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NURS 6630 Psychopharmacology Assignment Paper NURS 6630 Psychopharmacology Assignment Paper NURS 6630 Midterm and Final Exam Questions and Answers QUESTION 1 A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP). A.NURS 6630 Psychopharmacology Assignment Paper Permalink: https://nursingpaperessays.com/ nurs-6630-psycho…assignment-paper / ? “You have to take your medication to become stable.” BUY NURS 6630 EXAM PAPER HERE 1 points QUESTION 2 Which statement about neurotransmitters and medications is true? NURS 6630 Midterm and Final Exam Questions and Answers The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.NURS 6630 Psychopharmacology Assignment Paper 1 points QUESTION 3 When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 4 During gene expression, what must occur prior to a gene being expressed? A. Transcription factor must bind to the regulatory region within the cell’s nucleus. NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 5 While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? A. Genes impact neuron functioning directly. 1 points QUESTION 6 Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because: NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 7 Why is the cytochrome P450 enzyme system of significance to the PMHNP? NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 8 It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true?NURS 6630 Psychopharmacology Assignment Paper 1 points QUESTION 9 As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice? NURS 6630 Midterm and Final Exam Questions and Answers D. Medications used in practice may act as inverse agonists if the dosage is too high. 1 points QUESTION 10 The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition:NURS 6630 Psychopharmacology Assignment Paper The patient has chronic kidney disease, stage 2. D. Question 20 A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?NURS 6630 Psychopharmacology Assignment Paper a) order herpes simplex virus (HSV) antibody testing d) Prescribe hydromorphone (dilaudid) 2mg Question 21 The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? NURS 6630 Midterm and Final Exam Questions and Answers c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient d) Order a CBC to assess for an infection Question 22 An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do?NURS 6630 Psychopharmacology Assignment Paper a) order an X-ray because it is possible that she dislocated her hip b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon NURS 6630 Midterm and Final Exam Questions and Answers Question 23 The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP?NURS 6630 Psychopharmacology Assignment Paper a) Orders liver function tests NURS 6630 Midterm and Final Exam Questions and Answers d) Order BUN/Creatinine test Question 24 The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?NURS 6630 Psychopharmacology Assignment Paper a) Prescribe estrin FE 24 birth control b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain NURS 6630 Midterm and Final Exam Questions and Answers Question 25 A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? NURS 6630 Midterm and Final Exam Questions and Answers c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex” d) “the SNRI can increase neurotransmission to descending neurons” Question 26 A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?NURS 6630 Psychopharmacology Assignment Paper a) Venlafaxine (Effexor) b) Duloxetine (Cymbalta) c) Clozapine (Clozaril) d) Phenytoin (Dilantin) Question 27 The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels b) It will induce synaptic changes, including sprouting c) It will act on the presynaptic neuron to trigger sodium influx d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain Question 28 Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition?NURS 6630 Psychopharmacology Assignment Paper a) Venlafaxine (Effexor) b) Armodafinil (Nuvigil) NURS 6630 Midterm and Final Exam Questions and Answers Question 29 The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain? a) Methylphenidate (Ritalin) b) Viloxazine (Vivalan) Question 30 The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? a) Pregabalin (Lyrica) d) Atomoxetine (Strattera) Question 31 A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?NURS 6630 Psychopharmacology Assignment Paper a) Pregabalin (Lyrica) b) Gabapentin (Neurontin) NURS 6630 Midterm and Final Exam Questions and Answers Question 32 The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? a) Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” b) Targeting the patient’s symptoms with anticonvulsants that inhibits gray matter loss in the dorsolateral prefrontal cortex c) Mzatching the patient’s symptoms with the malfunctioning brain circuits and neurotransimitters that might mediate those symptoms d) None of the above Question 33 The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?NURS 6630 Psychopharmacology Assignment Paper c) “SSRIs only increase serotonin and norepinephrine levels” d) “SSRIs do not increase serotonin or norepinephrine levels” Question 34 A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? a) Antipsychotics b) Lithium Question 35 Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?NURS 6630 Psychopharmacology Assignment Paper a) “Naltrexone may be an appropriate option to discuss” b) “there are many medicine options that treat Kleptomania” NURS 6630 Midterm and Final Exam Questions and Answers Question 36 Which statement best describes a pharmacological approach to treating patients for impulsive aggression? a) Anticonvulsant mood stabilizers can eradicate limbic irritability b) Atypical antipsychotics can increase subcortical dopaminergic stimulation NURS 6630 Midterm and Final Exam Questions and Answers Question 37 A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?NURS 6630 Psychopharmacology Assignment Paper a) It will prevent feelings of euphoria b) It will amplify impulse control c) It will block testosterone d) It will redirect the patient to think about other things Question 38 Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? a) “Compulsive internet use can be treated similarly to how we treat people with substance use disorders” b) “internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences” Question 39 Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs”, he says. Which statement best describes the neurobiological parallels between food and drug addiction?NURS 6630 Psychopharmacology Assignment Paper a) There is decreased activation of the prefrontal cortex NURS 6630 Midterm and Final Exam Questions and Answers d) There are amplified reward circuits that activate upon consumption Question 40 The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? a) Histamine 2 receptor antagonist b) Benzodiazepines NURS 6630 Midterm and Final Exam Questions and Answers Question 41 The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?NURS 6630 Psychopharmacology Assignment Paper a) Avoiding prescribing the patient a drug that blocks H1 receptors b) Prescribing the patient a drug that acts on H2 receptors c) Stopping the patient from taking medicine that unblocks H1 receptors d) None of the above NURS 6630 Midterm and Final Exam Questions and Answers NURS 6630 Midterm and Final Exam Questions and Answers QUESTION 1 A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP). A. “You have to take your medication to become stable.” BUY NURS 6630 EXAM PAPER HERE 1 points QUESTION 2 Which statement about neurotransmitters and medications is true? NURS 6630 Midterm and Final Exam Questions and Answers The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.NURS 6630 Psychopharmacology Assignment Paper 1 points QUESTION 3 When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 4 During gene expression, what must occur prior to a gene being expressed? A. Transcription factor must bind to the regulatory region within the cell’s nucleus. NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 5 While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?NURS 6630 Psychopharmacology Assignment Paper A. Genes impact neuron functioning directly. 1 points QUESTION 6 Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because: NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 7 Why is the cytochrome P450 enzyme system of significance to the PMHNP? NURS 6630 Midterm and Final Exam Questions and Answers 1 points QUESTION 8 It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true?NURS 6630 Psychopharmacology Assignment Paper 1 points QUESTION 9 As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice? NURS 6630 Midterm and Final Exam Questions and Answers D. Medications used in practice may act as inverse agonists if the dosage is too high. 1 points QUESTION 10 The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition: The patient has chronic kidney disease, stage 2.NURS 6630 Psychopharmacology Assignment Paper D. Question 20 A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? a) order herpes simplex virus (HSV) antibody testing d) Prescribe hydromorphone (dilaudid) 2mg Question 21 The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? NURS 6630 Midterm and Final Exam Questions and Answers c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient d) Order a CBC to assess for an infection Question 22 An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do? a) order an X-ray because it is possible that she dislocated her hip b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon NURS 6630 Midterm and Final Exam Questions and Answers Question 23 The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? a) Orders liver function tests NURS 6630 Midterm and Final Exam Questions and Answers d) Order BUN/Creatinine test Question 24 The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?NURS 6630 Psychopharmacology Assignment Paper a) Prescribe estrin FE 24 birth control b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain NURS 6630 Midterm and Final Exam Questions and Answers Question 25 A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? NURS 6630 Midterm and Final Exam Questions and Answers c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex” d) “the SNRI can increase neurotransmission to descending neurons” Question 26 A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? a) Venlafaxine (Effexor) b) Duloxetine (Cymbalta) c) Clozapine (Clozaril) d) Phenytoin (Dilantin) Question 27 The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels b) It will induce synaptic changes, including sprouting c) It will act on the presynaptic neuron to trigger sodium influx d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain Question 28 Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition?NURS 6630 Psychopharmacology Assignment Paper a) Venlafaxine (Effexor) b) Armodafinil (Nuvigil) NURS 6630 Midterm and Final Exam Questions and Answers Question 29 The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain? a) Methylphenidate (Ritalin) b) Viloxazine (Vivalan) Question 30 The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?NURS 6630 Psychopharmacology Assignment Paper a) Pregabalin (Lyrica) d) Atomoxetine (Strattera) Question 31 A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?NURS 6630 Psychopharmacology Assignment Paper a) Pregabalin (Lyrica) b) Gabapentin (Neurontin) NURS 6630 Midterm and Final Exam Questions and Answers Question 32 The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?NURS 6630 Psychopharmacology Assignment Paper a) Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” b) Targeting the patient’s symptoms with anticonvulsants that inhibits gray matter loss in the dorsolateral prefrontal cortex c) Mzatching the patient’s symptoms with the malfunctioning brain circuits and neurotransimitters that might mediate those symptoms d) None of the above Question 33 The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? c) “SSRIs only increase serotonin and norepinephrine levels” d) “SSRIs do not increase serotonin or norepinephrine levels” Question 34 A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?NURS 6630 Psychopharmacology Assignment Paper a) Antipsychotics b) Lithium Question 35 Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? a) “Naltrexone may be an appropriate option to discuss” b) “there are many medicine options that treat Kleptomania” NURS 6630 Midterm and Final Exam Questions and Answers Question 36 Which statement best describes a pharmacological approach to treating patients for impulsive aggression? a) Anticonvulsant mood stabilizers can eradicate limbic irritability b) Atypical antipsychotics can increase subcortical dopaminergic stimulation NURS 6630 Midterm and Final Exam Questions and Answers Question 37 A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?NURS 6630 Psychopharmacology Assignment Paper a) It will prevent feelings of euphoria b) It will amplify impulse control c) It will block testosterone d) It will redirect the patient to think about other things Question 38 Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?NURS 6630 Psychopharmacology Assignment Paper a) “Compulsive internet use can be treated similarly to how we treat people with substance use disorders” b) “internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences” Question 39 Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs”, he says. Which statement best describes the neurobiological parallels between food and drug addiction?NURS 6630 Psychopharmacology Assignment Paper a) There is decreased activation of the prefrontal cortex NURS 6630 Midterm and Final Exam Questions and Answers d) There are amplified reward circuits that activate upon consumption Question 40 The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? a) Histamine 2 receptor antagonist b) Benzodiazepines NURS 6630 Midterm and Final Exam Questions and Answers Question 41 The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?NURS 6630 Psychopharmacology Assignment Paper a) Avoiding prescribing the patient a drug that blocks H1 receptors b) Prescribing the patient a drug that acts on H2 receptors c) Stopping the patient from taking medicine that unblocks H1 receptors d) None of the above NURS 6630 Midterm and Final Exam Questions and Answers As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.NURS 6630 Psychopharmacology Assignment Paper ORDER A PLAGIARISM-FREE PAPER NOW NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.NURS 6630 Psychopharmacology Assignment Paper Chapter 1, “Chemical Neurotransmission” Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action” Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action” Document: Midterm Exam Study Guide (PDF) Document: Final Exam Study Guide (PDF) Required Media Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Note: The approximate length of this media piece is 3 minutes. Accessible player Optional Resources Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Note: The approximate length of this media piece is 15 minutes. Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain.NURS 6630 Psychopharmacology Assignment Paper Accessible player Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Note: The approximate length of this media piece is 8 minutes. In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse.NURS 6630 Psychopharmacology Assignment Paper Accessible player To prepare for this Discussion: Review this week’s Learning Resources. Reflect on concepts of foundational neuroscience. Week 3 discussion Discussion: The Impact of Ethnicity on Antidepressant Therapy Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.NURS 6630 Psychopharmacology Assignment Paper Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 7, “Antidepressants” Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. Review the following medications: NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment amitriptylinE bupropion citalopram clomipramine desipramine NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment To prepare for this Discussion: Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.NURS 6630 Psychopharmacology Assignment Paper Case 1: Volume 1, Case #1: The man whose antidepressants stopped working Case 2: Volume 1, Case #7: The case of physician do not heal thyself Case 3: Volume 1, Case #29: The depressed man who thought he was out of options Review this week’s Learning Resources and reflect on the insights they provide. Go to the Stahl Online website and examine the case study you were assigned.NURS 6630 Psychopharmacology Assignment Paper Take the pretest for the case study. Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office. Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).NURS 6630 Psychopharmacology Assignment Paper Consider whether any additional physical exams or diagnostic testing may be necessary for the patient. Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance. Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Review the posttest for the case study. Week 7 discussion Discussion: Sleep/Wake Disorders It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep.NURS 6630 Psychopharmacology Assignment Paper A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors.NURS 6630 Psychopharmacology Assignment Paper NURS

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NURS 4105 – Advocacy Through Healthcare Policy Research Paper NURS 4105 – Advocacy Through Healthcare Policy Research Paper What is Health Policy Advocacy? Advocacy is defined as the support or defense of a cause and the act of leading on behalf of another person. Nurses engage in advocacy every day on behalf of their patients. In nursing practice, this means that nurses promote and strive to protect the health, safety, and rights of patients. Nurses also collaborate with other health professionals and the public to promote community, national, and international efforts to meet health needs. Furthermore, nurses advocate for the nursing profession and professional standards of practice. ORDER NOW FOR PLAGIARISM-FREE NURSING PAPERS Health Policy & Advocacy Committee The HP&A Committee of NAAN/NANNI (hereafter referred to collectively as NANN) acts to promote NANN as the professional voice that shapes neonatal nursing through excellence in practice, research, education and professional development.NURS 4105 – Advocacy Through Healthcare Policy Research Paper On behalf of NANN, the Committee pursues and promotes NANN’s legislative agenda by monitoring and responding to legislation, governmental regulations, and administrative actions that affect neonatal nurses, neonatal nurse practitioners, and the patients and families they serve. The Committee also encourages and assists NANN members to become involved in grassroots legislative activities in pursuit of common goals. NANN is not large enough to have, like some organizations, our own legislative representative or lobbyist. Even so, there is much we can do at the grassroots level, and to increase our effectiveness, NANN and NANNP are joined in these activities. Turning Outrage into Action Every day, people have experiences that are frustrating, unbelievable, or so outrageous that they think, “How can this be? There ought to be a law!” Nurses often experience this frustration in their day-to-day practice- fighting with managed care, facing inadequate Medicare reimbursement, and struggling with inadequate staffing or unsafe working conditions. Also every day, federal and state legislators are making decisions that affect neonatal nursing and our patients, often with very little knowledge or understanding of the issues and with little or no input from nurses. We can’t afford to let this happen. We must contribute our authority, leadership, and unique knowledge of neonatal nursing to the legislative process, or suffer the consequences.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Permalink: https://nursingpaperessays.com/ nurs-4105-advoca…y-research-paper / ? Health policy advocacy means channeling this sense of outrage about inadequately conceived laws, policies, and regulations or about the absence of a law when the need for one is clear. Advocates let policymakers know what they, as citizens and constituents, believe elected officials should do. Health policy advocacy can be easy, and it can make a difference in the outcome of our nation’s policy decisions. It doesn’t require any new skills, it just involves applying skills you already have, such as communication and building relationships, in a new context. Advocacy is a Right and a Responsibility Polls have found that Americans’ knowledge of television shows such as The Simpsons and American Idol far surpasses their familiarity with the First Amendment of the U.S. Constitution. The First Amendment guarantees freedom of speech, the press, religion, the right to peacefully assemble, and the right to petition the government for a redress of grievances. So if you are thinking, who am I to lobby Congress? I am just a nurse! The U.S. Constitution grants us the right to tell our elected officials our concerns and to take action to address them. Policymakers work for the citizens. Your tax dollars pay their salaries, their health insurance, retirement benefits, and travel. As their “employer,” you have every right to hold them accountable for their actions, tell them what you want them to do, and give feedback on how you think they are doing at their jobs.NURS 4105 – Advocacy Through Healthcare Policy Research Paper The ultimate job review you can give your public officials is by voting – either returning them to office or ending their service. The United States has a participatory democracy and representative government. Becoming involved is not only a right, but also a responsibility. And finally, Congress needs the expertise of nurses. Nurses have first-hand direct bedside experience and understanding of how decisions in Washington affect constituents. Nurses understand the “big picture,” relating to health issues. Nurses are trusted, tenacious, and reliable. Advocacy and health policy have important implications for what we do every day. Unless we communicate with lawmakers about key issues, laws and regulations will be created and enacted without the benefit of our expertise and unique perspectives. Nurse are a powerful and well-respected constituency; our active involvement in health policy issues helps policymakers take action on key issues, such as the nursing shortage. Engaging nurses in health policy advocacy is essential to ensuring that nursing and NANN’s priorities are received and addressed by policymakers. We can and must become involved in health policy advocacy. The following sections of this Health Policy & Advocacy Toolkit provide the tools needed to become effective health policy advocates at the national, state, and local level.NURS 4105 – Advocacy Through Healthcare Policy Research Paper What is a Healthcare Policy Advocate? One of the newest professions to emerge in the burgeoning healthcare system is that of a Healthcare Policy Advocate. This person speaks for patients who are at their most vulnerable state in an environment of increasing healthcare costs and privacy concerns that sometimes block access to resources. What does this profession entail and who are the people that work in the advocate position? Why Advocates are Needed The average household in the United States spends roughly $15,000 on healthcare each year, according to an article in a New York Times blog. That includes insurance premiums, Medicare taxes, Medicaid expenses and other costs in addition to out-of-pocket charges. The U.S. also spends a sixth of its annual gross product on providing healthcare. The health industry is big business. According to an article found in the Journal of Medical Ethics, the medical profession has, at its core, the goal of promoting a patient’s best interests, but, in reality, that must be tempered with an eye to the good of the community. In other words, what is good NURS 4105 – Advocacy Through Healthcare Policy Research Paper Who are Advocates? Some advocates work for healthcare facilities, some are employed by insurance companies, some work for “advocacy agencies” and some work as private practitioners. Obviously, the best advocate would be the patient, but advocacy is needed at a point when the patient is most vulnerable. Family or friends are also sometimes advocates. With all of these people, though, there may be a conflict of interests. Even family members sometimes struggle with how the wishes of the patient will impact their lives. What Do Advocates Do? There are two kinds of advocates: those who advocate for a class, and those who advocate for the individual. Nurses advocate for patients by attempting to change the system. Other advocates work on a more personal level, in face-to-face contact with their clients. Some of their duties are:NURS 4105 – Advocacy Through Healthcare Policy Research Paper Helping with insurance claims Informing patients of all treatment options Negotiate bills. This is especially true of an advocate who works for an insurance company or a healthcare facility. Support the patient emotionally Support patient decisions and make sure these are expressed to the healthcare providers. Educate the patient about his illness and possible treatments. The role of the advocate is not well-defined, because the position is so new and there are advocates from so many entities. The focus of the advocacy will depend upon who employs the advocate. In addition, there is a debate over whether the advocate should push for all patient requests or act in a parental capacity to advocate for what is actually in the patient’s best interests.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Policy & Advocacy With experience across a range of policy areas and issues, combined with our strong record working side-by-side with business, government, and community-based organizations, PHI and its programs are effective, influential advocates for public health in local, state and federal policy. Building on this success, PHI is now working to strengthen its role in U.S.-based policy that has implications for health domestically and worldwide. With strategic policy platforms, PHI addresses policy in areas such as obesity prevention, climate change and health reform. In addition, PHI tracks federal and state legislation, regulations and budgeting processes across a wide range of issues that impact the public’s health, and advances policy solutions that address the social determinants of health.NURS 4105 – Advocacy Through Healthcare Policy Research Paper PHI continues to produce forward-thinking research to support the public health perspective as it relates to many of the most complex policy challenges facing the nation today, including: agriculture and nutrition, transportation planning, climate change, economic development, obesity prevention, healthy communities, telehealth and health information technology, and alcohol, tobacco and substance use.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Policy advocacy is defined as active, covert, or inadvertent support of a particular policy or class of policies. [1] Whether it is proper for scientists and other technical experts to act as advocates for their personal policy preferences is contentious. In the scientific community, much of the controversy around policy advocacy involves precisely defining the proper role of science and scientists in the political process. [2] Some scientists choose to act as policy advocates, while others regard such a dichotomous role as inappropriate. [3] Providing technical and scientific information to inform policy deliberations in an objective and relevant way is recognized as a difficult problem in many scientific and technical professions. [4] The challenge and conflicts have been studied for those working as stock analysts in brokerage firms, [5] for medical experts testifying in malpractice trials, [6] for funding officers at international development agencies, [7] and for intelligence analysts within governmental national security agencies. [8] The job of providing accurate, relevant, and policy neutral information is especially challenging if highly controversial policy issues (such as climate change) that have a significant scientific component. [9] The use of normative science by scientists is a common method used to subtly advocate for preferred policy choices. [10]NURS 4105 – Advocacy Through Healthcare Policy Research Paper Defining policy advocacy The most basic meaning of advocacy is to represent, promote, or defend some person(s), interest, or opinion. Such a broad idea encompasses many types of activities such as rights’ representation 1 and social marketing 2 , but the focus of this manual is on the approaches adopted by organizations and coalitions in trying to change or preserve specific government programs, that is, approaches focused on influencing decisions of public policy. In order to distinguish this from other types of advocacy activities, it is often referred to as “policy advocacy.” This is also the term we use throughout the guide to make this distinction clear. There are many definitions of policy advocacy available from multiple authors and perspectives 3 . At their core are a number of ideas that continually come up, characterizing policy advocacy as follows: a strategy to affect policy change or action — an advocacy effort or campaign is a structured and sequenced plan of action with the purpose to start, direct, or prevent a specific policy change.NURS 4105 – Advocacy Through Healthcare Policy Research Paper a primary audience of decision makers — the ultimate target of any advocacy effort is to influence those who hold decision-making power. In some cases, advocates can speak directly to these people in their advocacy efforts; in other cases, they need to put pressure on these people by addressing secondary audiences (for example, their advisors, the media, the public). a deliberate process of persuasive communication — in all activities and communication tools, advocates are trying to get the target audiences to understand, be convinced, and take ownership of the ideas presented. Ultimately, they should feel the urgency to take action based on the arguments presented. a process that normally requires the building of momentum and support behind the proposed policy idea or recommendation. Trying to make a change in public policy is usually a relatively slow process as changing attitudes and positions requires ongoing engagement, discussion, argument, and negotiation.NURS 4105 – Advocacy Through Healthcare Policy Research Paper conducted by groups of organized citizens —normally advocacy efforts are carried out by organizations, associations, or coalitions represent the interests or positions of certain populations, but an individual may, of course, spearhead the effort. However, taking these basic elements outlined above a little further and emphasizing the specific challenge that we develop in this chapter, our definition is as follows: Policy advocacy is the process of negotiating and mediating a dialogue through which influential networks, opinion leaders, and ultimately, decision makers take ownership of your ideas, evidence, and proposals, and subsequently act upon them. In our definition, we place a great emphasis on the idea of the transfer of ownership of core ideas and thinking. In essence, this implies preparing decision makers and opinion leaders for the next policy window or even pushing them to open one in order to take action. If advocates do their job well, decision makers will take the ideas that have been put forward and make changes to the current policy approach in line with that thinking.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve community health and enhance health policy initiatives focused on available, safe and quality care. Health advocates are best suited to address the challenge of patient-centered care in our complex healthcare system. The Institute of Medicine (IOM) defines patient-centered care as: Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. [1] Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design. [2] Patient representatives, ombudsmen, educators, care managers, patient navigators and health advisers are health advocates who work in direct patient care environments, including hospitals, community health centers, long term care facilities, patient services programs of non-profit organizations or in private, independent practice. They collaborate with other health care providers to mediate conflict and facilitate positive change, and as educators and health information specialists, advocates work to empower others.NURS 4105 – Advocacy Through Healthcare Policy Research Paper In the policy arenas health advocates work for positive change in the health care system, improved access to quality care, protection and enhancement of patient’s rights from positions in government agencies, disease-specific voluntary associations, grassroots and national health policy organizations and the media. There may be a distinction between patient advocates, who work specifically with or on behalf of individual patients and families, or in disease-specific voluntary associations, and health advocates, whose work is more focused on communities, policies or the system as a whole. Often, however, the terms “patient advocate” and “health advocate” are used interchangeably NURS 4105 – Advocacy Through Healthcare Policy Research Paper Rapidly growing areas of health advocacy include advocates in clinical research settings, particularly those focused on protecting the human subjects of medical research, advocates in the many disease-specific associations, particularly those centered on genetic disorders or widespread chronic conditions, and advocates who serve clients in private practice, alone or in larger companies. With member hospitals, the Children’s Hospital Association works with policymakers—both in Congress and in the administration (White House and federal agencies)—to ensure children’s unique health care needs are considered and that every child has access to high quality, cost effective health care services tailored to meet their needs. We are the nation’s leading voice advocating on behalf of children’s hospitals and the millions of children they serve. NURS 4105 – Advocacy Through Healthcare Policy Research Paper ORDER NOW FOR PLAGIARISM-FREE NURSING PAPERS Through its advocacy efforts, the association: Works with member hospitals and Congress to craft, reform and promote health care legislation to benefit children, especially those with complex medical conditions Educates federal policymakers, both during legislative drafting and policy implementation about key issues that impact children’s health and children’s hospitals Analyzes and synthesizes federal legislation and regulations for their impact on children’s health care, and organizes input from a network of more than 220 children’s hospitals Assist children’s hospitals in understanding how federal policy may impact children’s health care in their communities Mobilizes a grassroots network of thousands of parents, health care providers and others concerned about children’s health to influence Congressional action Provides tools to advance children’s hospitals’ advocacy efforts at national, state and local levels Collaborates with other organizations concerned with children’s health to advance shared policy goals and amplify our reach on Capitol Hill, within the White House and key federal agencies, and in traditional and social media Health advocacy Advocacy is one strategy to raise levels of familiarity with an issue and promote health and access to quality health care and public health services at the individual and community levels. When trying to gain political commitment, policy support, social acceptance and systems support for a particular public health goal or program-me, a combination of individual and social actions may be used to try to affect change. This is one way of understanding Health Advocacy. The adoption of a health advocacy model can focus on an educational dimension when it identifies emerging public health issues that require action. It encompasses gathering information on existing practice related to public health, related legislation monitoring and providing feedback on how specific regulations impact local groups and communities. It may also help guiding health policy reforms. Often, health advocacy is carried out using mass and multi-media, direct political lobbying and community mobilization. It may materialize within an institution or through public health associations, patients’ organizations, private sector and NGOs. All health professionals have a major responsibility to act as advocates for public health at all levels in society.NURS 4105 – Advocacy Through Healthcare Policy Research Paper The National Association of Healthcare Advocacy is the professional healthcare advocacy organization; we are dedicated to the improvement of patient outcomes through continuing education, promotion of national standards of practice, and active pursuit of policy changes, leading to a high standard of person-centered healthcare. We promote rigorous standards for the practice of advocacy including ethical considerations and codes of conduct when providing medical decision-making support. We educate consumers and healthcare professionals on research and current trends in patient-centered navigation, advocacy and decision-making support. We partner with individual advocates and other grassroots organizations to collaborate on patient-centered reforms that maximize use of the healthcare system, protect consumer choice and improve access to high quality, affordable care. Health Policy and Advocacy Group The purpose of the Health Policy and Advocacy Group is to identify public policy issues and concerns affecting surgeons and our patients; prioritize these issues and concerns, identify those on which the American College of Surgeons (ACS) should focus its attention and resources, and recommend these priorities to the Board of Regents; develop action plans for addressing these issues, including recommending positions and initiatives the College should adopt; expand and monitor mechanisms by which the ACS makes surgeons, our patients, and the public aware of our health policies and agendas; and develop and maintain mechanisms by which legislative and regulatory issues can be addressed in a timely and effective manner.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Nursing Advocacy: Standing Up for Patients and the Profession When it comes to patient care, nurses consistently play the role of advocate as they support each patient’s emotional well-being, contribute to the healing process and speak on their patients’ behalf. Nurses can also put their advocacy skills to work in advocating for each other and for the nursing profession as a whole. “As nursing advocates we start with the foundation that we are servants to others and stewards of our profession,” said Ellen Noel, MN, RN-BC, clinical nurse specialist at Virginia Mason Medical Center (VMMC) in Seattle. “As an advocate we choose to lead from that servant position, making sure peoples’ needs are being met through wise and thoughtful interactions.” VMMC is creating a model of care based on the caring theory developed by Kristen Swanson, RN, Ph.D., FAAN, which provides a clear outline for advocating for patients and co-workers. Swanson’s five steps of caring are: knowing, being with, doing for, enabling and maintaining belief.NURS 4105 – Advocacy Through Healthcare Policy Research Paper “With the caring model, you start with the assumption that the person you are working with has valuable skills, that they are trying hard, that they want to improve and learn and that they have the best intentions,” explained Noel. “When you start with that attitude you give that person the best chance of taking control of their circumstances and reaching success.” “While we are just at the beginning of working out the logistics of implementing the caring model, we are already seeing an increase in awareness, empathy and understanding with others on the team,” remarked Alison Pyle, MN, MPH, RN, clinical director of the hospital’s nephrology/urology/neurology unit that is taking part in the pilot project. While a lot is written about the bullying that can go on within the nursing profession, Christine Szweda RN, BSN, MS, NE-BC, director of nursing education for competency and assessment at The Cleveland Clinic, believes nurses can instead provide each other with a powerful support network.NURS 4105 – Advocacy Through Healthcare Policy Research Paper “When it comes to supporting each other, it is great when nurses not only encourage a peer who is considering furthering his or her education, but when co-workers are also willing to be flexible with schedule changes that accommodate another nurse’s schooling needs,” she said. “Early in my career I decided I wasn’t going to talk about people in terms of their nursing education, because it was only divisive,” reflected Connie Curran, Ed.D., RN, FAAN, editor emeritus, Nursing Economic$ . “I have also made a commitment that when I find myself in a position of privilege, to respond by trying to get another nurse there as well. I was serving on a hospital board and realized I was the only nurse on the board. It turns out that nurses only make up 2 percent of hospital board members, but they are the ones who are there evenings and nights and know how the hospital works.” In response to this commitment, Curran started the company Best On Board, which is an educational program to help nurses get the education and certification they need to serve on boards. As board members, nurses have the influence and the know-how to create good environments for patients and caregivers. There are a number of ways that nurses can be involved in advocating for the nursing profession. Sometimes it is as simple as being the best nurse you can be and speaking with pride about the work you and other nurses do; it can also mean being involved in research, politics or with one’s professional organization. Most often, working to improve the profession also benefits patient care. “It is increasingly common for even young nurses to have opportunities to be involved in research that contributes to the body of knowledge of nursing science,” commented Szweda. “But even if you aren’t personally involved in research, you can be quick to share and implement best practices and support the research that has been done.”NURS 4105 – Advocacy Through Healthcare Policy Research Paper “Along those lines, be quick to embrace technology,” she continued. “I read a lot about nurses resisting the electronic medical record, but the richness of data that can be kept there will not only contribute to the body of knowledge, but having a consistent and integrated patient health record drives patient safety and better care.” Noel believes that a key component of nursing advocacy is to hold tight to procedures and competencies that ensure patients are safe, while also including staff nurses in determining how these evidence-based practices will be implemented. Through this approach VMMC has made significant improvements in the areas of preventing pressure wounds, patient falls and medication errors. “Participating in your professional society is a powerful way to advocate for the nursing profession and for patients,” remarked Charlotte L. Guglielmi, RN, BSN, MA, CNOR, preoperative nurse specialist at Beth Israel Deaconess Medical Center and immediate past president of the Association of preoperative Nurses (AORN). Ways Nurses Can Advocate for Patients Many nurses think of advocacy as the most important role we play in patient care. We need to remember that to best serve patients, we must have our own house in order. That house includes the other healthcare professionals with whom we and our patients interact, as well as the organizations providing those services and the policies and legislation that influence them. How can oncology nurses advocate for patients every day? Here are some examples.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Ensure Safety. Ensure that the patient is safe when being treated in a healthcare facility, and when they are discharged by communicating with case managers or social workers about the patient’s need for home health or assistance after discharge, so that it is arranged before they go home. Give Patients a Voice. Give patients a voice when they are vulnerable by staying in the room with them while the doctor explains their diagnosis and treatment options to help them ask questions, get answers, and translate information from medical jargon. Educate. Educate patients on how to manage their current or chronic condition to improve the quality of their everyday life is an important way nurses can make a difference. Patients undergoing chemotherapy can benefit from the nurse teaching them how to take their anti-nausea medication in a way that will be most effective for them and will allow them to feel better between treatments. Protect Patients’ Rights. Protect patients’ rights by knowing their wishes¾this might include communicating those to a difficult family member who might disagree with the patient’s choices and could upset the patient. Double Check for Errors. Everyone makes mistakes. Nurses can catch, stop, and fix errors, and flag conflicting orders, information, or oversights by physicians or others caring for the patient. Read the orders and previous documentation carefully, double check with other nurses and the pharmacist, and call the doctor if something is unclear before administering chemotherapy.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Connect Patients to Resources. Help patients find resources inside or outside the hospital to support their well-being. Be aware of resources in the community that you can share with the patient such as financial assistance, transportation, patient or caregiver support networks, or helping them meet other needs. While we function as advocates for patients, many of the tasks we do become automatic and we can forget they are really about advocacy. When we are short-staffed or tired, our ability to advocate becomes compromised. Advocacy for patients doesn’t happen in a vacuum. Every patient’s care is affected by the environment in which their care is provided, and the individuals providing that care. This means nurses need to have the time to be able to do these things and to become aware of patient needs, communicate, and follow through. The nurse needs to come to work not exhausted or burned out. A safe patient load is necessary, as well as support and backup from other staff in the facility. Administrators must understand our role as advocates for patients, so they can provide adequate staffing levels and an environment that allows us to fully care for our patients. When the administration does not understand, it is part of our advocacy duty to inform them. NURS 4105 – Advocacy Through Healthcare Policy Research Paper In my next post I will explore how nurses also play important roles as advocates for their own profession, and within the greater healthcare space where we exist, intertwined with physicians and other healthcare professionals who ultimately serve patients. ORDER NOW FOR PLAGIARISM-FREE NURSING PAPERS Effective nurse advocacy Advocacy means using one’s position to support, protect, or speak out for the rights and interests of another. Nurses have long claimed patient advocacy as fundamental to their practice. The American Nurses Association’s Code of Ethics for Nurses and Scope and Standards of Nursing Practice clearly identify nurses’ ethical and professional responsibility for protecting the safety and rights of their patients. State nursing practice acts may establish a legal duty for patient advocacy as well.NURS 4105 – Advocacy Through Healthcare Policy Research Paper Why must nurses advocate? Patient safety depends on nurse advocacy. Over 10 years ago, the Institute of Medicine (IOM) shocked the nation when it reported in To Err is Human: Building a Safer Health System that an amazing 100,000 deaths each year were attributable to medical errors. In 2004, the IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses highlighted the critical role of nurses in safety efforts and challenged organizations to design work environments in which nurses can provide safe care. Nurses are at the “sharp end” of errors in health care. Because of their proximity and continuity with patients, nurses are often the last opportunity to prevent an error—to spot a mislabeled I.V. bag before it’s infused, to recognize that a patient’s allergy band doesn’t match the medication administration record, to identify slight changes in a patient’s condition that could signal a significant c

Portal Hypertension and Effects of Portal Hypertension Essay Paper Portal Hypertension and Effects of Portal Hypertension Essay Paper Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal system develops. This increased pressure in the portal vein may lead to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area (belly button). Varices can rupture and bleed, resulting in potentially life-threatening complications. Portal Hypertension and Effects of Portal Hypertension Essay Paper Permalink: https://nursingpaperessays.com/ portal-hypertens…sion-essay-paper / In cirrhosis, tissue fibrosis and regeneration increase resistance in the sinusoids and terminal portal venules. However, other potentially reversible factors contribute; they include contractility of sinusoidal lining cells, production of vasoactive substances (eg, endothelins, nitric oxide), various systemic mediators of arteriolar resistance, and possibly swelling of hepatocytes. Over time, portal hypertension creates portosystemic venous collaterals. They may slightly decrease portal vein pressure but can cause complications. Engorged serpentine submucosal vessels (varices) in the distal esophagus and sometimes in the gastric fundus can rupture, causing sudden, catastrophic GI bleeding. Bleeding rarely occurs unless the portal pressure gradient is > 12 mm Hg. Gastric mucosal vascular congestion (portal hypertensive gastropathy) can cause acute or chronic bleeding independent of varices. Visible abdominal wall collaterals are common; veins radiating from the umbilicus (caput medusae) are much rarer and indicate extensive flow in the umbilical and periumbilical veins. Collaterals around the rectum can cause rectal varices that can bleed. Portosystemic collaterals shunt blood away from the liver. Thus, less blood reaches the liver when portal flow increases (diminished hepatic reserve). In addition, toxic substances from the intestine are shunted directly to the systemic circulation, contributing to portosystemic encephalopathy. Venous congestion within visceral organs due to portal hypertension contributes to ascites via altered Starling forces. Splenomegaly and hypersplenism commonly occur as a result of increased splenic vein pressure. Thrombocytopenia, leukopenia, and, less commonly, hemolytic anemia may result. Portal Hypertension and Effects of Portal Hypertension Essay Paper Portal hypertension is often associated with a hyperdynamic circulation. Mechanisms are complex and seem to involve altered sympathetic tone, production of nitric oxide and other endogenous vasodilators, and enhanced activity of humoral factors (eg, glucagon). Symptoms and Signs Portal hypertension is asymptomatic; symptoms and signs result from its complications. The most dangerous is acute variceal bleeding. Patients typically present with sudden painless upper GI bleeding, often massive. Bleeding from portal hypertensive gastropathy is often subacute or chronic. Ascites, splenomegaly, or portosystemic encephalopathy may be present. Diagnosis Usually clinical evaluation Portal hypertension is assumed to be present when a patient with chronic liver disease has collateral circulation, splenomegaly, ascites, or portosystemic encephalopathy. Proof requires measurement of the hepatic venous pressure gradient, which approximates portal pressure, by a transjugular catheter; however, this procedure is invasive and usually not done. Imaging may help when cirrhosis is suspected. Ultrasonography or CT often reveals dilated intra-abdominal collaterals, and Doppler ultrasonography can determine portal vein patency and flow. Esophagogastric varices and portal hypertensive gastropathy are best diagnosed by endoscopy, which may also identify predictors of esophagogastric variceal bleeding (eg, red markings on a varix). Portal Hypertension and Effects of Portal Hypertension Essay Paper Prognosis Mortality during acute variceal hemorrhage may exceed 50%. Prognosis is predicted by the degree of hepatic reserve and the degree of bleeding. For survivors, the bleeding risk within the next 1 to 2 yr is 50 to 75%. Ongoing endoscopic or drug therapy lowers the bleeding risk but decreases long-term mortality only marginally. For treatment of acute bleeding, see Overview of GI Bleeding : Treatment and Varices : Treatment. Treatment Ongoing endoscopic therapy and surveillance Nonselective beta-blockers with or without isosorbide mononitrate Sometimes portal vein shunting When possible, the underlying disorder is treated. Long-term treatment of esophagogastric varices that have bled is a series of endoscopic banding sessions to obliterate residual varices, then periodic surveillance endoscopy for recurrent varices. Long-term drug therapy for varices that have bled involves nonselective beta-blockers; these drugs lower portal pressure primarily by diminishing portal flow, although the effects vary. They include propranolol (40 to 80 mg po bid), nadolol (40 to 160 mg po once/day), timolol (10 to 20 po bid), and carvedilol (6.25 to 12.5 mg po bid), with dosage titrated to decrease heart rate by about 25%. Adding isosorbide mononitrate 10 to 20 mg po bid may further reduce portal pressure. Combined long-term endoscopic and drug therapy may be slightly more effective than either alone. Portal Hypertension and Effects of Portal Hypertension Essay Paper Patients who do not adequately respond to either treatment should be considered for transjugular intrahepatic portosystemic shunting (TIPS) or, less frequently, a surgical portacaval shunt. In TIPS, the shunt is created by placing a stent between the portal and hepatic venous circulation within the liver. (See also the American Association for the Study of Liver Diseases practice guideline The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: Update 2009.) Although TIPS may result in fewer immediate deaths than surgical shunting, particularly during acute bleeding, maintenance of patency may require repeat procedures because the stent may become stenosed or occluded over time. Long-term bene Portal hypertension is the major complication of cirrhosis and is responsible for complications such as massive gastrointestinal bleeding (oesophageal or gastric varices), ascites, hepatorenal syndrome, and hepatic encephalopathy. Portal hypertension is defined by a raised portal pressure above the normal values of 1–5 mm Hg; clinically significant portal hypertension is defined above the threshold of 12 mm Hg due to the potential development of portal hypertensive bleeding,1 the most serious complication of portal hypertension, as it is associated with high morbidity and mortality rate.2 Prospective studies have shown that more than 90% of cirrhotic patients will develop oesophageal varices sometime in their lifetime and of these 30% will bleed,3,4 and usually once developed, the varices increase from small to large, though regression has been reported with the improvement in liver function and abstinence from alcohol.5,6 The most important predictive factors for the risk of bleeding are severity of liver dysfunction (Child-Pugh classification; see table1), larger size of varices (increased tension of the variceal wall), and presence of red signs on the varices. These factors are combined in the North Italian Endoscopic Club Index for the prediction of the first bleeding. It is important to realise that patients with small varices and no red signs and Child-Pugh C score have a risk of 20% for first bleeding compared with a patient with Child-Pugh A score, large varices, and moderate red signs who has a 24% risk and a Child-Pugh C patient with small varices and moderate red signs who has a risk of 36%, thus underlying the importance of the liver function impairment. Portal Hypertension and Effects of Portal Hypertension Essay Paper However 30% of patients will first bleed without these risk factors.4 Increased variceal pressure has been shown to add to this model.7 Moreover, 5%–50% of cirrhotic patients (depending on the severity of the underlying liver dysfunction) with acute variceal bleeding will die often during the first days after the initial episode.2 Predictive factors of failure to control bleeding are active bleeding at endoscopy spurting or oozing (usually at the oesophagogastric junction), severity of liver disease,8 raised portal pressure hepatic venous pressure gradient (HVPG) ?20 mm Hg measured early after admission,9 and presence of bacterial infection.10 There is a high rate of early rebleeding in the first weeks after bleeding, which without specific treatment occurs in up to 50% within six weeks of admission.11 Although mortality from acute variceal bleeding has been decreasing,12,13 it still remains high (5%–35%) depending on the severity of liver disease and the age of the patient. There is a well documented association of variceal haemorrhage and bacterial infections10,14,15 that may represent a causal relationship. A hypothesis suggests infection is the triggering factor for the variceal bleeding.16 Two crucial steps for the onset of haemorrhage, which are related to the release of endotoxin into the systemic circulation, are vasoconstrictor induced contraction of stellate cells and worsening of haemostasis. Portal Hypertension and Effects of Portal Hypertension Essay Paper Portal hypertensive gastropathy (PHG) is a term used to describe the endoscopic appearance of the gastric mucosa, with characteristic mosaic-like pattern with or without cherry red spots, and is a common finding in patients with portal hypertension. Histologically there are dilated capillaries and venules in the mucosa and submucosa without erosion, inflammation, or fibrinous thrombi.17 The pathogenesis is not clearly defined and its prevalence parallels the severity of portal hypertension. It can progress from mild to severe and vice versa or even disappear completely, but bleeding is relatively uncommon and rarely severe.18 The same vasoactive agents used for variceal bleeding are used for PHG bleeding.19 In an uncontrolled study, somatostatin and octreotide has been shown effective in the context of acute bleeding from PHG.20 Endoscopic treatment does not have a role, whereas transjugular intrahepatic portosystemic shunts (TIPSs) and shunt surgery should be only used as a last resort and in patients where the benefit outweighs the risk. Only non-selective ?-blockers can prevent first and secondary bleeding from PHG.21 ACUTE VARICEAL BLEEDING (1) General management The cirrhotic patient is a complicated one who requires intensive nursing care and careful medical assessment. In particular, effective resuscitation, accurate diagnosis, and early treatment can reduce mortality.22 The initial priority is the protection of airway to prevent aspiration, with intubation to be considered in patients with impaired level of consciousness and severe uncontrolled bleeding particularly for endoscopy. A normal central venous pressure should be maintained (avoidance of prolonged hypovolaemia is very important to avoid the complications of renal failure and infection), but over transfusion (according to data from animal models) should be avoided because of the risk for rebound increase in portal pressure, with subsequently increased risk of poor control of bleeding. Portal Hypertension and Effects of Portal Hypertension Essay Paper Most importantly, prophylaxis of bacterial infection with oral quinolones or intravenous broad spectrum antibiotics has been shown not only to reduce infectious complications (relative risk (RR) 0.39; 95% confidence interval (CI) 0.32 to 0.48) but also to reduce mortality (RR 0.39; 95% CI 0.32 to 0.48).24 The effect on mortality is greater than that seen with specific vasoactive drugs versus placebo. Maintenance of renal function is of prime importance and therefore terlipressin may have an added role, as with albumin it can reverse hepatorenal syndrome.25 (2) Specific therapy The data on drugs favour the use of terlipressin (2 mg every four hours for the initial 24 hours and 1 mg four hourly for the next 24 hours; some units prolong its use to five days), as it is the only drug to have shown a reduction in mortality in acute variceal bleeding.26 Interestingly, early (before hospital admission) administration of terlipressin—plus glycerine trinitrate—improved the control of bleeding and reduced mortality.27,28 A Cochrane review on somatostatin and its analogues has only shown a reduction of one unit in terms of transfusion requirements.29 Recently, recombinant activated factor VII is related with transient improvement of haemostasis in the setting of acute variceal bleeding; further testing is needed.30,31 Endoscopic therapy has been considered the mainstay of specific treatment for acute variceal bleeding32 (provided that such facilities are available), with some authors emphasising the need for expert and rapid control of haemorrhage.33 Although randomised trials of sclerotherapy32 versus banding ligation have shown that ligation is more effective (pooled odds ratio (OR) 0.51; 95% CI 0.34 to 0.79) in controlling bleeding,34 there is no statistical difference in survival. As placement of the banding device requires extubation after the diagnostic endoscopy and then reintubation, this probably increases the risks of endoscopy, but this has not been assessed formally. The choice of technique should be left up to the experience of the operator, and the particular circumstances found during diagnostic endoscopy. A cumulative meta-analysis of trials of sclerotherapy versus vasoactive drugs clearly shows the consistent effect over time of the superiority of sclerotherapy for control of bleeding (OR 1.384; 95% CI 0.977 to 1.962) and also similar pattern for hospital or 42 day mortality (pooled OR 1.354; 1.032 to 1.777) but the effect is weak. A recent meta-analysis,35 which excluded one randomised trial36 and included another that was difficult to obtain the correct numbers for37 (and also did not confine the evaluation of efficacy to seven days but to six weeks), suggested drugs were equivalent. However, this interpretation is open to question as assessment should be only during the emergency period. In addition the evidence for efficacy of drugs on their own is very weak except for terlipressin. Finally, trials of sclerotherapy versus standard therapy (drugs ± balloon) showed the superiority of sclerotherapy. Portal Hypertension and Effects of Portal Hypertension Essay Paper To date the best evidence for efficacy in treating acute variceal bleeding is drugs combined with endoscopic treatment. Randomised trials have shown the greatest effect on control of bleeding (for initial five day control) but strangely no effect on mortality.38 This apparent paradox may be explained by the great variability in the efficacy rates of sclerotherapy used on its own in this group of studies,27 and makes the interpretation of meta-analysis difficult. (3) Rescue therapy There is no accepted definition regarding failure of drug and endoscopic therapy for acute variceal bleeding, but most units will only use two sessions of emergency endoscopic therapy.39 The rescue therapy of choice today is TIPS and if this is not available, staple transection of the oesophagus. TIPS is very effective in stopping bleeding in over 90% of the patients.40 Sources of continued bleeding or early rebleeding are often oesophageal ulcers caused by previous endoscopic therapy which is why endoscopic therapy should be limited in the acute setting. There are no randomised trials comparing TIPS with surgical treatments in uncontrolled variceal haemorrhage. It has been shown in uncontrolled studies that TIPS is highly effective in stopping variceal haemorrhage,41–45 but on the other hand TIPS in uncontrolled variceal bleeding still has a high mortality.46 Prognosis is poor if patients have developed sepsis, required inotropic support and ventilation (often due to aspiration), and if they have deteriorating liver and renal function,47 which still is a scenario when a TIPS could be placed. The technical expertise now exists to place TIPS in virtually any patient, even when portal vein thrombosis is present. Thus issues of the utility of treatment arise.47 Established renal failure in a cirrhotic who has had uncontrollable bleeding is in our unit a contraindication to TIPS placement. When TIPS is not available, alternative options are injections of tissue adhesives (Histoacryl, Bucrylate) or fibrin glue, or endoscopic detachable snare (Endoloops). There are no controlled data for these therapies. If there is a skilled operator it is certainly worth attempting in the absence of TIPS, particularly when the patient is a poor candidate for surgery. Portal Hypertension and Effects of Portal Hypertension Essay Paper GASTRIC VARICES Gastric varices can be found alone or in combination with oesophageal varices and the incidence of bleeding in most series is less than 10%.44 Patients with gastric variceal haemorrhage bleed more profusely, require more transfusions, have a higher risk of rebleeding, and have a higher mortality compared with those who bleed from oesophageal varices.48 The optimal treatment of gastric varices is not known. Sclerotherapy and banding are not useful. Bucrylate has shown better results than sclerosants in a study with 27 patients bleeding from oesophagogastric varices,49 and in another study was reported superior to ethanolamine, although the survival advantage of Bucrylate seemed partially related to increased early rebleeding rates in the ethanolamine group.50 In a recent randomised trial of 37 patients cyanoacrylate was more effective than alcohol injection in achieving faster obliteration of gastric varices, and appeared more useful in controlling acute gastric variceal bleeding, reducing the need for rescue surgery while mortality was similar in the two groups.51 Nevertheless, reports of cerebral and pulmonary embolism with tissue adhesives constitute a major drawback coupled with the expertise in their use. The protocol for tissue adhesives must be well worked out. Bovine thrombin has been used as intravariceal injection and in a study with 11 cases initial haemostasis was achieved in all patients and after a median follow up of nine months; only one patient rebled from gastric varices. The substitution of bovine with recombinant thrombin is expected to overcome the problem for possible transmission of the agent responsible for bovine spongiform encephalopathy.52 The combination of fibrinogen with thrombin was evaluated in a small study giving very good results in controlling gastric variceal bleeding.53 Unfortunately in all these studies there are considerable rebleeding rates; hence for patients with rebleeding or uncontrolled bleeding, there is the option of TIPS or surgery. TIPSs have been shown to be as effective for gastric bleeding as for esophageal variceal bleeding, having high success rates for initial haemostasis and acceptable rebleeding rates. Portal Hypertension and Effects of Portal Hypertension Essay Paper What are the treatment options for portal hypertension? The effects of portal hypertension can be managed through diet, medications, endoscopic therapy, surgery, or radiology. Once the bleeding episode has been stabilized, treatment options are prescribed based on the severity of the symptoms and on how well your liver is functioning. First level of treatment When you are first diagnosed with variceal bleeding, you may be treated with endoscopic therapy or medications. Dietary and lifestyle changes are also important. Endoscopic therapy consists of either sclerotherapy or banding. Sclerotherapy is a procedure performed by a gastroenterologist in which a solution is injected into the bleeding varices to stop or control the risk of bleeding. Banding is a procedure in which a gastroenterologist uses rubber bands to block the blood supply to each varix (enlarged vein). Medications such as beta blockers or nitrates may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in your varices and further reduce the risk of recurrent bleeding. Medications such as propranolol and isosorbide may be prescribed to lower the pressure in the portal vein and reduce the risk of recurrent bleeding. The drug lactulose can help treat confusion and other mental changes associated with encephalopathy. This medication has the ability to increase the amount of bowel movements you will have per day. Dietary and lifestyle changes Maintaining good nutritional habits and keeping a healthy lifestyle will help your liver function properly. Some of the things you can do to improve the function of your liver include the following: Portal Hypertension and Effects of Portal Hypertension Essay Paper Do not use alcohol or street drugs. Do not take any over-the-counter or prescription drugs without first consulting with your physician or nurse. Some medications may make liver disease worse, and they may interfere with the positive effects of your other prescription medications. Follow the dietary guidelines given to you by your physician or nurse. Follow a low-sodium (salt) diet. You will probably be required to consume no more than 2 grams of sodium per day. Reduced protein intake is required only if confusion is a symptom. Your dietitian will help you create a meal plan that helps you follow these dietary guidelines. Second level of treatment If the first level of treatment does not successfully control your variceal bleeding, you may require one of the following decompression procedures to reduce the pressure in these veins. Transjugular intrahepatic portosystemic shunt (TIPS): A radiological procedure in which a stent (a tubular device) is placed in the middle of the liver. Distal splenorenal shunt (DSRS): A surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in your varices and control bleeding. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy What happens during the TIPS procedure? During the TIPS procedure, a radiologist makes a tunnel through the liver with a needle, connecting the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (the 3 veins that carry blood from the liver). A metal stent is placed in this tunnel to keep the tunnel open. Portal Hypertension and Effects of Portal Hypertension Essay Paper The TIPS procedure reroutes blood flow in the liver and reduces pressure in all abnormal veins, not only in the stomach and esophagus, but also in the bowel and the liver. The TIPS procedure is not a surgical procedure. The radiologist performs the procedure within the vessels under X-ray guidance. The procedure lasts 1 to 3 hours. You should expect to stay in the hospital 1 to 2 days after the procedure. The TIPS procedure controls bleeding immediately in over 90% of patients. However, in about 30% of patients, the shunt may narrow, causing varices to bleed again at a later time. What are potential complications of the TIPS procedure? Shunt narrowing or occlusion (blockage) can occur any time after the procedure, and most frequently within the first year. Follow-up ultrasound examinations are performed frequently after the TIPS procedure to detect these complications. The signs of occlusion include increased ascites or recurrent bleeding. This condition can be treated by a radiologist who re-expands the shunt with a balloon or repeats the procedure to place a new stent. Encephalopathy, or mental changes caused by abnormal functioning of the brain that occur with severe liver disease, is another potential complication. Encephalopathy can be worse when blood flow to the liver is reduced by TIPS, which may result in toxic substances reaching the brain without being metabolized first by the liver. This condition can be treated with medications, diet or by replacing the shunt. What happens during the DSRS procedure? The DSRS is a surgical procedure. During the surgery, the vein from the spleen (called the splenic vein) is detached from the portal vein and attached to the left kidney (renal) vein. This surgery selectively reduces the pressure in your varices and controls the bleeding. Portal Hypertension and Effects of Portal Hypertension Essay Paper A general anesthetic is given to you before the surgery. The surgery lasts about 4 hours. You should expect to stay in the hospital from 7 to 10 days. DSRS controls bleeding in over 90% of patients; the highest risk of any recurrent bleeding is in the first month. However, the DSRS procedure provides good long-term control of bleeding. A potential complication of the DSRS surgery is ascites (an accumulation of fluid in the abdomen). This can be treated with diuretics and restricted sodium intake. What is the follow-up care after the TIPS or DSRS procedures? Follow-up medical care may differ from hospital to hospital. The following are some general guidelines for scheduling follow-up care: Ten days after your hospital discharge date, you will meet with your surgeon or hepatologist and nurse coordinator to evaluate your progress. Lab work will be done at this time. Six weeks after the TIPS procedure (and again 3 months after the procedure), you will have an ultrasound so your physician can check that the shunt is functioning properly. You will have an angiogram only if the ultrasound indicates that there is a problem. You will also have lab work done at these times and visit the surgeon or hepatologist and nurse coordinator. Six weeks after the DSRS procedure (and again 3 months after the procedure), you will meet with the surgeon and nurse coordinator to evaluate your progress. Lab work will be done at this time. Six months after either the TIPS or DSRS procedure, you will have an ultrasound to make sure the shunt is working properly. You will also visit the surgeon or hepatologist and nurse coordinator to evaluate your progress. Lab work and a galactose liver function test will also be done at this time. Twelve months after either procedure, you will have another ultrasound of the shunt. You will also have an angiogram so your physician can check the pressure within your veins across the shunt. You will meet with your surgeon or hepatologist and the nurse coordinator. Lab work and a galactose liver function test will be done at this time. If the shunt is working well, every 6 months after the first year of follow-up appointments you will have an ultrasound and lab work, and you will visit with your physician and nurse coordinator. More frequent follow-up visits may be necessary, depending on your condition. Portal Hypertension and Effects of Portal Hypertension Essay Paper Attend all follow-up appointments as scheduled to ensure that the shunt is functioning properly. Be sure to follow the dietary recommendations that your healthcare providers give you. What are other treatment procedures for portal hypertension? Liver transplant is done in cases of end-stage liver disease. Devascularization is a surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt is not possible or is unsuccessful in controlling the bleeding. The accumulation of fluid in the abdomen (called ascites) sometimes needs to be directly removed. This procedure is called paracentesis. Portal hypertension (PHT) is most commonly observed in patients with liver cirrhosis and is a major driver for associated complications, such as variceal bleeding, ascites or hepatic encephalopathy. Current PHT treatment strategies orientate on the existence and characterization of oesophageal varices, which strongly correlate with the hepatic venous pressure gradient (HVPG)—the gold standard for quantification of PHT. For prevention of variceal bleeding, oral non-selective beta blockers (NSBBs) are used, while, in acute bleeding situations, intravenous somatostatin, octreotide or terlipressin are available [1]. These drugs aim to decrease portal pressure; however, not all patients achieve a haemodynamic response, which is defined by a HVPG decrease >10% of baseline. Thus, current research intensively seeks new treatment options for PHT. Most experimental strategies aim at structural (liver fibrosis) and/or dynamic (endothelial dysfunction, hyperdynamic circulation) factors, which contribute to the severity of PHT. In this review, we summarize close to 100 different pharmacotherapies and their potential for future use in PHT. Portal Hypertension and Effects of Portal Hypertension Essay Paper Adrenoceptor drugs The dynamic component of PHT is attributed to an increase in splanchnic arterial vasodilation and intrahepatic vascular resistance, which is at least partly mediated via adrenergic receptors. The established therapy with beta blockers counteracts the increased cardiac output (via ?1) and substantially increases splanchnic resistance (via ?2), which together reduces portal pressure [2,3]. Furthermore, ?-receptor antagonism has been shown to additionally reduce intrahepatic resistance. While there exists a plethora of beta-blocking agents, only a few NSBBs (propranolol, nadolol and carvedilol) are currently recommended for the treatment of PHT [1]. Notably, selective ?1 blockade might even increase portal pressure, which has been shown for nebivolol in experimental cirrhosis [4]. On the other hand, additional ?-receptor antagonism supports the NSBB-mediated decrease in HVPG. This has been demonstrated in clinical studies by the use of carvedilol (combined non-selective ? and ?1-blockade) [5–7] or by add-on therapy with the ?1-antagonist prazosin [8,9]. Yet, according to a meta-analysis, haemodynamic response rates to NSBBs are only 46% [10]. Furthermore, beta-blocker therapy increases the risk of arterial hypotension, which is especially of concern when combined with ?-antagonism (e.g. carvedilol) and in decompensated patients, where NSBB therapy might be even detrimental [2,11]. Thus, research aims to refine adrenoceptor pharmacotherapy. In experimental cholestatic cirrhosis, short-term therapy with the ?2 antagonist BRL44408 significantly decreased portal pressure and did not alter systemic haemodynamics even without NSBB cotherapy, which, however, has been published in only two abstracts so far [12,13]. Portal Hypertension and Effects of Portal Hypertension Essay Paper While NSBB effects are mediated via ?1 and ?2 adrenoceptors, recent studies also shed light upon the lesser known ?3 adrenoceptor, which is up-regulated in experimental and human cirrhosis. Stimulation of ?3 adrenoceptors leads to relaxation of hepatic stellate cells (HSCs) and intrahepatic vasodilation via activation of the adenylyl cyclase and by inhibition of Rho-kinase. Accordingly, in cirrhotic rodent models, two studies measured significant declines in portal pressure after treatment with the ?3 agonists CGP12177A and SR58611A, respectively [14,15]. Improving adrenergic vascular contractility in the splanchnic area can also be achieved by neuropeptide Y, which seems to be especially effective in PHT [16,17]. Accordingly, treatment with neuropeptide Y in cirrhotic rats translated into a significant amelioration of the portal hypertensive syndrome and PHT without changing mean arterial pressure [18]. In line, also administration of zolmitriptan, which mediates mesenteric vasoconstriction not via beta blockade, but via the 5-HT1 receptor, dose-dependently reduced portal pressure. Although this portal hypotensive effect was of short duration, co-administration with NSBBs synergistically prolonged and enhanced the decrease in portal pressure [19]. For staging of chronic liver disease, a variety of different tools are available, including physical examination, laboratory tests, imaging techniques, and hemodynamic measurements ( Figure 2). Imaging techniques comprise endoscopy, ultrasound, determination of liver stiffness, computed tomography, and magnetic resonance imaging (MRI). Physical examination includes important

NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Advocacy plays a key role in building strong health systems. It gives people a voice in the decisions that affect their lives and health and helps hold governments accountable for meeting the health needs of all people, including marginalized groups. Health policies developed with broad participation help governments and institutions provide better healthcare.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper In the fields of HIV, family planning and reproductive health (FP/RH), and maternal health, advocacy occurs throughout the policy process. Advocates detect problems and raise awareness of those problems. They participate in policy dialogue and contribute to designing policy solutions, then marshal support to adopt those solutions. Their work doesn’t end with the passage of policy measures. Instead, they help ensure equitable and effective implementation of health policies, monitor the impact of those policies, and identify gaps and challenges. To do all this successfully requires a specialized set of skills and knowledge.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Permalink: https://nursingpaperessays.com/ nurs-5050-policy…signment-paper / ? Advocacy has often been described as a key strategy for the achievement of health promotion aims, but multiple and conflicting definitions and usages exist. The concept itself may be unnecessarily intimidating. Advocacy work can take place at the level of both ‘cases’ and ‘causes’. Two main goals underpin health advocacy—protection of the vulnerable (representational advocacy) and empowerment of the disadvantaged (facilitation al advocacy). This paper attempts to integrate existing models and definitions into a conceptual framework for considering the role of advocacy in addressing health inequalities. It argues that we need to pay some attention to the diversity of values and goals of health promotion if we are to understand which models and approaches to health advocacy apply and in what context. This paper concludes that advocacy for health fulfills two functions: as a form of practice and as a useful strategy for a discipline which has to be self-promoting as well as health-promoting in order to survive in the competitive political environment of contemporary health work.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper What is public health advocacy? The focus of this Discussion is on ‘policy-focused’ public health advocacy, i.e., activities that attempt to contribute to health promoting systemic change by influencing policy processes. While there are many available definitions of public health advocacy,2-4 these share key common elements, including: an emphasis on collective action to effect desired systemic change; a focus on changing “upstream factors like laws, regulations, policies, institutional practices, prices and product standards;”5 and an explicit recognition of the importance of engaging in political processes to effect desired policy changes. Public health advocacy is often defined as the process of gaining political commitment for a particular goal or program, and identified by some as a critical population health strategy.2,6Target audiences tend to be decision-makers, policy-makers, program managers, and more generally, those that are in a position to influence actions that affect many people simultaneously.4,7,8 Public health advocacy strategies espouse an upstream approach, recognizing that ‘individual’ and ‘personal’ problems are often reflective of social conditions. This approach involves situating ‘individual’ health issues within the broader context of social determinants external to individuals. It also recognizes the societal breadth of many public health problems, and the logistical and resource challenges inherent in approaching these challenges at the individual level.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper While downstream health promotion activities (such as primary or secondary smoking prevention, community-level interventions and provider education) play an important public health role and should be continued, “…to some they resemble fixing with a pick and shovel what is being destroyed with a bulldozer.”9Engaging in public health advocacy acknowledges the explicitly political aspects of public health, and the importance of addressing social determinants of health as a key component of a strategy for improving the health of populations. Put another way, public health advocacy is an important strategy for creating environments supportive of health.10 If the goal of public health is to reduce the societal burden of health problems, then effective interventions must “…alter the societal forces that foster these problems.”11 Ignoring the social and political dimensions of health has the effect of relegating public health practice to the “…prevention and promotion of individual risk factors.” Advocacy strategies draw from a range of tactics. These can involve “…creating and maintaining effective coalitions, the strategic use of news media to advance a public policy initiative and the application of information and resources to effect systemic changes that change the way people in a community live. It often involves bringing together disparate groups to work together for a common goal.”13 It can also involve gathering and presenting an evidence-base for desired changes, although it is worth noting that scientific evidence alone is rarely enough to achieve desired political support for public health goals. Evidence is often a necessary – but rarely sufficient – factor for influencing policy processes. The Ontario Health Promotion Resource System categorizes advocacy activities as low, medium, and high profile.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Low profile activities could include quiet negotiation, meetings with civil servants, sharing information, and the development of non-public briefs. Medium profile activities include on-going negotiation, development of public briefs, ‘feeding’ the opposition, giving deputations at committees, participating in meetings with elected officials, forming strategic alliances with other groups, and writing letters to elected officials or newspapers. High profile activities include public criticism, public relations activities, advertising campaigns, information distribution, letter writing, and participation in demonstrations and rallies.14Within this categorization system, many activities (e.g., meeting civil servants, sharing information) may fall within any of these categories, depending on the nature of the activity and its intended result. There are many examples of successful public health advocacy efforts, and “…every branch of public health can point to the critical role of advocacy in translating research into policy, practice and sea changes in public opinion.”15 To date, public health advocacy has been used to advance policies in several public health areas, including gun control, injury prevention, and tobacco control.13 In spite of the importance of this work, Chapman argues that “…advocacy remains a Cinderella branch of public health practice. Advocacy is often incandescent during its limited time on stage, only to resume pumpkin status after midnight. Routinely acknowledged as critical to public health, it is seldom taken seriously by the public health community, compared to the attention given to other disciplines.”16 The lack of attention paid to public health advocacy is reflected in the limited body of research literature on public health advocacy research or practice. Advocacy skills Engaging in policy advocacy requires a diverse set of skills. Comm et al. identify three core skills required for successful public health advocacy: 1) the ability to work collaboratively with multiple stakeholders, 2) strategic use of media, and 3) ability to conduct strategic analysis.17This latter skill requires a focus on three central questions (what is the problem? what is the desired solution? who is the target for change?) Although sometimes overlooked as a skill, being able to identify a policy solution is as important as being able to identify the problem in public health advocacy.18The ability to frame issues effectively is identified as a key component of public health advocacy. Chapman argues that “.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper What is Population Health Advocacy? Advocacy represents the strategies devised, actions taken and solutions proposed to influence decision-making on a particular cause/issue. The purpose of advocacy is to create positive change for people and their environments. Individuals, organizations, businesses and governments can all engage in advocacy activities. As seen in Appendix 1, advocacy efforts range from those on behalf of an individual to efforts directed at bringing about policy change. Population health advocacy is directed at actions to improve the overall health of a population. Generally, this is done through addressing the many social conditions that impact the health of populations, such as early child development, income, education, gender, etc. These conditions are often referred to as the non-medical or social determinants of health . The Enhancing the Role of Hospitals in Improving Population Health (EHPH) Learning Center was established to support the Robert Wood Johnson Foundation’s (RWJF) efforts to expand the number of hospitals and health systems active promoting healthy communities and committed to a Culture of Health. The EHPH Learning Center is focused on learning systematically across the field and is exploring ideas to transform health and health care and advance community health and well-being. The EHPH Learning Center is located at the NYU Langone Department of Population Health and staffed by Leora Horwitz, MD MHS, Jim Knickman, PhD and Carol Chang, MPH MPA. Leora is an associate professor and director of the Center for Healthcare Innovation and Delivery Science. Her recent research has focused on better coordination of hospitals and communities during the patient discharge process. Jim is the Derzon Chair in Health and Public Affairs with appointments at the Department of Population Health and NYU Wagner. He has many years of philanthropy experience, most recently as the president of the New York State Health Foundation. Carol is directing the EHPH project and is a former RWJF staff member who developed early grant making focused on population health including overseeing the Foundation’s Health and Society Scholars Program.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper The finite and generally scarce nature of available resources for population health improvement creates an imperative for focusing on those policies and programs that have been shown to be most effective. However, because tight resources also limit the quantity and quality of evidence on any given policy or program, it can be very challenging for those working to improve health to determine the best course of action. Fortunately, a growing number of online resources help point to recommended policies and programs. Policies can be implemented at many different levels, from an individual school or worksite to municipalities, regions, states, and even the national level. Examples of effective health policies include smoking bans, excise taxes on cigarettes and alcohol, seat belt laws, water fluoridation, and restaurant menu labeling. There is an increasing call for a “health in all policies” approach among population health academic and practice leaders. Emerging in response to a growing understanding and recognition of the many different factors that influence health, “health in all policies” underscores the need for policymakers in various sectors such as education, housing, transportation, agriculture, development, environment, and others to carefully examine the health implications of the policies they put into place. NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Programs aimed at population health improvement are extremely diverse and address the full range of health determinants/factors. They not only encompass efforts to improve access to health care and individual behavior but also work to create healthy options and opportunities in the environments where people live, learn, work, and play. Population health, a field which focuses on the improvement of the health outcomes for a group of individuals, has been described as consisting of three components: “health outcomes, patterns of health determinants, and policies and interventions”. [1] Policies and Interventions define the methods in which health outcomes and patterns of health determinants are implemented. Policies which are helpful “improve the conditions under which people live”. [2] Interventions encourage healthy behaviors for individuals or populations through “program elements or strategies designed to produce behavior changes or improve health status”. [3] Policies and interventions are needed due to the inequalities among st populations and the inconsistent way care is administered. Policies can include “necessary community and personal social and health services” [2] as well as taxes on alcohol and soft drinks and implement smoking cessation policies. Interventions can include therapeutic or preventative health care and may also include actions taken by the individual or by someone on behalf of the individual. The application of population health is determined by the policies and interventions which can be implemented within an organization, city, state or country.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Public policy frameworks for improving population health Four conceptual frameworks provide bases for constructing comprehensive public policy strategies for improving population health within wealthy (OECD) nations. (1) Determinants of population health. There are five broad categories: genes and biology, medical care, health behaviors, the ecology of all living things, and social/societal characteristics. (2) Complex systems: Linear effects models and multiple independent effects models fail to yield results that explain satisfactorily the dynamics of population health production. A different method (complex systems modeling) is needed to select the most effective interventions to improve population health. (3) An intervention framework for population health improvement. A two-by-five grid seems useful. Most intervention strategies are either ameliorative or fundamentally corrective. The other dimension of the grid captures five general categories of interventions: child development, community development, adult self-actualization, socioeconomic well-being, and modulated hierarchical structuring. (4) Public policy development process: the process has two phases. The initial phase, in which public consensus builds and an authorizing environment evolves, progresses from values and culture to identification of the problem, knowledge development from research and experience, the unfolding of public awareness, and the setting of a national agenda. The later phase, taking policy action, begins with political engagement and progresses to interest group activation, public policy deliberation and adoption, and ultimately regulation and revision. These frameworks will be applied to help understand the 39 recommendations of the Independent Inquiry into Inequalities in Health, the Sir Donald Acheson Report from the United Kingdom, which is the most ambitious attempt to date to develop a comprehensive plan to improve population health.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Towards the end of the last century, health improvement strategies (such as the World Health Organization’s seminal Health for all by the year 2000 ) tended to use phrases like ‘protecting and promoting health’. In more recent years, the vocabulary has broadened out to place an emphasis on well being as well as health. Today the phrase ‘population health’ is used to convey a way of conceiving health that is wider still. It includes the whole range of determinants of health and well being – many of which, such as town planning or education, are quite separate from health services. Referring to ‘population health’ rather than the more traditional phrase ‘public health’ also helps avoid any perception that this is only the responsibility of public health professionals. Population health is about creating a collective sense of responsibility across many organizations and individuals, in addition to public health specialists. Confusingly, the phrase ‘population health management’ is also widely used, with a specific meaning that is narrower in focus than population health. Population health management refers to ways of bringing together health-related data to identify a specific population that health services may then prioritize. For example, data may be used to identify groups of people who are frequent users of accident and emergency departments. This way of using data is also sometimes called ‘population segmentation’. Throughout all these changes in vocabulary, one element has consistently been essential: an emphasis on reducing inequalities in health, as well as improving health overall. This continues to be important in population health NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Medicalization And Health Policy A century ago, policy interventions addressing health vulnerability often reflected a broad view of the causes of vulnerability and the conditions that needed to be addressed through public action. The specific etiology of most illnesses and diseases was poorly understood. However, given the large and obvious statistical association between poverty and illness, health status vulnerability was readily seen as a consequence of socioeconomic vulnerability. 3 As a result, public health activities in the late nineteenth and early twentieth centuries focused on “upstream” causes of poor health, including poor sanitation, overcrowded and squalid housing conditions, work-related hazards, food security, and nutrition. 4 Interventions in these realms are believed responsible for sharp mortality declines across age groups in the United States. 5NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Concurrent with these public health improvements, a sea change was under way in biomedical science, with an increasing focus on individual causes and manifestations of illness and disease. This increasingly individualized perspective fostered a tendency to medicalize health and illness. 6 Irving Zola defines medicalization as the expansion of medicine as an institution and the use of a medical lens to view human processes and behavior. 7 A medicalized perspective tends to define health problems as the result of individual failures of biology, hygiene, and behavior, with the implicit or explicit belief that the primary strategy for addressing these problems is through biomedical treatments delivered to individuals by physicians and other providers. 8 Multiple economic, social, and political factors fueled the growth and dominance of individualistic, medicalized perspectives regarding public health, although a detailed analysis of this topic is outside of the scope of this essay. 9 Michael Katz argues that individualized accounts of illness and vulnerability strongly resonated with Americans’ historic ambivalence toward disadvantaged individuals and groups, with accompanying moral and ideological distinctions between citizens deemed worthy and unworthy of assistance. 10NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper As health status and health vulnerability became more medicalized throughout the twentieth century, discourse and decisions regarding policy priorities changed as well. Given an increasingly medicalized view of health vulnerability, public policy became focused on expanding access to individualized medical care. 11 The federal government was providing personal health services to certain populations (such as merchant seamen and Native Americans) before 1900. However, as the problems of vulnerable populations became more medicalized, policies and initiatives focusing on health care access proliferated across populations and across a range of pertinent medical services. Given this policy emphasis on medical care, a piecemeal, categorical, and separatist approach to providing health care services to vulnerable populations emerged. Throughout the twentieth century, the making and buying of health care services through government policy created facilities, systems, providers, financing arrangements, and bureaucracies that exist outside the mainstream health care delivery system and operate specifically for vulnerable populations. Examples abound, including community and migrant health centers, Title X family planning clinics, local public health clinics, Medicaid managed care, Medicaid expansions for pregnant women, the National Breast and Cervical Cancer Early Detection Program, and the State Children’s Health Insurance Program (SCHIP).NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper The Limits Of Medicalized Policy Responses Current public policy responses to health vulnerability focus primarily (although not exclusively) on the procurement of medical care services, with a reduction in access barriers proffered as the central benchmark for success. Although policies that address financial and geographic barriers to health care bring important services to populations in need, many such policies establish and reinforce a two-tier “safety-net” system in which vulnerable populations primarily go to separate institutions or providers for their health care. These separate programs are viewed as necessary as a result of the dominant system’s failure to provide adequate access for those who are marginalized and vulnerable. These programs, however, are not well funded, and the services provided are neither adequately paid for nor completely covered. 12 This leaves safety-net providers and programs plagued by financial pressures and often unable to deliver high-quality medical care to the populations they serve. 13 A second, less noticed consequence of medicalized perspectives is a conflation between health status disparities and health care disparities. Medicalization encourages the view that one can solve socioeconomic and racial/ethnic health status disparities through initiatives and policies that reduce disparities in health care access, use, and quality. This conflation, for example, can be seen in some aspects of the Health Disparities Research Plan of the National Institutes of Health (NIH) and also in the National Action Agenda of the Department of Health and Human Services (HHS) Office of Minority Health. 14NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper In turn, when health vulnerability and disparities are medicalized, health care access becomes overvalued and overemphasized as the most promising policy path. It is also an easier path, politically, than are fundamental social and economic reforms. The result is our current situation, in which an estimated 95 percent of U.S. health services spending goes toward direct medical services, and only 5 percent is invested in population or community approaches for prevention and health status improvement. 15 Medicalized framing of health vulnerability can be an effective strategy to defend policy benefits/transfers to the disadvantaged by sidestepping social and political debates over the deservingness or worthiness of vulnerable populations. The Supplemental Security Income and Social Security Disability Insurance programs are examples of how a medicalized approach to complex social problems can bring valuable income support and other benefits to people living with disabilities. 16 Similarly, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act provides housing and social services that extend beyond the domain of medical care to people living with HIV and AIDS. In addition, Medicaid provides a funding umbrella under which many states finance expanded services and social supports that extend beyond medical treatment and care. Nonetheless, these types of social services and interventions tend to become available only after a person is diagnosed as sick or disabled, and they focus on individuals and families rather than on the social and economic conditions of communities that are the fundamental drivers of poor health over the life course.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people. National health policies, strategies, plans National Health Policies, Strategies and Plans play an essential role in defining a country’s vision, policy directions and strategies for ensuring the health of its population. The development of National Health Policies, Strategies and Plans is a complex and dynamic process. Its precise nature varies from State to State according to the political, historical and socio-economic situation prevailing in the country. There is a renewed focus on strengthening countries’ capacity to develop robust National Health Policies, Strategies and Plans that can respond to the growing calls for strengthening of health systems and the renewal of Primary Health Care: universal coverage, people-centered care, emphasis on public health and health in all policies; serve to guide and steer the entire, pluralist health sector rather than being command-and-control plans for the public sector; go beyond the boundaries of health systems, addressing the social determinants of health and the interaction between the health sector and other sectors in society.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper WHO has a long track record of supporting Member States in to develop National Health Policies, Strategies and Plans through country-level technical cooperation, facilitation of national policy dialogue and inter-country exchange, as well as through normative work and high level international policy frameworks. Health policy can be defined as the “decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society”. [1] According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people. [1] There are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy. They may cover topics of financing and delivery of healthcare, access to care, quality of care, and health equity. [2 Healthcare Policies Health policy refers to decisions, plans, and actions which were undertaken to achieve specific health care goals within a society. An explicit health policy could achieve several things that include defining a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups and also builds consensus and informs people.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper There are many categories of health policies, including personal healthcare policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy. They may cover topics of financing and delivery of healthcare, access to care, quality of care, and health equity. What are some examples of healthcare policies that are implemented as a result of regulatory or legislative requirement? Does this include the Affordable Care Act? Healthcare Policies: Healthcare policies are created by legislation to improve the health of the public and to reach specific health goals. Factors involved in healthcare policies include socioeconomic status, social and physical environments, access to medical services, and lifestyle behaviors. Answer and Explanation: The Patient Protection and Affordable Care Act (ACA) is a healthcare policy put into place by President Obama in 2010. This policy expanded Medicaid, required people to have health insurance coverage, created more flexible options for health insurance, and removed preexisting conditions as a reason to be denied coverage.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper There are different types of healthcare policies that affect different aspects of organizations, employment, patient rights, and medical equipment. Regulatory health policies standardize and control the behavior of specific groups by monitoring and enforcing consequences when not followed. An example includes hospitals being required to complete an accreditation process through different organizations to make sure their health practice is meeting standards. Allocate health policies try to provide a benefit to different groups of people, often by choosing one group of people over another. Examples are the use of medical research funded by the government, and taxing one group of people to provide more affordable health insurance to those who cannot afford it such as Medicaid.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Public Health Africa Policy Forum This project aims to provide evidence-based policy options for relevant and appropriate sustainable health solutions in Africa. Despite the notable progress made in improving population health outcomes in sub-Saharan Africa over the past two decades, considerable health challenges remain throughout the region. Significant health inequalities, a large burden of diseases including major outbreaks in recent times, coupled with limited capacity and capability of a skilled health workforce, poor resource allocation and insufficient coordination, cohesion as well as accountability have compounded the difficulties of sub-optimal access to basic healthcare services.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper Whilst existing regional and global partnerships and initiatives have produced some progress within the region, African governments, policymakers and key stakeholders continue to search for sustainable public health policy options that are relevant and appropriate to the population of the region. The Chatham House Public Health Africa Policy Forum aims to facilitate the development of evidence-based policy options that are relevant and appropriate to sustainable health developments in Africa – for consideration by governments, health partners and wider public health stakeholders. With strong asset-based ethos of working in partnerships with governments, leading experts, policy institutions and relevant stakeholders in Africa, the forum aims to provide well-informed and credible research, analysis and policy options that take into account the region’s social, economic and intellectual assets as a means to achieving sustainable health solutions. The forum will create an enabling platform that will serves as a nexus for strengthening research translation al capabilities for informing better public health policies and outcomes in Africa.NURS 5050 – Policy and Advocacy for Improving Population Health Assignment Paper The forum will also focu

Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Read the scenario below. Respond to the questions in full sentences. Be sure to use standard English grammar and spelling Why is information on health literacy essential for this group? What is the initial step you would take before designing the program? What role/function would you play in the beginning of the assessment phase? What role/function would you play at the end of the program? What additional resources would be needed to implement this program?Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Scenario: As a Community Health Nurse, you are assigned to develop a health literacy program at the Yvonne Learning Center to promote health literacy in a low-income urban area. This program will focus on children ages 3-7 years old, 9-12 years old and 14 to 18 years old . You will provide basic health information and services about health and teach the children about their bodies and how having a positive attitude and good behaviors influence their health in general. The goal of information literacy is to promote self-learning and the ability to be self-sufficient. Developing a Health Literacy Program for Children in a Low Income Urban Area 1. Read the scenario below. 2. Respond to the questions in full sentences. Be sure to use standard English grammar and spelling. Please use APA format and include both a title page and a reference page with at least 3 references. • a. Why is information on health literacy essential for this group? b. What is the initial step you would take before designing the program? c. What role/function would you play in the beginning of the assessment phase? d. What role/function would you play at the end of the program? e. What additional resources would be needed to implement this program? Scenario: As a Community Health Nurse, you are assigned to develop a health literacy program at the Yvonne Learning Center to promote health literacy in a low-income urban area. This program will focus on children ages 3-7 years old, 9-12 years old and 14 to 18 years old . You will provide basic health information and services about health and teach the children about their bodies and how having a positive attitude and good behaviors influence their health in general. The goal of information literacy is to promote self-learning and the ability to be self-sufficient.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Although the connection between early life experiences and later health is becoming increasingly clear, what is needed, now, is a new organizing framework for childhood health promotion, grounded in the latest science. We review the evidence base to identify the steps in the overall pathway to ensuring better health for all children. A key factor in optimizing health in early childhood is building capacities of parents and communities. Although often overlooked, capacities are integral to building the foundations of lifelong health in early childhood. We outline a framework for policymakers and practitioners to guide future decision-making and investments in early childhood health promotion. There is a growing recognition that health in the earliest years lays the groundwork for lifelong well-being. This life-course view is particularly valuable for understanding the roots of health disparities and the potential role of early childhood policies and programs in producing benefits well into the adult years.1–5 Focusing health promotion and disease prevention efforts on children in the first 5 years of life can provide important strategies for reducing the population-level burden of disease. Several recent reports thoughtfully consider the factors that place young children at risk for poor outcomes and list recommendations for effective interventions.1,6 What is now needed, to advance the field of early childhood health promotion, is an underlying, organizing framework to illustrate the intermediate steps linking policies and programs to outcomes. Such a conceptualization will allow stakeholders to develop, apply, and sustain policies and programs that promote public health goals across early childhood settings.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper The framework presented here, introduced by the Harvard Center on the Developing Child in collaboration with the Women’s and Children’s Health Policy Center at Johns Hopkins University, illustrates the key pathway that policymakers and practitioners can follow to promote children’s health in the preschool years.5 This framework advances previous efforts to link policies to intended health outcomes by embedding the capacities of parents and communities within the pathway; these capacities are integral to ensuring optimal environments and experiences for young children. Our objectives are to (1) describe a framework linking early childhood policies and programs to subsequent health outcomes, (2) outline key action steps within the framework and the underlying scientific evidence, and (3) demonstrate how the framework can be applied to evaluate current policies and programs and spur innovative, evidence-based strategies to improve children’s health.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Family capacities are resources that parents and other caregivers bring to the tasks of raising young children. They can be grouped into 4 general categories9: financial resources (economic ability to purchase material goods or services), time spent with or for children, psychological resources (physical and mental health and parenting style), and human capital (knowledge and skills for decision-making acquired through education or training, experience, or interactions with medical providers or others outside the immediate family). Financial resources. More than 22% of children younger than 6 years in the United States live in poor families. This constitutes more than 5 million infants, toddlers, and preschoolers.10 Numerous studies have documented the link between childhood poverty and poor health and developmental outcomes in early life and subsequent adult attainment.11 The association, in large part, is associated with the availability of fewer resources for families living at or below poverty compared with those with higher incomes. Fewer financial resources may limit caregivers’ ability to purchase goods such as health care, housing, child care, and food Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Time investments. Most young children today are raised by working caregivers with serious time constraints. Despite the rise in maternal workforce participation, recent studies have observed an increase in the number of hours parents spend with their children.13,14 This uptick may be a result of families finding ways to maximize their time and decrease “work and family conflict,” by shifting occupations, altering places of work, and increasing fathers’ involvement.13,15 However, less-educated parents in low-wage jobs have not realized similar gains in time investments with their children. Well-educated parents allocate a higher number of hours to caring for children compared with less-educated parents. Less-educated working parents often do not have the same level of flexibility or resources to meet the challenges because of the demand of low-income jobs,16 which disproportionately require shift work or nonstandard hours.17 In addition, lack of paid leave may limit breastfeeding duration18 and time spent forming critical maternal–infant attachments Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Psychological resources. Psychological resources of family and caregivers are critical to children’s health and development. These resources include parental mental health and more broadly the skills and abilities caregivers possess to address parenting demands. Prevalence estimates of maternal depressive symptoms in the postpartum period range from 8% to 15%20 and approximately 32% in mothers of toddlers.21 The quality of parent–child interaction is an important mediator of the relation between depression and adverse child outcomes ranging from less favorable patterns of health care utilization to increased negative affect and aggression.2,22 Maternal depression is associated with more hostile and less responsive parenting behaviors. Less is known about this relation among fathers; however, studies of paternal depression also show negative effects on parenting and the parent–child relationship.23,24 In addition, sources of stress such as marital discord independently affect parenting practices and increase rates of children’s neglect and maltreatment Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Human capital. Human capital includes the skills that serve as an advantage related to employment opportunities for parents or increased knowledge about child rearing. Educational attainment is perhaps the most commonly recognized form of human capital. Approximately one fourth of children at 9 months of age have mothers who have not graduated high school, with rates varying by race/ethnicity.25 Multiple theoretical models describe the relation between parental education and child outcomes.26Educated parents are more likely to earn higher incomes, which in turn may allow for an increased financial investment with regard to providing enhanced resources and experiences for their children. Alternatively, higher educational attainment may be a proxy for quality of parent–child interactions or greater emphasis on learning and other behaviors that are rewarded in school. Health literacy of parent or caregiver is another important form of human capital. Health literacy is the capacity to obtain, process, and understand health information needed to make basic health-related decisions.27 Approximately 30% of US parents have limited health literacy skills.28 Caregivers’ health literacy influences children’s access to and use of health care services as well as the development of children’s own health literacy.29 Low parental literacy is associated with low levels of other preventive health behaviors such as breastfeeding and identification of appropriate food portion sizes for children, even after adjustment for demographic factors such as race/ethnicity and language Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Community Capacities Families and caregivers most directly influence young children, but there is extensive evidence highlighting the important role of communities.2,31 Community capacity can be described as the underlying processes within the neighborhood to affect health and well-being. Specifically, community capacity may affect early childhood health in 2 main ways—institutional resources and collective efficacy.32 Institutional resources. Institutional resources include parks, fresh food markets, and early education centers. These institutions play important roles in promoting the health and development of young children, yet there is varied level of investment across communities. Physical features such as the proximity of parks and green space increase physical activity for children and provide opportunities for children and parents to interact and enhance social ties.33,34 Proximity of parks alone does not guarantee use; other factors such as parental perceptions of safety and playground characteristics must also be considered in concert with increasing access to “built” environments.35,36Neighborhoods with access to retailers with fresh food options have healthier diets compared with neighborhoods with greater availability of processed food Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper In addition, one half to two thirds of early education centers fail to meet the minimum safety requirements.38 Children who attend poor-quality child care facilities receive less supervision and individualized attention; they are also at increased risk for injuries because of unsafe conditions including hazardous playground equipment, missing safety gates, and unsafe cribs.39,40 Collective efficacy. Collective efficacy is the ability of communities to establish informal social structures and a broader sense of mutual trust and shared values.32,41,42Collective efficacy emphasizes not only the role of social connections within communities but also the function of social control mechanisms. These mechanisms include monitoring the behavior of others and supervising children.41,43 Although parenting behavior has been hypothesized to be a primary mechanism by which collective efficacy may have an impact on child outcomes, little empirical research has examined this in the context of families with young children Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Linking the Foundations of Health to Health Outcomes The foundations of health refer to broad domains of personal experiences and environmental conditions in early childhood; these serve as important building blocks for later adult health. Basic biological processes and structures are shaped by early experiences. The interactions among experiences, environments, and biology are powerful influences on childhood health and exert their effects into adolescence and later adulthood. “Getting it right” in early childhood by ensuring children’s foundational needs are met can avoid costly and less effective solutions that are needed to “fix” later health problems. Thus, in describing the foundations of health, we focus on “positive” experiences and environments that are needed to optimize children’s health and development. However, investments in reduction of significant adversity, including neglect and maltreatment, are equally important as they undermine the foundations of health.1 The science across multiple fields including public health, medicine, psychology, and sociology points to 4 core foundations of children’s health: responsive caregiving, safe and secure environments, adequate and appropriate nutrition, and health-promoting behaviors. Focusing on these areas does not negate the importance of other influences, but does highlight 4 key contexts that are highly interconnected, are important for all children, and can be strengthened through early childhood policies and programs.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Rapid improvements in health and nutrition in developing countries may be ascribed to specific, deliberate, health- and nutrition-related interventions and to changes in the underlying social, economic, and health environments. This chapter is concerned with the contribution of specific interventions, while recognizing that improved living standards in the long run provide the essential basis for improved health. Consideration of the environment as the context for interventions is crucial in determining their initiation and in modifying their effect, and it must be taken into account when assessing this effect. Undoubtedly much change has stemmed from scientific advances, immunization being a prominent case. However, the organizational aspects of health and nutrition protection are equally critical. In the past several decades, people’s contact with trained workers has been instrumental in improving health in developing countries. This factor applies particularly to poor people in poor countries but is relevant everywhere; indeed, it is a reason that social services have essentially eliminated almost all occurrences of child malnutrition in Europe (where, when malnourished children are seen, it is caused by neglect).Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Community-based programs under many circumstances provide this crucial contact. Their role is partly in improving access to technology and resources, but it is also important in fostering behavior change and, more generally, in supporting caring practices (Engle, Bentley, and Pelto 2000; UNICEF 1990). Such programs may also play a part in mobilizing social demand for services and in generating pressure for policy change. Access to healthcare services is critical to good health, yet rural residents face a variety of access barriers. A 1993 National Academies report, Access to Healthcare in America , defined access as the timely use of personal health services to achieve the best possible health outcomes . A 2014 RUPRI Health Panel report on rural healthcare access summarizes additional definitions of accesswith examples of measures that can be used to determine access. Ideally, residents should be able to conveniently and confidently access services such as primary care, dental care, behavioral health, emergency care, and public health services. According to Healthy People 2020, access to healthcare is important for:Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Overall physical, social, and mental health status Disease prevention Detection, diagnosis, and treatment of illness Quality of life Preventable death Life expectancy Rural residents often encounter barriers to healthcare that limit their ability to obtain the care they need. In order for rural residents to have sufficient access, necessary and appropriate healthcare services must be available and obtainable in a timely manner. Even when an adequate supply of healthcare services exists in the community, there are other factors to consider in terms of healthcare access. For instance, to have good healthcare access, a rural resident must also have:Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Financial means to pay for services, such as health or dental insurance that is accepted by the provider Means to reach and use services, such as transportation to services that may be located at a distance, and the ability to take paid time off of work to use such services Confidence in their ability to communicate with healthcare providers, particularly if the patient is not fluent in English or has poor health literacy Trust that they can use services without compromising privacy Belief that they will receive quality care This guide provides an overview of healthcare access in rural America including discussion on the importance and benefits of healthcare access and the barriers that rural residents experience. The guide includes information on: Barriers to care, including workforce shortages and health insurance status Transportation Health literacy Stigma associated with conditions in rural communities, such as mental health or substance abuse Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Many low income first-generation college students who are reading and doing math at a seventh or eighth grade level are admitted into college. Every year, as many as 1.7 million first-year students entering both two- and four-year colleges will take a remedial course to learn the skills they need to enroll in a college-level course. African American, Hispanic, and low-income students represent the largest populations of entering college freshmen who require remedial courses. In fact, 64.7 percent of low-income students who are enrolled in a 2-year college and 31.9 percent enrolled in a 4-year college will require remediation. Academic challenges are often deep-seeded and begin in primary and secondary school, which when left unaddressed, often leads to remediation at the postsecondary level.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper In community-based programs, workers—often volunteers and part-time workers—interact with households to protect their health and nutrition and to facilitate access to treatment of sickness. Mothers and children are the primary focus, but others in the household should participate. Commonly, people go regularly to a central point in their community—for example, for growth monitoring and promotion—or are visited at home by a health and nutrition worker. The existence, training, support, and supervision of the community worker—based in the community or operating from a nearby health facility—are indispensable features of these programs. Thus community organizations are a key aspect of community-based health and nutrition programs (CHNPs). This chapter focuses on large-scale (national or state) programs. Although these programs are primarily initiated and run at the local level, links with the national level and levels in between are necessary. Both horizontal and vertical organizations are needed. Local organizations make action happen, but they need input and resources, such as training, supervision, and supplies, from more central levels.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper The experience on which this chapter is based comes from a considerable number of national and large-scale programs. Most of these programs include both nutrition and health activities, aimed particularly at the health and survival of reproductive-age women and children. We draw on these experiences as we try to put forward principles on which future programs can be based—programs that may have broader health objectives for other population groups and diseases. As of 2001, some 19 percent of global deaths were among children—and 99 percent of all child deaths took place in low- and middle-income countries. The disability-adjusted life years (DALYs) lost attributed to zero- to four-year-olds—plus maternal and perinatal conditions, nutrition deficiencies, and endocrine disorders—amount to 42 percent of the total disease burden (all ages, both sexes) from all causes for developing regions. CHNPs address about 40 percent of the disease burden. In terms of prevention, Mason, Musgrove, and Habicht (2003) estimated that eliminating malnutrition would remove one-third of the global disease burden. Comparative studies by Ezzati, Lopez, and others (2002) and Ezzati, Vander Hoorn, and others (2003) have reemphasized malnutrition as the predominant risk factor and improvement of nutrition as playing a potentially major role in reducing the burden. Clinical deficiencies contribute directly to malnutrition, but even more, malnutrition is a risk factor for infectious diseases (table 56.1). Furthermore, changes in child malnutrition levels in developing countries are closely related to the countries’ mortality trends (Pelletier and Frongillo 2003).Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Responsive caregiving. The care that infants experience, whether from parents, extended family members, or child care professionals, lays the groundwork for the development of a multitude of basic health processes, including self-regulation, attention, and, ultimately, social–emotional functioning.44–46 Moreover, the quality of the care children experience is predictive of a range of developmental and health outcomes.47–52 Early childhood is a time of rapid development in body systems that are critical to health, including the brain, nervous, endocrine, and immune systems. These systems are under construction even before birth, and, from the earliest moments of life, a child’s experiences and environments exert powerful influences on his or her development and subsequent functioning. Social, cultural, and economic determinants of health shape the context of early experiences and environments and are particularly salient in early childhood when the roots of lifelong health and development are being established. Poorly constructed systems have an impact on health in early life, and these effects may be magnified as children grow into adulthood. Establishing strong systems in early childhood by meeting the foundational needs of all children may avoid costly and less effective solutions required to redress disease later in life.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper The current patchwork of health-promotion policies and programs for young children and their families emerged during the growth of public health and medical care programs in the 20th century.8 As a consequence, this nonsystem does not reflect recent advances arising from molecular biology, genomics and epigenetics, neuroscience, and social science that emphasize the significance of early experiences and the importance of families and communities in promoting children’s health. Nor do they reflect the importance of considering social, economic, and cultural determinants of health in strategies to promote health and reduce disparities. A new framework grounded in the latest science is needed to conceptualize how early childhood programs should be designed to enhance children’s health and development and to inform investments in early childhood programs and policies.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Our framework illustrates (Figure 1) the pathway by which policies and programs can promote childhood health outcomes and ultimately have an impact on life-course health. Policies and programs operate to enhance family and community capacities. These capacities enable the building of the foundations of health in early childhood. The foundations of health encompass the basic needs of all children—responsive care, safe and secure environments, adequate and appropriate nutrition, and health-promoting behaviors. The foundations of health, in turn, influence basic biological mechanisms that shape health and development in early childhood and across the life span. In addition, the figure illustrates the moderating role of the 2 important contexts that are critical considerations for strategies aimed at promoting children’s health. First, social, economic, and cultural determinants of health, including the effects of poverty, education, and discrimination, directly and indirectly influence each aspect of the conceptual model. And second, the settings—or places—in which young children and their families live, work, and develop, are ideal sites for interventions. Building on the work of Bronfenbrenner and other social–ecological models, the framework illustrates the importance of considering the individual within a dynamic embedded system characterized by the interrelatedness of multiple levels of influence Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Health education is one strategy for implementing health promotion and disease prevention programs. Health education provides learning experiences on health topics. Health education strategies are tailored for their target population. Health education presents information to target populations on particular health topics, including the health benefits/threats they face, and provides tools to build capacity and support behavior change in an appropriate setting. The following definition of health promotion is from the World Health Organization’s Ottawa Charter for Health Promotion [71]: The process of enabling people to increase control over and improve their health.It involves the population as a whole in the context of their everyday lives, rather than focusing on people at risk for specific diseases, and is directed toward action on the determinants or causes of health.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Universal child and family health services have the opportunity to conduct a range of evidence-based health promotion strategies that aim to encourage families to create attitudes, behaviours and environments to promote optimal health for children. There are many ways in which health promotion is delivered in a universal child and family health service and these may include: the provision of information to parents through written or audio-visual resources; a discussion between the worker and the family, or demonstration of a health- promoting behaviour; role modelling through specifically set up groups and through experiences of other parents; and community awareness activities. There are four core service elements related to health promotion: 1. prevention of disease, injury and illness; 2. health education, anticipatory guidance and parenting skill development; 3. support that builds confidence and is reassuring for mothers, fathers and carers; and 4. community capacity building.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Prevention of disease, injury and illness Prevention of disease is a core component of child and family health service provision. The combination of monitoring of child and family health whilst conducting preventative health activities provides opportunities for early intervention and detection and the prevention of ill-health. Disease-prevention activities include: immunisation, promotion of breastfeeding and nutrition, information about SIDS and co-sleeping, oral health surveillance, and safety and injury prevention, for example, road safety. Examples of effective health promotion activities for child and family health Promoting breastfeeding Promoting child and family nutrition SIDS prevention and education [72] Injury prevention [73] Promoting physical activity Smoking cessation programs such as ‘quit’ activities and ‘brief interventions’ Promoting early literacy [63, 73] Health education, anticipatory guidance and parenting skill development Health education, anticipatory guidance and parenting skill development are interrelated components of health promotion. These components may occur during individual contact with parents and carers, or in a group setting [74, 75]. The benefits of a group delivery include peer support and cost-effective use of resources.Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper The World Health Organization (1998) defines health education as ‘consciously constructed opportunities for learning, involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conductive to individual and community health’. Health education is not only concerned with the communication of information, but also with fostering the motivation, skills and confidence (self-efficacy) necessary to take action to improve health. For example, health education by child and family health services includes providing structured breastfeeding support. Systematic reviews in the Cochrane Library have identified the importance of support to the success of breastfeeding [76] with both peer and professional support shown to be effective in increasing breastfeeding rates during the first two months following birth. Child and family health nurses are regularly involved in interventions providing structured breastfeeding support to mothers [77].Developing A Health Literacy Program For Children In A Low-Income Urban Area Essay Paper Universal child and family health services provide structured anticipatory guidance about a child’s development and behaviour. Anticipatory guidance gives parents practical information about ‘what to expect’ in the child’s behaviour, growth and development in the immediate and longer term. It provides parents with the knowledge they need to provide positive experiences and environments for their child and reduces the anxiety for new parents. For example, universal child and family health services are well positioned to actively influence parents and carers to undertake activities that promote literacy development [67]. Furthermore, through play, children practise and master the necessary skills needed for later childhood and adult life [78]. Parents and carers play an important role in the facilitation of play as they respond to and promote the interactions of their child. Child and family health services can promote play as the ‘work’ of infants and young children and necessary for the development of language, symbolic thinking, problem solving, social skills, and motor skills. Anticipatory guidance may also be provided for t

NURS 6210 – Healthcare Finance and Budgeting Research Paper NURS 6210 – Healthcare Finance and Budgeting Research Paper This course explores healthcare specific financial policies and issues, analytical framework and economic transformation for financial decisions (such as investment and working capital), methods of financial management, insurance coverage and financing. In addition, the course focuses on the ability to apply economic and population health models to address health service issues and problems. NURS 6210 – Healthcare Finance and Budgeting Research Paper You will use the knowledge gained in this course to financially structure and evaluate the opening of a private primary care medical practice with one physician provider. You will prepare an operating and capital budget as well as a narrative summary of at least 1,000 words to show your financial findings and recommendations. You will provide supporting documentation to support your findings and recommendations. Prior to writing your narrative summary you will need to prepare an operating and capital budget for the project. The well-prepared operating and capital budgets will demonstrate a keen knowledge of the market, pricing, activity, revenues, expenses, and potential impact on cash-flow and/or profitability. The capital budget will similarly demonstrate an awareness of the capital items and associated costs for project start-up. NURS 6210 – Healthcare Finance and Budgeting Research Paper Permalink: https://nursingpaperessays.com/ nurs-6210-health…g-research-paper / ? Prepare an annual statistical report that includes the following: Volume of patient visits Revenues (percentage of reimbursement from Medicare, Medicaid, Commercial Insurance and Self Pay) Expenses (Labor, Equipment, Supply, Overhead) Provide your assumptions to justify all volumes, revenues and expenses Prepare a three-year operating budget that includes the following: An estimate of revenue each year An estimate of expenses for each year The cash flow (negative or positive) generated from revenues and expenses Prepare a start-up capital budget listing the equipment you may need for this project including the cost and annual depreciation From your operating budget calculating the following: Projected cash flow over 3 years Break-even analysis Internal rate of return (IRR) Net present value (NPV) From your calculations, evaluate the financial risk involved with this project and make a recommendation as to whether this project is financially viable. NURS 6210 – Healthcare Finance and Budgeting Research Paper Prepare a 1000-word minimum narrative summary of your financial findings and recommendations. You will provide supporting documentation to support your findings and recommendations. Key points on budgeting in health No country has made significant progress towards universal health coverage (UHC) without increasing the extent to which its health system relies on public revenue sources. NURS 6210 – Healthcare Finance and Budgeting Research Paper Framing the approach to health financing policy in this way places the health sector within the overall public budgeting system and underscores the crucial role that the budget plays, or should play, for UHC. Historically, health financing discussions have been largely driven by demands to raise revenues and find new sources of funds, with much less discussion of overall public sector financial management and budgeting issues. An understanding of the core principles of public budgeting is essential for those who have an active interest in health financing reform because the budget is a primary instrument for strategic resource allocation. Even in contexts where health insurance funds manage a core part of health expenditure, budgeting rules continue to influence flows of funds and transfers to purchasing agencies and/or health facilities. Firstly, robust public budgeting in health, especially through the development of multi-year plans, is likely to improve predictability in the sector’s resources, which in turn increases the likelihood that defined plans can be translated in policy actions on the ground. NURS 6210 – Healthcare Finance and Budgeting Research Paper Secondly, proactive engagement of health ministries in the budgeting process can facilitate alignment of budget allocations with sector priorities, as laid out in national health strategies and plans. In doing so, allocate efficiency within the sector’s resource envelope can be improved. Thirdly, if budgets are better defined, budget execution can improve, which means that under spending – a common issue in low income countries – can decrease in the sector (i.e. budget is implemented according to the plan, which is defined and articulated with national priorities). Fourthly, if the health budget is formulated according to goals and the execution rules align with this logic, it will allow a certain degree of spending flexibility and make budgets more responsive to sector needs. Engaging in budget preparation, understanding the guiding principles of budgeting as well as the political dynamics that enable the budget elaboration and approval process, is essential for health planning stakeholders. Although health is financed by public and private funds, to make progress toward universal health coverage (UHC), a predominant reliance on public, compulsory, prepaid funds is necessary. Therefore, the way budgets are formulated, allocated and used in the health sector is at the core of the UHC agenda. This chapter outlines the overall budget process for the public sector, discusses the specific role of health within it, in particular the role of the ministry of health and other health sector stakeholders, to provide timely inputs into the budgeting process. NURS 6210 – Healthcare Finance and Budgeting Research Paper Several surveys have been administered over the last 40 plus years to learn about capital budgeting practices of healthcare organizations. In this report, we analyze and synthesize these surveys in a four-stage framework of the capital budgeting process: identification, development, selections, and post-audit. We examine three issues in particular: (1) efficiency of for-profit hospitals relative to not-for-profit hospitals, (2) capital budgeting practices of the healthcare industry vis-à-vis other industries, and (3) effects of healthcare mergers and acquisitions on capital budgeting decisions. We found indirect evidence that for-profit hospitals exhibited greater efficiency than not-for-profit hospitals in recent years. The acquisition of not-for-profits by for-profits is credited as the primary reason for growth of multi hospital systems; these acquisitions may have contributed to the more efficient capital budgeting practices. One unique attribute of healthcare is the dominant role of physicians in almost all aspects of the capital budgeting process. In agreement with some researchers, we conclude that the disproportionate influence of physicians is likely to impede efficient decision making in capital budgeting, especially for nonprofit organizations. The healthcare industry faces new challenges daily. Advancements in care keeps the field exciting and rewarding, while an increased population and a large generation of aging patients make healthcare tough. NURS 6210 – Healthcare Finance and Budgeting Research Paper It isn’t just patient care that makes the field a challenge. The administrative side of healthcare has its own concerns. These concerns aren’t always centered on financials, but financial planning and healthcare budgeting can play a huge role in helping doctors, hospitals, and other healthcare facilities address some of their biggest challenges head-on. Value-Based Payments A staggering truth about the healthcare industry is that half of hospital bills are never paid. Some of this is because of issues between insurers or Medicare and the providers. Others are due to confusion about bills or lack of ability to pay on the part of patients. To simplify the process, the federal government passed the Medical Access and Chip Re authorization Act, or MACRA, which is meant to move providers to a more value-based payment system. In other words, the better patients are served, the better healthcare providers are paid. For the first few years, providers will have the option to participate or not. The program will be fully rolled out in 2019 and will impact all hospitals as well as healthcare providers that service a significant number of Medicare patients. The effect on a facility’s bottom line, however, will vary throughout the roll out. NURS 6210 – Healthcare Finance and Budgeting Research Paper To accommodate the changes, healthcare administrators that can run different scenarios with their budgets and plans will be the ones best prepared to deal with the results of value-based payments. Being able to ask “what if?” and run multiple views of a financial plan will set healthcare providers up for success as the changes related to MACRA go into effect. Practice Cost Management Medical professionals understand cash flow issues and how they can affect their operations, but they also understand that cash flow is important to an organization’s financial well-being. Day to day obligations like salaries, supplies, legal fees, tools and equipment, and so on must be balanced with co-pays, insurance reimbursements and patient payments. Budgeting expenses against cash flow – and controlling costs – is a critical concern for healthcare administrators. NURS 6210 – Healthcare Finance and Budgeting Research Paper Understanding where and how money is spent requires slicing and dicing of data and analyzing where savings can be found. Reviewing budget data against actual s and utilizing easy to understand dashboards can point to expenses that can be improved on. Shifting Requirements and Regulations As government regulations and laws change surrounding healthcare, it is difficult to know what will be required of providers and how payment models and overages will change. Between the financial demands of becoming compliant with technology regulations and the shifting landscape of the ACA, providers must be flexible in planning and budgeting. NURS 6210 – Healthcare Finance and Budgeting Research Paper Volatility in financials requires systems that can change quickly and accurately. Unfortunately, spreadsheet budgets can be rigid with small errors resulting in potentially large miscalculations or reporting issues. Healthcare providers need FP&A systems that provide for rapid changes and projections. Some providers may even consider switching to rolling forecasts, allowing for changes to be incorporated more quickly. Healthcare providers face change and uncertainty, but must still plan financials like any other business. The key to doing so effectively is having a system that tolerates changes well, is flexible without adding significant operational overhead, provides accurate and easy to understand reporting and offers scenario planning. With these tools available to administrators, providers can be prepared for whatever lies ahead. NURS 6210 – Healthcare Finance and Budgeting Research Paper Funding for fundamental science and early-stage translation al medicine is becoming scarcer, and at the worst possible time—when we now have the scientific and engineering expertise to make major breakthroughs in our understanding of the molecular basis of many deadly diseases and how to treat or prevent them. The dearth of funding for translation al medicine in the so-called “Valley of Death” can be attributed to several factors, but a common thread among them is increasing financial risks in the bio pharma industry and greater uncertainty surrounding the economic, regulatory, and political environments within the biomedical ecosystem. Increasing risk and uncertainty inevitably leads to an outflow of capital as investors and other stakeholders seek more attractive opportunities in other industries. By applying financial techniques such as portfolio theory, secularization, and option pricing to biomedical contexts, more efficient funding structures can be developed to reduce financial risks, lower the cost of capital, and bring more life-saving therapies to patients faster. By taking this course, students will gain the background, resources, and framework to influence the healthcare industry. Health systems financing Health financing systems are critical for reaching universal health coverage. Health financing levers to move closer to universal health coverage lie in three interrelated areas: NURS 6210 – Healthcare Finance and Budgeting Research Paper raising funds for health; reducing financial barriers to access through prepayment and subsequent pooling of funds in preference to direct out-of-pocket payments; and allocating or using funds in a way that promotes efficiency and equity. Developments in these key health financing areas will determine whether health services exist and are available for everyone and whether people can afford to use health services when they need them. Guided by the World Health Assembly resolution WHA64.9 from May 2011 and based on the recommendations from the World Health Report 2010 “Health systems financing: The path to universal coverage”, WHO is supporting countries in developing of health financing systems that can bring them closer to universal coverage. Health financing system A good health financing system raises adequate funds for health, in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. [1] Health financing systems that achieve universal coverage in this way also encourage the provision and use of an effective and efficient mix of personal and non-personal services. NURS 6210 – Healthcare Finance and Budgeting Research Paper Three interrelated functions are involved in order to achieve this: the collection of revenues from households, companies or external agencies; the pooling of prepaid revenues in ways that allow risks to be shared – including decisions on benefit coverage and entitlement; and purchasing; the process by which interventions are selected and services are paid for or providers are paid. The interaction between all three functions determines the effectiveness, efficiency and equity of health financing systems. Health system inputs: from financial resources to health interventions Like all aspects of health system strengthening, changes in health financing must be tailored to the history, institutions and traditions of each country. Most systems involve a mix of public and private financing and public and private provision, and there is no one template for action. However, important principles to guide any country’s approach to financing include: raising additional funds where health needs are high, revenues insufficient and where accountability mechanisms can ensure transparent and effective use of resources; reducing reliance on out-of-pocket payments where they are high, by moving towards prepayment systems involving pooling of financial risks across population groups (taxation and the various forms of health insurance are all forms of prepayment); NURS 6210 – Healthcare Finance and Budgeting Research Paper taking additional steps, where needed, to improve social protection by ensuring the poor and other vulnerable groups have access to needed services, and that paying for care does not result in financial catastrophe; improving efficiency of resource use by focusing on the appropriate mix of activities and interventions to fund and inputs to purchase; aligning provider payment methods with organizational arrangements for service providers and other incentives for efficient service provision and use, including contracting; strengthening financial and other relationships with the private sector and addressing fragmentation of financing arrangements for different types of services; promoting transparency and accountability in health financing systems; improving generation of information on the health financing system and its policy use. Health Care Funding In the United States, health care providers (such as doctors and hospitals) are paid by the following: Private insurance Government insurance programs People themselves (personal, out-of-pocket funds) In addition, the government directly provides some health care in government hospitals and clinics staffed by government employees. Examples are the Veteran’s Health Administration and the Indian Health Service. Private insurance Private insurance can be purchased from for-profit and not-for-profit insurance companies. Although there are many health insurance companies in the United States, a given state tends to have a limited number. NURS 6210 – Healthcare Finance and Budgeting Research Paper Most private insurance is purchased by corporations as a benefit for employees. Costs are typically shared by employers and employees. The amount of money employers spend on an employee’s health insurance is not considered taxable income for the employee. In effect, the government is subsidizing this insurance to some degree. People may also purchase private health insurance themselves. The Patient Protection and Affordable Care Act (PPACA, or Affordable Care Act [ACA]), which became effective in 2014, is U.S. health care reform legislation intended, among other things, to increase the availability, affordability, and use of health insurance (see also the U.S. Department of Health & Human Services ACA official site). Many of the ACA’s provisions involve an expansion of the private insurance market. It creates incentives for employers to provide health insurance and requires that nearly all people not covered by their employer or a government insurance program (for example, Medicare or Medicaid) purchase private health insurance (individual mandate). NURS 6210 – Healthcare Finance and Budgeting Research Paper The ACA requires creation of health insurance exchanges, which are government-regulated, standardized health plans that are administered and sold by private insurance companies. Exchanges may be established within each state, or states may join together to run multistate exchanges. The federal government also may establish exchanges in states that do not do so themselves. There are separate exchanges for individuals and small businesses. The ACA requires that private insurance plans do the following: Put no annual or lifetime limits on coverage Have no exclusions for preexisting conditions (guaranteed issue) Allow children to remain on their parent’s health insurance up to age 26 Provide limited variations in price (premiums can vary based only on age, geographic area, tobacco use, and number of family members) Allow for limited out-of-pocket expenses (currently $5950 for individuals and $11,900 for families) Not discontinue coverage (called rescission) except in cases of fraud Cover certain defined preventive services with no cost-sharing Spend at least 80% to 85% of premiums on medical costs Recent and impending changes that will affect the ACA include: Stopping government funding of premium tax credits and cost-sharing reductions Expansion of association health plans (AHPs) and health reimbursement arrangements (HRAs), which are less expensive and less comprehensive than ACA marketplace plans Reduced regulatory burden imposed by the Notice of Benefit and Payment Parameters (NBPP), which will give states more leeway in defining essential health benefits NURS 6210 – Healthcare Finance and Budgeting Research Paper Repeal of the individual mandate These changes are intended to reduce government and individual spending on health plans, but some authors warn that overall spending on health care may not be reduced and that there may be increased numbers of uninsured or inadequately insured people. Alternative financing methods User fees User fees – direct charges to users for health services – have been implemented in many countries for a number of years now. Proponents of user fees suggest that fees could make the health system more efficient by guiding demand to cost-effective health care at the appropriate levels. Further, they could improve equity if revenues generated from fees are allocated to addressing the health needs of the poor. Others, though, argue that this reallocation is not guaranteed, and in the absence of exemption policies or other forms of financial protection, user fees actually price the poor out of the market for health care. The discussion paper below reviews the African experience with user fees. NURS 6210 – Healthcare Finance and Budgeting Research Paper Innovative financing methods In addition to the traditional methods of financial risk protection, there are a variety of other financing mechanisms with which countries are experimenting. The need for these additional sources of funds is driven by rising demand for health care services, escalating costs of care, rapid increases in technology, and a limit on how much can be raised through a traditional tax base. Some of these methods are nationally based, such as: hypothetical taxes, e.g. ‘sin taxes’ for tobacco and alcohol national and state lotteries dedicated to health public-private partnerships between governments and the private sector to co-fund health care. Other mechanisms are internationally focused, such as: the (recently proposed) International Finance Facility (IFF). This would front-load development assistance by selling government bonds secured by future aids flows debt for health swaps, in which both public and private financial institutions can be involved in the conversion of the debt the use of public-private partnerships to develop new products using capital markets. NURS 6210 – Healthcare Finance and Budgeting Research Paper It is clear that with the rising costs of health care, countries will begin to explore more of these ideas to augment traditional sources of health financing. Budgeting in health care systems During the last decade there has been a recognition that all health care systems, public and private, are characterized by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. NURS 6210 – Healthcare Finance and Budgeting Research Paper The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated output targets with defined budgets and incentives for decision makers to economize in their use of resources are being incorporated into experiments in the health care systems of Western Europe and the United States. Undue optimism about the success of these experiments must be avoided because these problems have existed in the West and in the Soviet bloc for decades and efficient solutions are noticeable by their absence. Budgeting is important in any organization. In healthcare, department level budgeting is often managed by healthcare professionals and managers with little or no financial background. Managers may be promoted from the front lines as they have demonstrated a strong understanding of department function, or are hired with significant work-related experience and/ or possess advanced education. Unfortunately, many healthcare managers that are placed in entry level management positions lack either formal or informal training for financial management. These managers generally possess a strong understanding of how to deliver quality patient care services but are not adequately prepared to operate the department respecting a business model. A basic foundation in financial management is critical to ensure that department management goals are aligned with the strategic vision of the organization and operate with projected budgetary targets. NURS 6210 – Healthcare Finance and Budgeting Research Paper Managers must possess or obtain a basic understanding of financial principles such as: financial statements, operating budgets, capital budgets, and how to perform a basic analysis of this information to make sound business decisions. Budgeting requires careful consideration and effective planning. Budgeting is considered an essential component of management to ensure that the department operates effectively and ensure the organization remains solvent. In most developed countries, two factors are certain: first, health care costs are consistently exceeding GDP growth year after year; and second, health care resources are increasingly scarce and competitive. Managers must understand that many factors that may impact or influence the operating budget and capital budget decisions. In the U.S., budgets available to various departments depend on many organizational factors which may include billing and coding practices, shareholder investment, potential to increase capital, potential for return on investment from equipment or services, percentage of private insured payers versus Medicaid or Medicare clients, impact of competition on the bottom line, availability of new or updated technology, and many other factors. The solvency of the organization can significantly impact budgets from year to year and even threaten the future of a department or service if it proves unprofitable or expendable. NURS 6210 – Healthcare Finance and Budgeting Research Paper Managers must have some basic knowledge of where costs fit into the budget. They must understand the difference between an operating budget and a capital budget. Durham-Taylor and Pinczuk (2006) explain that an operating budget covers day-to-day operations and may include such things as wages, office or medical supplies, equipment rental, and education,etc. Gruen, and Howarth (2005) explain that staff costs is the largest “cost item” in a healthcare operating budget and managers must understand how hiring decisions can affect the budget. Although staffing is generally a ‘fixed’ cost and is relatively static, managers must understand the impact of payout of overtime hours, overstaffing, and agency hiring to replace staff, on their overall operating budget. After salaries and benefits, the second largest cost for many units relates to supplies. Understanding how to cost audit and analyze budgetary items can have a significant positive impact on the department goal of staying within an operating budget. This differs from capital budgeting that covers fixed assets such as land, buildings, and long-life capital projects financed over two or more years. MacLean (2003) explains that capital budgeting is based on the overall operating plan and is part of the strategic vision for the organization. Bett (2010) states “capital budgeting refers to the analysis of investment alternatives involving cash flows received or paid over a certain period of time” (para 2). Capital projects are often funded from a combination of internal savings and/or through external sources of funding via financing or grants. Understanding how a capital budget for fixed assets differs from an operating budget for day-to-day operations is critical to understand how and why management, executives, trustees, accountants and other key stakeholders make the decisions that they do. NURS 6210 – Healthcare Finance and Budgeting Research Paper Bull (1993) explains that capital budget and planning has become increasingly important due to competition and a focus on long-term stability of the organization. Twenty years on, this is critically important, particularly in healthcare organizations where resources are increasingly scarce. Gairns (2006) cites Dufresne stating “capital planning is a way of defining how you’re going to spend money to get the most impact for your organization and its mission… Capital budgeting is knowing what you’re going to spend your money on in the next year (or two or three)” (para 2). Boundless.com (n.d.) explains that capital budget planning is essential to determine if investments and expenditures are worth pursuing. An investment appraisal helps decision-makers discern between proposed projects and prioritize its investment decisions. Ongoing care and maintenance of equipment and human resource costs must also be factored into capital budget proposals and decisions. NURS 6210 – Healthcare Finance and Budgeting Research Paper Healthcare Budget Variance Budgeting is an important activity within every healthcare organization. The particular challenges encountered, however, can vary depending on the type of organization. A state or federally funded organization, for example, will likely have a budget that is allocated to it, and it needs to follow specific guidelines on how the money can be used. A for-profit organization, by contrast, will typically have more influence and flexibility in setting up its budget and making choices on matters such as how much to spend on marketing, patient care, or incentives for employees. In addition to preparing budgets, as a healthcare administrator, you must also be able to evaluate whether or not you have achieved your budget using variance analysis. This is important because variance analysis measures the differences between the budget and actual results, and provides administrators with a starting point for correcting financial performance. For this Assignment, you conduct a variance analysis for a healthcare organization. NURS 6210 – Healthcare Finance and Budgeting Research Paper To prepare for this Assignment, review the Week 7 Assignment document provided to you by the Instructor. Examine the budgeted and actual revenues and expenses for a hospital. Reflect on concepts of budgeting and variance. Refer to Chapter 10 and Chapter 11 of Financial Management of Health Care Organizations: An Introduction to Fundamental Tools, Concepts and Applications Using an Excel spreadsheet to show your calculations, address the following: •Determine the total variance between the planned and actual budgets for Surgical Volume. Is the variance favorable or unfavorable? NURS 6210 – Healthcare Finance and Budgeting Research Paper •Determine the total variance between the planned and actual budgets for Patient Days. Is the variance favorable or unfavorable? •Determine the service-related variance for Surgical Volume. •Determine the service-related variance for Patient Days. •Prepare a flexible budget estimate. Present side-by-side budget, flexible budget estimate, and the actual Surgical Revenues. •Prepare a flexible budget estimate. Present a side-by-side budget, flexible budget estimate, and the actual Patient Expenses. •Determine what variances are due to change in volume and what variances are due to change in rates. steps for creating a health care budget It may seem odd at first to come up with a budget for something so important, and sometimes unpredictable, as your heal

Advanced Practice Nurse Assignment Papers. Advanced Practice Nurse Assignment Papers. Permalink: https://nursingpaperessays.com/ advanced-practic…ssignment-papers / Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses.Advanced Practice Nurse Assignment Papers. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system.Advanced Practice Nurse Assignment Papers. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours.Advanced Practice Nurse Assignment Papers. According to Antonelli (2017), ‘self-assessment of knowledge and accuracy of skill performance is essential to the practice of healthcare and self-directed life-long learning’. The emphasis on life-long learning is important. Sullivan and Hall (2017) suggest that a self-assessment can promote reflection on personal performance as well as to identify reasons for discrepancies between scores of assessors and assesse. Self-assessment is ‘the act of judging ourselves and making decisions about the next step.’(Boud.,2015). An important principle is that assessment must be followed by action.Advanced Practice Nurse Assignment Papers. The three strengths that I possess include; ability to complete accurately and thoroughly any physical exam that encompasses the patients using appropriate techniques as provisioned for in the diagnosis chart. I am also able to effectively communicate verbally as well as establish interpersonal communication with the patients and other staff within the healthcare facility, which is crucial in establishing a collaborative working relationship and a calm environment in which the patients can feel comfortable to articulate what they might be experiencing. The third strength is that I am a strong believer in patient education. All these three strengths complement each other and play a crucial role in ensuring that I am effective in patient handling as well as establishing close relationship with them. For example, the ability to carry out thorough and accurate physical exams and diagnosis on patients ensures that I am able to focus on the patient symptoms with more ease as well as effectively diagnose their condition. The effective verbal communication as well as interpersonal communication helps ensure that I can create a comfortable environment through which the patients can be able to narrate their medical history thus gives me an opportunity to effectively analyze their condition. The provision of patient education about the patient medication or examination helps ensures they gain autonomy and self-empowerment to control and manage their condition.Advanced Practice Nurse Assignment Papers. The three weaknesses that I have include; the lack of an understanding of the state’s nursing practice act, inability to add all differential patient diagnosis in my the patient assessment although I might carry out accurate assessments, as well as the need to improve on the use of medical literature and thus be able to plan treatment appropriately. I am currently working on gaining a better understanding of the nursing legal compliance within the state as well as ensuring that each day I undertake patient assessments and fill in the differential diagnosis to ensure that the assessments are not only accurate but also comprehensive (Schober, 2016). I am currently working on improving my understanding of medical literature as well as taking time to research and understand more on the pathology of diseases and their treatment plans.Advanced Practice Nurse Assignment Papers. The clinical skills that I intent to acquire before exiting the program include; cultural competency skills, critical thinking skills as well as decision making skills, all which will help ensure that I am able to expedite my duties as a nurse better. The acquisition of the cultural competency skills will help ensure that I am able to not only communicate but also understand information from patients drawn from diverse backgrounds (Buppert, 2015). This will be achieved by ensuring that I spend time with colleagues drawn from different backgrounds as well as read widely on the various cultures and their practices. The critical thinking and decision-making skills will be honed through active practice, in which I will ensure that in every engagement I am involved try to critically think before making the decision as well as evaluating the various scenarios and circumstances at hand before making the final decision.Advanced Practice Nurse Assignment Papers. Advanced practice nurses have evolved widely through the years as technology has become integrated into the nursing profession, with the intent of realizing new cost-effective methods of delivering care as well as increasing the ratio of practitioners to patients. The advanced practice nurses are expected to not only obtain health histories of the patients but also perform comprehensive examinations on the patients, develop differential diagnostics, evaluate the response of the patients to treatment as well as engage in research studies (Schober, 2016). As an advanced practice nurse, I will play a crucial role developing therapeutic plan of care, provide patient education and counseling as well as participate in research studies aimed at improving the nature of care that is available for the patients.Advanced Practice Nurse Assignment Papers. This power point will discuss highlights of our clinical courses and will provide a quick access guide , with classroom requirements and reminders. Nurse Practitioner (NP) student clinical orientation.Advanced Practice Nurse Assignment Papers. Dr. Jennifer Stone – Clinical Supervisor, [email protected] Dr. Tara Harris – PT Clinical Supervisor, [email protected] Welcome to NP Program Dr. Linda Steele – NP Program Director Dr. Timothy Legg – PMHNP Coordinator Dr. Salma Hernandez – AGACNP & AGPCNP Coordinator Dr. Phyllis Morgan – FNP Coordinator Dr. Stefanie Gatica – FNP Coordinator Dr. Jennifer Stone – Clinical Supervisor Dr. Tara Harris – Clinical Supervisor NP Full time faculty Dr. Rachel Carlton Dr. Eva Hvingelby Dr. Mahaman Moussa Dr. Erica Sciarra Dr. Jeani Thomas Dr. Cindy Trent Dr. Gretchen Zunkel Chain of Command and Course Coordinator Support Any questions or concerns about your clinical course: First point of contact is the Clinical faculty Didactic faculty – clinical faculty will contact if help is needed. Lead faculty – didactic faculty will contact if help is needed. Course coordinator – lead faculty will contact if help is needed Clinical Supervisors – faculty will contact for specific clinical issues or questions Course Coordinators Timothy Legg – 6512, 6630, 6640 Salma Hernandez – 6501, 6540, 6550, 6560 Phyllis Morgan – 6521, 6551, 6565 Stefanie Gatica – 6531, 6541 Student resources Student Assistance Program – Students, and anyone in their households, who want to use this service or are referred for assistance should be encouraged to call 1-866-465-8942 (TDD: 1-800-697-0353) or visit http://inside.WaldenU.edu/sap for more information. When students request services from the program, they will be asked for a Walden ID. That ID is SAP4EDU. Nurse Practitioner (NP) student clinical orientation..Advanced Practice Nurse Assignment Papers. Writing Center – http://academicguides.waldenu.edu/writingcenter/home Walden library – http://academicguides.waldenu.edu/library Technical support – 800-925-3368 PRE-CLINICAL INFORMATION Students are to create a schedule for clinical hours that the student and preceptor have agreed upon and email it to your clinical faculty Please save it in a calendar format and include your contact information as well as preceptor’s contact information on the schedule Save the file name and “clinical schedule” You must email the schedule to Clinical Faculty Clinical faculty will call or email student and preceptor to set up a minimum of 1 phone conference and 2 email contacts during the quarter PRECLINICAL INFORMATION FOR STUDENTS You should reflect and prepare learning goals and objectives for the course Review the course objectives Review SOAP notes article. Nurse Practitioner (NP) student clinical orientation. Review the preceptor evaluation of student Review the Competencies for your specialty (AGACNP, AGPCNP, FNP, PMHNP) by visiting the following sites: Core Competencies for nurse practitioners http://nonpf.com/associations/10789/files/NPCoreCompetenciesFinal2012.pdf AGPCNP Competencies http://nonpf.com/associations/10789/files/Adult-GeroPCComps2010.pdf FNP Competencies http://www.nonpf.org/associations/10789/files/PopulationFocusNPComps2013.pdf AGACNP Competencies http://www.aacn.nche.edu/geriatric-nursing/Adult-Gero-ACNP-Competencies.pdf PMHNP Competencies: http://www.aacn.nche.edu/education-resources/PopulationFocusNPComps2013.pdf CLINICAL ATTIRE STUDENTS MUST WEAR APPROPRIATE ATTIRE Name Tag Instructions for making your name tag Students go to myWalden Portal Welcome Center tab Get Prepared tab Scroll to bottom of page #7 Print ID badge If your clinical site requires a photo ID, please add a passport photo (scan your photo with name tag) Resources STUDENTS should take to CLINICAL Practice guidelines for your specialty program: FNP, AGACNP, AGPCNP, and PMHNP Ask preceptor if acceptable to use smartphones, etc. while in the setting Pharmacology applications on your smartphone or iPad, etc. Ask preceptor what resources they use most often STUDENT Expectations Print the Syllabus for the Course and hand deliver to your preceptor and review the objectives for the course. Nurse Practitioner (NP) student clinical orientation. Students should see the minimum number of patients outlined in this presentation. Generally you should: Ask the patient if they mind if you see them in combination with your preceptor Perform your assessment: Subjective, Objective Data Make a list of differential diagnoses Form a tentative plan of care – look for teaching opportunities – look for evidence to back your plan Consult with your preceptor and revise your assessment, diagnoses and plan STUDENTS First Day Students should be oriented to the clinical site by preceptor or office personnel for a maximum of 8 hours The lay out of the office Office procedures Lunch Restroom locations Other Orientation/observation to the site **NEW **Requirements for patient encounters per course Consensus of patient numbers by course. These are MINIMUM numbers of patients: NURS 6531 – 144 patients in 144 hours NURS 6540 – 100 patients in 144 hours NURS 6541 – 144 patients in 144 hours NURS 6550 – 75 patients in 144 hours NURS 6551 – 100 GYN patients; 25 OB patients in 144 required hours NURS 6560 – 75 patients in 144 hours NURS 6565 – 144 patients in 144 hours PMHNP Courses: NURS 6640, NURS 6650, NURS 6660, NURS 6670: “Students in the PMHNP program will need to complete 144 hours of practicum in EACH of the four practicum courses. It is acknowledged that a variety of factors will influence the number of clients seen, but students should strive to see as many clients possible each clinical day.”Advanced Practice Nurse Assignment Papers. *A minimum of 144 clinical hours are required in each practicum course. More hours can be completed but cannot transfer to another clinical course. Meditrek Students are to upload their information on the time log and patients log every 48 hours. Midterm and final evals by preceptor need to be completed in Meditrek. Midterm eval should be completed prior to midterm conference call, then reviewed. Didactic faculty are responsible to ensure ALL clinical students have their time logs signed and final evals completed prior to entering final grade. Nurse Practitioner (NP) student clinical orientation. Meditrek Contact Information If the preceptor does not receive an email with login information, the student or the preceptor should email the preceptor’s name and email, along with the student’s name and Walden ID number to [email protected] and the login information will be sent to the preceptor directly.Advanced Practice Nurse Assignment Papers. How do STUDENTS document patient encounters at clinical site? This will be up to the preceptor and clinical faculty It is a good idea to learn from each site as many have electronic medical records The preceptor may want you to hand write your SOAP note Documenting Clinical Experiences for the Course To prepare for this course’s Practicum Experience, address the following in Practicum Journal (AGPCNP and FNP students ONLY): Select and describe a nursing theory to guide your practice. Develop goals and objectives for your Practicum Experience in this course. When developing r goals and objectives, students are to be sure to keep the competency domains of practice in mind. Create a timeline of practicum activities based on your practicum requirements. Documenting Clinical Experiences for the Course All patients must be entered on the NP Patient Log within 48 hours of each clinic day. All clinic hours must be entered on the Time log within 48 hours of each clinic day. Clinical faculty will review all NP patient logs and Time logs periodically throughout the course. Students are to keep them up-to-date at all times. Nurse Practitioner (NP) student clinical orientation.Advanced Practice Nurse Assignment Papers. Weekly Journal Entries are required but only submitted Weeks 3, 7 and 10 (or as directed in clinical course). Grading CLINICAL JOURNALS and Time Logs Midterm and Final Evaluations All students are required to have their preceptor complete a midterm and final evaluation in order to pass the course Midterm evaluation is done through Meditrek and should be completed by the preceptor during weeks 4-6; the preceptor will receive login credentials to Meditrek beginning in week 3.Advanced Practice Nurse Assignment Papers. Students must have a satisfactory final evaluation by preceptor in Meditrek by end of week 10. All students are required to have their preceptor and practicum site evaluation in Meditrek by end of week 10. What happens if… Student or preceptor is ill or has an emergency Students are to notify their clinical faculty and make plans to obtain the missed hours If student is ill, please make sure you notify your preceptor If student and/or preceptor terminate the agreement Students are to notify clinical faculty immediately and be proactive in securing another preceptor Clinical Failure Behaviors constituting clinical failure include, however are not limited to, the following: Demonstration of unsafe performance and/or decision-making skills. Nurse Practitioner (NP) student clinical orientation. Failure to complete clinically related class assignments and/or clinical log. Failure to complete the required clinical hours and patients numbers Falsification of clinical hours, records, or documentation. Failure to complete clinical hours with approved preceptor. All preceptors must be approved or clinical hours will not count.Advanced Practice Nurse Assignment Papers. Students Must Remember… Students are a guest in the clinical setting and should act politely at all times Students are not make personal phone calls. Turn your phones on vibrate and take calls only during breaks Always thank the patient and preceptor and office staff Be active in the learning process You are there to learn to be a health care provider. You are not a nurse in the clinic. It is ok to be wrong. We expect that as part of the learning process. Ask questions! IF YOU DON’T KNOW… Ask preceptor Ask clinical faculty Ask didactic faculty We all want students to learn and be successful Nurse Practitioner (NP) student clinical orientation. Specialty Coordinators Dr. Salma Hernandez AGACNP and AGPCNP salma.hernandez@mail. waldenu.edu Dr. Phyllis Morgan FNP [email protected] Dr. Stefanie Gatica FNP [email protected] Dr. Timothy Legg Coordinator PMHNP [email protected] Clinical Supervisors Dr. Jennifer Stone – Full time Clinical Supervisor for FNP, AGACNP, AGPCNP, PMHNP [email protected] Dr. Tara Harris – Part time Clinical Supervisor for FNP, AGACNP, AGPCNP, PMHNP [email protected] Field Office Contacts Preceptors – [email protected] Field Sites for Affiliation Agreements – [email protected] Students – [email protected] Onboarding Questions – [email protected] THANK YOU! MUCH SUCCESS! Nurse Practitioner (NP) student clinical orientation. During NP clinical practicum experiences, we identify, as nurses, many health care issues that need to be addressed at the local, state, or national level. Addressing the need for change in health care policy is now an intricate part of your role as a social change agent. For this Discussion, you will identify a change needed in your community and what your nursing legacy for positive social change will be.Advanced Practice Nurse Assignment Papers. To prepare: Consider the health care issues and deficits you have recognized in your professional practice. Identify a change needed in your community in health care policy and discuss how you could impart change during your career as an NP. Consider your future as a NP and what your nursing legacy will be. How will you impart Social Change? By Day 3 Post a change needed in your community and an explanation for how you will begin to implement that change. Then, share with your colleagues a brief explanation of what your nursing legacy will be and how will you impart Social Change.Advanced Practice Nurse Assignment Papers. Enrollment is open for our new accelerated summer nursing transfer program, designed for students who have already completed 70-80 course credits. Qualified applicants may reduce up to a year off of graduation time, and competitive scholarships are available to qualifying transfers! Call our admissions team at 414-382-610 or email a copy of your transcripts to our admissions department. Apply by May 14 for your chance to fast track your future. Alverno guarantees clinical placements and features an on-campus, state-of-the-art Clinical Learning Center and Clinical Simulation Center to mimic real-life health care environments. And our ability-based curriculum will equip you with the career-readiness skills you need to become a leader in today’s rapidly changing health care field.Advanced Practice Nurse Assignment Papers. Here at CHLA, we believe every child deserves to enjoy all those special moments that childhood has to offer, free from pain and suffering. This is what inspires our staff to be their best—and they’re equipped with everything they need to succeed. If you want to help create more special moments for children where you’re empowered to deliver the highest quality of care, this is the place to do it.Advanced Practice Nurse Assignment Papers. Founded in 1901, Children’s Hospital Los Angeles is one of the nation’s leading children’s hospitals and is acknowledged worldwide for its leadership in pediatric and adolescent health. Children’s Hospital Los Angeles is one of only 10 children’s hospitals in the nation—and the only children’s hospital on the West Coast—ranked in all 10 pediatric specialties by U.S. News & World Report and named to the magazine’s Honor Roll of children’s hospitals. Children’s Hospital Los Angeles is a premier teaching hospital and has been affiliated with the Keck School of Medicine of the University of Southern California since 1932.Advanced Practice Nurse Assignment Papers. Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours.Advanced Practice Nurse Assignment Papers. According to Antonelli (2017), ‘self-assessment of knowledge and accuracy of skill performance is essential to the practice of healthcare and self-directed life-long learning’. The emphasis on life-long learning is important. Sullivan and Hall (2017) suggest that a self-assessment can promote reflection on personal performance as well as to identify reasons for discrepancies between scores of assessors and assesse. Self-assessment is ‘the act of judging ourselves and making decisions about the next step.’(Boud.,2015). An important principle is that assessment must be followed by action.Advanced Practice Nurse Assignment Papers. The three strengths that I possess include; ability to complete accurately and thoroughly any physical exam that encompasses the patients using appropriate techniques as provisioned for in the diagnosis chart. I am also able to effectively communicate verbally as well as establish interpersonal communication with the patients and other staff within the healthcare facility, which is crucial in establishing a collaborative working relationship and a calm environment in which the patients can feel comfortable to articulate what they might be experiencing. Advanced Practice Nurse Assignment Papers. The third strength is that I am a strong believer in patient education. All these three strengths complement each other and play a crucial role in ensuring that I am effective in patient handling as well as establishing close relationship with them. For example, the ability to carry out thorough and accurate physical exams and diagnosis on patients ensures that I am able to focus on the patient symptoms with more ease as well as effectively diagnose their condition. The effective verbal communication as well as interpersonal communication helps ensure that I can create a comfortable environment through which the patients can be able to narrate their medical history thus gives me an opportunity to effectively analyze their condition. The provision of patient education about the patient medication or examination helps ensures they gain autonomy and self-empowerment to control and manage their condition.Advanced Practice Nurse Assignment Papers. The three weaknesses that I have include; the lack of an understanding of the state’s nursing practice act, inability to add all differential patient diagnosis in my the patient assessment although I might carry out accurate assessments, as well as the need to improve on the use of medical literature and thus be able to plan treatment appropriately.Advanced Practice Nurse Assignment Papers. I am currently working on gaining a better understanding of the nursing legal compliance within the state as well as ensuring that each day I undertake patient assessments and fill in the differential diagnosis to ensure that the assessments are not only accurate but also comprehensive (Schober, 2016). I am currently working on improving my understanding of medical literature as well as taking time to research and understand more on the pathology of diseases and their treatment plans.Advanced Practice Nurse Assignment Papers. The clinical skills that I intent to acquire before exiting the program include; cultural competency skills, critical thinking skills as well as decision making skills, all which will help ensure that I am able to expedite my duties as a nurse better.Advanced Practice Nurse Assignment Papers. The acquisition of the cultural competency skills will help ensure that I am able to not only communicate but also understand information from patients drawn from diverse backgrounds (Buppert, 2015). This will be achieved by ensuring that I spend time with colleagues drawn from different backgrounds as well as read widely on the various cultures and their practices. The critical thinking and decision-making skills will be honed through active practice, in which I will ensure that in every engagement I am involved try to critically think before making the decision as well as evaluating the various scenarios and circumstances at hand before making the final decision.Advanced Practice Nurse Assignment Papers. Advanced practice nurses have evolved widely through the years as technology has become integrated into the nursing profession, with the intent of realizing new cost-effective methods of delivering care as well as increasing the ratio of practitioners to patients.Advanced Practice Nurse Assignment Papers. The advanced practice nurses are expected to not only obtain health histories of the patients but also perform comprehensive examinations on the patients, develop differential diagnostics, evaluate the response of the patients to treatment as well as engage in research studies (Schober, 2016). As an advanced practice nurse, I will play a crucial role developing therapeutic plan of care, provide patient education and counseling as well as participate in research studies aimed at improving the nature of care that is available for the patients.Advanced Practice Nurse Assignment Papers. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers Students in this synthesis course will focus on clinical competence in primary care settings by building on knowledge and skills gained in previous courses. Through clinical practice, students will build confidence as they begin the transition from the role of registered nurse to that of advanced practice nurse. Classroom activities and case studies will enable students to explore the salient nurse practitioner practice issues involved in the delivery of safe, competent, high-quality, cost-effective care of patients in a dynamic healthcare system. Advanced Practice Nurse Assignment Papers. Clinical experiences in primary care settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for patients with complex health conditions. The application of knowledge in the management of clients and collaboration among the advanced practice nurse and the client, family, and interprofessional healthcare team are emphasized. (Prerequisite(s): NURS 6501, NURS 6512, NURS 6521, NURS 6531 or NUNP 6531, NURS 6541 or NUNP 6541, and NURS 6551 or NUNP 6551.) Note: This course requires a minimum of 160 practicum hours.Advanced Practice Nurse Assignment Papers. ORDER A CUSTOM-WRITTEN PAPER NOW NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Course Readings Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long?” OJIN: The Online Journal of Issues in Nursing, 19(1).Advanced Practice Nurse Assignment Papers. Christensen, C. M., Bohmer, R. M. J., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102-112, 199. Ford, L. C.. & Gardenier, D. (2015). Fasten your seat belts – it’s going to be a bumpy ride. The Journal for Nurse Practitioners, 11(6), 575-577. Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). Hayes, E., Chandler, G., Merriam, D., & King, M. C. (2002). The master’s portfolio: Validating a career in advanced practice nursing. Journal of the American Academy of Nurse Practitioners, 14(3), 119. Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners -risks and rewards. New England Journal of Medicine, 368(20), 1935-1941. Jordan, L. M., Quraishi, J. A., & Liao, J. (2013). The national practitioner data bank and CRNA anesthesia-related malpractice payments. American Association of Nurse Anesthetists Journal, 81(3), 178-182. Kooienga, S.A. & Carryer, J.B. (2015). Globalization and advancing primary care health care nurse practitioner practice. The Journal for Nurse Practitioners, 11(8), 804–811. Miller, K. P. (2013). The national practitioner data bank: An annual update. The Journal for Nurse Practitioners, 9(9), 576-580. O’Connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: Using a capability framework in developing practice standards for advanced practice nursing. Journal of Advanced Nursing, 70(12), 2728-2735. Reinisch, C. E. (2014). Loretta Ford: Envisioning the future. Clinical Scholars Review, 7(1), 82-84. Rhodes, C. A., Bechtle, M., & McNett, M. (2015). An incentive plan for advanced practice registered nurses: Impact on provider and organizational outcomes. Nursing Economics, 33(3), 125-131. Silver, H. K,. Ford, L. C., & Day, L. R. (1968). The pediatric nurse-practitioner program: Expanding the role of the nurse to provide increased health care for children. JAMA, 204(4), 298-302. Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . . Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500. Stelmach, E. I. (2015). Dismissal of the noncompliant patient: Is this what we have come to? The Journal for Nurse Practitioners, 11(7), 723-725. Watson, E. (2014). Nursing malpractice: Costs, trends and issues. Journal of Legal Nurse Consulting, 25(1), 26-31. Weber, S. (2006). Developing nurse practitioner student portfolios. Journal of the American Academy of Nurse Practitioners, 18(7), 301-302. Westrick, Susan J., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics. The Journal for Nurse Practitioners, 12(2), 120-126. NURS 6565 Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings Essay Assignment Papers and Exam Questions and Answers NURS 6565 Week 2 Discussion: Ethical Challenges in Health Care for Practicing NPs Consider the following case study: Mrs. ABC is a 35 year old woman who has a scheduled business trip today. It is currently 8 am, and her plan is to leave at 6 pm. Mrs. ABC has a sore throat and she thinks it is strep because her 5 year old daughter was recently treated for strep. Mrs. ABC calls her physician for an appointment, but there are no appointments available until next week. Advanced Practice Nurse Assignment Papers. She has a mother who is a nurse practitioner and her office is 5 minutes away from where she lives. She calls and schedules an appointment with her mother. Her mother was surprised to see her daughter at the office. Mrs. ABC is frantic and begs her mother for an antibiotic. Her mother tests her and the rapid strep test is negative in office. Her mother (NP) sends out a strep DNA probe. Her mother prescribes an antibiotic and the patient (her daughter) is very satisfied. The results returned for the DNA probe 48 hours later and it confirmed negative for strep. NURS 6565 Synthesis in Advanced Practice Care of