Assignment Details

Patient care hinges in part on adequate and timely information exchange between treating providers. Referral and reply letters are common means by which doctors and nurse practitioners exchange information pertinent to patient care. Ensuring that letters meet the needs of letter recipients saves time for clinicians and patients, reduces unnecessary repetition of diagnostic investigations, and helps to avoid patient dissatisfaction and loss of confidence in medical practitioners.

As a Nurse Practitioner (NP) you will need to know the difference between a consultation and a referral for treatment, when ordering and when carrying out consultations or referrals.

Consultations

A consultation is a request for opinion or advice, so that the requestor can manage the patient. A consultation is billed under one of the consultation codes listed in Physicians’ Current Procedural Terminology (CPT) (99241-99245 for outpatient of office consultations). If the NP is the consultant, the NP should document the request for a consultation, the reason for the consult, and the NP’s evaluation and recommendations.

When an NP requests a consultation from another provider, the N P should request “consultation” on the referral form, rather than “referring.”

Referrals:

A referral is made when the referring provider wants to turn the management of the patient over to the referred-to provider, at least for the current complaint.

When a NP refers a patient, the NP should state on the referral form that the NP is “referring the patient for evaluation and treatment.” The referred-to provider will bill an evaluation and management code, rather than a consultation code.

Writing Assignment: Consult: Write up a consult request and include all key elements.

Ms. Perez has been referred to Ms. Wilson FNP-C,APRN, MSN  for consultation regarding eczema unresponsive to treatment in the past six months.

Document the evaluation and recommendations for how Ms. Wilson FNP-C,APRN,MSN should deal with the consultation request and bill a consultation code.

Writing Assignment: Referral: Write up a referral request and include all key elements.

As an NP and Ms. Perez primary care provider, you decide to refer her to Dr. Owens a dermatologist for evaluation and treatment regarding eczema unresponsive to treatment in the past six months.

1. Document your referral to Dr. Owens

2. Document the evaluation and recommendations for how Dr. Owens should deal with the referral and bill a referral code.

Written Paper (Microsoft Word doc): minimum 2000 words using 6th edition APA formatting  

Please review the grading rubric under Course Resources in the Grading Rubric section.

Doctorate degree Nursing program

 In your review of evidence, you locate a quasi-experimental research study as possible evidence to support a practice change. You notice that the study aims to make a prediction that relates to correlation between study variables. The study sample size is large and normally distributed. Reflect upon this scenario to address the following.

· In your appraisal of the evidence, you note that an independent variable is not present and that a Spearman’s ranked correlation is used to analyze data. Is this the correct level of correlational analysis? Explain your rationale.

· Are association and correlational analysis equivalent in determining relationships between variables?

· Do these findings impact your decision about whether to use this evidence to inform practice change? Why or why not?

Reading: 

Polit, D. F., & Beck, C. T. (Eds.). (2017). Nursing research: Generating and assessing evidence or nursing practice (10th ed.). Wolters Kluwer.

· Chapter 16: Descriptive Statistics

· Chapter 17: Inferential Statistics

· Chapter 18: Multivariate Statistics

· Chapter 19: Processes of Quantitative Data Analysis

· Chapter 20: Clinical Significance and Interpretation of Quantitative Result

1 page, single spacing.

at least 2 references (must be within 5 years so between 2015 and 2020) 

Absolutely plagirism free. Please run on turnitin.com

APA (7th ed) format. 

You are now in Phase 6 of your Capstone project. You have developed a comprehensive care plan for the aggregate. Over the next two weeks, you will develop an implementation plan for your aggregate.

The first step to effective implementation is planning. As you go about this task, answer the following questions:

• What small group would you select (for example, three families with young children, a group of five AIDS patients, and so on)? What made you select this particular group?
• What portion of the plan would you like to implement in the small group?
• What health risk do you expect to tackle by implementing this intervention?
• What results do you expect?
• How do you plan to implement this intervention? Do you have any specific strategy in mind? What resources will you need?
• How long do you think it will take for the results to be seen?
• What resources do you need?

By the due date assigned, prepare a 1-2 page Microsoft Word document with your responses to the questions above and submit it to the Submissions Area.

  Two separate responses 200 words each

I find myself to be most comfortable working with older adults between the ages of 70-85. As a nurse I have really only worked with the geriatric population. I work at a hospital in Arizona that is close to many different retirement communities. Our hospital’s average patient age is 74. This makes working with younger patients little more uncomfortable for me. I wonder if it is because younger patients are generally not as used to being in the hospital and I worry about not being able to calm their fears.

Cultures that are very different than mine also make me a little uncomfortable to communicate with them. I worry that I will offend the patient with something like eye contact. I work with a lot of Navajo patients. At first, I was nervous to work with Navajo patients because I did not know a whole lot about their culture, but as I have learned and worked with the Navajo, I have felt more comfortable being able to effectively communicate with them.

I had a patient from India and was nervous to be working with them for the same reason. This patient was one of the most kind hearted people I have ever met. By the time she was ready to be discharged I had learned a lot about her culture and enjoyed getting to know her.

            I do not feel uncomfortable communicating with other races, I feel more uncomfortable communicating with cultures that are different than mine. I think it is more that I am worried about possibly offending someone because of my own culture’s customs, and I can be unaware of other culture’s customs.  

            Communicating with someone of a different living situation is generally pretty easy for me as well. I have lived in communities that have a lot of diversity and that has helped me to understand the different living situations that people have.

            One thing I have recognized is that as a nurse, we work with so many different people. Everyone at some point in their life is going to need medical attention, and a nurse will be there to take care of them. As nurses we have to learn how to communicate with people who are very different from us and learn to adapt to the many different cultures and personalities we work with.

            When I was growing up, many of my experiences with how older adults are treated is mostly with respect. However, I also felt like older adults were seen as to be a burden on the family. I grew up learning that it may be best for older adults to be in an assisted living place. It has been found that many adult children are around the age of 60 or 70 when they are taking care of their 90-year-old parent (Graham, 2018, p. 1).  According to Graham (2018) Caregiving at the age of 60 or 70 can be very hard on the body and adds extra mental and physical stress (p. 1). I am not sure if having older adults in an assisted living is the best place for older adults, but I am interested in learning more about this topic this week.

Reference:

Graham, J. (2018, August 23). A late-life surprise: Taking care of frail, aging parents. Retrieved

from https://khn.org/news/a-late-life-surprise-taking-care-of-frail-aging-parents/.

2) 

Working in the healthcare settings, we come across many different people from different backgrounds, races, and living situation. The philosophy of any public space is the equality and standard way of thinking and feeling about others, but in reality, these differences could often cause tension and/or stress during the interaction of two people. When I come across a patient around my age group, I find that I speak to them as if they were a friend, often using slang and other gestures as I would with friends outside of the workplace. In contrast, with older adults I tend to speak a bit slower and professional due to the age difference. Being a 27-year-old Intensive Care RN, often times older patients initially feel as if my age will affect their care in a negative way because they relate young with inexperienced, therefore the tone and word choice are changed in order to instill confidence thru proper communication. The difference in gender can also have its changes of personality during a patient interaction. Being a male, I tend to talk to the guys a bit more straight forward and not so much emphasis on emotion, while with females, I tend to be more compassionate and understanding of their situation. As for the other factors that make a difference in people, race, sextual preference, living situation, that does not play a factor during patient communication as those are not important to me, instead I may feel the urge to ask more questions to get to know them and their culture or preferences if their difference interest me. 

             While growing up, the Latin culture has great respect for older adults. A young family member is always expected to take care of their older family members, especially the older females. Grandma’s, Aunt’s, and Mom are always the first to have priority in any situation, starting with the eldest one. The older males in the Latin culture are not left out behind, but typically are carefree to many situations, just wanting everyone to be happy regardless of where they stand. When I was about 5 years old in 1997, the respect for adults was already instilled in me. Always making sure that adults are respected and listened to what they asked of me. In 2007 I was 16, and things started changing, I would be able to challenge adults’ questions and figure out why things are the way that they are; this was a rebellious stage, but I was just trying to figure out why. Fast forward from the rebellious stage, 2011 I was 20 years old, and now had the knowledge as to why adults did what they did, and I understood the meaning behind it. The older adults in the family would now see me as an adult, and although the respect continued as such, I was now an adult as well with my own opinion and choice, regardless of their input. 

            The way we act and treat others is highly influenced by the upbringing that we have experienced as children, in my opinion, and therefore it is especially important for me to continue what I have been taught as a child, in the workplace, and continue the line of respect with those that surround me. In 2017, my niece was born, and now I find myself also educating her in what is acceptable and not acceptable in our eyes, to continue the same respect and behavior towards other, with her. For us, it doesn’t matter what color you are, which gender you like, where you live, which car you drive, which gender you are, what matters to us is the quality of person you are in the world and how you treat those that surround you.  
 

A  3 paged paper using APA format that addressing a nursing topics

1. Title, author, and resource of the article

2. Identify and define the QSEN concept selected “Evidence Based Practice”

3. In your own words, what are the “important components of the article?”

4. How is this concept implemented in todays health car system?

5. How does evidence based practice impacted patient centered care?