Our Previous Samples

Comprehensive SOAP Exemplar Paper

Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.

Patient Initials: _______                 Age: _______                                   Gender: _______

SUBJECTIVE DATA:

Chief Complaint (CC): Coughing up phlegm and fever

History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.

Medications:

• Lisinopril 10mg daily
• Combivent 2 puffs every 6 hours as needed
• Serovent daily
• Salmeterol daily
• Over the counter Ibuprofen 200mg -2 PO as needed
• Over the counter Benefiber
• Flonase 1 spray each night as needed for allergic rhinitis symptoms

Allergies:

Sulfa drugs – rash

Past Medical History (PMH):

1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.

2.) Hypertension – well controlled

3.) Gastroesophageal reflux (GERD) – quiet on no medication

4.) Osteopenia

5.) Allergic rhinitis

 

Past Surgical History (PSH):

• Cholecystectomy 1994
• Total abdominal hysterectomy (TAH) 1998

 

Sexual/Reproductive History:

Heterosexual

G1P1A0

Non-menstrating – TAH 1998

Personal/Social History:

She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.

Immunization History:

Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.

Significant Family History:

Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.

Lifestyle:

She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.

She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.

Review of Systems:

General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance.

HEENT: no changes in vision or hearing; she does wear glasses and her last eye exam was 1 ½ years ago. She reported no history of glaucoma, diplopia, floaters, excessive tearing or photophobia. She does have bilateral small cataracts that are being followed by her ophthalmologist. She has had no recent ear infections, tinnitus, or discharge from the ears. She reported her sense of smell is intact. She has not had any episodes of epistaxis. She does not have a history of nasal polyps or recent sinus infection. She has history of allergic rhinitis that is seasonal. Her last dental exam was 3/2014. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing.

Neck: no pain, injury, or history of disc disease or compression. Her last Bone Mineral density (BMD) test was 2013 and showed mild osteopenia, she said.

Breasts: No reports of breast changes. No history of lesions, masses or rashes. No history of abnormal mammograms.

Respiratory: + cough and sputum production (see HPI); denied hemoptysis, no difficulty breathing at rest; + dyspnea on exertion; she has history of COPD and community acquired pneumonia 2012. Last PPD was 2013. Last CXR – 1 month ago.

CV: no chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is unknown by patient.

GI: No nausea or vomiting, reflux controlled, No abd pain, no changes in bowel/bladder pattern. She uses fiber as a daily laxative to prevent constipation.

GU: no change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She has had a total abd hysterectomy. No history of STD’s or HPV. She has not been sexually active since the death of her husband.

MS: she has no arthralgia/myalgia, no arthritis, gout or limitation in her range of motion by report. No history of trauma or fractures.

Psych: no history of anxiety or depression. No sleep disturbance, delusions or mental health history. She denied suicidal/homicidal history.

Neuro: no syncopal episodes or dizziness, no paresthesia, head aches. No change in memory or thinking patterns; no twitches or abnormal movements; no history of gait disturbance or problems with coordination. No falls or seizure history.

Integument/Heme/Lymph: no rashes, itching, or bruising. She uses lotion to prevent dry skin. She has no history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties or history of transfusions.

Endocrine: no endocrine symptoms or hormone therapies.

Allergic/Immunologic: this has hx of allergic rhinitis, but no known immune deficiencies. Her last HIV test was 10 years ago.

OBJECTIVE DATA

Physical Exam:

Vital signs: B/P 110/72, left arm, sitting, regular cuff; P 70 and regular; T 98.3 Orally; RR 16; non-labored; Wt: 115 lbs; Ht: 5’2; BMI 21

General: A&O x3, NAD, appears mildly uncomfortable

HEENT: PERRLA, EOMI, oronasopharynx is clear

Neck: Carotids no bruit, jvd or tmegally

Chest/Lungs: CTA AP&L

Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial

ABD: benign, nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound

Genital/Rectal: external genitalia intact, no cervical motion tenderness, no adnexal masses.

Musculoskeletal: symmetric muscle development – some age related atrophy; muscle strengths 5/5 all groups.

Neuro: CN II – XII grossly intact, DTR’s intact

Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

ASSESSMENT:

Lab Tests and Results:

CBC – WBC 15,000 with + left shift

SAO2 – 98%

Diagnostics:

Lab:

Radiology:

CXR – cardiomegaly with air trapping and increased AP diameter

ECG

Normal sinus rhythm

Differential Diagnosis (DDx):

• Acute Bronchitis
• Pulmonary Embolis
• Lung Cancer

Diagnoses/Client Problems:

1.) COPD

2.) HTN, controlled

3.) Tobacco abuse – 40 pack year history

4.) Allergy to sulfa drugs – rash

5.) GERD – quiet on no current medication

PLAN: [This section is not required for the assignments in this course, but will be required for future courses.]

Conflict Resolution Sample Paper

Conflict is a common thing in almost all institutions. It is more common in healthcare facilities since there are plenty of human interactions, and the workload is sometimes hefty. Conflicts are more likely to occur during working hours, which are busy, like when there is an emergency. Professionals in the healthcare sector play different roles like caregiver, educator, leader or manager.

In all of these roles, there are various types of interactions between physicians, between physicians and members of staff, and between the health care team or staff and the sick person or patient’s family (Sexton & Orchard, 2016). When there are all these interactions, the chances of having a conflict at the facility increase substantially. The following excerpt discusses a scenario in an oncology setting as it evaluates the type of conflict involved, the conflict resolution adopted, and the best strategies for resolving such a conflict.

Analysis of the Conflict

In the scenario, there is a conflict in the Safety and Quality Department where the staff often cross paths with the department leader. The staff members feel that the quality and safety manager has excess power and authority, which sometimes results in most of the disagreements between them and their leader. Nonetheless, not each one of them has bothered to protest about it because they are afraid of getting fired or making things worse. Thus, there seems to be a conflict between the healthcare team. To resolve the conflict, the eleven staff members have opted to use the accommodation approach where the party affected continues to lose. In contrast, the other party (Safety and Quality Department leader) proceeds to win.

The scenario is a win/lose since one party does not mind forfeiting their position. It seems that the junior staff team wishes to safeguard the relationship between them and the manager rather than quarrel about the issues involved. They also fear losing their jobs. This conflict resolution approach is not very healthy since the junior staff team will continue to suffer. As much as they want to safeguard their jobs, working under such circumstances is not healthy. It may affect their productivity and how they relate to other professionals outside their department. The manager might also be unaware of the issue since it has not been brought up.

Recommendations

Instead of utilizing the accommodation approach, the junior staff should try using the collaboration approach, which has been deemed the most effective strategy for settling differences. This approach involves empathizing and trying to understand the other point of view (Wallensteen, 2018). It requires everyone to commit to arriving at the best outcome for every party involved. With this strategy, the junior staff team should raise the issue and try to talk to the management about reducing the powers of the safety and quality department leader, or ask him or her to change their leadership style.

They can also go for the compromise approach, where each side will have to forfeit one thing to gain the other in order to arrive at a middle ground. For instance, the junior staff team may choose to confront the manager and risk their relationship with them. The leader may choose to change their leadership style to accommodate their woes and have a better working environment where everyone is comfortable. That would be a win/win situation (Almost et al., 2016).

In conclusion, not making any efforts to resolve an issue leads to a situation where one party feels victimized. In specific scenarios, the party in the wrong is sometimes unaware of the effects of their actions on others. Thus, better conflict resolution approaches have to be adopted to bring a better outcome. Different strategies fit different circumstances and choosing the best strategy is the secret behind arriving at the best resolution.

References

• Almost, J., Wolff, A. C., Stewart?Pyne, A., McCormick, L. G., Strachan, D., & D’souza, C. (2016). Managing and mitigating conflict in healthcare teams: an integrative review. Journal of advanced nursing, 72(7), 1490-1505.
• Sexton, M., & Orchard, C. (2016). Understanding healthcare professionals’ self-efficacy to resolve interprofessional conflict. Journal of interprofessional care, 30(3), 316-323.
• Wallensteen, P. (2018). Understanding conflict resolution. Sage

Conflict Resolution Techniques Sample Paper

While conflicts are inevitable in any workplace, how they are handled determines their effect on an organization. To guide in conflict resolution, there are five major conflict resolution skills that should be considered. Depending on the nature of the conflict, parties involved should choose the best method to establish peace and reconciliation. The five major conflict resolution skills are avoiding, competing, accommodating, collaborating, and compromising.

First, avoiding involves withdrawing from a conflict or ignoring the fact that it exists. Conflicting parties choose this method when the reward of resolution is less than the discomfort caused by confrontation (Jit et al, 2016). Avoiding is beneficial to the facilitator but may not be worth it as people may be withholding important ideas that could add value to the conversation. However, it can be quite an effective tool when a cool-down period is required for either of the parties.

One of the major benefits of avoiding therefore is giving people time to calm down and possibly consider other perspectives that may be important in solving the conflict (Jit et al, 2016). However, caution should be observed not to use avoidance excessively as it may make conflicts worse.

Second, competing involves a lack of consideration of other people’s viewpoints and using all means possible to win. The method uses the assumption of winning and letting the other party lose and hence does not permit different perspectives into the resolution process (Jit et al, 2016). Competing is best suited for sports or when companies are contesting over the market but it is not applicable when solving problems within a group. The advantage is that the style solves disputes quickly as there is no room for disagreements or discussions. However, while it offers short-term rewards, competing can harm one’s business as relationships are in most cases broken.

Third, accommodating skills simply entail putting the other party’s concern before your own and letting them get their way. Accommodating is often used when one person does not care about the issues discussed compared to the other party (Gilin et al, 2015). It is also used when one feels like he/she is in the wrong or if prolonging the conflict is not worth the outcome. The method is therefore for maintaining the peace than it is for winning. While one may seem weak, accommodating is essential as it allows one to move on to more important issues. Nevertheless, as much as small issues may be handled easily, accommodating will not work in important or larger issues.

The fourth skill is collaborating which involves listening to the other party’s side, discussing an agreement goal, and ensuring an understanding from all parties. Collaborating skill thus requires a lot of consideration and great courage. Notably, for collaboration to work, both parties should be assertive and cooperative (Gilin et al, 2015). The main aim is to have a shared solution that each party is willing to support.

The parties thus sit down and negotiate the conflict in a bid to establish a win-win situation that leaves everyone satisfied. Due to the attempt to ensure that each party is satisfied, collaborating may take a lot of time than any other conflict resolution strategy. The skill is however beneficial as it leaves everyone satisfied and maintains harmony.

Finally, compromising technique seeks to find resolution by conceding due to the failure to agree on some concepts of the solution. Considerations and courage are required as parties try to look for common ground (Jit et al, 2016). Sometimes, compromising can lead to a lose-lose situation as parties give up on some things to focus on larger issues. The strategy is usually used to save time or when a solution is just required whether perfect or not. The benefit is that both parties are accommodated and can actually set the stage for collaboration in the future. The downside however is that none of the parties leaves completely happy.

References

• Gilin Oore, D., Leiter, M. P., & LeBlanc, D. E. (2015). Individual and organizational factors promoting successful responses to workplace conflict. Canadian Psychology/psychologie canadienne, 56(3), 301. https://doi.org/10.1037/cap0000032
• Jit, R., Sharma, C. S., & Kawatra, M. (2016). Servant leadership and conflict resolution: A qualitative study. International Journal of Conflict Management. https://www.emerald.com/insight/content/doi/10.1108/IJCMA-12-2015-0086/full/html

Consumer Informatics/Telehealth Case Study NR 706

Week 3 Consumer Informatics/Telehealth Case Study Discussion

Purpose

The purpose of this discussion is for you to investigate telehealth and technology relationships to social justice principles.

Case Study Scenario

Watch the following video.

Consumer Informatics/Telehealth Case Study (1:55)

Transcript

[MUSIC] Mr. Kasich is a 77-year old who was recently taken to the emergency room after he fell when trying to get out of bed. There, he was found to have a blood glucose level of 35 milligrams per deciliter and was diagnosed with uncontrolled type 2 diabetes mellitus and hypoglycemia despite many years of well-maintained the blood glucose levels. 

After further assessment, Mr. Kasich was transferred to a medical room in the hospital. His background includes diagnosed with type two diabetes mellitus, advanced congestive heart failure and lung cancer. Has Medicare parts A and B. Lives with wife in a remote area that is 40 miles from the closest healthcare provider. Is proficient using his home computer. 

Mr. Lane is a 42-year old who was admitted for exacerbation of heart failure. His background includes has diabetes mellitus type two. Is a long-haul truck driver with a large trucking company. Is privately insured. Is single and primarily lives in his truck. Both Mr. Kasich and Mr. Lane are going home with telehealth consisting of a telemonitoring device that transmits weight, blood pressure, blood glucose levels and pulse oximetry to a remote telehealth nurse. 

Even though the use of telehealth does not often include hands on interaction, the goal of keeping patients out of a hospital is consistent with quality nursing practice. Telehealth applications are designed to enhance the patient experience and improve clinical outcomes while providing care for patients in their home environment rather than an institutional setting. Telehealth supports self-care by empowering patients, which is a central tenet of nursing practice.

Consumer Informatics/Telehealth Case Study NR 706 Instructions

Review the case scenario above and address the following:

1. Examine concepts such as equity, respect, self-determinism, health literacy, cyclic disadvantage, and healthcare disparities among marginalized populations or groups and how they affect patient outcomes.
2. Compare and contrast how each patient in the video may benefit from telehealth services and the ethical considerations from the viewpoint of the nurse.
3. Propose barriers that must be removed to achieve well-being, sufficiency, and healthcare access for all.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

• Link (webpage): Graduate Discussion Grading Guidelines and RubricLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competencies:

2. Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
3. Appraises current information systems and technologies to improve health care. (POs 6, 7)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

3. Design programs that monitor and evaluate outcomes of care, care systems, and quality improvement. (PC 4; PO 7)
4. Evaluate the types of healthcare information systems, knowledge-based systems, and patient care technology and the impact on patient safety, quality of care, and outcome measurement. (PC 4; PO 7)
5. Appraise consumer health information sources for accuracy, timeliness, and appropriateness. (PC 4; PO 7)
6. Resolve ethical and legal issues related to the use of information, communication networks, and information and patient care technology. (PCs 2, 4; PO 6)

Due Dates

• Initial Post: By 11:59 p.m. MT on Wednesday
• Follow-Up Posts: By 11:59 p.m. MT on Sunday

NR 706 Week 4: Information Technology as the Basis for Quality Improvement

Week 4 References

Harris, C., Garrubba, M., Melder, A., Voutier, C., Waller, C., King, R., & Ramsey, W. (2018). Sustainability in healthcare by allocating resources effectively (SHARE) 8: Developing, implementing and evaluating an evidence dissemination service in a local healthcare setting. BMC Health Services Research, 18(1), 151. https://doi.org/10.1186/s12913-018-2932-1

McBride, S., & Tietze, M. (2023). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism (3rd ed.). Springer Publishing Company.

Otitigbe, J. (2017). Fishbone facilitation reflection: Team-based cause-and-effect study can point the way to the real problem. ISE: Industrial & Systems Engineering at Work, 49(7), 48-51.

Reed, J. E., Howe, C., Doyle, C., & Bell, D. (2018). Simple rules for evidence translation in complex systems: A qualitative study. BMC Medicine, 16(1) 92. https://doi.org/10.1186/s12916-018-1076-9

Schaefer, J. D., & Welton, J. M. (2018). Evidence-based practice readiness: A concept analysis. Journal of Nursing Management, 26(6), 621-629. https://doi.org/10.1111/jonm.12599

Warnick, R. E., Lusk, A. R., Thaman, J. L., Levick, A. H., & Seitz, A. D. (2020). Failure mode and effect analysis (FMEA) to enhance safety and efficiency of Gamma Knife radiosurgery. Journal of Radiosurgery and SBRT, 7(2), 115-125.

Week 4 Translating Evidence Into Practice Discussion

Purpose

The purpose of this discussion is for you to evaluate a National Practice Problem within the context of your practice problem idea and technology expansion within your healthcare setting.

Instructions

Select one leading National Practice Problem that is prevalent in your patient population or healthcare setting and address the following:

1. Describe an issue related to the National Practice Problem you selected that is impacting quality, safety, or financial outcomes at your practice setting.
2. Elaborate how technology such as the electronic medical record might assist in implementing, evaluating, or sustaining an evidence-based intervention to address the identified problem.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

• Link (webpage): Graduate Discussion Grading Guidelines and RubricLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competencies:

2. Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
3. Appraises current information systems and technologies to improve health care. (POs 6, 7)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

2. Use information technology to collect and analyze data to generate evidence-based nursing practice across healthcare settings. (PC 4; PO 7)
3. Design programs that monitor and evaluate outcomes of care, care systems, and quality improvement. (PC 4; PO 7)
4. Evaluate the types of healthcare information systems, knowledge-based systems, and patient care technology and the impact on patient safety, quality of care, and outcome measurement. (PC 4; PO 7)
5. Resolve ethical and legal issues related to the use of information, communication networks, and information and patient care technology. (PCs 2, 4; PO 6)

Due Dates

• Initial Post: By 11:59 p.m. MT on Wednesday
• Follow-Up Posts: By 11:59 p.m. MT on Sunday

NR 706 Week 4 Translation Science Project Assignment

Purpose

The purpose of this assignment is to identify a practice problem idea and an evidence-based intervention to address the practice problem idea. Data management is essential to drive actions and decisions to improve healthcare outcomes. The content will support the formulation of a literature synthesis related to your practice problem idea, which supports professional formulation, communication, and dissemination skills relevant to the DNP-prepared nurse.

Instructions

In order to create flexible options, we are providing you options on this assignment. Concept maps are an effective way to express complex ideas, especially for visual learners. For this assignment, each of the following sections may be presented either as a narrative or concept map:

• Practice Problem and PICOT Question
• Evidence Synthesis of Literature
• Data Driven Decision Making

Please note you are not required to complete any or all of the sections identified as conceptual maps. If you choose to use a concept map for a section, it should be created in Microsoft Word using Smart Art and placed in that section of the paper under the associated first level heading. The concept map must meet all the requirements outlined in the assignment rubric for each section. The rubric and page length are unchanged.

 Concept Map Resources

If you need additional information on concept maps and how to create a concept map in Microsoft Word, review the following resources:

• Link (article): Effects of Web-Based Concept Mapping Education on Students’ Concept Mapping and Critical Thinking Skills: A Double-Blind, Randomized, Controlled StudyLinks to an external site.

Concept Map (2:48) Information:

As a leader, how you manage, and present information may vary depending upon the project, stakeholders, and goals. One approach to present information to gain support for projects is with visual aids such as a concept map. A concept map organizes and displays knowledge in a graphical manner to show relationships between different concepts. By showing interrelationships, concept maps help engage and heighten problem solving. 

One way to construct a concept map is by using Word and its graphic art capabilities known as Smart Art. – Open a blank Word document. – Go to the toolbar. – Select Insert. – Select Smart Art. Select the graphic shape you think most accurately reflects the information you want to share. Let’s say the topic is related to Maslow’s Hierarchy of Needs. 

You know it is usually presented as a pyramid. So you select Pyramid from the SmartArt options. Once selected, it is placed on your Word document for editing. The Smart Art tool allows you to identify three sections of the pyramid. But Maslow’s Hierarchy has five levels, so you need to add two levels to the basic design. Place the cursor in the text box, right click, copy, and paste into position. You now should have four textboxes for the pyramid. 

Repeat the step to have five textboxes. Then, enter your labels inside each text box. This is one example to illustrate the ease of using Word Smart Art to create a concept map. Again, the concept map design depends upon the concepts of interest. Let’s try one more. You want to make a concept map of the three sciences integrated into nursing informatics: computer science, information science, and nursing science. – Open the Word document. – Go to Insert. – Select Smart Art. – Select Relationships, – Select Basic Venn Diagram. 

Click on the text boxes and enter Nursing Science in the top circle, then Computer Science and Information Science. Once you have identified a shape from Smart Art, in addition to adding or deleting parts of the graphic, you can change the location of parts of the graphic as well. Left click the part of the graphic you want to move and drag to a new location. You can connect with lines or arrows by going to the Toolbar and selecting, Insert and then Shapes. These are some basic examples of how to create a concept map. Follow the assignment instructions and use the rubric to guide your creation of the concept map.

Additionally, review the conceptual maps section in the current APA manual.

The assignment should include the following components. Contact course faculty for questions.

1. Introduction
   1. Develop a focused one-sentence purpose statement.
   2. Explain the selected practice problem idea in general terms (cited).
2. Practice Problem and Question (Narrative or Conceptual Map)
   1. Discuss the significance of the practice problem idea (cited).
   2. Discuss the prevalence of the practice problem idea (cited).
   3. Discuss the economic ramifications of the practice problem idea (cited).
   4. Identify an evidence-based intervention to address the selected practice problem idea (cited).
   5. Construct the practice problem PICOT in question format.
3. Evidence Synthesis of the Literature (Narrative or Conceptual Map)
   1. Discuss the scope of evidence including databases searched and keywords.
   2. Compare and contrast main points from the evidence integrated in a cohesive manner (cited).
   3. Provide objective rationale for the evidence-based intervention to address the practice problem idea. (cited).
4. Data-Driven Decision-Making (Narrative or Conceptual Map)
   1. Describe the source of the evidence (i.e., internal data to support the need for change at practicum site to improve outcomes and/or nursing practice. Example: incident reports, readmission rates, infection rates, etc.).
   2. Identify how the use of information technologies potentially influence data capture, process improvement, evaluation, and patient outcomes related to your practice problem idea.
5. Conclusion (Write one concise paragraph.)
   1. Summarize the impact of the practice problem idea.
   2. Summarize the role of the evidence-based intervention to address the practice problem idea.
6. References
   1. Identify and list four scholarly sources used in evidence synthesis on the reference pages.
   2. Identify and list other scholarly sources used in the paper on the reference pages.
   3. List scholarly sources in alphabetical order.
   4. Use correct hanging-indent format.
7. Appendix: Summary Table of the Evidence
   1. Attach the completed John Hopkins Nursing Evidence-Based Practice Individual Evidence Summary Tool.
      • Link (Word doc): John Hopkins Nursing Evidence-Based Practice Individual Evidence Summary ToolLinks to an external site.
   2. Provide a minimum of four research studies.
   3. Complete all sections completely for the four sources of evidence.
   4. Identify both the quality and level of evidence for each scholarly source on the table.

Level I Headings for the Assignment

• Practice Problem and Question
• Evidence Synthesis of the Literature
• Data-Driven Decision Making
• Conclusion
• References
• Appendix: Summary Table of the Evidence

Writing Requirements (APA format)

• Length: 6-8 pages (not including title page or references page)
• 1-inch margins
• Double-spaced pages
• 12-point Times New Roman or 11-point Arial font
• Headings & subheadings
• In-text citations
• Title page
• Reference page
• Standard English usage and mechanics

Graduate Re-Purpose Policy

The late assignment policy and the reuse repurpose policy (located in the student handbook) apply to this assignment.

Program Competencies

This assignment enables the student to meet the following program competencies:

2. Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
3. Appraises current information systems and technologies to improve health care. (POs 6, 7)

Course Outcomes

This assignment enables the student to meet the following course outcomes:

2. Use information technology to collect and analyze data to generate evidence-based nursing practice across healthcare settings. (PC 4; PO 7)
3. Design programs that monitor and evaluate outcomes of care, care systems, and quality improvement. (PC 4; PO7)
4. Evaluate the types of healthcare information systems, knowledge-based systems, and patient care technology and the imp act on patient safety, quality of care, and outcome measurement. (PC 4; PO 7)
5. Resolve ethical and legal issues related to the use of information, communication networks, and information and patient care technology. (PCs 2, 4; PO 6)

Due Date

• By 11:59 p.m. MT on Sunday
• Late Assignment Policy applies

Rubric

W4 Assignment Grading Rubric

W4 Assignment Grading RubricCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeIntroduction

Requirements:
1. Develop a focused one-sentence purpose statement.
2. Explain the selected practice problem idea in general terms (cited).

10 pts

Includes all requirements and provides an excellent introduction.

9 pts

Includes fewer than all requirements and/or provides a very good introduction.

8 pts

Includes fewer than all requirements and/or provides a basic introduction.

0 pts

Includes 1 or fewer requirements and/or provides a poor introduction.

10 ptsThis criterion is linked to a Learning OutcomePractice Problem and Question (Narrative or Conceptual Map)

Requirements:
1. Discuss the significance of the practice problem idea (cited).
2. Discuss the prevalence of the practice problem idea (cited).
3. Discuss the economic ramifications of the practice problem idea (cited).
4. Identify an evidence-based intervention to address the selected practice problem idea (cited).
5. Construct the practice problem PICOT in question format.

70 pts

Includes all requirements and provides an excellent description of the practice problem and question.

63 pts

Includes fewer than all requirements and/or provides a very good description of the practice problem and question.

56 pts

Includes fewer than all requirements and/or provides a basic description of the practice problem and question.

0 pts

Includes fewer than all requirements and/or provides a poor description of the practice problem and question.

70 ptsThis criterion is linked to a Learning OutcomeEvidence Synthesis of the Literature (Narrative or Conceptual Map)

Requirements:
1. Discuss the scope of evidence including databases searched and keywords.
2. Compare and contrast main points from the evidence integrated in a cohesive manner (cited).
3. Provide objective rationale for the evidence-based intervention to address the practice problem.

70 pts

Includes all requirements and provides an excellent evidence synthesis of the literature.

63 pts

Includes fewer than all requirements and/or provides a very good evidence synthesis of the literature.

56 pts

Includes fewer than all requirements and/or provides a basic evidence synthesis of the literature.

0 pts

Includes fewer than all requirements and/or provides a poor evidence synthesis of the literature.

70 ptsThis criterion is linked to a Learning Outcome Data-Driven Decision-Making (Narrative or Conceptual Map)

Requirements:
1. Describe the source of the evidence (i.e., internal data to support the need for change at practicum site to improve outcomes and/or nursing practice. Example: incident reports, readmission rates, infection rates, etc.).
2. Identify how the use of information technologies potentially influence data capture, process improvement, evaluation, and patient outcomes related to your practice problem idea.

70 pts

Includes all requirements and provides an excellent summary of data-driven decision-making.

63 pts

Includes fewer than all requirements and/or provides a very good summary of data-driven decision-making.

56 pts

Includes fewer than all requirements and/or provides a basic summary of data-driven decision-making.

0 pts

Includes fewer than all requirements and/or provides a poor summary of data-driven decision-making.

70 ptsThis criterion is linked to a Learning Outcome Conclusion (1 concise paragraph)

Requirements:
1. Summarize the impact of the practice problem idea.
2. Summarize the role of the evidence-based intervention to address the practice problem idea.

10 pts

Includes all the requirements and provides an excellent conclusion.

9 pts

Includes fewer than all requirements and/or provides a very good conclusion.

8 pts

Includes fewer than all requirements and/or provides a basic conclusion.

0 pts

Includes fewer than all requirements and/or provides a poor conclusion.

10 ptsThis criterion is linked to a Learning Outcome References

Requirements
1. Identify and list four scholarly sources used in evidence synthesis on the reference pages.
2. Identify and list other scholarly sources used in the paper on the reference pages.
3. List scholarly sources in alphabetical order.
4. Use correct hanging-indent format.

20 pts

Includes all requirements and provides excellent references.

18 pts

Includes fewer than all requirements and/or provides very good references.

16 pts

Includes fewer than all requirements and/or provides basic references.

0 pts

Includes one or fewer requirements and/or provides poor references.

20 ptsThis criterion is linked to a Learning OutcomeAPA Style and Organization for Scholarly Papers

Requirements:
1. Uses Level I headers.
2.References and citations are proper APA (current version).
3.Length of APA formatted paper is 6-8 pages (excluding title page and references).

15 pts

Includes all requirements and presents excellent APA style and organization.

14 pts

Includes fewer than all requirements and/or very good APA style and organization.

12 pts

Includes fewer than all requirements and/or provides basic APA style and organization.

0 pts

Includes one or fewer requirements and/or provides poor APA style and organization.

15 ptsThis criterion is linked to a Learning OutcomeClarity of Writing

Requirements:
1. Use of standard English grammar and sentence structure.
2. No spelling errors or typographical errors.

15 pts

Includes all requirements and demonstrates excellent clarity of writing.

14 pts

Includes fewer than all requirements and/or demonstrates very good clarity of writing.

12 pts

Includes fewer than all requirements and/or demonstrates basic clarity of writing.

0 pts

Includes 1 or fewer requirements and/or demonstrates poor clarity of writing.

15 ptsThis criterion is linked to a Learning OutcomeAppendix: Summary Table of the Evidence

Requirements:
1. Attach the completed John Hopkins Nursing Evidence-Based Practice Individual Evidence Summary Tool.
2. Provide a minimum of four research studies.
3. Complete all sections completely for the four sources of evidence.
4. Identify both the quality and level of evidence for each scholarly source on the table.

20 pts

Includes all requirements and provides an excellently completed summary tool.

18 pts

Includes fewer than all requirements and/or provides a very well completed summary tool.

16 pts

Includes fewer than all requirements and/or a?basically completed?summary tool.

0 pts

Includes no requirements and/or provides a poorly completed summary tool.

20 ptsTotal Points: 300

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Consumer’s Purchase Decision Assignment 13

Consumer’s Purchase Decision Assignment 13

• In the first paragraph of this chapter, the quote from Harold Coffin (1905-1981) stated: “A consumer is a shopper who is sore about something.” In essence, Mr. Coffin suggests that a marketer’s job is to tap into a problem or create a “problem,” that can only be “solved” by the consumer’s purchase of a particular product. Based on this concept, describe how consumer purchase decisions actually serve to resolve an unmet want or need. In replies to peers, provide real-world examples from your own life to illustrate the point.

ORDER THROUGH BOUTESSAY

Consumer’s Purchase Decision Assignment 13 Instructions

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting a hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
• Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage the overutilization of direct quotes in DQs and assignments at the Master’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report, and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Contemporary Nursing Practices Discussion HW

Contemporary Nursing Practices Discussion HW

Discuss nursing practice today by addressing the following:

1. Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
2. Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
3. Identify a patient care situation and describe how nursing care, or approaches to decision?making, differ between the BSN?prepared nurse and the ADN nurse.
4. Discuss the significance of applying evidence?based practice to nursing care and explain how the academic preparation of the RN?BSN nurse supports its application.
5. Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.

ORDER THROUGH BOUTESSAY

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, and double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting a hard copy, be sure to use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc.

Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage the overutilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources.

Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it.

This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something?

Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice.

We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Contemporary Nursing Practices Discussion HW

Contribution to Safe Practice Sample Paper

Introduction

Safe practice contributes to enhanced patient satisfaction and better patient experience, that in turn culminate in improved patient outcomes. Nurses are in more direct contact with patients than physicians, medical officers and other healthcare team members, owing to the more time they spend with patients. Consequently, nurses play a vital role in ensuring adherence to safe practice within healthcare settings, hence the need for comprehensive practice knowledge in an ever-evolving nursing work setting. This discussion explores nurses’ role in patient advocacy from both policy and stakeholder perspectives.

How to Contribute to Safe Practice

Nurses contribute towards safe practice via different ways. Their role in ensuring patient safety include monitoring patients for clinical deterioration, evaluating care processes and inherent weaknesses in some systems, identifying medication errors and misses, and identifying errors and misses within the practice and continuous survey of the patient to ensure high-quality care (Vanhook et al., 2018). Other actions that could improve patient outcomes include engaging in professional development activities, such as upgrading the educational level. In my opinion, at least possessing a bachelor’s degree equips the nurse with required skills that would translate to improved patient care and higher levels of patient satisfaction. Pursuing a Masters’ degree or even a PhD would expose the nurse to more scholarly literature and professional experience, ultimately culminating in more effective skills in patient care.

Besides having a higher educational qualification, the quality of the training may contribute significantly to patient safety. In this perspective, nurses may develop a standardized transitional process towards the independence practice training, similarly to the medical residents. The lack of a standardized transition, according to Birks et al. (2019), translates to inadequate training and mentorship in handling intricate clinical scenarios and systems shortfalls. I could approach a physician in a level five hospital and request to train by his/her side, enabling learning by apprenticeship. Since physicians are widely-experienced in majority of the patient care guidelines, clinical scenarios and recent practice advances, training beside them would be instrumental to boosting my skills and enhancing my quality of training.

Further, preventing burn out would remarkably contribute to patient safety. It is possible to avoid burn out at a personal level by ensuring plenty of rest when away from work, particularly the recommended six-hours-sleep for working professionals. Higher levels of burn out among nurses are associated with increased incidences of clinical errors, which would result in the nurse being prosecuted for crime.

Future Role Changes Resulting from Policy Changes

Advancing the education and training of nurses is a major step towards improving patient care. However, multiple challenges, Nonetheless, including, but not limited to, regulatory barriers that impede expansion of nursing scope of practice, health care system fragmentation, professional resistance to expanded roles for nurses, insurance policies inconsistent with current practice, challenges faced during transitioning to practice and demographic challenges can hamper the success of this approach (Birks et al., 2019). Thus future role changing would require mitigation of the afore-mentioned barriers to improve nurses’ education and training.

As mentioned, there is need to expand the nursing scope of practice to incorporate deeper theoretical grounding in the principles of patient management. Presently, nurses’ training is less intensive in pathophysiological and pharmacologic concepts compared to that of medical officers, clinical officers or physicians. Policies should transform this to incorporate deeper theoretical grounding for nurses that would result in higher-quality care (Padilha, Sousa & Pereira, 2018). Also, the policies could include keeping the nurses abreast with latest technological advances in patient care, especially electronic health records management and e-health.

Equally important is the need to increase the nurse-to-patient ratio to promote patient safety. Burn out is a major outcome of a high patients to nurses ratio, which lessens the quality of care. Policies governing nurses’ education could be reviewed to promote training of larger numbers of nurses in medical schools (Chicca & Shellenbarger, 2018). Additionally, student nurses should be able to access such incentives as government grants and part or full sponsorships to promote positive attitude towards the training. The approach would also contribute to increased numbers of nursing students, particularly individuals from financially challenged backgrounds that may find it difficult to pay the high fees in medical schools.

Roles of a Registered Nurse

The roles of a registered nurse are diverse, owing to the constantly emerging innovations and updates to existent practices. The common roles include administering medication while monitoring for side effects and reactions, recording and updating patient vital signs and medical information, maintaining detailed and accurate reports, and consulting and coordinating with other healthcare team plan members and educating patients and family members on care plans and treatments (Padhila, Sousa & Pereira, 2018). Emerging roles would include keeping abreast with upcoming technology and tools to assist provision of best care to patients and best support to other care providers.

Besides, I would engage in workshops and seminars involving incorporation of electronic health records and application of e-health to patient care. Skills attained in the mentioned events would be instrumental in recording and updating patient vital signs and medical information while maintaining accurate and detailed records. As Tubaishat (2018) observes, the importance of electronic health records in maintaining key patient information and availing it to the relevant parties is instrumental to contemporary nursing care goals. Electronic health records are less bulky as compared to traditional files, more resistant to errors owing to software that detects inconsistencies and alerts the care giver; and are more easily accessible, due to their versatility and ability to be shared with minimal effort.

Applying e-health in my practice would be resourceful in manifold manners. For starters, multiple health applications and websites allow patient access to healthcare from remote locations, easing the traditional physical consultation process that was more financially and timely constraining (Tubaishat, 2018). Remote accessibility of healthcare has provided emergency care services to critical patients, thereby reducing mortality from previously fatal complications. For instance, a patient with an acute asthmatic exacerbation could get appropriate instructions on how to manage the condition before he/she presents at a health facility, lessening the risks of complications that would otherwise ensue.

Furthermore, e-health has eased the consultation process for healthcare providers as they could access their patients from the comfort of their homes and offices without requiring actual physical presence. In the current coronavirus pandemic, avoiding physical consultations has reduced the likelihood of physicians, nurses and other care providers from getting infected with the flu.

RN Roles in Advocating for Healthcare Consumer

The role of a registered nurse in advocating for the healthcare consumer is integral to contemporary nursing practice. To begin with, the nurse could team up with colleague nurses, physicians, nutritionists, pharmacists, laboratory scientists and other personnel involved in patient care to keep abreast with latest advancements in electronic health records and e-health (Park & Yu, 2018). Since electronic health records is the future of patient care, adequate skills and competence in their application would be instrumental to enhancing safe practice among health professionals. One can easily attain proficiency in electronic health records and e-health applications via holding seminars, conferences and workshops offering training on the technology.

Insurance policies that are inconsistent with current practice are another limitation to nursing safe practice. The insurance policies are inconsistent due to being out-of-date with the actual world patient experience (Sommers, Gawande & Baicker, 2017). Whereas MediCare and MedicAid have prospective benefits for the middle-class Americans, they harbor minimal advantages to persons from the lowest socioeconomic class. Nurses could advocate for better insurance policies that favor medical insurance acquisition by poor persons (Vanhook et al., 2018). This objective would be achievable via collaborating with other health personnel, hospital management and insurance companies to devise more affordable insurance plans.

Another fact worth noting is the need to increase the scope of nursing practice to meet more patient needs. Whereas physicians and medical officers are responsible for handling majority of patient needs, they significantly spend less time with patients compared to nurses. According to Park and Yu (2018), while the former engages in reasoning to devise appropriate diagnosis and management for the patient, nurses come with an appropriate care plan to suit the patient needs. Nevertheless, increasing the scope of training for nurses would equip them with the requisite skills in handling the patient even in the absence of direct supervision by medical officers or physicians.

Conclusion

The role of nurses in ensuring adherence to safe practice cannot be overemphasized. The duties of nurses vary from providing accurate and detailed patient information, administering medication, and monitoring for adverse effects to identifying errors within existent systems. Additionally, nurses engage in professional development activities and advocate for appropriate policy reforms and keeping abreast with the latest practices and technological innovations. Consequently, to keep abreast with developments in the nursing care delivery profession, nurses must embrace continual learning, more so with the goal of enhancing their knowledge and competency in using technology in care delivery.

References

• Birks, M., Davis, J., Smithson, J., & Lindsay, D. (2019). Enablers and barriers to registered nurses expanding their scope of practice in Australia: a cross-sectional study. Policy, Politics, & Nursing Practice, 20(3), 145-152. https://journals.sagepub.com/doi/abs/10.1177/1527154419864176
• Chicca, J., & Shellenbarger, T. (2018). Generation Z: approaches and teaching–learning practices for nursing professional development practitioners. Journal for Nurses in Professional Development, 34(5), 250-256. https://journals.lww.com/jnsdonline/Citation/2018/09000/Generation_Z__Approaches_and_Teaching_Learning.3.aspx
• Padilha, J. M., Sousa, P. A. F., & Pereira, F. M. S. (2018). Nursing clinical practice changes to improve self?management in chronic obstructive pulmonary disease. International Nursing Review, 65(1), 122-130. https://onlinelibrary.wiley.com/doi/abs/10.1111/inr.12366
•  Park, H., & Yu, S. (2018). Policy issues in simulation-based nursing education and technology development. Health Policy and Technology, 7(3), 318-321. https://www.sciencedirect.com/science/article/abs/pii/S2211883718301503
• Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health—what the recent evidence tells us. The New England Journal of Medicine, 377(6), 586-593. http://medicine.tums.ac.ir/filegallery/2299016929/nezamoleslami%2031%20ordibehesht.pdf
• Tubaishat, A. (2018). Perceived usefulness and perceived ease of use of electronic health records among nurses: application of technology acceptance model. Informatics for Health and Social Care, 43(4), 379-389. https://doi.org/10.1080/17538157.2017.1363761
• Vanhook, P., Bosse, J., Flinter, M., Poghosyan, L., Dunphy, L., & Barksdale, D. (2018). The American Academy of Nursing on policy: Emerging role of baccalaureate registered nurses in primary care (August 20, 2018). Nursing Outlook, 66(5), 512-517. https://www.nursingoutlook.org/article/S0029-6554(18)30506-2/abstract

Contributions to Nursing Assignment Sample

            Health associated infections (HAI) have been a global concern for many epochs. Despite its endurance, the fights against the infections have not been completely achieved. The continued existence can be attributed to various factors. The emergence of antibiotic resistant microbes such as Vancomycin resistant enterococci contributes to the rising HAI (Reid, Sheehy & Jabbour, 2018). Additional factors include immunodeficiency, prolonged hospital stay greater than 30-days, poor hand hygiene adherences, poor understanding of the modes of transmission and frequent use of antibiotics (Reid et al., 2018). Even though the infections are a global health concern, they are more significant to developing countries which have limited finances and knowledge on the transmission and pathology of the infections.

Contributions to Nursing Practice and Profession

            Nosocomial infections are associated with both negative and positive impacts on the nursing profession. The negative effects however, overwhelm the positive impacts. The infections cause significant worldwide mortality estimated to be round 10% (Sikora & Zahra, 2020). A greater financial burden has been reported. Studies in the United States provide estimates of about $9.8 billion in acute adult care settings, and an annual cost between $28 billion to $45 billion (Sikora & Zahra, 2020). Recently, a relevant example of the health associated infections is the coronavirus.

Being that nurses are on the frontline in the care delivery, they are at risk of contacting the infections (Chen, Lai & Tsay, 2020). Psychological reactions such as fear of the infections, anxiety, worry, uncertainty and panic have overwhelmed the healthcare system (Chen et al., 2020). Adverse consequences such as death of healthcare workers have also been reported (Chen et al., 2020).

Despite the negative repercussions of HAI, the infections have spurred the quest for preventative interventions. Nurses have been on the frontline in the fights against the infections through screening, and observing standard precautions such as hand washing, use of personal protective equipment, disinfections and implementation of isolation centers (Li et al., 2017)). Further, HAI has steered research in treatment and prevention of the infections. In addition to the nosocomial infection surveillance systems, reduced infection rates have been reported.

References

• Chen, S., Lai, Y., & Tsay, S. (2020). Nursing Perspectives on the Impacts of COVID-19. Journal Of Nursing Research, 28(3), e85. https://doi.org/10.1097/nrj.0000000000000389
• Li, Y., Gong, Z., Lu, Y., Hu, G., Cai, R., & Chen, Z. (2017). Impact of nosocomial infections surveillance on nosocomial infection rates: A systematic review. International Journal Of Surgery, 42, 164-169. https://doi.org/10.1016/j.ijsu.2017.04.065
• Reid, R., Sheehy, C., & Jabbour, L. (2018). Risk Factors and Interventions Against Nosocomial Infections Across MultipleAfrican Coutries: A Systematic Review. Cientperiodique.com. Retrieved 20 January 2021, from https://www.cientperiodique.com/article/CPQME-2-2-46.pdf.
• Sikora, A., & Zahra, F. (2020). Nosocomial Infections. Ncbi.nlm.nih.gov. Retrieved 20 January 2021, from https://www.ncbi.nlm.nih.gov/books/NBK559312/.

Controlling Health Care Costs Discussion

April 5th, 2021

The Honorable A. B

U.S. Senate

Re: Controlling Health Care Costs

Dear Senator A. B.,

As a nurse, I write to you regarding the ever-increasing healthcare costs fanned in part by the expanding executive-physician wage gap and compensations to non-clinical workers. Given the growing population, the number of employed physicians and non-physician health workers is expected to rise. Specifically, concerns have emerged regarding the ever-growing executive-physician wage gap and the burden of non-clinical workers. A study by Du, Rascoe and Marcus established that between 2005 and 2015, mean worker wages increased by 8%, management worker wages by 14%, physician salaries by 10% and non-clinical worker compensations by 7%.

The high cost of salaries has consistently presented challenges to the U.S. health sector, as is the case in other developed countries. This trend aligns with the shift in focus from medical economics to patient satisfaction. The industry, however, needs to effectively use the available resources. A probable recommendation to the legislator is the need to evaluate labor management, including employees, scope of practice and technology cost control.

Patients should have access to healthcare as well as information at a single stop. Poor information regarding options available in seeking the service and alternative clinics limit the patient to the single hospital. Some countries have prices pinned on walls for patients to be aware before they get the service. The healthcare provider should not only talk about the cost of the service, but rather insist on value of the service in different clinics. This leaves the client with the option to figure out their best option. Further, patients should only be subjected to the necessary tests to avoid un-indicated tests. This cuts on cost-of-service delivery and reduces their hospital stay.

Most healthcare centres have normalised extended working shifts to offer round the clock outpatient services with goal of satisfying patient needs. However, this increases demand for human resource, for a service that economically and effectively can be provided during normal working hours. Avoiding duplication of services among staff cadres and in information technology reduces wastage of resources hence saving on costs of operation. For example, advanced practice nurses are entitled to educate patients on self-care and drug compliance, whereas a pharmacist also comes in to educate the patient on medication use. In addition, involvement of patients in decision making reduces likelihood of wrong choices and complexities of developing a care plan.

Arguing along the existing policies to regulate use of technology in provision of health services, the state legislator should harness the policy to allow registration of local physicians into remote healthcare options. Loosening the policy that requires a doctor to have had physical consultation with a patient prior to enrolling them to telehealth will make the utilization of health systems friendlier to the physicians. It also adds to the continuum of care for patients long before they are admitted for further management. The patient is prepared for his/her review or surgery prior to the day. This reduces the number of hospital visits and hence lesser resources are utilised.

As the Affordable Care Act of 2010 recommends, affordability and accessibility of healthcare services are both vital for citizens. However, with the surge in national medical cost burdens, review on resource management and accountability is imperative. The solutions to address this are myriad, among them being reviewing labour management practices that focus on value rather than patient satisfaction, application and regulation of technology, as well as transparency of information on costs to the service consumers.

Yours Sincerely,

Signed,

Name

Add email contact.

Controversy Associated with Dissociative Disorders NRNP 6665 Example Solution Included

Have you ever been driving and realized you don’t remember the last few minutes of driving? Or have you gotten so wrapped up in a book or movie that you lose some awareness of your surroundings? These are examples of common and very mild dissociation, or a disconnect or lack of continuity between thoughts, feelings, actions, and sense of self.

There are three major dissociative disorders defined in the DSM-5-TR: dissociative identity disorder, dissociative amnesia, and depersonalization-derealization disorder. Dissociative disorders may be associated with traumatic events in order to help manage difficult memories or experiences. Patients with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and eating disorders.

This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders as well as associated legal and ethical considerations.

Learning Objectives

Students will:

• Analyze issues related to the diagnosis and treatment of dissociative disorders
• Analyze legal and ethical considerations related to dissociative disorders

Controversy Associated with Dissociative Disorders

The DSM-5-TR is a diagnostic tool. It has evolved over the decades, as have the classifications and criteria within its pages. It is used not just for diagnosis, however, but also for billing, access to services, and legal cases.

Not all practitioners are in agreement with the content and structure of the DSM-5-TR, and dissociative disorders are one such area. These disorders can be difficult to distinguish and diagnose. There is also controversy in the field over the legitimacy of certain dissociative disorders, such as dissociative identity disorder, which was formerly called multiple personality disorder.

In this Assignment, you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.

To Prepare

• Review this week’s Learning Resources on dissociative disorders.
• Use the Walden Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment.

The Assignment (2–3 Pages)

• Explain the controversy that surrounds dissociative disorders.
• Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
• Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
• Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

Learning Resources

Required Readings

• Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
  • Chapter 11, “Dissociative Disorders”

Required Media

• Osmosis. (2017, November 20). Dissociative disorders – causes, symptoms, diagnosis, treatment, pathologyLinks to an external site. [Video]. YouTube. https://youtu.be/XF2zeOdE5GY
• Mad Medicine. (2019, August 18). Dissociative disorders (Psychiatry) – USMLE Step 1Links to an external site. [Video]. YouTube. https://youtu.be/Iz03M9pwhs0
• Grande, T. (2018, October 22). The dissociative identity disorder controversy (Trauma vs. Iatrogenic)Links to an external site.. [Video]. YouTube. https://www.youtube.com/watch?v=zqTP0CP9aDk

Controversy Associated with Dissociative Disorders NRNP 6665 Example Paper

Dissociative disorders involve problems with behavior, sense of self, memory, identity, perception, and emotion. Dissociative disorders include conditions such as dissociative amnesia and dissociative identity disorder.

Controversy.

Most of the controversy Dissociative Identity Disorder (DID) is whether it is a real disorder. This is despite the availability of research to validate this disorder. Dissociative identity disorder is listed as an official mental disorder in the DSM-5.

Another controversy arises from the confusion in diagnosing dissociative and personality disorders, especially borderline personality disorders. Both of these disorders have some similarities in symptoms.

The controversy around the causality of DID is also common. Many people believe that the disorder exists but is not caused by trauma but by sociocultural factors, sometimes called iatrogenic factors (?ar et al., 2017). People who believe in the existence of the disorder agree that the symptoms can be observable.

However, the side is inclined towards sociocultural factors as the causality argues that sometimes these symptoms are being faked, and patients give in to social influence. It is called iatrogenic because it is believed that clinicians could be causing the symptoms and reward patients when they manifest these symptoms.

DID is also mischaracterized in the media. In movies and TV shows, characters usually have an extreme characterization of DID, with characters showing extremely distinct personalities that operate for days on end. They typically have characteristics that are markedly different from the primary personality. DID used to be referred to as multiple personality disorder, which may have contributed to the mischaracterization and misunderstanding of this disorder.

Professional beliefs about dissociative disorders.

Dissociative disorders are not easy to diagnose. A disruption of normal identity, memory, consciousness, and behavior classically characterizes these disorders. Persons with DID are often misdiagnosed with other personality disorders, especially borderline personality disorder (Joos et al., 2017).  This is because of the overlap in the symptoms seen in both dissociative and personality disorders.

The criteria for the diagnosis of DID include the existence of more than one distinct personality state. Changes in memory, thinking, and behavior accompany these personalities. Another criterion is the presence of persistent gaps in memory, which are recurrent in nature. Another criterion is the presence of significant impairment in social, occupational, and other areas of functioning (Mychailyszyn et al., 2021)

Patients diagnosed with dissociative disorders have been exposed to extreme trauma and abuse coupled with some form of denial of the trauma (Lyssenko et al., 2018). Diagnosis of DID requires experienced psychiatric practitioners and psychologists. Diagnosis of these disorders involves assessment over a long period of time. A detailed history should be taken from the patient as well as from other sources, e.g., close friends and relatives.

Maintaining the Therapeutic Relationship.

Patients with DID tend to be very sensitive to interpersonal trust and rejection issues. Therefore, long-term treatment in an outpatient setting is ideal for handling such patients. Therapists who treat DID patients should see them once or twice weekly. This should go on for years, with the primary goal being the fusion of the personality states.

Cognitive-behavioral therapy (CBT) can effectively communicate with the alters and help the patient find better coping strategies than switching between alters (Ganslev et al., 2020).

Ethical and legal considerations

Diagnosis of Dissociative disorders requires experienced psychiatric practitioners. Therefore, a referral is necessary to avoid a misdiagnosis whenever the DID diagnosis is unclear. The patient should be informed once the correct diagnosis has been made. Because patients with DID have multiple alters, education must be done with all the alters. Patients’ privacy must be respected, and their diagnoses should not be shared publicly.

References

Ganslev, C. A., Storebø, O. J., Callesen, H. E., Ruddy, R., & Søgaard, U. (2020). Psychosocial interventions for conversion and dissociative disorders in adults. The Cochrane Database Of Systematic Reviews, 7(7), CD005331. https://doi.org/10.1002/14651858.CD005331.pub3

Joos, A., Baumann, K., Scheidt, C. E., Lahmann, C., König, R., Busch, H. J., & Schulze-Bonhage, A. (2017). Differenzialdiagnose dissoziativer Anfälle [Differential diagnosis of dissociative seizures]. Der Nervenarzt, 88(10), 1147–1152. https://doi.org/10.1007/s00115-017-0401-4

Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale. The American Journal Of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/appi.ajp.2017.17010025

Mychailyszyn, M. P., Brand, B. L., Webermann, A. R., ?ar, V., & Draijer, N. (2021). Differentiating Dissociative from Non-Dissociative Disorders: A Meta-Analysis of the Structured Clinical Interview for DSM Dissociative Disorders (SCID-D). Journal of Trauma & Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 22(1), 19–34. https://doi.org/10.1080/15299732.2020.1760169

?ar, V., Dorahy, M. J., & Krüger, C. (2017). Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychology Research And Behavior Management, 10, 137–146. https://doi.org/10.2147/PRBM.S113743

Controversy Associated with Dissociative Disorders NRNP 6665 Rubric

NRNP_6665_Week9_Assignment_RubricCriteriaRatingsPts

This criterion is linked to a Learning Outcome In 2–3 pages, address the following:

• Explain the controversy that surrounds dissociative disorders.

   

15 to >13.0 pts

ExcellentThe response includes an accurate and concise explanation of the controversy within the field related to dissociative disorders. 

13 to >11.0 pts

GoodThe response includes an accurate explanation of the controversy within the field related to dissociative disorders. 

11 to >10.0 pts

FairThe response includes a somewhat vague or inaccurate explanation of the controversy within the field related to dissociative disorders. 

10 to >0 pts

PoorThe response includes a vague or inaccurate explanation of the controversy within the field related to dissociative disorders. Or the response is missing.15 pts

This criterion is linked to a Learning Outcome

• Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.

   

25 to >22.0 pts

ExcellentThe response includes a thorough and well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale demonstrates critical thinking and is strongly supported with three scholarly references. 

22 to >19.0 pts

GoodThe response includes a well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale is clear and appropriately supported with three scholarly references. 

19 to >17.0 pts

FairThe response includes a somewhat vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current. 

17 to >0 pts

PoorThe response includes a vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is unclear and references are inappropriate. Or the response is missing.25 pts

This criterion is linked to a Learning Outcome

• Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

   

30 to >26.0 pts

ExcellentThe response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. 

26 to >23.0 pts

GoodThe response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. 

23 to >20.0 pts

FairThe response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. 

20 to >0 pts

PoorThe response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. Or the response is missing.30 pts

This criterion is linked to a Learning Outcome

• Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

   

15 to >13.0 pts

ExcellentThe response includes an accurate and concise explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. 

13 to >11.0 pts

GoodThe response includes an accurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. 

11 to >10.0 pts

FairThe response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. 

10 to >0 pts

PoorThe response includes a vague and inaccurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. Or, response is missing.15 pts

This criterion is linked to a Learning Outcome

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

   

5 to >4.0 pts

ExcellentParagraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 

4 to >3.5 pts

GoodParagraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 

3.5 to >3.0 pts

FairParagraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. 

3 to >0 pts

PoorParagraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.5 pts

This criterion is linked to a Learning Outcome

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

   

5 to >4.0 pts

ExcellentUses correct grammar, spelling, and punctuation with no errors 

4 to >3.5 pts

GoodContains one or two grammar, spelling, and punctuation errors 

3.5 to >3.0 pts

FairContains three or four grammar, spelling, and punctuation errors 

3 to >0 pts

PoorContains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding5 pts

This criterion is linked to a Learning Outcome

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

   

5 to >4.0 pts

ExcellentUses correct APA format with no errors 

4 to >3.5 pts

GoodContains one or two APA format errors 

3.5 to >3.0 pts

FairContains three or four APA format errors 

3 to >0 pts

PoorContains many (five or more) APA format errors5 ptsTotal Points: 100   

Also Read: Neurodevelopment Disorders Study Guide NRNP6665