Do you think that nurses should create a portfolio for their annual review? If not, why not?

Also, what does the research say about the importance or impact of using portfolios for the annual review process?

Assess the culture of the organization for potential challenges in incorporating the nursing practice intervention. Use this assessment when creating the strategic plan.

Write a 500 word strategic plan defining how the nursing practice intervention will be implemented in the capstone project change proposal.

Assessment 1

**** this assignment leads to assessment 2 and 3. Read directions carefully.
Rubric is attached. You must get distinguished score in all categories or revise it***

• Planning and Presenting a Care Coordination Project
• Develop a care coordination project plan for a population that is in need of care from multiple organizations. Then, develop 10–12 slides for use in presenting your plan to administrative decision makers.
  Note: Complete the assessments in the order in which they are presented. The assessments that follow will build upon the work you have completed in this first assessment.
  The role of professional nursing continues to expand and incorporate increasingly higher levels of expertise, specialization, autonomy, and accountability. This is particularly true in regard to the scope and challenges of providing coordinated care to members of various populations within a community. In addition, care coordination leaders must be confident in their abilities to navigate and lead change in their work environments.
  • Competency 1: Propose a project for change, for a community or population, within a care coordination setting. 
    • Articulate a vision of interagency coordinated care for a population.
  • Competency 2: Align care coordination resources with community health care needs. 
    • Determine the resource needs of a population.
  • Competency 3: Apply project management best practices to affect ethical practice and support positive health outcomes in the delivery of safe, culturally competent care in compliance with applicable regulatory requirements. 
    • Identify project milestones and outcome measures.
  • Competency 4: Identify ways in which the care coordinator leader supports collaboration between key stakeholders in the care coordination process. 
    • Identify the organizations and groups who must participate in caring for a population.
  • Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards. 
    • Present a project plan to administrative decision makers.
    • Support main points, arguments, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
  • us/article/Record-a-slide-show-with-narration-and-slide-timings-0b9502c6-5f6c-40ae-b1e7-e47d8741161c?ui=en-US&rs=en-001&ad=US 
    • A tutorial on recording slide narration and setting slide timing.
  • Writing Resources
    You are encouraged to explore the following writing resources. You can use them to improve your writing skills and as source materials for seeking answers to specific questions.
  • APA Module.
  • Academic Honesty & APA Style and Formatting.
  • APA Style Paper Tutorial [DOCX].
  • Capella Resources
  • Using Kaltura.
  • Disability Services.
  • Smarthinking.
  • ePortfolio. 
    • This resource provides information about ePortfolio, including how to use the different features of the product.
  • Additional Resources
    The following resources are books you may have used in your previous Care Coordination courses. You may find them helpful in providing background information for this course as well.
  • American Academy of Ambulatory Care Nursing. (2016). Scope and standards of practice for registered nurses in care coordination and transition management. Pitman, NJ: Author.
  • American Nurses Association. (2018). Care coordination: A blueprint for action for RNs. Silver Spring, MD: Author.
• Assessment Instructions
• ****Note:Your work in subsequent assessments will be based on the project plan you develop in this assessment. Therefore, complete the assessments in the order in which they are presented.
  Preparation
  For this assessment, you will assume the role of Care Coordinator Project Manager in your present organization or in an organization or setting you aspire to work in, are familiar with, or interested in. Within this context, you will develop a care coordination project plan for a population of your choice that is in need of care from multiple organizations.
  In this role, you must consider a comprehensive strategy to organize and coordinate care for the selected population on a local, state, national, or international level, depending upon the population. Your project plan will serve as a model for addressing the care coordination needs of another population, or of an entire community, in Assessments 2 and 3.
  After completing your project plan, you will then develop a presentation of your plan to gain the support of administrative decision makers in the organization.

  *******Use the speaker’s notes section of each slide to develop your talking points and cite your sources, as appropriate. If you need help designing your presentation, you are encouraged to review the presentation resources provided for this assessment. These resources will help you to design an effective presentation, whether you choose to use PowerPoint or other presentation software.

  • For this assessment:
    1. Develop a care coordination project plan for a population of your choice. For example:
  • Children or the elderly.
  • Chronic care patients.
  • Patients with disabilities.
  • End-of-life care patients.
  • Special needs patients.
  • Inner city or rural area residents.
• • 2. Develop a presentation of your plan for administrative decision makers in the organization to obtain their support.
    Note:Choose any population you are familiar with and interested in addressing. However, you will have an option to address the care coordination needs of an undocumented immigrant or refugee population in the next assessment, so donotchoose this population for this assessment.
    In addition to the requirements outlined below for developing and presenting your project plan, you are encouraged to include whatever additional information is appropriate for the specific population for whom you have chosen to provide a care plan.
    Project Plan and Presentation Format and Length
    You may use either Microsoft Word or Excel to format your project plan.
  • For Word documents, use theAPA Style Paper Template [DOCX]. An APA Style Paper Tutorial is also provided (linked in the Resources) to help you write and format your project plan. There is no required page length but be sure to include: 
    • A title page and references page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
  • For Excel spreadsheets, be sure to include properly formatted citations and references.
  • At a minimum, your presentation must include the following slides:
  • Title.
  • Purpose (the reasons for your presentation).
  • References (at the end of your presentation).
  • Your slide deck should consist of 10–12 slides, not including the title, purpose, and references slides.
    Supporting Evidence
    Cite 5–7 sources of scholarly or professional evidence to support your project plan.
    Developing and Presenting Your Project Plan
  • speaker notes
    Note:The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that, at a minimum, you address each criterion. You may also want to read the Planning and Presenting a Care Coordination Project scoring guide to better understand how each criterion will be assessed.
  • Articulate your vision of interagency coordinated care for this population.
    • Consider how you would organize and consolidate care for this population.
    • What assumptions underlie your vision?
  • Identify the organizations and groups who must participate in caring for this population.
    • Consider coordinated care on a local, state, national, or international level, as applicable.
    • Identify the team members who will comprise your interprofessional care coordination team.
  • Determine the resource needs of this population.
    • Operational and capital budgeting needs, including:
      • General supplies.
      • Staffing.
      • Capital purchases.
    • Costs: Estimated funds.
    • Assumptions.
  • Identify project milestones and outcome measures. 
    • Determine the key steps in attaining your goals for this project.
    • Determine timeframes for each milestone.
    • Identify outcome measures for your project.
  • Present your project plan to administrative decision makers. 
    • Be clear and focused about the why this care coordination project plan is important to successfully support this population.
    • Address the anticipated needs and concerns of your audience.
    • What questions or alternative points of view might you expect? How will you respond?
    • Express your main points, arguments, and conclusions coherently.
    • Proofread your slides to minimize errors that could distract the audience and make it more difficult to focus on the substance of your presentation.
  • Support main points, arguments, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style. 
    • Is your supporting evidence clear and explicit?
    • How or why does particular evidence support a claim?
      • Will your audience see the connection?
  • Additional Requirements
    Be sure that you have used the APA Style Paper Template [DOCX]to format your project plan and that your document includes:
  • A title page and references page.
  • A running head on all pages.
  • Appropriate section headings.
  • In addition, be sure that:
  • Your slide deck consists of approximately 10–12 slides, not including the title, purpose, and references slide.
  • You have cited 5–7 sources of relevant and credible scholarly or professional evidence to support your project plan.
  • Portfolio Prompt:You may choose to save your project plan and presentation to your ePortfolio.

Mr. Russell is a 73-year-old Caucasian male who presents to your clinic with complaints palpitations and intermittent light-headedness for approximately 1 month. He is currently being treated for hypertension and is taking HCTZ 25mg daily. He also is complaining of heartburn and belching after eating a large meal.

Vital Signs: B/P 159/95 (right arm), B/P 162/96 (left arm), HR 88, Resp. 22, Weight 99 kilograms (previous weight at last appointment 2 months ago was 95kg

Physical Exam:

Constitutional: Alert & oriented, well-developed.

Neck: No carotid bruit or JVD.

Heart: Regular rate without murmur or gallop.

Lungs: Slight crackles in RLL but otherwise clear to auscultation.

Abdomen: Soft, non-tender with + BS.

Legs: Left leg with moderate 3+ edema on RLE and leg 2+ edema on LLE.

Labs: NA 143mEq/L, CL 99 mmol/L BUN 18mg/dL, Hbg 15, TC 234 mg/dL, LDL 137 mg/dL, HDL 35 mg/dL, triglycerides 241mg/dL,

1. What are your treatment goals for Mr. Russell today?
2. What is your pharmacologic plan and rationale? (cite with appropriate clinical practice guidelines or scholarly, peer-reviewed journals)
3. What are five key patient education points based on your plan?
4. How would your plan change if your patient is African American?

 Identify and discuss the following:

• what is known/not known about the topic and the gap in knowledge the study is intended to fill.
• the research design, purpose of the study, and setting.
• information about the sample: 
  • method;
  • size;
  • inclusion/exclusion criteria,
  • attrition/loss to follow up/response rate, if any;
  • important characteristics of the sample.

 Medicare or Medicaid – which has greater impact in Florida?. Explain about that. APA format. At east two references. 

You can use this website:

 https://www.medicare. gov/yourmedicarecosts/get-helppayingcosts/medicaid 

I need this in about 120-150 words

I have ATTACHED a paper discussing the state of EBP competencies in US nurses. After reading the article, what are your thoughts on EBP competencies, importance of this class etc.

Instructions

In this assignment, you will be required to use the Heart Rate Dataset to complete the following:

• Use the classification of variables from the Unit 1 assignment to match each variable to one appropriate type of graph.
• Create graphs of those variables
• Give a brief written description of how the values of each variable are distributed in the sample. What does the graph tell us about the data in the heart rate sample?

Steps

1. Open the Heart Rate Dataset in Excel
2. Using the classification of variables from Unit 1 assignment as qualitative, quantitative discrete, or quantitative continuous, match each of the 3 variables to the most appropriate graph type. (For example, qualitative data can best be displayed with a pie chart or bar graph; continuous numerical data can best be displayed using a histogram)
3. Use the graphing functions in Excel to create an appropriate graph of the data for each variable. Remember to properly label and title your graphs to identify what the graph is about clearly.

Review these videos as needed:

Excel 2016: Creating a Pie Chart

(Tom Kleen, 2017)
Estimated time to complete: 9 minutes

Making a Simple Bar Graph in Excel

(Scott Stevens, 2014)
Estimated time to complete: 5 minutes

Additional Instructions:

Your assignment should be typed into a Word or other word processing document, formatted in APA style. The assignments must include

• Running head
• A title page with
  • Assignment name
  • Your name
  • Professor’s name
  • Course

Estimated time to complete: 3 hours

References

Scott Stevens. (, 2014). Making a simple bar graph in Excel [Video]. Retrieved from https://youtu.be/_Txpfyn4ipI

Tom Kleen. (2017). Excel 2015: Creating a pie chart [Video]. Retrieved from https://youtu.be/ZKa35Iz-aZ4

Assignment Files

Heart Rate Data Set [Excel File]

Antipsychotic Therapy Case Study 

Psychosis is a mental health condition that manifests in the case of patients experiencing episodes of hallucinations as described by Saha, et al. (2016). Patients with the psychotic conditions may hear or see things that do not exist in real life. Psychosis may result from bipolar condition, the schizophrenia or personality disorder condition besides occurring even in the absence of these conditions. The pharmacological treatment of the psychosis is through the use of the antipsychotic medications (Opler, Yavorsky, & Daniel, 2017). Antipsychotic drugs are used to treat several types of mental health disorders such as the dementia, major depression condition schizophrenia and schizoaffective disorder. The process of developing suitable features that would be associated with the increase in the quality of healthcare. antipsychotics occur in two types; first generation antipsychotics and second generation antipsychotics. Second generation antipsychotics were introduced to the market after the 1990s and are known to have less side effects as compared to the first generation types as agreed by Opler, Yavorsky, and Daniel, (2017). This paper discusses the choice of antipsychotic treatment for managing the presented case study. The rationale for selecting the medication and the expected impact of the medication is also discussed in this case. 

Decision #1

Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day four and monthly thereafter.

Rationale for Choice

The patient differential diagnosis is schizophrenia paranoid type. The presented antipsychotic medication options are all second generation antipsychotics (Saha, et al. 2016). All the conditions could be considered to have similar effectiveness in the management of the patient condition. The patient is middle aged adult and thus the limitation due to the elderly sides effects do not apply in all the presented options. The patient is presented to have stopped the use of the Risperdal and thus indicating the signs of non-adhering to medication instructions. Thus the most appropriate choice would be to have an intravenous medication. From the provided options, the other two are orally administered while Invega Sustenna is intravenous. 

Expected Outcome

The patient condition is expected to respond positively the PANSS positive score is expected to increase by at least 30% after the four weeks’ period. The PANSS negative score is also expected to reduce by the at least 25% while the composite scale score is expected to improve by at least 25% (Opler, Yavorsky, & Daniel, 2017). The episodes of hallucination are also expected to have reduced significantly over the period as a response to the medication. The frequency of the signs of paranoid condition will also be expected to have reduced. Considering the positive responses to the treatment, the patient would also be expected to be tolerant to the medication. 

Variation Between Actual Outcome and the Expected Outcome

After the four weeks, the patient returns to office for the appointment. The patient presented a 25% reduction in the negative PANSS score. The patient is also observed to be tolerate to the medication considering that she managed to turn up for the injection appointment. The PANSS positive score had not improved by the expected 30% and the composite score had also not improved by the expected 25%. The patient had gained 2 pounds within the four weeks and this was also not expected. This could be attributed to the side effects of using the medication as explained by Spertus, et al. (2018) The other unexpected patient experience was the pain at the injection site that made the patient to stay without the sitting for hours. 

Decision #2

Continue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300 mg intramuscular monthly with oral Abilify 10 mg in the MORNING for 2 weeks 

Rationale for Choice

The patient has proved to be positively responsive to the medication as the has been a 25% reduction in the PANSS negative score. Thus in order to obtain continuously positive responses, the patient should continue with the medication. The patient has also proved to be tolerant to the medication and thus making it a suitable option (Keks, Schwartz, & Hope, 2019). One of the side effects of using the Invega Sustenna is that it may cause weight gain and thus explains the 2 pound gained by the patient within the short period. The additional Abilify Maintena 300 mg intramuscular monthly with oral Abilify 10 mg orally every morning is aimed at increasing the rate of response. Since this is reversible, the patient should not be bothered. In order to address the issue of the pain at the injection site, the injection will be done on the deltoid. Deltoid injection would not deny the patient to sit down despite the pain. 

Expected Outcome

 Continuous use of Invega Sustenna is expected to further improve the condition of the patient. The PANSS negative score is also expected to reduce by 50% within the next four weeks. The PANSS positive score is also expected to increase by at least 50% before the next appointment. The hallucination symptoms are expected to continuously increase due to the additional Abilify Maintena. Since the deltoid injection will be adopted, the patient is not likely to complain of the pain that affected her sitting down for several hours after the injection (Saha, et al. 2016). One of the side effects that will be expected is the weight gain of an additional 1 to 2 pounds by the next visit. 

Variation Between Obtained outcome and the Expected Outcome

 After the next four weeks the patient was punctual to honor the appointment and thus indicating a high level of compliance. The PANSS negative score had reduced by 50% just as it had been anticipated. The patient condition had indicated high rate of responsiveness and this was encouraging. The frequency of hallucinations had reduced significantly as well as the paranoid nature. The aspect of weight gain increased beyond the expected outcome. The patient had gained 2.6 pounds over the four weeks. The other unexpected conditions that developed as was that the patient had developed salivary gland disorder besides the stiffening of feet. The patient had failed to complied to the oral medication instructions. 

Decision #3

Discontinue Abilify. Continue with the Invega Sustenna

Rationale for Decision

The discontinuation of the Abilify medication is due to the fact that the patient experienced more side effects from using this drug. The continuation with the use of Invega Sustenna based on the fact that the patient had consistently responded positively at the initial stage (Keks, Schwartz, & Hope, 2019). The patient had also experienced limited side effects since the only side effect was weight gain. Patient education on the approach to cope to normal life will also be made to accompany the injection. 

Expected Patient Outcome

 With the last four weeks of treatment period, the patient negative PANSS score would be expected to have reduced by 80%. The patient is also expected to be 100% tolerant to the medication as at this time, she will have adopted to the medication. The patient is expected to experience at most two episodes of hallucinations (Saha, et al. 2016). The patient is also expected to gain up to 4 pounds within the period of four weeks. The patient is also expected to further honor appointments with the assistance of the husband has they have been in the past appointments. The salivary gland disorder is also expected to stop after the four weeks. 

Variation Between Obtained outcome and the Expected Outcome

 The PANSS negative score had reduced by 75% contrary to the expected 80% reduction. The salivary glands had reduced by 75% while the patient had also gained 1.5 pounds within the four weeks. The patient was 100% compliant to the treatment and thus patient education was also provided at the period. The patient education will be targeted to improve further adherence to the medication instructions. 

Impact of Ethical Consideration on the Treatment Approach

 The treatment of psychotic health conditions should be considerate of the ethical factors for the improvement of the patient condition as elaborated by Hunt-Grubbe, (2020). The decisions made by the PMHNP should align to the ethical requirements. The aspect of the informed consent was strongly adhered to in the process of providing treatment to the patient. With the consideration of the patient religion, the hallucination of being Prophet Mohamed was also handled with adherence to the required ethics. The aspect of being paranoid was also addressed with ethical caution in order to avoid victimization of the husband. The false stigma due to her religion and ethnicity was also handled with consideration of ethics as the patient demonstrated possibility of false stigmatization. 

Summary

Antipsychotic treatments could be considered to be the most critical procedure that should be adhered to steadily. Critical thinking should also be applied when selecting the antipsychotic medication during the treatment plan. Response to treatment should be monitored at every appointment so as to determine whether to change the treatment approach. Ethical consideration should also be adhered to so as to maintain autonomy throughout the treatment process. Informed consent on the choice of antipsychotics is also important throughout the process. In the situation where the patient is from a different religious and cultural background, the PMHNP should always focus to maintain a suitable relationship with the patient. 

References

Hunt-Grubbe, H. (2020). Ethical Issues Arising from the Prescription of Antipsychotic Medication in Clinical Forensic Settings. In Ethical Issues in Clinical Forensic Psychiatry (pp. 99-114). Springer, Cham.

Keks, N., Schwartz, D., & Hope, J. (2019). Stopping and switching antipsychotic drugs. Australian Prescriber, 42(5), 152.

Opler, M., Yavorsky, C., & Daniel, D. G. (2017). Positive and Negative Syndrome Scale (PANSS) Training: Challenges, Solutions, and Future Directions. Innovations in clinical neuroscience, 14(11-12), 77–81.

Saha, K. B., Bo, L., Zhao, S., Xia, J., Sampson, S., & Zaman, R. U. (2016). Chlorpromazine versus atypical antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews, (4). 

Spertus, J., Horvitz-Lennon, M., Abing, H., & Normand, S. L. (2018). Risk of weight gain for specific antipsychotic drugs: a meta-analysis. NPJ schizophrenia, 4(1), 1-7.

TOPIC OF THE ESSAY IS  “ETHICAL dilemma  OF THERAPEUTIC COMMUNICATION”

 FOR THE INTRODUCTION IT SHOULD INCLUDE the following

1. Why is this topic important to investigate?
2. What is the scope, context and significance of the topic as an ethical dilemma?
3. Highlight the importance of the problem/issue and make general statements about the problem/issue
4. Summarize the current understanding and background information about the topic
5. Include one referenced source that will support your introductory thoughts about your topic.
6. APA 7th edition format; full sentences, attention to grammar
7. ATTACHED IS THE RUBRIC