Describe one internal and one external method for the dissemination of your evidence-based change proposal. For example, an internal method may be the hospital board, and an external method may be a professional nursing organization. Discuss why it is important to report your change proposal to both of these groups.

Describe one internal and one external method for the dissemination of your evidence-based change proposal. For example, an internal method may be the hospital board, and an external method may be a professional nursing organization. Discuss why it is important to report your change proposal to both of these groups. How will your communication strategies change for each group?

Ans.

Nursing practice is dynamic and always changing because of new information originating from research, client issues and technology development. Evidence based practice and research based practice often used interchangeably. Evidence based practice include nurse’s clinical experience, practice trends, and individual client preferences, whereas research based practice refers to the knowledge based on systematic research studies.

The six characteristics of Evidence based practice includes:

  • client centred
  • scientifically based
  • population outcomes based
  • Refined through quality improvement and benchmarking
  • individualised to each client
  • compatible with system policy.

Examples of EBP:

  • Reduce the time interval between when a physician writes the prescription order to when the patient receives the first dose.
  • Optimize the treatment and prevention of anaemia during caesarean section.
  • Improve the patient satisfaction in noise reducing activity.
  • Reduce the needle injuries in nursing personnel.

Examples of EBP results:

1. A study conducted regarding the benefits of discontinuing the routine practice of listening to the bowel sounds who have undergone abdominal surgery. The evidence based project resulted in saving nursing time without having negative patient outcomes.

2.Another evidence based results shows average nurses knowledge is outdated and they does not i improve the quality care and health outcomes.

The EBP project results should be discussed because

  • it improves the quality and patient outcome.
  • it enable the nurses to systemically transfer the evidence based knowledge into clinical practices.
  • it is essential to provide competent and safe nursing care.
  • it increases the confidence in decision making.
  • it improve the skills and critical thinking.
  • it enhances the nurses to lead a job satisfaction and group cohesion.
  • it reduces the cost in health care and saves time and effort.

For this Assignment, you will create a Personal Legislative Agenda in which you will detail your strategy for moving your policy through the legislative process. 

How can you move a policy forward? What strategies need to be implemented, evidence compiled, or resources utilized? What is the plan for the legislative process?

For this Assignment, you will create a Personal Legislative Agenda in which you will detail your strategy for moving your policy through the legislative process.

Begin working in Week 5, it is not due until Week 7.

 

  • Review the Personal Legislative Agenda and Action Plan Exemplar to demonstrate how you will construct your Personal Legislative Agenda for the state and federal proposed legislation.
  • Review the Personal Legislative Agenda and Action Plan Exemplar to determine which approach might work best for advancing your policy initiatives at various stages of the legislative process.

 

Submit a Personal Legislative Agenda detailing your strategy for moving your policy through the legislative process, using the Personal Legislative and Agenda and Action Plan Exemplar as your template.

In your Personal Legislative Agenda, choose from the strategies provided in Advocacy Toolkit resource that best suite moving your policies forward. Be sure to connect the strategies to the appropriate sections of the policy model you selected in Module 2.

Agenda: Nursing Shortage

See attachment for the form that needs to be used

Explain the physiological concepts associated with the lymphatic and immune systems. Summarize this module’s key points in 5-6 sentences.

After reviewing and studying this module’s content, answer the following questions. Be sure to complete all lab activities and attend/watch all live lectures before completing this assignment. All of your answers should be written in your own words, using full sentences, correct terminology, and proper spelling and grammar.

  1. Explain the anatomical concepts associated with the lymphatic and immune systems. Summarize this module’s key points in 5-6 sentences.
  2. Explain the physiological concepts associated with the lymphatic and immune systems. Summarize this module’s key points in 5-6 sentences.
  3. How will you apply the concepts you have learned about the lymphatic and immune systems in real life and in your future career?
  4. Which topic within this module has been the most valuable to your learning experience and why?
  5. Which topic(s) within this module did you struggle to understand and why?
  6. (Optional) Do you have any suggestions for your instructor on how they could help you connect with the difficult topics you’ve noted?

Immune system is the defence system by which body evade the invading the microorganisms and prevent the their pathology to cause disease.

Immunity is either by birth called innate immunity and  acquired immunity.

Anatomy of lymphatic system and immune system :

Inmune system : It contains the white blood cells in it and they are produced from different organs such as the bone marrow ,thymus.

Other lympatic organs are : lymph nodes and spleen and tonsils.

Bone marrow which is present within the bone will give the hematopoietic stem cells and forms the precursor lymphatic cells such as the B and T lymphocytes.

B lymphocytes get matured within the bone marrow where as T lymohocytes get matured in the thymus.

Other lympatic cells : Neurtophils, macrophages, monocytes, eosinophils , dendritic cells and natural killer cells.

​​​​​​There are number of lymph nodes which are located within the body at different regions.

Ex: Supraclavicular lymph nodes ,axillary nodes ( anterior,medial and lateral groups ),inguinal lymoh nodes ,submental lymph nodes etc..

All lymph nodes are composed of the B and T lymohocytes in them.

Lymphatic system:

Lymphatic system : which carry the lymphatic fluid back to the blood.

It is formed by the : lymphatic capillaries join together and forms lymphatic channels , lymphatic channels join together and forms vessels and then eventually forms the large lympatic vessel such as thoracic duct.

Lymphatic channels are made of three layers ; tunica intima ,media and adventitia.

They have valves in their lumen and which prevent the backflow of lymphatic fluid i.e one way carry of lymphatic fluid the venous blood.

Forward flow of lymphatic fluid is possible by means of the contraction of the smooth muscles in the lymphatic channels.

First lymphatic fluid carry to near by lymph node and here if any mircoorganisms are there they get eliminated then lymphatic fluid comes through the efferent lymphatic channels and eventually drains into the venous blood.

Spleen is the lymphatic organ which is rich in the white blood cells and it is the greviad of the red blood cells because destruction of the red blood cells takes place in here.

Functions of lymphatic and immune system :

Together play role in the immunity.

Restoration of the blood volume and remove of excess of carbon dioxide to out.

Lymphatic drainage : 

Right side of thorax ,face and right upper limb are drained into the right lympatic duct.

Rest all of the body lymphatic drainage is through the thoracic duct.

Distinguish between moral distress, burnout and compassion fatigue.

Many nurses are very concerned about what lies in the future of their careers. Each generation has their challenges, but this generation will probably always remember COVID-19. As nurses, we had to reflect on what happened during those days and we needed to soul search because of what we had to confront as nurses. Some of you are on the front lines of this pandemic taking care of patients that are affected.

Instructions:

  1. Go to the American Association of Critical-Care Nurses (AACN) website and read about moral distress.
  2. Please share a couple of experiences that you may have had or that you may imagine that you would have caring for a patient with COVID-19
    • Example: It really disturbs me that a person that is dying cannot communicate with their family. As a proponent of palliative care and hospice and all the ideas connected to this I am adamantly against any person going through the dying process without family present. This has really disturbed me to the point that I am personally dealing with feelings of distress that I cannot come up with an answer.
  3. Distinguish between moral distress, burnout and compassion fatigue. Classify the example that is given above.
  4. Read the AACN Position Statement: Moral Distress in Times of Crisis. Comment on the AACN Position Statement. Do you believe the same things about moral distress. What do you believe?

https://www.aacn.org/clinical-resources/moral-distress

https://www.aacn.org/policy-and-advocacy/aacn-position-statement-moral-distress-in-times-of-crisis

The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed right-sided pneumonitis.

AIDS (Acquired Immunodeficiency Syndrome)

 

Case Studies

 

The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic

diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed

right-sided pneumonitis. The following studies were performed:

 

Studies Results

Complete blood cell count (CBC), p. 156

Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 36% (normal: 42%–52%)

Chest x-ray, p. 956 Right-sided consolidation affecting the posterior

lower lung

Bronchoscopy, p. 526 No tumor seen

Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)

Stool culture, p. 797 Cryptosporidium muris

Acquired immunodeficiency syndrome

(AIDS) serology, p. 265

 

p24 antigen Positive

Enzyme-linked immunosorbent assay

(ELISA)

Positive

Western blot Positive

Lymphocyte immunophenotyping, p. 274

Total CD4 280 (normal: 600–1500 cells/L)

CD4% 18% (normal: 60%–75%)

CD4/CD8 ratio 0.58 (normal: >1.0)

Human immune deficiency virus (HIV)

viral load, p. 265

75,000 copies/mL

 

Diagnostic Analysis

 

The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is

an opportunistic infection occurring only in immunocompromised patients and is the most

common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium

muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool

culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his

prognosis is poor.

 

The patient was hospitalized for a short time for treatment of PCP. Several months after he was

discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually

and died 18 months after the AIDS diagnosis.

 

 

 

 

Case Studies

Copyright © 2018 by Elsevier Inc. All rights reserved.

2

Critical Thinking Questions

 

1. What is the relationship between levels of CD4 lymphocytes and the likelihood of

clinical complications from AIDS?

 

2. Why does the United States Public Health Service recommend monitoring CD4

counts every 3–6 months in patients infected with HIV?

 

3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you

approach to your patient to inform about his diagnosis?

 

4. Is this a reportable disease in Florida? If yes. What is your responsibility as a

provider?

A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on stopping his activity. He has no history of heart or lung disease. His physical examination was normal except for notable pallor.

Iron-Deficiency Anemia

Case Study

 

A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on

stopping his activity. He has no history of heart or lung disease. His physical examination was

normal except for notable pallor.

 

Studies Result

Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads

Chest x-ray study, p. 956 No active disease

Complete blood count (CBC), p.

156

 

Red blood cell (RBC) count, p.

396

2.1 million/mm (normal: 4.7–6.1 million/mm)

RBC indices, p. 399

Mean corpuscular volume

(MCV)

72 mm 3 (normal: 80–95 mm

3 )

Mean corpuscular hemoglobin

(MCH)

22 pg (normal: 27–31 pg)

Mean corpuscular hemoglobin

concentration (MCHC)

21 pg (normal: 27–31 pg)

Red blood cell distribution width

(RDW)

9% (normal: 11%–14.5%)

Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 18% (normal: 42%–52%)

White blood cell (WBC) count, p.

466

7800/mm 3 (normal: 4,500–10,000/mcL)

WBC differential count, p. 466 Normal differential

Platelet count (thrombocyte

count), p. 362

Within normal limits (WNL) (normal: 150,000–

400,000/mm 3 )

Half-life of RBC 26–30 days (normal)

Liver/spleen ratio, p. 750 1:1 (normal)

Spleen/pericardium ratio <2:1 (normal)

Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%)

Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL)

Blood typing, p. 114 O+

Iron level studies, p. 287

Iron 42 (normal: 65–175 mcg/dL)

Total iron-binding capacity

(TIBC)

500 (normal: 250–420 mcg/dL)

Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL)

Transferrin saturation 15% (normal: 20%–50%)

 

 

Case Studies

Copyright © 2018 by Elsevier Inc. All rights reserved.

2

Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL)

Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL)

Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34 mmol/L)

 

Diagnostic Analysis

 

The patient was found to be significantly anemic. His angina was related to his anemia. His

normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis..

His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency.

His marrow was inadequate for the degree of anemia because his iron level was reduced.

 

On transfusion of O-positive blood, his angina disappeared. While receiving his third unit of

packed RBCs, he developed an elevated temperature to 38.5°C, muscle aches, and back pain.

The transfusion was stopped, and the following studies were performed:

 

Studies Results

Hgb, p. 251 7.6 g/dL

Hct, p. 248 24%

Direct Coombs test, p. 157 Positive; agglutination (normal: negative)

Platelet count, p. 362 85,000/mm 3

Platelet antibody, p. 360 Positive (normal: negative)

Haptoglobin, p. 245 78 mg/dL

 

Diagnostic Analysis

 

The patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs

test and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count

dropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the

RBC reaction.

 

He was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal

examination indicated that his stool was positive for occult blood. Colonoscopy indicated a right-

side colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the

surgery well.

 

Critical Thinking Questions

 

1. What was the cause of this patient’s iron-deficiency anemia?

 

2. Explain the relationship between anemia and angina.

 

3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for

the answer

 

4. What other questions would you ask to this patient and what would be your rationale for

them?

Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care.

Purpose

The purpose of this assignment is to provide the student with an opportunity to explore the nurse practitioner (NP) practice requirements in his/her state of practice, NP competencies and leadership skills to develop a plan to support professional development.

Activity Learning Outcomes

Through this assignment, the student will demonstrate the ability to:

1. Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care. (CO1)

2. Analyze essential skills needed to lead within the context of complex systems. (CO3)

3. Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings. (CO4)

Due Date

Assignment should be submitted to the Roles in APN Professional Development Plan

When the assignment is placed in the dropbox, it will automatically be submitted to Turnitin. You may submit the assignment one additional time before the due date to lower the Turnitin score. If you choose to resubmit, the second submission will be considered final and subject to grading.  Once the due date for the assignment passes, you may not resubmit to lower a Turnitin score.

This assignment will follow the late assignment policy specified in the course syllabus.

Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.

In the event of a situation that prevents timely submission of an assignment, students may petition their instructor for a waiver of the late submission grade reduction. The instructor will review the student’s rationale for the request and make a determination based on the merits of the student’s appeal. Consideration of the student’s total course performance to date will be a contributing factor in the determination. Students should continue to attend class, actively participate, and complete other assignments while the appeal is pending.

 

Requirements

1. The  APN Professional Development Plan paper is worth 200 points and will be graded on the quality of the content, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.

2. Submit the paper as a Microsoft Word Document, which is the required format at Chamberlain University. You are encouraged to use the APA Academic Writer and Grammarly tools when creating your assignment.

3. Follow the directions below and the grading criteria located in the rubric closely.

4. The length of the paper should be 5-8 pages, excluding title page and reference page(s).

5. Support ideas with a minimum of 3 scholarly resources. Scholarly resources do not include your textbook. You may need to use more than 3 scholarly resources to fully support your ideas.

6. You may use first person voice when discussing information specific to your personal practice or skills.

7. Current edition APA format is required with both a title page and reference page(s). Use the following as Level 1 headings to denote the sections of your paper (Level 1 headings use upper- and lower-case letters and are bold and centered):

· APN Professional Development Plan (This is the paper introduction. In APA format, a restatement of the paper title, centered and bold serves as the heading of the introduction section)

· APN Scope of Practice

· Nurse Practitioner (NONPF) Core Competencies

· Leadership Skills

· Conclusion

Directions

1. Introduction: Provide an overview of what will be covered in the paper. Introduction should include general statements on scope of practice, competencies, and leadership, and identification of the purpose of the paper.

2. APN Scope of Practice: Research the Nurse Practice Act and APN scope of practice guidelines for the state in which you intend to practice after graduation. (Example: Students who intend to practice in California must research the California Nurse Practice Act and relevant Board of Registered Nursing regulations, such as obtaining a DEA number, and prescriptive requirements).  Describe the educational, licensure, and regulatory requirements for that state in your own words. Identify whether your state allows full, limited, or restricted NP practice. Discuss NP prescriptive authority in your state. Provide support from at least one scholarly source. Source may be the regulatory body that governs nursing practice in your state. (Students who intend to practice in California, include the use of written standard procedures that guide nurse practitioner practice in the state and physician supervision ratios).

3. Nurse Practitioner (NONPF) Core Competencies: Review the NONPF Core Competencies. Describe two competency areas you believe to be personal strengths and two competency areas in which you have opportunities for growth. Discuss two scholarly activities you could do during the master’s program to help yourself achieve NP competencies. Provide support from at least one scholarly source. Source may be NONPF Core Competencies document provided via the link in the week 2 readings.

4. Leadership Skills: Analyze three leadership skills required to lead as an NP within complex systems. Describe two strategies you could use to help you develop NP leadership skills. Provide support from at least one scholarly source. Textbooks are not considered scholarly sources.

5. Conclusion: Provide a conclusion, including a brief summary of what you discussed in the paper.

ASSIGNMENT CONTENT
Category Points % Description
Introduction 16 8% Provides an overview of what will be covered in the paper. Introduction should include:

1. general statements on scope of practice.

2. general statements on NP competencies.

3. general statements on leadership.

4. identification of the purpose of the paper.

APN Scope of Practice 72 36% 1. Identify the intended state of practice after graduation.

2. Describe the educational, licensure, and regulatory requirements for state.

3. Identify whether the state allows full, limited, or restricted NP practice.

4. Discuss NP prescriptive authority in the state.

Provides support from at least one scholarly source. Source may be the regulatory body that governs nursing practice in the state.

 

Nurse Practitioner (NONPF) Core Competencies 38 19% 1. Describe two competency areas believed to be student’s personal strengths.

2. Describes two competency areas in which student has opportunities for growth.

3. Discuss two scholarly activities to do during the master’s program to help student achieve NP competencies.

Provide support from at least one scholarly source. Source may be NONPF Core Competencies document provided via the link in the week 2 readings.

Leadership Skills 38 19% 1. Analyze three leadership skills required to lead as an NP within complex systems.

2. Describe two strategies student could use to help develop NP leadership skills.

Provide support from at least one scholarly source.

Conclusion 16 8% Provide a conclusion, including a brief summary of what was discussed in the paper.
  180 90% Total CONTENT Points= 180 points
ASSIGNMENT FORMAT
Category Points % Description
APA Formatting 10 5% Formatting follows current edition APA Manual guidelines for

1. title page

2. body of paper (including citations and headings)

3. reference page

Writing Mechanics 10 5% Writing mechanics follow the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA manual. The length of the paper is at least 5 pages but no more than 8 pages.
  20 10% Total FORMAT Points= 20 points
  200 100% ASSIGNMENT TOTAL=200 points

 

 

 

 
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeIntroduction

Provides an overview of what will be covered in the paper. Introduction should include: 1) general statements on scope of practice 2) general statements on NP competencies 3) general statements on leadership 4) identification of the purpose of the paper

16 pts

Excellent

Presentation of information is comprehensive and includes all four requirements.

15 pts

V. Good

Presentation of information is superficial and includes all four requirements.

13 pts

Satisfactory

Presentation of information includes three requirements.

8 pts

Needs Improvement

Presentation of information includes two requirements.

0 pts

Unsatisfactory

No introduction provided or introduction addresses fewer than two requirements.

 

16 pts
This criterion is linked to a Learning OutcomeAPN Scope of Practice

1) Identifies the intended state of practice after graduation 2) Describes the educational, licensure, and regulatory requirements for state 3) Identifies whether the state allows full, limited, or restricted NP practice 4) Discusses NP prescriptive authority in the state Provides support from at least one scholarly source. Source may be the regulatory body that governs nursing practice in the state.

72 pts

Excellent

Presentation of information is comprehensive and includes all four requirements AND Provides support from scholarly source or regulatory body.

66 pts

V. Good

Presentation of information is superficial in places and includes all four requirements AND Provides support from scholarly source or regulatory body.

60 pts

Satisfactory

Presentation of information includes three requirements AND Provides support from scholarly source or regulatory body.

36 pts

Needs Improvement

Presentation of information includes at least three requirements but does not provide support from scholarly source or regulatory body.

0 pts

Unsatisfactory

Presentation includes two or fewer requirements with or without scholarly sources.

 

72 pts
This criterion is linked to a Learning Outcome Nurse Practitioner (NONPF) Core Competencies

1) Describes two competency areas believed to be student’s personal strengths. 2) Describes two competency areas in which student has opportunities for growth 3) Discusses two scholarly activities to do during the master’s program to help student achieve NP competencies. Provides support from at least one scholarly source. Source may be NONPF Core Competencies document provided via the link in the week 2 readings.

38 pts

Excellent

Presentation of information is comprehensive and includes all three requirements AND Provides support from at least one scholarly source.

35 pts

V. Good

Presentation of information is superficial in places and includes all three requirements AND Provides support from at least one scholarly source.

32 pts

Satisfactory

Presentation of information is minimal and includes three requirements AND Provides support from at least one scholarly source.

19 pts

Needs Improvement

Presentation of information includes at least two requirements AND/OR Provides support from at least one source but source is not scholarly.

0 pts

Unsatisfactory

Presentation includes one or fewer requirements with or without scholarly source.

 

38 pts
This criterion is linked to a Learning OutcomeLeadership Skills

1) Analyzes three leadership skills required to lead as an NP within complex systems 2) Describes two strategies student could use to help develop NP leadership skills. Provides support from at least one scholarly source.

38 pts

Excellent

Presentation of information is comprehensive and includes both requirements AND Provides support from at least one scholarly source.

35 pts

V. Good

Presentation of information is superficial and includes both requirements AND Provides support from at least one scholarly source.

32 pts

Satisfactory

Presentation of information is minimal and includes both requirements AND Provides support from at least one scholarly source.

19 pts

Needs Improvement

Presentation of information is missing one requirement AND/OR Provides support from at least one source but source is not scholarly.

0 pts

Unsatisfactory

Leadership skills not discussed OR no resource support provided.

 

38 pts
This criterion is linked to a Learning OutcomeConclusion

Provides a conclusion, including a brief summary of what was discussed in the paper.

16 pts

Excellent

Provides a conclusion, including a brief summary of what was discussed in the paper.

15 pts

V. Good

Conclusion superficial in places, provides a brief summary of what was discussed in the paper.

13 pts

Satisfactory

Conclusion provides a partial summary of what was discussed in the paper.

8 pts

Needs Improvement

Conclusion minimal, does not provide a summary of what was discussed in the paper.

0 pts

Unsatisfactory

No Conclusion provided.

 

16 pts
This criterion is linked to a Learning Outcome APA Formatting

Formatting follows current edition APA Manual guidelines for • title page • body of paper (including citations and headings) • reference page One deduction for each type of APA format error.

10 pts

Excellent

0 to 1 APA error is present

9 pts

V. Good

2–3 APA errors are present

8 pts

Satisfactory

4–5 APA errors are present

5 pts

Needs Improvement

6–7 APA errors are present

0 pts

Unsatisfactory

8 or more APA errors are present

 

10 pts
This criterion is linked to a Learning Outcome Writing Mechanics

Writing mechanics Follow the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA manual

10 pts

Excellent

1–2 errors or exceptions

9 pts

V. Good

3–4 errors or exceptions

8 pts

Satisfactory

5–6 errors or exceptions OR the paper is less than 5 pages or greater than 8 pages

5 pts

Needs Improvement

7–8 errors or exceptions

0 pts

Unsatisfactory

9 or more errors or exceptions

 

Introduction

Advanced Registered Nurse Practitioners (ARNP) is a current trend in the delivery of healthcare in the USA. The American Association of Nurse Practitioners provides a detail of the services that nurse practitioners (NP) can provide. Specifically, the NP may order diagnostic studies, diagnose and manage ailments, prescribe medications, and provide necessary medical education to patients and their families (AANP, 2013). However, advanced practice nurses’ scope of practice varies based on the state in which they serve. Throughout this paper, the scope of practice for nurse practitioners in my preferred state of practice, leadership skills, and the NONPF competencies areas of personal strengths and areas for growth will be discussed.

Scope of Practice

Upon graduation, I desire to practice in the state of Florida. In the state of Florida, the practice of nursing is regulated by both the Medicine and the nursing board. Also in this state, the nursing practice is restricted, which is the most limiting form of regulation (Toney-Butler & Martin, 2019). This simply means that the nursing practitioner can only engage in a specified scope of work. That said, the nursing practitioner cannot participate in other areas of healthcare specialties without direction or delegation from a senior healthcare provider such as a physician or a dentist. Such restriction prevents the nursing practitioners from realizing their fullest potential since they undergo immense training in their prime years of education.

The Board of Nursing and the Board of Medicine in Florida mandates that the ARNP should hold an RN degree, ARNP Master’s degree, and national certification from an accredited nursing organization as a requirement for licensure and practice. The American Medical Association reports that a Medical Doctor (MD) must supervise an ARNP with no more than four satellite offices in a primary care setting (AANP, 2013). Additionally, they report that to obtain a working position as an ARNP, the hiring company must specifically outline the ARNP’s areas of practice including inclusions of practice and exclusions of practice which must be approved by the board of nursing before the start of employment.

The prescriptive authority also differs from state to state. Looking at the state of Florida, prescriptive authority for the nurse practitioner is defined in Florida statute (Toney-Butler & Martin, 2019). According to this statute, the nursing practitioner may prescribe drugs ranging from schedule II through IV by reaching a supervisory arrangement with a physician. Considering this, NPs must be equipped for the legal and professional accountability that comes with prescribing medications.

The Florida Board of Nursing further outlines the exact compliance needs for continued education (CE) for the ARNP’s. They are similar to those of RN requirements with some additions including 32 hours of CE’s upon first receiving licensure (Toney-Butler & Martin, 2019). Every 2 years, the ARNP must also complete 18 General CE’s approved by the state board as a requirement for renewal of licensure.

Core Competencies

The National Organization of Nurse Practitioner Faculties (NONPF) developed the core competencies of nursing practice, which are the essential conducts which all nursing practitioners should possess. Arguably, these competencies are vital for nursing practitioners to meet the complex challenges encountered in the constantly changing health care environment. Each of the core competencies is a means for the students to gain the knowledge, proficiencies, and aptitudes to practice as licensed independent practitioners. The demonstration of these competencies is evident upon graduation regardless of the medical specialty or patient population concentration they engage with. These nine areas of core competencies include scientific foundations, quality, independent practice, inquiry, technology and information literacy, leadership, policy, health delivery system, and ethics.

Areas of strength

I would consider the scientific foundation, information, and technology as the core competencies where my strength lies. The scientific foundation competency lays special emphasis on foundational knowledge, research, and theories (Thomas et al., 2017). As such, the NP’s should be in a position to utilize critical thinking and apply the aforementioned knowledge and skills in the provision of quality healthcare. This competency was instilled in us during the undergraduate program where we were introduced to concepts such as evidence-based research. Consequently, From undergraduate studies and now in my current practice, I have mastered the art of not only searching databases for current EBP but also to analyze, evaluate, critic, and apply them in the nursing practice. However, I believe there is adequate room for improvement to advance in these skills and knowledge on using theory and research to develop new approaches to nursing practice. Commitment coupled with discipline and hard work will go a long way in realization of this goal hence propelling me to become a top-notch advanced registered nurse practitioner.

The technology and information literacy competency involves the use of communication tools to effectively convey and interpret information. With the current trend of using the electronic medical record in hospital settings, I have been privileged to work in the electronic records department where I was involved in the documentation, storage, and update of patient information. It cannot go without saying that, communication is the foundation upon which rational decisions in healthcare are made (Thomas et al., 2017). Decision making in the nurse practice environment is a dynamic conceptual process in determining patient outcomes hence putting stamp to paper the importance of this competency.

Areas of growth

Two competencies that I would consider as areas of growth are policy and ethics. Advance registered practitioner nurses possess the skills and knowledge to drive, change, and create legislative policies to better improve healthcare delivery. The NONPF policy competency is formulated in such a way that the future NP has vast knowledge needed to influence healthcare reform policies (Thomas et al., 2017).  I soul searched and found that this is an essential area of personal growth owing to my limited knowledge of a nurse’s impact on policymaking.

Ethics competencies involve the ability to think through patients’ ethical dilemmas. This requires that all decisions regarding the care of patients are made with dire consideration of nursing ethics. To navigate through ethical dilemmas, a registered nurse should put in mind the cultural beliefs and biases that the patient’s case presents. The ability to demonstrate cultural humility can be an effective tool for navigating through the patients’ case scenario (Thomas et al., 2017). Even though this competency comes with loads of ethical complexities, I believe that it will go a long way to putting my mark in the nursing profession.

To achieve nursing practitioner competencies, I will engage in scholarly activities such as research initiatives and organizational membership during the master’s program.  Associating oneself with an active accredited organization increases one’s network, increases awareness on the role of advanced practice nurses and, provides one with current evidence-based practices.  For example, I intend to be a full member and participant of the Florida Council of Nurse Practitioners which aligns its goal with that of transforming healthcare. As a member, I will be privileged to grow in areas of policy and advocacy and having access to frequent journals and newsletters that will increase my knowledge and skills in the nursing field. My initiative to participate in research programs within and without the hospital will also play a pivotal role in molding me into an all-round nurse. This is because it will serve as a gateway for me to obtain exploratory skills from the research process and in the implementation of novel approaches in improving patient outcomes.

Leadership skills

The American health system is vast and highly flexible to change and as such, possessing the necessary leadership skills is essential to practitioners if not a requirement. The Three leadership skills that I can point out to be essential in effectively leading in healthcare are respect, decision-making, and strong communication skills (Johansen, & O’Brien, 2016). Foremost, respect is a critical leadership skill that every nurse practitioner should strive to possess.  Not only is it a key factor in teamwork but also a strong determinant in providing the best care for patients.

Communication is the act of exchanging verbal and non-verbal information to relay a message. Active listening is an essential component of the communication process. Strong communication skills assist nursing practitioners to actively engage in professional and patient collaboration (Scully, 2017). Ineffective communication skills can pose to be a menace in the delivery of healthcare since misinterpretations can occur ultimately leading to poor patient satisfaction.

Decision-making skill is crucial in nursing leadership. It encompasses making clinical decisions that direct the quality of care accorded to patients (Johansen, & O’Brien, 2016). One strategy that would help me to develop leadership skills while attending college would be to attend seminars that would expand my network and help me in picking mentors and role models in the field of nursing. The other strategy I could use to develop leadership skills is improving the aspects of effective communication. By communicating effectively, one can gain the trust of patients and colleagues (Scully, 2017). Further, it will aid in building personal confidence which can improve my engagement with stakeholders and colleagues further playing a part in driving organizational change.

Conclusion

Advanced practice nursing is the future of healthcare in providing cost-efficient holistic care to the community. Florida is where my future lies making it more important that I should possess the relevant skills. The nurse practitioners greatly influence the healthcare system because of foundational knowledge, leadership skills, advocacy, and evidence-based research to improve outcomes. Particularly, effective communication, decision making, and respect are essential for effective leadership.  The NONPF competency approach prepares future APN to function in the constantly changing, complex healthcare system. It is an expectation that the nurse should be competent in all the areas to provide patient-centered. I am glad I got the opportunity to learn about each core competency which enabled me to pick the strengths and areas of improvement. Developing these strategies will enable me to prepare myself for the future role of an ARPN.

 

A 61-year-old Black male with a history of hypertension presents to your clinic for complaints of headaches and blurred vision x 4 days. He denies any weakness, numbness, chest pain, shortness of breath, palpitations, or recent, illicit drug use.

A 61-year-old Black male with a history of hypertension presents to your clinic for complaints of headaches and blurred vision x 4 days. He denies any weakness, numbness, chest pain, shortness of breath, palpitations, or recent, illicit drug use. He states he has been compliant with his medications (hydrochlorothiazide and metoprolol), and he took his meds this morning.

His V/S include: B/P 190/100, P- 90, T- 98.9, R- 22. Recent labs show that TC- 260, LDL-190, HDL- 35, Trig- 320. He did not return for these results and did not start any new meds.

What are your diagnoses and plan of care for this patient? Remember to include your rationales.

Word at least 250.

Recent five year scholarly reference.

Ethical Decision making in Psychiatry.

Ethical Decision making in Psychiatry.

Using the following readings please discuss the following prompts:

1. Digital Psychiatry: Risks and Opportunities for Public Health and Well-Being https://philpapers.org/archive/BURDPE.pdf

2. Artificial Intelligence for Mental Health and Mental Illnesses: An Overview

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274446/

 3 Ethical Issues in Online Psychotherapy: A Narrative Review

https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00993/full

Questions:

1. What is the risk of using digital psychiatry on patients’ autonomy?

2. Does the passive collection of data impact a user’s ability to participate in the decision-making process?

3. What is the inherent risk of using AI for making diagnosis? What are the patient rights that may be violated?

4. What is the rational argument for conducting online psychotherapy? When look through the ethical paradigm What are the possible ethical issues that may become against offering this modality to patients?

 

 

Clinical Decision-Making Case studies: (SLO # 2, 5 & 7) 10% of the Total Grade

The discussion board will be utilized to hone skills needed to incorporate knowledge acquired from the readings. There will be case studies posted in the discussion section. Students will be expected to review the case study, relate the situation to the DSM-5 criteria, and determine a diagnosis and differential diagnosis. The student will post a response to two classmates. Initial post minimum of 240 words, and response minimum 100 words. APA citation guidelines for citations and references.

 

   Criteria   Meets Criteria    Partially Meets Criteria   Does Not Meet the Criteria
 Assessment: Discuss assessment findings and behaviors which meet your DSM-5 criteria; describe further assessment/screening tools which you would recommend to validate the diagnosis  Correctly identifies DSM-5 criteria to correlate with recognized diagnosis/differential diagnosis; screening tools specify and connect with diagnosis.  Identifies the most important findings and misses some minor ones. It doesn’t present results from all sections completed  Identifies some abnormal or pertinent findings but misses significant findings. Results come from only 50% of the sections completed.
 Interprets findings correctly, considering pathological, social, lifestyle, and genetic components.  The interpretation is correct. All pertinent details are discussed.  The interpretation is correct. Details consider the most relevant areas.  Interpretation is correct or partially correct. Minimal information is provided. All pertinent areas are not addressed.
 Diagnosis: Identify and Discuss your DSM-5 and differential diagnoses (including psychiatric and physical diagnoses).  identifies at least 1 DSM-5 diagnosis and two differential diagnoses, including psychiatric and physical diagnosis

 

 

 identifies only 1 DSM-5 diagnosis and one differential diagnosis  does not identify a DSM-5 diagnosis or differential diagnosis
 Supporting Research: Incorporate at least one scholarly evidence-based article that relates to your identified and differential diagnoses and can guide your treatment plan.  Discusses one scholarly evidence-based article which correlates with diagnosis/differential diagnosis and identifies how to guide the treatment plan  Discusses the article, but the writing is not considered a scholarly evidence-based source.  It does not discuss the scholarly, evidence-based article
 Reference: APA format Writing: Sentence structure, spelling, grammar  APA format followed with no errors; correct sentence structure and grammar usage.  APA format followed but with several errors and spelling/grammar errors.  APA format not followed; sentence structure incomplete and numerous grammar errors

Describe physical, cognitive, and psychosocial changes related to mental illness.

Learning Objectives

 

At the end of this activity students will be able to:

 

1. Apply observation and assessment skills essential to mental health nursing.

2. Describe physical, cognitive, and psychosocial changes related to mental illness.

3. Identify risk factors related to mental illness, treatment and rehabilitation.

4. Perform a mental status examination on patients with mental illness.

 

Activity Instructions

 

1. Select a patient from assigned unit.

2. Obtain approval from the primary RN and clinical instructor for appropriateness of patient.

3. Complete and submit the Mental Status Examination form as scheduled by your clinical instructor.

4. Review the Mental Status Examination (MSE) grading rubric.

5. Upload completed assignment to Brightspace.

 

Icon  Description automatically generatedOak Point University

NUR4020 Nursing Care of Mental Health Patients

Mental Status Examination Form Guidelines

 

 

 

 

3

 

 

Name: Gladys Mireku Date: 1/20/23

 

Personal Information/Demographics
Patient Name:

P. R

Admission Date and Unit Admitted to: Client was admitted to St Joseph hospital behavioral unit on the 2nd floor 1/20/23. Age and Gender: 23 years old male
Marital Status: Single Religious Preference:

Client believes in God use to go to church but has stopped

Race: white
Ethnic Background: American Employment: Unemployed Living Arrangements: Client said he lives with his mother.
Client’s Reason for Admission/ Chief Complaint:

Client was admitted to the hospital through emergency with the complaints of depression, suicidal ideation to hang or stub himself.

Co-morbid Condition:

Lymphoma

Mental Status Examination

 

  What You See (list) Descriptive example (narrative)
1. Appearance (observed)

· Grooming/Clothing

· Level of hygiene

· Pupil dilation or constriction

· Facial expression

· Height, weight, nutritional status

· Evidence of scars/ abrasions/ bruises/ tattoos/ or other physical markings

· Relationship between appearance and age

 

· The client was clean and well-dressed, but his hair was not well combed.

· The client wore sweatpants, sweaters and hospital socks.

· The client’s eye was normal it dilates about 2 to 4 mm and they are equal.

· The client’s skin color was pink and usual for ethnicity.

· The client ambulates independently with a steady gait.

· The client has no abrasions, bruises, tattoos or any other physical markings on his skin.

· The client weighs 174 lb., and his height was 5.2inches, which looks appropriate for his age.

 

The client is a 23-year-old American male who looks clean, well-groomed and had no body odor, but his hair was not well combed. The client is average in height and weighs 174 lb. and was 5.2 inches tall. The client was wearing sweatpants, a sweater and a pair of hospital socks. The clients eye was normal, it dilates about 2 to 4 mm and they are equal. The clients ambulate independently by himself with a steady gait. client has pink skin which is usual for ethnicity but has no tattoos, abrasions, bruises or physical markings on his skin . During a group therapy, he actively participated.
2. Behavior (observed)

· Excessive or reduced body movements

· Peculiar body movements (e.g., scanning of the environment, odd or repetitive gestures, level of consciousness, balance, and gait)

· Abnormal movements: (e.g., tardive dyskinesia, tremor/ tics/ abnormal movements)

· Level of eye contact (keep cultural differences in mind)

· Possible descriptors: agitated, restless, easily distracted, hyperactive, hypoactive, lethargic, catatonic, wavy flexibility, echopraxia, akathisia

-The client sat quietly in a chair listening attentively during group therapy on stress management.

-No evidence of tremors/tics/abnormal movements.

-There was no psychomotor retardation observed.

– He was able to follow instructions

The client-maintained eye contact throughout the interview stated that: “I feel happy talking to you” but I normally don’t talk to people I do not know.

Prior to interviewing the patient, I found him sitting quietly in a chair watching TV with others before the group therapy. Upon questioning, client was happy and answered all my questions. During the interview, the client-maintained eye contact, followed instructions appropriately displayed no abnormal movements nor psychomotor retardation.

 

 

3. Attitude (observed)

· Ability to follow commands

· Ability to provide reliable information.

Possible descriptors: cooperative, hostile, open, secretive, evasive, suspicious, apathetic, focused, defensive, defiant, oppositional, withdrawn, aggressive, reliable reporter/good historian.

-The client was cooperative and followed commands correctly.

-Reliably reported information and remembered clearly the events preceding his admission to the hospital.

 

The client cooperated and followed commands given correctly. client communicated openly about his life and shared how he has been depressed of late and felt nothing was working in his favor. He felt anxious about his future which according to him felt more dim. He felt happy that the hospital was a safe and secure place for him.

 

4. Speech

· Rate: slow, rapid, normal

· Volume: loud, soft, normal

· Disturbances (e.g., articulation problems, slurring, stuttering, mumbling)

· Cluttering (e.g., rapid, disorganized, tongue-tied speech)

-The client had no auditory or hallucinations.

-The client spoke clearly and with a medium volume.

– client spoke with an even tone and rhythm and communicated information coherently

 

During my conversation with the client, the client informed me he previously had intentions of hurting himself but at the time he was feeling happy and had no such thoughts. He reported that the hospital was a good place for him, and he felt comfortable. His speech content had no evidence of auditory hallucinations. He spoke with a medium voice.
5. Mood and Affect (inquired/observed)

Affect

· How the client outwardly is expressing emotion

· Appropriateness to situation

· Congruency with mood

· Congruency with thought

· Other descriptors include broad, restricted, constricted, blunted, flat, normal intensity, appropriate, incongruent, anxious, animate

Mood

· How the patient describes what they are feeling

· Possible descriptors include labile, sad, angry, hostile, indifferent, euthymic, dysphoric, detached, elated, euphoric, anxious, animated, irritable

AFFECT:

The client affect was appropriate to the situation. He was clear and consistent with his thoughts.

MOOD:

-I observed the patient was in positive mood as evidenced by patient displaying willingness to talk.

-During conversation, he was accommodative and actively participated.

He had a pleasant mood but became anxious when he discussed the future and fears associated with the unknown.

 

 

During my interaction with the client, I observed that he was in a positive mood and was pleasant during the entire period. He only appeared sad when he made mention of not working due to his health condition.

Also, I noted that his mood and affect had changed as compared to that on admission which on his chart had been indicated to be irritable.

He was a bit anxious and clearly expressed his fears about the future. His affect was congruent with mood. The client stated that he feels sad about not working due to his health condition.

 

 

 

6. Thought (inquired/observed)

Process

· Describes the rate of thoughts, how they flow and are connected

· Possible descriptors: Linear, goal-directed, disorganized, circumstantial, tangential, loose associations, flight of ideas, coherent, incoherent, evasive, racing, thought blocking, perseveration, neologisms.

Content:

· Refers to the themes that occupy the patient’s thoughts and perceptual disturbances

· Possible descriptors: preoccupations, ideas of reference, delusions, obsessions, suicidal/homicidal ideation, rumination

-The client had linear thoughts which were purposeful

The client provided direct and appropriate answers to questions and conversation.

-Patient experiences were realistic –patient had some small memory lapses especially on things that happened 2 to 3 years ago.

Chart stated patient has difficultly concentration due to flight of ideas.

 

 

-The client’s conversation was goal directed. He provided clear answers to questions asked. The patient had no delusion or auditory hallucinations.
7. Perceptual disturbances

· Hallucinations (e.g., auditory, visual)

· Illusions

The client denied experiencing auditory hallucination during the interview. Patient stated, he sometimes hears voices telling him to harm himself.
8. Cognition

· Orientation: time, place, person

· Level of consciousness (e.g., alert, confused, clouded, stuporous, unconscious, comatose)

· Memory: remote, recent, immediate

· Attention/concentration: performance on serial sevens, spelling a word backwards

· Abstract vs concrete thinking: proverbs, involving similarities

Judgment

· Good, fair, or poor

· Impulse control

Insight

· Good, fair, partial, poor

Adaptive Coping Strategies vs Defense Mechanisms

Possible defense mechanisms:

Denial, projection, rationalization, sublimation, undoing, displacement, intellectualization, avoidance, repression, suppression

-The client was alert and oriented x 4

-The client looked relaxed during first contact

-The client had no trouble remembering things that happened several years ago

-The clients have good judgement fair insight throughout the interview, e.g. I asked him if it was fair for the doctor to admit him in the hospital and he said yes he caused it if he had taken his medication he would not be depressed ,therefore he caused it,

 

 

 

 

 

 

 

 

 

 

 

-The client coping mechanism is suppression because he feels depressed for not being able to work due to his medical condition.

The client also said he sometimes talk to friends and family to relieve him of his depression.

The patient was able to state why he was at the hospital, what led him to come there and how he felt at this time. His chart supported that he has A/OX4.

I was able to assess his short- and long-term memory based the answers he gave me during questioning. He also appears to have good judgement and has fair insight. He reports that he avoids thinking about bad things as his life is full of those. However, this time things got really had that why he was contemplating to commit suicide prior to admission.

8. Safety of Self/ Others

Risk of Self/Suicidal/Self-Injury

· Fully assessed-no indicators of risk

· If yes, then

· Suicidal ideation (current, past)

· Suicide attempts (hx of)

· Plans to attempt (current, past)

· Access to means

· Family history

· Non-suicidal self-injury (cutting, scratching, or other self-mutilation) present?

· Unintentional (when delusions, demented, intoxicated, in manic stages) present?

Harm to Others/Aggression

· Fully assessed- no indication of risk identified

· If yes, then

· Plan (current, past) to assault

Property Destruction

· Fully assessed- no indication of risk identified

· If yes then

· Current admission

· Hx of

-The patient has not displayed any self-harm behaviors or threats to any other person

The client stated that he occasionally has thought of harming himself whenever he gets depressed.

The client said he had a history of property destruction when he was a toddler, he uses to throw their TV remote away and break it.

 

The client admitted having suicide by trying to harm himself with any sharp he get hold of.

 

 

 

 

The client currently has no thought of harming himself or anyone.

 

 

 

The client use to throw way their TV remotes and destroy them

.

According to his chart, he was admitted with complaints of depression with suicidal ideations to hang himself.

 

The client denial thought of harming himself and others at the hospital.