For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.

• Review this week’s Learning      Resources and consider the insights they provide about assessing and      diagnosing psychotic disorders. Consider whether experiences of      psychosis-related symptoms are always indicative of a diagnosis of      schizophrenia. Think about alternative diagnoses for psychosis-related      symptoms.
• Download the      Comprehensive Psychiatric Evaluation Template, which you will use to      complete this Assignment. Also review the Comprehensive Psychiatric      Evaluation Exemplar to see an example of a completed evaluation      document. 
• By Day 1 of      this week, you will be assigned to a specific video case study for this      Assignment. View your assigned video case, keeping the requirements of the      documentation template in mind.
• Consider what      history would be necessary to collect from this patient.
• Consider what      interview questions you would need to ask this patient.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate 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.
• Reflection notes: What would you do differently      with this client if you could conduct the session over? 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.).

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template

CC (chief complaint): 

HPI: 

Past Psychiatric History: 

· General Statement: 

· Caregivers (if applicable):

· Hospitalizations: 

· Medication trials: 

· Psychotherapy or Previous Psychiatric Diagnosis: 

Substance Current Use and History: 

Family Psychiatric/Substance Use History: 

Psychosocial History: 

Medical History: 

· Current Medications: 

· Allergies: 

• Reproductive Hx: 

ROS: 

· GENERAL: 

· HEENT: 

· SKIN: 

· CARDIOVASCULAR: 

· RESPIRATORY: 

· GASTROINTESTINAL: 

· GENITOURINARY: 

· NEUROLOGICAL: 

· MUSCULOSKELETAL: 

· HEMATOLOGIC: 

· LYMPHATICS: 

· ENDOCRINOLOGIC: 

Physical exam: if applicable

Diagnostic results: 

Assessment

Mental Status Examination: 

Differential Diagnoses: 

Reflections:

References

https://ezp.waldenulibrary.org/login?qurl=https://video.alexanderstreet.com/watch/training-title-24

As the team lead for your department, you have been asked to create a policy outline that details how pay for performance bonuses will be paid.

Include in your policy the following information: 2 page minimum 

• Title of the organization (use a company of your choice)
• Policy number
• Effective date
• Next review date 
• Policy approver
• Name of the policy
• List the department, product and function
• Summary of the policy structure

Gather your research from at least 2 sources, other than your textbook. Cite your sources using APA guidelines. All submitted work should be free of grammatical errors.

The Affordable Care Act (ACA) otherwise known as Obamacare, is a legislative health care provider that aims to improve the financial burdens that communities face. It creates an incentive for employers to provide health insurance and requires that nearly all people not covered by their employer or a government insurance program, enroll in Medicare or Medicaid, or purchase private health insurance (Schrek 2016).

      The most important element regarding this Act is the pre-existing condition coverage. It means that Health insurers can no longer deny coverage or charge more for services, once the insurance is bought and there’s a pre-existing condition like cancer or diabetes (U.S Department of Health & Human Services, 2017). This Act also aims to provide health insurance for those who would not have otherwise had the money. The role of the community and public health is to offer pre-screening for diseases, preventative care, and low-cost services that will benefit all the people.

      The role of the nurse in implementing this law is to advocate for patients to seek accessible health care and to seek preventative care even if they are healthy. For example, holding Fairs and Health information sessions to help with educating the community about vaccinations for the flu virus during the flu season, pre-screening for high blood pressure and annual health checks. Nurses play a role in the mission of the ACA, nationally and globally, provide equitable health care and the reduction of health disparities (Green 2018). The nursing profession is crucial in educating and taking care of the public. The American Nurses Association (ANA), is very supportive of the Affordable Care Act and upholds any court decisions. The ANA is “actively engaging with federal policymakers and regulators to advocate for system transformation” (ANA 2014).

I need an 8-12 page research proposal paper, excluding title and reference page, in APA format for a nursing research course. 

Paper must cover:

– Discuss the PICOT question, in detail, and explain why this research is important to the nursing profession. 

– Analyze the literature review, and determine how the current research supports the PICOT question, discussing all of the articles from the literature review. 

– Analyze possible evaluation and measurement strategies and potential outcomes. 

– Provide insight on how personal experience affects evidence-based practice. 

– Discuss change strategies and how to implement them in the work environment to help promote change. 

– Determine potential barriers in the workplace to consider when implementing change.

Supporting information:

– Part I: The PICOT question and explanation of the selected population (from Unit 2 Discussion Board). PICOT question is: In ambulatory infusion clinics, does adequate nurse staffing ratios improve patient care in three months 

– Part II: The intervention—what is the intervention, and why it is selected? see below

– Part III: The comparison—what is currently being done or what are other possible interventions to consider? Currently being done are nurses working overtime, supervisors providing staff coverage, supervisor tasks not being completed when supervisor is working as a staff nurse, reschedule patient appointments when staffing is inappropriate, and nurse burnout.

– Part IV: The outcome(s) and time frame—what is the anticipated outcome from the change in intervention? And, over what period of time? see below

My recent discussion:

I work in a military health facility which is the only level 1 trauma center in the Department of Defense and one of two level 1 trauma centers in San Antonio, Texas. The issues surrounding nursing shortages and appropriate nurse-patient ratios have been a concern in numerous healthcare facilities of both military and civilian organizations. It is highly understood that nursing shortages and inappropriate nurse-patient ratios contribute to high rates of staff turnover and job dissatisfaction (Helfrich et al., 2017, p. 764). There are many nursing and support positions within my organization that were victims to a hiring freeze. The hiring freeze has been lifted, and the news brought a lot of joy, excitement, and relief to the staff who, for over a year, have been doing the job they were hired for along with additional tasks to cover the hole left by open positions. Unfortunately, the joy of receiving this news was short lived. Although the hiring freeze has been lifted, the hiring process that was created during the hiring freeze is still in place. Supervisors cannot post vacant job positions and hire qualified candidates. Instead, supervisors must write an exception to policy stating why this vacant position needs to be filled. The exception to policy must be sent to higher decision makers who will determine which positions will be filled throughout the organization.

This requires supervisors to be creative when developing interventions to decrease the heavy workload felt by staff since nothing has changed with the nursing shortage in our organization (Chan, Wong, Cheung, & Lam, 2018, p. 6). Patient and staff safety are always the priority when implementing interventions. As a nursing manager of an infusion clinic, our patients are referred to us from other services to receive treatment. Most patients are referred from gastroenterology, rheumatology, or neurology services. One intervention is to transfer some infusions to other clinics who have trained staff to administer certain medications. Instead of having a centralized infusion clinic for the facility, this will allow us to utilize the resources of other clinics since the Infusion Clinic’s patient census is increasing. The second intervention is to revise our scheduling practices by scheduling more time for patient appointments to allow time for administrative tasks and infusion chair turnover between patients. The third intervention is to cross-train a nurse from another area to be an Infusion Clinic float nurse in the event of staff illness or call out. 

The outcomes to be measured are the number of missed administrative tasks, staff receiving uninterrupted lunches, the number of documentation errors, difference between patients’ appointment and check-in times, and the difference between patients’ appointment times and infusion start times. These outcomes will be measured by doing daily rounding and daily chart audits. The outcomes will be measured monthly over a period of six months to determine success or areas still needing improvement. If the outcomes are successful, this will be tremendous benefit to the outpatient clinics involved. Inpatient wards may have more staff overall, but they also have float nurses and similar systems in place to meet patient demands and staff call outs. 

References:

Ball, J. E., Griffiths, P., Rafferty, A. M., Lindqvist, R., Murrells, T., & Tishelman, C. (2016). A cross-sectional study of ‘care left undone’ on nursing shifts in hospitals. Journal of Advanced Nursing, 72(9), 2086-2097. doi:10_1111/jan.12976 

Chan, E. A., Wong, F., Cheung, M. Y., & Lam, W. (2018). Patients’ perceptions of their experiences with nurse-patient communication in oncology settings: a focused ethnographic study. PLOS ONE, 13(6). doi:10.1371/journal.pone.0199183 

Frith, K. H., Anderson, E. F., Tsdng, F., & Fong, E. A. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing   Economics, 30(5), 288-294.

Griffiths, P., Ball, J., Drennan, J., Dall’Ora, C., Jones, J., Maruottis, A., …Simon, M. (2016). Nurse staffing and patient outcomes: Strengths and limitation of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development. International Journal of Nursing Studies, 63, 213-225. Retrieved from http://dx.doi.org/10/1016/j.ijnurstu.2016.03.012

Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., …Ball, J. (2018). The association between nurse staffing and omission in nursing care: A systematic review. Journal of Advanced Nursing, 74, 1474-2487. doi:10.1111/jan.13564

Helfrich, C. D.,   Simonetti, J. A., Clinton, W. L., Wood, G. B., Taylor, L., Schectman, G., …Nelson, K. M. (2017). The association of team-specific workload and staffing with odds of burnout among VA primary care team members. Journal of General Internal Medicine, 32(7), 760-766. doi:10.1007/s11606-017-4011-4

Kouatly, I. A., Nassar, N., Nizam, M., & Badr, L. K., (2018). Evidence on nurse   staffing ratios and patient outcomes in a low-income country: Implications for   future research and practice. Worldviews on Evidence-Based Nursing, 15(5),   353-360. doi:10.1111/wvn.12316

Nelson, B. A., (2011). Healthcare team members’ perception of staffing adequacy in a comprehensive cancer center. Oncology Nursing Forum, 38(1), 52-59

 Approximately 150-180 words APA format with references and in-text citations. 

Where in the World is Evidence-Based Practice?

            This paper addresses the main discussion post regarding evidence-based practice (EBP).  EBP provides problem-solving to clinical practice that focuses on the best research, clinical expertise, and patient preferences or values (Melnyk & Fineout-Overholt, 2019, p. 8).  It is imperative to implement EBP into clinical practice as it leads to high-quality nursing care and better patient outcomes.  The purpose of this discussion post is to explore a healthcare organization website and determine if they are grounded in EBP.

Description of Healthcare Organization

            The healthcare organization website that I reviewed was the Centers for Medicare & Medicaid Services (CMS).  EBP appears in the quality initiatives section of the CMS website.  This section informs patients that CMS seeks information on how to transform clinician practices by changing practice behavior through evidence-based care to improve patient care and lower healthcare costs (CMS, 2018).  CMS has quality improvement organizations dedicated to improving health quality.  The mission of CMS quality improvement organizations is to improve the effectiveness, efficiency, and quality of services for Medicare patients (CMS, 2018).  CMS has developed Core Measures, which provides EBP information on health care quality that allows physicians, clinicians, and patients to make informed decisions (CMS, 2017).

Healthcare Organization Grounded in EBP

            Throughout the CMS quality initiatives website, there are indications that they are grounded in EBP to improve their patient’s care and outcomes.  In our required reading, it was noted that the most critical reason for implementing EBP is to provide the highest level of care and the best patient outcomes (Melnyk & Fineout-Overholt, 2019, p. 12).  CMS has also focused their aim on providing better care and better health at lower costs (CMS, 2018).  In our required reading, it was also noted that research shows that EBP leads to a reduction in healthcare costs (Melnyk, Fineout-Overholt, Stillwell, &Williamson, 2010, p. 51).

Changed Perception of the Healthcare Organization

            The information that I discovered on the CMS website has changed my perception of the organization by assuring me that they are using EBP to ensure that their patients receive the best possible care which improves patient care and outcomes (CMS, 2018).  For example, both of my parents have Medicare coverage; it is comforting to know that they are receiving care based on evidence that has been shown to improve their care and outcomes.  The aim at CMS is to provide better care at lower costs, which has also changed my perception (CMS, 2018).  For example, both of my parents live on fixed incomes, so it is essential for them to receive quality healthcare coverage as well as prescription drug coverage at a lower cost.

References

Centers for Medicare & Medicaid Services. (2017, July 28). Core measures. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html

Centers for Medicare & Medicaid Services. (2018, April 19). Quality initiatives – general information. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/index.html

Centers for Medicare & Medicaid Services. (2018, September 18). Quality improvement organizations. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53. Retrieved from https://ovidsp-tx-ovid-com.ezp.waldenulibrary.org/sp-3.33.0b/ovidweb.cgi?WebLinkFrameset=1&S=CGFCFPFNMMDDDBNJNCDKKDLBDJEIAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.22.23%257c0%257c00000446-201001000-00030%26S%3dCGFCFPFNMMDDDBNJNCDKKDLBDJEIAA00&directlink=https%3a%2f%2fovidsp.tx.ovid.com%2fovftpdfs%2fFPDDNCLBKDNJMM00%2ffs046%2fovft%2flive%2fgv023%2f00000446%2f00000446-201001000-00030.pdf&filename=Evidence-Based+Practice%3a+Step+by+Step%3a+The+Seven+Steps+of+Evidence-Based+Practice.&pdf_key=FPDDNCLBKDNJMM00&pdf_index=/fs046/ovft/live/gv023/00000446/00000446-201001000-00030

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.