nurse. As a
master’s prepared nurse, findings from biopsychosocial fields,
genetics, public health, health economics, translational science,
organizational science, science, humanities, and quality
improvement are incorporated together to continually improve
patient health (American Association of Colleges or Nursing

[AACN], 2011). This exemplar explained the incredible benefits
and absolute need for the use of evidenced-based practice as a
master’s prepared nurse.
Connect Concepts
Evidenced-Based Practice
A concept presented in this exemplar is evidenced-based
practice concept. Evidenced-base practice is utilized in practice
to solve problems and perform clinical decisions to improve
patient outcomes (Lippincott, 2020).
Health Promotion
Another concept presented by this exemplar is health
promotion. Health promotion relies on the actions and behavior
of the provider to improve health and well-being (Lippincott,
2020).
Reflection
It is very interesting to look back to the beginning of the
program and see how much I’ve grown as a nurse and how I’ve
developed my professional identity. This reflection of my
previous work has also opened my eyes to how much I have
developed my professional writing. Evidenced-based practice is
all founded in the competency’s Program Outcome #4, NONPF
#1, and Master’s Essential I. As a baccalaureate prepared nurse,
I had a good understanding of the importance and use of
evidenced-based practice. I will continue to use evidenced-base
practice in my daily use as a professional and will stay up to
date and current to provide optimal care and treatment to my
patients. The MSN program has developed me as a professional
and my abilities to utilize evidenced-base practice in the
improvement of patient health outcomes. At the end of the MSN
program, I now have a greater understanding of the achievement
I have made with Program Outcome #4, NONPF #1, and
Master’s Essential I Competencies.
Exemplar #2: NR512 Wisdom Versus Judgement Discussion
Wisdom in nursing informatics is utilizing knowledge at the
appropriate time when caring for a patient necessity or issue
(Ronquillo et al., 2016). “Wisdom” was introduced into the DIK

framework to aid in the use of evidenced based
practice (Ronquillo et al., 2016). Using evidenced based
practice can improve patient outcomes. When using wisdom,
knowledge and experience are combined to improve critical
thinking and clinician judgement (McGonigle et al., 2014).
During nursing school, lessons on critical thinking and nursing
judgement were taught to prepare us for the nursing world. For
testing purposes, I always reminded myself to “think like a
nurse” to do well on a test. Clinical judgment is an important
skill needed when caring and planning interventions for
patients, particularly with a rapidly declining patient (van Graan
et al., 2016). Using clinical judgement, the nurse would know
the appropriate actions when patients display specific
symptoms. I feel that wisdom and professional nursing
judgement are very similar and nursing judgments aids wisdom
in its success.
Nursing informatics provides all the tools required to improve
the DIKW route, and actually allows all information to be
readily accessible by the nurses (McGonigle et al.,2014).
Utilizing nursing informatics can create ease in the profession
in all areas. Data is used every day by nurses, such as vital
signs from a monitor and lab results (McGonigle et al., 2014). I
use data every time I’m at work such as when I am assessing my
patients and taking their vitals or reviewing their current or past
lab results. The data is used and has meaning as information and
can then be transformed into knowledge. My own nursing
knowledge grows and improves every time I’m at work caring
for my patients. The knowledge that I have obtained so far, I am
able to use to make sound judgements and critical thinking
when I am caring for my patients. I use wisdom when I apply
my knowledge to the care I give to my patients.Outcomes and
Competencies
Master’s Essential V
Exemplar #2 meets the Master’s Essential V which relates to
informatics and healthcare technologies. The Master’s Essential
V encompasses the utilization of patient care technologies to

maximize care, technology communication to integrate and
coordinate care, management of data in analysis to improve
outcomes, utilization and navigation of electronic health records
for improvement of patient care, and health data management
for evidence-based care and distribution of health education
(AACN, 2011). Exemplar #2 discusses the importance of daily
use of informatics and healthcare technologies to improve
patient health outcomes. For example, having the ability to
navigate through the patient’s electronic health records, the
provider can view past lab results and notes to assess the
improvement or worsening of the patient’s condition. The more
these technologies are used, the better the provider will become
in its utilization.
This exemplar also meets NONPF #5 which is Technology and
Information Literacy Competency. This exemplar meets NONPF
#5 Competency by the acknowledgment and intent to
incorporate the appropriate technologies for knowledge to
enhance patient health outcomes (NONPF, 2017). This
exemplar also explains the importance of the translation of
technical and scientific patient health information to prepare
appropriate patient education (NONPF, 2017). This discussion
post discussed the importance of information literacy skills in
making critical decisions in patient care (NONPF, 2017).
Exemplar #2 also discussed the importance of the ability to
readily use technology systems to observe and act when
appropriate in the presence of variables to ensure safe, quality,
and cost-efficient patient care (NONPF, 2017).
Connect Concepts
Communication
An important concept achieved and presented in this
exemplar is communication. Communication is the practice of
exchanging information by means of verbal and nonverbal
messages that are sent and received simultaneously (Lippincott,
2020). Communication is vital when practicing ensuring that a
patient’s care and treatment is being performed efficiently and

fully. Many times, technological communication is necessary
when caring for a patient especially when in collaboration with
other professionals.
Informatics
Informatics uses technology information to enhance the
effectiveness, quality, or delivery of patient health care
(Lippincott, 2020). The concept of informatics was present and
acknowledged in exemplar #2 and explained in detail.
Reflection
Before the MSN program I felt very proficient and at times
advanced in informatics and healthcare technologies.
Completing this program, I feel it has developed me even
further in those areas and I have become an expert in some
areas such as capturing and updating data, communicating
electronically, utilizing appropriate search databases for
evidenced-base information, and basic computer competencies.
The online studies MSN program has greatly improved my
abilities in navigating with ease in technology and informatics.
During clinicals I was able to utilize their electronic medical
records systems and I felt at ease with its use and at times
would even teach my preceptors how to navigate more easily. I
am eager to begin my first year as an APRN and utilize my
technology and informatic competencies from this program.
With the completion of this program, I feel I have surpassed my
abilities in meeting Master’s Essential V and NONPF #5
Competencies.
Exemplar #3: NR506 RN as Healthcare Policy Leader
If a mother is able to breastfeed her newborn and continue
doing so for 6 months or longer there are incredible benefits for
both mother and baby. Since working in labor and delivery, I
am even a bigger advocate for breastfeeding for my patients. I
do my best to explain all of the wonderful priceless benefits of
breastfeeding and give information on how to receive support
while they are in the hospital and when they are discharged and
home with their newborn.
Some of the breastfeeding benefits for the baby are fewer

infections during infancy, decreased the likelihood of chronic
diseases later in life, and increased cognition and IQ (Hamze et
al., 2018). The maternal benefits of breastfeeding include
quicker restoration to postpartum uterine tone, increased weight
loss postpartum, and delayed return of menstruation (Hamze et
al., 2018). Data shows that worldwide only 37% of babies that
are 6 months old or younger are exclusively breastfed (Hamze et
al., 2018). There can be many reasons that women do not
exclusively breastfeed for 6 months or longer, such as lack of
family support, lack of resources, or return to work with no
support for pumping.
To help support breastfeeding, practitioners should discuss the
benefits and resources available when mothers come in for their
appointments prenatal and postpartum (Louis-Jacques & Stuebe,
2018). Health care providers can advocate for their
breastfeeding patients by advocating for policies associated
with breastfeeding in the workplace and maternity leave (Louis-
Jacques & Stuebe, 2018). Even with the Affordable Care Act
implementing a break time and clean private area that is not a
bathroom for mothers pumping, there are still barriers to
mothers actually being able to pump in the workplace
(Kozhimannil et al., 2016). Workplaces should not hide the
policies related to pumping but rather let the policies be known
and support the mother on when and where she can pump during
the workday.Outcomes and Competencies
Program Outcome #4
Exemplar #3 meets Program Outcome #4 which is based on
integration of professional values using scholarship and
provision in health care (Chamberlain University, 2019). This
exemplar meets this competency by the acknowledgement of an
issue and the intent and action to remedy the issue by using the
knowledge of policies and problem-solving skills. By utilizing
knowledge and growth as a master’s prepared nurse, I am able
to educate the patient to the best of my ability in order to
empower the patient to also advocate for themselves.
Master’s Essential VI

This exemplar also meets Master’s Essential VI Health Policy
and Advocacy. Master’s prepared nurses have the knowledge
and skills to promote healthy lifestyles, influence the healthcare
system, and promote values such as social justice with policy
procedures and advocacy (AACN, 2011). The master’s prepared
nurse has the ability to interpret research and advocate for
policies that will improve healthcare for the public and in the
profession of nursing (AACN, 2011). This exemplar presents
that the ability and knowledge of the master’s prepared nurse
can promote positive changes in healthcare policy and advocate
for healthy patient outcomes (AACN, 2011).
This exemplar completes NONPF #6 Policy Competency.
Exemplar #3 meets this competency by an understanding and
utilization of the interdependence of practice and policy
(NONPF, 2017). Exemplar #3 discusses the advocacy for
patients to have the ability to breastfeed in a comfortable and
private area. Many patients are not aware of the policies present
to them and the master’s prepared nurse has the ability to
educate patients on what is available to them.
Connect Concepts
Advocacy
Advocacy is educating and assisting others to develop and
self-actualize by enlightening them of their rights and ensuring
they understand the information being presented (Lippincot t,
2020). A large part of nursing is being a patient advocate and
ensuring the patient has the proper information and education.
Health Policy
Health policy encompasses the laws that a nation
determines to oversee how health care is delivered to its people
(Lippincott, 2020). Health policy is a very important part of
nursing and its importance was presented in this exemplar.
Reflection
As nurses, we have the ability to be the biggest patient
advocates and educate our patients to become self-advocates.
Reflecting on this exemplar, I see how important policy and

patient advocacy is in nursing. Health care policy is an
important part of nursing and should be incorporated into
practice to produce optimal patient health outcomes. Reflecting
more on this exemplar, I feel well equipped to stay up to date
with policies especially the policy that ensures that
breastfeeding mothers are ensured a break from work in a clean
environment to breastfeed or pump. From the completion of this
course to now at the end of the MSN program, I have a fuller
understanding of the importance and necessity of knowledge in
health care policy. This exemplar was able to meet Program
Outcome #4, Master’s Essential VI, and NONPF#6
Competencies by acknowledgement and the knowledge of the
importance of healthcare policy in nursing.
Exemplar #4: NR510 Advanced Practice Nursing
Advance Practice Nurses (APN) are now allowed to prescribe
controlled substances in the state of Florida, which is the last
state to join, as of January 2017 (Kellams & Maye, 2017). All
APN roles must practice under the supervision of a physician in
the state of Florida which includes a written protocol between
the physician and APN with the provision of an annual review
(Florida Board of Nursing, 2018). The description of the duties
of both the APN and the physician are described in the protocol
and include the conditions of the specific therapies, treatments,
and drug therapies that may be made by the APN (Florida Board
of Nursing, 2018).
A Certified Nurse Practitioner (CNP) has the ability to work in
many different specialties like family practice, pediatric,
geriatric, acute care, emergency, neonatal and women’s health
(American Association of Nurse Practitioners, 2018). The CNP
may practice in clinics, hospitals, emergency rooms, urgent care
sites, private physician practices, nursing homes, schools,
colleges, and public health departments (American Association
of Nurse Practitioners, 2018). The CNP in Florida has a salary
between $92,027 and $107,737 (Salary.com, 2018). A pro for
this role is the ability to diagnose, treat and manage patients. A
con with the CNP role is the opinions of some patients feeling

the CNP is not as competent as the physician.
I chose the role of CNP advanced practice nurse versus the
other roles because I like the ability to have a variety of areas I
could go into with my degree and the ability to have a following
of patients that I am able to manage their healthcare. My entire
nursing career has been in labor and delivery, so I am very
comfortable with the idea of working in women’s health
following obtaining my license. The second area that I would be
interested in is the Acute Care Nurse Practitioner in an urgent
care center.
My idea of Nurse Practitioner practice in Florida has changed
slightly after researching the limitation of the CNP. I have been
enlightened by the fact that Florida is still a bit behind other
states that allow more autonomy. These limitations do not
completely discourage me from practicing in the state of Florida
as a CNP. I am excited for what the future brings in changes to
the limitations of the CNP in Florida.Outcomes and
Competencies
The exemplar meets NONPF #9 Independent Practice
Competency. Much has changed since I wrote this exemplar in
November 2018. APN’s are on their way to independent practice
in the state of Florida. As an APN, I will have the ability to
practice independently and manage previously diagnosed and
undiagnosed patients in my practice (NONPF, 2017). This
exemplar meets competency NONPF#9 Competency by the
acknowledgement and intention to practice independently,
educate other professionals and lay caregivers, collaborate with
other professionals or caregivers for optimal patient outcomes,
and the use of professional standards and evidenced-based
practice (NONPF, 2017).
NONPF #2 Leadership Competencies were met in this exemplar
by intention and acknowledgement to lead and foster
collaboration between multiple persons in order to improve
patient health care (NONPF, 2017). An APN must possess the

abilities and knowledge to perform as a leader to improve
patient health outcomes through critical and reflective thinking
(NONPF, 2017). As an APN, the provider must be willing and
able to meet the challenge of complex and advanced leadership
roles in order to provide healthy and necessary changes in
healthcare (NONPF, 2017).
Master’s Essential II
This exemplar also meets Master’s Essentials II organizational
and systems leadership. High quality and safe patient care
depend on organizational and systems leadership (AACN,
2011). The MSN program has been instrumental in preparing
graduates to assume a leadership role to provide high quality
and efficient patient care (AACN, 2011). This exemplar meets
Master’s Essentials II by the acknowledgement and intention to
develop a leadership role and use critical thinking and
communication skills between professionals and patients to
provide high quality patient care (AACN, 2011).
Connect Concepts
Leadership
Leadership is using one’s ability to positively influence and
encourage others to meet a goal using noncoercive measures
(Lippincott, 2020). A master’s prepared nurse must have the
abilities and knowledge to be a positive leader.
Management
Management is the ability to lead and influence an
organization through the disposition and guidance of resources
(Lippincott, 2020). An excellent leader is able to manage
patients and professional relationships carefully to create
effective change.
Reflection
It is a big role change to transition from staff nurse to
advanced-practice nurse. Reflecting back on this exemplar, it is
interesting to see how much I’ve grown and changed during this
program. The thought of being a leader was always a daunting
task for me since I always felt I was better as a follower. This
program and specifically this exemplar have encouraged me and

opened my eyes to the fact that I also can be a leader.
The class NR510 Leadership and Role of the APN and this
exemplar both meet the NONPF#2, NONPF#9, and Master’s
Essentials II competencies by their teaching and aid in
development of creating leaders of all MSN graduates despite
their very different backgrounds in nursing. During this
program I was still hesitant to acknowledge my leadership
skills, this exemplar, MSN program, and taking the role of
Charge RN in OB triage several shifts have shaped and
developed my leadership and management skills further.
Exemplar #5: NR505 Identification of Area of Interest
My EBP interest from NR500 was on the overuse of antibiotics
causing antibiotic resistance. As Nurse Practitioners in the
office setting, we will come across patients coming in for the
common cold and requesting antibiotics. They will push for
these medications because it seems like it will make them better
because other practitioners have prescribed this for them in the
past. It is not a harmless prescription though. Providers should
be educated about when and why antibiotics should be
prescribed.
My MSN program specialty track is the Family Nurse
Practitioner. MY EBP interest is consistent and relevant to my
specialty track because I will be working with providers that
will be frequently prescribing antibiotics for viral infections.
Providers that have this habit will try to teach new providers
their methods and the cycle will continue. I would like to keep
the same EBP area of interest from NR500 because I feel that it
is an important area of research to my future career.
Family nurse practitioners will quite frequently see patients for
the common cold or upper respiratory viral infections. In 1962
it was found that antibiotics were not an effective approach to
colds or upper respiratory viral infections (Jones & Samore,
2017). Today patients are still being prescribed antibiotics for
the common cold or viral infections (Jones & Samore, 2017).
Infections are more difficult to treat more than ever due to
overuse of antibiotics (Barth, 2016).

There is a direct link between overprescribing antibiotics and
bacterial resistant strains (Fromage, 2018). There are not
currently enough new antibiotics being produced to prevent
antibiotic resistance (Fromage, 2018). The common causes of
antibiotic resistance are overuse, improper prescribing,
agricultural utilization, failure to make new antibiotics
(Fromage, 2018).
The PICO questions I am considering is: In adult patients, how
does the use of alternative treatments for the common cold
compare to antibiotic prescription in reducing antibiotic
resistance? Outcome and Competencies
Program Outcome #5
Exemplar #5 was met by Program Outcome #5 which is
extraordinary nursing through advocacy for improved patient
outcomes by collaborative, evidenced-based, and compassionate
advanced nursing practice (Chamberlain University, 2019).
NR505 tasked students to present an area of interest for the
evidenced-based practice proposal with a PICOT question. My
area of interest to research more was reducing antibiotic
resistance. This exemplar meets Program Outcome #5 by the
interest in reducing antibiotic resistance and the plan and
intention to always use compassion, evidenced-based, and
collaborative advanced nursing practice to improve patient
outcomes.
This exemplar also meets NONPF #3 which is Quality
Competencies. NONPF #3 focuses on the use of the best
available evidence in order to ensure improvement in quality of
clinical practice (NONPF, 2017). Exemplar #5 had a goal of
using the best available evidence to reduce antibiotic resistance
in practice. Quality competencies looks at the relationship
between access, cost, quality, safety, and influence and how it
affects health care (NONPF, 2017). This exemplar reviewed
how marketing and care processes affect the quality of health
care and how it can be improved.
Master’s Essential IV

Lastly, this exemplar meets Master’s Essential IV which is
translating and integrating scholarship into practice. The use
and understanding of evidenced-base practice are vital to
healthy patient outcomes. The APN must use their critical
thinking skills, clinician judgement, ability to gather evidence
and translate those into practice to improve patient outcomes.
This exemplar met this competency by using my resources to
gather evidence on antibiotic resistance in order to translate the
information to be used into my daily practice.
Connect Concepts
Pharmacology
Pharmacology is the scientific study and understanding of the
biological results from chemicals (Lippincott, 2020). This
exemplar presents the concept of pharmacology by recognizing
the benefits and possible harms of medication.
Quality Improvement
Quality improvement is the practice and process of
ensuring that quality exertions are consistent to guarantee that
quality will always be improved (Lippincott, 2020). In practice
it is important to always practice quality improvement to ensure
patients are receiving optimal care.
Reflection
This assignment was interesting and assisted in the further
development of my abilities to be vigilant when researching
evidenced-based practice information to use in my own practice.
During clinical I was able to see how different providers
practiced and if they followed the guidelines for antibiotic use.
I noticed that the APRN I was following was very careful in her
prescriptions of antibiotics and the physician I followed would
prescribe antibiotics without thought especially if the patient
was asking for a script and didn’t need one.
The EBP proposal in NR505 was helpful in understanding how
much work is needed in order to promote and teach evidenced-
based practice to other professionals and patients. At the end of
this program, I have an even greater appreciation of evidenced-
based practice and all the work that goes into it to be put into

effect. NONPF#3, Program Outcome #5, and Master’s
Essentials IV were clearly met in this exemplar and especially
now they have been completed at the end of the MSN program.
According to the data for 2014 in the state of Florida,
2,445 adults aged 64 or older died from falls and more than
200,000 were hospitalized for fall injuries (Florida Department
of Health, 2016). Adults aged 85 years and older have a higher
risk of death or injuries from falls (Florida Department of
Health, 2016). Patients aged 65 and older are at an increased
risk of a fall by 8 falls per 1,000 patients after a hospital visit
(Demons & Duncan, 2014). Data has found that 1% of falls will
result in a hip fracture and 20% to 30% will result in relative to
intense injuries (Demons & Duncan, 2014).
Clutter in households can be very hazardous for a person with
unsteady gait caused by a chronic health condition. Patients
diagnosed with cancer, diabetes, asthma, stroke, obesity,
depression, chronic obstructive pulmonary disease, or coronary
artery disease are more prone to risks of falling (Paliwal et al.,
2017). Persons that do not participate in physical exercise or are
a part of the community for mental stimulation are more prone
to falls (Morris et al., 2016).
HP2020
The goal of Healthy People (2019) 2020 is to reduce emergency
department visits by 10 percent due to falls in adults aged 65
and older. The data in the National Snapshot for the year 2007
shows there were 5,235.1 emergency room trips per 100,000
caused by falls in adults aged 65 and older (Healthy People,
2019). The goal for 2020 is 4,711.6 emergency room trips per
100,000 caused by falls (Healthy People, 2019). In 2015 there
were 6,306.2 emergency room trips per 100,000 (Healthy
People, 2019). This data was collected from the National
Hospital Ambulatory Medical Care Survey from the emergency
department for the cause of their visit (Healthy People, 2019).
The Center for Disease Control (CDC) has implemented a
program called STEADI (Stopping Elderly Accidents, Deaths, &

Injuries) to screen, assess and then intervene in order to reduce
fall accidents in the elderly (Lee, 2017). The STEADI screening
is less reliable for cognitively impaired individuals so other
screenings should be utilized (Renfro et al., 2016). For persons
that are cognitively intact, the STEADI screening tool is found
to be adequate to excellent for reliability on test-retest and
inter-rater (Renfro et al., 2016).
Program Plan
The target population in Broward County is adults aged 65 years
and older. Physical therapy and balance classes, handl ebars
installed in all bathrooms, and instruction on the use of walkers
at all times regardless of location could possibly decrease the
number of falls in the population of adults aged 65 years and
older. There are specific exercise classes aimed at the ol der
adult community, but there are many people that do not know
about these classes.
Doctors’ offices and hospitals will provide information on
balance and Tai Chi classes to all adults aged 65 years and
older. Any patients that are required to use a walker will be
given clear and thorough instructions to use the walker at all
times regardless of the setting. Data will be collected from
hospitals in Broward County of the number of emergency visits
for fall-related injuries or deaths. Data will be collected again
one year later following the intervention to see the impact of the
fall prevention program. Outcomes and Competencies
Master’s Essential VIII
This exemplar that targets a plan for the prevention of falls is
met by Master’s Essential VIII which is the clinical prevention
and population health for improving health. The Healthy People
Curriculum Task Forced worked to produce the Clinical
Prevention and Population Health Curriculum Framework with
four main areas (AACN, 2011). Master’s Essential VIII is
focused on the implementing clinical prevention and population
health activities to accomplish the national goal of improving
the all-around health status in the United States (AACN, 2011).
This exemplar was able to demonstrate this competency by the

presentation of epidemiological data used to design an
evidenced-based plan to prevent falls (AACN, 2011). In this
exemplar, I designed a plan for the prevention of falls that is
patient centered.
Master’s Essential III
This exemplar is also met by Master’s Essential III which is
quality improvement and safety. This exemplar was successful
in analyzing information on quality initiatives and
implementing evidenced-based plans to improve quality of
patient care (AACN, 2011). The program plan created to reduce
elderly falls was successful in the intention to create safe
environments for the elderly.
Program Outcome #2
This exemplar also meets Program Outcome #2 which is care-
focused by creating an environment of caring in order to
achieve improved patient health outcomes. When creating the
program plan to prevent elderly falls, I kept in mind that it
should come from center of caring in order to reach patients
well. I feel patients and persons in general are able to give their
attention more when the person teaching is warm and caring.
Nursing should always involve caring and especially when
teaching to our patients. I feel it is easier for patients to
remember and follow directions when the care plan laid out for
them involved a caring nature. This exemplar discusses a
program plan to teach patients of their options to prevent falls.
One of the options was to have balance classes for patients,
which I think is an excellent way to learn and have fun with
others. I feel this exemplar and the completion of this program
has completed Program Outcome #2 competency.
Connect Concepts
Functional Ability
Functional ability focused on a person’s capability to execute
activities of daily living (ADLs) and instrumental activities of
daily living (IADLs) (Lippincott, 2020). This exemplar
highlights this concept because of its goal to improve ADL’s
and IADL’s to prevent patient falls, especially at home.

Safety
Safety entails the act of protecting from possible or real harm
and is considered one of the basic human needs (Lippincott,
2020). The goal of this exemplar is safety and to prevent an
injury from occurring which could progress to serious harm.
Reflection
I really enjoyed writing this exemplar in creating a
program plan to prevent falls in the elderly population,
especially since it is a great need. This exemplar and the
completion of the MSN program has aided in a better
understanding of how important it is to understand the
community resources available to share with patients. Being up
to date on evidenced-based practices is vital to give optimal
patient care.
Reflecting on this exemplar, I have realized that I can
make a small impact on the community by teaching patients
about all of the possible resources available to them. Any
patient teaching that I give I like to keep in mind that it is
coming from a center of caring. I have always felt that nursing
always involves caring and is one of the many reasons I chose it
for a career. I feel that this exemplar and the completion of the
program has met Program Outcome #2 and Master’s Essential
VIII competencies to completion.
Exemplar #7: NR507 Congestive Heart Failure Discussion
Heart failure is described as a decrease in cardiac output which
makes the heart no longer able to meet the needs and demands
of the body (Rogers & Bush, 2015). Mitochondrial
abnormalities have been found to be involved in heart failure
(McCance et al., 2019). A virus, hypertensive disease, or
genetic abnormalities can cause an injury to the heart muscles
which causes damage to the myocardial cells which in turn
reduces the efficiency of pumping (Lodge & Yousef, 2016). The
heart might initially try to compensate by increasing in volume
and wall thickness (Lodge & Yousef, 2016). Hypertension
greatly increases the workload on the heart and over time this
workload damages and weakens the heart which leads to heart

failure (Rogers & Bush, 2015). In diabetes mellitus, the high
blood glucose levels and changes in lipid metabolism results in
damage to the vessels that are suppliers of blood to the heart
(Rogers & Bush, 2015).
Left heart failure can either be heart failure with reduced
ejection fraction, also known as systolic heath failure, or heart
failure with preserved ejection fraction, also known as diastolic
heart failure (McCance et al., 2019). Systolic heart failure is
described as less than 40% ejection fraction and the heart's
incapability to produce an efficient cardiac output to perfuse all
vital tissues (McCance et al., 2019). Systolic heart failure is
more common in males, the left ventricle chamber is larger, and
there is pulmonary congestion with cardiomegaly (McCance et
al., 2019). Diastolic heart failure is described as the inability of
the left ventricle to relax like normal and pulmonary congestion
is present (McCance et al., 2019). Diastolic heart failure is more
common in women, the left ventricular chamber is smaller, and
there is pulmonary congestion with no cardiomegaly (McCance
et al., 2019).
When cardiac output is decreased, the sympathetic nervous
system releases epinephrine and norepinephrine which increases
peripheral vascular resistance, heart rate, and contractility
(Rogers & Bush, 2015). This activates the renin-angiotensin-
aldosterone system (Rogers & Bush, 2015). The secretion of
aldosterone promotes retention of sodium and fluid which
increases preload and afterload (Rogers & Bush, 2015). This
results in vascular and pulmonary congestion which leads to the
symptoms of shortness of breath and having to prop oneself up
to breathe (Rogers & Bush, 2015). This patient has been
increasing her exercise which causes increased cardiac output
that results in limited filling reserve which causes shortness of
breath (Lodge & Yousef, 2016).
Management of the patient's diabetes and hypertension is very
important to prevent further damage. There was research done
to see the long-term effects of liraglutide treatment for type II
diabetes mellitus on improving cardiac function (Arturi et al.,

2017). Liraglutide was found to improve cardiac function
significantly and patients in the study had no hypoglycemic
events or worsening heart failure (Arturi et al., 2017). It is very
important for this patient to be on an appropriate regimen for
her diabetes and she should be checking in with her family
healthcare provider regularly. I would remind the patient that if
she is feeling short of breath or fatigued that she should see her
healthcare provider right away.Outcomes and Competencies
Program Outcome #1
This exemplar completes Program Outcome #1 which is the
holistic health and patient-centered care competency. Program
Outcome #1 represents that care is high quality, safe, patient-
centered, and centered in holistic health values (Chamberlain
University, 2019). It is easy to focus and treat just one body
system and feel that your job is complete, when in reality the
body has to be viewed as an intertwined process that should be
viewed as a whole. In this exemplar I was tasked to review the
case study of a 64-year-old woman presenting with congestive
heart failure and notable medication history of type 2 diabetes
and hypertension. When creating a teaching and treatment plan
for this patient I kept in mind that her past medical history also
needed to be considered. Exemplar #7 was very successful in
completing Program Outcome #7 by a holistic treatment plan for
the case study patient.
Master’s Essential I is the background for practice from
sciences and humanities. Master’s Essential I was met by this
exemplar by the in-depth discussion and explanation of
congestive heart failure. This exemplar and class NR507 were
essential in completing Master’s Essential I due to its in-depth
study of advanced pathophysiology. My background as a
baccalaureate nurse was vital and helpful in the learning process
for NR507. NR507 was an incredible course that focused on
scientific bases of illness prevention and development, health
promotion, and wellness (AACN, 2011). With an in-depth
understanding of the body processes, it is easier to diagnose and

treat patients thoroughly and successfully.
Connect Concepts
Perfusion
Perfusion is the route of oxygenated capillary blood through the
body tissues (Lippincott, 2020). This exemplar discusses the
process of inadequate perfusion which leads to congestive heart
failure.
Assessment
Assessment is the process of continuous compilation,
examination, and communication of patient data (Lippincott,
2020). Assessment skills were utilized in this exemplar to
compile a plan of care for this patient.
Reflection
Reflecting on this exemplar and the completion of the MSN
program, I feel that case studies have been extremely helpful in
understanding the correct treatment of patient’s diseases. I also
have learned that it is important to know the guidelines for
specific treatment of diseases and illnesses in order to provide
high quality patient care. I know with repetition and frequency
of use of the guidelines it will become memory and I will start
to feel more comfort and ease in the treatment of patient’s
illnesses and disease. A holistic approach is very beneficial to
patient quality of care and will reduce patient concerns and
flare ups of chronic diseases.
Program Outcome #1 was met throughout the course and
especially in this exemplar and NR507 assignments. NR507 was
a very informative course and prepared me well to further my
development to complete the MSN program. This course and
exemplar were able to meet Program Outcome #1 and MSN
Essential I competencies.
Exemplar #8: NR601 Discussion Board-Polypharmacy
Polypharmacy is a harmful happening that currently affects the
majority of the geriatric population. Polypharmacy can be
defined as the regular use of 5 medications or more and can
greatly increase the risks of adverse medical outcomes (Halli -
Tierney et al., 2019). Another definition of polypharmacy is the

prescribing of potentially inappropriate medications (PIMs)
(Kennedy-Malone et al., 2019). PIMs include Timolol,
carvedilol, metformin, zolpidem, atorvastatin, ibuprofen, and
docusate (Nguyen et al., 2019).
The main reason for its occurrence is the many diseases an older
adult may have which can require many different medications
(Dunphy et al., 2019). Multiple comorbidities such as diabetes,
renal failure, and hypertension in patients can easily result in
multiple medications being prescribed. Patients living in long-
term facilities are at greater risk for polypharmacy since they
are usually on 5 or more medications (Halli-Tierney et al.,
2019). Long-term facility patients are at a greater risk of
polypharmacy due to the more likely occurrence of cognitive
impairment paired with multiple medical issues that require
multiple medications (Halli-Tierney et al., 2019). A risk factor
at the healthcare level can occur when the patient’s medications
are not adequately recorded it can result in discontinued
medications being refilled after an automatic refill request was
sent (Halli-Tierney et al., 2019).
A way to reduce polypharmacy is to review all medications with
the patient on the initial visit, every 6-12 months, and with any
medication changes. Collaboration with the pharmacist or other
health care providers can assist in deprescribing any PIMs
(Nguyen et al., 2019). The provider can request that the patient
bring in all of their medications they are currently taking in
their original bottles to properly record exactly what the patient
is taking (Dunphy et al., 2019).
The clinical preceptor provider uses safety precautions to avoid
polypharmacy. She routinely goes through the patient’s
medication lists to see if there are any medications that can be
discontinued to help reduce polypharmacy. She always lists all
of the patient’s other providers so she can collaborate with them
on the patient's care.Outcomes and Competencies
NONPF #4 Practice Inquiry competency was able to meet
exemplar #8 fully. This exemplar discussed the importance of

acknowledging the dangers of polypharmacy which is quite
prevalent in the elderly population. With this knowledge and
understanding, I developed a plan to reduce polypharmacy in
collaboration with the patient and other providers. NONPF #4
practice inquiry competency produces knowledge learned from
clinical practice in order to produce high quality patient and
practice outcomes (NONPF, 2017).
Meeting NONPF #4 means that the provider is able to apply
their clinical investigative skills, lead practice inquiry, analyze
clinical guidelines, and disseminate evidence in order to
produce high quality patient care and outcomes (NONPF, 2017).
Patients that came to the office were asked the names of their
providers so it could be recorded, and providers could be
contacted to collaborate in the patients care in order to reduce
polypharmacy. Teaching other providers and staff of the process
of asking the patients for a list of all their medications and
providers and to carry it with them at all times is vital in the
prevention of polypharmacy.
NONPF #7 Health Delivery System Competencies was
successful in meeting exemplar #8. NONPF #7 applies
knowledge of the practices and complex systems to help
improve patient health care delivery (NONPF, 2017). NONPF
#7 also collaborates with other providers and healthcare teams
to create a positive impact on healthcare delivery (NONPF,
2017). This exemplar represents NONPF #7 by the presentation
of knowledge of successful ways to reduce polypharmacy with
the collaboration of the patient and patient providers.
Connect Concepts
Healthcare Systems
The healthcare system is important to a nation to deliver
and pay for health care for its residents (Lippincott, 2020).
Clinical Decision Making
Clinical decision making refers to purposeful, goal-
oriented efforts that are used in a methodical way to determine a
choice between other alternatives correlated to patient care or

other clinical complications (Lippincott, 2020). This exemplar
presented clinical decision making by choosing a plan to reduce
polypharmacy among patients.
Reflection
As I go through and reflect on my assignments through the
MSN program, it is amazing to see how my writing and
professionalism advances throughout. Through knowledge and
clinical practice, I am more well equipped to care for patients in
a high-quality manner and put my critical thinking abilities to
proper use. This exemplar was very helpful in understanding
that I have the skills and thought process to make a difference
in clinical practice and provide improved patient health
outcomes. My time during clinical was priceless and so valuable
to my growth and development into an APRN.
Clinical practice was vital in gaining the knowledge on how to
prevent polypharmacy with patients by the development of a
plan. Having the knowledge and understanding of the process
and workings of health delivery systems is necessary in order to
provide quality health care to patients. NONPF #4 and #7 were
successfully met in this exemplar and through the clinical’s that
I had the privilege of being a part of.
Excerpt
Adequate and affordable care is a human right for women with
HIV and is covered under the American with Disabilities Act
(ADA) (Crowley et al., 2015). Before the ADA was set in place,
persons with HIV were discriminated against when being
considered for jobs or their access to health care (Crowley et
al., 2015). The ADA allows women with HIV access to
affordable health care and protects them from discrimination
from being denied health benefits (Crowley et al., 2015).
Women with HIV that have been incarcerated are experiencing
discrimination and segregation when their HIV status is
discovered (Rice et al., 2018). Women with HIV that have been

incarcerated have reported that they were separated to a cell
alone and also had their medical needs withheld (Rice et al.,
2018). Regardless of where a woman is located or her criminal
history, everyone should have the same access to appropriate
medical care and treatment.
Ethical Issues
Some women have reported they were not aware they had been
tested for HIV when their provider reported their HIV status
(Ion & Elston, 2015). Before testing for HIV, a patient must be
informed and give consent for HIV testing (Ion & Elston, 2015).
Tests should never be performed without the patient being
aware, it is a patient right to be aware of what tests are being
performed on them.
It is not a healthcare professionals’ role to disclose a patient’s
HIV status to the patients partner or family (Ion & Elston,
2015). When discussing the patients’ medical history, family
members and visitors should be asked to step outside of the
room for patient privacy and protection (Ion & Elston, 2015).
Trust between patient and providers can be created when the
healthcare provider respects the patient’s privacy by only
discussing their medical history with only them with a non-
judgmental and caring attitude. Women with HIV may already
feel ashamed and uncomfortable, it is the healthcare
professionals’ task to create a non-judgmental atmosphere for
the patient.
It is unethical to inform a patient they are HIV positive and not
properly educate them on what this means and how they should
care for themselves (Ion & Elston, 2015). Extensive discussion,
support, and education on their status is necessary to reduce the
spread of HIV and keep viral load undetectable. Providers
should be competent or become competent in their ability to
educate patients on self-care and treatment regimen of HIV.
Plan
The first measurable plan of action to address the marginalized
women with HIV is to create a collaborative team to care for
this group (Cook et al., 2018). Mental health professionals and

primary care providers can work together to care for women
with HIV both physically and mentally (Cook et al., 2018). HIV
does not only take a physical toll on a person, but it can affect a
person mentally by inciting shame and fear. To measure this
outcome, the primary care provider and mental health
professional can evaluate the patients progress both physically
and mentally.
The second measurable plan of action will be to address patients
that have been diagnosed with an STI and properly counsel and
educate them in a nonjudgmental manner to better equip
themselves when engaging in any sexual encounters. Women
that have been diagnosed with syphilis or gonorrhea should be
counseled on the risk of being infected with HIV and how to
prevent this occurrence (Peterman et al., 2015). Close follow up
with these patients will be a way to measure the outcome of the
effectiveness of the education and counseling given.
The third measurable plan of action to reduce stigma and
discrimination towards marginalized women with HIV. This can
be accomplished by educating other providers on proper body
language and attitudes when addressing any patient (Rice et al.,
2018). This plan may be measured by the feedback from
patients with how they felt their medical history was handled
and approached. Outcomes and Competencies
Program Outcome #3
This exemplar is a great representation of meeting Program
Outcome #3 which is cultural humility. Program Outcome #3
refers to the provider engaging in lifetime individual and
professional growth by the contemplative practice and
appreciation of cultural diversity (Chamberlain University,
2019). As providers, it is important to be aware of the broad
cultural diversity in practice and be sensitive to them to show
your patients that you care and are willing to learn about them
more. This exemplar identified women with HIV as a
marginalized group and reviewed the economic aspects, social
justice, ethical issues, and formed a plan to address how this
marginalized group will be attended in clinical practice. This

exemplar was very successful in the completion of Program
Outcome #3 by understanding the vast diversity in clinical
practice.
This exemplar met NONPF #8 Ethics Competencies. NONPF #8
integrates ethical principles, evaluates the decisions of ethical
consequences, and creates and applies ethically sound solutions
to complicated issues (NONPF, 2017). Healthcare is comprised
of several issues that need attention in order to improve patient
health outcomes. One of those issues is marginalized women
with HIV and the poor treatment they received. This exemplar
discussed the unethical nature of testing women for HIV
without their consent, discussing HIV status around patient’s
family without prior consent, not properly educating patients
with new HIV status, and patients being segregated in prison
once their HIV status was disclosed. Ethics were discussed at
length and well understood in this exemplar which was
successful in meeting NONPF #8.
Connect Concepts
Ethics
Ethics is the system that agrees on the standards of character
and behavior in relation to what is seen as right and wrong
(Lippincott, 2020). This exemplar is representative of some
ethical standards.
Diversity
Diversity refers to the differences between people in cultural
background, origin of race and ethnicity, religion, physical size,
sexual orientation, language, gender, age, disability, geographic
location, occupational status, and socioeconomic status
(Lippincott, 2020). This exemplar presented the importance of
being aware of the vast diversity we are surrounded in nursing.
Reflection
This exemplar was a vital portion of my learning process
especially in understanding diversity in healthcare and ethical
treatment and care. As healthcare providers, we are at r isk of
performing our jobs void of emotion. It is necessary to continue

a human connection with our patients and treat them as
individuals in order to give them high quality care. I always like
to think about how I would like to be treated by a provider and
try to tailor my care and treatment. Getting to know and
understand your patients’ culture and needs is a part of meeting
Program Outcome #3.
Patient information is private, and it is vital as providers to not
share that information to family unless the patient gives prior
consent. Ethical standards are necessary to respect patient
privacy and inform patients properly of any new diagnosis. This
exemplar discussed the cultural diversity and ethical practices
that come into play during clinical practice which meets
NONPF #8 Core Competency and Program Outcome #3.
Adult ADD
The primary diagnosis presented by CL is Adult Attention
Deficit Disorder (ADD). ADD should be diagnosed utilizing the
DSM-5 criteria, other testing and studies can be performed to
rule out other diagnoses. A referral to psychiatry is essential for
CL in the evaluation of severity of ADD, cognitive behavioral
therapy (CBT), and appropriate pharmacological regimen
(Wolraich et al., 2019).
Many family practice providers do not consider ADHD
diagnosis if it was not established during childhood (Post &
Kurlansik, 2012). Patients older than 17 years of age must meet
four criteria of DSM-IV instead of the six required for patients
under the age of 17 (APA, 2013). The DSM-IV criteria have
been criticized for the cutoff age and also the fact that the
presentation of ADHD differs in adults than children (Post &
Kurlansik, 2012). CL meets the criteria of failing to give close
attention to detail in work, does not seem to listen when spoken
to, avoids activities that require sustained effort mentally, and
she is easily distracted by stimuli extraneously (APA, 2013).
Physical and psychiatric conditions to consider as
differential diagnoses are thyroid disease, substance use
disorders, or mood disorders (Post & Kurlansik, 2012). To rule

out these other diagnoses, labs should be drawn such as a
thyroid panel and urine drug screen (Post & Kurlansik, 2012).
To distinguish between mood disorders and ADD, a mental
status exam and screening should be performed with a thorough
psychiatric and developmental history (Post & Kurlansik, 2012).
The confirmation of ADD can be made by ruling out all other
possible diagnoses through lab work, physical and psychiatric
exam, and meeting DSM-IV criteria (Post & Kurlansik, 2012).
Follow-up/Referrals
CL will be referred to psychiatry to follow along with new
treatment with stimulants and CBT (Wolraich et al., 2019).
When CL follows up in the office, she should have established
care with the referral to psychiatry and have been on her
medication for at least 2 weeks (Post & Kurlansik, 2012). The
follow up visit will include assessment of side effects of
medications, success of treatment, and urine drug screen for
confirmation of medication correct use. Dosing changes to
stimulants should be made after four to 6 weeks following
initiation of medication (Post & Kurlansik, 2012).
Quality
Family practice providers that are not experienced or
trained well in diagnosing and managing comorbid conditions,
should refer out to the appropriate specialties (Wolraich et al.,
2019). There are limited studies showing the effectiveness of
CBT as an adjunct in treatment of ADHD (Post & Kurlansik,
2012). Many patients are not comforta ble with admitting to any
psychiatric issues, so it is the providers job to achieve a
comfortable atmosphere for them to share and reveal what ails
them. Patients must be educated on the risks and benefits of the
pharmacological and non-pharmacological treatments available
to them. In the future, it must be kept in mind that every patient
is different and will not tolerate and react the same way to
every medication.
Outcomes and Competencies
Master’s Essential VII
Exemplar #10 met Master’s Essential VII Interprofessional

Collaboration for Improving Patient and Population Health
Outcomes. Master’s Essential VII advocates for the value of
the role of the APRN in the interprofessional healthcare team
and understands the scope of practice for other health
profession’s (AACN, 2011). This exemplar explains that for
some practitioners, mental health is not an area of expertise for
them, so they prefer to refer to Psychiatry professional
providers. Quality patient care requires understanding the
importance each professional play in the involvement of the
patient’s treatment plan. The MSN prepared nurse is able to
professionally communicate with the healthcare team to design
and coordinate evidenced-based practice care.
Master’s Essential IX
This exemplar was able to meet Master’s Essential IX
Master’s-Level Nursing Practice. Master’s Essential IX prepares
the APRN to perform a comprehensive and systematic
assessment to then apply evidenced-based practice to provide
quality patient care (AACN, 2011). The assessment of the
patient, CL, in exemplar #10 concludes that she presents with
Adult ADD and requires a treatment plan. This treatment plan
includes a referral to psychiatry for treat with CBT and the
management of stimulants prescribed. The patient, CL, will be
able to see the family practice provider for the stimulant refills
once it becomes maintenance and no longer needs titration. At
completion of the MSN program the master’s prepared nurse is
able to advocate for their patients and use their knowledge of
illness and disease management to prepare evidence-based care
plans to patients (AACN, 2011). The master prepared nurse uses
their advanced knowledge in science, ethics, and patient care to
perform quality patient care (AACN, 2011).
Connect Concepts
Collaboration
Collaboration is the functioning and open communication
between nursing and interprofessional teams to achieve high
quality patient care (Lippincott, 2020). Collaboration is evident
in this exemplar because the APRN and Psychiatry providers are

necessary in the treatment and care of the patient in question.
Development
Development is the organized pattern of the changes in
arrangement, feelings, outlooks, or behaviors due to growth,
experiences, and knowledge (Lippincott, 2020). The patient
presented in this exemplar has developed ADD over her lifetime
and requires treatment both pharmacologically and behavioral
therapy.
Reflection
Psychology has always been an area of interest for me. As
healthcare providers for patients across the lifespan, the
understanding of the body and possible diagnoses are very
broad so the APRN must have a good understanding of each
possibility. Anytime the provider is unsure of their care or
diagnosis it is appropriate to refer to other healthcare
professionals to collaborate and discover the appropriate
diagnosis and treatment plan for that patient. This exemplar
played an important role in the preparation and understanding of
the professional relationships that must be initiated and
developed.
This exemplar and the completion of the MSN program prepared
me to conduct a proper assessment, apply evidenced-base
practice, be a patient advocate, teach patients, and form
therapeutic relationships (AACN, 2011). This exemplar was
vital in meeting Master’s Essential VII and IX by the
development of the Master’s-Level nurse to perform to their full
potential in collaboration between the healthcare
interprofessional team.
Conclusion
This well-rounded MSN program greatly prepared me to
meet Program Outcomes 1-5, Master’s Essential Competencies
I-IX, and NONPF Core Competencies 1-9. To stay up to date on
best practice several resources can be used such as clinical
guidelines, most appropriate diagnostic and screening tools, and
evidence-based practice. Healthy and professional relationships
will be created with patients, healthcare professionals, and

patient families. Learning and growth will not cease at the
completion of the MSN program. I will strive to incorporate all
that I have learned from the MSN program, outcomes, and
competencies.
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Appendix A
Concept Map
Chamberlain Program Outcomes, NONPF Core Competencies,

Master's Essentials
Evidenced-based Practice
Advocacy
Leadership
Collaboration
Functional Ability
Communication
Informatics
Health Policy
Healthcare Systems
Management
Quality Improvement

Perfusion
Ethics
Development
Diversity
Assessment
Clinical Decision Making
Pharmacology
Health Promotion
Safety
1
9
Table of Contents
APN Capstone Portfolio Part 2 3
Exemplar #1: NR 500 Evidenced-Based Practice Discussion 3
Exemplar #2: NR512 Wisdom Versus Judgement Discussion 6
Exemplar #3: NR506 RN as Healthcare Policy Leader 9
Exemplar #4: NR510 Advanced Practice Nursing 12

Exemplar #5: NR505 Identification of Area of Interest 16
19
Exemplar #7: NR507 Congestive Heart Failure Discussion 23
Exemplar #8: NR601 Discussion Board-Polypharmacy 26
Excerpt 30
Adult ADD 34
Conclusion 38
References 39
Appendix A: Concept Map 46
APN Capstone Portfolio Part 2
My goal as a future nurse practitioner is to improve patient
health outcomes with the knowledge and materials, I have
obtained from the MSN program. This portfolio will display my
professional growth and learning through this program from
NR500: Foundational Concept and Applications to NR661: APN
Capstone Practicum. Each exemplar presented will be
accompanied with an explanation and reflection of how Program
Outcomes, the National Organization of Nurse Practice
Faculties (NONPF) Core Competencies, and the Essentials of
Master’s Education in Nursing completed and met these
exemplars.
Exemplar #1: NR 500 Evidence-Based Practice Discussion
As a nurse it is our duty to perform evidenced based practice for
our patients. The importance of evidenced based practice is to
improve patient care and results. (Stevens, 2013) The evidenced
based practice process has adapted over the years and around 50
models have been created. (Loversidge, 2016) The evidence-

based practice process starts with a question about patient care
and from there finding evidence-based research and validating
that evidence (Loversidge, 2016).
I chose the Nurse Practitioner track because I want to
advance my knowledge and be able to have more autonomy in
my practice. As a registered nurse it is not in my scope of
practice to diagnose and treat. I want to use my knowledge and
experience to care for my patients.
A topic that has special interest to me is the overuse of
antibiotics. In the nurse practitioner setting, many patients will
come in for cold symptoms. They are so uncomfortable and
miserable and want to speed up the process. They have come to
expect an antibiotic to speed everything up. Patients believe
that the antibiotics are working when in reality it’s just the
virus working its way out of their body. The antibiotic
prescription is not harmless though. It can cause antibiotic
resistance for the future.
Due to the overuse of antibiotics, easy to cure
infections are now more difficult to treat than ever and could
end in mortality (Barth, 2016). There is a direct link between
overprescribing antibiotics and resistant bacterial strains
(Fromage, 2018). Providers are still prescribing antibiotics for
the common cold despite knowing the problems with antibiotic
resistance. Current studies show that “30-50 % of cases,
antibiotic therapy has been incorrect, with the indication, choice
of agent or duration of treatment being suboptimal” (Fromage,
2018). It is important for providers to educate themselves
continuously on what is best practice of antibiotics and when it
is appropriate to use them (Fromage, 2018).Outcomes and
Competencies
Program Outcome #4
This exemplar met the Chamberlain Program Outcome #4,
which is the incorporation of professional values by services in
healthcare and scholarship to develop a professional identity
(Chamberlain University, 2019). In this discussion I presented

the reasons why I was working to obtain a master’s in nursing
and what it means to me. By utilizing evidenced-based practice
to better patient outcomes, I am able to build on my
professional identity to maximize my services in healthcare.
This exemplar also met the NONPF #1 which is the Scientific
Foundations Competency. NONPF #1 Compete ncy
acknowledges the importance and mastery of carefully
analyzing all data and evidence to improve patient outcomes
(The National Organization of Nurse Practitioner Faculties
[NONPF], 2017). This exemplar also discussed the importance
of evidence-based practice and its use to the master’s prepared
nurse. This exemplar met this competency by the
acknowledgement and intention to use evidenced-based practice
to improve my advanced nursing practice.
The last competency met by this exemplar is Master’s Essentials
I, which is the background for practice from sciences and
humanities. Utilizing what was learned as a baccalaureate
prepared nurse, I am able to build upon that to develop my
knowledge in becoming a master’s prepared nurse. As a
master’s prepared nurse, findings from biopsychosocial fields,
genetics, public health, health economics, translational science,
organizational science, science, humanities, and quality
improvement are incorporated together to continually improve
patient health (American Association of Colleges or Nursing
[AACN], 2011). This exemplar explained the incredible benefits
and absolute need for the use of evidenced-based practice as a
master’s prepared nurse.
Connect Concepts
Evidenced-Based Practice
A concept presented in this exemplar is evidenced-based
practice concept. Evidenced-base practice is utilized in practice
to solve problems and perform clinical decisions to improve
patient outcomes (Lippincott, 2020).
Health Promotion

Another concept presented by this exemplar is health
promotion. Health promotion relies on the actions and behavior
of the provider to improve health and well-being (Lippincott,
2020).
Reflection
It is very interesting to look back to the beginning of the
program and see how much I’ve grown as a nurse and how I’ve
developed my professional identity. This reflection of my
previous work has also opened my eyes to how much I have
developed my professional writing. Evidenced-based practice is
all founded in the competency’s Program Outcome #4, NONPF
#1, and Master’s Essential I. As a baccalaureate prepared nurse,
I had a good understanding of the importance and use of
evidenced-based practice. I will continue to use evidenced-base
practice in my daily use as a professional and will stay up to
date and current to provide optimal care and treatment to my
patients. The MSN program has developed me as a professional
and my abilities to utilize evidenced-base practice in the
improvement of patient health outcomes. At the end of the MSN
program, I now have a greater understanding of the achievement
I have made with Program Outcome #4, NONPF #1, and
Master’s Essential I Competencies.
Exemplar #2: NR512 Wisdom Versus Judgement Discussion
Wisdom in nursing informatics is utilizing knowledge at the
appropriate time when caring for a patient necessity or issue
(Ronquillo et al., 2016). “Wisdom” was introduced into the DIK
framework to aid in the use of evidenced based
practice (Ronquillo et al., 2016). Using evidenced based
practice can improve patient outcomes. When using wisdom,
knowledge and experience are combined to improve critical
thinking and clinician judgement (McGonigle et al., 2014).
During nursing school, lessons on critical thinking and nursing
judgement were taught to prepare us for the nursing world. For
testing purposes, I always reminded myself to “think like a
nurse” to do well on a test. Clinical judgment is an important
skill needed when caring and planning interventions for

patients, particularly with a rapidly declining patient (van Graan
et al., 2016). Using clinical judgement, the nurse would know
the appropriate actions when patients display specific
symptoms. I feel that wisdom and professional nursing
judgement are very similar and nursing judgments aids wisdom
in its success.
Nursing informatics provides all the tools required to improve
the DIKW route, and actually allows all information to be
readily accessible by the nurses (McGonigle et al.,2014).
Utilizing nursing informatics can create ease in the profession
in all areas. Data is used every day by nurses, such as vital
signs from a monitor and lab results (McGonigle et al., 2014). I
use data every time I’m at work such as when I am assessing my
patients and taking their vitals or reviewing their current or past
lab results. The data is used and has meaning as information and
can then be transformed into knowledge. My own nursing
knowledge grows and improves every time I’m at work caring
for my patients. The knowledge that I have obtained so far, I am
able to use to make sound judgements and critical thinking
when I am caring for my patients. I use wisdom when I apply
my knowledge to the care I give to my patients.Outcomes and
Competencies
Master’s Essential V
Exemplar #2 meets the Master’s Essential V which relates to
informatics and healthcare technologies. The Master’s Essential
V encompasses the utilization of patient care technologies to
maximize care, technology communication to integrate and
coordinate care, management of data in analysis to improve
outcomes, utilization and navigation of electronic health records
for improvement of patient care, and health data management
for evidence-based care and distribution of health education
(AACN, 2011). Exemplar #2 discusses the importance of daily
use of informatics and healthcare technologies to improve
patient health outcomes. For example, having the ability to
navigate through the patient’s electronic health records, the
provider can view past lab results and notes to assess the

improvement or worsening of the patient’s condition. The more
these technologies are used, the better the provider will become
in its utilization.
This exemplar also meets NONPF #5 which is Technology and
Information Literacy Competency. This exemplar meets NONPF
#5 Competency by the acknowledgment and intent to
incorporate the appropriate technologies for knowledge to
enhance patient health outcomes (NONPF, 2017). This
exemplar also explains the importance of the translation of
technical and scientific patient health information to prepare
appropriate patient education (NONPF, 2017). This discussion
post discussed the importance of information literacy skills in
making critical decisions in patient care (NONPF, 2017).
Exemplar #2 also discussed the importance of the ability to
readily use technology systems to observe and act when
appropriate in the presence of variables to ensure safe, quality,
and cost-efficient patient care (NONPF, 2017).
Connect Concepts
Communication
An important concept achieved and presented in this
exemplar is communication. Communication is the practice of
exchanging information by means of verbal and nonverbal
messages that are sent and received simultaneously (Lippincott,
2020). Communication is vital when practicing ensuring that a
patient’s care and treatment is being performed efficiently and
fully. Many times, technological communication is necessary
when caring for a patient especially when in collaboration with
other professionals.
Informatics
Informatics uses technology information to enhance the
effectiveness, quality, or delivery of patient health care
(Lippincott, 2020). The concept of informatics was present and
acknowledged in exemplar #2 and explained in detail.
Reflection
Before the MSN program I felt very proficient and at times

advanced in informatics and healthcare technologies.
Completing this program, I feel it has developed me even
further in those areas and I have become an expert in some
areas such as capturing and updating data, communicating
electronically, utilizing appropriate search databases for
evidenced-base information, and basic computer competencies.
The online studies MSN program has greatly improved my
abilities in navigating with ease in technology and informatics.
During clinicals I was able to utilize their electronic medical
records systems and I felt at ease with its use and at times
would even teach my preceptors how to navigate more easily. I
am eager to begin my first year as an APRN and utilize my
technology and informatic competencies from this program.
With the completion of this program, I feel I have surpassed my
abilities in meeting Master’s Essential V and NONPF #5
Competencies.
Exemplar #3: NR506 RN as Healthcare Policy Leader
If a mother is able to breastfeed her newborn and continue
doing so for 6 months or longer there are incredible benefits for
both mother and baby. Since working in labor and delivery, I
am even a bigger advocate for breastfeeding for my patients. I
do my best to explain all of the wonderful priceless benefits of
breastfeeding and give information on how to receive support
while they are in the hospital and when they are discharged and
home with their newborn.
Some of the breastfeeding benefits for the baby are fewer
infections during infancy, decreased the likelihood of chronic
diseases later in life, and increased cognition and IQ (Hamze et
al., 2018). The maternal benefits of breastfeeding include
quicker restoration to postpartum uterine tone, increased weight
loss postpartum, and delayed return of menstruation (Hamze et
al., 2018). Data shows that worldwide only 37% of babies that
are 6 months old or younger are exclusively breastfed (Hamze et
al., 2018). There can be many reasons that women do not
exclusively breastfeed for 6 months or longer, such as lack of
family support, lack of resources, or return to work with no

support for pumping.
To help support breastfeeding, practitioners should discuss the
benefits and resources available when mothers come in for their
appointments prenatal and postpartum (Louis-Jacques & Stuebe,
2018). Health care providers can advocate for their
breastfeeding patients by advocating for policies associated
with breastfeeding in the workplace and maternity leave (Louis-
Jacques & Stuebe, 2018). Even with the Affordable Care Act
implementing a break time and clean private area that is not a
bathroom for mothers pumping, there are still barriers to
mothers actually being able to pump in the workplace
(Kozhimannil et al., 2016). Workplaces should not hide the
policies related to pumping but rather let the policies be known
and support the mother on when and where she can pump during
the workday.Outcomes and Competencies
Program Outcome #4
Exemplar #3 meets Program Outcome #4 which is based on
integration of professional values using scholarship and
provision in health care (Chamberlain University, 2019). This
exemplar meets this competency by the acknowledgement of an
issue and the intent and action to remedy the issue by using the
knowledge of policies and problem-solving skills. By utilizing
knowledge and growth as a master’s prepared nurse, I am able
to educate the patient to the best of my ability in order to
empower the patient to also advocate for themselves.
Master’s Essential VI
This exemplar also meets Master’s Essential VI Health Policy
and Advocacy. Master’s prepared nurses have the knowledge
and skills to promote healthy lifestyles, influence the healthcare
system, and promote values such as social justice with policy
procedures and advocacy (AACN, 2011). The master’s prepared
nurse has the ability to interpret research and advocate for
policies that will improve healthcare for the public and in the
profession of nursing (AACN, 2011). This exemplar presents
that the ability and knowledge of the master’s prepared nurse
can promote positive changes in healthcare policy and advocate

for healthy patient outcomes (AACN, 2011).
This exemplar completes NONPF #6 Policy Competency.
Exemplar #3 meets this competency by an understanding and
utilization of the interdependence of practice and policy
(NONPF, 2017). Exemplar #3 discusses the advocacy for
patients to have the ability to breastfeed in a comfortable and
private area. Many patients are not aware of the policies present
to them and the master’s prepared nurse has the ability to
educate patients on what is available to them.
Connect Concepts
Advocacy
Advocacy is educating and assisting others to develop and
self-actualize by enlightening them of their rights and ensuring
they understand the information being presented (Lippincott,
2020). A large part of nursing is being a patient advocate and
ensuring the patient has the proper information and education.
Health Policy
Health policy encompasses the laws that a nation
determines to oversee how health care is delivered to its people
(Lippincott, 2020). Health policy is a very important part of
nursing and its importance was presented in this exemplar.
Reflection
As nurses, we have the ability to be the biggest patient
advocates and educate our patients to become self-advocates.
Reflecting on this exemplar, I see how important policy and
patient advocacy is in nursing. Health care policy is an
important part of nursing and should be incorporated into
practice to produce optimal patient health outcomes. Reflecting
more on this exemplar, I feel well equipped to stay up to date
with policies especially the policy that ensures that
breastfeeding mothers are ensured a break from work in a clean
environment to breastfeed or pump. From the completion of this
course to now at the end of the MSN program, I have a fuller
understanding of the importance and necessity of knowledge in
health care policy. This exemplar was able to meet Program

Outcome #4, Master’s Essential VI, and NONPF#6
Competencies by acknowledgement and the knowledge of the
importance of healthcare policy in nursing.
Exemplar #4: NR510 Advanced Practice Nursing
Advance Practice Nurses (APN) are now allowed to prescribe
controlled substances in the state of Florida, which is the last
state to join, as of January 2017 (Kellams & Maye, 2017). All
APN roles must practice under the supervision of a physician in
the state of Florida which includes a written protocol between
the physician and APN with the provision of an annual review
(Florida Board of Nursing, 2018). The description of the duties
of both the APN and the physician are described in the protocol
and include the conditions of the specific therapies, treatments,
and drug therapies that may be made by the APN (Florida Board
of Nursing, 2018).
A Certified Nurse Practitioner (CNP) has the ability to work in
many different specialties like family practice, pediatric,
geriatric, acute care, emergency, neonatal and women’s health
(American Association of Nurse Practitioners, 2018). The CNP
may practice in clinics, hospitals, emergency rooms, urgent care
sites, private physician practices, nursing homes, schools,
colleges, and public health departments (American Association
of Nurse Practitioners, 2018). The CNP in Florida has a salary
between $92,027 and $107,737 (Salary.com, 2018). A pro for
this role is the ability to diagnose, treat and manage patients. A
con with the CNP role is the opinions of some patients feeling
the CNP is not as competent as the physician.
I chose the role of CNP advanced practice nurse versus the
other roles because I like the ability to have a variety of areas I
could go into with my degree and the ability to have a following
of patients that I am able to manage their healthcare. My entire
nursing career has been in labor and delivery, so I am very
comfortable with the idea of working in women’s health
following obtaining my license. The second area that I would be
interested in is the Acute Care Nurse Practitioner in an urgent
care center.

My idea of Nurse Practitioner practice in Florida has changed
slightly after researching the limitation of the CNP. I have been
enlightened by the fact that Florida is still a bit behind other
states that allow more autonomy. These limitations do not
completely discourage me from practicing in the state of Florida
as a CNP. I am excited for what the future brings in changes to
the limitations of the CNP in Florida.Outcomes and
Competencies
The exemplar meets NONPF #9 Independent Practice
Competency. Much has changed since I wrote this exemplar in
November 2018. APN’s are on their way to independent practice
in the state of Florida. As an APN, I will have the ability to
practice independently and manage previously diagnosed and
undiagnosed patients in my practice (NONPF, 2017). This
exemplar meets competency NONPF#9 Competency by the
acknowledgement and intention to practice independently,
educate other professionals and lay caregivers, collaborate with
other professionals or caregivers for optimal patient outcomes,
and the use of professional standards and evidenced-based
practice (NONPF, 2017).
NONPF #2 Leadership Competencies were met in this exemplar
by intention and acknowledgement to lead and foster
collaboration between multiple persons in order to improve
patient health care (NONPF, 2017). An APN must possess the
abilities and knowledge to perform as a leader to improve
patient health outcomes through critical and reflective thinking
(NONPF, 2017). As an APN, the provider must be willing and
able to meet the challenge of complex and advanced leadership
roles in order to provide healthy and necessary changes in
healthcare (NONPF, 2017).
Master’s Essential II
This exemplar also meets Master’s Essentials II organizational
and systems leadership. High quality and safe patient care
depend on organizational and systems leadership (AACN,

2011). The MSN program has been instrumental in preparing
graduates to assume a leadership role to provide high quality
and efficient patient care (AACN, 2011). This exemplar meets
Master’s Essentials II by the acknowledgement and intention to
develop a leadership role and use critical thinking and
communication skills between professionals and patients to
provide high quality patient care (AACN, 2011).
Connect Concepts
Leadership
Leadership is using one’s ability to positively influence and
encourage others to meet a goal using noncoercive measures
(Lippincott, 2020). A master’s prepared nurse must have the
abilities and knowledge to be a positive leader.
Management
Management is the ability to lead and influence an
organization through the disposition and guidance of resources
(Lippincott, 2020). An excellent leader is able to manage
patients and professional relationships carefully to create
effective change.
Reflection
It is a big role change to transition from staff nurse to
advanced-practice nurse. Reflecting back on this exemplar, it is
interesting to see how much I’ve grown and changed during this
program. The thought of being a leader was always a daunting
task for me since I always felt I was better as a follower. This
program and specifically this exemplar have encouraged me and
opened my eyes to the fact that I also can be a leader.
The class NR510 Leadership and Role of the APN and this
exemplar both meet the NONPF#2, NONPF#9, and Master’s
Essentials II competencies by their teaching and aid in
development of creating leaders of all MSN graduates despite
their very different backgrounds in nursing. During this
program I was still hesitant to acknowledge my leadership
skills, this exemplar, MSN program, and taking the role of
Charge RN in OB triage several shifts have shaped and
developed my leadership and management skills further.

Exemplar #5: NR505 Identification of Area of Interest
My EBP interest from NR500 was on the overuse of antibiotics
causing antibiotic resistance. As Nurse Practitioners in the
office setting, we will come across patients coming in for the
common cold and requesting antibiotics. They will push for
these medications because it seems like it will make them better
because other practitioners have prescribed this for them in the
past. It is not a harmless prescription though. Providers should
be educated about when and why antibiotics should be
prescribed.
My MSN program specialty track is the Family Nurse
Practitioner. MY EBP interest is consistent and relevant to my
specialty track because I will be working with providers that
will be frequently prescribing antibiotics for viral infections.
Providers that have this habit will try to teach new providers
their methods and the cycle will continue. I would like to keep
the same EBP area of interest from NR500 because I feel that it
is an important area of research to my future career.
Family nurse practitioners will quite frequently see patients for
the common cold or upper respiratory viral infections. In 1962
it was found that antibiotics were not an effective approach to
colds or upper respiratory viral infections (Jones & Samore,
2017). Today patients are still being prescribed antibiotics for
the common cold or viral infections (Jones & Samore, 2017).
Infections are more difficult to treat more than ever due to
overuse of antibiotics (Barth, 2016).
There is a direct link between overprescribing antibiotics and
bacterial resistant strains (Fromage, 2018). There are not
currently enough new antibiotics being produced to prevent
antibiotic resistance (Fromage, 2018). The common causes of
antibiotic resistance are overuse, improper prescribing,
agricultural utilization, failure to make new antibiotics
(Fromage, 2018).
The PICO questions I am considering is: In adult patients, how
does the use of alternative treatments for the common cold
compare to antibiotic prescription in reducing antibiotic

19Table of ContentsAPN Capstone Portfolio Part 23Exempl

19Table of ContentsAPN Capstone Portfolio Part 23Exempl

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19Table of ContentsAPN Capstone Portfolio Part 23Exempl