How do best practices contribute to quality and safety?

 Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

·      Minimum of two references, not older than 2015.

• After watching Episode 3, discuss the following:
  • What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?
  • What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole? 
  • Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.
  • Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
• In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer. 
  • Discuss how you would have responded to this revelation. 
  • Describe how this information would inform your therapeutic approach. What would you say/do next?
• In Episode 5, Mr. Levy’s therapist is having issues with his story. 
  • Imagine that you were providing supervision to this therapist, how would you respond to her concerns?
• Support your approach with evidence-based literature.

 
Discuss the use of narcotic/opioid/barbiturate/sleep medication in the United States, including the change in patterns over the past 15 years, and the implications for health, insurers, and prescribers. 

 When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.To Prepare:

• Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy. These are the resources provided ( congress.gov.(n.d.). Retrieved September 20, 2018,from https://www.congress.gov/

     Klein,K.J.,& Sorra, J.S. (1996). The challenge of innovation implementation. Academy of management Review, 21(4), 1055-1080.doi:10.5465/AMR.1996.9704071863     Sacristan, J., & Dilla, T.D. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice, 21(6), 1014-1-17.     Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating  violence and injury prevention policies: Brief 4: Evaluating policy implementation. Retrieved from https://www.cdc.gov?injury/pdfs/policy?Brief%204-a.pdf

• Review the health policy you identified and reflect on the background and development of this health policy.

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples. ( Please in discussion 1, I need at least 3 resources, APA format and 1 Page)
 

Discussion 2: The Role of the RN/APRN in Policy-Making

Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation. To Prepare:

• Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making. Here is the resources ( American Nurses Association (ANA). (n.d.). Advocacy. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/
• Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples. ( 1 page for Discussion 2. APA format. 3 refences within past 5 years.)
They are two different papers.  

1. In your own words, discuss what it meant by the qualitative research approach to knowledge generation.
2. What are the characteristics of qualitative research studies?
3. Locate a nursing related journal article that used a qualitative research approach.  Using what you know about qualitative research, answer the following questions:
4. What was the problem area and research question?
5. What were the study’s concepts, independent variables, dependent variables, and operational definitions (if any)?
6. How did the author overcome the limitations of doing a qualitative study?
7. Did the author question any collective subjective beliefs? If so, what were they?
8. Did the qualitative study incorporate “human concern” for the client with effective nursing practice?  Explain, providing examples from the study. 

250-300 words needed

QUESTION 1 – 4 

A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling. 

Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia. 

Question 1 of 4:

Describe the positive symptoms of schizophrenia and relate those symptoms to the case study patient.  

Question 2 of 4:

Explain the genetics of schizophrenia.

Question 3 of 4:

The APRN reviews recent literature and reads that neurotransmitters are involved in the development of schizophrenia. What roles do neurotransmitters play in the development of schizophrenia?

Question 4 of 4

The APRN reviews recent literature and reads that structural problems in the brain may be involved in the development of schizophrenia. Explain what structural abnormalities are seen in people with schizophrenia.

QUESTION 1 – 6

A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment. 

Question 1 of 6:

Discuss the role genetics plays in the development of bipolar 2 disorders. 

Question 2 of 6:

Explain how the hypothalamic-pituitary-adrenal (HPA) system may be associated with bipolar type 2 disease. 

Question 3 of 6:

Discuss the role inflammatory cytokines play in the development and exacerbation of bipolar type 2 symptoms 

Question 4 of 6:

Discuss the role of the amygdala in bipolar disorder.

Question 5 of 6:

How does neurochemical dysregulation contribute to bipolar disorders?

Question 6 of 6:

What is the current status of the use of nutraceuticals in management of depression? 

QUESTION 1 – 2 

A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hour ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something “terrible is going to happen”. She denies having any similar episode in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesn’t know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26. Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patient’s symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack. 

Question 1 of 2:

What are panicogens and how do they contribute to the development of panic attack symptoms? 

Question 2 of 2:

How does the GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks/disorders?

QUESTION 1 – 2 

A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class where the class is preparing for the semester’s end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has a significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that has had a negative impact on both her scholarly and social endeavors. The APRN diagnoses the student with social anxiety disorder (SAD). 

Question 1 of 2:

Describe the areas of the brain that are associated with social anxiety disorder. 

Question 2 of 2:

How is oxytocin associated with SAD? 

QUESTION 1 – 2 

A 36-year-old female comes to see the APRN in clinic with a chief complaint of “I’m so and I feel all keyed up all the time”. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of “nerves” when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD). 

Question 1 of 2:

Discuss the role of neurotransmitters in the expression of GAD. 

Question 2 of 2:

Explain the structural brain changes that occur in people with GAD. 

QUESTION 1 – 2 

A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq. He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD). 

Question 1 of 2:

Describe the changes seen in the brain structure in patients with PTSD.

Question 2 of 2:

Briefly discuss the role glucocorticoids may have on the development of PTSD. 

QUESTION 1 – 2 

A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD). 

Question 1 of 2:

What is primary pathophysiology of OCD? 

Question 2 of 2:

Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors.

Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

1. New practice approaches
2. Interprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Practices of culturally sensitive care
6. Ensuring the integrity of human dignity in the care of all patients
7. Population health concerns
8. The role of technology in improving health care outcomes
9. Health policy
10. Leadership and economic models
11. Health disparities

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

The following case for discussion is from the eText, chapter 18, page 527:

Steven and Marisol are a young married couple who are concerned about passing genetic diseases to their children.  Members of Steven’s family have been diagnosed with Huntington’s disease, an incurable genetic disorder that causes cognitive problems, difficulties with movement that ultimately require full-time nursing care, and reduced life expectancy.  Members of Marisol’s family have tested positive for a mutation of the BRCA genes that are strongly associated with breast and ovarian cancer.

At a family reunion, they are discussing their decision to use in vitro fertilization and preimplantation genetic screening of embryos.  Seven’s cousin, Valerie, is appalled.  She is opposed to the idea of in vitro fertilization and to the entire idea of genetic screening. 

Valerie says, “You can’t just choose the babies you want to have.  God will only give you the challenges He knows you can handle.  And if a child is born with a disease, your job is to love that child, no matter what.” 

Steven is speechless.  But Marisol is not.  “But if we can guarantee that our child is healthy and will live a happy life, shouldn’t we do that?  We don’t want to raise a child who is doomed to genetic diseases.” 

Valerie shakes her head.  “There is no way to know,” she says.  “Kids get sick and die.  Some who have diseases get better.  You can’t control everything.  And besides, that test-tube baby stuff is really expensive.  How can you afford it?” 

Now Steven replies, “We want to invest in this procedure now because it might save money in the long run.  I’ve seen how much Huntington’s costs a family – so have you.  I’d rather pay to prevent it now than have to deal with the costs later.”

Valerie responds, “That sounds really rude.  It sounds like you resent people who get sick and need your help.  The whole thing is very selfish.”

Questions for discussion – Answer any two of the following questions:

With whom do you agree here: Steven and Marisol or Steven’s cousin, Valerie?  Explain.

Is it wrong to want to prevent genetic disease through use of IVF and preimplantation genetic screening?   Is it a wise investment?  Should it be covered by health insurance?

Is it selfish to want to control your child’s genes?  Explain your answer.

What about using IVF for selecting the gender of the baby you want to have?  Explain your reasoning.

These options are available to couples today: LINK

Concept Map. Complete the Map according to the information I send it with. All spaces must be filled out. I put an example as to how it should be, but with the new information, I give you. Everything has to be with references. 

Choose one of the numerous partners involved in global health (clinical care providers, governmental agencies, private foundations, corporations, intergovernmental groups, public-private partnerships, nonprofit organizations, the defense sector, universities, the media, and many others. 

1. Select a health related topic for which you want to advocate for. Request help from the agency/ entity of your choice in order to help the problem at hand.  Example: Request Apple to donate $1.00 for every iPhone they sell to provide clean water for the community in Bangladesh.
2. Create a 5 to 10 slide PowerPoint presentation to deliver your message to the agency/ entity of your choice about the health related issue you want help with. 
3. Your slides should:
   • first slide (after title slide) should explain at least three (3) objectives of your request.
   • clearly state purpose of request to agency/ entity. 
   • show relevant and up to date statistic on the problem you are trying to advocate for. (include references)
   • use references according to the APA Style Guide.
   • be original work, and will be checked for plagiarism.