Assignment 3 Week 4

Assignment 3 Week 4

Assignment 1: Decision Tree

For this Assignment, as you examine the client case study1 (See Below) in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

Learning Objectives

Students will:

· Evaluate clients for treatment of mental health disorders

· Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

THE ASSIGNMENT

Examine Case 1: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

· Which Decision did you select?

· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

· Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

Note:  Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

PLEASE INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES LESS THAN 5 YEARS OLD

Case #1  A woman with personality disorder

SUBJECTIVE

Rhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help.

Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you. She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!”

Rhonda explains that her current financial situation is also precarious. She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft. “It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.”

Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.”

OBJECTIVE

Rhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons. She was also arrested for cashing checks under an alias, for which she spent 120 days in jail.

Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police.

MENTAL STATUS EXAM

Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO RHONDA?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 Borderline Personality Disorder

 Histrionic Personality Disorder

 Antisocial Personality Disorder

 Answer Chosen:  

Antisocial Personality Disorder

Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Refer to psychologist for psychological testing

Begin Haldol 5 mg orally daily

Refer for psychodynamic psychotherapy

Answer Chosen:  

Refer to psychologist for psychological testing

RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

·  The psychologist’s report indicates that a comprehensive psychological battery was performed for the purposes of diagnostic clarification. The end result suggested that Rhonda has traits of multiple personality disorders, but scores highest in antisocial personality traits, suggesting antisocial personality disorder.

· When Rhonda returns to the office, you review the psychologist’s report with her. Rhonda seems upset, but also states “well, that’s why I am here, to get better … what do I need to do?”

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Refer to group-based cognitive behavior therapy

Begin Latuda 40 mg orally daily

Refer for dialectical behavior therapy

Answer Chosen:  

Refer to group-based cognitive behavior therapy

Some Guidance and Rationale for Answer to Chosen

Rhonda has APD; however, as you can see, she has signs/symptoms of other personality disorders. In many cases, individuals with personality disorders can demonstrate features of several personality disorders.

Referral to a psychologist was appropriate for the purposes of diagnostic clarification. Psychological tests can help tease out the actual personality disorder that Rhonda has. In this case, Rhonda’s symptoms are most consistent with antisocial personality disorder, but as you can see, she has signs/symptoms of other personality disorders.

There are currently no FDA-approved medications to treat APD, thus Risperdal would not be useful. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Of the available choices, group-based cognitive behavior therapy may be useful in treating individuals with this personality disorder, but all “improvement” in signs/symptoms should be met with great skepticism.

Beginning Latuda is not appropriate, as there are currently no FDA-approved medications to treat APD. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)

· Chapter 22, “Personality Disorders” (pp. 742–762)

· Chapter 13, “Psychosomatic Medicine” (pp. 451–464)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”

· Chapter 69, “Antisocial Personality Disorder”

· Chapter 70, “Borderline Personality Disorder”

· Chapter 71, “Histrionic Personality Disorder”

· Chapter 72, “Narcissistic Personality Disorder”

· Chapter 73, “Cluster C Personality Disorders

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

· “Personality Disorders”

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry: Interpersonal & Biological Processes, 76(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Rees, C. S., & Pritchard, R. (2015). Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52(1), 45–55. doi:10.1037/a0035158

Required Media

Laureate Education. (2017a). A woman with personality disorder [Interactive media file]. Baltimore, MD: Author. (See Case 1 (Rhonda)Above)

Kernberg, O. (n.d.). Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg, MD. [Video file]. Mill Valley, CA: Psychotherapy.net

FINANCIAL ANALYSIS REPORT 2

SAMPLE

Assignment: Decision Tree

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.

The Assignment:

Examine Case 2 : You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

1. Decision #1: Differential Diagnosis

0. Which Decision did you select?

0. Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

0. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

0. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

1. Decision #2: Treatment Plan for Psychotherapy

1. Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

1. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

1. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

1. Decision #3: Treatment Plan for Psychopharmacology

2. Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

2. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

2. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

1. Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Case #2 Anxiety disorder, OCD, or something else?

BACKGROUND

Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for.

Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.

His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”

Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.

OBJECTIVE

During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.

When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.

MENTAL STATUS EXAM

Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.

Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Generalized Anxiety Disorder (GAD)

 Obsessive Compulsive Disorder

 Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)

ANSWER CHOOSEN : Obsessive Compulsive Disorder

Decision Point Two

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Begin Zoloft 50 mg orally daily

Begin Fluvoxamine immediate release 25 mg orally at bedtime

Begin Fluvoxamine controlled release 100 mg orally in the morning

Discontinue Zoloft and begin Fluvoxamine controlled release 100 mg orally every morning In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this. Zoloft is FDA-approved to treat OCD in children. However, between ages 6 and 12, it should be started at 25 mg orally daily. If starting doses are too high, the child may experience side effects that he associates with the medication and as such, may refuse to take the medication. Starting at too high a dose can result in unfavorable side effects (gastrointestinal side effects are notable in this drug), and we can see that Tyrel is experiencing nausea and decreased appetite. In this case, it is recommended to wait to see if the side effects dissipate. Decreasing the dose to 12.5 mg orally daily for about 3 or 4 days, then going back to 25 mg orally daily may help to overcome the unfavorable side effects. If side effects persist, the PMHNP may need to consider switching to a different medication.Fluvoxamine controlled release is not FDA-approved for use in children with OCD (see “Special Populations: Children and Adolescents” in the Fluvoxamine monograph of Stahl’s Prescriber’s Guide for further details). Fluvoxamine 100 mg orally daily may not be tolerated in the morning secondary to the drug’s sigma-1 antagonist properties, which can cause sedation. Dosing of Fluvoxamine should be such that the larger dose is given in the evening to minimize daytime sedation. It is also worth noting that nothing in the scenario tells us that the Zoloft will not be effective.

ANSWER CHOOSEN: 

Begin Fluvoxamine immediate release 25mg orally at bedtime

1. Client returns to clinic in four weeks

1. Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.

1. She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.

RESULTS OF DECISION POINT TWO

1.  Client returns to clinic in four weeks

1. Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.

1.  She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Increase Fluvoxamine to 50 mg orally at bedtime

Augment with an atypical antipsychotic such as Abilify

Augment treatment with cognitive behavioral therapy

ANSWER CHOOSEN:  Increase Fluvoxamine to 50 mg orally at bedtime

Guidance to Student

In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.

Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.

At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.

Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.

Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

1. Chapter 31, “Child Psychiatry” (pp. 1253–1268)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

1. “Anxiety Disorders”

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf

McClelland, M., Crombez, M-M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Health Care, 29(5), 442–452. doi:10.1016/j.pedhc.2015.03.005

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

SEE BELOW THE ANSWER TO THE ABOVE DECISION TREE EXAMPLE

Decision Tree: Personality Disorders

Frank Jones Sam’s University

Nurs 3333: PMHNP Role IV

Dr. Joe Mark

October 20 , 2010

Decision Tree: Personality Disorders

As described by the American Psychiatric Association (APA) (2013), ‘‘personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment’’. There are different types of personality disorders classified into three clusters. Cluster A individuals are described as the odd or eccentric, cluster B as the dramatic, emotional, or erratic and cluster C as the anxious or fearful. The purpose of this paper is to discuss the case study of a young woman with personality disorder. This paper will explore threes decisions relating to differential diagnosis, psychotherapy and psychopharmacology based on the presented clinical manifestations.

Decision One

The clinical manifestation presented in the case study are indicative of more than one personality disorder, specifically borderline personality disorder (BPD) and antisocial personality disorder (ASPD). Patients exhibits a fear of abandonment which aligns with BPD. The patient mentioned an interpersonal relationship involvement which she exhibited idolization for the man of her interest, and now is devaluing the man. This is also evident in BPD as outlined by diagnostic criteria set forth by the APA (2013).

My diagnosis for this patient is ASPD, because the client exhibits clinical manifestations of ASPD than BPD. One of the reasons that led me to the diagnosis of ASPD is the client’s lack of remorse. The client stole from a friend, instead of being sorry, client’s blames friend instead. Client exhibits lack of respect for social norm and failure to comply with the law as evidenced by more than one record of arrest. The client fails to upholding financial obligation and is deceitful. Client shows irresponsibility evidenced by inability to keep a job. These presentations are evident in clients with ASPD as outlined in the DSM-5.

The two personality disorders which are classified as cluster B personality disorders by the APA (2013) have clinical manifestations which overlap, thus needs to be ruled out as differential diagnoses for each other. As described on the DSM-5 diagnostic criteria, BPD and ASD have similar features of impulsivity, aggression and manipulative behaviors, which client exhibits in the case study. The differing manifestation between the two is that in BPD, clients seek out interpersonal relationship, while ASPD client is unable to form any attachment to relationship. Clients with BPD exhibit self-mutilating behaviors and self-aggression, while in ASPD, aggression is directed on others. In ASPD clients are egocentric (also seen in narcisstic personality disorder), while BPD clients have a poor image of self.

Decision Two

Since the client exhibits symptoms which are synonymous with one more than personality disorder, specifically borderline and antisocial; the best decision is to opt to conduct a psychological testing. This will to further help the practitioner to decipher between the two diagnoses or conclude that patient indeed has the two personality disorders which is a possible occurrence. Psychological testing can be in the form of rating scales which includes questionnaires, checklists e.t c. According to Sadock, Sadock and Ruiz (2014), these scales are useful for monitoring patient overtime or to provide a comprehensive assessment information that was not obtained during a routine clinical interview.

There is limited evidence from existing literatures on the effectiveness of medications to target the core symptoms of ASPD. Khalifa et al. (2010) mentions that pharmacological interventions are not to be considered as monotherapy but as adjunctive intervention to target associated symptoms of ASPD such as depression, aggression etc. The option of Haldol, an antipsychotic medication can be used to address aggression but does not treat the core features of the disorder such as lack of remorse, deceitfulness. Furthermore, the plethora of side effects known to be caused by the medication can increase noncompliance. Psychotherapy can be beneficial, but psychodynamic is not appropriate for this patient because it may require patient to address emotional states. According to Hesse (2010), probing about ‘feeling states’ is unhelpful because the ASPD client may have difficulty accessing such state and may become aggressive when made to confront personal shortcoming.

Decision Three

In decision three, the recommendation is for a group-based cognitive therapy. Latuda an antipsychotic can be used to treat aggression but not the core symptoms of ASPD. Dialectical behavioral therapy will be more appropriate in the client with BPD than in ASPD. The most cited effective psychotherapeutic approach used in ASPD is cognitive behavioral therapy (CBT). This approach helps the client address distorted beliefs about self, others and the world. CBT can be used to enhance social and intrapersonal functioning.

A group setting may be beneficial for these clients as they may be able to learn from others experience or information shared about self. Psychotherapy for ASPD should be met with skepticism, but Hesse (2010) suggested that approaches that includes employing moral reasoning, cognitive behavioral approach, applying a social information processing approach, and planning for relapse prevention should be used. Additionally, the clients need a high level of external structure that includes supervision of the patient and reinforcement of positive social behaviors to yield increased outcomes for ASPD clients (Hesse, 2010).

Ethical and Legal Considerations

Due to the clinical manifestation of ASPD, some clinicians believe that it is hopeless to treat ASPD clients due to their clinical manifestation of aggression, deceitfulness and manipulation. Clients tends to be noncompliant, fueling the clinician’s pessimism. Existence of pessimism can hinder practitioners from upholding the ethical principles to do no harm and to do the best for the patient to full capacity. Hatchet (2015), implores clinicians to turn to published studies to become more aware of treatment options and to avoid expert opinions or clinical myths in regards to treating clients with ASPD. For these clients, autonomy may be purposely compromised to prevent harm to the patient and to others. This is seen in cases where patient refuse to comply with treatment plan or ordered into treatment and remain in treatment until deemed fit to come out of treatment.

Conclusion

It is essential for the practitioner to be knowledgeable about personality s disorder to effectively care for the patient. The practitioner should explore various options of medication, used to target accompanied symptoms. Psychotherapy, even though some might argue of its effectiveness, should not be ruled out. Assessment tools should be used to guide the clinicians, in diagnosing, especially with disorders that have overlapping symptoms.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

Khalifa, N., Duggan, C., Stoffers, J., Huband, N., Völlm, B. A., Ferriter, M., & Lieb, K. (2010). Pharmacological interventions for antisocial personality disorder. The cochrane database of systematic Reviews, (8). Doi: 10.1002/14651858.CD007667.pub2

Hatchett, G. T. (2015). Treatment guidelines for clients with antisocial personality disorder. Journal of mental health counseling, 37(1). Retrieved from Walden University Database

Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? Biomed central medicine, 8(66). DOI: 10.1186/1741-7015-8-66

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

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The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Assignment: Practicum: Planning for the Practicum

Assignment: Practicum: Planning for the Practicum

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Assignment: Practicum: Planning for the Practicum
The practicum experience provides a significant opportunity to cultivate your professional growth and development. What skills, attributes, or categories of knowledge do you most need or want to nurture? How would improving in these areas enable you to be a more effective leader? And how would that allow you to facilitate the translation of evidence into practice?
This course includes a 216-hour practicum as part of the 1,000 clinical hours that are required for the DNP credential. In your practicum experience for this course, you will examine the change process as it relates to the translation of evidence into practice. In addition, throughout your practicum experience you will pay close attention to the role of leadership in such endeavors and reflect on your own development of leadership competencies.
This week you develop a plan for your practicum.
Note: If you have not already done so, formalize the relationship with your practicum mentor.
To prepare:

• Review      the information presented in the Learning Resources, and consider what      approach you would use (including specific steps of the process) to plan      for and implement an aggregate-level change that facilitates the      translation of evidence into practice. Begin with the analytical process      required to identify the change that needs to be made.
• Think      about learning objectives that would guide your practicum hours, as well      as the activities you will undertake to achieve those objectives. Draft      two or three learning objectives that are related to the AACN DNP      Essentials, your practice area specialty competencies, and the focus of      this course—planning for and implementing a sustainable change related to      the translation of evidence into practice, as well as the development of      leadership competencies to facilitate this.
• Refer      to the Practicum Time Log and Journal document      (see attached file).
• Develop      a time line for your practicum experience. Note: You will      submit your time log and a journal entry by the end of Weeks 3, 7, and 11.

Note: It is important to formulate a big-picture view of this process. In Weeks 2 and 3, you will work with your practicum mentor to examine a change already underway or previously accomplished, and identify an additional aggregate-level change you would like to propose. You are not required to implement this change, but you do need to select an idea that is feasible, based on evidence, and appropriate for your practicum setting.
By Wednesday 2/27/19 before midnight, write a 3-page essay in APA format with at least 5 scholarly references from the list of required readings below. Include the level one headers as numbered below. 
To complete:
Write a 3-page paper that includes the following:
1) An outline or visual representation indicating how you would guide planning for and implementing change related to the translation of evidence into practice for your practicum setting
2) Three learning objectives for your practicum hours that are aligned to the AACN Essentials, your specialty area competencies, and the focus of this course (i.e., systems-related issues, translation of evidence into practice, intentional change, and leadership) (refer to the attached AACN Essential IV [Nursing Informatics]).
3) Key leadership and other activities you will undertake to fulfill your identified learning objectives
4) A proposed time line for accomplishing your practicum hours (divide 216 hours in 10 weeks to come up with how many hours per weeks in order to makeup the required 216 hours for this semester).
By Wednesday 2/27/19 before midnight
Submit this Assignment.
Required Readings
White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.
· Review Chapter 3, “Change Theory and Models: Framework for Translation”
As you review this chapter (assigned in a previous course), consider the foundational information about change. Also, pay attention to the frameworks and processes described, as they will be valuable as you proceed through this course. What insights arise regarding how you might be able to guide the implementation of change?
American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf (see attached file).
Use the information in this report to guide the formulation of goals for your practicum experience.
Bleich, M. R. (2011). IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health, 34(3), 169-170. doi:10.1002/nur.20433 (see attached file)
​IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health by Bleich, M. R., in Research in Nursing & Health, Vol. 34/Issue 3. Copyright 2011 by John Wiley & Sons – Journals. Reprinted by permission of John Wiley & Sons – Journals via the Copyright Clearance Center.
Pritham, U. P. (2016). Assessing DNP impact using program evaluations to capture healthcare system change. The Nurse Practitioner, (4), 44.
Kotter, J. P. (2007). Leading change: Why transformation efforts fail. Harvard Business Review, 85(1), 96-103. Retrieved from /orders/cb.hbsp.harvard.edu/cbmp/pl/76758028/76758030/42e82c2469b7f33387aa79dc5736bb1f
In this foundational reading, Dr. John Kotter discusses errors commonly made as organizations undergo change, and he recommends steps leaders can take to help avoid them (see attached file).
Moriber, N. A., Wallace-Kazer, M., Shea, J., Grossman, S., Wheeler, K., & Conelius, J. (2014). Transforming Doctoral Education Through the Clinical Electronic Portfolio. Nurse Educator, 39(5), 221-226. doi:10.1097/NNE.0000000000000053
Murphy, M. P., Staffileno, B. A., & Carlson, E. (2015). Original Article: Collaboration Among DNP- and PhD-Prepared Nurses: Opportunity to Drive Positive Change. Journal of Professional Nursing,31388-394. doi: 10.1016/j.profnurs.2015.03.001
Sherrod, B., & Goda, T. (2016). DNP-Prepared leaders guide healthcare system change. Nursing Management, (9). 13.
Optional Resources
Osters, S., & Tiu, F. S. (n.d.). Writing measurable learning outcomes. Retrieved from http://www.gavilan.edu/research/spd/Writing-Measurable-Learning-Outcomes.pdf (see attached file).

Practicum Journal Entry Week 1-3, 4-7 and 8-11
Name
University
Class
Date

Clinical Time Log and Journal
Student Name:
E-mail Address:

Practicum Placement Agency’s Name:

Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
Time Log
Note: Add rows as needed.
Total: Weeks 1-3:
Total Weeks 4-7:
Total: Weeks 8-11
Total Practicum Hours Completed for Course

Practicum Journal Entry Week 1-3
Description of the Observed Activities
In my first week at the Mercy Medical Center, there are various activities that I observed. For instance, I spent a better part of my time watching and participating in the process of updating care plans for the labor delivery unit. The administration of the Mercy Medical Center focused its attention on familiarizing nurses with its new policies and procedures.
Consequently, meetings were held to discuss the phasing out of old policies that are still being observed in the Epic. The agenda of the meeting was to advise nurses to avoid referencing old policies. After that, I met Karen, a nursing professional to discuss specimen collection. During this period, Karen audited the specimen collection information and instructed the nursing informatics to send it out. This session familiarized me with how nurses coordinate their tasks to generate positive patient outcomes. For an organization that is increasingly embracing information technology to support quality of care, concerns were also raised about switching from the Mobilab specimen collections system to the Epic. There were complaints that the Epic EHR system is still limited. Therefore, nurses have to revert to two nurses’ signoff for the specimens as labels no longer print at the patient bedside. Other meetings were held to explore care plan issues that were not built correctly in the Epic EHR.
Analysis of the Problems/ Issues
Mercy Medical Center is currently facing the challenge of slow implementation of its epic Electronic Health Record (EHR) system. The hospital recently transitioned from Meditech EHR system to Epic. The transition was not successfully implemented; as a result, many issues have arisen from the poor implementation of Epic as well as the Mobilab specimen collection that is marred by numerous inefficiencies. Nurses have also not yet familiarized themselves with the new EHR environment. Therefore, there is the slow pace of adoption of the system, thereby reducing operational efficiencies and quality of patient care (Tavana, 2014). EHRs are information systems that generate significant impacts on the usual clinical and administrative workflows, affecting users and the administrative systems. While significant planning may be undertaken before they are fully implemented, many challenges before the go-live and during the weeks and months after the initial date of full operation may be observed. Some of the issues that pose potential difficulties to nurses and other user groups include failure to train and familiarize nurses with the Epic EHRs, vendor challenges, and the general resistance by some nurses to the change process because they are not used to the new system. Furthermore, departmental coordination becomes a challenge when one department uses EHRs while others still operate on a pen-and-paper information system.
How the Real-World Mirrors Program-Related Evidence, Concepts, and Theories
In light of the rapid proliferation of evidence-based practices, there has been increased call for the identification of the core underlying mechanisms that are common to the many different evidence-based practices in the real world. With the growth and development of large databases, the utilization of EHRs, and sophisticated statistical techniques, the process of examining practices in the real world and comparing the effectiveness of interventions is often enhanced (McDaniel, 2009). Nurses and clinicians may face challenges associated with situations that lack definitive information regarding a course of action. I was exposed to information methodologies that can help inform practice decisions by evaluating outcomes in the real world. Patients may not be the same.
Given the above, the application of intervention may have multiple variations. Thus, the focus should be on external validity. It responds to the issue of whether similar outcomes can be attained on a broader population, in different contexts, with different clinicians, and most likely with limited resources.

References
McDaniel, J. G. (Ed.). (2009). Advances in information technology and communication in
health (Vol. 143). New York: Ios Press.
Tavana, M. (Ed.). (2014). Healthcare Informatics and Analytics: Emerging Issues and Trends:
Emerging Issues and Trends. New York: IGI Global.

Practicum Journal Entry Week 4-7

Description of the Observed Activities
There are various activities that I had observed in my experience. For instance, in my first week, I visited a Quality Council meeting with my preceptor, after which I participated in the Practice Council meeting. The fifth week kicked off with by attending several meetings in the entire day. Some of the issues that we discussed in the meeting included the negative findings of the Joint Commission’s recent visit of the Mercy Medical Center towards the end of December 2018. One of the outcomes of the Joint Commission was the fact that nursing professionals are not correlated to patients’ diagnosis or primary diagnosis to the patient individualized care plan. In the sixth week, discussions were aimed at exploring the Epic electronic health record system tickets that were sent out to the nursing informatics unit. The key issues that affected the mother-baby units relating to breast milk donor documentation. There included workflow issues related to feeding babies. Finally, in the seventh week, the Quality Council Meeting was convened. During that session, we found that the orthopedic floor is ranked leading above Johns Hopkins and the University of Maryland Medical Center Unit.
Analysis of the Issues, Problems, or Situations
The main problem that Mercy Medical Center faces is poor design and implementation of their new Epic electronic health record system (EHRs). The mother-baby unit is especially experiencing issues related to slow documentation of the breast milk donor which can take as long as 20 minutes because there was no bundle designed in their Epic EHRs related to donor breast milk, therefore, impeding the workflow for the nurses causing them to create workarounds. The health institution should re-engineer its processes by integrating EHRs in all its units and operations. This medium should be undertaken through a dynamic and iterative process. One of the most important issues about process reengineering is that not all steps in a process should be optimized. Some inefficiency should be designed into the workflow to improve the overall efficiency of the system. The Epic EHRs that has been introduced should be modified to enhance the quality of the outpatient clinical documentation (Skolnik, 2010). As such, all the components and prime quality scores should be remarkably improved. The critical elements that health care professionals should focus their attention on include chief complaints, history of present illness, physical findings, evaluations, and careplans. Since this health institution has poorly implemented its Epic electronic health record, it is still facing the challenge of low-quality scores on core elements. The electronic health records should have checkboxes to make it simpler for doctors and nurses to complete a comprehensive note.
How Real-World might Mirror the program-Related Evidence
The real world mirrors the program-related evidence in many ways. For instance, I have observed that integrating evidence-based real-world information into the care of patients necessitate having the correct information accessible at the right time. This correct time may include diagnostic procedures while providing care at the bedside of the patient or any specific point within a small period (Fowler et al., 2014). Nurses and physicians are often under pressure to attend to more patients within a short period (Silvia, Valerio & Lorenza, 2012). This medium is the precise problem that nurses are facing at Mercy Medical Center’s mother-baby unit, where they have many patients to attend to, but they spend at least 20 minutes with each patient. Nurses who are already experiencing pressure to see more patients in fewer periods would probably not look for information to inform their decisions when the search processes interrupt the flow of their work (Fowler et al., 2014). A mechanism to rectify this issue is to develop a clinical decision support system, which connects appropriate evidence-based data resources that can be retrieved straight from the EHRs (Fowler et al., 2014).

References
Fowler, S. A., Yaeger, L. H., Yu, F., Doerhoff, D., Schoening, P., & Kelly, B. (2014). Electronic health record: integrating evidence-based information at the point of clinical decision making. Journal of the Medical Library Association: JMLA, 102(1), 52. Doi: 10.3163/1536-5050.102.1.010
Skolnik, N. S. (Ed.). (2010). Electronic medical records: A practical guide for primary care. Springer Science & Business Media.
Silvia, B., Valerio, D., & Lorenza, G. (2012). The reflective journal: A tool for enhancing experience-based learning in nursing students in clinical practice. Journal of Nursing Education and Practice, 3(3), 102. Doi: /orders/doi.org/10.5430/jnep.v3n3p102

Practicum Journal Entry Week 8-11
The Observed Activities
The activities in week 8 involved a discussion of agendas about informatics in the Nursing informatics department that we were to present in the upcoming meetings. We attended the super-user clinical documentation meeting and took part in planning the Substance Use Screening and Brief Interventions meeting for the Labor/Delivery and Postpartum units. In the ninth week, I took part in auditing the patients’ charts to trace the inpatient nurses who have not been correlating standardized care plans to the patients’ diagnosis or primary problems upon admission. In week 10, I participated in the auditing of patients’ charts to track nurses who do not add standardized care plans to the patients’ diagnoses or primary problems. I also participated in the discussion about the best possible approaches to solve the situation, primarily through building an educational tool for the affected nurses so as they can be sufficiently educated on the matter. Through this approach, nurses who do not comply with the inpatient admission requirements in the affected departments will be held accountable for noncompliance.
Analysis of the Issue
There have been problems in the process of screening for substance use and brief interventions for the Labor and Postpartum units. Different challenges lead to this problem. The main ones include insufficient expertise and skills by some nurses in handling or operating the electronic equipment needed to accomplish this task, a large number of patients in these units, and noncompliance. The issue of poor understanding of the modern equipment that is required to be used for screening may appear simple, but some nurses are not sufficiently knowledgeable when it comes to operating this equipment (Clark, Raffray, Hendricks & Gagnon, 2016).
Consequently, such nurses may prefer to skip this step to avoid embarrassment by exposing their ignorance. This medium indicates that a good number of nurses are not sufficiently educated on standardized patients’ care plan documentation and need to be retrained more on the latest developments of health technology. Lack of enough knowledge on electronic systems such as the clinical decision support and other electronic health record (EHR), and noncompliance are also the main factors that make nurses fail to establish correlations between standardized care plans to patient diagnoses upon admission (Shin, Park & Kim, 2015). This issue calls for retraining and supervision to avoid such problems in the future.
How the Real World might Mirror or Diverge from Program-Related Evidence/Concepts
In clinical practice, the real world can uphold program-related concepts in many ways. These include: working with a patient-centered approach through avoiding cases of noncompliance. Healthcare providers also mirror program-related practice through constant training on the latest technologies that help to improve patient care. The regular training on health information technology ensures that nurses do not ignore crucial medical stages or processes due to insufficient knowledge or incompetence in handling electronic equipment (Clark et al., 2016). Nurses also mirror the program concepts through upholding ethical and moral values in their practice through treating all patients with dignity and respect irrespective of their cultural backgrounds and avoid negligence when handling patients. Nevertheless, there are some cases in which some nurses in some institutions are negligent possibly due to poor management policies, personal prejudices, or lack of sufficient training. Other ways through which nurses divert from what is required is through working without passion and ignoring their duties (Clark et al., 2016).

References
Clark, M., Raffray, M., Hendricks, K., & Gagnon, A. J. (2016). Global and public health core competencies for nursing education: a systematic review of essential competencies. Nurse education today, 40, 173-180. /orders/doi.org/10.1016/j.nedt.2016.02.026
Shin, S., Park, J. H., & Kim, J. H. (2015). Effectiveness of patient simulation in nursing education: meta-analysis. Nurse education today, 35(1), 176-182. /orders/doi.org/10.1016/j.nedt.2014.09.009

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Nursing Discussion Network Opportunity

Post a brief introduction of yourself to your colleagues. Include an explanation as to how Walden’s vision, mission, goals, and social change initiatives relate to your professional and academic goals and to your becoming a scholar-practitioner. Also include an explanation for how the Walden MSN Program Outcomes and perspectives relate to your professional and academic goals and to your becoming a scholar-practitioner. APA, Citation, Reference

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Health Leadership & Systems Thinking

Week 8: Health Leadership & Systems Thinking
 
Leader-Member Exchange
Good, professional relationships between leaders and subordinates may factor into an organization’s success. For example, as a hospital director for a high-risk, neonatal unit, you may find that encouraging positive, professional relationships with subordinates from diverse backgrounds is important in maintaining employee efficiency and effectiveness. Your subordinates may also recognize a similar value in your professional relationship in order to receive direction, goal achievement, and/or rewards. In the field of health care administration, an emphasis on good, professional relationships may assist your leadership success across diverse landscapes of health care administration problems.
 
This week, you examine two leadership perspectives: Leader-Member Exchange Theory as well as Social Network Theory. Think about how both theories may apply to health care administration leadership. You also continue to complete your Scholar-Practitioner Project: Health Care Administration Leadership Theory with the creation of a visual representation of your theory.
 
Learning Objectives
Students will:
· Compare Leader-Member Exchange with Social Network Theory
· Apply Leader-Member Exchange Theory to personal leadership theories
· Apply Social Network Theory to personal leadership theories
· Apply health care administration concepts and perspectives to create visual representations of leadership theories
 
 
Learning Resources
Required Readings
· Nahavandi, A. (2015). The art and science of leadership (7th ed.). Upper Saddle River, NJ: Pearson.
Chapter 3, “The Foundations of Modern Leadership” (pp. 64-89)
 
· Sin, H., Nahrgang, J. D., & Morgeson, F. P. (2009) Understanding why they don’t see eye to eye: An examination of leader-member exchange (LMX) agreement. Journal of Applied Pyschology, 94(4), 1048-1057.
 
· Van Dierendonck, D. (2011). Servant leadership: A review and synthesis. Journal of Management, 37(4), 1228-1261.
 
· Wilson, K. S., Hock-Peng, S., & Conlon, D. E. (2010). What about the leader in leader-member exchange? The impact of resource exchanges and substitutability on the leader. Academy of Management Review, 35(3), 358-372.
 
· Document: Scholar-Practitioner Project Overview (PDF)
Note: You will use this project overview to complete the remaining scholar-practitioner Assignments in Weeks 8 & 11.
 
Transcript of Scholar-Practitioner Project Overview
 
 
 
 
DDHA 8400: Health Leadership and Systems Thinking
Scholar-Practitioner Project Overview.
 
1. Many health care administration leaders are proactive and passionate about improving health in the
populations they serve. As such, an important aspect of the Walden University Doctor of Healthcare
Administration (DHA) program addresses how to lead, manage, and impact the well-being of
communities and health systems. As scholar-practitioners in this course, you are challenged to
develop your capabilities as a leader through developing a personal Health Care Administration
Leadership Theory that uses a systems thinking approach for improvement within the field of health
care administration.
2. This course includes a term-long, Scholar-Practitioner Project designed to promote positive social
change through the dissemination of information. This information highlights best practices in health
care administration leadership by addressing gaps within health care administration literature.
3. The Scholar-Practitioner Project Assignments highlighted below scaffold and complement the
Discussions and Assignments in the course. The work you do in Part 1 (Week 5) feeds the development of Part 2 (week 8). Parts 1 & 2 are used for Part 3(week 11.
Here is a summary of Scholarly-Practitioner Project Assignments:
Week & Title Assignment

 
 
Discussion Part
 
 
 
Building a Nest for Success: Leader-Member Exchange Theory and Social Network Theory
 
 
A Chinese proverb states, “In a broken nest, there are few whole eggs.” Within an organization, broken professional relationships may result in damage to the efficiency and effectiveness of the organization. For a leader, any “crack” or “break” in leadership may create future problems within the organization. With use of Leader-Member Exchange Theory and Social Network Theory, an effective leader may find that the creation of positive, professional relationships with subordinates is helpful in preventing breaks in relationships in order to guide an organization toward success.
 
· For this Discussion, reflect on the similarities and differences between Leader-Exchange Theory and Social Network Theory. Consider how you might integrate each theory into your own personal, unified leadership theory. Think about how you might use this theory in a health care administration scenario.
 
By Day 3
Post a brief comparison between Leader-Member Exchange and Social Network Theory. Then, explain how you might apply Leader-Member Exchange Theory and Social Network Theory into your personal, unified leadership theory. Finally, relate this personal, unified theory to a health care administration scenario with which you are familiar. Be specific and provide examples.
 
By Day 5
Continue the Discussion and provide a substantive reply to your colleagues in one or more of the following ways:
 
· Expand on the colleague’s posting with additional insight and resources.
· Offer polite disagreement or critique, supported with evidence.
In addition, you may also respond as follows:
 
· Offer and support an opinion.
· Validate an idea with your own experience.
· Make a suggestion or comment that guides or facilitates the discussion.
Support your postings and responses with specific references to the Learning Resources and the current literature.
 
 
Submission and Grading Information
Grading Criteria
To access your rubric:
 
Week 8 Discussion Rubric
 
Post by Day 3 and Respond by Day 5
To participate in this Discussion: Week 8 Discussion
 
 
Assignment
Scholar-Practitioner Project: Visual Representation of health care Administration Leadership Theory.
 
 
1. Having a Health Care Administration Leadership Theory is essential to any health care administration leader. With a well-constructed theory, you integrate leadership perspectives into practice in order to offer solutions to health care administration problems. Also, with a visual representation of your theory, you may present another way to highlight your research with effective design and theory implementation.
 
2. For this Assignment, you complete another part of your Health Care Administration Leadership Theory based upon your understanding of leadership perspectives you have reviewed in this course. In addition, you must use a systems thinking approach in the development of your visual representation of your personal Health Care Administration Leadership Theory.
 
3. This week you will provide a visual representation of your Health Care Administration Leadership Theory. It can be a table, schematic diagram, graph, or any other representation you choose. Please feel free to be creative. However, the focus MUST be on leadership.
 
The Assignment (3–4 pages):
 
· Provide a narrative explanation that shows how the developed theory can close the “gap” identified in the first part of the Project.
· Explain how it incorporates systems thinking.
4. Both the narrative explanation and the visual representation are included in the page count for the Assignment length. Remember, your theory can be based on those that we have examined in this course or that you have researched on your own. There is no wrong theory. What matters is the explanation of how it addresses the gap and uses systems thinking. While this does not have to be addressed now, keep in mind the last part of the Project will involve presenting a methodology that tests the developed theory empirically.
 
 
By Day 7
Submit your Scholar-Practitioner Project Assignment.
 
Support your Project with specific references to all resources and current literature used in its preparation. You are to provide a reference list for all resources, including those in the Learning Resources for this course.
 
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
 
· Please save your Assignment using the naming convention “WK8Proj+last name+first initial.(extension)” as the name.
· Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
· Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
· Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Proj+last name+first initial.(extension)” and click Open.
· If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
· Click on the Submit button to complete your submission.
 
Grading Criteria
To access your rubric:
 
Week 8 Project Rubric
 
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
 
Submit your Week 8 Project draft and review the originality report.
 
Submit Your Assignment by Day 7
To submit your Assignment: Week 8 Assignment

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Discussion Phar

READING AND VIDEO RESOURCES FOR PHARM
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
· Chapter 24, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 231–246)
· Chapter 25, “Antidepressants” (pp. 247–265)
· Chapter 26, “Drugs for Bipolar Disorder” (pp. 267–274)
· Chapter 27, “Sedative-Hypnotic Drugs” (pp. 275–285)
· Chapter 28, “Management of Anxiety Disorders” (pp. 287–292)
· Chapter 29, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 293–299)
 
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_03/index.html
 
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_09/index.html
 
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_04/index.html
 
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_05/index.html
WE ARE TO PICK ONLY ONE CASE STUDY AND WRITE ON IT.

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Research Analysis

Research Analysis

Architect Daniel Libeskind is credited with saying “To provide meaningful architecture is not to parody history, but to articulate it.” The suggestion is that his work does not copy the efforts of others but relies on it.
Understanding the work of others is critically important to new work. Contributions to the nursing body of knowledge can happen when you are able to analyze and articulate the efforts of previous research. Research analysis skills are therefore critical tools for your toolbox.
In this Assignment, you will locate relevant existing research. You also will analyze this research using a tool helpful for analysis.
To Prepare:

• Reflect on the strategies presented in the Resources this Module’s Learning Resources in support of locating and analyzing research.
• Use the Walden Library to identify and read one peer-reviewed research article focused on a topic in your specialty field that interests you.
• Review the article you selected and reflect on the professional practice use of theories/concepts described by the article.

The Assignment:
Using the “Module 4 | Part 4” section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identified. Be sure to include the following:

• Your topic of interest.
• A correctly formatted APA citation of the article you selected, along with link or search details.
• Identify a professional practice use of the theories/concepts presented in the article.
• Analysis of the article using the “Research Analysis Matrix” section of the template
• Write a 1-paragraph justification stating whether you would recommend this article to inform professional practice.
• Write a 2- to 3-paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following:
  • Describe your approach to identifying and analyzing peer-reviewed research.
  • Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research.
  • Identify at least one resource you intend to use in the future to find peer-reviewed research.

Note: Add your work for this Assignment to the original document you began in the Module 1 Assignment, which was built from the Academic Success and Professional Development Plan Template.

NURS 6003: Transition to Graduate Study for Nursing
 
 
 
 
Academic and Professional Success Plan Template
 
Prepared by:
 
<INSERT NAME>
 
This document is to be used for NURS 6003 Transition to Graduate Study for Nursing to complete Assessments 1-6. Just as importantly the document serves to organize your thoughts about planning for your academic and professional success.
For specific instructions see the weekly assessment details in the course, or ask your instructor for further guidance.
 
 
Week 1 | Part 1: My Academic and Professional Network
 
I have identified and secured the participation of the following academic (at least two) and professional (at least two) individuals and/or teams to form the basis of my network. This network will help me to clarify my vision for success and will help guide me now and in the future.
 
Directions: Complete the information below for each member of your network. For more than four entries repeat the items below with details of your additional network member(s) in the ‘ADDITIONAL NETWORK MEMBERS’ section.
 
 
NETWORK MEMBER 1
 
Name:
 
 
Title:
 
 
Organization:
 
 
Academic or Professional:
 
 
Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:
 
Notes:
 
 
 
 
NETWORK MEMBER 2
 
Name:
 
 
Title:
 
 
Organization:
 
 
Academic or Professional:
 
 
Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:
 
Notes:
 
 
NETWORK MEMBER 3
 
Name:
 
 
Title:
 
 
Organization:
 
 
Academic or Professional:
 
 
Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:
 
Notes:
 
NETWORK MEMBER 4
 
Name:
 
 
Title:
 
 
Organization:
 
 
Academic or Professional:
 
 
Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:
 
Notes:
 
 
 
ADDITIONAL NETWORK MEMBERS
 
Week 2 | Part 2: Academic Resources and Strategies
 
I have identified the following academic resources and/or strategies that can be applied to success in the nursing practice in general or my specialty in particular.
 
Directions: In the space below Identify and describe at least three academic resources or strategies that can be applied to the MSN program, and at least three professional resources that can be applied to success in the nursing practice in general or your specialty in particular. For each, explain how you intend to use these resources, and how they might benefit you academically and professionally.
 
 
Academic Resource/Strategy 1
 
 
 
 
Academic Resource/Strategy 2
 
 
 
 
Academic Resource/Strategy 3
 
 
 
 
Professional Resource/Strategy 1
 
 
 
Professional Resource/Strategy 2
 
 
 
Professional Resource/Strategy 3
 
 
 
 
ADDITIONAL RESOURCES/STRATEGIES
 
 
 
 
Week 3 | Part 3: Strategies to Promote Academic Integrity and Professional Ethics
 
I have analyzed the relationship between academic integrity and writing, as well as the relationship between professional practices and scholarly ethics. I have also identified strategies I intend to pursue to maintain integrity and ethics of my academic work while a student of the MSN program, as well as my professional work as a nurse throughout my career. The results of these efforts are shared below.
 
Directions: In the space below craft your analysis/writing sample, including Part 1 (The Connection Between Academic and Professional Integrity) and Part 2 (Strategies for Maintaining Integrity of Work).
 
 
Part 1: Writing Sample: The Connection Between Academic and Professional Integrity
 
In the space below write a 2- 3-paragraph analysis that includes the following:
 
· Explanation for the relationship between academic integrity and writing
· Explanation for the relationship between professional practices and scholarly ethics
· Cite at least 2 resources that support your arguments, being sure to use proper APA formatting.
· Use Grammarly and SafeAssign to improve the product.
· Explain how Grammarly, Safe Assign, and paraphrasing contributes to academic integrity
 
 
 
PART 2: Strategies for Maintaining Integrity of Work
 
Expand on your thoughts from Part 1 by:
 
Identifying and describing strategies you intend to pursue to maintain integrity and ethics of your 1) academic work while a student of the MSN program, and 2) professional work as a nurse throughout your career. Include a review of resources and approaches you propose to use as a student and a professional.
 
Week 4 | Part 4: Research Analysis
 
I have identified one topic of interest for further study. I have researched and identified one peer-reviewed research article focused on this topic and have analyzed this article. The results of these efforts are shared below.
 
Directions: Complete Step 1 by using the table and subsequent space below identify and analyze the research article you have selected. Complete Step 2 by summarizing in 2-3 paragraphs the results of your analysis using the space identified.
 
 
 
 
 
Step 1: Research Analysis
Complete the table below

Topic of Interest:
Research Article: Include full citation in APA format, as well as link or search details (such as DOI)
Professional Practice Use: One or more professional practice uses of the theories/concepts presented in the article
Research Analysis Matrix Add more rows if necessary	Strengths of the Research	Limitations of the Research	Relevancy to Topic of Interest	Notes

 
 
Step 2: Summary of Analysis
Craft a summary (2-3 paragraph) below that includes the following:
· Describe your approach to identifying and analyzing peer-reviewed research
· Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research
· Identify at least one resource you intend to use in the future to find peer-reviewed research
 
 
 
 
 
Week 5 | Part 5: Professional Development
 
I have developed a curriculum vitae to capture my academic and professional accomplishments to date.
 
The results of my efforts are below.
 
Directions: Complete Step a curriculum vitae (CV) in the space provided.
 
 
Curriculum Vitae (CV)
Use the space below to write your CV based on your current education and professional background. Alternatively, you may write this in a separate document and copy/paste the results below.
NOTE: If needed there are a variety of online resources available with tips and samples of graduate nurse CVs.
Week 6 | Part 6: Finalizing the Plan
 
I have considered various options for my nursing specialty, including a close look at my selected (or currently preferred) specialty and second-preferred specialty. I have also developed a justification of my selected (or preferred) specialty. Lastly, I have examined one professional organization related to my selected or preferred specialty and considered how I can become a member of this organization.
 
The results of my efforts are below.
 
Directions: Complete Step 1 by writing 2-3 paragraphs in the space below comparing the nursing specialty you have selected – or the one you prefer if your choice is still under consideration – to your second preference. Identify each specialty and describe the focus and the role that graduates are prepared for. Identify any other differentiators you feel are significant, especially those that helped or may help you reach a decision.
 
Complete Step 2 by writing a paragraph identifying and justifying your reasons for choosing your MSN specialization. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum.
 
Complete Step 3 by examining and identifying one professional organization related to your selected or preferred specialty. Explain how you can become a member of this organization.
 
 
Step 1: Comparison of Nursing Specialties
Use the space below to write 2-3 paragraphs comparing the nursing specialty you have selected – or the one you prefer if your choice is still under consideration – to your second preference. Identify each specialty and describe the focus and the role that graduates are prepared for. Identify any other differentiators you feel are significant, especially those that helped or may help you reach a decision.
 
Step 2: Justification of Nursing Specialty
Use the space below to write a paragraph identifying and justifying your reasons for choosing your MSN specialization. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum.
 
 
 
 
 
 
 
 
Step 3: Professional Organizations
Use the space below to identify and examine one professional organization related to your selected or preferred specialty. Explain how you can become a member of this organization.
 
 
 
 
 
 
 
 
 
 
– END –

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Part 1 – Developing an Advocacy Campaign. Select a population issue of interest

Application: Part 1 – Developing an Advocacy Campaign

The following application (Part 1) will be due in week 4.
To prepare:

• Select a population health issue of interest to you and identify the population affected by the issue.
• Locate two scholarly articles, each of which provides a description of an effective health advocacy campaign that addresses your issue. The articles need to focus on two different advocacy campaigns.
• Analyze the attributes of the two campaigns to determine what made them effective.
• Reflect on a policy you could propose or suggest a change to a current policy to improve the health of the population you selected.
• Consider how you could develop an advocacy campaign, applying the attributes identified in similar, effective campaigns.

To complete:
For the Part 1 application (approximately 3–4 pages of content with a title page and references in APA format) address the following:

• Describe your selected population health issue and the population affected by this issue.
• Summarize the two advocacy campaigns you researched in this area.
• Explain the attributes that made those campaigns effective.
• Begin to develop a plan for a health advocacy campaign that seeks to create a new policy or change an existing policy with regard to the issue and population you selected. Be sure to include in your plan:

 
A description of the public health issue and proposed policy solution/nurs-6050-walden-developing-a-health-advocacy-campaign-2/
below is the reading/Learning Resources.

An ounce of prevention is worth a pound of cure.
—Benjamin Franklin

The purpose of health policy is to improve the health of individuals and populations. As discussed in Week 2, health care reform efforts seek to improve access to quality health care for all individuals. Yet, as noted in Week 3, continued rising health care costs are not resulting in improved health outcomes. How can the United States improve its health status in a cost-efficient manner, and what is the role of the nurse in moving this agenda forward? Many believe the answer lies in focusing on preventive care and population health.
While nursing care has traditionally been centered on individuals, the emerging focus of population health allows nurses to take a broader view for improving health outcomes. This wider perspective means that nurses may now examine a range of factors that influence populations as a whole, rather than focus solely on individual patients.
This week, you will evaluate factors that impact population health, and thus, the health care system. These factors include access to health care, individual behavior, the social and physical environment, and genetics. You will also consider the role of epidemiologic data in the process of evaluating the health of a population.

Reference:
U.S. History.org. (2010). The electric Ben Franklin. Retrieved fromhttp://www.ushistory.org/franklin/info/

Learning Objectives

Students will:

• Analyze factors that influence a population health issue
• Apply the use of epidemiologic data to the design of population health measures and policy initiatives

Photo Credit: [Plume Creative]/[DigitalVision]/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

REQUIRED READINGS

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

• Chapter 5, “Population Health” (pp. 79–97)
  This chapter introduces the concept of population health, which views health issues at the population level rather than at an individual level.

Kindig, D. (2007). Understanding population health terminology. The Milbank Quarterly, 85(1), 139–161.
Retrieved from the Walden Library databases.
This article provides a valuable foundation in understanding the terminology of population health. Although written in 2007, the information in this article is very pertinent to the topics discussed this week.

Kindig, D., Asada, Y., & Booske, B. (2008). A population health framework for setting national and state health goals. JAMA, 299(17), 2081–2083.
Retrieved from the Walden Library databases.
Using a framework to craft policy and programs can help ensure that outcomes are measurable. The authors of this article note how some of the overarching goals of Healthy People 2010 were not measurable. They suggest a framework for developing more measurable goals for Healthy People 2020.

Centers for Disease Control and Prevention. (2010). Morbidity and mortality weekly report (MMWR). State health statistics. Retrieved from http://www.cdc.gov/mmwr/StateHealth/index.html
The CDC website provides health statistics gathered using epidemiologic methods. Explore the health statistics for your state or for a health problem of interest to you.

HealthyPeople.gov. (2010). Foundation health measures. Retrieved from http://healthypeople.gov/2020/about/tracking.aspx
Healthy People 2020 uses the four foundational measures presented at this website to monitor the health of the American population.

State of New South Wales, Department of Education and Communities and Charles Sturt University. (2012). Core 1: Health priorities in Australia: How are priority issues for Australia’s health identified? Retrieved from http://www.slideshare.net/MsRatusau/hsc-pdhpe-core-1-health-priorities-in-australia
Australia uses epidemiologic data to establish its health priorities. Review the information presented at this website, and consider how the United States sets its health priorities.

U.S. Department of Health and Human Services. (2010). Healthy People 2020. Retrieved from /orders/www.healthypeople.gov/sites/default/files/HP2020_brochure_with_LHI_508_FNL.pdf
This overview of Healthy People 2020 provides a description of goals of this program, along with indicators used to assess the health of the United States.

U.S. Department of Health and Human Services. (2012). Healthy People 2020 – Improving the health of Americans. Retrieved from http://www.healthypeople.gov/2020/default.aspx
This site contains a wide variety of information and resources dealing with the Healthy People 2020 goals, as well as information on how to implement the objectives.

University of Wisconsin Department of Population Health Sciences. (n.d.). What is population health? Retrieved from http://www.improvingpopulationhealth.org/blog/what-is-population-health.html
This website provides a definition of population health and health determinants. It also examines how health policy can influence determinants of health.

REQUIRED MEDIA

Laureate Education (Producer). (2012h). Population health. Baltimore, MD: Author.
Note: The approximate length of this media piece is 13 minutes.Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Discussion: Key Health Determinants

Did you know that the United States has a higher rate of infant mortality than Japan (CIA, n.d.)? Or, as Dr. Beilenson states in this week’s media presentation, that “your zip code that you live in makes more difference in your health and well-being than the genetic code that you’re born with?” What causes these differences in health outcomes?

To effectively develop policies and programs to improve population health, it is useful to use a framework to guide the process. Different organizations and governmental agencies (for example, Healthy People 2020) have created a variety of such frameworks, which establish measures for assessing population health. These measures frequently are derived from the examination of epidemiologic data, which include key measures of population health such as mortality, morbidity, life expectancy, etc. Within each measure are a variety of progress indicators that use epidemiologic data to assess improvement or change.
For this Discussion, you will apply a framework developed by Kindig, Asada, and Booske (2008) to a population health issue of interest to you. This framework includes five key health determinants that should be considered when developing policies and programs to improve population health: access to health care, individual behavior, social environment, physical environment, and genetics.
To prepare:

• Review the article “A Population Health Framework for Setting National and State Health Goals,” focusing on population health determinants.
• Review the information in the blog post “What Is Population Health?”
• With this information in mind, elect a population health issue that is of interest to you.
• Using this week’s Learning Resources, the Walden Library, and other relevant resources, conduct a search to locate current data on your population health issue.
• Consider how epidemiologic data has been used to design population health measures and policy initiatives in addressing this issue.
  

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 NURS 4005/4006 Assignment: Dashboard Analysis and Nursing Plan

NURS 4005/4006 Assignment: Dashboard Analysis and Nursing Plan
As Dr. Rempher and Ms. Manna discussed this week, data from the NDNQI is used to improve nursing practices and support the strategic outcomes of an organization. This data is also used to create the Dashboard. The Dashboard, then, is used to create an action plan. Correctly interpreting information presented on the Dashboard provides nurses with a better understanding of the goals of the action plan.
To prepare
For this Assignment, use the Dashboard located in this week’s Resources, to interpret the data and frame a nursing plan based on best practices.

• Review the Week 5 Assignment Rubric, provided in the Course Information area.
• Review the Week 4 Resources that pertain to the NDNQI and use of dashboards
• Choose a Nurse-Sensitive Quality Indicator that needs improvement based on the data presented in the Dashboard. Reflect on how you would develop a nursing plan with suggestions on how to improve performance in the chosen area.
• Develop a nursing plan that outlines suggestions on how to improve performance in the chosen area.
• Provide at least three best practices from evidenced-based literature to support your nursing plan.

Assignment

• Draft a 3- to 4 page paper analyzing areas where there is good performance and areas of opportunity from the sample Dashboard.
• Analyze the data provided in the Dashboard and select an area of performance that needs improvement. Include information on why this area was chosen.
• Develop a nursing plan that includes suggestions on how to improve performance on the selected indicator. Be sure to provide at least three best practices from the evidenced-based literature to support your suggested nursing plan.

This Assignment is due on Week 5 Day 7. It will be assessed using the Week 5 Assignment Rubric. Writing Resources and Program Success Tools

• AWE Checklist (Level 4000)
  This checklist will help you self-assess your writing to see if it meets academic writing standards for this course.
• Walden University. (n.d.). Walden templates: General templates: APA course paper template with advice (6th ed.).
  Retrieved May 31, 2019, from /orders/academicguides.waldenu.edu/ld.php?content_id=45326751

For this Assignment, review the following:

• AWE Checklist (Level 4000)
• Walden paper template (no abstract or running head required)

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Walden NURS 4006 Week 5 Assignment Dashboard Analysis and Nursing Plan

NURS 4006 Week 5 Assignment Dashboard Analysis and Nursing Plan

NURS4006 Topics in Clinical Nursing Week 5 Assignment

Dashboard Analysis and Nursing Plan DUE
As Dr. Rempher and Ms. Manna discussed this week, data from the NDNQI is used to improve nursing practices and support the strategic outcomes of an organization. This data is also used to create the Dashboard. The Dashboard, then, is used to create an action plan. Correctly interpreting information presented on the Dashboard provides nurses with a better understanding of the action plan’s goals.
To prepare
For this Assignment, use the Dashboard located in this week’s Resources, to interpret the data and frame a nursing plan based on best practices.
Review the Week 5 Assignment Rubric, provided in the Course Information area.
Review the Week 4 Resources that pertain to the NDNQI and use of dashboards
Choose a Nurse-Sensitive Quality Indicator that needs improvement based on the data presented in the Dashboard. Reflect on how you would develop a nursing plan with suggestions on how to improve performance in the chosen area.
Develop a nursing plan that outlines suggestions on how to improve performance in the chosen area.
Provide at least three best practices from evidenced-based literature to support your nursing plan.
Assignment
Draft a 3- to 4 page paper analyzing areas where there is good performance and areas of opportunity from the sample Dashboard.
Analyze the data provided in the Dashboard and select an area of performance that needs improvement. Include information on why this area was chosen.
Develop a nursing plan that includes suggestions on how to improve performance on the selected indicator. Be sure to provide at least three best practices from the evidenced-based literature to support your suggested nursing plan.
This Assignment is due on Week 5 Day 7. It will be assessed using the Week 5 Assignment Rubric. Writing Resources and Program Success Tools
AWE Checklist (Level 4000)
This checklist will help you self-assess your writing to see if it meets academic writing standards for this course.
Walden University. (n.d.). Walden templates General templates: APA course paper template with advice (6th ed.). Retrieved August 11, 2016, from http://academicguides.waldenu.edu/ld.php?content_id=7980455
For this Assignment, review the following:
AWE Checklist (Level 4000)
Walden paper template (no abstract or running head required)

Walden NURS 4006 Week 5 Assignment Dashboard Analysis and Nursing Plan Completed Assignment 

For health care facilities to enhance and improve the care they deliver to their patients, they rely on data collected within their facility and from surveys sent out to patients. The information collected is formatted into a quarterly dashboard, setting goals for each quality indicator and then interpreting if the facility met those goals. Through dashboards and quality indicators, proactive decisions can be made based on actual events rather than changing the plan of care based on assumptions. The dashboard is effective in determining particular areas in which improvements would benefit not only the patient’s care but also the healthcare facility’s overall morale. The dashboard is also helpful in strategic planning, where performance assessment can be undertaken (Tomlinson, Hewitt, & Blackshaw, 2013). The overall objective of this paper is to analyze areas where the facility excels and determine a plan of action to improve negative performance by utilizing evidenced based practice.

After carefully analyzing the data presented in this week’s dashboard, communication between the nurses and the patients excels. Nurses develop a good rapport with the majority of their patients and give thorough explanations of the care provided. However, their promptness and attention to detail needs to be an area addressed to improve patient outcomes. Thus, negative data could also be reflected on the dashboard that represents patient safety measures such as falls, pressure ulcers, mislabeled specimens and uncontrolled pain. Patient safety is crucial in the plan of care and, if not carefully addressed, could lead to adverse events and outcomes.

Attention to detail is important for avoiding errors, maintaining efficiency, preventing injuries, making a good impression and analyzing information. Attention to detail improves accuracy in performing tasks. Preventing errors is valuable when providing care to all patients. Careful management of details contributes to overall efficiency and success in the healthcare facility. Reducing errors also contributes to patient satisfaction. By developing a nurse-patient relationship, you are able to address needs and concerns of the patient, as well as pick up on detail-oriented cues that will need to be implemented for each individual patient in order to maintain a balance of trust and communication during the patients stay.

Attention of detail leads to patient safety. The leadership should develop patient safety throughout the hospital. Leadership assumes a role in establishing a culture of safety that minimizes hazards and patient harm by focusing on processes of care. The leaders of the organization are responsible for fostering an environment through their personal example; emphasizing patient safety as an organizational priority; providing education to medical and hospital staff regarding the commitment to reduction of medical errors; supporting proactive reduction in medical/health care errors; and integrating patient safety priorities into the new design and redesign of all relevant organization processes, functions and services (IHI, 2017).

Many quality indicators fall into the category of patient safety such as:  medication errors or adverse events, pressure ulcers, falls, restraint use, nosocomial infections, VTE, etc. Various tools can be set in place to ensure adequate monitoring of these areas to protect the patients and the facility. Conducting a thorough head-to-toe physical examination on admission is a high priority. Patients come into the hospital and we treat their presenting symptoms, however many times there may be an underlining problem that needs addressed to ensure an optimal outcome and patient experience. A full physical assessment gives you a thorough picture of the patient’s condition.

Best practice would be to conduct a fall risk assessment and a skin risk assessment on each patient every shift or as needed if there has been a change in the patient’s condition. A fall risk assessment can determine what interventions need put in place to ensure patients are free from physical injury while in our care. The fall risk assessment we use at our facility is similar to the one presented by John Hopkins, called the JHFRAT (Hopkins Medicine, 2017). The fall risk assessment tool addresses various patient safety indicators such as: age, history of falls within 6 months, elimination of bowel and bladder (incontinence, urgency or frequency), medications (PCA/opiates, anticonvulsants, antihypertensives, diuretics, hypnotics, laxatives, sedatives, psychotropic, etc.), use of patient care equipment (IV infusion, chest tube, indwelling catheter, SCDs, etc.), mobility (unsteady gait or needs assistance), sensations (decrease in hearing, vision, etc.), and cognition (impulsive behavior, sedation, or altered mental status). If the patient scores greater than 6 then they are required to wear fall-risk socks, fall risk bracelet, and bed/chair alarms are put in place. This is a great tool as we can reassess it multiple times throughout the day to ensure the patient’s safety and decrease the rate of falls on our dashboard to improve quality indicators. It also shows the patients that we are concerned for their safety and are putting all safety measures in place to ensure a positive outcome.

Another best practice tool we can utilize would be the skin risk assessment to prevent and manage pressure ulcers. The Braden Scale for predicting pressure sore risk is a clinically validated tool that allows nurses and other health care providers to reliably score a patient/client’s level of risk for developing pressure ulcers. It measures the functional capabilities of the patient that contribute to either higher intensity and duration of pressure or lower tissue tolerance for pressure. Lower functioning levels indicate higher risk for pressure ulcer development (NLM, 2013). The Braden Scale uses various categories to determine the patient’s skin risk such as: sensory perception (ability to respond meaningfully to pressure-related discomfort), moisture (degree to which skin is exposed to moisture), physical activity (degree of physical activity), mobility (ability to change and control body positions), nutrition (usual food intake pattern), and friction and shear risk. A score of 18 or below alerts the nurse that the patient may be at risk for pressure areas, a score 9 or less determines that the patient is high risk. Interventions should be put in place to prevent pressure ulcers for at risk patients. The nurses should be required to inspect patients’ skin each shift, manage moisture on the skin, conduct a skin risk assessment each shift or as needed if there is a change in the patient’s condition, minimize pressure to bony prominence by reposition patient every 1-2 hours, increasing nutrition intake and hydration (if the patient is unable to consume these orally then intravenous methods need to be implemented). By completing each of these steps for all patients it will prevent secondary diagnosis and prolonging of patient stay. Maintaining skin integrity will increase the patient’s outcome and satisfaction. NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay.

Through the use of quality indicators and data collection we have the ability to improve our patient satisfaction and the care we deliver on a daily basis. By utilizing best practices to maintain patient safety and recognizing the needs and concerns of our patients we can achieve high standards. We must realize though that perfect scores across the dashboard is unrealistic. Health care and evidenced-based practices are always changes and the care we are providing is becoming more acute. By continuing our education and having our patient’s safety as our number one priority we will continue to excel in the health care continuum. NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay

References

Tomlinson, P., Hewitt, S., & Blackshaw, N. (2013). Joining up health and planning: How Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning. Perspectives In Public Health, 133(5), 254-262. Retrieved from: http://dx.doi.org/10.1177/1757913913488331

Institute for Healthcare Improvement. (2017). Patient Safety Plan. St. Francis Health System: St. Joseph Medical Center. Bloomington, Illinois. Retrieved from: http://www.ihi.org/resources/Pages/Tools/PatientSafetyPlan.aspx

Hopkins Medicine. (2017). Fall Risk Assessment: JHFRAT. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Retrieved from: http://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html

National Library of Medication. (2013). Braden Scale. National Institutes of Health, Health & Human Services. Retrieved from: /orders/www.nlm.nih.gov/research/umls/sourcereleasedocs/current/LNC_BRADEN/

NURS 3001 Week 3 Discussion (Walden)

NURS 3001 Week 3 Discussion

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Professional Practice Models and their Impact on Nursing

​Currently I am employed by two facilities. One is a major Magnet designated facility and …

The Research on Magnet Status

​Since the inception of the idea of magnetism, organizations have worked to create the …

Nurse Retention and Magnet Status

​There are positive and negative aspects of magnet status in certain facilities. What …

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