NURS 8003 Week 10 portfolio artifact example

Portfolio Artifact: A Practice Council Briefing on Letting Inpatients Use Their Own Inhalers, With a Rationale for the Domain It Demonstrates

Student Name

College of Nursing, Walden University

NURS 8003: Foundations and Essentials in Nursing

Instructor Name

Month Day, Year

Portfolio Artifact: A Practice Council Briefing on Letting Inpatients Use Their Own Inhalers, With a Rationale for the Domain It Demonstrates

Part 1. Briefing for the Nursing Practice Council

To: Nursing Practice Council. From: Nurse Manager, 5 West Medical. Re: Should adults admitted with stable asthma or chronic obstructive pulmonary disease keep and use their own rescue and maintenance inhalers at the bedside?

The Problem

Our policy requires that all inhalers be stored in the medication room and administered by a nurse at scheduled times. Patients who manage their inhalers independently at home lose that control on admission. On 5 West, nurses report frequent requests for rescue inhalers that take time to fulfill during busy periods, and patients describe the delay as distressing. The policy also means patients leave the hospital without anyone having observed how they use their own devices. Patients admitted for an exacerbation are often the ones whose technique most needs checking, and the current process gives nurses no natural moment to do it.

What the Evidence Says

Two reviews examined hospital programs in which patients administer some of their own medications. A critical literature review of inpatient self-administration programs found that they were generally well received by patients and staff and could support patients' knowledge of their medicines, though study quality was variable and outcomes were not consistently measured (Wright et al., 2006). A later systematic review of self-administration schemes in hospital found that patients were generally satisfied, and some studies reported improved knowledge or adherence, but evidence on safety outcomes and medication errors was limited and mixed (Richardson et al., 2014). Neither review focused only on inhalers.

Table 1

Current Policy Compared With the Evidence

Recommendation for the Council to Consider

The council could consider a pilot on 5 West allowing eligible patients, adults with stable asthma or COPD who use inhalers independently at home and pass a brief technique check, to keep their own inhalers at the bedside, with patients recording doses on a simple log the nurse reviews each shift. Patients who are confused, sedated or clinically unstable would be excluded, and eligibility would be reassessed daily. The pilot would measure patient satisfaction, time from request to rescue dose, documentation completeness and any medication events over three months. Pharmacy and respiratory therapy would need to be part of the design before any change, and the council would review the pilot's results before deciding whether to extend it to other units.

Questions the Council Is Likely to Ask

What if a patient uses the rescue inhaler too often? The bedside log, reviewed every shift, would show frequent use, which is itself useful clinical information that current practice can miss when requests are handled one at a time. A threshold for notifying the provider would be set with respiratory therapy.

Who is responsible if a dose is missed or duplicated? The pilot would keep the nurse responsible for reviewing the log and the patient's condition, while the patient takes each dose. Eligibility would be reassessed daily and withdrawn if the patient's condition changes.

Does this conflict with regulations on medication storage? Pharmacy would need to confirm how bedside storage fits the hospital's policies and state rules before any pilot. The briefing does not assume the answer.

Why start with inhalers rather than all medications? Inhalers are used intermittently, are familiar to eligible patients and involve a technique that nurses should observe before discharge anyway. They offer a contained starting point for learning whether self-administration works on our units.

Part 2. Rationale: What This Artifact Demonstrates

I am including this briefing in my portfolio as evidence for Domain 4 of the 2021 AACN Essentials, scholarship for the nursing discipline, which asks nurses to integrate evidence into practice decisions (American Association of Colleges of Nursing, 2021). The briefing shows three parts of that competency. It frames a practice question from a real problem on my unit. It summarizes evidence from two reviews accurately, including their limits, rather than overstating what they show. And it translates the evidence into a proposal proportionate to its strength: a measured pilot, not a policy change.

The artifact does not demonstrate Domain 5, quality and safety, even though it touches safety. It proposes measures but has not implemented or evaluated them, so it shows planning, not improvement. It also does not demonstrate interprofessional partnership, because I wrote it alone; pharmacy and respiratory therapy appear as future partners rather than contributors. Claiming either domain would stretch the evidence.

I revised the briefing twice before including it. The first draft cited only one review and described self-administration as proven safe, which the evidence does not support. The second draft added the second review and the safety table. The version here is the third. I kept the earlier drafts in my files because the revisions themselves show the domain developing: the change from advocacy to proportionate recommendation is the scholarship I am claiming.

A reader might ask whether one briefing is enough to show a doctoral competency. On its own it is not; it shows the competency once, in one form. I intend to pair it in the portfolio with the evidence appraisal from earlier in the course, so that together they show appraisal and translation. If the council approves a pilot, a later artifact could show the evaluation that this one only plans.

Part 3. Why the Rationale Is Written in First Person

The rationale is written in first person because it is a claim about my own competence, made to a reader who will judge it. The briefing is written in the neutral voice a practice council expects. Keeping the two voices separate makes clear which document is the work and which is my argument about what the work shows.

References

American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education.

Richardson, S. J., Brooks, H. L., Bramley, G., & Coleman, J. J. (2014). Evaluating the effectiveness of self-administration of medication (SAM) schemes in the hospital setting: A systematic review of the literature. PLoS ONE, 9(12), Article e113912. https://doi.org/10.1371/journal.pone.0113912

Wright, J., Emerson, A., Stephens, M., & Lennan, E. (2006). Hospital inpatient self-administration of medicine programmes: A critical literature review. Pharmacy World and Science, 28(3), 140-151. https://doi.org/10.1007/s11096-006-9014-x