A 34-year-old Hispanic-American male with end-stage renal disease received kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued, and began to run temperatures up to 101˚F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection. 

 Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:

Explain why you think the patient presented the symptoms described. 

 The response includes accurate, clear, and detailed reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation. 

 Identify the genes that may be associated with the development of the disease. 

 The response includes an accurate, complete, detailed, and specific analysis of the genes that may be associated with the development of the disease. 

 Explain the process of immunosuppression and the effect it has on body systems.

The response includes an accurate, complete, detailed, and specific explanation of the process of immunosuppression and the effect it has on body systems.

Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

• Review the Resources and select one current national healthcare issue/stressor to focus on.
• Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.
Chapter 2, “Understanding Contexts for Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 37–62)
Chapter 3, “Current Challenges in Complex Health Care Organizations: The Triple Aim” (pp. 63–86)

Read any TWO of the following (plus TWO additional readings on your selected issue):

Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians—Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358–2360. doi:10.1056/NEJMp1801869
Note: You will access this article from the Walden Library databases.

Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. American Journal of Nursing, 118(2), 43–45. doi:10.1097/01.NAJ.0000530244.15217.aa
Note: You will access this article from the Walden Library databases.

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42(3), 231–245. doi:10.1097/NAQ.0000000000000303
Note: You will access this article from the Walden Library databases.

Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. Annals of Family Medicine, 16(3), 250–256. doi:10.1370/afm.2230
Note: You will access this article from the Walden Library databases.

Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses’ work settings, roles, and education preparation? Journal of Professional Nursing, 33(6), 400–404. doi:10.1016/j.profnurs.2016.11.005
Note: You will access this article from the Walden Library databases.

Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the Quadruple Aim. Journal of the American Board of Family Medicine, 31(4), 588–604. doi:10.3122/jabfm.2018.04.170388
Note: You will access this article from the Walden Library databases.

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from
https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3 

Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’ scope of practice in New York state: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse Practitioners, 30(6), 354–360. doi:10.1097/JXX.0000000000000040
Note: You will access this article from the Walden Library databases.

Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs, 32(11), 1874–1880. doi:10.1377/hlthaff.2013.0531
Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.

use 3 sources for this discussion

  The patient has been admitted to a 20-bed medical unit for treatment of acute diverticulitis. The provider has ordered Ultram (Tramadol hydrochloride) 50 mg p.o. every 6 hours prn pain. The patient is requesting a pain medication, as it has been 8 hours since his last dose. The nurse selects the individually wrapped medication from the patient’s assigned medication drawer and scans the barcode to determine if it is the correct medication. The scanner is not working again. As she wants to administer the pain medication as soon as possible, she types in the Internal Entry Number (IEN) and the computer indicates the medication is Ultracet 37.5/325 mg but the package says Ultram 50 mg. The nurse calls the pharmacy and the pharmacist says there is only one number different between Ultram and Ultracet and, since the package says Ultram, to administer the medication because she must have typed in the wrong number. The nurse administers the medication, and within 30 minutes the patient shows signs of an allergic reaction. The nurse checks the record and determines the patient is allergic to acetaminophen. The patient is treated for the allergic reaction, and a medication incident form is completed. The nurse manager asks for a Root Cause Analysis (RCA) to be completed for the medication error.

Review the case scenario included in this week’s media resources, and examine the process flow chart, cause/effect diagram, and Pareto chart related to the case scenario.

In the scenario, 

The nurse manager and the director of pharmacy blame each other for the error. The facilitator (quality assurance person) asks everyone to avoid blaming and focus on applying the tools to analyze the data and get to the root cause of the error.

While all of these tools contribute, for this Assignment : Select one tool to analyze.

·  

· Analyze the composition of the RCA team. 

· Explain what knowledge they can contribute to the RCA.

· Describe the collaboration in the case study that led to effective problem solving. Identify the evidence you observe in the scenario that demonstrates effective collaboration and the avoidance of blaming.

· Explain the team’s process in testing for and eliminating root causes that were not contributing.

· Select one of the performance improvement charts presented in the scenario and critique its effectiveness by explaining how it contributes to identifying the root cause and determining a solution to prevent repeat medication errors.

· Identify the contributing factors, and discuss how to prevent this kind of error from occurring in the future.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

NOTE; This should be a 5-paragraph (at least 550 words) response.

Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.

• Chapter 4, “Evaluating      Performance” (pp. 79-118)
• Chapter 5, “Continuous      Improvement” (pp. 119-142)
• Chapter 6, “Performance Improvement Tools”      (pp. 143-174)

Note: Although these chapters are previously assigned readings, please review them in preparation for this week’s material.

Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). St. Louis, MO: Mosby.

• Chapter 18, “Leading Change” (pp. 319-335)

https://class.content.laureate.net/a6596733e7b39b81cb24d77c15f22999.html#section_container0 

BACKGROUND

The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month. 

Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so. 

She currently weighs 140 lbs, and is 5’ 5”

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. 

Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman. 

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.

The PMHNP administers the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

At each decision point stop to complete the following:

• Decision #1
  • 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
  • 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
  • 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?

-Explain the concept of a  knowledge worker (in nursing).

-Define and explain nursing informatics and

– highlight the role of a nurse leader as a knowledge worker.

Include  –

-your examination of the data that you could use, 

-how the data might be accessed/collected, and 

-what knowledge might be derived from that data. 

Be sure to incorporate feedback received from your colleagues’ responses

Develop a simple infographic to help explain these concepts. 

Please note that this is not a Powerpoint!!, it should be an infographic. Again, please read the information under resources on how to create an infographic-I can give more info if needed. It is very simple

NOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources.

Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum (I will attach if needed).