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Professional Portfolio

Professional Goals & CNS Core Competencies Achievement Documents

Roshan Jan Muhammad Manasia RN, BScN

|Professional Goal Statement |

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|My professional goal upon completion of the CNS program is to obtain a work opportunity in the capacity of Clinical Nurse Specialist in an adult/geriatric acute/critical care unit/s. My vision is to |

|advance the scope of critical care nursing practice by implementing evidence based interventions and through clinical capacity building of nursing staff. Also, I intend to improve quality of care and |

|patient safety in acute/critical care unit/s by enhancing safety culture and by filling the cracks in the broken system and processes to eventually improve clinical outcomes. Moreover, I wish to |

|establish a professional group of critical care nurses in Pakistan to mediate improvement in nursing practice across various institutions in my home country. And, I want to contribute to the scholarly |

|work done by Clinical Nurse Specialists through publication. |

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|Documentation of achievement of CNS Core Competencies in Educational Program |

|CNS Core Competencies |Modes of Accomplishment |Documentation of Accomplishment |

|Use knowledge of differential illness diagnoses and |Didactic course work |Expanded knowledge to explain physiologic mechanisms and pathogenesis of selected |

|treatments in comprehensive, holistic assessments of|NR110.502 Physiology and pathophysiology I |disorders; integrate etiology, signs and symptoms and complications; analyze the |

|patients within the context of disease, diagnosis, | |results of various laboratory tests and diagnostic procedures; and apply it to |

|treatments. The outcome of differential diagnosis of| |clinical case studies to formulate differential diagnosis. |

|illness is to explicate etiology(ies) that require | |Case study: Management of cardiac failure |

|nursing interventions to prevent or alleviate the | | |

|illness; | |Acquired advanced knowledge of pharmacokinetics and pharmacodynamics of common |

| | |categories of drugs used in acute/critical care illnesses, related adverse effects, |

| |NR110.508 Clinical pharmacology |and nursing implications. |

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| | |Advanced skills in identifying, synthesizing and applying knowledge of complex |

| | |disease, multisystem pathophysiology, and advanced physical assessment skills for |

| | |symptom management in adult & geriatric patients with acute or critical illnesses to|

| |NR110.523 Clinical Judgment in Acute and Critical care I |improve clinical outcomes. |

| | |Case study discussions eg., Acute MI and burn. |

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| | |Incorporated knowledge and skills of health assessment to identify age specific |

| | |normal and pathological variations in geriatric patients. |

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| |NR110.536 Advanced Health Assessment and Measurement: |Advanced history taking and clinical assessment skills; clinical competency to |

| |Adult/Geriatric variations |identify abnormal findings; relate findings of diagnostic investigation; utilize |

| | |clinical reasoning and critical thinking to form differential diagnoses; and devise |

| |Clinical Practicum |plan of care. |

| |NR110.549 Advanced Health Assessment and Measurement |Conducted detailed assessment and history of 7 patients and completed two |

| | |comprehensive and one episodic history and physical examination. Completed formal |

| | |write-up of each with differential diagnosis and detailed plan of care. |

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| | |Demonstrated skills as an advanced practice nurse in the management of |

| | |acutely/critically ill patients by utilizing knowledge of advanced health assessment|

| | |skills; disease management; and pharmacology to plan and implement evidence based |

| | |care intervention and evaluate the care outcomes. |

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| | |Provided consultation to the nursing staff while managing acutely/critically ill |

| |NR110.520 CNS role practicum I |patients by utilizing advanced clinical knowledge and clinical expertise. |

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| | |Integrated knowledge of complex diseases, multisystem pathophysiology, advanced |

| | |physical assessment and evidence base knowledge to identify plan to care for |

| | |symptom management. |

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| |NR 110.521 CNS expert practicum II | |

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| |NR 110. 524 Clinical judgment, acute and critical care II | |

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|Design, implement, and evaluate innovative |Didactic course |Developed mini business plan to commission hypothetical JHUSON primary care clinic |

|individual and/or population-based programs of care |NR 110-504 Context of health care for advanced practice nursing |for high‐risk population in East Baltimore. Our group worked on problem |

|to achieve desired quality, cost-effective, and | |identification and need justification component of the business plan. I also |

|nurse-sensitive outcomes. | |critiqued other components of the business plan developed by other groups that |

| | |included service recommendations, resource allocation and budget planning. |

| | |Established quality and safety outcome indicators to evaluate the care outcomes of |

| | |above mentioned primary care clinic. |

| | |Reviewed various health care models and the role of advanced practice nurses in |

| | |these care delivery systems to target health concerns and population specific care |

| | |needs. |

| | |Issues manuscript: Virtual ICU care model, a remedy to prevent adverse event in |

| | |adult intensive care unit. |

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| | |Enhanced understanding of health promotion and disease prevention as they relate to |

| | |individuals, families and communities. Explored psychosocial, economical, behavioral|

| | |and ecological factors that affect health care behaviors of individuals and |

| | |communities at large, utilization of health care services and care outcomes. |

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| |NR 110.546 Health promotion and disease prevention |Developed hospital based therapeutic hypothermia protocol to improve neurological |

| | |and survival outcomes of adult post cardiac arrest patients. |

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| | |Assisting in development of sepsis protocol to guide early identification of septic |

| | |patient and related management in oncology population. |

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| |Clinical course |Reviewed JACHO standards on alarm safety and attended Webinar on medical alarm |

| |NR110.520 CNS role practicum I |safety and medical management. |

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| | |Devised a logic model to guide institution wide implementation of “rapid response |

| | |team program” in order to reduce mortality and morbidity. Detailed program planning |

| |NR 110.521 CNS expert practicum II |is in progress. |

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| | |Conducted outcome analysis to evaluate the impact of comprehensive unit based safety|

| | |program (CUSP) on safety culture of non-critical care units at Johns Hopkins |

| | |Hospital. |

| | |Developed a database on SPSS to assess the correlation of safety culture score with |

| | |falls rate at Johns Hopkins Hospital. |

| | |Attended five days patient safety certification program to acquire knowledge of |

| |NR110.560 Program Development and Evaluation in Health Care |tools and structured approaches to design, implement and evaluate the quality |

| | |initiatives. |

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| |NR 110.522 CNS outcomes practicum III | |

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|Serve as educator/leader/consultant/mentor/change |Clinical practicum |Conducted restraint competency recertification of nursing staff of care center. |

|agent in advancing the practice of nursing among |NR110.520 CNS role practicum I (3 credits) |Assisted novice nurses in management of acutely ill patients as an expert nurse and |

|other nurses and across organizations to achieve | |consultant. |

|outcomes. | |Developed educational module for nursing staff on therapeutic hypothermia as a part |

| | |of clinical project activity and conducted series of educational session. |

| | |Lead the clinical project of therapeutic hypothermia and facilitated the change |

| | |process through collaboration, collegiality, team building and staff training. |

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| | |Revising the content of critical care training program offered at Sidney Kimmel |

| | |Cancer Center (SKCC) based on current references and the scope of critical care |

| | |practice in the unit. |

| |NR 110.521 CNS expert practicum II |Comparing the efficacy of ECG module drafted by CNS versus ECG course offered by |

| | |ECCO through survey questionnaire and analysis of the post test results from both |

| | |program, to propose most suitable and cost effective option for teaching ECG for the|

| | |nurses at SKCC. |

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| | |Shadowed the preceptor in facilitating implementation of evidence based |

| | |comprehensive unit based safety program by unit champions to improve safety culture |

| | |and clinical outcomes of the units. |

| | |Presented the findings of the project to the group of CNS students to educate. |

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| | |Devised detailed educational plan utilizing teaching learning principles. |

| |NR 110.522 CNS outcomes practicum III |Conducted and evaluated the educational session on novel device called “subcutaneous|

| | |implantable cardioverter device” |

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| |Pending courses | |

| |NR.110.540 Teaching Strategies in Nursing | |

|Advance nursing practice through innovative |Didactic course work | |

|evidence-based interventions, best-practice |110.507 Statistical literacy and reasoning in nursing research. |Developed skills and knowledge to interpret and critically appraise the findings of |

|guidelines, and modification of professional | |descriptive and inferential statistical analysis presented in the research articles |

|standards and organizational policies that direct | |to draw conclusion for practice implication. |

|the care of nursing personnel and other providers of| |Critiqued statistical methodology of 10 articles during systematic review. |

|healthcare to improve outcomes. | | |

| | |Developed skills to review and critique research and non‐research evidences through |

| | |research appraisal process. Acquired understanding of process to synthesize |

| |NR 110.503 Application of research to practice. |knowledge to address practice concern and recommend evidence based strategies for |

| | |practice improvement. |

| | |Conducted systematic review entitled “ Is therapeutic hypothermia beneficial to |

| | |improve neurological and survival outcomes in adult post cardiac arrest patients” |

| | |Described detailed individual evidence summaries of 10 research articles to |

| | |determine level and quality of evidence. |

| | |Research critique: Performed two research articles critiqued based on established |

| | |criteria. |

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| | |Groomed to act as a moral agent in care delivery process and to utilize ethical |

| | |principles and theoretical premises to address and discern ethical conflicts and |

| | |dilemmas in patient care management. |

| | |PPT: Peaceful end of life care. |

| | |Ethics debate: Should health care professionals be authorized to unilaterally |

| | |discontinue life sustaining therapies they consider futile. |

| |NR. 110.500 | |

| |Philosophical, theoretical and ethical basis for nursing |Devised evidenced based therapeutic hypothermia protocol on the basis of |

| | |aforementioned systemic review to guide practice of medical and nursing staff to |

| | |improve neurological outcomes of adult post cardiac arrest patients. |

| | |Assisted in review of restraint documentation tool used at care center to improve |

| | |documentation compliance of nursing staff as per institutional policy and JACHO |

| | |standards. |

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| |Clinical practicum |Modified intra-abdominal pressure monitoring policy. |

| |NR110.520 CNS role practicum I (3 credits) |Reviewing oral chemotherapy protocol at SKCC based on new recommendations from |

| | |American Society of Clinical Oncology (ASCO). |

| | |Reviewing VTE prophylaxis assessment and management guidelines at SKCC to propose |

| | |recommendations based on 2013 guidelines from ASCO and other recent references. |

| | |Developing a fact sheet to re-enforce recommendations related to manual compression |

| | |devices. |

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| |NR 110.521 CNS expert practicum II | |

|Lead multidisciplinary groups to facilitate |Didactic course work |Describe strategies to leadership, management and consultative skills to improve |

|collaboration with other disciplines in the |NR110.523 Clinical Judgment in Acute and Critical care I |services in acute and critical care health care systems. |

|attainment of outcomes across the continuum of care.| | |

| |Clinical practicum |Enhanced leadership skills toward continuous improvement of patient outcomes and |

| |NR110.520 CNS role practicum I |nursing care in diverse health care systems. |

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| | |Leading the project called “therapeutic hypothermia in adult post cardiac arrest |

| | |patients”, in collaboration with chair of CPR committee, medical lead of ICU |

| | |committee and nursing management of intensive care unit. |

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| | |Refer description in goal number 2 |

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| | |Refer description in goal number 2 |

| |NR 110.521 CNS expert practicum II | |

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| |NR 110.522 CNS outcomes practicum III | |

| Interpret the dimensions of nursing care requiring |Didactic course work |Learned to analyze the influence of social, economic and health policy on health |

|resources at the system level, and provide |NR 110-504 Context of health care for advanced practice nursing |care delivery and scope of advanced nursing practice in various care models. |

|leadership to assure that the system adequately | | |

|supports the delivery of nursing care. | |Issues manuscript: Advanced practice nursing issues |

| |Clinical Practicum | |

| |NR110.520 CNS role practicum I |Clinical project of therapeutic hypothermia has anticipated the need of material |

| | |resources and clinical training to ensure that nursing staff receive adequate |

| | |support to execute change process. |

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|Expand the practice of nursing through ongoing |Didactic course work | |

|generation and acquisition of scientific knowledge |110.507 Statistical literacy and reasoning in nursing research. |Refer description in goal number 4. |

|and skills to maintain expert clinical competencies | | |

|that leads to desired outcomes. |NR 110.503 Application of research to practice. | |

| | |Refer description in goal number 4. |

| |NR 110.523 Clinical Judgment in advanced acute care nursing I | |

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| | |Enabled to acquire and relate advanced clinical knowledge in management of acute and|

| |Clinical Practicum |critically ill patients that incorporates evidence based strategies. |

| |NR110.520 CNS role practicum I | |

| | |Enhanced skills in the management of patients on Left ventricle assisting device. |

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| | |Reviewed literature on management of various cardiopulmonary disorders encountered |

| | |in acute care setting and expanded knowledge on the management of acute MI, cardiac |

| | |failure, ARDS and pulmonary embolism in lieu of current evidence based guidelines. |

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| | |Enriched my knowledge on the management on oncological emergencies/complications |

| | |requiring acute/critical care. |

| |NR 110.521 CNS expert practicum II | |

| | |Manuscript submitted for publication in Journal of Clinical Nurse Specialist: |

| | |“Implementing therapeutic hypothermia in post cardiac arrest patients: clinical |

| | |nurse specialist’s initiative in a developing world”. Conducting a first review |

| | |based on editors’ feedback. |

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| | |Writing a manuscript on the “The impact of comprehensive unit based safety program |

| | |on safety culture of non-critical care units at Johns Hopkins Hospital” |

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| |NR 110.522 CNS outcomes practicum III | |

|Demonstrate professional citizenship and fiscal |Didactic course work |Issue paper: Transition from traditional to evidence based practice, is it feasible |

|responsibility in the health care system by focusing|NR 110-504 Context of health care for advanced practice nursing |to utilize evidences from developed countries to ameliorate health care practices in|

|on health policy and/or resource management to | |developing countries. |

|ensure quality, cost-effective outcomes of nursing | | |

|care. | |Contributed to mini business plan to commission JHUSON primary care clinic. |

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| |Clinical Practicum |Developing capital and operational budget plan to implement therapeutic hypothermia |

| |NR110.520 CNS role practicum I |project. (In progress) |

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| | |Developed a logic model to identity resources needed to execute rapid response team |

| | |program. And, working on detailed budget report to guide resource planning and |

| |NR110.560 Program Development and Evaluation in Health Care |allocation for the said project. |

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