Nursing

You’re in the Manager’s Seat
Making Decisions
Mike has recently inherited a sizable amount of money and is looking to invest it.
He is considering several options and has met with a number of financial advisors to help him narrow down the options and decide where to invest his funds.
Stinky Business
Some of the advisors are suggesting funds that have characteristically been solid, conservative performers, but are based on products and services that are not environmentally friendly.
Environment
Since Mike is very passionate about supporting and protecting the environment, he consults with other advisors who suggest that he align his investment strategy with his passion.
They recommend several funds that are also solid performers, but not quite as aggressive as those funds that do not support environmental issues.
Tax Time
Mike needs to make a relatively quick decision, as the tax deadlines are looming.
Discussion
Given the results you got on your decision-making and creativity assessments, how would you invest the funds if you were Mike? See page 2
I scored 55.
Your decision-making process is okay. You have a good understanding of the basics, but now you need to improve your process and be more proactive. Concentrate on finding lots of options and discovering as many risks and consequences as you can. The better your analysis, the better your decision will be in the long term.
I scored 52.
Your creativity is a “work in progress.” You’ve had some successes, so now it’s time to let loose and stretch yourself. Share your ideas and perspectives with others, and ask them how they view problems. Adopt a collaborative approach to problem finding, and work actively with others to create and innovate.
I scored 59.
Your project management skills are okay, and when projects are relatively simple, your outcomes are often good. However, the more complex the projects you manage, the less control you will have and the more likely you are to deliver below expectations. Take time to improve your planning skills and prepare for the unexpected. The more time you spend on your up-front planning, the better your project outcomes will be.
Respond to the two post below:
1.
I have scored okay on the assessments. I have a good understanding of the basis, but I could improve on my skills and be more proactive. I also need to concentrate more on finding many options and discover risks and consequences. When choosing on how to invest you money is a big decision. If I were Mike, I would take my time and and do some research into other companies profits and also see which one has helped make a positive impact on the environment. I would do some research and try to find some other options that would be profitable or even environmental that could be helpful. Also meeting with investment firms is a good option as well which could help with finding what types of investments are available and to also ask myself do I need more money as soon as possible for the investment or am I okay with investing for less money.
2. If I am Mike the first thing I am doing is taking my time. Doing my due diligence and then taking it from there. Yes the tax deadline is approaching but a decision can still be made without rushing. Personally I would look into the companies profit margins over the last couple of years and see which ones have been producing the most and coming out above breaking even. Furthermore I would see which companies can still and will make a positive impact on the world and give people something that could be life changing. Depending on the funds I would put more into the company that has been tested and would be in the positive every year but also spread a small amount into a startup or newer company that could hit but also miss. That way I am involved in the potential gain but if they tank I do not miss out on the money I am losing or lost. This is based on my assessment that I got back, scoring above average in both and staying true to myself. I would not make a fast decision but would always have a back up plan.
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Solution
Making Decisions
Carrying out an investment requires effective decision-making skills, creativity, and management skills. Investment refers to the act of assigning resources with the aim of creating wealth or profits. Effective investment strategies involve putting capital or resources in well-known assets (Kalin et al., 2019). From the scenario given, Mike has enough capital to start an investment. In addition, he has effective decision-making skills, creativity, and management skills. Mike has numerous investment alternatives and passion. Advising Mike on investment strategies requires consideration of different factors, including the amount of capital, passion, and the level of management and operational skills.
If I were Mike, I would follow my passion when investing the inheritance. I would align my investment strategy with passion. As an environmental advocate, I would research and find different strategies on how to make a profit from the investment. With the increased desire to create a sustainable environment, there exist different investment opportunities that can be exploited. As a result, Mike will be able to find different opportunities in this area to make a profit. With passion, effective decision-making, and management skills, Mike will be able to undertake different processes geared towards profits. In Mike’s case, I would also recommend investing a different percentage of the inheritance in different businesses. However, the largest share should be invested in the area of passion. Apart from consultation and advice from that parties, I would use my decision and management skills to decide on some of the strategies to undertake for an effective investment process.
In conclusion, investment in one passion would ensure effective outcomes. However, there is the need to get advice from investment and financial experts who understand different markets and the trends that should be followed to make profits.
References
Kalin, R. M., Mwanamveka, J., Coulson, A. B., Robertson, D. J., Clark, H., Rathjen, J., &Rivett, M. O. (2019). Stranded assets as a key concept to guide investment strategies for sustainable development goal 6. Water, 11(4), 702. https://doi.org/10.3390/w11040702
Respond to the two post below:
I have scored okay on the assessments. I have a good understanding of the basis, but I could improve on my skills and be more proactive. I also need to concentrate more on finding many options and discover risks and consequences. When choosing on how to invest you money is a big decision. If I were Mike, I would take my time and and do some research into other companies profits and also see which one has helped make a positive impact on the environment. I would do some research and try to find some other options that would be profitable or even environmental that could be helpful. Also meeting with investment firms is a good option as well which could help with finding what types of investments are available and to also ask myself do I need more money as soon as possible for the investment or am I okay with investing for less money.
Response
Hello colleague. This is insightful the scores from the assessment show that Mike has effective decision-making and management skills; in addition, he has moderate levels of creativity that can inform effective investment processes. Investment processes require effective planning, studying the trend, and consultation. Effective investment strategies involve putting capital or resources in well-known assets. From the scenario given, Mike has enough capital to start an investment. In addition, he has effective decision-making skills, creativity, and management skills (Kalin et al., 2019). Investment processes require undertaking research to determine the risks and possible threats in the business. Through research processes, one is able to determine possible investment strategies that would ensure increased profits. If I were Mike, I would follow my passion. In other words, I would make an investment in the available environmental opportunities. Investment in one passion would ensure effective outcomes. However, there is the need to get advice from investment and financial experts who understand different markets and the trends that should be followed to make profits.
Reference
Kalin, R. M., Mwanamveka, J., Coulson, A. B., Robertson, D. J., Clark, H., Rathjen, J., &Rivett, M. O. (2019). Stranded assets as a key concept to guide investment strategies for sustainable development goal 6. Water, 11(4), 702. https://doi.org/10.3390/w11040702
2.If I am Mike the first thing I am doing is taking my time. Doing my due diligence and then taking it from there. Yes the tax deadline is approaching but a decision can still be made without rushing. Personally I would look into the companies profit margins over the last couple of years and see which ones have been producing the most and coming out above breaking even. Furthermore I would see which companies can still and will make a positive impact on the world and give people something that could be life changing. Depending on the funds I would put more into the company that has been tested and would be in the positive every year but also spread a small amount into a startup or newer company that could hit but also miss. That way I am involved in the potential gain but if they tank I do not miss out on the money I am losing or lost. This is based on my assessment that I got back, scoring above average in both and staying true to myself. I would not make a fast decision but would always have a back up plan.
Response
Hello colleague. This is insightful; taking time to analyze different situations is essential before undertaking investment processes. Besides, investors ought to undertake research processes to determine possible risks associated with each business. Also, there is the need for investors to engage in comparing the idea with other businesses. Before engaging in any form of investment, Mike needs to take time and analyze possibilities and opportunities in the market. However, top priority should be given to the area of interest (Kalin et al., 2019). In other words, Mike needs to consider investing in his passion, environmental opportunities available. As an environmental advocate, I would research and find different strategies on how to make a profit from the investment. With the increased desire to create a sustainable environment, there exist different investment opportunities that can be exploited.
Reference
Kalin, R. M., Mwanamveka, J., Coulson, A. B., Robertson, D. J., Clark, H., Rathjen, J., &Rivett, M. O. (2019). Stranded assets as a key concept to guide investment strategies for sustainable development goal 6. Water, 11(4), 702. https://doi.org/10.3390/w11040702

Advaanced Pharmacogoly Off-Label Drug Use in pediatrics
Week11 pharma 6521 | NURS 6521 – Advanced Pharmacology | Walden University
Assignment: Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Please provide as many details about your writing struggle as possible
Photo Credit: Getty Images
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Explain strategies to making off-label use and dosage of drugs safer for children from infancy to adolescence and descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Be specific.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

You have spent six weeks exploring theories of nursing. These represent the “how” of what we do as nurses. This week we enter a higher level of thought and explore the “why” of what we do. Present a personal nursing philosophy. Apply what you have read throughout the course and explore the literature on nursing philosophy. While Fawcett was not a nursing theorist, she is a nursing philosopher and her Metaparadigm of Nursing approaches philosophy over theory. Once you have discussed your philosophy, identify a theoretical framework (not the middle-range theories but the underlying assumptions in that framework) that fits your philosophy. Compare and contrast your philosophy and the chosen framework. Describe a possible situation in which the framework may conflict or not fit your philosophy. While it is an important skill to be able to match a theory with a situation, it is also critical to understand when a theory or framework does not fit a situation.
Expectations
Format: APA 7th edition
Length: 5 pages, excluding title and reference pages, References: 7-10
Utley et al., Page 370 and Ch 14
Abou Malham, S., Breton, M., Touati, N., Maillet, L., Duhoux, A., & Gaboury, I. (2020). Changing nursing practice within primary health care innovations: The case of advanced access model. BMC Nursing, 19(1), 115.
https://doi.org/10.1186/s12912-020-00504-z
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709259/
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Solution
Personal Theoretical Framework for Advanced Practice Nursing
Theoretical models and personal nursing philosophy significantly impact advanced practice nursing. Nurses are guided by various concepts outlined in theoretical frameworks in their clinical practices, thus providing quality and safe patient care to satisfy patients’ needs. This paper presents a personal nursing philosophy and underlying assumptions in Dorothea Orem’s Self-Care theory that fits the author’s philosophy. The paper will also compare the author’s nursing philosophy with Dorothea Orem’s Self-Care theory, indicating situations in which the Framework may conflict with the philosophy.
Personal Nursing Philosophy
My nursing philosophy is based on my role as an advanced nurse practitioner that involves providing holistic and patient-centered care to improve all my client’s physical, mental, and psychological well-being. Since when I enrolled for my nursing degree, I have perceived nursing as a helping profession in which practitioners should selflessly prioritize other people’s needs. For this reason, I always strive to help my clients to meet their health care needs, thus improving their quality of life and well-being. My primary goal is to assist people who cannot help themselves to prevent physical infirmity resulting in temporary or long-term impairment. Humans strive to meet their needs in 5 categories as prioritized by Abraham Maslow. People first focus on addressing their physiologic needs, including food, shelter, clothing, and oxygen since they are vital for survival. Secondly, individuals are interested in meeting their security, such as being free from any form of harm. The next category consists of belongingness and love, in which individuals strive to meet their need for affection. Meeting this need gives one fulfillment in belongingness. Individuals then strive to meet their esteem needs, including self-worth, respect, and accomplishment. A person acquires respect and reputation for their accomplishments in life. The last category involves self-actualization, which is at the pinnacle of Maslow’s hierarchy of needs triangle. Individuals in this category have achieved all their goals in life and have reached their full potential. People in this category can help or guide others to realize their potentials.
During my first clinical experience, I was assigned pediatrics. I was supposed to take care of the babies, including feeding them, changing their diapers, keeping them, and cuddling them. I ensured that all their physiologic needs were met at the right time to facilitate proper growth and development. Although a nurse practitioner should work alongside a pediatrician while diagnosing and treating children, nurses must meet babies’ physiologic needs. According to ?tefan et al. (2020), healthcare providers must meet the increasing patients’ needs and expectations to acquire a competitive advantage in the healthcare sector. Additionally, the significance of nursing theories during the delivery of health care was emphasized during my studies. Theories were considered the basis of providing quality, safe and efficient nursing care, thus restoring individuals’ health and well-being. However, most nurse practitioners failed to incorporate theories into their clinical practices. Instead, practitioners consider nursing as a profession dependent on doctors meaning nurses should practice “behind” physicians and not alongside the doctors. This incident results from the unwritten hierarchy, which exists in the medical industry. Additionally, inappropriate nurse-to-patient ratios hinder nurses from providing quality health care, leading to negative health outcomes. According to Griffiths et al. (2018), adverse clinical outcomes in a healthcare organization, particularly death is associated with low nurse staffing levels. Furthermore, nurses are usually underpaid; hence they provide health care services proportional to their compensation.
Nonetheless, I opposed the idea that nurses can only practice “behind” doctors and focus on my nursing philosophy, which involves assisting the patient in meeting their basic physiologic needs when functional abilities are impaired by their illnesses. This move will facilitate faster recovery, thus improving individuals’ quality of life and well-being. I believe that patients’ self-care deficits can be addressed by providing them with individualized nursing care, which will restore their health and functionality. I address the patient’s self-care deficits with compassion, respect, and empathy. Additionally, I will consider an individual’s beliefs, values, interests, and traditions to provide holistic care to my best level. This philosophy has been my guide throughout my nursing practice, and it will continue driving me once I become an advanced nurse practitioner. Upon being granted “Full Practice Authority,” I will rely on my philosophy during the diagnosis and treatment of all my patients without the supervision of a physician. As a nurse, I will always appreciate Maslow’s hierarchy of needs since health determines’ individual’s capacity to meet his or her needs. According to (their16), disorders impair individuals’ capacity to meet their needs, including the most basic ones.
Underlying Assumptions in Dorothea Orem’s Self-Care Theory that Fits Author’s Philosophy
Dorothea Orem’s Self-Care theory fits my nursing philosophy. This nursing theory focuses on helping individuals provide and manage self-care either to retain or improve human functioning effectively while at home. Orem’s theory emphasizes an individual’s capacity to take care of oneself (Abyu, 2020). Therefore, this theory concentrates on the practices and activities that a person can initiate and perform on their own to maintain health, quality of life, and well-being. Orem’s theory consists of three interrelated theories: the theory of self-care, the theory of nursing systems, and the theory of self-care deficit (Abyu, 2020). The theory of self-care focuses on how and why human beings take care of themselves. The theory of nursing systems or nursing systems focuses on relationships between nurses and their patients and the impact of this relationship on the quality of nursing care. Lastly, the theory of self-care deficit focuses on how nursing practice helps human beings.
Orem proposed three significant assumptions concerning requirements of self-care (Younas, 2017). The first assumption states that human beings have common needs; hence require the same materials to sustain life. This concept was described as the universal self-care requisite. The second assumption states that human beings require multiple actions to enhance their growth and development in various stages of life. This concept was described as a developmental self-care requisite. The third assumption states that individuals’ tendency to deviate from the normal functional and structural well-being needs actions to lower the occurrences of and regulate the effect of any deprivation. This assumption was termed as health deviation self-care requisite. Inadequacy of requisite skills and knowledge to self-manage leads to self-care deficits. Therefore, people with limited self-care knowledge and skills need nursing care to restore their health and quality of life (Gomez et al., 2017). These assumptions fit the author’s philosophy, which involves providing holistic and patient-centered care to improve all clients’ physical, mental, and psychological well-being, including those who cannot perform self-care due to inadequacy of requisite skills and knowledge.
Comparison between Author’s Nursing Philosophy with Dorothea Orem’s Self-Care theory and Situations in which the Framework may Conflict with the Philosophy
Similarities between Orem’s Theory and Author’s Philosophy
Self-care entails various actions and measures taken to meet the requirement of patients with inadequate self-care requisite skills and knowledge. These patient groups include infants, geriatrics, hospitalized individuals, and older people aged 75 years and above. Therefore, these groups are provided with nursing care to help them to meet their physiological needs. This concept of Orem’s theory matches my nursing philosophy, which involves providing holistic and patient-centered care to improve all clients’ physical, mental, and psychological well-being. I have realized that some patient populations, particularly infant, geriatrics, hospitalized individuals, and older adults aged 75 years and above, require nursing care due to the inability to perform self-care. According to (Abou Malham et al. (2020), transforming nursing practice is an important strategy for boosting the quality, safety, and efficiency of patient care in primary care settings to meet various categories’ healthcare needs, including individuals, families groups, and communities. Therefore, I will strive to benefit these individuals during my clinical practice by providing them with individualized patient care.
Orem also discusses two deliberate actions. The first one is deliberate action and nursing. Nursing practice is considered an action performed deliberately by a social group member to benefit other community members (Younas, 2017). In other words, nursing actions are focused on addressing self-care deficits in some groups of people. This concept of Orem’s theory matches with my nursing philosophy, which involves providing holistic and patient-centered care to improve the physical, mental, and psychological well-being of all my clients since I will provide nursing care, aiming at benefiting some community members, such as infants, geriatrics, and pediatrics.
Differences between Orem’s Theory and Author’s Philosophy
Orem also discussed deliberate action and patients, which requires them to be aware of their conditions and challenges. Thus, patients should strive to address these challenges in the best possible manner. This concept contradicts my nursing philosophy, which involves providing holistic and patient-centered care to improve all my client’s physical, mental, and psychological well-being, including those unable to address issues associated with their health conditions, such as critically-ill patients and the geriatrics.
Conclusion
Nurses’ clinical practices are guided by various concepts outlined in theoretical frameworks. Additionally, the provision of patient care is impacted by one’s nursing philosophy. One of the most influential nursing theories is Dorothea Orem’s Self-Care theory, which consists of three interrelated theories, including the theory of self-care, nursing systems, and self-care deficit theory. Orem’s theory emphasizes an individual’s capacity to take care of oneself. Therefore, this theory concentrates on the practices and activities that a person can initiate and perform on their own to maintain health, quality of life, and well-being. Orem’s theory matches and contradicts the author’s nursing philosophy, which involves providing holistic and patient-centered care to improve all clients’ physical, mental, and psychological well-being.
References
Abou Malham, S., Breton, M., Touati, N., Maillet, L., Duhoux, A., & Gaboury, I. (2020). Changing nursing practice within primary health care innovations: the case of advanced access model. BMC nursing, 19(1), 1-17.
Abyu, G, Y. (2020). Orem’s Self-Care Deficit Theory of Nursing. Research Gate https://www.researchgate.net/publication/339432461_Orem’s_self_care_deficit_theory_of_nursing
Gomez, N. J., Castner, D., & Hain, D. (2017). Nephrology nursing scope and standards of practice: Integration into clinical practice. Nephrology Nursing Journal, 44(1), 19-27.
Griffiths, P., Recio?Saucedo, A., Dall’Ora, C., Briggs, J., Mariotti, A., Meredith, P., … & Missed Care Study Group. (2018). The association between nurse staffing and omissions in nursing care: a systematic review. Journal of advanced nursing, 74(7), 1474-1487.
Linton, A. D. (2016). Psychological response to illness. An Introduction to Medical-Surgical Nursing (6th ed., p. 1273). Philadelphia, PA: Saunders.
?tefan, S. C., Popa, ?. C., & Albu, C. F. (2020). Implications of Maslow’s hierarchy of needs theory on healthcare employees’ performance. Transylvanian Review of Administrative Sciences, 16(59), 124-143.
Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23. doi:10.1891/1078-4535.23.1.13

Assignment 1: Clinical Hour and Patient Logs
Clinical Hour Log
For this course, all practicum activity hours are logged within the Meditrek system. Hours completed must be logged in Meditrek within 48 hours of completion to be counted. You may only log hours with Preceptors that are approved in Meditrek.
Students with catalogue years before Spring 2018?must complete a minimum of 576 hours of supervised clinical experience (144 hours in each practicum course). Students with catalog years beginning Spring 2018 must complete a minimum of 640 hours of supervised clinical experience (160 hours in each practicum course). By the end of Week 1, make sure you confirm your preceptor and clinical faculty are set up in?Meditrek.
Each log entry must be linked with an individual practicum Learning Objective or a graduate Program Objective. You should track your hours in Meditrek as they are completed.
Your clinical hour log must include the following:
• Dates
• Course
• Clinical Faculty
• Preceptor
• Total Time (for the day)
• Notes/Comments (including the objective to which the log entry is aligned)
Patient Log
Throughout this course, you will also keep a log of patient encounters using Meditrek. You must record at least 80 patients by the end of this practicum.
The patient log must include the following:
• Date
• Course
• Clinical Faculty
• Preceptor
• Patient Number
• Client Information
• Visit Information
• Practice Management
• Diagnosis
• Treatment Plan and Notes — Students must include a brief summary/synopsis of the patient visit—this does not need to be a SOAP note; however, the note needs to be sufficient to remember your patient encounter.
By Day 7
Record your clinical hours and patient encounters in Meditrek.
Please complete this assignment for 10 different patients thanks
MY CLINICAL PRACTICUM IS A PRIVATE PRACTICE , MY CLINICAL WORKING HOURS WILL BE Thursday AND FRIDAY 8 AM- 5 PM,
I WILL BE WORKING ALONG WITH MY PRECEPTOR WHO IS A PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER.
MY CLIICAL SITE IS A PRIVATE PRACTICE THEY PROVIDE DIRECT CLINICAL SERVICES SUCH AS PSYCHIATRIC EVALUATION, CRISIS INTERVENTION, PSYCHOMARMACOLOGY TREATMENTS AND REFERALS AS NECESSARY TO PATIENTS WITH DIFFERENT PSCHYTIATRIC DIAGNOSIS.
ON EACH OF MY CLINICAL DAY I WILL BE SEEING 5 PATIENTS AT MY PRACTICUM PER CLINICAL THIS MEANS THAT I WILL HAVE TO WRITE 5 DIFFERENT PATIENT NOTES.
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Solution
Clinical Logs
Major Depression
Name: C.Y
Age: 40 years
Diagnosis: Major Depression
S: C.Y is a 40-year-old client that came to the unit for her third follow-up visit, after she was diagnosed with depression four months ago. The client was diagnosed after she experienced symptomsthat included depressed mood in most of the days for every day. She was also socially isolated as he lacked interest in things and pleasure. She reported that the depressed mood had made it difficult for her to engage in her occupational roles. The client also reported that her ability to make decisions was also significantly affected. He level of irritability was also high. Based on the above, the client was diagnosed with major depression and initiated on psychotherapy and antidepressants.
O: The client appeared appropriately dressed for the occasion. She reported that her mood has been improving with the adopted treatments. The client was oriented to self, others, time, and events. She denied illusions, delusions, and hallucinations. She denied suicidal thoughts and attempts. She denied current suicidal plans. The client does not have a current suicidal plan. Her speech was reduced in terms or rate and volume.
A: The symptoms of depression have improved. The client reports that the treatment has been effective, as she experiences minimal depressive symptoms.
P: The client was advised to continue with the current treatment. She was also advised to come for a follow-up visit after four weeks.
Major Depression
Name: R.T
Age: 40 years
Diagnosis: Major Depression
S: R.T is a 40-year-old male who came to the clinic today for his follow-up visit after being diagnosed with major depressive disorder three months ago. The client has been on antidepressants and group psychotherapy treatments. R.T was diagnosed with major depressive disorder after he came to the clinic with complaints that included the feelings of sadness almost every day. The client also felt intense guilt that made him socially isolated. There was also the change in the sleeping habits of the patient. Accordingly, he noted the increasing difficulties he was experiencing to fall asleep and maintain sleep. The client also reported lack of energy, and suicidal ideations and attempts. There were also the complaints of lack of interest in the social and occupational roles that the patient used to engage in before the diagnosis. Based on the above symptoms, the client was diagnosed with depression and initiated on antidepressants and group psychotherapy.
O: The patient appeared appropriately dressed for the occasion. He was oriented to self, place, time and events. The rate and volume of speech of the patient was normal. The self-reported mood of the client was normal. The client denied illusions, delusions and hallucinations. He also denied recent history of suicidal thoughts, attempts, and plans.
A: The client is responding well to the treatment. The improvement in symptoms is in accordance with the developed treatment objectives. The client is also tolerating the adopted treatment interventions.
P: The decision that the patient continues with the current treatment was made. This was based on the improvement in the symptoms of depression.
Major Depression
Name: D.K
Age: 37 years
Diagnosis: Major Depression
S: D.K is a 37-year-old client that came to the clinic today for the sixth follow-up visit after being diagnosed with major depression seven months ago. He has been on antidepressants and group psychotherapy treatments. D.Kwas diagnosed with depression after she presented with complaints of feeling sad most of the days almost all the days, feeling worthless and guilty most of the times. There was also the complaint of decline in appetite, as she died not want any type of food. Her interest in pleasure also declined significantly. The client also reported suicidal thoughts without attempts or plans. The symptoms had affected significantly her ability to perform as expected in her occupational roles. The symptoms could not be attributed to other causes such as medication use, medical conditions or substance abuse. She was therefore diagnosed with major depression and has been undergoing treatment in the facility.
O: The patient appeared dressed appropriately for the occasion. She was oriented to self, place, time and events. Her judgment was intact. She denied any suicidal thoughts, attempts or plans as well as illusions, delusions and hallucinations. Her mood was normal.
A: The client has responded well to the treatments. Her mood has improved. She also tolerates the adopted treatments as expected.
P: Psychotherapy sessions were terminated with consent obtained from the client. She was advised to continue with antidepressant therapy. She was scheduled for follow-up visit after two months.
Major Depression
Name: K.A
Age: 28 years
Diagnosis: Major Depression
S: K.A is a 28-year-old male client who came to the unit for her first follow-up visit after being diagnosed with major depression a month ago. The client was brought due to his abnormal behaviors for the last six months. Some of the abnormal behaviors that had been reported during the previous visit to the clinic included losing interest and pleasure. The mood of the client was reported to have been always depressed in most of the days. The client also appeared socially withdrawn, as he did not want to interact with people. As a result, he stayed indoors for most of the times. The client also reported that his mood was severely depressed in most of the days with feelings of worthlessness. When asked about his sleeping and dietary habits, he reported that he rarely slept and had elevated appetite. He was also concerned that his ability to make decisions had worsened significantly over the past, as he found it difficult to concentrate.The client also reported suicidal thought without an attempt or plan. Based on the above data, the client was diagnosed with major depression and initiated on treatment.
O: The client appeared moderately groomed for the clinical visit. His mood was moderately depressed. His insight was normal. His speech was of normal rate and volume. His orientation to self, others, time, and events were intact. The client denied suicidal thoughts plans or attempts since the last visit to the clinic.
A: The client reports moderately improvement in symptoms of major depression. He is also tolerating the adopted treatment interventions.
P: The dosage of antidepressants was increased to achieve optimum therapeutic effect on symptom management. The client was advised to continue with the group psychotherapy sessions. He was scheduled for the next follow-up visit after four weeks.
Generalized Anxiety Disorder
Name: R.T
Age: 22 years
Diagnosis: Generalized Anxiety Disorder
S: R.T is a 22-year-old female client that that came to the clinic for her fourth follow-up visit for generalized anxiety disorder. She was diagnosed with the disorder after she presented to the clinic with complaints of excessive fear and anxiety that was beyond her control. The client also reported that the fear she had was related to her academic performance in the medical school. She was worried that she was likely to fail leading to her losing her scholarship for the program.Symptoms that included palpitations, chest tightness, sweating, and tremors accompanied the feelings of excessive fear. The excessive fear and anxiety had affected significantly the ability of the client to perform optimally in her academic and social roles. The symptoms could not be attributed to any cause such as medications, medical condition, or substance abuse. As a result, she was diagnosed with generalized anxiety disorder and initiated on treatment.
O: The client appeared appropriately dressed for the occasion. Her orientation to self, others, time and events were intact. The insight of the client was intact. She denied illusions, delusions, and hallucinations. She also denied suicidal thoughts, attempts, and plans.
A: The client reported that she no longer experiences excessive fear and anxiety. She also reported effectiveness of the psychotherapeutic strategies for managing her problem. The treatment outcomes have been achieved.
P: The participation of the client in group psychotherapy sessions was terminated with her consent. The sessions were terminated because the desired treatment outcomes had been achieved.
Panic Disorder
Name: C.P
Age: 24 years
Diagnosis: Panic Disorder
S: C.P is a 24-year-old male who came to the clinic for a follow-up visit for treatment due to panic disorder. He was diagnosed with the disorder five months ago and has been on treatment. The diagnosis of panic disorder was reached after the client presented with symptoms that included feelings of excessive fear of not performing as expected in his institution. The panic disorder was associated with a number of symptoms. They included palpitations, sweating, trembling, and feeling chocked. There were also the complaints of chest pain, feelings of chocking, dizziness, and feelings of unreality. The symptoms had affected significantly the functioning of the client. As a result, he was diagnosed with panic disorder and initiated on group psychotherapy.
O: The client appeared appropriately dressed for the occasion. He was oriented to self, space and time. The thought content of the client was normal. He denied illusions, hallucinations, and delusions. The client also denied suicidal thoughts, plans, and attempts.
A: The desired treatment outcomes have been achieved. The client reports effective coping with the distressing symptoms of panic disorder.
P: The psychotherapy sessions were terminated, as the treatment outcomes had been achieved. The client was scheduled for a follow-up visit after two months to assess his coping with the disorder.
Delusional Disorder
Name: D.E
Age: 34 years
Diagnosis: Delusional Disorder
S: D.E is a 34-year-old female client that came to the unit as a referral by her family physician for psychiatric assessment. She came with complaints of feeling that someone is planning to kill. She noted that she has had the feelings for the past year and she often feels insecure about her safety. The client also reported that someone wanted to kill her because of her position in society. She felt that someone targets her due to her immense achievements and the social connections she has with the most powerful people in the community. Further history taking from the client showed that the client has a history of bipolar disorder that has been managed using medications. Based on the above, the client was diagnosed with delusional disorder and initiated on treatment.
O: The client appeared dressed appropriately for the occasion. She was oriented to place, time, and self. She denied illusions and hallucinations. She was delusional. She denied any history of suicidal thoughts, plans, and attempts. Her speech was normal in terms of rate and volume.
A: The client is experiencing symptoms of delusional disorder. In specific, she is suffering from persecutory delusions and grandiose disorders.
P: The client was initiated on individual psychotherapy to address the delusions. The client was scheduled for a follow-up visit after four weeks.
Post-Traumatic Stress Disorder
Name: G.L
Age: 32
Diagnosis: Post-traumatic stress disorder
S: G.L is a 32-year-old female that came to the unit today for her first follow-up visit after being diagnosed with post-traumatic stress disorder. G.L was diagnosed with the disorder following her involvement in a road accident. According to her, she has been experiencing distressing memories about the accident. She has also been experiencing flashbacks and nightmares about the accident. She often engages in activities that divert her attention from the incident. She also reported to have been avoiding any situations that share similarities with the traumatic experience. The stressful memories and avoidance of situations associated with the accident had affected significantly her ability to perform optimally in her place of work. It also affected her ability to make decisions. Based on the above, G.L was diagnosed with post-traumatic stress disorder and initiated on antidepressants and group psychotherapy sessions.
O: The client appeared dressed appropriately for the occasion. She was oriented to self, others, time, and events. Her speech was of normal rate, content and volume. She maintained normal eye contact during the assessment. She denied illusions, delusions, and hallucinations. She also denied suicidal thoughts, plans, and attempts.
A: The client appears to respond well to treatment. She denies any side effects of the antidepressants. She is positive about attending group psychotherapy sessions.
P: The client was advised to continue with the current treatments. She was scheduled for a follow-up visit after four weeks.
Substance Abuse Disorder
Name: L.O
Age: 45 years
Diagnosis: Substance abuse disorder
S: L.O is a 45-year-old male that came today to the clinic for his fifth follow-up visit after being diagnosed with substance abuse disorder. L.O has been on pharmacological treatment and group psychotherapy to help him overcome addiction. He reported that he was diagnosed with substance abuse disorder after he came to the unit with complaints of binge consumption of alcohol. He noted that his alcohol consumption habits were worsening on a daily basis. He often had to increase the amount of alcohol consumed to get his desired level of intoxication. He also noted that he engaged in practices such as selling family properties and stealing to get money for purchasing alcohol. L.O also reported that he had enrolled in an Alcohol Anonymous group last year with the intention of stopping alcohol consumption. However, he was unsuccessful due to the effects of withdrawal symptoms. He came to the unit for assistance after he found that his binge consumption of alcohol was almost breaking his family. It was also affecting his social and occupational functioning. As a result, he was diagnosed with substance abuse disorder and initiated treatment.
O: The patient appeared appropriately dressed for the occasion. He appeared slightly underweight for his age. His orientation to self, place, time and events were intact. He denied altered thought processes, as evidenced by the absence of illusions, delusions, and hallucinations. He also denied suicidal thoughts, plans, and attempts. He demonstrated mild tremors during the assessment.
A: The client demonstrates improvement in symptoms when compared to the last visit. He has been actively participating in group psychotherapy sessions.
P: The patient continues to demonstrate improvement in symptoms. He also tolerates the prescribed medications. The client was initiated on Alcohol Anonymous group. He was also advised to continue with the current treatments. He was scheduled for a follow-up visit after four weeks.
Insomnia
Name: E.L
Age: 38 years
Diagnosis: Insomnia
S: E.L is a 38-year-old male that came to the clinic for the third visit after being diagnosed with insomnia. E.L has been on psychotherapy treatment. He recalled that he was diagnosed with insomnia after he presented to the unit with complaints of chronic lack of sleep. He noted that his quality and quantity of sleep started deteriorating six months prior to the visit to the hospital. He reported that he remained awake throughout most of the nights. He also experienced an awakening in some days, which made it difficult for him to fall asleep thereafter. He had tried using sleep-enhancing medications but they were not effective. The lack of sleep had affected his productivity in the workplace since he often fell asleep during the afternoon hours. Because of the above problems, he came to the unit for assessment where he was diagnosed with insomnia and initiated individual psychotherapy.
O: The patient appeared dressed appropriately for the occasion. He was oriented to self, others, time, and events. His thought content was intact. His speech was normal in terms of rate and volume. He denied illusions, delusions, and hallucinations. He also denied suicidal thoughts, plans, and attempts. He did not demonstrate any abnormal behaviours such as poor eye contact, yawning, and tremors during the assessment.
A: The psychotherapy treatment appears to be effective. The patient reports a significant improvement in his quality of sleep. He also reports enhanced engagement in occupational activities unlike in the past.
P: The client was advised to continue with the psychotherapy treatment, as it was effective. He was scheduled for a follow-up visit after four weeks.

Classmate Response Krista (2): PHN 652-Topic 8 DQ 1 -Evaluating Population-Based Interventions
Please elaborate on one or two points from the classmate’s post.
-Also, provide feedback to the classmate’s post.
-And also add other points related to the topic.
-Please use your own words and do not copy what she wrote
– Sources must be published within the last 5 years. It must be from 2017 and after and appropriate for the paper criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
Thank you.
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Solution
Classmate Response Krista Reply
I agree with you that some of the strategies that a public health nurse can utilize when evaluating an intervention include being organized, setting clear objectives, evaluating the effectiveness of the data collected and finally planning and understanding the desired outcomes and goals of the intervention being evaluated. However, I also believe that a public health nurse can adopt strategies such as engaging stakeholders with a clear description of a public health intervention program and focusing the evaluation on specific issues (Clarke et al., 2019). A public health nurse can also gather evidence so as to effectively engage in fact-finding, justify their conclusions and effectively share and apply the various lessons they learn. Relating to engaging stakeholders, public health nurses should therefore involve all the stakeholders involved in a public health program to conduct effective evaluations for the various interventions adopted (Stojanovic et al., 2020). On the other hand, public health nurses should also clearly describe the program and ensure that the objectives of such programs before conducting an evaluation. Having a specific focus to evaluate in a public health intervention would also go a long way in enhancing intervention evaluations. The forecast of an evaluation of an intervention should therefore be based on what is important to given stakeholders. A public health nurse should also be involved in activities to engage in fact-finding and gathering evidence in the evaluation of various interventions. This could include gathering data related to the timeframes, effectiveness and expenditure of certain programs and interventions in public health (Stojanovic et al., 2020). On the other hand, a public health nurse has to justify the conclusion of the year evaluation to certain interventions. Finally, public health nurse has to share and apply the various lessons they learn after evaluation of certain interventions in public health programs.
References
Clarke, G. M., Conti, S., Wolters, A. T., & Steventon, A. (2019). Evaluating the impact of healthcare interventions using routine data. BMJ, l2239. https://doi.org/10.1136/bmj.l2239
Stojanovic, J., Wübbeler, M., Geis, S., Reviriego, E., Gutiérrez-Ibarluzea, I., & Lenoir-Wijnkoop, I. (2020). Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.00106

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did two recent presidents handle the problem? What would you do differently?
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Presidential Agenda Health Topics: Affordable Healthcare
It is a known fact that healthcare in the United States is very expensive (Sultz & Kroth, 2018). Unlike other developed countries, the US did not really have a semblance of universal healthcare for all citizens until the 44th President (Barak Obama) signed into law in 2010 the Patient Protection and Affordable Care Act or ACA 2010 (Kominski et al., 2017). The question of affordable healthcare especially for the disadvantaged and the poor in the US is a very important public health issue. The much-touted ‘Medicare for All’ would have been the solution for the much-needed single-payer system that would have facilitated universal healthcare (Cai et al., 2020). The purpose of this paper is to look at the population health concern of affordable healthcare and to determine what the current and immediate former Presidents have done concerning the same.
Identification and Description of the Population Health Concern
The population health concern identified in this case is affordable healthcare. This is a very thorny public health and political issue that presidents have had to address it as a policy issue. Most healthcare in the United States is run as a private enterprise. Healthcare is run as business and prices are dictated by market forces just like in any other capitalistic society. Health insurance coverage is available but that too is quite expensive for the poor and marginalized. This is because healthcare coverage is also mainly in the hands of private entities (Sultz & Kroth, 2018). The result is that access to healthcare is not guaranteed for the poor and marginalized citizens who are then left to die from preventable causes.
For the first time, however, the administration of the 44th President of the United States Barak Obama came up with a revolutionary healthcare policy that would change things. The piece of legislation was called ACA 2010 and it was signed into law in the year 2010 (Kominski et al., 2017). It brought the provision of individual mandate whereby every citizen would be required to pay a minimal premium to access healthcare coverage. This would be mandatory and failure to do so would lead to penalties. The idea was to use economies of scale and have each and every American subscribe to the plan.
After its enactment, a total of 22 million poor and marginalized Americans were brought into healthcare coverage. Furthermore, there would be monetary incentives provided by the federal government to private healthcare insurers to cover pre-existing conditions. This was to be revolutionary and historic as most marginalized minority communities such as Hispanics and African Americans are the ones that have many persons with pre-existing conditions like diabetes.
How the Former and Current Presidents Approached the Issue of Affordable Healthcare
Donald Trump
The 45th President of the United States was Donald Trump. He is the immediate former President who unfortunately did not have a passion for equity and affirmative action. After he came into office following the expiry of the second term of President Obama, Donald Trump made it clear that his administration was determined to “repeal and replace” the ACA 2010 (Simmons-Duffin, 2019). At the center of this push to cancel out the gains made in providing affordable healthcare was the obsession with returning healthcare into the hands of private enterprise. In particular, the Trump administration wanted to do away with the individual mandate clause making a subscription to ACA 2010 optional. Of course, this would kill it as the intended economies of scale would have not worked.
The other target for repealing by the Trump administration was the coverage of pre-existing conditions. It wanted to stop the government from giving incentives to private insurers so that people with pre-existing conditions can be treated (Simmons-Duffin, 2019). The Trump administration never allocated any resources to facilitating the implementation and functioning of the ACA 2010.
Joe Biden
It cannot be forgotten that the current President (Joe Biden) was the Vice President when President Obama was signing the ACA 2010 into law. This means he was deeply involved in the formulation of the policy. Unlike Donald Trump, the first thing that President Biden did after assuming office was to reinstate all the provisions in the ACA 2010 that had been removed or watered down by the Trump administration. The Biden administration is also actively providing resources at all levels to see that affordable healthcare is made a reality.
Administrative Agency
The administrative agency that would most likely be responsible for helping address the affordable healthcare issue is the Center for Medicare and Medicaid Services or CMS. The reason for this is that the CMS is a major payer in the healthcare landscape of the US. The agency will therefore be helpful in that it will be responsible for the majority of the reimbursement for services rendered to the poor and marginalized.
The healthcare issue of affordable healthcare already got on the presidential agenda because it is such an important issue. Because the ACA 2010 legislative healthcare policy was to be implemented in phases over about 10 years, it is expected that the issue will remain on the presidential agenda for quite some time. The person I would choose to be a champion for affordable healthcare is Senator Susan Collins. She has been a champion of affordable and equitable healthcare for quite some time.
Conclusion
Affordable healthcare solutions in the US are badly needed. The ACA 2010 legislative healthcare policy was a major step towards the realization of these solutions. The former President who was Donald Trump attempted and succeeded to thwart the policy during his first and only term. However, the current President Joe Biden has already started by reinstating all provision in the ACA 2010 that may have been removed or altered. He is also allocating more resources to that end.
References
Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J.S., & Kahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), 1-18. https://doi.og/10.1371/journal.pmed.1003013
Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555
Simmons-Duffin, S. (October 14, 2019). Trump is trying hard to thwart Obamacare. How’s that going? https://www.npr.org/sections/health-shots/2019/10/14/768731628/trump-is-trying-hard-to-thwart-obamacare-hows-that-going
Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9th ed. Jones & Bartlett Learning.

NURS 6521 Week 9 discussion: Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I
Welcome to week 9
Posted on: Sunday, July 26, 2020 6:00:00 AM EDT
Dear Class,
Welcome to week 9 and 10, combined.
Topic: Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders, Part 1 and 2
For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.
To Prepare
Review the Resources for this module and reflect on the different health needs and body systems presented.
Your Instructor will assign you a complex case study to focus on for this Discussion. Last name A through M, CASE 1. Last name M through Z, CASE 2.
Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.
By Day 3 of Week 9
Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
You will respond to your colleagues’ posts in Week 10
Case Study 1
HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.
Ht: 5’8” Wt: 89 kg
Allergies: Penicillin (rash)
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Abstracts: Quantitative and Qualitive : Nursing: Emergency Department
This week, you will submit summaries of quantitative and qualitative studies. The purpose of this assignment is to become familiar with published research, research designs, and methodologies. For the assignment, you will select two original or primary research studies: one quantitative research study and one qualitative study related to the field of nursing. You will write an abstract of each study.
• The selected articles should be original research studies.
• Review articles, concept analysis, meta-analysis, meta-synthesis, integrative review, and systemic review should NOT be used.
• Mixed-methods studies should not be used.
Assignment Instructions:
1. Your abstracts should begin with the APA Style reference to the research article that is reviewed
2. Your abstracts should be written in your own words. (The abstracts within the studies your choose will not answer all of the assignment questions.)
3. Your abstracts should be accurate, brief, clear, between 150–250 words, and include only the most essential information.
4. Use current APA Style to format your paper and to cite your sources.
5. You are required to attach both research studies (the full articles) that you use to write your abstracts.The original research study articles may be copied onto a Word document or saved in a PDF format.
Address the following questions in each of your abstracts:
1. What type of research is it (quantitative, qualitative)?
2. What was the research question(s) or hypothesis?
3. What is the sample (population), the sample size, and sample attributes (characteristics)?
4. What is the setting (facility type, location, and country) of the study?
5. What were the researcher’s results and findings? (Identify one that clearly measures the dependent variable or objective of the research.)
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Quantitative Research Study Abstract
Goldstein et al. (2018) is a quantitative study that relies on the randomized control trial design to test the effectiveness of the point of care testing approach as an effective approach of helping to reduce the wait times in the emergency department. The main research question explored in Goldstein et al., (2018) qualitative study is what the effectiveness of the upfront point-of-care testing approach in reducing the patient wait times in the emergency department is? The central hypothesis of Goldstein et al. (2018) is that upfront point-of-care testing can help to significantly reduce the patient wait times in the emergency department.
Goldstein et al., (2018) study focused on a sample population of adults more than 18 years who presented to an emergency department during weekdays. The research participants include patients who were not pregnant and did not require immediate resuscitation after presenting to the emergency room. The research includes 1044 participants.
Goldstein et al., (2018) study took place in a tertiary academic hospital emergency department in a metropolitan area of Johannesburg, South Africa.
Goldstein et al., (2018) study results highlight that there was more than a 20% reduction in treatment waiting times for patients of different categories in the emergency department after the introduction of the point-of-care testing approach compared to the standard way of operations. (Goldstein et al. (2018) highlight that point-of-care testing is one of the most effective approaches that can be adopted in emergency departments of health care facilities to help significantly reduce patient wait times. According to Luppa (2020), the full benefit of point of care testing can therefore only be truly realized if it is introduced as part of the standard procedure in an emergency department prior to doctor evaluation.
Reference
Goldstein, L., Wells, M., & Vincent-Lambert, C. (2018). A Randomized Controlled Trial to Assess the Impact of Upfront Point-of-Care Testing on Emergency Department Treatment Time. American Journal of Clinical Pathology, 150(3), 224–234. https://doi.org/10.1093/ajcp/aqy042
Luppa, P. B. (2020). Point-of-care testing at the interface of emerging technologies and new clinical applications. Journal of Laboratory Medicine, 44(2), 59–61. https://doi.org/10.1515/labmed-2020-0020
Qualitative Research Study Abstract
Walker et al. (2020) is a qualitative study that utilizes the semi-structured interviews approach to determine whether different stakeholders in healthcare, such as patients and healthcare practitioners, would be interested in the display of estimated emergency department patient wait times. The research question that Walker et al. (2020) sought to answer is the perspective of patient communities, health administrators, and paramedics on the display of estimated wait times in the emergency department. The hypothesis explored in Walker et al., (2020) study is, that patients, paramedics, health administrators, and communities will be interested in the display of estimated patient wait times in the emergency department.
The sample population involved in Walker et al., (2020) study included paramedics, patients, and support persons in emergency departments, paramedic controllers, well community member general practitioners, and hospital administrators. The sample size in Walker et al., (2020) study included a total of 110 participants comprising 15 community members, 32 patients, 21 paramedics in the 22 carers, and 20 health service administrators.
Walker et al., (2020) study was undertaken in regional and tertiary hospitals in Melbourne, Australia.
The main results of Walker et al., (2020) qualitative study are that healthcare practitioners and patients face both physical and psychological difficulties when the wait times in the emergency department are not visible. Most patients want to see the triage-to-doctor times, while most health care practitioners and paramedics want to see the door to off stretcher times. The majority of both healthcare practitioners and patients rely on patient wait times to make decisions. Walker et al. (2020) concluded that paramedics and patients require emergency department wait time information visibility. They can therefore utilize this information in a variety of ways to enhance their health care experience.
Reference
Walker, K., Stephenson, M., Loupis, A., Ben?Meir, M., Joe, K., Stephenson, M., Lowthian, J., Yip, B., Wu, E., Hansen, K., Rosler, R., Buntine, P., & Hutton, J. (2020). Displaying emergency patient estimated wait times: A multi?centre, qualitative study of patient, community, paramedic and health administrator perspectives. Emergency Medicine Australasia. Published. https://doi.org/10.1111/1742-6723.13640

POLICY ANALYSIS FRAMEWORK PAPER
POLICY ANALYSIS FRAMEWORK PAPER
Purpose: This assignment will enhance your Skills in political analysis and strategies aimed at influencing policy changes.
****** The Policy I am supporting to be passed is the H. R. 1474: Alzheimer’s Caregiver’s Support Act
https://www.govtrack.us/congress/bills/117/hr1474
******I am a resident in the state of Texas*****
Directions: Upload a 5 paged double spaced paper (excluding cover page and reference page)
1. Define Context of the Policy Issue/ Problem: Briefly describe the political context for the issue under examination. Include the socio-political, economic, ethical, historical, cultural factors relevant to the issue. This step is crucial in forming the basis for the policy analysis. Include the 5Ws and H (who, what, when, where, why and how) aspects of the issue. Provide a specific practice based concern or public health issue of concern at State or National level.
2. Policy Lenses: Briefly discuss how your personal values, beliefs, experiences, ethics, political philosophies and ideologies guide your views about the issue.
3. Describe a specific policy framework/model of choice that applies to your issue
4. Evidence Based Policy Change: Discuss research and evidence based policy change strategies and options to address the issue. Using a balanced approach discuss at least two alternative policy responses for consideration Examine the “best practices” of other agencies, as well as emerging policy proposals.
5. Apply the selected model/framework and analyze the political feasibility of solving the issue using the selected framework. What are the key concepts in the model/framework? How does your policy issue fit within this framework? What are the barriers and facilitators in addressing the issue? How can you advance this issue on the policy agenda? Who holds the power to advance this issue? What networks and coalitions exist that are involved in this issue
6. Recommendations: Of the two policy alternatives you presented, end your policy analysis with a summary of the preferred policy option. Justify why this option is preferred. Conclude with a discussion of the implications for nursing leadership policy and practice.
Criteria Possible Points(100) Points Earned Comments
Policy Issue Description: Provide comprehensive overview of health policy issue to include socio-economic, political, cultural and ethical aspects of the issue 10
Policy Lenses: discuss how values, beliefs, experiences, political philosophy, and political ideologies influence decision making 20
Policy Analysis Framework: Describe and apply a specific policy framework/model of choice to the health policy issue of interest 20
Evidence Based Policy Change: Discuss research and evidence based policy change strategies and options to address the issue. Using a balanced approach discuss at least two alternative policy responses for consideration 20
Recommendations: Provide justification for policy recommendation and discuss implications for nursing health policy and practice 20
Clear grammar, spelling, writing style, references, double spaced paper within five page limit (excluding references and title page) and APA style. Headings are expected. Please use the grading criterial items for headings. 10
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Solution
Policy Implementation
The Alzheimer’s Caregiver Support Act in the 117th Congress on March 1, 2021, by Ms. Waters. The bill aimed at authorizing grants for training and supportive services for the families and the unpaid caregivers of the people living with Alzheimer’s disease or dementia related to the health condition. The grants cover for the training of the untrained caregivers living with the patients in enhancing knowledge on how to care for the patients, cope with stress in handling the patients, planning for the care, solving the problems emanating from their duties, and managing the behavioral symptoms presented by the patients (ALZ, 2021). The Act initiated educational value to the caregivers of dementia patients in ensuring quality life by encouraging the patients to participate in daily activities and tasks and understanding their illnesses or injuries that need care.
Caregiving services for dementia patients require more time than the other forms of caregiving. The increased time needed to take care of the patients reduces the capacity of the caregivers to develop economically. According to ALZ (2021), caregivers of people with dementia in 2019 provided 18.6 billion hours of unpaid assistance cumulatively. This indicates that the caregivers use much of their time offering unpaid care for the specified population, thus limiting their social value with other people and personal economic developments. Handling dementia patients is distressing, and thus the caregivers need training and other financial assistance in coping with the distressing conditions and meeting the stressing economic needs. In a study, 49% of the caregivers for dementia patients acknowledged being distressed compared to 35% of caregivers of the patients or people without dementia (ALZ, 2021). This shows the economic and social burden of unpaid caregivers. It is ethical to appreciate the caregivers in motivating them to provide safe, ethical, and professional care to the patients. Seidel & Thyrian (2019) indicated that high levels of dependency among dementia patients and the distressing factor among the caregivers increase the prevalence of physical and sexual violence against dementia patients. This shows the importance of the bill in improving the professionalism and psychological wellbeing of the caregivers.
Policy Lenses
My personal beliefs and values guide me in supporting the bill for providing grants to unpaid caregivers. I am a committed and reliable advocate for patients within the nursing profession, and thus in valuing health, I support the motions focused on improving the quality of health and patient care. I believe that people should provide healthcare services with a higher capacity, specially trained on how to provide the services, to positively impact the patients. Provision of patient care with knowledge limitations increases the risks of making unprofessional mistakes that may lead to health risks, ethical malpractices, and poor patient interpersonal relationships. The caregivers should thus be trained to understand the basic and best ways to handle patients with dementia. Being a nurse professional and through experience, I have learned that a distressed caregiver is prone to punching the same to the healthcare recipient, and thus, limiting the distress encourages the professional to observe ethical principles and provide quality care. I believe in the socialistic political philosophies that are built not on individualism but societal gain. Socialism rejects the desire to count on the personal gain without focusing on other people’s needs, as it is in the liberal or conservative philosophies. Quality healthcare is a right to everyone and not a privilege to some members of society. A socialistic view thus encourages to devise a plan to equalize the quality of care for those underpaid professional caregiving services and those under unpaid caregiving. In this context, the unpaid caregivers may provide uninformed and unqualified care to the patients with dementia which causes disparity in care compared to those under professional nurse care. Provision of professional training and support to the caregivers thus balances the quality of care for the specified population.
Policy Framework/ Model
There are various policy models applicable to the policy implementation process. The most applicable policy framework for the described policy is the multiple streams policy model, popularly known as Kingdon’s model. According to the model, formulation and implementation of a policy happen when the three streams converge in accepting the terms of solving the issue (Judy Gregg et al., 2018). The first stream is the problem stream which involves the identification and definition of the problem. A problem, not a condition, is a consistent issue that needs to be resolved. It concerns a public matter that has been recognized as a problem. The policy stream involves the change proposals in addressing the problem identified. The policy stream provides a list of proposals driven by the interest groups such as activists and professional associations. The policy stream puts the demands for change through various policy change proposals. The academicians and researchers in Texas should seek evidence on the impact of grants to the unpaid caregivers and support the intervention. The politics stream entails political issues in collaborating the efforts and resources to consider the policy impacts and costs. This constitutes the pressure groups campaigns and the administrative or legislative activities that weigh on various factors about the identified problem and the projected solutions through the policy stream (Macaulay & Focsa, 2016). This is the role of the professional bodies of healthcare providers and the legislature in determining the effectiveness of the provided policy proposals. According to the model, convergence of the three streams forms an opportunity window for policy change. This model applies to the identified problem of poor quality of caregiving services and wellbeing of the unpaid caregivers.
Evidence-Based Policy Change
The provision of quality healthcare is dependent on the wellbeing of the care providers, the availability of resources, and the professional capacity of the healthcare providers. The major problem identified by the bill is the inadequacy in the quality of care to the dementia patients by the unpaid caregivers. One quality of the unpaid caregivers is that they lack the training and professionalism in caring for the patients and thus the poor quality. Training improves the skills on handling healthcare-related issues and the psychological issues revolving around the patient and resulting from the dementia condition. Weir et al. (2021) conducted a systematic review on the effectiveness of caregiver training for informal caregivers assisting patients diagnosed with neurological disorders. The researchers established that the training contributed to improved quality of services and wellbeing of the patients compared to their performance before the intervention. The training improved the levels of confidence among the unpaid caregivers in delivering care.
Payment is used as a motivation and compensation for services delivered. Even though caregiving is much of a call to help other people gain health and wellbeing, payments and stipends motivate the caregivers to provide the caregiving services even in meeting the challenges. Caregiving for the patients suffering from dementia takes a lot of time, requiring concentration on the behaviors and activities of the patients, an indication that the caregivers have less time for their personal development and social life. This may lead to disinterest in caregiving and depression due to strains and thus negatively impact their caregiving processes. Reckrey et al. (2021) conducted a study on the impact of paying family caregivers caring for dementia patients on the quality of care. According to the study, caregivers who received part-time and zero payment lacked emotional attachment to the caregiving activities and performed poorly compared to those who received quality appreciation. This shows that appreciation to the family caregivers for dementia patients improves the quality of care and wellbeing of the caregivers.
The bill provides a solution of providing grants to unpaid caregivers to be trained on effective caregiving. This training includes how to effectively handle the patients, cope with the distressing care, and ensure quality care and relationship with the patients. This strategy largely focuses on the training measure that increases the knowledge on quality care. An alternative strategy in solving the problem is increasing the healthcare coverage to incorporate the professional healthcare providers in the caregiving process to collaborate with the unpaid caregivers for quality improvement in care. Additionally, the government can include the unpaid caregivers in the plan of optimal pay and incorporate the local healthcare providers such as public health nurses in training and inducting the caregivers.
Recommendation
Providing grants for both training and stipends for unpaid caregivers may largely impact the quality of care for dementia patients. Caregiving is a physically, emotionally, and financially draining role that requires general support from all stakeholders. Increased emotional, financial, and physical stability project an equal quality in care for dependent patients such as dementia patients. The provision of payments would thus help improve and cover the financial deficits, compensating the caregivers for their time and energy in caring for dementia patients. This, to their functions as an appreciation for their services to the patients. Clark (2021) points out that paying family caregivers is possible since some states in the United States are doing it and are helping improve the quality of care. Some states, such as California, New York, and Washington, have formalized paying family caregivers through Medicaid plans. Education and training of unpaid family caregivers are essential in improving the quality of care. Paying for education can be difficult for Texas and thus can encourage the paid caregivers to seek education and collaboration with the local healthcare providers for improved skills. Through a study, Burgdorf et al. (2019) established that the family caregivers who received payments were four times more likely to seek training and education programs.
References
ALZ. (2021). Bipartisan Legislation to Expand Caregiver Training and Support Introduced in 117th Congress. Alzheimer’s disease and dementia. https://www.alz.org/news/2021/bipartisan-legislation-to-expand-caregiver-training
Burgdorf, J., Roth, D. L., Riffin, C., & Wolff, J. L. (2019). Factors Associated With Receipt of Training Among Caregivers of Older Adults. JAMA internal medicine, 179(6), 833–835. https://doi.org/10.1001/jamainternmed.2018.8694
Clark, A. (2021, September 13). What States Pay Family Caregivers in 2021? The Senior List. https://www.theseniorlist.com/caregiving/caregiver-funding-by-state/
Judy Gregg, D. N. P., Miller, J., & Tennant, K. F. (2018). Nurse policy entrepreneurship in a rural community: A multiple streams framework approach. Online Journal of Issues in Nursing, 23(3), 1-11.
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Reckrey, J. M., Boerner, K., Franzosa, E., Bollens-Lund, E., & Ornstein, K. A. (2021). Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit?. Clinical Therapeutics.
Seidel, D., & Thyrian, J. R. (2019). The burden of caring for people with dementia–comparing family caregivers and professional caregivers. A descriptive study. Journal of multidisciplinary healthcare, 12, 655.
Weir, R. L., Danilovich, M. K., & Hoover, D. L. (2021). A systematic review of the effectiveness of caregiver training with functional mobility tasks for informal caregivers assisting patients with neurological diagnoses. Disability and Rehabilitation, 1-8.