Discussion/Conclusion

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The discussion section is a place to highlight the successes and the challenges that may be experienced through the process of implementing the proposed intervention and the results of the anticipated and unanticipated outcomes. Should end with clear and data-driven conclusions and implications. You should highlight the lessons learned, including next steps for future investigations and challenges to the proposed intervention. Include implications of policy, education, practice, research and/or management as applicable.

Cite any sources in APA format.

W5 os

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taking into account internal and external criticism that is used to evaluate mid-range theories or their use in research. critique Self-Efficacy theory using the internal and external critique evaluation process

Blog

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 blog on evidence-based practice in the healthcare organization where you practice. (psychiatry)Drawing on your understanding of EBP and your firsthand observations within your organization, include the following content in your blog: 

parapharse

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plese follow all directions

Evidence-Based Population Health Improvement Plan

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For this assessment, you will create a 5-7 slide PowerPoint presentation about a population health improvement plan. You will then record a video of no more than five minutes presenting your PowerPoint.

Introduction

Master’s-level nurses need to be able to think critically about the evidence, outcomes data, and other relevant information they encounter throughout their daily practice. Often the evidence or information that a nurse encounters, researches, or studies is not presented in the exact context of that nurse’s practice. A key skill of the master’s-level nurse is to transfer evidence from the context in which it was presented and apply it to a different context in order to maximize the benefit to patients in that new context.

Professional Context

Master’s-level nurses need to be able to think beyond the bedside. It is important to be able to research, synthesize, and apply evidence that will result in improved health outcomes for the communities and populations that are part of your care setting. Improving outcomes at a community or population level, even incrementally, can create noticeably significant, aggregate health improvements for patients across all of a care setting.

Scenario

Your organization has created an initiative to improve one of the pervasive and chronic health concerns in the community. Some examples of possibilities for health improvement initiatives include type 2 diabetes, HIV, obesity, and communicable diseases. You will need to do your own research to gather and evaluate the relevant data for your chosen issue.

Once you have created a presentation for the initiative, you have been asked to present to a group of community stakeholders. The purpose of your presentation is to inform and enlist support for the initiative from your audience.

Instructions

The optional Evidence-Based Population Health Improvement Plan Presentation Template [PPTX] is provided to help you prepare your slides. If you choose to work without the template, consider referring to Creating a Presentation: A Guide to Writing and Speaking and Guidelines for Effective PowerPoint Presentations.

The suggested headings for your presentation are:

  • Community Data Evaluation.
  • Meeting Community Needs.
  • Measuring Outcomes.
  • Communication Plan.
  • Evidence.

In your presentation, you will:

  • Evaluate the environmental and epidemiological data about your community to determine a population-focused priority for care.
    • Identify the relevant data. This can be communicated in a table or chart. 
    • Describe the major population health issue suggested by the data within your community.
    • Explain how environmental factors affect the health of community residents.
    • Identify the level of evidence, validity, and reliability for each source.
    • Explain what evidence in the current literature (within the last 5 years) supports your evaluation of the data and the population focused priority of care you have selected.
  • Develop an ethical health improvement plan with outcome criteria that addresses the population health priority that you identified in your evaluation.
    • Consider the environmental realities and challenges existing in the community.
    • Include interventions that will meet community needs.
    • Address potential barriers or misunderstandings related to various cultures prevalent in the community.
    • Propose criteria that can be used to evaluate the achievement of the plan’s outcomes for your population health improvement.
      • Explain why your proposed criteria are appropriate and useful measures of success.
  • Explain a plan to collaborate with a specific community organization to support the implementation of the population health improvement in an ethical, culturally sensitive, and inclusive way.
    • Identify the community stakeholders that are relevant to your Population Health Improvement Plan.
    • Develop a clear communication strategy that is mindful of the cultural and ethical expectations of colleagues and community members regarding data privacy.
    • Ensure that your strategy enables you to make complex medical terms and concepts understandable to members of the community regardless of disabilities, language, or level of education.
  • Explain the value and relevance of the evidence and technology resources used as the basis of a population health improvement plan.
    • Explain why the evidence is valuable and relevant to the community health concern you are addressing.
    • Explain why each piece of evidence is appropriate and informs the goal of improving the health of the community.
  • Communicate the Evidence-Based Population Health Improvement Plan in a professional, effective manner that engages the community organization stakeholders and the community-at-large to implement and sustain change.
    • What specific actions can the community stakeholders take themselves to build a feeling of community ownership in your plan?
  • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Submission Requirements

  • Length of submission: 5–7 slides. Balance text with visuals. Avoid text-heavy slides. Use speaker’s notes for additional content.
  • Length of Video Presentation: No more than five minutes.
  • Font and font size: Appropriate size and weight for a presentation, generally 24–28 points for headings; no smaller than 18 points for bullet-point text. Use a suitable professional typeface, such as Times or Arial, throughout the presentation.
  • Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your evaluation, recommendations, and plans. Current source material is defined as no older than five years unless it is a seminal work.
  • APA formatting: Resources and citations are formatted according to current APA style.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

  • Competency 1: Apply evidence-based practice to plan patient-centered care.
    • Explain a plan to collaborate with a specific community organization to support the implementation of the population health improvement in an ethical, culturally sensitive, and inclusive way.
  • Competency 2: Apply evidence-based practice to design interventions to improve population health.
    • Develop an ethical health improvement plan with outcome criteria that addresses the population health priority for care identified in the evaluation.
  • Competency 3: Evaluate the value, relevance, and ethics of available evidence upon which clinical decisions are made.
    • Evaluate the environmental and epidemiological data about your community to determine a population-focused priority for care.
    • Explain the value and relevance of the evidence and technology resources used as the basis of a population health improvement plan
  • Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
    • Communicates the Evidence-Based Population Health Improvement Plan in a professional, effective manner that engages the community organization stakeholders and the community-at-large to implement and sustain change.
    • Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

Nursing D.Saa Cultural Wk 1 Written Assignment

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Although no formal assignment is due for this week, I would like everyone to discuss the outcomes of their cultural assessment evaluation. 

Please document your outcomes (written in Microsoft Word) and think of strategies you will employ to enhance your cultural knowledge as you prepare for Cultural Health Issues.  No less than 500 words.

DB

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Answer with at least 6 sentences, one scholarly reference ( discussion doesn’t have to be long just enough to get the question answered ) 

  

Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.” 

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question:

Which cholesterol is considered the “good” cholesterol and what does it do?

W5 R see attachment

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Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .



Lili Ketema


Clinical Decision Support Systems

Pros

Cons

Patient Safety. Clinical Decision Support Systems empower Advanced Practice Nurses to make decisions in a timely and informed manner by detecting diseases early and managing them effectively (Ayed Aloufi, 2020). CDSS has reminder systems for medical events different from the ones related to medicine. For example, CDSS for measuring blood glucose in the ICU can decrease the frequency of hypoglycemia events (Sutton et al., 2020). This CDSS automatically prompts nurses to take glucose measurements with respect to the local glucose monitoring protocol that specifies particular patient demographics and previous glucose trends.

Overreliance. CDSS may increase patient safety but increase reliance on the system, resulting in a decrease in critical thinking capabilities since the APN does not feel impelled to utilize their clinical judgment capabilities. This development is undesirable because the APN becomes less equipped for a task that they can execute in the absence of a CDSS. Sutton et al. (2020) compare overreliance on CDSS to using a calculator in math; the authors indicate that the user’s mental math skills decline with extended use. Therefore, APNs may end up less equipped to execute the services they should execute with ease. 

Improved Accuracy and Efficiency. CDSS can process significant quantities of patient data swiftly and precisely, empowering providers of care to effectively diagnose and plan for treatment (Ayed Aloufi, 2020). This decreases the possibility of errors by providing computerized consultation. The Diagnostic Decision Support Service provides data/user selections and then outputs a list of possible diagnoses (Sutton et al., 2020). These developments enhance EHR-integration as well as standardized vocabulary such as Snomed Clinical Terms.      

System and Content Maintenance. Maintenance is an often neglected aspect of the lifecycle of the CDSS. Maintenance encompasses technical and content of the systems that power the CDSS. The applications and knowledge-base of the CDSS should always be apace with the shifting nature of clinical guidelines and medical practice. Failure to stay updated may limit the CDSS’ capacity to maintain the desired levels of accuracy and efficiency. Sutton et al. (2020) assert that even the healthcare institutions that are highly advanced experience challenges keep9ing abreast with keeping their systems updated due to the inevitability of changes in medical knowledge bases. 

Cost Containment. The capacity of CDSS to decrease the length of stay for in-patients, provide clinical interventions, decrease test duplication, and suggest cheaper alternatives of medicine makes the systems more efficient (Sutton et al., 2020). For example, a CPOE-integrated has the capacity to limit the scheduling of blood count to a 24-hr interval when implemented in a paediatric cardiovascular intensive care unit. This laboratory resource utilization cost-reduction has a predictable cost discount of $717,538 every year, minus increasing mortality or length of stay. These advantages reveal the highly capabe nature of the CDSS to contain costs associated with hospital procedures and the overall ROI associated with CDSSs.  

The system is predicated on computer literacy. Decreased proficiency in technology can be limiting when a person is engaging with CDSS. The high design details associated with CDSS may be exceedingly complicated, decreasing the capacity of some APNs to use them to reach the advantages associated with the implementation of the system within a hospital setting (Sutton et al., 2020). Although some systems stay as close to close functionality as possible, every new system has a learning period, meaning the baseline of the technological competence of users is appropriate. Further training for APNs increase on the costs that the institution was aiming at cutting in the first place.

Future role as an APN and clinical patient and scenario 

A 68 year old man who has a history of diabetes, hypertension, and chronic renal disease shows up at the clinic complaining of fatigue, increased thirst, and frequent urination. Since I feel the patient's symptoms might be brought on by uncontrolled diabetes, I have made the decision as a prospective APN healthcare professional to ask for a blood test to confirm the diagnosis.

Impact of CDSS: Before prescribing any new medications, the system alerts me about the patient's current medications, which include metformin and lisinopril. The CDSS also prompts  to consider the patient's renal status.

After noting the CDSS alert, I decide to review the patient's most recent lab results, particularly the estimated glomerular filtration rate (eGFR). The patient has substantial renal impairment, as seen by their eGFR, which is less than 30 mL/min/1.73m2, as I learned after examining the lab results.

In light of the CDSS alert and the patient's test results, I decide to alter the patient's prescription regimen. As opposed to providing a conventional oral anti-diabetic prescription like sulfonylureas, which may be contraindicated in patients with severe renal impairment, as APN i would consider alternate choices such insulin treatment or a newer family of anti-diabetic pharmaceuticals that are safe for patients with renal impairment.

Based on the patient's renal function and the medications they were taking at the time, the CDSS made recommendations. This let the medical practitioner make a more informed decision and avoid any side effects or drug interactions.

This scenario demonstrates how a CDSS might influence a provider's decision by providing timely reminders and cautions based on the patient's specific clinical data. It guarantees that the healthcare provider considers all relevant information and selects the best course of action for the patient's unique needs.

References

Ayed Aloufi, M. (2020). Effect of clinical decision support systems on quality of care by nurses. 
International Journal for Quality Research, 
14(3), 665–678. https://doi.org/10.24874/ijqr14.03-01

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for Success. 
Npj Digital Medicine, 
3(1). https://doi.org/10.1038/s41746-020-0221-y

 

PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

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TO PREPARE:

· Choose
one of the two following specific populations: either
pregnant women or
older adults. Then, select a specific disorder from the 
DSM-5-TR to use.

· Use the Walden Library to
research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.

BY DAY 3 OF WEEK 9

· Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

· Explain the risk assessment you would use to inform your treatment decision  making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

· Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

· Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder