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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 Respond one of your colleagues’ posts by offering a possible resolution to their  questions/concerns with supporting documentation.  

at least 2 references in each peer responses

  

           A cost-benefit analysis is an estimate that analyzes the cost and benefit of a policy or project to evaluate its worth (Hwang, 2016). For lawmakers, the value of a political decision is measured by votes gained compared to votes loss. The fear of being voted out of office definitely played a role in derailing the efforts to repeal and replace the Affordable Care Act (ACA). The pushed to repeal and replace ACA begin to heat up after President Trump was sworn into office as a part of his campaign promise. Many Americans are divided on the issue, with the growing majority against the repeal and replace proposal (Milstead & Short, 2019). The divide creates a challenging decision for politicians hoping to get reelected in the battleground states. The problem arises because no political spin can deny that more people are covered since the passing of ACA, and the repeal of ACA would cause millions of Americans to lose coverage (Grogan, 2017). 

The decision made by legislative leaders are affected by the views of the voters if it poses a threat to the leaders reelection. While having control of both houses in congress republicans were still leary about voting on issues that impacted Medicaid and Medicare (Mistead and Short, 2019). The issue of healthcare is one that exposes all the tricks and tactics that make up politics. The proceed with caution mood looming over political decisions related to healthcare indicate that politicians care more about being reelected than the issue itself (Mistead and Short, 2019). It is a logical strategy. Elected officials have all made the claim that their purpose is to represent the people. Legislative leaders are so worried about the blow back from a decision affect their reelection that it was even suggested that they should repeal ACA symbolically without actually changing anything (Leonard, 2017). 

The cost-benefit analysis was originally a political tactic used to discredit regulatory programs (Sinden, 2019). According to Sinden (2019), the cost of implementing project would be inflated over the value of the benefit to devalue the benefit of the regulation. According to Cole (2012), CBAs are subjective, and the value human lives can easily be manipulated and discounted to promote or denounce regulations. In the case of our legislative leaders, the vote is more valuable than a human life. 

 

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Create 1–2 page outlines of your response plan for three intervention scenarios.

Nurse leaders need to quickly identify a strategy for evaluating a nursing leadership problem and the dynamics related to the problem, in order to orchestrate intervention efforts and put together a plan of action that leads to stakeholder cooperation.

 

Preparation

Use the Internet to research change theory, leadership, and communication strategies. Use the Suggested Resources to research leadership and communication concepts and change theory.

• The challenge in this assessment is to create a response plan for several intervention scenarios.
  • There are three deliverables required for this assessment.

Rationale for this assessment:

Nurse leaders solve problems or resolve conflict on a daily basis. Understanding how change theory can be applied to a situation and examining various types of interventions in advance can relieve pressure on the nurse leader and improve the workplace environment and outcomes. Rehearsing potential interventions provides a mental toolkit on which to rely during stressful times.

Your management training workshop continues:

The second day of HR’s Nursing Leadership Workshop is designed to help you identify and practice effective responses and interventions to common problems and situations. Participants are presented with three scenarios and must create a response plan for each scenario, in the form of a 1–2 page outline.

Deliverables: Submit three Response Plans to complete this assessment.

• Choose 3 of the 5 Intervention Scenarios linked in the Required Resources for this assessment.
• For each scenario you choose, develop a separate Response Plan in the form of a 1–2 page outline.
  • Label each outline using the example below:
    • Example: Response Plan for School Nurse.

Instructions

Analyze each Intervention Scenario and describe the leadership, communication, and management strategies you believe would be most effective for each situation.

Use the following subheadings to organize your Response Plan outline for each situation.

• Change Theory: Explain concepts of change theory and how it can be used as a tool to manage situations.
  • Identify elements of change theory that fit best with the scenario.
  • How can you use change theory to deal with conflict?
• Strategies and Rationale: Describe an effective leadership style you would employ to address a problem.
  • Explain the rationale for choosing a leadership strategy to solve a problem.
  • Identify interventions to address the problem.
• Expected Outcome: Describe how outcomes or success of the style selected for each situation could be measured.
  • Describe how you could determine improved outcomes or measure success of the leadership style selected for each situation.
    • What might go wrong and how would you deal with that?
• Professional Standards: Explain how professional and legal standards guide the effective nurse leader when making decisions.

Additional Requirements

• Written communication: Written communication should be free of errors that detract from the overall message.
• APA formatting: Resources and in-text citations should be formatted according to current APA style and formatting.
• Length: Each outline should be 1–2 pages double-spaced.
• Font and font size: Times New Roman, 12 point.
• Number of resources: Use a minimum of three peer-reviewed resources.

The intervention scenarios to choose from are attached, must choose 3.

The grading rubric is attached. 

 

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