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NRS 434 Shadow Health Focused Exam Cough Results

NRS 434 Shadow Health Focused Exam Cough Results

Within the Shadow Health platform, complete the Focused Exam: Cough Results. The estimated average time to complete this assignment each time is 1 hour and 15 minutes. Please note, this is an average time. Some students may need longer.

This clinical experience is a focused exam. Students must score at the level of “Proficiency” in the Shadow Health Digital Clinical Experience. Students have three opportunities to complete this assignment and score at the Proficiency level. Upon completion, submit the lab pass through the assignment dropbox.

Each of you will be completing a Shadow Health Assessments each week. You will need to sign into the account, and please make sure you register under the correct date. You will get all your information under the Course Materials.

If you have problems signing in, you will need to call the Help Desk for them. Make sure you are reading the rubric for each Shadow Health assignment, because sometimes you will only have 1 try to pass, and other times you may only have 3, but with significant point reduction each try.

You do not need a PIN to sign in. Go to PATH, then Course Material. You will see: Shadow Health Digital Clinical Experience. Go there and follow the instructions. Thanks

Please upload all assignment completions under your assignment due area. Thanks

• Students successfully scoring within the Proficiency level in the Digital Clinical Experience on the first attempt will earn a grade of 10 points
• Students successfully scoring at the Proficiency level on the second attempt will earn a grade of 90 points
• Students successfully scoring at the Proficiency level on the third attempt will earn a grade of 80 points.
• Students who do not pass the performance-based assessment by scoring within the Proficiency level in three attempts will receive a failing grade (68 points).

ORDER THROUGH BOUTESSAY

If Proficiency is not achieved on the first attempt, it is recommended that you review your answers with the correct answers on the Experience Overview page. Review the report by clicking on each tab to the left titled Transcript, Subjective Data Collection, Objective Data Collection, Documentation, and SBAR to compare your work. Reviewing this overview and the course resources may help you improve your score.

Please review the assignment in the Health Assessment Student Handbook in Shadow Health prior to beginning the assignment to become familiar with the expectations for successful completion. You are not required to submit this assignment to LopesWrite.

NRS 434 Shadow Health Focused Exam Cough Results

Subjective Data

Scored Items

• Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

• A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Chief Complaint

Finding: Established chief complaint

Finding: Reports cough (Found)
Pro Tip: Asking a patient broadly about their chief complaint allows them to answer in their own words and confirm information that you may have already received from another source.
Example Question: Do you have a cough?

History of Presenting Illness

• Finding: Asked about onset of cough

Finding: Reports cough started 3 days ago (Found)
Pro Tip: Whenever you are assessing a symptom or a health condition, in this case the patient’s cough, inquiring about onset assesses the severity and the progression of the problem.
Example Question: How long have you had a cough?

• Finding: Asked about characteristics of cough

Finding: Reports cough is wet (Available)
Pro Tip: The characteristics of a cough, such as whether it is dry or wet, can indicate key information about the type of illness the patient has.
Example Question: Is your cough a wet cough?

Finding: Reports clear sputum with cough (Available)
Pro Tip: The characteristics of a cough, such as whether it is productive, can indicate key information about the type of illness the patient has.
Example Question: Do you produce any phlegm or sputum with your cough?

• Finding: Asked about frequency and duration of cough

Finding: Reports coughing every few minutes (Available)
Pro Tip: Establishing how frequently Danny coughs will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question: How frequently are you coughing?

Finding: Reports coughs last a few seconds (Available)
Pro Tip: Establishing how long Danny’s coughs last will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question: How long do your coughs last?

• Finding: Asked about aggravating factors for cough

Finding: Reports cough is worse at night (Available)
Pro Tip: Establishing a timeline for Danny’s coughing will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question: Is the cough worse at night?

Finding: Denies smoking (Available)
Pro Tip: Tobacco use puts the patient at risk for many medical conditions. Asking even young patients about whether they consume tobacco products helps you assess this risk factor.
Example Question: Do you smoke?

Finding: Reports being exposed to secondhand smoke through father (Available)
Pro Tip: Tobacco use puts the patient at risk for many medical conditions. Asking about whether a patient is exposed to secondhand smoke allows you to assess this risk factor.
Example Question: Are you ever around cigarette smoke?

Finding: Reports he doesn’t know what triggers the cough (Available)
Pro Tip: Asking about aggravating factors of Danny’s cough will allow you to determine potential causes and educate the patient on what to avoid.
Example Question: What makes your cough worse?

• Finding: Asked about relieving factors for cough

Finding: Reports cough is temporarily relieved by cough medicine (Found)
Pro Tip: Asking about how the patient has been managing their pain assesses their current condition and their approach to self-care. The results of their previous treatment may be helpful in your diagnosis and the development of their new treatment plan, as well as a good opportunity to educate the patient on effective self-care practices.
Example Question: Have you done anything to treat your cough?

• Finding: Followed up on cough medicine

Finding: Reports cough medicine was purple (Available)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the cough medicine’s color may help you identify the type of medication it is.
Example Question: What color was the cough medicine?

Finding: Reports taking one spoonful of cough medicine (Available)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the dose of cough medicine allows you to determine whether it is being taken correctly.
Example Question: How much medicine did you take?

Finding: Reports mother gave him the medicine (Found)
Pro Tip: Children should only take medication under the supervision of an adult who can assure it is taken as directed. You should ask younger patients whether the medicine was given to them and by whom.
Example Question: Who gave you the medicine for your cough?

Finding: Reports only took the medicine this morning (Found)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the frequency Danny took cough medicine allows you to determine whether it is being taken correctly.
Example Question: How many times have you taken the cough medicine? Shadow Health: Focused Exam: Cough Results Danny Riviera

Finding: Denies home remedies (Available)
Pro Tip: Patients sometimes try non-medicinal home remedies to treat coughs, such as breathing steam, or drinking tea with honey. Not all home remedies are effective or advisable, so it’s important to find out what remedies the patient has tried.
Example Question: Have you tried any home remedies for your cough?

• Finding: Asked about typical medication use

Finding: Denies taking medication (Available)
Pro Tip: Knowing a patient’s current medication regimen helps you determine if any future treatments will be safe and effective.
Example Question: Do you take any medications from a doctor?

Finding: Reports taking daily vitamin (Available)
Pro Tip: Some symptoms can occur as a result of a vitamin deficiency, and others as a result of vitamin excess. Vitamins can also interfere with some treatments, so it’s important to know what your patient is taking.
Example Question: Do you take vitamins?

• Finding: Asked about activity level

Finding: Reports typical high activity level (Available)
Pro Tip: Establishing a patient’s typical activity level is an important baseline to help you determine how an illness is affecting his life.
Example Question: Are you usually active?

Finding: Reports activity level low since getting sick (Available)
Pro Tip: Establishing a patient’s activity level, and whether it has been impacted since becoming ill, is an important baseline to help you determine how an illness is affecting his life.
Example Question: Have you been less active since getting sick?

Finding: Reports still able to run or play (Available)
Pro Tip: Ability to remain active indicates that the patient’s breathing is not dangerously affected, and that the patient isn’t seriously fatigued.
Example Question: Are you able to keep up when you play with your classmates?

Finding: Reports focusing in class is difficult (Available)
Pro Tip: Mental lethargy and difficulty concentrating are common symptoms when a patient is sick.
Example Question: Are you able to focus in class?

• Finding: Asked about nasal symptoms

Finding: Reports current runny nose (Found)
Pro Tip: Asking your patient if his nose is running will allow you to determine the symptoms he is experiencing and possible triggers.
Example Question: Do you currently have a runny nose?

Finding: Denies sneezing (Available)
Pro Tip: Asking your patient if he has been sneezing will allow you to determine the symptoms he is experiencing and possible triggers.
Example Question: Have you been sneezing?

• Finding: Followed up on nasal discharge

Finding: Reports nasal discharge is clear (Available)
Pro Tip: The color of a patient’s nasal discharge can provide you key information as to the type of condition the patient has.
Example Question: What color is your snot?

Finding: Reports nasal discharge is thin (Available)
Pro Tip: The consistency of a patient’s nasal discharge can provide you key information as to the type of condition the patient has.
Example Question: What is the consistency of your nasal discharge?

• Finding: Asked about ear symptoms

Finding: Denies ear pain (Available)
Pro Tip: Ear pain is often coincident with coughs and sinus problems. Asking about them allows you to ascertain if Danny needs follow-up care for his ears.
Example Question: Do you have any ear pain?

Finding: Reports history of frequent ear infections (Available)
Pro Tip: Asking about Danny’s history of ear infections allows you to ascertain his risk for current and future ear infections.
Example Question: Have you ever had ear infections?

Finding: Denies ear discharge (Available)
Pro Tip: Asking Danny about ear discharge, which are often coincident with of ear infections, allows you to ascertain his risk for current and future ear infections.
Example Question: Do you have any ear discharge?

Finding: Denies hearing problems (Available)
Pro Tip: Simply talking with the patient assesses his hearing; however, some types of hearing loss are only apparent in specific settings such as noisy environments. Asking the patient about hearing problems identifies conditions that may not be readily apparent.
Example Question: Do you have any hearing problems? Shadow Health: Focused Exam: Cough Results Danny Riviera

• Finding: Asked about throat symptoms

Finding: Reports sore throat (Available)
Pro Tip: Sore throats are often coincident with coughs and sinus problems. Asking about them allows you to ascertain if Danny needs follow-up care for his throat.
Example Question: Is your throat sore?

Finding: Reports a little pain with swallowing (Available)
Pro Tip: Pain when swallowing helps you understand how severe the patient’s sore throat is.
Example Question: Does it hurt when you swallow?

Past Medical History

• Finding: Asked about relevant medical history

Finding: Reports frequent runny noses (Available)
Pro Tip: Asking how often Danny experiences runny noses like the one he has now may help you determine the source of the problem.
Example Question: Do you get runny noses often?

Finding: Reports past frequent coughs (Available)
Pro Tip: A patient experiencing a cough should be asked about their history of coughs so you can determine whether their current condition fits into a recurring pattern.
Example Question: Do you have coughs very often?

Finding: Reports past pneumonia (Available)
Pro Tip: Pneumonia is a serious medical condition that can be life-threatening if not managed appropriately. Regardless of the patient’s presenting illness, it is critical to identify current medical conditions in order to treat the patient appropriately. Specific questions should be asked about previous medical problems, even if the patient doesn’t notice current symptoms.
Example Question: Have you had pneumonia?

Finding: Denies asthma diagnosis (Available)
Pro Tip: Asthma is a serious medical condition that can be life-threatening if not managed appropriately. Regardless of the patient’s presenting illness, it is critical to identify current medical conditions in order to treat the patient appropriately. Specific questions should be asked about previous medical problems, even if the patient doesn’t notice current symptoms.
Example Question: Do you have asthma?

Finding: Reports immunizations as current (Available)
Pro Tip: A health assessment should include an evaluation of the patient’s immunization status in order to identify diseases to which the patient is vulnerable.
Example Question: Do you have current immunizations?

• Finding: Asked about allergies

Finding: Denies seasonal allergies (Available)
Pro Tip: Seasonal allergies can cause symptoms like runny nose, cough, and discomfort. Asking Danny if he has seasonal allergies can help you to ascertain possible triggers for symptoms.
Example Question: Do you have seasonal allergies?

Finding: Denies food allergies (Available)
Pro Tip: Knowing if your patient has food allergies is important and relevant medical history. Asking your patient about food allergies will allow you to most effectively treat him.
Example Question: Do you have food allergies?

Finding: Denies medication allergies (Available)
Pro Tip: Knowing if your patient has allergies to medicine is important and relevant medical history. Asking your patient about medicine allergies will allow you to most effectively treat him.
Example Question: Are you allergic to any medication?

• Finding: Asked relevant family history

Finding: Reports father has history of asthma (Available)
Pro Tip: Medical problems such as asthma that are present in a patient’s immediate family can represent increased risk factors to respiratory conditions such as the ones the patient currently has.
Example Question: Do you have a family history of asthma?

Finding: Denies family history of allergies (Available)
Pro Tip: Medical problems such as allergies that are present in a patient’s immediate family can represent increased risk factors to respiratory conditions such as the ones the patient currently has.
Example Question: Do you have a family history of allergies?

Review of Systems

• Finding: Asked about constitutional health

Finding: Denies chills (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has chills will illustrate the way his symptoms manifest.
Example Question: Do you have chills?

Finding: Denies fever (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has a fever will illustrate the way his symptoms manifest.
Example Question: Do you have a fever?

Finding: Reports feeling somewhat fatigued (Found)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has fatigue will illustrate the way his symptoms manifest.
Example Question: Do you have fatigue?

Finding: Denies night sweats (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has night sweats will illustrate the way his symptoms manifest.
Example Question: Do you have night sweats?

Finding: Reports cough makes it difficult to sleep (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has had difficulty sleeping will illustrate the way his symptoms manifest.
Example Question: Have you been sleeping okay?

Finding: Denies swelling (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has had swelling will illustrate the way his symptoms manifest.
Example Question: Have you noticed any swelling?

• Finding: Asked about additional review of systems for HEENT

Finding: Reports frequent colds (Available)
Pro Tip: A patient such as Danny who is presenting with a cough and a runny nose may have a cold, so you should ask about his history of colds to determine whether this is part of a larger pattern.
Example Question: Do you have unusually frequent colds?

Finding: Denies headaches (Available)
Pro Tip: Headaches are a common complaint that can be caused by a variety of benign conditions. However, headaches can be an indicator of serious underlying neurological conditions such as cerebral hemorrhage, meningitis, or brain tumors. They may also be a symptom of sinus infection.
Example Question: Do you get headaches?

Finding: Denies nosebleeds (Available)
Pro Tip: When a patient presents with symptoms that are often seen with respiratory infections, you should ask about similar signs of respiratory infections such as nosebleeds.
Example Question: Do you have nosebleeds?

Finding: Denies vision difficulty (Available)
Pro Tip: Eye or vision problems can lower one’s ability to function and can be a major safety risk.
Example Question: Do you have any problems with your vision?

Finding: Denies dizziness (Available)
Pro Tip: Asking about dizziness helps you assess the risk for inner ear, neurological, or cardiovascular problems.
Example Question: Do you have any dizziness?

Finding: Denies watery eyes (Available)
Pro Tip: Whether a patient has watery eyes may help you indicate the type of sinus problem he is experiencing.
Example Question: Do you have watery eyes?

Finding: Denies eye redness (Available)
Pro Tip: Whether a patient has eye redness may help you indicate the type of sinus problem he is experiencing.
Example Question: Do you have eye redness?

Finding: Denies eye pain (Available)
Pro Tip: Eye pain can lower one’s ability to function and can be a major safety risk.
Example Question: Do you have any eye pain?

Finding: Denies sinus pain (Available)
Pro Tip: Patients with sinus problems such as a runny nose may be at greater risk for sinus pain.
Example Question: Do you have any sinus pain?

• Finding: Asked about review of systems for respiratory

Finding: Denies chest tightness (Available)
Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest tightness is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort.
Example Question: Do you have chest tightness?

Finding: Denies chest pain (Available)
Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest pain is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort.
Example Question: Do you have any chest pain?

• Finding: Denies difficulty breathing.

Also Read:

NRS-434VN Topic 1: The Health Assessment of Infants

NRS 434 Topic 2: Health Assessment of the Toddler, Preschool, and School-Aged Child

NRS 434 Patient Safety: Help Patients Understand

Nrs 434 Infant Assessment

NRS 434 Shadow Health Focused Exam Cough Results Instructions

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

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

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

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

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

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

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

Weekly Participation

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

APA Format and Writing Quality

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

Use of Direct Quotes

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

LopesWrite Policy

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

Late Policy

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

Communication

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

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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

NRS 434 Shadow Health Focused Exam Cough Results

Qualitative data have been described as voluminous and sometimes overwhelming to the researcher. Discuss two strategies that would help a researcher manage and organize the data.

JANAE

In qualitative research, non-numerical data are gathered and analyzed

NRS 445 Critical Analysis of Literature Assignment

This NRS-445 Nursing Research and Evidence Based Practice Course is a writing-intensive course that promotes the use of research findings as a basis for improving clinical practice. Quantitative and qualitative research methodologies are analyzed with an emphasis on the critical review of research studies and their application to clinical practice. Students develop evidence-based practice recommendations from the critical analysis of available literature guided by a PICOT question. Prerequisite: HLT-362V.

Research Critiques and PICOT Question Example Paper

The nursing practice involves addressing various healthcare issues and challenges that affect patient care, healthcare providers, and healthcare systems. Among these challenges are non-adherence to tuberculosis (TB) treatment and job stress experienced by nurses. Non-adherence to TB treatment is a significant global health concern. At the same time, job stress is a substantial issue in the nursing profession that can affect patient care quality and nurse well-being. This paper aims to synthesize and compare the findings of four recent research studies that explore factors influencing TB treatment adherence and coping strategies for job stress among nurses. The paper will critically appraise the studies to support evidence-based practice in addressing these healthcare challenges.

PICOT Question

In patients diagnosed with tuberculosis (TB) and nurses experiencing job stress (P), what interventions (I) can be implemented to improve patient adherence to TB regimen and nurses’ well-being (O) within six months (T) considering individual and social vulnerabilities such as job stress, economic precariousness, stigma, medication side effects, and lack of knowledge compared to standard care alone or no intervention (C)?

Background of Studies

The first article, a qualitative study, analyzed nurses’ coping process with job stress. The study utilized a grounded theory approach to identify four axial concepts and a core variable constituting the coping process (Eslami et al., 2017). The study discovered that the context-based nature of coping processes in nurses was crucial in reducing the adverse effects of coping.

In the second article, the role of mindfulness in reducing stress among healthcare providers was examined. The study aimed to investigate the association between the change in non-reactivity to inner experience after Mindfulness-Based Stress Reduction (MBSR) and the adjusted changes in perceived stress among healthcare providers (Benzo et al., 2018). The study’s findings revealed that non-reactivity to inner experience was an essential aspect of MBSR that was independently associated with a change in perceived stress in healthcare providers.

The third article is a qualitative study investigating patients’ perceptions of individual and social vulnerabilities affecting their adherence to tuberculosis treatment in a large municipality in northeastern Brazil (Da Silva et al., 2017). The study found that social exclusion, stigmatization, economic insecurity, and poor access to transportation were significant barriers to adherence.

The fourth study, conducted in Asmara, Eritrea, aimed to identify factors influencing patients’ adherence to tuberculosis treatment. The study involved focus groups, in-depth interviews with patients, and key informant interviews with healthcare providers (Gebreweld et al., 2018). The study identified several factors that worked against patients staying on their prescribed treatment. The four studies provide valuable insights into interventions that can be implemented to improve patient adherence to tuberculosis regimens and nurses’ well-being while considering individual and social vulnerabilities, which are of great significance to nursing.

How Articles Support the Nursing Practice Problem

The four articles provide valuable information that can be used to answer the PICOT question about interventions that can improve patient adherence to TB regimens and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The first article’s findings on the coping process of nurses with job stress can help develop interventions that address nurses’ coping strategies. The second article’s focus on mindfulness-based interventions can inform interventions aimed at reducing stress among healthcare providers. The study’s findings can help develop interventions that improve nurses’ well-being and reduce stress in the workplace.

The third article’s qualitative study on patients’ perceptions of individual and social vulnerabilities can help develop interventions that address these vulnerabilities and facilitate adherence to tuberculosis treatment. The fourth article’s focus on identifying factors influencing patient adherence to tuberculosis treatment can help develop interventions that address these factors. The findings of the four studies can be used to compare the effectiveness of the interventions against standard care alone or no intervention, as per the PICOT question.

While not all articles provide interventions that directly address the PICOT question, the insights provided by the studies can be used to develop interventions that improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The interventions and comparison groups identified in the articles can be adapted and compared to standard care alone or with no intervention as per the PICOT question.

Method of Studies

The first study used a qualitative grounded theory approach, while the second used a quantitative methodology. The third and fourth studies also used qualitative methods. However, the third used a qualitative descriptive cross-sectional study design, while the fourth used a combination of in-depth interviews, focus groups, and key informant interviews. One benefit of the grounded theory approach used in the first study is that it allows for developing a theory grounded in the data collected. However, a limitation is that the sample size may be small, which could limit the generalizability of the findings.

In the second study, a benefit of using a quantitative methodology is that it can provide objective, numerical data that can be analyzed statistically to make generalizations. However, a limitation is that it may need to capture the nuances and complexities of the phenomenon being studied (Bhandari, 2020). A benefit of the qualitative descriptive cross-sectional study design used in the third study is that it allows for an in-depth exploration of complex phenomena and provides rich, detailed data. 

However, a limitation is that it may not be suitable for examining causal relationships. In the fourth study, a benefit of using a combination of in-depth interviews, focus groups, and key informant interviews is that it allows for a more comprehensive understanding of the phenomenon being studied from multiple perspectives. However, a limitation is that the small sample size may limit the generalizability of the findings to other settings beyond Asmara, Eritrea.

Results of Studies

The first study focuses on nurses and their coping mechanisms for job stress. The study found that individual and extrinsic factors can affect coping processes and lead to stress reduction and occupational health issues. The second study looks at the effectiveness of mindfulness practices in reducing perceived stress among healthcare providers. Completing an MBSR program significantly reduced stress and improved overall quality of life. Non-reactivity and mindfulness of emotions were strongly associated with reduced perceived stress.

The third qualitative study explored the barriers and enabling factors to adherence in patients with chronic illnesses. The study identified social stigma, prejudice, and discrimination as significant barriers to adherence, medication side effects, work incapacity, malnutrition, and alcoholism. On the other hand, support from family members, health professionals, and faith and religiosity were enabling factors for adherence.

The fourth study investigates factors influencing adherence to tuberculosis treatment in Asmara, Eritrea. The study found various factors affecting adherence, including a lack of knowledge about the disease, transportation issues, loss of income, social factors, drug side effects, and extended treatment periods. These studies have implications for nursing practice. The studies indicate that nursing practice can benefit from incorporating coping mechanisms for job stress, mindfulness practices for self-care, addressing barriers to treatment adherence, and identifying enabling factors that support adherence.

Ethical Considerations

Ethical considerations in research are vital to protect participants’ well-being, rights, and privacy. This includes obtaining informed consent, maintaining confidentiality, and minimizing risks (Bhandari, 2021). The four studies followed ethical guidelines by obtaining informed consent, ensuring anonymity, and providing debriefing and follow-up sessions. The research ethics committees also approved their projects, while participants were informed of their right to withdraw at any time.

Outcomes Comparison

The anticipated outcomes for the PICOT question revolve around improving patient adherence to tuberculosis treatment regimens and the well-being of nurses. Specifically, the desired outcomes include improved patient adherence, improved nurses’ well-being, and job satisfaction, reduced adverse effects of job stress on patient care, increased patient knowledge about the importance of adherence, increased social support for patients with tuberculosis, reduced stigma and social exclusion experienced by patients with tuberculosis, and reduced medication side effects and financial hardships for patients with tuberculosis.

The four studies selected provide insights into interventions that can be implemented to achieve these outcomes. The first two studies focus on improving nurses’ well-being and job satisfaction by understanding their coping processes and the effectiveness of mindfulness-based interventions. These interventions can positively impact patient care and adherence to tuberculosis treatment regimens by reducing the negative effects of job stress.

The third and fourth studies highlight the importance of patient perceptions of individual and social vulnerabilities that affect their adherence to treatment and the critical role of social support, education, and effective communication with healthcare providers in improving patient adherence to tuberculosis treatment regimens. Interventions to provide social support, reduce stigma and social exclusion, and address medication side effects and financial hardships can improve patient adherence to treatment and overall health outcomes.

Proposed Evidence-Based Practice Change

The PICOT question is focused on interventions that can improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The four research articles provide valuable insights into the coping processes of nurses, mindfulness-based interventions for reducing stress among healthcare providers, patients’ perceptions of individual and social vulnerabilities affecting adherence to tuberculosis treatment, and factors influencing patient adherence to tuberculosis treatment. These insights can be used to develop interventions that address these issues and improve patient adherence to TB regimens and nurses’ well-being.

Based on the information provided, a proposed evidence-based practice change is implementing a mindfulness-based stress reduction (MBSR) program for nurses working with tuberculosis patients. The program will address individual and social vulnerabilities affecting nurses’ well-being and patient adherence to treatment. The MBSR program includes mindfulness practices, such as body scans, sitting and walking meditation, and mindful breathing (Kriakous et al., 2021). The program will also include education on coping strategies, stress reduction techniques, and communication skills for effectively addressing patients’ concerns and needs. 

The program will be evaluated by comparing the effectiveness of the program against standard care alone or no intervention in improving patient adherence to the TB regimen and nurses’ well-being within six months. The program will also be adapted and implemented in other healthcare settings to improve healthcare providers’ well-being and patient outcomes.

Conclusion

Nursing practice faces various healthcare challenges, including non-adherence to tuberculosis (TB) treatment and job stress experienced by nurses. This paper has reviewed four recent research studies that explore factors influencing TB treatment adherence and coping strategies for job stress among nurses. The findings of the studies provide valuable insights into interventions that can be implemented to improve patient adherence to TB regimens and nurses’ well-being while considering individual and social vulnerabilities. 

Although the studies utilized different methodologies, they all contribute to evidence-based practice in addressing healthcare challenges. The paper’s insights can be used to develop interventions that improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities.

References

Benzo, R. P., Anderson, P. M., Bronars, C., & Clark, M. (2018). Mindfulness for healthcare providers: The role of non-reactivity in reducing stress. EXPLORE, 14(6), 453–456. https://doi.org/10.1016/j.explore.2018.03.008

Bhandari, P. (2020, June 12). What is quantitative research? | definition, uses, and methods. Scribbr. https://www.scribbr.com/methodology/quantitative-research/

Bhandari, P. (2021, October 18). A guide to ethical considerations in research. Scribbr. https://www.scribbr.com/methodology/research-ethics/

Da Silva, R. D., de Luna, F. D. T., de Araújo, A. J., Camêlo, E. L. S., Bertolozzi, M. R., Hino, P., Lacerda, S. N. B., Fook, S. M. L., & de Figueiredo, T. M. R. M. (2017). Patients’ perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: A qualitative study. BMC Public Health, 17(1). https://doi.org/10.1186/s12889-017-4752-3

Eslami Akbar, R., Elahi, N., Mohammadi, E., & Fallahi Khoshknab, M. (2017). How do nurses cope with job stress? A study with grounded theory approach. Journal of Caring Sciences, 6(3), 199–211. https://doi.org/10.15171/jcs.2017.020

Gebreweld, F. H., Kifle, M. M., Gebremicheal, F. E., Simel, L. L., Gezae, M. M., Ghebreyesus, S. S., Mengsteab, Y. T., & Ward, N. G. (2018). Factors influencing adherence to tuberculosis treatment in Asmara, Eritrea: A qualitative study. Journal of Health, Population, and Nutrition, 37(1). https://doi.org/10.1186/s41043-017-0132-y

Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness, 12(1). https://doi.org/10.1007/s12671-020-01500-9

NRS 450 Nursing Informatics Assignment

In this GCU NRS-450 Nursing Informatics Course, the focus is on the methods and technologies used to acquire, process, and analyze patient data, emphasizing information and communication technologies that support the documentation of care and effective communication among health team members at all system levels. Essentially, this course provides students with an understanding of the importance of professional and ethical standards pertaining to the regulation and security of health information.

Nursing Informatics in Health Care Example Paper

McGonigle and Mastrian (2021) define nursing informatics as the nursing subspecialty that enables nurses to master data, information, know-how, and wisdom through subspecialties that combine nursing science with information and computer science (p.56). Information technology has changed nursing care and transformed healthcare practice by assisting care delivery, supplementing decision-making, and predicting future trends in care using data. Technology’s potential to improve patient safety and quality of care is enormous (Schoenbaum & Carroll, 2020). 

However, technology keeps advancing, and better methods are being incorporated into practice. However, these technologies still require human interaction and human input to influence patient care. This proposal describes the role of a nurse informaticist, especially in an interdisciplinary team, explains the impact of full nurse engagement in technology, and finally suggests opportunities and predicts challenges that including a nurse informaticist in an interdisciplinary team creates.

Nursing Informatics and the Nurse Informaticist

Recent developments in healthcare, including the COVID-19 pandemic, opened our eyes to the need to harness the potential of technology in making healthcare efficient and meeting the needs of many patients remotely. Before this, the National League for Nursing, through their new vision, had urged nursing education programs to teach and prepare them for practice in the era of healthcare technologies (McBride & Tietze, 2022). However, the workload from clinician care needs and care efficiency needs can overwhelm the individual nurses, thus the need for interdisciplinary collaboration. 

Nurse informaticists are specialists trained with scientific and artistic knowledge and skills in utilizing data science to influence care through communication, decision-making, and daily monitoring workflow in healthcare systems. Their role is crucial in an interdisciplinary team approach to care because they enable the interdisciplinary teams to work efficiently. Nurse informaticists can influence policymaking and implementation, technical capacity, and patient outcomes.

Nurse informaticists have played an essential role in selecting and implementing appropriate technologies to meet patient care needs in various hospitals. Enhancing technology usability by matching user needs and vendor software features is another way nurse informaticists have ensured that organizations get worth for their expenditures on technologies and that patients have received safe care by using appropriate, safe, and high-yield technologies.

Nurse Informaticists and Other Health Care Organizations

Various institutions have implemented the informaticist role in the clinical and administrative care hierarchies. Nurse informaticists support other nurses, healthcare professionals, patients, and other stakeholders by enabling information structures, processes, and technologies. According to McBride and Tietze (2022), nurse informaticists have improved patient safety and reduced care-associated costs (P.10). The achievements of these outcomes have been possible through safe medication administration systems using technology, predicting patient care changes through the prediction of patterns of previous outcomes, and easy documentation, retrieval and access of patient records.

Nursing Education for the Healthcare Informatics (NEHI) developed a model in 2013 through which nurse informaticists interact with other providers and care processes to achieve desired outcomes. According to the NEHI model, nurse informaticists influence public policy formation and the healthcare delivery environment by improving point-of-care technology, patient safety and care quality, and data management (McGonigle & Mastrian, 2021). Therefore, these nurses bridge the clinical and technological care delivery to meet efficiency and safety needs. Nurse informaticists in an interdisciplinary team initiate communication and champion communication technologies to facilitate team activities.

Informaticists also ensure that the team gets access to a high-quality electronic source of health information that would influence evidence-based decision-making. More importantly, they safeguard the security and privacy of patients’ protected health information (PHI) (McGonigle & Mastrian, 2021). Nurse informaticists ensure that members of the interdisciplinary team use technologies and patient information in a well-coordinated manner so that interruptions and distractions do not breach care continuity and give more room for medical and medication errors. Nurse informaticists ensure that uniform technology use empowers members to maintain patient safety and meaningful use by developing protocols and procedures for using these technologies.

Impact of Full Nurse Engagement in Health Care Technology

Patient Care

Engaging nurses in healthcare technology impacts patient care, workflow, and costs. Evidence-based practice is the current nursing care paradigm shift. Practice guidelines and decision-making require clinical evidence to improve patient safety and quality of care. Fully engaging nurses in health care technology will enable them to stay abreast of the current practice guidelines and information for decision-making. Healthcare technologies will enable nurses to access evidence-based information from online databases and also enable them to analyze future outcomes of practice using current and past data and information. Therefore, patient care outcomes result from safe and current evidence-based practices. 

Protected Health Information

Protected health information (PHI) can be used to identify patients; inappropriate handling of this information can lead to a breach of patient privacy, confidentiality, and data security. As aforementioned, nurse informaticists enable communication between interdisciplinary team members to ensure successful care coordination. However, coordination requires collecting and sharing patient information that includes PHI. 

Nurse informaticists ensure that this information is protected by implementing access controls such as ensuring secure communication in the team and regularly assessing and emulating system communication methods to ensure that PHI privacy and security are not breached (Lindley et al., 2020). In-service staff session updates ensure that nursing staff and other healthcare professionals’ knowledge and information skills are up-to-date with PHI privacy rules and guidelines (Park & Jeong, 2021). This increases professionalism that increases awareness levels.

Workflow

Nurse engagement in healthcare technology improves workflow by enhancing care flexibility, improving care efficiency, and facilitating collaboration. Nurses can deliver care remotely to their patients by using technology. Additionally, they can deliver care in a shorter time when they use technology to care interventions and prevent errors. Finally, nurses’ full engagement in technology enables them to collaborate with other care professionals through effective communication.

Costs and Return on Investment

As aforementioned, fully engaging nurses in healthcare technology improves car efficiency. Efficiency improvement reduces the work input required to achieve care outcomes. However, the costs of the initial implementation strategies will increase due to the costs of purchasing these technologies and training nurses on how to use them. When used efficiently and successfully, technologies could improve patient safety, costs, and quality outcomes. 

Opportunities and Challenges

Adding a nurse informaticist’s role would improve care efficiency by improving technology uptake and use among team members. This technology would enhance interdisciplinary collaboration to improve workflow and team outcomes, such as work efficiencies. Therefore, adding a nurse informaticist role would generally improve care delivery in the interdisciplinary approach. However, adding a nurse informaticist role would change the workflow in the healthcare organization because they would take up some roles of current work. 

Role overlap can lead to conflicts that would deter successful collaboration. Therefore, team planning and nursing leadership would be required to ensure successful collaboration in the team. Team communication and regular monitoring of team outcomes would improve collaboration. Team decision-making could ensure that every member owns the outcomes of the team activities. 

Summary of Recommendations

This proposal has analyzed the benefits and shortcomings of adding a nurse informaticist role into the organization’s workforce structure. These are the four key takeaways from the proposal about the nurse informaticist role. Nursing informatics is a field that combines nursing science with information and computer science to manage and communicate data, information, knowledge, and wisdom in nursing practice. 

The role of the nurse informaticist is to support the use of technology in nursing practice and facilitate the integration of technology into the daily work of nurses and other healthcare providers. Fully engaging nurses in health care technology can positively impact patient care, including improved patient outcomes, reduced errors, and increased patient satisfaction. Adding a nurse informaticist role to an interdisciplinary team can bring both opportunities and challenges, including initial costs, changes to workflow, and resistance to change. 

However, with careful planning and support, these challenges can be overcome, and the use of technology can ultimately lead to improved patient care and better patient outcomes. Nurse informaticists can play a crucial role in improving the usability and effectiveness of healthcare technology by matching user needs and vendor software features and by influencing the selection and implementation of appropriate technologies. This can ensure that this organization gets value for its investments in technology and that patients receive safe, high-quality care.

NRS 450 Nursing Informatics Assignment References

Lindley, L. C., Svynarenko, R., & Profant, T. L. (2020). Data infrastructure for sensitive data: Nursing’s role in the development of a secure research enclave. Computers, Informatics, Nursing: CIN, 38(9), 427–430. https://doi.org/10.1097/CIN.0000000000000677

McBride, S., & Tietze, M. (2022). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism. Springer Publishing.

McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett.

Park, H.-K., & Jeong, Y.-W. (2021). Impact of nursing professionalism on the perception of patient privacy protection in nursing students: Mediating effect of nursing informatics competency. Healthcare (Basel, Switzerland), 9(10), 1364. https://doi.org/10.3390/healthcare9101364

Schoenbaum, A. E., & Carroll, W. M. (2020, September 30). Nursing Informatics Key Role in Defining Clinical Workflow, Increasing Efficiency and Improving Quality. HIMSS. https://www.himss.org/resources/nursing-informatics-key-role-defining-clinical-workflow-increasing-efficiency-and

Nursing Informatics in Healthcare Example

The healthcare technology field is considerably dynamic, and technological advancement has made it change at a very high speed. Healthcare institutions continue to adapt healthcare technology from administrative and clinical information systems to promote healthcare service delivery, improve patient safety and outcomes, and reduce costs. Consequently, the need for healthcare informatics skills and knowledge in these institutions has increased. This proposal justifies the need for introducing a nurse informaticist role in the organization. The proposal will entail an exploration of nursing informatics, the nurse informaticist, the impact of full nurse engagement in healthcare technology, and the opportunities and challenges to the nurses and the Interprofessional team with the introduction of the new role.

Nursing Informatics and the Nurse Informaticist

According to the Health Information and Management Systems Society (HIMSS) (n.d.), nursing informatics is the science and practice specialty that combines computer, nursing and information technology sciences to enhance the management and communication of information, knowledge, and data in nursing practice. Nursing informatics is a subset of healthcare informatics as a field that integrates healthcare and information technology, which is specific to integrating information technology into nursing practice. The nursing informatics field mainly assists healthcare institutions in applying healthcare technology by bridging the technical and clinical perspectives gap to maintain patient safety and improve care.

The nurse informaticist is a specialist that works with the healthcare institution’s stakeholders across the care continuum to link nursing science and information technology. The specialist not only works with the nurses and the Information Technology specialists but also collaborates with other healthcare providers in the interprofessional team to promote patient safety and care outcomes while applying healthcare technology at the bedside and organizational levels. Strudwick et al. (2019) note that the nurse informaticist must have robust technical and nursing skills, alongside data analysis, leadership, project management and interpersonal skills to play the specialty role effectively.          

Nursing Informaticists and Other Healthcare Organizations

Many healthcare organizations have adopted the nurse informaticist role following the advancement of healthcare technology and the increased need for nursing informatics expertise. These healthcare organizations enjoy the benefits of having this active role since it is easier for them to adapt new healthcare technology applications, devices and systems, implement related policies and analyze and manage healthcare data to inform practice. In addition, organizations with nurse informaticists have improved patient safety and care outcomes since the nurse informaticist’s main aim is to ensure patient safety while using healthcare technology. The organizations also have easier management processes and structures since the nurse informaticist works with the administrators to implement and use administrative information systems.

Nurse Informaticists interact with the rest of the nursing staff and other interprofessional team members by working with them daily. They collaborate with nursing staff to gain and develop feedback on using healthcare technology at the bedside level. The feedback is used to improve healthcare technology, thus improving the quality of patient care. According to Vos et al. (2020), nurse informaticists collaborate with physicians, pharmacists and other medical specialists in the interprofessional team to ensure that healthcare technology, such as electronic health records, are used appropriately to ensure optimum patient care quality. For example, the nurse informaticist works with the doctors to ensure that electronic patient files are accurate, thus avoiding related mistakes such as patient misidentification, which would negatively impact patient care quality. Effective collaboration of the nurse informaticist with other nursing staff and medical specialists in the interprofessional team is facilitated by constant communication, openness, and respect for each specialist’s contribution to the team.  

Impact of Full Nurse Engagement in Healthcare Technology

Full engagement of nurses in healthcare technology begins with introducing the role of a nursing informaticist in the organization. The engagement positively impacts patient care by providing a platform whereby nurses can give feedback on the healthcare technology used in patient care at the bedside level. The feedback helps improve these technological applications, systems, and devices, thus providing potential for better patient care. HIMSS (n.d.) notes that nurses can utilize EHR, online portal systems, and patient monitoring devices through nursing informatics to facilitate care services, thus improving overall patient care.

Additionally, the nurse informaticist and other interdisciplinary team members are expected to manage patients’ protected health information by safeguarding privacy, security and confidentiality. According to Chen et al. (2019), managing patients’ protected information is the responsibility of every interdisciplinary team member, who are expected to maintain the set policies and safeguards of the institution. The interdisciplinary team and the nurse informaticist can use evidence-based practices to manage patients’ protected health information, including technical, physical, and administrative safeguards (Chen et al., 2019).

Technical safeguards include installing antitheft software, firewalls, and encryption of patient information. The physical safeguards include protecting the specific physical setting where technology stores the information, using access control locks and alarms. Administrative safeguards include developing institutional policies regarding the protection of patient information. Other practices include using strong passwords, biometric identification, and login out of computers to prevent unauthorized access to patient information (Healthit.gov, n.d.).

Nurse engagement in technology reduces the cost of care and increases the return on investment for the organization. The HIMSS (n.d.) notes that nurse informaticists have a deep understanding of medical economics. The understanding helps the nurse informaticist to advise the organizational administrators and stakeholders on the healthcare technology they should invest in to maximize return on investments and, at the same time, reduce the cost of care. In addition, engaging nurses in healthcare technology enables them to design processes that make workflow more efficient.

Opportunities and Challenges

Adding the new nurse informaticist role in the institution will have different challenges and opportunities for nurses and the interprofessional team. The opportunities include having technical assistance provided by the nurse informaticist to the nurses and the interprofessional team at any time needed since the nurse informaticist has technical experience in healthcare technology. Additionally, the adoption and application of new healthcare technology will be made easier due to the prior training and guidance offered by the nurse informaticist.

However, their introduction of the nurse informaticist role may bring different challenges to the interprofessional team. According to Peltonen et al. (2019), the nurse informaticist may bring power and authority issues within the team, thus leading to a loss of respect among team members. For instance, the nurses and the nurse informaticist may have role, power, or expertise conflicts, posing a major challenge to the functionality of the interprofessional team. Differences in the understanding of different issues in nursing or technology may also complicate the interaction of the nurse informaticist and the interprofessional team.

Summary of Recommendations

Introducing the nurse informaticist role in the organization will benefit patient care quality, return on investments, workflow, and managing patients’ protected health information by increasing the efficiency of care services (Chen et al., 2019; Strudwick et al., 2019). The nurse informaticist will also play a major role in linking information technology knowledge and nursing practice. In addition, the new role will enhance nurses’ engagement in healthcare technology, positively impacting patient care and organizational performance. The nurse informaticist will also collaborate with nurses and the other members of the interdisciplinary team to promote care efficiency. Therefore, it is vital to introduce the nurse informaticist’s role in the organization.  

References

Chen, Y., Ding, S., Xu, Z., Zheng, H., & Yang, S. (2019). Blockchain-based medical records secure storage and medical service framework. Journal of Medical Systems, 43, 1-9. https://doi.org/10.1007/s10916-018-1121-4

Peltonen, L. M., Nibber, R., Lewis, A., Block, L., Pruinelli, L., Topaz, M., Perezmitre, E. L., & Ronquillo, C. (2019). Emerging Professionals’ Observations of Opportunities and Challenges in Nursing Informatics. Nursing leadership (Toronto, Ont.), 32(2), 8–18. https://doi.org/10.12927/cjnl.2019.25965

Strudwick, G., Nagle, L., Kassam, I., Pahwa, M., & Sequeira, L. (2019). Informatics Competencies for Nurse Leaders: A Scoping Review. The Journal of Nursing Administration, 49(6), 323–330. https://doi.org/10.1097/NNA.0000000000000760

The Health Information and Management Systems Society. (n.d.) What is Nursing Informatics? Accessed 12th June 2023 from https://www.himss.org/resources/what-nursing-informatics

The Office of the National Coordinator for Health Information Technology (Healthit.gov). (n.d.). Guide to Privacy and Security of Health Information. Accessed 12th June 2023 https://www.healthit.gov/sites/default/files/pdf/privacy/onc_privacy_and_security_chapter4_v1_022112.pdf  

Vos, J. F., Boonstra, A., Kooistra, A., Seelen, M., & van Offenbeek, M. (2020). The influence of electronic health record use on collaboration among medical specialties. BMC Health Services Research, 20(1), 1-11. https://doi.org/10.1186/s12913-020-05542-6

NRS 455 Pathophysiological Processes of Disease Essay

NRS-455: Pathophysiology Course builds upon the existing knowledge of the pathophysiological processes of disease as they affect patients across the life span, recognizing the nurse’s multidimensional role in health promotion and disease management and prevention, which include biological, environmental, social, psychological, and spiritual dimensions. Integration of nutritional and pharmacological concepts encourages critical thinking and application of nursing interventions. Prerequisite: NRS-420.

Pathophysiology of Bronchiolitis Example Paper

Bronchiolitis is a common lower respiratory tract infection primarily affecting infants and young children. It is characterized by inflammation of the small airways, leading to airway obstruction, mucus production, and respiratory distress. Bronchiolitis is particularly prevalent during winter and autumn, with sporadic occurrence witnessed throughout the year. It mainly affects children under 2, with the occurrence within the initial year of life at 11% to 15%, with a minimum of 5 hospitalizations in every 1000 children below two years old (O’Brien et al., 2019).

In Australia, an estimated 13,500 children are hospitalized annually due to bronchiolitis. This paper delves into a case study of Joe, a 21-month-old boy with bronchiolitis secondary to an RSV infection; the paper will also focus on the pathophysiology of bronchiolitis, outline the nursing assessments and management strategies for Joe, and address health promotion measures for Joe and his family upon discharge.

Bronchiolitis

The pathophysiology of bronchiolitis is attributed primarily to the respiratory syncytial virus (RSV). However, various other viruses, including human rhinovirus, coronaviruses, human metapneumovirus, adenovirus, parainfluenza virus, and human bocavirus, have also been recognized over time (Justice & Le, 2022). These viruses infiltrate the respiratory epithelial cells, inducing inflammation and necrosis of the epithelial lining.

This inflammation causes small airway obstruction, increased mucus production, and decreased mucociliary clearance. As a result, airway resistance increases, leading to impaired airflow, hyperinflation, and respiratory distress. The combination of inflammation, mucus plugging, and airway narrowing results in decreased ventilation and poor oxygen exchange, leading to hypoxemia (Erickson et al., 2020).

Joe’s clinical presentation aligns with the progression of bronchiolitis. The increased respiratory rate of 57 breaths per minute compensates for maintaining oxygenation due to the narrowed airways. As highlighted by Ozdem?r and Songül Yalç?n (2021) in their study of “the role of body temperature on the respiratory rate in children with acute respiratory infections,” the elevated temperature of 39.5°C indicates the presence of infection and the body’s immune response.

The decreased % oxygen saturation of 90% suggests impaired oxygen exchange due to compromised airway function. The rapid heart rate of 148 beats per minute responds to the increased respiratory effort. At the same time, the elevated blood pressure of 105/70 mmHg may be related to the fever and respiratory distress. The prolonged capillary refill time reflects poor perfusion, likely due to increased respiratory effort and oxygen demand.

Joe’s restlessness, apathy, and disinterest in his environment are consistent with the general malaise associated with the illness. The increased work of breathing, intercostal retractions, and nasal flaring indicate significant respiratory distress as his body attempts to overcome the compromised airway function. Furthermore, Joe’s continued feeding difficulties can be attributed to his respiratory symptoms. The increased effort required for breathing may make it challenging for him to coordinate feeding, leading to poor intake and potentially contributing to his lethargy and dehydration.

Nursing Assessments and Management:

The nursing assessment and management of a child with bronchiolitis involve a comprehensive approach to relieve symptoms, prevent complications, and promote recovery. The initial step in managing a child with bronchiolitis involves thoroughly assessing the child’s respiratory status. As Justice and Le (2022) highlight, the nurse should monitor the child’s respiratory rate, depth, and effort, looking for signs of increased work of breathing such as nasal flaring, intercostal and subcostal retractions, and use of accessory muscles. Auscultation of lung sounds is also critical in identifying wheezing, crackles, and decreased breath sounds indicative of airway obstruction and reduced ventilation.

In the given case study, Joe, a 21-month-old boy, has been admitted to the pediatric short-stay unit due to bronchiolitis from a respiratory syncytial virus (RSV) infection. A comprehensive assessment of the initial observations reveals potential nursing issues requiring timely and focused interventions. These issues include fever, tachypnea, increased work of breathing, oxygen desaturation, increased heart rate, elevated blood pressure, poor feeding, restlessness, lethargy, and signs of respiratory distress.

A range of nursing assessments needs to be undertaken to provide comprehensive nursing care for Joe. The primary assessments should focus on the child’s airway, breathing, circulation, and level of consciousness (ABC). These assessments are critical in identifying any immediate threats to Joe’s life (Peate & Brent, 2021). Given the signs of respiratory distress and decreased oxygen saturation, assessing his respiratory status is a priority. The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) framework can help guide the nursing assessment.

Starting with the airway assessment, the nurse should examine Joe’s airway for any obstruction or signs of distress. His intercostal retractions, nasal flaring, and increased work of breathing indicate compromised airway patency (Yadav et al., 2022). The breathing assessment shows that Joe’s respiratory rate of 57 breaths per minute, along with the intercostal retractions and nasal flaring, suggests respiratory distress. His oxygen saturation of 90% indicates poor gas exchange and the need for supplemental oxygen. The circulation assessment reveals a heart rate of 148 beats per minute and blood pressure of 105/70mmHg, which shows an increased cardiac workload likely due to fever and respiratory distress.

The disability assessment highlights Joe’s lethargy and poor feeding, indicating altered neurological status and dehydration. After the initial ABC assessment, other assessments are necessary to gather more information about Joe’s condition. His elevated temperature of 39.5°C indicates a fever that can exacerbate his distress. Addressing his poor feeding is crucial to ensure proper nutrition and hydration. Additionally, a general assessment of Joe’s appearance, responsiveness, and signs of discomfort is essential. His restlessness, apathy, and disinterest in the environment indicate his discomfort and distress (Nurseslabs, 2019). Capillary refill time of 2-3 seconds suggests adequate perfusion but needs ongoing monitoring.

Considering these assessments, it is crucial to tailor Joe’s nursing management to his specific needs. Given his respiratory distress and oxygen desaturation, providing supplemental oxygen as prescribed by the physician is essential to improve oxygenation and alleviate the work of breathing. According to a study by Brekke et al. (2020) on the value of vital signs in predicting clinical deterioration, early detection of changes in vital signs before clinical deterioration has been proven crucial in timely intervention. Close monitoring of vital signs, particularly heart rate, respiratory rate, oxygen saturation, and blood pressure, is necessary to track Joe’s response to interventions and identify any deterioration.

Family-centered care is crucial in pediatric nursing as it focuses on involving and supporting the entire family unit to ensure comprehensive and effective healthcare for the child. A scoping review by Kokorelias et al. (2019) found that family plays a vital role in ensuring the health and well-being of infants by providing essential care, emotional support, a safe environment, and the foundation for healthy development.

The relationships, experiences, and interactions within the family unit during this crucial stage of life can have a profound and lasting impact on the child’s well-being. In this case, involving Joe’s mother, Molly, in the care plan by explaining the interventions and rationale will help her understand the importance of interventions such as oxygen therapy, which can be unfamiliar and unsettling for parents.

Holistic health considerations consider all aspects of an individual’s well-being, recognizing that various interconnected factors influence health. This approach goes beyond addressing physical symptoms and encompasses emotional, mental, and social dimensions (Wopker et al., 2021). In the context of a child’s health, this means that nurses should not only focus on treating the child’s physical ailments but also pay attention to their emotional and psychosocial needs and those of their family. For Joe, reducing distress through comfort measures, such as creating a calm and soothing environment, may help decrease his anxiety. Additionally, ensuring Molly is well-informed and emotionally supported can positively impact her coping abilities and, consequently, Joe’s overall well-being.

Regular reassessments are essential in determining the effectiveness of interventions and identifying any changes in Joe’s condition. If there is an improvement in his oxygen saturation, respiratory rate, and general appearance, this could indicate a positive response to the interventions. However, escalating care to higher levels, such as the pediatric intensive care unit, would be necessary if his distress worsens.

Health Promotion

After discharge, health promotion strategies should be implemented to support Joe and his family. Educating the family about proper hand hygiene, avoiding exposure to sick individuals, and maintaining a smoke-free environment can help prevent future infections. Demonstrating proper administration of medications and explaining their purposes is essential to ensure compliance. Referring the family to community support resources, such as local pediatric clinics, support groups, and online resources related to bronchiolitis and RSV infections, can provide ongoing assistance. Additionally, arranging a follow-up appointment with Joe’s primary care provider will facilitate ongoing recovery monitoring.

Conclusion

This paper has explored the multifaceted aspects of bronchiolitis through the lens of a case study involving Joe, a 21-month-old boy. The pathophysiology of bronchiolitis, predominantly linked to the respiratory syncytial virus, was examined, highlighting its impact on airway obstruction and compromised respiratory function. The nursing assessments and management strategies demonstrated a comprehensive approach to addressing Joe’s distressing symptoms and guiding his care. Family-centered care and holistic health considerations were emphasized in promoting Joe’s well-being and his mother’s understanding. Integrating health promotion measures post-discharge underscores the importance of preventative education and ongoing support for Joe’s recovery.

References

Atay, O., Pekcan, S., Gokturk, B., & Ozdemir, M. (2020). Risk factors and clinical determinants in bronchiolitis. Turkish Thoracic Journal. https://doi.org/10.5152/turkthoracj.2019.180168

Brekke, I. J., Puntervoll, L. H., Pedersen, P. B., Kellett, J., & Brabrand, M. (2020). The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLoS One, 14(1). https://doi.org/10.1371/journal.pone.0210875

Erickson, E. N., Bhakta, R. T., & Mendez, M. D. (2020). Pediatric bronchiolitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519506/#:~:

Justice, N. A., & Le, J. K. (2022, July 29). Bronchiolitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441959/

Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family-centered care: A scoping review. BMC Health Services Research, 19(1), 1–11. https://doi.org/10.1186/s12913-019-4394-5

Martin, P. (2023, April 30 – Updated). 7 Bronchiolitis & Respiratory Syncytial Virus (RSV) Nursing Care Plans. Nurseslabs. https://nurseslabs.com/bronchiolitis-nursing-care-plans/

O’Brien, S., Wilson, S., Gill, F. J., Cotterell, E., Borland, M. L., Oakley, E., & Dalziel, S. R. (2019). The management of children with bronchiolitis in the Australian hospital setting: Development of a clinical practice guideline. BMC Medical Research Methodology, 18(1). https://doi.org/10.1186/s12874-018-0478-x

Ozdem?r, B., & Songül Yalç?n, S. (2021). The role of body temperature on respiratory rate in children with acute respiratory infections. African Health Sciences, 21(2), 640–646. https://doi.org/10.4314/ahs.v21i2.20

Peate, I., & Brent, D. (2021). Using the ABCDE approach for all critically unwell patients. British Journal of Healthcare Assistants, 15(2), 84–89. https://doi.org/10.12968/bjha.2021.15.2.84

Wopker, P. M., Schwermer, M., Sommer, S., Längler, A., Fetz, K., Ostermann, T., & Zuzak, T. J. (2021). Expert consensus-based clinical recommendation for an integrative anthroposophic treatment of acute bronchitis in children: A Delphi survey. Complementary Therapies in Medicine, 60, 102736. https://doi.org/10.1016/j.ctim.2021.102736

Yadav, S., Lee, B., & Kamity, R. (2022, July 25). Neonatal respiratory distress syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560779/

NRS 460 Complex Disease Management and EBP Assignments

The goal of NRS-460 Complex Disease Management Course is to integrate knowledge from pathophysiology, pharmacology, nursing theory, and current evidence-based practice to inform clinical judgment and to ensure safe, effective, and holistic care. It applies the nursing process to provide safe, quality care reflecting cultural humility across the life span. The course pays particular attention to interprofessional collaboration in the process of disease management and care coordination.

Complex Disease Management and Care Plan

Heart disease is the leading cause of increased mortality rates, comorbidities, prolonged hospitalization, high rates of readmissions, compromised quality of life, and a steady increase in care costs. According to Roth et al. (2020), cardiovascular diseases like heart disease, stroke, and heart failure accounted for approximately 19.7 million deaths in 2019.

Similarly, the global trends for disability-adjusted life years (DALYs) and years of life lost doubled from 17.7 million to 34.4 million from 1990 to 2019. The modifiable and non-modifiable risk factors for heart disease include physical inactivity, smoking, unhealthy diet, obesity, poor stress management, family history of cardiovascular disease, age, and genetics.

When developing a care plan for people with heart disease, it is vital to address modifiable risk factors to prevent complications and improve disease management approaches. Therefore, this final care coordination plan focuses on issues facing people with heart disease, patient-centered interventions, ethical considerations for individualized care approaches, relevant health policy implications for coordinating care, and the priorities for the care coordination plan.

Patient-centered Health Interventions

People with heart disease face various issues and challenges, including unfamiliarity with self-management interventions, limited access to timely care, and unawareness of early vital sign identification, reporting, and monitoring. Jaarsma et al. (2020) state that self-management approaches for heart disease entail pharmacologic and non-pharmacologic interventions like adherence to prescribed medications, engaging in physical activity, complying with healthy diet plans, and self-care monitoring competencies.

Patient-centered interventions for improving patients’ self-management competence include educating them on disease management activities, linking them to community resources, incorporating technology like telehealth to promote remote monitoring, and fostering effective communication. Equally, patients with heart disease can leverage community resources, including community-based health organizations, expert offices, and online databases like the American Heart Association (AHA) to improve self-management competencies.

Secondly, limited access to timely and convenient care exacerbates heart disease complications. According to White-Williams et al. (2020), poor social determinants of health, including poverty, low-level education attainment, health illiteracy, uninsurance, and infrastructure deficiencies, are the profound causes of limited access to quality and timely care for people with heart disease.

It is possible to address these issues by educating people about the causes, effects, and management approaches for heart disease, collaborating with local authorities to modify the environment, and providing infrastructures like accessible sidewalks, gymnasia, and other public opportunities for physical activity. Equally, it is possible to utilize community resources like recreational parks, community amenities for physical activity, and health institutions that provide information regarding heart disease management and prevention.

Thirdly, people with heart disease grapple with the challenge of unawareness of early vital sign detection, reporting, and management. According to Conn et al. (2019), in-home vital sign monitoring can transform the healthcare system by facilitating care transition from reactive to proactive and preventive care.

Improving individual awareness of vital sign monitoring and reporting is possible by strengthening the use of mHealth and telehealth technology to foster communication, educating people on how to use these technologies, and coordinating care with community-based organizations to ensure timely response in the case of deteriorating signs. In this sense, individuals with heart disease and other cardiovascular conditions can utilize community resources like healthcare institutions, expert offices, and free-access databases to gain insights into appropriate interventions for conducting vital sign monitoring.

Ethical Decisions in Designing Patient-centered Health Interventions

Patient-centered interventions for improving heart disease management and control should rely massively upon ethical considerations. Tomaselli et al. (2020) contend that patient-centered care entails respecting patients’ demands, preferences, and principles. This care dimension results in patient empowerment and enhancement of individual decision-making competencies necessary for influencing care trajectories. According to Varkey (2021), healthcare professionals have an ethical obligation to benefit patients, prevent harm, ensure justice and fairness, and respect values, preferences, and decisions.

The four bioethical principles of beneficence, non-maleficence, autonomy, and justice enshrine these moral obligations by requiring healthcare professionals to provide care consistent with individual needs and interests. When designing and implementing patient-centered interventions to improve the health of people with heart disease, it is vital to involve them, understand their learning priorities, empower them to make decisions, and ensure that the subsequent approaches are consistent with established collective goals and objectives.

Health Policy Implications for Coordination and Continuum of Care

Developing a care coordination plan for managing heart disease and improving the health of people grappling with this disease is consistent with the Affordable Care Act (ACA) 2010 provision, which requires hospital and healthcare professionals to prevent avoidable readmissions. According to the Centers for Medicare and Medicaid Services [CMS] (2022), the Hospital Readmissions Reduction Program (HRRP) is a value-based program that encourages hospitals to improve communication and enhance care coordination to reduce avoidable readmissions perpetrated by various diseases, including acute myocardial infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD). Further, this program enables CMS to track hospital readmission rates (HRRs) and determine benefits and penalties based on the organizational ability to reduce preventable readmissions. 

In this sense, CMS can provide incentives for hospitals that reduce preventable readmissions to the acceptable benchmarks while reducing Medicare payments to institutions with high readmission rates. Gai & Pachamanova (2019), the HRRP program proposes various interventions for reducing preventable readmissions, including coaching patients on discharge instructions and self-management, improving care coordination and care setting transition planning, and performing medication reconciliation. These approaches align with the proposed patient-centered interventions for improving the health and wellness of people with heart disease.

Priorities for Care Coordination

Notably, it is essential to communicate the plan with patients and family members before enacting it. Equally, making changes consistent with patients’ feedback, external evidence, and contextual issues is vital. For example, patients with heart disease may fail to adhere to the requirement of 150 to 300 minutes of physical exercise per week due to the underlying complications associated with the disease. Therefore, altering the intervention schedule should be consistent with patients’ preferences, needs, and values.

Equally, the care coordinator should emphasize various priorities when discussing the plan with patients and family members and when making changes based on evidence-based practice. These priorities include improving patients’ health literacy, enhancing their self-management competencies, and bolstering their knowledge of appropriate technologies for care coordination and effective communication.

Learning Sessions

The learning sessions for improving the health and wellness of people with heart disease contain various topics, including practices of a healthy diet, recommended measures and length of physical exercise, smoking cessation approaches, and strategies for vital sign monitoring. These sessions align with the evidence from the current scholarly literature that supports the process of improving patients’ self-management competencies and enabling them to prevent disease progression by addressing modified risk factors for heart disease.

According to Podvorica et al. (2021), education sessions for people with heart disease should focus on increasing patients’ knowledge in improving modifiable factors like nutrition, physical activity, body mass index (BMI) monitoring, glycemia, and cholesterol. Undoubtedly, focusing on these themes is fundamental in improving self-management competencies, enhancing the quality of life, reducing readmissions, and minimizing eventual complications associated with heart disease.

Equally, the proposed patient-centered interventions for improving the health and wellness of people with heart disease are consistent with Healthy People 2030’s objectives. For instance, Healthy People 2030 aims to reduce cholesterol in adults to about 186.4 mg/dL by emphasizing physical activities and healthy weight management approaches (Healthy People 2030, n.d.). Other Healthy People 2030 objectives for heart disease include reducing the proportion of adults with high blood pressure, increasing aspirin use for secondary prevention of atherosclerotic cardiovascular disease, and enhancing control of high blood pressure in adults.

Conclusion

While heart disease is the leading cause of increased mortality rates, comorbidities, prolonged hospitalization, increased care costs, and compromised quality of life, implementing patient-centered interventions and ensuring care coordination can improve the health and wellness of people living with the disease. Examples of patient-centered approaches for addressing the disease include emphasizing physical activity sessions, educating patients on self-management interventions, linking patients to community resources, improving their health literacy, and coordinating with community-based organizations to foster communication, timely care delivery, information transfer, and consultations.

When implementing these approaches, it is vital to incorporate ethical considerations, align them with external evidence, and make changes consistent with patients’ preferences, needs, and values. Finally, it is crucial to uphold the Hospital Readmissions Reduction Program (HRRP) provisions and evaluate the Healthy People 2030 objectives to ensure consistency with the final care coordination plan.

References

Centers for Medicare and Medicaid Services. (2022). Hospital readmissions reduction program (HRRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program

Conn, N. J., Schwarz, K. Q., & Borkholder, D. A. (2019). In-Home cardiovascular monitoring system for heart failure: Comparative study. JMIR MHealth and UHealth, 7(1), e12419. https://doi.org/10.2196/12419

Gai, Y., & Pachamanova, D. (2019). Impact of the Medicare hospital readmissions reduction program on vulnerable populations. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4645-5

Healthy People 2030. (2020). Heart disease and stroke. https://health.gov/healthypeople/objectives-and-data/browse-objectives/heart-disease-and-stroke

Jaarsma, T., Hill, L., Bayes?Genis, A., La Rocca, H. B., Castiello, T., ?elutkien?, J., Marques?Sule, E., Plymen, C. M., Piper, S. E., Riegel, B., Rutten, F. H., Ben Gal, T., Bauersachs, J., Coats, A. J. S., Chioncel, O., Lopatin, Y., Lund, L. H., Lainscak, M., Moura, B., & Mullens, W. (2020). Self?care of heart failure patients: Practical management recommendations from the heart failure Association of the European Society of Cardiology. European Journal of Heart Failure, 23(1). https://doi.org/10.1002/ejhf.2008

Podvorica, E., Bekteshi, T., Oruqi, M., & Kalo, I. (2021). Education of the patients living with heart disease. Materia Socio Medica, 33(1), 10. https://doi.org/10.5455/msm.2021.33.10-15

Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A. Z., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J., Catapano, A. L., Chugh, S. S., Cooper, L. T., Coresh, J., & Criqui, M. (2020). Global burden of cardiovascular diseases and risk factors, 1990-2019: Update from the GBD 2019 study. Journal of the American College of Cardiology, 76(25), 2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010

Tomaselli, G., Buttigieg, S. C., Rosano, A., Cassar, M., & Grima, G. (2020). Person-Centered care from a relational ethics perspective for the delivery of high quality and safe healthcare: A scoping review. Frontiers in Public Health, 8(44). https://doi.org/10.3389/fpubh.2020.00044

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

White-Williams, C., Rossi, L. P., Bittner, V. A., Driscoll, A., Durant, R. W., Granger, B. B., Graven, L. J., Kitko, L., Newlin, K., & Shirey, M. (2020). Addressing social determinants of health in the care of patients with heart failure: A scientific statement from the American Heart Association. Circulation, 141(22). https://doi.org/10.1161/cir.0000000000000767

NRS 465 Evidence-Based Patient-Centered Needs Assessment Project

NRS-465: Applied Evidence-Based Project and Practicum is the final course in the Rn to BSN Degree program program. This writing-intensive integrates the academic and practical knowledge students have acquired throughout the program’s curriculum. Students participate in planned clinical experiences that refine professional competencies at the baccalaureate level and enable them to integrate new knowledge and enhanced skills to advance nursing practice. Clinical practice hours are dedicated to learning objectives in leadership and community health.

The evidence-based project provides students an opportunity to identify a clinical nursing practice issue and propose a possible solution. Students, under the guidance of faculty and approved preceptors, identify and analyze a nurse practice issue, develop a change project, and propose an evidence-based solution that reflects synthesis and integration of course content and professional practice. The evidence-based project development is guided by the baccalaureate program learning outcomes. Clinical hours: 100. 50 hours in leadership and 50 hours in community health. Prerequisite: NRS-415, NRS-420, NRS-425, HLT-362V, NRS-445, PHI-413V, NRS-450, NRS-455, NRS-460.

Evidence-Based Patient-Centered Needs Assessment Essay

This paper’s identified population is people addicted to alcohol and other substances. Despite the numerous efforts that different governmental and non-governmental institutions have implemented, the addiction problem still haunts many people. Addicted persons continuously abuse substances despite the adverse effects that are associated with them. There are apparent effects on a person’s social, mental, and physical well-being. Some addiction-related factors include personal preferences, environmental factors, and genetic predisposition (Nawi et al., 2021).

Addiction to substances can lead to psychological and physical symptoms such as withdrawal symptoms of discontinuation of abusing the substance. The different approaches to managing addiction include support groups and behavioral and pharmacological therapies. To prevent addiction, diverse populations need to be educated about the risks associated with the substances abused. It is also vital for healthcare givers to address the underlying mental health issues that may predispose these individuals to addiction.

In managing addiction, healthcare workers must address the addicts’ health, economic and cultural needs. This approach must be based on the best available evidence and prioritize the fact that addiction influences an individual’s health differently. When engaging patients, healthcare providers collaboratively develop individualized treatment plans considering the patient’s unique cultural, economic, and health circumstances. Involving patients in their care empowers them to make informed decisions concerning their treatment.

Patient involvement in care has been shown to reduce the healthcare costs associated with addiction. Engaging patients in self-care can lead to more adherence to treatment protocols, decreasing the rates of hospital admissions and the likelihood of relapsing (Abdisa et al., 2020). Cultural factors can influence their understanding of addiction and willingness to seek health care. The involvement of cultural factors in the plan of care can help healthcare professionals to come up with strategies that are appropriate and culturally sensitive for each individual.

The Importance of Addressing Patient Engagement

Patient engagement is essential to help patients manage their health conditions. When patients are engaged in the plan of their care, they are more likely to comprehend their situation, adhere to treatment, and attain informed decision-making concerning their care. A study by Kuipers et al. (2019) notes that when healthcare workers involve patients in developing personalized care plans, they will likely consider their goals, needs, values, and preferences. Understanding the patient’s condition can help them achieve enhanced self-management, which may entail managing their symptoms and making necessary lifestyle adjustments to impact their health positively and adherence to treatment plans.

Involving patients in their care plan has been shown to help healthcare workers manage the conditions better, resulting in fewer complications and an overall improvement in the quality of life achieved by the patients. An improvement in the quality of life can help to achieve a reduction in the burden of disease observed. The patient’s satisfaction and care received at the health care organization can be increased when they are engaged in their care.

Client satisfaction in healthcare increases the chances that they are likely to utilize the services again, which can lead to improved outcomes concerning their health. Similarly, when patients are involved in managing their conditions, the healthcare givers can have a deeper understanding of their needs and come up with preferences and goals, which can be taken into account to improve the overall experience. In addition, they can be provided with individualized management plans that are likely to be successful when adhered to consistently.

Evidence that Supports the Benefits of Patient Engagement

Studies by Marzban et al. (2022)  and Aboumatar et al. (2022) have indicated that interventions aimed at patient engagement, such as patient activation and decision-making involvement, are associated with improved health outcomes in patients with chronic health conditions. There are also reduced costs associated with healthcare and an overall improvement in patient satisfaction.

Another study by Kichloo et al. (2020) indicated that the utilization of telehealth and patient portals was associated with an enhancement in adherence to medication and an overall reduction in the number of hospitalizations. There was an overall increase in healthcare utilization in patients who utilize this technology. Similarly, remote healthcare coaching and promotion of self-management in persons who have an addiction were associated with enhanced health outcomes.

The Potential Use and Impact of the Information and Communication Technology

For people with an addiction, applying information and communication technology tools may significantly improve their health literacy. According to the Centers for Disease Control and Prevention (2022), health literacy refers to the ability of patients to access, comprehend, and utilize information and services and make informed decisions about their health. The improvement of health literacy in people with an addiction can help them manage their conditions and other resulting health-related issues.

Utilizing mobile health applications can also help improve consumer health literacy. This application helps with the need to access information and other resources to help them manage their challenges. They can help with medication adherence, have a range of support groups to choose from, and track their symptoms resulting from drug abuse.

Similarly, telehealth can help these individuals remotely access beneficial information, which can help reduce transportation and time constraints challenges (Gajarawala & Pelkowski, 2020). Individuals will likely face stigma or other barriers that hinder them from accessing quality health care and benefit from this approach.

The use of social media services can help this individual access other beneficial education resources and support groups where they can share their experiences with individuals suffering from the same condition. Healthcare givers can use electronic health records to help them enhance consumer health literacy for these individuals. The use of electronic health records can increase patients’ accessibility to their health information and help them communicate efficiently with their healthcare providers.

Tools to Facilitate Improvement in Patient Care

There are other mobile applications and telehealth features that can help to facilitate an improvement in patient care. Mobile applications enable patients to access health information remotely, access resources they need to manage their condition and get support from other individuals or organizations (Haleem et al., 2021). Some of the features these applications can offer include tracking symptoms, educational materials, and medication reminders to help them adhere to treatment.

Accessibility to remote healthcare services has also been enhanced through telehealth features. For instance, individuals living far away from healthcare facilities can use telehealth to remove transportation barriers. They can schedule video visits with their healthcare professionals and benefit from remote monitoring of their symptoms and accessibility to virtual support groups (Jin et al., 2020). Electronic health records facilitate communication between patients and healthcare providers and enable them to access their health information. Patient confidentiality can be promoted by using secure systems, which help promote coordination between different healthcare professionals as they allow easy information sharing.

Value and Relevance of the Technology Modalities

It is crucial to promptly address the needs of those with an addiction so they can enjoy quality health outcomes and lead no more lives. The use of telehealth and other health applications cannot be overlooked. With such modalities, patients can access quality and reliable information that can help them make informed decisions about their health and adopt different lifestyle adjustments that can help them improve their lives.

Accessibility to healthcare workers remotely can enable addicts to share information in real-time and get feedback from healthcare givers (El-Sherif et al., 2022). Therefore, healthcare providers are encouraged to adopt such technology that can help them monitor their patients closely and ensure that collaboration among different healthcare workers is achieved to promote quality health outcomes. These modalities have also helped increase patient confidentiality by ensuring that only individuals can access patient information.

Encouragement of Patient Engagement in Ethical, Culturally Sensitive, and Inclusive Ways

By considering ethics culture and inclusiveness, healthcare providers can ascertain that applying technology and managing different patient conditions respect their right to autonomy and enhance accessibility to equitable healthcare. Mobile healthcare applications provide tailored information to each individual and ensure addicts can access quality and reliable information (Kernebeck et al., 2020). For instance, providing information about a smoker’s different behavioral strategies to help them quit the habit will enable the individual to follow these guidelines and achieve the best outcomes.

Other individuals with visual impairments can also benefit from the use of mobile applications that have been designed to accommodate their disabilities. When telehealth is adopted, healthcare workers can promote culturally sensitive and ethical patient engagement, protecting their privacy and considering the right to autonomy. Before engaging in any intervention, patients are informed about the benefits and risks of engaging in that Intervention. Patients are likely to face stigmatization from different people protected through telehealth.

Conclusion

The engagement of patients in self-management is a vital component of delivering high-quality healthcare. The utilization of healthcare modalities such as electronic health records, telehealth, and mobile applications has been determined to increase the engagement of patients in their health care in an inclusive, culturally sensitive, and ethical manner. Recent literature has indicated that using these modalities can help reduce costs associated with health care, enhance patient satisfaction, and improve the health outcomes of these patients. All healthcare organizations are encouraged to adopt evidence-based technology that has been shown to promote individualized patient care.

References

Abdisa, E., Fekadu, G., Girma, S., Shibiru, T., Tilahun, T., Mohamed, H., Wakgari, A., Takele, A., Abebe, M., & Tsegaye, R. (2020). Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. International Journal of Mental Health Systems, 14(1). https://doi.org/10.1186/s13033-020-00391-6

Aboumatar, H., Pitts, S., Sharma, R., Das, A., Smith, M., Day, J., Holzhauer, K., Yang, S., Bass, B., & Bennett, W. L. (2022). Patient engagement strategies for adults with chronic conditions: An evidence map. Systematic Reviews, 11(1). https://doi.org/10.1186/s13643-021-01873-5

Centers for Disease Control and Prevention. (2022, February 2). What is health literacy? Centers for Disease Control and Prevention; U.S. Department of Health & Human Services. Accessed on April 21st from https://www.cdc.gov/healthliteracy/learn/index.html

El-Sherif, M., Abouzid, M., Elzarif, T., Ahmed, A., Albakri, A., & Alshehri, M. (2022). Telehealth and artificial intelligence insights into healthcare during the COVID-19 pandemic. Healthcare, 10(2), 385. https://doi.org/10.3390/healthcare10020385

Gajarawala, S., & Pelkowski, J. (2020). Telehealth benefits and barriers. The Journal for Nurse Practitioners, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013

Haleem, A., Javaid, M., Singh, P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2(2), 100117. https://doi.org/10.1016/j.sintl.2021.100117

Jin, X., Kim, Y., Miller, J., Behari, G., & Correa, R. (2020). Telemedicine: Current impact on the future. Cureus, 12(8), e9891. https://doi.org/10.7759/cureus.9891

Kernebeck, S., Busse, S., Böttcher, D., Weitz, J., Ehlers, J., & Bork, U. (2020). Impact of mobile health and medical applications on clinical practice in gastroenterology. World Journal of Gastroenterology, 26(29), 4182–4197. https://doi.org/10.3748/wjg.v26.i29.4182

Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, C., Kanugula, K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic, and the future: A narrative review and perspectives moving forward in the USA. Family Medicine and Community Health, 8(3), e000530. https://doi.org/10.1136/fmch-2020-000530

Kuipers, J., Cramm, M., & Nieboer, P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19(1), 1–9. https://doi.org/10.1186/s12913-018-3818-y

Marzban, S., Najafi, M., Agolli, A., & Ashrafi, E. (2022). Impact of patient engagement on healthcare quality: A scoping review. Journal of Patient Experience, 9, 237437352211254. https://doi.org/10.1177/23743735221125439

Nawi, M., Ismail, R., Ibrahim, F., Hassan, R., Manaf, A., Amit, N., Ibrahim, N., & Shafurdin, N. S. (2021). Risk and protective factors of drug abuse among adolescents: A systematic review. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11906-2

NRS 490 Capstone Project Change Proposal Sample

Shared Medical Appointments with Registered Nurse for Better AIC Control in Diabetes

Background

Diabetes described as a complex, chronic illness that requires tight glycemic control to prevent risk factors associated with Diabetes. There is evidence of tighter glycemic control helping reduce risks associated with diabetes like vascular damage and organs failure. The chronic hyperglycemia associated with long-term damage, dysfunctional organs and potential organs failure. Uncontrolled diabetes affects the eyes, kidneys, the heart, nerves, and blood vessels (American Diabetes Association, 2014: S83).

The growing incidences of diabetes without a comparable level of care and glycemic control exposes individuals to the risk factors associated with diabetes. However, research on lifestyle interventions has demonstrated delayed onset of diabetes-related risks with people with impaired glucose tolerance (Chen, 2018: 13). This paper aims to validate the effect of consistent medical intervention exploring the mediating role of the registered nurse. The PICOT study shades light using empirical evidence.

Problem Statement of PICOT Study

Diabetes has persistent being a health concern globally despite improvement in treatment and growing knowledge in its management. The prevalence of non – communicable diseases is on the rise with 19 million mortality associated with cardiovascular diseases; diabetes is remaining a significant contributor (Vakili et al., 2015). Globally 1.7 billion people are overweight with a substantial 315 million being obese. The population with type 2 diabetes estimated at 250 million people and the number is projected to increase to 400 million by 2025 according to Marseglia et al. (2016).

PICOT Question:  

1. An increased glucose level is independently related to an increased A1C level. Does reducing the A1C levels with specialized teaching from the nurse, practitioners, and dieticians help to control diabetes on adult patients?
2. Do shared medical appointments improve glycemic control through Registered Nurse Mediation?

Population:

The populations for the study are American adult patients diagnosed for type 2 diabetes, aging 40 to 60 years old. This population is heterogeneous concerning co-morbidities and general health status, which is essential to establishing the appropriate intervention.

Intervention:

The proposed intervention involves active Registered Nurses involvement in assisting patients with type 2 Diabetes keep appointments, observe strict adherence to medications, dietary and other recommendations. The nurse would help monitor record keeping with regard to fasting blood sugars, time of taking medication in the 12 weeks during the study. The study will note the essential parameters like blood sugar, weight, and other vital measurements at the beginning of the study and the end of the study.

Comparison:

To determine whether the intervention is successful; A1C levels would be measured before and after the changes in lifestyle and diet.

Outcome:

At the end of the study, it is expected that the A1C levels of adult diabetic patients that adhere to study recommendations would reduce.

Timeframe:

The research proposed to take 12 weeks.

PICOT Purpose Statement

Control of type 2 diabetes for American newly diagnosed adult patients has been problematic (P) due to the poor lifestyle and diet, which leads to an increased glucose level. Specialized teaching from the nurse, practitioners, and dieticians is an effective strategy to make the patients live appropriately by eating the right food and doing exercises (I), which can enable them to control their A1C levels (C) and live the normal life (O) within 12 weeks (T).

Education as regards to lifestyle modifications has been proved to be an effective intervention for controlling type 2 diabetes. Kuo et al. (2015) indicate that lifestyle interventions such as regular exercises and diet changes reduce the incidence of diabetes by 53 percent compared to the control group. People assigned to these interventions reported reduced A1C levels than the control group. In a similar study by Islam et al. (2014), changing the lifestyle plays a crucial role in reducing the glucose levels, which further minimizes the cases of diabetes by 27 percent.

Hence, there is an essential relationship between increased glucose level and increased A1C level as well as the lifestyle change and reduced A1C levels, which leads to effective control of diabetes. Among patients with pre-diabetes, it is worth to control their diet and do regular exercises to help in a decrease of diabetes occurrence. Failure to prevent diabetes means increased mortality. It is, therefore, the responsibility of each person to ensure they are living a healthy life to lower the risk of diabetes.

Literature Review

There is evidence of the efficacy of oral anti-glycemic agents in controlling diabetes. In the PICOT statement, do socioeconomic factors, biochemical characteristics and oral medications relate to the complications of diabetes? This question aims at investigating the clinical features of patients with type 2diabetes on oral drugs and determines the complications and risk factors in the patients. (Islam, 2014:7). Does uncontrolled diabetes affect cognitive function-a predisposition to dementia? This other research question aims at finding out the effect of uncontrolled diabetes on the risk of dementia. (Marseglia, 2016:1072)

Is there a difference in cost between Nursing practitioners and primary care physicians? This research question aims at investigating if there is a difference in cost and level of care between Nursing practitioners and primary care physicians. It also consists of an explored eye examination, cholesterol, HbA1C, neuropathy, referrals, and costs between Nursing practitioners and Primary physicians (Kuo, 2015:1982). Does medication adherence have any effect on glycemic control among diabetic patients? This research question aims at looking at the quantitative study of medication in relevance to diabetic patients. (Almadhoun, 2018:3).

The research questions relate closely with the aim of finding out more information and statistics about diabetes and the precautions that can be taken to prevent its development. My capstone project research question; does diabetes nursing visits and improving A1C levels to the required status over 12 weeks help control diabetes? This question aims at finding out if regular visits of the patients by nursing practitioners and improving their A1C levels will help control diabetes.

Theory of Planned Behavior

The PICOT study is grounded in the theory of planned behavior advanced by Ajzen (1991). The approach has been used in many fields to explain behavior and intentions. The approach is relevant in the current study because there are aspects of patients desiring health that can be achieved through lifestyle modification, adhering to medication treatment protocols and exercising. The motivation to modifying lifestyle is triggered to avert risks associated with uncontrolled diabetes.

Implementation plan

The study will recruit 20 types 2 diabetic patients with uncontrolled diabetes, ten male and ten female between the ages of 40-60 years. The respondents’ vital data will be collected at the beginning of the intervention and monitored over twelve weeks and at the end of the study. The data will then be analyzed to determine the effect of registered nurses in facilitating adherence to treatment and lifestyle modifications by the study respondents as suggested by physicians, dieticians, and pharmacists. The intervention plan is a multi-dimensional and holistic to determine the mediating role of the registered nurse influence in diabetes control.

Potential Barriers to the Intervention

There are inherent limitations to the PICOT study; first, the respondents may drop-off during follow-up thus affecting the survey. Secondly, the study sample size may be too small to allow generalization. Thirdly, there is the possibility of data interference reducing reliability and validity of the study. Lastly, the follow-up period may be too short to experience a remarkable change in outcome. The limitations were overcome by the nurse taking leadership in communicating and creating professional relationships with the respondents. Calls were made in advance to confirm clinic days, reminder respondents to take medication and adhere to the study protocol.

Conclusion

In conclusion, as evident in the article, there have been various research projects that offer factual support to the PICOT study. Research projects are relatable in a way that they aim at finding out the best applicable methods of controlling diabetes and AIC levels.

There are reports and research findings that contribute to providing more information on the control and management of diabetes. These include; Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2 and the effects of health mentoring program in community-dwelling vulnerable elderly individuals with diabetes. The proposed PICOT study will illuminate the possible mediating role of the Registered Nurse in improving the treatment and management of type 2 Diabetes. The results from the PICOT study demonstrate that the part of the nurse is vital is achieving tighter glycemic control. All cases except one recorded a real reduction in AIC.

References

• Almadhoun, M.R (2018) Journal of Clinical and Experimental pharmacology 8 (3), pp.1-10
• American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Supplement 1), S81-S90. DOI:10.4172/2161-1459.1000250
• Gong, Q., Zhang, P., Wang, J., Ma, J., An, Y., Chen, Y. & Chen, Y. (2018). Reducing Morbidity and Mortality in Type 2 Diabetes by Lifestyle Intervention: 30-Year Follow-Up of the Da Qing Diabetes Prevention Study.http://dx.doi.org/10.3233/JAD-160266
• Islam, S.M.S., Alam, D.S., & Wahiduzzaman, M., Nielsen, L.W, Fresch, G., Ferrari, U, Seisoler, J, Rouf, H, M.A & Lechner, A. (2014). Clinical Characteristics and Complications of Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh. Diabetes and Metabolic Syndrome: Clinical Research Reviews, 1-7 http://dx.doi.org/10.1016/j.dsx.2014.09.014
• Kuo, Y., Goodwin, J.S. & Chen, N. Lwin, K.K., Baillargeon, J., & Raji, M.A. (2015). Diabetes Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians, Journal of American Geriatric Society. 63 (10), 1980-1988
• Marseglia, A., Fratigioni, L., Laukka, E.J., Santoni, G., Pedersen, J., Backman, L. & Xu, W. (2016). Early Cognitive Deficits in Type 2 Diabetes A Population-Based Study. Journal of Alzheimer Disease. 53, 1069-1078
• Ruszkowska-Giastek, B., Sollup, A., Wernik, T., Rupiecht, Z., Golalczkyk, K., Gadomska, G. & Rosc, D. (2015). Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2. Zhejiang University- Science (Biomedical and Biotechnology) 16 (5), 355-361

NRS-493 Professional Capstone and Practicum Assignments

NRS-493 Professional Capstone and Practicum Assignments

NRS-493 Topic 1 Identification of issue Significant to Nursing Practice I

The first step in developing an evidence-based, practice change proposal is to identify an issue or problem that is significant to nursing practice. In this topic, students will examine a health care clinical problem or an organizational issue and its implications to nursing practice.

NRS-493 Professional Capstone and Practicum Assignments Objectives:

1. Create a plan for successful completion of the course.
2. Integrate reflective practice in the form of a reflective journal.
3. Demonstrate interprofessional collaboration during the creation of the capstone project change proposal.

Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice

Read “Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice,” by Stillwell, Fineout-Overholt, Melnyk, and Williamson, from American Journal of Nursing (2010).

URL:
https://journals.lww.com/ajnonline/Fulltext/2010/03000/Evidence_Based_Practice,_Step_by_Step__Asking_the.28.aspx

Evidence-Based Practice: The Future of Nursing and the Role of Nurse

Read “Evidence-Based Practice: The Future of Nursing and the Role of Nurse,” by Jyothi, from International Journal of Nursing Education (2012).

URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104394666&site=eds-live&scope=site

Evidence-Based Practice: Share the Spirit of Inquiry

Read “Evidence-Based Practice: Share the Spirit of Inquiry,” by Arzouman, from MEDSURG Nursing (2015).

URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsovi&AN=edsovi.00008484.201507000.00001&site=eds-live&scope=site

Guidelines for Undergraduate Field Experiences

Review the Guidelines for Undergraduate Field Experiences, located in the Student Success Center. This material contains important information for your clinical experience and the evaluation process.

Optional: GCU Library Webinars

For additional information, the following is recommended:

Review the webinar information offered by the GCU Library. From the “Webinars and Workshops: Webinar Calendar” page, select the “Category” tab and scroll down to the Nursing and Health Sciences selection. Webinar participation is optional.

URL:
http://libguides.gcu.edu/webinars

NRS-493 Individual Success Plan

Review the “NRS-493 Individual Success Plan” resource to familiarize yourself with the requirements for the Individual Success Plan (ISP) assignment in this topic.

Also Read:

NRS 493 Grand Canyon University Scholarly Virtual Tools Activities Discussion

NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I

Scholarly Activities

Throughout the RN-to-BSN program, students are required to participate in scholarly activities beyond their employment in a clinical practice setting. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available in an organizational setting, in the community, or nationally.

This submission should include how you were involved and contributions made to interdisciplinary initiatives. In Topic 10, students will submit a summary report of the scholarly activity and their involvement in any interdisciplinary initiatives. Students must use the “Scholarly Activity Summary” resource to guide this assignment.

This document describes the scholarly activity elements that should be included in a five paragraph summary. You may use this resource to help guide the preparation of the Scholarly Activities assignment, due in Topic 10.

NRS-493 Professional Capstone and Practicum Assignments Overview

This section consists of a single paragraph that succinctly describes the scholarly activity that you attended/participated in, the target market for the activity, and the benefit of the activity to you.

Problem

This section consists of either a short narrative or a list of bullet points that concisely identifies the problems the scholarly activity is designed to solve. Educate: What is the current state of the activity topic? Explain why this is a problem, and for whom is it a problem? Inspire: What could a nurse achieve by participating in the scholarly activity? Use declarative sentences with simple words to communicate each point. Less is more.

Solution

This section consists of either a short paragraph or a list of bullet points that concisely describes the solution to a proposed practice problem that the scholarly activity addressed and how it addresses the problem outlined in the previous section.

Opportunity

This section consists of short paragraphs that define the opportunity that the scholarly activity is designed to capture. It is important to cover the objectives and goals that were met. How will attending/participating in this scholarly activity help you grow as a nurse?

Program Competencies Addressed

This section consists of a list of program competencies that were addressed in this scholarly activity. Pleas euse the list from the ISP.

NRS-493 Individual Success Plan (ISP)

Planning is the key to successful completion of this course and program-related objectives. The Individual Success Plan (ISP) assignment requires early collaboration with the course faculty and your course preceptor. Students must establish a plan for successful completion of

1. The required 50 community direct clinical practice experience hours, 50 leadership direct clinical practice hours, and 25 indirect clinical experience hours.
2. Completion of work associated with program competencies.
3. Work associated with completion of the student’s capstone project change proposal.

Students will use the “Individual Success Plan” to develop an individual plan for completing practice hours and course objectives. As a part of this process, students will identify the number of hours set aside to meet course goals.

Student expectations and instructions for completing the ISP document are provided in the “NRS-493 Individual Success Plan” resource, located in the Study Materials and in the assignment instructions.

Students should apply concepts from prior courses to critically examine and improve their current practice. Students are expected to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.

After the ISP has been developed by the student and approved by the course faculty, students will initiate a preconference with the faculty and preceptor to review the ISP.

You are not required to submit this assignment to LopesWrite.

Work with your preceptor to perform a needs assessment of the organization and community for your practicum. Review the needs assessment to identify possible project topics. In preparation for the capstone change project proposal, compile a list of three to five possible topics for your project and submit to the assignment instructor in LoudCloud.

You are not required to submit this assignment to LopesWrite.

Professional Capstone and Practicum Reflective Journal

Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

1. New practice approaches
2. Interprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Practices of culturally sensitive care
6. Ensuring the integrity of human dignity in the care of all patients
7. Population health concerns
8. The role of technology in improving health care outcomes
9. Health policy
10. Leadership and economic models
11. Health disparities

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

NRS-493 Professional Capstone and Practicum Reflective Journal Rubric

No of Criteria: 13 Achievement Levels: 5

• Criteria
• Achievement Levels
• Description
• Percentage

1: Unsatisfactory 0.00 %2: Less Than Satisfactory 75.00 %3: Satisfactory 79.00 %4: Good 89.00 %5: Excellent 100.00 %

New Practice Approaches 8.0

• New practice approaches are not present.

• New practice approaches are present, but they are incomplete or otherwise lacking in required detail.

• New practice approaches are present. Some minor details or elements are missing, but the omissions do not impede understanding.

• New practice approaches are present and complete. The submission provides the basic information required.

• New practice approaches are present, complete, and incorporate additional relevant details and critical thinking to engage the reader.

Interprofessional Collaboration (C4.3) 8.0

• Interprofessional collaboration information is not present.

• Interprofessional collaboration information is present, but it is incomplete or otherwise lacking in required detail.

• Interprofessional collaboration information is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Interprofessional collaboration information is present and complete. The submission provides the basic information required.

• Interprofessional collaboration information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health Care Delivery and Clinical Systems 8.0

• Health care delivery and clinical systems information is not present.

• Health care delivery and clinical systems information is present, but it is incomplete or otherwise lacking in required detail.

• Health care delivery and clinical systems information is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Health care delivery and clinical systems information is present and complete. The submission provides the basic information required.

• Health care delivery and clinical systems information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Ethical Considerations In Health Care (C2.3) 8.0

• Information regarding ethical considerations in health care is not present.

• Information regarding ethical considerations in health care is present, but it is incomplete or otherwise lacking in required detail.

• Information regarding ethical considerations in health care is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Information regarding ethical considerations in health care is present and complete. The submission provides the basic information required.

• Information regarding ethical considerations in health care is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Practice of Culturally Sensitive Care (C5.3) 8.0

• Information regarding the practice of culturally sensitive care is not present.

• Information regarding the practice of culturally sensitive care is present, but it is incomplete or otherwise lacking in required detail.

• Information regarding the practice of culturally sensitive care is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Information regarding the practice of culturally sensitive care is present and complete. The submission provides the basic information required.

• Information regarding the practice of culturally sensitive care is present and complete, and incorporates additional relevant details and critical thinking to engage the reader.

Preservation of Integrity of Human Dignity in the Care of All Patients (C5.4) 8.0

• Information regarding the preservation of integrity and human dignity in the care of all patients is not present.

• Information regarding the preservation of integrity and human dignity in the care of all patients is present, but it is incomplete or otherwise lacking in required detail.

• Information regarding the preservation of integrity and human dignity in the care of all patients is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Information regarding the preservation of integrity and human dignity in the care of all patients is present and complete. The submission provides the basic information required.

• Information regarding the preservation of integrity and human dignity in the care of all patients is present and complete, and incorporates additional relevant details and critical thinking to engage the reader.

Population Health Concerns 8.0

• Information regarding population health concerns is not present.

• Information regarding population health concerns is present, but it is incomplete or otherwise lacking in required detail.

• Information regarding population health concerns is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Information regarding population health concerns is present and complete. The submission provides the basic information required.

• Information regarding population health concerns is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Role of Technology in Improving Health Care Outcomes (C4.1) 8.0

• Information on the role of technology in improving health care outcomes is not present.

• Information on the role of technology in improving health care outcomes is present, but it is incomplete or otherwise lacking in required detail.

• Information on the role of technology in improving health care outcomes is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Information on the role of technology in improving health care outcomes is present and complete. The submission provides the basic information required.

• Information on the role of technology in improving health care outcomes is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health Policy 8.0

• Health policy information is not present.

• Health policy information is present, but it is incomplete or otherwise lacking in required detail.

• Health policy information is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Health policy information is present and complete. The submission provides the basic information required.

• Health policy information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Leadership and Economic Models 8.0

• Information on leadership and economic models is not present.

• Information on leadership and economic models is present, but it is incomplete or otherwise lacking in required detail.

• Information on leadership and economic models is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Information on leadership and economic models is present and complete. The submission provides the basic information required.

• Information on leadership and economic models is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health Disparities 8.0

• Information on health disparities is not present.

• Information on health disparities is present, but it is incomplete or otherwise lacking in required detail.

• Information on health disparities is present Some minor details or elements are missing, but the omissions do not impede understanding.

• Information on health disparities is present and complete. The submission provides the basic information required.

• Information on health disparities is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Outline of Overall Personal Discovery 8.0

• Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is not present

• Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present, but it is incomplete or otherwise lacking in required detail.

• Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present. Some minor details or elements are missing, but the omissions do not impede understanding.

• Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present and complete. The submission provides the basic information required. 

• Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present and complete, and incorporates additional relevant details and critical thinking to engage the reader.

Mechanics of Writing (includes spelling, punctuation, grammar, language use) 4.0

• Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

• Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

• Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

• Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

• Writer is clearly in command of standard, written, academic English.

Total Percentage  100 

 

NRS 493 Professional Capstone and Practicum Reflective Journal Example

A reflection is an essential tool for professionalism and tracking progress in tasks. It is also a source of motivation and improvement by looking at the archived objectives and the areas for improvement available. This essay is a reflection of week four of the capstone change project.

This week was quite a busy week with care delivery to the patients. My mentor assigned me leadership roles to oversee other care providers in preparation for my capstone project implementation. During the week, I coordinated care teams in providing diabetes care, such as diabetic foot examinations and eye examinations. The experience taught me the importance of good leadership and ethical consideration in healthcare.

Leadership skills are vital in ensuring all care team members cooperate and perform their roles. The community clinic is free; hence there are few economic considerations, and they are all handled at the management level. Respecting all professionals, shared-decision making, and open and free communication are important for all leaders to succeed in their roles (Peterson et al., 2019).

 Informed consent, autonomy, confidentiality, and social justice are the most important ethical considerations in diabetic patients. Updating the patient of all care interventions and providing feedback promoted patient participation (Lee et al., 2019). Assuring them their information was safe also helped their openness and readiness to share information. The patient-care provider relationship is based on mutual trust, and thus ethical responsibility of the healthcare provider helps build a better relationship. Thus, ethical considerations such as informed consent, transparency, and confidentiality will be integral in the capstone project. In addition, good leadership skills will help coordinate the care providers for its successful implementation.

References

Lee, S. K., Shin, D. H., Kim, Y. H., & Lee, K. S. (2019). Effect of diabetes education through pattern management on self-care and self-efficacy in patients with type 2 diabetes. International journal of environmental research and public health, 16(18), 3323. https://doi.org/10.3390/ijerph16183323

Peterson, K., Anderson, J., Bourne, D., Charns, M. P., Gorin, S. S., Hynes, D. M., … & Yano, E. M. (2019). Health care coordination theoretical frameworks: a systematic scoping review to increase their understanding and use in practice. Journal of general internal medicine, 34(1), 90-98. https://doi.org/10.1007/s11606-019-04966-z

NRS-493 Professional Capstone and Practicum Assignments Topic 1 DQ 1

Identify two GCU Library scholarly databases that will help you find the best research articles to support your capstone project change proposal. Discuss why these two databases are better than Google Scholar or a general Internet search.

NRS-493 Topic 1 Identification of issue Significant to Nursing Practice I Topic 1 DQ 2

The Institute of Medicine has stated a goal that 90% of practice be evidence-based by 2020.  According to HealthyPeople.gov, the United States is currently at approximately 15%. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which identified barriers may be addressed.

evidence-based capstone project change proposal using components developed in previous course topics.Integrate a plan for evaluating the nursing intervention in the written comprehensive