NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Gastrointestinal and Hepatobiliary Disorders

Hepatitis C is one of the main sources of cirrhosis and builds the danger of wellbeing difficulties, particularly when there is liver irritation. Before interceding, there is a need to comprehend the patient’s clinical history since it may impact measures to improve the patient’s prosperity (Rosenthal & Burchum, 2020). For example, prednisone smothers the immune system, and there is a need to comprehend why the patient is utilizing the intercession. The clinical history likewise extends to the period when the side effects have happened and Hepatitis.

Primary Diagnosis

            Although a comprehensive history and physical assessment, a diagnostic workup is expected to concoct a primary diagnostic; in light of the introducing symptoms, I will give a primary finding of intense gastroenteritis (Chalasani, Younossi, & Lavine, 2018). The cause is that the stomach and intestinal system are frequently triggered by the virus and bacterial disturbances/aggravation of foods sullied with viruses and parasites. Squeezing, nausea, groaning, or running can have symptoms. Most of the disease efficiently spread from contact with a weakened person or consumes, and drinks of sullied food or foods often spread the disease (Arcangel & Peterson, 2017). The signs typically occur one to three days after pollution. Because the patient is sick, loose, and thick bowels and does not have a fever, I would end up with severe bacterial gastroenteritis.

Differential Diagnosis

            In the context of the history of the patient’s drug abuse, I will be speaking of a specific assessment of hepatitis C severity in the use of IV medicines and of adding indications. Hepatitis C is a serious hepatitis disease caused by hepatitis C infection. It usually results from harming blood or bodily fluid, sex, or needle exchange, which may be severe unclear stomach torment, and often diarrhea, individually or separately. It may be caused by the use of illicit drugs or drugs (Rosenthal & Burchum, 2020)Intense hepatitis C causes diarrhea. Though this underlying infection is most unlikely to cause signs, about 21-30 % of people show indicators approximately 1 to 3 months after the infection has occurred. NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Drug Therapy and Treatment Plan

            The primary goal of treatment is lessening the indications and the avoidance of complications. Because the patient is vomiting, dehydration and diarrhea, either 0.8 percent of intravenous liquid hydration will lead to the depletion of fluid from and runs and will avoid further dehydration (Chalasani, Younossi, & Lavine, 2018). I advise the patient to drink clear beverages and stock to support the lack of supplants and electrolytes as nausea subsides. On the other hand, if it is bacterial contamination, I will proceed with IV liquid and an anti-infection like an expansive range anti-toxin like Ciprofloxacin.

References

Arcangel, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Wolters Kluwer.

Chalasani, N., Younossi, Z., & Lavine, J. E. (2018). The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology, 328-357.

Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier – Health Sciences Division.

 

Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

 

Photo Credit: Getty Images/iStockphoto

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

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To Prepare
  • Review the case study assigned by your Instructor for this Assignment
  • Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
  • Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
  • Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
By Day 7 of Week 4

Write a 1-page paper that addresses the following:

  • Explain your diagnosis for the patient, including your rationale for the diagnosis.
  • Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
  • Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission. NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Excellent Good Fair Poor
Explain your diagnosis for the patient, including your rationale for the diagnosis.
23 (23%) – 25 (25%)
The response accurately and clearly explains in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment.
20 (20%) – 22 (22%)
The response provides a basic explanation of 1-2 diagnoses for the patient, including an accurate rationale for the diagnosis that may support clinical judgment.
18 (18%) – 19 (19%)
The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment.
(0%) – 17 (17%)
The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing.
Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
27 (27%) – 30 (30%)
The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
24 (24%) – 26 (26%)
The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
21 (21%) – 23 (23%)
The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
(0%) – 20 (20%)
The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.
27 (27%) – 30 (30%)
The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient. 

The response includes specific, accurate, and detailed examples that fully support the justification provided.

24 (24%) – 26 (26%)
The response provides a basic justification for the recommended drug therapy plan for this patient. 

The response includes only 1-2 examples that fully support the justification provided.

21 (21%) – 23 (23%)
The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient. 

The response may include examples, which may inaccurately or vaguely support the justification provided.

(0%) – 20 (20%)
The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing. 

The response does not include examples that support the justification provided, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
(5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
(4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
(0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
(4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
(0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
(5%) – 5 (5%)
Uses correct APA format with no errors
(4%) – 4 (4%)
Contains a few (1–2) APA format errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
(0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100

NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders

NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders

Week 2 Case Assignment

Patient Factor

The patient factor I chose is to conduct factors, which centers on the AO’s obesity. Obesity is a risk factor for both hypertension and hyperlipidemia, just as different conditions, for example, diabetes that can confound treatment for cardiovascular issues. Two components influencing the pharmacokinetics for this patient incorporate helpless nourishment and diminished course. It is expected that this current patient’s sustenance is poor, as this generally goes with obesity (Burchum & Rosenthal, 2017). Decreased circulation can be influenced by restricted physical movement, vasoconstriction that goes with hypertension, and the potential for plaque development in hyperlipidemia. Understanding these danger factors just as the potential impacts they may have on the patient’s capacity to react suitably to a medicine routine and get restorative treatment, the patient should be urged to adjust their eating regimen and exercise propensities too, especially through the proposal of the DASH diet.

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Improving the Drug Therapy Plan

            There are a few regions for development in AO’s medication plan. Initially, beta-blockers are known to add to hyperlipidemia. Additionally, beta-blockers are not regularly utilized as a first-line treatment for hypertension. Getting this, the atenolol should be suspended. Since the atenolol is being ended, hydralazine should also be ceased, as it should in a perfect world be given with a beta-blocker and a diuretic. Since the suggested first line of treatment for hypertension is diuretics, a portion of 12.5 mg of hydrochlorothiazide should be started every day (Jiang & Lu, 2016).  This medication was chosen since thiazide diuretics are viewed as safe in diabetics, with a decrease in mortality from coronary illness and stroke. The dose was chosen because, however, they are viewed as sheltered and helpful; people with diabetes should be regulated thiazide diuretics at the most minimal conceivable portion. Though the patient is not a known diabetic, the person has many risk factors for the sickness, and it should be viewed as an undeniable chance that the patient either as of now has or will before long create diabetes (Quintana, Janszky, & Gigante, 2016). Simvastatin is a suitable decision for hyperlipidemia, as the statin drug class is the suggested first-line treatment and individual medication decision is directed by the cholesterol levels, which I was not given. NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders 

References

Burchum, J., & Rosenthal, L. (2017). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants – E-Book. Elsevier Health Sciences.

Jiang, S.-Z., & Lu, W. (2016). Obesity and hypertension. Experimental and therapeutic medicine, 30-35.

Quintana, H. K., Janszky, I., & Gigante, B. (2016). Diabetes, hypertension, overweight and hyperlipidemia and 7-day case-fatality in first myocardial infarction. IJC Metabolic & Endocrine, 30-35.

 

 

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

Photo Credit: Getty Images/Science Photo Library RF

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare
  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
  • Review the case study assigned by your Instructor for this Assignment.
  • Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
  • Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
  • Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission. NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders

 

Excellent Good Fair Poor
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
23 (23%) – 25 (25%)
The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.
20 (20%) – 22 (22%)
The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.
18 (18%) – 19 (19%)
The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.
(0%) – 17 (17%)
The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing.
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
27 (27%) – 30 (30%)

The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy.

Accurate, complete, and aligned examples are provided to support the response.

24 (24%) – 26 (26%)

The response accurately describes how changes in the processes might impact the patient’s recommended drug therapy.

Accurate examples may be provided to support the response.

21 (21%) – 23 (23%)

The response inaccurately or vaguely describes how changes in the processes might impact the patient’s recommended drug therapy.

Inaccurate or vague examples are provided to support the response.

(0%) – 20 (20%)

The response inaccurately and vaguely describes how changes in the processes might impact the patient’s recommended drug therapy, or is missing.

Inaccurate and vague examples may be provided to support the response, or is missing.

Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements.
27 (27%) – 30 (30%)

The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan.

The response includes an accurate and detailed explanation to support the recommended improvements.

24 (24%) – 26 (26%)

The response accurately explains how to improve the patient’s drug therapy plan.

The response may include an accurate explanation to support the recommended improvements.

21 (21%) – 23 (23%)

The response inaccurately or vaguely explains how to improve the patient’s drug therapy plan.

The response may include an inaccurate, vague, or misaligned explanation to support the recommended improvements.

(0%) – 20 (20%)

The response inaccurately and vaguely explains how to improve the patient’s drug therapy plan, or is missing.

The response may include an inaccurate and vague explanation to support the recommended improvements, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
(5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
(4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
(0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
(4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
(0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
(5%) – 5 (5%)
Uses correct APA format with no errors
(4%) – 4 (4%)
Contains a few (1–2) APA format errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
(0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100

NURS 6521: Advanced Pharmacology Discussions, Assignments and Exams

NURS 6521: Advanced Pharmacology Discussions, Assignments and Exams

Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

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This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors. NURS 6521: Advanced Pharmacology Discussions, Assignments and Exams

Learning Objectives

Students will:

  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
  • Assess patient factors and history to develop personalized plans of care
  • Evaluate ethical and legal implications related to prescribing drugs
  • Analyze ethical and legal practices of prescribing drugs
  • Analyze strategies to address disclosure and nondisclosure
  • Justify advanced practice nurse strategies to guide prescription drug decision-making
  • Analyze the process of writing prescriptions to avoid medication errors

Learning Resources

Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare
  • Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
  • Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
  • Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease. NURS 6521: Advanced Pharmacology Discussions, Assignments and Exams
  • Think about a personalized plan of care based on these influencing factors and patient history in your case study.
By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

By Day 6 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion


Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient? NURS 6521: Advanced Pharmacology Discussions, Assignments and Exams

These are some of the questions you might consider when selecting a treatment plan for a patient.

Photo Credit: Getty Images/Caiaimage

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare
  • Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
  • Review the scenario assigned by your Instructor for this Assignment.
  • Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
  • Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
  • Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

  • Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
  • Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
  • Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
  • Explain the process of writing prescriptions, including strategies to minimize medication errors.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 1 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 1 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission. NURS 6521: Advanced Pharmacology Discussions, Assignments and Exams
Grading Criteria

To access your rubric:

Week 1 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 1 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 1

To participate in this Assignment:

Week 1 Assignment


What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will examine the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders and the types of drugs prescribed to patients with respiratory disorders.

Looking Ahead: Week 2 Assignment

In Week 2, your Instructor will assign you a case study related to Assignment 1 by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and Learning Resources in order to complete your Assignment on time.

Photo Credit: Getty Images/iStockphoto

Next Week

Discussion: Review of Current Healthcare Issues

Discussion: Review of Current Healthcare Issues

Discussion: 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 Discussion: Review of Current Healthcare Issues.

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. Discussion: Review of Current Healthcare Issues

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By Day 3 of Week 1

Post 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 1

Respond 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 Discussion: Review of Current Healthcare Issues

Assignment: Analysis of a Pertinent Healthcare Issue

Assignment: Analysis of a Pertinent Healthcare Issue

Assignment: Analysis of a Pertinent Healthcare Issue

Analysis of Pertinent Healthcare Issue

The healthcare issue addressed at Bergen New Bridge Medical Center Paramus, NJ (BNBMC) entails timely access to aftercare either in Psychiatric partial hospitalization, (PHP) intensive outpatient (IOP), or outpatient (OP) level of care. The ACA’s focus on increasing and improving healthcare systems remains an issue at BNBMC (Broom & Marshall, 2021). The ACA goal for healthcare in the United States to enhance healthcare access to health rather than disease is germane to expanding resource availability. PHP, IOP, and OP remain limited at BNBMC. PHP evaluations are only available Monday, Wednesday, and Friday. Therefore, a request to expand available PHP appointments to more than three and IOP and OP appointments for evaluations to more than two per week. The inadequacy puts patients at high risk for relapse after leaving the emergency department and in need of inpatient hospitalization Assignment: Analysis of a Pertinent Healthcare Issue.

The leadership proposal is to expand virtual appointments for evaluations for all outpatient levels of care mentioned. Furthermore, the request is for hiring additional staff to accommodate the need for timely appointments to evaluate and have patients begin treatment within the same week they have presented to the emergency department due to a psychiatric crisis. A review of two recent studies regarding the effectiveness of virtual psychiatric care will follow. Assignment: Analysis of a Pertinent Healthcare Issue

First Brief Summary of an Article Supporting Efficacy and Effectiveness to Expand use of

Telepsychiatry to Accommodate Healthcare Needs

The broad study of literature found the COVID-19 pandemic has initiated extraordinary healthcare system adjustments benefiting psychiatry for one through telepsychiatry (Chen et al.,2020). The pandemic propelled insurance payment for telepsychiatry by reducing regulations previously prohibiting the same (2020). The research findings show effectiveness, and at times telepsychiatry demonstrates above-average benefits than in-person psychiatric treatment (2020). Psychotherapist and psychiatric clinicians note the advantage of seeing a glimpse into the patients’ lives while in their home environment through virtual treatment connections (2020) Assignment: Analysis of a Pertinent Healthcare Issue. Psychiatric clinician reviews of their experience of conducting telepsychiatry provide communication to the leadership of additional needs to effectively provide care (2020). Some of those needs include additional supervision, support and validation, and ongoing research on telepsychiatry care (2020).

Advocacy for the expansion of outpatient providers in psychiatry to comply with enhancing healthcare access to focus on health rather than disease is pertinent to expanding resource availability at BNBMC.

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 Second Brief Summary of Article Supporting Efficacy and Effectiveness to Expand use of

Telepsychiatry to Accommodate

Transition from in-person to psychiatry’s virtual format during the COVID-19 pandemic thrust upon the healthcare community. The experience has demonstrated the capability of healthcare services to be creative and resilient. Once considered limited out of necessity in remote locations has become the dominant form of outpatient psychiatric treatment. One facility readily adapted to the development of a virtual psychiatric partial hospitalization by patients and clinical staff. Clinical staffs’ creation of protocols for evaluation with the inpatient clinical team to determine patient appropriateness for virtual PHP became routine (Hom et al., 2020). Based on a basic assessment of the patients’ capability to use a smartphone or iPad, focusing and engaging mentally and emotionally came first. Confirmation that the patient had established an outpatient therapist and psychiatric clinician was necessary for the patients’ emergency needs during off-hours (2020). Patients accepted into the PHP were given an orientation while still inpatient to accessing the virtual environment in addition to a packet of written material with a schedule (2020) Assignment: Analysis of a Pertinent Healthcare Issue.

Gathering treatment outcome data and patients’ evaluations to determine the effectiveness of this essential modality of treatment will further inform of overall strengths and feasibility to continue virtual PHP, IOP, and outpatient treatment post-COVID-10 pandemic (2020). These activities will serve well to inform leadership and the payor sources of the same. Again, the need to expand virtual psychiatry is at hand to accommodate those patients in need who may otherwise fall through the cracks when discharged without a follow-up plan.

 

Strategies Used to Address the Organizational Impact of National Healthcare

Issues/Stressors

The national healthcare issue of COVID-19, while striving to reach the ACA focus to increase and improve healthcare systems, remains an issue at BNBMC. The problem existing at BNBMC to accommodate patients discharged from the emergency department with a timely appointment in PHP, IOP, or OP levels of care requires attention…

 

Assignment: Analysis of a Pertinent Healthcare Issue

The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time Assignment: Analysis of a Pertinent Healthcare Issue.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

  • Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
  • Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
  • Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

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The Assignment (3-4 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

  • Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
  • Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
  • Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.
Excellent Good Fair Poor
Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing the selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following: 

·   Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).

23 (23%) – 25 (25%)

The response accurately and thoroughly describes in detail the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate, clear, and detailed data to quantify the impact of the national healthcare issue/stressor selected Assignment: Analysis of a Pertinent Healthcare Issue.

20 (20%) – 22 (22%)

The response describes the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate data to quantify the impact of the national healthcare issue/stressor selected.

18 (18%) – 19 (19%)

The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague or inaccurate.

The response includes vague or inaccurate data to quantify the impact of the national healthcare issue/stressor selected.

(0%) – 17 (17%)

The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague and inaccurate, or is missing.

The response includes vague and inaccurate data to quantify the impact of the national healthcare issue/stressor selected, or is missing.

·   Provide a brief summary of the two articles you reviewed from outside resources, on the national healthcare issue/stressor and explain how the healthcare issue/stressor is being addressed in other organizations.
27 (27%) – 30 (30%)

A complete, detailed, and specific synthesis of two outside resources reviewed on the national healthcare issue/stressor selected is provided. The response fully integrates at least 2 outside resources and 2 or 3 course-specific resources that fully support the summary provided.

The response accurately and thoroughly explains in detail how the healthcare issue/stressor is being addressed in other organizations.

24 (24%) – 26 (26%)

An accurate synthesis of at least one outside resource reviewed on the national healthcare issue/stressor selected is provided. The response integrates at least 1 outside resource and 2 or 3 course-specific resources that may support the summary provided.

The response explains how the healthcare issue/stressor is being addressed in other organizations.

21 (21%) – 23 (23%)

A vague or inaccurate summary of outside resources reviewed on the national healthcare issue/stressor selected is provided. The response minimally integrates resources that may support the summary provided.

The response explains how the healthcare issue/stressor is being addressed in other organizations that is vague or inaccurate.

(0%) – 20 (20%)

A vague and inaccurate summary of no outside resources reviewed on the national healthcare issue/stressor selected is provided, or is missing.

The response fails to integrate any resources to support the summary provided.

·   Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected and explain how they may impact your organization both positively and negatively. Be specific and provide examples.
27 (27%) – 30 (30%)

A complete, detailed, and accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response accurately and thoroughly explains in detail how the strategies may impact an organization both positively and negatively, with specific and accurate examples.

24 (24%) – 26 (26%)

An accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively. May include some specific examples.

21 (21%) – 23 (23%)

A vague or inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively that is vague or inaccurate. May include some vague or inaccurate examples.

(0%) – 20 (20%)

A vague and inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided, or is missing.

The response explains how the strategies may impact an organization both positively and negatively that is vague and inaccurate, or is missing. Does not include any examples.

Written Expression and Formatting – Paragraph Development and Organization: 

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

(5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

(4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

(0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards: 

Correct grammar, mechanics, and proper punctuation

(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
(4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
(0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
(5%) – 5 (5%)
Uses correct APA format with no errors.
(4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
(0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100

COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues

COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues

Competing Needs of Resources During the COVID-19 Pandemic on the Development of Policy

 

The coronavirus 2019 (COVID-19) pandemic has rocked the national healthcare system to its core. Nurses have been

hailed as heroes for putting themselves in harm’s way in an attempt to save lives. In the early stages of the COVID-19

pandemic, personal protective equipment (PPE) was scarce. Nurses faced a tremendous ethical dilemma. Healthcare workers

had to decide to continue without adequate protection or leave the hospitals critically short-staffed. This discussion will

address how the COVID-19 pandemic has caused nurses and patients to compete for resources and policies that have been

developed to address the shortfalls.

 

How Competing Needs of Nurses Versus Patients May Impact Policy Development

 

Registered nurses have a moral and ethical obligation to provide the best care possible to their patients, even in the face

of danger (Culberson, 2020). The COVID-19 pandemic put the nursing profession to the test. Before the emergence of

COVID-19, PPE was primarily disposable. Masks and gloves were routinely changed after each patient. In the early weeks

of the pandemic, it was discovered much of the national stockpile of medical PPE was expired (Centers for Disease Control

and Prevention, 2020). Some of the stockpile items were already starting to degrade. Hospitals scrambled to obtain PPE for

their front-line employees, but many times these items were not available or a limited supply would be offered at an

exorbitant price. Policies would need to be implemented to address how hospitals would handle the limited amount of PPE COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

A shortage of nurses has been ongoing (Broome & Marshall, 2020). With the additional pressures of a pandemic,

finding additional staff became a concern for most healthcare facilities. States would need to develop policies to address the critically low availability of nurses. Nurse travel agencies tried to fill the void, but hospitals watched the price of travel nurses double, then triple, within weeks of COVID-19 sweeping the nation. By November 2020, hospitals offered incentives of up to $10,000 a week for travel nurses (Hawryluk & Bichell, 2020). Nurse- patient ratios reached unprecedented numbers, and in Illinois and New York, nurses were routinely having up to nine patients each (Lasater et al., 2020). In this situation, nurses had to make an ethical decision. Would the nurse accept an assignment that was not a safe nurse-patient ratio, or would they refuse the assignment and force another nurse to work a double shift potentially? According to the American Nurses Association (2020), there may be times during a crisis that a nurse must decide, based on their moral grounds to maintain professional integrity. Each state has different laws regarding a nurse’s duty to provide care when faced with a dangerous situation. Each nurse is responsible for knowing the laws that govern their practice in the event of a crisis COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

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Limited Resource’s Impact on the Development of Policy 

Instead of policies being put in place to protect nurses and patients during the COVID-19 pandemic, guidelines were developed that relaxed regulations that protected nurses. These changes were implemented in an attempt to relieve the critical shortage of staff. California, which is known for having the most comprehensive laws regarding nurse-patient ratios, removed those restrictions on March 30, 2020, to address the evolving COVID-19 pandemic (Lasater et al., 2020). COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues. In an attempt to allow more nurses into a state’s workforce, some states permitted nurses licensed in other states to obtain

temporary provisions to practice in other states. The Centers for Disease Control and Prevention posted on their website that

if nurses could not obtain adequate PPE, bandanas may be worn as a last resort (Centers for Disease Control and Prevention,

2020). Nurses have continued to be thrown under the proverbial bus throughout the COVID-19 crisis. Instead of lawmakers

committing to protect this vital workforce, policies have continued to be implemented that remove much of the limited

protection that nurses have. Nurses have a moral and ethical obligation to care for patients and need to speak up about

barriers that compromise patient care and nurse welfare (Kelly & Porr, 2018). Hospitals and lawmakers are responsible for

ensuring nurses are protected while fulfilling their duties (Broome & Marshall, 2020).

 

Policy Development to Address PPE and Nurse Shortage at a Northern Virginia Hospital

 

At the beginning of the COVID-19 outbreak, a Northern Virgina regional trauma center required nurses to reuse

disposable PPE. At the beginning of the COVID-19 pandemic, the facility would not allow nurses to use homemade face

masks, but relaxed that policy as their PPE supply dwindled. New hospital policies stated disposable masks were to be worn

until the masks were falling apart. Disposable respirators that could be washed were sent to a company to be disinfected,

then reissued to staff for continued use. As more and more patients became critical, the patients’ need for care was

competing with the nurses’ needs to have adequate PPE, safe nurse-patient ratios, and a reasonable work schedule. Travel

nurses were secured to help offset the significant increase of COVID-19 patients. The hospital continues to look for ways to

add nurses to their roster COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

References

 

American Nurses Association. (2020). Nurses, ethics, and the response to COVID-19 pandemic.

https://www.nursingworld.org/~495c6c/globalassets/practiceandpolicy/work-environment/health–

safety/coronavirus/nurses-ethics-and-the-response-to-the-covid-19-pandemic.pdf

 

Broome, M., & Marshall, E. S. (2020). Transformational leadership in nursing: From expert clinician to influential leader.

(3rd ed.). New York, NY: Springer.

 

Centers for Disease Control and Prevention. (2020). Considerations for Release of Stockpiled N95s Beyond the

        Manufacturer-Designated Shelf Life. https://www.cdc.gov/coronavirus/2019-ncov/hcp/release-stockpiled-N95.html

 

Culbertson, R. (2020). Attaining the Quadruple Aim of Worker Well-Being in the COVID-19 Crisis: Competing Ethical

Priorities. Journal of Healthcare Finance, 46(4), 77-84.

http://www.healthfinancejournal.com/index.php/johcf/article/view/223/225

 

Hawryluk & Bichell. (2020). Need a COVID-19 Nurse, That’ll Be $8,000 a Week.

https://www.medscape.com/viewarticle/941641

 

Lasater, K. B., Aiken, L.H., Sloane, D. M., French, R., Martin, B., Reneau, K., Alexander, M., & McHugh, M. (2020).

Chronic hospital nurse understaffing meets COVID-19: an observational study.

BMJ Quality & Safety. DOI: 10.1136/bmjqs-2020-011512

 

Kelly, P., & Porr, C. (2018). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. OJIN:

 The Online Journal of Issues in Nursing, 23(1). DOI: 10.3912/OJIN.Vol23No01Man06 COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues

Discussion: Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

To Prepare:

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

By Day 6 of Week 3

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

 

response 1

I enjoyed reading your post and agree with you that occasions arise when nurses face ethical dilemmas arising from competing resources available for patient care during the COVID-19 pandemic. The third provision of the ethical code for nurses (3.4) outlined that nurses have the professional responsibility of promoting the culture of safety (American Nurses Association, 2015). However, some facilities put nurses who are at the frontline in a tight situation by exposing them to the coronavirus infection through awkward policies that do not promote both nurses’ and patients’ safety. These facilities do not provide adequate PPEs for the care of these infected patients, and in most cases, the nurse to patient ratio is overwhelming.

In as much as the government and healthcare establishments are trying to stem the tide of the rising infection rate, the policies they make do not support the nursing staff in the discharge of their duties due to some competing needs. Hence nurses are occasionally facing the ethical dilemma of putting themselves in danger while caring for the COVID-19 patients. Employers have a duty to their employees to provide adequate PPE, and any harm that may come to patients through lack of PPE and personnel to safely care for patients is a failure of institutions and systems, not of individuals (Morley et al., 2020). If employers provide adequate PPE and appropriate guidance on how to use it, and reasonably address and mitigate the additional foreseen risks that caring for patients with Covid‐19 present, then nurses and others will continue to provide patient care that is more aligned with the usual risks that health care workers knowingly take on when they enter their professions COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

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References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only

Morley, G., Grady, C., McCarthy, J., & Ulrich, C. M. (2020). Covid-19: Ethical Challenges for Nurses. The Hastings Center report50(3), 35–39. https://doi.org/10.1002/hast.1110 COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues

response 2

Excellent post and I agree nurses are faced with more ethical dilemmas because of the COVID pandemic. A major burden COVID has brought is more critical patients with limited resources; especially in emergency rooms and intensive care units (Chamsi-Pasha et al., 2020).

At the beginning of this pandemic, my workplace issued every staff member one face mask and told staff this mask needs to last 3-4 weeks. We were also given a paper bag to store the mask in. If the mask got soiled and staff member needs a replacement mask, they are to notify their manager. The Unit Manager would then issue a new one, along with writing down the employee’s name. Weeks later, a staff member contacted a local news channel to report the issue. Soon after the news report, Unit Managers distributed two additional masks to all employees throughout the hospital. In a recent article by Vordos et al. (2020), social media influencers created a task force to address the lack of PPE by using 3D printers. This did help solve the problem in their area. Unfortunately, it’s a national issue. In my area, local businesses were donating supplies to the hospital. COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues

In nursing school, we were taught to be patient advocates, but who’s advocating for nurses. When an issue is present, we have three opinions; avoid the problem, face the problem but handle it poorly, or lastly face the problem and handle it well (Ulrich, 2018). I’m thankful one nurse spoke up; all it takes is the right person and the right audience to create a change COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

References

Chamsi-Pasha, H., Chamsi-Pasha, M., & Albar, M. (2020). Ethical dilemmas in the era of COVID-19. Avicenna Journal of Medicine10(3), 102–105. https://doi-org.ezp.waldenulibrary.org/10.4103/AJM.AJM_119_20

Ulrich, B. (2018). From the Editor. Speaking Up for Nurses and Patients. Nephrology Nursing Journal45(5), 407–410.

Vordos, N., Gkika, D. A., Maliaris, G., Tilkeridis, K. E., Antoniou, A., Bandekas, D. V., & Ch. Mitropoulos, A. (2020). How 3D printing and social media tackles the PPE shortage during Covid – 19 pandemic. Safety Science130https://doi-org.ezp.waldenulibrary.org/10.1016/j.ssci.2020.104870

response 3

I enjoyed reading your post and appreciate your argument that questions whether the decisions being made by many healthcare organizations in response to the high numbers of COVID-19 patients in hospitals that seem to “relax” the rules that were in place to ensure safety to allow for nurses to be spread thinner to allow for ever-increasing patient numbers.  It seems to me that these approaches are quite reactive in nature, which I would argue needs to be corrected sooner rather than later to avoid a catastrophic loss of nurses due to illness and/or burnout.  Heath et al., (2020) notes that large amounts of physical and psychological stress are experienced by healthcare workers during the COVID-19 pandemic related to the ever-increasing demands placed upon them as an attempt to keep up with the pandemic situation; Heath et al., assert that in response to this healthcare workers are adapting, though much of the adaptation may likely be harmful to their resilience capabilities.  Heath et al. also state that this will become a catastrophic situation if the maladaptive responses are not mitigated soon, and potentially could lead to evidence-based best practice divergence or worse, burnout of staff.

To promote ethical nursing practice, organizations should shift decision-making processes, especially regarding the nursing care of patients, to follow a collaborative model that includes all levels of stakeholders, especially nurses (Rushton, 2016).  Nurses are the most visible and present providers in the entire healthcare system; they are the direct link between patient and organization.  It is the nurse’s responsibility to provide ethical care, yet all too often, providing ethical care directly contradicts the policies of an organization, or worse, the organization changes policy to meet demand, such as the situation  you describe in your post, but this new policy diverges from ethical considerations nurses are bound to follow (Kelly, 2018).   I admire your conviction and commitment to standing up for changing what should not become the status quo COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

Leslie

References

Heath, C., Sommerfield, A., & von Ungern‐Sternberg, B. S. (2020). Resilience strategies to manage psychological distress amongst healthcare workers during the COVID‐19 pandemic: a narrative review. Anaesthesia75(10). https://doi.org/10.1111/anae.15180

Kelly, P., Porr, C., (January 31, 2018) “Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 6.

Rushton, C. H. (2016). Creating a culture of ethical practice in health care delivery systems. Hastings Center Report, 46, S28–S31. https://doi-org.ezp.waldenulibrary.org/10.1002/hast.628 COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues

Essay 2

COVID 19 Burnout is affecting hospitals and healthcare systems across the The United States and the globe. Burnout occurs after a person has reached beyond their limit of mentality, emotionally, and physically (Queen & Harding 2020). Persistent stress of patient care increased workloads and acuity all compounded often lead to a sense of powerlessness that subsequently causes burnout (Croke 2020). Hospital administrators and nurse leaders equally can feel drained and anxious in tackling the ongoing patient care deficits and preventing and treating staff burnout.

There are several interventions that have been implemented across the globe that can have a lasting impact on individual nurses and on nursing as a profession. Interventions that will remain beyond the reaches of COVID 19. Hospitals and healthcare providers that implement interventions to prevent staff burnout focusing on individual well-being have systematically less turnover and increased patient satisfaction (Croke 2020).

A few interventions that hospitals and healthcare industry leaders can be but not limited to. First, leaders can listen both actively and empathetically to nurses hearing their individual challenges and struggles (Foster 2020).  Secondly, hospital leaders can develop and promote a RISE (Resilience in Stressful Events) team at their institutions focusing on debriefing nurses after stressful events such as but not limited to a patient demise, loss of a coworker. Finally, nurse leaders can promote shared governance and develop an evidence–based unit tool kit that focuses on meaningful recognition, including nurses with decision making, and provide greater support and involvement daily (Croke 2020) COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

Leadership needs to be cognizant of the potential of nurses and other health care professional’s ability to become burnt out from the increased demands related to COVID –19, equipment shortages or challenges, risk of infection, perpetual isolation, elongated hours (Queen &Harding 2020). Nurse leaders now more than ever need to educate staff on becoming observant of the early warning signs of burnout. Burnout has significant consequences for nurses and hospitals that have a direct effect on patients and the entire population (Foster 2020). To prevent burnout hospital leaders and administrators must create and enact policies helping nurses realize that the administration is fully aware of the strain on them and that their administration is genuinely concerned for their wellbeing. Increasing nurses’ overall sense of value, sense of community, and resiliency (Foster, 2020).

References:

Croke, L. (2020). Organizational and personal strategies to support well‐being and address burnout. AORN Journal, 112(2), P8–P10. https://doi-org.ezp.waldenulibrary.org/10.1002/aorn.13154

 

Foster, S. (2020). Burnout: a continuing problem. British Journal of Nursing, 29(12), 721. https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2020.29.12.721

Queen, D., & Harding, K. (2020). Societal pandemic burnout: A COVID legacy. International Wound Journal, 17(4), 873–874. https://doi-org.ezp.waldenulibrary.org/10.1111/iwj.13441

response

 I agree that nursing burnout is a problem, even more so now with the COVID-19 pandemic. My brother works in ICU with COVID-19 patients, and he told me the other day that the hospital is making nurses work their shifts even when they are sick and febrile because otherwise, they would have no staff to take care of the patients. I was shocked. Talk about burnout; not only are the nurses unable to get off work for vacation, but they also cannot even get off work due to being sick. I think this is an ethical issue. Nursing staff are silent with these concerning issues due to fear, pressure from the administration, or not wanting to appear incompetent (Kelly & Porr, 2018). When nurses do not stand up for concerning issues, the healthcare organization will continue to abuse them. Nurses that come to work sick cannot take care of their patients correctly and give them the care they deserve; they are doing themselves and their patients a disservice. In this situation, superior leadership is much needed. Leaders need to act in the best interest of their co-workers and stand up for what is ethically right, not support mandates that have been imposed upon them due to the hospital worried about the bottom line (Broome & Marshall, 2021) COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

Thank you,

References

Broome, M. E., & Marshall, E. S. (Eds.). (2021). Transformational leadership in nursing (3rd ed.). Springer. https://doi.org/10.1891/9780826135056

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing23(1). https://doi.org/10.3912/OJIN.Vol23No01Man06 COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues.

Assignment: Developing Organizational Policies and Practices

Assignment: Developing Organizational Policies and Practices

Assignment: Developing Organizational Policies and Practices

Analysis of Pertinent Healthcare Issue

The healthcare issue addressed at Bergen New Bridge Medical Center Paramus, NJ (BNBMC) entails timely access to aftercare either in telepsychiatric partial hospitalization, (PHP) intensive outpatient (IOP), or outpatient (OP) level of care. The Accountable Care Act (ACAs’) focus on increasing and improving healthcare systems remains an issue at BNBMC (Broom & Marshall, 2021). The ACA goal for healthcare in the United States to enhance healthcare access to health rather than disease is germane to expanding resource availability. PHP, IOP, and OP remain limited at BNBMC. PHP evaluations are only available Monday, Wednesday, and Friday. Therefore, a request to expand available PHP appointments to more than three and IOP and OP appointments for evaluations to more than two per week. The inadequacy puts patients at high risk for relapse after leaving the emergency department and in need of inpatient hospitalization Assignment: Developing Organizational Policies and Practices.

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The leadership proposal is to expand virtual appointments for evaluations for all outpatient levels of care mentioned as needed. Furthermore, the request is for hiring additional staff to accommodate the need for timely appointments to evaluate and have patients begin treatment within the same week they have presented to the emergency department due to a psychiatric crisis. Moreover, the purpose of this paper is to demonstrate the benefits of telepsychiatry in outpatient levels of care, such a PHP and IOP (Hom et al., 2020). Not only is this modality of treatment a viable form of follow-up treatment but, it enhances the provision of care well beyond the COVID-19 pandemic as a quality and effective level of care that improves outcomes (Hom et al., 2020). Additionally, the paper’s purpose encompasses supporting the achievement of the Quadruple Aims goals of making healthcare more accessible as telepsychiatry does without the need to commute and decreasing cancellations or no-shows (Broom & Marshall, 2021). Besides, telepsychiatry care is more affordable for patients by diminishing the cost of the commute and time away from work or family (Broom & Marshall, 2021). Improvement in quality of care is supported by providing a view into the patients’ home environment and how it translates into patients’ behaviors, therefore giving substance to accurate treatment planning (Broom & Marshall, 2021). Lastly, creating flexibility for the clinicians to work around their home responsibilities achieves improved work-life balance addressing the fourth aim (Boom & Marshall, 2021).  A review of two recent studies regarding the effectiveness of virtual psychiatric care will follow Assignment: Developing Organizational Policies and Practices.

Efficacy and Effectiveness to Expand use of telepsychiatry

A broad study of literature found the COVID-19 pandemic has initiated extraordinary

 

healthcare system adjustments benefiting psychiatric care for one through telepsychiatry (Chen

 

et al., 2020). The pandemic propelled insurance payment for telepsychiatry by reducing

 

regulations previously prohibiting the same (Chen et al., 2020). The research findings show

 

effectiveness, and at times telepsychiatry demonstrates above-average benefits than in-person

 

psychiatric treatment (Chen et al., 2020). Again, psychotherapists and psychiatric clinicians note

 

the advantage of seeing a glimpse into the patients’ lives while in their home environment

 

through virtual treatment connections (Chen et al., 2020). Psychiatric clinician reviews of their’

 

experience of conducting telepsychiatry provide communication to the leadership of additional

 

needs to effectively provide care (Chen et al., 2020). Some of those needs include additional

supervision, support and validation, and ongoing research on telepsychiatry care (Chen et al.,

2020). Furthermore, advocacy for the expansion of additional outpatient providers to be hired in

psychiatry to comply with enhancing healthcare access to focus on health rather than disease is

pertinent to expanding resource availability at BNBMC Assignment: Developing Organizational Policies and Practices. 

Efficacy and Effectiveness to Expand use of telepsychiatry

Transition from in-person to psychiatry’s virtual format during the COVID-19 pandemic came as a thrust upon the healthcare community. The experience has demonstrated the capability of healthcare services to be creative and resilient. Once considered limited out of necessity in remote locations has become the dominant form of outpatient psychiatric treatment. One facility readily adapted to the development of a virtual psychiatric PHP of patients and clinical staff. Clinical staffs’ creation of protocols for evaluation with the inpatient clinical team to determine patient appropriateness for virtual PHP became routine (Hom et al., 2020). Based on a basic assessment of the patients’ capability to use a smartphone or iPad, focusing and engaging mentally and emotionally came first. Confirmation that the patient had established an outpatient therapist and psychiatric clinician was necessary for the patients’ emergency needs during off-hours (Hom et al., 2020). Patients accepted into the PHP were given an orientation while still inpatient to accessing the virtual environment in addition to a packet of written orientation material with a schedule (Hom et al., 2020) Assignment: Developing Organizational Policies and Practices.

Gathering treatment outcome data and patients’ evaluations to determine the effectiveness of this essential modality of treatment will further inform of overall strengths and feasibility to continue virtual PHP, IOP, and outpatient treatment post-COVID-10 pandemic (Hom et al., 2020). These activities will serve well to inform leadership and the payor sources of the same. Again, the need to expand virtual psychiatry is at hand to accommodate those patients in need who may otherwise fall through the cracks when discharged without a follow-up plan.                   

       National Healthcare Strategy Issues/Stressors Impact

The national healthcare issue of COVID-19, while striving to reach the ACA focus to increase and improve healthcare systems, remains an issue at BNBMC. The problem existing at BNBMC to accommodate patients discharged from the emergency department with a timely appointment in PHP, IOP, or OP levels of care requires attention. The experience of lack of timely follow-up appointments in virtual psychiatric PHP and IOP within seven days of inpatient psychiatric hospitalization discharge is often inadequate for those who meet the criteria.

The psychiatry department at Massachusetts General Hospital identified the massive issue encountered of limited technological capacity with the existing platform concerning the enormous demand for telepsychiatry in March 2020 at the beginning of the COVID-19 pandemic (Chen et al., 2020). The leadership approved the transition to the use of phone calls and commercial platforms such as doxy.me, Doximity, and Zoom (Chen et al., 2020). The psychiatric department outpatient had a 22% hike in productivity (Chen et al., 2020). BNBMC has kept virtual telepsychiatry at a level they can manage. Increasing capacity to manage the number of patients in the population needed through creative measures such as done at Massachusetts General Hospital Assignment: Developing Organizational Policies and Practices.

BNBMC does need to expand its ability to accommodate a more significant number of patients with telepsychiatry. There could be financial restraints due to the pandemic.

The hospital inpatient census has been decreased by not admitting as many patients as usual to minimize exposure to COVID-19 during the second wave. McClean Hospital / Harvard Medical School Belmont, Massachusetts remark on the need to explore the continuation of virtual PHP in the long-term concerning onboarding new staff (Hom et al., 2020). Historically new clinicians shadowed seasoned clinical staff (Hom et al., 2020). New procedures developed to accommodate the training of new staff creation began. Similar procedures are needed by having new clinical staff observe and eventually conduct groups with the observation by supervising them.

BNBMC has been letting staff go due to decreased census since the pandemic’s first wave. Lockdowns have impacted canceled elective surgery, fewer emergency trauma hospitalizations, and some illnesses. When the pandemic is under control, the determination of the expansion of telepsychiatry continuing will influence expansion.

Competing needs for patient follow-up appointments and facilities challenges remain.

BNBMC has heeded the need to implement telepsychiatry since the beginning of the COVID-19 pandemic, much like most facilities nationally and internationally. The use of telepsychiatry has seen an astounding increase of 4347% since the COVID-19 pandemic began, per data (Mahmoud et al., 2020). The stunning increase in implementation has come with challenges related to facilities’ ability to effectively implement the service (Mahmoud et al., 2020). Reports of challenges need thorough documentation to develop improved planning and implementation of telepsychiatry programs (Mohmoud, 2020). BNBMC historically has been a county psychiatric hospital serving the disadvantaged individuals in the community. They often treat patients such as homeless, jobless, and without benefits. The state does supplement the facility for treating these patients. Just the same revenue is less than ideal for implementing progressive programs such as telepsychiatry’s technical needs. Furthermore, indigent patients do not all have a smartphone and are so compromised with dual diagnosis’ thus creating barriers that are difficult to bridge even with the advantages of use of technology. Psychiatric care is poorly funded compared to medical/surgical care Assignment: Developing Organizational Policies and Practices.

The challenges noted for BNBMC are one side of the coin. On the flip side is the potential for improving care for this population with telepsychiatry availability.  Advantages mentioned previously include ease of access with supported smartphone provision. In Chicago, Illinois, The Josselyn Center, a community mental health center, deal with similar problems due to treating those who have insurance coverage and those who can not afford to pay (Mahmoud et al., 2020). They too suffer from shortages in staff and psychiatric prescribers due to limited funding to hire (Mahmoud et al., 2020). An additional challenge is finding psychiatric providers willing to work in community mental health centers due to having the choice of working in private practice in the suburbs (Mahmoud et al., 2020).

Policy and practice

The advent of a crisis in this century of such magnitude has created transformation at a speed not considered viable pre-COVID-19 (Sinsky & Linzer, 2020).  Regulators and payors approved at record speed needed for the trade-off between costs and benefits to implement telepsychiatry and telehealth (Sinsky & Linzer, 2020). Practice and policy got temporarily implemented with the experience of informing all stakeholders of the actual benefits outweighing the drawbacks seen and some encountered (Sinsky & Linzer, 2020). The experience has brought to light the significance of protecting health care professionals’ work-life, cognitive capacity, and emotional resilience capacity for caring for patients (Sinsky & Linzer, 2020). Alternatively, instead of utilizing resources on unnecessary tasks and technology better spent on practices and policies recreated through a revolution out of need (Sinksy & Linzer, 2020) Assignment: Developing Organizational Policies and Practices. Note, through changes in practice and policy during the COVID-19 pandemic it is postulated they continue post-pandemic with the resulting improvement in reduction of administrative burden, while simultaneously improving care, thus furthering achievement of the Quadruple Aim (Sinksy & Linzer, 2020). BNBMC practice and policy got replaced with a hybrid form of psychiatric PHP according to their ability to function with the resources. They have made progress simply by making the transition to telepsychiatry. Transition to predominantly telepsychiatry will take time to achieve. PHP psychiatric residents are at the beginning of the learning process of becoming a clinician. Confidence will need to be built with safety and development of effectiveness in a beginner to handle treating this psychiatric population. Another challenge noted is multicultural clientele and novice clinicians, perhaps further conflicting with the teaching facilities’ full transition to telepsychiatry.

Critique of the policy for ethical considerations

BNBMCs’ policy to limit the number of psychiatric PHP openings available does indicate an adherence to a policy based on an ethical principle. Nurses recognize ethical awareness at BNBMC who have experienced the patient population (Milliken, 2018). BNBMC psychiatric PHP accepts the number of patients they can realistically handle based on the number of experienced clinicians available. Fundamentally, the nurses in PHP psychiatric hospitalization are equipped to manage a limited number of patients. The patients treated at BNBMC often have violent history towards themselves and or others. Patients need to have support on off hours from the treatment day. That includes a therapist and psychiatric prescriber. These patients often do not have established providers, and newly assigned providers often would not commit to patient responsibility where there is no therapeutic relationship established. The ethical implications for nurses, outpatient clinicians, and psychiatric prescribers are high risk, therefore, understandable (Miliken, 2018). The policy to limit the number of psychiatric PHP patient acceptances is valid with a critique of the policy at BNBMC Assignment: Developing Organizational Policies and Practices.

Recommended policy/practice changes

BNBMC policy of limiting the number of telepsychiatry PHP evaluations and admissions from the emergency department needs explanation. A recommended change in policy is monthly communication on exactly what the reasons are for limited admissions. The nursing and social work discharge planners are left in the dark to speculate on reasons for referrals only accepted Monday, Wednesday, and Friday. Seamless care delivery requires transparency (Broome & Marshall, 2021). Teamwork in the emergency department would prosper with coordination between the psychiatric outpatient departments and the state of affairs explained weekly (Broome & Marshall, 2021). An integrated care model’s advantages can improve outcomes and reduce unnecessary conflicts between team members, spoken and unspoken (Broome & Marshall, 2021). Understanding the issues care management run into from limiting the search for an appropriate alternative telepsychiatry PHP is needed. Wasted time and angst diminish, accomplishing improved patient care and care management success with knowledge of the facts.

Ethical issues can apply to accessing the appropriate care level to offer the patient before discharging the patient (Milliken, 2018). To assist the patient in obtaining care recommended and accepted, the nurse care manager needs to know what options are available. Maintaining updated knowledge of the psychiatric outpatient departments’ availability of telepsychiatry PHP and outpatient care appointments allows the nurse care manager to uphold the ethical duty to diligently locate the next available appointment elsewhere without delay or be at risk of loss of accommodations for the patient Assignment: Developing Organizational Policies and Practices.

Conclusion

In conclusion, this paper reviewed the unexplained limited telepsychiatry PHP appointment availability for discharge planning from the emergency department at BNBMC. The Quadruple Aim of providing access to the care needed and managing healthcare costs would decrease the risk of relapse, and re-admit to an inpatient level of care is noted (Broome & Marshall, 2021). The patient’s maintenance in the healthcare system stepped down, allowing for continued accurate information flow in the electronic health record (Broom & Marshall, 2021). Organized teamwork with transparent communication of affairs between departments diminishes burn out of healthcare workers (Broome & Marshall, 2021). Notation of the rapid transformation of healthcare during the COVID-19 pandemic with the creation of telepsychiatry and telehealth for outpatient levels of care. Analysis of telepsychiatry’s benefits and the challenges encountered with suggestions for policy change to facilitate improved telepsychiatry functioning in the outpatient level of care Assignment: Developing Organizational Policies and Practices.

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References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From ex-

pert clinician to influential leader (3rd ed.). New York, NY: Springer.

Chen, J. A., Chung, W. J., Young, S. K., Tuttle, M. C., Collins, M. B., Darghouth, S. L.,

Longley, R., Huffman, J. C., Razafsha, M., Kerner, J. C., Wozniak, J. & Huffman, J. C. (2020). COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future, 66, General Hospital Psychiatry. www.elsevier.com/locate/genhospsych.

Hom, M. A., Weiss, R. B., Millman Z. B., Christensen, K., Lewis, E. J., Cho, S., Yoon, N. A.,

Meyer, J. D., Shavit, E., Schrock, M. D., Levendusky, P. G. & Bjorgvinsson, T. Development of Virtual Partial Hospital Program for an Acute Psychiatric Population: Lessons Learned and Future Directions for Telepsychiatry, 30(2), Journal of Psychotherapy Integrationhttp://dx.doi.org/10.1037/int0000212

Mahmoud, H., Naal, N., & Cerda, S. (2020). Planning and Implementing Telepsychiatry in a

Community Mental Health Setting: A Case Study Report, Community Mental Health

Journal. https://doi.org/10.1007/s10597-020-00709-1

 

Miliken, A. (2018). Ethical Awareness: What it is and why it matters. OJIN: Online 

Journal of Issues in Nursing, 23(1). Manuscript

1.Doi:10.3912/OJIN.Vol23No01Mar01.

Rosen, L. A., Morland, L. A., Glassman, B. P., Weaver, M. K., Smith, C. A., Pollack, S. &

Schnurr, P. P. (2020). Virtual Mental Health Care in the Veterans Health   Administration’s Immediate Response to Coronavirus Disease-19, American Psychologist, Online First Publication, American Psychological Association. http://dx.doi.org/10.1037/amp0000751

Sinsky, C. & Linzer, M. (2020). Practice And, Policy Reset Post-COVID-19: Reversion,

Transition or Transformation? Health Affairs, 39(8), COVID-19, HOME HEALTH &

MORE COMMENTARY.https://doi.org/10.1377/hlthaff.2020.00612

Assignment: Developing Organizational Policies and Practices

Assignment: Developing Organizational Policies and Practices

Competing needs arise within any organization as employees seek to meet their targets and leaders seek to meet company goals. As a leader, successful management of these goals requires establishing priorities and allocating resources accordingly.

Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice.

Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization Assignment: Developing Organizational Policies and Practices.

To Prepare:

  • Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected.
  • Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor.
  • Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs.

The Assignment (4-5 pages):

Developing Organizational Policies and Practices

Add a section to the paper you submitted in Module 1. The new section should address the following:

  • Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.
  • Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.
  • Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.
  • Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.
  • Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.
  • Due to the nature of this assignment, your instructor may require more than 7 days to provide you with quality feedback Assignment: Developing Organizational Policies and Practices.

NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator

NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator

NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator

Describe the nurse’s role and responsibility as health educator. What strategies, besides the use of learning styles, can a nurse educator consider when developing tailored individual care plans, or for educational programs in health promotion? When should behavioral objectives be utilized in a care plan or health promotion?

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Re: Topic 1 DQ 1

As per Global Health Education (2020), nurse educators inspire, teach, and mentor the next generation of nurses, leading the way to the future of patient care. Without them, graduating nurses would be ill-equipped to face the ever-changing demands of today’s dynamic healthcare system. Nurse educators lead by example as they support and guide nurses during transitional periods. They serve with ethical conviction and professionalism, encouraging their team to do the same. Through their actions, nurse educators are responsible for creating a team that communicates well and works together, improving patient care along the way. With the help of nurse educator new nurses are able to educate, teach and provide quality of care to their patient safely NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator.

A learning style a nurse educator can consider when developing individual care plan is to involve (assess) patient and their family to find out how to get the patient to be involve in their care when developing a care plan the patient. When a patient is included when developing a care plan, it allows the nurse educator to learn the patient’s preference. According to Smith & Zsohar (2013), for patient teaching to be effective, nurses must know their patients and individualize patient education. Nurse educator should find out what motivates each patient. What’s important to him or her. nurses should allow the patient to choose the topic most interest, and then address that area first. Lastly, based on the assessment of patient learning needs and styles, the education provided should use common words, readable materials and various teaching techniques based on learning styles.

Nurses who support the interests, decisions and safety of patients and their family members are advocates. Advocacy is important because it may reduce the chances of errors and harmful treatments to patients. Behavioral objectives should be utilized in a patient’s care plan when the patient is willing to learn and change. Before a nurse can utilize the behavioral objective, they need to determine the patient’s readiness to change and create on objective for the patient’s stage (Whitney, 2018). There are six stages of change. Nurses play a crucial role in patient education and are key players in improving patient health and wellness NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator.

References

Smith, J. A., & Zsohar, H. (2013). Patient-education tips for new nurses. Nursing, 43(10), 1-3. doi:10.1097/01.nurse.0000434224.51627.8a

Keypath Education. (2020, August 21). The role of nurse educators. Global Health Education. Retrieved October 3, 2021, from https://globalhealtheducation.com/article/role-of-nurse-educators.

Whitney, S. (2018). Teaching and Learning Styles. In Health Promotion: Health & Wellness Across the Continuum. Grand Canyon University NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator.

sample 2

Re: Topic 1 DQ 1
As a nurse education begins upon first meeting a patient. The nurse’s role is to promote health and provide their patients with evidence-based research education material, which they are ethically and professionally responsible for (Whitney, 2018). Fundamentally, educating patients is a nurse’s most important job.A strategy a nurse can use to develop a tailored individual care plan is properly assessing the patient before planning and implementation. Communication is key. By engaging with patients in their own care and constructing the patient-clinician partnership determines in part how successfully the patient moves from illness to wellness (Marshall, et.al, 2020). The information gathered from assessing will guide a specific teaching style and approach that will be most useful. Also, assessing the educational needs and motivation will help the nurse in developing a tailored care plan. As stated by Marshall, et.al., (2020), the nurse can implement the following bedside strategies for patients who do not fully engage such as: 

 

  • Provide daily goals
  • Structure the task
  • Provide procedural advice
  • Attribute mistakes to effort
  • Show coping models
  • Model positive mood
  • Monitor and give feedback

Behavioral objectives should be used for strategies to change behaviors NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator. An example would be to advocate for health promotion in smoking cessation. Behavioral objectives are defined as the change a patient will do in their behavior to promote health and wellbeing (Whitney, 2018). It should be utilized after the nurse has assessed the patient’s willingness/motivation to make a change. Without a willing participant the objectives may not be met.

References

Marshall, L. C., Dall’Oglio, I., Davis, D., Verret, G., & Jones, T. (2020, November 16). Nurses as educators within health systems. Retrieved February 02, 2021, from https://nursingcentered.sigmanursing.org/features/more-features/Vol41_4_nurses-as-educators-within-health-systems

Whitney, S. (2018). Teaching and Learning Styles. Retrieved October 5, 2021 from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1 NRS 429VN: Topic 1 DQ 1 – Nurse’s role and responsibility as health educator

NRS 429VN: Topic 1 DQ 2 – Health promotion model used to initiate behavioral changes

NRS 429VN: Topic 1 DQ 2 – Health promotion model used to initiate behavioral changes

Describe a health promotion model used to initiate behavioral changes. How does this model help in teaching behavioral changes? What are some of the barriers that affect a patient’s ability to learn? How does a patient’s readiness to learn, or readiness to change, affect learning outcomes?

Re: Topic 1 DQ 2

The health promotion model was developed in 1982 by Dr. Nola J. Pender. The theorist, Nola J. Gender. Pender believed that the goal of nursing care was to help their patients achieve optimal health and well-being. The health promotion model claims that each individual’s characteristics and life experiences have a direct impact on their actions and decisions regarding their health (Butts & Rich, 2018, p.446) NRS 429VN: Topic 1 DQ 2 – Health promotion model used to initiate behavioral changes.

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Pender’s health promotion model concentrates on three major categories: individual characteristics and experiences, behavior-specific cognitions and affect and lastly, the behavioral outcomes (Butts & Rich, 2018, p.446). The second category involves the behavior-specific cognitions and affect which have a direct impact on the individual’s motivation for change (Butts & Rich, 2018, p.447). Behavior plays an important role in people’s health. Behaviors such as , smoking, poor diet, lack of exercise and sexual risk-taking can cause a large number of diseases. Interventions to change behavior have enormous potential to alter current patterns of the disease that can be acquired from us behavior mentioned above. The goal of the health promotion model is to stimulate a behavioral change that results in a positive health outcome.

Barriers such as individuals’ inability to see or hear properly, culture, language, and religion, etc. can affect a patient’s ability to learn. teaching patients about their respective illnesses and finding ways to engage patient on how to best manage these illnesses guide the patient to pursue better health as well as suitable health.

Learning readiness refers to how likely a person is to seek out knowledge and participate in behavior change. Individuals go through various stages in order to adopt or maintain a new health behavior. In the contemplative stage, the person is generally not aware of a problem or ready to act. Many factors influence a patient’s readiness to learn. Anything that affects physical or psychological comfort such as pain, fatigue, anxiety, fear also affects a person’s ability and motivation to learn NRS 429VN: Topic 1 DQ 2 – Health promotion model used to initiate behavioral changes.

In order for a behavioral change to occur and be maintained it must be self-initiated (Butts & Rich, 2018, p.449). One must consider the individual’s previous behavior and characteristics that can have a direct influence on future health-promoting behavior. Perceived personal value or benefit, as well as, self-worth can be a driving focus to achieve participation (Butts & Rich, 2018, p.449). A strong indication for commitment to health-promotion behavior can be achieved when others in their environment support and display the behavior.

Reference

Butts, J. B., & Rich, K. L. (2018). Philosophies and Theories for Advanced Nursing Practice. Burlington, MA: Jones & Bartlett Learning.

response

you made some great points in your DQ. Nurses play an important roles in teaching or educate patients with information about healthy behavior. Many health conditions can be prevented by simple lifestyle changes. To make teaching more effective, nurses need to know about patient’s learning factors such as readiness, environment factors, health status, and cultural awareness. Nurses also use the health belief model to motivate people to take positive health actions. The desire to avoid a negative health consequence can be used as the initiative motivation. Receptiveness of the patient needs to be present in order for the patient to be able to absorb the knowledge that you are implanting to them. The plan for patient education should be checked for its efficacy and should be analyzed and acted upon after implementation. Nurses should also reassess the way that the patient is learning and if they are indeed learning at all. Therefore, a follow up conversation at some point should be implemented to assure their understanding NRS 429VN: Topic 1 DQ 2 – Health promotion model used to initiate behavioral changes.

response2

That is a very important point you stated, “a strong indication for commitment to health promotion behavior can be achieved when others in their environment support and display the behavior.” Including a family member or caregiver at discharge or for education on diagnosis management, helps support the patient. Family members can enhance, reiterate and assist the patient to wellness by implementing new information learned to improve health. Outcomes can be better reached when there are support people available whom may also benefit from change.

response 3

In regards to Penders model, one of the important factors in health promotion is experience as you stated. Experienced behaviors will determine how well a patient or family unit is willing to change. As Nurses sometimes we make a less than meaningful attempt to teach a patient and the nurse might feel rushed to provide the information. Previous experiences in regards to promoting health changes, or the approach that is given plays a role. In health promotion is valuable to also assess past experiences with interactions that patient has had with health professional NRS 429VN: Topic 1 DQ 2 – Health promotion model used to initiate behavioral changes.

NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay

NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay

NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay
Re: Topic 1 DQ 2
Describe a health promotion model used to initiate behavioral changes. How does this model help in teaching behavioral changes? What are some of the barriers that affect a patient’s ability to learn? How does a patient’s readiness to learn, or readiness to change, affect learning outcomes?Nursing staff in all areas educate and advocate clients through motivating patients to improve and good lifestyle habits to reduce the get worse may cause chronic conditions. Whitney (2018). Pender’s health promotion module is one of the health promotion models used to begin changes in behavior. The promoting health module includes much more than just treating disease or illness, but it also encourages people to have healthy lifestyles. One of its model’s key flaws is the view that health requires more than only the absence of diseases or freedom from suffering, but also a greater predictive attitude. This even covers a person’s relationship towards their environments in terms of improving wellness NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay. The model is used to evaluate experiences and qualities, emotion, and behavior, as well as behavioral consequences. Each patient may have some factors that may impact their potential to grow and gain knowledge such as the capability to learn. (Nursing Theory, 2018). Multiple factors can have a significant impact on the health improvement or promotion such as a lack of knowledge of the disease process, misinformation foundation, and misunderstanding of may lead to the potential risk for behaviors changes.

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The major factor in Pender’s health promotion module is family members includes relatives and friends. Whitney (2018). The family is one factor to use for promoting health in Pender’s health promotion module. The patient’s relatives and friends are affected in changes and improving the health of the patients. The patient’s family are their support system and motivation to promote health and wellbeing. The patient must be willing to change their behaviors in order to succeed and meet the outcomes. The patient’s surroundings and environment are important. So, patients need to adjust their surroundings in order to improve their health and achieve the outcomes. Nurses are playing a role by providing information to patients’ families, patients, and other support regarding their new habits and keep a healthy lifestyle. These behavioral changes will help patients to improve their health, promote, prevent before getting severe and improve quality of life. (Nursing Theory, 2018) NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay.

 

Reference
Nursing Theory. (2016). Health promotion model. Retrieved from

https://nursing-theory.org/theories-and-models/pender-health-promotion-model.php

Whitney, Stacy. (2018). Health promotion: Health & wellness across the continuum. Grand Canyon University (Eds.), Teaching and learning styles. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the- continuum/v1.1/

response 1

Penders’ Health Promotion Module incorporates the family and friends much like the Family systems theory. I believe family support and family participation in patient care plans improve patient outcomes.

response 2

I think involving the patients family or support system is tremendously important and improves the outcome. Having support when making changes or attempting to implement new habits is extremely important. acording to Whitney, by incorporating respect and open communication, individual family members and health care providers can work together by using the participatory health model to form an effective team.

Whitney, S. (n.d). Teaching and learning styles. https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1 NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay

sample essay 2

Re: Topic 1 DQ 2

Pander’s health promotion model, as stated by Whitney, “Developed in 1982, provides a framework to understand health promotion behaviors by recognizing the family as the unit” (2018). Our focus as health care workers is the patient. Often, family is a major source of the patients drive to make changes for better quality of life. This model is based on “Cognitive-perceptual factors influencing engagement in health promoting behaviors” (Khodaveisi, Omidi, Farokhi, & Soltanian, 2017). This model helps teach behavioral changes by educating the entire family and providing them with evidenced based research and an interdisciplinary team to help them reach their goals. Education is stronger when it can be reinforced through an entire household that understands how important it is for their loved one to succeed.

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It can be challenging to educate a patient and their family members when there are differences of opinion, changes from disease processes or even effects of medication. Learning styles are another important part of educating patients. A full assessment is needed to choose the correct model of teaching for the patient and family member. There are many factors that become variable with education. For example, the patient that needs education is blind and they lean on their family member for support. Assessing the family member of their learning needs creates an avenue for reinforcement when the patient isn’t doing their best.

Readiness to learn and change must come about by the patient’s own accord. The saying you can bring a horse to water but can’t make them drink is true in this situation. In this situation, assessment of the patient’s motivation, ability to apply and life experiences are needed to create beneficial outcomes (Whitney, 2018). As nurse’s we can educate until we are blue in the face but if the patient isn’t ready to learn, nothing will become accomplished. In that situation, we provide the most amount of information that we can, with different learning styles in mind, and send the patient to where ever they are going with the tools to succeed NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay.

Khodaveisi, M., PhD, Omidi, A., Ms, Farokhi, S., Ms, & Soltanian, A. R., PhD (2017). The Effect of Pender’s Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women. International journal of community based nursing and midwifery, 5(2), 165–174.

Whitney, S. Grand Canyon University (Ed). (2018). Health promotion: Health & wellness across the continuum.Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/

 

response

Re: Topic 1 DQ 2

Motivation seems to be a key factor in all health promotion models. I’m not an equestrian, but if a horse is not thirsty it will not drink. Probably if the horse gets a little exercise it might become thirsty.

 

 

response 2

i liked your post on the theory of pender health promotion. i like the way you use horse as an example and i partially agree to that point. i think all the theories are connected to each other for example, The health belief model can be used to predict or explain health behavior as well as change readiness. The health care provider can understand why some patients are more adherent to health care instructions than others by using information about the individual’s values and expectations, the HBM is based on psychology and behavioral theory, with the premise that the two components of health-related behavior are 1) the desire to avoid sickness, or conversely, to get well if already ill, and 2) the belief that a certain health action will prevent or cure illness. Finally, an individual’s course of action is frequently determined by the person’s beliefs of the benefits and barriers associated with health behavior. while your theory focus on family the HBM mainly focus on the patient’s interest overall all theories look on the patient behaivour NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay

references

Whitney, S. (2018). Teaching and learning styles. Gcumedia.com. https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1

https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories2.html NRS 429VN: Topic 1 DQ 2 – Pender’s health promotion model essay