Doctor of Nursing Portfolio

Doctor of Nursing Practice PORTFOLIO

"As a nurse we have the opportunity to heal the heart, mind, soul, and body of our patients, their families, and ourselves."

M J Hoist ARNP, MHS

Debra J. Massaro

420 Eggleston Rd. Pembroke, VA 24136 (540) 449-6077

dmassaro@radford.edu 07/03/2013

Debra Massaro

Table of Contents The Nurse Within Me: My Philosophy of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Ideal Position Description. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Curriculum Vitae and Personal Data Sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.

Academic Transcripts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2. Licensure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Appendix A: Clinical Expertise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 License / Certifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Appendix B: Teaching Role. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1. Paper: The Modern School Nurse of the 21st Century. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2. Power Point Presentation: The Modern School Nurse of the 21st Century. . . . . . . . . . . . . . . . . . 60

Appendix C: Scholarship and Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 1. Paper: Critique and Application of Human-to-Human Relationship Theory . . . . . . . . . . . . . . . . 80 2. Research Proposal Paper: In Rural Adults with Type II Diabetes, . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Do Those Who attend Four Weekly Community-Based Self-Management Classes Have Greater Improvement in HgA1C levels than Those Who Attend Four Weekly Support Group Sessions?

3. Grant Proposal Paper: Grant Proposal for Adult Type 2 Diabetes Self-Management . . . . . . . . 92 Classes in Craig County, VA 4. Letters of Recommendation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 5. Fall 2012, Graduate Teaching Assistantship Award. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Appendix D: Leadership and Healthcare Policy Advocate. . . . . . . . . . . . . . . . . . . . . . . . . 117 1. Memberships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 2. Involved Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Health Care Policy Advocate: 1. Legislative Advocacy Project Paper: Examining House Bill 1680 . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Amendment of Temporary Detention Order Time Peri 2. Health Care Issue Paper: Caring for the Future: The DNP and Health Care Reform . . . . . . . . . 167

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My Philosophy of Nursing

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My Philosophy of Nursing

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The Modern School Nurse of the 21st Century

Ideal Position Description

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Curriculum Vitae and Personal Data Sheet

Debra J Massaro 420 Eggleston Road, Pembroke, VA 24136 Home: (540) 626-5727 - Cell: (540) 449-6077 : dmassaro@radford.edu

Summary Assessment-oriented RN, BSN, accurately using evidence-based practice in school setting with six years of dedicated experience. Talented with team building approach, professionally motivating faculty, administrators and counselors to improve wellness and academic success of students. Brings positive life experiences and variety of nursing background to draw on for success.

Core Qualifications • Expertise in coordinating delivery of care in the school community setting • Active management of juvenile diabetic patients • Excellent assessment of illness and injuries in students • Triaging and multi-task management of diverse health needs • Teaching in classroom setting • Patient health education, counseling, leadership skills • Proctor of BSN and LPN students

• Facilitative collaboration with client, family, school staff and counselors • Integrating research findings into practice • Consideration of safety, wellness, immunization requirements throughout life span • Skilled at managing asthmatic crises and lifethreatening allergic reactions • Positive role model and mentoring of students

Achievements Leadership: Successful management of annual state mandated school screenings, six years running.

Upheld State Requirements: Two successful state immunization audits of school records.

Process Implementation: Accurate fulfillment of annual staff Bloodborne Pathogen Training.

Team Building and Advocate: Initiated school Diabetes Support Group for students with Type 1 Diabetes.

Research: Accurate recording and reporting of student illnesses and treatments, providing monthly and end of the year reports to school district health coordinator, six years running.

Professional Experience Registered Nurse August 2006 to Current Montgomery County Public Schools – Blacksburg, VA • Management of School Health Clinic Registered Nurse October 2003 to January 2011 Professional Portfolio of Debra Massaro 6

Curriculum Vitae and Personal Data Sheet Intravene – Lynchburg, VA Part-time management of travel vaccine clinic.

Teacher Assistant November 2005 to August 2006 Montgomery County Public Schools – Blacksburg, VA Special Education Teacher Assistant Housekeeper February 2005 to October 2005

Housekeeper for Blitzkleen Company – Pearisburg, VA • Cleaning and detailing of student and family housing Homemaker January 1993 to January 2005 Pembroke, VA Activities: School volunteer and School Substitute teaching experience during this time. Also served as volunteer child care position for Bible Study Fellowship International for six years.

Registered Nurse May 1990 to December 1992 Florida Hospital – Orlando, FL Worked in Employee Health Clinic managing employee injuries, illnesses and workers compensation case management.

BSN Student January 1987 to May 1990

University of Central Florida – Orlando, FL Licensed Practical Nurse May 1985 to January 1987 Private Physician Practice – Winter Park, FL Licensed Practical Nurse to Family Practice Physician.

Licensed Practical Nurse May 1983 to May 1985

Florida Hospital – Orlando, FL Licenced Practical Nurse working in Oncology and as Float Nurse.

Insurance Liability Coder/Rater June 1976 to May 1983 American States Insurance Company – Orlando, FL Insurance coder, data input, rating of home owner's insurance policies.

Waitress/Cashier May 1975 to June 1976

Burger King Restaurant – Maitland, FL Dining and Front Cashier experience.

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Curriculum Vitae and Personal Data Sheet University of Central Florida 1990 Orlando, FL, U.S. Nursing Science Bachelor of Science Successfully passed boards as Registered Nurse.

Florida Hospital School of Practical Nursing 1983 Orlando, FL, U.S. Practical Nursing Technical Training - Practical Nurse Successfully passed boards as License Practical Nurse.

Seminole Community College 1981 Sanford, FL, U.S. General Associate of Arts

Lyman high School 1975 Longwood, FL, U.S. General High School Diploma Certifications Red Cross First Aid Training - 10/26/2011 American Heart Association BLS - Adult and Child CPR and AED Training - 12/01/2011 Community Involvement Current Volunteer Member of the New River Valley Medical Reserve Corp chapter; VAEMS Affiliations Member-Sigma Theta Tau Honor Society Member-Phi Kappa Phi Honor Society Have been a Ruritan Club Member-Virginia Chapter NCEA Teacher's Association Member-Montgomery County, VA, Chapter Additional Information • • • •

Extra Curricular Activities Have been a Sunday School Teacher for Holy Family Catholic Church Have been a Ruritan Club Member Served on JDRF Fundraising Committee for Diabetes Fund Raiser - March, 2012

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Academic Transcripts

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Academic Transcripts

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Academic Transcripts

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Academic Transcripts

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Appendix A: Clinical Expertise Supporting Documents:

1. Nurse Licensure

-- Commonwealth of Virginia, State of Florida

2. Certifications -- American Red Cross Standard First Aid, Heart Saver CPR,

AED, Healthcare Provider

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Licensure

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Certification

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Certification

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Appendix B: Teaching Role Supporting Documents:

1. Paper: The Modern School Nurse of the 21st Century 2. Power Point Presentation: The Modern School Nurse of the 21st Century

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The Modern School Nurse of the 21st Century

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The Modern School Nurse of the 21st Century

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The Modern School Nurse of the 21st Century - Slide Presentation

I’d like to talk to you about how the school nurse could become much more modern in her job role. This advancement could be brought about by the utilization of technology, through a new product line called a student “Electronic Health Record Surveillance System.”

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The Modern School Nurse of the 21st Century - Slide Presentation

School nursing is a lot of fun. There are many exciting occurrences that happen each year while watching the kids grow and change. This job involves a great deal of support from the school nurse and much work, too.

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The Modern School Nurse of the 21st Century - Slide Presentation

I’ve worked in the school system for 7 years and each year, I have not seen much in the way of change for the nurse in the work flow of her job position. The only thing that seems to be changing is the increase in the number of forms and paperwork.

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The Modern School Nurse of the 21st Century - Slide Presentation

These days people are doing almost everything online. People do their banking, shopping, and even socializing all on their computer. The public is even adapting to the idea of having their medical information online, as long as it is kept in a confidential manner. The SNAP Software Program which I am recommending is approved by the state for firewall protection. It follows government guidelines for the privacy of students according to the Health Insurance Portability and Accountability Act of 1996 and the Family Educational Rights and Privacy Act of 1974.

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The Modern School Nurse of the 21st Century - Slide Presentation

Right now, binders essentially hold all of the 900 student’s medical nursing note records. A school nurse easily sees an average of 30-40 students per day in the clinic. Each of those records must be retrieved from here by hand as the student enters the clinic. There are lots of chart notes kept in here on each visit. These records would be susceptible to fire or water damage and are not very private or confidential. Instead of this system, there are systems of software where the nurse’s notes could be charted such as the SNAP Healthcenter Student Information System which I am proposing. With this software program, the nurse can have available hundreds of nursing care templates to quickly mark diseases or treatments by using check boxes and drop down menus to choose from. They can combine these with free text spaces for personal notations, as well.

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The Modern School Nurse of the 21st Century - Slide Presentation

These filing cabinets are where medications are kept. Each medication has anywhere from 2 to 4 forms to also be accessed. All of these forms are actually incorporated into the SNAP software records. Instead of the nurse reaching in and pulling the med permission form, the medication administration form and care plan each time the med is given. We will see how all of this can be viewed from one computer screen.

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The Modern School Nurse of the 21st Century - Slide Presentation

Every year, the nurse works with at least twice as many forms as these for documentation. These must be filled out manually for everything from nutrition to seizure care plans. These are all ready to be filled out online in a permanent electronic record for the students with SNAP.

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The Modern School Nurse of the 21st Century - Slide Presentation

This is the monthly report form which is turned into the County Health Coordinator. The nurse must count up every visit to the clinic in each month and classify each visit by type. Nurses can have anywhere from around 1000 to 1500 people coming to the clinic in any given month and it is difficult to count that many visits without error. The software program could make that report literally in a snap! When the child visits, the type and reason could be entered into a field code and the computer program could tabulate this much easier than by hand.

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The Modern School Nurse of the 21st Century - Slide Presentation

The annual report of diseases and abnormalities found among the student population could be generated quickly at the end of the year. A computer program could find outlying values by flagging charts with abnormal vision, hearing or scoliosis. As you can see, much of the school nurse’s job is in the collection and reporting of data. This work is better done by a computer.

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The Modern School Nurse of the 21st Century - Slide Presentation

This is an example of the number of Chronic Diseases reporting form that is done and counted manually once a year.

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The Modern School Nurse of the 21st Century - Slide Presentation

The greatest feature of the SNAP software program is its online network capability for the School Concussion Assessment Tool. Snap Healthware is the forerunner in its field for this capability. The way it works is that if a Practitioner out in the community evaluates a student and fills out this form online, it goes into a data bank anytime, 24 hours per day. The school becomes part of the network provider system. The Snap system receives the data of any SCAT tool assessment done in that district and passes it automatically to the schools and the nurse is notified. If a child is in a football game over the weekend, the nurse will be notified of his injury the first thing Monday morning. This allows her to quickly bring about activity restrictions for that student in the P.E. classes or athletic activity. This provides a safety surveillance for the student which is not removed until the injury resolves.

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The Modern School Nurse of the 21st Century - Slide Presentation

This is the PSNI Software Introductory screen.

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The Modern School Nurse of the 21st Century - Slide Presentation

This is a screen shot of the student’s medical record and how it appears in SNAP software. It has 12 tabs.

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The Modern School Nurse of the 21st Century - Slide Presentation

This slide demonstrates how multiple aspects of the students record and care can be accessed without turning a page.

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The Modern School Nurse of the 21st Century - Slide Presentation

This is a picture of the charting templates.

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The Modern School Nurse of the 21st Century - Slide Presentation

This slide demonstrates how a certain area of the body can be demarcated for lesions or injuries.

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The Modern School Nurse of the 21st Century - Slide Presentation

This slide would replace the Bmi and growth chart paperwork.

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The Modern School Nurse of the 21st Century - Slide Presentation

The SNAP system is cost effective and offers technological support to school employees.

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The Modern School Nurse of the 21st Century - Slide Presentation

Here are my references. Thank-you for allowing me to present this.

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Appendix C: Scholarship and Research Supporting Documents:

1. Theory Paper: Critique and Application of Human-to-Human Relationship Theory

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Critique and Application of Human-to-Human Relationship Theory

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Critique and Application of Human-to-Human Relationship Theory

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Critique and Application of Human-to-Human Relationship Theory

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Critique and Application of Human-to-Human Relationship Theory

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Critique and Application of Human-to-Human Relationship Theory

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Critique and Application of Human-to-Human Relationship Theory

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Critique and Application of Human-to-Human Relationship Theory

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In Rural Adults with Type II Diabetes

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In Rural Adults with Type II Diabetes

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In Rural Adults with Type II Diabetes

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In Rural Adults with Type II Diabetes

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In Rural Adults with Type II Diabetes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Grant Proposal for Adult Type 2 Diabetes Self-Management Classes

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Letters of Recommendation

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Letters of Recommendation

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Letters of Recommendation

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Graduate Teaching Assistantship Award

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Appendix D: Leadership and Healthcare Policy Advocate Supporting Documents:

Leadership:

1. Memberships

-- Sigma Theta Tau International Honor Society of Nursing -- The Honor Soiety of Phi Kappa Phi

-- Virginia Nurses Association

2. Involved Actiities -- New River Valley Medical Reserve Corps -- Montgomery Regional Hospital

Health Care Policy Advocate: 1. Legislative Advocacy Project Paper: Examining House Bill 1680 Amendment of Temporary Detention Order Time Peri

2. Topic One - Caring for the Future: The DNP and Health Care Reform

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Membership and Healthcare Policy Advocate

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Legislative Advocacy Project Paper

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Topic One - Caring for the Future: The DNP and Health Care Reform

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Topic One - Caring for the Future: The DNP and Health Care Reform

experience the need for care which underserved Americans exhibit. Many who are left out of the loop of insurance benefits become frustrated and depressed, leading to a distrust of medical workers and increased burden of chronic disease, causing patients to even give up trying to do better.

“Under the Affordable Care Act, over 30 million uninsured Americans will have increased access to affordable, quality health coverage options, such as those through the new Health Insurance Exchanges which will provide essential benefits” (HealthCare.gov, 2013, para. 3).

This influx of new patients along with increased complexities will pose challenges revolving around the most optimal methods of their reabsorption into the health care system. The DNP practitioner stands qualified and ready to take on this challenge.

With the much needed health care reform will come a new focus for reimbursement and care quality. Reporting and outcome standards of the ACA will become more evident to the DNP and other practitioners. Practitioners will necessarily have to adapt to a new vocabulary in practice including terminologies such as patient-centered care, capitation, bundled approach, Quality and Accountable Care Organizations, and medical home as buzz words. Tom Daschle in A New Paradigm (UCTV, 2012) outlines the need for a regulatory system similar to the Federal Reserve to watch over “mini-systems” called Quality Care Organizations (QCO’s). These QCO’s will shape the way the DNP practices and the interactions between them and insurance providers, other members of the health care team, and patients. Electronic Health Records (EHR’s) will be of greater demand offering much needed research data and leaving paper records as a thing of the past. All practitioners will need to better coordinate their professional health care as team members to reduce waste and increase beneficial communication. The EHR will encourage increased communication, information sharing, and transparency between the practitioner, patient, and significant others. Insurance companies and the government must act to uphold medically recognized standards of practice to raise our nation’s level of wellness as a whole.

“Health reform is designed to make our health care system stronger and make it work better” for all practitioners and their patients (HealthCare.gov, 2013, para. 2). The astute practitioner will embrace the ACA reform actions allowing them to bring about a cohesive and scholarly approach to what can be achieved through collegiate cooperation.

Along with broader and more secure medical insurance options offered to the general public, the ACA also has objectives of reducing administrative costs, paperwork, and requiring more equitable treatment towards patients. According to information on the HealthCare.gov (2013) website, investments in “medical homes” will increase the focus on patient-centered care, coordination and disease management; ensuring a more efficient and seamless care approach.

This tightening up on tests, referrals, and procedures is slated to have a net effect of bringing down health care costs through the use of health insurance exchanges and primary care relationships contracted through ACO’s. DNP’s must posture themselves in such a manner as to

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Topic One - Caring for the Future: The DNP and Health Care Reform

become an indispensable member of the health care team, taking on the role of leadership when offered. The HealthCare.gov (2013) website states the “new program is designed to encourage primary care doctors, specialists, hospitals, and other care providers to coordinate their care under a final regulation on ACO’s” (para. 1). The new Medicare Shared Savings will extend savings to providers who meet the following four domains of quality standards: “patient experience, care coordination and patient safety, preventive health, and caring for at-risk populations” (Healthcare.gov, para 5). The educational background of the DNP prepares them to be competent in all of the preceding aspects of patient care.

Today’s DNP training programs meet and in many ways exceed the five core competencies outlined in the Institute of Medicine (IOM) report Health Professions Education: A Bridge to Quality (2003) report. This training allows the DNP the confidence to take on a leadership role in the area of practice specialty they choose. The DPN must work with other Advanced Practice Registered Nurses (APRN’s) to remove federal and state level barriers which prevent them from forming their own ACO’s in practice. The U.S. population is experiencing aging as a whole and facing the possibilities of more chronic illnesses in the coming years. This trend along with the millions more Americans who will be joining the qualified health care masses and the new emphasis on preventative care, will bring about increased needs for primary practitioners in the health care industry. Accredited DNP programs teach prospective nurse practitioner candidates how to provide high quality, patient-centered care through their studies of nursing theory, research, and professional roles classes. Finkelman and Kenner (2013, pp. 266, 7) provide a Patient-Centered Care diagram representing the key elements of the IOM (2003) and its “identified five key core competencies for all healthcare professionals.” The DNP can utilize critical thinking and reasoning skills to better enhance any health care team’s effort to perform patient-centered care.

The DNP must self-advocate for increased recognition as a fully qualified member of the health care team to practice at their full level of training. This can be done politically through lobbying groups such as the American Nurses Association (ANA), the Virginia Nurses Association (VNA), and the American Association of Colleges of Nursing (AACN). In an archived article accessed on the ISPUB.com (2013) website, Sherwood, Brown, Fay, and Wardell (1997) state fewer medical school graduates are choosing primary care residencies and that Nurse Practitioners (NPs) “are uniquely qualified with advanced practice skills to meet the increased demand for primary care services.” Underutilization of DNP’s and NP’s altogether may lead to shortages in the ACA goals for the patient-centered model of care management. In a telephone interview with Suzanne Miyamoto, Director of Government Affairs of the American Association of Colleges of Nursing, the role of the DNP with the ACA has the potential to place a greater leadership demand on all NP’s, however it would “require additional legislation to allow the DNP to become an ACO manager” (Personal communication, Suzanne Miyamoto, 2013). Ms. Miyamoto further states the increased educational level of the DNP “cannot be matched by increased Medicare/Medicaid reimbursement at this time and for this to change will

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require all nurse practitioner degrees to be offered at the same DNP level and scope of practice” (Personal communication, Suzanne Miyamoto, 2013). In order for DNP’s to respond to a greater demand for patient-centered care and exciting future of health care reform, this writer feels a need for a more unified political voice among DNP’s and goals towards standardization of DNP degree programs to be an entry level requirement.

References AARP. (2013). The health care law: Improvements to preventive and wellness benefits.

Retrieved June 7, 2013, from http://www.aarp.org/content/dam/aarp/health/healthcare_reform/2013-04/the-health-carelaw-improvements-to-preventive-and-wellness-benefits-aarp.pdf Finkelman, A. & Kenner, C. (2013). Professional nursing concepts: Competencies for quality leadership. Burlington, MA: Jones & Bartlett Learning LLC. HealthCare.gov. (2013). Health care providers and the affordable care act. Retrieved June 7, 2013, from http://www.healthcare.gov/news/factsheets/2010/07/health-care-providers.html Institute of Medicine: of the National Academies. (2010). Health professions education: A bridge to quality. Retrieved June 8, 2013, from http://www.iom.edu/Reports/2003/HealthProfessions-Education-A-Bridge-to-Quality.aspx ISPUB.com. (2013). Defining nurse practitioner scope of practice: Expanding primary care service. Retrieved June 8, 2013, from http://archive.ispub.com/journal/the-internet-journalof-advanced-nursing-practice/volume-1-number-2/defining-nurse-practitioner-scope-ofpractice-expanding-primary-care-services

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National Conference of State Legislatures. (2013). Disparities in health. Retrieved June 7, 2013, from http://www.ncsl.org/issues-research/health/health-disparities-overview.aspx UCTV. (2012). A new paradigm for health care in America. Retrieved January 20, 2013, from http://www.uctv.tv/shows/A-Conversation-with-Tom-Daschle-A-New-Paradigm-forHealth-Care-in-America-24578

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