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NR 524 Nurse Educators School of Nursing Curriculum Plan

NR 524 Nurse Educators School of Nursing Curriculum Plan

Developing an ADN Mission Statement for a Community College

Nurse educators are mandated with vital roles in developing the nursing practice, preparing future nurses, and developing an elaborate, succinct, and appropriate nursing education curriculum (De Gagne & Phillips, 2017). The development of nursing education programs requires a sound and formidable mission statement, sum up the program’s objectives and target, and outline its achievability.

Appropriate mission statements are essential in giving the program clarity and direction as to its core objectives and the roles of stakeholders therein. Notably, a program’s mission statement should echo and align with the parent organization’s mission statement. This paper will develop an ADN program’s mission statement for Chamberlain University College of Nursing and outline the ADN mission statement consistent with the parent organization.

Parent Organization Mission Statement

Chamberlain University mission statement is “To educate, empower, and embolden diverse healthcare professionals who advance the health of people, families, communities, and nations.” The Chamberlain mission statement outlines the organization’s commitment to the promotion of health provision services of not only individuals but across nations through empowering and appropriate education of health care providers.

Furthermore, the mission statement captures a critical aspect in healthcare: diversity, showing an orientation towards empowering healthcare providers to embrace the aspect.

The Associate Degree in Nursing Program Mission Statement

The healthcare provision discipline is increasingly becoming dynamic and vast due to technological and changing patient needs, i.e., the surge in patients requiring geriatric care (Kadhium, 2021). The Chamberlain University College of Nursing considers this in developing the ADN program to prepare RNs for nursing practice and future advancement to BSNs.

The Chamberlain ASN program’s mission will be “To equip nursing students with adequate, appropriate and culturally sensitive knowledge and skills for advancement in the clinical setting with the use of research and evidence-based practice while providing high quality, compassionate care on a regional, national and global level.”

Elements of the ADN Program’s Mission Statement

The ADN’s mission statement is categorically congruent with the Chamberlain University mission statement as it echoes the core organizational objectives of the institution.

Furthermore, as a program meant for the development of nursing students, its key focus is on providing excellent teaching services meant for the improvement of nursing care. Another element of the ADN mission statement is that it touches on the program’s unique values. Finally, is the target population set to benefit from the program, and how they will benefit.

Congruency of the ADN Program’s Mission Statement with Chamberlains’

The Chamberlain University mission statement outlines its vital commitment to the education, empowerment, and emboldening of diverse healthcare professionals. The organization essentially prepares healthcare professionals to advance health to people, families, communities, and nations (Shustack, 2019).

Congruent with Chamberlain’s mission statement is the ADN mission, which explicitly targets nursing students with adequate knowledge to be advanced in clinical settings to better people’s health. Another aligning factor between the two mission statements is the focus on diversity;

ORDER THROUGH BOUTESSAY

Chamberlain University’s mission aims to produce diverse healthcare professionals, a concept reflected in the ADN program’s mission emphasis on cultural sensitivity. Teaching and Service The program’s mission statement highlights the ADN commitment to providing adequate and appropriate knowledge and skills to the nursing students, i.e., its emphasis on using evidence-based practice among its targets (Kadhium, 2021).

Furthermore, cultural competence is a crucial component of the nursing teaching program, which will capitalize on intensive research 4 and evidence-based practice, thus fostering the quality of teaching. Regarding service delivery, the program’s ultimate goal, as outlined in the mission statement, is to provide compassionate and high-quality services to all those whom the program’s graduates will handle.

Unique Qualities in the ADN Mission Statement

There exist numerous ADN programs; however, the Chamberlain one will stand out of the rest as one committed to producing culturally competent RNs, as cultural competence is a significant ingredient of its mission statement (McCoy & Anema, 2018).

Furthermore, the mission statement emphasizes using research and evidence-based practices in the knowledge dissemination process, and nursing practice further makes the program unique. Finally, what makes tick out is the focus on the high quality and compassionate care offered by graduates of the program.

Target Population

The program’s mission statement brings out the program’s primary target to be the future nurses, i.e., as with other ADNs, the Chamberlain’s ADN will strive to prepare nursing students aiming to be RNs and advance to BSN in the future (Robert, 2018). The mission statement’s emphasis on cultural awareness further highlights the programs targeting highly diversified students and the patients who will benefit from the program’s graduates.

From the mission statement, the target beneficiaries of the program’s graduates are all people in need of nursing care regardless of their cultural background, on a regional, national and global level.

Peer Collaboration Influence on the Final Mission Statement

The final ADN program mission statement is a refined version of the initial mission statement, which was relatively uninformed, non-congruent with Chamberlain’s mission, and lacked the unique qualities of the intended program. Through collaboration with my peers, I got 5 the insight to drop the specific target of pre and post-partum care and replace it with all in need of care; this scope-widening, according to my peers, gave the ADN program’s graduates a wider variety of specialization in their future pursuit (Kadhium, 2021).

The peer discussion further opened my eyes to the need to incorporate the program’s unique qualities into the mission statement, i.e., cultural competence, focus on research, and evidence-based practice. Finally, through a scholarly work review and considering the insights from the peer discussion, I came up with the current mission statement.

Conclusion

A mission statement is a vital part of a developed nursing program as it gives clear objectives of the program and the direction to be followed. The ADN mission statement strives to be congruent with Chamberlain University’s mission to echo and propagate the organization’s key objectives. Unique features of the program are snapshotted in the mission statement, and the mission captures the program’s commitment to teaching and service delivery.

Finally, peer consultation and review of scholarly works are pertinent in developing and refining a program’s mission statement.

NR 524 Nurse Educators School of Nursing Curriculum Plan References

• De Gagne, J. C., NPD-BC, C. N. E., & Phillips, B. C. (2017). Teaching in nursing and role of the educator: The complete guide to best practice in teaching, evaluation, and curriculum development.
• Springer Publishing Company. How to Develop & Evaluate Educational Programs. Springer Publishing Company. 6 Kadhium, V. (2021). Do Mission Statements Matter? An Evaluation of Dental School Mission Statements. Journal of Dentistry and Oral Sciences. doi: 10.37191/-2582-3736-3(1)-074
• McCoy, J. L., & Anema, M. G. (2018). Fast Facts for Curriculum Development in Nursing: Robert, N. (2018). Predictors of program completion and NCLEX-RN success in an associate degree nursing program. Nursing Education Perspectives, 39(1), 38-39.
• Shustack, L. M. (2019). A qualitative case study of a high performing practical nursing program in Pennsylvania. Teaching and Learning in Nursing, 14(1), 15-20.

NR 524 Nurse Educators School of Nursing Curriculum Plan

Chamberlain College of Nursing

NR524

Curriculum Development

Curriculum Plan

Course Syllabus

PURPOSE

The purpose of this assignment is to:

• Develop a curriculum plan and course syllabus
• Demonstrate skills in the development and articulation of ideas in a scholarly manner.

DUE DATE

• Submit by 11:59 p.m. MT Sunday of Week 6.

TOTAL POINTS POSSIBLE: 230

NR 524 Nurse Educators School of Nursing Curriculum Plan Course Outcomes:

• CO 1: Design curricular components based upon knowledge and concepts from education and related disciplines to achieve quality health outcomes (care-focused). (PO 2)
• CO 2.Demonstrate critical understanding of curriculum processes that benefit diverse learners (cultural humility). (PO 3)
• CO 4: Develop curriculum that reflects current trends, addresses community and societal needs, and prepares graduates for practice in a complex, dynamic healthcare environment (care-focused). (PO 2)

NR 524 Nurse Educators School of Nursing Curriculum Plan Requirements

Assignment Criteria for the Paper

1. Curriculum Plan reflects original work of the student.

2. Curriculum Plan reflects the requirements of the State Board of Nursing (academic) or a professional organization (hospital).

3. The syllabus includes all the required elements.

4. Use of the template provided is required for the assignment.

5. Grammar, spelling, punctuation, references, and citations are consistent with formal academic writing and APA format as expressed in the current edition.

Chamberlain College of Nursing NR524 Curriculum Development Directions

Curriculum Plan

Academic Nurse Educators: School of Nursing

• Use the table below to develop the Curriculum Plan for either the associate degree program or the pre-licensure Baccalaureate program. Include all general education courses, science courses, and nursing courses.
• Identify the course by the prefix, number, and name of the course. Include the total credit hours for the course and then the breakdown of hours by theory (T), clinical (C), and laboratory (L). For example: NUR101 Fundamentals of Nursing, 6 credits (3T, 1L, 2C).
• Academic Nurse Educators: Base your courses on the requirements from either the Florida State Board of Nursing: https://floridasnursing.gov/licensing/practical-and-registered-nurse-education-program/ OR the California State Board of Nursing: § 1426.

Required Curriculum.

• 16 CA ADC § 1426 BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS. http://carules.elaws.us/code/t.16_d.14_art3_sec.1426
• Indicate the state you have chosen on the template.

Reminder:

Associate Degree Program = 60 credits

Baccalaureate Degree Program = 120 credits

Curriculum Plan—Associate Degree Program Template (Add additional lines, columns to the template as needed for your program)

Course Requirements from State of ____________________(please include name of the state) Prerequisites (if required; list by course number and name)

Chamberlain College of Nursing NR524 Curriculum Development Total Credit Hours:

• First Year
• Second Year
• First Semester
• Second Semester

Total Credits =

Total Credits =

• First Semester
• Second Semester

Total Credits =

Total Credits =

Total Credits for Year =

Total Credits for Year =

Total Credits for Program =

Peer Collaboration Influence on Curriculum Development Curriculum Plan—Baccalaureate Program Template

Chamberlain College of Nursing NR524 Curriculum Development (Add additional lines, columns to the template as needed for your program)

Course Requirements from State of ____________________(please include name of the state) Prerequisites (if required; list by course number and name):

Total Credit Hours:

• First Year
• Second Year
• First Semester
• Second Semester

Total Credits =

Total Credits =

• First Semester
• Second Semester

Total Credits for Year = 4

Chamberlain College of Nursing

• Third Year
• Fourth Year

NR524 Curriculum Development

Total Credits =

Total Credits =

• First Semester
• Second Semester

Total Credits =

Total Credits =

• First Semester
• Second Semester

Total Credits =

Total Credits =

Total Credits for Year =

Total Credits for Year =

Total Credits for Year.

Total Credits for Program =

Peer Collaboration Influence on Curriculum Development Curriculum Plan Nursing Professional Development Specialists: Hospital Orientation

Use the table below to develop the Curriculum Plan for a hospital orientation. Model the following hospital orientation guidelines found in the Hospital Orientation Requirements document from the Week Five Peer Collaboration to develop your curriculum.

Identify each course with a title, the number of hours in the course, if the course includes a skills laboratory or clinical component, and when the course is offered in the sequence of the orientation.

Curriculum Plan—Hospital Program Template (Add additional lines, columns to the template as needed for your program) Orientation Plan for Hospital Orientation/Critical Care Orientation Orientation Day

• Course Name
• Number of Hours of the Course Skills
• Laboratory or Clinical Component with Hours
• Identified Course
• Conducted By (Department Title)

Peer Collaboration Influence on Curriculum Development Directions

Syllabus Academic Nurse Educators Use the template below to develop a syllabus for one of the nursing courses in your Curriculum Plan. If you choose a course that has a laboratory and/or clinical component, then be sure to include that information in the template. Submit the template for grading.

SYLLABUS TEMPLATE

• Name of School
• Course Number and Name
• Course Credits
• Prerequisites
• Faculty Information
• Name
• E-mail
• Phone
• Office Hours

Course Description

Program Outcomes (use the outcomes developed in the Week 4 assignment)

Course Schedule

Course Assignments

Grading Scale Policies

Attendance and Participation:

Academic Integrity (including Plagiarism):

Use of Mobile Devices: Civility in the Classroom:

Late Assignments:

NR524 Curriculum Development Nursing Professional Development Specialists

Use the template below to develop a syllabus for one of the nursing courses in your Curriculum Plan. If you choose a course that has a laboratory and/or clinical component, then be sure to include that information in the template. Submit the template for grading.

SYLLABUS TEMPLATE

Name of Facility

Course Number

Course Hours

Prerequisites

Faculty Information

Name

E-mail

Phone Office Hours

NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr 9 Chamberlain College of Nursing NR524 Curriculum Development Course Description Program Outcomes (use the outcomes developed in the Week 4 assignment) Course Outcomes Hospital Policies and Resources for Orientees Orientation Schedule Orientation Assignments NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr 10 Chamberlain College of Nursing NR524 Curriculum Development Grading Scale (Can be identified as Pass/Fail with explanation) Policies Attendance and Participation: Orientation Integrity (including Plagiarism): Use of Mobile Devices.

Civility in the Classroom: Missed Days of Orientation: GRADING CRITERIA Category Curriculum Plan Points % 50 22 Description The content in the curriculum plan is congruent with the State Board of Nursing requirements (academic) or the professional organization (hospital). NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr 11 Chamberlain College of Nursing NR524 Curriculum Development Curriculum Plan 15 7 The course number, title, and credit hours are defined for each course within the nursing academic programs. The course title and number of course hours are identified for each course in the hospital setting Curriculum Plan 15 7 Courses are identified with laboratory and/or clinical hours as appropriate. Syllabus: Description 20 8 Descriptions accurately describe the course with laboratory and clinical components as appropriate. Syllabus: Outcomes 20 8 Outcomes support the program outcomes. Syllabus: Schedule 20 8 Schedule clearly identifies the time frame for the content and the flow of the content during the course. Syllabus: Assignments 20 8 Assignments are clearly identified with point values and due dates within the nursing academic programs. Assignments are clearly identified with a pass/fail grade and due dates for the hospital setting. Assignments are appropriate for the course content. Syllabus: Grading 15 7 Grading clearly identifies the letter grade and percentage/point value needed to obtain the letter grade in the academic setting OR pass/fail and the consequence of failure in the hospital setting Syllabus: Policies 20 8 Policies are clearly defined in the syllabus. Peer Collaboration Influence on Curriculum Plan 20 8 Influence of peer collaboration on Curriculum Plan is clearly identified. Graduate-Level Writing Style 15 7 The required content includes the following. • Correct spelling, grammar, and punctuation • Exceptional writing style with clarity, flow, and organization of information throughout the paper • Congruence with APA mechanics of style Total 230 100% A quality paper will meet or exceed all of the above requirements. NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr 12 Chamberlain College of Nursing Assignment Criteria Exceptional; Outstanding level of performance NR524 Curriculum Development Meets expectations Needs improvement 80% 50% Unsatisfactory level of performance 0% 100% Content Possible Points = 230 Points 50 Points NR524_W6_ NR 524 Nurse Educators School of Nursing Curriculum Plan

CurriculumPlan_2018.08.26_revised 2019.04.12rr 40 Points 25 Points 0 Points 13 Chamberlain College of Nursing NR524 Curriculum Development Curriculum Plan: Content The content in the Curriculum Plan is congruent with the State Board of Nursing requirements (academic) or the professional organization (hospital). The content in the Curriculum Plan is partially congruent with the State Board of Nursing requirements (academic) or the professional organization (hospital). The content in the Curriculum Plan is minimally congruent with the State Board of Nursing requirements (academic) or the professional organization (hospital). The content in the Curriculum Plan is not congruent with the State Board of Nursing requirements (academic) or the professional organization (hospital). Curriculum Plan: Courses 15 Points 12 Points 8 Points 0 Points The course number, title, and credit hours/number of hours are defined for each course. Curriculum Plan: Course Hour Breakdown Syllabus: Description The course number, title, and credit hours/number of hours are partially defined for each course. 15 Points Courses are identified with laboratory and/or clinical hours as appropriate. 12 Points Some courses are identified with laboratory and/or clinical hours as appropriate. 20 Points 16 Points Descriptions accurately describe the course with laboratory and clinical components as appropriate. Descriptions partially describe the course with laboratory and clinical components as appropriate. NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr The course number, title, and credit hours/number of hours are minimally defined for each course. 8 Points Minimal courses are identified with laboratory and/or clinical hours as appropriate. 10 Points Descriptions minimally describe the course OR the laboratory and clinical components are not included as appropriate. The course number, title, and credit hours/number of hours are missing from the courses. 0 Points Courses are not identified with laboratory and/or clinical hours as appropriate. 0 Points Descriptions are not included OR the laboratory and clinical components are not included as appropriate. 14 Chamberlain College of Nursing Syllabus: Outcomes 20 Points Outcomes support the program outcomes. Syllabus: Schedule Syllabus: Grading 16 Points Outcomes support the program outcomes with rare exceptions. 20 Points Schedule clearly identifies the time frame for the content and the flow of the content during the course/orientation Syllabus: Assignments NR524 Curriculum Development 16 Points Schedule identifies the time frame for the content and the flow of the content during the course/orientation with rare exceptions. 10 Points Outcomes only minimally support the program outcomes OR the outcomes are not written using Bloom’s taxonomy. 0 Points Outcomes do not support the program outcomes 10 Points 0 Points Schedule only partially identifies the time frame for the content and the flow of the content during the course/orientation. Schedule does not identify the time frame for the content and the flow of the content during the course/orientation. 20 Points 16 Points 10 Points 0 Points Assignments are clearly identified with point values or pass/fail and due dates. Assignments are appropriate for the content. Assignments are clearly identified with point values or pass/fail and due dates with minimal exceptions. Assignments are appropriate for the content. Assignments are only partially identified with point values or pass/fail and due dates OR assignments are not appropriate for the content.

Assignments are not identified with point values or pass/fail and due dates AND assignments are not appropriate for the course content. 15 Points 12 Points 8 Points 0 Points Grading clearly identifies the letter Grading partially identifies the letter grade NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr Grading minimally identifies the letter Grading does not identify the letter 15 Chamberlain College of Nursing grade and percentage/point value needed to obtain the letter grade for the academic nursing program. For Hospital Setting: Grading clearly identifies pass/fail and the expectations if the student is not successful. Syllabus: Policies and percentage/point value needed to obtain the letter grade for the academic nursing program. For Hospital Setting: Grading partially identifies pass/fail and the expectations if the student is not successful. grade and percentage/point value needed to obtain the letter grade OR the point values are inaccurate for the academic nursing program. For Hospital Setting: Grading minimally identifies pass/fail OR the expectations if the student is not successful are not included. grade and percentage/point value needed to obtain the letter grade AND the point values are inaccurate for the academic nursing program. For Hospital Setting: Grading is not included. 16 Points 10 Points 0 Points 20 Points Policies are clearly defined in the syllabus. All five of the required policies are included. Peer Collaboration Influence on Curriculum Plan NR524 Curriculum Development Policies are partially defined in the syllabus OR only four of the required policies are included in the syllabus. 15 Points Influence of peer collaboration on Curriculum Plan is clearly identified. 12 Points Influence of peer collaboration on Curriculum Plan is identified but with occasional inaccuracies or lack of clarity. NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr Policies are minimally defined in the syllabus OR only three of the required policies are included. 8 Points Influence of peer collaboration on Curriculum Plan does not identify specific details. Two or fewer policies are defined in the syllabus. 0 Points Influence of peer collaboration is not included. 16 Chamberlain College of Nursing NR524 Curriculum Development _____of 75 points Format Possible Points = 20 Points Scholarly Writing at the Graduate Level 20 Points 16 Points 10 Points 0 Points 0–1 error or exceptions to the rules of APA citation style, grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA Manual. 2–3 errors or exceptions to the rules of APA citation style, grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA Manual. 4–5 errors or exceptions to the rules of APA citation style, grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA Manual. 6 or more errors or exceptions to the rules of APA citation style, grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA Manual. Format Subtotal Total Points = 230 NR524_W6_ CurriculumPlan_2018.08.26_revised 2019.04.12rr __ Points 17 This week in the peer collaboration area, you will develop program outcomes for your school or the staff development department. For the academic programs, you will base the program outcomes on either the AACN Essentials of Baccalaureate Education OR the NLN Competencies for graduates of Associate Degree Programs.

N Competencies for graduates of Associate Degree Programs (2010) 1. Human Flourishing: Advocate for patients and families in ways that promote their self determination, integrity, and ongoing growth as human beings 2. Nursing Judgment: Makes judgments in practice, substantiated with evidence, that integrate nursing science in the provision of safe, quality care and promote the health of patients within a family and community context 3. Professional Identity: Implement one’s role as a nurse in ways that reflect integrity, responsibility, ethical practices, and an evolving identity as a nurse committed to evidence-based practice, caring, advocacy, and safe, quality care for diverse patients within a family and community context 4. Spirit of Inquiry: Examine the evidence that underlies clinical nursing practice to challenge the status quo, question underlying assumptions, and offer new insights to improve the quality of care for patients, families, and communities Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety Essential III: Scholarship for Evidence-Based Practice AACN Essentials of Baccalaureate Education Essential IV: Information Management and Application of Patient Care Technology http://www.aacnnursing.org/EducationResources/AACN-Essentials (Links to an external site.)) Essential V: Health Care Policy, Finance, and Regulatory Environments Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes Essential VII: Clinical Prevention and Population Health Essential VIII: Professionalism and Professional Values Essential IX: Baccalaureate Generalist Nursing Practice For the hospital-based program, you will develop program outcomes based on the 2020 Joint Commission Hospital National Patient Safety Goals (Links to an external site.) 1. Identify patients correctly. 2. Improve staff communication. 3. Use medicines safely. 4. Use alarms safely. 5. Prevent infection. 6. Identify patient safety risks. 7. Prevent mistakes in surgery. Nursing schools and healthcare staffs mainly focus on professional growth through acquiring new skills and enhancing effectiveness in care provision. Nurse educators play a crucial role in training nurses and creating succinct and elaborate nursing education programs and courses. According to De Gagne & Phillips (2017), the development of nursing education programs requires comprehensive program outcomes that outline the program’s objectives, target, and achievability. Different programs have different program outcomes based on the learning environment. Academic programs have slightly different program outcomes from hospital-based programs, but they seek to achieve evidence-based and patient-centered nursing practice. A program’s vision and mission statement inform the program outcomes. The mission is “To equip nursing students with adequate, appropriate and culturally sensitive knowledge and skills for advancement in the clinical setting with the use of research and evidence-based practice while providing high quality, compassionate care on a regional, national and global level.” Therefore, the program outcomes will be based on the “Essentials of Baccalaureate Education by the American Association of Colleges of Nursing (AACN)” (AACN Essentials, 2021). The essentials require that at the end of the program, the learners will: 1.

Champion for quality health outcomes founded on evidence-based and collaborative care practice. The student should identify, integrate, and evaluate the available evidence and research findings and integrate them with clinical expertise. 2. Integrate professionalism and related values in the practice and care provision. Students will engage in ethical reasoning and promote leadership, social justice, advocacy, and collaboration in care provision. 3. Provide safe, patient-centered, and high-quality care based on holistic care principles. Learners will be able to appreciate and understand the importance of teamwork and collaboration with patients and their families/friends. 4. Appreciate cultural diversity and use reflective practice to engage in lifelong personal and professional growth. References AACN Essentials. (2021). The New AACN Essentials. Aacnnursing.org. Retrieved 21 September 2021, from https://www.aacnnursing.org/AACN-Essentials. De Gagne, J., & Phillips, B. (2017). Teaching in Nursing and Role of the Educator (2nd ed.). Springer Publishing Company. 1 Curriculum Plan for the Ever Hearts Associate Degree in Nursing Program Curriculum Plan—Associate Degree Program Template Course Requirements from the State of Florida: https://floridasnursing.gov/licensing/practical-and-registered-nurse-educationprogram/ (Links to an external site.) 2 Courses to be Completed Before Joining the Ever Hearts ADN Program Include: 1. 2. 3. 4. 5. 6. Bio 241: Human anatomy and physiology (2-semester credits) Chem 121: Fundamentals of chemistry (2-semester credits) Bio 216: Microbiology (2-semester credits) Math 130: Basics of statistics (2 credits) ENG 101: Research paper (2 credits) PSYC 200: Lifespan psychology (2 credits) Total Credit Hours: 12 First Year Second Year First Semester Second Semester NUR101 Basics of Nursing, five credits (3T, 2C, IL) NUR102 Pharmacology 7 credits ( 2T, 3C,2L) BIO142: Human anatomy and physiology (ii), seven credits (2T, 2C, 3L) NUR103 Prenatal and postnatal, seven credits, (2T, 3C,2L) Total Credits = 12 Total Credits = 12 First Semester Second Semester NUR201 Mental health, 6 credits (2T, 3C,1L) NUR203 Medicalsurgical, 7 credits (2T, 3C,2L) Total Credits for Year =24 3 Additional Graduation Requirements NUR202 Geriatrics, 5 credits (2T,2C,1L) NUR 204 Evidencebased practice and ethical issues, 6 credits (3T,2C,1L) Total Credits = 11 Total Credits = 13 Activities = 2 credits Guidance= 2 credits Total Credits for the Program Peer Collaboration Influence on Curriculum Development Total Credits for Year =24 = 60 credits Reviewing other developed curricula for other faculties at the Ever Hearts University and other educational institutions informed the current curriculum develo

NR 533 Financial Management in Healthcare Organizations

Week 4: Staffing Budgets/FTEs/ Variance Analysis

Assignment Guidelines with Scoring Rubric

Purpose

This assignment provides learners with the opportunity to apply budgeting knowledge and skills by calculating full-time equivalents for a nursing unit, projecting FTE needs related to census changes, and analyzing a variance scenario.

Due Date:  Sunday 11:59 p.m. MT at the end of Week 4

Total Points Possible: 150

Requirements

Description of the Assignment

This assignment is in two scenario-based sections each related to staffing budgets. In the first, the student will perform multistep calculations of FTEs and projection of future FTE needs for a selected nursing unit. The second section involves calculation of budget variance and its analysis. Each section requires supported written interpretation of findings.

Criteria for Content

Answer the questions and complete the calculations required for the two sections of the assignment.

Key points related to Calculations:

1. When performing calculations, standard rounding rules apply. If the number to the right of the decimal is less than 5, round down to the nearest whole number, e.g., 33.4 = 33 If the number to the right of the decimal is 5 or greater, round up to the nearest whole number, e.g. 33.5 =34.
2. Read the question carefully. Pay close attention to the units be asked and keep them consistent. For example, hours vs FTEs; days vs months vs years.
3. Provide ALL formulas with references. Designate which formula associates with which source. It is not sufficient to simply list the source at the beginning of the section. Write out the formula used BEFORE filling in the numbers.

Example: Efficiency Variance + Volume Variance + Cost Variance = Total Variance

Rundio, A. (2016). The nurse manager’s guide to budgeting and finance. 2nd. Ed., Indianapolis, IN: Sigma Theta Tau International.

• Section One: Staffing Budget and FTEs
  • Calculations of full-time equivalents (FTEs)
  • Project FTE needs related to census changes
• Section Two: Variance Analysis
  • Calculating variance
  • Variance analysis with explanation

Download the Assignment Word Document and submit your answers directly onto the form. When completed, upload into the assignment portal in your course. For the questions requiring a written response, please adhere to proper grammar and syntax, and provide references. For the questions requiring calculations, show all your work including the formula used. Include the references for formula chosen.

Preparing the Assignment

Section One—Staffing Budget and FTEs

Personnel Budget Case Study

Sandra Chambers has recently accepted the position of assistant administrator for the department of nursing at Potter Regional Medical Center where she will oversee the operations of five medical units. As she evaluates the budgets for the different cost centers, she finds that all are being used at near or full capacity. The activity in four of the five has remained steady over the past 2 years. A fifth unit has realized a steady increase in patient volume during that time and is currently at 88% capacity. It has been projected that within the next 12 months the volume of patients moving through that unit will increase by 20%. Sandra needs to determine if the current FTEs for the unit will be sufficient to ensure quality and safe care continues to be provided, and if not, what is the number of FTEs that will be needed to cover a 20% increase in volume.

1. Suggest all the information Sandra needs to collect in order to project the FTEs needed for the next fiscal year accounting for the projected increased capacity. Remember, she is new to her position so be sure to include background data on the unit itself as it relates to previous budgets, nursing staff, and the organization. In other words, summarize your approach to this Case Study.
2. Sandra has collected the following census information on all five units for the last month, in

addition to what was asked in question number one. Calculate the ADC and Occupancy Rate for each unit using the Daily Census/Occupancy Rate table to determine which unit is currently at 88% occupancy rate and projected to increase over the next year.

 

Unit

   Beds12345678910111213141516171819202122232425262728293031Total Patient DaysA353130313029303130312929323133313133343434343230323130303331340941B1515141197121215131316151515161615141516151313171615161614150424C131012111111131313121312121213131313131313131313121212121313130372D323027272426232729282825273026313130303032323226252525233131300841E6633335552222443300065533325433097

(adapted from…..Healthcare Financial Management Association (2012).  Managing fiscal resources: A budget and productivity case study.  Retrieved from hfmamd.org

ACD formula: Total number of days/total census numbers (Griffiths et al, 2020)

% occupancy formula: Average daily census /number of beds x 100 (Welch & Smith 2020)

 

Average Daily Census/Occupancy RateUnitADCOccupancy (%)A31(941/30)89B14(424/30)93C12(372/30)92D28 (841/30)88E3(97/30)50

The Unit with an 88% occupancy rate is __UNIT D___.

3. Using data contained in the first questions, complete the table below and determine the Average Length of Stay (ALOS) for the following three units. Show your work.

Unit# BedsPatient Days# DischargesAverage Length of Stay (ALOS)A35941   1109 (941/110)C13372      964 (372/96)D32841      8510 (84/185)

What is the ALOS for the unit you identified earlier at an 88% occupancy rate?  _10 DAYS____

You have determined the Unit for which Sandra must make FTE projections. For the remaining questions in this section, refer to the figures used and or obtained related to the Unit identified in Question 1.

Additional information includes

• the budgeted hours of care per patient day (HPPD-budgeted) is 8.0
• each employee receives 300 paid non-productive hours/year.

4. Calculate the number of FTEs needed for the Unit. Show the formulas used and all calculations. Include the reference used for your calculations at the beginning of your work.

FTE= total number of hours worked per year/the number of hours one FTE works per year (2080)

Total hours of care expected to be delivered=total days spent with the patients per year x Hours of care per patient days (Hunt, 2018).

As per Unit D:

Total patient days for a year = 841 x12 months = 10092

Budgeted hours of care per patient day=6.5

10092 x 6.5=65,598

Total hours of care to be delivered=65,598/2080=36 FTEs

5. Calculate the TOTAL FTEs needed accounting for nonproductive time. Include the reference used for your calculations at the beginning of your work.

Total benefit hours=2080=productive hours worked

One FTE=2080 -yearly productive hours = 1780

65,598/1780 hours (Tawfik et al, 2020) = 36 FTEs

6. Sharon now knows how many total FTEs are currently needed on the unit to provide safe, quality care to the patients on the unit. However, with a 20% projected increase in occupancy rate and average length of stay remaining steady on the unit, how will the required FTEs be affected?

An increase of total patient days by 20% represents an increase from 10092 to 12110. If you consider the number into the same formula, then the number of FTEs rise from 32 to 44 (Griffiths et al, 2020).

7. Calculate the TOTAL FTEs required to reflect an increased patient volume of 20% (don’t forget to account for nonproductive time). Include the reference used for your calculations at the beginning of your work.

10092 x 0.2= 12110 total patient days considering the 20% increase

12110 x 6.5 (HPPD budget) =78,715 hours of care

78,715/1780 (number of productive hours spent working) = 44 FTEs (Welch & Smith, 2020)

8. When Sharon calculated the number of FTEs budgeted currently in this unit and compared it to the number of actual FTEs being paid for, she found she was under budget by three FTEs. Explain how that could have happened and how this information affects her FTE budget request for the next year.

Operating underbudget is usually a rare case in healthcare. On the same note, it is a financial norm that if you fail to fully utilize your budget in the previous year, then your next year’s budget will be cut under the assumption that you don’t need additional budget. For instance, Sharon had only used 41 out of the 44 FTEs she had and therefore the financial department will assume that she only needs 41 FTEs.

_______________________________________________________________________________

Section Two—Variance Analysis

Variance Analysis Case Study

During the month of February, an outpatient surgery clinic has incurred a significant unfavorable variance. The director of the clinic is quite concerned, as this has never occurred before. The director gathers information on total nursing care hours, average hourly rate of the employees, and total patient visits to determine what caused the variance. In addition, the director receives the patient acuity levels for the month of February.

BudgetActualBudget VariancePatient Days47556590Nursing Care Hours22502912662HPPD7.07.6Average Hourly Pay$35.00$45.00$10.00Total Payroll Costs$78,750$131,040$52,290

(Table adapted from: Rundio, A. (2016). The nurse manager’s guide to budgeting and finance, 2nd. Ed, Indianapolis, IN: Sigma Theta Tau International)

1. Complete the monthly personnel report for the surgical unit.
2. Calculate each of the following. Include the formulas used with reference. Remember, as this monthly report deals with payroll, the variances should be in dollars.
3. Volume (efficiency) variance: 11,865

Volume variance+ Total extra nursing care hours x the hourly wage in the budget: 339 x 35= 11,865.

Total extra hours of nursing care=Average extra hours of nursing care x Actual patient days: 0.6 x 565=339

Average extra hours of nursing care=actual HPPD – budgeted HPPD= 7.6-7.0=0.6

1. Quantity (volume) variance: $22,050

Quantity variance = extra number of care hours provided x hourly pay rate as per the budget: $630×35=$22,050

Extra hours of nursing care provided= extra patient days x Budgeted HPPD:90 x 7.0= 630

Extra patient days = actual patient days-budgeted patient days: 565-475= 90 (Hunt, 2018)

1. Cost (price) variance: $29,120

Cost variance = actual hours worked x cost variance

2912 x 10= $29,120

Cost difference = actual average hourly rate paid- budgeted average hourly rate paid: 45-35= $10 (Tawfik et al, 2020)

3. What is the total variance in personnel budget for this month?
4. Total variance= Cost variance+ quantity variance+ volume variance
5. 29,120+$22,050+$11,865 = $63,035 (Hunt, 2018)

 

6. Analyze all the factors that made the differences and why the variances occurred. How can this variance be justified?

The cost variance area presented with the largest variance. This is attributable to the large difference in the hourly rate between the actual rate and the budgeted rate. Such variances may occur as a result of many reasons. for instance, the facility might have hired more experienced staff who require a higher pay rate; or staff working overtime as a result of higher population.

7. In what ways might these variances inform the current or future budgets?

If the variance was caused by overtime hours it may be useful in the future to ask for more FTEs or a higher rate because there are several staff working overtime and the additional staff or hours is needed.

 

DIRECTIONS AND ASSIGNMENT CRITERIA

 

CategoryPoints%DescriptionSection One: Staffing Budget and FTEsBackground Information1010%Approach to Personnel Case Study is clearly articulated and contains the elements needed to address the situation presented in the scenario.ADC and Occupancy Rate1010%ADC/Occupancy Rate table completed with reference for formulas included, formulas and work shown, correct unit calculations, correct unit identified.Average LOS1010%ALOS table completed with reference for formulas, formula and work shown, correct calculations, ALOS of identified unit correct.Current FTE1515%Current FTEs of identified unit calculated correctly and includes reference for formulas used, formula and work shown, calculations correct.Total FTE (Current)1515%Total FTEs (accounts for nonproductive time) of identified unit calculated correctly and includes reference for formulas used, formula and work shown, calculations correct.Effect of Volume Increase on FTE1010%Describes effect of increase of patient volume on FTEs over the next year. Describes what effect an increased length of stay would have on FTEs.Total FTE (Projected)1515%Total FTEs (accounts for nonproductive time) for projected volume increase of identified unit calculated correctly and includes reference for formulas used, formula and work shown, calculations correct.FTE Difference Explanation1010%Explains potential causes for being under budget and explicitly describes its effect on the budget request for next year. Uses data from given and calculated elements to support explanations.Section Two: Variance AnalysisCalculation of Total Variance3535%Calculations that lead to the total variance of the unit are present and include volume efficiency, volume (quantity), and cost variances. References for formulas used, formulas and all work are shown, calculations are correct.Analysis of Variances1515%All elements of variances explained, variance justification present and supported with evidence, effect on current and future budges explicit and clearly articulated.Writing conventions, format, and reference citations55%Writing is clear and concise without grammatical and spelling errors. All references are correctly cited (if applicable) and written. 150150%A quality assignment will meet or exceed all of the above requirements.

 

NR 601 FINAL EXAM STUDY GUIDE Week 5

Week 5: Glucose metabolism disorders

Types of DM

1. Type 1– severe insulin deficiency resulting in reduction or absence of functioning beta cells in the pancreatic islets of Langerhans.  This leads to hyperglycemia due to altered metabolism of lipids, carbs, and proteins.   Initial s/s of hyperglycemia.  Subjective findings- polyuria, polydipsia, nocturnal enuresis and polyphagia with paradoxical weight loss, visual changes and fatigue.

Objective-dehydration(poor skin turgor and dry mucous), wt loss despite normal/increase appetite, reduction in muscle mass. DKA-fatigue, cramping, abnormal breathing

2. Type 2– Type 2 DM is characterized by the abnormal secretion of insulin, resistance to the action of insulin in the target tissues, and/or an inadequate response at the level of the insulin receptor. A patient may, however, present with pruritus, fatigue, neuropathic complaints such as numbness and tingling, or blurred vision.
3. Prediabetic– fasting glucose consistently elevated above the normal range but less than 100-125. Impaired glucose tolerance (IGT) state of hyperglycemia where 2 hr post glucose load glycemic level is 140-199

Diagnostic criteria- there are 4 lab-based criteria to confirm DM: A1C, random plasma glucose, fasting plasma glucose, and 2-hr post load plasma glucose

• AIC of 6.5 or higher=diabetes
• Random plasma glucose level of 200 WITH classic symptoms of hyperglycemia or a hyperglycemic crisis
• Fasting plasma glucose level of 126 or higher on TWO occasions(fasting is defined as no caloric intake for at least 8 hrs
• 2-hour post load plasma glucose level of 200 or higher during an OGTT, following consumption of a glucose load containing the equivalent of 75g of anhydrous glucose dissolved in water (OGTT is also used to screen for diabetes during pregnancy)

*** In the absence of unequivocal hyperglycemia results should be confirmed by repeat testing on a new blood sample without delay, preferably using the same type of test.***

• *All above-but confirmation of type 2 diabetes mellitus requires: two fasting blood glucoses ?126 mg/dL or two random blood glucoses ?200 mg/dL.
• You do not screen for type 1 diabetes but you do screen for type 2 if an individual is overweight or obese, regardless of age, and for all adults aged 45 years and older. Tests should be repeated at a minimum of 3 year intervals

Initial Treatment-

Type 1- FIRST LINE: INSULIN.  The initial goal of treatment for type 1 DM is to normalize the elevated blood glucose level. This is best accomplished by intensive insulin regimens to achieve the following goals: plasma glucose levels of 80 to 130 mg/dL before meals, peak postprandial (1–2 hours after the beginning of a meal) glucose levels of less than 180 mg/dL, and an A1C below 7% for adults with type 1 DM. A comprehensive treatment plan requires exogenous insulin, frequent self-monitoring of blood glucose (SMBG), medical nutrition therapy, regular exercise, continuing education in prevention and treatment of diabetic complications, and the periodic reassessment of treatment goals.

(Type 1A: insulin  dependent, Type 1B: variably insulin dependent). The ADA Standards of medical care in diabetes states that the majority of patients with type 1 DM, should be treated with multiple daily injections of prandial insulin and daily basal insulin or with a continuous subcutaneous insulin infusion pump. INITIATION OF INSULIN THERAPY IN NEWLY DIAGNOSED TYPE 1 DM, SHOULD BE MANAGED BY OR IN CLOSE COLLABORATION WITH AN ENDOCRINOLOGIST.

Type 2-FIRST LINE: LIFESTYLE MANAGEMENT. Interventions should include treatments directed at both risk reduction and glycemic control. Lifestyle management is an important part of treatment and comprises nutrition therapy, activity prescriptions for exercise, decreased prolonged sitting, and in older adults, training in balance and flexibility. Lifestyle management should focus on mental health, sleep, and smoking cessation. Obesity management has become a high-level target in the treatment of pts with type 2 DM. ADA states that every patient should receive diabetes self-management education and diabetes self-management support at the time of diagnosis.

Pharmacological therapy for type 2 DM is required when lifestyle management does not result in adequate blood glucose control.  Drug therapy should always be considered an adjunctive therapy to lifestyle management, as the latter is typically initiated first.  The ADA and AACE recommend metformin if there are no contraindications, such as renal disease or abnormal creatinine clearance, acute myocardial infarction, or septicemia.

The AACE recommends adding a second agent to lifestyle treatment and metformin if the A1C is more than 7.5% at the time of diagnosis or after 3 months of monotherapy without achievement of the patient’s blood glucose goals. Metformin can be used as a monotherapy unless the patient has contraindications or intolerance. Although metformin is the first-line medication recommended by the ADA and the AACE for DM type 2, it should be used only in patients with adequate renal function and should not be used in patients with an eGFR below 45 mL/min/1.73 m2.

• Immediately upon diagnosis of type 2 DM, begin lifestyle therapy with medically assisted obesity treatment.
• If glycemic goals are still not met 3 months later, begin single-agent or dual therapy with oral antidiabetic agents, depending on whether A1C is less than or greater than 7.5%.
• If glycemic goals are not met in 3 months, initiate triple therapy.
• If after 3 additional months (or at the time of diagnosis) A1C is 9.0% or higher and the patient is symptomatic, add insulin therapy.
• A1c-Gyycemic level over 2-3months and is helpful is documenting control and continuing care.
• A1c less than 7% indicate strong control
• 5%or less decrease occurrence of complications achieved w/o hypoglycemia or other adverse effect.

Medication Side Effects

-Type 1:

Hypoglycemia is a common occurrence in patients with type 1 DM and occurs for a variety of reasons: excessive exogenous insulin, missed meals or inadequate food intake, excessive exercise, alcohol ingestion, drug interactions, or decreases in liver or kidney function. Signs and symptoms: diaphoresis, tachycardia, hunger, shakiness, altered mentation (ranging from an inability to concentrate to frank coma), slurred speech, and seizures.

The ADA classifies hypoglycemia as a plasma glucose level of < 54 as serious, clinically significant hypoglycemia. A blood glucose level of 70 is considered a threshold level that requires intervention. Examples of appropriate foods: #1 choice: pure glucose, ½ cup fruit juice, 6oz regular soda (not diet or sugarless), 1 cup milk, or glucose tabs. Candy is only a last resort. Recheck glucose 15 minutes after treatment. Additional carbs can be given if glucose is still less than 70

-Type 2:

Metformin can cause: hypoglycemia esp in older adults, adverse reactions such as GI disturbances and metallic taste, and is contraindicated in renal disease so assess renal function prior to prescribing.

Metformin also has a boxed warning in its FDA-approved prescribing information for lactic acidosis, although this side effect is very rare. Metformin should be discontinued 24 to 48 hours before diagnostic and surgical procedures due to the risk of decreased kidney function, and its administration should not be resumed for at least 6 hours after these procedures or until the patient is adequately hydrated. Initial dosing is 500 mg once a day with breakfast or dinner for 1 week, then twice daily with breakfast and dinner. Several weeks of therapy may be needed to achieve maximum effects of the given dose.

Common adverse reactions include diarrhea, nausea, anorexia, and abdominal discomfort, which usually resolve with a gradual increase of dosage. Metformin has been shown to cause decreased vitamin B12 absorption, and patients on long-term metformin therapy should undergo periodic testing for B12 deficiency, especially if the patient complains of peripheral neuropathy. At the maximum dose, the monthly cost of metformin in the United States is approximately $4 on many generic formularies. Metformin is currently found in 20 combination formulations with other medications

NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS

NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS

The WEEK 1 QUIZ focuses on the assessment, diagnosis, and treatment

Delirium is characterized by a .

Attention, awareness, and cognition are all disrupted.

a HALLMARK

Delirium is characterized by a clouding of consciousness, as well as a difficulty to focus, sustain, or shift attention, as well as a change in cognition, including short-term memory impairment, disorientation, and perceptual problems NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS.

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Diagnostic Criteria for Delirium

1. A disturbance in attention and awarenessB. The disturbance develops over a SHORT period of time (usually hours to a few days),C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).

Diagnostics for delirium

Chest x-ray study, Other Diagnostics, ECG, Head CT or MRI*, Lumbar puncture*

CBC and differential, ESR, Platelet count, Serum electrolytes, Serum glucose, Calcium, Magnesium, Phosphorus, BUN, Creatinine, LFTs, Vitamin B12, Folate, Thiamine, Ammonia, Thyroid function tests

Which tool is now the most widely used tool for evaluation of the presence of delirium

NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS

The Confusion Assessment Method

Which medication class has long been implicated as a risk factor for delirium,

Anticholinergic medications

Treatment of delirium is both- definitive and palliative

Definitive care of those with delirium is aimed at identification and treatment of the precipitating causes

palliative care of those with delirium is directed toward- the management of symptoms, such as agitation, restlessness, and hallucinations. NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS

These medications may be useful in controlling agitation and psychosis, although there is no compelling evidence that demonstrates improvement in the prognosis of delirium with their use

Antipsychotic medications such as haloperidol and droperidol

These newer medications may be used in small doses for behavior management in the short term when patient or staff safety is compromised NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS.

Newer antipsychotics such as risperidone, quetiapine, and olanzapine

These medications are useful in the treatment of alcohol and sedative withdrawal.

Benzodiazepines. The goals of treatment for the patient with delirium are to, promote recovery, to prevent additional complications, to maintain the patient’s safety, maximize function.

What is Meniere’s disease? Meniere disease is a chronic condition of the inner ear characterized by recurrent vertigo and hearing loss.

What are the four symptoms characterized by Meniere’s disease?1.dizziness described as spinning vertigo, 2. low-frequency sensorineural hearing loss, 3. tinnitus, 4. a feeling of fullness in the affected ear NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS.

Pathophysiology of Meniere’s Disease 

Meniere disease involves excess fluid and pressure in the labyrinth of the inner ear that episodically distends the structures of the labyrinth and damages the vestibular and cochlear hair cells

Causes of Meniere’s Disease–caused by viral infections or immune system-mediated mechanisms

Clinical Presentation of Meniere’s Disease- Early in the disease process-patients have intermittent attacks of vertigo that last from minutes to hours, often associated with nausea and vomiting.These episodes are commonly accompanied by pressure in the ear, low-pitched tinnitus fluctuating in intensity, and unilateral hearing loss

Diagnosis of Meniere disease is based on–clinical criteria and/or response to treatment; however, it is important to differentiate Meniere disease from other causes of vertigo and hearing loss

Physical Examination of Meniere’s disease should include

A thorough head and neck examination to exclude acute otitis media or another infectious process, a comprehensive neurologic examination a, On physical examination, sound will lateralize to the unaffected ear in the Weber test; in the Rinne test, air conduction will be greater than bone conduction. Spontaneous nystagmus occurs during attacks and may not be present between attacks.

Diagnostic criteria for Meniere’s disease include—two episodes of spontaneous vertigo lasting at least 20 minutes each, audiometrically documented hearing loss, tinnitus or aural fullness, and the exclusion of other causes NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS

Diagnostic testing for Meniere’s disease include

an audiogram, and MRI to rule out central nervous system (CNS) lesions

Laboratory testing for Meniere’s disease include: thyroid-stimulating hormone (TSH), rapid plasma reagin (RPR) testing for syphilis, serum glucose, and Lyme serologies

Differential Diagnoses for Meniere’s disease include

Benign Paroxysmal positional vertigo, Vestibular neuritis, Vertebrobasilar insufficiency, Acoustic neuroma, Migraine headache

If Meniere’s disease is suspected a referral to _____________ should be made

otolaryngologist

The goals of care for Meneires Disease includes: managing vertigo, Arresting the disease process

For symptomatic relief of Meneires Disease what medications should be used?

meclizine and antiemetics such as promethazine (Phenergan) may be beneficial for some patients

Patient and family education regarding Menieres Disease includes

Patient safety during acute episodes of vertigo and the sedative side effects of prescribed medications

Traumatic Brain Injury is defined as an alteration in brain function, or other evidence of brain pathology CAUSED BY AN EXTERNAL SOURCE.

The Glascow Coma Scale is defined as

the measurement tool most frequently used to measure the level of consciousness immediately following an injury

The three categories that makes up the GCS eye opening, motor response, verbal response

Which GCS score indicates severe Traumatic Brain Injury?8 or less

Which GCS score places an individual in the moderate severity Traumatic Brain Injury? 9-12

Which GCS score places an individual in the mild severity Traumatic Brain Injury?13-15

Major leading cause of Traumatic Brain Injury–Falls in both adults and children

Two main phases of primary injury that can result in cognitive dysfunction are

direct impact  & rotational acceleration

The two main phases of injury, direct impact and rotational acceleration, give rise to systemic complications and cellular injury mechanisms that result in…

cell death, axonal injury, impaired synaptic plasticity

4 categories of s/s of concussion physical, cognitive, emotional, sleep

What is the most common symptom of a concussion—headache

What is the definition of post concussion syndrome the persistence of post-concussive symptoms beyond the expected timeframe.
symptoms occurring 7-10 days after a mild traumatic brain injury that CAN LAST FOR WEEKS TO MONTHS AND UP TO A YEAR

Persons experiencing Post concussion syndrome report limitations in

functional status, activities of daily living, school or work related activities, leisure and recreational activities, social interactions, financial independence

Risk factors for PCS include, comorbid psychiatric illness, advanced age, heightened symptoms, intense emotions (severe anxiety) at the time of injury

A patient with a blow to the head with an object, you can expect…

damage to underlying tissue/vessels

A patient that is thrown against a wall or solid surface, you can expect…

focal and diffuse damage

A patient that is punched in the face or head, you can expect…

contusions/bruising/bleeding

A person that experiences violent shaking of the body, you can expect

diffuse agonal injuries/torn nerve tissue

A patient that falls and hits their head…you can expect

focal and diffuse damage

A patient that is being strangled, you can expect…

diffuse damage (hypoxia)

A patient that had a near drowning, you can expect…

diffuse damage (hypoxia)

A patient that was shot in the face or head, you can expect…

disintegration of brain tissue

Chronic Traumatic Encephalopathy (CTE)

a progressive, degenerative condition involving brain damage resulting from multiple episodes of head trauma

4 stages of chronic traumatic encelopathy

Stage 1-patients experience depression, headaches, and short term memory loss

Stage 2-difficulty controlling impulses, suicidal thoughts and severe headaches

Stage 3-apathy, severe memory problems and impaired judgement

Stage 4-paranoia, severe depression, aggression, dementia and suicidal behaviors

What is he fifth cranial nerve,–the trigeminal nerve,

What is the trigeminal nerve? is a large, mixed sensory and motor nerve that originates in the brainstem and travels in the cervical cord, with the sensory ganglion found in the Meckel cave in the middle cranial fossa

What is the he primary feature of Trigeminal Neuralgia===recurrent paroxysms of pain in the distribution of any branch of the trigeminal nerve.

The pain is usually described as burning, stabbing, sharp, penetrating, or electric shock-like and usually is on ONE SIDE OF THE FACE.

patient does not awaken from sleep during a paroxysm.

A characteristic feature of trigeminal neuralgia is the

trigger zone, a small area of the skin or orobuccal mucosa that the patient can identify as the point that sets off an attack.

Criteria for diagnosis of Trigeminal neuralgia include:

• Paroxysms of pain lasting from a fraction of a second to 2 minutes and affecting one or more divisions of the trigeminal nerve without radiation of symptoms, Pain characterized as at least three events of intense, sharp, superficial, or stabbing nature and precipitated from trigger areas or trigger factors, No clinically identified neurologic deficit, Not attributable to another disorder

Diagnostics include- MRI, CT, Electrophysiology testing

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The two major types of migraine are–migraine with aura and migraine without aura

Most common type of migraine–migraine without aura

Characteristics of a migraine, pounding or throbbing,moderate to severe in intensity, aggravated by PHYSICAL ACTIVITY, which is episodic, lasts 4 to 72 hours, may be associated with nausea, vomiting, photophobia, and phonophobia NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS.

common triggers of migraines include, medication overuse, obesity, depression, stressful life events, sleep problems including snoring, weather changes, foods (cheese, chocolate), alcohol, change in altitude, delay or skipping of a meal, hormonal changes.

In a migraine with aura, when does the aura usually occurs

before the onset of head pain, although it can sometimes extend into the period of headache.

Visual auras can also be characterized by spots, shimmering bright lights, or areas of visual loss (scotomas).

A prodrome can be part of a migraine. What describes a prodrome

Several days before the aura or start of the head pain, the person may have feelings of doom or fatigue.

Acute tension-type headaches are described as-  feeling like there is a tight band around the head. Nausea and vomiting are NOT present, pain can be mild to moderate in intensity

Most common trigger of a tension-type headache is stress. Acute tension-type headache is described as .a nagging headache that occurs FEWER than 15 days per month, is present most of the day, and may start after the person wakes up. It rarely awakens the person

Chronic tension-type headache is described as

is similar in presentation to the acute type but occurs more often than 15 days per month.

What are the characteristics of a cluster headache

is usually AWAKENS patients during the night with severe unilateral, retro–orbital pain. A cluster headache reaches maximum intensity in about 15 minutes and usually lasts about 90 minutes, although some can last 3 hours.

Subjective examination of a patient with headache should include, The history is the most important part of the evaluation, describing the duration, quality, and location of the pain. The presence or absence of any precipitating factors, or triggers, and the age at onset should be established. The presence of associated symptoms, such as nausea, vomiting, and photophobia, should be explored.

Are migraines familial? yes

Physical examination should include: cardiopulmonary and complete neurologic assessment with a major focus on the following:• Funduscopic and pupillary assessment• Auscultation of the carotid and vertebral arteries• Mental status examination• Palpation of the head, neck, and temporal arteries• Evaluation for any neck stiffness, focal weakness, sensory loss and gait• Vital signs

Serious symptoms and findings of a migraine include

a headache accompanied by a stiff neck; fever; malaise; nausea or vomiting; presence of any aphasia, weakness, or poor coordination

Other danger signs include the following • Onset of headache after the age of 50 years
• Asymmetry of pupillary responses • Decreased deep tendon reflexes• Headache described as “THE WORST EVER EXPERIENCED”• Personality change
• Onset of a new or different headache• Onset of a headache that progressively worsens• Papilledema• Painful temporal arteries

Lab tests for migraines include CBC, ESR, CRP, Thyroid function, Lyme titer, Rheumatoid factor, CSF cell count, Diagnostic imaging for migraines includes, CT scan, MRI*, CSF, cerebrospinal fluid;

Referral for those with migraines should be made when

suspected temporal arteritis, change in mental status, nuchal rigidity, neurologic deficit, or new onset of headache-especially over the age of 50.

Immediate emergency department referral for one with a migraine is indicated for

abrupt onset “THUNDERCLAP HEADACHE,” trauma, or headache with associated neurologic abnormalities on physical examination

Two areas of pharmacological management of migraines abortive and preventive

Preventive pharmacological management is indicated when patients if they are unable to deal with their attacks, they experience MORE THAN FOUR headaches a month, or, the attacks are prolonged and refractory to medicine

Abortive therapy is used to treat

the intensity and duration of pain during an attack and to manage associated symptoms, such as nausea and vomiting

First line treatment of migraines include

Simple analgesics, such as acetaminophen and aspirin, can represent first-line treatment in the management of mild to moderate headaches.

NSAIDS===if not relieved…..Corticosteroids, Triptans

When simple analgesics are ineffective in treating migraines, the next step would be to combining them with a short-acting barbiturate, such as butalbital (Fioricet, Fiorinal, Esgic),

Indications for Referral or Hospitalization for those with migraines not easily controlled by routine headache medicines.

• Rebound headaches or habituation limits outpatient therapy.

• Headache is new and progressively worsening.
• Headache is described as the “worse headache of my life.”

• Headache is affecting the patient’s quality of life.

• Headache is accompanied by neurologic symptoms that last longer than 30 minutes or is accompanied by numbness or hemiparesis

Mild cognitive impairment (MCI) is thought to be a, transitional state between normal aging and dementia

Two types of MCI, amnestic, nonamnestic,

Amnestic mild cognitive impairment is characterized by deficits in memory;

Nonamnestic MCI involves impairments in other cognitive functions

Mild cognitive impairment or MCI is a risk factor for dementia

Alzheimer disease is characterized by amyloid plaques and neurofibrillary tangles.
Examinations of the brains of patients with Alzheimer disease show atrophy of the cerebral cortex that is usually diffuse but may be more pronounced in the frontal, temporal, and parietal lobes.

Vascular Dementia is Multiple areas of focal ischemic change characterize vascular dementia, formerly known as multi-infarct dementia the defining lesion is the lacunar infarct.

Patients with which history are particularly at risk for developing dementia hypertension, diabetes, hyperlipidemia, peripheral vascular occlusive diseases are at particular risk.

Lewy body dementia is characterized by the presence of Lewy bodies in the brain. There is a loss of dopamine-producing neurons, similar to that seen in Parkinson disease, and a loss of acetylcholine, similar to that seen in Alzheimer disease.

Pseudodementia–Depression in older adults can lead to memory loss, attention deficits, and problems with initiation

Clinical Presentation of a patient with dementia, Memory loss, personality changes, language disturbances, problems with independent activities of daily living

Clinical Presentation of a patient with Lewy body dementia visual hallucinations, motor impairments, postural instability, sleep disturbances

Patients with Lewy body dementia get worse with which type of medication

Haldol

Three stages of alzheimers early, middle, and late

What is the initial symptom of alzheimers==short-term memory loss.

The early stages of alzheimers is characterized by anxiety and depression.
Word finding and naming problems may emerge as symptoms progress.

The middle stage of alzheimers is characterized by a worsening of memory and language as well as judgment. Disorientation to time and place is common.
There may be neuropsychiatric symptoms, including paranoia, hallucinations, and delusional thinking. Urinary incontinence may be a problem.

The late stage of alzheimers is characterized by

motor rigidity, prominent neurologic abnormalities including apraxia and agnosia,
severe cognitive and language impairment, death.

Labs for dementia CBC, LFTs, TSH, Vitamin B12, Folate, Serum electrolytes, BUN, Creatinine, Serum glucose, Drug and alcohol levels*

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Diagnostics for dementia, non contrast CT, MRI

The goal of management includes treatment of all correctable factors that may impair cognition to improve daily functioning and to delay disability.
Activities that promote and enhance cognition and social engagement are to be encouraged.

Which supplementation is recommended for those with Alzheimer’s

2000 IU of vitamin E daily is reasonable to consider in appropriate patients.

Which Two classes of drugs are currently approved by the U.S. Food and Drug Administration to treat the cognitive symptoms of dementia:

the cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists.

________________________ is an NMDA receptor antagonist that can be used in combination with a cholinesterase inhibitor for those with moderate to severe disease

Memantine (Namenda)

these medications do not alter the course of dementia, they have been shown to delay or to slow worsening of symptoms==cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists.

patients with dementia develop depression, which class of medications is preferred

selective serotonin reuptake inhibitors (SSRIs)

Which class of medications have a “black box” warning due to increased risk of cardiovascular events when prescribing to those with dementia risperidone, olanzapine, and aripiprazol

What is the focus for patient education fo those with dementia to maintain independence by emphasizing patients’ strengths and allowin g them to continue normal activities

Benzodiazepines can be utilized in all of the following scenarios except for: Group of answer choices

Maria is a 22-year-old woman who has been complaining of headaches, dizziness, and memory problems. In addition, there are bruises on her neck and arms. She mentions that she is in an intimate relationship with someone who has a bad temper. What is NOT an appropriate approach for the screening of traumatic brain injury in this patient? Immediate Post-Concussive Assessment and Cognitive Testing (ImPACT)

Which of the following is NOT an overlapping symptom of Post Traumatic Stress Disorder (PTSD) and Persistent Post Concussive Syndrome (PPCS):

• (TBI) medication cause paradoxical agitation?

Different head injuries and what they cause:

• symptoms, intense emotions (severe anxiety) at the time of injury
• A patient with a blow to the head with an object, you can expect…
• damage to underlying tissue/vessels
• A patient that is thrown against a wall or solid surface, you can expect…
• focal and diffuse damage
• A patient that is punched in the face or head, you can expect…
• contusions/bruising/bleeding
• A person that experiences violent shaking of the body, you can expect
• diffuse agonal injuries/torn nerve tissue
• A patient that falls and hits their head…you can expect
• focal and diffuse damage
• A patient that is being strangled, you can expect…
• diffuse damage (hypoxia)
• A patient that had a near drowning, you can expect…
• diffuse damage (hypoxia)
• A patient that was shot in the face or head, you can expect…
• disintegration of brain tissue
• “Which type of medication may be particularly dangerous when treating aggression in patients with traumatic brain injury (TBI) because it could cause paradoxical agitation?”

NR 661-667 Capstone Project APEA Exam Questions

QUESTION#35

A 45-year old man presents with malaise and a copper coloured  macular rash that covers the trunk ,arms ,legs, palms, and soles of feet. These symptoms began 2days ago. The nurse practitioner suspects:

• primary syphilis
• secondary syphilis
• early latent syphilis
• late latent syphilis

QUESTION#36

A 10 year old infant girl has a  history of prematurity and prolonged febrile seizures occurring on two occasions. When discussing the prognosis with the mother, the nurse practitioner informs her that:

• the child now has two risk factors for developing epilepsy
• the child already has the following Diagnosis of epilepsy because she has had two seizures
• febrile seizures are usually benign and alone do not signify epilepsy
• children with febrile seizures are more likely than general population to develop epilepsy

 

QUESTION#37

The diagnostic test to confirm acute lymphoblastic leukemia in a 5year old child is:

• chest radiography
• lumbar puncture
• bone marrow biopsy
• hemoglobin electrophoresis

 

QUESTION#38

Ferrous sulfate is initiated in a 24year old woman with iron deficiency anemia. Which of the following patient statement indicates a need for further patient teaching?

• “My body absorbs the iron pill better when l take it with my orange juice at breakfast or with my vitamin C pill in the evening”
• “When l come back to the clinic in a month, that finger stick test will show whether my anemia is getting better.”
• “l take my iron pill with a glass of milk so it won’t upset my stomach.”
• “I take my iron pill in the morning and my milk of magnesia at night.”

QUESTION#39

A 42 year old man presents with orbital edema, Facial edema , and proteinuria. He states that the symptoms pronounced in the morning or after lying supine. These findings are likely indicative of :

• nephronic syndrome
• myxedema
• cushing ‘s syndrome
• heart failure

 

QUESTION#40

At a follow-up visit, a pregnant patient asks for further explanation about inheritance patterns after completing a family history questionnaire . The nurse practitioner explains that X-linked dominant disordes occur.

• Only in men
• Through father-to-son transmission.
• In both men and women, with more severe disease in men.
• When the man and woman are both carriers.

QUESTION #41

In a 35 year old man, the symptoms that is most suggestive of testicular cancer is:

A-testicular swelling

B-penile warts

C-testicular pain

D-erectile dysfunction

 

QUESTION#42

Dizziness with activity is the major complained of a 75ear old man with a longstanding history of hypertension and coronary artery disease Initially , the nurse practitioner should:

• order an echocardiogram
• order an ultra sound of the carotid arteries
• obtain blood pressure measurements white the patient is standing, sitting ,and supine
• order 24 –hour ECG monitoring

 

QUESTION#43

A 30 year old obese woman presents with a small , firm breast nodule .History is significant for fibrocystic breast disease. Axillary lymphadenopathy is palpated on exam .The most appropriate intervention is to:

• reassure her that the nodule is part of the fibrocystic breast disease
• inquire about her menstrual cycle
• order a diagnostic mammogram and ultra sound
• refer her for biopsy

 

QUESTION#44

The history and assessment of 50 year old woman identify stress incontinence .The patient asks what could cause this condition .The most appropriate responds is :

• urinary tract infection
• constipation
• aging a estrogen deficiency
• diabetic neuropathy

 

QUESTION#45

The most common type of dysrhythmia in children is:

• atrial flutter
• sinus tachycardia
• premature atrial contractions
• paroxysmal supraventricular tachycardia.

QUESTION#46

A 35 year old recently widowed woman experiences her first episode of depression. She is started on an antidepressant .After complete remission of symptoms, the medication should be continued for  at least :

• 2months
• 4 months
• 6 months
• 12 months

 

QUESTION#47

A 32year old pregnant woman at 32 weeks gestation presents with complications of right upper quadrant pain ,midepigastric tenderness, headache ,and malaise. Blood pressure 135/90mm Hg .The MOST likely diagnosis is :

• Preeclampsia
• Eclampsia
• HELLP ;syndrome
• chronic hypertension

 

QUESTION#48

Lifestyle modifications have not improved interstitial cystitis symptoms in a 38year old woman . Which oral medication is NOT considered an initial oral medication?

• hydroxyzine (Vistaril)
• tramadol (Ultram ER)
• amitriptyline (Elavil)
• ibuprofen(Motrin IB)

 

QUESTION#49

The sexually transmitted disease that is NOT likely to be transmitted through oral-penile contact in men who have sex with men is:

• herpes
• human papillomavirus
• chlamydia
• gonorrhea

 

QUESTION#50

An 80 year old man with symptoms of depression will benefit from treatment with a selective serotonin reuptake inhibitor (SSRI). Before prescribing, the nurse practitioner should order a (n):

• CBC
• fall risk evaluation
• electrocardiogram(ECG)
• renal panel

 

QUESTION#51

A 24 year old pregnant woman states that she has been experiencing increased mucus formation during her first trimester .This is most likely :

• trichomoniasis
• candidiasis
• physiologic leucorrhea
• bacterial vaginosis

QUESTION#52

The mechanism of action of medication used to treat overactive bladder include selective stimulation of beta-3 adrenergic receptors, which relax the smooth muscle of the bladder .The medication that falls in this category is:

• finasteride (Procsar)
• dutasteride (Avodart)
• tamsulosin(Flomax)
• mirabegron(Myrbetriq)

 

QUESTION#53

A 22 year old woman is in the clinic with genital warts. Appropriate treatment for genital warts does NOT include:

• crytheraphy
• prodofilox (Condylox)0.5%gel
• salicylic acid (Virasal)
• electrodessication

 

QUESTION#54

The nurse practitioner is evaluating the patient’s understanding of Chlamydia trachomatis treatment with mycin. Which statement demonstrates proper understanding of the medication?

• l should abstain from sexual intercourse for 24 hours after starting the medication
• I can have sexual intercourse f72 hours after completing the medication
• My partner should use a condom if we are going to have sexual intercourse within the next 5 days
• I should abstain from sexual intercourse for 7 days

 

QUESTION#55

A-68-year-old man has a history of long-term tobacco use, uncontrolled hypertension, and hyperlipidemia. He presents with sudden, intense left lower abdominal pain that radiates to the backs and has a tearing sensation. A pulsation is palpated in the mid abdomen. The MOST appropriate step should be to:

• order an outpatient abdominal CT scan.
• refer the patient to the emergency department.
• order an abdominal ultrasound.
• refer the patient for angiography.

 

QUESTION#56

The class of antihypertensive agents that should be avoided as initial therapy for a 38-year-old woman with uncomplicated hypertension is:

• Angiotensin-converting enzyme (ACE) inhibitors.
• Beta blockers.
• Calcium channel blockers (CCBs).
• Angiotensin receptor blockers (ARBs).

 

QUESTION#57

A 60-year-old man is experiencing paroxysmal nocturnal dyspnea. This condition typically occurs in combination with:

• Chest palpitations.
• Left ventricular hypertrophy.
• Nocturnal asthma attacks.

 

QUESTION#58

The MOST appropriate initial treatment of idiopathic facial nerve palsy (Bell’s palsy) for a patient who began to notice a facial droop 2days prior is:

• Acyclovir (Zovirax).
• Botox injections.
• Oral glucocorticoids.
• Gabapentin (Neurontin).

 

QUESTION#59

A 32-year-old man presents with a 24-hour history of fever, diarrhea, nausea, and dehydration. The symptom most suggestive of infection with an invasive organisms:

• Dehydration

 

QUESTION#60

A 38-year-old man has polycythemia vera and is scheduled for phlebotomy. The goal of therapeutic is to reduce blood viscosity .It is at bringing which compound of the CBC into normal range?

• Hemoglobin
• Hematocrit
• Plateletes
• Mean corpuscular volume (MCV)

 

QUESTION#61

Which statement about the glomerular filtration rate (GFR)is true?

• The GFR correlates exactly to the loss of functioning nephrons
• GFR is used as the sole of chronic kidney disease
• A stable GFR implies stable rental disease
• An increase in GFR may indicate a compensatory hyper filtration response

 

QUESTION#62

A16year old girl presents with sore throat. Mononucleosis and streptococcal pharyngitis are suspected. Which medication should be avoided?

• Cephalexin (Keflex).
• Amoxicilin (Amoxil).
• Doxycycline (Vibramyclin).
• Azithromycin (Zithromax).

 

QUESTION#63

A 6-year-old boy exhibits nuchal rigidity. In children, this finding is indicative of.

• Seizure activity.
• Meningeal irritation.
• Mono paresis.
• Central nervous system damage.

 

QUESTION#64

A 20-years-old man has a history of testicular fixation due to testicular torsion. The nurse practioner should make the patient aware that he:

• Remains at risk for recurrent torsion, even many years later.
• Should have testosterone levels drawn annually.
• Is at risk for benign prostatic hypertrophy.
• Is at increased risk for urinary reflux syndrome.

 

QUESTION#65

Which of the following is NOT considered a potential trigger of migraine headaches?

• Nitrites
• Folic acid
• Tyramine
• Monosodium glutamate

 

QUESTION#66

Routine self-monitoring of capillary blood glucose is not required when taking:

• Basal insulin.
• Glipizide (Glucotrol XL).
• Metformin (Glucophage).
• Rapid-acting insulin

 

QUESTION#67

When evaluating a patient for postpartum depression, which tool is the most appropriate?

• The Hamilton Depression Rating Scale(HDRS)
• The beck depression inventory scale (EPDS)
• The Edinburgh Postnatal Depression(EPDS)
• The Patient Health Questionnaire(PHQ)

 

QUESTION#68

A 35 year old woman complains of fatigue and weight gain over the past 6 months. Which thyroid study should be ordered?

A-Thyroid panel

B-Thyroid-stimulation hormone

C-Free T4 and Free T3

D-T4 uptake

 

QUESTION#69

A58year old woman is being treated with basal insulin for type 2 diabetes mellitus. In planning, the dietary component that directly determines postprandial blood sugar is the intake of:

• Carbohydrate
• Fiber
• Proteins
• polyunsaturated fats

 

QUESTION#70

A repeat knee X-ray on a 60 year old woman with a previous right knee sprain revealed no evidence of a fracture. However, moderate osteopenia was noted. The most appropriate test to order at this time is:

• an MRI of right knee
• a CT scan of both knees
• bone densitometry
• an MRI of the spine

 

QUESTION#71

The physical examination of a 4 year old boy reveals large-appearing caves, and the child experiences mild difficulty when arising from  a seated position. The nurse practitioner is considering Duchenne muscular dystrophy. To evaluate this, the nurse practitioner should order:

• a serum phosphorus level
• X-ray of the lower legs
• serum creatinine kinase level
• a consultation for a muscle biopsy

QUESTION#72

Renal function in a patient with diabetes is assessed by obtaining:

• a serum BUN
• whole blood for albumin level
• a routine urinalysis
• urinary albumin-to-creatinine ratio.

QUESTION#73

A 32 year old school teacher states that she been exposed to a student with pertussis. Which medication class is recommended for prophylaxis?

• Tetracycline
• Cephalosporin
• Macrolide
• Fluoroquinolone

 

QUESTION#74

The factor that has the greatest impact on decreasing premature Deaths in the United States is:

• a patient’s sex
• a college education
• genetics
• cultural influences

 

QUESTION#75

A 76 year old man has normocytic normochromic anemia with normal RDW. Which one of the following diagnosis is most likely?

• Acute gastrointestinal bleeding
• iron deficiency
• Thalassemia
• Pernicious anemia

 

QUESTION#76

Acute otitis media has been diagnosed in 10-month-old infant girl. This infant should be treated with an appropriate antibiotic for:

 

QUESTION#77

A pregnant woman is requesting the attenuated influenza vaccine because she is fearful of needles which response by the nurse practitioner is appropriate?

• “You can receive the immunization in your second trimester.”
• “The attenuated influenza is a live virus and not advised during pregnancy.”
• “The attenuated influenza vaccine is always a good choice if you are fearful of needles.”
• “The influenza vaccine in any form is not recommended during pregnancy.”

 

QUESTION#78

Vomitus that is bilious suggests:

• Gastrointestinal obstruction proximal to the duodenum.
• Obstruction of the small intestine.
• Gastric outlet obstruction.
• Peptic ulcer disease.

 

QUESTION#79

A 7-year-old girl presents with a urinary tract infection (UTI) for the first time. Which of the following statement is true?

• This is unusual at this age.
• This is indicative of an underlying problem.
• This is probably due to E. coli.
• This is likely caused by constipation.

 

QUESTION#80

The formal review and approval of educational degree or certification programs in nursing by a recognized agency is termed:

 

QUESTION#82

A 66-year-old woman presents with flu-like symptoms and a rash on the soles and palms. The BEST intervention is to:

• Order a rapid plasma reagin.
• Order a rapid plasma reagin and prescribe penicillin.
• Order an enzyme-linked immune sorbent assay.
• Prescribe penicillin and test for all STDs.

 

QUESTION#83

A 78-year-old woman has a mean corpuscular volume (MCV) of 85fL (norm=80-95fL), hematocrit (HCT) of 33% (norm= 37-47%), and hemoglobin (Hgb) of 11g/dL (norm= 12-16g/dL). The differential should include:

• Iron deficiency anemia.
• Anemia of chronic disease.
• Folic acid deficiency anemia.
• Thalassemia minor.

 

QUESTION#84

A 40-year-old man has acute bronchitis and presents to the nurse practitioner for treatment. The most likely reason for seeking treatment is:

• A sore throat.
• A cough.

 

QUESTION#85

During an acute episode of bacterial prostatitis, assessing the prostate by massage can result in:

 

QUESTION#86

An 18-year-old woman with anorexia nervosa returns for a 1month evaluation of the effectiveness of cognitive behavioral therapy (CBT). On examination, She is hypotensive, has a heart rate of 55, and a body temperature of 96 F.

Her weight has fallen below the 75th percentile. The nurse practitioner Should:

• Order bupropion (wellbutrin).
• Order a selective serotonin reuptake inhibitor (SSRI).
• Refer her to a dietitian.
• Refer her to a psychiatrist.

 

QUESTION#87

Evaluation of cognitive function in a 70-year-old man reveals that he has transient difficulty recalling names of people,  objects , or certain details of specific events. Reasoning and judgement skills are intact. These symptoms are consistent with:

• Transient ischemic attacks.
• Dementia
• Benign forgetfulness.
• Alzheimer’s

 

QUESTION#88

The term syndactyly refers to a person who has:

• Webbed fingers or toes.
• An extra finger or toe.
• Less than five fingers or toes on one hand or foot.
• A missing thumb or great toe.

QUESTION#89

A 45-year-old man complains of acute flank pain radiating toward the groin and testicle. For suspected nephrolithiasis, the first-line treatment regimen includes ketorolac (Toradol) IM plus.

• Ciprofloxacin (Cipro) and hydrocodone orally.
• Hyoscyamine (Levsin) and sulfamethoxazole-trimethoprim (Bactrim DS) orally.
• Indomethacin (Indocin) and nitrofuration (Macrobid).
• Indomethacin (Indocin) and tamsulosin (Flomax).

 

QUESTION#90

A 30-year-old woman with iron deficiency anemia received a prescription for oral iron replacement therapy today. To evaluate response to therapy, the hemoglobin and hematocrit should be checked:

• Within 1week of initiating therapy.
• 2weeks after initiating therapy.
• 3weeks after initiating therapy.
• 4weeks after initiating therapy.

 

QUESTION#91

Graves’ disease is suspected in a 40-year-old woman. The first laboratory test(s) that should be ordered include:

• TSH, T3.
• Thyroid-stimulating hormone.
• Free T4
• Thyroid-stimulating hormone and T7

 

QUESTION#92

An adolescent visits the nurse practitioner for a pre-participation sports physical. While the patient is standing, the NP notices that the right shoulder is not symmetrical with the left. This is most likely related to:

• Poor posture.
• Dislocation of shoulder at birth.
• Curvature of the spine in the coronal plane.
• Congenital dysplasia of the hip.

 

QUESTION#93

Screening for human papillomavirus (HPV) infection in a 30-year-old woman is:

• A form of primary prevention.
• Considered secondary prevention.
• Initiated at the age of 30 and, If negative, no further screening is required.
• Not recommended if the received the HPV vaccine.

 

QUESTION#94

The appropriate pharmacologic choice for a pregnant woman with newly diagnosed deep vein thrombosis (DVT) in her left leg is:

• Direct thrombin inhibitor (Dabigatran).
• Oral anticoagulation (warfarin).
• Oral factor Xa inhibitor (Rivaroxaban).
• Low molecular weight heparin (lovenox).

 

QUESTION#95

When managing older adult patient’s preventive health services should be aimed at maintaining quality of life. In determining the appropriate interventions, the provider should:

A-consider the lag time to benefit

B-include all screening interventions, regardless of age

C-focus on disease management instead of prevention

D-consider Medicare payment guidelines to make decisions

 

QUESTION#96

A 40 year old man who has sex with men was exposed to the HIV virus 3 days ago. An antigen/antibody test can usually detect HIV infection as early as:

• 7 days after contact
• 10 days after contact
• 18 days after contact
• 30 days after contact

 

QUESTION#97

A 59 year old nurse has varicose veins in her lower extremities. Which of the following findings can be attributed to varicose veins?

A-Leg pain increases with ambulation

B-Bilateral orthostatic edema

C-Decreased pedal pulses

D-Diminished sensation in the feet

 

QUESTION#98

Pioglitazone (Actos) should be prescribed cautiously in patient who have a comorbidity of:

A-diverticulosis

B-hypertension

C-hyperlipidemia

D-heart failure

 

QUESTION#99

A 23 year old woman complains of breakthrough bleeding and spotting after starting an oral contraceptive 2 months ago. This is most consistent with:

A-too much estrogen

B-too little estrogen

C-too much progestin

D-too little progestin

 

QUESTION#100

Administration of the pneumococcal vaccine should be considered in patients at highest risk for invasive pneumococcal disease. Which of the following is NOT considered at highest risk?

A-children younger than 2 year old

B-adults younger than 65 with no comorbidities

C-A 20 year old with HIV infection

D-A 45 year with a history of pneumonia in the past year

 

QUESTION#111

A 38-year-old woman reports experiencing vaginal bleeding daily for the last 4 weeks. She describes it as a scant amount of brownish discharge. Differential diagnoses would NOT include:

• Ectopic pregnancy.
• Intrauterine pregnancy.
• Ruptured ovarian cyst.
• Cervical neoplasia.

 

QUESTION#112

A 27-year-old woman missed her follow-up appointment for migraine headaches today. The patient has called after hours for medication to treat the pain. How should the nurse practitioner respond?

• Refer the patient to the emergency department.
• Tell the patient to continue the sumatriptan and come to the office in the morning for assessment.
• Reprimand the patient about missing the appointment.
• Question the patient further about the headache.

 

QUESTION#113

Which of the following symptoms is most typical of trichomoniasis in a woman?

• Thick, cloudy or bloody vaginal discharge, painful bowel movements, and anal itching
• Clear, white or yellowish vaginal discharge, strong vaginal odor, and vaginal itching
• Vaginal itching or irritation with thick, white collage-cheese like discharge
• Fever, headache, and lymphadenopathy.

QUESTION#114

Which does NOT typically aggravate symptoms of reflux disease?

• Coughing
• Bending over
• Eating salty foods
• pylori infection

 

QUESTION#115

Accurate peak flow readings depends on:

• The patient’s ability to hold his breath for 10seconds before the procedure.
• The voluntary effort and muscular strength of the patient.
• Adherence to continued monitoring.
• The patient’s adherence to prescribed medications.

 

QUESTION#116

A 32-year-old woman with a confirmed pregnancy in the first trimester presents with abdominal pain, cervival motion tenderness and vaginal bleeding. She has a history of sexually transmitted disease and a tubal ligation. The MOST serious differential diagnosis is:

• Threatened miscarriage.
• An extra uterine pregnancy.
• A cervical pathology.

 

QUESTION#117

A term used to describe involuntary spasms of the stomach, diaphragm, and esophagus preceding and resulting in vomiting is:

QUESTION#118

A sexual maturity assessment of a 12-year-old boy indicates that he is starting puberty. The most likely finding was:

• Testicular enlargement.
• The presence of pubic hair.
• A rapid increase in vertical growth.
• Lengthening of the penis.

 

QUESTION#119

A highly contagious disease that causes a blister-like, pruritic rash with fatigue and fever can be prevented by receiving the:

• HPV vaccine
• Meningococcal vaccine
• Shingles (Herpes zoster)
• Varicella vaccine

 

QUESTION#120

A-AST =35;ALT=125

B-AST=75;ALT=42

C-AST=16;ALT=68

D-AST=148;ALT=45

 

QUESTION#121

Approximately 1 hour ago, a 10 month old infant experienced a febrile seizure. The mother should be informed that:

A-ibruprofen (Advil)and acetaminophen (Tylenol)should be administered every 2 hours for fever management.

B-the etiology of the fever must be determined

C-the infant requires 24-hour electroencephalogram (ECG)monitoring

D-anticonvulsant therapy should be initiated

 

QUESTION#122

Who would NOT qualify for Medicaid coverage?

A-A college student attending school on a visa

B-pregnant women

C-older adults

D-low-income patients

 

QUESTION#123

Nephrolithiasis should be suspended in 40 year old man presenting with:

• Tenderness in the scrotal area.
• A reported inability to void
• Nausea and an inability to keep still
• Frequency, urgency, and polyuria

 

QUESTION#124

A murmur is auscultated in a 64 year old man. Which finding indicates a need for a referral?

• The murmur is associated with a click
• The murmur is associated with anemia
• The murmur worsens with inspiration
• The murmur is associated with a thrill

QUESTION#125

An 81 year old woman comes to the office with mental status changes. Her daughter says that she has confused for the past 3days, and that she has complained of fatigue and headache. The initial diagnostic test in the evaluation of this patient is a:

• CT scan of the head
• Urinalysis
• Chest X ray
• Complete blood count

 

QUESTION#126

The nurse practitioner empirically suspects hypothyroidism in a 32 year old woman. A common symptoms of hypothyroidism is:

• Heat intolerance
• Diarrhea
• Hyperkeratosis
• Insomnia

 

QUESTION#127

A31 year old woman is diagnosed with vulvovaginal candidiasis. The finding that is LEAST likely associated with this diagnosis is:

• Dyspareunia
• The absence of a vaginal discharge
• Vulvar erythema
• A malodorous discharge

 

QUESTION#128

A 50 year old immune competent woman with a 30 pack year history of tobacco use is diagnosed with community acquired pneumonia. The nurse practitioner prescribes azithromycin (Zithromax) the patient to return:

• In 2 weeks to repeat a CBC
• In 7weeks for a repeat chest X ray
• Within 24 hours if symptoms persist
• As needed because there is no need to follow if compete resolution occurs

 

QUESTION#129

A70 year old man is diagnosed with new onset delirium. The initial step by the NP should be to:

• Rule out infection and other medical causes
• Initiate IV fluid and recommended adequate hydration
• Obtain a mental health consult
• Order a sedating medication

 

QUESTION#130

When prescribing pregabalin (Lyrical)a schedule controlled substance, for a patient with neuropathy, the prescription should NOT:

• Be transmitted in writing
• Be faxed
• Have any refills
• Have more than 5 refills

QUESTION#131

Which condition is often associated with acanthosis nigricans in black adolescent patients?

• Type 1 diabetes
• Type 2 diabetes
• Diabetes insipidus
• Gestational diabetes. NR 661-667 Capstone Project APEA Exam Questions

 

QUESTION#132

A16 year old boy has sickle cell anemia. The nurse practitioner suspects a sickle cell crisis with pulmonary involvement due to fever and:

• Tachycardia
• Pulmonary hypertension
• Chest pain
• Priapism

 

QUESTION#133

A28 year old man presents with complaints of diarrhea. Which assessment finding is a strong indicator of ulcerative colitis?

• Negative hemoccult
• Bloody nocturnal diarrhea
• Mucosal thinning visible on abdominal radiography
• Stool positive for leukocytes

 

QUESTION#134

Iron supplementation is no longer in the treatment of iron deficiency anemia when laboratory testing reveals a normal:

• Hemoglobin, hematocrit and total iron binding capacity
• Complete blood count ,mean corpuscular volume and mean corpuscular hemoglobin
• Complete blood count with normal red cell distribution
• Complete blood count and serum ferritin

 

QUESTION#135

A 36 year old man with gastroesophageal reflux disease (GERD) is experiencing symptoms of esophagitis. The NP prescribed a proton pump inhibitor (PPI) instead of an H2 receptor antagonist because the PPI:

• Has better efficacy for healing of esophagitis.
• Has a more immediate onset of action.
• Is better at controlling nocturnal acid breakthrough.
• Fewer side effects.

 

QUESTION#136

A32-year-old woman presents with complains of brief periods of intense chest pain, shortness of breath, and a rapid heart rate. The symptoms occur unexpectedly and without an identified trigger. She expresses fear of having a serious physical condition.

• Posttraumatic stress disorder
• Munchausen by proxy.
• Panic disorder.
• Generalized anxiety disorder.

 

QUESTION#137

Mr. Poole presents to the clinic with complaints of a rash that has lasted for weeks. For about 10days, He has been using a typical steroid prescribed for his wife. Prolonged use of a topical steroid can increase the risk for:

• Skin cancer.
• Secondary bacterial infections.
• Actinic keratosis.

 

QUESTION#138

A nurse practitioner wishes to delegate medication administration to a medical assistant. To determine if this is an appropriate action, the nurse would refer to:

• State rules and regulations governing nurse practitioner practice
• The federal APRN regulatory model
• The American Association of Nurse Practitioner
• Institutional policies and procedures

 

QUESTION#139

Which of the following symptoms would be typical of gonorrhea or chlamydia infection in a woman?

• Vaginal discharge, pain or burning on urination
• Clear, white, or yellowish vaginal discharge , strong vaginal odor, and dyspareunia
• Vaginal itching or irritation with thick , white cottage –cheese like discharge
• Fever, headache, and lymphadenopathy

 

QUESTION#140

When examining the middle ear, the NP notes a malodorous discharge along with a retracted pocket in the upper part of the middle ear. Keratin formation is also note. The tympanic membrane is intact with mucoid appearance

The may be suggestive of:

• A cholesteatoma
• An osteoma
• A cyst
• An exostosis

 

QUESTION#141

When discussing breast cancer screening with a 40 year old woman, the nurse practitioner explains that:

• there is no need for screening at this age for a woman at average risk of developing breast cancer
• screening is only recommended in patients with an immediate family history of breast cancer
• the decision to begin screening is highly dependent on the patient’s values and preferences
• a baseline mammogram is recommended now, with follow up every 5years

QUESTION#142

Mr. Harris is started on metformin (Glucophage) for a hemoglobin A1C of 7.2%. The n

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

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.

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

NR 706 Week 4 Translation Science Project Assignment 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 OutcomeData-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 OutcomeConclusion (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 OutcomeReferences

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

PreviousNext

9)

Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)

Leads others in professional identity

NR 718 Week 1 Discussion Evaluating Leadership Competencies for the Advanced Practice Nurse

Evaluating Leadership Competencies for the Advanced Practice Nurse Example

Leadership competencies are essential for advanced practice nurses (APNs) as they play a vital role in healthcare delivery. Effectively leading and managing healthcare teams can significantly impact patient outcomes. APNs must possess various leadership competencies, including clinical, professional, and health systems leadership competencies (Chair et al., 2023). This paper aims to examine these competencies and identify strengths and areas for development.

Clinical leadership competency involves providing leadership and liaising with other health agencies and professionals to improve patient care (Heinen et al., 2019). This competency is one of my strengths in my current psychiatric mental health nurse practice. This competency has enhanced my effective communication and collaboration with the interdisciplinary team to provide patient care. It has also enhanced my skills in analyzing organizational systems for barriers and promoting enhancements that affect client healthcare status.

Professional leadership competency is my second strength, and it involves participating in professional organizations and activities that influence advanced practice nursing (Heinen et al., 2019). As an APN in psychiatry and mental health, I am interested in advancing the nursing profession and have actively participated in professional organizations. This has enhanced my knowledge and skills in advanced practice nursing.

My third strength is health systems leadership competency, which involves demonstrating leadership in enhancing group dynamics and managing group conflicts within the organization (Heinen et al., 2019). In my current practice as a psychiatric mental health nurse, I have experience in managing conflicts and fostering a positive work environment, which has improved teamwork and, ultimately, patient care.

As a DNP-prepared psychiatric and mental nurse, I am interested in further developing my clinical and health systems leadership competencies, specifically in advanced communication skills, health policy, and creating a supportive organizational environment. I aim to enhance my ability to effectively lead quality improvement and patient safety initiatives using advanced communication skills and processes (Howick et al., 2019). I am also interested in applying business, finance, economics, and health policy principles to develop and implement effective plans for practice-level and system-wide initiatives that improve the quality of care delivery (Heinen et al., 2019). Lastly, I advocate for and create an organizational environment supporting safe client care, collaborative practice, and professional growth.

NR 718 Week 1 Discussion Evaluating Leadership Competencies for the Advanced Practice Nurse References

Chair, S. Y., Wong, F. K. Y., Bryant-Lukosius, D., Liu, T., & Jokiniemi, K. (2023). Construct validity of advanced practice nurse core competence scale: An exploratory factor analysis. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01203-1

Heinen, M., Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378–2392. https://doi.org/10.1111/jan.14092

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninyt?, E., Hu, X.-Y., Aveyard, P., & Onakpoya, I. J. (2019). Effects of empathic and positive communication in healthcare consultations: A systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), 240–252. https://doi.org/10.1177/0141076818769477

Also Read:

NR717 Week 1 ErnestYoung Leading Culturally and Linguistically Appropriate Healthcare Discussion

NR 718 Week 1 Discussion Evaluating Leadership Competencies for the Advanced Practice Nurse Instructions

Purpose

The DNP-prepared APN works to affect change in practice to provide safe and high-quality patient care. The purpose of this discussion is to evaluate the leadership competencies of the APN.

Instructions

Review the lesson and readings from this week and the following article:

Heinen, M., van Oostveen, C. Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice.Links to an external site. Journal of Advanced Nursing, 75, 2378-2392. https://doi.org/10.1111/jan.14092 (see Table 2)

Then, respond to the following:

1. Identify and evaluate three competencies that are a strength for you in your current practice.
2. Identify and examine three competencies that you are interested in further developing as you prepare for your role as a DNP-prepared nurse.

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

• Link (webpage): DNP Discussion Guidelines.

Program Competencies

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

• Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
• Appraises current information systems and technologies to improve health care. (POs 6, 7)
• Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)

Course Outcomes

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

1. Identify advanced practice leadership competencies. (PCs 2, 4, 5; POs 2, 6)

NR 718 Week 2 Advanced Practice Nurse Clinical Leadership: Identifying Grants to Fund Practice Change Initiatives Discussion

Purpose

The purpose of this discussion is to demonstrate your understanding of a literature synthesis of the practice problem. The DNP-prepared nurse uses the information to identify and seek grant funding to financially support the project and to begin writing a successful grant proposal.

Instructions

Review the lesson and readings from this week and respond to the following:

1. Use a synthesis of research study evidence and non-research evidence to introduce the implications of the practice problem including the significance, mortality, and economic ramifications of the problem.  
2. Present your practice change idea to address your practice problem.
3. Identify a potential non-research grant to support your evidence-based practice change initiative (these can often be in the form of quality improvement funding). Tip- look at the different nurse practitioner organizations for grant funding.  
4. Present a summary of the grant proposal requirements of the grant funding agency with deadline dates as applicable.  

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

• Link (webpage): DNP Discussion Guidelines.

Program Competencies

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

1. Integrates scientific underpinnings into everyday clinical practice. (POs 3, 5)
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. Uses analytic methods to translate critically appraised research and other evidence into clinical scholarship for innovative practice improvements. (POs 3, 5)
4. Appraises current information systems and technologies to improve health care. (POs 6, 7)
5. Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)
6. Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)

Course Outcomes

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

1. Identify advanced practice leadership competencies. (PCs 2, 4, 5; POs 2, 6)
2. Translate research into clinical practice to provide optimal wellness and disease prevention throughout the patient population. (PCs 1, 3, 5, 7, 8; POs 1, 3, 4, 9)
3. Critically appraise research as it applies to evidence-based practice to provide the most current and effective care to patient populations. (PCs 1, 3, 5, 8; POs 3, 4, 9)

NR 718 Week 3 Advanced Practice Nurse Health Systems Leadership to Ensure Culturally Competent Care to Address Health Inequities Discussion

Purpose

The purpose of this discussion is to examine the role of the APN as a leader in healthcare delivery of high-quality, evidence-based care to culturally diverse populations who experience health inequities.

Instructions

Review the lesson and readings from this week and provide an example of how health system leaders can reduce health inequities to improve quality and outcomes.

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

• Link (webpage): DNP Discussion GuidelinesLinks to an external site.

Program Competencies

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

1. Integrates scientific underpinnings into everyday clinical practice. (POs 3, 5)
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. Uses analytic methods to translate critically appraised research and other evidence into clinical scholarship for innovative practice improvements. (POs 3, 5)
4. Appraises current information systems and technologies to improve health care. (POs 6, 7)
5. Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)
6. Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
7. Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (POs 1, 4)

Course Outcomes

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

1. Identify advanced practice leadership competencies. (PCs 2, 4, 5; POs 2, 6)
2. Apply various strategies to improve access to quality, cost-effective healthcare. (PCs 5, 7, 8; POs 1, 4, 9)
3. Translate research into clinical practice to provide optimal wellness and disease prevention throughout the patient population. (PCs 1, 3, 5, 7, 8; POs 1, 3, 4, 9)
4. Critically appraise research as it applies to evidence-based practice to provide the most current and effective care to patient populations. (PCs 1, 3, 5, 8; POs 3, 4, 9)

Advanced Practice Nurse Leadership to Ensure Culturally Competent Care Example

Health inequities refer to disparities in healthcare outcomes resulting from systemic, social, and economic factors that are avoidable, unfair, and unjust and can create unequal health opportunities (Lee et al., 2020). Culturally competent care is crucial in reducing health inequities. Advanced practice nurses (APNs) can significantly address health inequities by assuming leadership positions in healthcare systems. APNs are uniquely qualified to lead efforts to reduce health inequities by promoting culturally competent care.

Advanced practice nurse health system leaders are essential in reducing health inequities by implementing strategies that ensure culturally competent care to diverse populations. APNs can identify and address language barriers, cultural beliefs, and practices that may impact patient care (Swihart & Martin, 2022). They can also ensure culturally competent care by hiring a diverse workforce that reflects the patient population to be served. Culturally competent care must also be integrated into healthcare policies, procedures, and practices.

One example of how APN health system leaders can reduce health inequities is by addressing the mental health needs of culturally diverse populations. APNs can lead efforts to develop and implement evidence-based interventions that improve mental health outcomes for diverse populations by ensuring that mental health services are culturally appropriate and address the unique needs of patients from different backgrounds. APN leaders can also promote cultural competence by ensuring that interdisciplinary teams are trained in cultural sensitivity, communication, and awareness of the social determinants of health (Liu et al., 2022). Furthermore, APNs can advocate for policy changes that address health inequities by engaging in advocacy efforts to reduce healthcare disparities in underserved communities, such as policies on improved access to care for vulnerable populations.

As discussed above, advanced practice nurses can play a crucial role in reducing health inequities and ensuring culturally competent care. APN health system leaders can lead efforts to identify and address language barriers, cultural beliefs, and practices, hire a diverse workforce, and develop evidence-based interventions that are culturally appropriate. APN leaders can also engage in advocacy efforts to reduce healthcare disparities in underserved communities. These actions can help ensure all patients receive accessible, equitable, and culturally competent care.

References

Lee, H., Kim, D., Lee, S., & Fawcett, J. (2020). The concepts of health inequality, disparities, and equity in the era of population health. Applied Nursing Research, 56, 151367. https://doi.org/10.1016/j.apnr.2020.151367

Liu, T.-T., Chen, M.-Y., Chang, Y.-M., & Lin, M.-H. (2022). A preliminary study on the cultural competence of nurse practitioners and its affecting factors. Healthcare, 10(4), 678. https://doi.org/10.3390/healthcare10040678

Swihart, D. L., & Martin, R. L. (2022, November 14). Cultural religious competence in clinical practice. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493216/

NR 718 Week 3 Leading Evidence-Based Practice Change: Part 1 Assignment

Purpose

The purpose of this assignment is to demonstrate clinical and health systems leadership by writing a grant proposal for an evidence-based practice change project to address a practice problem. You will use the practice problem identified in previous courses. This assignment focuses on the first part of a grant proposal:

• Specific Aims
• Background and Significance
• Translational Science Model
• Setting

Instructions

Review feedback from the discussion and write the beginning of the grant proposal that includes the following required content:

1. Introduction (maximum of 1 paragraph): Provide a brief introduction that describes the following:
   1. Introduce the paper’s purpose and the importance of the practice change project.
   1. Describe intended accomplishments and long-term project goals.
   1. Provide a brief and defining statement of what will be discussed in the paper.
2. Specific Aims (maximum of 1 paragraph)
   1. Describe what is hoped to be accomplished with the project, such as increased access or quality of care, etc.
3. Background and Significance (maximum of 2 pages): This section lays out the reason for the grant proposal. It should make a clear, concise, and well-supported statement of the problem. The information provided should be both factual and directly related to the problem addressed by the grant proposal. The following should be addressed in this section:
   1. Define the purpose for developing the grant proposal.
   1. Identify the problem and address why this is a problem.
   1. Describe the nature of the problem. Provide as much evidence as possible, including the non-research data along with the research findings. Provide a synthesis of research study evidence and non-research evidence to introduce the implications of the practice problem that include the significance, mortality, and economic ramifications of the problem.
   1. Describe the stakeholders, who they are, and how they will benefit from the practice change project. 
   1. Describe the specific way the problem(s) might be solved using the grant funding. 
4. Translational Science Model (maximum of 1 paragraph)
   1. Identify and briefly describe an appropriate translational science model to guide the project implementation.
5. Setting (maximum of 1 paragraph)
   1. Describe the setting to include the type of organization (e.g., hospital, clinic, long-term care facility, etc.).
   1. Describe the specific population served by the organization.
   1. Describe the ethnic, racial, and cultural diversity of the community.

APA Guidelines 

Use the current American Psychological Association (APA Manual) and the Chamberlain Guidelines for Writing a Professional Papers (located in the APA Basics section of the Writing Center) to complete this assignment.?Follow these guidelines when completing each component. Contact your course faculty if you have questions.  

1. Use the APA Paper Template (located in the Writing Center) to format this assignment.  
2. Turn on Grammarly to check the correctness of the grammar and punctuation as you write. (Note: if you have not already done so, please download the free version at Grammarly.com before construction of the assignment.)  
3. Construct a title page using the APA paper template (Example: The Nurse Educator and Leading Social Change).  
4. Use the following prescribed Level I headings for the paper:  
   1. Title of the paper for Introduction 
   1. Specific Aims 
   1. Background and Significance 
   1. Translation Model 
   1. Setting 

Writing Requirements (APA format)

• Length: 3-4 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 and subheadings
• In-text citations
• Title page
• Reference page
• Standard English usage and mechanics
• Organized presentation of ideas 

Program Competencies

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

1. Integrates scientific underpinnings into everyday clinical practice. (POs 3, 5)
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. Uses analytic methods to translate critically appraised research and other evidence into clinical scholarship for innovative practice improvements. (POs 3, 5)
4. Appraises current information systems and technologies to improve health care. (POs 6, 7)
5. Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)
6. Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
7. Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (POs 1, 4)

Course Outcomes

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

1. Identify advanced practice leadership competencies. (PCs 2, 4, 5; POs 2, 6)
2. Apply various strategies to improve access to quality, cost-effective healthcare. (PCs 5, 7, 8; POs 1, 4, 9)
3. Utilize translation science to affect evidence-based practice change to impact quality and safety of patient care. (PCs 1, 3; POs 3, 5)
4. Translate research into clinical practice to provide optimal wellness and disease prevention throughout the patient population. (PCs 1, 3, 5, 7, 8; POs 1, 3, 4, 9)

NR 718 Week 3 Assignment Grading Rubric

Week 3 Assignment Grading RubricCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeIntroduction Requirements:
1. Introduce the paper’s purpose and the importance of the project.
2. Describe the intended accomplishments and long-term project goals.
3. Provide a brief and defining statement of what will be discussed in the paper.20 pts Includes all requirements and provides an excellent introduction. 18 pts Includes all requirements and provides a very good introduction. 16 pts Includes fewer than all requirements and/or provides a basic introduction. 0 pts Includes fewer than all requirements and/or provides a poor introduction.20 ptsThis criterion is linked to a Learning OutcomeSpecific Aims Requirements:
1. Describe what is hoped to be accomplished with the project such as increased access or quality of care, etc.20 pts Includes all requirements and provides an excellent description of the specific aims. 18 pts Includes all requirements and provides a very good description of the specific aims. 16 pts Includes fewer than all requirements and/or provides a basic description of the specific aims. 0 pts Includes fewer than all requirements and/or provides a poor description of the specific aims.20 ptsThis criterion is linked to a Learning OutcomeBackground and Significance Requirements:
1. Define the purpose for developing the grant proposal.
2. Identify the practice problem and address why this is a problem.
3. Describe the nature of the problem. Provide as much evidence as possible, including the non-research data along with the research findings. Provide a synthesis of research study evidence and non-research evidence to introduce the implications of the practice problem that include the significance, mortality, and economic ramifications of the problem.
4. Describe the stakeholders, who they are, and how they will benefit.
5. Describe the specific way the problem(s) might be solved.50 pts Includes all requirements and provides an excellent description of the background and significance. 45 pts Includes all requirements and provides a very good description of the background and significance. 40 pts Includes fewer than all requirements and/or provides a basic description of the background and significance. 0 pts Includes fewer than all requirements and/or provides a poor description of the background and significance.50 ptsThis criterion is linked to a Learning OutcomeTranslational Science Model Requirements:
1. Identify and briefly describe an appropriate translational science model to guide the project implementation.30 pts Includes all requirements and provides an excellent discussion of the translational science model. 27 pts Includes all requirements and provides a very good discussion of the translational science model. 24 pts Includes fewer than all requirements and/or provides a basic discussion of the translational science model. 0 pts Includes fewer than all requirements and/or provides a poor discussion of the translational science model. epidemiology.30 ptsThis criterion is linked to a Learning OutcomeSetting Requirements:
1. Describe the setting to include the type of organization.
2. Describe the specific patient population served by the organization.
3. Describe the ethnic, racial, and cultural diversity of the community.30 pts Includes all requirements and provides an excellent discussion of the setting. 27 pts Includes all requirements and provides a very good discussion of the setting. 24 pts Includes fewer than all requirements and/or provides a basic discussion of the setting. 0 pts Includes fewer than all requirements and/or provides a poor discussion of the setting.30 ptsThis criterion is linked to a Learning OutcomeReferences Requirements:
1. Identify and list scholarly sources and other sources on the reference pages.
2. List sources in alphabetical order.
3. Use correct hanging-indent format.10 pts Includes all requirements and provides excellent references. 9 pts Includes all requirements and provides very good references. 8 pts Includes fewer than all requirements and/or provides basic references. 0 pts Includes fewer than all requirements and/or provides poor references.10 ptsThis criterion is linked to a Learning OutcomeAPA Style and Organization for Scholarly Papers Requirements:
1. Use prescribed Level I headers as described in the assignment guidelines.
2. Reference and citations are in current APA style.
3. Paper length is 3-4 pages, excluding title and reference pages.10 pts Includes all requirements and provides excellent APA style and organization. 9 pts Includes all requirements and provides very good APA style and organization. 8 pts Includes fewer than all requirements and/or provides basic APA style and organization. 0 pts Includes fewer than all requirements and/or provides poor APA style and organization.10 ptsThis criterion is linked to a Learning OutcomeClarity of Writing Requirements:
1. Use of Standard English usage and mechanics
2. No spelling or typographical errors
3. Organized presentation of ideas30 pts Includes all requirements and demonstrates excellent clarity of writing. 27 pts Includes all requirements and provides very good clarity of writing. 24 pts Includes fewer than all requirements and/or provides basic clarity of writing. 0 pts Includes fewer than all requirements and/or provides poor clarity of writing.30 ptsTotal Points: 200

NR 718 Week 4 Advanced Practice Nurse Clinical and Health Systems Leadership in Action: The Evaluation Plan Discussion

Purpose

The purpose of this discussion is to develop an evaluation plan for the grant proposal.

Instructions

Review the lesson and readings from this week. Continuing with the practice problem you identified in the Week 3 Assignment, respond to the following:

1. Identify the primary outcome(s) for your evidence-based intervention.
2. Describe how this will be measured (i.e., how the evidence-based intervention will be evaluated when it is fully implemented).

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

• Link (webpage): DNP Discussion Guidelines.

Program Competencies

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

1. Integrates scientific underpinnings into everyday clinical practice. (POs 3, 5)
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. Uses analytic methods to translate critically appraised research and other evidence into clinical scholarship for innovative practice improvements. (POs 3, 5)
4. Appraises current information systems and technologies to improve health care. (POs 6, 7)
5. Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)
6. Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
7. Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (POs 1, 4)

Course Outcomes

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

1. Identify advanced practice leadership competencies. (PCs 2, 4, 5; POs 2, 6)
2. Apply various strategies to improve access to quality, cost-effective healthcare. (PCs 5, 7, 8; POs 1, 4, 9)
3. Utilize translation science to affect evidence-based practice change to impact quality and safety of patient care. (PCs 1, 3; POs 3, 5)
4. Translate research into clinical practice to provide optimal wellness and disease prevention throughout the patient population. (PCs 1, 3, 5, 7, 8; POs 1, 3, 4, 9)
5. Critically appraise research as it applies to evidence-based practice to provide the most current and effective care to patient populations. (PCs 1, 3, 5, 8; POs 3, 4, 9)

NR 718 Week 5 Advanced Practice Nurse as Clinical and Health Systems Leader to Promote Quality and Safety Discussion

Purpose

The purpose of this discussion is to examine the role of the APN as a clinical and health systems leader to promote quality and safety.

Instructions

Review the lesson and readings from this week and respond to the following:

Examine a quality or safety initiative at your organization. Explain how the problem was identified and what evidence-based inte

NR451 Capstone Project Milestone 1 Practice Issue and Evidence Summary

NR451 CAPSTONE PROJECT MILESTONE 1 PRACTICE ISSUE AND EVIDENCE SUMMARY

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

NR451 Capstone Project Milestone 1 Practice Issue and Evidence Summary Directions

1. Refer to the guidelines for specific details on how to complete this assignment.

2. Type your answers directly into the worksheets below.

3. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.

4. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.

NR451 Capstone Project Milestone 1 Practice Issue and Evidence Summary Practice Issue Worksheet

• List the topic and include the citation for the systematic review you have selected:
• What is the practice issue you have identified related to the topic you have chosen?
• Define the scope of the practice issue:
• What is the practice area?

___ Clinical

___ Education

___ Administration

___ Other (List):

• How was the practice issue identified? (check all that apply)

___ Safety/risk management concerns

___ Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

• Describe the rationale for your checked selections:
• What evidence must be gathered? (check all that apply)

___ Literature search

___ Guidelines

___ Expert Opinion

___ Patient Preferences ___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

• Describe the rationale for your checked selections:

NR451 Capstone Project Milestone 1 Practice Issue and Evidence Summary Worksheet

Directions: Please type your answers directly into the worksheet.

• Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:
• Type the complete APA reference for the systematic review article you chose from the list provided, It must be relevant to the practice issue you described above.
• Identify the objectives of the article.
• Provide a statement of the questions being addressed in the work and how they relate to your practice issue:
• Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.
• Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper.
• Outline evidence-based solutions that you will consider for your project.
• Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project.

Capstone Project Practice Issue and Evidence Summary – NR 451

NR 451 Capstone Project Milestone 1 Practice Issue and Evidence Summary Purpose

Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star Model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.

NR 451 Capstone Project Milestone 1 Practice Issue and Evidence Summary Course Outcomes

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

• CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO4)
• CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO8)

NR 451 Capstone Project Milestone 1 Practice Issue and Evidence Summary Due Dates

Milestone 1 consists of the completion of ONE form with two worksheets called the.courselearn.net/lms/content/1500/50031/NR451/NR451_W3_Milestone1_Evidence_Worksheet2.docx”>Practice Issue and Evidence Summary Worksheets. (Links to an external site.)Links to an external site. Complete both worksheets and submit the form by Sunday, 11:59 p.m. MT at the end of Week 3.

Points

Milestone 1 is worth175 points(75 points for the Practice Issue and 100 points for the Evidence Summary).

Practice Issue Worksheet Directions

1. A tutorial with tips for completing this Capstone Project: Practice Issue and Evidence Summary – NR451 assignment may be viewed
2. Choose the ONE systematic review topic that is of most interest to you, or most relevant to your practice situation, from
3. Follow the grading criteria below to formulate your practice issue, which must be based on the topic of the systematic review you have selected.
4. Use the worksheet to document the practice issue presented and approved by your instructor in the Week 2 Discussions.
5. Your practice issue will be the same for all three Milestone assignments in this course.
6. Please type your answers directly into the worksheet.

Evidence Summary Worksheet Directions

1. Develop an evidence summary by following the grading criteria below.
2. Document this on the evidence summary portion of the worksheet.
3. You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment.
4. Please type your answers directly into the worksheet.

Academic Integrity Reminder

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this Capstone Project: Practice Issue and Evidence Summary – NR451 assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Please see the grading criteria and rubrics on this page.

NOTE: Please use your browser’s File setting to save or print this page.

List of Approved Systematic Reviews

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NR451 Capstone Project Milestone 1 Practice Issue and Evidence Summary Project

Directions: Please choose ONE topic and its corresponding systematic review that is of most interest to you, or most relevant to your practice. This systematic review will be the basis for your capstone project. Please refer to the guidelines for each milestone for more details.

Obstetrics/Delivery

Gupta, J. K., Sood, A., Hofmeyr, G. J., & Vogel, J. P. (2017). Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews,Issue 5, Art. No.: CD002006.

Strobel, N. A., Arabena, K., East, C. E., Schultz, E.M., Kelaher, M., Edmond, K. M., … Chamberlain, C. (2017). Care co-ordination interventions to improve outcomes during pregnancy and early childhood (up to 5 years) (Protocol). Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD012761.

Health-Associated Infections (HAI)

Verbeek, J. H., Ijaz, S., Mischke, C., Ruotsalainen, J. H., Mäkelä, E., Neuvonen, K., … Mihalache, R. C. (2016). Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD011621.

Dumville, J. C., Gray, T. A., Walter, C. J., Sharp, C. A., Page, T., Macefield, R., … Blazeby, J. (2016). Dressings for the prevention of surgical site infection. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD003091.

Wound Care

Walker, R. M., Gillespie, B. M., Thalib, L., Higgins, N. S., & Whitty, J. A. (2017). Foam dressings for treating pressure ulcers. Cochrane Database of Systematic Reviews, Issue 10. Art. No.: CD011332. DOI: 10.1002/14651858.CD011332.pub2.

Childhood/School Health

Hodder, R. K, Stacey, F. G., Wyse, R. J., O’Brien, K. M., Clinton-McHarg, T., Tzelepis, F., … Wolfenden, L. (2017). Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD008552. DOI: 10.1002/14651858.CD008552.pub3.

Parab, C. S, Cooper, C., Woolfenden, S., & Piper, S. M. (2013). Specialist home-based nursing services for children with acute and chronic illnesses. Cochrane Database of Systematic Reviews, Issue 6. Art. No.: CD004383. DOI: 10.1002/14651858.CD004383.pub3.

Hospital Readmissions

Hall, K. K., Chang, A. B., & O’Grady, K.F. (2016). Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness (Protocol). Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD012315. DOI: 10.1002/14651858.CD012315.

NR451 Milestone 2: Design for Change Proposal

Purpose

You are to create a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Project worksheet (PDF uploaded). Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program.

Rubric (PDF also uploaded)

Click to view and download the NR451 Milestone 2: Design for Change Proposal Rubric.

Points

Milestone 2 is worth 225 points.

Directions

1. A tutorial with tips for completing this assignment may be viewed at https://atge.webex.com/atge/ldr.php?RCID=b0c912eaf53b4aabb1347a026466c60e
2. Review the feedback you received from your instructor for worksheet, and use it to develop this milestone.
3. Create a proposal for your Design for Change Capstone Project. Open the Milestone 2 Design Proposal Template. (PDF also uploaded)Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.
4. The format for this proposal will be a paper following the Publication manual of APA6th
5. The paper is to be five pages.
6. As you organize your information and evidence, include the following topics.
   1. Introduction: Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.
   2. Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.
   3. Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.
   4. Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.
   5. Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.
7. Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
8. Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.

NR 451 Week 6: Capstone Project: Milestone 3: Educating Staff (graded) Assignment

Capstone Project Milestone 3: Educating Staff: Implementing Change Guidelines

NR 451 Week 6: Capstone Project: Milestone 3 Purpose

The purpose of this assignment is to create the Educating Staff: Implementing Change Project PowerPoint presentation. Your plan is to educate the staff that will be involved in the pilot program. NR451 Capstone Project Milestone 1: Practice Issue and Evidence Summary. You will need to educate them on the problem, show the supporting evidence, and how your pilot plan will be implemented.

NR 451 Week 6: Capstone Project: Milestone 3 Course Outcomes

This assignment enables the student to meet the following Course Outcomes.

• CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO2)
• CO3: Communicates effectively with patient populations and other healthcare providers in managing the healthcare of individuals, families, aggregates, and communities. (PO3)
• CO7: Integrates the professional role of leader, teacher, communicator, and manager of care to plan cost-effective, quality healthcare to consumers in structured and unstructured settings. (PO7)

NR451 Capstone Project Milestone 1: Practice Issue and Evidence Summary Due Date

Milestone 3 consists of the PowerPoint presentation Educating Staff: Implementing Change Project. Submit the PowerPoint file by Sunday, 11:59 p.m. MT by the end of Week 6.

Points

Milestone 3 is worth 200 points.

NR 451 Week 6: Capstone Project: Milestone 3 Directions

1. A tutorial with tips on completing this assignment may be viewed at https://atge.webex.com/atge/ldr.php?RCID=8912a4b3268463312e115abf9e73efd6 (Links to an external site.)Links to an external site.
2. Create an educational presentation for staff before the launch of your change project. This should inform the staff of the problem, your potential solution, and their role in change project.
3. The format for this proposal will be a PowerPoint presentation.
4. Tutorial: For those not familiar with the development of a PowerPoint slideshow, the following link to the Microsoft website may be helpful. http://office.microsoft.com/en-us/support/training-FX101782702.aspx. The Chamberlain Student Success Strategies (SSPRNBSN) offers a module on Computer Literacy that contains a section on PowerPoint. You can access SSPRNBSN from  your Canvas course list.
5. The length of the PowerPoint presentation should be 15-20 slides; excluding the title and reference slides.
6. Below are the main topics or bullet points for your slides:

1. Title slide
2. Description of the Ace Star change model that you have used for this project.
3. Practice Issue
4. Scope of the problem—use basic statistics from what you know of the problem in your work area.
5. Your team/stakeholders
6. Evidence to support your need for change—from your Evidence Summary
7. Action Plan
8. Timeline for the plan
9. The nurse’s role and responsibility in the pilot program
10. Procedure (what steps are to be taken to complete this change process, from start to finish?)
11. Forms that will be used (if applicable)
12. Resources available to the staff—including yourself
13. Summary
14. References

6. Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. Citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means choose peer-reviewed journals and credible websites.

NR 451 Week 6: Capstone Project: Milestone 3 Guidelines

• Application: Use Microsoft PowerPoint 2010 or later.
• Length: The PowerPoint slide show is expected to be between 15-20 slides in length (not including the title slide and reference list slides).
• Submission: Submit your by 11:59 p.m. Sunday by the end of Week 6.
• Late Submission: See the Policies on late submissions.
• Tutorial: For those not familiar with the development of a PowerPoint slideshow, the following link to the Microsoft website may be helpful. http://office.microsoft.com/en-us/support/training-FX101782702.aspx. The Chamberlain Student Success Strategies (CCSSS) offers a module on Computer Literacy that contains a section on PowerPoint. The link to SSP CCSSS may be found under your course list in the student portal.

Best Practices in Preparing a PowerPoint Presentation

The following are best practices in preparing this presentation.

1. Be creative.
2. Incorporate graphics, clip art, or photographs to increase interest.
3. Make easy to read with short bullet points and large font.
4. Use speaker notes (found under the section View and “Notes” in the PowerPoint template you choose. These are for your personal use to use as a reference if you are giving your presentation to an audience and they help faculty identify what you will speak to your audience about.
5. Review directions thoroughly.
6. Cite all sources within the slides with (author, year) as well as on the Reference slide.
7. Proofread prior to final submission.
8. Spell check for spelling and grammar errors prior to final submission.

**Academic Integrity Reminder**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Please see the grading criteria and rubrics on this page.

NR451 Capstone Project Systematic Reviews

List of Approved Systematic Reviews

NR451 Capstone Project

Directions: Please choose ONE topic and its corresponding systematic review that is of most interest to you, or most relevant to your practice. This systematic review will be the basis for your capstone project. Please refer to the guidelines for each milestone for more details.

Promoting breastfeeding

Sinha, B., Chowdhury, R., Sankar, M. J., Martines, J., Taneja, S., Mazumder, S., … Bhandari, N. (2015). Interventions to improve breastfeeding outcomes: A systematic review and meta-analysis. Acta Paediatrica, 104, 114-134. doi:10.1111/apa.13127.

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Preventing central venous catheter-related infections

Lai, N. M., Lai, N. A., O’Riordan, E., Chaiyakunapruk, N., Taylor, J. E., & Tan, K. (2016). Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database of Systematic Reviews, (7), CD010140. doi:10.1002/14651858.CD010140.pub2.

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Increasing health insurance coverage for vulnerable populations

Jia, L., Yuan, B., Huang, F., Lu, Y., Garner, P., & Meng, Q. (2014). Strategies for expanding health insurance coverage in vulnerable populations. Cochrane Database of Systematic Reviews, (11), 1-41. CD008194. doi:10.1002/14651858.CD008194.pub3.

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Preventing teen pregnancy and sexually-transmitted disease

Mason-Jones, A. J., Sinclair, D., Mathews, C., Kagee, A., Hillman, A., & Lombard, C. (2016). School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database of Systematic Reviews, (11), CD006417. doi:10.1002/14651858.CD006417.pub3.

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Reducing hospital readmissions

Mistiaen, P., & Poot, E. (2006). Telephone follow-up, initiated by a hospital-based health professional, for post discharge problems in patients discharged from hospital to home. Cochrane Consumers and Communication Group. (4), CD004510. doi:10.1002/14651858.CD004510.pub3.

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Obstetrics/Delivery

Lemos, A., Amorim, M. M. R., Dornelas de Andrade, A., Souza, A. I., Calbral Filho, J. E., & Correia, J. B. (2017). Pushing/bearing down methods for the second stage of labour.  Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD009124. DOI: 10.1002/14651858.CD009124.pub3.

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Moore, E. R., Bergman, N., Anderson, G. C., & Medley, N. (2016). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub4.

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Health-Associated Infections (HAI)

Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5.

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Wound Care

Moore, Z. E. H., Webster, J., & Samuriwo, J. (2015). Wound-care teams for preventing and treating pressure ulcers. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011011. doi:10.1002/14651858.CD011011.pub2.

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Childhood/School Health

Janicke, D. M., Steele, R. G., Gayes, L. A., Lim, C. S., Clifford, L. M., Schneider, E. M., & … Westen, S. (2014). Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity. Journal of Pediatric Psychology, 39(8), 809-825.

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Hospital Readmissions

Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., & … Montori, V. M. (2014). Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. doi:10.1001/jamainternmed.2014.1608

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Fox, M. T., Persaud, M., Maimets, I., Brooks, D., O’Brien, K., & Tregunno, D. (2013). Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: A systematic review and meta-analysis. BMC Geriatrics, 13(1), 1. doi:10.1186/1471-2318-13-70

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