Category: Nursing

Refer to the outline example within your EBP packet to assist you in creating a well prepared outline for your paper. An outline is essential to the development of a paper and will basically write your paper for you if it is done correctly. Please refer to the grading rubric within your EBP packet. Also an article grid is required for each article and there are 4 articles. A gin matrix is required for the guideline. I will attach all the articles and guideline below

Describe three barriers that have slowed down the progress of advanced practice nursing and strategies to help overcome these barriers. (Saunders, 2014)
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Your case study should be a 4- to 6-page Microsoft Word document with 12-point Times New Roman font and one-inch margins. All citations and references should be formatted according to the most recent APA guidelines.
please review/add
-Good choice in an ethical theory.  I would be sure to tie the theory directly to this case.  
-Good discussion on an SDM.  What specific SDM would you want to address here?  
Introduction:
Summarize the selected case, including information on the stakeholders involved, the problem, and the time period in which the incident occurred.
Medical Malpractice Component: In this section, you will evaluate the case to address the legal components, the malpractice policies similar to this case, and the standard of care given to the patient and how it was breached. Then, you will draw connections to how this malpractice case impacted stakeholders and healthcare consumers outside of the case.
Explain the key legal components of the case, including the nature of the issue and the rules that applied.
Determine relevant malpractice policies in place for addressing the issues within the case.
Analyze the malpractice case for the standard of care provided to the victim. Be sure to apply what the law states about standard of care to support whether or not it was breached in the case.
Analyze how the malpractice case would impact healthcare consumers from different cultural backgrounds. For example, would this case have a similar impact on a person from a culture different from the one in the case? How could this incident change the views of these healthcare consumers toward the healthcare system?
Assess the malpractice case for accountability based on its severity. To what extent was the healthcare provider held accountable?
Ethical Component: In this section, you will evaluate the case to identify the specific ethical issues and determine ethical theories and shared decision- making models that would help resolve the issue and provide a safe, quality healthcare experience. Then, you will propose and defend ethical guidelines for healthcare providers to follow in order to avoid future incidents.
Describe the ethical issues that led to the malpractice case and explain why the issues are credited with causing the incident. Support your response with research and relevant examples from the case.
Describe an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient. Support your response with research and relevant examples from the case.
Select a physician–patient shared decision-making model and explain how it would provide a safe, quality healthcare experience for the patient.
Propose ethical guidelines that would have helped prevent the incident and would help the organization prevent future incidents.
Defend how your proposed ethical guidelines will hold healthcare providers accountable to themselves, their profession, their patients, and the public.
Recommendations: In this section, you will utilize the knowledge you gained from your malpractice and ethical analyses to recommend and defend strategies that would help improve medical practices and avoid future liability.
Recommend preventative strategies the healthcare provider could implement to avoid liability in the future.
Defend how your recommended preventative strategies would assist the healthcare provider in avoiding liability and provide a safe, quality healthcare experience for the patient.

You are seeing a 15-year-old female patient for a gynecological exam and to explore birth control options. The patient’s mother scheduled the appointment after learning that her daughter has become sexually active. The patient is current with all immunizations, including Gardasil, and has no significant health history that would contraindicate the use of birth control.
This is the patient’s first gynecological exam, and she expresses feeling nervous and embarrassed that her mother has shared her sexual experience with strangers. Taking this into account, how would you begin the patient encounter?
As you begin asking questions to determine the patient’s gynecological history, the patient appears frustrated and embarrassed and reminds you that she has only had sex one time. What should the patient understand about the importance of reviewing gynecological history?
What are the most popular birth control methods prescribed in the United States? What determines the success or failure of a birth control method?
The patient expresses a desire for the most effective form of birth control but is concerned about weight gain and other side effects. How should you respond to her concerns?
The patient seems unsure about the best option for birth control and asks if she can take some time to think about the choices. As the use of birth control is ultimately the patient’s choice, you offer to answer any questions and agree to a follow-up visit or call. The patient asks whether using a condom is okay if she decides to have sexual intercourse before selecting a method of birth control. What should you tell her?
REQUIREMENTS:
The paper should be formatted per current APA 7 EDITION and 2 pages in length, excluding the title, abstract and references page.
Incorporate a minimum of 4 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
*WILL BE SUBMITTED AGAINST TURNITIN, NEEDS LESS THAN 20% SIMILARITY SCORE*
PAPER HAS TO BE APA 7 EDITION FORMATTED
ALL 5 QUESTIONS NEED TO BE ANSWERED 

Step 1 Introduction:
Open up a Word Document and write directly into the word document. Remember you need to save on your computer and another reliable drive or computer. You don’t want to lose your work, so save often and to 2 different places….ALWAYS!  Save as you go and do not wait until your assignment is complete to save or you will risk losing information. 
Write an introduction to the discussion. A good, solid introduction will grab the reader’s attention by stating interesting facts, statistics or points about your topic. Then you should conclude this introductory paragraph by including one, concise thesis or purpose statement. The thesis tells the reader why you are writing the discussion. The entire paragraph should be about 3-5 sentences. Keep in mind that paragraphs should include a topic sentence, 2-3 support sentences (min.) and one concluding statement (thesis sentence).  Review APA manual 7th edition section 3.4 for details on starting your paper and rules on introductions.
Step 2 Concepts:
Use a proper heading with this section, then begin your 2nd paragraph. You can look at APA p. 47-49 for the proper level of headings. In this section you need to differentiate among research, evidence-based practice (EBP) and quality improvement (QI) in a robust discussion. When you differentiate between these concepts, they should explain why they are similar (if applicable) or different and should summarize similarities and differences rather than definitions. In fact, you should be paraphrasing what you review in the textbooks about these concepts and describe how they are applied to your specific phenomenon of interest (POI) and in relationship to your Advanced Practice Nurse role. This section  should be no more than 2 paragraphs. Textbooks/peer reviewed resources serve as great resources here. 
Step 3 Health Disparities
In this section you are taking a deeper dive into health disparities. According to the Centers for Disease Control, health disparities are experienced by socially disadvantaged groups of people based on preventable differences in the burden of disease, injury, violence, or opportunities that would allow you to otherwise achieve optimal health. Health disparities are inequitable and have a direct correlation to unequal distribution of resources. They can be improved though. Addressing the social determinants of health can help by addressing the positive and negatives associated with 5 key domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. In this section you should provide a robust discussion on how a person’s health or burden of disease is impacted by these domains. Be sure to discuss these areas in relation to your POI/APN Role. Support this section with peer reviewed references. You should have 2-3 well developed paragraphs for this section.
Be sure to review the links that were provided to you in the Readings/Resources section of the module: 
Health Disparities LinkLinks to an external site.
Social Determinants of HealthLinks to an external site.
Step 4: Donabedian Model:
In this section of the discussion, you will differentiate among 3 measures: structure, process, and outcomes. Be sure to clearly describe how they are different.  Then you will apply each of the measures (structure, process, outcome)  directly to your POI. Think about why you chose that POI and what you would like to change in practice. What did you describe in your clinical question of the POI approval process?  Is there a new policy, a metric that you want to improve? This should guide the direction of your focus for each of your measures as you determine what is needed to accomplish change. Likewise, this serves as a building block for future assignments. Each measure should be specific rather than generalized so that you can see exactly what is needed to determine success or failure. Below is a comparison of a general versus specific measure. You will re-visit the concept of structure, process, and outcome measures throughout the coursework and program so be sure that you have a good understanding of the concepts now. Be sure to incorporate peer reviewed references throughout your discussion. You should include 2-3 paragraphs for this section. 
Incorrect General Measure that lacks specificity:  Patient satisfaction scores will be improved.
Correct Measure that includes specicity: Patient satisfaction scores will be 85% or higher and evaluated quarterly for improvements. 
Be sure to review the link below for assistance on the measures
Donabedian ModelLinks to an external site.
Step 5 Conclusion:
Include a heading and write your conclusion paragraph. A good conclusion:-never introduces new info.-summarizes what was learned/discussed and does not simply state what you did or re-state only the purpose statement-citations are not expected in this section.
Step 6: Turnitin:
Submit your initial post ONLY to Turnitin. Be sure to review the info. on turnitin so you know how to submit, what to look for when your report is returned, etc.  Rather than focus on the percentage of similarity, review what was highlighted and change anything that can and should be changed. There is some wording that can’t be changed, i.e. quality of life, American Academy of Pediatrics, Institute of Medicine Aims, so don’t worry about those. Focus on changing the areas of similarity that you can change and re-submit the paper. You do not have to submit this report to the assignment area;  faculty will review the reports directly in Turnitin. You do NOT have to submit the cross or peer posts to Turnitin. 
Initial Post References:   
Minimum of 2 peer reviewed  from journals that are current (within 5 years) references in the initial post; no more than 1000 words excluding headings, in-text citations, and references.
Copy and paste your discussion directly into the discussion area. Attachments should not be included in the discussion area. No title page needed. Try to make sure that there is at least 1 space in between all paragraphs and individual references. You do not need to double space this document. You are permitted to use first person for these informal discussions.

CREATE RESPONSE TO DISCUSSION Question
I am enrolled in the Psychiatric Nurse Practitioner Program, and I was interested in finding a peer review on the Therapeutic Nurse-Patient Relationship in the Acute Mental Healthcare setting. I began my search by accessing the Walden University Library: Databases A-Z: Nursing link provided in this week’s module Required Reading section. From there, I navigated to the APA Psycinfo link, which brought me to the EBSCOhost search page. Using the “Select a Field” search bar, I entered “Peer-Review,” and in the “Keyword” bar, I entered “Psychiatric Nurse.” The search yielded four reviews, with only one delivering the content I was looking for, from The International Journal of Nursing Studies, “Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review” (McAllister et al., 2019). The content was clear, concise, and relevant, with the only downfall being that it originated from the Netherlands.
The database was easy to navigate and provided valuable information. The only issue I encountered was that my topic of interest didn’t return any results from the United States. Once I found the topic I was looking for, I explored random topics and found a wealth of results. This database will benefit me and my colleagues as we progress through our studies. The database allowed me to search for information from various sources, enabling me to access multiple materials; I would recommend this resource to my colleagues. “Research databases offer users access to thousands of books, magazine articles, images, charts, and primary sources. These databases contain scholarly and peer-reviewed articles written by credible authors, such as journalists, researchers, and experts in their field. Since databases provide powerful search tools for narrowing results, users are able to more quickly find the information they need” (EBSCO, n.d.).
Reference
Walden University Library. (n.d.). Databases A-Z: NursingLinks to an external site. Links to an external site.. Retrieved October 4, 2019, from
https://academicguides.waldenu.edu/az.php?s=19981 Links to an external site.
McAllister, S., Robert, G., Tsianakas, V., & McCrae, N. (2019, May). The International Journal of Nursing Studies. Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. Retrieved June 15, 2024, from
https://web.p.ebscohost.com/ehost/detail/detail?vid=12&sid=4a15fc1f-98ba-42e2-a3d5-91be04f05a1e%40redis&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1laG9zdC1saXZlJnNjb3BlPXNpdGU%3d#AN=2019-24838-013&db=psyh Links to an external site.

The underlying purpose of the Vulnerable Patient Clinical Case Studies is to apply an assessment of the social determinants of health, appraisal of policy mechanisms that improve/hinder health, critique the United States’ approach to addressing healthcare for vulnerable populations, and evaluate the sources/levels of vulnerability. 
Instructions:
The case studies should not be in essay form. Attached is a form that should be filled out for each case study.
Please note that short responses, incomplete sentences, and opinions not supported by literature are unacceptable for graduate-level work and will result in a deduction of points. For this assignment,  break down each case study and share substantial responses to each of the prompts located on the form.
It is pertinent to cite the work of others when used. Follow the rubric closely. 
Case Study #2: Elderly 

For this assignment, you will choose between two case studies: Gabe or Larry. Listen to your chosen case study carefully, as the interview details are key to constructing an accurate pedigree and answering the questions below. 
Select either “Gabe” and “Gabe #2” OR” Larry” on genomicscases.net and listen to all of the questions and answers provided in the interview of your 1 chosen case study. 
To access all of the questions, click on “CLICK HERE TO CHOOSE ANOTHER QUESTION”.
If you choose the case study of Gabe, please be sure to watch both “Gabe” and “Gabe #2” case studies. 
Do not complete the questions/assignments from the website.
Review the information provided about your chosen case study on the website before starting to build your pedigree. Be sure to use Bennett et al. guidelines. 
After constructing your pedigree, answer the corresponding questions with the case study you have chosen (either Gabe or Larry)
After constructing your pedigree, answer the corresponding questions with the case study you have chosen (either Gabe or Larry). Both your answers and the pedigree should be in the same document file. 
If your pedigree is hand drawn, you will have to scan it into a .doc, .docx, or .pdf file or take a picture. Hand drawn pedigree must be clear and legible. 
Copy and paste your pedigree to whatever format you choose (e.g., Word, PowerPoint) to answer the questions below. It would be best to add the pedigree in the Landscape orientation for easier viewing. 
References should not be older than 5 years old. 
**PLEASE NOTE:
For Gabe (1st case study) case study, there is an error. The case study states he is 44, though he is 55.
For Larry case study, be sure to review the most current drug package insert, not the one provided on the website.
Questions:
Be sure to answer the following questions in 2 paragraphs per question and attach your answers with your pedigree submission. Follow APA format for title page, format, in-text citations, and references (including pedigree programs, if used). 
QUESTIONS FOR GABE (Be sure to watch both Gabe interviews – Gabe and Gabe #2)
Explain the pharmacogenomic testing available to evaluate warfarin metabolism. Specifically, explain the different genotypes (alleles) of CYP2C9, what each causes, how they affect warfarin metabolism, and the recommended changes in dose.  Will INR levels still be used to monitor the dose?  What is the chromosomal location of the CYP2C9 gene?
Explain the pharmacogenomic testing available to evaluate warfarin metabolism. Specifically, explain the mechanism of the VKORC1 gene, its different genotypes (alleles), how they affect warfarin metabolism, and the recommended changes in dose. Will INR levels still be used to monitor the dose?   What is the chromosomal location of the VKORC1 gene?
Does the FDA recommend or require this testing before starting warfarin? Look at current FDA Package Insert.
Two hereditary syndromes related to colon cancer include Lynch syndrome and FAP. Explain Lynch Syndrome and FAP, and the defining characteristics of each. Identify the red flags in Gabe’s family history.  Do any of these match the characteristics of Lynch or FAP?  Based on your findings, if you were his nurse, what would you do?
Based on Gabe’s history, how often should he receive colonoscopies? (See attached algorithm)
What are the nursing implications? What should Gabe’s nurse do next? 
QUESTIONS FOR LARRY’S CASE STUDY
Explain mechanism of action, general indications, contraindications, and risk factors/side effects of clopidogrel. 
How is clopidogrel metabolized?  What enzymes are necessary? Explain why a patient taking clopidogrel should avoid CYP2C19 inhibitors.  What happens if a patient taking clopidogrel also takes a CYP2C19 inhibitor? Give some examples of strong, moderate, and weak CYP2C19 inhibitors.
Discuss the use of CYP2C19 testing related to clopidogrel dosage/response. What are the possible different genotypes (alleles) and how do they affect response?
Explain how race/ethnicity can influence response to clopidogrel. Provide the most common ethnicities of poor metabolizers. What are the percentages in these populations?
Describe the current status of the FDA boxed warning for clopidogrel regarding drug response in poor metabolizers. Does the FDA recommend testing before starting clopidogrel?
What are the nursing implications? What should Larry’s nurse do next? 

Describe the data-driven quality improvement problem I dentitfied (use LC4002A paper toassist)
Explain the importance of the quality improvement practice problem I identiofied for nursing practice. Support your explanation by synthesizing eveidenced-based literature found through a literature search using a minimum of 5 scholarly articles (use LC4002A paper toassist)
Describe the QI tools that will aid un the interpretation of the data that will support addressing the QI practice problem identified (Use LC4003A and LC4004A to assist)
Explain why these QI tools are most usesful in addressing the QI practice problem (use LC4004A tp assist)
Explain how i would apple the PDSA QI improvement process to my QI practive problem, Support the plan by synthesixing a minimum of 5 pieces of scholarly evidence found through a literature search (Use LC4003A to assist)
Be sure to integrate capstone-0level writing guidelines in the completetion of this comprehensive paper.
**see uploaded RUN CHART for up-to-date data**

For this assessment, you will complete an evidence-based patient-centered needs assessment of prospective health care technology that will improve patient engagement. You will write a 4-5 page paper explaining the process and considerations that went into completing the patient needs assessment.
PLEASE SEE ATTACHMENTS FOR COMPLETE INSTRUCTIONS