The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

Assignment 1: Early Onset Schizophrenia

Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest.

In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.

Learning Objectives

Students will:

· Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia

· Analyze legal and ethical issues surrounding the forceful administration of medication to children diagnosed with schizophrenia

· Analyze the role of the PMHNP in addressing issues related to the forceful administration of medication to children diagnosed with schizophrenia

To Prepare for this Assignment:

· Review the Learning Resources concerning early-onset schizophrenia.

The Assignment (2 pages):

· Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.

· Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.  

Note:  all papers submitted should include a title page, introduction, summary, and references.   

Assignment 1: Early Onset Schizophrenia

Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest.

In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.

Learning Objectives

Students will:

· Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia

· Analyze legal and ethical issues surrounding the forceful administration of medication to children diagnosed with schizophrenia

· Analyze the role of the PMHNP in addressing issues related to the forceful administration of medication to children diagnosed with schizophrenia

To Prepare for this Assignment:

· Review the Learning Resources concerning early-onset schizophrenia.

The Assignment (2 pages):

· Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.

· Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.  

Note:  all papers submitted should include a title page, introduction, summary, and references. 

Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient. 

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

ASSIGNMENT:

The scenario for this week’s assignment is below:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Write a 2- to 3-page paper that addresses the following:

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.

Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation. 

Explain the process of writing prescriptions, including strategies to minimize medication errors

REQUIRED READINGS;

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Chapter 1, “Prescriptive Authority” (pp. 1–3)

Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 5–9)

Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 11–16)

Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)

Chapter 5, “Adverse Drug Reactions and Medical Errors” (pp. 41–49)

Chapter 6, “Individual Variation in Drug Response” (pp. 51–56)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

his article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html

This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. Silver Spring, Maryland: American Nurses Association, 2015. 

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

Assignment 1: Practicum – Client Termination Summary

Although termination is an inevitable part of the therapeutic process, it is often difficult for clients. However, by discussing termination throughout therapy, you can better prepare your clients for life without you. Once a client has achieved his or her therapeutic goals, termination sessions should be held and documented in a client termination summary. For this Assignment, you have the opportunity to practice writing a termination summary for a client with whom you have worked during your practicum experience.

Learning Objectives

Students will:

· Develop client termination summaries

To prepare:

· For guidance on writing a client termination summary, review pages 693–712 of Wheeler (2014) in this week’s Learning Resources.

· Identify a client who may be ready to terminate therapy.

The Assignment

· Identifying information of client (e.g., hypothetical name and age)

· Date the client initially contacted therapist, date therapy began, duration of therapy, and date therapy will end

· Total number of sessions, including number of missed sessions

· Whether termination was planned or unplanned

· Presenting problem

· Major psychosocial issues

· Types of services rendered (e.g., individual, couple/family therapy, group therapy)

· Overview of treatment process

· Goal status (goals met, partially met, unmet)

· Treatment limitations (if any)

· Remaining difficulties and/or concerns

· Recommendations

· Follow-up plan (if indicated)

· Instructions for future contact

· Signatures

With the client you selected in mind, address in a client termination summary (without violating HIPAA regulations) the following: