Nursing

The impact of nursing informatics on patient outcomes and patient care efficiencies
Assignment: The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies
In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined?
Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.
To Prepare:
Review the concepts of technology application as presented in the Resources.
Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.
The Assignment: (4-5 pages not including the title and reference page)
In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:
Describe the project you propose.
Identify the stakeholders impacted by this project.
Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
Identify the technologies required to implement this project and explain why.
Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.
Use APA format and include a title page and reference page.
Use the Safe Assign Drafts to check your match percentage before submitting your work.
Excellent
In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient care efficiency. Your project proposal should include the following:
· Describe the project you propose.
· Identify the stakeholders impacted by this project.
· Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving, and explain how this improvement would occur. Be specific and provide examples.
· Identify the technologies required to implement this project and explain why.
· Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.
77 (77%) – 85 (85%)
The response accurately and thoroughly describes in detail the project proposed.
The response accurately and clearly identifies the stakeholders impacted by the project proposed.
The response accurately and thoroughly explains in detail the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an accurate and detailed explanation, with sufficient supporting evidence of how this improvement would occur.
The response accurately and clearly identifies the technologies required to implement the project proposed with a detailed explanation why.
The response accurately and clearly identifies the project team (by roles) and thoroughly explains in detail how to incorporate the nurse informaticist in the project team.
Includes: 3 or more peer-reviewed sources and 2 or more course resources.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
ORDER A PLAGIARISM-FREE PAPER HERE !!
Solution
Nursing informatics
A description of the project I propose
Nursing leadership plays a fundamental role in the development and implementation of nursing informatics solutions since they understand and oversee nursing care. Together nurse informaticists and nurse executives are forming novel informatics solutions to improve the processes of nursing and patient care (Mosier et al. 2019). The electronic clinical documentation system is an evidence-based clinical documentation (EBCD) project I propose to the leadership of my organization.
Electronic clinical documentation is an electronic system that nurses and other health care providers use for systematic documentation of clinical information that pertains to an individual’s health. According to Akhu-Zaheya et al. (2017), Nurses, as the biggest group of health professionals play a vital role in improving performance within a healthcare organization.
The role requires nurses to document and manage patient information by coordinating care and effectively communicate with other members of the interdisciplinary team complete and accurate nursing documentation promotes continuity and quality of care.
Paper-based documentation does not result in high-quality documentation and communication among providers, since it is inaccurate and time-consuming. According to Saraswasta et al. (2021), the implementation of electronic nursing documentation improves the quality of information by facilitating effective communication of nurses in a healthcare facility.
Communication by nurses is regarded effective if it is done in a complete, accurate, timely, and not confusing and is understandable by the recipient of information to lessen errors in the provision of nursing care.
Applying electronic-based documentation assists nurses in collecting, analyzing, transferring, and accessing information accurately and quickly in order to enhance the implementation of effective communication.
The stakeholders impacted by this project
The key stakeholders impacted by the project include nurses, student nurses, physicians, medical students, nurse managers, and patients. Nurses participate in numerous activities from the time a patient is admitted to the time he or she is discharged from the hospital assisting patients to meet their needs. Every nursing activity must be documented appropriately as genuine and crucial evidence.
According to Asmirajanti et al. (2019), nursing care that will take place or has been completed should be appropriately documented. Accurate documentation plays an integral role effective delivery of health care services. Documentation offers details of the patient’s condition, the provided nursing interventions as well as patient response to these interventions.
Nursing documentation facilitates interprofessional communication between nurses and other healthcare providers for the delivery of nursing care, assessing how the patient is progressing as well as outcomes, and offering consistent patient protection. Correct documentation helps nurses in establishing continuity between diagnosis, intervention, and progress, and outcome evaluation. Supervision by the nurse manager/ head nurse is needed for accurate, succinct, and complete nursing care documentation (Asmirajanti et al., 2019).
Explain patient-care efficiencies this project is aimed at improving
Many nurses have used electronic health documentation to document nursing care, entailing the nursing process like accessing laboratory results, and entering orders and also to support other health care providers to process, manage, and communicate data in a wide range of settings.
According to Saraswasta and Hariyati (2018), electronic health care documentation has the potential to improve the safety of the patient, ensure proper utilization of resources, enhance providers’ access to the healthcare information of a patient and improve communication among providers.
Akhu-Zaheya et al. (2017) emphasize that failure to effectively communicate happens because important patient information is at times not documented, is inaccurate, and cannot quickly be accessed. Thus, nurses should document patient information effectively, briefly, timely, and accurately. Implementing electronic nursing documentation enhances the implementation of effective communication.
Electronic-based nursing care documentation is aimed at improving care quality. Documentation of nursing care is an important indicator of the quality of care that the patient receives. High-quality nursing documentation enables members of the healthcare team to effectively communicate and cooperate, and thus provide quality care (Saraswasta& Hariyati, 2018).
For example, by utilizing electronic documentation, data about a patient will be integrated with the information system of the hospital. The ability to ease easily access data by utilizing integrated electronic health records hastens decision making in the provision of care to patients, and thus patients receive efficient services.
Nursing interventions available in electronic care documentation are based on evidence. This assists nurses to select interventions that are best for individual patients. The provision of proper interventions will improve the care that prioritizes the safety of the patients and eventually assist lessen hospital costs (Saraswasta &Hariyati, 2018). Akhu,-Zaheya et al. (2017)emphasize that nursing documentation is a key clinical source for the condition of the patient, and it plays a crucial role in assessing the delivery of effective care; thus it needs to be based on robust scientific nursing knowledge which is essential for the profession of nursing.
The technologies required to implement this project
Clinical documentation is a time-consuming process but cannot be avoided and can be a source of error, for example, transcription errors. The crucial goal of the project is to facilitate documentation for health care providers and to improve the safety of patients for improved quality of care. Tablet PCs and internet connections are technologies required to implement an electronic nursing documentation system. Because tablets do not need to be fixed in one location and are easy to carry, nurses will be able to easily move from one patient room to another, inputting data with a digital pen. Direct entry of data on a mobile device can reduce the potential transcription errors and also delays in the accessibility of collected data.
The roles of the project team
The project team will be composed of the chief nursing officer (CNO) council, content team, and clinical experts. The CNO council will play the role of overseeing the progress of the project. This group will act as a champion to the nursing agenda of the organization and offer guidance as well as input into decisions related to nursing care documentation and patient care (Mosier et al., 2019).
The content team will be lead by clinical leaders and will include an ad hoc committee of clinical experts from all specialties. The committees will focus on precise tasks and issues pertinent to their area of expertise. Clinical experts experienced in patient care will define the flow of data required to support workflows that had been developed in the past. Regulatory subject matter experts will responsible for ensuring the system complies with regulations and will also conduct on-site assessments for regulatory compliance (Mosier et al., 2019).
I would incorporate the nurse informaticist in the project team because nursing with informatics knowledge understands the complex nature of nursing along with the challenges of a disrupting routine. Thus, this nurse would provide education about the electronic documentation system before it is implemented, ensuring testing completion and offer hands-on training with the system. The informatics nurse will also explain the benefits of an electronic documentation system compared to paper-based documentation.
A nurse informatician has project management knowledge and skill set. According to Sipes (2016), project management competencies and skills include tasks such as the development of the implementation of work plans, design or development of systems, function as a project or lead manager in all states of the systems life cycle, and development and implementation of all documents in the organization as a project manager for successful management of a project. nurse leaders must have informatics and computer knowledge for them to effectively execute their roles.
References
Akhu-Zaheya, L., Al-Maaitah, R., & Hani, S. B. (2017). Quality of nursing documentation: Paper-based health records versus electronic-based health records. Journal of Clinical Nursing, 27(3-4), 1-12. DOI:10.1111/jocn.14097
Asmirajanti, M., Hamid, A. Y., & Hariyati, T. S. (2019). Nursing care activities based on documentation. BMC Nursing, 18, 23. https://doi.org/10.1186/s12912-019-0352-0
Mosier, S., Roberts, D., & Englebright, J. (2019). A Systems-Level Method for Developing Nursing Informatics Solutions. Journal of Nursing Administration, 49(11), 543-548. doi: 10.1097/NNA.0000000000000815.
Saraswasta, I. W., Hariyati, T. S., Yetti, K., & Nuraini, T. (2021). Implementation of Effective Nurse Communication in Hospital Through Electronic Nursing Documentation (END). Indian Journal of Public Health Research & Development, 12(1), 294-299.
Saraswasta, I. Y., & Hariyati, T. S. (2018). The Implementation of Electronic-Based Nursing Care Documentation on Quality of Nursing Care: A Literature
Review. International Journal of Nursing and Health Services, 1(2), 19-31.
Sipes, C. (2016). Project Management: Essential Skills of Nurse Informaticists. IOS Press. doi:10.3233/978-1-61499-658-3-252

PRAC 6531 WK9 Episodic SOAP Note for Meditrek Patient 85
History of Present Illness Mnemonics
PQRST
P—palliative or provocative factors
Q—quality of pain
R—region affected
S—severity of pain
T—timing
LOCATES
L—location
O—onset
C—character
A—associated signs and symptoms
T—timing
E—exacerbating/relieving factors
S—severity
OLD CHARTS
O—onset
L—location
D—duration
CH—character
A—alleviating/aggravating
R—radiation
T—temporal pattern
S—symptoms associated
COLDERAS
C—character
O—onset
L—location
D—duration
E—exacerbating factors
R—relieving factors
A—associated signs and symptoms
S—severity
LIQORAAA
L—location
I—intensity
Q—quality
O—onset
R—radiation
A—associated signs and symptoms
A—alleviating factors
A—aggravating factors
QFLORIDAA
Q—quality
F—frequency
L—location
O—onset
R—radiation
I—intensity
D—duration
A—alleviating/aggravating
A—associated signs and symptom
Past Medical History
Use the past medical history (PMH) section to document the patient’s past and current health. Document when each condition was diagnosed, and indicate its present status, such as stable, uncontrolled, or resolved
. You may subdivide information in the PMH into past medical history, past surgical history or other hospitalizations, medications, drug allergies, and health maintenance and immunizations.
Using subheadings within the PMH, as shown in Table 2-3, makes it easier to locate information and identify the change from one topic to another.
Table 2-3 Subheadings Used for Past Medical History
Past Medical History
Medical
Surgical/hospitalizations
Medications
Allergies
Health maintenance/immunizations
if the patient has multiple medical problems, it may be helpful to document them as an enumerated list rather than in paragraph format.
If the patient has had any surgery or hospitalizations for major trauma or other reasons, be sure to include the type of operation and date of the surgery; if known, you can include the name of the doctor who performed the surgery.
You should document a medication list as part of the PMH.
This includes both prescription medications and over-the-counter products, such as herbal supplements, vitamins, minerals, and dietary supplements.
Be sure to include the name of the medication, the dose, how frequently it is taken, and ideally, why the patient takes the medication.
Review the list of medications with the patient at every visit to ensure accuracy.
It is extremely important to document any drug allergies the patient has. You may document food allergies in this section also.
You should document the specific reaction the patient experiences when the food or drug is ingested. In most settings, there will be a specific way to indicate a drug allergy, such as a special sticker affixed to the front of the patient’s chart, so that it is not overlooked.
In an electronic medical record (EMR), the text may be a different color or there may be a special tab or menu bar to highlight any allergies.
It is critically important to inquire specifically about and document an allergy to latex. A patient with a latex allergy will need special equipment.
You should document environmental allergies, such as an allergy to cats that results in allergic rhinitis, in the PMH. If the patient is treated regularly for allergy-related conditions, document these conditions under the heading of Medical Conditions rather than Allergies.
The health maintenance and immunization section of the PMH will vary according to the patient’s age and gender. Chapters 5, 6, and 7 discuss documentation of health maintenance activities and immunizations in the pediatric, adult, and older adult patient, respectively.
Family History
Typically, you should document the medical history of first-degree relatives, that is, the family history (FH) for parents, grandparents, siblings, and children.
Remember that a spouse’s medical history is not considered part of the patient’s FH, although it may be applicable in situations in which a couple presents because of infertility or genetic counseling.
Document the age and status (living, deceased, health status) of the first-degree relatives. If those relatives are deceased, include the age at time of death and cause of death.
If the relatives are still living, document their current age and medical conditions, paying particular attention to those conditions that have a familial tendency such as cardiovascular disease, diabetes, and certain cancers, osteoporosis, and sleep apnea.
Also determine whether any first-degree relatives have or had the condition with which the patient is presenting. In addition to medical conditions, inquire about any substance abuse, addictions, depression, or other mental health conditions of family members.
Social History
One of the main goals of documenting the social history (SH) of the patient is to identify factors outside of past or current medical conditions that may influence the patient’s overall health or behaviors that create risk factors for specific conditions.
These risk factors include use of tobacco, alcohol, and drugs. If these risk factors are present, document quantity of use and how long the use has occurred. Smoking history should include number of packs per day and the number of years the patient has smoked.
If the patient formerly smoked or used smokeless tobacco, you still should document the details of the tobacco use with the addition of how long it has been since the patient quit.
Avoid ambiguous terms such as social drinker that do not assist you or other readers in determining whether there is a risk factor associated with substance use.
Typically, the use of illegal substances is documented as drug use, but also you should determine whether the patient is taking substances prescribed for someone else or misusing prescription medication.
If a risk factor is identified, be sure to include it in the problem list and assessment and plan. Age-specific SH is discussed in other chapters. Information about the patient’s sexual orientation, gender identification, marital status, and number of children is included.
Documentation of the patient’s past and current employment may help identify potential occupational hazards. Include any military service and where stationed (stateside or overseas) as well as any possible exposures.
If the patient has lived or traveled abroad, document locations and potential exposures, if any. It is important to document the patient’s educational level and ability to read and write.
If the patient speaks more than one language, you should document which language the patient prefers.
Religion and religious and cultural beliefs may have an impact on a patient’s overall health. It can be difficult to determine the difference between a religious belief and a cultural belief, although typically it is not necessary to do so.
Specific documentation of the religious and cultural history includes beliefs related to health and illness, family, symbols, nutrition, special events, spirituality, and taboos. Table 2-4 shows questions that you can ask as part of the religious and cultural history.
Table 2-4Questions to Ask for Cultural and Religious History
Communication
Is a translator needed?
What is your primary oral language?
What is your primary written language?
Beliefs Affecting Health and Illness
What do you think caused your illness or condition?
How does it affect your life?
Have you seen anyone else about this problem?
If yes, who?
Have you used any home remedies for your problem?
If yes, what?
Are you willing to take prescription medications?
Are you willing to use alternative therapies, such as herbal medicine?
Family
Definition of family
Roles within family
Who has authority for decision-making related to your health care?
Symbols
Special clothing
Ritualistic and religious articles
Nutrition
Specific food rituals
Specific food avoidances
Major foods
Preparation practices
Special Events
Prenatal care
Death and burial rituals
Beliefs of afterlife
Willing to accept blood transfusions?
Willing to accept organ transplantation?
Organ, blood, or tissue donor?
Spirituality
Dominant religion
Active participant?
Prayer and meditation
Special activities
Relationship between spiritual beliefs and health practices
Taboos
Describe any taboos that would affect health care
Document nutritional information in terms of type of diet the patient follows, caffeine intake, and food allergies or avoidances. If there are questions or concerns about a patient’s diet, it may be helpful to record a “typical day” or “last 24 hours” of food intake.
Sedentary lifestyle is a risk factor for certain diseases, so document whether the patient exercises. If the patient exercises, include the type, frequency, and duration of exercise.
One basic consideration of a patient’s ability to access health care is whether the patient has health-care insurance or some other form of payment, such as Social Security or workers’ compensation.
Although financial records generally should be kept separate from the medical records, you should document whether the patient is insured or uninsured.
If uninsured, information about income or ability to self-pay becomes essential. The provision or lack of insurance will guide many health-care choices, especially related to prescribing medications.
Using generic instead of brand-name medications will result in cost savings for the patient and is often medically neutral, meaning the patient should get the same benefit from generic as from brand-name medications.
MEDICOLEGAL ALERT!
Documenting that you have counseled the patient on the risks of negative health habits and the management of chronic disease is an important part of the management of medicolegal risk. Providers have been sued for not providing patient education and counseling.
One such case involved a 33-year-old woman who was obese and hypertensive and smoked. She had frequent visits to the clinic for various complaints.
Routine screening tests revealed marked hypercholesterolemia and an abnormal ratio of high-density lipoprotein (HDL) to low-density lipoprotein (LDLNurs 6665 week 2 Assignment 1: Evaluation and Management (E/M)).
The health-care provider never counseled the patient regarding her risk for coronary artery disease. Several years later, the patient presented to an emergency room with crushing chest pain that radiated to her arms and neck.
The diagnosis of myocardial infarction was confirmed, but by the time the diagnosis was made, the window of opportunity for thrombolytic therapy had closed.
The patient sued the clinic and the health-care provider for malpractice. The health-care provider was found negligent for not educating and counseling the patient about her risk factors for developing heart disease.
Review of Systems (SUBJECTIVE)
The review of systems (ROS) is an inventory of specific body systems designed to document any symptoms the patient may be experiencing or has experienced.
Typically, you should document both positive symptoms (those the patient has experienced) and negative symptoms (those the patient denies having experienced).
A positive response from a patient about any symptom should prompt you to explore all elements of that symptom just as you would for the HPI (location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms).
Rather than asking whether the patient has ever experienced any of the symptoms listed, it is appropriate to limit the review to a specific time frame. That time frame might change depending on the patient’s CC and HPI; if you are seeing a patient for the first time, it is usually sufficient to ask about the past year.
If the patient has been seen before, ask about the time frame since the previous visit.
Consistent with the 1995 and 1997 CMS guidelines, 14 systems are identified, and specific symptoms that should be explored in each system are included here.
How many symptoms are explored within each system is up to you as indicated by the patient’s presenting complaint.
Constitutional: these symptoms do not fit specifically with one system but often affect the general well-being or overall status of a patient. Specific symptoms include weight loss, weight gain, fatigue, weakness, fever, chills, and night sweats.
Eyes: change in vision, date of last visual examination, glasses or contact lenses, history of eye surgery, eye pain, photophobia, diplopia, spots or floaters, discharge, excessive tearing, itching, cataracts, or glaucoma.
Ears, nose, and mouth/throat (ENT):
Ears: change in or loss of hearing, date of last auditory evaluation, hearing aids, history of ear surgery, ear pain, tinnitus, drainage from the ear, history of ear infections.
Nose: changes in or loss of sense of smell, epistaxis, obstruction, polyps, rhinorrhea, itching, sneezing, sinus problems.
Mouth/throat: date of last dental examination, ulcerations or other lesions of tongue or mucosa, bleeding gums, gingivitis, dentures, or any dental appliances.
Cardiovascular (CV): chest pain, orthopnea, murmurs, palpitations, arrhythmias, dyspnea on exertion, paroxysmal nocturnal dyspnea, peripheral edema, claudication, date of last electrocardiogram or other cardiovascular studies.
Respiratory: dyspnea, cough, amount and color of sputum, hemoptysis, history of pneumonia, date of last chest radiograph, date and result of last tuberculosis testing.
Gastrointestinal (GI): abdominal pain; dysphagia; heartburn; nausea; vomiting; usual bowel habits and any change in bowel habits; use of aids such as fiber, laxatives, or stool softeners; melena; hematochezia; hematemesis; hemorrhoids; jaundice.
Genitourinary (GU): frequency, urgency, dysuria, hematuria, polyuria, incontinence, sexual orientation, number of partners, history of sexually transmitted infections, infertility.
Males: hesitancy, change in urine stream, nocturia, penile discharge, erectile dysfunction, date of last testicular examination, date of last prostate examination, date and result of last prostate-specific antigen (PSA) test.
Females: GU symptoms as described previously and gynecological symptoms; age at menarche; gravida, para, abortions; frequency, duration, and flow of menstrual periods; date of last menstrual period; dysmenorrhea; type of contraception used; ability to achieve orgasm; dyspareunia; vaginal dryness, menopause; breast lesions, date and type of last breast imaging; date and result of last Papanicolaou smear, date of last pelvic examination.
Musculoskeletal (MSK): arthralgias, arthritis, gout, joint swelling, trauma, limitations in range of motion (ROM), back pain. (Note that numbness, tingling, and weakness are typically not included in musculoskeletal but in neurological system.)
Integumentary: rashes, pruritus, bruising, dryness, skin cancer or other lesions.
Neurological: syncope, seizures, numbness, tingling, weakness, gait disturbances, coordination problems, altered sensation, alteration in memory, difficulty concentrating, headaches, head trauma, or brain injury. (Headache, head trauma, or brain injury may also be listed under head, as part of Head, Eyes, Ears, Nose, Mouth/Throat, or HEENT.)
Psychiatric: emotional disturbances, sleep disturbances, substance abuse disorders, hallucinations, illusions, delusions, affective or personality disorders, nervousness or irritability, suicidal ideation or past suicide attempts.
Endocrine: polyuria, polydipsia, polyphagia, temperature intolerance, hormone therapy, changes in hair or skin texture.
Hematologic/lymphatic: easy bruising, bleeding tendency, anemia, blood transfusions, thromboembolic disorders, lymphadenopathy.
Allergic/immunologic: allergic rhinitis, asthma, atopy, food allergies, immunotherapy, frequent or chronic infections, HIV status; if HIV positive, date and result of last CD4 count.
You may use standard forms or templates for gathering much of the history information, and this is certainly an acceptable, time-saving practice. However, you have an obligation to review and verify the information that the patient provides. Staff members may use the forms to enter information into an EMR. The original paper forms should be scanned into the EMR.
Physical Examination (OBJECTIVE)
The rationale for physical examination rests on a basic assumption that there is such a thing as normality of bodily structure and function corresponding to a state of health and that departures from this norm consistently result from or correlate with specific abnormal states or disease.
It is helpful to think about a “range of normal” when it comes to physical examination findings, rather than a single “normal” for every part of the examination.
The physical examination may confirm or refute a diagnosis suspected from the history, and by adding this information to the database, you will be able to construct a more accurate problem list.
Like the history, the physical examination is structured to record both positive and negative findings in detail.
Generally, the examination will proceed in a head-to-toe fashion. In some instances, it may be necessary to deviate from this order, such as performing an invasive component at the end of the examination or examining an area of pain last.
Regardless of the order in which the examination is performed, documentation of the physical examination should follow the order that follows and in Table 2-5.
Consult other textbooks for instruction on how to perform the physical examination and for a discussion on the importance of any findings; here the emphasis is on the documentation of a comprehensive physical examination.
General assessment (OBJECTIVE)
Vital signs: temperature, pulse, respiration, blood pressure, height, weight, body mass index (BMI)
Skin
HEENT
Neck
Respiratory
Cardiovascular
Abdomen
Genitourinary or gynecological
Musculoskeletal
Neurological
General: age, race, gender, general appearance. Documentation of general appearance could include alertness, orientation, mood, affect, gait, how a patient sits on the examination table or chair, grooming, and the patient’s reliability to provide an adequate history. Document whether the patient is in any distress or whether the patient appears markedly older or younger than the stated age.
OBJECTIVE DATA
Vital signs: temperature, blood pressure, pulse, respiratory rate, height, weight, and body mass index (BMI).
Skin: presence and description of any lesions, scars, tattoos, moles, texture, turgor, temperature; hair texture, distribution pattern; nail texture, nail base angle, ridging, pitting.
HEENT:
Head (including face): size and contour of head, symmetry of facial features, characteristic facies, tenderness, or bruits of temporal arteries.
Eyes: conjunctivae; sclera; lids; pupil size, shape, and reactivity; extraocular movement (EOM); nystagmus; visual acuity. Ophthalmoscopic findings of cornea, lens, retina, red reflex, optic disc color and size, cupping, spontaneous venous pulsations, hemorrhages, exudates, nicking, arteriovenous crossings.
Ears: integrity, color, landmarks, and mobility of the tympanic membranes; tenderness, discharge, external canal, tenderness of auricles, nodules.
Nose: symmetry, alignment of septum, nasal patency, appearance of turbinates, presence of discharge, polyps, palpation of frontal and maxillary sinuses.
Mouth/throat: lips, teeth, gums, tongue, buccal mucosa, tonsillar size, exudate, erythema.
Neck: ROM, cervical and clavicular lymph nodes, thyroid examination, position, and mobility of the trachea.
Respiratory: effort of breathing, breath sounds, adventitious sounds, chest wall expansion, symmetry of breathing, diaphragmatic excursion.
Cardiovascular: heart sounds, murmurs or extra sounds, rhythm, point of maximal impulse, peripheral edema, central and peripheral pulses, varicosities, venous hums, bruits.
Breast: symmetry, inspection for dimpling of skin, nipple discharge, palpation for tenderness, cyst or masses, axillary nodes, gynecomastia in males.
Abdomen: shape (flat, scaphoid, distended, obese), bowel sounds, masses, organomegaly, tenderness, inguinal nodes.
Male genitalia or gynecological (breast examination sometimes documented here).
Male genitalia: hair distribution, nits, testes, scrotum, penis, circumcised or uncircumcised, varicocele, masses, tenderness.
Gynecological: External inspection of the perineum for lesions, nits, hair distribution, areas of swelling or tenderness, labia and labial folds, Skenes and Bartholin glands, vaginal introitus; noting any discharge or cystocele if present. Internal—inspect vaginal walls and cervix for color, discharge, lesions, bleeding, atrophy; inspect cervical os for size and shape; bimanual examination for size, shape, consistency and mobility of the cervix; cervical motion tenderness, uterine or ovarian enlargement, masses, tenderness, adnexal masses or tenderness.
Rectal: hemorrhoids, fissures, sphincter tone, masses, rectocele; if stool is present, color and consistency of stool, test stool for occult blood; prostate examination for males, noting size, uniformity, nodules, tenderness.
Musculoskeletal: symmetry of upper and lower extremities, ROM of joints, joint swelling, redness or tenderness, amputations; inspection and palpation of spine for kyphosis, lordosis, scoliosis, musculature, range of motion, muscles for spasm, or tenderness.
Neurological:
Mental status: level of alertness; orientation to person, time, place, and circumstances; psychiatric mental status or mini–mental state examinations if indicated.
Cranial nerves: see Table 2-6 for details of the 12 cranial nerves and their functions.
Motor: strength testing of upper and lower extremity muscle groups proximally and distally graded on a scale of 0 to 5 as shown in Table 2-7.
Cerebellum: Romberg test, heel to shin, finger to nose, heel-and-toe walking, rapid alternating movements.
Sensory: sharp/dull discrimination, temperature, stereognosis, graphesthesia, vibration, proprioception.
Reflexes: brachioradialis, biceps, triceps, quadriceps (knee), and ankle graded on a scale of 0 to 4+ as shown in Table 2-8.
Based on your reading, complete the application exercises that follow.
Cranial Nerve Number, Name, and Major Function
Olfactory – Smell
Optic – Visual acuity, visual fields, fundi; afferent limb of pupillary response
III, IV, VI – Oculomotor, trochlear, abducens – Efferent limb of pupillary response, eye movements
– Trigeminal – Afferent corneal reflex, facial sensation, masseter and temporalis muscle testing by biting down
– Facial- Raise eyebrows, close eyes tight, show teeth, smile or whistle, efferent corneal reflex
– Acoustic – Hearing
– Glossopharyngeal and vagus – Palate moves in midline, gag reflex, speech
– Spinal accessory- Shoulder shrug, push head against resistance
– Hypoglossal – Stick out tongue
Table 2-7 Muscle Strength GradingMuscle Grading and Meaning
– No motion or muscular contraction detected
– Barely detectable motion
– Active motion with gravity eliminated
– Active motion against gravity
– Active motion against some resistance
– Active motion against full resistance
Grading Reflex and Meaning
0 Absent
1+ Decreased or less than normal
2+ Normal or average
3+ Brisker than usual
4+ Hyperactive with clonus
Laboratory and Diagnostic Studies
Following documentation of the H&P, document the results of any studies, such as laboratory tests, radiographs, or other imaging studies.
All results should be specifically recorded. For instance, rather than documenting, “the complete blood count (CBC) is normal,” document the value for each part of the CBC.
This is done for several reasons. First, it presents the actual values and allows readers of the H&P to formulate their own conclusions regarding the meaning of the values.
Second, it documents the baseline values that the patient has as a reference point. Third, it saves time for other readers to have the values listed rather than having to look them up.
Problem List, Assessment, and Differential Diagnosis
Once you have documented all the elements of the H&P and results of diagnostic studies, you can evaluate all the information to identify the patient’s problems.
Use a numbered list that includes the date of onset and whether a particular problem is active or inactive. List the most severe problems first. After the initial list is generated, new problems are listed chronologically.
Make an assessment of each current problem. This entails a brief evaluation of the problem with differential diagnosis.
This is a very important component of the comprehensive H&P because it demonstrates your judgment and documents the medical decision-making that you considered regarding each problem.
Plan of Care
Document any additional studies or workup needed, referrals or consultations needed, pharmacological management, nonpharmacological or other management, patient education, and disposition such as “return to clinic” or “admit to the hospital.”
There are different ways that you can document the assessment and plan. Sometimes you will see assessment and plan documented as numbered or bulleted lists under separate headings, or you may see them together.
Example 2.1 demonstrates the difference in these approaches. Either is acceptable and which is used depends largely on health-care provider preference and whether documentation is paper-based or EMR-based.
EXAMPLE 2.1
Assessment:
Cough: nonproductive and no signs or symptoms of infectious process. Recently started an angiotensin-converting enzyme (ACE) inhibitor, so may be side effect of medication.
Diabetes, not well controlled: review of home glucose monitoring logs shows fasting range of 150 to 180.
New onset left leg swelling: no trauma, no erythema. Pulses are present. Concern for deep vein thrombosis (DVT).
Plan:
Stop ACE inhibitor. Will switch to losartan 50 mg once daily.
Check HgbA1C; continue metformin, add glipizide 5 mg twice daily. Continue home glucose monitoring.
Left leg Doppler flow study.
Return to clinic in 2 weeks.
Assessment/Plan:
Cough: nonproductive and no signs or symptoms of infectious process. Recently started an ACE inhibitor, so may be side effect of medication. Stop ACE inhibitor. Will switch to losartan 50 mg once daily.
Diabetes, not well controlled: review of home glucose monitoring logs shows fasting range of 150 to 180. Check HgbA1C; continue metformin, add glipizide 5 mg twice daily. Continue home glucose monitoring.
New onset left leg swelling: no trauma, no erythema. Pulses are present. Concern for DVT; left leg Doppler flow study.
Return to clinic in 2 weeks.
Sample Comprehensive History and Physical Examination
A sample comprehensive H&P for Mr. William Jensen is shown in Figure 2-2. Mr. Jensen is a new patient to the practice of Dr. Vernon Scott, and you will follow his medical course through the documentation of his encounters with a surgeon, his admission to the hospital, surgery, hospital course, and discharge.
In addition to documentation related to Mr. Jensen, you will have the opportunity to evaluate other documentation.
Summary
The comprehensive history and physical examination (H&P) is one of the most important documents in the patient’s entire medical record.
The H&P will vary somewhat in content at different ages and stages of life and among different medical disciplines as discussed in other chapters; however, the structure of the H&P is typically the same.
Typically, you will complete the comprehensive H&P at an initial patient visit in the ambulatory setting, and documentation of subsequent visits will not be as detailed.
The goal of the H&P is to elicit detailed information about the patient’s medical history to identify risk factors, guide decisions for health maintenance, and to identify and treat conditions that will impact the patient’s health and quality of life.
Completing the worksheets that follow will help reinforce the material presented in this chapter. And be sure to review Appendix A, the Document Library, for full case examples of patient documentation.

Assignment: Academic Success and Professional Development Plan Part 5: Professional Development
Assignment: Academic Success and Professional Development Plan Part 5: Professional Development
In this Module’s Discussion, you were introduced to the concept of an academic portfolio to begin building your own brand. However, portfolios have value that goes beyond brand building. An academic and professional portfolio can also help you to build your own vision and mission and establish your development goals. In this regard, a portfolio becomes yet another tool in your toolbox as you build your success.
In this Assignment you will continue developing your Academic Success and Professional Development Plan by developing the fifth component–a portfolio for your academic and professional efforts.
To Prepare:
Consider your goals for academic accomplishments while a student of the MSN program.
The Assignment:
Using the Academic Success and Professional Development Plan Template document that you began to work on in Module 1 and have continued expanding throughout this course, you will develop a curriculum vitae (CV) in Part 5 based on your current education and professional background.
Note: Add your work for this Assignment to the original document you began in the Module 1 Assignment, which was built from the Academic Success and Professional Development Plan Template.
By Day 7 of Week 9
Submit Part 5.
RUBRIC below:
Excellent Good Fair Poor
Using the Academic Success and Professional Development Plan Template, address the following:
Develop a curriculum vitae (CV) based on your current education and professional background.
86 (86%) – 95 (95%)
A fully developed and accurate curriculum vitae based on current education and professional background is provided.
76 (76%) – 85 (85%)
A partially developed curriculum vitae based on current education and professional background is provided.
67 (67%) – 75 (75%)
A vague or inaccurate developed curriculum vitae based on current education and professional background is provided.
0 (0%) – 66 (66%)
A vague and inaccurately developed curriculum vitae based on current education and professional background is provided, or is missing.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) grammar, spelling, and punctuation errors.
0 (0%) – 3 (3%)
Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Total Points: 100
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Solution
Week 5 | Part 5: Professional Development
OBJECTIVE
I seek to contribute to the advancement of nursing through caring for patients and developing nursing solutions. I appreciate that nursing is an evolving science that has experienced significant changes in the process of improving service efficiency and effectiveness. This has been possible because nurses took the effort to improve themselves, identifying problems and develop solutions.
Similarly, I am seeking to improve myself even as I improve nursing science and practice. My contributions in caring for patients and developing nursing solutions will help in establishing the legitimacy of nursing as an important tool for improving public health and addressing existing concerns.
SKILLS
Applying critical thinking skills in exploring, understanding and resolving problems in the nursing practice environment.
Applying innovative thought processes to develop personalized solutions that make the best use of the available resources.
Effectively communicating with other medical personnel within interdisciplinary teams and accounting for the professional nursing functions to accomplish the desired health care outcomes.
Being accountable for the care decisions made and taking responsibility for care delivery for the designated time frame.
Providing excellent care in a timely manner.
Maintaining complete records of care delivery efforts.
Interpreting and performing complex medical procedures that address the specific needs of patients.
Providing competent and high quality care that responds to the unique needs of each patient.
Assessing patients to include developing, evaluating and modifying their care plans with a focus on achieving targeted objectives.
Coordinating interdisciplinary team approaches in the delivery of holistic care that is not limited to assessing patients and administering medication.
PROFESSIONAL NURSING EXPERIENCE
2015-Present – Staff Clinical Nurse, xxx University Hospital
Registered nurse with experience in Med-Surg and Trauma.
Relevant experiences include:
Educating patients and families regarding diagnosis and disease processes, including discharge planning.
Performing physical assessments, administering medications, inserting IV’s, and drawing blood samples.
Monitoring and treating post-op patients, reading and monitoring telemetry for patient rhythm and heart rate changes.
Providing general nursing care and assessment, monitoring lab values, tracheotomy and wound care.
Charge nurse responsibilities.
2012-2015 – Registered Nurse, Name of facility xxxx
Relevant experience includes:
Assessing patients, monitoring lab values, medication administration.
End of life care for 18-20 patients in skilled nursing unit.
1992- Present – Esthetician, Manager, Name of Salonxxx
Relevant experience includes:
Providing a variety of services, procedures, products, and consultations to help improve and maintain the appearance and health of the client’s skin.
Supervising and managing overall performance of the staff.
Achieving organizational goals and objectives.
Employee selection, identifying problems, creating choices and providing alternative courses of action.
ADDITIONAL EXPERIENCES
2020 – Attended the Einstein Trauma Symposium.
Ongoing – Volunteer work at an animal shelter.
PROFESSIONAL EDUCATION BACKRGOUND
Expected June, 2020 – Walden University, Psychiatric Nurse Practitioner.
May, 2014 – Slippery Rock University, Bachelor of Science in Nursing.
2011 – Delaware County Community College, Associate Degree in Nursing, graduated with Honors.
2003 – Venus Beauty Academy, Cosmetology Degree.
1997 – Delaware County Community College, Surgical Technology Degree.
LICENSURE AND CERTIFICATION
Xxx University Hospital Trauma Nurse Course Certification 2016.
IV Venipuncture Certification.
Pennsylvania Registered Nurse License, issued 2011.
Basic Life Support (BLS) Certification.
Pennsylvania Cosmetology License, issued 2003.
ANCC Medical Surgical Nursing, February 18, 2019.
AVAILABLE UPON REQUEST
References, publications, trainings, and certifications.
?
?

Topic 1: Foundational Issues in Christian Spirituality and Ethics
Resources
The Story of the Bible
View “The Story of the Bible” on the Bible Project website (2018). https://thebibleproject.com/videos/the-story-of-the-bible/
Literary Styles in the Bible
View “Literary Styles in the Bible” on the Bible Project website (2018). https://thebibleproject.com/videos/literary-styles-bible/
10 Things You Should Know About Scientism
Read “10 Things You Should Know About Scientism,” by Moreland, on the Crossway website (2018). https://www.crossway.org/articles/10-things-you-should-know-about-scientism/
What Is the Bible?
View “What Is the Bible?” on the Bible Project website (2018). https://thebibleproject.com/videos/what-is-bible/
Faith and Spiritual Decision-Making in Health Care Professions
View both “Faith and Spiritual Decision-Making in Health Care Professions” video messages to RN to BSN students from Dr. Lisa Smith and Dr. Maria Quimba, from the College of Nursing and Health Care Professions.
https://www.gcumedia.com/lms-resources/student-success-center/?mediaElement=7285A42D-1FDE- E811-844B-005056BD1ABC
Optional – Topic 1: Optional Resources
For additional information, see the “Topic 1: Optional Resources” that are recommended.
Practicing Dignity: An Introduction to Christian Values and Decision-Making in Health Care
Read Chapters 1 from Practicing Dignity.
https://www.gcumedia.com/digital-resources/grand-canyon-university/2020/practicing-dignity_an- introduction-to-christian-values-and-decision-making-in-health-care_1e.php
What Is Scientism?
Read “What Is Scientism?” by Burnett, on the American Association for the Advancement of Science website (2018).
https://www.aaas.org/programs/dialogue-science-ethics-and-religion/what-scientism
Assessments
Class Introductions
Start Date & Time Due Date & Time Points Dec 13, 2021, 12:00 AM Dec 15, 2021, 11:59 PM 0
Take a moment to explore your new classroom and introduce yourself to your fellow classmates. What are you excited about learning? What do you think will be most challenging?
Assignment: Worldview Analysis and Personal Inventory
Based on the required topic Resources, write a reflection about worldview and respond to following:
1. In 250-300 words, explain the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism within health care.
2. In 250-300 words, explain what scientism is and describe two of the main arguments against it.
3. In 750-1,000 words, answer each of the worldview questions according to your own personal perspective and worldview:
1. What is ultimate reality?
2. What is the nature of the universe?
3. What is a human being?
4. What is knowledge?
5. What is your basis of ethics?
6. What is the purpose of your existence?
Remember to support your reflection with the topic Resources.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Topic 1 DQ 1
What would spirituality be according to your own worldview? How do you believe that your conception of spirituality would influence the way in which you care for patients?
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Solution
Spirituality entails the recognition of a sense of belief that something greater than myself exists. The existence of the supreme being is more than being human and having a sensory experience. Spirituality recognizes that as a human being, one is part of cosmic or divine in nature. Imperatively, spirituality implies that our lives have significance in a context that is beyond the ordinary existence at the biological needs’ levels. Spirituality entails have faith in a power and being greater than oneself (Smothers et al., 2019). Based on my worldview, spirituality entails having a connection with God as the source of moral goodness and love for all human beings, irrespective of their diversity.
In their article, Rego et al. (2020) recognize the central role that spirituality plays in decision-making among palliative care patients. Accordingly, spiritual wellbeing is linked to increased levels of physical, and emotional functioning and a high quality life. My conception of spirituality influences the way I care for patients because it implores me to consider them as higher beings who love to understand the disease process beyond their existence on earth. It is due to these beliefs that one must conduct themselves in a moral and ethical way. Using these beliefs leads to better care through showing values and virtues like empathy, and understanding (Timmins & Caldeira, 2019). The spiritual conception allows me to ensure that I offer holistic care plans for patients due to their different needs. Through spirituality, I can offer my patients comfort and relief from their anxieties and help them focus on better and positive outcomes from their conditions. Being spiritual is not simply showing empathy and in-depth comprehension of God’s teachings but deploying values and aspects that enhance quality of life for patients and other providers.
References
Rego, F., Gonçalves, F., Moutinho, S., Castro, L., & Nunes, R. (2020). The influence of
spirituality on decision-making in palliative care outpatients: a cross-sectional study. BMC palliative care, 19(1), 1-14. DOI: https://doi.org/10.1186/s12904-020-0525-3
Smothers, Z. P. W., Tu, J. Y., Grochowski, C., & Koenig, H. G. (2019). Efficacy of an
educational intervention on students’ attitudes regarding spirituality in healthcare: a cohort study in the USA. BMJ open, 9(4), e026358. doi:10.1136/bmjopen-2018-026358
Timmins, F., & Caldeira, S. (Eds.). (2019). Spirituality in healthcare: Perspectives for innovative
practice. Cham: Springer International Publishing.

Assignment Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.
Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.
In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.
To Prepare:
Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
https://content.waldenu.edu/6d9a2ec9f787fcfd21087636c6e61b45.pdf
https://www.healthit.gov/faq/what-electronic-health-record-ehr
https://www.painmanagementnursing.org/article/S1524-9042(17)30433-2/fulltext
https://doaj.org/article/01d0b14596e4496d92ef16177ed2c5a1
Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
Identify and select 4 peer-reviewed research articles from your research
for information about annotated bibliographies, visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies ( see sample attached)
The Assignment: (4-5 pages not including the title and reference page)
In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:
Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
Include an introduction explaining the purpose of the paper.
Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
Use APA format and include a title page.
Use the Safe Assign Drafts to check your match percentage before submitting your work.
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Solution
The Use of Clinical Systems to Improve Outcomes and Efficiencies
The rapid growth of technology has impacted various aspects of life with significant effects aligning towards the healthcare sector. The implementation of technology in the healthcare sector has transformed the provision of healthcare services which has incased the healthcare efficiencies and improved health outcomes.
One of the main fields of health care that has been significantly impacted by technological advancements is health informatics which is a scientific field of study that develops methods and technologies that can be applied in the provision of healthcare as well as processing of patient information to determine specified patient and disease patterns.
Health informatics is a specialty that has evolved simultaneously with the advancement of technology to the point of gaining steady momentum and its subsequent implementation in healthcare.
A major clinical system that is part of health informatics which has gained significant appraisal and implementation in healthcare is telehealth. Telehealth is a technological system that emphasizes on the use of communication technologies to remotely access healthcare services at the convenience of the patient and the healthcare provider.
The application of telehealth has significantly improved healthcare services as well as patient outcomes by enhancing access to healthcare. This paper will critique four research articles that assess the use of telehealth to improve patient outcomes and efficiencies.
Article 1
Doraiswamy, S., Abraham, A., Mamtani, R., & Cheema, S. (2020). Use of telehealth during the COVID-19 pandemic: scoping review. Journal of medical Internet research, 22(12), e24087.
Doraiswamy et al., (2020) conducted a literature review of the existing literature from various articles to determine the application of telehealth in enhancing efficiencies and its general application amid the rising cases of COVID-19. According to the article, the COVID-19 the beginning of the pandemic saw a rise of COVID -19 infections with at least at least 37.8 million cases reported and over one million deaths as a result of the pandemic.
Since then, the numbers have transformed to unimaginable patterns with the infection ravaging the healthcare system globally. Through innovations, such as the application of telehealth, the healthcare system was able to solve public health emergencies.
In the context of COVID-19 the research article demonstrated that telehealth was significantly used in the management of COVID-19 cases due to its application in diagnosis, surveillance, e-prescription and also in enhancing effective follow-up. The use of telehealth during the COVID-19 pandemic was complemented with the use of wearable devices such as hand-held devices.
The research further suggested that telehealth was extensively used during the pandemic to offer medical education and also in public health sensitization. The ravaging pandemic was very unique that even experts found it difficult to study the virus with preventive measures remaining to the most effective control measure for the spread of the virus.
During the sensitization campaigns, telehealth was used to ensure that the public was informed about the various preventive measures. Besides, telehealth was also used in enhancing medical education and training to help medical students continue with their studies despite of the pandemic. The research further found that telehealth was used during the pandemic to control and manage various non-communicable diseases within the population including COVID-19.
Article 2
Hyder, M. A., & Razzak, J. (2020). Telemedicine in the United States: an introduction for students and residents. Journal of medical Internet research, 22(11), e20839.
According to Hyder and Razzak, (2020), the COVID-19 pandemic led to a surge in the application and subsequent use of telehealth to provide healthcare services to a large population of people and more especially patients. The use of telehealth was facilitated as a means of minimizing person to person I interactions which facilitates the spread of the virus.
The authors’ further note that advancements in telehealth used be made to complement the healthcare system in a bid to use technology in opening and reinforcing some of the healthcare sectors that have not realized their full potential. Besides, due to the significant impact that has been witnessed amid the use of telehealth; more research is needed to unveil the patient benefits and financial implications of implementing telehealth in healthcare.
According to the article, the use of telehealth has spread significantly in the United States and more especially during the COVID-19 pandemic with several legislations implemented to facilitate acceptance and accessibility to telemedicine. According to Hyder and Razzak, (2020), the field of psychiatry which traditionally relied on face-to-face interactions is currently relying on telehealth. For instance, in 2016, at least 43% of all the people with mental illnesses at least used telehealth.
Another important patient outcome associated with the use of telehealth is the advancement of at home telehealth monitoring among patients with chronic condition. The provision is specifically important both to the patients as well as the healthcare providers. The patient protection and the affordable care act is one of the legislations that have enhanced telehealth where penalties are implemented to hospitals for readmissions of less than 30 days after discharge. To avoid the penalties, healthcare facilities have shifted to the use of telehealth to respond to patient issues. In turn, the continued use of telehealth has improved patient outcomes.
Article 3
Omboni, S., Ballatore, T., Rizzi, F., Tomassini, F., Panzeri, E., & Campolo, L. (2021). Telehealth at scale can improve chronic disease management in the community during a pandemic: An experience at the time of COVID-19. PloS one, 16(9), e0258015.
According to the article, the use of telehealth became widespread during the COVID-19 pandemic, a move that was geared towards minimizing the spread of the novel coronavirus. Besides, the increase in the use of telehealth was to enhance continuity in healthcare provision healthcare services to patient populations with chronic health conditions including hypertension and heart disease.
Telehealth significantly aided the initiative of home blood pressure control after a lockdown was imposed to limit the spread of the virus. Interestingly, there are instances where some patients were isolated and hence missed important doctors’ appointments; the use of telehealth helped to bridge the gap by connecting the patients with their doctors. Besides, telehealth helped improve the efficiencies and outcomes as doctors were able to adjust ongoing treatment plan to fit the needs and interest of the patients. During the lockdown period, the patients under isolation were able to adhere to treatment protocols due to the use of telehealth services.
Article 4
Orlando, J. F., Beard, M., & Kumar, S. (2019). Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health. PloS one, 14(8), e0221848.
According to Orlando et al., (2019), technology has been essential in eliminating various barriers that hinder effective access to healthcare and more especially among people in remote and rural areas. Some of the technological advancements that have been made to improve patient care through the use of technology include videoconferencing. Videoconferencing is an essential telehealth technique that enhances real-time communications which is closely similar to face-to-face interactions.
Telehealth has significantly enhanced patient satisfaction which has increased the efficiency of service delivery. Patient satisfaction as a result of effective implementation of telehealth is related to patient engagement in the provision of healthcare services as well as compliance to treatment regimens. Patient satisfaction when using telehealth has significantly improved treatment outcomes while increasing the efficiency of healthcare.
Besides, telehealth has enhanced patient centered care because telehealth focuses on the needs of individual patients which help in improving patient outcomes. With the pandemic paralyzing healthcare provision such as the inhibition of the commonly face to face interactions between the patients and the healthcare providers, the use of telehealth helps in overcoming the challenges and ensuring that patients received appropriate care as required. In the midst of the pandemic, telehealth helped to overcome travel challenges while saving on the cost of travelling to healthcare facilities.
Conclusion
From the literature review conducted on the use of clinical systems to improve patient outcomes and efficiencies, the use of telehealth has proven to be a great tool in promoting population health. In the wake of the COVID-19 pandemic, several barriers to access of healthcare emerged. Patients with chronic illnesses became the most affected as management of their illnesses require routine hospital visits.
However, with the use of telehealth, patients were able to receive the necessary healthcare services which were closely related to the usual face to face interactions. Videoconferencing for instance has been an essential telehealth tool that has facilitated effective healthcare among patient populations.
References
Doraiswamy, S., Abraham, A., Mamtani, R., & Cheema, S. (2020). Use of telehealth during the COVID-19 pandemic: scoping review. Journal of medical Internet research, 22(12), e24087.
Hyder, M. A., & Razzak, J. (2020). Telemedicine in the United States: an introduction for students and residents. Journal of medical Internet research, 22(11), e20839.
Omboni, S., Ballatore, T., Rizzi, F., Tomassini, F., Panzeri, E., & Campolo, L. (2021). Telehealth at scale can improve chronic disease management in the community during a pandemic: An experience at the time of COVID-19. PloS one, 16(9), e0258015.
Orlando, J. F., Beard, M., & Kumar, S. (2019). Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health. PloS one, 14(8), e0221848.

NRNP 6541 Adolescent . Ihuman . Week 2. And soap note
Week 2: Infants, Toddlers, and Preschoolers
When we think of human growth and development, perhaps no age comes to mind more vividly than the youngest children. Tracking the extraordinary changes that occur with often amazing speed from birth to the advent of formal schooling around age 5 is exciting, awe-inspiring, and frequently, anxiety producing for families. The spectrum of where children may fall in growth and development is particularly wide in these years. And recognizing when extra attention is needed or a condition is present to be addressed can be made more complicated by family interpretations or expectations, and the limited capacity of infants, toddlers, and preschoolers to convey what they are, or are not, experiencing.
NRNP 6541 Adolescent . Ihuman
Primary care of infants, toddlers, and preschoolers requires both detective and diplomatic skills on the part of nurse practitioners. Assessing very young children involves employing knowledge of child development and developmental milestones with what you can observe and interpreting red flags that may signal developmental issues. As to diplomacy, families can hold beliefs, notably resistance to vaccines and immunization protocols, which impact young children’s health and well-being. Working with families to understand and address their ideas, preferences, and possible misconceptions is vital for developing a solid care team of key adults and you.
This week you will prepare for your youngest patients with Learning Resources on topics related to care and development of infants, toddlers, and preschoolers, as well as recognizing and responding to developmental concerns. Through your first i-Human Case Study Assignment this week, you will assess, evaluate, diagnose, treat, and manage patients with potential growth and development issues. Keep in mind that considering the unique needs of the family is an essential element of this and every pediatric visit in the course, and your future practice.
NRNP 6541 Adolescent . Ihuman . Week 2. And soap note
Learning Objectives
Students will:
Assess growth and development in pediatric patients
Evaluate health conditions of pediatric patients
Formulate differential diagnoses for pediatric patients
Analyze socio-cultural needs of pediatric patients and families
Formulate evidence-based treatment and management plans
Recommend evidence-based care strategies and wellness education for pediatric patients and families
Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
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Assignment: i-Human Case Study: Evaluation and Management of Growth and Development Issues
Photo Credit: Getty Images/Blend Images
Imagine this is your first day or perhaps your 500th day as a Family Nurse Practitioner. You enter the examination room where a young child—infant, toddler, preschooler—and one or more family members, who may be a parent, grandparent, or other caregiver, are waiting for you. Imagine the child and family are new patients, and this is your first time meeting them.
That introduction sets the stage for this Assignment. You will use the i-Human technology to meet and treat your avatar pediatric patient. Pay particular attention to the socio-cultural details that are provided for the featured family. Consider what would be important for you to know and to ask in order not only to assess, evaluate, and diagnose a young child, but also to develop evidence-based treatment and management plans and recommend specific activities and routines to promote health and wellness.
To prepare:
Review the Learning Resources. Consider how to apply understanding of developmental milestones and socio-cultural family needs in assessing, diagnosing, and treating pediatric patients.
Access i-Human Patients from this week’s Learning Resources and review the i-Human Case Study. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
Identify 3–5 possible conditions that may be considered in a differential diagnosis for the patient.
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients and families.
Assignment:
As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform.
By Day 7 of Week 2
Complete your Assignment in i-Human.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 2 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 2 Assignment draft and review the originality report.
Submit Your Assignment by Day 7
To participate in this Assignment:
Week 2 Assignment

Discussion: The Inclusion of Nurses in the Systems Development Life Cycle
Discussion: The Inclusion of Nurses in the Systems Development Life Cycle
In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.
In this Discussion, you will consider the role you might play in systems development and the ramifications of not being an active participant in systems development.
To Prepare:
Review the steps of the Systems Development Life Cycle (SDLC) as presented in the Resources.
Reflect on your own healthcare organization and consider any steps your healthcare organization goes through when purchasing and implementing a new health information technology system.
Consider what a nurse might contribute to decisions made at each stage of the SDLC when planning for new health information technology.
By Day 3 of Week 9
Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.
By Day 6 of Week 9
Respond to at least two of your colleagues* on two different days, by offering additional thoughts regarding the examples shared, SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
RUBRIC:
Excellent Good Fair Poor
Main Posting 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not post by day 3.
First Response 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
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Solution
The Inclusion of Nurses in the Systems Development Life Cycle
Technological tools are increasingly being implemented in the health care field. The tools enhance cost-effectiveness, quality, and efficiency. The system development life cycle allows for the integration of technology and helps health care organizations to solve challenges faced by hospitals in integrating technology (McMurtrey, 2013).
The system development life cycle entails following specific steps from the time of project inception to its completion. The steps followed in the cycle include planning, system analysis, system designing, execution, integration and testing, and operations and maintenance. System development life cycle models are not similar; however, most of them apply similar steps in implementing new systems.
In the healthcare center that I worked for once, the management utilized what looked like the waterfall model of the system development life cycle. The waterfall is sequential, and each step provides a basis for the next one (McGonigle & Mastrian, 2017). Nurses play an important part in the interdisciplinary teams in all stages of the system development life cycle (Weckman & Janzen, 2009). Our organization wanted to incorporate a patient check-in kiosk in the electronic health record system.
For this project, the management met with representatives from different workgroups, including nurses, physicians, and others, to check whether the system would be feasible. Next, the requirements and goals of the new system were put in place, which encompassed clear instructions for patients through a user-friendly interface.
After setting all the requirements based on recommendations from the different workgroups, the new system’s design was authorized and handed over to hired design team. The designers incorporated all the goals and requirements into the new system by constantly collaborating with the workgroups such as nurses from the hospital.
Finally, the design team tested the functionality of the new user-patient system before handing it over to the hospital’s IT team. The IT team was responsible for providing technical support and ensuring that necessary upgrades are made based on the need.
References
McGonigle, D., & Mastrian, K. (2017). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers. https://books.google.co.ke/books?hl=en&lr=&id=d94XEAAAQBAJ&oi=fnd&pg=PP1&dq=info:_oSnB7aGxOQJ:scholar.google.com/&ots=NjzVxILxp_&sig=LjgcxhL3G0aA8-ELfTpzPsHsmow&redir_esc=y#v=onepage&q&f=false
McMurtrey, M. (2013). A case study of the application of the systems development life cycle (SDLC) in 21st-century health care: Something old, something new? Journal of the Southern Association for Information Systems, 1(1). https://quod.lib.umich.edu/j/jsais/11880084.0001.103?view=text;rgn=main
Weckman, H., & Janzen, S. (2009). The critical nature of early nursing involvement for introducing new technologies. OJIN: The Online Journal of Issues in Nursing, 14(2). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No2May09/Nursing-Involvement-and-Technology.html

Capstone Project Change Proposal
Assessment Traits Benchmark Requires Lopeswrite Assessment Description In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course.
For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. Develop a 2,500-4,000 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: Background Clinical problem statement.
Purpose of the change proposal in relation to providing patient care in the changing health care system. PICOT question. Literature search strategy employed. Evaluation of the literature. Applicable change or nursing theory utilized. Proposed implementation plan with outcome measures. Discussion of how evidence-based practice was used in creating the intervention plan. Plan for evaluating the proposed nursing intervention. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. Appendix section, for evaluation tools and educational materials, etc. are created.
Review the feedback from your instructor on the PICOT Question Paper, and Literature Review. Use this feedback to make appropriate revisions to these before submitting. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark Information This benchmark assignment assesses the following programmatic competencies: RN to BSN 1.4: Implement patient care decisions based on evidence-based practice. 2.2: Manage patient care within the changing environment of the health care system.

Assignment: Ethical and Legal Implications of Prescribing Drugs
What type of drug should you prescribe based on your patient’s diagnosis?
How much of the drug should the patient receive?
How often should the drug be administered?
When should the drug not be prescribed?
Are there individual patient factors that could create complications when taking the drug?
Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient.
SCENARIO-For the Assignment, please use the following scenario:
As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.
As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.”
It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice.
Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.
To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
Review the scenario assigned by your Instructor for this Assignment.-copied and pasted above
Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
By Day 7 of Week 1
Write a 2- to 3-page paper that addresses the following:
Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
Explain the process of writing prescriptions, including strategies to minimize medication errors.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Explain the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family: 23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail the ethical and legal implications of the scenario selected on all stakeholders involved.
The response includes accurate, clear, and detailed explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.
Describe strategies to address disclosure and nondisclosure as identified in the scenario selected. Be sure to reference laws specific to your state: 18 (18%) – 20 (20%)
An accurate, detailed, and clear description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.
The response includes specific, detailed, and accurate reference to state laws related to the scenario.
Explain two strategies that you, as an advanced practice nurse would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation: 18 (18%) – 20 (20%)
The response accurately and thoroughly explains in detail at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.
The response accurately and completely explains whether they would disclose the error, including an accurate, detailed, and clear justification for the explanation provided.
Explain the process of writing prescriptions including strategies to minimize medication errors.
18 (18%) – 20 (20%)
The response provides an accurate, detailed, and thorough explanation of the process of writing prescriptions, including detailed strategies to minimize medication errors.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
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Solution
Ethical and Legal Implications of Prescribing Drugs
Prescription writing is a significant task by a health professional during patient management. Lack of attention during the writing of a prescription can result in prescription errors which subsequently can adversely affect the well-being of a patient. Prescription errors usually occur as a result of hastiness and careless attitudes exhibited by some health professionals when writing prescriptions (Dyasanoor & Urooge, 2016).
The prescriber and the pharmacist are ethically and legally responsible for preventing prescription error because almost all interactions between a patient and a health professional end with prescription writing. When dosage calculations are made in error, medication errors occur. Another worker should always check your dosage calculations. Doses must be measured out with complete accuracy. In the scenario, the pharmacist should have checked the prescriber’s dosage calculations. Conn et al. (2021) indicate that pharmacists are responsible for supporting safe prescribing by guiding prescribers, identifying errors, and delivering education.
Communication with parents and children might lead to errors. This is pertinent during drugs reconciliation when parents/ carers at times provide incomplete or inaccurate information. . Errors might arise when prescribers alter a medication’s solution strength of a drug without notifying parents or when prescribers orally notify patient’s family of updated doses without passing the information to the child’s general practitioner (Conn et al., 2021).
Strategies to address disclosure and nondisclosure
Responding to and disclosing medication errors are a portion of the professional obligations for which the nurse is liable. If a medication error arises, it must be reported, whether the error was made by a professional nurse or a nursing student. The nurse should follow health care institution procedures and policies for disclosing and documenting the error closely and carefully (Lilley et al., 2019).
In my state (Pennsylvania), the Medical Care Availability and Reduction of Error Act (Mcare) mandates disclosure of all serious events. Health professionals should verbally disclose serious events to the family or patient must occur within twenty-four hours of the event while written confirmation must take place within seventy-two hours. The serious event determination should be electronically reported to the Pennsylvania Patient Safety Authority (Painter et al., 2018).
Strategies to guide decision making
Professional values of honesty and integrity will guide my decision making in the scenario. As an advanced practice nurse, I would disclose the error to the child’s family and the health care institution because it is my ethical and legal obligation to provide full disclosure to patients and my organization when errors occur in patients’ care.
I will also give factual information and proactively apologize and accept responsibility for the error as this can help avoid litigation As indicated by Lilley et al. (2019) when a medication error occurs, the nurse must complete all appropriate forms, entailing an incident report as per the I procedures and policies of the health care institution. , and offer appropriate documentation. The medication error should be documented, nevertheless, by offering only truthful information about the medication error. Documentation should be objective, thorough, and accurate
The process of writing prescriptions, and strategies to minimize medication errors
When writing a prescription, the major elements that must be present to compose a complete prescription include prescriber name, contact information and license number; patient name and date of birth; prescriber DEA number if applicable; name of the medication; patient allergies; medication strengths, m indication for medication; dose of medication and frequency, medication strength; number of refills, and number of capsules or tablets to dispense. (Rosenthal & Burchum, 2020).
Electronic prescribing is a strategy to minimize medication errors. According to Rosenthal and Burchum (2020), using an electronic medical record permits the provider to select a specific, patient-selected pharmacy. After entry of correct medication information, the prescription is automatically sent to the selected pharmacy. This is beneficial because information is directly transmitted, making errors less likely. Encouraging patient care by a multidisciplinary team, with the participation of a pharmacist is another strategy to minimize medication errors. Working as a multidisciplinary team minimizes prescribing errors, particularly when the pharmacist is in the team.
References
Conn, R., Fox, A., Carrington, A., Dornan, T., & Lloyd, M. (2021). Prescribing errors in children: why they happen and how to prevent them. The Pharmaceutical Journal, 306, 7946. DOI:10.1211/PJ.2021.1.42997
Dyasanoor, S., & Urooge, A. (2016). Insight Into Quality of Prescription Writing –An Institutional Study. Journal of Clinical and Diagnostic Research, 10(3), ZC61–ZC64. doi: 10.7860/JCDR/2016/18011.7472
Lilley, L. L., Collins, S. R., & Snyder, J. (2019). Pharmacology and the Nursing Process E-Book. Elsevier.
Painter, L. M., Kidwell, K. M., Kidwell, R. P., Janov, C., Voinchet, R. G., Simmons, R. L., & Wu, A. W. (2018). Do Written Disclosures of Serious Events Increase Risk of Malpractice Claims? One Health Care System’s Experience. Journal of Patient Safety, 14(2), 87-94. doi: 10.1097/PTS.0000000000000178
Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier.

Discussion: Strategies for Academic Portfolios
In the realm of marketing, a successful branding strategy is one of the most important contributors to organizational success. A solid branding strategy can help add visibility and credibility to a company’s products.
Similarly, nurse-scholars can build a personal brand to add visibility and credibility to their work. You can begin building your brand by developing and maintaining an academic portfolio. Such an activity can help share the results of your efforts and contribute to your success. This Module’s Discussion asks you to consider and share strategies for building your portfolio.
To Prepare:
Reflect on strategies that you can pursue in developing portfolios or portfolio elements that focus on academic achievements.
Review one or more samples from your own research of resources focused on portfolio development.
By Day 3 of Week 8
Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples.
By Day 6 of Week 8
Respond to at least two of your colleagues’ posts by offering additional ideas regarding academic achievements to include or offering alternative ways of presenting the current achievements.
RUBRIC BELOW:
Excellent Good Fair Poor
Main Posting 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not post by day 3.
First Response 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
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Solution
Strategies for Academic Portfolios
Having a well-put together academic portfolio is an important selling point for any contemporary nurse. The portfolio is more comprehensive and presents more information about a professional than just the résumé or curriculum vitae. Actually, the academic portfolio includes all the information that would usually be in one’s curriculum vitae plus more concerning the academic and professional achievements of the nurse professional (Clarke, 2019; Schneider, 2016; Davies, 2015).
Technology has however revolutionized every aspect of life and profession. For this reason, the trend these days is to develop an ePortfolio that is basically an electronic version of the academic portfolio.
It makes use of one’s social media presence to paint a picture of what kind of professional the owner is (Hannans & Olivo, 2017). It is advisable for all nurse professionals to make a professional ePortfolio for better career advancement.
There are several strategies for including academic activities and accomplishments in one’s professional goals. Two of these strategies are to get student membership of a professional nursing organization, and to keep a record of academic service rendered to the university or community.
Professional organizations such as the American Nurses Association (ANA) have opportunities for professional development as well as forums where experts share research experience. Attendance to any of these should go into the academic portfolio (Little-Wienert & Mazziotti, 2017). Participation in academic community initiatives like research into the behavioral factors fuelling disease should be documented in the academic portfolio too.
The above two strategies are congruent with the Walden University’s philosophy of positive social change. Participation in the professional and academic activities of professional organizations like ANA exposes the student nurse and makes them important primary health care assets to the community bringing social change. Participation in community programs on the other hand directly impacts the community in positive ways such as disease prevention.
References
Clarke, M. (April 19, 2019). The importance of a professional nursing portfolio. https://www.healthleadersmedia.com/nursing/importance-professional-nursing-portfolio
Davis, C. (2015). Developing a professional nursing portfolio. Nursing Made Incredibly Easy! 13(1), 4. https://doi.org/10.1097/01.NME.0000457285.39465.5c
Hannans, J., & Olivo, Y. (2017). Craft a positive nursing digital identity with an ePortfolio. American Nurse Today, 12(11), 48-49. https://www.myamericannurse.com/craft-a-positive-nursing-digital-identity-with-an-eportfolio/
Little-Wienert, K., & Mazziotti, M. (2017). Twelve tips for creating an academic teaching portfolio. Medical Teacher, 40(1), 26–30. https://doi.org/10.1080/0142159X.2017.1364356
Schneider, A. (2016). Building a professional nursing portfolio. https://www.rn.com/nursing-news-building-professional-nursing-portfolio/