I need a response for these 2 peers

Peer 1 

Societal justice and critical reflection are the fundamental concepts underlying community activism. The former refers to the unbiased distribution of resources for a prolific and fulfilling lifestyle (Reichlin et al., 2019). For instance, through campaigns and demonstrations, nurses, practitioners and the general community would be able to advocate the cause of providing adequate medical amenities.  

Critical reflection boosts one’s understanding of the resident community’s issues (such as inadequate staffing) as well as those of others across the globe. Through this approach, the management and staff members would be able to devise long-term resolutions that ensure adequate staffing in the present and future (Reichlin et al., 2019). For example, pursuing suitable programs at academic institutions can steer students in the direction of the healthcare industry.  

Paying attention and keeping up with the trends in the tobacco industry is vital. This effort helps the advanced practice nurses to engage in community activism for preventing the negative health impacts associated with Big Tobacco in their respective societies (Salmond & Echevarria, 2017). As a result, the nurses would be in a position to enlighten the community members on addictiveness and diseases (such as lung cancer) associated with the increased consumption of tobacco products.  

Organizing programs to campaign against smoking is an essential stratagem that would aid nurses in educating the public on why tobacco control policy measures such as higher taxes are needed to ensure reduced consumption. With this tactic, nurses could participate in community activism to curb any further ill effects arising from the use of Big Tobacco (Salmond & Echevarria, 2017). Moreover, holding seminars that counsel smokers and non-smokers, especially the youth, to remain vigilant against industry-instigated efforts would be essential in discouraging the consumption of tobacco products. 

Peer 2 

Through schooling, training, and knowledge learned along the way, Advanced Registered Nurse Practitioners (ARNPs) are equipped with the necessary skillset and tools to assist members of the community have improvement in their health outcomes. As key players in patient, ARNPs play a vital role in community activism to bridge the gap in healthcare disparities across different population groups and to improve the community. Maryland & Gonzalez (2012) asserts that the vast “amount of interactions that nurses have with patients leads to them personally witnessing the positives and negatives of the current healthcare system and consequently enable them to identify the needs of their patients by the care or the lack of it they receive.” Due to their first-hand interaction, nurses can advocate for their patients and their families and convey their experiences to the public and policymakers to bring about change in current health care policies (Maryland & Gonzalez, 2012).  

According to Messias (2019), community activism entails the key concepts of “community, social justice, raising consciousness, critical reflection, praxis, and empowerment of members of the community.” With each key concept comes certain actions on the part of the activist and subsequent delineations of certain orders of events. Nurse Practitioners can embody all the characteristics of community activism Messias asserts to promote the overall health status of the community. According to Messias (2019), community activism starts with an understanding of the community, in which individuals must realize that they are part of a larger group and share common interests in order to catalyze change. Praxis entails the process of ideas and theories being made and actualized, which consequently brings about unification—or division—of members of the community. Praxis affects the practices and customs of members of the community and affect the interaction of these individuals. With social justice, the way individuals perceive justice and what is right or wrong, affects the justice system and what behaviors are viewed as deviant in the community.  

Raising consciousness and empowerment of members of the community are vital to altering the status quo hopefully for the better but negative impacts can ensue. Teaching members of the community that they have rights can empower them to develop or defend them against lawmakers. Shining light on certain issues, such as through protest and petition with local or federal elected officials can bring about necessary changes in the management of certain disease plaguing the community (Mason, Gardner, Outlaw, & O’Grady, 2016). Empowerment is the ultimate goal (Mason et al., 2016) as by doing so individuals in the community will do what is necessary to improve their health on a holistic level.  

Maryland & Gonzalez (2012) argues that nurses can make significant influence in community activism on a multilevel approach. Maryland & Gonzalez (2012) asserts that school nurses can attend school board meetings to voice their personal viewpoint of the ramifications of inadequate staffing to monitor the health of school children. They are only equipped with the knowledge to voice this opinion because of their personal experience with performing their duties of providing basic healthcare to their patients (in this case, school children). My daughter is a third grader at a local elementary school. In a school of more than 800 students, there is only one nurse. Imagine how difficult it is to provide care to these students during the cold and flu season or any ordinary day for that matter. This stresses the importance of community activism by nurses and advanced practice nurses. The level of care they provide to their patient population is affected by factors in the community so who is best to make the issues known and advocate for and against them but nurses? Nurses, through their inimitable experience with their patients, can bring to the forefront issues that affect their patient and the community. Policymakers should hold the voice of nurses in high-esteem prior to making any changes that will affect individuals of a community.  

From a community activism approach, ARNPS can mitigate further negative health impacts from Big Tobacco by bringing social awareness and consciousness to the issue. Letting members of the community become aware or reminded of the ramifications of smoking cigarettes or consuming other tobacco products will greatly decrease the number of individuals in the community that smoke or will smoke. Health fairs broadcasting posters of individuals with lung cancer or tracheostomies from cigarette smoking or oral cancers from chewing tobacco are one of the ways that ARNPS can use community activism to help manage the negative impact of Big Tobacco. On each healthcare visits, ARNPs need to assess if their patients smoke and make them aware of the ramifications in addition to offer smoking cessation counseling and education. Empowerment is necessary to help individuals in the community to stop because many of them have been smoking since childhood. Smoking is also a way that many of these individuals cope and manage stress. Offering them alternative coping measures is crucial to getting them to stop smoking. Educating the community of the long-term risk of smoking, the consumption, and second-hand smoking, is vital to deterring the use of tobacco and promoting the overall health of the community. Mason et al. (2016) states that tobacco usage and exposure is the foremost cause of preventable death in the nation. This statement alone will serve to remind individuals of the negative consequences of smoking and will lead to many of them quitting. 

To conclude, advanced practice nurses play a rather significant role in patient advocacy to improve the health outcomes of their patients. Nurses can employ various teaching methodologies to assist their patients improve their overall health. Tackling issues at the community level can help nurses being awareness to issues that directly and indirectly affect patients. Bringing awareness to certain issues, such as the negative influence of Big Tobacco on the overall health of individuals in a community, are one of the many ways that ARNPS can help ameliorate the health status of the community. The ARNP can collaborate with other members of the interdisciplinary team and elected officials to maximize the impact of decreasing negative health issues in the community. 

Response posts must be minimum 100 words each. Word document, double space. APA (6th) 

This the original work if you needed 

Describe the key concepts underlying community activism and give examples of how each of these concepts applies to a specific context. Examine how advanced practice nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities. 

Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism. 

Patient Advocacy and in the Community and Legislative Arena: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print 

 

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Respond to your colleagues post by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.

at least 2 references in each peer responses!   

Registered nurses (RNs) and advanced practice registered nurses (APRNs) play a significant role in policy evaluation. Nurses represent the most substantial portion of the healthcare population (Milstead & Short, 2019). They possess the experience and expertise to positively affect quality improvement and efficiency when they are included as a member of policy and health care teams (Milstead & Short, 2019). RNs and APRNs can become involved in policy review on a local level, state level, or federal level (Milstead & Short, 2019). 

Members of the nursing profession can become involved in policy evaluation on a local level by joining a policy review committee at their place of employment. My current job offers incentives to Nurses that participate in the policy and procedures committees. RNs and APRNs can also become members of the policy board. This will allow them to evaluate policies and advocate for policy changes that improve the quality of care at their facility. Recently at my facility, a surge committee was assembled to redesign the surge policy and protocols. Multiple members of the healthcare team, including RNs and APRNs, participated and provided insight on working during a surge or sudden influx in patient flow. They were able to make suggestions that contributed to the new design for our surge policy at the facility. 

Another way RNs and APRNs can become involved in policy change on a large scale is to join an organization like the American Nurses Association (ANA). According to the ANA (2020), developing effective and useful policy is a core principle. Members of the ANA influence state and federal policymakers. The ANA provides expert information to lawmakers on policies (Milstead & Short, 2019). They assist with data collection and the evaluation of policies (Milstead & Short, 2019). According to Milstead and Short (2019), the process of policy evaluation is similar to the steps of the nursing process, making nurses a valuable asset to redesigning the healthcare system. Joining organizations like the ANA provides the opportunity for RNs and APRNs to lend their expertise to policy analysis. 

The cost will always be a challenge that must be considered when evaluating policy. Sometimes a solution that is recommended during the evaluation of a policy lands outside the budget. This is true on the local, state, and federal levels of policymaking. A cost-benefit analysis (CBA) can be conducted to overcome this challenge. A CBA compares the cost of a program or a policy with its benefits to select the most cost-effective and beneficial solution (Hwang, 2016). Some challenges that may occur when evaluating policy are out of the control of the evaluator, including the pace of policy change, issues with ethics, and political biases (Milstead & Short, 2019). For example, The ANA is known to support democratic candidates (Milstead & Short, 2019). This could decrease the value of the input provided by the ANA amongst policymakers that do not support the democratic agenda. 

References

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

American Nurses Association. (2019) Expert policy analysis. Retrieved https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/expert-policy-analysis/

Hwang, K. (2016). Cost-benefit analysis: its usage and critiques: CBA: its usage and critiques. Journal of Public Affairs (16) p.75-80. Retrieved https://www.researchgate.net/publication/274967779_Cost-benefit_analysis_its_usage_and_critiques_CBA_its_usage_and_critiques

 

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Respond to your colleagues’ posts by offering additional ideas regarding academic achievements to include or offering alternative ways of presenting the current achievements.at least 2 references in each peer responses! 

Creating a professional portfolio will assist with career planning in so many ways. It is always a way to add value to the efforts I have placed on lifelong learning. Some of the information to be included in a portfolio include references, academic achievements, continuing education information, and personal values (Thompson, 2011, p. 169).  I would also want to include letters of recommendation, awards, and future career goals. I have not ever created an actual portfolio.  Still, my resume has been fine-tuned over the years, and I mention the majority of the information included in a professional portfolio.  After reading the Thompson article, I am excited to create an e-portfolio. The digital portfolio is much easier to keep updated and to share with others online (Thompson, 2011).

I created an Indeed portfolio several years ago and will update this occasionally. I see the importance of showcasing my accomplishments after further review of the module 5 resources. Networking in the digital age is incredibly important for professional growth (Hannans & Olivo, 2017, p. 49).  Another fantastic aspect of the professional portfolios is the ability to improve the chance for hire, keeping the interview focused and efficient, as well as open the floor for me to discuss all of the staff development ideas I have (Smith, 2011).  I have created staff training procedures, protocols, policy and procedure training, as well as my very own medication administration system for boarding schools. The portfolio would be the perfect place for me to showcase this and then assist in the delivery of information during the interview.

I did some more research as I was trying to find what an employer may want to see specifically regarding education. Transcripts have never been a topic of discussion during an interview. Interestingly, I found an article that states transcripts are an exceptional way to showcase my accomplishments as well as highlight the program details (Bellingham Technical College [BTC], n.d.).  I am excited to see how my professional portfolio develops throughout the next few years.

 

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Discussion Assignment:

Respond to the following Case study:

Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings.

· Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

·  

· Suggest additional health-related risks that might be considered.

·  

· Validate an idea with your own experience and additional research.

·  

· Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format.

Case Study Response

  

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty 

List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions

1.How are you performing in school?

     Rationale:  Children with ADHD portray academic underachievement due to inattentiveness and disruptive as well as disruptive behavior. Their general academic achievement is affected by these behaviors and the results are challenges in reading, spelling and math (Leahy, 2018).

2.How is your relationship with your family members, your teachers and your friends?

Rationale: This question is meant to elicit information regarding this patient’s social skills. Most ADHD children have problematic peer relations as well as emotional dysregulation . Therefore, it is possible that  this patient will report always being in trouble with teachers, as well as not being like by her peers due to her poor social skills ( Sjowall, D., & Thorell, L. B. 2014)

3. Do you find it hard to read and follow instructions, and do you have a hard time understanding and finishing your assignments?

Rationale: Most children with ADHD have trouble following instructions, either because they do not understand the instructions or because they do not want to. Most children are therefore academically challenged ( Parker, 2005)

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

The patient’s parents( Mother, father), the patient’s grandparents if they are close to the child, the child’s siblings, peers, and teachers who interact with the patient.

The questions would include

1.When did you start getting concerned about her symptoms?

Rationale: This question would be asked to parents or grandparents who help take care of  the patient .  Most children generally have inattentiveness and hyperactivity. Most of them cannot adequately follow orders or concentrate on a task for a long time. However, there is that time when a parent gets concerned about these symptoms and decide to seek for professional opinion or diagnosis.

2. Is there somebody in either her father’s or mother’s side of the family that has ADHD?

This question is to the parents and grandparents who know the patient’s background. This question is meant to find out if ADHD runs in the family and if it is genetic.

3. To the mother: Were you smoking or drinking when you were pregnant with the patient?

Rationale:  Alcohol and tobacco use during pregnancy can cause a child to be born with ADHD.

4. Is the patient able to finish her homework on time?

Rationale: This question can be asked to both the parents and the teacher. This is to find out if the patient is able to complete her tasks.

5. Is the patient  able to interact and play normally with friends?

Rationale: This is a question to her teachers and her friends. Most ADHD patients do not have social skills and so they prefer to stay on their own and do not play well with their peers (CDC 2019).

6. Is the patient disruptive in class?

Rationale: This question is to the teacher. Most ADHD  patients have disruptive behavior, they talk too much, are overly active and have trouble controlling impulses.

7.What learning disabilities does the patient have?

Rationale: Most children with ADHD have problems with math, reading and spelling (Wender, 2000).

Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

As of date, there is no single laboratory test that is used to diagnose ADHD. Psychiatrists rely on continuous performance tests( CPT) for the diagnosis This is an automated scoring test whose results analysis and interpretation are also automated ( Boutros, Fraenkel,  & Feingold, 2005). 

A neurologic exam such as EEG or MRI  of the brain  would also be necessary to ensure that the patient does not have any brain injury   since one of the causes of ADHD is brain injury. A DSM5 diagnostic exam would be done to find out if the patient has all the symptoms of ADHD ( Leahy, 2018).

Head to toe physical exam would be the first thing to conduct on this patient. Since the patient comes in with fever and sore throat, it is important to first find out why she has fever and sore throat. Throat cultures will be collected to check for the organisms causing t sore throat. Also, blood cultures will need to be sent to find out if the patient has systemic infection. The other test to conduct would be the hearing and vision test. This is to make sure that these problems are not causing  all these issues (CDC2019).

List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

Attention-Deficit and Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a  Inability to pay attention, control impulses and behaviors as well  as overactivity. Although most children will have some of these characteristics, ADHD is set apart by the  intensity, pattern and persistence of these characteristics (CDC 2019).  

Some symptoms of ADHD include extreme day dreaming,, forgetfulness, loosing or displacing things a lot, over talkativeness, making careless mistakes as well as extreme fidgeting and squirming ( CDC 2019). The causes of ADHD include alcohol and tobacco  consumption by the mother while pregnant, low birth weight, brain injury, premature delivery and exposure to pollutants such as lead ( Parker,2005).

Diagnosis of ADHD is often difficult since the symptoms resemble  characteristic behavior of some normal children and therefore, no one particular  test has been discovered and tried out to successfully diagnose  ADHD. Tests may include physical exams to rule out deficits such as hearing and vision, which could be responsible for some behaviors.

Attention-Deficit and Hyperactivity Disorder and

Oppositional Defiant Disorder  (ODD) co morbidity

Oppositional Defiant Disorder (ODD), is a condition in which a child exhibits extreme anger, irritability, temper tantrums, refuses to follow orders and directions and is easily annoyed, for a period of at least 6 months (Ehmke, 2019). According to  Wender, (2000), between 20-30% of children with ADHD also have learning disabilities, while 35% of those with ADHD have Oppositional Defiant Disorder(ODD).Children with ADHD are likely to have learning disabilities such as problems reading, spelling and math (Wender, 2000).

Developmental Delays

           Children who have developmental or intellectual  delays normally have learning, behavior, physical and language challenges in life. Developmental delay begins at infancy, but proper diagnosis is only possible after 5 years of age when IQ tests can be performed reliably . Children with developmental delays are always lagging behind in achieving age-related  milestones. When a child lags behind in more than one area of development, they are said to have global developmental delays(Stojanovic,2020).

           The cause of developmental delays is not clearly known, but premature birth,  genetic factors, infection during pregnancy are thought to be some of the causes of developmental delay. Developmental delays may also be a sign of other underlying problems such as Down’s Syndrome, autism, cerebral palsy, fetal alcohol spectrum disorders and Angelman’s Syndrome among other neurological and genetic conditions(Chung et al, 2011).

List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

Methylphenidate (D,L) is an FDA approved central nervous system stimulant which is commonly prescribed to both children and adults for the treatment of ADHD. According to CDC (2019), children on fast acting methylphenidate have between 70-80% decrease in ADHD symptoms. Methylphenidate inhibits dopamine reuptake while at the same time it increases norepinephrine and dopamine activity, thus enhancing concentration, attention and wakefulness ( Fairman,  Peckham, & Sclar, 2020).

At this age, the patient can get the transdermal patch with a starting dose of 10mg every 9 hours, with an increase of 5mg weekly to a maximum dose of 30mg every 9 hours (Stahl,2014b). The pharmacokinetics of methylphenidate (D.L.) in children present a delay in minimum peak concentrations and second peak concentrations when compared to adults causing children to have higher concentrations of the drug, due to their smaller body size and the total volume of distribution(Rafael, 2008).

Guanfacine XR is a selective  adrenoreceptor  agonist that  works on alpha 2A agonist  sites on the prefrontal cortex of the brain It is an FDA approved  non-stimulant medication for children and adolescents with ADHD  and Oppositional Defiant Disorder symptoms ( Ngairita, 2007).

Guanfacine increases attention,, improves memory, planning and control, as well as  reduces impulsivity.  Dosage is calculated on mg/kg basis (0.05mg/kg to 0.12mg/kg) to be taken once daily. It may take days for  full benefits of Guanfacine to be realized ( Stahl,2014b).  Guanfacine  should be swallowed whole with a small amount of water or milk and high fat foods should be avoided as they cause an increase in the blood levels of guanfacine  (Guanfacine extended release (XR). (2013 ).

If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.

This case shows several weeks of ADHD treatment with little success. Although the diagnosis of ADHD  was properly diagnosed and was being treated as a solo case, the Physicians did not diagnose ODD as an accompanying diagnosis for this patient. The patient experiences increased attention while on Lisdexamfetamine and dextroamphitamine, but has no improvement on Symptoms related to ODD. To top it all, the patient has insomnia, which could be as a result of  D-methylphenidate XR stimulant in the initial stages.

Multi drug therapy  approaches should have been initiated  to help decrease ODD symptoms (Vitiello et al., 2015).  A combination therapy of guanfacine XR and lisdexamfetamine  should have been utilized as they have been  proven to be effective  for these two conditions. (Diane Christopher, 2010).

Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.

           From this case, I have learnt that an effective diagnosis leads to effective and timely treatment. In this case, there was delay in achievement of full therapeutic effects of treatment because the diagnosis was not completed on time.  I have also learnt that at times, it is necessary to try a multi-drug therapy instead of using just one drug for  the treatment of some conditions. In this case, the original belief was that Guanfacine XR alone would be sufficient in the treatment of the patient because unlike methylphenidate its efficacy in the treatment both ADHD and ODD is known.  However, after reviewing the outcome, it was decided that this patient required Multidrug therapy in order to achieve full therapeutic benefits.  From this case, it is clear that PMHNP should keep their knowledge on mental health up to date in order to be effective in diagnosing and treating mental health disorders.

            It is also clear from this case that in order for diagnosis and therapy to be effective, there should be cooperation from family members, teachers and peers. Sometimes parents tend to cover up for their children and excuse their behavior, leading to delayed diagnosis and start of therapy.

 

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