1. Portfolio part II 

a) APRN protocol also known as collaborative agreement with supervising physician(s).

b.) business proposal (refer to portfolio explanation/examples found on your BB lecture section. 

There is an example of a business proposal. Use the example to create a brief business proposal with no more than two pages word or power point as your choice;

c.) Create a LinkedIn page and send me a proof of you creating the link.

The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. 

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia. 

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Trazodone: 50–100 mg daily at bedtime 

RESULTS OF DECISION POINT ONE

• Patient returns to clinic in 2 weeks
• Patient states medication works well but gives him an unpleasant side effect of a prolonged erection of the penis, approximately 15 minutes after waking 
• Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning
• Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

Explain that priapism is a side effect of trazodone that should diminish over time. Continue dose 

RESULTS OF DECISION POINT TWO

• Patient returns to clinic in 2 weeks
• Patient states priapism has diminished over time
• Patient denies auditory/visual hallucinations and is future oriented 
• Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness
• Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

Continue dose. Explain to patient he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks 

Guidance to Student
Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.
The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks. 

Assignment: Agenda Comparison Grid and Fact Sheet or Talking Points Brief

It may seem to you that healthcare has been a national topic of debate among political leaders for as long as you can remember.

Healthcare has been a policy item and a topic of debate not only in recent times but as far back as the administration of the second U.S. president, John Adams. In 1798, Adams signed legislation requiring that 20 cents per month of a sailor’s paycheck be set aside for covering their medical bills. This represented the first major piece of U.S. healthcare legislation, and the topic of healthcare has been woven into presidential agendas and political debate ever since.

As a healthcare professional, you may be called upon to provide expertise, guidance and/or opinions on healthcare matters as they are debated for inclusion into new policy. You may also be involved in planning new organizational policy and responses to changes in legislation. For all of these reasons you should be prepared to speak to national healthcare issues making the news.

In this Assignment, you will analyze recent presidential healthcare agendas. You also will prepare a fact sheet to communicate the importance of a healthcare issue and the impact on this issue of recent or proposed policy.

To Prepare:

• Review the agenda priorities of the current/sitting U.S. president and the two previous presidential administrations.
• Select an issue related to healthcare that was addressed by each of the last three U.S. presidential administrations.
• Reflect on the focus of their respective agendas, including the allocation of financial resources for addressing the healthcare issue you selected.
• Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.

The Assignment: (1- to 2-page Comparison Grid, 1-Page Analysis, and 1-page narrative) with a title page, an introduction, purpose statement, and a conclusion. This is an APA paper.

Part 1: Agenda Comparison Grid

Use the Agenda Comparison Grid Template found in the Learning Resources and complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the two previous presidential administrations and their agendas related to the public health concern you selected. Be sure to address the following:

• Identify and provide a brief description of the population health concern you selected and the factors that contribute to it.
• Describe the administrative agenda focus related to the issue you selected.
• Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue.
• Explain how each of the presidential administrations approached the issue.
• At least 3 resources must be used

Part 2: Agenda Comparison Grid Analysis

Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:

• Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected?
• How do you think your selected healthcare issue might get on the agenda for the current and two previous presidents? How does it stay there?
• Who would you choose to be the entrepreneur/ champion/sponsor of the healthcare issue you selected for the current and two previous presidents?

Part 3: Narrative

Using the information recorded on the template in Parts 1 and 2, develop a 1-page narrative that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:

• Summarize why this healthcare issue is important and should be included in the agenda for legislation.
• Justify the role of the nurse in agenda setting for healthcare issues.
• The response fully integrates at least 2 outside resources and 2-3 course specific resources that fully supports the summary provided.

Submit your final version of Part 1: Agenda Comparison Grid, Part 2: Agenda Comparison Grid Analysis, and Part 3: Narrative.

Grading Criteria

To access your rubric:

Assignment Overview

Strong writing skills enable you to create doctoral projects that articulate a purpose. Creating a plan to improve these skills, using selected resources, sets the stage for writing. In this assignment, you will create a writing skills development plan by applying a selected EBP model to address strengths and weaknesses and fulfill the writing goals you have created.

What You Need to Know

Applying Conceptual Models, Theoretical Frameworks, and EBP Models

There is increasing recognition that efforts to change practice with the EBP process should be guided by conceptual models and grounded by theoretical frameworks.

A conceptual model provides an understanding about how a health care challenge will best be explored and addressed, and it offers a logical structure of connected elements that help provide a picture or visual display of how ideas in a study or project relate to one another. Existing conceptual models can be found in the literature, or they can be created by the researcher or the team exploring and addressing the problem. A theoretical framework is derived from an existing theory in the literature that has already been tested and validated by others and is considered a generally accepted theory in scholarly literature. A good way to distinguish between a conceptual model and a theoretical framework is to think of the conceptual model as the floor plan of a house and the theoretical framework as the 3-D image showing the spatial relationships among rooms.

Application of the EPP Model

In the event of a hurricane, tornado, or other natural disaster, immediate activation of the local public health agency (LPHA) emergency preparedness system is crucial. The workforce at the LPHA is essential for locally-driven disaster recovery efforts as they are responsible for coordinating a large number of health services. Each individual employee must perform their job quickly and efficiently. But in the face of an emergency, when stress levels and emotions are running high, how do we know that LPHA employees are able to do their jobs effectively? Perhaps they are overcome with fear and are responding with denial or avoidance. Do employees perceive that they perform their jobs well and that they are effective in helping people? What could the LPHA do to increase employees’ motivation to do their jobs well and improve the effectiveness of disaster response efforts?

Researchers at the Johns Hopkins Bloomberg School of Public Health proposed in 2015 that a behavioral framework, the Extended Parallel Process (EPP) Model, could be used to examine LPHA workers’ disaster recovery perceptions and to implement an evidence-based educational intervention to improve workers’ effectiveness. The model predicts that in the face of a disaster, people will engage in proactive behaviors if they perceive the disaster as a real threat or danger, and if they believe they can perform their tasks effectively to minimize the risk to themselves and others.

The conceptual map created by the researchers illustrates the application of the EPP Model, showing that during periods of perceived threat or danger, when employees feel strongly that they are able to do their jobs well and that their efforts are effective (high level of self-efficacy), they are motivated toward responding quickly and efficiently. With the application of the EPP model in this scenario, it would be appropriate to then identify research evidence to support the implementation of an educational intervention to improve employees’ self-efficacy and effectiveness.

EBP Models

Early in the EBP movement, health care scientists, including many nurse scientists, developed models based on existing theories, experience, evidence, and concepts to organize our thinking about EBP and help us understand how various aspects of EBP work together to improve care and outcomes. These models guide the design and implementation of approaches intended to strengthen evidence-based decision making and help professionals implement an evidence-based change in practice (Melnyk & Fineout-Overholt, 2019).

References

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

Walsh, L., Garrity, S., Rutkow, L., Thompson, C. B., Strauss-Riggs, K., Altman, B. A., . . . Barnett, D. J. (2015). Applying a behavioral model framework for disaster recovery research in local public health agencies: A conceptual approach. Disaster Medicine and Public Health Preparedness, 9(4), 403–408. 

APPLYING AN EBP FRAMEWORK TO IMPLEMENT A WRITING DEVELOPMENT PLAN

This assignment focuses on using the EBP process and applying an EBP model or framework to improve your writing skills. Writing that is characterized by strong organization, appropriate use of evidence, scholarly tone, grammatically-sound sentence structure, and correctly-formatted citations and references is of paramount importance in all aspects of your professional role. Excelling in all three of these areas enables you to seamlessly integrate them into aspects of your professional life, including your roles of scholar-practitioner and health care leader. Creating and implementing your own plan to continually develop these skills will set the stage for improvements in your writing so that you communicate accurately and eloquently.

In this assignment, you will choose one of eight EBP models or frameworks that best applies to a PICO(T) question focused on the continued development and improvement of writing skills. You will then create a writing skills development plan by applying the EBP model or framework. Your aim is to facilitate the achievement of two specific writing improvement goals you created when you reflected on and examined feedback received throughout this course from Smarthinking and your instructor.

The following PICOT question will serve as the basis for this assignment:

• For my professional roles of scholar, practitioner and healthcare leader (P), will a writing skills development plan based on a specific EBP model or framework (I) improve my writing skills and facilitate the achievement of my two writing goals (C, O) in the next 3-6 months (T)?

In this PICO(T) question, the population (P) is you and the professional roles you seek to enrich, improve and refine. The writing skills development plan, based on the application of an EBP model of your choice, is the evidence-based intervention (I). The outcomes (O) include improved writing skills, as delineated by two specific writing goals you have identified for yourself from the results of your Writing Self-Assessment and feedback received from Smarthinking and your instructor, which also serve as the baseline or comparison (C). The timeframe (T) should be a realistic, feasible amount of time in which you will monitor and observe demonstrated improvements.

Preparation

Be sure that you’ve completed the Writing Self-Assessment.

Instructions

Create a writing skills development plan.

Plan Format and Length

• Use the APA Style Paper Template [DOCX]. An APA Style Paper Tutorial [DOCX] is also provided to help you in writing and formatting your plan. Be sure to include:
  • Title page and references page. An abstract is not required.
  • A running head on all pages.
  • Appropriate section headings.
  • Add your concept map as an appendix.

Your plan should be 4–5 pages in length, not including the title page and references page.

Assignment Grading

The following requirements correspond to the scoring guide criteria, so be sure to address each point. Read the performance-level descriptions in the scoring guide for each criterion to see how your work will be assessed.

• Assess your writing strengths and weaknesses.
  • Use the results from your writing self-assessment and feedback received from Smarthinking and from your instructor via the writing feedback tool, scoring guides, discussions, and any other courseroom communications.
  • What are the implications of your current skill level for writing at the doctoral-level?
• Discuss specific writing development or improvement goals as they relate to each element in a PICO(T) question.
• Create a concept map that illustrates the application of an EBP model or framework to achieve your writing development or improvement goals.
• Identify the implementation strategies and resources needed to carry out a writing skills development plan.
• Support main points, assertions, arguments, or conclusions with relevant and credible evidence.
• Adhere to the rules of grammar, usage, and mechanics.

Information literacy is critically important for all nurses, especially APNs. APNs must be able to determine what information is needed, find the information, critique the information, provide care based on this information, and evaluate the outcomes of the process. Sound challenging? Continue to reflect upon strategies to facilitate this process. Provide a brief response (100 words or less)