Searching For Evidence To Improve Nursing Outcomes – 2025 All articles that I access for any purpose are evidence based peer reviewed literature I usually obtain literature from the university

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Searching For Evidence To Improve Nursing Outcomes – 2025

All articles that I access, for any purpose, are evidence-based, peer reviewed literature. I usually obtain literature from the university library, but I have used CINAHL previously. I used the Chamberlain University Library for this assignment, which took me to ProQuest. Both articles I accessed were published in nursing literature related to my topic of concern.

The problem I identified just yesterday was that out of 58 students in my Pharmacology class, 6 of these students evidently had issues with how to use the Publication Manual of the American Psychological Association [APA] (use of quotation marks, citations, and references [also, using WebMD and WebEx] and they don’t know how to properly develop the reference list). I don’t think there was intentional plagiarism by a few students, but I looked for articles on how to help students with this kind of work. Again, for this literature search I utilized the Chamberlain Library and clicked on the “search articles” header, and from their I went straight to ProQuest Nursing. From there, I used the advanced search putting in key words: nursing students and APA, followed by checking the Peer Review box. Although I found 479 results, there is a dearth in more current literature that specifically addresses APA formatting in writing (McGuire, Gerber, Elgsti, & Currin, 2001), where the 4th edition of the APA manual was used as a reference. When I narrowed the date of publication down to 2010 to 2019, I found 279 results that were all over the map (279 results), and I found few that were focused on APA usage by nursing students.

I was able to locate one current article that was published in Nursing Open by authors at two Canadian schools of nursing. The authors identified the purpose: “To explore self-efficacy among first-year nursing students in the context of disciple-specific writing” (Mitchell, Harrington & McMillan, 2017, p. 240). The design was identified as a quasi-experimental study, and the methods used were data collection before and after a writing course was completed by nursing students during orientation (Mitchell et al.). The researchers described participants as 132 Baccalaureate nursing students that were spilt into 3 groups: full study participants that received the course and were tested pre- and post-course; experiment only group that did not receive the course but had both the pre- and post-test; and, a control group that had a pre- and post-test within a specific timeframe. The study was noted to have ethical (IRB) approval, and the authors also described the course with sources identified and these, in my opinion, seemed sound based on the topics and were taken from credible literature including the Journal of Nursing Education, Journal on Excellence in College Teaching, Nurse Education in Practice, Quality Advancement in Nursing Education, and others. The authors reviewed and discussed relevant literature review in the article as well. The authors used citations, references, and tables to substantiate the findings of the study. Study limitations were clearly identified as well as suggestions for further research.

The Self-Efficacy Scale for Academic Writing (SESAW) was created by Mitchell using a 4-point Likert Scale for 10 questions in the test. They also used the STAI (State Trait of Anxiety Inventory) tool by Spielberger (as cited by Mitchell et al.). A “One-way Analysis of Variance (ANOVA)” (Mitchell, et al., p. 243) was used by the authors for statistical significance. Pearson’s r calculations were used for statistical analysis as well as independent t tests. Results of the study findings are indicated by Mitchell et al., are as follows:

1. An improvement in APA usage and grammar over time

2. Correlations between anxiety trait and SESAW identified

3. Students that entered nursing school directly from high school did not do as well as others who had more academic experience

4. English as Second Language students showed no difference in performance

In the final conclusions, Mitchell et al., noted that the study indicates: “discipline-specific

writing instruction can influence writing self-efficacy in first year nursing students.” (p. 249).

              I plan to share this article with Chamberlain University leadership in hopes that we could have something like this for all our students and before they start their nursing courses (perhaps during orientation?). Moreover, I really wish I could focus my DNP project on just such a topic, but I don’t suppose it’s clinical enough. I look forward to hearing your thoughts and suggestions as well, even on my reference of an article without a DOI that I struggled with (see below).

References

McGuire, S.L., Gerber, D.E., & Currin, M.D. (2001). Helping students use APA format. Journal of

Nursing Education, 40(9), 414-416. URL: https://chamberlainuniversity.idm.oclc.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdocview%2F203935573%3Faccountid%3D147674 (Links to an external site.) accessed on 29 Sept 2020.

Mitchell K.M., Harrigan T. & McMillan, D.E. (2017). Writing self‐efficacy in nursing students: The

influence of a discipline‐specific writing environment. Nursing Open, 4(4), 240-50.

DOI:10.1002/nop2.90 accessed 29 Sept 2020.

I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO PARAGRAPH AND TWO SOURCES NO LATER THAN FIVE YEARS

P5#2 – 2025 Hello i need a Briefly Good and Positive Comment for this Post Thank you

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P5#2 – 2025

 Hello i need a Briefly, Good and Positive Comment for this Post.Thank you.  I need at least two references  

  

Yvonne Amune 

Week 5 discussion Attachment

COLLAPSE

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NURS 6660 Week 5 Clinical Supervision Discussion Video Transcript

           Anxiety disorders are psychiatric conditions that share characteristics of excessive fear of real or perceived imminent threat. According to Thibaut (2017), anxiety disorders are the most prevalent psychiatric disorders- accounting for 7.3% of all psychiatric disorders worldwide. Anxiety disorders are distinguished from one another by the triggers that induce the anxiety, fear, or other associated behavior and may include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, selective mutism, separation anxiety disorder, medication/substance-induced anxiety disorder, and social phobia (American Psychiatric Disorder, 2013; Thibaut, 2017).

           A client I observed is N.B, a 15-year old male Caucasian presented to the clinic by his mother, who was concerned about his anxious behavior. The client’s mother described him as a shy person with little friends. For this reason, N.B spends most of his time playing video-games in his room. The client’s mother also revealed that N.B has always had problems meeting new people. During the interview, N.B looked uncomfortable. He could not keep eye contact and was fidgeting. N.B’s mother also revealed that he has always struggled in the presence of his peers. N.B has severally turned down his peer’s invitations to hang out and often engages in avoidance behaviors. After assessing the client, a diagnosis was made for social anxiety disorder (Social phobia) 300.23 (F40.10) (American Psychiatric Disorder, 2013).

           The DSM-5 diagnostic criteria for social anxiety disorder (Social phobia) involves marked fear or anxiety of one or more social situations where an individual is exposed to scrutiny by others- (in peer settings for children). The social situations always provoke fear or anxiety and must have been lasting for six months or more. In the given case, the client met the diagnostic criteria for social anxiety disorder.

Therapeutic Approach and perceived Effectiveness

           The most appropriate treatment for N.B is cognitive behavioral therapy (CBT). CBT is regarded as the approach with the highest level of evidence in the treatment of social anxiety disorder (Bandelow et al., 2017). CBT’s goal in treating social anxiety disorder is to enable the client to gain self-consciousness by changing maladaptive behaviors and negative thoughts that make oneself uncomfortable in social situations. In their study, Pinjarkar et al. (2015) examined the effectiveness of CBT in treating social anxiety and found a clinically significant improvement in the subject’s self-consciousness and avoidance behavior (63.79%). In another study, David et al. (2014) concluded that cognitive therapy resulted in better outcomes than wait-list in the treatment of social anxiety disorder patients (78% of the subjects did not meet avoidant personality criteria at the end of treatment). The study also showed that cognitive-behavioral therapy was more superior to expressive and art therapy in the treatment of social anxiety disorder (71%) (David et al., 2014).

Thank you for listening to me.

I look forward to hearing from you on alternate therapeutic approaches.

 

References

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety             disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107.

David M., C., Anke, E., Ann, H., Freda, M., Melanie, F., Nick, G., Louise, W., & Jennifer,          W. (2014). Cognitive therapy versus exposure and applied relaxation in social   phobia: A Randomized controlled trial. Journal of Consulting and Clinical             Psychology, 74(3), 568–578.

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders:        an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337–      346.

Pinjarkar, R. G., Sudhir, P. M., & Math, S. B. (2015). Brief cognitive behavior therapy in         patients with social anxiety disorder: A preliminary investigation. Indian Journal of       Psychological Medicine, 37(1), 20–25. https://doi.org/10.4103/0253-7176.150808

Thibaut F. (2017). Anxiety disorders: A review of current literature. Dialogues in Clinical           Neuroscience, 19(2), 87–88.

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Week5 Responses 6053 – 2025 Jonise Flynn Strengths Revealed from Gallup Assessment Leaders are known to possess a variety of characteristics that motivate followers

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Week5 Responses 6053 – 2025

Jonise Flynn 

Strengths Revealed from Gallup Assessment

Leaders are known to possess a variety of characteristics that motivate followers to work towards a common goal. My results from the Gallup test revealed that my leadership strengths are achiever, competition, input, learner, and restorative. It is essential as a leader to recognize your strengths and weaknesses to guide others towards positive outcomes. Gallup (2020) describes an achiever as someone who works beyond the requirements. An achiever spends more time working on a goal than any other task (Gallup, 2020). The strength of competition drives a person to always want to be the best at whatever job (Gallup, 2020). Competitors are always comparing themselves to others to gain insight on how to be ahead of their competitors (Gallup, 2020). The strength of input arouses curiosity and inquisition. A person with the strength of input is always inquisitive about innovative events and seeking new information (Gallup, 2020). The strength of input refers to those persons who are knowledge seekers (Gallup, 2020). Much like input, the learner also has a strong sense of curiosity. The learner wants to be continuously taught and gather new ideas to expand current expertise (Gallup, 2020). Finally, the restorative strength is reserved for persons who seek perfection and are continuously reviewing ideas and avenues to reach a high-level goal (Gallup,2020). Overall, the described strengths each contribute to leadership characteristics.

Strengthening Core Values

The assessment not only reveals strengths but also shows my underlying weaknesses. I need to strengthen a few core values or beliefs after reviewing my assessment results. Oh et al. (2018) informs us that maintaining core values in leadership inspires subordinates to have a more incredible passion for their work, set higher standards, and work towards organizational goals. When core values are aligned to meet the organization’s needs, job satisfaction occurs (Oh et al., 2018). Marshall & Brome (2017) states that having defined beliefs “models the way” for others, articulating the significance of everyone’s participation in organizational goals(p.120). One core value that I need to strengthen based on my results is self-confidence. The strength of competition fuels my efforts to compare to others and want to do better continually. With competition, however, also comes self-doubt. I need to look less at what others are doing and ensure myself that I am making the right decisions for the organization. Strengthening my self-confidence also inspires others to trust me to be a confident, reliable leader.

Another core value that I need to evaluate is communication. An effective leader needs o to be able to commend others on their achievements and offer constructive criticism. There are staff members that have been on the unit longer than I have, and sometimes I find it hard to communicate criticism efficiently due to the feeling of not wanting to offend anyone. As a leader, I need to work on ways to communicate both successes and failures to the staff so that they are cognizant of their need for improvement. Communicating and helping staff understand where they could accelerate contributes to the success of the organization.

Improving my Strengths

My two strengths that need to be improved as a developing leader are learner and restorative. As a learner, I always want to acquire new knowledge. I’m always looking for an opportunity to understand how to run the unit better, care for specific patient populations, and much more successfully. My strength in restorative is what drives my strength in the learner area. My strength of restorative urges me to seek daily improvements, which triggers my learner curiosity. Using my restorative strength, I strive to improve on how we deliver patient care daily and how the team interacts to meet organizational needs. With both my strengths, to improve, I need to look for more learning and restorative opportunities. Instead of being consumed by nursing tasks, I should incorporate periods of learning and evaluation for restoration. These two strengths are sometimes overshadowed by workloads that, as a leader, I forget to use those strengths to better the organization.

Strengthening My Characteristics

One characteristic that I need to strengthen is in agreeableness. States that due to the amount of time nurses spend connecting with interdisciplinary persons, agreeableness is a characteristic that is necessary for quality patient care. With the workloads, all departments can become frustrated, and sometimes we take the discontent out on each other. Working on being more agreeable can significantly improve patient care and influence how followers also interact with other departments. 

Another characteristic that I would like to work on is emotional stability. Results from a study show that emotional instability is high in the nursing profession due to burnout and job dissatisfaction. As a leader, I must work on my emotional stability to model behaviors for others. There are times when the work gets overwhelming, and I find myself complaining out loud. When I feel emotionally overwhelmed, I need to focus on maintaining emotional stability because it influences how others portray the work environment. The only way to keep a positive environment is to set the tone as a great leader.

In conclusion, although the assessment revealed many of my strengths, weaknesses also exist. There are many aspects of becoming a leader that I need to focus on and further develop. Core values, current strengths, and characteristics are all essential areas of self-development that improve patient experience and those of organizational members. 

References

Çakıroğlu, O. Ç., & Harmancı Seren, A. K. (2019). The relationship between attitudes towards change and five factor personality traits in nurses. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 10(3).https://doi.org/10.14744/phd.2019.34713

Gallup. (2020).Jonise Flynn: Strengths insight guide. Retrieved on September 30, 2020, from https://gx.gallup.com/services/pdf?v=pdfGeneration.prince.7.0.binPath

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

Oh, J., Cho, D., & Lim, D. H. (2018). Authentic leadership and work engagement: the mediating effect of practicing core values. Leadership & Organization Development Journal.https://doi.org/10.1108/LODJ-02-2016-0030

Anita Herrera 

Description of the Assessment

            This writer has completed the StrengthsFinder assessment which resulted in the following characteristics: Input, Positivity, Responsibility, Futuristic and Learner. The Input attribute is summarized as having the zeal to collect enough insight to thoughtfully examine an abstract concept, theory, or idea. The Positivity attribute is descriptive as generous with praise, quick to smile and always on the lookout for the positive in situations surrounding this writer. Responsibility is characterized by the taking psychological ownership for anything this writer commits to, and whether large or small, feels emotionally bound to follow it through to completion. Being a Futuristic is described as the kind of person who loves to peer over the horizon, fascinated about the future and sees in detail what the future might hold, which helps pulls this writer forward, into tomorrow. The final strength identified was Learner. This described the writer as someone who is very much interested and determined to learn new things and drawn to the process of learning. The process, more than the content or the results is especially exciting to this writer (Gallup, Inc., 2020).

Core Values

            The information the StrengthsFinder Assessment generated is interesting. It helps an individual to keep grounded and provide perspective. It also helps to manage the direction in life and work as a leader. Two core values that were identified were Honesty and Confidence. Honesty should be the bedrock of an individual’s foundation, as it will define who a person is before others can know more. If things are dealt with in truth, it allows individuals to live a life with far less worry. Analytical minds can be used to think of new ideas, rather than lies and excuses. Honest intentions in speech and action gain the attention and respect of others. Honesty promotes openness, empowers us and enables us to develop consistency in how we present the facts. Honesty sharpens our perception and allows us to observe everything around us with clarity. Honesty in the workplace is key to building a strong team that trusts each other. To build integrity and a good reputation among coworkers, it is important to always keep your word when you say you are going to do something. When mistakes are made, take responsibility for them. Be transparent in everything said or done. Also respect confidential information, whether business-related or personal.

            A major component of confidence is the value a person place on him/herself. Confidence is about the faith you have in your abilities, the person you are, and how you view your most important relationship. With confidence, one can rise to the top of their profession. It keeps one balanced and grounded. It is a powerful value that gives so much definition to the core of who we are. Confidence gives us the strength to pursue our dreams. It psyches us up to get the job or opportunity we have prepared and dreamed about (Scully, 2015).

Strengths Identified

            There are two personal strengths this writer identified from the StrengthsFinder assessment. The first strength is the ability to learn new skills. Knowing how to actively grow and develop a skill is a skill itself, and if you understand how the principles of learning work, it will be easier to learn any new skill in the future. It is therefore worth putting some effort into understanding the benefits of not staying away from new skills. This writer has never been afraid to learn new procedures introduced at the place of work. New ideas are greatly appreciated and embraced no matter how big or small. It is important to learn new things especially, new technologies since the world is currently evolving around technology. New software use at work might be challenging, but this writer endeavors to delve into it and make it easier for others to learn, without being intimidated. My willingness to soak up with newness calm others fears and spur them into action (Gallup, Inc., 2020).

            The second strength identified is being positive about everything. People exceptionally talented in the positivity theme have contagious enthusiasm. This writer brings enthusiasm to people, group and place of work. Stimulating my team to be more productive and hopeful at work is what this writer is best known for. When colleagues complain about a task that needs to be finished within a timeframe, this writer tries to make it fun for everyone to feel energized from start to finish. Even if it is not going on well as planned, because they most of the times rely on this writer to help them rise above frustrations, energy will be focused on good things that have been previously achieved to see the need to take it to the next level. This writer can deliberately help others see the things that are going well for them and keep their eyes on the positive.

Areas for Improvement

            Out of the four domains of team strengths from the StrengthsFinder Assessment: Executing, Influencing, Relationship Building and Strategic Thinking, this writer needs to improve on the Influencing aspect. The ability to influence is an essential leadership skill. To influence is to have an impact on the behaviors, attitudes, opinions and choices of others. Influence is not to be confused with power or control. It is not about manipulating others to get your way.

            The first characteristic to improve on is communication. Being able to communicate as a leader is vital. That means it does not matter what the issue is, it must be communicated for everyone to be on the same page. Communication skills are abilities this writer needs to use when giving and receiving different kinds of information. Some examples include communicating ideas, feelings or what is happening. Communication skills involve listening, speaking, observing and empathizing. This writer needs to improve on how information is given across to bring the best out of situations. Communication skills are needed to speak appropriately with a wide variety of people whilst maintaining good eye contact, demonstrate a varied vocabulary and tailor your language to your audience, listen effectively, present ideas appropriately, write clearly and concisely, and work well in a group.

            The second characteristic that needs to be worked on Self Assurance. This is described as the ability to take risks and manage one’s own life. Individuals with this characteristic have an inner compass that gives them certainty in their decisions. People with the strength of Self-Assurance have great faith in their own strengths. They are confident in their abilities and their judgments. They know they are unique, and this gives them confidence to face challenging situations. This writer needs to have this characteristic to believe in the abilities and capacities and know I can deliver exactly what is needed (Khalil, 2016). People who have Self Assurance behave as if they have an inner compass pointing them in the right direction, and they believe this right direction is right. They might act right even when they are not. This confidence impacts people, it increases their belief and confidence in themselves. This writer needs to master self-assurance characters so that confidence in others does not intimidate, but to encourage to be even more confident.

References

Gallup, Inc. (2020). Your Signature Theme Report.

Khalil, R. (2016). Influence of extroversion and introversion on decision making ability. International Journal of Research in Medical Sciences, 4(5), 1534-1538. http://dx.doi.org/10.18203/2320-6012.ijrms20161224

Laureate Education. (Producer). (2018). The leader in you [Video webcast]. Retrieved from https://class.waldenu.edu/bbcwebdav/institution/USW1/202030_27/MS_NURS/NURS6053_module03.html?course_uid

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd. ed.). New York, NY: Springer

Scully, N. J. (2015). Leadership in nursing: The importance of recognizing inherent values and attributes to secure a positive future for the profession. Collegian, 22(4), 439-444. 

3 sources for each response

Discussion – 2025 Low carb diets are believed to have positive effects for weight loss increased performance management of diabetes

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Discussion – 2025

 

Low carb diets are believed to have positive effects for weight loss, increased performance, management of diabetes, and even curing cancer.  In the JAMA article, low carb is compared to low fat diets in a 12 month trial.  Discuss the effectiveness of low carb diets in relation to:

1)   Weight changes between a healthy low-fat diet vs a healthy low-carbohydrate diet

2) Genotype pattern and baseline insulin secretion associated with the dietary effects on weight loss

3) Which diet was better for whom?

Caso Study 3 &4 – 2025 Review the case study and answer all questions with a scholarly response using APA and include

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Caso Study 3 &4 – 2025

 

Review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references, per case. Answer both case studies on the same document.

Case Studies will be put through TURN-It-In (anti-Plagiarism program) 

Turn it in Score must be less than 15% or will not be accepted for credit, must be your own work and in your own words.  Please see College Handbook with reference to Academic Misconduct Statement.

Community Nursing Week # 5 DQ 1 Student Reply – 2025 Less than 10 similarity References APA This is another student post to which i have to react

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Community Nursing Week # 5 DQ 1 Student Reply – 2025

 

Less than 10 % similarity

References APA

This is another student post to which i have to react adding some extra information related this post. 

short answers

 

Emerging Infectious Diseases

To what could your neighbor have been exposed, and how could the exposure have occurred?

           Zika virus is an infectious disease influenced by microbial adaption and change and travel (DeMarco & Healey-Walsh, 2020). CDC (2019) identifies various symptoms of the Zika Virus, including fever, rash, headache, joint pain, conjunctivitis, and muscle pain. From the list of symptoms gathered from my neighbor, she may be infected with the virus. It is transmitted by mosquitoes that carry the virus, and a bite transmits the virus into the bloodstream. It is also possible for the virus to be transmitted sexually and through blood transfusion, as the virus remains in the body for a while, affecting people differently, and there may not be any signs or symptoms available in the person.

What advice would you give your neighbor?

           Mayo Clinic (2018) identifies risks of miscarriages linked to the Zika virus, making it crucial that the neighbor immediately sees a doctor. Although the symptoms go away after a week of rest and hydration, it poses a risk to the fetus by causing microcephaly, a potentially fatal congenital brain condition (Mayo Clinic, 2018). It can also cause other neurological disorders, which can be damaging to a developing fetus. Reduced body movement due to too much muscle tone after birth, eye damage, joint problems, and brain damage and reduced brain tissue are other complications and defects that the virus may cause to a child (Mayo Clinic, 2018). Since the virus remains in the bloodstream for about a week, conducting a blood test would confirm the virus’s presence or lack thereof. There is no known treatment for the virus, which makes prevention the best alternative available. Pregnant women should avoid traveling to places associated with the virus due to the various complications it ay have on fetus development.

Reference

CDC, A. (2019, May 21). Zika virus: Symptoms, Testing, & Treatment.

Retrieved September 30, 2020, from https://www.cdc.gov/zika/symptoms/index.html

DeMarco, R. F. & Healey-Walsh, J. (2020) Community and Public Health Nursing (3th Edition).

Philadelphia: Wolters Kluwer

Mayo Clinic, A. (2018, December 21). Zika virus.

Retrieved September 30, 2020, from https://www.mayoclinic.org/diseases-conditions/zika-virus/symptoms-causes/syc-20353639

CLASS DISCUSSION REPONSE – 2025 Peer initial posting Many Who Buy ACA Health Plans For 2019 Find Lower Prices And More Choice focuses

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CLASS DISCUSSION REPONSE – 2025

Peer initial posting:

Many Who Buy ACA Health Plans For 2019 Find Lower Prices And More Choice focuses on the stabilization of the health care market after the removal of some “structural underpinnings” in 2017. The cost for health insurance rose steeply from 2017 to 2018 with the average premium going up by over 10% for most states (Rau, 2018). A portion of the price increase was driven by insurance monopolies, so, with no competition, insurance companies had no fear about raising premiums while reducing coverage.

The cost of health care has been a hot topic for a long time, especially as prices have been going up. The cost to insure a single person in 2018 has become similar to the average cost of family coverage 20 years ago (NCSL, 2018). For many people, the question of health care is how much is a person willing to pay for their health on average, which becomes problematic very quickly as the averages can be relatively easily skewed. Even for people who receive health insurance through work, the average cost of insurance premiums is $5,714 and additional out-of-pocket costs, which bring up the average spending on health to 11.7% of total income per year (NCSL, 2018). While there is good news for the public at large at the reduced costs for 2019 insurance plans, there are still many problems with health insurance. Insurances only cover certain providers, hospitals, or services, and for people with established providers, this may mean finding a new provider or paying more for their insurance, and those are only options if there is even an insurance company that works with that provider. Overall, I am not optimistic about a system where the cost of a service can be difficult to obtain and the response of most customers is basically “at this point, I’ll take whatever I can get” (Rau, 2018).

 Link:    https://www.npr.org/sections/health-shots/2018/11/23/667466242/many-who-buy-aca-health-plans-for-2019-find-lower-prices-and-more-choice   

References

Rau, J. (2018)  Many Who Buy ACA Health Plans For 2019 Find Lower Prices And More Choice Retrieved from https://www.npr.org/sections/health-shots/2018/11/23/667466242/many-who-buy-aca-health-plans-for-2019-find-lower-prices-and-more-choice

NCSL (2018) Health Insurance: Premiums and Increases Retrieved from https://www.ncsl.org/research/health/health-insurance-premiums.aspx

 INSTRUCTIONS

Review the initial postings from your peers. Click on the link provided in the initial response to read/listen to the story. Respond to one peer according to the following prompts and the grading rubric.

  1.  What are your overall thoughts about this posting/topic?
  2. Do your share common or differing thoughts from the other student? Explain. 
  3. Your post must be supported with at least one source of literature (can use required readings) but must also incorporate at least one source in addition to those provided to receive full points. The date of publishing should be within the past 2 years. APA Style 7th edition.

Nursing An Ethical (Due 48 Hours) – 2025 1 Minimum 7 full pages Follow the 3 x 3 rule minimum three

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Nursing An Ethical (Due 48 Hours) – 2025

 

1) Minimum 7  full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

              Part 1: Minimum 4 pages

              Part 2: minimum 3 pages

              

Submit 1 document per part

2)¨******APA norms, please use headers

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 5 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1:

Transgender patients face an extreme amount of resistance and discrimination within the community daily. Unfortunately, the health care arena is no exception. 

1. What challenges do transgender patients face within healthcare? 

2. How does discrimination from healthcare providers impact the transgender community? 

3. What can be done to change or alleviate this issue–what program, system, or process can be created to help the transgender patient and the healthcare provider. 

4. How would you ensure that transgender patients don’t experience discrimination or ambivalence when seeking healthcare?

Part 2:  Health Choice Illinois Reform (Illinois Medicaid Reform) (See sample)

The purpose of this assignment is to familiarize students with health reform strategies adopted by states. Students will select a state health policy reform innovation and describe the rationale, how it was adopted (e.g., federal waivers, passage by state legislature), the funding structure, and (to the extent statistical data are available) its impact 

Include (Mandatory):

1.   Rationale 

2.   Adoption of the Reform

3.  Funding Plan

4.   Impacts

COPD Case Study – 2025 Mr B is a 75 year old white male Source Self reliable source Subjective Chief complaint I feel winded HPI Patient

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COPD Case Study – 2025

Mr. B is a 75-year-old, white, male

Source: Self, reliable source

Subjective:

Chief complaint: “I feel winded.”  

HPI:  Patient states he has been feeling short of breath with exertion for years now. However, over the past year he feels he has been worsening. He decided to come in today as he experienced shortness of breath mowing his lawn yesterday and had to take two breaks. He has a cough, generally productive. He denies any chills or fever. He denies any chest pain or lower extremity swelling. He denies any nausea or vomiting. He has not taken anything OTC for his symptoms.

Allergies: NKA

Current Mediations:

Lisinopril, 20 mg, daily

Propranolol ER, 120 mg, daily

Simvastatin, 40 mg, daily

Aspirin, 81 mg, daily

Tamsulosin, 0.4 mg, daily

Sertraline, 100 mg, daily

Omeprazole, 20 mg, daily

Metformin, 1000 mg, BID

Glimepiride, 4 mg, daily

Insulin glargine, 10 units, nightly                                                                                                                      

Pertinent History: Hypertension, hyperlipidemia, diabetes mellitus, benign prostatic hyperplasia, anxiety, gastritis, obesity, nicotine dependence

Health Maintenance. Immunizations: Immunizations up to date, to include PPSV-23. He has refused recommended yearly low dose CT screens (candidate given at least 30 pack-year-smoking history).

Family History:

            Father – Congestive heart failure, hypertension, hyperlipidemia (deceased age 81)

            Mother – atrial fibrillation (deceased age 79)

Social History: Patient lives with his wife. He smokes 1ppd (40 pack year history). He drinks “a beer or two a day” and denies drug use.

ROS: Incorporated into HPI

Objective:

VS – BP: 118/68, HR: 86, RR: 16, Temp 97.6, oxygenation 100%, weight: 340 lbs, height: 64 inches.

Mr. B is alert, awake, oriented x 3.  Patient is clean and dressed appropriate for age.

Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop. No peripheral edema or jugular vein distention

Respiratory: Clear to auscultation, but decreased breath sounds

Chest x-ray shows no consolidation or masses

ECG shows sinus rhythm

Spirometry shows FEV1/FVC < 0.7 and FEV1 of 65% predicted

Assessment:

Diagnosis: Moderate chronic obstructive pulmonary disorder, ICD-10: J44.9

Please answer the following:

  1. Utilizing the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines mentioned in your lecture, what is your prescribed treatment plan (include specific dosage, frequency)? Why did you choose this treatment plan? In your answer, please describe, briefly, the pharmacodynamics (1 point) and pharmacokinetics (1 point) of your treatment choice and how they influenced your choice. Please describe how the patient comorbidities influenced your choice as well (1 point).  Are there any medical interactions to your choice (1 point)? 
  2. Document the education you would provide for this patient, specific to the prescribed medication(s). Please include information pertinent to the patient (2 points) and common potential adverse effects for each prescribed medication (2 points)

Nursing (BSN) – Root Cause Analysis (RCA) And Failure Mode And Effects Analysis (FMEA) – 2025 Must have experience with healthcare nursing related topics Additional documents attached INTRODUCTION Healthcare organizations accredited by

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Nursing (BSN) – Root Cause Analysis (RCA) And Failure Mode And Effects Analysis (FMEA) – 2025

Must have experience with healthcare/nursing related topics. Additional documents attached.

  

INTRODUCTION

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident. 

SCENARIO

It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.

Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B.

Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders.

After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.

Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.

Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading.

Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc.

At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected.

A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care.

Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.

Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.

REQUIREMENTS

  Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Explain the general purpose of conducting a root cause analysis (RCA).

1. Explain each of the six steps used to conduct an RCA, as defined by IHI.

2. Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome.

B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome.

1. Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan.

C. Explain the general purpose of the failure mode and effects analysis (FMEA) process.

1. Describe the steps of the FMEA process as defined by IHI.

2. Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. 

Note: You are not expected to carry out the full FMEA.

D. Explain how you would test the interventions from the process improvement plan from part B to improve care.

E. Explain how a professional nurse can competently demonstrate leadership in each of the following areas:

• promoting quality care

• improving patient outcomes

• influencing quality improvement activities

1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities.

F. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

G. Demonstrate professional communication in the content and presentation of your submission.