please see attached

Develop an intervention (your capstone project), as a solution to the patient, family, or population problem you've defined. Submit the proposed intervention to the faculty for review and approval. This solution needs to be implemented (shared) with your patient, family, or group. You are not to share your intervention with your patient, family, or group or move on to Assessment 5 before your faculty reviews/approves the solution you submit in Assessment 4. In a separate written deliverable, write a 5–7 page analysis of your intervention.

Please submit both your solution/intervention and the 5–7 page analysis to complete Assessment 4.

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Introduction

In your first three assessments, you applied new knowledge and insight gleaned from the literature, from organizational data, and from direct consultation with the patient, family, or group (and perhaps with subject matter and industry experts) to your assessment of the problem. You’ve examined the problem from the perspectives of leadership, collaboration, communication, change management, policy, quality of care, patient safety, costs to the system and individual, technology, care coordination, and community resources. Now it’s time to turn your attention to proposing an intervention (your capstone project), as a solution to the problem.

Preparation

In this assessment, you’ll develop an intervention as a solution to the health problem you’ve defined. To prepare for the assessment, think about an appropriate intervention, based on your work in the preceding assessments, that will produce tangible, measurable results for the patient, family, or group. In addition, you might consider using a root cause analysis to explore the underlying reasons for a problem and as the basis for developing and implementing an action plan to address the problem. Some appropriate interventions include the following:

· Creating an educational brochure.

· Producing an educational voice-over PowerPoint presentation or video focusing on your topic.

· Creating a teaching plan for your patient, family, or group.

· Recommending work process or workflow changes addressing your topic.

Plan to spend at least 3 direct practicum hours working with the same patient, family, or group.

In addition, you may wish to complete the following:

· Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.

· Conduct sufficient research of the scholarly and professional literature to inform your work and meet scholarly expectations for supporting evidence.

Note: As you revise your writing, check out the resources listed on the Writing Center’s 

Writing Support
 page.

Instructions

Complete this assessment in two parts: (a) develop an intervention as a solution to the problem and (b) submit your proposed intervention, with a written analysis, to your faculty for review and approval.

Part 1

Develop an intervention, as a solution to the problem, based on your assessment and supported by data and scholarly, evidence-based sources.

Incorporate relevant aspects of the following considerations that shaped your understanding of the problem:

· Leadership.

· Collaboration.

· Communication.

· Change management.

· Policy.

· Quality of care.

· Patient safety.

· Costs to the system and individual.

· Technology.

· Care coordination.

· Community resources.

Part 2

Submit your proposed intervention to your faculty for review and approval.

In a separate written deliverable, write a 5–7 page analysis of your intervention.

· Summarize the patient, family, or population problem.

· Explain why you selected this problem as the focus of your project.

· Explain why the problem is relevant to your professional practice and to the patient, family, or group.

In addition, address the requirements outlined below. These requirements correspond to the scoring guide criteria for this assessment, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.

· Define the role of leadership and change management in addressing the problem.

· Explain how leadership and change management strategies influenced the development of your proposed intervention.

· Explain how nursing ethics informed the development of your proposed intervention.

· Include a copy of the intervention/solution/professional product.

· Propose strategies for communicating and collaborating with the patient, family, or group to improve outcomes associated with the problem.

· Identify the patient, family, or group.

· Discuss the benefits of gathering their input to improve care associated with the problem.

· Identify best-practice strategies from the literature for effective communication and collaboration to improve outcomes.

· Explain how state board nursing practice standards and/or organizational or governmental policies guided the development of your proposed intervention.

· Cite the standards and/or policies that guided your work.

· Describe research that has tested the effectiveness of these standards and/or policies in improving outcomes for this problem.

· Explain how your proposed intervention will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.

· Cite evidence from the literature that supports your conclusions.

· Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.

· Explain how technology, care coordination, and the utilization of community resources can be applied in addressing the problem.

· Cite evidence from the literature that supports your conclusions.

· Write concisely and directly, using active voice.

· Apply APA formatting to in-text citations and references.

Additional Requirements

·
Format: Format the written analysis of your intervention using APA style. 

APA Style Paper Tutorial [DOCX]
 is provided to help you in writing and formatting your paper. Be sure to include:

· A title page and reference page. An abstract is not required.

· Appropriate section headings.

·
Length: Your paper should be approximately 5–7 pages in length, not including the reference page.

·
Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.

·
Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.

Portfolio Prompt: Save your intervention to your 
ePortfolio. After you complete your program, you may want to consider leveraging your portfolio as part of a job search or other demonstration of your academic and professional competencies.

Competencies Measured

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

· Competency 1: Lead people and processes to improve patient, systems, and population outcomes.

· Define the role of leadership and change management in addressing a patient, family, or population health problem and includes a copy of intervention/solution/professional product.

· Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.

· Explain how a proposed intervention to address a patient, family, or population health problem will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.

· Competency 4: Apply health information and patient care technology to improve patient and systems outcomes.

· Explain how technology, care coordination, and the utilization of community resources can be applied in addressing a patient, family, or population health problem.

· Competency 5: Analyze the impact of health policy on quality and cost of care.

· Explain how state board nursing practice standards and/or organizational or governmental policies guided the development of a proposed intervention.

· Competency 6: Collaborate interprofessionally to improve patient and population outcomes.

· Propose strategies for communicating and collaborating with a patient, family, or group to improve outcomes associated with a patient, family, or population health problem.

· Competency 8: Integrate professional standards and values into practice.

· Write concisely and directly, using active voice.

· Apply APA formatting to in-text citations and references

Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. 

A 70 year old black American female who has the following
preexisting conditions;

Hypertension (HTN): longterm

Heart failure (CHF) : 2 months

Coronary artery disease (CAD) : longterm

Myocardial infarction (MI) : five years ago

Ejection (EF) of 55% : 2 months ago

Socioeconomic data:

Widow, Lives alone, independent ADL’s, Nonsmoker, Nondrinker

Pharmacologic data:

Aspirin (acetylsalicylic acid, ASA)

Clopidogrel bisulfate (Plavix)

Lisinopril (Prinivil, Zestril)

Carvedilol (Coreg)

Furosemide (Lasix)

Potassium chloride (KCL)

Client Profile:

70 year old woman originally from Alabama. She lives alone and is able to manage herself independently. She is active in her community and church. Diagnosed with heart failure 2 months age and is followed up at home with a visiting nurse every other week for to assist is managing her heart failure symptoms. She is being referred to the nurse practitioner for follow up of changes in her symptoms.

Assessment:

At the office the following subjective and objective data was supplied:

“I noticed my legs were getting a bit bigger and they are achy, too.”

She has gained 10 pounds over the last 5 days.

She gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down to catch her breath.

Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds.

She denies any chest, arm, or jaw pain or nausea.

She denies any back pain, stomach pain, confusion, dizziness, or a feeling faint.

She admits only to feeling a little more tired than usual.

Eats Southern Cooking when at home.

Vital signs :

T= 97.6 F (36.4C), BP 140/70, P 93, R 22.

Labs ordered:

complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), troponin, creatine kinase (CPK), creatine kinase-MB (CKMB), and albumin. The APN also prescribes oral (PO) Furosemide and arranges an outpatient electrocardiogram (ECG, EKG), chest X-ray, and echocardiogram.

Questions

1. Which assessment findings during this visit are consistent with heart failure?

2. Why did the APN ask about back pain, stomach pain, confusion, dizziness or a feeling that she might faint?

3. Explain what the following terms indicate and include the normal values: cardiac output, stroke volume, afterload, preload, ejection fraction and central venous pressure. Is an ejection fraction of 55% significant. Provide rationale.

5. Discuss the body’s compensatory mechanisms during hear failure. Include an explanation of the Frank-Starling law in your discussion.

6. Heart failure can be classified as left or right ventricular failure, systolic versus diastolic, according to the New York Heart Association (NYHA) and using the ACC/AHA (American Heart Association) guidelines. Explain these four classification systems and the signs and symptoms that characterize each. Which Classification fits this patient?

7. Provide a rationale for why each of the following medications have been prescribed: Aspirin, Clopidogrel bisulfate (Plavix), Lisinopril(Prinivil/Zestril) , and Carvedilol (Coreg).

8. What information will each of the following tests provide: CBC, BMP, BNP, Troponin, CPK, CKMB, and albumin, EKG, CXR, and Echocardiogram

What challenges to completion do you anticipate you will encounter in your doctoral program? What strategies for successful completion do you anticipate will be the most useful for you, and how will you work toward implementing these strategies to meet your goals?

Review the Marshall et. al. (2017) Reading Excerpt linked 

Marshall, S. M., Klocko, B., & Davidson, J. (2017). Dissertation completion: No longer higher education’s invisible problem. Journal of Educational Research and Practice, 7(1), 74-90. https://doi.org/10.5590/JERAP.2017.07.1.06