Assignment 1 Week 7 Voluntary and Involuntary commitment

Assignment 1 Week 7 Voluntary and Involuntary commitment

Assignment: Practicum Journal – Voluntary and Involuntary Commitment

PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.

Scenario for Week 7 Case:

You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

Learning Objectives

Students will:

• Evaluate clients      for voluntary commitment
• Evaluate clients      for involuntary commitment based on state laws
• Recommend      actions for supporting parents of clients not eligible for involuntary      commitment
• Recommend      actions for treating clients not eligible for involuntary commitment

To Prepare for this Practicum:

• Review the      Learning Resources concerning voluntary and involuntary commitment.
• Read the Week 7      Scenario in your Learning Resources.
• Research your      state’s laws concerning voluntary and involuntary commitment.

The Assignment (2–3 pages):

• Based on the      scenario, would you recommend that the client be voluntarily committed?      Why or why not?
• Based on the      laws in your state, would the client be eligible for involuntary      commitment? Explain why or why not.
• Did      understanding the state laws confirm or challenge your initial      recommendation regarding involuntarily committing the client? Explain.
• If the client      were not eligible for involuntary commitment, explain what actions you may      be able to take to support the parents for or against voluntary      commitment.
• If the client      were not eligible for involuntary commitment, explain what initial actions      you may be able to take to begin treating the client.

Assignment

· Presume that the organization you selected has recently implemented a customer relationship management (CRM) system.

· Research the key elements of a CRM system and defend at least three best practices that your organization can use to improve its customer retention. Make sure you support your choices with well-reasoned arguments and external sources.

· Justify at least five critical pieces of customer information needed from your key market segment. Why do you need to collect this specific data?

· Justify five survey questions that might be used to evaluate the segment’s experience with your organization. Why do you need to know this information?

· Justify a plan for how customer data (previous two bullet points) will be collected. The plan should detail the methods to be used (e.g. written survey, focus groups, interviews, etc.) and where those methods will be integrated into the organization’s processes (e.g., a hotel sending an e-mail survey following a customer’s stay at a specific location).

Submission Details:

· Submit your plan in a 3- to 4-page Microsoft Word document, using APA style.

Required Readings ( need 3 references).

Kaltiala-Heino, R. (2010). Involuntary commitment and detainment in adolescent psychiatric inpatient care. Social Psychiatry Epidemiology, 45(8), 785-793. doi: 10.1007/s00127-009-0116-3.

Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010). Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. General Hospital Psychiatry, 32(3), 300-309. doi:10.1016/j.genhosppsych.2010.01.007

McGavey, E. L., Leon-Verdin, M., Wancheck, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors. Psychiatric Services, 64(2), 120-126.

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. Assignment 1 Week 7 Voluntary and Involuntary commitment

• 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.

• 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.

• 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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Trend Analysis And Forecasting

Week 5: Forecasting

It is far better to foresee even without certainty than not to foresee at all.  — Henri Poincaré, The Foundations of Science
All strategic ventures involve uncertainty, as it is difficult to ascertain what the future holds. By collecting and evaluating data from the past and present, analyzing trends, and making predictions about what is to come, leader-managers can help groups and organizations to mitigate the risk inherent in an uncertain future. This process, known as forecasting, is a critical part of strategic planning. It allows groups and organizations to identify potential challenges and opportunities for change.
This week, you examine forecasting, including how to identify appropriate sources of data and evaluate the literature to identify trends that may have an impact on nursing and health care. You consider how leader-managers can use forecasting to identify unmet needs.
Also this week, you preview the Course Project: Developing a Strategic Plan.
Learning Objectives
Students will:
· Analyze future trends in health care
· Analyze historical data and forecasts to identify opportunities for change*
· Identify topic for a culminating project* *These Learning Objectives assigned this week will be assessed in Week 7
Photo Credit: PBNJ Productions/Blend Images/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
Ursell, F. (2011). Care home funding: What to expect and what to do. Nursing & Residential Care, 13(2), 94–96.
Retrieved from the Walden Library databases.
 
This article provides an example of forecasting for the costs associated with running nursing and residential care homes and examines related future trends.
Weiss, R. (2010, Summer). The forecast for health care. Marketing Health Services, 30(3), 7.
Retrieved from the Walden Library databases.
 
The author describes predictions for future developments in health care.
 
Harding, S. (2012, November 15). Long-term forecasts are mostly worthless. Forbes. Retrieved from http://www.forbes.com/sites/greatspeculations/2012/11/15/long-term-forecasts-are-mostly-worthless/
 
The author addresses the notion that trends only continue until they are interrupted by change, so predictions rarely actualize as expected.
 
Peters, B. (2012, February 16). Healthcare forecast: Increasing clouds with a chance of dramatic improvement. Forbes. Retrieved from http://www.forbes.com/sites/bradpeters/2012/02/16/healthcare-forecast-increasing-clouds-with-a-chance-of-dramatic-improvement/
 
The author discusses a key technology-related trend in health care.
 
Document: Course Project: Developing a Strategic Plan—Overview (PDF)
 
Required Media
Laureate Education (Producer). (2013i). Trends in health care organizations [Video file]. Retrieved from /orders/class.waldenu.edu
 
Note: The approximate length of this media piece is 4 minutes.
 
Dr. Carol Huston discusses the dynamic nature of health care and trends that are impacting the industry.
 
Accessible player
Optional Resources
Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.
· Review Chapter 7, “The Three Key Elements of the Strategic Planning Process: A Vision That Guides Nursing’s Future Action” (pp. 117–143)
 
Discussion: Trend Analysis and Forecasting
Green Hills Health System comprises a small community hospital and a primary care practice. Located in a rural area, the nearest large city is approximately 100 miles away. Individuals age 60 and older constitute one of the largest patient populations Green Hills serves. Recently, members of the nursing staff have noticed that the numbers of geriatric patients admitted to the hospital seem to be increasing. Many of these patients have multiple comorbidities and need specialty care that is not available through Green Hills Health System. Some of the patients have commented that they lack the financial resources and transportation required to travel to the large metropolitan health care center that provides a variety of specialty services.
Imagine that you are a nurse leader-manager in the organization described above. How could conducting an internal and external scan of the environment help you and your colleagues to identify opportunities for change moving forward? What literature sources would you consult to learn about trends and emerging issues that are likely to affect the organization? What data would you examine?
In this Discussion, you analyze trends that are likely to have a significant impact on nursing and health care in the coming years. You may use this Discussion to formulate initial thoughts related to trends and unmet needs that you might choose to address through the Course Project, which is introduced this week.
To prepare:
· Review the information on forecasting and trends in the Learning Resources.
· Conduct a search of the literature to investigate trends and emerging issues in nursing and health care. Evaluate the research evidence in the literature.
· Based on your research, identify three trends that are likely to impact nursing and health care in the coming decade.
· Select one of these trends on which to focus in greater detail. Then, conduct additional research and analyze evidence-based issues related to this trend.
· Based on your analysis, consider whether this trend creates or contributes to an unmet need that currently impacts, or will impact, a specific group, unit, or organization.

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6052 Assignment Part 3

Critiquing the validity and robustness of research featured in journal articles provides a critical foundation for engaging in evidence-based practice. In Weeks 5 and 6, you explored quantitative research designs. In Week 7, you will examine qualitative and mixed methods research designs. For this Assignment you critique a quantitative and either a qualitative or a mixed methods research study and compare the types of information obtained in each.
To prepare:
· Select a health topic of interest to you that is relevant to your current area of practice. The topic may be your Course Portfolio Project or a different topic of your choice.
· Using the Walden Library, locate two articles in scholarly journals that deal with your portfolio topic: 1) Select one article that utilizes a quantitative research design and 2) select a second article that utilizes either a qualitative OR a mixed methods design. These need to be single studies not systematic or integrative reviews (including meta-analysis and metasynthesis). You may use research articles from your reference list. If you cannot find these two types of research on your portfolio topic, you may choose another topic.
· Locate the following documents in this week’s Learning Resources to access the appropriate templates, which will guide your critique of each article:
o Critique Template for a Qualitative Study
o Critique Template for a Quantitative Study
o Critique Template for a Mixed-Methods Study
· Consider the fields in the templates as you review the information in each article. Begin to draft a paper in which you analyze the two research approaches as indicated below. Reflect on the overall value of both quantitative and qualitative research. If someone were to say to you, “Qualitative research is not real science,” how would you respond?
To complete this Assignment:
· Complete the two critiques using the appropriate templates.
· Write a 2- to 3-page paper that addresses the following:
· Contrast the types of information that you gained from examining the two different research approaches in the articles that you selected.
o Describe the general advantages and disadvantages of the two research approaches featured in the articles. Use examples from the articles for support.
o Formulate a response to the claim that qualitative research is not real science. Highlight the general insights that both quantitative and qualitative studies can provide to researchers. Support your response with references to the Learning Resources and other credible sources.
· Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.
· Combine all three parts of this assignment into one Word document including both critique templates and the narrative with your references. Submit this combined document.
Critique Template for a Qualitative Study
NURS 5052/NURS 6052
Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies (due by Day 7 of Week 7)
Date:       FORMTEXT
Your name:       FORMTEXT
Article reference (in APA style):       FORMTEXT
URL:       FORMTEXT
What is a critique? Simply stated, a critique is a critical analysis undertaken for some purpose. Nurses critique research for three main reasons: to improve their practice, to broaden their understanding, and to provide a base for the conduct of a study.
When the purpose is to improve practice, nurses must give special consideration to questions such as these:
· Are the research findings appropriate to my practice setting and situation?
· What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness?
· How might a proposed change in practice trigger changes in other aspects of practice?
To help you synthesize your learning throughout this course and prepare you to utilize research in your practice, you will be critiquing a qualitative, quantitative, or mixed-methods research study of your choice.
If the article is unavailable in a full-text version through the Walden University Library, you must e-mail the article as a PDF or Word attachment to your Instructor.
QUALITATIVE RESEARCH CRITIQUE
1. Research Issue and Purpose
What is the research question or issue of the referenced study? What is its purpose? (Sometimes ONLY the purpose is stated clearly and the question must be inferred from the introductory discussion of the purpose.)
 
2. Researcher Pre-understandings
Does the article include a discussion of the researcher’s pre-understandings? What does the article disclose about the researcher’s professional and personal perspectives on the research problem?
 
3. Literature Review
What is the quality of the literature review? Is the literature review current, relevant? Is there evidence that the author critiqued the literature or merely reported it without critique? Is there an integrated summary of the current knowledge base regarding the research problem, or does the literature review contain opinion or anecdotal articles without any synthesis or summary of the whole? (Sometimes the literature review is incorporated into the introductory section without being explicitly identified.)
 
4. Theoretical or Conceptual Framework
Is a theoretical or conceptual framework identified? If so, what is it? Is it a nursing framework or one drawn from another discipline? (Sometimes there is no explicitly identified theoretical or conceptual framework; in addition, many “nursing” research studies draw on a “borrowed” framework, e.g., stress, medical pathology, etc.)
 
5. Participants
Who were the participants? Is the setting or study group adequately described? Is the setting appropriate for the research question? What type of sampling strategy was used? Was it appropriate? Was the sample size adequate? Did the researcher stipulate that information redundancy was achieved?
 
6. Protection of Human Research Participants
What steps were taken to protect human research subjects?
 
7. Research Design
What was the design of the study? If the design was modeled from previous research or pilot studies, please describe.
 
8. Data Collection/Generation Methods
What methods were used for data collection/generation? Was triangulation used?
 
9. Credibility
Were the generated data credible? Explain your reasons.
 
10. Data Analysis
What methods were used for data analysis? What evidence was provided that the researcher’s analysis was accurate and replicable?
 
11. Findings
What were the findings?
 
12. Discussion of Findings
Was the discussion of findings related to the framework? Were those the expected findings? Were they consistent with previous studies? Were serendipitous (i.e., accidental) findings described?
 
13. Limitations
Did the researcher report limitations of the study? (Limitations are acknowledgments of internal characteristics of the study that may help explain insignificant and other unexpected findings, and more importantly, indicate those groups to whom the findings CANNOT be generalized or applied. It is a fact that all studies must be limited in some way; not all of the issues involved in a problem situation can be studied all at once.)
 
14. Implications
Are the conclusions and implications drawn by the author warranted by the study findings? (Sometimes researchers will seem to ignore findings that don’t confirm their expectations as they interpret the meaning of their study findings.)
 
15. Recommendations
Does the author offer legitimate recommendations for further research? Is the description of the study sufficiently clear and complete to allow replication of the study? (Sometimes researchers’ recommendations seem to come from “left field” rather than following obviously from the discussion of findings. If a research problem is truly significant, the results need to be confirmed with additional research; in addition, if a reader wishes to design a study using a different sample or correcting flaws in the original study, a complete description is necessary.)
 
16. Research Utilization in Your Practice
How might this research inform your practice? Are the research findings appropriate to your practice setting and situation? What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness? How might the utilization of this research trigger changes in other aspects of practice?
 

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 SOCW6351 week 2 Dq2

SOCW6351 week 2 Dq2
Discussion 2: The
Research Approval Process
The early years of the
20th century were host to a number of unethical research studies. Research
involving the way that a young child reacts to and generalizes fear responses,
medical experiments conducted in concentration camps, and observing the way people
respond to authority were just a few of the most famous experiments whose
byproduct was placing clients in physical pain and/or mental anguish. Since
then, it has been recognized that research subjects need to be protected from
the flagrant disregard of researchers. This week, you consider the guidelines
in Walden University’s Institutional Review Board (IRB) document,
“Research Ethics FAQs for Doctoral Students in the Clinical/Intervention
Fields: Practical Tips for Avoiding Delays and Problems in the Research
Approval Process.”
By Day 5
Post a description of two ways the guidelines in
Walden University’s IRB document may impact the selection of a research
population, research setting, and/or research design. Please use the resources
to support your answer.
By Day 7
Respond to a colleague’s post in one of the following ways:
1. Expand upon your colleague’s post regarding ways
that the IRB’s ethical guidelines may impact his or her study.
2. Explain an insight you gained from this week’s
Resources that addresses a topic in your colleague’s post.
Please use the resources
to support your post.
Submission and Grading Information
Grading Criteria

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DNP Project: Scholarly Product For Dissemination

For this assignment you will prepare a scholarly product that reports your progress (or results) and implications of your DNP project to a designated audience. If you are not in the implementation or evaluation phases of your DNP project  you may report on a project that you have worked on during your practicum experiences with the practicum site. While you are not required to actually present your work it will be beneficial for you to prepare your product for dissemination now while you can receive feedback from your peers and faculty committee.
Your scholarly product may be in the form of a manuscript for publication, project summary and evaluation report, conference proceedings, poster presentation, program evaluation report, grant proposal, media or technology-based deliverable, or a different faculty approved product. The scholarly product is due to your Instructor by Day 7 of Week 10 so you may receive feedback on it before finalizing your DNP Project Paper (a DNP program requirement). Unless otherwise arranged with your Project committee, your final product must include the following information, and must be written in a style appropriate for your intended audience:

• Background, Purpose, and Nature of the Project
  Describe the larger problem or issue you explored in your DNP Project. Explain how this problem or issue affects nursing practice and the overall health care system, and describe how your DNP Project explored possible strategies for addressing the problem or issue.
• Research Design, Setting, and Data Collection
  Briefly explain the methods you used to carry out your DNP Project, including any relevant theoretical frameworks or models. Identify the practice setting and context in which you conducted your project, as well as the sample/population as applicable. Outline your data collection methods and justify why you chose these methods.
• Presentation of Results
  Explain the results of your DNP Project. Include any relevant graphs, tables, charts, models, or other visual representations of your data/results. Include a short description of each visual, what it displays, and how it relates to your project.
• Interpretation of Findings, and Implications for Evidence-Based Practice
  Share the results of your DNP Project, and provide an interpretation of your findings. Describe how the results can be translated into evidence-based practice. Explain how this would impact the main problem or issue you explored in your DNP Project.AbstractImpact of Nurse Education Program on 30-Day Readmissions among Ischemic Stroke Patients
  by
  Mariana Tsucuneli
  MS, Walden University, 2018
  BS, Davenport University, 2014
  Mariana Tsucuneli
  Proposal Submitted in Partial Fulfillment
  of the Requirements for the Degree of
  Doctor of Nursing Practice
  Walden University
  May 2020
  Abstract
  Unplanned 30-day readmissions among patients diagnosed with Ischemic stroke (IS) is a major public health problem in the United States (US). The Affordable Healthcare Act introduced financial penalties and incentives for facilities to encourage care plans aimed to reducing 30-day readmissions rates for stroke and other five illnesses. Facilities with high rates of 30-day readmissions for IS patients, are therefore penalized by the centers for Medicare and Medicaid services in addition to receiving poor scores on the quality of care they provide. The proposed project will be a staff education program aimed to improve post-acute stroke transitional care to reduce 30-day readmission rates. The project will be guided by the question; among nurses caring for IS patients, does an educational program focused on active engagement and caring for patients compared to standard practice, reduce the 30-day readmission rates? The design of the educational intervention, its implementation, and evaluation will be guided by the competency, outcomes, and performance assessment (COPA) model focused on the integration of interactive learning, practice-based outcomes, and competency assessment.
  Keywords: 30-day readmissions, care bundle, ischemic stroke, educational program.
  Impact of a Nurse Education Program on 30-Day Readmissions among Ischemic Stroke Patients
  by
  Mariana Tsucuneli
  MS, Walden University, 2018
  BS, Davenport University, 2014
  Project Submitted in Partial Fulfillment
  of the Requirements for the Degree of
  Doctor of Nursing Practice
  Walden University
  May 2020
  Table of Contents
  1 Section 1: Nature of the Project
  1 Introduction
  2 Problem Statement
  3 Purpose
  4 Nature of the Doctoral Project
  6 Significance
  7 Summary
  9 Section 2: Background and Context
  9 Introduction
  9 Concepts, Model and Theories
  9 Model
  11 Theory
  13 Concepts
  13 Relevance to Nursing Practice
  15 Local Background and Context
  17 Role of the DNP Student
  18 Summary
  19 Section 3: Collection and Analysis of Evidence
  19 Introduction
  19 Practice-focused Question
  20 Sources of Evidence
  22 Nature of the Data
  22 Participants
  23 Procedures
  24 Ethical Considerations
  24 Analysis and Synthesis
  24 Summary
  26 References
  31 Appendix: Educational Program
   
  Section 1: Nature of the Project
  Introduction
  Patient readmission within 30 days following initial stay and discharge is a common problem in the United States (US) occurring at an estimated 14% of all hospital admissions (Hughes & Witham, 2018). The 30-day readmission rates in US hospitals are used as quality measures, and the hospital readmission reduction program (HRRP) established in the Affordable Care Act provides financial incentives to healthcare facilities with lowered readmission rates (Centers for Medicare and Medicaid [CMS], 2019). The CMS also fines hospitals with high 30-day readmission rates relative to other healthcare facilities under the HRRP (CMS, 2019). Using 30-day readmission rates as a quality measure also affects facilities with high re-hospitalization frequency and is used as an indicator of inadequate care provision (Vahidy et al., 2017). Hospital readmission is also associated with other problems for the facility, including longer stays and a higher risk of complications for the patient (Hughes & Witham, 2018).
  Ischemic stroke (IS) is one of the health conditions whose 30-day readmission is monitored by the CMS under the HRRP (CMS, 2019). Approximately 12% of IS patients are readmitted to hospitals within 30 days of discharge in the US (Vahidy et al., 2017). Readmissions due to IS are considered high risk and the use of the readmission rates as a measure of quality is prioritized at the national level (Andrews & Freburger, 2015). The type of post-acute stroke care has been associated with transitional care outcomes including 30-day readmissions and recovery (Poston, 2018). Educational interventions for nurses have been associated with improved patient and quality of healthcare outcomes in stroke care (Jones et al., 2018). The proposed DNP project will involve developing a nurse educational program focused on transitional care for IS patients associated with reducing 30-day readmissions. The developed program will be implemented to all the nursing staff working at post-acute IS ward in a rehabilitation center in the north-eastern US. The expected social change will be in transitional behaviors among the nurses to include checking for risk factors for post-acute stroke disorders. The anticipated implications for social change will be the reduction of risk of post-acute stroke disorders and 30-day readmissions among stroke survivors.
  Problem Statement
  The target healthcare facility is an inpatient rehabilitation facility with a stroke unit which has prevalent unplanned 30-day readmissions. Up to 60% of the patients admitted at the facility have more than one comorbidity. Among patients with stroke, comorbidities such as respiratory diseases and urinary tract infections are associated with high risk of 30-day readmissions (Poston, 2018). Inadequate transitional care including failure to identify post-stroke disorders, risk factors, and lack of social engagement among IS patients have also been associated with increased rates of 30-day readmissions (Poston, 2018). A brief needs assessment established that there was a gap in adequate transitional care knowledge among the nurses as well as harmonization of the care procedures among all post-acute stroke patients.
  Stroke is among the leading causes of mortality and long-term disability (Poston, 2018). With the aging population rising, IS prevalence is expected to increase with projections of up to 20.5% surge by 2030. Improving the quality of transitional care in healthcare facilities is expected to help prevent the occurrence of post-stroke conditions requiring hospital readmissions (Poston, 2018). Additionally, understanding IS, and its risk factors could lead to a more focused quality of care, potentially reducing the risk of readmissions (Andrews & Freburger, 2015). In a facility with high 30-day readmission rates among IS patients, a staff educational intervention aimed to improve the understanding of post-acute stroke readmission risk factors would be helpful in reducing the prevalence of re-hospitalizations.
  The nursing workforce is the most involved of all healthcare providers in patient care (American Association of Colleges of Nursing [AACN], 2019). In the treatment of IS, up to 60% of the survivors require post-acute care services in rehabilitation, skilled nursing facilities, and in-home healthcare; services that are primarily provided by nurses (Poston, 2018). Nurses, therefore, have the ability to transform the quality and type of healthcare provided to post-acute stroke patients. With improved awareness, the nurses will be able to identify post-transition issues early enough and address them to avoid re-hospitalizations (Poston, 2018). A nurse educational program on patient engagement and risk factors for post-stroke disorders requiring acute care is significant and would improve prevention of 30-day readmissions, (Nakibuuka et al., 2016). The project will, therefore, contribute to the nursing practice by adding to the existing knowledge of evidence-based nursing practices such as patient engagement. The project will contribute evidence in support of nursing practices aimed to improve the quality of care as well as patient and facility outcomes. Patients whose risk factors for post-stroke readmissions will be identified and addressed at an early stage will benefit from the prevention strategies by improving their recovery and health outcomes (Porter, 2018).
  Purpose
  The gap in nursing practice this proposed staff education doctoral project will address is the lack of adequate knowledge related to post-acute stroke transitional care. The aim of implementing the project will be to address the lack of adequate knowledge on active engagement of patients and early identification of risk factors for post-stroke readmissions. The purpose of the DNP project will be to develop and implement a nurse educational program on post-acute stroke transitional care to reduce 30-day readmission rates among IS patients. The DNP staff education project will be guided by the following practice-focused question: Among nurses caring for IS patients, does an educational program focused on active engagement and caring for patients compared to standard practice, reduce the 30-day readmission rates?
  The project will be a staff education program focusing on active patient engagement and identification of post-stroke readmission risk factors with the aim of decreasing 30-day readmission rates at the facility. The quality of care provided during the transitional period from hospital to a rehabilitation facility has a significant effect on the readmission rates of IS patients (Hudali, Robinson, & Bhattarai, 2017). Evidence has also shown that most of the post-stroke disorders requiring readmissions are preventable (Poston, 2018). Providers who are more knowledgeable of the type of care to offer patients during transition and rehabilitation period will be able to identify the predictors of readmissions and address them at an early stage. The staff education will be focused on addressing the gap in knowledge of the nursing staff working at the rehabilitation facility and enable them to identify and address risk factors for post-stroke disorders that might lead to unplanned hospital readmissions.
  Nature of the Doctoral Project
  The proposed project will involve the development and implementation of a nurse education program on the care of IS patients in an inpatient rehabilitation facility located in the Northern United States (US). The focus of the project will be on the development of an educational program on a post-acute stroke transition care plan for nurses, its implementation, and evaluation of its effectiveness on reducing 30-day readmission rates in the IS unit. The educational program will be developed from reviewed literature and validated by an expert panel at the facility of implementation. The transition care plan will involve a patient engagement focused-care, identification, and addressing of preventable post-stroke disorders. The nursing staff working at the unit will be educated to improve their knowledge on the type of care to provide to IS patients before discharge to prevent unplanned 30-day readmissions. The education program will be designed with input from an expert panel and based on the review and synthesis of the literature on the appropriate transitional care for IS patients to avoid 30-day readmissions. The de-identified data to support the effectiveness of the staff education program post–implementation will be obtained by the staff from the hospital electronic health records (EHR) and analyzed by the DNP student to determine the rate of 30-day readmissions in patients diagnosed with IS.
  Project data will be organized into pretest and post-intervention columns. Pre-intervention data on the number of readmissions recorded eight weeks before the project implementation will be obtained from EHR by the staff. Post-intervention data will be the number of readmissions associated with IS diagnosis recorded eight weeks after the staff education program is implemented. Analysis of the outcome by the DNP student will be done by comparing the pretest and post-intervention data to determine significant differences. Reduction in readmissions after the intervention will indicate the effectiveness of the staff education program. The eight-week timeframe for pre and post-intervention data collection is selected in order to get sufficient population data for evaluating the project outcomes. The outcomes of interest are the 30-day readmission rates; the staff education program will be conducted in two to four sessions, held once a week. Post-intervention data will be collected eight weeks after the intervention is implemented.
  The aim of conducting the Doctor of Nursing practice (DNP) project is to improve the knowledge of nurses on post-acute stroke transitional care. The purpose of the DNP project will be to develop and implement a nurse educational program on post-acute stroke transitional care to reduce 30-day readmission rates among IS patients. The project’s objective will be to improve the knowledge of the nursing staff on the care of IS patients to reduce 30-day readmission rates.
  Significance
  The primary stakeholders for this DNP project are the IS patients, administrative staff, and nurses working at the stroke rehabilitation unit in the healthcare facility. Patients’ recovery and post-discharge progress will be dependent on the type and quality of care provided to them before leaving the hospital. The quality of care that nurses provide to these patients will be affected by the educational intervention presented in the scholarly DNP project. The intervention is the first of the kind to be implemented at this specific facility, thus it will be an update on the current evidence best practice knowledge for the nursing staff. Other stakeholders of the project include the nursing manager and the administrators of the facility. The nursing manager supervises the nurses, and any improvement in the type of care provided will reflect their superior’s commitment to quality improvement within the facility. The facility administrators will also benefit from improved IS patient outcomes, reducing the rates of 30-day readmission, thus allowing the hospital to qualify for CMS incentives. Given that the IS 30-day readmission rates are used as quality measures by the CMS, an observed reduction would positively reflect on the type of care provided at the facility.
  A positive outcome of the project will provide evidence on the effectiveness of a staff educational program focused on discharge and transitional care for IS patients. The evidence will contribute to available nursing practices supporting quality improvement in healthcare facilities (Poston, 2018). Nurses have been urged to embrace evidence-based practice as they pursue their quest to improve healthcare outcomes (ACCN, 2019). If the staff educational program is found to be effective, a need for regular training programs for the nurses will be confirmed in addition to identifying and improving areas in care delivery where they lack current knowledge.
  Similar educational programs can contribute to nursing staff working with patients requiring care bundles for improved health outcomes such as sepsis. Programs can be adopted where a care bundle can be designed, and training conducted for the nursing staff to understand and implement the recommended evidence-based practices, thus resulting in early identification of sepsis and improving the overall health outcomes. Other scenarios where nurse educational programs can be adopted include the prevention 30-day readmission rates among patients with the conditions that are monitored by the CMS, such as myocardial infarction, chronic pulmonary disorders, and pneumonia, among others (CMS, 2019). These conditions require appropriate monitoring and care during the transitional period and before discharge to prevent chances of readmission, thus reducing the financial expenditure.
  The potential implications for positive social change involve equipping nurses with the evidence- based knowledge and skills to adequately care for IS patients before discharge to prevent readmissions. The hospital should benefit from the reduced rates by gaining relief from previous financial penalties imposed on the facility by CMS for having high rates of 30-day readmissions. If the 30-day readmission rates are reduced compared to the other facilities within the region, the facility will receive financial incentives from CMS. Reduced rates of readmissions are also an indication of the quality of care offered at the hospital, thus attracting more patients.
  Summary
  Unplanned patient readmission rates are costly for healthcare facilities and negatively impact the rankings of the hospital-based on care quality (Hughes & Witham, 2018). High 30-day readmission rates in IS patients are among the most prevalent problems faced by healthcare facilities in the US. Patients with IS are at a high risk of mortality and long-term disability, which increases significantly with every hospitalization (Poston, 2018). With the population of IS patients expected to increase, it is imperative that the problem of 30-day readmission rates among hospital clients be addressed. The purpose of the DNP project will be to develop and implement a nurse educational program on post-acute stroke transitional care to reduce 30-day readmission rates among IS patients. In the inpatient rehabilitation facility where the project will be implemented, it was established that the nurses lack adequate knowledge on early identification of post-stroke disorders symptoms leading to frequent unplanned readmissions. The facility has, in the recent past, experienced increased 30-day readmission rates in patients with IS.
  The project will involve educating all the nursing staff working at the IS unit on the use of a post-acute stroke transitional care plan. The care plan will focus on patient engaging care that involves early identification of post-stroke disorders associated with possible readmissions. The post-implementation outcome to be evaluated in the project will be the 30-day readmission rates among IS patients observed eight weeks prior and after the implementation of the educational program. The outcome data will be obtained from patient charts by the records staff at the facility. The first section has introduced the DNP project and its relevance to the facility of implementation and nursing practice. Section 2 presents the background and contextual information on the project.
  Section 2: Background and Context
  Introduction
  In a healthcare facility located in the northwestern region of the US, 30-day readmission rates are a concern. The CMS often ranks the facility’s performance as below average in its attempts of reducing 30-day readmission rates in IS patients. The proposed project will involve developing and implementing an educational program for the nursing staff working at the facility’s stroke unit to improve their knowledge on the best evidence-based post-acute stroke transitional care. The DNP student will develop the educational program based on literature review on nursing practices involving patient engagement and identification of post-acute stroke risk factors and comorbidities. The developed educational program will be reviewed and validated by an expert panel before implementation. The DNP project will be guided by the practice focused question: Among nurses caring for IS patients, does an educational program focused on active engagement and caring for patients compared to current standard of practice, reduce the 30-day readmission rates? The purpose of the DNP project will be to develop and implement a nurse educational program on post-acute stroke transitional care to reduce 30-day readmission rates among IS patients.
  This section presents the background and contextual information on the project. The concepts, theories, or models to be used in the project will be reviewed in the first subsection. The relevance of the project to nursing practice as well as the local background information on the problem and intervention will be presented. The role of the DNP student and the project teams will also be reviewed in this section.
  Concepts, Model and Theories
  Model
  The model to be used in the project will be the competency, outcomes, and performance assessment (COPA) model, which will inform the design and implementation of the educational program. The COPA model was developed by Lenburg (1999) in the 1990s following extensive educational work with the New York Regents College Nursing Program. The COPA is a learning model focused on the integration of interactive learning, practice-based outcomes, and competency assessment (Lenburg, 1999). The COPA model identifies the critical skills needed for practice, the most effective way to integrate those skills, and the most efficient methodology to teach these skills so that staff integrates them into practice (Chianchana & Wichian, 2016). The COPA approach also requires that the educators evaluate the relevant environmental needs in order to identify the content and competencies to be achieved in the teaching program (Lenburg, 1999).
  The COPA model is comprehensive and requires the educator and other stakeholders to address the four essential questions; (a) what are the essential competencies and outcomes for contemporary practice? (b) what are the indicators that define those competencies? (c) what are the most effective ways to learn those competencies? and (d) what are the most effective ways to document that practitioners have achieved the required competencies? The DNP student will respond to each of the four questions during the designing of the evidence-based intervention and the evaluation plan.
  The COPA model has been proven as valid in its application in best-evidence nursing practice. According to Lazarte (2016), the COPA model can be used to evaluate a wide range of nursing practice core competencies. The educational program on IS care bundle will be integrated into the COPA concepts to promote nurses’ knowledge gain and its transference to practice. The COPA model has been used in other educational programs for nurses, including the training of novice nurses to gain practice experience. Lin, Wang, and Ye (2015) also utilized the COPA model to explore various methods of injection and intravenous infusion among animals, and how they can be used to improve the core professional nursing competencies. In another study, Manojlovich, Lee, and Lauseng (2016) demonstrated the efficacy of using the COPA model to address core competencies of patient care such as safety and care quality offered by nurses and other healthcare professionals. De Stampa et al. (2014) also evaluated the impact of the COPA model on hospital admissions. The study used the COPA model to provide integrated primary care with intensive case management for community-dwelling, frail elderly patients (Den Stampa et al., 2014).
  Theory
  Kurt Lewin (1951) theorized change in three steps; unfreeze, change, refreeze. Lewins theorized the unfreeze-change-refreeze change model as requiring participants to discard their previous knowledge and learn the new one (Cummings, 2016). The unfreeze-change-refreeze model is focused on identifying the influencing forces to change, hence knowing which ones to strengthen or weaken for new behavior to be adopted (Ellis & Abbot, 2018). Both driving and restraining forces are responsible for any equilibrium to take effect and the Lewin’s theory of change states that when the former is strong and/or the latter weak, then change is guaranteed to occur (Lewin, 1951).
  The first step of change, unfreezing, involves individuals rejecting their old behavior and overcoming the resistance and conformity (Cummings, 2016). The driving and restraining forces for the change are identified at this stage, and the former can be strengthened in preparation for change (Lewn, 1951). In the proposed project, the unfreezing stage will involve educating nurses working at the target facility of the current status regarding the preventable readmission rates and the potential benefits of introducing the proposed change in improving the desired patient outcomes. Informing nurses about the high rates of 30-day readmissions will help in increasing the driving force for accepting the proposed change.
  The second step, moving or change, involves the process of altering individuals’ feelings, thoughts, and behaviors (Lewin, 1951). Change can be facilitated by challenging the status quo and providing a fresh perspective or finding new information to influence the preferred change (Ellis & Abbot, 2018). In the proposed project, the second step of the change theory will involve conducting a staff education on the IS care bundle. Educating the nurses on the IS care bundle will provide them with a fresh perspective on the type of care to offer to their patients, thus prompting its use and the attainment of the desired patient outcomes.
  The final step is the refreezing and involves ensuring the sustainability of the adopted new habit. Lewin (1951) theorized that the refreezing stage is fundamental in ensuring that the change introduced will be sustained as the new equilibrium. The final stage in the project will involve informing the nurses regarding the evaluation outcome and the facility’s reaffirmation that the care bundle will be adopted as the new standard of care practice. The DNP student will provide recommendations for sustaining the IS care bundle in the facility to the nursing manager.
  Lewin’s change theory has been validated in its application in care practice modifications. Gupta, Boland, and Aron (2017) supported the change theory in their study findings that clinical practice constantly requires unlearning and learning. Ellis and Abbot (2018) also supported the application of the change model as essential in healthcare because change is inevitable in the practice. Ellis and Abbot (2018) specifically supported the application of the model in implementing change in a kidney care unit. Similarly, Bender (2016) supported the application of the model in nursing practice in introducing and implementing a clinical nurse leader role. Therefore, the change theory can be effectively used to implement practice change in the proposed project.
  Concepts
  · Client is used in this project to represent a patient receiving care at the inpatient rehabilitation unit. The term resident may also be used to refer to the patients receiving care at the unit.
  · Caregiver is used in this project to refer to any healthcare provider providing care to the patients/ residents at the rehabilitation unit, or at home after discharge. A caregiver may also be used to refer to the patient’s family or any other person caring for them at home after discharge.
  · The term care bundle is used to refer to the type of care nurses will be educated on to offer to IS patients. The care bundle will involve active engagement of patients in their care, and communication with their caregivers and family on their care needs after discharge.
  · Active engagement in patient care is used to refer to the type of care where the patient is involved, such as asking about how they feel, talking to them about their symptoms, etc. Active engagement is a type of care advocated in the care bundle, and it is expected to help providers to identify and address stroke risk factors at an early stage before adverse events occur.
  · 30-day readmissions in this project refer to the unplanned cases where patients have to be sent back to the hospital for acute care; 30 days after admission at the rehabilitation unit. Unplanned readmission cases maybe due to sudden illness requiring in acute care, or stroke reoccurrence within 30 days of admission in the rehabilitation unit. All occurrences where residents have to be sent back to the hospital either for acute care or for scheduled check-up are recorded. All readmissions requiring acute-care within 30-days of prior hospitalization will be referred as 30-day readmission rates.
  Relevance to Nursing Practice
  A hospital’s ability to reduce adverse effects likely to cause unplanned admissions after initial diagnosis is used as the quality indicator of its providers (Kim et al., 2015). Hospitals unable to reduce its 30-day readmissions pay financial penalties to the CMS in additional to scoring poorly its quality rankings (Kim et al., 2015). Stroke, a leading cause of mortality, is one of the health conditions associated with a high prevalence of unplanned 30-day readmissions (Lichtman, Leifheit-Limson, & Goldstein, 2015). A recent study found that up to 12.4% of IS patients are re-hospitalized within 30-days of initial discharge in the US (Bambhroliya et al., 2015; Vahidy et al., 2017).
  The goal of primary care providers is to provide quality care to their patients (Hudali et al., 2017). Primary care providers are focused to address the issues that reduce the quality of care they aspire to provide to their patients (Hudali et al., 2017). With stroke certified a major public health problem, the focus on reducing adverse effects that cause unplanned 30-day readmissions in IS patients has shifted to primary healthcare providers (Lichtman et al., 2015). Through evidence-based practices, research has established that the most prevalent causes of 30-day readmission of IS patients include infection, falls, electrolyte abnormalities, cardiovascular events, and recurrent stroke (Mittal, Rabinstein, Mandrekar, Brown, & Flemming, 2017). The project will focus on preventable and controllable causes such as electrolyte imbalance, infections, and cardiovascular events. Electrolyte imbalance can be prevented with attentive caregivers and infections can be controlled if detected early; similarly, the risk factors for recurrent stroke and cardiovascular events can be identified in some cases, and measures put in place to reduce likelihoods of unplanned readmissions (Mittal et al., 2017). In addition, 30-day readmission rates can be prevented with adequate discharge planning, effective communication, and efficient follow-up of patient’s condition (Andrews, Li, & Freburger, 2015). With the causes of 30-day readmissions identified, the focus of improving the quality of care is now on the prevention of these adverse events before occurrence.
  The identification of risk factors associated with infections or cardiovascular events is important and ensures that the symptoms are addressed before they occur (Poston 2018). Nurses and other primary care providers striving to improve the quality of care offered to their clients can utilize the findings of evidence-based research to understand the role they have to play. For example, improving communication and discharge planning has been found to improve the health outcome of discharged patients, which is likely to reduce 30-day readmissions (Andrews et al., 2015). Providing an actively patient engaging care will also allow nurses to identify the symptoms of infections before they occur and address them, accordingly, reducing the likelihood of 30-day readmission rates (Poston, 2018). Actively engaging IS patients will also help in the prevention of falls and management of electrolyte abnormalities and cardiovascular events before they advance to adverse events also reducing the likelihood of unplanned 30-day readmission (Mittal et al., 2017).
  Nurse’s knowledge of the appropriate care to offer is an important indicator of patient outcomes (Wu et al., 2018). According to Poston (2018), the first step to improving health outcomes for stroke survivors in the knowledge gain among nurses on the appropriate level of care they need to offer. Educational interventions for nurses have been found effective in improving their knowledge regarding the type of care they have to offer (Jones et al., 2018). Educational programs for nurses have also been associated with their improved adoption of evidence-based practices (Melender Mattila, & Häggman-Laitila, 2016). Nurse targeted education interventions on evidence-based practices have also shown promising results direct improvement of patient outcomes (Jones et al., 2018; Wu et al., 2018).
  Local Background and Context
  Hospitalizations related to stroke are costly for both the hospitals and the CMS whereby, it is estimated to cost between 18,963 and $21,454 per patient (Poston, 2018). Unplanned readmissions have been known to result in more adverse health outcomes than the initial hospitalization (Hughes & Witham, 2018). The cost of treatment as a result of readmission is expected to be more expensive compared to the initial hospitalization. Patient outcomes also decrease considerably lowering their quality of life (Poston, 2018). The hospitals also face financial consequences as the CMS declines to reimburse for preventable readmissions (Hughes & Witham, 2018). Unplanned 30-day readmissions due to IS are considered to be preventable, therefore, financial penalties are inflicted on hospitals with relatively higher than average rates (CMS, 2019). The HRRP launched in the Affordable Care Act insists on the penalization of hospitals with high rates of 30-day readmission rates as an attempt to reduce public spending related to re-hospitalizations and improve the quality of care patients receive.
  At the target facility, there is a need to conduct staff education on patient engagement and early identification of the risk factor of acute post-stroke disorders to minimize the 30-day readmission rates among patients. The hospital has scored higher than average in facilities with high 30-day readmission rates related to stroke. According to the Agency for Healthcare Research and Quality [AHRQ] (2019), providing ongoing patient engaging care for IS clients would ensure that they understand their diagnoses, follow-up needs, and the person to contact in the occurrence of the problem after being discharged. This would reduce the occurrence of adverse events requiring unplanned hospitalizations within 30 days of discharge. Therefore, the objective of the proposed DNP project will be to improve the knowledge of nurses regarding the transitional care requirements of post-acute stroke patients. The project will involve developing and implementing a nurse educational program on post-acute stroke transitional care for nurses to reduce 30-day readmission rates among IS patients. Nurses will be expected to provide patient-engaging transitional care for their patients following the implementation of the educational program.
  The target facility is a rehabilitation unit within a larger healthcare system. The unit serves stroke and cancer patients, among others requiring health with their daily living activities during recovery from a major illness. The unit has a post-stroke rehabilitation department, which is where the project will be implemented. Readmissions at the facility are classified as either planned or planned. The focus of the project will be on unplanned 30-day readmission rates. All readmissions are recorded at the facility including the cause and time the patient was sent to hospitals. In the local context, readmissions refer to the events where patients have to leave the rehabilitation unit for acute care services at a hospital or emergency care department.
  Role of the DNP Student
  As a DNP nursing student, my role in the facility will be to serve as team leader for the project. I work as a patient care coordinator at the facility which allows me to have firsthand knowledge of the systems and the type of care provided. However, I have no personal relationships with any of the nurses and patients at the facility. I have also never been in contact with patient EHR records regarding readmissions or IS diagnoses at the facility. I will also not have access to the patient EHR records during the course of the project but will have medical records personnel at the facility abstract and de-identify the data before I handle it.
  My role in the project will be to develop the educational program under guidance from an expert panel, and to direct its implementation. I will develop the educational intervention based on evidence-based literature regarding the transitional care for IS patients to prevent adverse events leading to readmissions (Mittal et al., 2017). I will hand over the developed educational program to the facility for implementation. My roles will be to develop the educational program utilizing an expert panel from the facility for review and validation, provide guidance on its presentation and collection of de-identified data from patient charts, and analyze the received data to determine its effectiveness on reducing 30-day readmissions. I will meet with two personnel from the medical records department who will collect and provide the de-identified data from the EHRs. The meeting will be to review with the staff regarding the type of data to collect and how to present it de-identified.
  My motivation to conduct this project is the low rankings the facility has continually received from CMS regarding its inability to reduce 30-day readmissions. As a nurse practitioner, I observe and understand the hard work other nurses put in caring for patients. Low rankings and frequent unplanned patient readmissions tend to demoralize nurses who often feel they are not doing enough. I hope to provide the nurses here with additional evidence-based knowledge on transitional care for stroke survivors. I do not believe I have any biases that could affect the project outcome. I will not come into contact with the EHRs and will only receive de-identified data for analysis.
  Summary
  Unplanned 30-day readmissions in IS patients are a major public health problem (Kim et al., 2015). However, research has established that the adverse events associated with readmissions in patients with IS can be prevented (Mittal et al., 2017). The project will focus on educating nurses on offering active patient engagement care allowing for the symptoms of such adverse events to be identified and addressed in advance. The COPA model which is focused on the integration of interactive learning, practice-based outcomes, and competency assessment will be utilized in the design, implementation, and evaluation of the project outcomes (Lenburg, 1999). The Lewin’s theory will guide the practice change among the nurses to adopt the care bundle for the IS patients. The healthcare facility of implementation has frequently featured in below-average rankings regarding 30-day readmission reduction and quality of care. The motivation for the project will be the high prevalence of 30-day readmissions in IS patients at the rehabilitation facility. The role of the DNP student will be to develop the educational program and present it for implementation as well as educate records personnel on data abstraction to help in evaluating the project outcome. The next section explores the methods used in implementing and evaluating the project.
  Section 3: Collection and Analysis of Evidence
  Introduction
  Frequent patient readmission after initial diagnosis and treatment is a common problem in the US (Hughes & Witham, 2018). Unplanned 30-day readmission rates in patients diagnosed with IS is an indicator of the quality of care provided in a healthcare facility (Vahidy et al., 2017). The CMS monitors the readmission rates of IS among other fatal health conditions penalizing and offering financial incentives to the hospitals with relatively high and low rates respectively (CMS, 2019). Many of the post-stroke disorders responsible for 30-day readmission rates are preventable when identified and addressed early enough. This doctoral project will focus on educating nurses how to implement a pre-discharge care by engaging patients in their care and the ability to identify and address post-stroke disorders. The purpose of the DNP project will be to develop and implement a nurse educational program on post-acute stroke transitional care to reduce 30-day readmission rates among IS patients. The project’s objective will be to improve the knowledge of the nursing staff on the care of IS patients to reduce 30-day readmission rates. The project implementation will be guided by the COPA model from design to evaluation.
  Section 3 presents the methodology utilized to design, implement, and evaluate the educational intervention. An in-depth discussion on the practice-focused question, sources of evidence, implementation, and evaluation stages will be conducted. The steps for analysing and synthesizing the evidence collected will be discussed as well.
  Practice-focused Question
  The local problem to be addressed is the high rates of 30-day readmission in IS patients. The facility where the project will be implemented has been found to have poor transitional care pre and during IS patients’ discharge to either go home or continue rehabilitative care. Communication among nurses, with caregivers, patients, and their families has been found to be low in the project. The gap in practice to be addressed by the project is lack of adequate knowledge related to post-acute stroke transitional care including identification of the risk factors of post-stroke disorders leading to 30-day readmissions. The high rate of 30-day readmissions among these patient populations is the problem to be addressed by the project. The project will be guided by the practice focused question: Among nurses caring for IS patients, does an educational program focused on active engagement and caring for patients compared to standard practice, reduce the 30-day readmission rates? The purpose of the DNP project will be to develop and implement a nurse educational program on post-acute stroke transitional care to reduce 30-day readmission rates among IS patients. The post-acute stroke care will be patient involving including routinely discussing patient symptoms, and feelings regarding the care approach taken compared to the current practice where the patients are not engaged regarding their condition and care.
  Based on the practice-focused question, nurses will be educated to follow new protocols in caring for IS patients during rehabilitative care and the transition to recovery from acute stroke. The content of the educational program will be derived from empirical research on nurse-targeted interventions for improving post-stroke transitional care health outcomes. The care plan will involve an active engagement patient care including identification and addressing of the risk factors for post-stroke conditions that could lead to 30-day readmissions. Thirty-day readmissions will be used to refer to unplanned re-hospitalizations in patients diagnosed with IS due to stroke-related conditions within 30 days after initial discharge. The educational program will refer to the intervention that involves educating nurses on how to care for IS patients.
  Sources of Evidence
  The source of evidence used in the project will be the hospital health records for IS patients regarding 30-day readmissions before and after implementation of the educational program. Evidence will be the 30-day readmissions data of IS patients obtained from health records at the facility. Patients being admitted at the facility will be questioned regarding prior hospitalizations and their responses compared to the patient health records. Patients previously admitted due to IS will be compared to determine the length of time between the admissions. Patients who had been discharged within 30-days of the current hospitalization will be recorded. The number of 30-day readmissions eight weeks before the educational program is implemented will be collected and compared to the same time after the intervention.
  The de-identified data, collected by the medical records staff, from patient charts will be the number of patients admitted within 30-days of discharge, which relates to the purpose of the project. The data collected pre- implementation of the educational program will be compared to that collected after. The two datasets will be compared for significant differences. A study by Lichtman et al. (2015) established that 11.9% of IS readmissions among Medicare patients were as a result of preventable causes. A 10% reduction in 30-day readmissions in the data collected eight weeks after the educational intervention will be anticipated in the proposed project and will be associated with the project intervention. Comparing 30-day readmissions pre and post implementing the educational program will be useful in establishing its effectiveness.
  Collecting the de-identified data and its analysis will enable the comparison of the impact of the care provided by nurses after the educational program in comparison to usual practice. The data collected before the implementation of the educational program will be representative of the outcome of usual care practices. The data collected after the education program is presented will be the true reflective of the impact of the intervention on 30-day readmission outcomes. A 10% reduction is expected. Comparing the data will align with the practice-focused question of the comparison between usual care to the one focused on active patient engagement. The processes of collecting and analyzing the evidence for the project, therefore, align with the practice-focused question.
  Nature of the Data
  Data will be collected every 24 hours from the EHRs during the timeline of the project. Pre-intervention data will be collected by abstracting the EHRs to generate reports on the number of 30-day readmissions recorded every day for the eight weeks preceding the intervention. The data will be abstracted by trained medical record officers working at the facility. The collected data are relevant to the practice problem because of their direct portrayal of the 30-day readmission circumstances at the facility before and after the implementation of the intervention. Data recorded on the EHRs are available every 24 hours, thus the collected evidence was relevant to the project.
  All cases of 30-day readmissions are recorded at the facility. Data recorded in EHRs is usually accurate, complete, and comparable boosting the validity and reliability of the project evidence (Chan, Fowles, & Weiner, 2010). Data from EHRs have also been validated for use as quality measures and improvement purposes further supporting its use in the current project (Chan et al., 2010). Access to the data for the doctoral student will be granted by the facility administrator. The student will not be involved in collecting the data; rather two trained medical records personnel working at the facility will extract the data from the EHRs. Data will be abstracted from 30-day readmission records for only the stroke unit. The reason for admission will also be collected, as well as whether it was planned or not. The doctoral student will receive de-identified data and conduct analysis using only the unplanned cases.
  Participants
  The project participants will include all the nursing staff working at the inpatient stroke rehabilitation unit at the healthcare facility located in the northwestern US. The nursing staff comprises of registered nurses (RNs), licensed vocational nurses (LPNs), and nurse practitioners (NPs). The target will be all the staff who provide direct care to patients at the stroke unit. All the nursing staff at the unit will be targeted to attend the educational program. Having all the nurses trained will be a helpful, making the outcome a reflection of the impact of the training. Training all the nursing staff at the unit will ease the process of evaluating the effectiveness of the educational intervention on patient outcomes for the ward.
  Procedures
  The first step will involve a comprehensive literature synthesis on post-IS care. Review of previous literature on caring for IS patients to prevent 30-day readmissions will help the doctoral student to design the educational program based on active patient-engaging care (Appendix). The intervention will then be presented to the nursing manager and expert panels at the facility for review. After the nursing manager is satisfied with the educational program, it will be presented to the nursing staff at the unit. The approved educational plan will then be presented to the nurses, educating them on post-acute stroke transition with the goal of reducing the rate of readmission. The nurse manager at the facility will determine the number of sessions held to ensure that all nurses working at the stroke unit are educated. The DNP student will recommend attending at least one 60-minute session for each nurse.
  The Doctoral student will meet with the medical records team to review the data abstraction process. The data will be abstracted and presented to the student within eight weeks after the project implementation. De-identified data on the patients’ frequency of readmissions for the 30 days’ period before and after the staff education project will be collected. The readmission rates will be evaluated using percentages and frequencies to determine whether there is an improvement.
  Ethical Considerations
  The proposed project will adhere to all requirements pertaining to the protection of human subjects. The DNP student will seek approval from the Walden’s Institutional Review Board (IRB) before initiating the project. Authorization from the target setting to use patient data from the facility’s EHR database will also be sought. After getting approval, the student will provide assurances for confidentiality and anonymity of patient data. Confidentiality will be addressed by storing the provided data on a password-protected laptop. Anonymity will be addressed by de-identifying all patient data.
  Analysis and Synthesis
  Data will be abstracted by hand by two trained records personnel within the unit, handed over to the DNP student and stored in a Microsoft Excel file. The analysis will involve a comparison a comparison of pre and post -intervention data using percentages and tables. A Pearson’s chi-squared test (χ2) will also be used to determine if the changes observed in the 30-day readmission rates pre and post the intervention were as a result of the educational program and care bundle. Comparison using the χ2 test will be done to establish the significance of the relationship between the observed change and the intervention. Findings will be interpreted at 0.05 level of significance. Percentage change in overall number of readmissions 8 weeks before and after the interventions will also be computed.
  Summary
  The purpose of the proposed project will be to evaluate the impact of the staff education program on 30-day readmission rates in patients with IS. The source of evidence to evaluating the project will be EHRs where patient diagnosis, admission, and discharge data are recorded and made available within 24 hours. The evidence required to evaluate the project outcome will be the 30-day readmission rates in IS patients observed eight weeks before and after implementation of the educational program. Permissions for implementing the project and collecting the data will be requested from both the Walden University IRB and the facility administrator. The intervention will be designed by the DNP student and implemented by the nursing manager to all the nursing staff including the RNs, LPNs, and NPs working at the stroke rehabilitation unit. Trained medical records personnel will abstract the data and de-identify it before presenting it to the DNP student for analysis. The analysis of the obtained data will involve the use of a χ2 test interpreted at 0.05 level of significance and computing of percentage changes in readmission rates. The next section will present the results obtained from the analysis.
  References
  Agency for Healthcare Research and Quality. (2019). Readmission and adverse events after discharge. Retrieved from /orders/psnet.ahrq.gov/primers/primer/11/Readmissions-and-Adverse-Events-After-Discharge
  American Association of Colleges of Nursing. (2019). Nursing fact sheet. Retrieved from /orders/www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Fact-Sheet
  Andrews, A. W., Li, D., & Freburger, J. K. (2015). Association of rehabilitation intensity for stroke and risk of hospital readmission. Physical Therapy, 95(12), 1660-1667. doi:10.2522/ptj.20140610
  Bambhroliya, A. B., Donnelly, J. P., Thomas, E. J., Tyson, J. E., Miller, C. C., McCullough, L. D., … & Vahidy, F. S. (2018). Estimates and temporal trend for us nationwide 30-day hospital readmission among patients with ischemic and hemorrhagic stroke. JAMA Network Open, 1(4), e181190-e181190. doi:10.1001/jamanetworkopen.2018.1190
  Bender, M. (2016). Clinical nurse leader integration into practice: developing theory to guide best practice. Journal of Professional Nursing, 32(1), 32-40. /orders/doi.org/10.1016/j.profnurs.2015.06.007
  Centers for Medicare and Medicaid. (2019). Hospital readmission reduction program (HRRP). Retrieved from /orders/www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html
  Chan, K. S., Fowles, J. B., & Weiner, J. P. (2010). Electronic health records and the reliability and validity of quality measures: a review of the literature. Medical Care Research and Review, 67(5), 503-527. /orders/doi.org/10.1177%2F1077558709359007
  Chianchana, C., & Wichian, S. N. (2016). Validation of the Assessment of Performance Competency. Polish Journal of Management Studies, 13(2), 27-35 doi:10.15405/epsbs.2016.05.21
  Condon, C., Lycan, S., Duncan, P., & Bushnell, C. (2016). Reducing readmissions after stroke with a structured nurse practitioner/registered nurse transitional stroke program. Stroke, 47(6), 1599-1604. /orders/doi.org/10.1161/STROKEAHA.115.012524
  Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human Relations, 69(1), 33-60. /orders/doi.org/10.1177%2F0018726715577707
  De Stampa, M., Vedel, I., Buyck, J., Lapointe, L., Bergman, H., Beland, F., & Ankri, J. (2014). Impact on hospital admissions of an integrated primary care model for very frail elderly patients. Archives of Gerontology and Geriatrics, 58(3), 350-355. doi: 10.1016/j.archger.2014.01.005
  Ellis, P., & Abbott, J. (2018). Applying Lewin’s change model in the kidney care unit: movement. Journal of Kidney Care, 3(5), 331-333. /orders/doi.org/10.12968/jokc.2018.3.5.331
  Fehnel, C. R., Lee, Y., Wendell, L. C., Thompson, B. B., Potter, N. S., & Mor, V. (2015). Post–acute care data for predicting readmission after ischemic stroke: A Nationwide cohort analysis using the minimum data set. Journal of the American Heart Association, 4(9), e002145. /orders/doi.org/10.1161/JAHA.115.002145
  Gupta, D. M., Boland, R. J., & Aron, D. C. (2017). The physician’s experience of changing clinical practice: a struggle to unlearn. Implementation Science, 12(1), 28. doi: 10.1186/s13012-017-0555-2
  Hudali, T., Robinson, R., & Bhattarai, M. (2017). Reducing 30-day re-hospitalization rates using a transition of care clinic model in a single medical center. Advances in Medicine, 2017(2017), 1-6. doi:10.1155/2017/5132536
  Hughes, L. D., & Witham, M. D. (2018). Causes and correlates of 30 day and 180-day readmission following discharge from a Medicine for the Elderly Rehabilitation unit. BMC Geriatrics, 18(1), 197. doi:10.1186/s12877-018-0883-3
  Jones, S. P., Miller, C., Gibson, J. M., Cook, J., Price, C., & Watkins, C. L. (2018). The impact of education and training interventions for nurses and other health care staff involved in the delivery of stroke care: An integrative review. Nurse Education Today, 61, 249-257. doi: 10.1016/j.nedt.2017.11.024
  Kim, H., Hung, W. W., Paik, M. C., Ross, J. S., Zhao, Z., Kim, G. S., & Boockvar, K. (2015). Predictors and outcomes of unplanned readmission to a different hospital. International Journal for Quality in Health Care, 27(6), 513-519. /orders/doi.org/10.1093/intqhc/mzv082
  Kristensen, H. K., Tistad, M., Koch, L. v., & Ytterberg, C. (2016). The importance of patient involvement in stroke rehabilitation. PloS one, 11(6), e0157149. doi: 10.1371/journal.pone.0157149
  Lazarte, F. C. (2016). Core Competencies of Beginning Staff Nurses: A Basis for Staff Development Training Program. Journal of Advanced Management Science Vol, 4(2). Retrieved from http://www.joams.com/uploadfile/2015/0407/20150407035021813.pdf
  Lenburg, C. B. (1999). The framework, concepts and methods of the competency outcomes and performance assessment (COPA) model. Online Journal of Issues in Nursing, 4(2), 1-12. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/COPAModel.html
  Lewin, K. (1951). Field theory in social sciences. New York: Harper & Row.
  Lichtman, J. H., Leifheit-Limson, E. C., & Goldstein, L. B. (2015). Centers for Medicare and Medicaid services Medicare data and stroke research: goldmine or landmine? Stroke, 46(2), 598-604. doi:10.1161/STROKEAHA.114.003255
  Lin, H., Wang, W., & Ye, Y. J. (2015). Diversified teaching methods in nursing: Using animal experimentation to promote core professional competencies in basic nursing training. Chinese Nursing Research, 2(4), 99-102. /orders/doi.org/10.1016/j.cnre.2015.10.001
  Manojlovich, M., Lee, S., & Lauseng, D. (2016). A systematic review of the unintended consequences of clinical interventions to reduce adverse outcomes. Journal of Patient Safety, 12(4), 173-179. doi:10.1097/PTS.0000000000000093
  Melender, H. L., Mattila, L. R., & Häggman-Laitila, A. (2016). A systematic review on educational interventions for learning and implementing evidence-based practice in nursing education: The state of evidence. Nordic Journal of Nursing Research, 36(1), 3-12. /orders/doi.org/10.1177%2F0107408315595161
  Mittal, M. K., Rabinstein, A. A., Mandrekar, J., Brown, R. D., Jr, & Flemming, K. D. (2017). A population-based study for 30-day hospital readmissions after acute ischemic stroke. The International journal of neuroscience, 127(4), 305–313. doi:10.1080/00207454.2016.1207642
  Nakibuuka, J., Sajatovic, M., Nankabirwa, J., Ssendikadiwa, C., Kalema, N., Kwizera, A., … & Katabira, E. (2016). Effect of a 72-hour stroke care bundle on early outcomes after acute stroke: A non-randomized controlled study. PloS One, 11(5), e0154333. /orders/doi.org/10.1371/journal.pone.0154333
  Nouh, A. M., McCormick, L., Modak, J., Fortunato, G., & Staff, I. (2017). High mortality among 30-day readmission after stroke: predictors and etiologies of readmission. Frontiers in Neurology, 8, 632. /orders/doi.org/10.3389/fneur.2017.00632
  Okere, A. N., Renier, C. M., & Frye, A. (2016). Predictors of hospital length of stay and readmissions in ischemic stroke patients and the impact of inpatient medication management. Journal of Stroke and Cerebrovascular Diseases, 25(8), 1939-1951. /orders/doi.org/10.1016/j.jstrokecerebrovasdis.2016.04.011
  Poston, K. M. (2018). Reducing readmissions in stroke patients. American Nurse Today, 13 (12). Retrieved from /orders/www.americannursetoday.com/reducing-readmissions-in-stroke-patients/
  Vahidy, F. S., Donnelly, J. P., McCullough, L. D., Tyson, J. E., Miller, C. C., Boehme, A. K., … & Albright, K. C. (2017). Nationwide estimates of 30-day readmission in patients with ischemic stroke. Stroke, 48(5), 1386-1388. doi:10.1161/STROKEAHA.116.016085
  Wu, Y., Brettle, A., Zhou, C., Ou, J., Wang, Y., & Wang, S. (2018). Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review. Nurse Education Today, 70, 109-114. doi: 10.1016/j.nedt.2018.08.026
  Appendices
  Appendix A: Educational Program
  Learning Objectives
  1. Nurses should be able to list the major risk factors for 30-day readmissions in post-stroke patients
  2. Nurses should be able to list the causes of unplanned 30-day hospital readmissions post-acute stroke.
  3. Nurses should be able to list strategies for reducing 30-day readmission rates in ischemic stroke patients
  4. Nurses should be able to describe sample approaches for addressing the risk factors for post-stroke disorders

  Educational Content

  Up to 12.1% of ischemic stroke patients are readmitted within 30 days of discharge, were 89.6% of the readmission cases are unplanned (Poston, 2018; Vahidy et al., 2017). Rates for 30-day readmissions are used as quality measures, and the hospital readmission reduction program (HRRP) established in the Affordable Care Act provides financial incentives to healthcare facilities with lowered readmission rates (Centers for Medicare and Medicaid [CMS], 2019). The CMS also fines hospitals with high 30-day readmission rates relative to other healthcare facilities under the HRRP (CMS, 2019).

  Risk Factors for Readmissions

  · High comorbidity score (Fehnel et al., 2015; Nouh, McCormick, Modak, Fortunato, & Staff, 2017; Okere, Renier, & Frye, 2016).
  · Age 75 years and above (Fehnel et al., 2 015; Nouh et al., 2017; Okere et al., 2016).
  · Living in a nursing facility prior to stroke (Okere et al., 2017)
  · Some comorbidities, such as previous stroke, diabetes, renal failure, heart failure, hypertension, and atrial fibrillation (Condon, Lycan, Duncan, & Bushnell, 2016; Fehnel et al., 2015; Nouh et al., 2017).
  · Admission to a non-neurology service (Okere et al., 2016).
  · Untreated high cholesterol (Fehnel et al., 2015).
  · Low social engagement in the rehabilitation facility (Okere et al., 2017).
  · Poor social support (Condon et al., 2016).

  Identified Cause of Readmissions

  · Respiratory diseases such as pneumonia and influenza (Fehnel et al., 2015).
  · Urinary tract or respiratory infections (Nouh et al., 2017).
  · Recurrent stroke or transient ischemic attack (Nouh et al., 2017).
  · Gastrointestinal complications (Okere et al., 2017)
  · Injuries such as those originating from falls (Okere et al., 2 017).

  Preventing 30-day Readmissions

  Involving patients in decisions on care and treatment and having health services needs met in areas such as falls, fatigue, emotion, memory, speaking, and reading (Kristensen, Tistad, Koch, & Ytterberg, 2016). Frequent contact and communication with patients will help identify and address needs such as poor medication adherence, and risk of infections (Poston, 2018). Identify and stratify patients depending on the risks they have for 30-day readmissions, then address each risk separately (Condor et al., 2016; Kristensen et al., 2016; Poston, 2018).

  References

  Centers for Medicare and Medicaid. (2019). Hospital readmission reduction program
  (HRRP). Retrieved from /orders/www.cms.gov/medicare/medicare-fee-for-service- payment/acuteinpatientpps/readmissions-reduction-program.html
  Condon, C., Lycan, S., Duncan, P., & Bushnell, C. (2016). Reducing readmissions after
  stroke with a structured nurse practitioner/registered nurse transitional stroke program. Stroke, 47(6), 1599-1604. /orders/doi.org/10.1161/STROKEAHA.115.012524
  Fehnel, C. R., Lee, Y., Wendell, L. C., Thompson, B. B., Potter, N. S., & Mor, V. (2015).
  Post–acute care data for predicting readmission after ischemic stroke: A Nationwide cohort analysis using the minimum data set. Journal of the American Heart Association, 4(9), e002145. /orders/doi.org/10.1161/JAHA.115.002145
  Kristensen, H. K., Tistad, M., Koch, L. v., & Ytterberg, C. (2016). The importance of patient
  involvement in stroke rehabilitation. PloS one, 11(6), e0157149. doi: 10.1371/journal.pone.0157149
  Nouh, A. M., McCormick, L., Modak, J., Fortunato, G., & Staff, I. (2017). High mortality
  among 30-day readmission after stroke: predictors and etiologies of readmission. Frontiers in Neurology, 8, 632. /orders/doi.org/10.3389/fneur.2017.00632
  Okere, A. N., Renier, C. M., & Frye, A. (2016). Predictors of hospital length of stay and
  readmissions in ischemic stroke patients and the impact of inpatient medication management. Journal of Stroke and Cerebrovascular Diseases, 25(8), 1939-1951. /orders/doi.org/10.1016/j.jstrokecerebrovasdis.2016.04.011
  Poston, K. M. (2018). Reducing readmissions in stroke patients. American Nurse Today, 13
  (12). Retrieved from /orders/www.americannursetoday.com/reducing-readmissions-in- stroke-patients/
  Vahidy, F. S., Donnelly, J. P., McCullough, L. D., Tyson, J. E., Miller, C. C., Boehme, A. K.,
  … & Albright, K. C. (2017). Nationwide estimates of 30-day readmission in patients with ischemic stroke. Stroke, 48(5), 1386-1388. doi:10.1161/STROKEAHA.116.016085
   

   

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Week4 Assignment

Assignment: Academic Success and Professional Development Plan Part 4: 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. Hence research analysis skills are 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 week in support of locating and analyzing research.
• Use the Walden Library to identify and read one peer-reviewed research article focused on a topic of interest to you in your specialty field.
• Review the article you selected and reflect on the professional practice use of theories/concepts as described by the article

The Assignment:
Using the ‘Week 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:

• Clearly identify the topic of interest you have selected.
• Provide an accurate and complete APA formatted citation of the article you selected, along with link or search details.
• Clearly identify and describe in detail a professional practice use of the theories/concepts presented in the article.
• Provide a clear and accurate analysis of the article using the Research Analysis Matrix section of the template.
• Write a 1-paragraph justification that clearly and accurately explains in detail whether you would recommend the use of this article to inform professional practice. Note: You can use the CARP method as presented in the Resources for this week on evaluating resources.
• Write a 2- to 3-paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following:
  • Clearly and accurately describe in detail your approach to identifying and analyzing peer-reviewed research.
  • Clearly identify and accurately describe in detail at least two strategies that you would use that you found to be effective in finding peer-reviewed research.
  • Provide a complete, detailed, and specific synthesis of at least one resource you intend to use in the future to find peer-reviewed research.
  • Integrate at least one outside resource and 2-3 course specific resources to fully support your summary.

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

By Day 7

Submit your analysis, including your competed section of the Academic Success and Professional Development Plan Template sections including your matrix and summary.

Remember to include an introduction paragraph which contains a clear and comprehensive purpose statement which delineates all required criteria, and end the assignment Part with a conclusion paragraph.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 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 “WK4Assgn+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.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6002_Week_4_Assignment_Rubric

• Grid View
• List View

ExcellentGoodFairPoorUsing the Week 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:
·   The topic of interest you have selected.
·   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.18 (18%) – 20 (20%)The response clearly identifies the topic of interest selected.
The response accurately and completely provides a citation of the article selected, including an accurate and complete link or thorough search details.
The response clearly identifies and describes in detail a professional practice use of the theories/concepts presented in the article.16 (16%) – 17 (17%)The response partially identifies the topic of interest selected.
The response provides a partial citation of the article selected, including a partial link or search details.
The response partially identifies and describes a professional practice use of the theories/concepts presented in the article.14 (14%) – 15 (15%)The response vaguely identifies the topic of interest selected.
The response vaguely or inaccurately provides a citation of the article selected, including vague or inaccurate search details.
The response vaguely or inaccurately identifies and describes a professional practice use of the theories/concepts presented in the article.0 (0%) – 13 (13%)The response vaguely and inaccurately identifies the topic of interest selected, or is missing.
The response vaguely and inaccurately provides a citation of the article selected, including vague and inaccurate search details, or is missing.
The response vaguely and inaccurately identifies and describes a professional practice use of the theories/concepts presented in the article, or is missing.Analysis of the article using the Research Analysis Matrix section of the template.
·   Write a one-paragraph justification explaining whether or not you would recommend the use of this article to inform professional practice.18 (18%) – 20 (20%)The response clearly and accurately provides a detailed analysis of the article using the Research Analysis Matrix section of the template.
The response clearly and accurately explains in detail the justification of whether to recommend the use of the article to inform professional practice.16 (16%) – 17 (17%)The response provides a partial analysis of the article using the Research Analysis Matrix section of the template.
The response partially explains the justification of whether or not to recommend the use of the article to inform professional practice.14 (14%) – 15 (15%)The response provides a vague or inaccurate analysis of the article using the Research Analysis Matrix section of the template.
The response vaguely or inaccurately explains the justification of whether or not to recommend the use of the article to inform professional practice.0 (0%) – 13 (13%)The response provides a vague and inaccurate analysis of the article using the Research Analysis Matrix section of the template, or is missing.
The response vaguely and inaccurately explains the justification of whether or not to recommend the use of the article to inform professional practice, or is missing.Write a 2-3 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.
·   Iintegrate at least 1 outside resource and 2-3 course specific resources to fully support summary.41 (41%) – 45 (45%)The response clearly and accurately describes in detail the approach to identifying and analyzing peer-reviewed research. The response clearly identifies and accurately describes in detail at least two strategies used to be effective in finding peer-reviewed research.
The response provides a complete, detailed, and specific synthesis of at least one outside resource that may be used in the future to find peer-reviewed research. The response fully integrates at least 1 outside resource and 2-3 course specific resources that fully supports the summary provided.36 (36%) – 40 (40%)The response partially describes the approach to identifying and analyzing peer-reviewed research. The response partially identifies and describes at least two strategies used to be effective in finding peer-reviewed research.
The response provides an accurate synthesis of at least one outside resource that may be used in the future to find peer-reviewed research. The response integrates at least 1 outside resource and 2-3 course specific resources that support the summary provided.32 (32%) – 35 (35%)The response vaguely or inaccurately describes the approach to identifying and analyzing peer-reviewed research. The response vaguely or inaccurately identifies and describes at least two strategies used to be effective in finding peer-reviewed research.
The response vaguely or inaccurately synthesizes at least one outside resource that may be used in the future to find peer-reviewed research. The response minimally integrates resources that may support the summary provided.0 (0%) – 31 (31%)The response vaguely and inaccurately describes the approach to identifying and analyzing peer-reviewed research, or is missing. The response vaguely and inaccurately identifies and describes at least two strategies used to be effective in finding peer-reviewed research, or is missing.
The response fails to integrate any resources that may be used in the future to find peer-reviewed research to support the summary provided, or is missing.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.5 (5%) – 5 (5%)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.4 (4%) – 4 (4%)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.3.5 (3.5%) – 3.5 (3.5%)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.0 (0%) – 3 (3%)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 punctuation5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors.4 (4%) – 4 (4%)Contains a few (1-2) grammar, spelling, and punctuation errors.3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) grammar, spelling, and punctuation errors.0 (0%) – 3 (3%)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, running head, parenthetical/in-text citations, and reference list.5 (5%) – 5 (5%)Uses correct APA format with no errors.4 (4%) – 4 (4%)Contains a few (1-2) APA format errors.3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) APA format errors.0 (0%) – 3 (3%)Contains many (≥ 5) APA format errors.Total Points: 100

Name: NURS_6002_Week_4_Assignment_Rubric

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SOCW6101 Week 2 Discussion (September 2019)

SOCW6101 Week 2 Discussion (September 2019)
SOCW 6101 Essential Skills
Week 2 Discussion
Challenges in Micro Work
Working effectively with individuals means building relationships. As a social worker, there are certain qualities, such as empathy, warmth, and genuineness, that help you develop rapport with clients. However, even when you appropriately utilize your micro skills, rapport building can be difficult with some clients. Challenges may include client hostility, silence, a request for self-disclosure, or the necessity of using confrontation. Social workers need to develop skills to appropriately work through these challenges.
For this Discussion, you begin developing these skills through practice and analysis of practice.
To prepare: Watch the Parker video. In the video, the clients express hostility toward each other, as well as toward the social worker. In addition, Stephanie asks the social worker for self-disclosure when she asks, “Wouldn’t you?” and “You really think you can fix that?” The scene ends with the client and social worker falling into silence. Consider the challenges depicted in the video. How would you respond?
By Day 3
Post:
Explain when it would be appropriate to use self-disclosure.
Provide a specific example of the type of self-disclosure you might use in this scenario.
Identify an interviewing technique you learned from this week’s resources that you would use when working with this client.
Provide a specific example of the interviewing technique.
For example, if you would use an empathetic statement or an open-ended question to elicit information, provide a specific example of the statement or question that you would use.
Explain why you would use this technique.
Support your post with citations to the course text to demonstrate that you have completed the required readings, understand the material, and are able to apply the concepts. As the course progresses, you will be expected to cite using APA. To develop APA skills, utilize resources from the Writing Center /orders/academicguides.waldenu.edu/writingcenter/apa.
By Day 6
Respond to at least two colleagues:
Provide an example of a 3rd technique not previously recommended by you or your colleague and explain why you believe that technique might also effective in this scenario.

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 SOCW6101 Week 1 Discussion (dq1+dq2) (September 2019)

SOCW6101 Week 1 Discussion (dq1+dq2) (September 2019)
SOCW 6101 Essential Skills
Week 1 Discussion
DQ1Generalist Intervention Model
You may have been drawn to social work because of a desire to help a specific population or to address certain social problems. You may already possess a large amount of knowledge related to these populations or problems based on past work experience, personal history, or academic studies. But as you also may know, a social worker cannot assume a client’s experience based on an identity category. Individuals hold multiple, intersecting identities, which influence their unique experience. This is why research and evidence-based practice are essential to social work.
You and your colleagues may have interests in different fields of social work practice or may be interested in assuming different social work roles. However, all will need foundational knowledge and skills related to understanding how the environment affects individual experience, assessing the influence of diversity and difference, and applying advocacy on behalf of client welfare and social justice. For this Discussion, you consider these issues with your colleagues.
To prepare:
Review this week’s Learning Resources.
Then, select a population with whom you would be interested in working as a future social worker and address each point in the following directions related to working with this population. Remember, your response should demonstrate that you have read and are able to apply the material from the required resources.
By Day 3
Post:
Describe your population of interest.
Identify one professional role that a social worker may assume when working with this population.
Explain how you might apply ecological or systems theory when working with the population.
Describe specific steps you will take to develop your knowledge of this population through critical thought and research.
Support your post with citations to the course text to demonstrate that you have completed the required readings, understand the material, and are able to apply the concepts. As the course progresses, you will be expected to cite using APA. To develop APA skills, utilize resources from the Writing Center /orders/academicguides.waldenu.edu/writingcenter/apa.
By Day 6
Respond to two colleagues who selected a different population from the one you selected:
Analyze how dimensions of diversity and intersecting identities may influence the experience of the population that your colleague identified.
Describe an area where a social worker may advocate on behalf of this population.
DQ2 Introduction Video
In order to practice presenting yourself to others and fostering collaboration within an academic community, you will upload a video introducing yourself to your colleagues. This Assignment has a lower point value to reduce first-week anxiety around technology requirements. However, you are required to learn this technology as you will be using Kaltura Media in your final project for this course, as well as in other courses within the program. Learning the technology now allows you to develop the skills needed to complete later course requirements.
When recording videos, remember that you are creating a professional presentation. If you stumble a bit, don’t feel you have to record yourself again because this is not a formal presentation, such as a speech. However, your video does need to be professional. In other words, dress professionally and conduct yourself as if you are in an agency setting with colleagues and supervisors. Be sure to record yourself in a room that is quiet and where no one interrupts you.
To upload your media to this discussion thread, use the Kaltura Media option from the mashup tool drop-down menu. Refer to the Kaltura Media Uploader area in the course navigation menu for more information about how to upload media to the course.
To prepare: Watch the video Anna Scheyett: Social Workers as Super-Heroes.
By Day 7
Post a 3- to 5-minute video introducing yourself to the class. Please include:
Your name
Your geographic location
A brief description of your educational accomplishments (e.g., degrees and schools attended)
A brief description of your employment history and/or experience in the social work field
A description of your vision of a social work hero
An explanation of how you might use principles related to strengths, empowerment, and resiliency in your practice
To ensure accessibility for your peers, please use the closed captioning function available in the Kaltura Media player.

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Week 9 Assignment NURS 6630

Week 9 Assignment NURS 6630

Assignment: Assessing and Treating Patients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

To prepare for this Assignment:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.

The Assignment: 5 pages

Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Week 9: Therapy for Patients With ADHD/ODD

Diego, a 9-year-old third grader, had always been an energetic child with a short attention span. For years, his mother attributed his behaviors to him being “all boy” and assumed it would improve as he grew older. Instead, daily tasks like chores and homework became increasingly overwhelming for Diego, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Diego was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).
ADHD is a prevalent disorder for patients across the lifespan, as more than 6 million children (CDC, n.d.) have been diagnosed with the disorder. Further, consider that about 60% of children with ADHD in the United States become adults with ADHD (ADAA, n.d.). Like Diego, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, patients often respond well to therapies and have positive health outcomes.
This week, as you study ADHD therapies, you examine the assessment and treatment of patients with ADHD. You also explore ethical and legal implications of these therapies.
References:
Centers for Disease Control and Prevention. (n.d.). Data and statistics about ADHD. /orders/www.cdc.gov/ncbddd/adhd/data.html
Anxiety and Depression Association of America. (n.d.). Adult ADHD (Attention Deficit Hyperactive Disorder). /orders/adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd

Learning Objectives

Students will:

• Assess patient factors and history to develop personalized therapy plans for patients with ADHD
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for ADHD
• Synthesize knowledge of providing care to patients presenting for ADHD
• Analyze ethical and legal implications related to prescribing therapy for patients with ADHD
• Identify concepts related to psychopharmacologic treatments and therapy for patients across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

Prince, J. B., Wilens, T. E., Spencer, T. J., & Biederman, J. (2016). Stimulants and other medications for ADHD. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 99–112). Elsevier.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). /orders/doi.org/10.1176/appi.books.9780890425596

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. /orders/doi.org/10.2165/11599630-000000000-00000

Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric Times.
/orders/www.psychiatrictimes.com/view/5-question-quiz-adhd

Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex. /orders/www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

• armodafinil
• amphetamine (d)
• amphetamine (d,l)
• atomoxetine
• bupropion
• chlorpromazine
• clonidine
• guanfacine
• haloperidol
• lisdexamfetamine
• methylphenidate (d)
• methylphenidate (d,l)
• modafinil
• reboxetine

Required Media (click to expand/reduce)

Case Study: A Young Caucasian Girl with ADHD 
Note: This case study will serve as the foundation for this week’s Assignment.

Attention Deficit Hyperactivity Disorder – A Young Girl With ADHD

BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give you a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.
Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.
SUBJECTIVE
Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”
Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.
MENTAL STATUS EXAM
The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
RESOURCES
§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.
Decision Point One

Select what you should do:

Decision Point One
Begin Wellbutrin (bupropion) XL 150 mg orally daily
RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point Two
Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and re-start the drug at the previous dose
RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Katie’s parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents and they stopped giving her the medication
• At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer

Decision Point Three
Discuss the use of a medication such as Adderall and its evidence for treating ADHD

Guidance to Student
Bupropion is used off-label for ADHD and is used more commonly in adults. It’s mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.
At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.
In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.
You should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow you to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.

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.

• 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. Week 9 Assignment NURS 6630

• 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.

• 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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 SOAP Note for Anxiety, PTSD, and OCD

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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