Professional Portfolio Anil Khurana R.N.

1. Professional PortfolioAnil Khurana R.N. California State University Dominguez Hills Master of Science in Nursing, Family Nurse Practitioner Culminating Activity Presented October 28, 2009.

2. Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning. • Albert Einstein

3. Introduction • Registered Nurse since 2006. • Pediatrician from India. • Happily married to Deepa, the love of my life, for 35 years. • One son, Ribhu, One daughter, Radha. • One granddaughter, Anyaa.

4. Education • Candidate, Master of Science in Nursing,Family Nurse Practitioner option, California State University, Dominguez Hills, CA, Fall Semester 2009. • Associate Degree in Nursing, Excelsior College, Albany, NY, 2005. • Doctor of Medicine (Pediatrics), Government Medical College, Patiala, India. • Bachelor of Medicine and Bachelor of Surgery, Government Medical College, Amritsar, India.

5. Professional Experience • Director of Patient Care Services, Haven Hospice, Signal Hill, CA. • RN Case Manager, Haven Hospice & Home Health, Signal Hill, CA. • Practicing Pediatrician, Jalandhar, India. • Head of Pediatric Service, V.M. Civil Hospital, Jalandhar, India.

6. Integrate knowledge, theory, research and skills in planning and evaluating comprehensive plans of care for individuals, families and populations • Demonstration of Clinical Proficiency at School • Examining 10 –16 patients/week at Paja Medical Clinic, site for clinical hours. Utilizing guidelines at National Guideline Clearinghouse website while writing plan for patients with multiple and complex problems like diabetes mellitus, hypertension, autoimmune diseases.

7. Integrate knowledge, theory, research and skills in planning and evaluating comprehensive plans of care for individuals, families and populations • Demonstration of Clinical Proficiency at school and work • During MSN 510, Theories for Advance Nursing Roles, I utilized Peplau’s theory of interpersonal relations (Peplau, 1988) to study the relationship of a nurse with a patient with chronic pain. • Utilizing the knowledge gained to plan care of hospice patients at work to optimize pain relief by maintaining consistency of nurse for eachpatient to allow for development of therapeutic relationship.

8. Integrate knowledge, theory, research and skills in planning and evaluating comprehensive plans of care for individuals, families and populations. • Demonstration of Clinical Proficiency at work • Planning and guiding end-of-life care of 120 patients with various life limiting illnesses. • Integrating knowledge of theory, research findings from National Guideline Clearinghouse, and knowledge acquired during graduate education to develop comprehensive plans of care for patients and their families.

9. Design culturally sensitive programs and systems of care that meet the needs of diverse and vulnerable populations. • Demonstration of sensitivity to problems of vulnerable populations • During the MSN 514(Health Promotion & Disease Prevention) I used the TransTheoretical Model (TTM) (Prochaska & Velicer, 1997) to understand the readiness to change of youth with substance abuse problems and their families. • I use this model to ascertain the readiness to change habits when I write care plans for patients from vulnerable populations at clinical site and at work.

10. Provide evidence-based, clinically proficient care using critical thinking skills in advanced nursing roles. • Using evidence based interventions in Advanced Nursing Roles • I studied how to critically evaluate research in MSN 530 Research Utilization in Advanced Nursing Roles • I wrote a paper on Pediatric Palliative Care for MSN 513 Healthcare policy and economics. I received a good grade for this paper. I also found evidence of the obstacles to providing sensitive and adequate care to dying children (Carter et al, 2006) & (Hayes, 2006). • I utilized knowledge gained from this paper to advocate for a separate IDT for children on Pediatric Palliative Care and the setting up of a non-profit, Haven’s Heart, at my workplace to assist with such care financially leading to improved parent satisfaction.

11. Adapt oral, written and technological communication skills to be effective and appropriate in clinical, educational, and professional contexts and systems. • Utilizing Oral Skills • While speaking to team members, patients and attendants in their preferred language, English or Spanish. • While providing patient, active listening to patients and attendants. • While providing education to patients and care givers. • While leading Inter-Disciplinary Team Meetings at work.

12. Adapt oral, written and technological communication skills to be effective and appropriate in clinical, educational, and professional contexts and systems. • Utilizing Oral Skills • While presenting In-services to Inter-Disciplinary Team at work. • When unusual occurrence reports indicated an increase in hospitalizations R/T falls, I conducted an evidence-based in-service on fall prevention which resulted in a 21% decrease in falls in one quarter.

13. Adapt oral, written and technological communication skills to be effective and appropriate in clinical, educational, and professional contexts and systems. • Adapting written skills • To write scholarly papers for various MSN courses at CSUDH. Received a perfect score for paper “Healthcare in the media” in MSN 566. • To initiate & respond to graduate level discussions with peers which are critiqued by senior faculty at CSUDH • To write reports, incident reports, and employee evaluations at work using graduate level language skills.

14. Adapt oral, written and technological communication skills to be effective and appropriate in clinical, educational, and professional contexts and systems • Adapting Technological Communication Skills at school • To undertake an online course requiring internet, email, word processing and power point skills. • To utilize nursing journal databases in CSUDH library to write evidence based scholarly papers. • For synchronous and asynchronous communications with peers and faculty connected mainly by electronic communication.

15. Adapt oral, written and technological communication skills to be effective and appropriate in clinical, educational, and professional contexts and systems. • Adapting Technological Communication Skills at work • To provide clinical and administrative support to clinicians providing patient care in an approximately 14000 sq mile service area. • To utilize telephone, voice mail, email, and instant messaging on the Blackberry to support clinical team. • To utilize Global Positioning application, Comet Tracker, to pin point location of team members to provide time & cost sensitive care to patients in the service area.

16. Integrate ethical theory andprinciples into nursing theory, research and practice in advanced nursing roles. • Using ethical principles at school • In my MSN 531 scholarly paper I learnt how ethical principles of autonomy and nonmaleficence (Beauchamp & Childress, 2001) pertained to the care of a terminally ill South Asian lady and her family. I learnt how to empower this patient and her family, to take the decisions to allow her to pass on pain free, with dignity, at home amongst her dear ones, and according to her expressed wishes.

17. Integrate ethical theory andprinciples into nursing theory, research and practice in advanced nursing roles. • Using ethical principles at work • I use these ethical principles every day at work when I plan and direct the care of terminally ill patients. I do my best to protect their rights during a time when the spouse, significant other and family tend to overlook or override these rights. I use these principles while navigating our complex healthcare system to ensure patients receive the best care possible, with dignity.

18. Advocate for healthcare policies and financing that promote, preserve and restore public health. • Healthcare policy and financing advocacy at school. • During the Fall 2007 semester while in the MSN 513, Healthcare Policy & Economics, I learnt about the processes involved in creating new healthcare policies or changing existing ones. I learnt how nurses can individually, and through our professional organizations, influence health care policy.

19. Provide leadership in collaborative efforts with other disciplines to influence improvement in healthcare systems • Leadership at school • I have learnt to lead my small group as Small Group Leader while assigning tasks, observing timelines and holding members of the group accountable. • I have learnt online etiquette and how to be assertive without appearing aggressive.

20. Provide leadership in collaborative efforts with other disciplines to influence improvement in healthcare systems • Leadership at school • I have come to understand how various disciplines combine to improve healthcare by observing my preceptors, one a Family Nurse Practitioner and the other a Physician, at my clinical hours site.

21. Provide leadership in collaborative efforts with other disciplines to influence improvement in healthcare systems. • Leadership at work • At work every Monday I lead an Interdisciplinary Team (IDT) meeting, which comprises of Physicians, Registered Nurses, Licensed Vocational Nurses, CHHAs, Companions, M.S.Ws & Spiritual and Bereavement Counselors. We all interact to improve the care of our patients.

22. Demonstrate commitment to lifelong learning to enhance the nursing profession. • Learning at school • I have displayed my commitment to learning by completing this program. • I have learnt Spanish to better communicate with Hispanic patients at my clinical site and at work. • I intend to join a Doctor of Nursing Practice program as soon as one becomes available within a reasonable distance or over the Internet

23. Demonstrate commitment to lifelong learning to enhance the nursing profession. • Learning at work • I recently (September 2 to 4, 2009) completed a Pain Resource Nursing (PRN) Course at the City of Hope Hospital, Duarte, CA. • I frequently complete C.M.Es on pain, palliative care and current topics in nursing. • I also keep abreast of topics at the CDC website.

24. Demonstrate commitment to lifelong learning to enhance the nursing profession. • Teaching at clinical site • I teach the patients I see at my clinical site about their illnesses, recommended life style, the medicines they are taking or are being prescribed at a visit, and adverse effects to look out for. • I learn valuable lessons from my patients everyday.

25. Demonstrate commitment to lifelong learning to enhance the nursing profession. • Teaching at work • I am currently precepting my 3rd, 4th & 5th BSN students from CSUDH while they complete the requisite hours in a Home Health setting. • I take pride in imparting them my knowledge about Hospice philosophy and services. • One of my preceptees is now working as a Hospice Registered Nurse.

26. Demonstrate commitment to lifelong learning to enhance the nursing profession. • Teaching at work • I teach BSN students of the American University of Health Sciences, Signal Hill, CA. I teach them Clinical Leadership and Home Health skills when they come for these rotations. I have educated two batches of 20 students each. I utilize skills I have learnt as a graduate student to train future nurses.

27. Community Service • Volunteer Registered Nurse • I volunteered at a Free Health Fair organized by the Guru Nanak Sikh Temple in Buena Park, CA, on February 8, 2009. I recorded the Blood Pressures, and calculated the Body Mass Indices of 51 patients at this fair. I provided those with high BP readings or B.M.Is in the over- weight or obese ranges education on maintaining a healthy life style. I utilized my knowledge of various diseases and health promotion at this camp. • Adapt oral, written and technological communication skills to be effective and appropriate in clinical, educational, and professional contexts and systems.

28. Community Service • Volunteer Registered Nurse • I have participated in Health Fairs organized by South Asian Network (SAN) in association with University of California, Irvine (UCI) in 2007 and 2008. I utilized clinical skills acquired during the MSN-FNP program to assess and educate the patients attending these camps. These camps were organized in the City Centers of Cerritos and Anaheim respectively. • Presented PPT “Prevention of osteoporosis” at these fairs. • Adapt oral, written and technological communication skills to be effective and appropriate in clinical, educational, and professional contexts and systems.

29. References Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th Ed.). New York: Oxford Carter.B. S. et al (2004). Circumstances Surrounding the Deaths of Hospitalized Children: Opportunities for Pediatric Palliative Care. PEDIATRICS Vol. 114 No. 3 September 2004. Comet tracker www.actsoft.com/products/comettracker.aspx CSUDH Library http://library.csudh.edu

30. References contd. • Hays R. M. et al (2006). The Seattle Pediatric Palliative Care Project: Effects on Family Satisfaction and Health-Related Quality of Life.JOURNAL OF PALLIATIVE MEDICINE Volume 9, Number 3, 2006 • National Guidelines Clearinghouse http://www.guideline.gov/ • Peplau H. (1988) Interpersonal constructs for nursing practice. Nurse Education Today, 7(5):201‑208. • Prochaska J.O, Velicer W.F. (1997) The transtheoretical model of health behavior change. Am J Health Promotion. 1997;12:38–48.

31. Thank you for listening • A big thank you to my instructors during this program. • Questions please?