Evidence of Achievement: 

• Translates research and other forms of knowledge to improve practice processes and outcomes.

• Develops new practice approaches based on the integration of research, theory, and practice knowledge.

1. I consistently used evidence-based resources during sick visits to ensure that I was providing current and relevant treatments and education.  During a sick visit for a 30-year-old female who presented with persistent nausea and vomiting for three days, I used UpToDate to determine if stool testing was indicated.  Based on my research, I learned that this was a clinical diagnosis and that stool testing for a specific viral pathogen is not indicated nor changes the management of the illness.  Next, I was able to use this resource to thoroughly educate the patient on supportive care measures such as, increasing her fluid intake with electrolyte-rich beverages, and how to properly disinfect her home (Alexandraki & Smetana, 2024).

2. I had a 34-year-old patient with a history of polysubstance abuse, diabetes, and obesity present for a routine follow up of his chronic health conditions.  During our visit, I reviewed his hemoglobin A1C and found that it had been trending around 8.0% and was not improving. During my assessment, the patient stated that he was struggling with his alcohol dependence and was trying to stay sober so that he was not kicked out of his new living situation.  I had previously come across an article disucssing the effects of GLP1-RAs on alcohol consumption.  The randomized controlled trial by Hendershot et al. (2025)  yielded a significant reduction in participants' alcohol cravings and daily consumption. Therefore, I discussed a trial of semaglutide with the patient and my preceptor.  He was an excellent candidate because of his obesity, alcohol dependence, and uncontrolled diabetes mellitus that could potentially be treated with a single medication.

Evidence of Achievement: 

• Analyzes clinical guidelines to determine treatment pathway

2.  I used evidence-based research to guide my treatment of a patient who presented with acute chest pain to the office.  I completed a thorough history and physical exam, medication reconciliation, and review of systems to help formulate my differential diagnoses.  When approaching a patient with chest pain, I triaged him by listening to his heart in lying, supine, and standing positions, assessing the quality of pain and if it radiates, exacerbating or alleviating factors, and timing and severity of the pain.  Based on my findings, he states that he is a restaurant manager and feels the pain when he is experiencing stress or high emotions and during exercise.  To add, he also actively smokes and has a positive family history for cardiac events (his father had a myocardial infarction with a triple bypass). Due to his positive family history and my findings, I decided to order an EKG and compared the findings to his previous one from 2023.  He had a bundle branch block that was not new, but he states that his symptoms were mild and persistent.  Therefore, I decided that the best course of action was to rule out any electrolyte or metabolic abnormalities and refer to cardiology for an echocardiogram and stress test.  In addition, I also used the American Heart Association's guidelines to order a chest radiograph for other etiologies that could be causing his symptoms, such as fracture (Gulati et al., 2021).

Evidence of Achievement:

• Clinical decision-making based on evidence and shared decision-making

• Functions as a licensed independent practitioner 

1. I saw a 65 year old patient this rotation for a well visit.  While reviewing her health maintenance, I saw that she was overdue for her pneumococcal vaccination.  I asked the patient if he was ready for his vaccine, but he became perturbed and stated that he did not want anything in his body.  I took the opportunity to provide him with a vaccine information sheet and explain the importance of this vaccine in relation to her personal risk factors: COPD, smoking, and heart disease.  The patient was not ready to be vaccinated, so I also offered a follow up visit for her shot.  I referred her to the Centers for Disease Control and Prevention (CDC) website for information on the pneumococcal vaccine.

https://www.cdc.gov/pneumococcal/vaccines/index.html 

2. I saw another patient independently who presented with rectal pain after a recent GI infection.  She was concerned for hemorrhoids. I completed an entire history and physical exam, review of systems, and documented my diagnosis of external hemorrhoids in the medical record.  In addition, I counseled the patient on increasing her fiber intake, stool softeners, sitz baths, and prescribed some Anusol suppositories for her discomfort. Afterwards, I reviewed my findings with my preceptor and reported off on my plan of care. During this visit, I required no assistance or input from my preceptor with developing my differentials and plan of care.  

Evidence of Achievement:

• Inter-professional collaborative relationships

• Evaluates the impact of healthcare delivery systems on patients, providers, stakeholders, and the environment

1. Consultations are a form of collaboration that connects health delivery systems. As a nurse practitioner, I am expected to work within my scope and defer to expertise when indicated.  I saw a 27-year-old female patient for depression that was refractory to treatment with multiple SSRIs.  She was becoming frustrated because she felt like nothing would help her symptoms. To add, she also found difficulty getting into a psychiatrist for medication management.  I was able to refer her to a colleague of mine who is a psychiatric mental health nurse practitioner.  I provided her with his office's information so that she could call and set up an appointment.  On a follow up visit, she explained that she started seeing mental health services and was initiated on Wellbutrin.  

2. I exemplified cost-effective care during a visit with a patient who expressed financial strain. This patient was a former home healthcare nurse but was not working due to an injury.  As a result, he was unable to afford his Ozempic and his A1C was increasing outside of our established goal. He also had hyperlipidemia but was compliant with his medications and  maintained a well-balanced diet.  As a result, I reviewed literature from the American Diabetes Association to help me choose a similar therapy that was cheaper but would provide the same benefits as an injectable GLP-1. I chose an oral GLP-1, Rybelsus, because it can lower his risk of cardiovascular disease (ElSayed et al., 2024).  Since he was not actively working, I offered him a trial supply of the drug from the office. 

Evidence of Achievement:

• Uses best available evidence to continuously improve clincial practice 

• Evaluates relationships among access, cost, quality, and safety, and their influence on healthcare

1. I use evidence-based resources in each patient encounter to help with diagnosis, treatment, and patient education. During one visit with a 27 -year-old woman, she relayed to me that she was using her albuterol inhaler 6 days a week for shortness of breath and wheezing.  The patient was never prescribed a maintenance inhaler for her asthma.  Therefore, I reviewed the updated GINA 2024 Asthma guidelines and found that she needed to be on a maintenance ICS-LABA in addition to her SABA (Global Initiative for Asthma [GINA], 2024). I ordered her to be on Symbicort (Budesonide/Formoterol) and reviewed how to use her inhaler properly.  

2. I saw a 35-year-old male patient who was diagnosed with HIV and presented to the office for antiretroviral therapy (ART). He was concerned about remembering to take his medication and potentially missing a dose. I introduced the patient to Cabenuva, a long-acting injectable antiretroviral that lasts up to 2 months.  I discussed my pharmacology project on Cabenuva with my preceptor during this time, as I have great interest in HIV research and treatments.  I did educate the patient that the drug is relatively new and would most likely require insurance prior authorization for it to be approved. I provided resources on the drug and directed the patient to a patient assistance program if he was denied for coverage.

https://www.viivconnect.com/hcp/get-financial-support/cabenuva?cc=ps_VXPN2JQT7UN853X2252979&gclsrc=aw.ds&gad_source=1&gbraid=0AAAAADMWLynj6bNd5v3lffqXaYwnNHMoA&gclid=CjwKCAjw5PK_BhBBEiwAL7GTPWejcW_at08X8f-Lmd4J3tQ1iYisk_o1OrflfxDQgaGpcBDYuO6S9xoCCzMQAvD_BwE