Due April 6 at 11:59 PM

The Impact of Chronic Illness

In a Microsoft Word document of 4-5 pages formatted in APA style, describe the information collected about a person with a chronic illness.

Identify one person from the illness group you chose in Week 1 to interview. The person should not be a patient at the facility in which you work. You can use friends, family members, or coworkers. Do not use the person’s name in the paper, only initials.

Administer the questionnaire you created in Week 1 to that person and address the following:

• Compile the data and analyze the responses to better illustrate where this person, his or her family, and friends are in relation to accepting the diagnosis in relation to the standard health or illness definitions.
  • The analysis should also include coping skills, treatment, and support aspects of the illness.
• Explain how this information will direct care plan development for the chosen illness group.
• Include a copy of the interview you created with the responses from the person interviewed in an Appendix.

Support your responses with examples and information from library resources, textbook and lectures.

On a separate reference page, cite all sources using APA format.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

• Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
• Identify the  pathophysiology of the disorders presented in each of the three scenarios, including their  associated alterations. Consider the adaptive responses to the alterations.
• Review the examples of  “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease  (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified  from the scenarios. Use the examples in the media as a guide to construct a  mind map for the disorder you selected. Consider the epidemiology, pathophysiology,  risk factors, clinical presentation, and diagnosis of the disorder, as well as  any adaptive responses to alterations.
• Review the Application Assignment Rubric found under  Course Information 

To Complete

Write a 2- to 3-page paper  excluding the title page, reference page and Mind Map that addresses the  following:

• For each of the three scenarios explain the pathophysiology,       associated alterations and the patients’ adaptive responses to the       alterations caused by the disease processes.  You are required to discuss all three       scenarios within the paper component of this assignment.
• Construct one mind map on a selected disorder  presented in one of the scenarios. Your Mind Map must include the epidemiology,  pathophysiology, risk factors, clinical presentation, and diagnosis of the  disorder, as well as any adaptive responses to alterations.

resources:

Huether, S. E., & McCance, K. L. (2017). Understanding  pathophysiology (6th ed.). St. Louis, MO: Mosby.
 
Chapter 6, “Innate Immunity: Inflammation and Wound Healing”

This chapter examines how the body responds to injury and infection by exploring the first, second, and third lines of defense. It also covers wound healing and alterations of the wound healing process.

Chapter 7, “Adaptive Immunity”

This chapter examines the third line of defense, adaptive immunity. It also covers the roles of antigens and immunogens, the humoral immune response, cell-mediated immunity, and the production of B and T lymphocytes in the immune response.
Chapter 8, “Infection and Defects in Mechanism of Defense”

This chapter covers the epidemiology, clinical presentation, and treatment of disorders resulting from infection, deficiencies in immunity, and hypersensitivity. It also examines the pathophysiology of an important immune disorder—HIV/AIDS.
Chapter 9, “Stress and Disease”

This chapter evaluates the impact of stress on various body systems and the immune system. It also examines coping mechanisms and disorders related to stress.
Chapter 10, “Biology of Cancer”

This chapter explores the developmental process of cancer and factors that impact the onset of cancer at the cellular level. It also describes various treatment options.
Chapter 11, “Cancer Epidemiology”

This chapter reviews genetic, environmental, behavioral, and diet-related risk factors for cancer. It also examines types of cancers that result from risk factors.

Chapter 12, “Cancer in Children and Adolescents”        

This chapter focuses on the presentation and prognosis of childhood cancers. It examines the impact of genetic and environmental factors on these cancers.

Chapter 38, “Structure and Function of the Musculoskeletal System”

This chapter covers the structure and function of bones, joints, and skeletal muscle. It also explores effects of aging on the musculoskeletal system.
Chapter 39, “Alterations of Musculoskeletal Function”

This chapter examines the pathophysiology, clinical manifestations, and evaluation and treatment of bone, joints, and skeletal muscle disorders. Additionally, it explores musculoskeletal tumors, osteoarthritis, and rheumatoid arthritis.
Chapter 40, “Alterations of Musculoskeletal Function in Children”

This chapter includes musculoskeletal disorders that affect children, such as congenital defects, bone infection, juvenile idiopathic arthritis, muscular dystrophy, musculoskeletal tumors, and nonaccidental trauma.
Chapter 41, “Structure, Function, and Disorders of the Integument”

This chapter begins with an overview of the structure and function of skin. It then covers effects of aging on skin, as well as disorders of the skin, hair, and nails.
Chapter 42, “Alterations of Integument in Children”

This chapter covers alterations of the integument that affect children. These include acne vulgaris, dermatitis, infections of the skin, insect bites and parasites, vascular disorders, and other skin disorders.
 

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th  ed.). New York, NY: McGraw-Hill Education.
 
Chapter 3, “Disorders of the Immune System”

This chapter explores the anatomy and physiology of the immune system. It also explores the pathophysiology of various immune disorders such as primary immunodeficiency diseases and AIDS.
Chapter 8, “Diseases of the Skin”

This chapter begins with an overview of the anatomy and physiology of skin. It also explores the pathophysiology of various types of skin lesions and inflammatory skin diseases.
Chapter 24, “Inflammatory Rheumatic Disease”

This chapter explores the pathogenesis of inflammation and its role in rheumatic diseases. It also examines the clinical presentation, etiology, pathophysiology, and clinical manifestations of rheumatic diseases such as gout and rheumatoid arthritis.

Rubic:              

Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–Levels of Achievement:Excellent 27 (27%) – 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
Good 24 (24%) – 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.
Fair 21 (21%) – 23 (23%)
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.
Poor 0 (0%) – 20 (20%)
Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.Feedback:

Quality of Work Submitted:
The purpose of the paper is clear.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria.
Good 4 (4%) – 4 (4%)
Purpose of the assignment is stated, yet is brief and not descriptive.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Purpose of the assignment is vague or off topic.
Poor 0 (0%) – 3 (3%)
No purpose statement was provided.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Understand and interpret the assignment’s key concepts.–Levels of Achievement:Excellent 9 (9%) – 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts.
Good 8 (8%) – 8 (8%)
Demonstrates a clear understanding of key concepts.
Fair 7 (7%) – 7 (7%)
Shows some degree of understanding of key concepts.
Poor 0 (0%) – 6 (6%)
Shows a lack of understanding of key concepts, deviates from topics.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–Levels of Achievement:Excellent 18 (18%) – 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.
Good 16 (16%) – 17 (17%)
Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.
Fair 14 (14%) – 15 (15%)
Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.
Poor 0 (0%) – 13 (13%)
Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings,  textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–Levels of Achievement:Excellent 18 (18%) – 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.
Good 16 (16%) – 17 (17%)
Summarizes information gleaned from sources to support major points, but does not synthesize.
Fair 14 (14%) – 15 (15%)
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.
Poor 0 (0%) – 13 (13%)
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.Feedback:

Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity
Good 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.
Poor 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.Feedback:

Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) grammar, spelling, and punctuation errors.
Poor 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback:

Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) APA format errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) APA format errors.
Poor 0 (0%) – 3 (3%)

 Respond to this post with a positive response :

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Use at least 3 references

                            The Accountability and Affordable Care Act of 2010

            A public policy that is impacting my workplace along with the rest of the nation’s healthcare is the Accountability and Affordable Care Act of 2010 (ACA).  Overall, this policy expanded eligibility for Medicaid to millions of Americans (Frank, Beronio, & Glied, 2014).  Before the ACA, the mentally ill was a population who struggled to gain access to care.  Fortunately, now the mentally ill can get insurance coverage which has impacted the facility in which I work.  We are always full with a waiting list of patients trying to get admitted.  

The ACA was designed to improve access, cost, and quality to care for all Americans.  According to the Substance Abuse and Mental Health Services Administration (2018), it has dramatically impacted the number of Americans who have access to mental health care.  According to Laureate Education (2012a), 32 million Americans who did not have coverage before this act will have coverage.  In conjunction with the Mental Health Parity and Addictions Equity Act, about 60 million Americans will have access to mental health services (Frank et al., 2014).  Also, the ACA was designed to help the cost of healthcare.  Unfortunately, this cost was initially expensive for our nation (Laureate Education, 2012a).  However, in the long run, the Affordable Care Act will hopefully save the nation money (Laureate Education, 2012a).  Lastly, quality was a goal of the ACA.  The ACA prompted changing payment models so that facilities are held accountable for quality care, and value of delivered care effects reimbursement rates (Knickman & Kovner, 2015).  Overall, the ACA is still a work in progress to improve access, cost, and quality of care.

As a nurse in a psychiatric facility, the ACA has impacted my daily life.  Due to the increase in access to care, my facility is always busy.  We are continuously full, and there are always patients waiting to get in.  Next week, our new building will be opening which will more than double our beds.  The ACA has also affected the quality of care given in my facility.  High importance is placed on care coordination to make sure the patient has follow-up care to avoid readmission.  Also, leadership is focused on monitoring incidences and near misses to avoid errors as errors are expensive.  The ACA has, unfortunately, added much stress to the daily lives of healthcare professionals in my facility.

Staffing in Healthcare

An enormous struggle we are facing in our facility, and one I would like to see change through public policy, is staffing of nurses and patient care techs.  This issue seems to come up in every conversation among nurses no matter where they work.  Soon, my facility will have the supply of rooms along with the demand of patients, but we do not have the staff.  This staffing crisis makes me nervous.

Kingdon’s model identifies four influential factors to get issues on the public agenda (Milstead, 2019).  First, the problem stream is the staffing crisis that hospitals and agencies face all over our nation (Milstead, 2019).  In my 11 years of nursing in three different hospitals, staffing ratios have only worsened.  Second, the policy stream attaches a solution to the problem (Milstead, 2019).  The answer to the staffing crisis may be to implement policy not allowing hospitals to admit patients if they can’t maintain a specific staffing ratio of nurses to patients.  Third, the political stream includes getting the problem and solution government attention (Milstead, 2019).  As nurses, we could set up a campaign to get the word out regarding staffing and could notify our local representatives.  The fourth factor that influences getting issues on the public agenda is the window of opportunity (Milstead, 2019).  This concept is about the timing of introducing a problem.  A good time may be close to an election year when it is vital for local representatives to get votes from their constituents (Laureate Education, 2012b).  

Due to the ACA, millions of Americans, especially the mental health population, were given access to more affordable and quality healthcare.  Unfortunately, the healthcare industry is not ready.  Staffing is the next problem needing to be addressed by our government.   

References

Frank, R.G., Beronio, K., & Glied, S.A. (2014). Behavioral health parity and the affordable care act. J Soc Work Disabil Rehabil, 13, 31-43. doi: 10.1080/1536710X.2013.870512

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

Laureate Education (Producer). (2012a). Introduction to healthcare delivery, part II: Healthcare reform. Baltimore, MD: Author.

Laureate Education (Producer). (2012b). Health policy and politics. Baltimore, MD: Author.

Milstead, J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones and Bartlett Publishers.

Substance Abuse and Mental Health Services Administration. (2018). Laws and Regulations. Retrieved from https://www.samhsa.gov/about-us/who-we-are/laws-regulations

 Read a qualitative nursing study. If a different investigator had gone into the field to study the same problem, how likley is it that the conclusions would have been the same? How transferable are the research’s findings? 

APA Style 4 paragrphs, no Abstract needed, with Citations and References

NO PLAGIARISM PLEASE

Please In 2-3 paragraph respond to this post : 

A Walk Through The Steps of a Nursing Research Study-2.docx 

What have you learned and will it make a difference?

In my welcome letter to you, I indicated that every class should change your thinking about the focus of the class. Again read the provided ” A Walk Through The Steps of a Nursing Research Study”.  This is the same document you were provided during Week 1. Has your ability to read with understanding changed? Briefly share your thoughts regarding this experience. In this discussion forum  from a “qualitative approach” briefly reflect on what you have learned about nursing research, evidence based nursing and its impact on you as a professional nurse earning a baccalaureate degree in nursing.  From a “quantitative approach”, reflect on your response to the scale of your reading and understanding of nursing research you identified in week 1. How has it changed? What activities most contributed to your enhanced knowledge base?  

Additionally, I would like you to discuss your preparedness to respond to the Institute of Medicine’s mandate that “Participants have set a goal that, by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence* (IOM, 2007).   What strategies can you personally implement to address this mandate on a personal/professional level beyond obtaining your baccalaureate degree in nursing? What is the state of your employing institution (no need to name your institution-just identify if it is an acute care setting, long term setting etc) in addressing this mandate since it was initiated in 2007 and with only 1 year left?  Will your employing institution meet the mandate? Initiate a discussion regarding this mandate with a managerial/administrative/ person in your employing institution to gain their perspective on evidence based practice. Here is a website that you can select to review to gain information on this directive. If possible, informally ask some of your nursing colleagues if they are aware of the mandate. What challenges do you foresee to the implementation of evidence-based nursing practice in your workplace?

http://www.ncbi.nlm.nih.gov/books/NBK52821/

Lastly, discuss how you would identify the “best available evidence” and what is the  significance of “Level of Evidence” as it relates to evidence that informs your nursing practice. 

It is expected in this forum that you use/implement the appropriate nursing research terminology. Hint: consider your words like research, prove etc. 

Also my initial respond about level of understanding of  article”A Walk Through The Steps of a Nursing Research Study-“from week 1 was: 

“I read the document ” A Walk Through The Steps of a Nursing Research Study”, my comfort level in reading and understanding this document was satisfying me since I got all explanation very organized and well formated that made it easy to read and get the idea.My knowledge base of nursing and all types of researches was my effective tool to understand most of the document. From quantitative approach I can rate my comfort level 8 out of 10, which I am still happy to this level of understanding.”

Now by the end of this course is expected that my level of understanding increased, so you know how to answer this question compare to my initial post from first week.