reply to this discussion 

Kurt Lewin created change theories in nursing that consisted of three steps: unfreezing, moving and refreezing. His theory focused on the idea that to change a current process or practice, you have to freeze it, then movement can occur and a new process of refreezing once a new idea has been brought to the attention of all (Levasseur, 2001). “The first step of Lewin’s model tells us how to minimize barriers to change and increase the odds of a successful change effort” (Levasseur, 2001). Involving everyone in the change will create a more successful change process. Lewin identified 3 concepts in his change theory: driving forces, restraining forces and equilibrium. He believed “all three phases of the change process, found that workgroups participating in the introduction and design of changes in work methods produced more and had less turnover than groups that did not” (Zand, 1975). This makes for a more successful change including all members of the process. Lewin focused more on the change process and less about the psychology of society. 

     Alfred Adler was a theorist born to a large family in 1902. He experienced medical problems as a young child from the death of his brother to battling rickets. He focused his readings on psychotherapy, “to build a flourishing school that promoted an understanding of human behavior that focused on healthy relationships” (Alder, 2020). He created a theory known as the Birth Order Theory that was based on your birth orders and the personalities that you possessed. He then went to different areas of the world including Europe and the United States and taught, “Adler’s vision was to cultivate confident, community-oriented, mentally healthy individuals who could contribute to the common good” (Alder, 2020). He eventually died at the age of 67 from a heart attack. Alder differed from Lewin who focused more on communities and created value on societies. 

     To be able to implement EBP intervention, I would have to use Lewin’s theory to push for a change in current behaviors and mindsets. Creating a welcoming environment of multiple disciplinary approaches would develop interest and understanding of change.  My preceptor has not expressed any theories but we will be using ideas from both theorists listed above.

 Discuss how genogram and ecomaps are used in nursing. Why and how would they incorporate these tools into their care of families? How does the use of these tools affect family risk appraisal? 

Directions:
•With the realization that pain is highly prevalent among older adults, please answer the following questions.

Questions:
1. What are some ways you as the nurse can utilize to determine pain in the older adult?
2. What are some of the potential barriers related to self-reporting of pain in the older adult?
3. What is the prevalence of pain in the older adult?
4. Describe and compare your findings for each of the following:
a. Numeric rating scale
b. Visual analog scale
c. McGill pain questionnaire
d. Pain in dementia patients

Location: UPTOWN CHICAGO NEIGHBORHOOD

Part 2: Analysis of Assessment Data

1. Based on observations from the windshield survey, identify strengths of the community.

2. List and prioritize 5 potential community risk factors (weaknesses).

3. Identify community resources that may help address the highest priority weakness (either currently in existence or something you propose to help address this problem).

The U.S. Department of Health & Human Services released a comprehensive Clinical Practice Guideline for Treating Tobacco Use and Dependence–2008 Update 

https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html 

The goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health systems, insurers, and purchasers assist clinicians in making such effective treatments available. 

After reading these recommendations answer the following questions.

1. what are the clinical interventions for patients unwilling to quit cigarette smoking?

2. According to the best practices what are the best strategies to help your clients quit smoking?

3. are there any specific smoking cessation recommendations for especial populations such as teenagers or the elderly?

Every student must post just once during the time frame Discussion Forum is Open.

APA 6TH EDITION

2-3 REFERENCES NO OLDER THAN 5 YEARS

NO PLAGIARISM

350 WORD AT LEAST

Identify current Disparities in Cardiovascular Care of Women in the hospital and share and come up with two key evidence based ideas or concepts that can improve practice as a nurse. 1.5 pages

Peer initial posting:

Many Who Buy ACA Health Plans For 2019 Find Lower Prices And More Choice focuses on the stabilization of the health care market after the removal of some “structural underpinnings” in 2017. The cost for health insurance rose steeply from 2017 to 2018 with the average premium going up by over 10% for most states (Rau, 2018). A portion of the price increase was driven by insurance monopolies, so, with no competition, insurance companies had no fear about raising premiums while reducing coverage.

The cost of health care has been a hot topic for a long time, especially as prices have been going up. The cost to insure a single person in 2018 has become similar to the average cost of family coverage 20 years ago (NCSL, 2018). For many people, the question of health care is how much is a person willing to pay for their health on average, which becomes problematic very quickly as the averages can be relatively easily skewed. Even for people who receive health insurance through work, the average cost of insurance premiums is $5,714 and additional out-of-pocket costs, which bring up the average spending on health to 11.7% of total income per year (NCSL, 2018). While there is good news for the public at large at the reduced costs for 2019 insurance plans, there are still many problems with health insurance. Insurances only cover certain providers, hospitals, or services, and for people with established providers, this may mean finding a new provider or paying more for their insurance, and those are only options if there is even an insurance company that works with that provider. Overall, I am not optimistic about a system where the cost of a service can be difficult to obtain and the response of most customers is basically “at this point, I’ll take whatever I can get” (Rau, 2018).

 Link:    https://www.npr.org/sections/health-shots/2018/11/23/667466242/many-who-buy-aca-health-plans-for-2019-find-lower-prices-and-more-choice   

References

Rau, J. (2018)  Many Who Buy ACA Health Plans For 2019 Find Lower Prices And More Choice Retrieved from https://www.npr.org/sections/health-shots/2018/11/23/667466242/many-who-buy-aca-health-plans-for-2019-find-lower-prices-and-more-choice

NCSL (2018) Health Insurance: Premiums and Increases Retrieved from https://www.ncsl.org/research/health/health-insurance-premiums.aspx

 INSTRUCTIONS

Review the initial postings from your peers. Click on the link provided in the initial response to read/listen to the story. Respond to one peer according to the following prompts and the grading rubric.

1.  What are your overall thoughts about this posting/topic?
2. Do your share common or differing thoughts from the other student? Explain. 
3. Your post must be supported with at least one source of literature (can use required readings) but must also incorporate at least one source in addition to those provided to receive full points. The date of publishing should be within the past 2 years. APA Style 7th edition.

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?