In Weeks 3 and 4, you conducted a concept analysis. As Walker and Avant (2019) explain, “concepts allow us to classify our experiences in a meaningful way both to ourselves and others….The ability to express a relationship between two or more concepts is even more useful and efficient” (p. 63). In this Discussion, you create statements about the relationships between two or more concepts, which are critical for developing your theoretical foundation for a program of research.

In this Discussion, you also examine assumptions that may influence your program of research. Assumptions are another type of statement; these statements are considered true, even when they have not been tested. They often go unrecognized because they are deeply embedded in thinking and behavior, so it is important to engage in critical reflection to identify them.

In addition, during this Discussion you consider how nursing’s metaparadigm relates to the theoretical foundation you are developing.

To prepare

• Continue to review the literature that features concepts related to your phenomenon of interest. As you read each article, consider the relationships between and among concepts. Also identify assumptions that are implicit or explicit in the research.
• Select one article from your literature review and apply the seven steps of statement analysis that Walker and Avant (2019) present in Chapter 11 of their text. What insights does this give you about the relationships described in the article, as well as for your own work?
• Think more deeply about the conceptual relationships that may distinguish the theoretical foundation for your future program of research. Also, analyze assumptions that may influence your research (McEwen and Wills, 2019, p. 81).
• Review the information on nursing’s metaparadigm in McEwen and Wills (2019, pp. 41–45). Consider how the metaparadigm concepts of patient, health, nurse, and environment relate to your theoretical foundation.

By Day 3

Post a synopsis of an article that features conceptual relationships related to your phenomenon of interest, and explain the insights you gained by applying Walker and Avant’s steps for statement analysis. Compare the information in the article with your current thinking about your own theoretical foundation for research, including relationships between and among concepts, and assumptions. Describe implications of nursing’s metaparadigm for your theoretical foundation.

As a nurse, you serve an important role in identifying strategies to effectively manage health care resources and in leading health care quality improvement. You must be able to decide what leadership style or strategy to apply in a given situation to achieve an effective resolution of the issue. Read the following two scenarios and select one to focus on in this Discussion. Consider the leadership style or strategy that might be most effective in the scenario you selected.

Scenario 1

You work in a for-profit nursing home, with about 100 beds, on a 20-bed unit that is largely patients with Alzheimer’s disease. Your patient mix is predominantly Medicare and Medicaid patients. Your nursing home is part of a larger system that includes a major medical center, as well as VNA, outpatient dialysis, and a fully integrated network. Your nurse manager is getting feedback from the hospital that your nursing home is sending too many patients to the ED who really don’t need to go. How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?

Scenario 2

You’ve been associated with an outpatient cardiology clinic that is part of a large academic medical center. Your patients are mostly charity care and managed Medicaid. Most have a prescription plan, but none have a “family doctor” and use the clinic (and the ED) regularly. Most are unfamiliar with their medications and do not have the resources for care coordination in their family/social network. About 25 CHF patients have been “lovingly,” but inappropriately, called “frequent fliers” because of their inability to manage their own care, their frequent visits to the ED, and their “one night stays” paid at the observation rate. As a staff nurse in this clinic, describe the strategies you could devise for you and your fellow staff nurses targeting these 25 patients. Find at least one article from the professional literature to corroborate your recommendations.

By Day 3

Select one of the scenarios, and post the following:

Describe the most appropriate leadership style and/or strategy to apply in the scenario you chose in order to implement the recommendations successfully. Justify your selection.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)

  In a well-developed paragraph (300–350 words)  , 2 APA format references each, respond to the below responses

Respons 1 

Allergic dermatitis

        There are different types of skin conditions that can affect patients during their life spam. Some conditions might be chronic or acute and, on many occasions, may cause physical and social discomfort in the patient due to dermatological appearance in the body parts that are exposed. In this discussion board, this writer will address allergic dermatitis. Contact dermatitis is blanched into two types of dermatitis which are irritant and allergic dermatitis and it is confined to contact with the irritant or the allergen (Woo, 2020). Therefore, in this discussion post, this writer will address allergic dermatitis, including a drug choice and its pharmacokinetics, pharmacodynamics, interactions, side effects, monitoring, and patient education for the patient.

        Irritants that can cause allergic dermatitis are all over the environment, and each person might be inclined to react to a particular irritant. Allergic contact dermatitis is a reaction or response to an allergen (Woo, 2020). The treatment options for this condition can only be defined after the interaction with the allergen and there is no preventative treatment. Except to protect itself when a known allergen such as poison ivy, poison oak, or other well-known allergens are present. Treatment may be based on the patient’s history of allergies and is mostly topically applied, except when the condition is exacerbated or would not have a good outcome with the topical treatment.

        Among different options for treatment, this writer will address the treatment of allergic(contact) dermatitis by using a low potency medication hydrocortisone. The medication hydrocortisone is a good choice of treatment and is available over the counter as a cream, lotion, and ointment (Lexicomp, 2020). The good thing about the treatment is the facility to be obtained OTC and is easily applied by the patient on different occasions. The pharmacokinetics/pharmacodynamics of hydrocortisone is that it is a corticosteroid and acts as a glucocorticoid and mineralocorticoids, absorbed primarily in the skin, and a small amount absorbed into the systemic circulation is metabolized by the liver and inactive compounds (PubChem, 2020). The advantage of hydrocortisone is that being applied topically it does not affect the systemic circulation as other medications are taken by other routes during treatment.

        Hydrocortisone, like any other, still has some adverse effects which can be minimal compared to other medications in its class. Although the systemic circulation does not absorb a significant amount of the medication it is important to monitor for glucose levels, electrolytes, blood pressure, weight, itchiness to the site, and increased redness (Dastgheib et a., 2017). The clinician needs to teach the patient about those adverse effects and any other abnormalities that affect the patient during the treatment.

        The use of hydrocortisone cream can be used in all populations, including children > 3 months old (Lexicomp, 2020). However, monitoring and dosage need to be observed for patient safety. The treatment should be graded from a low potency to a higher potency which can be divided into creams and lotions. The initiation of treatment should start with cream which a lotion which is the least potent, then to a less occlusive cream, and then ointments which is more occlusive and more potent (Woo, 2020). The clinician should also bear in mind the price range that the patient can pay for the medication and the time on which the medication should be used for the treatment of the condition.

        The clinician needs to educate the patient to apply the amount prescribed as ordered by the clinician. It should also do not cover the area with an occlusive dressing, which can cause increased absorption of the medication, children should be supervised when medication is applied (Woo, 2020). The prescribing of a more or less potent should be done related to the seriousness of the skin condition. The patient should be aware of the risk of taking any other medication that may interact with this medication.

Response 2 

Eczema or atopic dermatitis is a chronic skin disorder that affects individuals of all ages. It often begins in infancy and affects approximately 10-15% of children. Eczema may subside in adolescence and may reoccur in adulthood. Eczema rashes have a different appearance depending on the age that is affected. In infants, they may appear as a red, vesicular rash on the face, scalp, trunk, and extremities. Meanwhile, eczema in adults may appear as scaly, dry, thick, and leathery on the flexure surfaces of hands, face, neck, and upper chest. Eczema also tends to be worse in cold and winter season (Woo & Robinson, 2020).

Rational Drug of Choice

            Rational drug selection aims to decrease the severity of symptoms when an acute attack is present and then preventing further exacerbations. The rational drug of choice would be a low potency topical steroid such as 1% hydrocortisone cream. Creams are the least potent and contain the most water compared to ointments (Woo & Robinson, 2020). Low potency topical steroids such as 1% hydrocortisone are the safest agents for long-term use, on large surface areas, on the face, and on areas with thinner skin for children (Rathi & D′souza, 2012). Because of the safety and efficacy of all ages, low cost, and availability over the counter, 1% hydrocortisone would be the appropriate initial drug of choice.

Hydrocortisone cream contains anti-inflammatory properties. It works by suppressing the release of proinflammatory cytokines, inhibits the formation and release of endogenous mediators involved in the inflammatory process, and inhibits the migration of macrophages and leukocytes into the effected area. This then reverses the vascular dilatation and permeability, and development of edema, erythema, and pruritis at the effected site. Absorption of the drug depends on where on the body it is applied, body temperature, and hydration status. Infants and young children should be prescribed the lowest yet most effective topical steroid to prevent systemic effects from the drug. The recommended amount of topical steroids applied will differ among age and where anatomically it is applied. Adults will require a larger dose compared to infants. Topical steroids are pregnancy category C and should not be used extensively or long-term in these patients. Side effects of hydrocortisone cream include acne, dry, scaly skin, mild burning or tingling at site, and change in skin color. Topical steroids can also be rapidly absorbed into the bloodstream. Therefore, the patient should call her doctor if she experiences weight gain, thinning of hair, increased body hair, muscle weakness, fatigue, or irritability (Hydrocortisone, 2019). Some drug interactions with hydrocortisone include mifepristone, aspirin, ibuprofen, and Lasix. Hydrocortisone should not be used in premature infants, patients with PUD, GI perforation and in patients with active infections (Hydrocortisone Drug Interactions, 2020).

Monitoring for patients using 1% hydrocortisone will include the effectiveness of the treatment, presence of any side effects, or development of secondary infections (Woo & Robinson, 2020). If initial therapy of 1% hydrocortisone is ineffective, then a topical steroid with an intermediate or higher potency may be necessary. If that therapy remains ineffective, then the use of oral corticosteroids and immunomodulators may be necessary. The patient should be educated on how to use the prescribed drug, importance on adherence to drug regimen to decrease severity of symptoms, and report to healthcare provider if eczema symptoms do not resolve in a couple of weeks, signs and symptoms of systemic reaction to steroids or signs and symptoms of a secondary infection are emerging. Avoid getting hydrocortisone cream in your eyes or mouth. In addition to the use of the topical steroid, the patient can be educated on avoiding skin irritants, avoid scented lotions or perfumes, taking warm baths may help with skin hydration and apply topical steroid after bath (Woo & Robinson, 2020)

research the tympanic membrane and the thyroid gland. In a Microsoft Word document of 4-5 pages formatted in APA style, address each of the following criteria.

• Two focused health assessment histories
  • One assessment related to the tympanic membrane and the other focused on the thyroid gland.
  • The assessments can be hypothetical patients or patients you have had in the past (remember HIPAA if you are describing a previous patient).
• A description of the normal and abnormal findings of the tympanic membrane.
• Information on how to examine the thyroid gland using both the anterior and posterior methods.
• A concise note in the subjective, objective, assessment (be sure to include the NANDA diagnosis as well as the medical diagnosis), and plan (SOAP) format with each patient’s encountered findings.
  • For a review of SOAP notes:
  • SOAP Documentaion
• Information about laboratory/diagnostic tests used for screening clients with tympanic membrane or thyroid gland issues.
  • Include the expected normal results for each test.

just something about malnutrition !

Week 4: Advocacy Letter

Submit Assignment

Purpose:

The purpose of this assignment is to provide an opportunity for students to apply and disseminate information based on the status of public health policies and practices designed to address important public health problems, concerns, and implications for nursing practice.

Requirements:

Through this assignment, the student will write a letter to their legislator (House of Representatives or Senator) on a public health topic. The student will state relevant statistics in the area, indicate how this issue is affecting nursing practice, and describe the action the student would like the legislator to take in regards to a current bill, or in support of the issue. Please see the attached document for full instructions.  See the sample letter for a template to use. 

NR442_Faculty Assignment_Advocacy Letter (1).docx

sampleletter (1).pdf

Rubric

Advocacy Letter RubricAdvocacy Letter RubricCriteriaRatingsPtsThis criterion is linked to a Learning OutcomePurpose and IdentityPurpose and Identify (includes correct identification of the legislator based on address)15.0 pts
This criterion is linked to a Learning OutcomeBackgroundIncludes:
Two statistics
Affected population20.0 pts
This criterion is linked to a Learning OutcomeRequest of legislator:• Solution identified and is realistic10.0 pts
This criterion is linked to a Learning OutcomeGrammar and Construction• Proper grammar and mechanics
• Correct spelling
• Websites or resources for statistics
• Word count5.0 pts
Total Points: 50.0PreviousNext

There are several interventions we employ to identify knowledge gaps in nursing practice in the department of behavioral health. The most impactful process is the monthly chart audits that are completed on each nurse, APP, and MD who provide care in our department  The data that we collect during the audit process is based on EBP and reported up through our Quality Committee. Three years ago during our quality audits, we noted that depression inventories were not being completed on a regular basis. According to Dham et. al (2017), depression screens assure not only quality care that is cost-effective but also helps guide clinicians in diagnosis and treatment.

    When we identify a knowledge gap, we complete an evidence search to determine what EBPs are available to overcome the gap. Linking the evidence to the practice environment is challenging and a Quality Improvement model is crucial in supporting staff as they adapt their practice models (Taylor et al., 2013)  Our QI team takes the forefront on educating staff through team meetings, department meetings, one on one training as well as mandatory LEAP modules. The Learning Engagement and Performance (LEAP) system modules are used at MetroHealth Medical Center to cover information required by several compliance and accreditation organizations to help keep our staff, our patients, and our visitors safe. The Plan-do-study-act model is another QI model that can be used to adopt changes.

I believe empowering staff is paramount in maximizing their potential to overcome knowledge gaps. Individuals involved in the process are engaged in the process, and in return are committed to the process. We utilize TeamSTEPPS to place the problem in the hands of those who are entrenched in the problem- they know it best.  By tasking them to take ownership we build a competent and connected workforce. TeamSTEPPS has five key principles and is based on team structure, communication, leadership, situation monitoring, and mutual support.

I will guide evidence-based practice by leading when necessary and facilitating when needed. Arming staff with knowledge on how research, EBP, and QI work together to overcome knowledge gaps is an important foundation to lay when addressing needed process changes. I will also be open and non-dismissive with others who are naïve to the process, cultivating an environment where learning and creativity can blossom.    

REFERENCES            

Dham, P., Colman, S., Saperson, K., McAiney, C., Lourenco, L., Kates, N., & Rajji, T. K. (2017). Collaborative care for psychiatric disorders in older adults: A systematic review. Canadian Journal of Psychiatry, 62(11), 1–11. https://doi.org/10.1177/0706743717720869 (Links to an external site.)

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2013). A systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23, 290–298. https://doi.org/10.1136/bmjqs-2013-001862

I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO-THREE  PARAGRAPH AND TWO SOURCES NO LATER THAN FIVE YEARS

The questions are multiple choice choose the correct answer only one answer

• Describe a beneficial use for bacteria of the microbiome in treating disease. These answers can vary and may be experimental. Use some outside library resources like CINAHL Plus with Full Text or NCBI.gov to find these unique viral applications. Entries should include an overview of the viral application and the benefit to patient health or society.
• Also include any complications with this strategy preventing its immediate application.

Please be sure to validate your opinions and ideas with citations and references in APA format.

This should be between 300-500 words

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

this is the rubric for the assignment.

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16742105_1&rubric_id=_1942266_1