Health Care Delivery Models and Nursing Practice 

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

 Write a brief Introduction why you chose these decisions .

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility. 

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes. 

References

Attached you will find the instructions for the assignment. 

• Week 3 insturctions attachment give details on how the assignment needs to be completed. 

• Materials and Methods Example: Shows an example of how it should be written.

• USE THESE CONTROL & EXPERIMENTAL GROUPS AND INDEPENDANT/DEPENDANT VARIABLE: Tells you the independent and dependent variables for my study. 
• Two graphs MUST be included. The specifics are written in the same attachment mentioned ABOVE

Assignment needs to be completed by tomorrow.

Discussion: Cognitive Behavioral Therapy: Group Settings Versus Family Settings

As you might recall from Week 5, there are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in group settings and family settings, consider challenges of using this approach with your own groups.

Learning Objectives

Students will:

• Compare the use of cognitive behavioral therapy for groups to cognitive behavioral therapy for families
• Analyze challenges of using cognitive behavioral therapy for groups
• Recommend effective strategies in cognitive behavioral therapy for groups

To prepare:

• Reflect on your practicum experiences with CBT in group and family settings.

Post an explanation of how the use of CBT in groups compares to its use in family settings. Provide specific examples from your own practicum experiences. Then, explain at least two challenges counselors might encounter when using CBT in the group setting. Support your response with specific examples from this week’s media.

Journal Details

Writing about one’s personal experience encourages self-reflection and improves self-awareness. In this activity students are invited to reflect, in writing, on their experiences related to managing clinical risks for patients. Students to write about an event they observed or were involved in during their nursing profession that they feel might have placed a patient at risk. Alternatively, students may want to write about an event that occurred to them as recipients of healthcare, or as an observer to their friends’ or family members’ experiences. The event may be one that they feel related to any of anticipation, recognition, or management of a patient safety risk. Safe patient care and reducing medical-legal risk requires nurse practitioners to be aware of potential risks and how to avoid them.

The narrative should include:

• a description of the event
• an explanation of how this event placed a patient at risk
• the student’s reflections on the event including:
• if and how the event was recognized
• why and how the event occurred, for example, was the event due to
  • action or inaction by an individual healthcare provider
  • system failure(s)
  • a combination of systems failure(s) and individual provider performance issues
• what changes or improvements they would make, if any
• how they felt at the time
• how they currently feel about the even
• Were you personally involved in the event? Discuss.
• What, if any, workplace factors contributed to the event? (e.g., Was it during a handover? Did it involve a medication?)
• How aware was the healthcare provider(s) of what was going on around them? (situational awareness)
• How did the health care provider(s) recognize the safety problem, and how did they respond?
• How did this event affect you?
• What did you take away that you will use in the future?
• I would do something differently next time because 

Assignment Requirements:

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

Your writingAssignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style; and
• use APA 6th Edition format as outlined in the APA Progression Ladder.