Position Paper / Nursing Research (330)

NURS 431- Transition to Professional Nursing Practice

Purpose of Assignment
The purpose of this assignment is to address the students attainment of all eight behaviors and/or
competencies that are specific outcomes of the program in relation to the position paper
including: critical thinking, nursing practice, communication, teaching, research, leadership,
professionalism, and culture.

Student Approach to Assignment

This paper summarizes the progression that I have made from my sophomore to senior year.
Specific examples provide insight into exactly how I grew in the eight core curriculum
objectives. I am able to highlight my personal progress as I move towards becoming a registered
nurse. This paper is an excellent reflection of my experiences in nursing school. The approach to
the position assignment was to prepare an argument reflecting two sides of a researched topic.

Reason for Inclusion of the Assignment in the Portfolio

This assignment is included in the portfolio because it showcases my progress in the eight core
curriculum behaviors of: critical thinking, nursing practice, communication, teaching, research,
leadership, professionalism, and culture. It is a required component in my portfolio that
highlights how I fulfilled a number of the end program outcomes.

Critical Thinking
Evaluates nursing care outcomes through the acquisition of data and the
questioning of inconsistencies

Example: page 7 paragraph 1 (Junior year):

The rate of incidence of multiple births is the highest if the mother is in the age
range of 20-29. If the mother is in the age range of 40-44, the incidence of
multiple births was still significantly decreased even if 5 embryos are transferred
for implantation. This is a significant statistic because a common reason for
undergoing IVF is advanced maternal age

Revises actions and goals based on evidence rather than conjecture

Example: page 7 paragraph 3 (Junior year):

Nursing considerations should be kept in mind when caring for patients with this
history. These women will experience fluctuations in anxiety levels during their
pregnancy that other patients would not during the pre-conception phase and in
the first trimester. A self-assessment form of study was conducted that indicated
the experience of significant anxiety level variation in starting fertility IVF
treatments, in the diagnosis of a multifetal pregnancy, and the confrontation of a
 choice in which to complete or not complete selective reduction (Britt, Risinger,
Mans, & Evans, 2003). This showed both a higher mean level of anxiety and
more variation in the anxiety levels, indicating a need for specific nursing care
and intervention when treating patients who have undergone IVF and are faced
with a multifetal pregnancy or when treating any woman with a multifetal
pregnancy confronting the further obstacles from that.

Nursing Practice
Establishes and/or utilizes outcome measures to evaluate the effectiveness of care

Example: page 4 paragraph 1 (Junior year)

Prior to viability, a twin with a low fetal weight and markers for congenital
abnormalities may be an indicator for this procedure (Moise, Kugler, & Jones,
2012). The positive outcome for a singleton pregnancy is greatly increased when
compared to a twin pregnancy this could help a healthy fetus develop in an
environment where a second fetus demise is anticipated. The enacting of a
selective reduction procedure on that type of pregnancy would then leave a fetus
with a greater chance of reduced complications from currently known causes. In
specific relation with IVF, live birth rates can be increased in IVF if fewer
embryos are implanted. This creates a safer environment in which a fewer number
of fetuses can develop without fear of intrauterine growth restriction (IUGR) or
the many cardiac/perfusion problems associated with multifetal pregnancies
(Scheieve, Peterson, Meikle, & Jeng, 1999).

Communication
Produces clear, accurate, and relevant writing using correct grammar, spelling and
punctuation
Example: page 2 paragraph 1 (Junior year)
Selective reduction is the procedure of reducing the number of fetuses in a
multifetal pregnancy in and outside of in vitro fertilization (IVF). This process can
be used to reduce any number, down to reducing a twin pregnancy to a singleton
pregnancy.

Teaching
Provides teaching to patients and/or professionals about health care procedures
and technologies in preparation for and following nursing or medical interventions
Example: page 2 paragraph 1 (Junior year)
This procedure is completed using one of three methods: injection of potassium
into the fetal heart via Ultrasound guided needle, radiofrequency ablation, and
occlusion of the umbilical cord through Bipolar Cord Coagulation (BCC), with
 radiofrequency ablation and occlusion of the umbilical cord being the most
successful (preformed from 18-25 weeks gestation). This is a relatively new
option for women created in the 1980s and grew alongside the increasing success
of IVF (Wimalasundera, 2010).

Uses information technologies and other appropriate methods to enhance ones

own knowledge base

Example: page 8 paragraph 2 (Junior year)

I have learned a significant amount in the area of stress on the mother and have
gained contributions to a better understanding of not only this procedure, but also
of the methods, the outcomes, the pregnancy statistics for fetal life, and the care
for a stressed patient. These considerations should be maintained when the RN (or
any member of the care team) is treating a patient undergoing IVF, has been
diagnosed with a multifetal pregnancy, and/or is considering selective reduction
or has undergone selective reduction.

Research
Evaluates research that focuses on the efficacy and effectiveness of nursing
interventions

Example: page 8 paragraph 1 (Junior year)

A self-assessment form of study was conducted that indicated the experience of
significant anxiety level variation in starting fertility IVF treatments, in the
diagnosis of a multifetal pregnancy, and the confrontation of a choice in which to
complete or not complete selective reduction (Britt, Risinger, Mans, & Evans,
2003). This showed both a higher mean level of anxiety and more variation in the
anxiety levels, indicating a need for specific nursing care and intervention when
treating patients who have undergone IVF and are faced with a multifetal
pregnancy or when treating any woman with a multifetal pregnancy confronting
the further obstacles from that.

Professionalism
Applies an ethical decision-making framework and legal guidelines to clinical
situations that incorporate moral concepts, professional ethics, and advocacy for
patient well-being and preferences

Example: page 5 paragraph 1 (Junior year)

 These arguments are contended by many in abortion debates arguing that a
woman should be able to choose what she does with her body in regards to
medical procedures. This argument holds that the governing bodies of any state or
federal establishment should not be able to pass laws regulating health care
procedure decisions. Even if a woman elects not to undergo a procedure such as
an abortion or selective reduction, this argument contends that a woman should
have the ability to choose to do so. This argument also holds that the start of life
under the assumption of personhood does not begin until after birth. Some ethical
scholars, such as Mary Anne Warren, do not believe that even young children hold
the necessary qualities for personhood until well after birth.

Example: page 5 paragraph 2 (Junior year)

One of the most obvious arguments against selective reduction is the moral
stance on abortion and abortion-like procedures. An important point in this
argument is that the cessation of life in all humans is wrong if that can be
prevented by any person (especially a member of a healthcare team) or if that is
caused by any person. If any termination of human life is wrong, that would then
imply that the termination is wrong in any stage of life. If a fetus is a human, it
falls under that category of life regardless of personhood status. Therefore,
cessation of a fetus life would be erroneous. Another point is that even if a fetus
has not yet developed enough to be in the realm of personhood, it is still a human
and therefore is a person in the moral sense that a benign tumor growth is still
cancer even though it has not been left to mature to a point of malignancy.

Understands the effect of legal and regulatory processes on nursing practice and
health care delivery, as well as limits to ones own scope of practice

Example: page 2 paragraph 1 (Junior year)

Since the procedure does not aim to remove all of the fetuses and empty the
uterus, this procedure does not fall under current abortion laws. Currently, no laws
specific to selective reduction are in place. This is a relatively new option for
women created in the 1980s and grew alongside the increasing success of IVF
(Wimalasundera, 2010). The issue of concern for many people, and subsequently
for many government bodies in passing a law in line with this topic, is the ending
of a fetal life during what is essentially an abortion of a particular fetus. The
juxtaposing issue is the restriction of female choice in their own healthcare.

Culture
Demonstrates sensitivity to personal and cultural definitions of health, and how
these beliefs influence an individuals reactions to the illness experience and end
of life

Example: page 4 paragraph 3 (Junior year)

The risk of a miscarriage or a premature birth and the ensuing complications are
lower than attempting carrying a multifetal pregnancy. This alone shows the
benefit of the selective reduction procedure in pregnancy outcomes. On top of
these outcome differences, there is also the moral stance that a womans body
should be her own dominion. These arguments are contended by many in abortion
debates arguing that a woman should be able to choose what she does with her
body in regards to medical procedures.