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 FINAL PAPER DUE Week 10 (today). Topic: Select Health Policy Analysis Paper on a local, state, or federal policy that you have explored along with recommendations based upon the analysis. • Analyze and evaluate the Health Policy • Identify application of health policy into clinical practice. ➢ Your paper must have an Introduction and a Conclusion ➢ Maximum of 6 pages (not including Title and Reference page). ➢ APA format ➢ At least 5 references within 5 years 

 As you consider the process of evidence based practice, do you agree or disagree that evidence-based practice is an iterative process? Explain your rationale

What are your thought???

Working with a case manager I have learned about concerns specific to discharging patients from the acute care setting. Per my preceptor, a problem the organization is facing is creating safe discharge plans for homeless patients. Often patients require additional services at discharge including outpatient wound care or follow up appointments. This makes creating a safe discharge plan difficult as patients that are homeless typically do not have access to necessary resources. Without access to necessary outpatient resources, this patient population is at an increased risk for readmission to the hospital. According to my preceptor, due to this issue, one patient has been readmitted to the hospital 5 times over the last few months.

Readmission is an issue for both the organization and nursing staff. Working with a patient with a difficult discharge plan and high risk for readmission is a challenge for the case managers. There are only so many resources available within the community and once those have been exhausted it can be difficult to create a new, safe, plan. This is also a concern for the organization as depending on the diagnosis, readmission can impact reimbursement rates for the patient’s stay. Being a case managemer requires extensive knowledge of resources and collaboration to create a safe discharge plan for patients. Nurses working in case management are constantly working on finding new ways to meet the needs of patients.

 Respond to  your  colleagues by recommending at least one additional way you would treat a  child or adolescent client differently than you would an adult and at  least one additional way you would address the legal and ethical issues  involved.  

NOTE: Positive Comment

                                                        Main Discussion

Psychiatric  emergencies are severe behavioral changes that may result from  worsening mental illness. Psychiatric emergency is any disturbance in  thoughts, feelings, or actions that require immediate therapeutic  intervention (Stahl, S. M., 2014). The providers approach, attitudes and  work environment may escalate the situation and interfere with the  quality of care. Certain therapeutic measures can reduce the intensity  of the situation and provide a more dignified way for patients to  recover from the crisis. It is thus important that the PMHNP understand  how to assess patient’s emergency status and address their unique needs  while maintaining safety.

  Case selected.

Patient  is a 25-year-old AA male who presents to the emergency department with  psychotic behavior in believing he should kill his mother which led to  his attempt to stab his mother. Patient is admitted for inpatient  psychiatric stabilization. Patient has a history of schizoaffective  disorder and major depression that was managed with use of clozapine  150mg twice a day and Zoloft 100mg daily. Family reported that patient  has a history of medication non-compliant and had been on different  psychiatric medications in the past but were not working for him.  Additional reports by his parents shows that patient had missed several  doses of his medication, decompensated and they had notices some changes   recently including increase agitation, delusional believes that he is  the savior in the family and God had directed him to cast the demon in  his mother. Reports also that he had drawn a picture of himself with  knives cutting a woman he portrayed as a demon with blood flowing with a  man standing to the side, laughing. Patient currently stated that he  participates in a meeting with angels from which he gets directives on  how to attack his mother which led to his attempt to stab his mother.  Because of this, patient was considered dangerous to his mother per  admitting physician. Patients symptoms include psychosis, extreme  agitation, paranoia, verbal outburst, combative and very difficult to  redirect. Patient has no known drug allergies per parents.  Verbal  restraint was used including letting patient know what will happen if  he does not comply, respecting his autonomy, empathetic listening,  decrease environmental stimulation, reassure patient that they will be  safe, and maintain a safe environment. The patient was given emergency  medications including haloperidol lactate 5mg, lorazepam 2mg, and  diphenhydramine 50mg all IM for severe agitation and danger to others.  To prevent re-hospitalization within 12-24 hours of discharge, the  physician ordered outpatient therapy and continued use of clozapine and  Zoloft along with necessary lab work.

 How I would treat the client differently if he or she were a child or adolescent

Children and adolescent are usually brought for treatment when  their behavior or thoughts come to the attention of parents, teachers,  social workers, or school.  For pediatric patients in a mental health  crisis, the typical chaotic nature of the situation may easily further  exacerbate an already traumatized state of the patient. Just like in  adults, as a PMHNP I would perform an evaluation to determine the type  of emergency and contributing factors in child and adolescent emergency  by assessing not just the child but also the entire family.  Additionally, safety and protection are essential mandate in psychiatric  emergency evaluation especially when the patient pose imminent threat  to self or others. What I will do different when interviewing children  especially younger children is to assess the underlying cause of the  violent behavior and delusional symptoms within a developmental context. Specifically,  I would clarify that “bizarre thinking ” or accounts of seeing or  hearing things that others do not see or hear are different from  developmentally appropriate fantasy or difficulty while distinguishing  inner voices from distressing hallucinations. On like in adults where  they can provide information during the interview, when it comes to  younger children, I would need to obtain information from parents or  guardian. For adolescents,  I would obtain information from the patient first then talk to their  parent or guardian if the adolescent is able to tell most of their own  story. This may also help to give a sense of autonomy and control to the  adolescent which promote cooperation with the interview process.   However, information from family is very crucial particularly for a  child who is psychotic, frightened, unable, or unwilling to corporate  with the provider to help understand how the situation occurred and the  severity of the behavior. 

Same  interviewing strategies used in adult may be used including speaking in  a soft voice respecting patients’ autonomy, assuring safety, validating  feelings, offering distractions (like video games) especially with very  young children, and clear limit-setting can be helpful. However,  children should be evaluated in a carefully planned setting with doors  closed for limiting access, and be sure appropriate backup is available  (Margret, C. P., & Hilt, R., 2018).  

In  violent situations children may require a different approach in  deescalating the situation than adults. Safety is the essential mandate  in an aggression evaluation, with the interviewer specifically looking  for imminent threats, plans, targeted people, and access to means of  harm (Margret, C. P., & Hilt, R., 2018). Because adults are much  stronger, they may require physical restrain specially to administer  medication to calm the patient. Verbal restrain such as providing verbal  directions in a nonthreatening manner, setting limits, and assuring the  child that treatment may help them calm may be used for children first.  However, if the child is dangerously out of control and aggressive,  they may need medication to keep them calm and safe.

Legal or ethical issues I would consider when working with a child or adolescent emergency case

The  ethical issue I will consider when working with children and adolescent  is respect for their autonomy, privacy, and confidentiality. For very  young children parents must consent to treatment and the health care  provider treating the child should make every reasonable effort to  obtain and document informed consent. (American Academy of Pediatrics,  2015). Just like adults, maintaining a patient’s confidentiality is an  important ethical consideration when providing care to children and  adolescents. However, when  a PMHNP is concerned that the patient may be at imminent risk for harm  to self or others, confidentiality requirements no longer apply (Chun,  T. H., Katz, E. R., & Duffy, S. J., 2013). This means that the PMHNP  in this situation may disclose information collected  from patient to  caregivers or others as needed and may obtain information from others  such as friends, family members, school personnel, employers and other  without obtaining consent from the patient or guardians (Chun, T. H.,  Katz, E. R., & Duffy, S. J., 2013. Patient  autonomy is a major principle in making decisions about an individual’s  health, and as a PMHNP we are obligated to respect this right and allow  patients to practice their autonomy in the course of their treatment  (Parsapoor, A., Parsapoor, M. B., Rezaei, N., & Asghari, F., 2014).  However, a psychiatric emergency and age may limit a child’s ability to  make such decisions. Regardless, it is always important to involve the  child in informed decision making even if the consent is signed by the  parents or guardian.

References

Chun, T. H., Katz, E. R., & Duffy, S. J. (2013). Pediatric mental health emergencies and special 

health care needs. Pediatric clinics of North America, 60(5), 1185–1201. Retrieved from,

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792398/

Da Silva, A. G., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. P. (2020). The 

Impact of Mental Illness Stigma on Psychiatric Emergencies. Frontiers in psychiatry, 11, 

573. https://doi.org/10.3389/fpsyt.2020.00573

Margret, C. P., & Hilt, R. (2018). Evaluation and Management of Psychiatric Emergencies in 

Children. Pediatric Annals, 47(8), e328–e333. https://doi-

org.ezp.waldenulibrary.org/10.3928/19382359-20180709-01

Parsapoor, A., Parsapoor, M. B., Rezaei, N., & Asghari, F. (2014). Autonomy of children and 

adolescents in consent to treatment: ethical, jurisprudential and legal considerations. 

Iranian journal of pediatrics, 24(3), 241–248. Retrieved from, 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276576/

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New 

York, NY: Cambridge University Press.

 Read the article, and address ONE of the following criteria to interpret the results of the study.

 State whether this criteria was MET AND SUPPORT your response with evidence from the article.

The journal article: An Empirical Analysis of Nurse Retention: what keeps RNs in Nursing?

1. The credibility and accuracy of the result.

2. The precision of the estimate of effect.

3. The generalizability of the results

Compose a focused paper that explains and describes your healthcare issue or topic from a cultural and ethical perspective of inquiry. (You will cover two perspectives in one paper.)

Form and answer two levels of research questions for each inquiry to address your chosen topic.

• Choose a “Level 1 Research Question/Writing Prompt” from both of the lists below to answer in the paper.
• Compose a “Level 2 Research Question/Writing Prompt” for each kind of inquiry that provides detail, specificity, and focus to your inquiry, research, and writing.
• State your research questions in your paper’s introduction.
• Form the body of your paper by answering each research question and support your assertions with evidence (research).
• In the conclusion of the paper, briefly review the issues, research questions, answers, and insights.

Level 1 Research Questions/Writing Prompts
ETHICAL Perspective of Inquiry

• What laws govern or pertain to the issue?
• What ethical obstacles affect how the medical community addresses the issue?
• How do ethical theories apply to the issue?
• How do money, power, and control matters relate to the issue and its treatment?

Level 1 Research Questions/Writing Prompts
CULTURAL Perspective of Inquiry

• Which cultural values and/or norms influence the issue?
• How is the issue addressed differently in varying cultural contexts and situations?
• Which cultures or societies are most affected by the issue? Why?
• Which cultural traditions affect the treatment(s)?

Your paper must be five pages in length and reference four to six scholarly, peer-reviewed resources. Be sure to follow current APA Style (e.g., spacing, font, headers, titles, abstracts, page numbering).

The following there weeks will review the APRN scope of practice. We must know and get familiar with the procedures, actions, and processes permitted by our professional license.

Review the following article: https://journals.sagepub.com/doi/full/10.1177/0193945918820338

Mark, B. A., & Patel, E. (2019). Nurse Practitioner Scope of Practice: What Do We Know and Where Do We Go?. doi:https://doi.org/10.1177/0193945918820338

 assignment:

 From above identify three challenges the Advanced Nurse Practitioner encounter in their Scope of practice (SOP), include them on this week first peer response due.

Scholarly article as reference must be included on your post and peer responses when due.

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we will be covering the APNP scope on practice: relationship with supervised physician via protocol covered on your portfolio assignment, new introduced controlled substance prescribed abilities, our role on research and evidence based practice, etcetera. It is very important to understand your scope of practice which basically determined yours legal scope of practice.

The scope of practice describes the procedures, actions, and processes that a health care practitioner is permitted to undertake in keeping with the terms of their professional license.

(Scope of practice – Wikipediahttps://en.wikipedia.org/wiki/Scope of practice)

Recommended readings:

1. Scope of practice of nurse practitioners: professional role.https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

2. State practice environment (AANP).https://www.aanp.org/advocacy/state/state-practice-environment

3. I want to take an opportunity to discuss our new granted privilege to prescribe controlled substance. There are five classes of substance considered under the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Comprehensive Drug Abuse Prevention and Control Act of 1970, 2019).This privilege was legally approved in Florida, the last state to grant such a privilege for midlevel practitioners, in 2017( Kellangs & Maye, 2017). Once licensed as Florida Nurse Practitioner (NP) license, you will need 2 hours of controlled substance prescription CEUs and to apply for the DEA license. The application cost $ 731 and it’s valid for three years. NPs are required to have a controlled substance agreement with the supervising physician.

DEA website https://apps.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp

References

Comprehensive Drug Abuse Prevention and Control Act of 1970. Retrieved on March 10, 2019 fromhttps://en.wikipedia.org/wiki/

Comprehensive Drug_Abuse_ Prevention_and_Control_Act_of_1970

Kellams, J. R., & Maye, J. P. (2017). The last state to grant nurse practitioners DEA licensure: An education improvement initiative on the Florida prescription drug monitoring program. Journal of addictions nursing, 28(3), 135-142. doi: 10.1097/JAN.0000000000000177

U.S Department of Justice and Drug Enforcement Administration. Diversion control division. Application for Registration Under Controlled Substances Act of 1970 (NewApplicants Only). Retrieved from https://apps.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.js

PICOT QUESTION: Advantages of Breast Feeding for a Newborn Baby

For this assignment, you will locate two research studies related to the topic and PICOT questions that you developed in Week 2. The articles must be current (within the last five years), and one article must be quantitative, and one article must be qualitative.

Article choice is very important, therefore:

• Articles used for this assignment cannot be used for the other assignments. The selected articles should be original research studies. Review articles, concept analysis, meta-analysis, meta-synthesis, integrative review, and systemic review articles should not be used.
• Mixed-methods studies should not be used.

There are two parts to this assignment.

Part 1: Complete a Rapid Critical Appraisal Checklist

• Select one each: qualitative and quantitative research articles.
• Create a Rapid Critical Appraisal Checklist for the two research articles (one column per article).
• Complete with brief, concise, summarized information.

Part II: Write a summary (one- to two- pages)

• Identify differences between quantitative and qualitative designs and research methods.
• Use current APA Style for your summary paper and to cite your sources.
• Submit the checklist and summary.

Purpose: PICO questions are used by practicing nurses and researchers to focus research questions and develop an efficient literature search strategy.  It is essential that future nurses learn how to do this to develop evidenced-based solutions to patient care problems in a healthcare organization. 

Assessment:  This assignment is worth 68 points and represents 20% of your final course grade.  It is graded according to the embedded rubric in this submission folder.  Late submissions will incur a 10% deduction per day, unless a Late Pass is used.

Instructions:

1. Write a PICO question based on a scenario you choose from the list of scenarios attached below.  Use the templates in the EBP Step by Step 3 article to help create your questions. You may need to do a pre-search to finding an intervention (the “I”) that has been studied and published to solve the problem.
2. Identify the PICO elements for each question. 
3. Develop a search strategy using at least 3 keywords from the P, I, and O parts of your PICO, 1 synonym for one of the keywords, and 1 MeSH term for one of your keywords. 
4. Locate 4 articles that help answer your PICO question.  The articles must meet the following requirements: 
   • must be primary source quantitative research articles.  
   • No article can be older than 2016. 
5. Obtain pdfs of the four articles you selected from the ResU database.  If not available for the ResU database, you may request access from the ResU Library, or you can email me the citation for the article, and I will attempt to locate a pdf of it. 
6. On a Word document, include your scenario; write your PICO question as a sentence; identify the P, I, C, and O for each question; and list the search terms (3 keywords, 1 synonym, 1 MeSH term) for each. You may use the template attached here. See also the link to the MeSH terms website below.
7. Provide a properly formatted APA reference page for your selected articles from Step 4 of these instructions. See the link to the APA and Writing LibGuide below.
8. Name each document (one Word doc and 4 article pdfs) as follows and upload to the appropriate submission folder in Brightspace:  

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.