Posts in category: Nursing Papers

Policies and programs to improve population health

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-(SELECT CHILDHOOD OBESITY)
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.
Post a summary of how the five population health determinants (access to health care, individual behavior, social environment, physical environment, and genetics) affect your selected health issue, and which determinants you think are most impactful for that particular issue and why.
Explain how epidemiologic data supports the significance of your issue, and explain how this data has been used in designing population health measures and policy initiatives.
What is population health?
The population health perspective taken by this blog is a broad one, as the model below illustrates (1) [This model was adapted from the original Evans and Stoddart field model (2) and expands on Kindig and Stoddart (3)].
 
Policies and programs produce changes in health determinants or factors , then produce the health outcomes in the left hand box.
  
Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. (3,4) These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group. The health outcomes of such groups are of relevance to policy makers in both the public and private sectors.
(This is an adaption of the original Evans and Stoddart field model4)   Note that population health is not just the overall health of a population but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy—even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced. The right hand side of the figure indicates that there are many health determinants or factors, such as medical care systems, individual behavior, genetics, the social environment, and the physical environment. Each of these determinants has a biological impact on individual and population health outcomes.   Isn’t this so broad to include everything? Population health, as defined above, has been critiqued as being so broad as to include everything—and that it therefore is not useful in guiding research or policy. But we believe that a broad guiding synthesis of knowledge is essential. Integration of knowledge about health and its multiple factors otherwise would seldom occur. Policy managers typically have responsibility for a single sector; advocacy groups typically often have an interest in only one disease or factor. No one in the public or private sectors currently has responsibility for overall health improvement. The importance of a population health perspective is that it forces review of health outcomes in a population across factors. For population health research, specific investigations into a single factor, outcome measure, or policy intervention are relevant, and may even be critical in some cases, but must should be recognized as only a part and not the whole.   What is the difference between population health and public health? The distinction between public health and population health is sometimes confusing. For those who would define public health as the “health of the public,” there would be little difference from the population health definition offered here. However, not everyone believes that  governmental public health activity in the United States has a mandate to address all the  determinants of health, such as , education and income, since they are outside of public health authority and responsibility. The broader definition of the “public health system” offered by the Institute of Medicine5 reaches beyond this view towards a “new generation of intersectoral partnerships” is consistent with the population health framework of this blog.   References 1.    Kindig, DA and G Stoddart. 2003. What is population health? American Journal of Public Health 93:366-369. 2.    Kindig DA. Understanding Population Health Terminology. Milbank Quarterly 2007; 85 (1) 139-161. 3.    Kindig D, Asada Y., Booske B.  A Population Health Framework for Setting National and State Health Goals. JAMA 2008; 299:2081-2083. 4.    Evans R, Stoddart GC. Consuming Health Care, Producing Health. Soc. Sci. Med. 1990; 33:1347-1363. 5.    Institute of Medicine 2002. The Future of the Public’s Health in the 21st Century. Washington, DC, The National Academies Press. What Are Population Health Outcomes? Many health improvement models have identified two broad outcome goals: increasing overall or mean population health and eliminating disparities within the population. For example, the goals of Healthy People 2010 are to “increase the quality and years of healthy life” as well as “eliminate health disparities.” The outcomes component of our population health modelpopulation health model is shown in the left hand side of the figure below1,2     For overall or mean population health, two components are displayed: mortality (length of life), and health-related quality of life, or morbidity. Healthy People 2010 defines defined health-related quality of life as “a personal sense of physical and mental health and the ability to react to factors in the physical and social environments.”3 Simply put, the one goal of population health improvement is to increase years of life and the quality of those life years.   Another goal is We also want to reduce the differences or disparities in these health outcomes among different subgroups in the population.4 The figure indicates a number of subgroups that are associated with significant differences or disparities in both mortality and health-related quality of life. Those featured here are race/ethnicity, socioeconomic status (SES), gender, and geography. Many other subgroups besides these are associated with population health disparities. All differences are not necessarily of policy interest or are equally important in all situations.5   It is important to note that in this figure each quadrant is arbitrarily sized equally, as are the components within disparities (i.e., race/ethnicity, SES, geography, and gender). The relative importance of each cell is not a research question but a value choice for different nations, states, or other population groups to make. Some may focus more on years of life and others more on the quality of those years. Some may think that socioeconomic disparities are the most important while others could prioritize disparities of gender or geography. In the Health of Wisconsin State Report Card, an overall grade for health disparity was given based on a multidomain index across four disparity domains.6   References 1.    Kindig, DA. Understanding Population Health Terminology. Milbank Quarterly 2007 85 (1) 139-161. 2.    Kindig DA, Asada, Y, Booske B. A Population Health Framework for Setting National and State Health Goals. JAMA 299 (17) 2081-2083, 2008 3.    Healthy People 2010. Office of Disease Prevention and Health Promotion. US Dept. of Health and Human Services. http://www.healthypeople.gov. Accessed April 19, 2010. 4.    Kawachi, I, S.V. Subramanian, and N. Almeida-Filho. 2002. A Glossary for Health Inequalities. Journal of Epidemiology and Community Health 56:647–52. 5.    Graham, H. 2004. Social Determinants and Their Unequal Distribution: Clarifying Policy Understandings. Milbank Quarterly 82(1):101–24. 6.    Booske, BC, Rohan, A, Kindig, DA., Remington, PL  2010. Grading and Reporting on Health and Health Disparities. Preventing Chronic Disease 7(1): 1-7  What Are Population Health Determinants or Factors? Health outcomes, however defined and measured, are produced by determinants or factors. They often are sorted into the five categories presented on the right in the following model.   Medical Health care determinants generally include access, cost, quantity, and quality of health care services. Individual behavior determinants include choices about lifestyle or habits (either spontaneously or through response to incentives) such as diet, exercise, and substance abuse.Social environment determinants include elements of the social environment such as education, income, occupation, class, social support. Physical environment determinants include elements of the natural and built environment such as air and water quality, lead exposure, and the design of neighborhoods. Genetic determinants include the genetic composition of individuals or populations. The subcomponents of these determinants or factors can be measured in many different ways. The County Health Rankings includes many such measures in each category that are available at the county level. A series of articles commissioned by the MATCH project, to be published in the online journal Preventing Chronic Disease starting in June 2010, outline current thinking regarding conceptualizing and measuring each of these categories. In the model above, each category is depicted as the same size, implying that they each contribute equally to health outcomes. Although useful for illustration, in reality those determinants will carry different weights (and hence would be different sizes). Differences exist depending on the population studied, and because cross-sectoral economic analysis is complicated by interactions between determinants and the latency over time of their effects. In the MATCH County Health Rankings, health care is weighted 20%, b
ehaviors 30%, the social environment 40%, and the physical environment 10%. An explanation of the process used to assign these particular weights is available. However, Establishing more solidlydetermining the correct weights for each category and the policies and programs underpinning them is remains the a major challenge for population health research. It is important, too, to realize the presence of “reverse causality,” which is why there is a small arrow in the above model going from outcomes to determinants/factors. This reflects the fact that outcomes such as morbidity can produce a change in a determinant or risk factor. For example, childhood illness can be responsible for lower educational attainment. In this case, the definitions of outcomes and determinants are reversed; morbidity would be the determinant or factor and educational attainment the outcome. Separating out the different directions of causality is an important and difficult research challenge. PROGRAMS AND POLICIES The population health perspective taken by this blog is a broad one, in which population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.1,2 These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group. The health outcomes of such groups are of relevance to policy makers in both the public and private sectors.   We find the model below useful in thinking about population health.3 Here we see that programs and policies produce changes in health determinants or factors, which then produce the health outcomes in the left hand box.     (This is an adaption of the original Evans and Stoddart field model4)   Note that population health is not just the overall health of a population but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy—even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced. The right hand side of the figure indicates that there are many health determinants or factors, such as medical care systems, individual behavior, genetics, the social environment, and the physical environment. Each of these determinants has a biological impact on individual and population health outcomes.   Isn’t this so broad to include everything? Population health, as defined above, has been critiqued as being so broad as to include everything—and that it therefore is not useful in guiding research or policy. But we believe that a broad guiding synthesis of knowledge is essential. Integration of knowledge about health and its multiple factors otherwise would seldom occur. Policy managers typically have responsibility for a single sector; advocacy groups typically often have an interest in only one disease or factor. No one in the public or private sectors currently has responsibility for overall health improvement. The importance of a population health perspective is that it forces review of health outcomes in a population across factors. For population health research, specific investigations into a single factor, outcome measure, or policy intervention are relevant, and may even be critical in some cases, but must should be recognized as only a part and not the whole.   What is the difference between population health and public health? The distinction between public health and population health is sometimes confusing. For those who would define public health as the “health of the public,” there would be little difference from the population health definition offered here. However, not everyone believes that  governmental public health activity in the United States has a mandate to address all the  determinants of health, such as , education and income, since they are outside of public health authority and responsibility. The broader definition of the “public health system” offered by the Institute of Medicine5 reaches beyond this view towards a “new generation of intersectoral partnerships” is consistent with the population health framework of this blog.   References 1.    Kindig, DA and G Stoddart. 2003. What is population health? American Journal of Public Health 93:366-369. 2.    Kindig DA. Understanding Population Health Terminology. Milbank Quarterly 2007; 85 (1) 139-161. 3.    Kindig D, Asada Y., Booske B.  A Population Health Framework for Setting National and State Health Goals. JAMA 2008; 299:2081-2083. 4.    Evans R, Stoddart GC. Consuming Health Care, Producing Health. Soc. Sci. Med. 1990; 33:1347-1363. 5.    Institute of Medicine 2002. The Future of the Public’s Health in the 21st Century. Washington, DC, The National Academies Press. What Are Population Health Outcomes? Many health improvement models have identified two broad outcome goals: increasing overall or mean population health and eliminating disparities within the population. For example, the goals of Healthy People 2010 are to “increase the quality and years of healthy life” as well as “eliminate health disparities.” The outcomes component of our population health modelpopulation health model is shown in the left hand side of the figure below1,2     For overall or mean population health, two components are displayed: mortality (length of life), and health-related quality of life, or morbidity. Healthy People 2010 defines defined health-related quality of life as “a personal sense of physical and mental health and the ability to react to factors in the physical and social environments.”3 Simply put, the one goal of population health improvement is to increase years of life and the quality of those life years.   Another goal is We also want to reduce the differences or disparities in these health outcomes among different subgroups in the population.4 The figure indicates a number of subgroups that are associated with significant differences or disparities in both mortality and health-related quality of life. Those featured here are race/ethnicity, socioeconomic status (SES), gender, and geography. Many other subgroups besides these are associated with population health disparities. All differences are not necessarily of policy interest or are equally important in all situations.5   It is important to note that in this figure each quadrant is arbitrarily sized equally, as are the components within disparities (i.e., race/ethnicity, SES, geography, and gender). The relative importance of each cell is not a research question but a value choice for different nations, states, or other population groups to make. Some may focus more on years of life and others more on the quality of those years. Some may think that socioeconomic disparities are the most important while others could prioritize disparities of gender or geography. In the Health of Wisconsin State Report Card, an overall grade for health disparity was given based on a multidomain index across four disparity domains.6   References 1.    Kindig, DA. Understanding Population Health Terminology. Milbank Quarterly 2007 85 (1) 139-161. 2.    Kindig DA, Asada, Y, Booske B. A Population Health Framework for Setting National and State Health Goals. JAMA 299 (17) 2081-2083, 2008 3.    Healthy People 2010. Office of Disease Prevention and Health Promotion. US Dept. of Health and Human Services. http://www.healthypeople.gov. Accessed April 19, 2010. 4.    Kawachi, I, S.V. Subramanian, and N. Almeida-Filho. 2002. A Glossary for Health Inequalities. Journal of Epidemiology and Community Health 56:647–52. 5.    Graham, H. 2004. Social Determinants and Their Unequal Distribution: Clarifying Policy Understandings. Milbank Quarterly 82(1):101–24. 6.    Booske, BC, Rohan, A, Kindig, DA., Remington, PL  2010. Grading and Reporting on Health and Health Disparities. Preventing Chronic Disease 7(1): 1-7  What Are Population Health Determinants or Factors? Health outcomes, however defined and measured, are prod
uced by determinants or factors. They often are sorted into the five categories presented on the right in the following model.   Medical Health care determinants generally include access, cost, quantity, and quality of health care services. Individual behavior determinants include choices about lifestyle or habits (either spontaneously or through response to incentives) such as diet, exercise, and substance abuse.Social environment determinants include elements of the social environment such as education, income, occupation, class, social support. Physical environment determinants include elements of the natural and built environment such as air and water quality, lead exposure, and the design of neighborhoods. Genetic determinants include the genetic composition of individuals or populations. The subcomponents of these determinants or factors can be measured in many different ways. The County Health Rankings includes many such measures in each category that are available at the county level. A series of articles commissioned by the MATCH project, to be published in the online journal Preventing Chronic Disease starting in June 2010, outline current thinking regarding conceptualizing and measuring each of these categories. In the model above, each category is depicted as the same size, implying that they each contribute equally to health outcomes. Although useful for illustration, in reality those determinants will carry different weights (and hence would be different sizes). Differences exist depending on the population studied, and because cross-sectoral economic analysis is complicated by interactions between determinants and the latency over time of their effects. In the MATCH County Health Rankings, health care is weighted 20%, behaviors 30%, the social environment 40%, and the physical environment 10%. An explanation of the process used to assign these particular weights is available. However, Establishing more solidlydetermining the correct weights for each category and the policies and programs underpinning them is remains the a major challenge for population health research. It is important, too, to realize the presence of “reverse causality,” which is why there is a small arrow in the above model going from outcomes to determinants/factors. This reflects the fact that outcomes such as morbidity can produce a change in a determinant or risk factor. For example, childhood illness can be responsible for lower educational attainment. In this case, the definitions of outcomes and determinants are reversed; morbidity would be the determinant or factor and educational attainment the outcome. Separating out the different directions of causality is an important and difficult research challenge. PROGRAMS AND POLICIES<br Note that population health is not just the overall health of a population but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy—even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced. The right hand side of the figure indicates that there are many health determinants or factors, such as medical care systems, individual behavior, genetics, the social environment, and the physical environment. Each of these determinants has a biological impact on individual and population health outcomes.
Isn’t this so broad to include everything?
Population health, as defined above, has been critiqued as being so broad as to include everything—and therefore not very useful in guiding specific research or policy. The truth is, no one in the public or private sectors currently has responsibility for overall health improvement. Policy managers, for example, tend to have responsibility for a single sector while advocacy groups likewise focus on a single disease or factor.
The inherent value of a population health perspective is that it facilitates integration of knowledge across the many factors that influence health and health outcomes. For population health research, specific investigations into a single factor, outcome measure, or policy intervention are relevant, and may even be critical in some cases–but they should be recognized as only a part and not the whole.
 
What is the difference between population health and public health?
The distinction between public health and population health deserves attention since it has been at times both confusing and even divisive. Traditionally, public health has been understood by many to be the critical functions of state and local public health departments such as preventing epidemics, containing environmental hazards, and encouraging healthy behaviors.
The broader current definition of the public health system offered by the Institute of Medicine reaches beyond this narrow governmental view. Its report, The Future of the Public’s Health in the 21st Century, calls for significant movement in “building a new generation of intersectoral partnerships that draw on the perspectives and resources of diverse communities and actively engage them in health action (5).”
However, much of U.S. governmental public health activity does not have such a broad mandate even in its “assurance” functions, since major population health determinants like health care, education, and income remain outside public health authority and responsibility. Similarly, current resources provide inadequate support for traditional–let alone emerging–public health functions. Yet for those who define public health as the “health of the public,” there is little difference from the population health framework of this blog.
 
References:
1. Kindig D, Asada Y, Booske B. (2008). A Population Health Framework for Setting National and State Health Goals . JAMA, 299, 2081-2083.
2. Evans R, Stoddart GC. (1990). Producing Health, Consuming Health Care . Soc. Sci. Med. 33, 1347-1363.
3. Kindig, DA, Stoddart G. (2003). What is population health? American Journal of Public Health, 93, 366-369.
4. Kindig DA. (2007). Understanding Population Health Terminology . Milbank Quarterly, 85(1), 139-161.
5. Institute of Medicine. (2002). The Future of the Public’s Health in the 21st Century . Washington, DC, The National Academies Press.

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The Impact Of Standardized Nursing Terminology

Among the Resources in this module is the Rutherford (2008) article Standardized Nursing Language: What Does It Mean for Nursing Practice? In this article, the author recounts a visit to a local hospital to view the recent implementation of a new coding system.
During the visit, one of the nurses commented to her, “We document our care using standardized nursing languages but we don’t fully understand why we do” (Rutherford, 2008, para. 1).
How would you respond to a comment such as this one?
To Prepare:

• Review the concepts of informatics as presented in the Resources, particularly Rutherford, M. (2008) Standardized Nursing Language: What Does It Mean for Nursing Practice?
• Reflect on the role of a nurse leader as a knowledge worker.
• Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:
In a 2- to 3-page paper, address the following:

• Explain how you would inform this nurse (and others) of the importance of standardized nursing terminologies.
• Describe the benefits and challenges of implementing standardized nursing terminologies in nursing practice. Be specific and provide examples.
• Be sure to support your paper with peer-reviewed research on standardized nursing terminologies that you consulted from the your school.

Resources:
Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

• Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)
• Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)
•  

/orders/www.healthit.gov/sites/default/files/snt_final_05302017.pdf
Rubric:

In a 2- to 3-page paper, address the following:
·   Explain how you would inform this nurse (and others) of the importance of standardized nursing terminologies.
·   Describe the benefits and challenges of implementing standardized nursing terminologies in nursing practice. Be specific and provide examples.
·   Be sure to support your paper with peer-reviewed research on standardized nursing terminologies that you consulted from the Walden Library.–

Levels of Achievement:  Excellent 77 (77%) – 85 (85%)    Good 68 (68%) – 76 (76%)    Fair 60 (60%) – 67 (67%)    Poor 0 (0%) – 59 (59%)

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)

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Assignment WK 10

Your Leadership Profile

Do you believe you have the traits to be an effective leader? Perhaps you are already in a supervisory role, but as has been discussed previously, appointment does not guarantee leadership skills.
How can you evaluate your own leadership skills and behaviors? You can start by analyzing your performance in specific areas of leadership. In this Discussion, you will complete Gallup’s StrengthsFinder assessment. This assessment will identify your personal strengths, which have been shown to improve motivation, engagement, and academic self-conference. Through this assessment, you will discover your top five themes—which you can reflect upon and use to leverage your talents for optimal success and examine how the results relate to your leadership traits.
To Prepare:
To take the Assessment, visit http://walden.gallup.com. Using the Guidance Document Resource(s) for the Strengths Finder assessment, follow the instructions for setting up an account. If the link does not work, please copy and paste the link into your web browser.

Please Note: This Assessment will take roughly 30 minutes to complete.

• Once you have completed your assessment, you will receive your “Top 5 Signature Themes of Talent” on your screen.
• Click the Download button below Signature Theme Report, and then print and save the report. We also encourage you to select the Apply tab to review action items.

NOTE: Please keep your report. You will need your results for future courses. Technical Issues with Gallup:
If you have technical issues after registering, please contact the Gallup Education Support group by phone at +1.866-346-4408. Support is available 24 hours/day from 6:00 p.m. Sunday U.S. Central Time through 5:00 p.m. Friday U.S. Central Time.

• Reflect on the results of your Assessment, and consider how the results relate to your leadership traits.

By Day 3 of Week 5

Post a brief description of your results from the StrengthsFinder assessment. Then, briefly describe two core values, two strengths, and two characteristics that you would like to strengthen based on the results of your StrengthsFinder assessment. Be specific.
Please find the attached result from strengh finder

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Complex Regional Pain Disorder White Male With Hip Pain

Complex Regional Pain Disorder White Male With Hip Pain

Decision Point One
Savella  12.5 mg once daily on day 1; followed by 12.5 mg BID on day 2 and 3;  followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter
RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Client comes into the office to without crutches but is limping a  bit. The client states that the pain is “more manageable since I started  taking that drug. I have been able to get around more on my own. The  pain is bad in the morning though and gets better throughout the day”.  On a pain scale of 1-10; the client states that his pain is currently a  4. When asked what pain level would be tolerable on a daily basis, the  client states, “I would rather have no pain but don’t think that is  possible. I could live with a pain level of 3.”. When questioned  further, the PMHNP asks what makes the pain on a scale of 1-10 different  when comparing a level of 9 to his current level of 4?”. The client  states that since using this drug, I can get to a point on most days  where I do not need the crutches. ” The client is also asked what would  need to happen to get his pain from a current level of 4 to an  acceptable level of 3. He states, “If I could get to the point everyday  where I do not need the crutches for most of my day, I would be happy.”
•  Client states that he has noticed that he frequently (over the  past 2 weeks) gets bouts of sweating for no apparent reason. He also  states that his sleep has “not been so good as of lately.” He does  complain of nausea today
•  Client’s blood pressure and pulse are recorded as 147/92 and 110  respectively. He also admits to experiencing butterflies in his chest.   The client denies suicidal/homicidal ideation and is still future  oriented

Decision Point Two
 Continue with current medication but lower dose to 25 mg twice a day  
RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Client comes to office today with use  of crutches. He states that his current pain is a 7 out of 10. “I do not  feel as good as I did last month.”
• Client states that he is sleeping at night but woken frequently from pain down his right leg and into his foot
• Client’s blood pressure and heart rate recorded today are 124/85 and 87 respectively. He denies any heart palpitations today
• Client denies suicidal/homicidal ideation but he is discouraged about the recent slip in his pain management and looks sad

Decision Point Three
 Change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME 

Guidance to Student
The client has a complex neuropathic  pain syndrome that may never respond to pain medication. Once that is  understood, the next task is to explain to the client that pain level  expectations need to realistic in nature and understand that he will  always have some level of pain on a daily basis. The key is to manage it  in a manner that allows him to continue his activities of daily living  with as little discomfort as possible. Next, it is important to explain  that medications are never the final answer but a part of a complex  regimen that includes physical therapy, possible chiropractic care, heat  and massage therapy, and medications. Savella is a SNRI that also  possesses NMDA antagonist activity which helps in producing analgesia at  the site of nerve endings. It is specifically marketed for fibromyalgia  and has a place in therapy for this gentleman. Tramadol is never a good  option along with other opioid type analgesics. Agonists at the Mu  receptors does not provide adequate pain control in these types of  neuropathic pain syndromes and therefore is never a good idea. It also  has addictive properties which can lead to secondary drug abuse.  Reductions in Savella can help control side effects but at a cost of  uncontrolled pain. It is always a good idea to start with dose  reductions during parts of the day that pain is most under control. The  addition of Celexa with Savella needs to be done cautiously. Both  medications inhibit the reuptake of serotonin and can, therefore, lead  to serotonin toxicity or serotonin syndrome.Assessing and Treating Adult Clients with Mood Disorders
A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial appointment with depression.  Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016).  There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016).  The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID.  As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one.  Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013).  SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) which impedes the reabsorption of the neurotransmitters serotonin and norepinephrine changing the chemistry in the brain to regulate mood (Stahl, 2013). Bhat and Kennedy (2017) describe antidepressant discontinuation syndrome (ADS) as a “medication-induced movement disorder” along with various adverse reactions such as intense sadness and anxiety; periods of an “electric shock” sensation; sights of flashing lights; and dizziness upon movement (Bhat & Kennedy, 2017, p. E7).  These symptoms are often experienced a few days after sudden discontinuation of an antidepressant with a shorter-life (3-7 hours) such as venlafaxine or paroxetine (Bhat & Kennedy, 2017; Stahl, 2017). Moreover, Stahl (2017) indicates venlafaxine is one of the drugs with more severe withdrawal symptoms in comparison to other antidepressants. It may take some clients several months to taper off of this medicine; therefore, Effexor is not the optimal selection at this time.
Phenelzine is classified as an irreversible monoamine oxidase inhibitor (MAOI) which impedes the monoamine oxidase from deconstructing serotonin, dopamine, as well as norepinephrine.  Thus, boosting the levels of neurotransmitters in the brain to regulate mood (Stahl, 2017).  Park and Zarate (2019) purport the use of monoamine oxidase inhibitors have a higher risk profile; therefore, are not typically utilized unless a newer antidepressant is considered ineffective. Bhat and Kennedy (2017) indicate there is a need for a long taper with MAOIs. Further, this medication may lose effectiveness after long-term use, and it is considered to have habit-forming qualities for some individuals (Stahl, 2017). The initial dose for phenelzine is taken three times a day which research suggests medication adherence is often tricky when the administration is more than once a day (Goette & Hammwöhner, 2016).  Stahl (2017) describes certain risk factors comprising of frequent weight gain, interference of certain food products containing tyramine, drug interactions (serotonin syndrome), as well as a hypertensive crisis. When utilizing this medication for treatment-resistant depression, the advance practitioner is aware of the detrimental adverse reactions which may occur. Therefore, phenelzine is not the safest option for this client.
The overarching goal for this male client is to reduce the symptoms related to his major depressive disorder and to eventually achieve remission without relapse where he can maintain normalcy in his life. After four weeks, his depressive symptoms decrease by 25 percent which is progress; however, he has a new onset of erectile dysfunction (Laureate Education, 2016). Sexual dysfunction is a notable side effect of sertraline (Stahl, 2017). Therefore, the clinician will reevaluate the plan of care given this new information. The outcomes were to be expected as the client was started on a low dose of sertraline, and treatment is typically 50 mg to 200 mg.  A continuation in progress may require more time, approximately six to eight weeks in total (Stahl, 2017).
Decision Point Two
The present selections include decrease dose to 12.5 daily orally, continue same dose and counsel client, or augment with Wellbutrin 150 IR in the morning.  The preference for decision point two is Wellbutrin (bupropion) 150 IR, which is considered a norepinephrine dopamine reuptake inhibitor (SDRI).  An SDRI elevates the neurotransmitters dopamine, noradrenaline, and norepinephrine in the brain to achieve an improvement in depressive symptoms (Stahl, 2017). The purpose of utilizing this agent is three-fold: (1) To boost mood (2) To treat the new onset of sexual dysfunction (3) To aid in weight-loss.  According to the National Alliance on Mental Illness [NAMI] (2018a), Wellbutrin is a medication administered for major depressive disorder often in conjunction with an SSRI (NAMI, 2018a).
Further, Wellbutrin may be prescribed with an SSRI to reverse the effects of SSRI-induced sexual dysfunction (Stahl, 2017). Dunner (2014) purports combining antidepressants are safe and may enhance efficacy; however, the combination of medications may also be utilized as an approach to reduce the effects of antidepressant pharmacotherapy. Dunner (2014) concurs that bupropion is frequently used with an SSRI or SNRI to alleviate sexual dysfunction.  Stahl (2017), findings indicate the most common side effects of bupropion consist of constipation, dry mouth, agitation, anxiety, improved cognitive functioning, as well as weight loss. The client in this scenario has gained 15 pounds over two months; thus, this medication may aid in his desire to lose weight (Laureate Education, 2016).  Further, this agent typically is not sedating as it does not have anticholinergic or antihistamine properties yet have a mild stimulating effect (Guzman, n.d).
Decreasing the Zoloft dose from 25 mg daily to 12.5 mg would not prove feasible as the client has reached a 25 percent reduction in symptomology.  The treatment for adults is 50 mg-200 mg, taking an approximate six to eight weeks to see the results in some individuals (Stahl, 2017). If the provider is tapering the medication as part of the client’s plan of care, reducing the dose to 12.5 mg would prove beneficial.  Research finds that when taking an antidepressant, the neurons adapt to the current level of neurotransmitters; therefore, if discontinuing an SSRI too quickly some of the symptoms may return (Harvard Health Publishing, 2018). Under some circumstances, discontinuation signs may appear, such as sleep changes, mood fluctuations, unsteady gait, numbness, or paranoia (Harvard Health Publishing, 2018).  However, the client is experiencing slow and steady progress on his current dose of Zoloft, so no adjustments are warranted.
At this point, positive results have been verbalized with the current dose of Zoloft 25 mg daily, with the exception of the onset of erectile dysfunction, which is a priority at this time.  One study finds that comorbid depression and anxiety disorders are commonly seen in adult males with sexual dysfunction (Rajkumar & Kumaran, 2015). An estimated 12.5 percent of participants experienced a depressive disorder before the diagnosis of sexual dysfunction. The author’s findings suggest a significant increase in suicidal behaviors with this comorbidity.  Moreover, the study indicates, some men experienced a sexual disorder while taking prescribed medication such as an antidepressant (Rajkumar & Kumaran, 2015).  According to Li et al. (2018), cognitive-behavioral therapy (CBT) is a beneficial tool utilized with clients experiencing mood disorders.  The implementation of CBT may increase the response and remission rates of depression. However, the option of continuing the same dose and engaging in counseling services is not the priority at this time.  It is essential to address this side effect to enhance his current pharmacotherapy and prevent an increase in depressive symptoms.
The continued goal of therapy is to achieve “full” remission of this individual’s major depressive disorder and to enhance his wellbeing.  After four weeks, the client returns to the clinic with a significant reduction in depressive symptoms along with the dissipation of erectile dysfunction.  However, he reports feelings of “jitteriness” and on occasion “nervousness” (Laureate Education, 2016).  This course of treatment has proven successful thus far, and the outcomes are to be expected due to the medication trials.
Decision Point Three
The present selections are to discontinue Zoloft and continue Wellbutrin, change Wellbutrin to XL 150 mg in the morning, or add Ativan 0.5 mg orally TID/PRN for anxiety.  The selection for decision point three is to change the Wellbutrin from IR to XL 150 mg in the morning. The first formulation is immediate- release (IR) and the recommended dosing is divided beginning at 75 mg twice daily increasing to 100 mg twice daily, then 100 mg three times a day with the maximum of 450 mg (Stahl, 2017).   The second formulation is extended-release (XL), where the administration for the initial dose is once daily taken in the morning; the maximum is 450 mg in a single dose (Stahl, 2017).  The peak level of bupropion XL is approximately five hours; therefore, the side effects reported may subside as the absorption rate is slower than the IR dose (U.S. Food and Drug Administration, 2011a). The immediate-release peak level is approximately two hours which may account for the client’s notable feelings of being jittery and at times nervous (U.S. Food and Drug Administration, 2011b).  Furthermore, clients are switched to extended-release to improve tolerance and treatment adherence to once-daily treatment (Guzman, n.d). As a mental health provider, caring for this client, changing the formulation is the best decision at this point as well as to continue to monitor side effects.
As mentioned above, Zoloft, an SSRI, can be utilized as a first-line agent for major depressive disorder (Masuda et al., 2017).  Using Wellbutrin as an adjunct to the regimen has continued to reduce his symptoms of depression and has alleviated one of his primary concerns which is sexual dysfunction.  Therefore, discontinuing Zoloft and maintaining the use of Wellbutrin is not an appropriate option at this time.
Ativan (lorazepam) is a benzodiazepine with anxiolytic, anti-anxiety, and sedative properties. It provides short-term relief of anxiety symptoms or insomnia (U.S. National Library of Medicine [NLM], n.d.).  Lorazepam works by enhancing the effect of the inhibitory neurotransmitter GABA, which inhibits the nerve signals, in doing so, reducing the “nervous excitation” (NLM, n.d., para. 1).  In some instances, a low dose, 0.5 mg, may be administered short-term to reduce side effects from another medication. Stahl (2017), indicates many side effects will not improve with an augmenting drug. Common side effects consist of confusion, weakness, sedation, nervousness, and fatigue (Stahl, 2017). Further, Ativan has an increased risk for abuse potential as it is known to have habit-forming properties (Stahl, 2017). As a result, administering Ativan would not be in the best interest of the client.
The ultimate goal is to achieve remission of his mood disorder.  The medication regimen has proven effective; thus, considering this to be a successful plan of care.  Taking both the sertraline and bupropion can exhibit side effects of jitteriness; however, changing to the extended-release may aid in the dissipation of these feelings.  The addition of Ativan to relieve side effects, that are perhaps temporary, is against better judgment without first making an effort to change or modify the medication regimen (Laureate Education, 2016).
Summary with Ethical Considerations
Mood disorders affect millions of individuals in the United States on an annual basis. The prevalence of mental illness continues to flourish, impacting one’s quality of life. Initiating treatment, under the guidance of a healthcare professional, is of the utmost importance. Further, an individualized plan of care comprising of education, therapy, medication, and support is crucial for overall health and wellbeing.
The client is a Hispanic American male employed as a laborer in a warehouse (Laureate Education, 2016).  It is essential to assess his financial means before prescribing medications.  Although one cannot assume the client has financial hardships, having this knowledge will guide in the process of treatment. If the client is without insurance and has to pay out-of-pocket, medication adherence may not be sustainable.  Therefore, as a psychiatric nurse practitioner, providing a cost-effective means whether, through generic prescriptions, discount pharmacies, or prescribing a larger quantity may be a necessary option (Barker & Guzman, 2015).  Further, the partnership among clients and practitioners is essential; to establish trust and respect as well as understanding cultural preferences while avoiding stereotypes is vital.
 
References
Barker, K. K., & Guzman, C. E. (2015). Pharmaceutical direct‐to‐consumer advertising and US Hispanic patient‐consumers. Sociology of Health & Issues, 37(8), 1337-1351. Doi:10.1111/1467-9566.12314
Bhat, V., & Kennedy, S. H. (2017). Recognition and management of antidepressant discontinuation syndrome. Journal of Psychiatry & Neuroscience, 42(4), E7-E8. Doi:10.1503/jpn.170022
Dunner, D. L. (2014). Combining antidepressants. Shanghai Archives of Psychiatry, 26(6), 363-364. Doi:10.11919/j.issn.1002-0829.214177
Goette, A., & Hammwöhner, M. (2016). How important it is for therapy adherence to be once a day? European Heart Journal Supplements, 18 (1). Doi:10.1093/eurheartj/suw048
Guzman, F. (n.d). The psychopharmacology of bupropion: An illustrated overview. Retrieved from /orders/psychopharmacologyinstitute.com/section/the-psychopharmacology-of-bupropion-an-illustrated-overview-2051-4056
Harvard Health Publishing. (2018). Going off antidepressants. Retrieved September 11, 2019, from /orders/www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
Laureate Education. (2016). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author
Li, J. M., Zhang, Y., Su, W. J., Liu, L. L., Gong, H., Peng, W., & Jiang, C. L. (2018). Cognitive behavioral therapy for treatment-resistant depression: A systematic review and meta-analysis. Psychiatry Research, 268, 243–250. Doi:10.1016/j.psychres.2018.07.020
Masuda, K., Nakanishi, M., Okamoto, K., Kawashima, C., Oshita, H., Inoue, A., … Akiyoshi, J. (2017). Different functioning of prefrontal cortex predicts treatment response after a selective serotonin reuptake inhibitor treatment in patients with major depression. Journal of Affective Disorders, 214, 44-52. Doi:10.1016/j.jad.2017.02.034
Mental Health.gov. (2017). Depression. Retrieved from /orders/www.mentalhealth.gov/what-to-look-for/mood-disorders/depression
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from /orders/www.researchgate.net/publication/224773098_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change
National Alliance on Mental Illness. (2018a). Bupropion (Wellbutrin). Retrieved from /orders/www.nami.org/Learn-More/Treatment/Mental-Health-Medications/bupropion-(Wellbutrin)
National Alliance on Mental Illness. (2018b). Sertraline (Zoloft). Retrieved from /orders/www.nami.org/Learn-More/Treatment/Mental-Health-Medications/sertraline-(Zoloft)
Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. The New England Journal of Medicine, 380, 559-568. Doi:10.1056/NEJMcp1712493
Rajkumar, R. P., & Kumaran, A. K. (2015). Depression and anxiety in men with sexual dysfunction: A retrospective study. Comprehensive Psychiatry, 60, 114-118. bDoi:10.1016/j.comppsych.2015.03.001
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practice

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. Complex Regional Pain Disorder White Male With Hip Pain

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

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. Complex Regional Pain Disorder White Male With Hip Pain

• Communication

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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Psychotherapeutic Approach To Group Therapy With Children

Psychotherapeutic Approaches to Group Therapy with Children and Adolescents
Group therapy may be beneficial for children and adolescents, because it often provides an environment that normalizes clients’ thoughts, feelings, and behaviors. However, as with any therapeutic approach, group therapy might not be appropriate for every client, every setting, or even every therapist. When selecting therapies, you must always consider the psychodynamics of the client and your own skill set.
This week, as you assess and develop diagnoses for clients presenting for child and adolescent group psychotherapy, you examine the effectiveness of this therapeutic approach. You also consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders.
Learning Objectives
Students will:
· Assess clients presenting with disruptive behavior
· Analyze group therapeutic approaches for treating clients presenting with disruptive behavior
· Evaluate outcomes for clients presenting with disruptive behavior
To prepare:
· Review this week’s Learning Resources and reflect on the insights they provide.
· Read the case study I am Feeling Like I’m Going Crazy below
· For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.
Post an explanation of the most likely DSM-5 diagnosis for the client in the case study. Be sure to link those behaviors to the criteria in the DSM-5. Then, explain group therapeutic approaches you might use with this client.  Explain expected outcomes for the client based on these therapeutic approaches. Finally consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders. Support your approach with evidence-based literature.
Required Readings( Need 3 references)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism and Developmental Disorders, 44(8), 2041-2051. doi:10.1007/s10803-014-2087-9
Restek-Petrović, B., Bogović, A., Mihanović, M., Grah, M., Mayer, N., & Ivezić, E. (2014). Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: A preliminary study. Nordic Journal of Psychiatry, 68(5), 333-340. doi:10.3109/08039488.2013.839738
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

• Chapter 17, “Psychotherapy      with Children” (pp. 597–624)
• Chapter 20, “Termination and Outcome      Evaluation” (pp. 693–712)

Document: I am Feeling Like I’m Going Crazy
Required Media
Microtraining Associates (Producer). (2009). Leading groups with adolescents [Video file]. Alexandria, VA: Author.
Psychotherapy.net (Producer). (2002). Adlerian parent consultation [Video file]. Mill Valley, CA: Author.
The approximate length of this media pice is 117 minutes.
Optional Resources
Psychotherapy.net (Producer). (2012). Group counseling with adolescents: A multicultural approach [Video file]. Mill Valley, CA: Author.

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NURS-6050-WEEK8-ASSIGNMENT

Assignment: Advocating for the Nursing Role in Program Design and Implementation

As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.
Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.
In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.
To Prepare:

• Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
• Select a healthcare program within your practice and consider the design and implementation of this program.
• Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.

The Assignment: (2–4 pages)
In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:

• Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
• Who is your target population?
• What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
• What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
• What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
• Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?4
   
  Name: NURS_6050_Module04_Week08_Assignment_Rubric
   
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  	Excellent	Good	Fair	Poor
  Program Design In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions. ·   Tell us about a healthcare program within your practice. What are the costs and projected outcomes of this program? ·   Who is your target population? ·   What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples? ·   What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples? ·   What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?	Points Range:41 (41.00%) – 45 (45.00%) Response provides a clear and complete summary of the healthcare program, including an accurate and detailed description of the costs and projected outcomes of the program. Response provides a clear and accurate description that fully describes the target population. Response provides a clear and accurate explanation of the role of the nurse in providing input for the design of the program, including specific examples. Response provides an accurate and detailed description of the role of the nurse advocate for the target population for the healthcare program selected. Response provides an accurate and detailed explanation of how the advocate’s role influences design decisions as well as fully explaining impacts to program design.	Points Range:36 (36.00%) – 40 (40.00%) Response provides a summary of the healthcare program, including a description of the costs and project outcomes of the program. Response provides an accurate description of the target population. Response provides an accurate explanation of the role of the nurse in providing input for the design of the program, including some examples. Response provides an accurate description of the role of the nurse advocate for the target population for the healthcare program selected. Response provides an accurate explanation of how the advocate’s role influences design decisions and somewhat explains impacts to program design.	Points Range:31 (31.00%) – 35 (35.00%) Response provides a summary of the healthcare program that is vague or incomplete or does not include costs or projected outcomes of the program. Description of the target population is vague or inaccurate. Explanation of the role of the nurse in providing input for the design of the program is vague, inaccurate, or does not include specific examples. Description of the role of the nurse advocate for the target population for the healthcare program selected is vague or inaccurate. Explanation of how the advocate’s role influences design decisions and impacts to program design is vague or inaccurate.	Points Range:0 (0.00%) – 30 (30.00%) Response provides a summary of the healthcare program that is vague and inaccurate, does not include costs or projected outcomes of the program, or is missing. Description of the target population is vague and inaccurate, or is missing. Explanation of the role of the nurse in providing input for the design of the program, and specific examples is vague and inaccurate, or is missing. Description of the role of the nurse advocate for the target population for the healthcare program selected is vague and inaccurate, or is missing. Explanation of how the advocate’s role influences design decisions and impacts to program design is vague and inaccurate, or is missing.
  Program Implementation ·  What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples? ·   Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why you think this?	Points Range:36 (36.00%) – 40 (40.00%) Response provides a clear, accurate, and complete explanation of the role of the nurse in healthcare program implementation. Response provides an accurate and detailed explanation of how the role of the nurse is different between design and implementation of healthcare programs, including specific examples. Response provides an accurate and detailed description of the members of a healthcare team needed to implement the program selected. The response fully integrates at least 2 outside resources and 2-3 course specific resources that fully supports the summary provided.	Points Range:32 (32.00%) – 35 (35.00%) Response provides an accurate explanation of the role of the nurse in healthcare program implementation. Response provides an accurate explanation of how the role of the nurse is different between design and implementation of healthcare programs, and may include some specific examples. Response provides and accurate description of the members of a healthcare team needed to implement the program selected. The response integrates at least 1 outside resource and 2-3 course specific resources that may support the summary provided.	Points Range:28 (28.00%) – 31 (31.00%) Explanation of the role of the nurse in healthcare program implementation is vague, inaccurate, and/or incomplete. Explanation of how the role of the nurse is different between design and implementation of healthcare programs is vague or inaccurate and/or does not include specific examples. Description of the members of a healthcare team needed to implement the program selected is inaccurate or incomplete. The response minimally integrates resources that may support the summary provided.	Points Range:0 (0.00%) – 27 (27.00%) Explanation of the role of the nurse in healthcare program implementation is vague and inaccurate, or is missing. Explanation of how the role of the nurse is different between design and implementation of healthcare programs is vague and inaccurate, or is missing. Description of the members of a healthcare team needed to implement the program selected is vague and inaccurate, incomplete, or is missing. The response fails to integrate any resources to support the summary provided.
  Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.	Points Range:5 (5.00%) – 5 (5.00%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.	Points Range:4 (4.00%) – 4 (4.00%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.	Points Range:3.5 (3.50%) – 3.5 (3.50%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	Points Range:0 (0.00%) – 3 (3.00%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion was provided.
  Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	Points Range:5 (5.00%) – 5 (5.00%) Uses correct grammar, spelling, and punctuation with no errors.	Points Range:4 (4.00%) – 4 (4.00%) Contains a few (1-2) grammar, spelling, and punctuation errors.	Points Range:3.5 (3.50%) – 3.5 (3.50%) Contains several (3-4) grammar, spelling, and punctuation errors.	Points Range:0 (0.00%) – 3 (3.00%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
  Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	Points Range:5 (5.00%) – 5 (5.00%) Uses correct APA format with no errors.	Points Range:4 (4.00%) – 4 (4.00%) Contains a few (1-2) APA format errors.	Points Range:3.5 (3.50%) – 3.5 (3.50%) Contains several (3-4) APA format errors.	Points Range:0 (0.00%) – 3 (3.00%) Contains many (≥ 5) APA format errors.

  Name:NURS_6050_Module04_Week08_Assignment_Rubric
   
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Week 3 Assignment

• Review the video, Case Study: Dev Cordoba. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.

The Assignment

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also, incorporate one health promotion activity and one patient education strategy.
• Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
• Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
  NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template

  Week (enter week #): (Enter assignment title)
  Student Name
  College of Nursing-PMHNP, Walden University
  NRNP 6675: PMHNP Care Across the Lifespan II
  Faculty Name
  Assignment Due Date
  Subjective:
  CC (chief complaint):
  HPI:
  Substance Current Use:
  Medical History:
  · Current Medications:
  · Allergies:
  · Reproductive Hx:
  ROS:
  · GENERAL:
  · HEENT:
  · SKIN:
  · CARDIOVASCULAR:
  · RESPIRATORY:
  · GASTROINTESTINAL:
  · GENITOURINARY:
  · NEUROLOGICAL:
  · MUSCULOSKELETAL:
  · HEMATOLOGIC:
  · LYMPHATICS:
  · ENDOCRINOLOGIC:
  Objective:
  Diagnostic results:
  Assessment:
  Mental Status Examination:
  Diagnostic Impression:
  Reflections:
  Case Formulation and Treatment Plan:
  References

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Focused SOAP Note For Anxiety, PTSD, And OCD

PLEASE FOLLOW THE INSTRUCTIONS BELOW
4 REFERENCES
In assessing patients with anxiety, obsessive-compulsive, and trauma and stressor-related disorders, you will continue the practice of looking to understand chief symptomology in order to develop a diagnosis. With a differential diagnosis in mind, you can then move to a treatment and follow-up plan that may involve both psychopharmacologic and psychotherapeutic approaches.
In this Assignment, you use a case study to develop a focused SOAP note based on evidence-based approaches.

To Prepare

• Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing anxiety, obsessive compulsive, and trauma-related disorders.
• Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
• Review the video, Case Study: Dev Cordoba. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.

The Assignment

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
• Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
• Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
  

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Assignment 2: Clinical Skills Self-Assessment/PRAC 6645: Psychotherapy With Multiple Modalities Practicum

Before embarking on any professional or academic activity, it is important to understand the background, knowledge, and experience you bring to it. You might ask yourself, “What do I already know? What do I need to know? And what do I want to know?” This critical self-reflection is especially important for developing clinical skills such as those for advanced practice nursing.
The Psychiatric-Mental Health Nurse Practitioner (PMHNP) Clinical Skills List and Clinical Skills Self-Assessment Form provided in the Learning Resources can be used to celebrate your progress throughout your practicum and identify skills gaps. The list covers all necessary skills you should demonstrate during your practicum experiences.
Just as you did in PRAC 6635, for this Assignment, you assess where you are now in your clinical skill development and make plans for this practicum. Specifically, you will identify strengths and opportunities for improvement regarding the required practicum skills. In this practicum experience, when developing your goals and objectives, be sure to keep assessment and diagnostic reasoning in mind.

To Prepare

• Review the resources and clinical skills in the PMHNP Clinical Skills List document. It is recommended that you print out this document to serve as a guide throughout your practicum.
• Review the “Developing SMART Goals” resource on how to develop goals and objectives that follow the SMART framework.
• Review the resources on nursing competencies and nursing theory and consider how these inform your practice.
• Download the Clinical Skills Self-Assessment Form to complete this Assignment.

Assignment

Use the PMHNP Clinical Skills Self-Assessment Form to complete the following:

• Rate yourself according to your confidence level performing the procedures identified on the Clinical Skills Self-Assessment Form.
• Based on your ratings, summarize your strengths and opportunities for improvement.
• Based on your self-assessment and theory of nursing practice, develop 3–4 measurable goals and objectives for this practicum experience. Include them on the designated area of the form.

By Day 7

Submit your completed Clinical Skills Self-Assessment Form.
Master of Science in Nursing  
 
 
 
Practicum Experience Plan
 
 
Overview:
 
Your Practicum experience includes working in a clinical setting that will help you gain the knowledge and skills needed as an advanced practice nurse. In your practicum experience, you will develop a practicum plan that sets forth objectives to frame and guide your practicum experience.
 
As part of your Practicum Experience Plan, you will not only plan for your learning in your practicum experience but also work through various patient visits with focused notes as well as one (1) journal entry.
 
Complete each section below.
 
Part 1: Quarter/Term/Year and Contact Information
 
Section A
 
Quarter/Term/Year:
 
Student Contact Information
Name:
Street Address:
City, State, Zip:
Home Phone:
Work Phone:
Cell Phone:
Fax:
E-mail:
 
Preceptor Contact Information
Name:
Organization:
Street Address:
City, State, Zip:
Work Phone:
Cell Phone:
Fax:
Professional/Work E-mail:
 
 
Part 2: Individualized Practicum Learning Objectives
 
Refer to the instructions in Week 2 to create individualized practicum learning objectives that meet the requirements for this course. These objectives should be aligned specifically to your Practicum experience. Your objectives should address your self-assessment of the skills found in the “PMHNP Clinical Skills Self-Assessment Form” you completed in Week 1.
 
As you develop your individualized practicum learning objective, be sure to write them using the SMART format. Use the resources found in Week 2 to guide your development. Once you review your resources, continue and complete the following. Note: Please make sure each of your objectives are connected to your self-assessment. Also, consider that you will need to demonstrate how you are advancing your knowledge in the clinical specialty.
 
Objective 1: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)
 
Planned Activities:
Mode of Assessment: (Note: Verification will be documented in Meditrek)
 
PRAC Course Outcome(s) Addressed:
 
· (for example) Develop professional plans in advanced nursing practice for the practicum experience
· (for example) Assess advanced practice nursing skills for strengths and opportunities
 
Objective 2: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)
 
Planned Activities:
 
Mode of Assessment: (Note: Verification will be documented in Meditrek)
 
PRAC Course Outcome(s) Addressed:
 
·
 
Objective 3: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)
 
 
Planned Activities:
 
Mode of Assessment: (Note: Verification will be documented in Meditrek)
 
PRAC Course Outcome(s) Addressed:
 
·
Part 3: Projected Timeline/Schedule
 
Estimate how many hours you expect to work on your Practicum each week. *Note: All of your hours and activities must be supervised by your Preceptor and completed onsite. Your Preceptor will approve all hours, but your activities will be approved by both your Preceptor and Instructor. Any changes to this plan must be approved.
 
This timeline is intended as a planning tool; your actual schedule may differ from the projections you are making now.
 
I intend to complete the 144 or 160 Practicum hours (as applicable) according to the following timeline/schedule. I also understand that I must see at least 80 patients during my practicum experience. I understand that I may not complete my practicum hours sooner than 8 weeks. I understand I may not be in the practicum setting longer than 8 hours per day unless pre-approved by my faculty.
 
 

 
 
 
 
 
 
Part 4 – Signatures
 
Student Signature (electronic): Date:
 
 
Practicum Faculty Signature (electronic)**: Date:
 
 
** Faculty signature signifies approval of Practicum Experience Plan (PEP)
 
Submit your Practicum Experience Plan on or before Day 7 of Week 2 for faculty review and approval.
 
Once approved, you will receive a copy of the PEP for your records. You must share an approved copy with your Preceptor. The Preceptor is not required to sign this form.
 
 
 
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