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Assessment 4 Instructions: Capstone Reflection

Develop a 5-10 minute video in which you reflect on your capstone experience.Important: Complete this assessment fourth.For this assessment, you will reflect on various aspects of your capstone experience. This will give you a chance to discuss elements of the project of which you are proud and aspects of the experience that will help you grow in your personal practice and nursing career.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Competency 2: Make clinical and operational decisions based upon the best available evidence.Reflect on use of evidence and the literature to plan and implement a capstone project, and compare project outcomes to initial predictions based on a review of the literature.Competency 4: Apply health information and patient care technology to improve patient and systems outcomes.Reflect on the degree to which health care technology was leveraged successfully to improve outcomes or communication to relevant stakeholders in a capstone project.Competency 5: Analyze the impact of health policy on quality and cost of care.Reflect on how organizational and governmental health policy influenced the planning and implementation of a capstone project, as well as any contributions of the project to policy development.Competency 8: Integrate professional standards and values into practice.Reflect on personal and professional growth throughout the capstone project and the BSN program, addressing the provision of ethical care and demonstration of professional standards.Communicate professionally in a clear, audible, and well-organized presentation, with correct grammar, spelling, and use of APA style.Important: You must complete all of the assessments in order for this course.Professional ContextBSN-prepared nurses have many opportunities to reflect on their contributions to patient care outcomes during clinical experiences. After a patient care interaction, it is important to evaluate how well you addressed the criteria set for the nurse-patient interaction and consider future improvements. Research suggests that creating and sharing video reflections may enhance learning (Speed, Lucarelli, & Macaulay, 2018).PreparationThis assessment requires you to prepare a 5–10-minute video reflection on your capstone clinical practicum experience. Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact [email protected] to request accommodations. If you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment.Complete the following preparatory activities:If necessary, set up and test your microphone or headset per the manufacturer instructions.Practice using the equipment to ensure the audio quality is sufficient.Consult the Campus resourceUsing Kaltura [PDF]for guidance on recording and uploading your assessment in the courseroom.Begin developing your reflection. Some questions you might address in your reflection video are:What were your most important outcomes or findings?What challenges did you overcome throughout your project?How did your initial research and evidence base help you plan and execute your capstone project?How were the outcomes similar to and different from your expectations?How did you feel your professional product turned out?What impacts of the implementation of your professional product did you observe?To what degree were you successful in using technology in your capstone project?How did organizational or governmental health policy impact the way in which you approached your project?What contributions did you make to your organization’s policies throughout the course of your project?In which areas do you feel you grew the most?How will your learning affect your professional practice and ability to implement ethical care in accordance with professional codes of conduct?What would you do differently if you could do the capstone project or program again?What accomplishment are you most proud of, within the context of the capstone or the program as a whole?Examine your capstone project through the lens of your initial plan and literature review.InstructionsUse Kaltura to record a 5–10-minute video reflection addressing the following scoring guide grading criteria. Please study the scoring guide carefully so you know what is needed for a distinguished score:Reflect on how evidence and the literature were utilized to plan and implement a capstone project, as well as how project outcomes compared to initial predictions based on a review of the literature.Reflect on the degree to which health care technology was successfully used to improve outcomes or communication to relevant stakeholders in the capstone project.Reflect on how organizational and governmental health policy influenced the planning and implementation of a capstone project as well as any contributions to policy development that the project made.Reflect on personal and professional growth throughout the capstone project and the BSN program, paying special attention to growth related to the provision of ethical care and demonstration of professional standards.Communicate audibly and professionally, using proper grammar and including a reference list formatted in current APA style.Important Note: You do not need to submit the transcript of your video, but do address each scoring guide criterion in the video, including a discussion of authors in the literature who support the ideas presented. Please submit a separate APA-formatted reference list for the resources discussed in your reflection.Additional RequirementsReferences: Cite a minimum of three scholarly and/or authoritative sources to support your assertions.APA style and format: Submit, along with the video, a separate references page that follows APA style and formatting guidelines. Refer to theAPA Moduleas needed.

Health Promotion Plan Presentation

Build a slide presentation (PowerPoint preferred) of the health promotion plan you developed in the first assessment. Then, implement your health promotion plan by conducting a face-to-face educational session addressing the health concern and health goals of your selected community member or group. In addition, collaborate with any participants in setting goals for the session, evaluating session outcomes, and suggesting possible revisions to improve future sessions.As you begin to prepare this assessment, you are encouraged to complete the Vila Health: Conducting an Effective Educational Session activity. The information gained from completing this activity will help you succeed with the assessment as you consider key issues in conducting an effective educational session for a selected audience. Completing activities is also a way to demonstrate engagement.Professional ContextHealth education is any combination of learning experiences designed to help community individuals, families, and aggregates improve their health by increasing knowledge or influencing attitudes (WHO, 2018). Education is key to health promotion, disease prevention, and disaster preparedness. The health indicator framework identified in Healthy People 2020 helps motivate action in such areas as health service access, clinical preventive services, environmental quality, injury or violence, maternal, infant and child health, mental health, nutrition, substance abuse, and tobacco use.Nurses provide accurate evidence-based information and education in various formal and informal settings. They draw upon evidence-based practice to provide health promotion and disease prevention activities to create social and physical environments conducive to improving and maintaining community health. When provided with the tools to be successful, people demonstrate lifestyle changes (self-care) that promote health and help reduce readmissions. They are better able to tolerate stressors, including environmental changes, and enjoy a better quality of life. In times of crisis, a resilient community is a safer community (ODPHP, n.d.; Flanders, 2018).This assessment provides an opportunity for you to apply teaching and learning concepts to the presentation of a health promotion plan.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Competency 3: Evaluate health policies, based on their ability to achieve desired outcomes.Evaluate educational session outcomes in terms of progress made toward Healthy People 2020 goals and leading health indicators.Competency 4: Integrate principles of social justice in community health interventions.Evaluate educational session outcomes and the attainment of agreed-upon health goals in collaboration with participants.Competency 5: Apply professional, scholarly communication strategies to lead health promotion and improve population health.Present a health promotion plan to an individual or group within a community.ReferencesU.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP). (n.d.). Healthy People 2020. Retrieved from https://www.healthypeople.gov/Flanders, S. A. (2018). Effective patient education: Evidence and common sense. Medsurg Nursing, 27(1), 55–58.Note: This is the second part of a two-part assessment. You must complete Assessment 1 before completing this assessment.PreparationThis assessment builds upon Assessment 1 where you contacted and secured local individuals or group in your community who were open to a presentation about a health concern and health promotion strategies. Once again, you will assume the role of a community nurse tasked with addressing the specific health concern within your chosen community. This time, you will implement the health promotion plan that you developed in Assessment 1 as a PowerPoint presentation. This presentation must be live and face-toface. You know that you must determine an effective teaching strategy, communicate the plan with professionalism and cultural sensitivity, obtain input on the value of the plan to the individual or group, and revise the plan, as applicable, to improve future educational sessions. To engage your audience, you decide to develop a slide presentation to communicate your plan. A copy of the slide presentation could also be given to the individual or group for future reference.Remember that your first assessment (Assessment 1) MUST be satisfactorily completed to initiate this assessment (Assessment 4). These assessments meet the three-hour clinical learning experience required in this coursePlease review the assessment scoring guide for more information.To prepare for the assessment, you are encouraged to complete the Vila Health: Conducting an Effective Educational Session simulation. You may also wish to review the health promotion plan presentation assessment and scoring guide to ensure that you understand all requirements.Note: Remember that you can submit all, or a portion of, your draft plan toSmarthinking Tutoringfor feedback before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.InstructionsComplete the following:Prepare a PowerPoint presentation of the health promotion plan you developed in Assessment 1, with detailed speaker’s notes that include your evaluation of session outcomes. Speaker notes should reflect what you will actually say when you conduct the face-to-face session.Implement your health promotion plan by conducting a face-to-face educational session addressing the health concern and health goals of your chosen participants. Collaborate with the participants in setting session goals, evaluating outcomes, and suggesting possible revisions to improve future sessions.As you begin to prepare this assessment, you are encouraged to complete the Vila Health: Conducting an Effective Educational Session activity. The information gained from completing this activity will help you succeed with the assessment as you consider key issues in conducting an effective educational session for a selected audience. Completing activities is also a way to demonstrate engagement.Completion of this assessment, and the course, requires that you spend a minimum of three hours face-to-face working with your identified patient who may be a community member or group. Remember that it is a requirement to log your direct clinical hours in the CORE ELMS system.Please be advised that the Volunteer Experience form requires that you provide the name and contact information for at least one individual with whom you worked as part of your direct clinical activity. Your faculty may reach out to this individual to verify that you have accurately documented and completed your clinical hours.PRESENTATION FORMAT AND LENGTHYou may use Microsoft PowerPoint (preferred) or other suitable presentation software to create your slides. If you elect to use an application other than PowerPoint, check with your faculty to avoid potential file compatibility issues.The number of content slides in your presentation is dictated by nature and scope of your health promotion plan. Be sure to include title and references slides per the following:Title slide:Health promotion plan title.Your name.Date.Course number and title.References (at the end of your presentation).Be sure to apply correct APA formatting to your references.The following resources will help you create and deliver an effective presentation:Record a Slide Show With Narration and Slide Timings.This Microsoft article provides steps for recording slide shows in different versions of PowerPoint, including steps for Windows, Mac, and online.Microsoft Office Software.This Campus page includes tip sheets and tutorials for Microsoft PowerPoint.PowerPoint Presentations Library Guide.This library guide provides links to PowerPoint and other presentation software resources.SoNHS Professional Presentation Guidelines [PPTX].This presentation, designed especially for the School of Nursing and Health Sciences, offers valuable tips and links, and is itself a PowerPoint template that can be used to create a presentation.SUPPORTING EVIDENCESupport your plan with at least three professional or scholarly references, which may include peer-reviewed articles, course study resources, and Healthy People 2020 resources.GRADED REQUIREMENTSThe requirements outlined below correspond to the grading criteria in the assessment scoring guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.Present your health promotion plan to your chosen audience.Tailor the presentation to the needs of your audience.Adhere to scholarly and disciplinary writing standards and APA formatting requirements.Evaluate educational session outcomes and the attainment of agreed-upon health goals in collaboration with participants.Which aspects of the session would you change?How might those changes improve future outcomes?Evaluate educational session outcomes in terms of progress made toward Healthy People 2020 goals and leading health indicators.What changes would you recommend to better align the session with Healthy People 2020 goals and leading health indicators?Grading Rubric:1.  Present a health promotion plan to an individual or aggregate within a community.Passing Grade: Presents a professional, evidence-based, and engaging presentation with clear audio appropriate for the participant(s). The plan is based on specific, identified health needs and goals, and is well supported by error-free slides that enhance key points and adhere to visual design best practices. Provides speaker notes.2.  Evaluate educational session outcomes and the attainment of agreed-upon health goals in collaboration with participants.Passing Grade:  Evaluates educational session outcomes and the attainment of agreed-upon health goals in collaboration with participants. Clearly explains the need for revisions to future educational sessions.3.  Evaluate educational session outcomes in terms of progress made toward Healthy People 2020 goals and leading health indicators.Passing Grade:  Evaluates educational session outcomes in terms of progress made toward Healthy People 2020 goals and leading health indicators. Clearly explains the need for revisions to better align future sessions with Healthy People 2020 goals.

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Week 10 Assignment: Special Examinations—Breast, Genital, Prostate, and Rectal/Genitalia assessment

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.To PrepareReview the Episodic note case study for this week’s Assignment.Based on the Episodic note case study:Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.Consider what history would be necessary to collect from the patient in the case study.Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.The Lab AssignmentUsing evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.Analyze the subjective portion of the note. List additional information that should be included in the documentation.Analyze the objective portion of the note. List additional information that should be included in the documentation.Is the assessment supported by the subjective and objective information? Why or why not?Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.Week 10 Assignment: Special Examinations—Breast, Genital, Prostate, and Rectal/Genitalia assessmentSubjective:CC: “I have bumps on my bottom that I want to have checked out.”HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.PMH: AsthmaMedications: Symbicort 160/4.5mcgAllergies: NKDAFH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERDSocial: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)Objective:VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbsHeart: RRR, no murmursLungs: CTA, chest wall symmetricalGenital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labiaAbd: soft, normoactive bowel sounds, neg rebound, neg Murphy’s, neg McBurneyDiagnostics: HSV specimen obtainedAssessment:ChancrePLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.By Day 7 of Week 10

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Assignment: Academic Success and Professional Development Plan Part 3: Strategies to Promote Academic Integrity and Professional Ethics

Nurse-scholars have a significant obligation to their community as well. Their work must have academic and professional integrity. Their efforts are designed to add to the body of knowledge, advance the profession, and ultimately help in the care of patients. Work that lacks integrity is subject to erode quickly or worse.Fortunately, there are strategies and tools that can help ensure integrity in academic and professional work. This assignment asks you to consider these tools and how you might apply them to your own work.In this Assignment, you will continue developing your Academic Success and Professional Development Plan by appending the original document you began in the previous assignment.To Prepare:Reflect on the strategies presented in the Resources for this Module in support of academic style, integrity, and scholarly ethics.Reflect on the connection between academic and professional integrity.The Assignment:Part 3, Section 1: Writing Sample: The Connection Between Academic and Professional IntegrityUsing the Academic and Professional Success Development Template you began in Module 1 and expanded in Module 2, write a 2- to 3-paragraph analysis that includes the following:An explanation for the relationship between academic integrity and writingAn explanation for the relationship between professional practices and scholarly ethicsCite at least two resources that support your arguments, being sure to use proper APA formatting.Use Grammarly and SafeAssign to improve the product.Explain how Grammarly, Safe Assign, and paraphrasing contributes to academic integrity.Part 3, Section 2: Strategies for Maintaining Integrity of WorkExpand on your thoughts from Section 1 by:identifying and describing strategies you intend to pursue to maintain integrity and ethics of your: (1) academic work as a student of the MSN program and (2) professional work as a nurse throughout your career. Include a review of resources and approaches you propose to use as a student and a professional.Note: Add your work for this Assignment to the original document you began in the Module 1 Assignment, which was built from the Academic Success and Professional Development Plan Template.Rubric and template attached below.

Transition to the Nursing profession

RUA: Transitions Paper  (Summuraize this article as an essay  2 full pages not including title page and reference page)  (I upload  below the article and the student paper to follow as an example)The title of the essay is “Safety””Does Nursing Home Compare Reflect Patient Safety In Nursing Homes? Article upload to write about”APA format:https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/in_text_citations_the_basics.htmlOnly use this website or library to find the article to support the essay:CINAHL with Full TextProQuest NursingAccess MedicineCochrane LibraryPubMedCriteria1) Include the following sections.A. Introduction – 20 points/13%• Clearly establishes the purpose of the paper• Includes key points to be covered• Captures the reader’s interestB. Body of Paper – 60 points/40%• Complete, well-developed discussion of key points• Supports the purpose or main idea of the paper• Logical development of ideas with clear and accurate information• Ideas and statements are supported by three or more examples from personal and/or professional experiences• Provides own perspectives on the topic that is reflective, insightful, and originalC. Conclusion – 30 points/20% • Clear and concise• Summarizes key points discussed in the paper• Leaves a strong impression, message, or idea on the readerD. Writing Style – 15 point/10% e. Correct use of standard English grammar, paragraph, and sentence structureF. No spelling or typographical errorsG. Organized around required componentsH. Information flows in a logical sequence that is easy for the reader to followI. APA Format, and References – 25 points/17%• There is a correct and appropriate use of margins, spacing, font, and headers• Document setup includes title and reference pages in correct APA format NR103 Transition to the Nursing Profession Transitions Paper Guidelines NR103_Transitions_Paper_Guidelines 2• Citation of sources included in the body of the paper uses the correct APA format for direct and indirect quotes• All elements of each reference are included in the correct order• All information taken from the source, even if summarized, is cited and listed on the Reference page• All sources used are nursing journals published within the last five years For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library

week11 6053

Assignment: Change Implementation and Management PlanIt is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.To Prepare:Review the Resources and identify one change that you believe is called for in your organization/workplace.This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.Reflect on how you might implement this change and how you might communicate this change to organizational leadership.The Assignment (5-6-minute narrated PowerPoint presentation):Change Implementation and Management PlanCreate a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.Your narrated presentation should be 5–6 minutes in length.Your Change Implementation and Management Plan should include the following:An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)A description of the change being proposedJustifications for the change, including why addressing it will have a positive impact on your organization/workplaceDetails about the type and scope of the proposed changeIdentification of the stakeholders impacted by the changeIdentification of a change management team (by title/role)A plan for communicating the change you proposeA description of risk mitigation plans you would recommend to address the risks anticipated by the change you proposeLearning ResourcesRequired ReadingsMarshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.Chapter 8, “Practice Model Design, Implementation, and Evaluation” (pp. 195–246)Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222–230. Retrieved from https://medcom.uiowa.edu/annsblog/wp-content/uploads/2012/10/JONA-FINAL-Cullen-2012.pdfPollack, J., & Pollack, R. (2015). Using Kotter’s eight stage process to manage an organizational change program: Presentation and practice. Systemic Practice and Action Research, 28(1), 51-66.Note: You will access this article from the Walden Library databases.Seijts, G. H., & Gandz, J. (2016). Transformational change and leader character. Business Horizons, 61(2), 239-249. https://doi.org/10.1016/j.bushor.2017.11.005Note: You will access this article from the Walden Library databases.Tistad, M., Palmcrantz, S., Wallin, L., Ehrenberg, A., Olsson, C. B., Tomson, G., …Eldh, A. C. (2016). Developing leadership in managers to facilitate the implementation of national guideline recommendations: A process evaluation of feasibility and usefulness. International Journal of Health Policy and Management, 5(8), 477–486. doi:10.15171/ijhpm.2016.35. Retrieved from http://www.ijhpm.com/article_3183_5015382bcf9183a74ef7e79b0a941f65.pdfRequired MediaTEDx. (2013, January). Six keys to leading positive change: Rosabeth Moss Kanter at TEDxBeaconStreet [Video file]. Retrieved from https://www.youtube.com/watch?v=owU5aTNPJbs

Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.To Prepare:Review the Resources and select one current national healthcare issue/stressor to focus on.Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.By Day 3 of Week 1Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.By Day 6 of Week 1Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.Will be adding two discussions that will need at least three references all in APA 7 format each. will be included in this payment.The mail discussion will need at least 3 references and also in APA 7 formatAdams DiscussionCurrent Healthcare IssueNational Healthcare StressorThe last decade in healthcare has been volatile at best with the adoption of the Affordable Care Act (ACA) and performance-based payment systems, the ever-increasing polar divide between our political party’s healthcare theories and the never ending back and forth political discord that threatens to blow it all up and start over with something better, but never explained in detail. One of the constants that I continue to see is the increase in psychiatric patients coming into the hospital that I work. A number of these patients are undiagnosed with a psychiatric diagnosis or cannot find a provider that is seeing new patients. Many providers that are seeing new patients currently have wait times four weeks out. Someone that is experiencing psychiatric symptoms this wait could have a derailing effect on the efficacy of the treatment.The number of patients needing psychiatric treatment in the United States is increasing and roughly one-third of the 10 million Americans are diagnosed with a psychiatric disorder but not getting treatment. (Olfson, 2016) One of the reasons for this is the lack of providers in the psychiatric specialty. With reimbursement rates falling lower than many other specialty services many institutions are struggling to cover salaries. With more than 60% of current providers aged 55 years or greater, this is also adding to the decreasing numbers. Another factor, is the increase in acceptability in discussing mental health issues and seeking out treatment. According to Weiner, (2018), with more patients seeking treatment, current providers are unable to increase their treatment numbers.Impact on work settingThe institution that I work at is a safety net hospital that provides medical and social care to a population where 70% live at or below the poverty line. Many of these patients have undiagnosed or unmanaged psychiatric disorders that provide harm and are a detriment to their medical issues such as diabetes, cardiac issues and COPD. Working nights, I am accustomed to doing more with less. One of the challenges that I face constantly is the lack of psychiatric evaluations once a patient leaves the emergency department. Medical teams are forced to make psychiatric pharmaceutical decisions off the cuff until 7 AM when the psychiatric team rounds on a particular patient. This is particularly difficult on patients and staff alike.Respondence to the issueTo create a discussion on this our staff used our unit council to speak to the Director of Critical Care, Nursing and Medicine, inviting the Psychiatric department to our monthly unit council meeting in hopes to better understand why this was not a priority as well as speaking to the Vice President of Nursing and the Medical Director about the importance of psychiatric services outside the emergency room on a 24 hour basis. After years of voicing concerns to upper Medicine and Nursing Management our institution increased inpatient psychiatric coverage to 24 hours per day.  Patients in need of psychiatric evaluations who have made in past the emergency room have an opportunity to be treated when they arrive on our unit. Our ICU team now has a partner when questioning what type of medication to give an irate patient who is a danger to himself or others. This intervention exemplifies the use of the quadruple aim approach with its increase in global health, improving patient experience, lowering costs and improving work-life for our staff. (Jacobs et al., 2018)References:Jacobs, B., Heinmiller, J., McGovern, J., & Drenkard, K. (2018). Engaging Employees in Well-Being: Moving From the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42(3). https://doi.org/10.1097/NAQ.0000000000000303Olfson, M. (2016). Building The Mental Health Workforce Capacity Needed To Treat Adults With Serious Mental Illnesses. Health Affairs, 35(6), 983–990.https://doi.org/10.1377/hlthaff.2015.1619Weiner, S. (2018, February 12). Addressing the escalating psychiatrist shortage. AAMC. https://www.aamc.org/news-insights/addressing-escalating-psychiatrist-shortage.Rebeccas DiscussionReview of Current Healthcare IssuesNational Healthcare Issue/StressorHealthy People is a set of strategic goals released by the U. S. Department of Health and Human Services designed to measure progress towardspecific health objectives aimed at enabling people to live long and healthy lives. Healthy People 2020 is the fourth Healthy People initiative released.It includes the goal of improving mental health through prevention and by ensuring access to appropriate, quality mental health services (HealthyPeople, 2020).  Mental health disorders such as anxiety, depression, and substance abuse are increasing in prevalence and most cases of mentalillness occur earlier in life. The disease burden and costs associated with untreated or under-treated mental health disorders are rapidly increasing.Mental health disorders are a common cause of disability and suicide is the 10th leading cause of death in the U.S. In addition, our country will see aheavier mental health burden due to the COVID-19 pandemic (Stephenson, 2020). Therefore, it is crucial to include mental health objectives in theHealthy People goals, to measure our progress, and to recognize the importance of meeting these goals.Impact on Work SettingCurrently, I work for a large health insurance company where I conduct medical necessity reviews of behavioral health treatment modalities toinclude both inpatient and outpatient care.  Our company has seen sharp increases in the need for behavioral health treatment to include inpatientmental health stays, inpatient detox stays, partial hospital stays, and intensive outpatient therapy.  More behavioral health clinicians had to bebrought on and trained to meet this current demand. Another impact to my work setting involves the fact that poor mental health has negativeimpacts on physical health. Untreated mental illness can lead to chronic diseases which drive up the cost of health care.  Active treatment of mentalhealth issues, as opposed to prevention and early intervention, is more costly.Responding to the issueOur company firmly believes in quality, cost-effective care and awards facilities that meet these milestones.  We continuously assess and updateour guidelines and coverage policies to reflect this. The company recognizes that mental health treatment is not a one-size-fits-all approach.  Recentlywe changed guidelines for reviewing substance abuse treatment to the American Society of Addiction Medicine (ASAM) guidelines.  This approachlooks at the whole patient by assessing 6 dimensions that consider a person’s needs and severity of illness to help develop a treatment plan. Thepremise is that patients can be assigned to treatments that “yield the best outcomes in the least restrictive and costly settings” (Stallvik et al., para 8).By reviewing against these guidelines, we are ensuring that patients get the appropriate treatment at the appropriate time.The company has been educating staff on current behavioral health trends, new treatments, and the impact of the COVID pandemic. We have anactive behavioral health case management team that reaches out to patients before, during, and after treatment to ensure they are set up with thenecessary follow up. We encourage and assist patients with finding primary care providers.  Park et al. (2018) state that primary care produces ahigher quality of care, improves access and outcomes, and lowers cost.  Additionally, one of our nurse leaders recently posted an informative seriesabout the social determinants of health and the importance of helping our patients overcome barriers so they can achieve their best physical andmental health.  An organization needs effective leaders like this who can bring these issues to the forefront and encourage others to become activeparticipants in the change process (Broome & Marshall, 2021). The company’s website includes links to many resources such as food pantries, ride-sharing, and mental health services.  By making this information readily available, we are making efforts to increase prevention and earlyintervention. As a whole, I believe the company has responded well to the national healthcare issue of mental illness and I feel confident that we willcontinue to look for ways to improve patient access and patient outcomes.ReferencesBroome, M., & Marshall, E.S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY:Springer.Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2020: Mental health and mental disorders. Retrieved November 28, 2020from  https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disordersPark, B., Gold, S.B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on theQuadruple Aim. Journal of the American Board of Family Medicine, 31(4), 588-604.Stallvik, M., Gastfriend, D.R., & Nordahl, H. M. (2015). Matching patients with substance use disorder to optimal level of care with the ASAM Criteriasoftware. Journal of Substance Use, 20(6), 389-398.  https://doi.org.ezp.waldenulibrary.org/10.3109/14659891.2014.934305Stephenson, J. (2020). CDC report reveals “considerably elevated” mental health toll from COVID-19 stresses. Retrieved November 29, 2020 fromhttps://jamanetwork.com/channels/health-forum/fullarticle/2770050