Nursing

DNR Case Study

Application and interpretation of Public Data-QUESTION-TOPIC 8 DQ 1
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QUESTION-TOPIC 8 DQ 1 “Statistics is an important component of public health. Explain the relevance of statistics in the planning, implementation, and evaluation of a health promotion intervention. How do you envision using statistics in your current or future career?” After completing the course, how has your vision changed regarding the role statistics will have in your current or future career?
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Solution
Statistics in Public Health
Statistics is essential in managing public health data, especially in a critical issue that affects a large population. They are used to evaluate research data and find out if there is any association between groups. Researchers use different statistical methods to ensure effective findings and desirable outcomes. Statistics impact public health in that data is analyzed critically by testing the hypothesis (Rodrigues et al., 2017).
Importance in Planning, Implementation, and Evaluation
Statistics articulate an impact in the planning, implementing, and evaluating of health promotion interventions. For example, several healthcare facilities have developed various health promotion interventions to promote quality healthcare in public health. In addition, public health areas such as community health have implemented programs that have helped prevent outbreaks and diseases that affect the population. Therefore, health practitioners need to ensure that appropriate use of statistics will help in reducing many causalities.
Statistics have a beneficial impact on the planning process of the health promotion intervention. For instance, the hypothetical statement is derived, and questions. This can only be possible through testing the hypothesis. The results will lead the flow of the study. Thus an error in testing can affect the findings of the study. Implementing health promotion interventions will require statistics, especially determining the number of participants and the appropriate methodologies to apply (Clarke et al., 2019). Evaluation of data in a study entails focusing on all the study aspects and presenting empirical data. For instance, assessing the number of those infected with the covid-19 virus will require health practitioners to use effective methodologies to interpret, analyze and present empirical data.
Based on my knowledge and skills of statistics in public health, I will study epidemiology and relate it to finding the prevalence and transmission rate of an outbreak in the future. Finding the number of those infected, especially in the community, will help develop appropriate and effective approaches to managing the occurrence. In addition, the role of statistics will enable me to analyze and summarize the patients’ diagnose and treatments based on their data, thus providing quality healthcare. Knowledge in statistics role has enabled me to understand the importance of using the appropriate statistical methods in collecting proficient data.
References
Clarke, G. M., Conti, S., Wolters, A. T., & Steventon, A. (2019). Evaluating the impact of healthcare interventions using routine data. bmj, 365. https://www.bmj.com/content/365/bmj.l2239.full
Rodrigues, C. F. D. S., Lima, F. J. C. D., & Barbosa, F. T. (2017). Importance of using basic statistics adequately in clinical research?. Revista brasileira de anestesiologia, 67, 619-625.https://www.scielo.br/j/rba/a/N5PgBCrzhDkfRbX8QXsctHx/?lang=en&format=html
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Qualitative Data Collection-Topic 7 DQ 1 -Response 1
QUESTION- Describe three methods for qualitative data collection and discuss an example of when each method would be used.
Classmate(Chayah’s) Response -There are multiple methods that researchers use to collect data during a qualitative study. One is research interviews. These can be structured, semi structured or unstructured. A structured interview is when a researcher basically reads a questionnaire to a participant. The questions are written ahead of time and the format stuck to as much as possible to have the process be as similar as process for participants (Gill et al., 2008). An unstructured interview may begin with an open-ended question and the questions may change depending on participants answers (Gill et al., 2008). A semi structed interview is a mixture of predetermined questions to give direction to the areas the researcher wants to gather data in and has allowance to go into different ideas if that’s where the interview goes. It allows the input of the participant which may provide additional information not originally in the questions (Gill et al., 2008).
The purpose of using a research interview when gathering qualitative data is that it can provide understanding of participants views, beliefs, deeper thoughts, and opinions that may dictate their actions. Interviews can be used when there is little known information about a topic and can provide privacy about topics that someone may not be open about in a group setting (Gill et al., 2008). Examples could be an instructed interview asking a participant how do you feel about masking? A structed interview could be having a questionnaire and going through a list of questions asking specifically things like do you wear a mask at the grocery store? Do you wear a mask when walking down the street? Both of these examples would gain data about masking but one would potentially provide lots of in-depth data needing to be organized and the other would have yes and no responses with succinct data cc masks and behavior.
Another method to gather qualitative data would be focus groups. A focus group is a group discussion of a topic that is guided by a moderator. It allows the gathering of data from multiple persons at a time (Gill et al., 2008). A focus group can be stand alone or part of a mixed method approach. The mixture of persons in the group affects results which including things like age and gender. Groups can be strangers or people that have a known shared experience. Questions may be all premeditated or may also allow for a divergence of questions based on response (Gill et al., 2008). A best practice size may be 6-8 participants but may be smaller or larger depending on circumstance. A too small group could have limited input and discussion but a large group risk can be difficult to manage and more dominant personalities may monopolize speaking time. Moderating taking skill in order to keep a discussion on the main topic without leading participants down a preconceived notion of the moderators, they must keep speaking roles balances and maintain a group that is allowing all to speak (Gill et al., 2008). Using the mask example from above a focus group could be created from parents at a school to gather data on individual beliefs and also, they want as a group. Parents may have a variety of opinions and they may as a group show what the population of that school is thinking, believing, and acting upon in terms of masking.
Another method to gather data would be ethnography. Ethnography collects data through participant observation and analyzes certain people groups or cultures. A researcher seeks to learn through another population (Grand Canyon University [GCU], 2016). The researcher is engaged to find out data about experiences based on different aspects of this different people group. The researcher immerses in the other culture. Many times, this kind of data collecting takes a long amount of time (GCU, 2016). Keeping with the mask example an expatriate living in Asia may evaluate how they feel and act about masks based on their cultural lenses and a previous more common use of masking when ill.
References
Gill, P., Stewart, K., Treasure, E., Chadwick, B. (2008). Methods of data collection in qualitative research: interviews and focus groups. British Dental Journal 204, 291–295. https://doi.org/10.1038/bdj.2008.192
Grand Canyon University. (Ed.). (2016). GCU doctoral research: Quantitative and qualitative research concepts.
Please elaborate on particular points from the classmate’s essay. (See upload)
-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 2016 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
Methods of Qualitative Data Collection
Hello, thank you for the opportunity to contribute to the discussion. I appreciate your contributions and agree with your response. I will only add a few views to the post. All the three methods that you have discussed emphasize the relevance towards the development of research and show how important they are for researchers. They all show their uniqueness based on the methodologies and approaches moderators and researchers apply to their work. Thus appropriateness of the data collection method will determine the suitability of findings and the results of the study. Therefore, it is important to carry out adequate research before using any data collection method.
Research interviews help gather in-depth and richer data that has various views and perceptions from those who have experienced a similar situation. In addition, the interviewer can articulate and feel the interviewee’s expressions and reactions through their responses, thus assisting in collecting authentic data on the little-known topic. Normally, the interview is conducted one-on-one, allowing participants to express their feelings on certain beliefs and views without being judged (Paradis et al., 2016).
Focus group discussions help in solving a social occurrence. This saves time and repetition since the researchers can compare the similarities and differences of participants’ views towards a similar experience. In most times, the number of participants in a group depends with the research questions in a specific circumstance, therefore, it is vital to ensure that the group size is not too small or large as this will have an impact on the outcome of the study. Health researchers can use this method in gathering information regarding experience on medical interventions based on patients’ experiences (Hammarberg et al., 2016). Ethnography requires researchers to be more patient as it can involve too much than expected on the population’s lifestyle and culture, though it is an effective method of understanding different characters in a study to understand a certain phenomenon in a societal set-up.
References
Hammarberg, K., Kirkman, M., & de Lacey, S. (2016). Qualitative research methods: when to use them and how to judge them. Human reproduction, 31(3), 498-501. https://academic.oup.com/humrep/article/31/3/498/2384737?login=true
Paradis, E., O’Brien, B., Nimmon, L., Bandiera, G., & Martimianakis, M. A. (2016). Design: Selection of data collection methods. Journal of graduate medical education, 8(2), 263-264. https://meridian.allenpress.com/jgme/article/8/2/263/34418/Design-Selection-of-Data-Collection-Methods

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.
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Solution
Personal Theory Framework for Advanced Practice Nurse
The purpose of this essay is to provide a detailed analysis of my philosophy of nursing to inform my nursing career. It will integrate Florence Nightingale’s environmental theory and Jacqueline Fawcett’s four meta-paradigm concepts of (a) health, (b) person, (c) environment, and (d) nursing to create a solid understanding of the critical similarities and differences in the selected theoretical framework and my nursing philosophy. As a registered nurse with 17 years of experience, my primary goal is to gain the requisite knowledge, skills and competencies, values, and experiences that would enable me to offer holistic, safe, top-quality, and patient-centered care and support. The paper provides a solid discussion of my personal philosophy of nursing by referring to my own experiences as an Advanced Practice Nurse and to the knowledge, competencies, and skills I have acquired throughout my nursing career.
My Personal Nursing Philosophy
First, my choice of nursing as a noble career path was inspired by my unrelenting ambition to become a productive, helpful, and meaningful community member with the ability to assist people with healing and recovery. My philosophy as an Advanced Practice Nurse (APN) is that nurses have a significant responsibility of providing evidence-based care and patient-centered care. I hold that this kind of patient-oriented care should respond to the distinct needs and conditions of each individual regardless of their socio-economic background, race/ethnicity, religion, and gender (Ayse et al., 2019). Ideally, I firmly believe that patients must be recognized and treated as individuals who deserve individualized attention and care as the fundamental basis for improving their health condition and wellbeing. As an Advanced Practice Nurse (APN), I have focused on acquiring relevant knowledge and skills in nursing. I have no doubt that these competencies would enhance my overall ability to offer exceptional nursing and clinical services in a calm and supportive environment characterized by (a) empathy, (b) communication, (c) collaboration, (d) learning, and (e) diversity.
Personal Meanings within Nursing’s Metaparadigm
The four-domain metaparadigm articulated by Fawcett can organize nursing knowledge, competencies, values, and beliefs associated with the nursing practice. These concepts include (a) person, (b) health, (c) nursing, and (d) environment. Fawcett (1984) indicated that applying these metaparadigm concepts in developing and implementing treatment plans can prove instrumental in enabling improvements in the provider-patient therapeutic relationships and, subsequently, ensuring high quality and safe patient care.
Person
The first concept is the person. Fawcett (1984) indicated that a person is a human being. Ideally, the person’s centrality in nursing care is based on the understanding that individuals live with others in the society in a unitary, rational and relational manner. As a Family Nurse Practitioner, I consider patients as people first, which has been instrumental in enabling me to forge two-way and collaborative relationships during my encounters with individuals. Moreover, I also consider patients to be partners in the treatment process based on how they possess vital knowledge regarding their medical condition and the capacity to pursue decisions and actions that can impact their care (Sullivan, 2016). As a family nurse practitioner, I often strive to establish and maintain meaningful encounters and relationships with patients to create a working environment where shared negotiation, two-way communication, and collective responsibility are genuinely practiced.
Health
The second metaparadigm concept is health. Miriam (2018) noted that health is a multi-faceted term that reflects the state of being secure and comfortable in the physical, spiritual, mental, and social domains of life. As a nurse, I hold the perspective that good health extends beyond the absence of illness or disease, and hence my commitment to improving patients’ health is based on providing holistic, tailored, and evidence-based care and support. Moreover, I have often focused on gaining a better understanding of each patient’s distinct needs, realities, and conditions as the basis for tailoring treatment plans and interventions to suit their health concerns (Sullivan, 2016).
Environment
The third concept is the environment. According to Nightingale’s environmental theory, providing a safe, supportive, calm, and clean physical environment is integral in nursing practice. I have always ensured that the patients I interact with are able to access the relevant support systems and to maintain their sense of self, freedom, and independence. Throughout my nursing career, I intend to create positive conditions where patients can receive holistic care and achieve positive improvements in their health and wellbeing. Moreover, focusing on the patient’s state of mind may become a practical means to understand some of the intervening environmental factors that influence their health condition and recovery.
Nursing
The other concept of the metaparadigm is nursing. According to Nightingale’s theory, nursing has one primary objective, “to put the patient in the best condition for nature to act upon him/her” (Riegel et al., 2021, p.3). This conceptualization applies to my nursing philosophy based on how it captures the art of nursing as a people-oriented endeavor that is focused on assisting the patient in restoring his/her health and wellbeing. Moreover, I believe that effective nursing practice is focused on enhancing patients’ lives with empathy and compassion. The core nursing values that inform my practice include (a) respect, (b) honesty, (c) altruism, (d) human dignity, (e) autonomy, (f) integrity, and (g) social justice. Riegel et al. (2021) pointed out that these core values are shared and practiced within the medical community and reflect the spiritual and human approach to the nursing practice. Therefore, my nursing philosophy embraces these core values, and I intend to embed them in my day-to-day operations to ensure caring, holistic, and patient-centered care and support to patients.
Analysis
My philosophy of nursing correlates with the philosophies of Fawcett and Florence Nightingale. Ideally, the core teachings advanced in the philosophies of these two individuals focussed on providing an integrative and holistic viewpoint regarding nursing as a people-centered profession. Moreover, the main ideas advanced in Nightingale’s framework sought to embrace the different components of nursing as the fundamental basis for looking into some of the key factors and themes that can be considered to ensure the delivery of patient-centered and evidence-based nursing care (Riegel et al., 2021).
Regarding a situation where the framework fits my philosophy, I consider patient-centered care to be at the forefront in enhancing the experience of care of people using nursing services. I believe that the importance of considering the patient as an individual lies in the fact that the practitioner and the health care provider must focus on adopting individuals and comprehensive care plans that capture the patient’s mental, physical, and sociocultural needs. Therefore, the person component as exemplified in the framework is well placed in my nursing philosophy based on how it calls for a good deal of respect, two-way communication, and collaboration between and among the different partners across the care continuum. A better understanding of the patient’s cultural background, preferences, and beliefs is required to inform culturally-competent nursing service.
Moreover, I have also understood that the quality of care offered to patients should be the same irrespective of the (a) geographic location, (b) cultural factors, (c) gender, and (d) socio-economic conditions. As a provider, the practicing family nurse practitioner must be well-positioned to identify differences in norms, demographics, desires, and practices associated with providing care in diverse environments. Therefore, Fawcett has successfully established upon Nightingale’s original concept of seeing the patient as a living and whole individual with the capacity to interact with his/her environment. Ideally, the concept of patient, therefore, fits my philosophy based on how it captures the centrality of identifying and responding to each patient’s distinct realities and conditions as the fundamental basis for providing patient-oriented care and support.
Pender’s Health Promotion Model (HPM) is the selected middle-range theory that resonates with my nursing philosophy. As an advanced practice nurse, the theory provides the basis for developing empathetic and compassionate relationships with people to provide appropriate medical, emotional, and physical support to patients. Precisely, the theory offers a guide for examining the complex bio-psychosocial processes, relationships, and factors that assume a role in motivating individuals and groups to pursue a health-promoting lifestyle or behaviour (Pool et al., 2018).
Conclusion
Overall, my nursing philosophy is still developing as I gain more knowledge, experience, competencies, and skills in the ever-changing nursing field. I believe that providing patient-centered care and support is integral to meeting each patient’s distinct needs and demands. Integrating nursing theories and frameworks in my philosophy is undoubtedly a meaningful starting point to enhance my sense of personal confidence as a family nurse practitioner and passion for nursing practice, knowledge, and values.
References
Ayse, D., Oznur, K., Ruveyde, A., & Kamile, K. (2019). Nursing Students’ Perceptions of
Nursing Metaparadigm: A Phenomenological Study. Journal of Nursing Research, 27(5), 1-8. doi: www.10.1097/jnr.0000000000000311
Fawcett, J. (1984).The Metaparadigm of Nursing: Present Status and Future Refinements. The Journal of Nursing Scholarship, 16(3):84-9. doi: www.10.1111/j.1547-5069.1984.tb01393.x.
Miriam, B. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3), 1-9. https://doi.org/10.1111/nin.12243
Riegel, F., Crossetti, O., Martini, J.G., & Nes, G. (2021). Florence Nightingale’s theory and her contributions to holistic critical thinking in nursing. Rev Bras Enferm, 74(2), 1-5 doi: www.10.1590/0034-7167-2020-0139.
Sullivan, M. D. (2016). Patient-centered care or patient-centered health? Oxford Medicine Online. doi: www.10.1093/med/9780195386585.003.0002
Pool, N., Koithan, M., & Ringdahl, D. (2018). Nursing as an integrative healthcare profession. Integrative Nursing, 350-362. https://doi.org/10.1093/med/9780190851040.003.0023

NURS 6521 week 1
Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
Photo Credit: Getty Images/Ingram Publishing
When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.
To Prepare
• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.
By Day 3 of Week 1
Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_6521_Week1_Discussion_Rubric
• Grid View
• List View
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 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. 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
Total Points: 100
Name: NURS_6521_Week1_Discussion_Rubric
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
• Chapter 1, “Prescriptive Authority” (pp. 1–3)
• Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
• Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
• Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
• Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
• Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)
American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767
American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.
This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.
Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm
This website outlines the code of federal regulations for prescription drugs.
Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.
Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html
This website details key aspects of drug registration.
Fowler, M. D. M., & American Nurses Association. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application (2nd ed.). American Nurses Association.
This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.
Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list
This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.
Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17
This article provides NPs with information regarding state-based laws for NP prescribing.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist?led educational intervention for nurse practitioner students. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446
The authors of this article assess the impact of a pharmacist?led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.
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Infection Case Study
Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines as well as the course textbook.
Anthony Miller, a 59-year-old male, presents to the clinic with complaints of cough, shortness of breath, and increased sputum production. His past medical history is significant for COPD with chronic bronchitis, hypertension, diabetes, and hyperlipidemia. He reports that his sputum has increased in consistency and amount over the past few days. His last exacerbation was about 6 months ago, for which he received amoxicillin. This is his third exacerbation in the past year. He has a 40-pack year history of cigarette smoking and quit smoking 3 years ago. He does not take chronic steroids. Physical exam reveals rhonchi and expiratory wheezes. His vital signs are blood pressure 140/83 mm Hg, pulse rate 80 beats/min, respiration rate 20 breaths/min, and temperature 98.8°F. He has no known drug allergies. A sputum Gram stain in the office reveals purulent sputum (presence of WBCs). Chest x-ray findings are negative for pneumonia.
Diagnosis: Acute Exacerbation of Chronic Bronchitis—Please provide your rationales for each answer with supporting data
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Which of the following would suggest the need for antibiotic therapy in A.M.?
Cough, history of smoking, and expiratory wheezes on physical examination
Elevated respiratory rate and shortness of breath
Increased dyspnea, increased sputum production, and increased sputum purulence
History of previous COPD exacerbations, cough, and fever
What is a likely pathogen associated with an acute exacerbation of chronic bronchitis in A.M.?
Mycobacterium tuberculosis
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pneumonia
What antibiotic would be most appropriate to treat an acute exacerbation of chronic bronchitis in A.M.?
Amoxicillin–clavulanate
Azithromycin
Linezolid
Sulfamethoxazole/trimethoprim
What is the mechanism of action of the medication of choice in question #3? Provide rationale.
What kind of counseling points would you provide for A.M.?

Assignment 2: Practicum – Week 8 Journal Entry
Reflect on geriatric patients from your practicum site. Consider frail elder patients that you have assessed for skin wounds such as bumps, bruises, shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome, etc. Explain the consequences of these types of wounds for frail elders. Then, describe a patient case including the care plan for assessment, diagnoses, treatment, management, and patient education. Explain whether the patient’s care plan was effective. Include how you might proceed differently in the future. If you did not have an opportunity to evaluate a patient with this background during the last 8 weeks, you can select a related case study or reflect on previous clinical experiences.

Population School-age children with obesity
Obesity among school-age children has reached epidemic levels in the United States. De Lorenzo et al. (2019) described obesity as a significant public health concern since it affects the physical, psychological, and cardiovascular health of the affected populations. Data from 2015-2016 shows that 1 in 5 children in the United States aged 6 to 19 years has obesity, and the rate has tripled since the 1970s (Centers for Disease Control and Prevention, 2018). Risk factors include poor eating habits, lack of physical activity, genetics, and negative childhood events. Therefore, immediate, evidence-based, and population-driven interventions are necessary to reduce the surging rates.
Reducing screen time
Increased screen time is among the unhealthy lifestyles reducing the level of physical activity among school-age children. According to Robinson et al. (2017), screen media exposure increases obesity levels by encouraging more eating while viewing, reducing sleep duration, and increasing the possibility of taking sugary and low-nutrient foods. In addition, more screen time also exposes children to marketing that influences their eating habits and preferences. As a result, reducing screen time is a perfect intervention to keep children from these dangers to reduce obesity incidence.
Refer to the PICOT you developed for your evidence-based practice project proposal. If your PICOT required revision, include those revisions in this assignment. You will use your PICOT paper for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.
Write a 750-1,000-word paper that describes your PICOT.
Describe the population’s demographics and health concerns.
Describe the proposed evidence-based intervention and explain how your proposed intervention incorporates health policies and goals that support health care equity for the population of focus.
Compare your intervention to previous practice or research.
Explain what the expected outcome is for the intervention.
Describe the time for implementing the intervention and evaluating the outcome.
Explain how nursing science, social determinants of health, and epidemiologic, genomic, and genetic data are applied or synthesized to support population health management for the selected population.
Create an Appendix for your paper and attach the PICOT. Be sure to review feedback from your previous submission and revise your PICOT accordingly.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper.
Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.
You are required to cite at least four to six peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
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Solution
Population’s Demographics and Health Concerns
The population described in this evidence-based practice project is school-aged children (aged six to twelve). School-aged children are highly dependent on elder people such as parents, guardians and teachers for nutrition, hobbies, learning and general health (Al-Balawi et al., 2018). Besides, school-aged children undergo development in different aspects, including physical as evidenced by differences in height, weight and general body build. Some children develop obesity where body mass index is at the 95th percentile or above the normal range (Al-Balawi et al., 2018). A school-aged boy will be considered obese when his BMI is 25.5 or above, while the 95th percentile for school-aged girls is 24.5 (varies with age).
Childhood obesity is a major healthcare issue in the U.S, which puts children at risk for morbidities and poor health. According to a survey by the CDC 2017-2018, obesity had affected 20.3% of school-aged children. The prevalence rate has surged over the years, indicating the need for immediate interventions. The risk factors for childhood obesity include poor eating habits, genetic predisposition, lack of aerobic physical exercises, and unhealthy childhood events.
According to Jackson and Cunningham (2017), childhood obesity affects children’s physical, psychological, and cardiovascular aspects of health. Obese children are more vulnerable to heart diseases, cancer, and type 2 diabetes than normal children are. Generally, the level of heath declines in obese children who are less productive as expected. Healthcare professionals continue to intensify interventions to reduce the prevalence of obesity. Efforts of healthcare professionals to reduce the prevalence of obesity are unsuccessful due to existing risk factors, including sedentary living (Jackson and Cunningham, 2017). Increased screen time enhances the consumption of fast foods, low physical activity, among other sedentary living behaviors. Mozafarian et al. (2017) highlight that regulating screen time is significant in reducing childhood obesity. Screen time encompasses the duration taken in playing computer games, watching and using technology to socialize. Parents, teachers, healthcare providers have a role in collaborating and encouraging children to reduce screen time (Mozafarian et al., 2017). Educators should also encourage children to participate in physical activities at home, school or other social facilities in the community.
Proposed Evidence-Based Intervention
The proposed EBP intervention discussed in this Benchmark Evidence-Based Practice Project is the reduction of screen time among school-aged children to control obesity coupled with educating parents and children. Obesity is a significant public health concern that requires prompt, evidence-based, and population-driven actions to decrease the surging rates. Studies show that increased screen time is an unhealthy lifestyle that causes children to reduce their participation in physical activity (Mozafarian et al., 2017). The authors highlighted that the increased obesity levels relate to screen media exposure, which more eating while viewing. Other unhealthy practices related to increased screen time are reduced sleep duration, increased intake of sugary food and a low-nutrient diet. The evidence from studies reveals the dire need to reduce screen time as an appropriate intervention to keep school-aged children from danger related to obesity.
Health Policies and Goals
The proposed intervention incorporates child health policies of providing a holistic equal, and unified approach to child development and health. Besides, the intervention incorporates global health policies involving nutrition education in schools, a ban of food vending machines in schools, regulating complementary foods and alcoholic beverages to children, and restricting high fat, sugar or salt foodstuffs to children. The project incorporates the Sustainable Development goal of protecting children and adolescents against diet-related non-communicable diseases and obesity. The goal supports equity of children to ensure they live within normal weight for height ranges.
Comparison of Intervention to Previous Practice or Research
The study by Hamilton et al. (2016) showed that parental responsibilities in modeling children help regulate their screen time, involvement in physical exercises and proper nutrition. The authors explain that the shortage of home-focused interventions addressing healthy behaviors contributes to childhood obesity. Study findings also recommend parental awareness of the relationship between obesity and screen time and the need to control the behavior (Lin et al., 2021). Therefore, parental education is integral in encouraging them to model children into healthy behaviors.
Expected Outcome for the Intervention
The author expects that parental education on a child’s screen time will lead to behavioral change. Education strategies will increase parental awareness of the relationship between screen time and obesity (Lin et al., 2021). The author expects parents to regulate children’s screen time and guide them into physical exercises and healthy eating. The outcome of the reposed intervention will be a reduction of obesity among school-age children.
Time for Implementing the Intervention and Evaluating the Outcome
The implementation of this EBP will be immediate to promote gradual behavioral change among the focus population with the assistance of their parents. Instant implementation of the project will help produce effects within six months. Evaluation of the outcome will occur after six months of interventions. Summative evaluation will be significant in determining the extent of achievement and areas requiring improvement.
Application of Nursing Science, Social Determinants of Health, and Epidemiologic, Genomic, and Genetic Data
In this evidence-based practice project, the author considers theories from nursing science, which provide practical concepts in managing population health concerns. The author acknowledges that social determinants of health or the conditions around a child’s birth, living and growth affect weight management. The social environment when children grow can influence the development of obesity. Epidemiological data on obesity, dietary intake, physical activity among children and other variables is integral in this EBP. Genomic and genetic data also influence the prevalence of obesity since acquired characteristics predispose some children to this health issue.
In conclusion, school-age children need protection and quality health interventions against vulnerabilities, including overweight and obesity (Lin et al., 2021). Nurses should use evidence-based practice to promote the adoption of best interventions, which enhance children’s health. Conducting parental education on screen time and obesity is an evidence-based practice that will reduce the incidence, increase the child’s involvement in physical exercises, and reduce the intake of too many calories.
Appendix
PICOT question
Among school-aged children, does parental education on-screen time reduce the prevalence of obesity coupled with increased involvement in physical activity and reduced intake of too many calories within six months compared to no intervention.
References
Al-Balawi, M. M., Al-Harbi, M. F., & Yakout, S. M. H. Maternal Perception of Body Mass Index and Dietary Habits Leading to Obesity Among Saudi School-Aged Children a Comparative Study. World, 3(1), 23-31.
Hamilton, K., Spinks, T., White, K. M., Kavanagh, D. J., & Walsh, A. M. (2016). A psychosocial analysis of parents’ decisions for limiting their young child’s screen time: An examination of attitudes, social norms and roles, and control perceptions. British Journal of Health Psychology, 21(2), 285-301.
Jackson, S. L., & Cunningham, S. A. (2017). The stability of children’s weight status over time, and the role of television, physical activity, and diet. Preventive medicine, 100, 229-234.
Lin, Y. M., Kuo, S. Y., Chang, Y. K., Lin, P. C., Lin, Y. K., Lee, P. H., … & Chen, S. R. (2021). Effects of parental education on screen time, sleep disturbances, and psychosocial adaptation among Asian preschoolers: A randomized controlled study. Journal of Pediatric Nursing, 56, e27-e34.
Mozafarian, N., Motlagh, M. E., Heshmat, R., Karimi, S., Mansourian, M., Mohebpour, F., … & Kelishadi, R. (2017). Factors associated with screen time in Iranian children and adolescents: the CASPIAN-IV study. International journal of preventive medicine, 8.

Developing a Case Management Plan
Developing a Case Management Plan
Jimmy Jansen is a 44-year-old man with type 1 diabetes mellitus. He was recently referred to your home health agency for case management follow-up at home. He is experiencing multiple complications from his diabetes, including the recent onset of blindness and peripheral neuropathy. His left leg was amputated below the knee last year because of a gangrenous infection of his foot. He is unable to wear his prosthesis at present because he has a small ulcer at the stump site. His chart states that he has been only “intermittently compliant” with blood glucose testing or insulin administration in the past despite the visit of a community health nurse on a weekly basis over the past year. His renal function has become progressively worse over the past 6 months, and it is anticipated that he will need to begin hemodialysis soon.
His social history reveals that he recently separated from his wife and has no contact with an adult son who lives in another state. He has not worked for more than 10 years and has no insurance other than Medicaid. The home he lives in is small, and he says that he has not been able to maintain it with his wife gone. No formal safety assessment of his home has been conducted. He also acknowledges that he is not eating right because he now must do his own cooking. He cannot drive and states, “I don’t know how I’m going to get to the clinic to have my blood cleaned by the kidney machine.”
ASSIGNMENT:
Mr. Jansen has many problems that would likely benefit from case management intervention.
1. Make a list of five nursing diagnoses for Mr. Jansen that you would use to prioritize your interventions.
2. Then make a list of at least five goals that you would like to accomplish in planning Mr. Jansen’s care. Make sure that these goals reflect realistic patient outcomes.
3. What referrals would you make? What interventions would you implement yourself? Would you involve other disciplines in his plan of care?
4. What is your plan for follow-up and evaluation?
Instruction….
• List which Learning Exercise you are solving at the start of your analysis and provide a brief summary of the case. Be sure to apply an appropriate problem-solving/decision-making model (Traditional Problem-Solving Process, Managerial Decision-Making Model, The Nursing Process, or the Integrated Ethical Problem-Solving Model) in determining what you should do. Justify your decision with supporting evidence
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Solution
Nursing Diagnosis for Mr. Jansen
Higher risk of unstable blood glucose
Deficient knowledge related to the management of type 1 diabetes
Risk for infection
Imbalanced nutrition
A high risk of ineffective therapeutic regimen management (Cárdenas-Valladolid et al., 2018)
5 Goals to Accomplish Related to Mr. Jansen’s Care
To normalize insulin activity of the patient, including normalizing their blood glucose level so as to reduce or prevent the development of any complications that may be vascular or neuropathic in nature.
Provide patient education and ensure that the patient is adequately empowered to adhere to the best treatment regimen for type 1 diabetes.
To demonstrate various techniques and changes to the patient’s lifestyle, which can help prevent the onset of infections and to identify various interventions to reduce the risk of infection on the patient.
To ensure that the patient ingests the appropriate amount of nutrients and calories daily and to ensure that the patient displays their usual energy levels.
To ensure that the patient displays adequate knowledge of various self-care measures related to diabetes and to ensure that the patient is able to effectively verbalize the potential complications related to diabetes in the diabetes disease process (Anderson & Moore, 2017).
Referrals and interventions
To effectively treat the patient with type 1 diabetes mellitus, I would only refer the patient to a nephrologist who would help to assess his renal function and to conduct hemodialysis.
On the other hand, I would implement several interventions on the patient with type 1 diabetes mellitus as their case manager. This would include adopting interventions to normalize the insulin activity of the patient and their blood glucose level, adopting interventions to educate the patient effectively on issues related to type 1 diabetes, and providing interventions to change the patient lifestyle to avoid the risk of infections. I would also add up interventions to ensure that the patient receives a healthy diet and is adequately educated on issues related to type 1 diabetes (Cárdenas-Valladolid et al., 2018).
The first intervention I would implement as a case manager for the type 1 diabetes patient would be to stabilize the patient’s glucose. I will therefore assess the patient for hyperglycemia and assess the patient’s blood glucose levels before meals and at bedtime, monitor the patient’s weight daily, and monitor the patient’s glycosylated hemoglobin. I would then administer insulin consistently to the patient and also teach the patient how to perform effective glucose monitoring at home. I would also educate the patient on how to take insulin as directed.
On the other hand, the second intervention I would conduct on the type 1 diabetes patients would be to adequately educate the patient on all issues related to type 1 diabetes and to ensure that the patient understands the symptoms of low blood glucose levels, adequate insulin injection and the treatment of hypoglycemia and the diet they would need to take (Anderson & Moore, 2017).
The word intervention I would conduct on the type 1 diabetes patient would be to educate the patient on various interventions they would utilize to avoid the risk of infection, such as the gangrenous infection he experienced in the past. To avoid infections, the patient will therefore need to change his lifestyle and come up with a specific strategy to reduce the risk of infections (Anderson & Moore, 2017).
On the other hand, I would involve a nutritionist in the type 1 diabetes patient’s plan of care. The nutritionist would help to develop an adequate food plan for the patient and to ensure that the patient follows the suggested food plan (Anderson & Moore, 2017).
Plan for Follow-Up and Evaluation
Mr. Jansen would need to visit the home health agency every two weeks for evaluation and follow-up of his progress in managing type 1 diabetes.
References
Anderson, N. T., & Moore, E. P. (2017). A Clinical Practice Lifestyle Intervention for Type 2 Diabetes. The Journal for Nurse Practitioners, 13(1), e35–e38. https://doi.org/10.1016/j.nurpra.2016.07.021
Cárdenas-Valladolid, J., López-de Andrés, A., Jiménez-García, R., de Dios-Duarte, M. J., Gómez-Campelo, P., de Burgos-Lunar, C., San Andrés-Rebollo, F. J., Abánades-Herranz, J. C., & Salinero-Fort, M. A. (2018). Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study. BMC Family Practice, 19(1). https://doi.org/10.1186/s12875-018-0800-z