Porfolio 2
-APRN protocol
-Business proposal
-CEU’s Please included the requirements for certification application CEUs
-ARNP Application State Florida Testing
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Population Health 6 Dq 2
How can large, aggregated databases be used to improve population health? 1 page, 2 sources. APA.
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Population Health 19451917
how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).
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Population Cultural Considerations And Genetic Predispositions
Practicum Discussion: Culturally aware nurses recognize that states of health are revealed differently across cultures and ethnicities. Culture and ethnic background will affect the way each individual responds to health, illness, and death (Stanhope & Lancaster, 2016). These nurses are also aware of their own biases, which may affect the care they provide to others (Stanhope & Lancaster, 2016). Because most nurses work in institutions with individual patients, they are accustomed to delivering culturally competent care on a one-on-one basis. When a public health nurse deals with a population, he or she must consider how the population culture affects the ways in which the community nurse may interact. This can be with regard to the provision of education or mass health care needs such as those required in a foodborne illness, if mass vaccinations are needed for a communicable disease outbreak, or if education is required to prevent heart disease. In addition to understanding the nuances of the culture of a population, community health nurses must understand the role genetics play in health. Some disorders, such as glaucoma and diabetes, have a genetic link, as do some cancers, such as breast and ovarian.
Please discuss the following questions in your Practicum Discussion:
- Provide a few examples of community resources that should be put in place to assist your population in resolving their health care needs. What gaps in service do you see that affect your population?
- Are there any cultural considerations that might inform your approach to caring for this population?
- Does your population have a genetic predisposition to the health care problem you have identified?
- Identify at least one evidence-based, culturally competent behavior change that would promote health for your selected population and for the specific health care problem you are addressing?
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Portofolio Part 1
Submit Part One Portfolio
3 .Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.
Practice
1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.
2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.
3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.
4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.
Education
1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.
2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.
3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.
4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.
Research
1. Increase the integration of evidence-based care across the dimensions of end-of-life care.
2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.
3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.
4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.
5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.
Administration
1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.
2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.
3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.
4. Support the development and integration of palliative care services for all in- and outpatients and their families.
Discussion Board Question 2: End of Life Care.
Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management.
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Portofolio Part 1 N
The Professional Portfolio
A professional portfolio is the evidence of your skills, achievements, and professional experience. Your résumé /CV. Portfolios come in two varieties: a Growth and Development portfolio is your main portfolio. It holds all evidence of your education and achievements and is for your eyes only, and a Best Work portfolio or Profile is a collection of materials you select from your Growth and Development portfolio for review by others for a specific purpose, such as a promotion or an award.
How do I use my portfolio?
You’ll use your professional portfolio to plan your continuing education and professional development. You can also use your portfolio to market yourself. When applying for a career-ladder promotion, a new position, or admission to an education program, review your portfolio and select the appropriate materials for submission. You can do the same when you think you deserve an award or other recognition.
Several professional associations are either using portfolios for certification or developing a plan to do so. Also, several states have considered or are considering requiring a professional portfolio for re-licensure. So you may be using your portfolio to select evidence for these purposes, as well.
For the purpose of this course the following are the tags required for your professional portfolio:
Part 1
- Professional letter examples. It is your cover letter, the one you send as an invitation to consider you as a candidate for work position, or research grant recipients as two examples of its use.
https://www.indeed.com/career-advice/cover-letter-samples/nurse-practitioner
http://www.coverletter.us/nurse-practitioner-cover-letter/
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Post Abby 19081095
Respond to this post with a positive response :
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Use references
INITIAL POST
Diet and Overweight in Tennessee
A significant behavioral risk factor affecting our nation’s population is unhealthy diet resulting in obesity (Knickman & Kovner, 2015). Unfortunately, this health issue significantly influenced the great state of Tennessee. Tennessee is ranked 15th out of all the states for highest obesity rates in adults and ranked 20th for ages 10-17 (The State of Obesity, 2018). Tennessee’s obesity rate has increased dramatically in the past few decades. In 1990, the obesity rate for the state was 11.1%, rose to 20.9% in 2000, and 32.8% in 2017 (The State of Obesity, 2018). This obesity has affected a rise in health conditions such as diabetes with a current rate of 13.1%, hypertension with a current rate of 38.7%, and heart disease with a current rate of 38.7% (The State of Obesity, 2018). If the trend of obesity continues at this rate, disease is going to increase substantially in Tennessee. To stop the trend of poor diet and obesity in Tennessee, drastic interventions are needed.
Population-Based Intervention Model Examples
According to the Population-Based Intervention Model, effective interventions include downstream, midstream, and upstream (Knickman & Kovner, 2015). Downstream interventions include interventions based on an individual. Providers in my community should focus on BMI at well-visits with individuals. As part of the well-visit, the provider needs to provide education on the individual’s BMI. Specifically, discussion regarding what it means and how to decrease it or prevent it from elevation is imperative. The provider should review the patient’s regular diet, make suggestions on improvements, and provide resources related to healthy eating. In small southern Tennessee towns, education on healthy nutrition is lacking. However, people seem to trust their doctors in the rural community. Individual focus on diet by the providers would be beneficial.
Midstream interventions of the Population-Based Intervention Model are interventions focused on communities (Knickman & Kovner, 2015). When traveling through Tennessee, the importance of southern cooking and fast food is announced all over the interstate billboards. Manchester, TN is no exception as Interstate 24 runs straight through it creating the nickname, Interstate Town. Manchester is the main town in Coffee County with even smaller towns surrounding it. This is the community in which I live, full of fast food and very limited healthy restaurant options. The United States Department of Agriculture (2017) reported 38 fast food restaurants in 2014, making 0.71 fast food restaurants for every 1,000 people. Restaurants with healthy options in Manchester, TN are nearly non-existent. An example of an effective midstream intervention in Manchester would be to bring in healthier restaurants. This busy, working-class community full of families eats out a lot while focusing on church events, sports, and volunteering. Having quick, healthy restaurant options would be helpful in improving health and decreasing obesity in this area.
Upstream interventions of the Population-Based Intervention Model are interventions made by policies at the state and national levels (Knickman and Kovner, 2015). According to The State of Obesity (2018), Tennessee has yet to make any laws concerning the requirement of posting caloric information in restaurants. Perhaps, if individuals saw this information on their regularly eaten food options, they would get accustomed to choosing the lesser calorie options. Also, this policy may help to inform community members as to why eating at home or having healthier restaurants would be beneficial to their health.
Summary
Poor diet and obesity are huge concerns in Tennessee as the increasing trends will only worsen disease rates in the future. Ideas such as one-on-one nutritional attention by providers, healthier restaurant choices, and policies requiring posted nutritional information could increase the health of the Tennessee population.
References
Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.
The State of Obesity. (2018). The state of obesity in tennessee [data file]. Retrieved from https://stateofobesity.org/states/tn/
United States Department of Agriculture. (2017). Economic research service [data file]. Retrieved from https://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas/
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Post A Short Reflection Approximately 1 Paragraph In Length Discussing Your Thoughts And Opinions About One Or Several Of The Specific Theories Covered In The Readings Chapters 21 And 22 2 References
Text and materials:
Ruth M. Tappen. (2015). Nursing Research. Advanced Nursing Research: From Theory to Practice. (2nd ed.). ISBN-13: 9781284048308. ISBN-10: 1284048306. Publisher: Jones & Bartlett Learning
Section VI: Middle Range Theories
Chapter 21: Katharine Kolcaba’s Comfort Theory
Chapter 22: Joanne Duffy’s Quality-Caring Model
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Post A Description Of The Interview And Communication Techniques You Would Use With Your Selected Patient Explain Why You Would Use These Techniques Identify The Risk Assessment Instrument You Selected And Justify Wh
Post a description of the interview and communication techniques you would use with your selected patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
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Post 19477263
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 isn’t 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 patient’s son. The case study states the son visits her often so he should know the patient’s 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 patient’s 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 patient’s 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 individual’s 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 bupropion’s mechanism of action and the patient’s 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 https://thiswayup.org.au/how-do-you-feel/sad/Stahl, S. M. (2008). Essential psychopharmacology online. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/viewPdf?page=csEP_16.pdf&vol=2Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide (6th ed.). San Diego, CA: Cambridge University Press.
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