Reply DB 1 2025

Discussion # 1 Advanced Primary Care of Family Shared decision-making leads to better health knowledge among the elderly, children, and veterans. They leave the decision-making to caregivers and practitioners. For children and the elderly, they do not participate in their examination, diagnosis, and treatment options because of their limited literacy. The same impacts how this population responds to the management of chronic illnesses and other aspects of care (Seo et al., 2016). Shared-decision making provides the elderly with an opportunity to ask questions when needed, seek more information about their condition, and communicate their health needs. Through this process, older adults gain an understanding of their health and become experts in the decision-making process. Today, best practices of models of care such as patient-centered care enhance communication between practitioners and patients. For instance, allowing a patient to be at the forefront of the medical process is an incentive for self-management (Narva, Norton, & Boulware, 2016). The elderly are particularly vulnerable to illiteracy and will tend to research more when they are perceived as decision-makers. They will be keen on the medical process and gain knowledge as a result. Additionally, motivational interviewing ensures that children and older adults are influential in the decision-making process. It breaks the barrier of uncertainty and facilitates curiosity among the elderly, who then learn to decode instructions, and risk asking questions about various aspects of their care (LeDoux & Mann, 2019). It is a strategy that promotes autonomy during the care process, which enhances learning. References LeDoux, J., & Mann, C. (2019).Addressing Limitations in Health Literacy: Greater Understanding Promotes Autonomy and Self-Determination. Professional case management , 24 (4), 219-221. Narva, A. S., Norton, J. M., & Boulware, L. E. (2016). Educating patients about CKD: the path to self-management and patient-centered care. Clinical Journal of the American Society of Nephrology , 11 (4), 694-703. Seo, J., Goodman, M. S., Politi, M., Blanchard, M., & Kaphingst, K. A. (2016). Effect of health literacy on decision-making preferences among medically underserved patients. Medical Decision Making , 36 (4), 550-556.

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NR533 Week2 TP 2025

Respond EXPERIENCE The demographics at the CVAMC is a wide mix of veterans. We have different levels of service connection, privately insured patients as well as many patients with no other forms of insurance, and a high rate of homeless veterans. As discussed in the first touchpoint, many of the patients rely on Medicare and the federal government benefits gained through active military service to pay for their healthcare. With a shared governance delivery system, the VA encourages the patient to have an active hands-on approach with their healthcare, placing the veterans and their families at the forefront of decision making. While this is easy for the VA to state, its not as easier to perform to the standards, as the constraints of federal funding may pose hinderance on the quality or type of care the veteran may receive. Currently, the VA uses a volume-based reimbursement system. As stated previously, it is difficult to navigate the VA reimbursement system, as there are so many different rules and regulations. There are even regulations on what Medicare (one of the top reimbursements) can reimburse for. The VA isn’t allowed to receive Medicare payment for the treatment of nonservice-connected medical conditions on enrolled Medicare-eligible veterans, even if their health care is routinely covered under Medicare (American Legion, 2011). This simple rule is one of many that makes it difficult to place the VA under simply the value or volume-based reimbursement system, but yet, shows that it is appropriate to use a mix of the two in order to be the most fiscally responsible in billing and reimbursement funding. REFLECTION The type and quality of care provided at the VAMC should still be at the optimal level, regardless of where the funding is coming from. In order to achieve excellence in patient outcomes, the organization must adhere to and follow the mission, vision, and values. Consistently remembering that the organization exists because of the veterans and their service to our nation is something that can be easily forgotten or overlooked, but is the most important aspect of this business. Following the American Nurses Credentialing Center’s (ANCC) model for magnet recognition will also be an excellent guide to increasing patient outcomes while maintaining fiscal responsibility. Excelling in transformational leadership, structural empowerment, exemplary professional practice, learning new knowledge, innovation, & improvements will lead to empirical quality results (American Nurses Credentialing Center (ANCC), (n.d)). Strategic management will make goals and objectives for clinical service, determine the resources needed to be allocated to achieving those goals and objectives, and will establish policies for getting and using resources. Strategies that take into account incentives and responsibilities faced by the veterans who receive care and the payors that reimburse for that care are important to consider when developing relationship building with providing availability to different types of care at the VAMC (Finkler, Jones, & Kovner, 2013). IMPLICATIONS FOR THE FUTRUE Erroneous colorectal cancer screening is a major fiscal hindrance. Proper screening is an absolute must for facilities to decrease expenditures. The average cost for colonoscopies as a screening tool is almost four times the amount of a FIT/FOBT test. Patients that are average or low-risk with no family history should be screened with a FIT/FOBT test for cost effectiveness for both the facility and the patient. Actual costs of clinical services are highly dependent on the ability to negotiate payment rates with providers, therefore making the actual cost of the clinical services dependent on the provider supply. Colorectal cancer screening programs incur substantial non-clinical costs, regardless of whether the program is colonoscopy- or FOBT/FIT-based (Subramanian et al., 2017). Correct colorectal cancer screening will help eliminate incorrect costs for the CVAMC and the patients. Even though it is a federal government facility, many patients still pay out of pocket expenses and must submit charges to their private insurance companies. Appropriate colorectal cancer screening will eliminate erroneous use of staff’s time and the facility’s resources. Proper colorectal cancer screening will also eliminate stress for the patients and assist with the proper education to the patients. Adjustments such as teaching methods or timeframes for education of the providers will have to be routinely evaluated, along with the amount of staff available to implement this project.

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State Strategies Assignment 2025

State Strategies (20% of grade) 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. Students should summarize their findings in a 1-2 page, single-spaced memo. Sample memo attached. A memo is required, see attached sample. A few examples of state innovations include Vermont’s single payer system, Massachusetts’ health reforms and Kentucky’s Medicaid healthcare program (none of these can be used).

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The Purpose Of The Literature Review. 2025

Discuss the purpose of the literature review and in which situation will you use it? Discuss also what are the challenges that nurses are facing today when they have to do a literature review? APA Format at least 3 paragraphs, with 3 sentences each one 2 citations and references NO PLAGIARISM PLEASE,,, NO ABSTRACT NEEDED

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Response 2025

Discussion Assignment: Respond to the following Case study: Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings. · Share additional interview and communication techniques that could be effective with your colleague’s selected patient. · · Suggest additional health-related risks that might be considered. · · Validate an idea with your own experience and additional research. · · Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format. Age: _42__ Gender: ___Male___ SUBJECTIVE DATA: Chief Complaint (CC): Back Pain History of Present Illness (HPI): A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. Medications: Multivitamins 1 tab daily, Motrin 800mg q4-6hr Allergies: No Known Allergies Past Medical History (PMH): none Past Surgical History (PSH): none Sexual/Reproductive History: Heterosexual single male for 10 years and no sex for 1 year. Personal/Social History: Smoking in the past since19 year of age: Recently quit 2 months ago Immunization History: Up to date. Recent influenza given 12/30/1985 at this clinic Significant Family History: No kids. Never married. Paternal Grandma HTN, Diabetes age 81, Mother HTN Age 69, Father Diabetes, HTN Age 68 Lifestyle: LB work as a registered nurse at Triangle springs over 10years. LB lives in a house he bought in Cary, NC over 4 years ago. LB is a Jehovah Witness but doesn’t practice. LB feels safe at home and denies any signs of depression. LB family are very supportive and they go for family date once every week. LB had a weight loss over a year of 5bs. Review of Systems: General: LB is a pleasant, 42-year-old Caucasian who presents with back pain. He is the primary source of the history. LB offers information freely and without contradiction. LB speech is clear and coherent. He maintains eye contact throughout the interview HEENT: LB does not wear any corrective eye and have not visited an optometrist in over 3 years. Dental was 1 year ago. Denies any other complications. Neck Thyroid smooth, no goiter or lymphadenopathy Breasts: No history of lesions, masses and/or rashes Respiratory: Denies cough, dyspnea, wheezing, or shortness of breath. Cardiovascular/Peripheral Vascular: Reports no tachycardia, edema, palpation or easy bruising. Gastrointestinal: Denies food intolerance. No reports of pain, vomiting, constipation, diarrhea, nausea and/or indigestion. Genitourinary: No reports of flank pain, dysuria, nocturia, polyuria, and/or hematuria Musculoskeletal: Lower back pain over one month ago with radiation to the leg pain a 9/10 and increases higher with standing or sitting long periods of time. Motrin eases pain 1-0/10. Denies numbness. Denies weakness. Pain 0/10 at rest. Psychiatric: Denies any depression, suicidal thoughts or ideation. No anxiety Neurological: No loss of coordination or sensation, dizziness, lightheadedness. No sense of disequilibrium or seizures. Skin: No rashes, no moles Hematologic: Reports no blood disorders or complications Endocrine: No endocrinology symptoms nor hormone therapies Allergic/Immunologic: No allergies OBJECTIVE DATA Physical Exam: Vital signs: Temperature 98.2, BP 122/77, Resp 14, Spo2 100, HR 64, Ht 69 inches Wt 202lbs. BMI 21.6 HEENT: PERRLA, Head, ears, eyes and mouth are symmetry. Snellen chart showed 20/20 in both eyes. Equal hair distribution of hair on eyebrows, lashes, head. Gag reflex intact. Whisper heard bilateral. Oral mucosa is moist and has no lesion or pain. Nasal mucosa pink and moist. Neck Thyroid smooth, no goiter or lymphadenopathy. Chest/Lungs: Chest is symmetry. Auscultation clear lower and upper lobe bilaterally. Resonant percuss throughout . Heart/Peripheral Vascular: S1, S2 without murmurs, rubs and or gallops. Heart regular. PMI is at midclavicular line, 5th intercoastal space with no thrills, lifts, and heaves. Bilateral peripheral pulses equal. Capillary refill less than 3 seconds. No peripheral edema. Bilateral carotids equal without bruit . Abdomen: Bowel sounds normoactive in all four quadrants. No tenderness or guarding during palpation. No organomegaly. Abdomen symmetric, no scars and/or lesions. Tympanic throughout percussion. Musculoskeletal: Full ROM in bilateral upper and lower extriemities, No swelling, deformity, or swelling. Neurological: Equal bilateral in upper and lower extremities and DTRs 2.CN II -XII grossly intact. Skin: No rashes, warm to touch, no wounds. Labs: X ray, CT scan, and/or MRI to look at the bones in lumbar and find the issue CBC and Urinalysis to check for infection/UTI ASSESSMENT: Watch LB walk to check gait. Also lay flat, bend and others that can help me identify LB limitation and things he can do Diagnosis 1) Lumbar Herniated Disk. The lumbar spine contents 5 bony segments in the lower back area, which is where lumbar disease occurs. In herniation and or ruptures the disk continues to break down, or with continued stress on the spine, the inner nucleus pulposus may rupture out from the annulus. This is a ruptured, or herniated disk. The fragments of disc material could then press on the nerve roots located right behind the disk space. This can cause pain as to the legs, weakness, numbness, or changes in sensation (Raj M. Amin, 2017). This also causes leg pain which LB has. 2) Sciatica are back pain caused by a problem with the sciatic nerve. This is a large nerve that runs from the lower back down the back of each leg. LB has pain that goes down to his legs. Sciatica happens when something injures or puts pressure on the sciatic nerve, it can cause pain in the lower back that spreads to the leg, hip, and buttocks (Davis & Vasudevan, 2015). 3) Lumbar spinal stenosis happens when the narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. LB is having his issues While it may affect younger patients, due to developmental causes, which according to the assessment LB has not or it has gone undiscovered, it is more often a degenerative condition that affects people who are typically age 60 and older. LB does smoking which could affect his bones (Carlos Bagley, 2019). 4) Lower back strain is acute pain that is caused by damage to the muscles and ligaments of the back. It is also referred to as a pulled muscle. … Lumbar muscle strain occurs when a back muscle is over-stretched or torn, which damages the muscle fibers. When one of the ligaments in the back tears, it is referred to as a sprain. LB could have been lifting or pulling heavy object or inappropriate working position. As a nurse taking care of patient and not having the back at your level this could happen (Massimo Allegri, 2016). 5) Idiopathic back pain is back pain that physicians cannot explain because there is not obvious structural cause of the pain like a herniated disc, degenerative disc disease, or stenosis. Idiopathic back pain is the “diagnosis” given by doctors to patients that have chronic which is over 6 months back pain and they have been unable to figure out why (Massimo Allegri, 2016). LB has had back pain for a month but do not know the cause at this time. Depending on diagnosis LB may need a topical pain cream, physical therapy, surgery, a back brace. LB will need education on proper body mechanics.

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