Nurses as Change Agents in the Community

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

.

In the chapter, “How Community-Based Organizations Are Addressing Nursing’s Role in Transforming Health Care,”(SEE ATTACHED DOCUMENT HAVE THE CHAPTER TO READ))))) the authors describe the community as the focus of advocacy action for change. They list a series of questions that help community teams develop organizing principles to guide their interventions, and the aim is to attack social determinants of health to make community change.

Suppose a community team identifies lack of access to exercise modalities as a public health issue. If the team were to determine that pedestrian walkways need to be constructed, discuss at least two factors that would facilitate the development of the walkways and two that would hinder the development. For the hindrances, discuss ways that the team might work to overcome those hindrances.

Continue to read daily from one of the policy briefs that are included in your weekly readings list. POLITICO Pulse is a daily briefing from POLITICO, and the Kaiser Health News Morning Briefing is a daily briefing from the Kaiser Family Foundation. Both focus on health care. Either one will keep you abreast of what is happening in health care policies and politics.

In addition, subscribe to the “HealthCetera” podcast and listen to the podcast weekly. This is a production of WBAI, free speech radio of Pacifica Foundation Radio in New York City. Diana Mason and Barbara Glickstein are founders and codirectors of the Center for Health Media Policy (CHMP). Both are recognized as experts in media, nursing, health, and health policy. They have a longstanding relationship as producers and moderators of HealthCetera, a live, award-winning radio program on public radio and iTunes. They are bloggers for Disruptive Women in Health Care and for the American Journal of Nursing (AJN). The CHMP is an interdisciplinary initiative for advancing the health of the public and healthy public policies through media, research, education, and public forums. Listen to the podcast throughout the course and think on the topics that are discussed, especially as they relate to how we advocate for issues of importance in this contemporary political environment.

Required Reading

Anonymous. (2015). Enforcement procedures for the Occupational Therapy Code of Ethics. The American Journal of Occupational Therapy, 69(Suppl. 3) 1-13. Retrieved from the Trident Online Library.

Baker, K. R. (2016) An obligation to society. Drug Topics, 160(10). Retrieved from the Trident Online Library.

Battie, R. N. (2015) Thriving through trust: Ethical practice, quality care. AORN Journal, 101(5). 505-507. Retrieved from the Trident Online Library.

Chiarello, E. (2015) The War on Drugs comes to the pharmacy counter: Frontline work in the shadow of discrepant institutional logics. Law and Social Inquiry, 40(1) 86-122. Retrieved from the Trident Online Library.

Divakar, D. D., Al Kheraif, A. A., Ramakrishnaiah, R., Al Zhrane, M., Al-Hazmi, A., and Parine, N. R. (2015). Ethics in dentistry an overview: Electronic search study. Revista Romana de Bioteca, 12(3). Retrieved from the Trident Online Library.

Grass, J. C. (2016). The Medicine Shoppe v. Loretta Lynch, et al.: Pharmacists and prescribing physicians are equally liable. The Health Lawyer, 28(3), 28-37. Retrieved from the Trident Online Library.

Limenti, A. E. (1999). The role of ethical principles in health care and the implications for ethical codes. Journal of Medical Ethics, 25. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC479265/pdf/jmedeth00006-0032.pdf

Yang, Y. T., Attanasio, L. B., & Kozhimannil, K. B. (2016). State scope of practice laws, nurse-midwifery workforce, and childbirth procedures and outcomes. Women’s Health Issues, 26(3) 262-267. Retrieved from the Trident Online Library.

Young, G., Hulcombe, J., Hurwood, A., & Nancarrow, S. (2015). The Queensland Health Ministerial Taskforce on health practitioners’ expanded scope of practice: Consultation findings. Australian Health Review, 39(3), 249-254. Retrieved from the Trident Online Library.

Optional Reading

American Clinical Social Work Association (n.d.) Code of Ethics. Retrieved from http://www.acswa.org/code-ethics/

American Society of Clinical Laboratory Science (n.d.) Code of Ethics. Retrieved from  http://www.ascls.org/about-us/code-of-ethics

International Board of Lactation Consultant Examiners (2015) Code of Professional Conduct. Retrieved from https://iblce.org/wp-content/uploads/2017/05/code-of-professional-conduct.pdf

National Association of Emergency Medical Technicians (2013). Code of Ethics. Retrieved from https://www.naemt.org/about-ems/emt-oath

**Homework Case Assignment

All health and allied-health professions have a Code of Ethics that is designed to guide those within the field. For this assignment, if you work in an allied-health field, please locate your professional Code of Ethics. If not, please choose a Code of Ethics from the Optional Reading.

1. Provide an overview of the Code of Ethics that you have chosen. What are some of the major areas that are covered? Why are these important to the profession?
2. Are there areas that you think are missing and relevant to the profession? Explain why or why not. This should not be opinion but should be supported by reliable sources. For example, you can use another Code of Ethics that covers the area(s) that you feel are important to support your argument, or also use scholarly and professional articles.
3. Are any of the ethical principles discussed earlier in the course mentioned in the Code of Ethics? If none are mentioned specifically, are they alluded to in the Code? Give examples.
4. Why is it important for all health professionals to have a Code of Ethics?

Assignment Expectations

1. Conduct additional research to gather sufficient information to support your writing. This should not be an opinion piece, but an analysis.
2. Avoid the use of first person in your paper.
3. Limit your response to a maximum of 3-5 pages.
4. Support your paper with peer-reviewed articles and reliable sources, and use at least 3 references. For additional information on how to recognize peer-reviewed journals, see http://www.angelo.edu/services/library/handouts/peerrev.php and for evaluating internet sources:
   https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content
5. You may use the following source to assist in your formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/

DUE 3/15/2018 8 P.M EST

PUBLIC HEALTH ….CAMPAIGN PRESCRIPTION DRUG OVERDOSE

APA FORMAT MIN 4 REFERENCES

  

Discussion: The Planning Process

In planning for your public health campaign (PRESCRIPTION DRUG OVERDOSE), first you must identify the problem. You ask questions such as “what is happening in the community?” and “what are the critical issues that need to be addressed within my target audience?” By asking these types of questions, you gain knowledge about the true needs of the community and can develop public health campaigns reflecting those needs. Second, you must establish your goals for your campaign, and identify effective marketing techniques and a communication plan. The planning process is a comprehensive yet valuable tool for any public health leader to maintain clarity, organization, and focus of the campaign.

For this Discussion, consider the important elements of the planning process and what factors (individual, environmental, financial, social, to name a few) could inhibit or enhance the development and/or implementation of your public health campaign.

With these thoughts in mind:

Post a brief description of which element of the planning process is most valuable in developing a public health campaign (PRESCRIPTION DRUG OVERDOSE) and explain why. Then describe one factor (individual, environmental, financial, etc.) that may facilitate and one factor that may inhibit the planning of your public health campaign and explain why.

   

                                            Assignment: Decision Tree

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.

                                                          The Assignment:

Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

• Decision #1: Differential Diagnosis
  • Which Decision did you select?
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. 
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
• Decision #2: Treatment Plan for Psychotherapy
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. 
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
• Decision #3: Treatment Plan for Psychopharmacology
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. 
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
• Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. 

                                                                                Case #2
Anxiety disorder, OCD, or something else? 

                                                                    BACKGROUND

Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for. 

Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street. 

His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.” 

Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations. 

                                                                OBJECTIVE

During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders. 

When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.  

        

                                                         MENTAL STATUS EXAM

Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation. 

Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. 

                                                   Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 

Generalized Anxiety Disorder (GAD)

Obsessive Compulsive Disorder

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)

 ANSWER CHOOSEN: Obsessive Compulsive Disorder 

                                                 Decision Point Two

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

 

Begin Zoloft 50 mg orally daily

Begin Fluvoxamine immediate release 25 mg orally at bedtime

Begin Fluvoxamine controlled release 100 mg orally in the morning

 

Discontinue Zoloft and begin Fluvoxamine controlled release 100 mg orally every morning In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this. Zoloft is FDA-approved to treat OCD in children. However, between ages 6 and 12, it should be started at 25 mg orally daily. If starting doses are too high, the child may experience side effects that he associates with the medication and as such, may refuse to take the medication. Starting at too high a dose can result in unfavorable side effects (gastrointestinal side effects are notable in this drug), and we can see that Tyrel is experiencing nausea and decreased appetite. In this case, it is recommended to wait to see if the side effects dissipate. Decreasing the dose to 12.5 mg orally daily for about 3 or 4 days, then going back to 25 mg orally daily may help to overcome the unfavorable side effects. If side effects persist, the PMHNP may need to consider switching to a different medication.Fluvoxamine controlled release is not FDA-approved for use in children with OCD (see “Special Populations: Children and Adolescents” in the Fluvoxamine monograph of Stahl’s Prescriber’s Guide for further details). Fluvoxamine 100 mg orally daily may not be tolerated in the morning secondary to the drug’s sigma-1 antagonist properties, which can cause sedation. Dosing of Fluvoxamine should be such that the larger dose is given in the evening to minimize daytime sedation. It is also worth noting that nothing in the scenario tells us that the Zoloft will not be effective. 

ANSWER CHOOSEN: Begin Fluvoxamine immediate release 25  

mg orally at bedtime 

·Client returns to clinic in four weeks

·Upon return to the clinic, Tyrel’s mother reported that he has had some 

 decrease in his symptoms. She states that the frequency of the handwashing 

  has decreased, and Tyrel seems a bit more “relaxed” overall. 

·She also reports that Tyrel has not fully embraced returning to school, but that 

 his attendance has improved. She reported that over this past weekend, Tyrel  

 went outside to play with his friend from across the street, which he has not done in a while.

RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

· Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.

·  She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.

                                                       Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

 

Increase Fluvoxamine to 50 mg orally at bedtime

Augment with an atypical antipsychotic such as Abilify

Augment treatment with cognitive behavioral therapy

ANSWER CHOOSEN: Increase Fluvoxamine to 50 mg orally at 

 bedtime

 

Guidance to Student

In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.

Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.

At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.

Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.

Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well.

                                                 Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter      31, “Child Psychiatry” (pp. 1253–1268)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Anxiety Disorders”

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf 

McClelland, M., Crombez, M-M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Health Care, 29(5), 442–452. doi:10.1016/j.pedhc.2015.03.005

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. 

SEE ATTACHED ASSIGNMENT OF DECISION TREE AND ASSIGNMENT EXAMPLE/SAMPLE 

Due Tomorrow At 1:00 PM

Discussion Board #6

HCA 340

Discussion Board Assignment #6

Chapter 7–The Health Care Workforce and Chapter 8—Financing Health

Answer the following questions on Health Care Workforce/Personnel:

1. The majority of schools of medicine, dentistry, nursing, and other professions and their teaching hospitals are heavily subsidized by federal and state funds. Many of those graduates, when they become health practitioners, feel no obligation to society for their publicly supported education. Do health care providers who reap the benefits of high compensation and social position have an ethical responsibility to repay taxpayers by meeting the needs of the medically underserved?
2. Technical advances in health care have spawned an ever-increasing number of specialty- trained personnel. More recently, however, hospitals and other institutions are promoting the cross-training of personnel so that they can perform multiple tasks and work more flexibly, based on institution needs. What are the implications of cross training, in terms of quality of care, costs, and efficiency?
3. Men comprise a small segment of the nurse population, although their numbers are increasing.  Given the good income potential of the nursing profession and continuing demand, what is your opinion about why nursing does not attract more males?

Answer the following questions on Health Care Financing:

1. Name one (1)  way each of the following has affected the costs of health care in the US?
   • The health insurance industry
   • Advances in medical care technology
   • Changes in U.S. demographics
   • Government support for health care
   • Consumer expectations
2. If we accept the premises that resources available to meet the costs of health care are finite, and that continuing to increase dollars allocated for health care expenses carries “opportunity costs“ for the nation and society, discuss your position on the following: As a national policy should we allocate a set level of resources and apply them to achieving “the greatest good for the greatest number” (necessarily leaving some out) OR should we adopt the individualist approach of “those who can pay get, those who can’t pay, don’t?”
3. From the patient perspective, what might be some of the positive and negative aspects of “disease management programs?”