Consider what was happening in nursing in the late 1970’s and early 1980’s with the change from diploma programs to an associate degree program. Martha Rogers believed that nursing is a separate and essential discipline and a unique field of study. She worked hard to establish nursing in higher education. Explain the importance of this shift and how it impacted nursing as a profession. 

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Using the readings from McEwen and Wills (2014) chapter 19: application of theory in nursing research, address the following for your initial discussion post:Complete a library search for a peer-reviewed journal article that integrates nursing theory and research.Present the article and discuss the nursing theory used, as well as the benefits of nursing theory in nursing research.Discuss the relationship between theory and research in nursing.Be sure to supplement your discussion with personal and professional experiences.Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.Please be sure to validate your opinions and ideas with citations and references in APA format. 

References:McEwen, M. & Wills, E. (2014). Theoretical Basis for Nursing (4th Ed.); Lippincott Williams and Wilkins.

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Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates.

1. Gatekeepers are primary care physicians.  They serve as the first contact in healthcare, so they can control utilization. (Module- 2 Home Managed Care, 2019).  If patients were able to self-refer for expensive exams, it would be chaotic.  Not to mention the expense for both the patient and insurance companies.  There are steps when ordering diagnostic testing for patients.  For example, breast imaging starts with an X-Ray (mammogram). If the radiologist sees something that requires further testing, he/she will order an ultrasound, and then a biopsy.  If a patient went straight for the biopsy they don’t need, they’d be putting themselves through unnecessary trauma and costs.  Some insurance companies will not cover expensive imaging without documentation that the proper steps were taken. Medicaid won’t cover a PET/CT scan if there is not a cancer diagnosis.  I worked at a PET/CT imaging center. We had to have documentation and prior imaging results before submitting the patient’s packet for Medicaid approval.  It’s an expensive exam and insurance companies do not want to pay for something they don’t have to. We had patients pay out of pocket because they thought for sure something was wrong with them that their doctor could not find. Even then, they still need a doctor’s order before they can get a nuclear med imaging test. 

2. The gatekeeper approach is exactly what patients need. Reminder, that the patients must come first, and must be respected within the healthcare process. The most important thing to keep in mind as healthcare professionals, is that if they’re going to take care of the patients, they must abide with the core ethical principles such as beneficence, nonmaleficence, autonomy, and justice (Flite, Harman, 2013). One that pops the most is beneficence, which is defined as “providing benefits and balancing benefits and risks/harm” (Chiropr, 2011). The care should start with the general practitioner or primary care providers, where their roles are to “collaborate with other healthcare providers, such as other specialists and therapists, to ensure the patient has all of their needs met” (Fritzel, 2019). In addition, they must educate patients and have an oversight of their entire healthcare needs. This not only provides the needs of the patients, but benefits them by avoiding unnecessary cost and harm to the patients who decide to take matters into their own hands.  

3.   As a Primary Care Provider (PCP) they have been given the title of gatekeeper. This means they delegate the path a patient must take to return them to a healthier state if capable. I do believe that the gatekeeper system has achieved its purpose. The gatekeepers can have positive attributes. For example, children have been known to see their pediatrician for 15 years before they age out. So a well established rapport is built and the physician has an understanding of what treatments work whether that be holistic, conventional medicine, or alternative medicine for the patient. Unlike an adult in certain medical systems may see several PCP’s within a timeframe due to the shortage of physicians. Meaning, your PCP has become unavailable for whatever reason, so another physician must cover down on the patient load. Weinstein (2001) commented, “Physicians, each acting in the best interests of their own patients, collectively reach the limits of health care resources, with the result that access to care and quality of care are compromised” (p. 268).  Where the negative aspect comes into play as a gatekeeper would be going to the dentist and finding a mass in the annual panorama x-ray. The patient must go though the gatekeeper in order to be seen by an ENT physician which prolongs their treatment. This example seems very minuet, but take for instance a single mom, the finances, time off work, and dragging kids along just to get the gatekeeper to write the consult for ENT. This becomes an extra hurdle just to achieve the end result.  

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200 words

1. Describe the relationship between the kidney ,diabetes mellitus and heart disease and why they are commonly presented together in patients.
2. According to the website, what is the most common cause of kidney failure?

 https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521?topicid=6 

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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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