Nursing

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem. The PICOT question will provide a framework for your capstone project change proposal. In a paper of 550 words, clearly identify the clinical problem “Reducing falls in the Elderly population” and how it can result in a positive patient outcome. Describe the problem in the PICOT question as it relates to the following: 1.     Evidence-based solution 2.     Nursing intervention 3.     Patient care 4.     Health care agency 5.     Nursing practice

Discuss the financial considerations, limitations, benefits associated with the development of the change project. Explains the financial considerations, limitations and benefits associated with the change project Develops a potential budget for the change project, identify where resources would be allocated from and where cost savings would be utilized

Develop a 3-4 page preliminary care coordination plan for a hypothetical individual in your community. Identify and list available community resources for a safe and effective continuum of care. The first step in any effective project or clinical patient encounter is planning. This assessment provides an opportunity for you to strengthen your understanding of how to plan and negotiate the coordination of care for an individual in your community as you consider the patient’s unique needs; the ethical, cultural, and physiological factors that affect care; and the critical resources available in your community that are the foundation of a safe plan for the continuum of care. Demonstration of Proficiency By successfully completing this assessment, you will demonstrate your profiency in the course competencies through the following assessment scoring guide criteria: Competency 1: Adapt care based on patient-centered and person-focused factors. Analyze a health concern and the associated best practices for health improvement. Competency 2: Collaborate with patients and family to achieve desired outcomes. Establish mutually agreed-upon health goals for a care coordination plan, in collaboration with the patient. Competency 3: Create a satisfying patient experience. Identify available community resources for a safe and effective continuum of care. Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care. Write clearly and concisely in a logically coherent and appropriate form and style. Preparation Imagine that you are a staff nurse in a community care center. Your facility has always had a dedicated case management staff that coordinated the patient plan of care, but recently, there were budget cuts and the case management staff has been relocated to the inpatient setting. Care coordination is essential to the success of effectively managing patients in the community setting, so you have been asked by your nurse manager to take on the role of care coordination. You are a bit unsure of the process, but you know you will do a good job because, as a nurse, you are familiar with difficult tasks. As you take on this expanded role, you will need to plan effectively in addressing the specific health concerns of community residents. As you assume your expanded care coordination role, you have been tasked with addressing the specific health concerns of a particular individual within the community. You decide to prepare a preliminary care coordination plan and proceed by identifying the patient’s three priorities for health and by investigating the resources available in your community for a safe and effective continuum of care. Develop the Preliminary Care Coordination Plan Complete the following: Identify a health concern as the focus of your care coordination plan. Possible health concerns may include, but are not limited to: Stroke. Heart disease (high blood pressure, stroke, or heart failure). Home safety. Pulmonary disease (COPD or fibrotic lung disease). Orthopedic concerns (hip replacement or knee replacement). Cognitive impairment (Alzheimer’s disease or dementia). Pain management. Mental health. Trauma. Identify available community resources for a safe and effective continuum of care. Document Format and Length You can use the linked templates as a guide for the needs of your hypothetical patient who has a selected health care problem. For your care coordination plan, you may use the a provided care coordination template or choose a format used in your own organization, or choose a format you are familiar with that adequately serves your needs for this assessment. Your preliminary plan should be 3–4 pages in length. In a separate section of the plan, identify the hypothetical person you have chosen to work with. Document the community resources you have identified using the provided community resources template You can use real or fictitious names/addresses for the community resources you identify The type of resource, not the name, is what you need to pay attention to for this assessment. Supporting Evidence Cite at least two credible sources from peer-reviewed journals or professional industry publications that support your preliminary plan. Grading Requirements The requirements, outlined below, correspond to the grading criteria in the Preliminary Care Coordination Plan Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed. Analyze your selected health concern and the associated best practices for health improvement. Cite supporting evidence for best practices. Consider underlying assumptions and points of uncertainty in your analysis. Identify a hypothetical individual who would benefit from a care coordination plan. Document goals for the care coordination plan. Identify available community resources for a safe and effective continuum of care. Write clearly and concisely in a logically coherent and appropriate form and style. Write with a specific purpose with your patient in mind. Adhere to scholarly and disciplinary writing standards and current APA formatting requirements. Additional Requirements Before submitting your assessment, proofread your preliminary care coordination plan and community resources list to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan. Be sure to submit both documents.

Do you think transcultural nursing applies to Case Management?  Why or why not? (no one liner) Describe cultural competence.  Describe the purpose of cultural competence. Describe how cultural awareness affects the healthcare industry. https://www.rasmussen.edu/degrees/nursing/blog/what-is-transcultural-nursing/ https://pubmed.ncbi.nlm.nih.gov/19172978/ https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/ https://www.youtube.com/watch?v=E4k8YWqkjqo https://www.rasmussen.edu/degrees/nursing/blog/what-is-transcultural-nursing/ https://pubmed.ncbi.nlm.nih.gov/19172978/ https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/ https://www.youtube.com/watch?v=E4k8YWqkjqo

two replies to responses First response Reflect on the triple aim and describe your role as an APRN in achieving the triple aim. The triple aim was designed to improve health care in the United States by implementing a system that enriches the experience of care, enhances the overall health of populations, and decreases per capita costs of health care (Berwick et al., 2008).  While the triple aim is ideal, it has not become a standard of practice in today’s healthcare industry, which seems to be driven by profits and the filling of hospital beds.  I believe that the APRN is a vital component in implementing and achieving the triple aim.  When I graduate as a future APRN, I would like to open a small practice comprised mainly of 3-4 APRNs.  We would enrich the experience of patient care by centering the operation of our clinic around the patient.  We would function in a manner consistent with timeliness and efficiency in scheduling and treating patients.  Offering convenient services such as telehealth appointments may increase perceived quality of care, and facilitate access to care (Polinski et al., 2016).  This would enhance the overall health of populations by offering a new and more time efficient way to receive healthcare.  Per capita costs of healthcare would be reduced for providers as it would reduce the amount of office overhead that goes to waste due to patients who “no show” to appointments due to various circumstances.  Not to mention the cost savings that would be passed along to the patient.  Telehealth would allow the provider to offer remote visits at a lower rate than what they normally offer and may even save the patient from unnecessary emergency room visits (Cheney, 2019).    Identify a population of interest to you. This population can be broad (national) or local (community). Describe the population. How do you know what defines that population? What health outcomes would you define for this population?A population of interest to me is the geriatric population aged 65 and older.  This is one of the fastest growing populations that is projected to almost double from 52 million in 2018 to around a staggering 95 million by 2060 (Mather et al., 2019). There will likely be inconsistency in the economic and physical welfare of this population based on gender and ethnic groups.  Statistical analysis of this population group has shown us that older women are more likely to live alone and tend to be poorer, black men and women have lower life expectancies, and minorities are more likely to rely solely on Social Security for their family income (Mather et al, 2019).  With the lower economic status that is prevalent in this population, I would expect there to be more health issues and roadblocks to receiving healthcare.  This population would have to prioritize necessities such as shelter and food against costly healthcare and medications.  I would anticipate there to be more cases of self-neglect, injuries related to falls due to limited mobility and failing eyesight, and age-related onset problems such as diabetes and arthritis. For your chosen population, identify two or three health disparities that are common to the population. Why do these disparities exist among your population of interest? Common health disparities in the geriatric population are diabetes, high blood pressure, heart disease, arthritis, and cancer.  These disparities exist due to baby boomers (ages 51 to 69 in 2015) living longer than previous generations (Mather et al., 2019).  Older adults are less active and the prevalence of obesity in the United States is skyrocketing which leads to many of the chronic health conditions mentioned. Using the various statistical and data websites, discuss your population of interest using data. What statistics define the population? Provide background data that allow readers to understand your population of interest. What health disparity statistics can you share with the group? This would allow readers to understand the critical disparities among your population of interest. The geriatric population is age 65 and older and is one of the fastest growing populations that is projected to almost double from 52 million in 2018 to around a staggering 95 million by 2060  (Mather et al., 2019).  One of the largest growing health disparities in this group is obesity, which leads to chronic health issues.  Recent analysis of the U.S. obesity trends revealed that in the population aged 65 to 74, the number of men who were obese increased from 24 percent to 36 percent over a two-decade period; women increased from 27 percent to 44 percent (Mather et al., 2019).  Second post The “Triple Aim” describes a set of interconnected goals that when collectively achieved, can have a positive systemic effect on health care (Berwick et al., 2008). The three goals comprised in the Triple Aim are: improvement of patient care experience; optimization of the health of populations; and reduction in health care costs per capita of populations (Berwick et al., 2008). As an APRN and a future healthcare leader, I am obliged to be an active participant in the pursuit of the Triple Aim. Specifically, I must be a productive member of a team of “integrators”, or “… an entity that accepts responsibility for all three components of the Triple Aim for a specified population” (Berwick et al., 2008). According to Berwick (et al., 2008), “pursuit of the Triple Aim requires that the population served become continually better informed about both the determinants of their own health status and the benefits and limitations of individual health care practices and procedures”. As an APRN and integrator for the Triple Aim, it is my duty to thoroughly educate my patients so they may take active roles in their care. Furthermore, “a conscientious integrator would aspire to produce or contract for individual care and population-based interventions that are evidence-based and highly reliable”. Another aspect of my role as an APRN in achieving the Triple Aim is to stay abreast of the most current evidence-based practice methods in order to provide patients with the best possible outcomes. My population of interest is women diagnosed with cervical cancer living in the state of Texas. The population is identifiable by their gender, Texas residency and diagnosis of cervical cancer reported in the Texas Cancer Registry database (Lin et al., 2015, p. 22). The health outcomes I would define for this specific population would be either survival or mortality of their cervical cancer diagnosis. Lin et al. (2015) and his cohorts further differentiate the population’s outcomes by categorizing the women based on the grade of tumor and type of treatment used (p. 24). Lin et al. (2015) performed a study on approximately 11,212 women who were diagnosed with cervical cancer while living in Texas between 1995 and 2005 (p. 22). The study revealed disparities among the population, specifically with race and socioeconomic status (Lin et al., 2015, p. 24).  The authors “… found that African-Americans had higher overall mortality risk, which is consistent with findings of several studies conducted in the United States” (Lin et al., 2015, p. 25). In an attempt to rationalize this disparity, Lin et al. (2015) explains, “according to the Behavioral Risk Factor Surveillance System (BRFSS), African Americans had a persistently higher percentage of not having health insurance when compared to non-Hispanic whites in Texas during 2002-2010 (as cited in Center for Health Statistics, 2012). Furthermore, the study yielded evidence that suggests an inverse relationship between socioeconomic status and mortality rate; risk of death among individuals increased the lower the SES (Lin et al., 2015, p. 24). The screening tool used to detect HPV, a virus that can lead to cervical cancer, is the Pap smear. According to KFF.org (2020), from 2016-2018, 73% of Texas women ranging in age from 18-64 reported having a pap smear within the last three years. Therefore, 23% of the studied population was not screened for HPV, increasing the likelihood for the development of cervical cancer among these individuals (KFF.org, 2020). Furthermore, 20% of Texas women reported not being seen by a healthcare provider in the previous year (KFF.org, 2020). There were likely several factors that influenced the above statistic, one of them being lack of insurance. As reported by KFF.org (2020), in 2018, 23% of women in Texas ages 19-64 were uninsured. Lack of access to healthcare leads to a decrease in screening for HPV in this population, increasing the risk for development of cervical cancer.  org (2020) reports 2.7 cervical cancer deaths per 100,000 women in Texas in 2018. Furthermore, the incidence of cervical cancer deaths among black women was almost double that of white women in Texas in 2018 (KFF.org, 2020). It is statistically evident that there is a racial disparity amongst the population group. To further support this finding, Lin and his cohorts found African American women to be 38% more likely to succumb to their diagnosis of cervical cancer than non-Hispanic white women (Lin et al., 2015, p. 24)

https://www.youtube.com/watch?v=hXvoKE6_wQo https://www.youtube.com/watch?v=lw8HPXJP1VA References “How to Choose A Research Topic For A Dissertation Or Thesis (7 Step Method + Examples).” (n.d.). Retrieved January 12, 2020, from https://www.youtube.com/watch?v=hXvoKE6_wQo. “How to Write a Literature Review in 3 steps.” Grad Coach, 19 Nov. 2019, www.youtube.com/watch?v=lw8HPXJP1VA.                                                                                   Tappen, R.M. (2015). Nursing Research. Advanced Nursing Research: From Theory to Practice. (2nd ed.). Jones & Bartlett Learning.

Organizational and Systems Leadership: Ethical Considerations  Identifies three ethical considerations and discusses how these can impact the implementation of the change project

I am required to respond to the below discussion, one to 1/2 a paragraph with 2 references is good. Thanks. Policy and Advocacy for Improving Population Health Healthcare issues are amongst the issues that dominate campaigns every election year. The three most current presidents of the United States have handled health issues differently to create policies and advocacy for improving population health. Focusing on George W. Bush, his campaigns in the first term were characterized by aiming to widen private plans in Medicare, adding a drug benefit through private plans, allowing small-business purchasing pools, interstate shopping: deductions, tax credits, and medical savings accounts for coverage and reforming medical malpractices. In his second term, Bush’s campaigns were characterized by aiming to provide premium tax deductions and tax credits for plans connected to health savings accounts, develop association health plans, and reform medical malpractices. Focusing on Barack Obama, his campaigns in the first term concerning healthcare were centered on developing private insurance and public plan, tax credits, and other subsidies to cover all Americans. Obama advocated for reducing drug prices and an increase of capacity (DeMarco & Tufts, 2014). In his second term, his primary healthcare policy was implementing the Affordable Care Act and expanding capacity. Lastly, focusing on Donald Trump, his health priorities have been repealing and replacing the Affordable Care Act with health savings accounts and tax deductions. Trump also advocated for no preexisting condition denials for individuals possessing continuous coverage, interstate shopping, reforming medical malpractices, and converting Medicare to premium support and Medicaid to state block grants (Milstead, 2019). An evaluation of the strategies applied by the three shows that they lack a collaborative approach to advocacy and promotion of healthcare (Lamb et al., 2015). I would engage all stakeholders in the healthcare sector to formulate policies and advocate for practices that will improve all Americans’ health. This would help ensure all support the formulated health policies. References DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nursing Outlook, 62(3), 219–224. doi:10.1016/j.outlook.2014.04.002 Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., & Naylor, M. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521-530. Milstead, J. A. (Ed.). (2019). Health policy and politics: A nurse’s guide. Jones & Bartlett Learning.

Discussion Prompt: Holistic care refers to approaches and interventions that address the needs of the whole person: body, mind, emotion, and spirit. Consider the following case study: You are caring for a first-time mother in a health clinic. While assessing the woman, you notice she is becoming visibly upset. When you ask, she notes that her mother, with whom she was very close, died last year and that she really would have loved to have shared this pregnancy with her. You empathize with the patient, as your own mother just died 6 months ago. She also notes that she and her partner have been bickering a lot lately on top of her feeling generally sore, tired, and overwhelmed. Define holistic care in your own words. Describe four ways you can implement a holistic nursing approach to care and facilitate healing. In addition, you may consider the intersection of holistic care and caritas principles from Jean Watson’s Theory of Human Caring/Caring Science from Week 1. 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

Discussion Questions DQ 1. Please answer all parts of the DQ. In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and examples that demonstrate a clear connection to the readings. Discussion Question 1 Answer the following:     Coaching and mentoring should be a core competency of nurses prepared at the graduate level. Do you agree or disagree with this statement? Defend your response.     Based on your graduate specialization (Family Nurse Practitioner), identify one coaching activity that you can do in this advanced practice role. What strategies would you employ for this activity?     Describe one mentoring activity you might complete with a mentor that would help you to acclimate to your new advanced practice role. Should this activity be structured or unstructured?