Nursing

NURS 6521N, WEEK 11, WALDEN, ASSIGNMENT, OFF-Label drug use in Pediatrics
Week 11: Pediatrics
Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?
This week, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings.
Learning Objectives
Students will:
Evaluate the practice of prescribing off-label drugs to children
Analyze strategies to make the off-label use of drugs safer for children
Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Chapter 8, “Drug Therapy in Pediatric Patients” (pp. 65—67)
Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/
This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse.
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
Note: You will access this article from the Walden Library databases.
This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD.
Required Media (click to expand/reduce)
Laureate Education (Producer). (2019i). Therapy for pediatric clients with mood disorders [Interactive media file]. Baltimore, MD: Author.
Assignment: Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Photo Credit: Getty Images
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Zoloft 25 mg orally daily
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
No change in depressive symptoms at all
Decision Point Two
Increase dose to 37.5 mg orally daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Depressive symptoms decrease by 20%. Client reports feeling a little bit better
Decision Point Three
Maintain current dose
Guidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Decrease dose for 7 days then return to previous 10 mg day dose
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose
Decision Point Three
Attempt to decrease dose for another 7 days then return to 10 mg dose
Guidance to Student
Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.
Client complained of feeling “sad”
Mother reports that teacher said child is withdrawn from peers in class
Mother notes decreased appetite and occasional periods of irritation
Client reached all developmental landmarks at appropriate ages
Physical exam unremarkable
Laboratory studies WNL
Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.
You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)
RESOURCES
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Decision Point One
Select what you should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Increase dose to 20 mg orally daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Nausea, vomiting, and diarrhea has increased and client is refusing to take medication
Decision Point Three
Discontinue Paxil and begin Prozac 10 mg orally daily
Guidance to Student
Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in continued refusal to take treatment. Changing to a different SSRI may be appropriate if the trial decrease of dose is unsuccessful and if the nausea, vomiting, and diarrhea return with reinitiation of 20 mg orally daily. Changing the medication may be appropriate as not all SSRIs have the same side effect profile in all clients.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Wellbutrin 75 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Child is unable to fall asleep at night
Decision Point Two
Change from immediate release to extended release 150 mg orally daily in the morning
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Child’s sleep patterns return to baseline. No change in depressive symptoms
Decision Point Three
Change to SSRI
Guidance to Student
You can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.
REFERENCE GIVEN IN THE SYUDENT PORTAL
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
-REFERENCE GIVEN IN THE STUDENT PORTAL
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J Pediatr Pharmacol Ther
v.20(4); Jul-Aug 2015
PMC4557722
J Pediatr Pharmacol Ther. 2015 Jul-Aug; 20(4): 316–328.
doi: 10.5863/1551-6776-20.4.316
PMCID: PMC4557722
PMID: 26380572
Unlicensed and Off-Label Drug Use in Children Before and After Pediatric Governmental Initiatives
Jennifer Corny, PharmD, Candidate,1 Denis Lebel, BPharm, MSc,1 Benoit Bailey, MD, MSc,2 and Jean-François Bussières, BPharm, MSc, MBA1,3
Author information Copyright and License information Disclaimer
This article has been cited by other articles in PMC.
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Abstract
OBJECTIVES: Governmental agencies (US Food and Drug Administration and European Medicines Agency) implemented initiatives to improve pediatric clinical research, starting in 1997 and 2007, respectively. The aim of this review was to quantify the unlicensed and off-label drug uses in children before and after these implementations.
METHODS: Literature review of unlicensed and off-label drug uses was performed on PubMed and Google-Scholar from 1985 to 2014. Relevant titles/abstracts were reviewed, and articles were included if evaluating unlicensed/off-label drug uses, with a clear description of health care setting and studied population. Included articles were divided into 3 groups: studies conducted in United States (before/after 2007), in Europe (before/after 2007), and in other countries.
RESULTS: Of the 48 articles reviewed, 27 were included. Before implementation of pediatric initiatives, global unlicensed drug use rate in Europe was found to be 0.2% to 36% for inpatients and 0.3% to 16.6% for outpatients. After implementation, it marginally decreased to 11.4% and 1.26% to 6.7%, respectively. Concerning off-label drug use rates, it was found to be 18% to 66% for inpatients and 10.5% to 37.5% for outpatients before the implementation. After implementation, it decreased marginally to 33.2% to 46.5% and to 3.3% to 13.5%, respectively. In other countries, unlicensed and off-label drug use rates were found to be, respectively, 8% to 27.3% and 11% to 47%.
CONCLUSIONS: Governmental initiatives to improve clinical research conducted in children seem to have had a marginal effect to decrease the unlicensed and off-label drug uses prevalence in Europe.
INDEX TERMS: off-label use, pediatrics, review
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INTRODUCTION
Before a drug can be approved for sale in a given market, governmental authorities in each country have to assess its safety, efficacy, and quality. At the end of this process, pharmaceutical companies are granted market authorization, and the drug gets a license for marketing in the country (e.g., Notice of Compliance in Canada). The drug also has a label (i.e. drug monograph), specifying the details for drug use (e.g., target population, dose, indication, specific use).
Virtually all drugs that get an approval for use in adults should also get an approval for use in children; this is often not the case considering the paucity of clinical research for that population. Therefore, drug monographs are frequently silent about the use of the drug in children. However, in most legislation, clinicians can prescribe to children a drug approved for adult (i.e., an off-label use). In some case, clinicians must also import from another country a drug that has not obtained a license for marketing (i.e., an unlicensed use). Both situations expose clinicians and patients to delays, costs, and risks. In response to these challenges, governmental authorities have established various strategies and regulations to oversee and promote clinical research in children and hopefully to decrease both unlicensed and off-label drug uses.
In 1997, the US Food and Drug Administration (FDA) adopted the FDA Modernization Act (FDAMA),1 followed in 2002 by the Best Pharmaceuticals for Children Act (BPCA),2 which provided an incentive for drug companies to conduct FDA-requested pediatric studies. In 2003, the FDA also created the Pediatric Research Equity Act (PREA), which requires drug companies to study their products in children under certain circumstances.3 In Europe, the European Medicines Agency (EMA) created the European (EU) Pediatric Regulation, in 2007.4 Its objective was to improve the health of children in Europe by facilitating the development and availability of medicines for that population. In other countries, such as in Canada, the Pediatric Expert Advisory Committee was created in 2009 to provide advice to Health-Canada in the development, licensing, and post-approval monitoring of drugs.5
Our hypothesis was that even though these initiatives were not implemented to decrease unlicensed or off-label drug use rates, they probably would have a favorable consequence on those uses. Ten years after the first regulations, we could expect that the prevalence of unlicensed and off-label prescriptions in children would have decreased. Thus, we reviewed the literature to explore the effect of the regulatory changes.
The primary objective of this literature review was to determine the effect of governmental initiatives to improve clinical research in children on unlicensed and off-label drug uses in inpatient and outpatient settings in the world. The secondary objective was to determine the unlicensed and off-label drug use rates in countries where no governmental initiatives to improve clinical research in children have been implemented.
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
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SOLUTION
Off-Label drug use in Pediatrics
Off-label prescribing involves the prescription of drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of diseases other than the condition being treated (Panther et al., 2017). Prescription of these drugs to children is done under multiple circumstances including when limited clinical research is available regarding the treatment of children with particular infections. The absence of effective, licensed, standard and safe therapeutic options for specific health conditions also promote the use of off-label drugs in children. Moreover, the easy access of these medicines as well as the doctor’s knowledge of the child’s illness can result in these prescriptions. For example the FDA prohibitive costs makes the availability of approved drugs expensive and time consuming especially when the child is in a critical condition (Corny et al., 2015).
The strategies for making the off-label use and dosage of drugs safer for children from infancy to adolescence include development of medications suitable for all age groups (Rosenthal & Burchum, 2018). As such, the formulation, taste and strength of drugs should be accommodative to various ages. In addition, pharmaceuticals should be restricted from manufacturing and marketing these products for purposes other than safety and effectiveness. Physicians should also prescribe the drugs for their effectiveness following the review of scientific evidence associated with the drug and not from pharmaceutical incentives.
Extra care and attention is necessary during the prescription of off-label drugs to pediatrics. Some of these drugs are SSRI antidepressants like Prozac often used for the management of mental health disorder (Laureate Education, 2019i). Others include morphine used for pain management and Amoxicillin (high dose), antibiotic, for treatment of otitis media. The use of these drugs should maintain dosages appropriate to age to prevent side effects relating to poisoning and death.
References
Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/
Laureate Education (Producer). (2019i). Therapy for pediatric clients with mood disorders [Interactive media file]. Baltimore, MD: Author.
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

NURS 6050 Discussion Essay
Program/Policy Evaluation
RNs and APRNs need to be involved in the evaluation process of policies and programs to ensure they are functioning and accomplishing the intended goals. This practice is an essential piece of the policy implementation process that nurses and even policymakers forget (Laureate Education, 2018b). The Patient Protection and Affordable Care Act (ACA) passed in 2010 required healthcare facilities to evaluate and plan their programs and policies. Part of this requirement focuses on the leadership roles of nurses and meeting what is considered the quadruple aim (Milstead & Short, 2019). The quadruple aim consists of improved quality of care, reduced costs, improved population health, and job satisfaction of the healthcare employees (Milstead & Short, 2019) NURS 6050 Discussion Essay.
RNs and APRNs should look to actively participate in policy reviews to assess how and if the quadruple aim is meeting expectations. Nurses use assessment and evaluation skills in their day-to-day practice. There are informal and formal evaluation processes. Informal evaluation occurred in small groups and is more gossip than an evaluation. This informal evaluation can cause information gathered to be inaccurate (Milstead & Short, 2019). Formal evaluations involve standardized processes that keep all stakeholders involved in the process and assess the effectiveness of the program or policy overall (Milstead & Short, 2019). An ongoing evaluation must begin during the planning stage of the policy change (Laureate Education, 2018a). Nurses should be consistently assessed for improvement and challenges while planning and implementing policy and program changes (Milstead & Short, 2019) NURS 6050 Discussion Essay.
Policy evaluation does not come without its challenges. Sometimes policy changes can happen too quickly or too slowly. Policy changes may be rushed due to pressure from the government. It is essential to be aware of the economic conditions of a sample population, public awareness of the policy change, and the influence of social media outlets and ongoing political campaigns (Milstead & Short, 2019). Nurses must ensure that evaluation reports contain carefully collected data, analyzed, and released by reputable sources and if the answer regarding the desired outcomes is clear (Milstead & Short, 2019).
Nurses can be involved with policy evaluation by being active in professional nursing organizations such as the American Nurses Association (ANA). The ANA is active in the policy-making process by lobbying for improvements to the nursing profession. They are involved in ongoing data collection and disseminating the results to the public and interprofessional networks (Milstead & Short, 2019). As stated above, nurses are constantly assessing and re-assessing the effectiveness of nursing interventions, and the same process is used for policy evaluation (Milstead & Short, 2019). During the entire process of policy planning, implementation, and evaluation, nurses should monitor and gather data and present it to and educate stakeholders on whether the data shows the policy is working or not working (Yoder-Wise, 2020) NURS 6050 Discussion Essay.
References
Laureate Education (Producer). (2018a). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018b). Program Policy and Evaluation [Video file]. Baltimore, MD: Author.
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Yoder-Wise, P. S. (2020). A framework for planned policy change. Nursing Forum, 55(1), 45-53 NURS 6050 Discussion Essay.
response
I agree with your statements of nurses needing to be a part of policy review since they are mainly the personnel implementing policies. it is simpler for nurses to implement policies because of their lifelong learning, development of their knowledge, and skills and competency throughout their professional lives (Hlongwa et. al, 2019). As you stated, nurses use assessment and evaluation skills in their day-to-day practice that can help them be good addition in policy review. Policy review can be more beneficial and have better outcomes when different individuals are helping to make a decision. According to Clifford et. al, policy process theory can usefully articulate the complexity of working with multiple policy actors in differing contexts (2019). Every individual has their own input and role in policy review. Nurses have an important role in policy review because of the responsibilities they have in patient care. Nurses assess, evaluate, and carry out decisions and policies daily. With that being said, nurses are key people in policy review because they can see first-hand the effectiveness of policies. As you stated, policy review is not simple and can have challenges. When it comes to nurse’s input in policy review; nurses may have challenges in ensuring feedback and data is collected carefully and presented appropriately. According to Glasgow et. al, greater attention needs to be paid to documenting intervention reach, adoption, implementation, and maintenance. Recommendations are offered to help close the gap between efficacy and effectiveness research and to guide evaluation and possible adoption of new programs (2003) NURS 6050 Discussion Essay.
References
Clifford, B., Wilson, A., & Harris, P. (2019). Homelessness, health and the policy process: a literature review. Health Policy, 123(11), 1125–1132. https://doi-org.ezp.waldenulibrary.org/10.1016/j.healthpol.2019.08.011
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93(8), 1261–1267.
Hlongwa, E. N., & Sibiya, M. N. (2019). Challenges affecting the implementation of the policy on integration of mental health care into primary healthcare in KwaZulu-Natal province. Curationis, 42(1), 1–9. https://doi-org.ezp.waldenulibrary.org/10.4102/curationis.v42i1.1847 NURS 6050 Discussion Essay
response 2
Hello, xx. The policy evaluation process is essential because there are chances of omitting fundamental aspects of the health care system during the policymaking process (Scott et al., 2020). Health care policy evaluation involves a systematic approach of gathering and analyzing the vital information in the policy to enhance the policy’s ability to promote public health. The nurses’ involvement in the evaluation process of the health care policies is essential because it results in improved service delivery and performance in the health care system. According to Poorchangizi et al. (2017), crucial patients’ needs that were omitted during policy making will be added during policy review. The importance of involving the nurses in health care policy evaluation is because they are always involved in most of the activities in the system to ensure that therefore knowledgeable about the challenges and the areas the policy will affect. Thus, the nurses will point out the areas of the policy that need an adjustment NURS 6050 Discussion Essay.
References
Poorchangizi, B., Farokhzadian, J., Abbaszadeh, A., Mirzaee, M., & Borhani, F. (2017). The importance of professional values from clinical nurses’ perspective in hospitals of a medical university in Iran. BMC medical ethics, 18(1), 1-7. https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-017-0178-9
Scott, J. W., Schwartz, T. A., & Dimick, J. B. (2020). Practical guide to health policy evaluation using observational data. JAMA Surgery, 155(4), 353-354. doi:10.1001/jamasurg.2019.4398 NURS 6050 Discussion Essay
Discussion: The Role of the RN/APRN in Policy Evaluation
In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?
Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?
In this Discussion, you will reflect on the role of professional nurses in policy evaluation NURS 6050 Discussion Essay.
To Prepare:
In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
Review the Resources and reflect on the role of professional nurses in policy evaluation.
By Day 3 of Week 9
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.
By Day 6 of Week 9
Respond to at least two of your colleagues* on two different days by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.
Policy Review Opportunities
There are numerous opportunities for registered nurses (RNs) and advanced practice registered nurses (APRNs) to participate in policy review. First, nurses can participate in a program evaluation design within their organization (Milstead & Short, 2019). During a program evaluation meeting, the team can discuss organizational policies, expected outcomes of the policies, data collection methods, and final result planning (Milstead & Short, 2019). To illustrate this, let us say that a hospital decides to implement mandatory influenza vaccines yearly for all employees. If an employee is non-compliant with the vaccine, they must wear a mask on the property from the start to end of flu season NURS 6050 Discussion Essay. The expected outcome would be that most hospital employees would be compliant in receiving the influenza vaccine. Data collection would consist of tracking the number of employees who received the vaccine versus the number of employees who declined to receive the vaccine. Based on the results, the program evaluation team may choose to implement additional restrictive measures for employees who decline the vaccine or offer incentives for employees who receive the vaccine to increase hospital-wide compliance. Second, as with aiding in policy-making, nurses can join a professional nursing organization to assist with policy review. Nurses played a significant role in implementing the Affordable Care Act by reviewing processes and supplying data to lawmakers (Milstead & Short, 2019).
Challenges and Strategies
When reviewing policies, nurses are bound to face challenges. Very few prevention and health promotion interventions are applied in healthcare settings (Glasgow et al., 2003). Two challenges may arise in social media and public awareness, or lack thereof (Milstead & Short, 2019). Let us take the policy discussed above regarding compliance with the influenza vaccine within a hospital system. As we have seen with COVID-19, many individuals refuse the vaccine due to a lack of education and social media’s strong influence. Education of hospital employees should include facts and efficacy statistics of the vaccine to combat false information seen on the internet NURS 6050 Discussion Essay. To advocate for policy-review opportunities, nurses must know the positive impact they make at the state and national levels. In Hawaii, policy teams have worked together to reduce health disparities for state citizens (Shiramizu et al., 2018). Word of mouth is the best advocate in this scenario. Nurses should also be encouraged to participate on local nursing boards and with national nursing organizations. Being involved with nursing groups provides strength in numbers when it comes to policymaking and review.
References
Glasgow, R., Lichtenstein, E., & Marcus, A. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93(8), 1261-1267.
Milstead, J., & Short, N. (2019). Health policy and politics: A nurse’s guide. Jones & Bartlett.
Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T., Ho, T., Mokuau, N., & Hedges, J. (2018). Leading by success: Impact of a clinical & translational research infrastructure program to address health inequities. NCBI. https://doi.org/10.1007/s40615-016-0302-4
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sample response
You provide an excellent example about vaccine education and the importance of being able to dispel rumors regarding illnesses and vaccines. The hospital I work at has said that employees will likely have to wear barrier masks during cold and flu seasons in the future, regardless of vaccination status. After reading your discussion, I wonder if this will affect the influenza vaccine rate of employees at UW Hospital. UW has sent out numerous emails to staff about how to have conversations with patients and family members about conspiracy theories and misinformation surrounding Covid-19. I am grateful that my hospital supports us to have these conversations thoughtfully, but as a nurse, I am frustrated that these conversations even exist NURS 6050 Discussion Essay.
Nurses often discuss vaccines with patients and family members (Navin, Kozak, & Deem, 2020). Nurses need to develop a positive rapport and gain the trust of the individual before discussing the importance of vaccination, as this is a topic that some individuals do not take lightly. Education can occur through more than just discussion, though. As you pointed out, social media can be very polarizing and often supports the spread of vaccine misinformation. Enhanced vaccine education can occur through social media, virtual reality, cartoons, smartphone apps, and more. People are entitled to their own beliefs, but hopefully, people who have false beliefs about Covid-19 and vaccines have good opportunities for education during the pandemic.
References
Kashangura, C. (2020). Enhanced education on vaccines can reduce the scourge of vaccine rejection and hesitation. South African Journal of Science, 116(9/10). https://doi-org.ezp.waldenulibrary.org/10.17159/sajs.2020/8143
Navin, M. C., Kozak, A. T., & Deem, M. J. (2020). Perspectives of public health nurses on the ethics of mandated vaccine education. Nursing Outlook, 68(1), 62–72. https://doi-org.ezp.waldenulibrary.org/10.1016/j.outlook.2019.06.014 NURS 6050 Discussion Essay
sample response 2
There are indeed many opportunities for the nurses to participate in the health care policy evaluation. They can participate through the nurses’ professional organizations such as the American Nursing Association, The National League for Nursing (NLN), The American Board of Nursing Specialties (ABNS), Sigma Theta Tau International Honor Society of Nursing (Sigma), and The National Student Nurses Association (NSNA) (Lake et al., 2019). These organizations participate actively in politics during elections, creating a political environment that will enable them to be considered by Congress during the policy evaluation process. They have advocates who will efficiently evaluate the policies to ensure the policies meet the healthcare system’s needs (O’Rourke et al., 2017). The organizations also influence the members to vote for several professional nurses to Congress during the elections. When they are elected, they can represent the nurses in evaluating the health care policies that might not be forwarded to the organizations for evaluation. The representatives will also influence the other legislatures in Congress to support their recommendations to solve the challenges in the health care system.
References
Lake, E. T., Sanders, J., Duan, R., Riman, K. A., Schoenauer, K. M., & Chen, Y. (2019). A meta-analysis of the associations between the nurse work environment in hospitals and 4 sets of outcomes. Medical care, 57(5), 353. https://dx.doi.org/10.1097%2FMLR.0000000000001109
O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and participation of nurse practitioners. Policy, Politics, & Nursing Practice, 18(3), 135-148. https://doi.org/10.1177%2F1527154417728514 NURS 6050 Discussion Essay

Select one of the following discussion prompts to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 vitamin deficiencies.
Consider the impact of spinal cord injury and the potential scope of lifetime disability and sequelae associated with spinal cord injury. The greatest challenge facing the neuroscience community involves developing therapy that will allow damaged nerve tissue to be regrown and regenerated. Reflect on this article (Links to an external site.)and discuss the importance of Schwann cells and their impact on damaged axons.
Describe the genetic components, pathophysiology, and major neurologic features of neurofibromatosis, Cri du chat syndrome, Tay-sachs disease, and Parkinson disease (early onset).
Define dementia of Alzheimer type (DAT) and describe the pathophysiology, clinical manifestations, evaluation and treatment.
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Week 5 Nurs 530
Choice 3: Dementia of Alzheimer type
Alzheimer’s disease (AD) is a gradual degenerative disorder affecting the neurologic system. It is insidious and presents with a progressive cognitive function loss causing dementia and alterations in affect and behavior (Weller & Budson, 2018). AD is a common neurodegenerative disorder that causes dementia. The onset of AD occurs in middle age, and thus it is not found exclusively in the elderly.
Pathophysiology
AD dementia occurs when the number of neurons and synapses reduces in the cerebral cortex and various subcortical area. The reduced number of neurons causes atrophy of the affected brain regions (Silva et al., 2019). The pathophysiology of AD dementia is complex and involves various cellular, molecular, and physiological pathologies. The most affected brain regions in AD are the neurons in the hippocampus, amygdala, neocortex, and the basal forebrain cholinergic system (Silva et al., 2019). Patients with AD dementia present with specific neuropathologic and biochemical changes. They comprise neurofibrillary tangles which is a knotted mass of non-functioning neurons, and neuritic plaques, which are amyloid protein deposits in the brain. The damage of neurons in AD dementia take place mainly in the cerebral cortex and causes a decreased brain size.
Clinical Manifestations
The clinical manifestations of AD progress from the early stages to the terminal stages. Signs and symptoms in the initial stages include mild memory loss (Weller & Budson, 2018). An individual may encounter mild challenges in occupational and social activities but has ample cognitive function to conceal the memory loss and functions independently. Late clinical manifestations include increasing memory loss that is evident in most daily activities. Individuals lose their capacity to identify familiar faces, objects, and places and may get lost in familiar places (Weller & Budson, 2018). There are repetitions and diminished ability to create concepts and think abstractly. In addition, individuals become depressed, paranoid, hostile, and even combative. Physical activity and agitation increase, and the individual may wander at night. In the terminal stage, the individual is usually immobile and needs total nursing care due to a lack of bladder and bowel control (Weller & Budson, 2018). They experience significant weight loss, difficulty swallowing, skin infections, grunting, and increased sleeping.
Evaluation
The diagnosis of AD dementia is made by taking a patient history and conducting mental status examination. Diagnostic studies are used to aid in the diagnosis, including blood studies such as Complete blood count, chemistry profile, HIV testing, VDRL test for syphilis, vitamin B12 to assess hematologic disease, and thyroid-stimulating hormone test to rule out thyroid disorder (Silva et al., 2019). Brain CT scan or MRI are performed in the initial evaluation of persons with dementia to visualize lesions that lead to cognitive impairment such as stroke and brain tumor (Silva et al., 2019). A lumbar puncture is performed to examine the cerebrospinal fluid and rule out disorders such as CNS infections and normal-pressure hydrocephalus.
Treatment
The standard pharmacological treatment for AD dementia includes partial N -methyl-D-aspartate (NMDA) antagonists and cholinesterase inhibitors (ChEIs). ChEIs are used to treat mild to moderate AD dementia (Zucchella et al., 2018). The FDA-approved ChEIs include Rivastigmine, Donepezil, and Galantamine, which block the breakdown of acetylcholine. ChEIs exhibit a modest impact on aspects of cognitive function and performing activities of daily living (Zucchella et al., 2018). Moderate to severe AD dementia is managed using NMDA antagonist memantine, an FDA-approved agent to treat moderate and severe AD.
References
Silva, M. V. F., Loures, C. D. M. G., Alves, L. C. V., de Souza, L. C., Borges, K. B. G., & das Graças Carvalho, M. (2019). Alzheimer’s disease: risk factors and potentially protective measures. Journal of biomedical science, 26(1), 1-11. https://doi.org/10.1186/s12929-019-0524-y
Weller, J., & Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Research, 7, F1000 Faculty Rev-1161. https://doi.org/10.12688/f1000research.14506.1
Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., … & Bartolo, M. (2018). The multidisciplinary approach to Alzheimer’s disease and dementia. A narrative review of non-pharmacological treatment. Frontiers in neurology, 9, 1058. https://doi.org/10.3389/fneur.2018.01058

NURS – 6501N
Week 1: Cellular Processes and the Genetic Environment
Discussion: Alterations in Cellular Processes. 2 Peer Respond.
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.
For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.
To prepare:
• By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
By Day 3 of Week 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
• The role genetics plays in the disease.
• Why the patient is presenting with the specific symptoms described.
• The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
• The cells that are involved in this process.
• How another characteristic (e.g., gender, genetics) would change your response.
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not
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Solution
Response 2: Cellular Processes and the Genetic Environment Discussion: Alterations in Cellular Processes
Hello Kevin. I agree with your assessment of the patient’s presenting symptoms in the provided case study to come up with rhabdomyolysis as the primary diagnosis. I am also convinced with your rationale based on the patient’s hyperkalemia and necrotic tissues of the forearm and hip. One of the main causes of this condition is opioid abuse which was displayed as the reason behind the patient’s unresponsiveness resolved by naloxone (Nelson et al., 2021). You have further explained the cellular processes involved in the pathogenesis of the disease in the second paragraph. For instance, a decrease in the production of ATP leads to dysregulation of potassium, sodium, and calcium leading to peroxidation, apoptosis, and tissue breakdown. This explains the patient’s symptoms, in addition to hyperkalemia and tissue necrosis.
The last two paragraphs elaborate on the physiological response to stimulus and other characteristics in addition to genetic factors and the role they play in the disease process. However, the information that you have provided is quite limited, failing to mention the actual genetic factors associated with opioid overuse and the development of rhabdomyolyses, such as the DRD2 gene and opioid genes like OPRD1, OPRM1,and OPRK1(Agrawal et al., 2019). However, you have clearly defined how hyperkalemia is associated with the peaked T waves and prolonged PR intervals recorded by the patient. Your discussion is also missing information regarding additional factors such as gender, and occupation which would change the reasoning behind the disease process. For instance, studies show that working in industries and places with increased risk of trauma or injury are associated with an increased prevalence of rhabdomyolysis due to immobilization, extensive third-degree burns, and crush injury (Nelson et al., 2021).
References
Agrawal, S., Sharma, N., Jain, S., Attri, R., & Bhatia, M. S. (2019). Opioid-Induced Rhabdomyolysis with Acute Sensorimotor Axonal Neuropathy: An Unusual Presentation. Asian Journal of Case Reports in Medicine and Health, 1-3. https://doi.org/10.22037/emergency.v6i1.22475
Nelson, K. R., Dolbec, K., Watson, W., Yuan, H., & Ibraheem, M. (2021). Review of Neurologic Comorbidities in Hospitalized Patients with Opioid Abuse. Neurology: Clinical Practice. https://doi.org/10.1212/CPJ.0000000000001080

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Post a reflection on your personal and/or professional experiences with quality improvement. First, assess your familiarity with quality improvement in healthcare. Then, describe a time you experienced healthcare that was representative of either high or low quality. Be specific and provide examples. Explain which domains of healthcare quality were present and absent in that scenario.
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Solution
Quality Improvement
Quality improvement in health care is essential to ensure high-quality, safe, and responsive services for patients. According to Drew (2020), a quality improvement is a systematic approach that utilizes specific methods to improve quality. It requires disciplined and systematic ways to improve experiences and outcomes for patients, eradicate waste from processes, and eliminate errors.
I was once involved in a hand hygiene quality initiative to improve staff’s compliance to hand hygiene to control the transmission of pathogens that cause healthcare-associated infections(HAIs) and reduce the rates of HAIs in the health care facility. I collected data adherence hand hygiene compliance before and after the intervention and I was also allowed to express my opinions during the designing and implementation phases of the program.
The time I experienced healthcare that was representative of low quality is when patients had to wait for up to 60 minutes before they receive care. Long wait times were inconvenient for patients as they did not receive care on time which led to frustrations. The staff had to work overtime and deal with frustrated patients. As indicated by Robinson et al.(2020), .long patient wait time negatively impacts staff, physician, and patient satisfaction as clinics operate till late hours and providers have to manage dissatisfied patients and incur misses breaks and overtime.
Timely, patient-centered, efficient, and safe are domains of healthcare quality absent in the scenario. As explained by Salmond and Echevarria (2017), safe implies the system protects from being injured by the system that is supposed to help them through risk prevention and mitigation. Timely means reducing waits and detrimental delays while efficient implies avoiding waste, including waste of energy and time. Patient-centered means care that is responsive to patients’ specific needs and patients are involved in decisions about their care.
Equitable and effective are domains of healthcare quality present in the scenario. Equitable means providing care that does not vary in quality due to personal characteristics like ethnicity, gender, and socioeconomic status. Effective means decision-making and care are based on evidence, without overutilization or underutilization of beast available techniques (Salmond & Echevarria, 2017).
References
Drew, J. R. (2020). Why healthcare leadership should embrace quality improvement. BMJ, 368, m872. https://doi.org/10.1136/bmj.m872
Robinson, J., Porter, M., Montalvo, Y., & Peden, C. J. (2020). Losing the wait: improving patient cycle time in primary care. BMJ Open Quality,9, 000910. doi:10.1136/bmjoq-2019-000910
Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic Nursing, 36(1), 12-25. doi: 10.1097/NOR.0000000000000308

Topic 6: Regression- TOPIC 6 DQ 1-The question is on Topic 6: Regression
QUESTION-TOPIC 6 DQ 1
Given the limited amount of statistical calculations required by some public health positions, explain why it is important for you to know how to utilize appropriate software to analyze public health data. Support your ideas with reasons, facts, and examples.
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Solution
Utilizing Appropriate Software to Analyze Public Health Data
Public health relies on data to make decisions that will make a difference in the lives of the people. The presence of detailed and in-depth information facilitates the making of informed decisions. Public health departments globally have embraced the use of data for practical use. The advancement in technology and the increase in population demand appropriate software to analyze data in public health (Dash et al., 2019). This paper focuses on the importance of utilizing appropriate software in analyzing public health data.
The use of appropriate software in analyzing public health data saves time and money. With the increase in population, there is a likelihood of an increase in the health information of the public members. To analyze the information faster, I will need the help of other public health nurses. The involvement of other nurses may take a longer time, and it may require additional funds hence becoming costly. With appropriate software, I will analyze the data fast, and I will get time to offer other health services. For example, the Electronic Health Records (EHR) software will record and store all the patient information recorded during an encounter. With the software, minimal time is needed in accessing the information.
Appropriate software ensures data protection. As a public health nurse, it is crucial to have the patient’s data safe from unauthorized access. Most of the information in public health is confidential, and only authorized persons should access it. The breach of data in healthcare has dire consequences both to an individual or even the entire organization (Crowhurst & wells, 2019). As a nurse, I should guarantee the privacy, freedoms, and privacy of patients. Appropriate software plays a vital role in protecting information from unauthorized access hence the protection of patient data.
References
Crowhurst, N., Bergin, M., & Wells, J. (2019). Implications for nursing and healthcare research of the general data protection regulation and retrospective reviews of patients’ data. Nurse researcher, 27(1).https://journals.rcni.com/nurse-researcher/evidence-and-practice/implications-for-nursing-and-healthcare-research-of-the-general-data-protection-regulation-and-retrospective-reviews-of-patients-data-nr.2019.e1639/print/abs
Dash, S., Shakyawar, S. K., Sharma, M., & Kaushik, S. (2019). Big data in healthcare: management, analysis, and future prospects. Journal of Big Data, 6(1), 1-25.https://journalofbigdata.springeropen.com/articles/10.1186/s40537-019-0217-0

Theory description and evaluation paper
Articles used have to be within 10years . My paper should be about how Bronfenbrenner’s social ecological model applies to readmissions in my area of practice. There are 2 specific articles u need to use for 2 of the questions in the rubric
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Introduction
Hospital readmission is defined as the admission of a patient within a specified time after discharge. In most cases, readmissions are in-patient admissions that occur within 30 days after discharge from a healthcare facility. Patient readmissions have been linked to several negative outcomes, including increased mortality rates; several studies have suggested that in-patient mortality rates are higher among re-admitted patients compared to those who are not re-admitted. Readmission is also associated with the increased cost of health care services; readmission leads to longer hospital stays and expenditure of more health resources, which lead to higher costs for the care services. It is estimated that hospital readmissions cost about $26 billion annually. Hospital readmissions can be prevented by appropriate case management during the care process (Banerjee et al., 2021).
Case management is a process that involves facilitating collaboration to assess, plan, implement, monitor, and evaluate the health interventions necessary to meet the health needs of a patient. The case manager assesses the various options available for the patient and recommends the most suitable options to ensure the delivery of quality care services with minimal financial implications. Hospital readmissions are affected by the environmental factors within the health care, and these factors can be controlled or manipulated through the case management process. To explore these factors, Bronfenbrenner’s social-ecological model theory would be appropriate. The theory focuses on external factors that influence the development of children and can be applied to nursing practice to evaluate how hospital readmissions can be prevented using the theory (Hertler et al., 2018). This paper will specifically assess the application of Bronfenbrenner’s social-ecological model theory in case management to reduce hospital readmission rates.
Theory Description
Bronfenbrenner’s ecological systems theory was developed by Urie Bronfenbrenner, who was critical of the theories that then explained child development. He believed that the theories were ecologically invalid, and the laboratory features of previous research that contributed to the development of other theories on child development were not representative of the actual environment that a child grew up in. He looked beyond individual development and included other ecological factors that he believed interacted with the child and affected the child’s development. He then developed the theory based on the environment’s interactions with child development. His theory holds that individuals encounter different environments throughout their lifespan, affecting the way they behave in different situations. Bronfenbrenner proposed that a child’s environment comprises nested structure arrangement where each structure is contained within the next. He then described the structures depending on their impact on a child’s development (Guy-Evans, 2020).
The microsystem is the first structure, and it includes things that are in direct contact with the child. This comprises relationships with parents, siblings, peers, and other relatives. The microsystem directly influences the child, and the child can also influence the beliefs and attitudes of others in the microsystem. The mesosystem is the second system, and it involves interactions between the different components in the microsystem, but they affect the child’s development. An example is an interaction between a parent and teacher, if their interaction is positive, the child will be positively impacted, and if it is negative, the child will experience the negative impact. The exosystem includes informal and social structures that indirectly affect the child (Hertler et al., 2018). For example, the work environment can impact the parent’s mood and therefore affect the relationship with the child. The macrosystem focuses on the cultural elements, including socioeconomic status, and how they impact the child’s development. Hospital readmissions can be affected by the macrosystem, and the exosystem of a patient, since components such as socioeconomic factors and hospital environment influence the prevalence of disease and general quality of care services (Tan et al., 2020).
Application to Research
Bronfenbrenner’s social-ecological theory has been extensively used in research. Huang et al. (2021) used the theory to assess the influence of social interactions on adult preferences for palliative care and life-sustaining treatments. The researchers specifically explored the importance of professional support in the community, culture, social interactions, and determinants of adult preferences for palliative care and life-sustaining treatments. Four levels of societal influence were selected, including cultural, interpersonal, community, and intrapersonal. The researchers used these concepts to determine their influence on patient preferences regarding life-sustaining treatments and palliative care. Intrapersonal and interpersonal concepts included fear of death, personal attributes, and knowledge about existing services and support. The community concept included community support resources, and cultural influence involved adherence to cultural values.
Adu & Oudshoorn (2020) utilized Bronfenbrenner’s theory to propose a process that can be used to deinstitutionalize psychiatric services in Ghana and transition to community-based mental healthcare. Deinstitutionalization was defined as a policy initiative that aimed at closing the current large mental health institutions to establish alternative institutions in the community. Four concepts were identified microsystem, mesosystem, macrosystem, and exosystem. The microsystem was defined as the innermost ecological level where the patient resides. Mesosystem was identified as comprising associative relationships between the patient and other factors in the microsystem. These relationships affect the psychosocial well-being of the patients. The exosystem includes the neighborhood, external family, community resources, and mass media. All these factors affect the psychosocial well-being of a patient. Macrosystems included political environment, cultural belief systems, health policies, and economic systems. While the macrosystems are far from the patients, they affect their daily activities and, therefore, are essential in the mental well-being of the patients.
Application to Practice
Hospital readmissions are a common occurrence in the healthcare industry. They are, however, associated with poor patient outcomes, such as higher mortality rates among re-admitted patients, and they also impose a significant economic burden on patients and healthcare providers in general. The causes for hospital readmission can be grouped in different ecological systems identified by Bronfenbrenner. Some of the concepts that will be of interest in hospital readmission include microsystem, mesosystem, and macrosystem (Tan et al., 2020). Microsystem, in this case, will be defined as patients’ immediate interactions and relationships with those surrounding them, which are important in providing basic care assistance after they are discharged from the healthcare facilities. For example, the availability of care providers at home ensures that discharge instructions and prescriptions are followed, therefore minimizing readmissions (Guy-Evans, 2020).
The mesosystem will include relationships between healthcare providers and the patients’ support system. Patient education is required to include patients’ immediate support system to ensure that discharge instructions are followed. When necessary, good relationships between healthcare providers and support providers can facilitate consultations, which is crucial in preventing readmissions for most patients. The macrosystem will be defined as the cultural factors that influence the health beliefs and practices adopted by the patients once they are discharged. The levels of the ecological system identified by this theory can be used in case management to identify factors that affect collaboration between care providers and those factors that lead to frequent hospital readmissions. For example, macrosystem concepts can be used to assess predictors that a patient will be re-admitted (Tan et al., 2020). Based on the theory’s proposition, some of the questions include the influence of cultural and environmental factors on a patient’s health and the likelihood of being re-admitted to a healthcare facility. What is the impact of patient education on readmission rates among patients who have undergone major surgeries? (Hertler et al., 2018).
Theory Evaluation
Bronfenbrenner’s social-ecological theory has been tested empirically by several researchers and is valid and accurate. For example, Lippard et al. (2018) examined children’s experiences in the classroom, specifically the interpersonal interactions between teachers and children and their impact on classroom behavior and academic achievement of the children. The social-ecological theory holds that these interactions uniquely impact children’s development and performance. The researchers showed that the relationship and the interaction were congruent with classroom behavior and the children’s academic achievements. This suggests that the relationships are essential and therefore supports Bronfenbrenner’s social-ecological theory. Erickson et al. (2018) assessed their use in public mental health research and their contribution to public mental health practices and policies. The researchers established that the use of the theory has resulted in the development of the most useful recommendations that guide public mental health practice and policies.
While the theory was primarily formulated to explain child development and ecological factors affecting development, the theory is generalizable to other phenomena. Its framework can be used to guide research in areas that involve behavioral changes. For example, the theory can be used in mental health and health promotion to understand why individuals adopt specific health behaviors and explain the impact of the environment and culture on individuals (Hertler et al., 2018).
Some of the theory’s strengths include its wide application; this theory is not limited to application in children. It can be used in diverse settings, including the corporate world, classrooms, and healthcare settings. It provides a clear breakdown of the ecological factors, which allows for easy formulation and implementation of interventions. However, some of the weaknesses are that testing the theory empirically is usually a challenge since it is hard to determine that observed outcomes were due to the application of the theory. It can also cause assumptions that those without positive ecological systems lack in development; however, this can be misleading since some people lacking are well-developed (Guy-Evans, 2020).
The theory agrees with some of the nursing standards, interventions, and therapeutics. The theory holds that individuals encounter different environments, affecting how they behave and eventually leading to specific positive or negative outcomes. Some of the nursing interventions, such as health promotion, aim to create a positive environment by creating awareness to drive behavioral change. The nursing standards and intervention aim to influence one of the systems outlined in theory, and therefore they are congruent (Tan et al., 2020).
The theory holds some social and cross-cultural relevance and can explain some of the occurrences, for example, the negative behavior in some members of the society in poor environments or good conduct among individuals with good social backgrounds. However, in some cases, the theory lacks relevance and cannot explain the observations. For example, when people from good social backgrounds exhibit negative behaviors (Hertler et al., 2018).
The theory can be used in nursing to explain the factors that affect behavior among different age groups or cultures, including health behaviors. Using the theory framework develop interventions that address specific environmental factors to cause a behavior change. For example, the theory can be applied to design the most effective interventions in health promotion (Tan et al., 2020).
Conclusion
Hospital readmissions are a major concern in the healthcare industry due to the poor patient outcomes and the financial burden they impose on the industry. Bronfenbrenner’s social-ecological model theory can be used to assess the factors that contribute to hospital readmissions and therefore be used to guide case managers. The theory outlines ecological systems that influence the child’s development throughout life. By replacing the child with a patient, the theory can be used to assess how different factors interact and affect a patient’s health from sickness to full recovery. Therefore, the theory would be useful to case managers as they coordinate different players to ensure patients’ full recovery and prevent hospital readmissions.
References
Adu, J., & Oudshoorn, A. (2020). The deinstitutionalization of psychiatric hospitals in Ghana: An application of Bronfenbrenner’s social-ecological model. Issues in Mental Health Nursing, 41(4), 306-314. https://www.tandfonline.com/doi/abs/10.1080/01612840.2019.1666327
Banerjee, S., Paasche-Orlow, M. K., McCormick, D., Lin, M. Y., & Hanchate, A. D. (2021). Association between Medicare’s Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share. BMC health services research, 21(1), 1-9. https://link.springer.com/article/10.1186/s12913-021-06253-2
Eriksson, M., Ghazinour, M., & Hammarström, A. (2018). Different uses of Bronfenbrenner’s ecological theory in public mental health research: what is their value for guiding public mental health policy and practice?. Social Theory & Health, 16(4), 414-433. https://link.springer.com/article/10.1057/s41285-018-0065-6
Guy-Evans, O. (2020). Bronfenbrenner’s ecological systems theory. https://www. simplypsychology. org/Bronfenbrenner. html. https://www.simplypsychology.org/Bronfenbrenner.html
Hertler, S. C., Figueredo, A. J., Peñaherrera-Aguirre, M., & Fernandes, H. B. (2018). Urie Bronfenbrenner: Toward an evolutionary ecological systems theory. In Life history evolution (pp. 323-339). Palgrave Macmillan, Cham. https://link.springer.com/chapter/10.1007/978-3-319-90125-1_19
Huang, Y. L., Yates, P., Thorberg, F. A., & Wu, C. J. J. (2021). Influence of social interactions, professional supports and fear of death on adults’ preferences for life-sustaining treatments and palliative care. International journal of nursing practice, e12940. https://onlinelibrary.wiley.com/doi/full/10.1111/ijn.12940?casa_token
Lippard, C. N., La Paro, K. M., Rouse, H. L., & Crosby, D. A. (2018, February). A closer look at teacher–child relationships and classroom emotional context in preschool. In Child & Youth Care Forum (Vol. 47, No. 1, pp. 1-21). Springer US. https://link.springer.com/article/10.1007/s10566-017-9414-1
Tan, K., Tan, N., Rao, J., & Foo, Y. Y. (2020). Is Bronfenbrenner’s Ecological Systems Theory useful for understanding Interprofessional Collaboration?(1613). https://n.neurology.org/content/94/15_Supplement/1613.abstract

Discussion Post Assignment
Discussion Post
Conflict Negotiation
The Thomas-Kilmann Model identifies 5 skills related to conflict negotiation: Competing, Collaborating, Compromising, Avoiding, and Accommodating.
1. Choose the skill you are most likely to use and describe a time when you have used it and have achieved fantastic outcomes.
2. Choose the skill you tend to use the least and describe a time when – based on the outcome, you should have used it and did not.
Instructions
Initial post: Reflection, application with exemplar and resources. Maximum of 500 words, at least 2 APA 7th edition resources. Rubric uploaded.
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Solution
Discussion Post
Various types of conflicts involving multiple healthcare stakeholders can occur in a healthcare setting. The parties involved use different methods to resolve conflict, depending on the situation, the outcomes, and personal values. Most people use specific preferred conflict resolution strategies. Sometimes the preference can be more than one strategy. Thomas-Kilmann, in his conflict resolution Model, identifies five approaches that can be applied to resolve conflict. Avoiding strategy entails ignoring the conflict and hoping it will resolve itself with time. Accommodating strategy entails focusing on satisfying the other party’s concerns at the expense of your own desires (Fahy, Mueller & Fecteau, 2021).
Compromising involves finding an acceptable resolution that will partly but not entirely satisfy the concerns of all parties involved. Competing entails striving to satisfy one’s desires at the expense of the other parties involved. Finally, collaborating consists of finding a solution that entirely satisfies the concerns of all involved parties. In his model, the Thomas-Kilmann model asserts that the balance between assertiveness and cooperativeness influences the strategy chosen by an individual (Fahy, Mueller & Fecteau, 2021). Assertiveness involves taking action to satisfy personal needs, while cooperativeness involves taking action to satisfy the other’s needs. Therefore, each of the five strategies involves different degrees of assertiveness and cooperativeness. For example, accommodating involves a high degree of cooperativeness and a low degree of assertiveness, as opposed to competing (Elmasry & Wang, 2021).
Of these five stages, the skill that I am most likely to use is accommodation. I am a selfless person, thus more concerned about other people’s needs than mine. I have employed this skill previously in my work environment and achieved fantastic outcomes. The case involved an issue-based conflict in a medical-surgical unit. It involved caring for a post-surgical wound. Based on my experience from previous travel nurse assignments, I found myself disagreeing with how a staff nurse was changing a patient’s bandages in my new facility. The nurse claimed that she was following the standard protocol in the specific facility. Instead of coercing the staff nurse into adapting my preferred method of changing wound bandages, I consulted with other nurses on the unit. I realized that my preferred way of changing bandages is different from facility protocol. Using the accommodating conflict resolution strategy, I adopted the facility’s protocol for changing patient bandages while on that assignment.
Among the five conflict resolution strategies proposed by Thomas-Kilmann, the strategy I tend to use the least is collaboration. Reflecting on my past practice, one instance that I think I should have used a collaboration strategy entailed a chronically ill patient who refused to adhere to the prescribed treatment. She preferred taking cultural herbal medicine. I insisted the patient take the biomedicine because they were evidence-based. Although the target treatment outcome was obtained, the patient reported low satisfaction with the care provided. In addition, the patient reported the incidence to the hospital management. Reflecting on the adverse outcomes that resulted from competing conflict resolution strategies, I think a collaboration strategy would have yielded better outcomes.
In that case, applying a collaboration strategy would have entailed the collaboration of both patient and care provider in designing the care plan. This would have resulted in incorporating traditional and biotherapy into the treatment plan. My role as a care provider in the process would have been to guide the patient on how to integrate cultural medicine into the treatment plan safely. Although the therapeutic outcomes would be similar to the initially applied strategy, the second approach would have yielded a better patient experience and more satisfaction. It would have also promoted culturally competent care.
References
Elmasry, K., & Wang, Y. (2021, October). How to Improve Conflict Management in Hospitals in the Healthcare Industry. In International Workshop of Advanced Manufacturing and Automation (pp. 495-499). Springer, Singapore. DOI: 10.1007/978-981-19-0572-8_63
Fahy, A. S., Mueller, C., & Fecteau, A. (2021, October). Conflict resolution and negotiation in pediatric surgery. In Seminars in Pediatric Surgery (Vol. 30, No. 5, p. 151100). WB Saunders. https://doi.org/10.1016/j.sempedsurg.2021.151100

Assignment: NUR 6501: Case Study Analysis
Module 7 Assignment: Case Study Analysis
An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient.
Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.
An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factored in the diagnosis, and you explain the implications to patient health.
Assignment: NUR 6501: Case Study Analysis
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the Course Announcements section of the classroom for your assignment from your Instructor.
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
The factors that affect fertility (STDs).
Why inflammatory markers rise in STD/PID.
Why prostatitis and infection happens. Also, explain the causes of a systemic reaction.
Why a patient would need a splenectomy after a diagnosis of ITP.
Anemia and the different kinds of anemia (i.e., micro and macrocytic).
Day 7 of Week 10
Submit your Case Study Analysis Assignment by Day 7 of Week 10
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates).
All papers submitted must use this formatting.
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NUR 6501 : Case Study Analysis
Health is a state of full physical and emotional well-being (Sterba et al., 2017). Healthcare transpires to help individuals maintain an ideal form of health. These individual’s health can be affected by infections if not cared for well. Women and men fight infection differently. Females are better set to fight any infection than men, and their bodies suffer lesser collateral harm when an infection hits. These individuals can also be affected by hematologic disorders that involve blood and include issues with the red and white blood cells, bone marrow, platelets, spleen, and lymph nodes. Females have low hematocrit as compared to men. It has been revealed that women have an average hematocrit level of approximately 12 percent lower than men. It is perhaps a direct effect of the sex hormones, both androgens, and estrogen, on erythropoiesis. This paper will explore on the factors affecting fertility (STDs), why the inflammatory markers rise in the STD, and why prostatitis and the infection occur, explaining the cause of the systemic reaction. It will also highlight why patient presented would require a splenectomy after diagnosing ITP and, finally, anemia and its different kinds.
Factors Affecting Fertility (STDs)
Numerous STDs factors may make conceiving harder. Conceiving requires healthy sperms, consistent intercourse around ovulation time, quality eggs, and a healthy pelvic environment. Occasionally an issue in only one of these areas might lead to a delay in getting pregnant. Chlamydia and gonorrhea are some of the STDs that may cause infertility (Tsevat et al., 2017). The patient in the case may be having these illnesses following her complaints. Chlamydia may cause the infection of fallopian tube infection without the symptoms. The PID and the “silent” infection in the upper genital tract may cause long damage to the uterus, fallopian tubes, and the surrounding tissues leading to infertility. Most women affected with gonorrhea or chlamydia mostly lack symptoms. When it comes to gonorrhea, it may lead to key problems, like infertility in the women if untreated. It may spread to the uterus and fallopian tubes, causing the pelvic inflammatory illness that might result in the scarring of tubes, more risk of pregnancy problems, and infertility.
Reason for the Inflammatory Markers to Rise in STD/PID.
Inflammatory markers involve C reactive protein, erythrocyte sedimentation rate, fibrinogen, plasma viscosity, ferritin, and some severe phase proteins. However, only the first three are usually referred to as the inflammatory markers (Mozos et al., 2017). The reason why inflammatory markers rise in STD, in this case, is because the white blood cell count is high, indicating that pelvic inflammatory illness is more serious. Any infection’s inflammatory response is a sign of infection. As well, chemical and physical barriers form the first line of defense when the body is attacked. The skin has a thick layer of dead cells in the epidermis that cause the physical barrier. The episodic shedding of the epidermis removes the microbes. Mucous membranes form the mucus that usually traps the microbes.
Why Prostatitis and Infection occur Explaining the Cause of the Systemic Reaction
Acute bacterial prostatitis is regularly triggered by common bacteria strains. Infection may begin when the bacteria in the urine leak to an individual’s prostate. The antibiotics are used to treat the disease. In case they do not eliminate bacteria, prostatitis may recur or be hard to treat (Delcaru et al., 2016).
When the inflammation spreads from an organ’s contained area to the rest of the body’s organ systems, it is identified as a systemic reaction. Inflammation may be from allergies, toxins, or infections. Prostate massage must not be done in the patient with alleged acute prostatitis as it might induce sepsis. Sepsis from the prostatitis is rare but can occur in an immunocompromised patient.
Why a Patient would require a Splenectomy after Diagnosis of ITP
Splenectomy is an active treatment for the steroid-refractory or the dependent immune thrombocytopenia. With the beginning of therapeutic replacements like rituximab, splenectomy use has failed and is usually kept for the patients who miss numerous medical treatments. In individuals with ITP, the system of immune treats the platelets as foreign, destroying them completely. The spleen is accountable for eliminating injured platelets, and thus removal of the spleen may help keep extra platelets moving in the body.
Anemia and its Different Kinds (i.e., micro and macrocytic)
Anemia is a disorder in which an individual lacks sufficient healthy red blood cells to transport appropriate oxygen to the body’s tissues. Anemia may make the patient feel weak and tired. There are numerous anemia forms, each caused by different sources. Anemia may be long-term or temporary, ranging from mild to severe. One type of anemia is Microtic anemia
Microcytic anemia is the incidence of small, frequently hypochromic, red blood cells in the peripheral blood smear characterized by the low MCV. The iron deficit remains a common cause of this kind of anemia.
Another type is macrocytic anemia. This type of anemia means that red blood cells similarly have low hemoglobin. Hemoglobin is an iron-containing protein that carries oxygen around the body (Cakmakli et al., 2019). Deficits in vitamin B-12 or folate mostly cause macrocytic anemia, which is sometimes known as vitamin deficiency anemia. Hypochromic microcytic anemia is another kind of anemia where circulating RBCs are lesser than usual RBCs size and have a reduced red color. This type of anemia is caused due to distraction of iron in diets because of a reduced amount of iron in the diet, pathology of small intestines such as sprue and the enduring diarrhea, deficit of vitamin C in the diet, and gastrectomy.
Conclusion
Woman’s and man’s health is important. Health may be affected by infections and hematologic disorders. As part of infections, chlamydia and gonorrhea are some of the STDs that may cause infertility. The inflammatory markers rise in STD because the white blood cell count is high, indicating that pelvic inflammatory illness is more serious. Acute bacterial prostatitis is regularly triggered by common bacteria strains. Infection may begin when the bacteria in the urine leak to an individual’s prostate. When the inflammation spreads from an organ’s contained area to the rest of the body’s organ systems, it is identified as a systemic reaction. Inflammation may be from allergies, toxins, or infections.
Splenectomy is an active treatment such as steroid-refractory. In individuals with ITP, the systems of immune treat the platelets as foreign destroying them. The spleen is accountable for eliminating injured platelets, and thus spleen removal may help keep extra platelets moving in the body. Anemia is a disorder in which an individual lacks sufficient healthy red blood cells to carry appropriate oxygen to the body’s tissues. Some kinds of anemia include Micro, Macrocytic, and Hypochromic microcytic anemias, among others.
References
Cakmakli, H. F., Torres, R. J., Menendez, A., Yalcin-Cakmakli, G., Porter, C. C., Puig, J. G., & Jinnah, H. A. (2019). Macrocytic anemia in Lesch–Nyhan disease and its variants. Genetics in Medicine, 21(2), 353-360. Retrieved from https://www.nature.com/articles/s41436-018-0053-1
Delcaru, C., Alexandru, I., Podgoreanu, P., Grosu, M., Stavropoulos, E., Chifiriuc, M. C., & Lazar, V. (2016). Microbial biofilms in urinary tract infections and prostatitis: etiology, pathogenicity, and combat strategies. Pathogens, 5(4), 65.
Mozos, I., Malainer, C., Horba?czuk, J., Gug, C., Stoian, D., Luca, C. T., & Atanasov, A. G. (2017). Inflammatory markers for arterial stiffness in cardiovascular diseases. Frontiers in immunology, 8, 1058. Retrieved from https://www.frontiersin.org/articles/10.3389/fimmu.2017.01058/full
Sterba, K. R., Zapka, J., Armeson, K. E., Shirai, K., Buchanan, A., Day, T. A., & Alberg, A. J. (2017). Physical and emotional well-being and support in newly diagnosed head and neck cancer patient-caregiver dyads. Journal of psychosocial oncology, 35(6), 646-665. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/07347332.2017.1323817
Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American journal of obstetrics and gynecology, 216(1), 1-9.