If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

• Review the Resources and select one current national healthcare issue/stressor to focus on.
• Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

references

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

• Chapter 2, “Understanding Contexts for Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 37–62)
• Chapter 3, “Current Challenges in Complex Health Care Organizations: The Triple Aim” (pp. 63–86)

45 (45%) – 50 (50%)   Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Each person has his or her own personal history; that is, his or her collected experiences. Everything you have ever seen, heard, felt, learned, or experienced has lead to the development of this personal history. Factors that affect this history include your gender, race, age, ethnicity, culture, education, native language, and religion, to name a few. Collectively, these factors create the sum total of who you are as a person. Bias occurs when a person has a tendency towards a particular perspective or ideology (i.e. your personal history); after all, you see the world through your own eyes. To some extent, every person has a natural bias. However, if or when your personal bias interferes with your ability to be unprejudiced or objective – especially in your nursing practice – your biases can become problematic. In this discussion, you will have the opportunity to determine how strong your biases are.You should post your original message by 23:59 PM Wednesday. You should also reply to posts by two of your peers by 23:59 PM, Saturday of Module 3.

GUIDELINES

In the professional nursing practice, nurses must provide unbiased care, even in situations where the person/s being treated have different backgrounds (language, religion, culture, ethnicity, etc.) than you. The first step in overcoming and minimizing personal biases is to recognize them. In this discussion, you will assess your personal biases. Answer the questions honestly and to the best of your ability, noting that there are no right or wrong answers.

· Complete the General Awareness and Attitudes Scale

o The General Awareness and Attitudes Scale is adapted from the Cultural Awareness Scale by Catterson, Cookston, Martinez, & Rew (1998). Answer the question as honestly as possible. There are no right or wrong answers.

· Once you complete and score the General Awareness and Attitudes Scale, answer the following questions:

· What does the scale say about you?

· How strong are your biases?

· NOTE: Do NOT post your individual scores. This discussion is not about how you score, but about personal discovery. In other words, the focus of this discussion is about what you learn about yourself. You also do NOT need to share your score with your academic coach.

· How can you address these personal biases in your professional nursing practice?

Your original post should consist of complete sentences and should be at least two complete paragraphs but no more than three paragraphs.

The University of Texas at Arlington

School of Nursing

General Awareness and Attitudes Scale

Based on Cultural Awareness Scale by Shirin Catterson, Jeff Cookston, Stephanie Martinez, Lynn Rew

With permission from Dr Lynn Rew

Student Name: ________________________________________________

Use the scale of 1 to 7 (1=Strongly Disagree, 4=No Opinion, 7-Strongly Agree) to indicate how much you agree or disagree with each statement.

		Does not apply	Strongly Disagree			No Opinion			Strongly Agree
1.	I think my beliefs and attitudes are influenced by my culture.		1	2	3	4	5	6	7
2.	I think my behaviors are influenced by my culture.		1	2	3	4	5	6	7
3.	I often reflect on how culture affects beliefs, attitudes, and behaviors.		1	2	3	4	5	6	7
4.	When I have an opportunity to help someone, I offer assistance less frequently to individuals of certain cultural backgrounds.		1	2	3	4	5	6	7
5.	I am less patient with individuals of certain cultural backgrounds.		1	2	3	4	5	6	7
6.	I feel comfortable working with persons of all ethnic groups.		1	2	3	4	5	6	7
7.	I believe ones’ own cultural beliefs influence their professional decisions.		1	2	3	4	5	6	7
8.	I typically feel somewhat uncomfortable when I am in the company of people from cultural or ethnic backgrounds different from my own.		1	2	3	4	5	6	7

Assignment: Evidence-Based Practice and the Quadruple Aim

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

• Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
• Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
• Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

• Patient experience
• Population health
• Costs
• Work life of healthcare providers

Concept Synthesis Paper on Personal Nursing Philosophy

You are required to submit a scholarly paper in which you will identify, describe, research, and apply the concepts that underlie your personal philosophy for professional nursing practice.

This will help you identify your own values and beliefs about the established metaparadigms and metatheories of the discipline. It will also help you identify and articulate concepts relevant to your specific practice. This paper is intended to be an exercise in clarification and organization of your professional foundation. You are also required to provide a list of assumptions from personal nursing practice that illustrate the concepts and framework of your theory.

Your paper should follow a format that includes:

• Nursing Autobiography: A brief (1 page) discussion of your background in nursing.
• The Four Metaparadigms: Identification, discussion, and documentation from the literature of your perspective on the basic four metaparadigms/concepts of patient, nurse, health, and environment.
• Two Practice-Specific Concepts: Identification, discussion, and documentation from the literature of your perspective on at least two other concepts specific to your own practice.
• List of Propositions: A numbered list of at least five propositions or assumption statements that clearly connect the concepts described.

Your paper should integrate these discrete elements and reflect your personal nursing philosophy.

Consider the following questions as you complete your various tasks related to this assignment.

1. How do I define and employ the four basic metaparadigms of nursing theory in my professional practice?

2. What are the major concepts I employ that are unique to my professional practice?

3. What philosophies and theories from the literature of nursing and other disciplines/domains are consistent with these concepts?

4. How are the concepts of transcultural nursing, the health promotion model, skill acquisition, role theory, and change theory specifically integrated into  my philosophy and practice?

5. What research supports these theories and concepts?

6. How do I integrate role and change theory into my professional practice and how may these theories be applied to the organization in which I practice?

The paper is to be thoroughly researched and well documented, with relevant material from the nursing theorists presented incorporated into the paper. Use the current edition of the APA Manual throughout the paper. Sources should focus on references from nursing theory but may also include conceptual and theoretical material from other professional domains. The paper, excluding references or appendices, is to be limited to 6-10 pages. Writing should be succinct and well organized, as it is impossible for the facilitator to evaluate form and content separately.

Your philosophy/framework is to be given a title that is appropriate to its content and emphasis.

To help with this paper, here is my brief nursing background: “I have been in the medical field since 2001 in Cuba. I got my RN license in the USA this past April after a long process which included the NCLEX RN exam, English proficiency, and submission of all my documentation from my university. Working as a home health nurse since April 2019. My future plan is to keep growing as a nurse, work as a family NP in some hospital or family clinica where I can offer the best of my knowledge to my patients. I would like to be able to practice different specialities so that way I would integrate my skills for the benefits of my patients. “

I need about 100-120 words for each question. I want each question with its references, and please, no plagiarized work.

 

MODULE 1

DQ1

Describe a situation in which a new clinical practice was put into place. Was there a DNP-prepared nurse leading the translation of the practice from research to practice? If so, describe the process that individual took for translation and why it made a difference in the translation. If there was not a DNP-prepared nurse, describe the process and what would have been different about the process had there been a DNP-prepared nurse leading the practice translation?

DQ2

Compare the PhD and DNP degrees. Define the differences in roles and education associated with the two degrees. Describe future opportunities for DNP-prepared nurses.

MODULE 2

DQ1

Which research methodology would be the most appropriate for your project and how does it align with your clinical question, data collection, and data analysis? Demonstrate an example of when you might use the opposite methodology in your EBP projects and why.

DQ2

Within nursing, the patient’s perception is recognized as the patient’s reality. How does this way of knowing in nursing fit within an objective or subjective paradigm of the world? Explain your reasoning.

MODULE 3

DQ1

Which method do you prefer in determining levels of evidence? Describe two advantages to the method and one disadvantage to the method. Explain how you have used this method in your current practice or education. Why are levels of evidence important in selecting empirical articles for your ROL (Chapter 2 of your DPI project)?

DQ2

Research can take between 10-20 years to be translated into practice. Discuss your thoughts on the reasons why this may occur and describe the barriers within your own practice that prevent you from practicing from a 100% evidence base.

MODULE 4

DQ1

Reliability and validity are often misunderstood and not given much notice in research articles. Using any example, demonstrate how you would correctly describe these two terms to a nurse prepared at a bachelor’s degree level or below. Then describe why the reliability and validity of a study is important for translation.

DQ2

What are the criteria for selecting qualitative versus quantitative resources in relation to your literature review? Which method(s) of research are you selecting? Why?

MODULE 5

DQ1

What effect does a meta-synthesis or meta-analysis have on research translation? Describe a clinical practice in place that is supported by this level of evidence.

DQ2

Comparative effective research is important in translating research. Describe one study that used comparative effective research. What were the findings and were they translated into practice?

MODULE 6

DQ1

There is a heavy focus on achieving statistical significance when evaluating outcomes. Often in research or EBP projects, there is no statistical significance, only possible clinical significance. When is it appropriate to deem a project’s outcomes successful only using clinical significance as the only measure of success?

DQ2

The three components of EBP include clinical expertise, best evidence, and patient preference. Often, patient preference and clinical expertise are at odds with each other. Describe a scenario where you might need to mediate this issue and what is the solution when this occurs. It can be a real-life example as well.

MODULE 7

DQ1

Choose one model for EBP implementation. Describe its components and why you believe this model is most appropriate for assisting in translational activities. Contrast this model with another.

DQ2

Discuss the role of the DNP-prepared nurse in sustaining an EBP culture. What are two effective methods the DNP can use in sustaining an EBP culture?

MODULE 8

DQ1

Describe and discuss the differences between research, research utilization, and evidence-based practice. Provide examples.

DQ2

Describe how you will assist others to generate their own evidence-based practice questions. Discuss what your professional obligation as a DNP-prepared nurse is related to evidence-based practice, patients, and other nurses?

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

• For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes.  You are required to discuss all three scenarios within the paper component of this assignment.
• Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

Do you have experience hiring and/or managing people? Yes

Please describe your experiences and associated responsibilities and duties in those roles. Please highlight how many people you managed in each case. 

Do you have experience owning and operating your own business? Yes

Please describe your responsibilities and duties in these roles. Please highlight relevant people management experience.

If selected to own and operate a Delivery Service Partner, what personal and business goals would you hope to achieve by starting your company? 

What three words would you use to describe the culture you would foster at your company? Explain why you chose each word to represent your company’s culture.

Please describe your leadership style 

Please list and briefly describe your current involvement in the community (i.e. social, public, private, and professional organization)?{ ANS: PROFESSIONAL Organisation, provides health services to individuals with intellectual and developmental disability}

Is there anything in your personal, professional, or financial history that requires explanation? 

Strategies to Promote Academic Integrity and Professional Ethics

I have analyzed the relationship between academic integrity and writing, as well as the relationship between professional practices and scholarly ethics. I have also identified strategies I intend to pursue to maintain integrity and ethics of my academic work while a student of the MSN program, as well as my professional work as a nurse throughout my career. The results of these efforts are shared below.

Directions: In the space below craft your analysis/writing sample, including Part 1 (The Connection Between Academic and Professional Integrity) and Part 2(Strategies for Maintaining Integrity of Work).

Part 1: Writing Sample: The Connection Between Academic and Professional Integrity In the space below write a 2- 3-paragraph analysis that includes the following: • Explanation for the relationship between academic integrity and writing• Explanation for the relationship between professional practices and scholarly ethics • Cite at least 2 resources that support your arguments, being sure to use proper APA formatting. • Use Grammarly and SafeAssign to improve the product.• Explain how Grammarly, Safe Assign, and paraphrasing contributes to academic integrity

PART 2: Strategies for Maintaining Integrity of Work Expand on your thoughts from Part 1 by:  • Identifying and describing strategies you intend to pursue to maintain integrity and ethics of your 1) academic work while a student of the MSN program, and 2) professional work as a nurse throughout your career. Include a review of resources and approaches you propose to use as a student and a professional.

https://www.nursingworld.org/resources/

https://journal.alt.ac.uk/index.php/rlt/article/view/1648/pdf_13

The first link takes you to The Joint Commission website
You will notice that National Patient Safety Goals (NPSG) are separated by type care provided. Choose the long term care link.

1. Choose one of the goals listed and list three ways you might be able to meet that goal.

The next link will take you to the “Speak Up” initiative.

1. Choose and view one of the videos. In a paragraph discuss your impression of the videos and if you think that they will improve patient outcomes.

A NSPG that is threaded into every health care setting is HAND HYGIENE.

1. Search and explore the Centers for Disease Control or the World Health Organization websites for hand washing/hand hygiene. Are you surprised at the volume of information? Provide a list of the reasons you think that people don’t wash their hands. How does hand washing relate to patient safety? What can be done to improve hand hygiene in patients and in providers?
2. Here are some helpful links:
   1. Hand Hygiene
   2. Clean Care is Safer Care

Save your assignment as a Microsoft Word document. (Mac users,  please remember to append the “.docx” extension to the filename.) The  name of the file should be your first initial and last name, followed by an  underscore and the name of the assignment, and an underscore and the date. An  example is shown below:

Access the NDC-HCPCS crosswalk and locate HCPCS code J2997.  Identify the NCD codes for J2997.  Is the configuration of the NDC codes HIPAA compliant?  Why or why not?  How can the same HCPCS code have different NDC codes?  Find the NDC Label for Cathflo activase.  Search the Internet for the official site for this drug.  Locate the billing FAQs.  What NDC code is provided in the FAQs?

Respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described.

In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

 

Main Post

Pharmacokinetics and Pharmacodynamics

A solid understanding of how drugs impact the body is essential. Pharmacokinetics explains how the body metabolizes drugs, and pharmacodynamics describes the effect of the drug on the body. This post will explore a patient case, including factors that might have altered the patient response to medication therapy and a discussion of a personalized plan of care for the above patient.The case is about an adverse drug reaction (ADR).

According to Rosenthal and Burchum (2018), there has been a dramatic increase in ADRs despite efforts to reduce them. Although many of these events are preventable with careful prescribing, some are not. About two years ago, I went to work and received morning report for my patients. One particular patient stood out. He was an otherwise healthy 19-year-old with no known medication allergies, no active home medications, or medical conditions. The prior evening, he had become agitated because he wanted to leave the hospital and received Haldol 5 mg, Ativan 2 mg, and Benadryl 50 mg. I went to assess him and saw him unresponsive to his environment, standing at the wall, facing it, and mumbling. He was not alert to person, place, time, nor situation. I immediately suspected rhabdomyolysis and alerted the provider. The provider looked at him and stated: “he is just crazy.” I explained the patient history and demanded an order to send the patient to the emergency department (ED), which occurred. Later on, I called the ED, and the diagnosis was indeed rhabdomyolysis. It would be too easy to state that the scenario above was merely an unfortunate adverse event. Dr. Buttaro had it correct when she mentioned in the video that prescribing is about ensuring the right drug, right patient, right time, and the right dose (Laureate Education, 2019). I believe that a different medication choice in the scenario would have prevented rhabdomyolysis or lower doses.

The most likely etiology of the rhabdomyolysis was the administration of these medications. I do not think genetics, sex, age, ethnicity, or existing disease impacted this scenario. All three drugs increase the risk of developing rhabdomyolysis, especially for someone who had never taken antipsychotics or benzodiazepines (Stanley & Adigun, 2018). My plan of care for the patient would include verbal de-escalation as the first line of treatment and a low dose of hydroxyzine for agitation if needed. This medication choice would most likely be sufficient for someone who does not take medications at all. A safe rule for a prescriber is to go low and slow when prescribing drugs and monitor responses to therapy accordingly.

References

Laureate Education, Inc. (Executive Producer). (2019). Introduction to Advanced Pharmacology. Baltimore, MD: Author.Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO:        Elsevier.Stanley, M., & Adigun, R. (2018). Rhabdomyolysis. In StatPearls. Retrieved from        https://www.ncbi.nlm.nih.gov/books/NBK448168/

Part Two:

Assignment:

Describe the processes that take place during a typical hospitalization, or emergency department visit for a consumer under the ACA. From admission to discharge, including aftercare, rehab, and acquisition of medications; address the differences, with the same experience from before the ACA was passed into law?

Assignment Expectations: How will students be successful?

• Length:
  • 1500-2000 words (6-8 pages); answers must thoroughly address the questions in a clear, concise manner
• Structure:
  • Include a title page and reference page in APA style
• References:
  • Two scholarly references are required; you should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions

Investigate your organization’s compliance rate with one specific core measure of your choice and write a 2-3-page (maximum) executive summary analyzing the financial and regulatory impact of organizational compliance with your chosen measure. Include recommendations for improving performance on the measure.

 

For this assessment, write an executive summary analyzing the financial and regulatory impact of organizational compliance with a specific core measure of your choice. The summary must include recommendations for improving performance on the measure.

You must be able to explain the financial implications associated with the measure, as well as its importance in terms of policy, regulation, and finance. This is another good opportunity to consult with a key stakeholder within the organization. Talking to someone who works closely with the organization’s finances can help you develop a deeper understanding of the financial aspects of compliance. You also need to suggest ways your organization can improve compliance and how you would implement changes and overcome obstacles.

This may seem like an enormous undertaking, but you should approach it as if you were to present this information to your supervisor or manager. Keeping in mind that people in these positions do not have time to read a 10–12-page report, you would typically give them only an executive summary of your analyses and recommendations. That means that you will need to be very clear and very concise with the information you choose to include in the executive summary. Say as much as possible with as few words as possible.

Directions

Select a core measure and investigate your organization’s compliance rate with the measure. In your executive summary, address the following:

1. Compare the compliance rates of your organization with those of other organizations.
2. Explain why the measure is important in terms of policy, regulation, and finance.
3. Describe changes that could be made that would improve compliance with the measure.
4. Identify the stakeholders who would be affected by the changes.
5. Identify obstacles you would expect to encounter and explain strategies to overcome these obstacles.

Additional Requirements

• Format: Include a title page and references page. As this is an executive summary, do not use APA style and formatting. To determine the appropriate format, it may be helpful for you to review the documents used in your organization. How do they look? What kind of language is used in memos? These can help guide your development of this executive summary. Certainly, feel free to use bullet points as appropriate.
• Length: Write a 2–3-page (maximum) summary of your information, not including the title page and references page.
• References: You must still reference scholarly resources to support your work. Use at least three current scholarly or professional resources.
• Font: Use 12-point, Times New Roman font.

Reflect on everything you have accomplished in your program and what it means in terms of career advancement. There is no required minimum length for your summary, but be sure you address each program outcome as thoroughly as possible.

 

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 5: Communication – Communicate effectively with all members of the healthcare team, including interdepartmental and interdisciplinary collaboration for quality outcomes.
  • Write coherently to support a central idea with correct grammar, usage, and mechanics as expected of a nursing professional.
• Competency 9: Professional Role – Incorporate the qualities, skills, behaviors, and knowledge required to function as a patient advocate, practice high-quality care, assess and evaluate patient outcomes, and provide leadership in improving care.
  • Reflect on growth in the qualities, skills, behaviors, and knowledge required to function as a patient advocate.
  • Reflect on how BSN experiences have improved abilities to practice high quality care, assess and evaluate patient outcomes, and provide leadership in improving care.
• Competency 10: Global Accountability and Public Service – Integrate a holistic approach to local, regional, national, and global dynamics in nursing and healthcare system delivery.
  • Reflect on the role of the BSN-prepared nurse in public service.
  • Reflect on aspirations to facilitate change and foster innovation to improve the health care system.

Competency Map

 

For this assignment, please address the following questions related to the above competencies:

• Reflect on how you have grown in the qualities, skills, behaviors, and knowledge required to function as a patient advocate.
• Reflect on how your BSN experiences have improved your abilities to practice high quality care, assess and evaluate patient outcomes, and provide leadership in improving care.
• Reflect on the role of the BSN-prepared nurse in public service.
• Reflect on your aspirations to facilitate change and foster innovation to improve the health care system.
• Write coherently to support a central idea with correct grammar, usage, and mechanics as expected of a nursing professional.

Additional Requirements

• Format: You do not need to use APA formatting for this assessment.
• Length: There is no required minimum length for your summary, but be sure you address each program outcome as thoroughly as possible.
• References: You do not need to use any supporting resources other than your completed assessments.
• Font: Use double-spaced, 12-point, Times New Roman font.

Post a description of the national healthcare issue/stressor of escalating cost,  explain how the healthcare issue of escalating cost may impact your hospital or clinic work setting. Then, describe how your hospital or clinic work setting has responded to the healthcare issue/stressor of escalating cost, including a description of what changes may have been implemented. Be specific and provide examples.

Assignment Content

1. Create an organizational chart that outlines the leadership structures and clinical departments at the facility you are planning. Include all positions that are required in your health care facility.

   Cite three reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
   Please complete assignment off of attached file.
   Submit your assignment. For additional help, check out the ULTRA: Access your assignments page.

   Copyright 2018 by University of Phoenix. All rights reserved.

Below is my nursing assignment and this is the Professor’s instruction:

· Please write one paragraph for each question.

· Each question should be one paragraph (no less than 3 sentences and no more than 7 sentences), and well detailed.

· Plagiarized content of your assignment will get you a zero or withdrawal from class.

· Copying all or part of your classmate’s answers will earn you a zero.

· Works cited for each question is required.

· Deadline for submission is Wednesday 28th August 2019 by 6:00pm EST.

QUESTIONS:

1. Discuss one male reproductive system disorder and relate how you would plan and intervene

2. Discuss one diagnosis related to transgender care and how you would plan and intervene

3. Discuss one sexually transmitted disease in men or women and related few possible treatments

Respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described.

In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Main Post

Clinical Scenario

The patient is a tall, lanky 67-year-old male with end-stage renal failure and cirrhosis of the liver.  He presents to the Emergency Department (ED) with an inguinal hernia that he cannot reduce.  He rates his pain 10/10 on a scale of 1-10, with 0 being no pain and 10 being extreme pain.  The patient appears uncomfortable, complains of dizziness, and constipation.  Social history consists of smoking a pack a day or cigarettes for 25 years, moderate alcohol consumption, daily marijuana use, poor diet, and decreased mood.  His medications are centered around pain control and include the use of narcotics every 4 hours.  The patient is given a dose of Toradol 30mg, intravenously (IV).  After ten minutes, the patient is asking for more pain medication.  Fentanyl 50 mcg, IV is given with no pain relief reported by the patient.  Finally, Hydromorphone 1mg, IV is administered.  After an hour, the patient still reports pain 10/10.

Pharmacokinetics and Pharmacodynamics

Pharmacokinetics studies the absorption, distribution, metabolism, and excretion of drugs within the body system (Ball, Dains, Flynn, Solomon, & Stewart, 2019).  The use of pharmacokinetics enables providers to determine the appropriate drug for a patient’s diagnosis.  Pharmacodynamics refers to how the body is affected by the use of certain medications (Fox, Hawney, & Kaye, 2011).  Due to the individualized nature of the human body, finding a drug that responds with minimal side effects are desired.Pharmacokinetics, as it relates to this patient’s pathophysiology, creates difficulty for the patient due to the diagnosis of kidney failure and cirrhosis.  Cirrhosis of the liver prevents the body from absorbing, distributing, and metabolizing the drug.  With significant disease process in effect, it is difficult for the body to absorb the drug at a rate that provides effective pain control.  The first-pass metabolism with hydromorphone is decreased in liver cirrhosis and has a likelihood of high hepatic extraction (Wehrer, 2015).  Whereas, fentanyl, is a protein-bound medication is reportedly unaffected by cirrhosis (Wehrer, 2015).  Though the patient tolerated the fentanyl in our case, no specific relief is found due to the chronic nature of the pain. Decreased kidney function reduces the excretion of drugs from the body creating an accumulation of medication in the entire body (Ball et al., 2019).  Frequent use of medications creates a tolerance to that medication and accelerates metabolism of the drug.  Tolerance and increased metabolism results in ineffective pain management outcomes (Ball et al., 2019).  The use of opioids for pain management, in this case, may create an antagonist effect causing unwanted consequences such as constipation, the potential for abuse, and withdrawal (Walter, Knothe, & Lotsch, 2016).  Due to the patient’s continued alcohol consumption and disease processes, the use of acetaminophen or ibuprofen is not encouraged (Wehrer, 2015).

Contributing Factors

For the patient above, behavioral and pathophysiological changes are contributing factors for the choice of medications given.  Alcohol use is the highest contributing factor to cirrhosis (Askgaard, Gronbaek, Kjaer, Tjonneland, & Tolstrup, 2015).  This behavior, as well as smoking, will need to be eliminated to be on the transplant list.  The pathophysiological changes created altered renal excretion and inability of the liver to metabolize medications given for pain control.

Personalized Plan of Care

The plan of care for this patient is to control the pain from the inguinal hernia until it can either be repaired or reduced.  The ability to control pain at a level of 5/10 is the first goal.  A discussion with the patient is necessary to establish realistic goals in light of the chronic conditions.  Focusing on the pain from the hernia is our primary focus.  Initiation of other medications for pain such as Ketamine, Benadryl, or Reglan can decrease pain by 50 percent.  Lastly, non-medication alternatives such as positioning, distraction, and ice-therapy can provide temporary relief.

References

Askgaard, G., Gronbaek, M., Kjaer, M. S., Tjonneland, A., & Tolstrup, J. S. (2015). Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. Journal of Hepatology, 62(5), 1061-1067. http://dx.doi.org/10.1016/j.jhep.2014.12.005Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Fox, C. J., Hawney, H. A., & Kaye, A. D. (2011). Opioids: Pharmacokinetics and Pharmacodynamics. New York, NY: Springer.Walter, C., Knothe, C., & Lotsch, J. (2016). Abuse-deterrant opioid formulations:Pharmacokinetic and pharmacodynamic considerations. Clinical Pharmacokinetics, 55(7), 751-767. http://dx.doi.org/10.1007/s40262-015-0362-3Wehrer, M. (2015, December 14). Pain management considerations in cirrhosis. U.S. Pharmacist, 40(12), HS5-HS11. Retrieved from https://www.uspharmacist.com/article/pain-management-considerations-in-cirrhosis

Write a description of the pathophysiology of acute, chronic, and referred pain, including similarities and differences between them. Then, explain how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain.

Read the below instruction carefully:

Assignment:

Role Strain and Burnout in Nursing

Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

• What happens to the nurse when role stress or strain becomes too overwhelming? What happens to patient care? How is this related to possible ethic and legal issues? Discuss how nurses can manage or reduce role stress and role strain.
• Explain two issues that lead to nurse burnout and discuss a solution for each issue.
• Think of an experience in your nursing profession where you either felt strain or burnout and how you overcame this event. (Since this is personal experience, you can use first person narration for this portion of your essay.)

Assignment Expectations:

Length: 1000-1500 words; answers must thoroughly address the questions in a clear, concise manner.

Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of three (3) scholarly sources are required.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf)

File name: Name your saved file according to your first initial, last name, and the assignment number (for example, “RHall Assignment 1.docx”)

Read

• American Association of Colleges of Nursing (AACN). (2018). Nursing faculty shortage.
• American Association of Colleges of Nursing (AACN). (2018). About the nursing shortage.
• Carte, N. S., & Williams, C. (2017). Role strain among male RNs in the critical care setting: Perceptions of an unfriendly workplace. Intensive & Critical Care Nursing, 43, 81-86.
• Iel Marciano de, M. F., & de Almeida, R. J. (2016). Occupational stress at work in nursing in brazil: An integrative review. Revista Brasileira Em Promocao Da Saude, 29(3), 447-454.
• Johnston, D. W., Jones, M. C., Charles, K., Mccann, S. K., & Mckee, L. (2013). Stress in nurses: Stress-related affect and its determinants examined over the nursing day. Annals of Behavioral Medicine, 45(3), 348-56.

Assignment Description

Infographic

Choose one older adult community population and create an infographic on a topic of preventative screenings or vaccines for this population. You may choose to focus on one specific preventative screening (like colonoscopy) or one specific vaccine (like pneumovax).  You will create a one page infographic and then write an essay on the topic you chose.

View websites on How to create Infographics:

*http://blog.hubspot.com/blog/tabid/6307/bid/34223/5-Infographics-to-Teach-You-How-to-Easily-Create-Infographics-in-PowerPoint-TEMPLATES.aspx

*http://blog.hubspot.com/marketing/free-ppt-infographic-templates-designs-ht

• Submit an 8 X 11.5 color (one page Word or pdf. document) infographic on the importance of one of the concepts found in one of the assigned websites.
• Include a detailed description of the infographic and the APA references in an APA-formatted essay.

The description part of the essay assignment should be written in an APA-formatted essay. The essay should be at least 750 words in length and include at least two scholarly sources other than provided materials.

Assignment Expectations:

Length: One-page infographic PLUS essay of 750 to 1000 words in length

Structure: Infographic: One-page. Essay: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

Write a conclusion for Mayo Clinic

 

Impact of economic and outside influences to the organization

• National and world economy impact

• Explanation of the sustainability of this organizational care model

• Healthcare reform

• Regulations

• Summarize the info regarding organization

• Provide a glimpse into the future for the organization based on your learning

APA / 1600-2000 words / 4 references

APA format 3 references 1 from walden university library 1pg

using Topic of Andragogy

 

Applying Educational Pedagogies

Just as theory underpins nursing practice, so too does theory support and inspire educational practice. Educational theories provide nurse educators with a unique lens for the development and evaluation of learning experiences. As a nurse educator, it is imperative that you become familiar with the theories that will help to drive your curriculum.

In this week’s Discussion, you explore three* pedagogies that are well known in the field of education: andragogy, Gagne’s Nine Events of Instruction, and constructivism. Though andragogy and constructivism are essentially theories of learning and Gagne’s Nine Events of Instruction is thought to be a model of learning, each is also referred to as pedagogy, or the practice and science of teaching.

*Note: By Day 1 of this week, your Instructor will assign one of these three pedagogies to you for your Discussion: andragogy, Gagne’s Nine Events of Instruction, or constructivism. Be sure to match your initial posting to the thread of the pedagogy that your Instructor will assign you. For example, if you are assigned andragogy, then post to the Discussion – Week 1 (andragogy) thread.

To prepare

• Review Chapter 2, “Theoretical Basis of E-Learning,” and Chapter 3, “Instructional Design for E-Learning in Nurse Education,” of the Bristol and Zerwekh course text. Reflect on the ways nurse educators use pedagogies to guide the development of curricula.
• Search the Internet to locate a learning experience that adheres to the following guidelines:
  • The learning experience is described in detail through a step-by-step Lesson Plan, lesson summary, or an online video.
  • The learning experience is representative of nursing curriculum (i.e., the lesson teaches a technical skill or concept that could be beneficial to nursing students, staff, or patients).
  • You are able to share the learning experience with colleagues via a Word Document, PDF, hyperlink, or another method.
• Search the Walden Library as well as other reputable sites to locate one scholarly article related to the use of your assigned pedagogy. Consider how your article and your assigned pedagogy are applicable to the education of nursing students, staff, and/or patients. Conduct further research as needed.
• Examine your selected learning experience through the lens of your assigned pedagogy.
  • Is this pedagogy implicitly or explicitly used in this lesson?
  • If you were the instructor, how might you integrate (or further include) this pedagogy to enhance the learning experience?

Complementary and alternative therapies are often used in combination with traditional medical practices to provide enhanced treatment. This is known as Integrative Medicine. Other times these therapies are used alone in place of traditional medicine. Choose a complementary or alternative therapy that interests you and research how it is used alone or in combination with traditional medicine.

Write a 1-2 page paper (not including title page and reference page) that describes following:

1. Describe the complementary/alternative therapy and how it is used in practice.
2. Discuss your personal and professional opinion about this therapy and how it will influence your care for a client using this therapy.

You should include a minimum of 3 references. Include a title page, in-text citations, and a reference page in APA format.

Technology is integral to successful implementation in many projects,   through either support or integration or both. Name at least one   technology that could improve the implementation process and the   outcomes of your EBP project. Do you plan to use this technology? If   not, what are the barriers that prevent its use?

Kimberly s response

One way in which technology is important in my EBP is by the utilization of the Michigan Care Improvement Registry (MCIR). This system was originally created in 1998 to be a database which held childhood immunization registries. It has since been further developed due to the change in the Michigan Public Health Code. It now includes not only children but citizens of all ages. It is a program which allows all providers including pharmacies, schools, and other health care organizations to input immunization information into one comprehensive record (MCIR, n.d.). It also includes things such as hearing and vision testing and lead testing. Because lead testing is found in this database, it would help me to identify children who may be at a higher risk of lead exposure from addresses located within the database as well as if they have had lead testing done.

Another avenue which I may decide to look at would be the Women, Infant, Children (WIC) program. They use a database provided by the State of Michigan which provides a central schedule. If I identify families who may need education regarding lead I can see if they have an appointment and, if so, offer them lead education.

As far as utilizing this technology, I am unsure right now. If I need to after talking at more length with my mentor, I will not hesitate to use it. It is my plan to develop a pamphlet which can be handed out to high risk families which would mean I would not need to use the database. If CCPHD would like a more targeted approach, then I will utilize WIC and MCIR which would allow me names and addresses of families in high risk areas.

Reference

MCIR. (n.d.). Improving healthcare in Michigan. Retrieved from https://www.mcir.org/

In this course, there are numerous resources; there are assigned weekly readings, valuable “Optional Audio and/or Visual Items” (button on L-hand side of the site), databases that may be new to you, and scholarly references located through your literature searches. As you save, bookmark, and/or reference any of these items for this course, you may consider placing them in the annotated bibliography. Further, consider what may be of use to you in the remainder of the program (e.g., Capstone course, 49800) and your professional career. For example, you will need to create a PICO question in this course. Any EBP resources you use now many be of use to you during your Capstone project as well, as the project is an EBP project and you will be required to create a PICO question then as well. Therefore, consider placing those resources in your annotated bibliography as well. This assignment is intended to create something for you to refer to during this course as you work on the assigned project as well as to take with you at the end of this course. As such, it should hold value to you.

Each of your annotations should summarize, assess, and reflect. Please see the Purdue OWL website for further information on how to create a summary and evaluation of each resource:  Annotated Bibliographies and Samples. Well-informed opinions are encouraged in each annotation; if you find a website that isn’t user-friendly, for example, state that in your evaluation of the resource. Including such evaluations in your annotated bibliography will ensure that your future self will be well-informed.

Prior to your list of annotations, write a brief paragraph at the beginning of your document that describes your rationale for selecting included annotations. There is no minimum or maximum number of annotations. There is no required content or resources that must be included. The intent is to have a repository of resources deemed useful by you and for you.

Present your Annotated Bibliography in a scholarly and professional manner (i.e., APA formatting and no errors in spelling or grammar).

These are 2 resources i used that need for bibliography:

 

Joanna Briggs institute. (2016). Pressure area care. Retrieved from http://ovidsp.tx.ovid.com/sp-3.19.0a/ovidweb.cgi?&S=GJJCFPJOKFDDGOPENCIKMCGCBHLNAA00&Complete Reference=S.sh.21|2|1#below-banner

Swafford, K., Culpepper, R., & Dunn, C. (2016). Use of a Comprehensive Program to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in an Intensive Care Unit. American

 I need 3 more resources for my case study, case study is in attachment

Project 1: Hospital-acquired Pressure Ulcer

Our HAPU rates on Unit A have risen significantly over the past 6 months. We have a Wound and Skin Care Nurse (WSCN) who has training in wound care. This nurse does not have a Master’s degree or specialty certification in this area but does have a lot of experience. The Wound and Skin Care Nurse is scheduled to work from Monday through Friday, 8a-5p. The WSCN nurse visits every unit and asks about each of our patients. If we identify someone as having a red spot or a potential area of breakdown, we let her know during her rounds.

The WSCN visits patients daily if they are on a computer-generated list of patients at risk for skin breakdown. The list is created when a box is checked in the computerized charting skin assessment area that asks if the patient is on bed rest or is unable to move independently. If a ‘yes’ is checked then the patient’s name is automatically placed on the list. In addition, the computerized Braden Scale is added to the patient’s documentation. The WSCN downloads the list every morning. If someone is identified at risk during the day shift the WSCN does not know about it until the next day.

The WSCN spends a lot of time on our unit. We sometimes have a problem when a patient needs to be seen by the WSCN but do not appear on the list. The nurses do not see the list, only the WSCN nurse. Our current process is to perform the Braden Scale upon initial admission assessment, then once a day if the patient is noted to be at risk, usually during the midnight shifts. The information is entered into the electronic chart (documentation system). We can track the patients’ progress and see what treatments are given to the patient. For the most part, the WSCN does all the treatments unless we are given specific instructions about an individual patient. We are not aware of what evidence supports any of the treatments. Because we have a WSCN, the direct care nurses are not familiar with how to care for the patient with skin breakdown unless the WSCN provides specific directions. We need to know what the best practices are for caring for a patient with a HAPU, including nurse driven care versus what the WSCN does for the patient.

Draft Discuss “Anesthesia for patients with hypertension”

· Start the body of the paper on a new page after the title page

· 4 pages not including the cover page or the references page

· The introductory section must give information necessary to make the remainder of the project understandable

· If you are discussing a disease and its pharmacologic management, you must provide information regarding the pathology, epidemiology, clinical course, and treatment of the disease

Your paper should be in APA 6th Edition Format complete with an APA-style cover page and reference page

All sources must be correctly cited and your paper must be written in Times New Roman 12-point font, be double spaced, and have 1 inch margins.

You may not use any direct quotations; paraphrase what you read.

For your papers, you may not use websites as sources of information. You must provide a minimum of five, peer-reviewed (that is, research) articles.