1. In the last century, what historical, social, political, and economic trends and issues have influenced todays health-care system?

2. What is the purpose and process of evaluating the three aspects of health care: structure, process, and outcome?

3. How does technology improve patient outcomes and the health-care system?

4. How can you intervene to improve quality of care and safety within the health-care system and at the bedside?

2. Select one nonprofit organization or one government agencies that influences and advocates for quality improvement in the health-care system. Explore the Web site for your selected organization/agency and answer the following questions:

What does the organization/agency do that supports the hallmarks of quality?

What have been the results of their efforts for patients, facilities, the health-care delivery system, or the nursing profession?

How has the organization/agency affected facilities where you are practicing and your own professional practice?

NO MINIMUM WORD COUNT

3 CITATIONS WITH REFERENCES

 

Transcultural Perspectives in the care of Older Adults.

Review the attached PowerPoint presentation.  Once done, read the following clinical case below and answer the questions;

Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world. On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic Whites of similar age. Diet is a key factor in controlling blood glucose levels and preventing serious cardiac, renal, peripheral vascular, and retinal complications such as heart attacks, renal failure, limb amputations, and blindness.

An Indian Health Service (IHS) nurse visits a patient in her mobile home, located on an Arizona Indian reservation. The patient is a 72-year-old, obese, female Pima Indian with a blood glucose level of 280. She is at risk for serious complications of type 2, or noninsulin-dependent, diabetes mellitus. With type 2 diabetes, the body either resists the effects of insulin or doesnt produce enough insulin to maintain a normal blood glucose level. The patient lives with her adult daughter, two grandchildren, and five great-grandchildren. The nurses goals are to use culturally appropriate diet education to repattern the patients eating habits for the purpose of reducing the blood glucose level to normal (between 70 and 110 mg/dL); promoting steady sustained weight loss (5 pounds per week); encouraging increased exercise and activity. The nurse also asks the patient to participate in group sessions at the Pima Community Center focused on healthy food preparation and eating a balanced meal.

1. If you were a nurse who just began doing home health care on the Pima Reservation, how would you learn about the specific cultural beliefs and practices related to nutrition and diet for this patient as a member of the Pima Indian Nation, versus stereotypes about the diet of Native Americans in general?
2. Given that the patients family doesnt own a vehicle, how will you encourage her to shop for healthy foods, prepare them, and actively participate in weight loss and exercise programs held free of charge at the Pima Community Center?
3. How would you assess the patients eating habits, for example, type of food, method of preparation, amount eaten, etc.?
4. Each of the patients children, grandchildren, and great-grandchildren is obese. How would you involve the patients family in the plan of care and motive them to lose weight as well?

800 WORD COUNT

3 CITATIONS WITH REFERENCES

Case Study

Chief complaint: Im here for a medication refill because I ran out of my medicines. 

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway. 

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF) 

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) 

Differential Diagnosis: Peripheral Vascular Disease (PVD) 

Plan: 

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP not available. 

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease). 

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI? 

Posts must be supported by at least 2 peer reviewed references and all paragraphs must be cited. APA 6th

 

Attend a committee meeting in your health care organization. If you are not currently employed in a health care setting, you may elect to attend a committee meeting at another company, a community center, a local school, local chamber of commerce or other professional organization.

Observe the interactions between committee members and the process used by the committee to arrive at decisions.

In 500-750 words, describe the function of the committee and the roles of those in attendance. Describe your observations of the interactions between members of the committee and determine whether the process used to arrive at decisions is a form of shared governance.

A minimum of two academic references from credible sources are required for this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide

First: I need two papers. 

One for me and one for my girlfriend. As an advanced practice nurse, one can engage in activism in order to achieve desired policy change at various levels including their own organization. 

Examine the following questions

 1) should nurses be unionized and #2) how does being unionized impact a workforce culture of safety? Be sure to #3)  include one MSN Essential in your discussion that relates to this topic. 

APA style. 250 words. References 2 (5-7 years or less)

 

As an advanced practice nurse, one can engage in activism in order to achieve desired policy change at various levels including their own organization. Examine the following questions.

 #1) should nurses be unionized and

 #2) how does being unionized impact a workforce culture of safety?

#3) Be sure to  include one MSN Essential in your discussion that relates to this topic.

  all discussion posts must be minimum 250 words, references must be cited in APA format, and must include minimum of 2 scholarly resources published within the past 5-7 years. 

 

Discuss the Nurse Practice Act in your state.  How does the Nurse Practice Act affect your practice as a professional?  As an individual?  Give clear examples.

Reference: 

Cherry, B. & Jacob, S. (2018). Contemporary Nursing: Issues, Trends & 

 Management (8 th ed.). Elsevier. (e-Book) 

MEDICATIONS

1. Prozac 40mg daily

2.gabapentin 100mg TIP

3. Lithium 300mg BID

4.Zypreak 10mg

5.Metform 500mg BID

DIAGNOSIS:Depression 

HE is an 18 yrs old transgender from female to male

  

Does Psychotherapy Have a Biological Basis?

Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology? For this Discussion, consider whether psychotherapy also has a biological basis.

Learning Objectives

Students will:

Evaluate biological basis of psychotherapy treatments

Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments

To prepare:

Review this weeks Learning Resources.

Reflect on foundational concepts of psychotherapy.

Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence ones perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.

Resources for reference ( 3 reference needed).

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 1 Assessment      (pages 44 & 45)

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

• Chapter 1, The Nurse Psychotherapist and a      Framework for Practice (pp. 352)

 

Reading Assignments for this week:

Chapter 16 – Margaret Newman Theory of Health Expanding Consciousness

Chapter 17 – Madeleine Leiningers Theory of Culture Care Diversity and Universality

Chapter 18 Jean Watsons Theory of Human Caring

Lets discuss who are the presenting theorist for this week.

Who is Margaret Newman? What is her Theory of Health Expanding Consciousness?

• Website Link: Nursing Theory: HEALTH AS EXPANDING CONSCIOUSNESS

• Article Link: Margaret Newman’s Theory of Health as Expanding Consciousness and a Nursing Intervention from a Unitary Perspective

• Video Link: Margaret Newman Theory Presentation

Who is Madeleine Leininger? What is her Theory of Culture Care Diversity and Universality?

• Website Link: The Transcultural Nursing Society

• Article Link: Mapping the literature of transcultural nursing

• Video: Madeleine Leininger Interview Part 1

• Video: Madeleine Leininger Interview Part 2

Who is Jean Watson? What is her Theory of Human Caring?         

• Website Link: WATSON’S PHILOSOPHY AND SCIENCE OF CARING

• Evolution of Jean Watsons Carative Factors/Caritas Processes Over Time

• Article Link: Healthcare interprofessional team members’ perspectives on human caring: A directed content analysis study

• Video: History of Caring Science at The University of Colorado College of Nursing

Discussion Question: Our two-part discussion question for this week is the following:

How does the theory of expanding consciousness apply to our healthcare society today? Our nursing population to provide care to a diverse population of patients. Please choose either Madeleine Leiningers or Jean Watsons theory and explain how their theory would apply closely to the patient population or working environment that you currently serve or work with.