Initial Post Instructions
For the initial post, pick two (2) of the following settlements:

• Southern colonies
• Chesapeake colonies
• Middle colonies
• New England colonies

Then, address the following for your selections:

• Compare and contrast the settlement patterns.
• What forces and ideas shaped their origin?
• Examine the influence of religion for those settlements (e.g., Puritanism, Quakers, and the Anglican Church).
• ***Minimum 2 references with in text citation***
• APA format for in-text citations and list of references

 
Review the roles and functions of a professional nurse found in Chapter 1 of your textbook (Table 1-2 – Nursing Roles in All Settings). Write a 2-3 page paper. Identify one strength you bring to each role and one area you need to develop. 

Review the IOM report, “The Future of Nursing: Leading Change, Advancing Health,” and explore the “Campaign for Action: State Action Coalition” website. In a 1,000-1,250 word paper, discuss the influence the IOM report and state-based action coalitions have had on nursing practice, nursing education, and nursing workforce development, and how they continue to advance the goals for the nursing profession.Include the following:Describe the work of the Robert Wood Foundation Committee Initiative that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”Outline the four “Key Messages” that structure the IOM Report recommendations. Explain how these have transformed or influenced nursing practice, nursing education and training, nursing leadership, and nursing workforce development. Provide examples.Discuss the role of state-based action coalitions. Explain how these coalitions help advance the goals specified in the IOM report, “Future of Nursing: Leading Change, Advancing Health.”Research the initiatives on which your state’s action coalition is working. Summarize two initiatives spearheaded by your state’s action coalition. Discuss the ways these initiatives advance the nursing profession.Describe barriers to advancement that currently exist in your state and explain how nursing advocates in your state overcome these barriers.You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. 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. You are required to submit this assignment to Turnitin. 

***(Just write it as indicated and I will read it and record it.)***

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     Prepare an 8-10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators.
  As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality healthcare delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.
  The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI) in 1998 to track and report on quality indicators heavily influenced by nursing action.
  NDNQI was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.
  The quality indicators the NDNQI monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedians theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove, Gray, Jay, Jay, & Burns, 2015).
  Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.
  The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 810 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses role in supporting accurate reporting and high quality results.
  Reference
  Grove, S. K., Gray, J. R., Jay, G.W., Jay, H. M., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice (6th ed.). St. Louis, MO: Elsevier.
  Demonstration of Proficiency
  By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
   
  • Competency 1: Describe nurses and the interdisciplinary teams role in informatics with a focus on electronic health information and patient care technology to support decision making.     
    • Describe the interdisciplinary teams role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.
  • Competency 3: Evaluate the impact of patient care technologies on desired outcomes.     
    • Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.
  • Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.     
    • Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.
  • Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.     
    • Deliver a professional and effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
    • Follow APA style and formatting guidelines for citations and references.
  • Preparation
    This assessment requires you to prepare an 810 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:
     
  • Select a single nursing-sensitive quality indicator that you see as important to a selected type of health care system.
  • Conduct independent research on the most current information about the selected nursing-sensitive quality indicator.
  • Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data. You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview:     
    • What is your experience with collecting data and entering it into a database?
    • What challenges have you experienced?
    • How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?
    • What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process?
  • Watch the .
  • Recording Your Presentation
    To prepare to record the audio for your presentation, complete the following:
     
  • Set up and test your microphone or headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone.
  • Practice using the equipment to ensure the audio quality is sufficient.
  • Review the for Kaltura to record your presentation.
  • View . This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage.
  • Notes:
     
  • You may use other tools to record your tutorial. You will, however, need to consult for instructions on how to upload your audio-recorded tutorial into the courseroom, or you must provide a working link your instructor can easily access.
  • You may also choose to create a video of your tutorial, but this is not required.
  • If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact to request accommodations.
  • Instructions
    For this assessment, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.
    The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.
    As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.
    You determine that you will cover the following topics in your audio tutorial script:
    Introduction: Nursing-Sensitive Quality Indicator
     
  • What is the NDNQI?
  • What are nursing-sensitive quality indicators?
  • Which particular quality indicator did you select to address in your tutorial?
  • Why is this quality indicator important to monitor?     
    • Be sure to address the impact of this indicator on quality of care and patient safety.
  • Why do new nurses need to be familiar with this particular quality indicator when providing patient care?
  • Collection and Distribution of Quality Indicator Data
     
  • According to your interview and other resources, how does your organization collect data on this quality indicator?
  • How does the organization disseminate aggregate data?
  • What role do nurses play in supporting accurate reporting and high-quality results?     
    • As an example, consider the importance of accurately entering data regarding nursing interventions.
  • After completing your script, practice delivering your tutorial several times before recording it.
    Additional Requirements
     
  • Audio communication: Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
  • Length: 810 minute audio recording. Use Kaltura to upload your recording to the courseroom, or provide a working link your instructor can access.
  • References: Cite a minimum of three scholarly and/or authoritative sources.
  • APA: Submit along with the recording a separate Reference page that follows APA style and formatting guidelines. For an APA refresher, consult the page on Campus.
  • Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.

Assessment 3 Instructions: Annotated Bibliography on Technology in Nursing 

     

Content

•  Print
    
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     Write a 4-6 page annotated bibliography where you identify peer-reviewed publications that promote the use of a selected technology to enhance quality and safety standards in nursing.
  Before you begin to develop the assessment you are encouraged to complete the Annotated Bibliography Formative Assessment. Completing this activity will help you succeed with the assessment and counts towards course engagement.
  Rapid changes in information technology go hand-in-hand with progress in quality health care delivery, nursing practice, and interdisciplinary team collaboration. The following are only a few examples of how the health care field uses technology to provide care to patients across multiple settings:
   
  • Patient monitoring devices.
  • Robotics.
  • Electronic medical records.
  • Data management resources.
  • Ready access to current science.
  • Technology is essential to the advancement of the nursing profession, maintaining quality care outcomes, patient safety, and research.
    This assessment will give you the opportunity to deepen your knowledge of how technology can enhance quality and safety standards in nursing. You will prepare an annotated bibliography on technology in nursing. A well-prepared annotated bibliography is a comprehensive commentary on the content of scholarly publications and other sources of evidence about a selected nursing-related technology. A bibliography of this type provides a vehicle for workplace discussion to address gaps in nursing practice and to improve patient care outcomes. As nurses become more accountable in their practice, they are being called upon to expand their role of caregiver and advocate to include fostering research and scholarship to advance nursing practice. An annotated bibliography stimulates innovative thinking to find solutions and approaches to effectively and efficiently address these issues.
    Demonstration of Proficiency
    By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
     
  • Competency 3: Evaluate the impact of patient care technologies on desired outcomes.     
    • Analyze current evidence on the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team.
    • Integrate current evidence about the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team into a recommendation.
  • Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.     
    • Describe organizational factors influencing the selection of a technology in the health care setting.
    • Justify the implementation and use of a selected technology in a health care setting.
  • Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.     
    • Create a clear, well-organized, and professional annotated bibliography that is generally free from errors in grammar, punctuation, and spelling.
    • Follow APA style and formatting guidelines for all bibliographic entries.
  • Preparation
    To successfully complete this assessment, perform the following preparatory activities:
     
  • Select a single direct or indirect patient care technology that is relevant to your current practice or that is of interest to you. Direct patient care technologies require an interaction, or direct contact, between the nurse and patient. Nurses use direct patient care technologies every day when delivering care to patients. Electronic thermometers or pulse oximeters are examples of direct patient care technologies. Indirect patient care technologies, on the other hand, are those employed on behalf of the patient. They do not require interaction, or direct contact, between the nurse and patient. A handheld device for patient documentation is an example of an indirect patient care technology. Examples of topics to consider for your annotated bibliography include:     
    • Delivery robots.
    • Electronic medication administration with barcoding.
    • Electronic clinical documentation with clinical decision support.
    • Patient sensor devices/wireless communication solutions.
    • Real-time location systems.
    • Telehealth.
    • Workflow management systems.
  • Conduct a library search using the various electronic databases available through the Capella University Library.     
    • Consult the for help in identifying scholarly and/or authoritative sources.
    • Access the NHS Learner Success Lab, linked in the courseroom navigation menu, for additional resources.
  • Scan the search results related to your chosen technology.
  • Select four peer-reviewed publications focused on your selected topic that are the most interesting to you.
  • Notes
     
  • Publications may be research studies or review articles from a professional source. Newspapers, magazines, and blogs are not considered professional sources.
  • Your selections need to be currentwithin the last five years.
  • Annotated Bibliography
    Prepare a 46 page annotated bibliography in which you identify and describe peer-reviewed publications that promote the use of your selected technology to enhance quality and safety standards in nursing. Be sure that your annotated bibliography includes all of the following elements:
     
  • Introduction to the Selected Technology Topic 
    • What is your rationale for selecting this particular technology topic? Why are you interested in this?
    • What research process did you employ?       
      • What databases did you use?
      • What search terms did you use?
      • Note: In this section of your bibliography, you may use first person since you are asked to describe your rationale for selecting the topic and the research strategies you employed. Use third person in the rest of the bibliography, however.
  • Annotation Elements 
    • For each resource, include the full reference followed by the annotation.
    • Explain the focus of the research or review article you chose.
    • Provide a summary overview of the publication.       
      • According to this source, what is the impact of this technology on patient safety and quality of care?
      • According to this source, what is the relevance of this technology to nursing practice and the work of the interdisciplinary health care team?
      • Why did you select this publication to write about out of the many possible options? In other words, make the case as to why this resource is important for health care practitioners to read.
  • Conclusion/Recommendation 
    • How would you tie together the key learnings from each of the four publications you examined?
    • What organizational factors influence the selection of a technology in a health care setting? Consider such factors as organizational policies, resources, culture/social norms, commitment, training programs, and/or employee empowerment.
    • How would you justify the implementation and use of the technology in a health care setting? Consider the impact of the technology on the health care organization, patient care/satisfaction, and interdisciplinary team productivity, satisfaction, and retention.
  • Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:
     
  • .
  • Additional Requirements
     
  • Written communication: Ensure written communication is free of errors that detract from the overall message.
  • Length: 46-typed, double-spaced pages.
  • Number of resources: Cite a minimum of 4 peer-reviewed resources.
  • Font and font size: Use Times New Roman, 12 point.
  • APA: Follow APA style and formatting guidelines for all bibliographic entries.
  • Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final capstone course.

 For our discussion board this week, I would like each one of you to introduce yourself to me and to your classmates. Please tell us about your nursing journey, your place of employment, your job, your short- and long-term goals, and what specifically you plan to do with your FNP degree. I’m looking forward to knowing you better. Thank you. 

I put my job.

 TRICARE Introduction: TRICARE is the healthcare provider for active or retired military personnel. It also covers the family of these persons. There are a variety of plans and qualifications that go along with this coverage. In order to understand TRICARE, it is important to understand the benefits available and to whom they are available.  Tasks: Summarize the benefits of TRICARE for an active military person. What if the active military person has family? Describe the benefits if the active military person is overseas. What if the active military person overseas brings family? Submission Details: To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.  Your initial posting should be addressed in 150300 words. Submit your document to this Discussion Area by the due date assigned. 

Respond  of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues case studies to you own practice in clinical settings.

                                               Main Post

                                  Sleep/Wake Disorders

The patient is an obese 70-year-old female with a chief complaint of being sad. Her husband passed away several years ago due to coronary artery disease (CAD). She lives at home alone and has a home health aide help her. Her son comes to visit her often. She was feeling well until her hearing began to diminish in both ears. Her mobility has declined, so she has not been able to get out as much. She is often lonely at home. She has daily crying spells, is often very tired, has good insight to her illness, and wants to get better. 

Three Questions to Ask the Patient and Why            

The case study mentioned that the patient is a candidate for cochlear implants, but it is a long way off. Thus, my first question to ask the patient is what is preventing her from getting cochlear implants?  

She began experiencing sadness when she began to lose her hearing and mobility. Therefore, regaining her hearing may help decrease the depression. If its financial reasons, maybe there are resources that can help her. Finding out the reason the patient isnt getting the implants can help the provider and patient find solutions.             

The patient also mentioned that her sleep was awful, stating her legs ache and jump, she takes frequent naps during the day, and admits to snoring frequently. Thus, the second question I would ask is what are her sleeping habits like? 

Individuals who have good sleep habits sleep better. Getting better sleep can be obtained by being consistent by going to bed at the same time each night and waking up the same time each day (Centers for Disease Control and Prevention, [CDC], 2016).  Individuals can make sure the room is dark, quiet, and cool (CDC, 2016). Additionally, remove electronic devices, avoid large meals, caffeine, and alcohol can help with getting better sleep (CDC, 2016).              My third question would be what do you do when you are sad? Individuals who are depressed often have a negative view of the world and often think of themselves as worthless (This Way Up, n.d.). They often blame themselves when something bad happens and feel like they are unlucky (This Way Up, n.d.). Thus, helping individuals identify negative thinking and reframe the way they think about life can help improve depressive symptoms (This Way Up, n.d.). 

People to Speak to with Specific Questions to Ask 

The first person I would want to speak to is the patients son. The case study states the son visits her often so he should know the patients habits. First, I would ask him the same questions I asked the patient such as what is preventing the patient from getting cochlear implants, what are her sleep habits, and what does she do when she is sad? By asking the son the same questions, insight can be shown on how the son views things and how the patient views things. I would also him when he began to notice her depressive symptoms because that will help provide a timeline as to when it all began.             

The second person I would talk to is her home health aide because she is familiar with the patient. I would ask her what the patients home life is like such as how is she maintaining her house? Is she able to clean up after herself? How is she doing with activities of daily living? 

These questions can provide insight on the severity of the patients depressive symptoms. 

Physical Exams and Diagnostic Tests and How Results Would Be Used            

The first diagnostic test I would want to perform on the patient is the 9-item Patient Health Questionnaire (PHQ-9). The PHQ-9 is a screening tool for major depression (Na et al., 2018). The test is a reliable and valid measurement of depressive symptoms that also asks about the individuals thoughts of death or self-injury within the last two weeks (Na et al., 2018). The results would be used to determine the severity of her depression. Another diagnostic test that can be performed on this patient is a polysomnography. A polysomnography is a sleep study that helps providers diagnose sleep apnea, periodic limb movement disorder, restless leg syndrome (RLS), insomnia, and nighttime behaviors (National Sleep Foundation, n.d.). The results would be used to can help determine the cause of her daytime sleepiness such as sleep apnea or RLS. I would also want to run a complete blood count (CBC) with differential on the patient. I would specifically want to obtain a red blood cell count (RBC) and white blood cell count (WBC). Thus, a CBC with differential would help determine if the patient is fatigued due to anemia or an underlying infection.

 Three Differential Diagnosis and Why

The three potential differential diagnoses include:Major Depressive DisorderPersistent Insomnia Disorder Obstructive Sleep Apnea Hypopnea The most likely differential diagnosis is major depressive disorder (MDD). The diagnostic criteria for MDD is five or more symptoms during the same 2-week period and a change from previous functioning (American Psychiatric Association, 2013).  The symptoms include: depressed mood most of the day, marked diminished interest or pleasure in all or almost all activities most of the day, significant weight loss or weight gain, insomnia or hypersomnia neatly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of energy nearly every day, feelings of worthlessness or excessive or inappropriate guilt nearly every day, diminished ability to concentrate, and recurrent thoughts of death (American Psychiatric Association, 2013). The patient fits this diagnosis as evidence by depressed mood, diminished interest in activities she used to enjoy, fatigue, diminished ability to concentrate, and psychomotor retardation.

Two Pharmacological Agents and Dosing and Why 

One pharmacologic agent that can be tried is doxepin 3 mg at bedtime for insomnia. Doxepin works by boosting serotonin and norepinephrine by blocking the serotonin reuptake pump and norepinephrine reuptake pump (Stahl, 2017). At hypnotic doses, doxepin blocks histamine-1 receptors, which promotes sleep (Stahl, 2017). Doxepin is a substrate for CYP450 2D6 and has a half-life of 8-24 hours (Stahl, 2017). In the elderly, the recommended dose for insomnia is 3 mg per day (Stahl, 2017).             Another pharmacologic agent that I would like to start the patient on is bupropion (extended release) XL 150 mg daily in the morning. Bupropion is used to treat MDD and works by boosting norepinephrine and dopamine by blocking the norepinephrine reuptake pump and dopamine reuptake pump (Stahl, 2017). Bupropion inhibits CYP450 2D6, has a parent half-life of 10-14 hours, and a metabolite half-life of 20-27 hours (Stahl, 2017). Thus, since bupropion blocks the dopamine reuptake pump and norepinephrine reuptake pump, this medication is beneficial in improving symptoms of loss of happiness, joy, interest, pleasure, energy, enthusiasm, alertness, and self-confidence (Stahl, 2013). Thus, because of bupropions mechanism of action and the patients symptoms, I would want this patient to try this medication. 

Lessons Learned  

Lessons learned during this case study is that geriatric depression can be difficult to treat. They often have multiple comorbidities with the possibility of more pronounced side-effects (Stahl, 2008). Additionally, medications can have contraindications that do not previously exist prior to the patient being put on medication. Thus, providers must be aware of new and old warnings on medications in the event there are changes made to medications. I will apply this information when I am in practice by paying close attention to dosages, side effects, and potential contraindications when providing medication to the geriatric population. 

                                                  References

American Psychiatric Association. (2013). Diagnostic and statistical manual od mental disorders (5th ed.). Washington, DC: Author. Centers for Disease Control and Prevention. (2016). Tips for better sleep. Retrieved from https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.htmlNa, P. J., Yaramala, S. R., Kim, J. A., Kim, H., Goes, F. S., Zandi, P. P.,Bobo, W. V. (2018). The PHQ-9 item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ-9)-9 item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). Journal of Affective Disorders, 232, 34-40. doi: https://doi.org/10.1016/j.jad.2018.02.045National Sleep Foundation. (n.d.). Sleep apnea. Retrieved from https://www.sleepfoundation.org/sleep-apneaThis Way Up. (n.d.). How do you feel? Retrieved from Stahl, S. M. (2008). Essential psychopharmacology online. Retrieved from Stahl, S. M. (2013). Stahls essential psychopharmacology: Neuroscientific basis and practical    applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. (2017). Stahls essential psychopharmacology: Prescribers guide (6th ed.). San Diego,  CA: Cambridge University Press. 

Grading for participation in postings (Possible points: 10)

Main Post (by Wednesday November)

1. Identify three areas to assess when working with a person who has been sexually assaulted.
2. Formulate two long-term outcomes and two short-term goals for the nursing diagnosis posttrauma syndrome.

  

Foundation of the Role of the Nurse Practitioner as Prescriber Legal and Professional Issues in Prescribing. Make sure to read highlighted instructions in the upload file. The state will be FLORIDA (the main one for this paper). The other state to compare please do Massachusetts. 

Scholar within 5 years PLEASE!!!! And include doi# also. Pay attention to the due date and also perfect grammar