Nursing

Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review.  Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges.  Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

Chamberline care emphasises personal care communication.

Please respond to each of the 4 discussions listed below. Each should be 1/2 page in response with 1 source per response. Responses should add to / reflect on the discussion.  HPF Discussion 1n in response to Tori Lynn  This week for the discussion I want to discuss the lack of performance related to mental health and mental health care coverage and how it is affecting our patients and our healthcare employees. There has been a stigma around mental health for years. These patients feel like they are drowning within themselves, there are mental hurdles that they can’t cross themselves, which causes sincere anxiety, depression, PTSD, OCD, etc. Then we tack on the inability to get coverage to speak to a psychiatrist to provide help and guidance. I personally know 3 nurses in my department alone who have had to seek out psychiatrists for help, who accept our hospital insurance, but it only covers the initial consultation. The remaining sessions are $175/hr. This is insane! Most people cannot afford this or don’t have insurance at all and have to pay out of pocket for the entirety. This typically leads to self healing; alcohol abuse, substance abuse, domestic abuse, etc. Many times I have seen patients come in as a Baker Act who have tried committing suicide with pill overdose because they couldn’t afford the help they need. It is sad to see so many patients and employees suffering during this pandemic. Patients being quarantined are trying to commit suicide, the nurses providing care are seeing so much death that they are losing their mental strength. Meanwhile, the institute for healthcare improvement is trying to implement the triple aim initiative to improve the US healthcare system. The triple aim initiative involves improving the patient’s care and satisfaction, improving the population’s health, but also cutting healthcare cost per capita (IHI, 2019).  My two suggestions for improving mental health care coverage are; 1) Have regular behavior health screenings as part of yearly physical; and 2) build mental health inservices within the community to promote self care, that is covered with health insurance or free to the general public. Part of improving mental health is noticing the signs and symptoms. This can be determined during a yearly physical with a focus on behavior. This way it is included in the physical, and that patient can get help if need be. The mental health inservices will promote how to notice the signs and symptoms, what triggers these episodes, how to promote self care, and how to find help. These suggestions will help to promote patient satisfaction , the population’s health, and healthcare per capita.  IHI. (2019). The IHI Triple Aim | IHI – Institute for Healthcare Improvement. Institute of Healthcare Improvement. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx#:%7E:text=It%20is%20IHI’s%20belief%20that,capita%20cost%20of%20health%20care (Links to an external site.).   HPF Discussion 2 in response to Christy C. I currently am not working in the health care setting, however, a performance issue in the U.S. health care system would be the lack of access individuals have to health care. As discussed throughout this course thus far most of us if not all of us have mentioned the lack of organization and access the U.S. health care system delivers. For example, insurances may not cover medications that would be more beneficial then current prescribed medications a patient is receiving for their condition. Or maybe they do not have insurance in general and cannot afford medication needed for treatment. The U.S. health care system is complex, but there needs to be adjustments to improve patient outcome and reduce the per capita cost of health care. The economy also hurts from patients who need care and receive it but are unable to pay for their medical bills. The Institute for Healthcare Improvement (IHI) has developed a framework for developing quality health programs across institutions, states, and even other countries (Galen College of Nursing, n.d.-a). The framework is called the triple aim, which consists of 3 “pillars”: improving patient experience, improving the health of populations, and reducing the per capita cost of health care (Galen College of Nursing, n.d.-a). Two ways performance could be improved upon in the U.S. health system would be prioritizing quality and safety. Communicating to all employees not only nurses and health care providers, but to admitting clerks and housekeeping staff the importance of their job description. This is because everyone who works in the health care setting has a duty that influences the patient experiences and outcomes. For example, housekeeping staff are important in influencing patient experience because without them it would be hard to control infections if the halls, restrooms, and patient rooms are dirty (Galen College of Nursing, n.d.-b). The second way performance could be improved would be finding a health care system that benefits patients, the entire population, and its economy. References Galen College of Nursing. (n.d.-a). Health system performance [PowerPoint slides]. https://files.galencollege.edu/media/bsn/NUR410/unit_5/unit_5_2/NUR410_unit_5_2.pdf Galen College of Nursing. (n.d.-b). Quality of health care- part 1 [PowerPoint slides]. https://files.galencollege.edu/media/bsn/NUR410/unit_5/unit_5_3/NUR410_unit_5_3.pdf     EBR discussion 1 in response to Sarah F The article found is called A qualitative study exploring patient motivations for screening for lung cancer.      According to Brown (2018), qualitative and quantitative research are important for a more well-rounded view of what is going on. The method used for this study according to Roth et al. (2018) was semi-structured qualitative interviews of people that have on low-dose computed tomography of the chest for lung cancer screening for heavy smokers. The advantages of qualitative research are to get opinions about low-dose computed tomography lung screenings. The question was why these patients seek this test out. The disadvantages to this is this type of test is not testing numerical calculations. It will not tell them how many people seek preventive screenings that are heavy smokers. This research done for qualitative lung cancer screening research could give insight on how healthcare providers can reach out to patients that fit the criteria to catch lung cancer before advancing. References Brown, S. J. (2018). Evidence-Based Nursing The Research-Practice Connection (4th ed.).  (Ed.). Burlington, MA: Jones & Bartlett Learning. Roth, J. A., Carter-Harris, L., Brandzel, S., Busit, D. S., & Wernil, K. J. Qualitative study exploring patient motivations for screening for lung cancer. Public Library of Science, 1-11. https://doi.org/10.1371/journal.pone.0196758         EBR discussion 2 in response to Trista T Review the data provided for appraisal of quantitative research where you will compare and contrast studies to draw conclusions (click here for the data). After reviewing the data presented in the table, answer the following questions: 1.     What two patterns in the study can you identify? (Consider the sample and its size, study methods and whether it was appropriate to test the data, similarities/differences in the findings, and statistical significance or p value). Two patterns that I was able to identify within the study and subsequent evidence table was both the sample size/characteristics of the participants as well as the length of the studies that were conducted. All participants we at least 60 years old and all three studies compiled data from six months in order to report specific findings. 2.     What are two strengths or limitations of the data? One limitation to the supplied data is within the prospective cohort study conducted by Marrero, Fortinsky, Kuchel, and Robison (2017) the methods used was completion of a survey in which the accuracy of collected data hinges directly upon the ability of the participants to be subjective versus objective, tangible data provided within the other two study samples. Another limitation to the data is that all three study designs explored were different (i.e. randomized clinical trial, prospective cohort study, and a longitudinal cohort study) thus resulting in a wider variety of feedback based solely on the type of study conducted in each situation. 3.     What is one practice recommendation that you could make based on your analysis of the studies? One practice recommendation that I could make based on my own analysis of the provided studies would be to further reduce potential variables that may result in inaccurate findings by limiting information to objective instead of reported or subjective data. In order to make this possible, I would only allow incidents to be reported directly by medical staff or falls that have been documented in a patient’s medical chart to be allowed into the study for consideration to result in more conclusive findings. Reference: Sample Quantitative Evidence Table [Lecture File]. Retrieved from              file:///C:/Users/trist/Downloads/NSG%204000%20Quant%20Evidence%20Table_%20Jan%202020%20Term-1%20(2).pdf

As a doctorally prepared nurse, it is imperative that you are prepared to lead Continuous Quality Improvement (CQI) projects. Some of you may decide to complete a CQI program as your scholarly project. Thus, this 3 part assignment is designed to provide an opportunity for students to work as a team to develop a framework for a proposed CQI project and address other supports and assessments that are required while completing a CQI project. To get started, access the Human Services and Resources Administration (HRSA) web site: Developing and Implementing a QI Project: http://www.hrsa.gov/quality/toolbox/methodology/developingandimplementingaqiplan/index.html Also, at the bottom of this webpage, there is a list of bureaus and offices which list regulatory guidelines for care, such as Bureau of Primary Health Care and national organizations such as The Joint Commission. It is strongly recommended that you review the resources on the HRSA website and bookmark it for future use as a reference. Resources included on this site include but are not limited to: Developing and Implementing a QI plan, Improvement Teams, Managing Data for Performance Improvement, Performance Management and Measurement, Quality Improvement, Readiness Assessment and Developing Project Aims, Redesigning a System of Care to Promote QI and Testing for Improvement. Developing and Implementing a QI Project: http://www.hrsa.gov/quality/toolbox/methodology/developingandimplementingaqiplan/index.html Also, at the bottom of this webpage, there is a list of bureaus and offices which list regulatory guidelines for care, such as Bureau of Primary Health Care and national organizations such as The Joint Commission. It is strongly recommended that you review the resources on the HRSA website and bookmark it for future use as a reference. Resources included on this site include but are not limited to: Developing and Implementing a QI plan, Improvement Teams, Managing Data for Performance Improvement, Performance Management and Measurement, Quality Improvement, Readiness Assessment and Developing Project Aims, Redesigning a System of Care to Promote QI and Testing for Improvement. Background: You will be assigned to work in teams on a proposed CQI project. The assignment is divided into 3 parts. Each part of the assignment will specifically address a different aspect of the CQI project. You will work together to select a fictitious quality or safety issue which may be commonly seen in a health care setting such as primary care, hospital/health care organizations or underserved countries. Set up team guidelines for cooperation. Choose a topic for the CQI Plan, i.e. Medication Errors in the Hospital Setting. Consider the following as background to your plan: Organizational mission, values, program goals and objectives. The project consists of the following elements as outlined in each part. Each part will be written by the team in current APA  7 format and will include a title page and reference page.  You may also include appendices if needed for work plans or other forms. These are not included in the page count. O   ASSIGNMENT · Discuss the descriptions of accountability including protection of patient information (HIPPA), ethical legal considerations, team members required and roles and responsibilities for  creating a Clinical decision support system at the point of care in a primary care family facility for  adults 18 years of age and older at risk for metabolic syndrome

In this assignment, you are to create a PowerPoint presentation outlining one of the theories in this week’s reading. You must include the following concepts: Choose one middle range theory from the week’s reading and discuss why you chose it. Provide a brief overview of the theory (assumptions, propositions, definitions, etc.) Discuss the applications of the theory. Provide a minimum of one example of the nursing theory in action in nursing practice. The PowerPoint presentation must meet following criteria: The PowerPoint must have a minimum of 10 slides. The PowerPoint must have a separate slide for references and references must be in APA style and format. All references must be cited within the text and all in-text citations must have a reference in APA style and format. Please choose ONE from the following theories: Afaf Meleis’ Transitions Theory Katharine Kolcaba’s Comfort Theory Joanne Duffy’s Quality-Caring Model Pamela Reed’s Theory of Self-Transcendence Patricia Liehr and Mary Jane Smith’s Story Theory The Community Nursing Practice Model Locsin’s Technological Competency as Caring in Nursing

Log onto website where you can observe your service bill for the last 12 months (electric bill, cell phone bill, water bill, etc.). If you do NOT feel comfortable sharing this data, you can make up values. In excel, list the values of your bill for the last 12 months on one column. Find the sample mean and sample standard deviation of your data. Pick three bills from the last 12 months and change the values into z-scores. What does the z-score tell you about that particular month? Analysis Between what two values would be considered a normal bill? Remember, being within 2 Standard Deviations is considered normal. Are any of your bills in the last 12 months unusual? Very unusual? Are there times when you would accept an “unusual” bill? Explain.

Emergency preparedness entails several steps that are undertaken to ensure the safety of individuals or communities before, during, and after an emergency have happened or a natural disaster. The steps are undertaken to ensure the safety of individuals and are especially important and necessary both in nature as well as in human-made disasters. Healthcare professionals have a role to play in emergency preparedness; however, healthcare workers are guided by the healthcare policies that are formulated specially to address this issue. The health policies offer nursing roles during the occurrence of an emergency. This helps during emergency cases as the health professionals are guided by the health policies on the necessary actions and steps to address the emergency and mitigate any loss that might occur as a result of the crisis (Staebler et al., 2017). Health policy outlines the different training that nurse practitioners need to undergo to be able to respond to different kinds of emergencies. This training helps identify priority areas in emergency preparedness hence ensuring that the nurse practitioners can react appropriately to an emergency when and if it occurs. The training is an essential part of emergency preparedness because it provides nursing practitioners the right skills to respond to an emergency. In emergency preparedness, the public policy outlines the steps to be followed by nurse practitioners in the occurrence of an emergency. Therefore, this is a quick guide that saves nurse practitioners time and effort in determining which action to undertake in the event of an emergency (Annesley, 2019). This also boosts the nurse practitioners’ confidence as they undertake the different duties in responding to an emergency because the public policy offers the right guidance and direction. The nurse practitioners can demonstrate their knowledge and skills in emergency preparedness as outlined in the public policy. Through the health policy, nurse practitioners influence nursing practice standards and nursing procedures to assure the quality of care. In emergency preparedness, the nurse practitioners, therefore, through the public policy, ensure that the appropriate tactics and mechanisms are put to ensure the health department is always well prepared to respond to any emergency case. With their knowledge and skills in emergency cases, the nurse practitioners can help formulate the right health policies that will effectively address emergency preparedness. The health policy can significantly and positively influence the nursing practice in emergency preparedness. Through the outlined actions that the health policy recommends the nurse practitioners undertake in emergency preparedness, the role of the nurses is determined by the policy (Staebler et al., 2017). This entails the techniques that the nurse practitioners are to use in responding to emergencies. Therefore, it is a guide that influences the practices that nurse practitioners engage in when addressing emergencies. The public policy considers the interests of the general population when formulating policies. This means that it ensures the best policies are formulated to put the right measures for emergency preparedness (Cordova et al., 2018). Public policies or emergency preparedness policy a significant role in influencing the role of nurse practitioners in this field. Through their guidance, nurse practitioners can prepare for emergencies. The policies help in developing strategies for responding to emergencies before during and after they have occurred Nursing Emergency Preparedness  2 Hospitals rely on a stalwart nursing workforce to ensure that they can effectively respond to a public health emergency, such as the recent coronavirus pandemic. In fact, as a consequence of this pandemic, there is a looming global shortage of nurses in the United States and the rest of the world. This is an obvious indicator that public health emergency preparedness can be challenging and even the U.S. does not have a comprehensive national strategy to address it. Therefore, it is critical for public health policies to focus on factors, such as not being aware of institutional plans and relevant emergency drills and exercises, which are responsible for their lack of preparedness. Such policies need to be implemented in various healthcare settings, especially hospitals, to address the lack of public health emergency preparedness of their nursing workforce. As a result, the nursing workforce is likely to become more assertive and prepared to respond more effectively to public health emergencies. No doubt, the recently growing nursing shortage has somewhat been a result of the COVID-19 pandemic, it is not the only factor that has contributed to it. Plenty of nurses have either retired from the profession or have quit because of adverse work environments and finding more rewarding alternative employment opportunities elsewhere. Another reason that the U.S. nursing workforce has not managed to expand is because most of teaching faculty at nursing schools is close to or at the age of retirement (Richardson, 2011). Moreover, funding and infrastructure are not adequate enough as well (Cagliuso, 2014). Amidst this, the need for health care has also been rising, especially during this pandemic. Hence, there needs to be an annual increase in graduating nurse practitioners in order to ensure emergency preparedness and meet these growing demands. Consequently, due to this growing demand and shortage, nurses have had to occupy multiple roles, which have also led to an overestimation of the available, supplemental workforce. Some policy efforts have been attempted to address these issues, such as enabling nurses to practice in multiple states under mutual recognition of licensure and a wide range of laws to protect volunteer health practitioners (Sauer et al., 2014). However, these efforts have not proven to be sufficient, perhaps due to not having been tested throughout the nation. Another reason behind the ineffectiveness of existing policy efforts is the lack of funding. Moreover, they do not emphasize on expanding nursing education, faculty development (Penn, Wilson, & Rosseter, 2008) and the size of the workforce itself to meet the estimated demand. Therefore, in order to be truly effective any healthcare policy would need to have adequate funding (Cagliuso, 2014) and scope in order to improve both the level of education and the total number of nurses. Considering how complicated patient care has become, especially during this time of pandemic, nurses must now possess the relevant expertise and knowledge in order to meet the rapidly growing demand. Increasing the number of nurses with a baccalaureate degree will automatically increase the number of advanced-practice nurses and the teaching faulty too. In inadequate public health emergency preparedness is a consequence of the shortage of the nursing workforce. Additionally, hospitals often rely on supplement nurse practitioners, who are also in limited numbers because of the shortage. By addressing this shortage, especially by investing in nursing education and infrastructure, a healthcare policy could effectively ensure nurses of the future will be well-prepared for any public health emergencies like the present coronavirus pandemic.   References Cagliuso, N. V. (2014). Stakeholders’ experiences with US hospital emergency preparedness: Part 1. J Bus Contin Emer Plan, 8(2), 152–168. Penn, B. K., Wilson, L. D., & Rosseter, R. (2008). Transitioning From Nursing Practice to a Teaching Role. The Online Journal of Issues in Nursing, 13(3). Richardson, K. A. (2011). Journal of Global Health Care Systems, 1(1), 1–16. Sauer, L. M., Catlett, C., Tosatto, R., & Kirsch, T. D. (2014). The Utility of and Risks Associated With the Use of Spontaneous Volunteers in Disaster Response: A Survey. Disaster Medicine and Public Health Preparedness, 8(1), 65–69. https://doi.org/10.1017/dmp.2014.12

Click [Start a New Thread] to post to the discussion, and then click [Post] once complete. Be sure to post a response to all discussion topics. Please review the Discussion Board Participation grading rubric under Course Resources. This is important information that will ensure that you earn maximum points. Your postings should be qualitative and provide substantive depth that advances the discussion. Please see the Writing Center for assistance with writing, APA, and online communication. Topic: Infectious Disease Read the following case and answer the questions using EBP. AJ is a 44-year-old male who presents to ED with sudden onset of shaking-chills, fever, and a productive cough. He reports that he was in his usual state of health until one week ago, when he developed a mild nasal congestion and achiness. Otherwise, he felt well until last night when he became feverish and developed a cough associated with right sided pleuritic chest pain. He says he is not in pain unless he coughs and headache, throat soreness, and voice changes. He reports a thick yellow sputum occasionally with no odor. He denies chest pressure, radiating pain, SOB, DOE, orthopnea. He denies N/V/D and unintentional weight loss. He does not recall being around anyone with the flu or other illnesses and has not had any travel outside the U.S. in the past year. He has no past medical history but admits he does not go to the doctor regularly, admits to smoking ½ pk per day of cigarettes, no drug use, and occasional alcohol. He is married with 2 children and works as a lineman. He takes no medications and no OTC supplements, but does take ibuprofen for occasional aches and pains. Physical Exam Remarkable for the following: BP: 118/72 HR: 113 Respirations: 20 Temp: 102.1 SPo2: 99% RA WT: 185 Ht: 72” Lungs: Bronchial Breath sounds and End-inspiratory Crackles in RLL CV: RRR, no murmurs, rubs, or gallops Diagnostic & Lab Results Chest Xray shows a RLL consolidation CBC: WBC 7.4, RBC 5.2, Hemoglobin 15.3, Hematocrit 44.0, Plt 302 BMP: sodium 138, potassium 4.2, bicarbonate 25, BUN 20, creatinine 1.0, glucose 122 Update: While AJ was awaiting discharge home on PO medication, he started having increased SOB and now appears mildly diaphoretic. New labs are pending.  Questions: What are you top 3 differential diagnosis and your final diagnosis? Based on updated information, how will you treat AJ? (Give any newly created tests ordered, results, and/or findings). What is the most likely pathogen? Empiric Therapy: What will you use? (Think about your hospital antibiogram when prescribing) What would you change if AJ was allergic to PCN? How will you alter the dosing if AJ develops ARF? For any additional or missing information, you may make up any missing data according to how you think it may have presented. Please support all decisions with evidence via guidelines and peer-reviewed articles (a minimum of 3).

Make a COMPARATIVE TABLE between:   – Cardiac bradyarrhythmias   – Cardiac Tachyarrhythmias   They must include the following topics:  1. Signs and symptoms  2- Diagnosis  3- Patient Management (Treatment with medication and doses and Health Education).

Write a short scenario that illustrates a particular type of dysfunctional conflict. Provide the who and what of the conflict. Discuss the components of the scenario that characterize the particular type of dysfunctional conflict. From your readings, identify and explain two strategies to effectively deal with the conflict. Length: A minimum of 250 words, not including references Citations: At least one high-level scholarly reference in APA from within the last 5 years lecture – Negotiation, Conflict Resolution, Collaboration: Clarifying Terms (by Lucille A. Joel) Joel: Ch.  8 (pg 123-141) – The Kaleidoscope of Collaborative Practice Ch. 12 – Mediated Roles: Working With and Through Other People Ch. 19 – Culture as a Variable in Practice Ch. 20 – Conflict Resolution in Advanced Practice Nursing Nurse Practice Act in your State for Advanced Practice APN Practice Act American Association for Nurse Practitioners ‘State Practice Environment’ M