Therapeutic drug monitoring is a frequent practice in health care. How does age affect drug absorption, metabolization and excretion?
· The use of salt substitutes can cause hyperkalemia in older adults when use in conjunction with what types of drugs?
· Describe how you would prevent and evaluate risk factors for medication nonadherence in older adults?
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
To Prepare:
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
Submit your completed healthcare program/policy evaluation analysis.
Week 3 peers response
Class 6050
Response #1
3 days ago
Marie Joseph
RE: Discussion – Week 3
Initial Post
In an effort to reform the American Healthcare system, President Barack Obama signed The Affordable Care Act into law in 2010. This bill is supposed to guarantee health insurance to millions of uninsured Americans and lower the cost associated with healthcare. Its constitutionality has been challenged in court in 2012 and 2015, but the Supreme Court ruled in its favor (Auerbach, 2019)
Many families in the United States are debating how it will affect them if they “repeal and replace the Affordable Care Act (ACA)”. They are wondering if they will be able to keep or afford their health coverage or their prescribed medications. Deductibles and out-of-pocket costs are so high causing most of the working adults to be underinsured despite being enrolled in the ACA. Repeal the Affordable Care Act (ACA) will have a devastating effect on the families and the elected officials as well as they are no clear alternative to replace it. It is costly but needed. It is estimated that 13 million Americans will lose their healthcare coverage over a decade as a result and States will lose in federal funding and subsidies paid to the marketplace (Thompson et al 2018).
Among the successes of the ACA, one can name: people can’t be denied coverage due to pre-existing conditions, Medicaid is expanded and individuals can get preventative services at no charge.
In her article Pros and Cons of the Affordable Care Act, Champagne (2014) found many issues with marketplace processing and lot of inconsistencies with what people are being told. She gave an example where families have to get different coverage for different members. A mother was told that her newborn was covered by Medicaid and her other two children have a state insurance plan. It turned out that the baby was not and the other two were dropped by the system because it shows that they have a third party coverage which doesn’t exist.
All this reveal the importance of an established plan to strengthen the health care system. The plan must be highlighted from the start to make the system works for every American Citizen. And the civil society will benefit the most from its best practices.
References
Auerbach, M. P. (2019). Patient Protection and Affordable Care Act. Salem Press Encyclopedia, 2019. Retrieved on September 13, 2020 from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=3&sid=
Champagne, D. M. (2014). Pros and Cons of Affordable Care Act. Daily Record. Retrieved on September 13, 2020 from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?
Thompson, F. J; Gusmano, M. K; Shinohara; S. Publius: The Journal of Federalism: Summer 2018, Vol.48 Issue 3 p.396-424. Access from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/results?vid=13&sid=
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Donald Freeman
RE: Discussion – Week 3
Week 3 Discussion
Main Post
The cost-benefit for legislators can be a complicated subject. In the case of The Affordable Care act, there are many different sub-categories to consider since the act covers a wide range of issues from financial to medical. It has been said that the “number one job of a legislator is to be re-elected” (Walden University, n.d.). This is not a valid statement and appears to be used to sway the beliefs of the reader to a particular viewpoint that is the same as the author. The responsibilities of a legislator according to Article 1 of the Constitution (Whitehouse.gov, n.d.) is that:
The Legislative Branch consists of the House of Representatives and the Senate, which together form the United States Congress. The Constitution grants Congress the sole authority to enact legislation and declare war, the right to confirm or reject many Presidential appointments, and substantial investigative powers.
Legislators have taken up a role that does not necessarily conform to the restraints and confines of the Constitution of the United States. Although it is not a popular view when lobbying a legislator, one must uphold strict adherence to the rule of law and not consider that the legislator needs to be re-elected, and therefore might not listen to the particular petition or agree with it. A nation cannot survive if it goes down the slippery slope that has more than taken over popular views in the legislative process and academics.
As it relates to The Affordable Care Act, many republican legislators ran their campaigns based on “repeal and replace.” In 2017, 43 republicans voted to repeal and replace the bill, while nine Republicans voted no. The procedural vote failed with a 57 to 43 vote in the senate (The New York Times, 2017). The line between politics and healthcare is thin. In 2019, those who lobbied against the unconstitutional provisions in the bill won. Because the legislators that crafted the bill included unconstitutional mandates, the Department of Justice backed the court that ruled the ACA bill as being unconstitutional (Straub, 2019). Although the republican legislators are focused on their voters that might vote for another candidate if they do not carry out legislation that is important to the voters, they can still accomplish constitutional legislation. Nurses, such as the author of this article, expect the legislators to follow the rule of law and would lobby them in that manner requiring legislators to stand against unconstitutional legislation. Some lobbyists demand unconstitutional laws and the legislators feel obligated to put those requests into law for fear of losing their job. For instance, abortion. Many nurses lobby for the killing of infants in the mother’s womb and other legislation that is associated with that practice even though Americans have a right to life. The fourteenth amendment of the Constitution Section 1 states that (Congress.gov, n.d.):
No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Legislators make laws as if there is a mandate to kill unborn infants. They know that they will lose their seat if they don’t vote for this injustice. That line of reasoning is a gross breach of the Constitution and the law. Many voters expect that the democrat party will continue to defend the killing of infants. Some would say, “What would be the use of lobbying a democrat legislator about the basic human right to life?” This nurse would explain, “Stand up for the law, human rights and dignity.” As a nurse, we have to pursue ethical standards. These standards would include the protection of life, even the life of infants. Our lobbying will reflect our values. The Affordable Care Act included funding for abortion (Abortion in Obamacare, n.d.). This, among some other unconstitutional provisions are included in the healthcare plan due to the lobbying the health care industry.
References
Abortion in Obamacare. (n.d.). Family Research Council. http://www.obamacareabortion.com/
Clowes, B. (2018, June 28). Isn’t Abortion Protected by the Constitution. https://www.hli.org/resources/abortion-no-constitutional-human-right/
Congress.gov. (n.d.). Constitution of the United States. https://constitution.congress.gov/constitution/amendment-14/
Straub, S. (2019, March 25). DOJ Determines Obamacare is Unconstitutional and Illegal. https://thefederalistpapers.org/us/doj-determines-obamacare-unconstitutional-illegal
Taylor, D., Olshansky, E. F., Woods, N. F., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education [Nursing Outlook 65/2 (2017) 242–245]. Nursing Outlook, 65(3), 346–350.
The Legislative Branch. (n.d.). Whitehouse.gov. https://www.whitehouse.gov/about-the-white-house/the-legislative-branch/
The New York Times. (2017, July 28). How each senator voted on Obamacare repeal proposals. https://www.nytimes.com/interactive/2017/07/25/us/politics/senate-votes-repeal-obamacare.html
Walden University. (n.d.). Discussion: Politics and the Patient Protection and Affordable Care Act. https://class.content.laureate.net/2c51bef1aefbf63b0e5c7e8b705335ad.html
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CLASS 6051
RESPONSE #1
Patrinia Sanders
RE: Discussion – Week 3
NURS 6051
DISCUSSIONN BOARD : Week3
Nurse Informaticist interaction with other professionals within the organization
Nurse informatics requires nurse leaders to have competencies in computer information. The nurse informaticist should have project management skills, which needs to be integrated with nursing science with information and analytical science to identify, define manage and communicate data and information (Sipes, 2016).
The goal of the Nurse informaticist is to improve the organization nursing agenda and provide guidance into decision as they relate to the improvement of patient care. The nurse informaticist will have communication with other team members, other nurse managers, social workers/case managers, medical doctor, psychiatric doctor, all communication need to be clear and concise and related in a manner so that others involved in patient care will do so with the best treatment plan which is patient centered. The Nurse informaticist interaction with other professionals also known as the content team is important as findings or fallouts can be corrected (Mosier, et al., 2019)
The nurse leader the serves as an informaticist when there is a meeting he communicates with the team via cell phone where we have Zoom Meeting simply providing us with a host number which to call and an access Identification to join meetings. The dynamics of informatics in communication is realized when staff members from other hospitals join the meeting. Issues as it relates to patient care can be addressed and input from staff, which include other team members not only nurses, but the social workers and mental health technician (Ng, et al., 2018).
Another example of the nursing informaticist using information to relate to other professional is in assessment process of the patient. The facility provides suicide assessment scale, use on the behavioral health unit which is known as the Columbia Suicide Scale that is used of assessing the severity of suicide ideation on all patients that are on the unit.
The Columbia suicide scale is used to access all patients that are admitted on the unit. The range of the scale ranges from high risk, moderate risk, low risk, and no risk. This assessment is done on admission and on once every shift. The Columbia Scale is completed by the nurses. The nurse leader runs report on these results. If the patient is high risk or moderate risk after assessment then the doctor should be notified, so that an order can be given for High Risk Patient for a 1:1
Monitoring. If the patient is moderate risk for suicide he or she may be put on a line of sight where the patient remains within view of a staff member. The nurse Informaticist can access this information. If a patient is not on the appropriate precaution the nurse leader as an informaticist can reach out to the nurse /doctor / the social worker to discuss then need for the suicide precaution and the social worker can decide if it is safe for the patient to be discharged from the facility based on feedback from the nurse or doctor.
Another example is when the nurse Informaticist can access cameras at work from his home, also access information within the facility. Active communication is present at the facility as the director can look at cameras and correspond with staff, any safety breech on the unit can be addressed in real time. Staff without goggles or masks are encouraged to put on goggles for the safety of the patient especially during the COVID pandemic.
Patients that have a fall there is a protocol, which needs to be followed. Then informaticist can access records to ensure that all information that needs to be completed by all the interdisciplinary team is completed.
I believe the continued evolution of nursing informatics and the emergence of technological advancement will have positive impact on interaction and communication between interdisciplinary team member, with the best outcome for patient centered care. The nurse informaticist in assessing and sharing information need to value patient rights and privacy and be autonomous even with beneficial technological growth.
Reference
Mosier, S., Roberts, W.D., & Englebright, J. (2019). A System -Level Method of Developing
Nursing Informatics Solutions: The role of Executive Leadership. JONA: The Journal
of Nursing Administration, 49(11), 543-548.
Ng, Y.C., Alexander, S., & Frith, K.H. (2018). Integration of Mobile Health Applications in
Health Information Technology Initiatives: Expanding Opportunities for Nurse
Participation in Population Health. CIN: Computer, Informatics, Nursing, 36(5),
209-213.
Sipes, C., (2016). Project management: Essential skill of nurse informaticists. Studies in
Health Technology and Informatics. 225., 252-256.
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RESPONSE #2
Folakemi orekoya
RE: Discussion – Week 3
Interaction between Nurse Informaticists and Other Specialists
Informatics has continued to change the face of healthcare. With technology advancement, health care providers can collect, analyze, and leverage data more effectively. The informatics influence how care is delivered, how resources are managed, the way teams operate in their daily activities. Nurse informaticists facilitate the integration of data and knowledge to offer support to the nurses, patients, and other providers in decision making within the health care environment (McGonigle & Mastrian, 2017). They help improve accuracy and provide critical data analysis to help health care providers enhance the quality of patient care. In my experience, the nurse informaticists in our organization work with the IT team to find ways to streamline and improve documentation using information technologies. They also help in improving the accuracy, timeliness, and speed of patient charting. Nurse informaticists’ continued support can enhance these interactions in the coordination and exchange of crucial clinical and technical information (Hoy & Frith, 2017). The objective can be attained by supporting and bringing together safe, effective patient care and efficient workflow.
The continued evolution of nursing informatics has a significant impact on communication in the health care organization. Communication between health professionals is simplified by informatics, and they can communicate more effectively through email, instant messages, or texts (Nagle et al., 2017). This, in turn, improves communication for health specialists to spend less time tracking each other down to communicate about their patients, hence improving the quality of care the patients receive.
References
Hoy, H., & Frith, K. H. (Eds.). (2017). Applied clinical informatics for nurses. Jones & Bartlett Learning.
Nagle, L. M., Sermeus, W., Junger, A., & Bloomberg, L. S. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 212.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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I HAVE THIS EXTRA QUESTION FROM THE TEACHER
Question for Iraisy
Excellent post Iraisy Let’s talk informatics savvy :-)..
How can I help my colleagues and patients understand and use the current technology that is available?
Please Reword.
I Choose Respiratory Syndrome Coronavirus (MERS-CoV)- 2015-2018),
Week 1
Evidence based practice, research and theory are the pillars of the nursing profession. The interaction of these three principles is mutual and aids with the collaboration of educating novice nurses. Nursing, as a profession, is committed to recognizing its own unparalleled body of knowledge vital to nursing practice—nursing science (Marrs, 2006).To distinguish this foundation of knowledge, nurses need to identify, develop, and understand concepts and theories in line with nursing. Florence Nightingale, the mother of nursing, defined nursing in her “Environmental Theory” as “the act of utilizing the environment of the patient to assist in recovery”.
For theory, clinical evidence-based practice creates research questions and knowledge. Research drives evidence based practice and develops knowledge through the advancement of theories. Theory guides research and improves evidence-based practice. Nursing is a unique discipline and is separate from medicine. It has its own body of knowledge on which delivery of care is based upon.
The aim of the research is enrichment of knowledge in any field. Research seeks for the truth that is already there but needs to be explored. Successful nursing practice involves the use of knowledge, skills, care, and creativity in an efficient, effective, and considerate manner to treat patients (Marrs, 2006). Research findings provide an important part of the knowledge involved in making health decisions in nursing. Moreover, all recommendations on medical care should be focused on evidence from research. To establish a protocol, research results are used and the plan is implemented in everyday clinical practice.
Using research in day-to-day nursing practice will enhance patient care and nursing practice, and can help to provide safe and cost-effective care. The survival of nursing as a profession depends on nurses’ ability to understand and apply theory while providing optimum care. An ongoing challenge to the nursing profession is to keep the important relationship between research, theory and practice in force (Veloza, 2016). As a proficient clinician, we rely strongly on research and practice to determine the treatment that will be rendered. At times, I tend to analyze situations, regardless of what the physician orders because they are not visually viewing the patients.
The relationship between research and theory is reciprocal where research generate more knowledge and theory. Theory is central to the research process, where it is necessary to use theory as a context to support the research with insight and direction. Theory may be used by creating and evaluating hypotheses of interest to direct the research process. The relationship between theory and evidence based practice reciprocal. Practice is the basis for the development of nursing theory whereas nursing theory must be validated in practice (Marrs, 2006).
Research relies on theory and vice-versa. The scenario of nursing practice that is distinguished by good care must be supported by nursing science in which the development and spread of knowledge through research is a two-way street between theory, founded on the concepts and propositions of nursing science and practice (Veloza, 2016). Nursing is based on the theory of what nursing is, what nurses do, and why nurses exist. We are the foundation of healthcare and without nurses, the body of healthcare will never be the same.
References:
Nursing theory and practice: connecting the dots. Marrs JA, Lowry LW. Nurs Sci Q. 2006 Jan;19(1):44-50. doi: 10.1177/0894318405283547. PMID: 16407599
Veloza-Gomez M. The Research-Theory-Practice Relationship a Reference for the Discipline of
Nursing. Ann Nurs Res Pract. 2016; 1(1): 1004.
Topic 4 DQ 2
Research a health concern that impacts a population with which you are familiar. How do biostatistics affect the research focus? How do you define the population as your patient? Make sure to include the population and health concern. Give 2 references & 2 responses.
reply1
My father is African and while he grew up very differently than most of his culture, he still portrays some of the traits of the African culture, especially when it comes to health care.
Language: It is important with the African culture to assess and be sure of the language they speak. There are many different languages spoken within the African population including many different dialects. If unsure always use a translator as this will make the difference in patient education.
Family: Family is the center of importance in the African culture. The family model is an extended one including immediate family and relatives, and loyalty to the family is expected. It is also expected that children abide by their parent’s rules and live up to their expectations. In healthcare settings, Africans may be unwilling to acknowledge strong emotion, grief, or pain due to their family and cultural values. Western medical professionals often find the stoic demeanors of African people difficult to interpret. In my practice as a nurse I have been a part of many situations where the family did not want the patient to know about the diagnosis until they have had time to talk it over with the family. This obviously brings up ethical issues within the patient care and it is important to know whether the patient wants the family involved in the care.
Cultural Differences: Within this culture it is particularly important to ask whether the patient takes any herbal medication and traditional treatments as this is an important practice in their culture. Most people of the African culture still only report to western medicine only if their traditional methods are failing. In turn, this means most patients will not seek out preventative measures, diagnostic testing, and treatment.
Methods of communication: Within this culture, communication can be very misinterpreted. The African culture believes in harmony and avoids conflict, therefore they may agree with a healthcare provider but have no intentions on following through with the teaching. Also, they do not ask for help because they do not want to be bothersome and will often dismiss their needs and pain. It is important to anticipate their needs and ask several times. There are also several nonverbal things Africans find unacceptable such as pointing, and eye contact.
Falvo, D. R. (2011). Effective Patient Education, A guide to Increased Inherence. Fourth Edition https://viewer.gcu.edu/RQBKXW
Schyve PM. Language differences as a barrier to quality and safety in health care: the Joint Commission perspective. J Gen Intern Med. 2007;22(Suppl 2):360–361.
reply2
Recently, I had to care for a patient of Hispanic culture from Mexico who immigrated few years ago into the country. The patient was obese with diabetes and hypertension that was becoming difficult to manage. Upon investigation, it was clear that the patient did not have enough knowledge of how to control and manage his condition. During the interaction, language was a barrier because he has only learnt it recently when he got into the country. The previous doctors he saw had given him information in pamphlets written in English. The patient was finding a difficult time understanding the information. When presenting the education, a nurse could use videos instead of pamphlets and have someone to translate the difficult words that the patient does not understand. Also, with advanced technology, a health professional can use videos with Hispanic subtitles or language. This can help the patient understand the information.
Family is a very important aspect of the Hispanic culture and plays a vital role when it comes to health (Falvo, 2011). Family is very important, and each member has a role to play with gender having different roles. Hispanic families are organized into large groups that include extended family members such as cousins and aunts. Within health care, members may tend to avoid undertaking expensive treatment when it can take a toll on the family and prefer to visit a hospital only when it is necessary (Juckett, 2013). This affects preventive care especially if the family is not well-off enough to afford insurance.
One of the biggest cultural differences of Hispanic culture comes from organized parties where large proportions of food are served. One of the biggest health issues in this culture is obesity, with a prevalence of 43% compared to 33% in Caucasian people (Juckett, 2013). These organized mealtimes bring the family together, which makes it difficult for a member to miss because he or she can be seen as not wanting to be part of the family. There is a need to involve the family in patient education so that they can understand why the patient cannot eat the same meals or normal proportions as before.
The best method of communication would be verbal communication. Because the patient has been in the country for a few years, there is a need to involve family members who have lived longer in the country to help with acculturation as well as understanding the information provided. The best approach should involve an interpersonal communication that goeas both ways. While many professionals only inform, there is a need to listen to the patient as well, get to understand his issues, perception, and level of understanding of the content. This can only be achieved through a two-dimensional communication (Falvo, 2011).
References
Falvo, D. R. (2011). Effective patient education: A guide to increased adherence (4thed.). Sudbury Massachusetts, M.A. Jones and Bartlett Publishers.
Juckett, G. (2013). Caring for Latino patients. American Family Physician, 87(1), 48-54.
Answer the following question thoughtfully.
Please limit your response to 1-2 pages (typed, double-spaced)
Why have you chosen nursing as your career path?
Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.
Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.
In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.
Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
