Respond to two of your peers and briefly analyze their articles, commenting on whether they are supportive of their PICO(T) question and why. Also make comments or suggestions for improvement regarding their search methods flow chart.
both peers are attached below
Respond individually.
Discussion: Health Care Policy
In this week’s media presentation, Dr. Trautman, Dr. Wakefield, and Ms. Coyle discuss how public policies initiated at the national or state level ultimately influence what occurs at the institutional and local level of nursing practice and health care delivery. Health care policy usually is developed to address health care cost, quality, or access, or a combination of the three. Due to the nature of their interaction with patients, nurses are well situated to be effective, knowledgeable advocates for their patients.
In this week’s Discussion, you will examine how current policies impact how you as a nurse provide health care. You will then select an issue of interest and determine how you could advocate for policy in that area.
To prepare:
Select one public policy that currently is impacting you and your practice. Consider the following:
What health care driver was the policy designed to address: cost, quality, access, or a combination?
Does the policy appear to be achieving its intended results? On what data are you basing your assumption?
What have been the effects (adverse or positive) of this policy on health care cost, quality, and access?
How is this policy affecting your nursing practice?
Next, select a health care issue—something you see or experience on a daily basis—about which you would like to influence a practice change through the policy process.
Review the Learning Resources, focusing on Kingdon’s Model. How would you utilize this model to guide your policy development?
Post a brief description of a public policy that is having an impact on your practice; summarize your analysis of the policy using the bulleted list above as a guide. Then, summarize the issue you would like to influence though a change in public policy, and outline how you would utilize Kingdon’s Model to guide your policy development.
Required Readings
Milstead, J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones and Bartlett Publishers.
Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. xvi -13)
This chapter explains public policy and the nurse’s role in directing health care issues to the government and securing a response.
Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention” (pp. 16-34)
This chapter provides examples of the process of moving a problem to the attention of the government so the solution can be considered at the state and federal levels.
Chapter 3, “Government Response: Legislation” (pp. 36-54)
This chapter explores the multiple factors that influence the development of public policy through the legislative branch of government.
NOTE: CHECK THE BOOK, DOCUMENT AND MEDIA PRESENTATION ATTACHED BELLOW TO COMPLETE THE ASSIGNMENT
List the objective(s) met and Briefly
see attach
WHAT I NEED IS 1 REPLY COMMENT PER POST, EACH COMMENT NEEDS TWO HAVE TWO APA REFERENCE ABOVE 2013 WITH CITATION.
POST1
The selected case for this discussion is case number five which involves sleepy woman with anxiety.
The three questions to ask the patient
a. Does anxiety interfere with your ability to concentrate?
The choice for this question is based on the fact that anxiety can send one into a true tailspin of disruptive and irrational thinking which interferes with the ability to focus
b. Which medication did you use for narcolepsy?
The question will help in determining if the drugs used to treat past narcolepsy was effective to avoid possible onset.
c. Do you experience headache, dizziness, nausea, vomiting, constipation or dry mouth?
The question will help determine if the patient is responding positively to bupropion. These are some of the side effects of bupropion and therefore, persistent of these symptoms would mean the patient is not responding well to bupropion
The people in the patient’s life to speak to or get feedback from for further assessment of the patient’s situation
a. The husband: How do you describe the sleeping pattern of your wife?
The question will help in determining if the patient is having sleeping disorder, that is, excessive sleep.
b. Former class teacher: How do you describe the concentration of the patient while in class?
Lack of concentration is one of symptoms of sleep apnea and therefore, the question will determine if the patient has recurring sleep apnea.
The physical exams and diagnostic tests that would be appropriate for the patient and the use of the results
I will perform physical exam to look for signs and symptoms of anxiety such as nervousness, restlessness, panics, rapid heartrate and weakness and lethargy. The result will be used to determine severity of the anxiety disorder and consequently helps in selecting the most effective medication. I will also use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). I will also use polysomnography to monitors heart, lung and brain activity, breathing pattern to help in ruling the presence of absence of sleep apnea (Mokhlesi & Cifu, 2017).
The three differential diagnoses for the patient
The first differential diagnosis is anxiety disorder. The patient presents symptoms of anxiety such as excessive sleep during the day.
The second differential diagnosis could be sleep apnea. This order can make one to feel tired and unrefreshed. During the day, one may feel fatigued and experiencing difficulty concentrating or unintentionally fall asleep. Further, obstructive sleep apnea is the most likely differential diagnosis for this patient. This is because obstructive sleep apnea is associated with excessive daytime sleep just like evidenced in the patient.
The third differential diagnosis is narcolepsy. The past medical history of the patients showed that she had been diagnosed with narcolepsy and therefore, it is possible that the patient has another onset of narcolepsy.
Hypersomnia is another possible condition of the patient because she is having or excessive sleepiness. The patient has trouble staying awake during the day. Insomnia is another possible condition as the patient has daytime impairment related daytime sleepiness (Ardani et al. 2016).
Two pharmacologic agents and their dosing appropriate for the patient’s sleep/wake therapy
The first pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy by considering that the patient has narcolepsy is to start initial dosage of amphetamines at 10 mg orally per day in divided doses. The medication will be used induce daytime alertness because the patient is experiencing excessive sleep which is a symptom of obstructive sleep apnea. The second pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy is gabapentin. The medication is useful in patients with restless leg syndrome and insomnia just like the patient in the case study. The dosage for gabapentin would be 600 mg orally once daily together with food (Schroeck et al. 2016).
Therapeutic changes and check point
The following for this client based on amphetamines dosage, the daily dose will be raised in 10 mg increments at weekly intervals up to the point when the optimal response is achieved.
The “lessons learned” from the case study
One of the challenges in the case is to use effective drug to treat resistant anxious depression while taking into consideration excessive sleep symptoms. A comprehension of the electrophysiologic, as well as, neurochemical that correlates with the stages of sleep is necessary in defining sleep disorders. Just like evidenced in the patient, excessive daytime sleepiness is normally associated with disorders such as obstructive sleep apnea and depression.
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Ardani, A. R., Saghebi, S. A., Nahidi, M., & Zeynalian, F. (2016). Does abstinence resolve poor sleep quality in former methamphetamine dependents?. Sleep Science (sao Paulo, Brazil), 9, 3.
Schroeck, J. L., Ford, J., Conway, E. L., Kurtzhalts, K. E., Gee, M. E., Vollmer, K. A., & Mergenhagen, K. A. (November 01, 2016). Review of Safety and Efficacy of Sleep Medicines in Older Adults. Clinical Therapeutics, 38, 11, 2340-2372.
Mokhlesi, B., & Cifu, A. S. (2017). Diagnostic Testing for Obstructive Sleep Apnea in Adults. Jama, 318, 20, 2035.
POST2
Case 1: Volume 2, Case #16: The woman who liked late-night TV List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
I would ask the following questions from the patient How has your life changed after the death of your husband?
The case reveals that patient’s husband died many years ago. This is an open ended question to ask about changes in patient’s life after the death of her husband. May be she feels lonely, maybe she does not have someone to listen to her views. Spending such a life for years might have resulted in symptoms of depression. Social isolation affects behavioral health in elderly people. It contributes to depression and sleep disturbance (Choi, et al., 2015). Do you feel stressful in your life?
Depression and sleep problems are often associated with stress. Sleep disturbances often occur during high-stress periods (Schlarb, et al., 2017). This question access if patient’s sadness and sleep issues are due to stress in her life. May be feels stressful about something in her life. May be to deal with stress she prefer to watch TC until late at night. What do you feel about your cochlear implant?
The case reveal that patient has a chief complaint of being sad. She is also expected to have a cochlear implant in future. This question access if her sadness issue is related to her hearing issue. The answer to this question would reveal if patient’s hearing problem is the reason behind her sadness or there is something else. Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
I would ask specific questions and would take specific feedback from patient’s son. The case reveal that patient has a son who visits him often but does not live with her. Patient is 70-year-old, is elderly and has hearing issues. Asking the following questions from her son would be helpful to understand her problem in detail Other than your father’s death, has anything tragic happened in your mother’s life? Have you notices anything notable in your mother’s behavior over the past six months? Do you think your mother hearing and sadness problems are interrelated? Why you do not keep your mother with yourself? Does your mother ever insist to take her with you?
The above mentioned questions would provide useful insight to evaluate the health condition, past life condition and social life of the patient. I would indicate when the patient’s problem started.
Patient is an elderly and wants support from her love one still her son does not live with him. The other person caring for patient is her aide and I would also ask from questions from her to access patient’s condition and underlying problems more accurately. Since when you have been caring for the patient? How does the patient behaves with you? Have you noticed any changes in patient’s behavior over the past few months? What do you think might be the cause of her sleeping and sadness issues?
These questions would help analyze the relationship between patient and her aide. Patient is taken care by her aide. At this point we do not know the behavior of her aide. These questions are important to access if aide is caring for her in the right manner or she is not taking care of the patient. Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
A complete physical exam would be performed for the patient. Patient has depression, sleeping problems and leg ache. Physical exam would help determine if physical problems or weakness are the underlying cause of these problems. An eye exam would also be performed during physical exam to access why the patient is having the issue of tears in her eyes. Her eye problem would be accessed and appropriate eye drops would be prescribed. Thyroid test would be important to access the level of thyroid hormone in the body. This is because thyroid hormonal level is found to have a relationship with depression (Dayan & Panicker, 2013). Iron level test would also be needed to identify if inadequate levels of iron in the body are causing of restless leg syndrome (Cochrane, 2016). DSM-5 criteria would be used to determine the patient’s mental health problem and diagnosis. List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
Based upon the signs and symptoms and patient’s condition revealed in the given case, following are the three differential diagnosis for the patient
Restless Legs Syndrome (RLS):
This condition also called Willis-Ekbom Disease causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or in evening hours, and are often most severe at night when a person is resting such as lying or sitting (Guo, et al., 2017). Symptoms may also occur when someone remains in an inactive position for a long period of time for instance when sitting in an airplane for long hour or watching a movie. The intensity of symptoms in increased during night time and therefore it is often difficult to sleep at night or return to sleep after waking up.
Restless leg syndrome is the most likely diagnosis for the patient. This is because patient has complaints of ‘ache and jump’ and due to this condition she is unable to fall asleep at night.
Insomnia:
Insomnia is the most common sleep complaint. This condition occur when someone has trouble falling asleep or staying asleep even though he has the opportunity to get a full night of sleep. The symptoms, causes and severity of insomnia vary from person to person. Symptoms of the condition may include difficulty falling asleep; waking up too early in the morning; difficulty staying asleep throughout the night (Singh, 2016). In the current case, patient reports problem with sleeping, she has difficulty falling asleep at night. Therefore, the differential diagnosis for insomnia is included.
Obstructive Sleep Apnea (OSA):
This is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. There are several types of sleep apnea, but the most common type is obstructive sleep apnea. This condition occurs when the throat muscles intermittently relax and block the airway during sleep. A noticeable sign of obstructive sleep apnea is snoring (Foroughi, et al., 2016).
In the current case, patient might also be suffering from this disorder because she reported snoring during sleep.
At this point, it can be inferred that patient is having comorbid medical conditions including restless leg syndrome and obstructive sleep apnea. These two conditions are affecting her sleep pattern and due to lack of quality sleep she might be having depressive symptoms. Sleep problems often result in depressive problems (Luca et al., 2013) List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
The two pharmacologic agents that would be appropriate for the patient include: modafinil Mirapex
Modafinil is a wake-promoting agent approved for the treatment of excessive sleepiness associated with shift work disorder, obstructive sleep apnea (OSA) and narcolepsy (Stahl, 2014). This drug would be helpful for patient in controlling her problem of obstructive sleep apnea (OSA) that is causing her issues of snoring. The current dose of modafinil prescribed to the patient is 400 mg/day. This dose is the full dose. However, I would not prescribe full dose to the patient considering her age and possible side effects of the medicine at full dose.
Mirapex is prescribed for treatment of restless legs syndrome and Parkinson’s disease. The medicine can improve symptoms of restless legs syndrome and Parkinson’s disease and can improve sleep (Stahl, 2014). The medicine should be started at lowest dose (0.125 mg) and increased necessary every 5 to 7 days until symptoms are controlled (Stahl, 2014). Therefore, for the treatment of RLS, Mirapex would be prescribed to the patient. If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
A potential mistake or medical prescription error I noted in the case was that at second interim follow up Celexa was increased to 30 mg/day. However, maximum dose of Celexa for elderly is 20 mg/day (Stahl, 2014). Considering the age of patient, I would have not increased the dose to 30 mg/day. Another issue that I noted in the case was that patient did not agree for CPAP in repeated visits. I would have researched for new generation CPAP equipment and would have motivated the patient for CPAP treatment. Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.
Through the case study I learnt how the symptoms of multiple conditions overlap and create difficulty for patient’s to cope up with the symptoms. This case also though to how to use polypharmacy for patients suffering from a number of sleep problems. In the current case, patient has suffering from restless leg syndrome and obsessive sleep apnea. For OSB, CPAP treatment was recommended for the patient which she denied. If I would be in a similar situation in my clinical practice, I would try to convince my patient for CPAP treatment. If however, patient would not agree then I would consider other treatment options. References
Choi, H., Irwin, M. R., & Cho, H. J. (2015). Impact of social isolation on behavioral health in elderly: Systematic review. World Journal of Psychiatry, 5(4), 432-436. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694557/
Cochrane. (2016). Iron for restless legs syndrome. Retrieved from https://www.cochrane.org/CD007834/MOVEMENT_iron-for-restless-legs-syndrome
Dayan, C. M., & Panicker, V. (2013). Hypothyroidism and depression. European Thyroid Journal, 2(3), 168-179. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017747/
Foroughi, M., Razavi, H., Malekmohammad, M., Naghan, P. A., & Jamaati, H. (2016). Diagnosis of Obstructive sleep apnea syndrome in adults: A brief review of existing data for practice in Iran. Tanaffos, 15(2), 70-80. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127617/
Guo, S., Huang, J., Jiang, H., Han, C., Li, J., Xu, X., & Wang, T. (2017). Restless Legs Syndrome: From pathophysiology to clinical diagnosis and management. Frontiers in Aging Neuroscience, 9(1), 171-182. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454050/
Luca, A., Luca, M., & Calandra, C. (2013). Sleep disorders and depression: Brief review of the literature, case report, and nonpharmacologic interventions for depression. Clinical Interventions in Aging, 8(1), 1033-1042. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760296/
Schlarb, A. A., Claßen, M., Grünwald, J., & Vögele, C. (2017). Sleep disturbances and mental strain in university students: Results from an online survey in Luxembourg and Germany. International journal of mental health systems, 11(1), 24-29. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372247/
Singh, P. (2016). Insomnia: A sleep disorder: Its causes, symptoms and treatments. International Journal of Medical and Health Research, 2(10), 37-41.
Stahl, S. M. (2014). The prescriber’s guide. New York, NY: Cambridge University Press. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?page=9781316618134c114.html.therapeutics&name=SERTRALINE&title=Therapeutics
Week 3: Shared Governance and the Magnet Model
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Describe the nursing care delivery model used at your current or previous employer. Would you utilize this model at SLMC? Discuss current interprofessional collaboration and how you would encourage collaborative efforts. Does the model support the person-centred nursing framework by McCormack and McCance (2017)? Explain your rationale for choosing to use or not use the person-centred nursing framework.
Please refer back to the 2017 PCNF overview presented below.
Patient-Centered Care: A Person-Centred Care Model Revisited
Caring continues to be a central concept in nursing; however, the context for caring is transforming, resulting in conceptual and theoretical advancements related to the evolving healthcare practice settings. McCormack and McCance originally developed a Person-Centred Nursing (PCN) Framework in 2006 and updated it in 2010 that can be applied to practice in complex healthcare systems (McCormack & McCance, 2006; McCormack & McCance, 2017). The PCN Framework provides a standard of care for practice and is a multidimensional process that places emphasis on the person as the center of care delivery (McCance, McCormack, & Dewing, 2011). The PCN Framework fosters outcomes related to therapeutic relationships through respecting individuals as persons and partners in care. The Person-Centred Care Nursing Framework consists of four constructs: prerequisites, the care environment, person-centred processes, and outcomes (McCance et al., 2011). To deliver effective care, one must work from the outer circle first to the core. McCormack, B. & McCance, T. (2017)Prerequisites focus on the attributes of the nurses and include being professionally competent, having developed interpersonal skills, being committed to the job, being able to demonstrate clarity of beliefs and values, and knowing self. The care environment focuses on the context in which care is delivered and includes appropriate skill mix, systems that facilitate shared decision making, effective staff relationships, organizational systems that are supportive, the sharing of power, the potential for innovation and risk taking, and the physical environment. Person-centred processes focus on delivering care through a range of activities and include working with a patient’s beliefs and values to overcome this gap between the concept and the reality of person-centred care we have developed the Person-Centred Nursing Framework…engagement, having sympathetic presence, sharing decision making, and providing holistic care. Outcomes, the central component of the Framework, are the results of effective, person-centred nursing and include: satisfaction with care, involvement in care, feeling of well-being, and creating a therapeutic environment. (McCance, McCormack, & Dewing, 2011).
McCormack, B. & McCance, T. (2017)
Reference
McCormack, B. & McCance, T. (2017). Person-centered practice in nursing and health care. Theory and practice (2nd ed.). Oxford: Wiley Blackwell.
In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
1.Background
2.Problem statement
3.Purpose of the change proposal
4.PICOT
5.Literature search strategy employed
6.Evaluation of the literature
7.Applicable change or nursing theory utilized
8.Proposed implementation plan with outcome measures
9.Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
10.Appendix section, if tables, graphs, surveys, educational materials, etc. are created
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
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 required to submit this assignment to Turnitin.
Write 2-3 page report on any aspect of the connection to global health (title and reference page not included in page count). Be sure to include at least one reference to support your work (beyond the book itself). The reference can be one that was discussed during the course. Submit under the Course Materials tab in Blackboard.
The book’s name:
Timmerman, K. (2009). Where am I wearing? A global tour to the countries, factories, and people that make our clothes. New Jersey: Wiley. ISBN 978-0-470-37654-6
Select an ethnic minority group that is represented in the United States (American Indian/Alaskan Native, Asian American, Black/African American, Hispanic/Latino, Native Hawaiian, or Pacific Islander). Using health information available from Healthy People, the CDC, and other relevant government websites, analyze the health status for this group.
In a paper of 1,000-1,250 words, compare and contrast the health status of your selected minority group to the national average. Include the following: Describe the ethnic minority group selected. Describe the current health status of this group. How do race and ethnicity influence health for this group? What are the health disparities that exist for this group? What are the nutritional challenges for this group? Discuss the barriers to health for this group resulting from culture, socioeconomics, education, and sociopolitical factors. What health promotion activities are often practiced by this group? Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective in a care plan given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice. What cultural beliefs or practices must be considered when creating a care plan? What cultural theory or model would be best to support culturally competent health promotion for this population? Why?
As an advanced practice nurse, one can engage in activism in order to achieve desired policy change at various levels including their own organization. Be sure to include one MSN Essential in your discussion that relates to this topic. Less than 15 % similarity, APA format. 250 words or more.
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