Submit Part One Portfolio 

3 .Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.

Education

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.

Research

1. Increase the integration of evidence-based care across the dimensions of end-of-life care.

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.

Administration

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.

4. Support the development and integration of palliative care services for all in- and outpatients and their families.

Discussion Board Question 2: End of Life Care.

Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management.

Purpose

The purpose of this assignment is to demonstrate the skills of the professional nurse as an educator. You are to prepare a guide that will serve as a handout to assist a specific patient that you identify. Your guide or handout should help this patient find and evaluate a reliable mobile health, or mHealth application (app) that is already developed. This may be related to the patient’s disease process or diagnosis, or may be an app that can help a patient maintain or improve good health, and prevent illness.

You will develop the guide using Microsoft PowerPoint. PowerPoint is a versatile application that lets you design slideshows and handouts. For this assignment, you will be using PowerPoint to create a guide or handout that you may print and give to patients and families. You will be submitting this PowerPoint file for grading.

Directions

• You are required to complete this assignment using the productivity tools required by Chamberlain University, which is Microsoft Office 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.pptx” format. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page.
• You are required to cite your source(s) as it relates to your application slide. Other citations are permitted, but this is not a requirement for the assignment.
• Title slide (first slide): Include a title slide with your name and the title of the presentation.
• Scenario Slide (one slide): This slide should include a brief scenario, then identify a patient who is experiencing a specific disease process or diagnosis who would benefit from an already developed and reliable mHealth app. Or it could identify a person who is currently healthy and would like to maintain or improve health and prevent illness. Be sure to include the nurse’s assessment of the patient’s learning needs and readiness to learn. Be specific.

Example:

Scenario for Ms. Ellis

Jane Doe (your name here)

• Jennifer Ellis, a 62-year-old African American woman, has been recently diagnosed with chronic kidney disease (CKD). She has been prescribed several medications she must take every day.
• The nephrologist has stressed the importance of leading a healthy lifestyle to slow or stop the progression of CKD.
• She is interested in ways in which she can better track her health and make healthier choices.
• She is a high school graduate and iPhone user, mostly to send text messages to family and friends.
• She is eager to learn how to use an app that can help her manage her CKD.

Prepare the following slides as if you are presenting them to the patient.

• mHealth application slide (one to three slides): Identify a developed and reliable mHealth app that could benefit the patient. Describe the app, including the following.
• Name
• Purpose
• Intended audience
• Mobile device(s) upon which it will operate
• Where to download or obtain it (include a working link if it is to be downloaded from a website)
• Any other information you believe would be pertinent to this situation
• Be sure to cite all sources you use.
• Teaching slides (one to three slides): Prepare slides that contain important points about the app that you want to teach to the patient, such as how to use the app safely and effectively (including how to interpret and act on the information that is provided).
• Evaluation slide (one to three slides): Describe how you would determine the success of the patient’s use of this app. For example, include ways to evaluate the effectiveness of the teaching plan that are a good fit for the type of app or focus on specific ways that this app benefits the patient’s health and wellness.
• References (last slide): List any references for sources that were used or cited in the presentation.

Writing and design: There should be no spelling or grammatical errors. Writing is concise and clear. Avoid words that the patient may not understand. Slides are visually appealing, incorporating graphics, photographs, colors, and themes.

Review the section on Academic Integrity Policy found in the RNBSN Policies. All work must be original (in your own words) unless properly cited.

Best Practices in Preparing PowerPoint Slideshows

• Be creative but realistic.
• Incorporate graphics, color, themes, or photographs to increase interest.
• Make it easy to read with short bullet points and large font.
• Review directions thoroughly.
• Cite all sources within the slides with (author, year), as well as on the reference slide.
• Proofread prior to final submission.
• Check for spelling and grammar errors prior to final submission.
• Abide by the Chamberlain academic integrity policy.
• Tutorial: For those not familiar with the development of a PowerPoint slideshow, the following link to the Microsoft website may be helpful. http://office.microsoft.com/en-us/support/training-FX101782702.aspx (Links to an external site.)Links to an external site. The Chamberlain Student Success Strategies (CCSSS) offers a module on Computer Literacy that contains a section on PowerPoint. The link to SSPRNBSN may be found in your student portal.

Poor Patient Outcome

Relying solely on the classic features of a disease may be misleading. That’s because the clinical presentation of a disease often varies: the symptoms and signs of many conditions are non-specific initially and may require hours, days, or even months to develop.

Generating a differential diagnosis; that is, developing a list of the possible conditions that might produce a patient’s symptoms and signs — is an important part of clinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.

This case portrays a poor patient outcome after a misdiagnosis.

Case scenario

A previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly 2 hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal.

On physical examination the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.

The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.

Written Assignment:

Developing a list of possible conditions that might produce a patient’s symptoms and signs is an important part of clinical reasoning.

1. As an NP in primary care what would you have done differently?
2. Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?

If a serious diagnosis comes to mind based on a patient’s symptoms:

• Ask yourself; Have you considered the likelihood of it and whether it needs to be ruled out by testing or referral?
• Because many serious disorders are challenging to diagnose, have you considered ruling out the worst case scenario?
• Ask yourself: Do you have sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?
• What other diagnosis could it be? How might the treatment to date have altered the patient outcome?
• What other diagnostic and laboratory or imaging was needed in order to make a complete differential list?  What support tools would you consider using in helping to create a differential diagnosis list?
• Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?
• 5 pages

 

Using the client family from your Week 3 Practicum Assignment, address in a progress note (without violating HIPAA regulations) the following:

• Treatment modality used and efficacy of approach
• Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the treatment plan for progress toward goals)
• Modification(s) of the treatment plan that were made based on progress/lack of progress
• Clinical impressions regarding diagnosis and or symptoms
• Relevant psychosocial information or changes from original assessment (e.g., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job)
• Safety issues
• Clinical emergencies/actions taken
• Medications used by the patient, even if the nurse psychotherapist was not the one prescribing them
• Treatment compliance/lack of compliance
• Clinical consultations
• Collaboration with other professionals (e.g., phone consultations with physicians, psychiatrists, marriage/family therapists)
• The therapist’s recommendations, including whether the client agreed to the recommendations
• Referrals made/reasons for making referrals
• Termination/issues that are relevant to the termination process (e.g., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)
• Issues related to consent and/or informed consent for treatment
• Information concerning child abuse and/or elder or dependent adult abuse, including documentation as to where the abuse was reported
• Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

Part 2: Privileged Note

Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment.

In your progress note, address the following:

• Include items that you would not typically include in a note as part of the clinical record.
• Explain why the items you included in the privileged note would not be included in the client family’s progress note.
• Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

Please develop a marketing plan for a healthcare facility that was recently cited by the OIG (Office of Inspector General), or has been investigated by a journalist (eg., newspaper article, journal). The marketing plan must include a cover page, reference page and must be completed using Microsoft PowerPoint. 

Please answer the following items in your marketing plan: minimum 8 slides 

1. Organizational Summary – Explain why the company is in trouble
2. Analysis of the External Environment – (Public perception, economy)
3. Threats and Opportunities                                                           
4. Marketing Goals and Objectives                                     
5. The Target Market
6. Competition – List possible competitors                                                
7. Marketing Strategy                                                            
8. Action Programs (Marketing tactics)                         
9. Budgets – How much money do you think this would cost?