Tag: Clinical-Nursing

NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum

Think about your practicum project and the issue you identified in Module 3. What issue or problem did you identify? (Note: You may have also selected a prominent nursing practice issue that is of interest to you.)

Analyze scholarly literature related to the issue/problem of and strategies for resolution. Review different nursing theories that could support a resolution to the practice issue or problem you have identified. NOTE: Many students may be inclined to choose Lewin’s Change Theory. This is not a nursing theory and would not apply to the required content for this assignment.

In a three-to-six-page scholarly paper, address the following elements. Include a minimum of three scholarly sources, current within 5 years, to support your work. See rubric for specific, required content

criteria within each section of the presentation:

o Introduction

o Description of Issue or Problem

o Nursing Theory

o Application of Theory

o Conclusion

Title page, pagination, subheadings, body of paper, citation of sources, and reference page must follow APA guidelines as found in the current edition of the manual.

NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum

Medication administration errors (MAEs) pose a significant threat to healthcare accountability, quality of care, and patient safety. Despite advances in safety protocols, barcode medication administration, and electronic prescribing, errors persist in clinical settings. Nursing practicums are particularly vulnerable to MAEs because nursing students are still developing confidence, clinical judgment, and technical skills. These practicums expose students to real-world challenges, including time pressures, frequent interruptions, high patient acuity, and difficulties with interdisciplinary teamwork. Together, these factors increase the mental workload nurses carry and may jeopardize safe medication practices. Simply emphasizing procedural compliance is insufficient. Instead, a theoretical framework is needed to understand how nurses develop judgment and competence over time. Medical and nursing theories offer valuable insights into the experiential, behavioral, and cognitive aspects of practice improvement. This paper reviews MAEs observed during practicums, analyzes current research, and applies Benner’s Novice-to-Expert Theory to propose evidence-based solutions.

Description of the Problem

During the nursing practicum, it became evident that nursing students and novice nurses are more susceptible to medication errors. Observations showed inconsistent safety checks, misunderstandings of drug mechanisms, delays in administering medication, and near misses. Workflow interruptions were common, often caused by conflicting clinical priorities, staff interactions or alarms, and disruptions during medication preparation. These problems reflect recent research suggesting that medication errors mainly result from individual factors—such as decreased situational awareness, anxiety about performance, limited pharmacology knowledge, and fatigue—as well as system factors like challenges with medication technology usability, communication barriers, staffing changes, and high workload (Naseralallah et al., 2023; Kellett et al., 2024).

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Multitasking and interruptions can cause medication errors. Cognitive psychology research shows that interruptions interfere with working memory, increasing the risk of mistakes and slips during tasks such as dosage verification and calculations (Park et al., 2023). In addition, nursing students and novice nurses often adhere strictly to rules and protocols without fully considering the clinical context, increasing the risk of errors when faced with patient situations that differ significantly from standard scenarios. They tend to hesitate to report near misses because they fear the consequences or blame, which limits opportunities for organizational learning (Arkin et al., 2023).

Importantly, MAEs in practicum settings highlight systemic problems within clinical and educational environments rather than focusing solely on individual mistakes. Clinical areas crafted mainly for seasoned nursing practitioners can inadvertently overwhelm novice nurses and nursing students who are still honing automatic skills and pattern recognition. To minimize MAEs, there is a need to apply strategies that focus on creating a safe system, promoting cognitive growth, and enhancing skills. It is essential to choose the right nursing theory that allows the interventions to be customized according to learners’ developmental levels NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum.

Nursing Theory

Benner’s Novice-to-Expert Theory offers a valuable framework for comprehending the development of competence and its importance for safe medication practices. Based on Dreyfus’s Model of Skill Acquisition, five levels of nursing expertise can be outlined, including novice, advanced beginner, competent, proficient, and expert. Each of the five stages and the transitions between them involve notable changes in clinical abilities, decision-making, and perception. Novices rely on explicit features and rules. Advanced beginners begin to recognize meaningful, recurring patterns. Competent nurses improve their prioritization and planning skills. Proficient and expert nurses develop a holistic understanding and intuitive judgment (Lamichhane, 2025).

Recent research continues to affirm the significance of Benner’s theory in modern clinical education. The research indicates that novice nurses encounter greater cognitive challenges, are more prone to making errors, and tend to make slower decisions under time constraints (Pol-Castañeda et al., 2022). Benner’s theory focuses on experiential learning and mentorship, reinforcing evidence that patient safety and clinical skills benefit from guided practice and reflective feedback (Cunja et al., 2025). In addition, the theory highlights the importance of considering context when making decisions, which is especially relevant in medication administration, as patient-specific factors influence monitoring, timing, and dosing.

Benner’s framework is particularly focused on nursing, highlighting how practitioners integrate perception, experience, and knowledge. It treats medication safety not as a simple technical skill but as a developing interpretive and cognitive competence. Recognizing that learners progress through distinct developmental stages, Benner’s theory helps design tailored clinical and educational approaches. This approach is especially useful for managing MAEs identified during practicum.

Application of Theory

Applying Benner’s theory underscores the need for developmentally appropriate strategies that evolve with the learners’ skills to reduce medication errors. At the novice level, nursing students should receive clear guidance, have explicit rules and guidelines, and engage in repetitive practice. Resources such as close supervision, detailed medication protocols, and standardized checklists are essential for reducing cognitive load and uncertainty (Park et al., 2023). Simulation-based education proves highly effective at this stage; high-fidelity simulations enable nursing students to practice error detection, barcode medication administration, dosing calculations, and medication preparation in a safe setting (Pol-Castañeda et al., 2022). Moreover, simulated interruptions train learners to stay focused and recover swiftly from disruptions.

For advanced beginners, effective learning should foster understanding within context and support pattern recognition. Using guided reflections, clinical scenario discussions, and case-based learning helps learners interpret patient-specific factors impacting pharmacotherapy (Cunha et al., 2025). Clinical preceptors are critical because they demonstrate expert reasoning; techniques such as “thinking aloud” during medication administration reveal implicit clinical judgments and improve situational awareness. Providing constructive feedback encourages correct practice and turns mistakes into valuable learning opportunities rather than punishments (Arkin et al., 2023).

Environmental interventions improve educational strategies, as evidence indicates that reducing interruptions significantly lowers MAEs. Increasing staff awareness of medication safety times, using visual cues such as signs or vests, and establishing dedicated “no-interruption” zones help maintain cognitive function during essential tasks (Kellett et al., 2024). Additionally, streamlining workflows and effectively managing workloads can further reduce the risk of errors.

As nursing students and practitioners develop their professional skills, interventions should gradually shift from strict adherence to rules to a focus on clinical judgment, anticipation, and prioritization. Participating in interprofessional collaboration activities enhances communication clarity, thereby reducing errors stemming from misunderstandings or ambiguous instructions. Debriefing sessions and reflective journaling help cultivate the metacognitive skills essential for safe practice. Overall, Benner’s theory supports a variety of interventions that align system design, mentorship, and education with the learner’s evolving clinical competence.

Conclusion

MAEs remain a significant risk and challenge in healthcare, particularly in nursing practicum settings. The principal concern is the higher risk of MAEs among nursing students and novice nurses, driven by factors such as organizational culture, environmental complexity, and cognitive development. Recent studies indicate that inexperience, communication issues, workload stress, and interruptions are primary causes of MAEs
NR520
Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum. Consequently, developing a framework that illustrates high nurses gain clinical judgment and competence over time is essential.

Benner’s Novice-to-Expert Theory provides a nursing-focused view on how decision-making, perception, and performance develop across different stages. By tailoring MAE-reduction strategies to each level of nursing expertise, clinical leaders and educators can implement targeted interventions that enhance patient safety and support professional growth. This is a theory-based solution that includes mentorship programs, reflective practices, structured supervision, simulation exercises, and methods to reduce interruptions. Incorporating nursing theory into practical improvements ensures that strategies go beyond targeting procedural adherence to the experiential and cognitive aspects of safe medication administration. This theory-based approach enhances clinical education while improving patient safety outcomes.

Reference

Arkin, L., Schuermann, A. A., Loerzel, V., & Penoyer, D. (2023). Original Research: Exploring Medication Safety Practices from the Nurse’s Perspective.
The American journal of nursing, 123
(12), 18–28.
https://doi.org/10.1097/01.NAJ.0000996552.02491.7d

Cunha, L. D. M., Ventura, F., Pestana-Santos, M., Mota, M., Lomba, L., & Santos, M. R. (2025). Decision support strategies for bedside nursing clinical reasoning: A scoping review.
International journal of nursing studies advances, 9
, 100393.
https://doi.org/10.1016/j.ijnsa.2025.100393

Kellett, P. L., Franklin, B. D., Pearce, S., & Benn, J. (2024). Resilience in nursing medication administration practice: a systematic review with narrative synthesis.
BMJ open quality, 13
(4), e002711.
https://doi.org/10.1136/bmjoq-2023-002711

Lamichhane, G. (2025). Shaping professional nursing practice using Benner’s novice to expert theory
. British journal of nursing (Mark Allen Publishing), 34
(22), 1133–1137.
https://doi.org/10.12968/bjon.2024.0387

Naseralallah, L., Stewart, D., Price, M., & Paudyal, V. (2023). Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review.
International journal of clinical pharmacy, 45
(6), 1359–1377.
https://doi.org/10.1007/s11096-023-01626-5

Park, O., Jeon, M., Kim, M., Kim, B., & Jeong, H. (2023). The Effects of a Simulation-Based Patient Safety Education Program on Compliance with Patient Safety, Perception of Patient Safety Culture, and Educational Satisfaction of Operating Room Nurses.
Healthcare (Basel, Switzerland), 11
(21), 2824.
https://doi.org/10.3390/healthcare11212824

Pol-Castañeda, S., Carrero-Planells, A., & Moreno-Mulet, C. (2022). Use of simulation to improve nursing students’ medication administration competence: a mixed-method study.
BMC nursing, 21
(1), 117.
https://doi.org/10.1186/s12912-022-00897-z 
 NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum

Vila Health – Planning for Community and Organizational Change – NURS-FPX6218 Leading the Future of Health Care

Planning for Community and Organizational Change

After assessing the most immediate issue that affects the Jordan community, Jordan Middle School proved to have an urgent need for a mental health program that would benefit middle school students. That is because the students are more vulnerable to mental health issues after the middle school teacher notifies that the school has had a case of a student who committed suicide just before graduation. Since then, most students have been affected by the incidence. Therefore, this proposal paper will identify the need to engage in a mental health program for the Jordan Middle school student community, deal with stakeholders’ unfounded conclusions, why organizations face change barriers, and use barriers as opportunities. The paper will also evaluate the strategy for helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system and develop a grant proposal and associated budget for a proposed change Vila Health – Planning for Community and Organizational Change.

Mental Health Program Benefits and Implications

The proposed change for Jordan Middle School starts with a mental health program essential to create awareness among the children regarding various mental health issues and how to deal with different circumstances. Initially, the middle school teacher indicates that apart from problems with mental health like suicide, the students also have a hard time dealing with bullying. The school has even tried to bring along counselors but still feels that the mental health issues awareness is yet to be fully addressed. Hence, the mental health program for the middle school students will help bridge the existing gap, especially for these students believing that they are the only people struggling in the world. According to Feiss et al. (2019), school-based mental health practices are essential since they are a solid student support system. Hence, when school-going individuals become mentally healthy, they will most likely be more productive in schools, thus giving these communities positive change drivers. That is unlike when students develop undetected mental health issues where some become drug addicts terrorizing the communities while others become suicidal, thus blurring the community’s future.

Consequently, the school community will also benefit since once the program facilitators streamline students’ mental health, the schools will experience minimized cases of bullying, thus providing all students with a friendly environment. According to Berger (2019), most scholars have identified the need for schools to develop comprehensive mental health programs since most studies show that such programs have been one reason why students complete their education successfully. It offers them social skills, caring connections with other students and community members and increases self-awareness. The issue of stakeholders who might fail to resonate with the mental health program may arise since most people believe that mental health issues only affect adults. In such a case, the school will need to organize a meeting with all stakeholders to help sensitize them about why mental health program is necessary for the school. Such sensitization will help the stakeholder support the proposed plan implementation for the sake of the middle school students’ well-being.

Potential Barriers to Change

The main potential barriers that may affect the mental health program for Jordan Middle School are failed support from the parents and school management and logistics barriers.

Failed Support from the Parents and School Management

Change is inevitable, and it also turns out to be the most challenging plan for organizations and communities, especially if the change planners have no vision towards the change. According to Maynard et al. (2019), the issue of mental health for students may arise from both the school environment and the students’ home environment. In such a case, the parents, one of the stakeholders, may be out of reach when the change implementers need them. If the clinicians find those students who may need clinical intervention, there is a high likelihood that the clinicians will require their parent’s consent. In such a case, the planned change implementers need to strategize how the parents can occasionally be part of the program to ensure that they will not derail any of its plans. Consequently, some teachers and school management may oppose the planned change since some may believe that the program may affect the school’s reputation. In such a case, the planned change initiators will need to clarify that the program mainly wants to cater to the students’ mental well-being to prevent adverse effects of issues like anxiety and depression that may result from the student’s past experiences.

Logistic Barriers

Logistic barriers may also be a potential barrier since most school environments prove to be crisis-driven and hectic. The main reason is that there is a possibility of facing problems with finding the time and acquiring space within the school environment where the planned change initiators will hold the program. In such a case, the program implementers may find it challenging to ensure that the students arrive for the program on time since once some students fail to meet the program meeting time, the program may turn out to be ineffective for them (Maynard et al., 2019). That is considering that the program has to run parallel to the regular learning program of Jordan Middle School, while the psychiatrists will most probably be undertaking part-time schedules. Hence, before the program implementation starts, there will be a need to ensure that the change team has comprehensive talks with the school management to prevent such barriers, especially in establishing the appropriate student schedules and the space that will be more appropriate for the program.

Articulate Strategies for Changing Barriers into Opportunities and Resolving Conflict

Through identifying the change barriers that may affect the Mental Health Program for Jordan Middle School, it will be necessary for the change implementers to find effective ways to use these barriers as opportunities that will help in making the implementation process a success. According to Carsley et al. (2018), competing responsibilities are the main barrier that impacts all change processes, especially with the non-implementers that endorse the change. In that case, the barrier that may arise from the student’s parents and school management not supporting the implementation present an excellent opportunity for the change plan implementers. That is because they will need to seek help from the community clinicians that may be well known and trusted by the community members. These community clinicians will effectively engage the parents and school administration to ensure that they understand the importance of having a mental health program in the school (Powell et al., 2020). Also, these community clinicians will effectively carry out the follow-ups for those students that may be under treatment. As a result, these clinicians will help reduce the financial burden and time used by primary change team clinicians, thus preventing instances of these clinicians from experiencing burnout as they try to balance their duties, thus increasing their productivity in the program.

Regarding the logistics barrier, the change team will need to conduct evidence-based research on how other change teams on mental health programs in schools ensured that the barrier did not affect the plan. According to Powell et al. (2020), when change teams engage in evidence-based research, they have higher chances of using the most appropriate method that fits their change plan. They are presented with opportunities to evaluate different ways to solve the problem.

Stakeholder Communications

The main stakeholders for the planned change in Mental Health Program in Jordan Middle school include the Jordan teachers, school management, students, and parents. The stakeholders will also have the community and other reliable clinicians. Through these stakeholders, the planned change team will manage to intervene in the current mental health crisis that Jordan Middle School students are undergoing. Hence, the planned change will need to collect enough data through interviews and questionnaires from the teachers and students, and the surrounding communities to ensure that the decision-makers will have a complete picture of the current situation in the school.

Grant Proposal and Associated Budget for a Proposed Change

Grant Proposal

From:
Jordan Middle School Planned Change Team

To:
Funding Authorities

Topic: Grant Proposal for Jordan Middle School Mental Health Program

After researching Jordan Middle School’s problems, the research team identified that the students have significant mental health issues. Currently, most students are dealing with grief issues concerning one of the students that committed suicide while still in school. Also, some students may still suffer from bullying, leading to adverse mental health effects like depression and anxiety that risk the students’ well-being. In that case, the research team has identified the need to develop a Mental Health Program for the students to create awareness of issues concerning mental health. The program will run for two years, and the following is the first-year budget.

Budgetary Requirements

Costs

Number of the Program Beneficiaries

Cost per Student/clinician ($)

Total Cost (Annually) ($)

Stage One: Screening and Enrollment

(Assumption that 90 percent of the students will comply)

1,100

20

22,000

Stage Two: Clinical Evaluation (With an assumption that 20% have mental health issues)

220

40

8800

Stage Three: Referral

(Assuming that 30 percent of the positive cases will need a referral)

66

 

50

3300

Community Clinicians

6

150

900

Building Renovation and Utility cost

80,000

Total Cost

115000

 

Conclusion

The paper has evaluated the need to engage in a mental health program for the Jordan Middle school student community, deal with stakeholders’ unfounded conclusions, why organizations face change barriers, and use barriers as opportunities. The paper has also assessed the strategies necessary in helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system and developed a grant proposal and associated budget for the proposed change.

 

References

Berger, E. (2019). Multi-tiered approaches to trauma-informed care in schools: A systematic review.
School Mental Health
,
11
(4), 650-664. https://doi.org/10.1007/s12310-019-09326-0

Carsley, D., Khoury, B., & Heath, N. L. (2018). Effectiveness of mindfulness interventions for mental health in schools: A comprehensive meta-analysis.
Mindfulness
,
9
(3), 693-707. https://doi.org/10.1007/s12671-017-0839-2

Feiss, R., Dolinger, S. B., Merritt, M., Reiche, E., Martin, K., Yanes, J. A., … & Pangelinan, M. (2019). A systematic review and meta-analysis of school-based stress, anxiety, and depression prevention programs for adolescents.
Journal of youth and adolescence
,
48
(9), 1668-1685. https://doi.org/10.1007/s10964-019-01085-0

Maynard, B. R., Farina, A., Dell, N. A., & Kelly, M. S. (2019). Effects of trauma‐informed approaches in schools: A systematic review.
Campbell Systematic Reviews
,
15
(1-2). https://doi.org/10.1002/cl2.1018

Powell, B. J., Haley, A. D., Patel, S. V., Amaya-Jackson, L., Glienke, B., Blythe, M., … & Weinberger, M. (2020). Improving the implementation and sustainment of evidence-based practices in community mental health organizations: a study protocol for a matched-pair cluster randomized pilot study of the Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS).
Implementation science communications
,
1
(1), 1-13. https://doi.org/10.1186/s43058-020-00009-5

 

Vila Health – Planning for Community and Organizational Change – NURS-FPX6218 Leading the Future of Health Care

Draft a 5 page change proposal to executive leaders, soliciting their support for a change to the health care system in the community you selected in the previous assessment.

Introduction

To improve health care outcomes within a community, leaders must understand the needs of specific populations. In addition, it is important that leaders are able to gather and present persuasive evidence to decision makers to obtain the necessary funding and establish these needs as priorities for budget and resource planning. Thus, proposed changes should support improved outcomes and align with the current or needed health care policy.

This assessment provides an opportunity to propose a community health care change that is based on the community health assessment you completed in Assessment 2.

Preparation

Your community health assessment was well received by the executives at Vila Health. Consequently, they have asked you to recommend a change in the community that will improve health outcomes. They have also asked you to submit your recommendation in a formal change proposal. You are confident that you can present a strong case for change, including a financial plan, that will ensure the success of this initiative.

In this assessment, you will draft a change proposal to executive leaders to solicit support for a change to the current community health care system. To prepare for the assessment, you are encouraged to begin thinking about your justification for establishing the recommended change as a priority, a strategy for leading change, and how the change will be funded. In addition, you may wish to:

Review the assessment requirements and scoring guide to ensure that you understand the work you will be asked to complete.

Review Guiding Questions: Planning for Community and Organizational Change [DOCX], which includes questions to consider and additional guidance on how to successfully complete the assessment.

Note: Remember that you can submit all or a portion of your draft change proposal to Smarthinking Tutoring for feedback before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

The following resource is required to complete the assessment.

Vila Health: Planning for Change.

Vila Health is a virtual environment that simulates a real-world health care system. In the various Vila Health scenarios, you will apply professional strategies, practice skills, and build competencies that you can apply to your coursework and in your career. The information you gather in this scenario will help you to complete the assessment.

TEMPLATES

Use this template for your change proposal.

Change Proposal Template [DOCX].

Requirements

Complete this assessment in two steps:

If you have not already done so, complete the Vila Health: Planning for Change simulation.

Draft a change proposal to justify your recommendation for improving the health of the community and establish the change as a priority for the next budget cycle. Consider the feasibility of your proposed change, in terms of overall scope, funding, and timeframe.

The change proposal requirements outlined below, correspond to the grading criteria in the scoring guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed. The Guiding Questions: Planning for Community and Organizational Change document provides additional considerations that may be helpful in completing your assessment. In addition, be sure to note the requirements below for document format and length and for citing supporting evidence.

Identify the benefits of proposed health care system changes and its implications for a community.

Describe potential barriers to change in an organization or community.

Develop strategies for changing barriers into opportunities and resolving conflict.

Develop a strategy for helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system.

Develop a grant proposal and associated budget for a proposed change to an existing health care system.

Write clearly and concisely in a logically coherent and appropriate form and style.

Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.

Document Format and Length

Use the Change Proposal Template. This APA Style Paper Tutorial [DOCX] can help you in writing and formatting your assessment. If you would like to use a different template or document format for your change proposal, obtain prior approval from faculty.

Your change proposal should be 5 pages in length, not including the title page and references page.

Be sure to apply correct APA formatting to all source citations and references.

Supporting Evidence

Cite 5 credible sources from peer-reviewed journals or professional industry publications to support your change proposal.

Additional Requirements

Proofread your change proposal before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your analysis.

Portfolio Prompt: You may choose to save your change proposal to your ePortfolio.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Identify the challenges and opportunities facing health care.

Identify the benefits of proposed health care system changes and its implications for a community.

Competency 2: Compare the effects of different health care finance models and policy frameworks on resources and patient outcomes.

Describe potential barriers to change in an organization or community.

Develop a grant proposal and associated budget for a proposed change to an existing health care system.

Competency 4: Develop proactive strategies to change the culture of the organization by incorporating evidence-based practices.

Develop a strategy for helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system.

Develop strategies for changing barriers into opportunities and resolving conflict.

Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style consistent with applicable organizational, professional, and scholarly standards.

Write clearly and concisely in a logically coherent and appropriate form and style.

Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.

The following must be included:

1. Identifies the benefits of proposed health care system changes and its implications for a community. Articulates clear goals or outcomes for proposed changes that are well-supported by credible evidence.

2. Describes potential barriers to change in an organization or community. Identifies the causes of resistance and supports claims with credible evidence.

3. Develops strategies for changing barriers into opportunities and resolving conflict. Strategies reflect clear vision and drivers of change, including a viable approach for resolving conflict.

4. Develops a strategy for helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system. Describes the effects of these changes on the organization and identifies the specific information needs of the decision makers.

5. Develops a grant proposal and associated budget for a proposed change to an existing health care system that presents a compelling argument for funding. Budget line items reflect clear and specific needs that are well-articulated and justified in the proposal.

6. Writes clearly and concisely in a logically coherent and appropriate form and style. Main points, ideas, arguments, or propositions are well-developed and engaging. Adheres to all applicable disciplinary and scholarly writing standards and conventions.

7. Supports assertions, arguments, propositions, and conclusions with relevant, credible, and convincing evidence. Skillfully combines error-free source citations with a perceptive and accurate synthesis of the evidence.

Guiding Questions for Assessment 3

Planning for Community and Organizational Change

This document is designed to give you questions to consider and additional guidance to help you successfully complete the Planning for Community and Organizational Change assignment. You may find it useful to use this document as a pre-writing exercise, an outlining tool, or as a final check to ensure that you have sufficiently addressed all the grading criteria for this assignment. This document is a resource to help you complete the assignment. Do not turn in this document as your assignment submission.

Change Proposal

Draft a change proposal to justify your recommendation for improving the health of the community and establish the change as a priority for the next budget cycle.

Identify the benefits of proposed health care system changes and its implications for a community.

• What are the direct benefits of your proposed changes?

• How will improvements in overall health affect the community?

• What evidence supports your claims?

• What is the possibility that stakeholders jump to conclusions that are unfounded, given the nature and scope of the change? How would you avoid this risk?

Describe potential barriers to change in an organization or community.

• Why do people resist change?

• What factors in the organization and community create or contribute to resistance?

• What evidence do you have to support your claims?

Develop strategies for changing barriers into opportunities and resolving conflict.

• What are the drivers of change in organizations and communities?

• What is your vision for change?

• What are the expected outcomes and timeline? Vila Health – Planning for Community and Organizational Change

• How will you communicate with stakeholders and overcome resistance?

• How will you resolve conflict among competing interests?

Develop a strategy for helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system.

• Who are the key stakeholders in the organization?

• What influence do they have on your proposal?

• How will your proposed changes affect the organization?

• What data and information will you provide to decision makers?

Develop a grant proposal and associated budget for a proposed change to an existing health care system.

• Be specific and thorough in identifying budgetary requirements.

• Consider how you can present a compelling argument to the funding authority.

Write clearly and concisely in a logically coherent and appropriate form and style.

• Write with a specific purpose and audience in mind.

• Adhere to scholarly and disciplinary writing standards and APA formatting requirements.

Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.

• Integrate relevant and credible evidence from 5 peer-reviewed journals or professional industry publications.

• Is your supporting evidence clear and explicit?

o How or why does particular evidence support a claim?

o Will your reader see the connection?

• Did you summarize, paraphrase, and quote your sources appropriately?

Submission Reminders

• Have you identified the benefits of proposed health care system changes and the implications for the community? Have you provided supporting evidence?

• Have you described potential barriers to change in the organization or community and provided supporting evidence?

• Have you developed sound strategies for changing barriers into opportunities and resolving conflict?

• Is your plan for helping organizational stakeholders understand and evaluate proposed changes to the existing health care system complete?

• Is your proposal well-supported by 5 sources of relevant and credible evidence?

• Is your proposal properly formatted and 5 pages in length, not including the title page and references page?

• Did you proofread your writing?

The following resource is required to complete the assessment.

Vila Health: Planning for Change.

Vila Health: Planning for Change

Intro

To improve health care outcomes within a community, you need to provide persuasive evidence to decision makers in order to demonstrate your project as a priority for budget and resource planning. One important step to gathering such evidence comes from talking to stakeholders in the community. What are the problems people are facing and how will your project provide a solution to those problems?

Select each location to familiarize yourself with the needs and issues being faced by each community. Jordan is a small town in the Minnesota countryside. Armatage is a neighborhood on the south side of Minneapolis.

Jordan

Jordan City Council or History Center

City Council Member:

We’re seeing more poverty in Jordan and need to address that. I think as a community, we sometimes live in the past and for good reasons. Traditionally, we’ve been kind of a “Lake Wobegon” kind of place — everything and everyone was above average. When I first was elected to the city council, the population here was 94% white. Our last census put that at 89%. Now, don’t misunderstand me — I think diversity is good for this community. All I’m saying is that we need to be aware of the ways this community is changing and make sure we support the growth and change.

Jordan Middle School

Middle School Teacher:

I worry about a lot of these kids. There’s a serious drive to get more mental health education and awareness into the schools, but it isn’t happening very quickly here. We’ve looked at ways we can bridge the gaps, but I don’t see much more than figurative band-aids. We had a situation in the high-school last year with a very popular student who committed suicide just before his graduation. Because this is a small community, a lot of the middle school kids knew him, so we brought in grief counsellors. I just think kids need to have a place where mental health issues are discussed. They think they’re the only one in the world struggling with certain issues, and it would help to know that’s not true. There’s also so much attention to bullying, but are we doing enough? Vila Health – Planning for Community and Organizational Change

Residential Area

Jordan Parent:

There aren’t words strong enough to express how frightened I am about this whole opioid thing. My kids are still young — 11 and 9 — but when do you start to worry? My sister-in-law has been put through the wringer dealing with her oldest. Rehab — court — jail. The kid’s only 25 and he’s got a record a mile long. He was a nice kid, too. That’s the thing. So, how do we keep our kids safe from this poison?

Food Shelf

Food Shelf Manager:

The need for our services has been growing steadily ever since we moved into our current space. When we moved in here, we were serving less than 100 families a month. That was three years ago. Now, we’re seeing almost 200 families a month. Donations help, but we have a limited budget and we have to do our best to make sure our shelves stay stocked. So, yes. There is an over emphasis on carbs and processed foods. I wish there was a way to offer better quality protein and fresh fruits and vegetables. We got a donation of apples in one time from one of the orchards — they were seconds that didn’t look so nice, but were still good. You’d have thought they were gold. It broke my heart to see how excited people were over reject apples, but I figure there were a bunch of pies being baked that week.

Jordan Community Education and Recreation Center

Recreation Center Manager:

I’ll be honest — the kids I am seeing are out of shape and often not well prepared for school. I don’t like to sound like an old fogey, but they spend so much time on their phones and other electronics. They aren’t riding their bikes, they aren’t playing baseball, they aren’t reading… It’s all Mariobox and Fortcrafter and it’s taking a toll on the overall health of these kids.

Shopping Plaza

Property Manager:

We have a lot of vacant retail and commercial property in this town. It’s a shame, because I think there’s a lot of potential for many of these sites, but it’s hard for small business owners. You used to see, like a women’s clothing store or a little coffee shop, but those businesses have a hard time competing against the bigger chains. So, they go under and there’s a vacant property on either side of one that’s still hanging in there. That hurts the one’s that are still there. It would be great to get something into these properties, even if it isn’t necessarily a store or a restaurant.

Veteran’s Park

Parks Department Representative:

Funding cuts have taken a toll on a lot of our after-school programs. That’s bad enough, but because there aren’t organized events, the parks are turning into the place where kids hang out after dark. Most mornings, particularly after a weekend, the parks are littered with beer cans and worse. We’ve gotten complaints from parents of young children that they go to the playground and there’s beer cans and booze bottles everywhere.

Jordan City Sign

Bike Club President:

We have a very active membership, but recruitment has been difficult. The problem is that the bike trails we do have aren’t very long and they don’t connect to anything. A lot of our members who are avid bikers will use the roads to get places, but novice bikers want trails and ours are pretty random and short.

Senior Living Center

Jordan Family Member of Senior Center Client:

I work at a restaurant and really depend on the adult day care here. The trouble is that Mom isn’t always in the frame of mind where she can do the adult day care. Right now, I can get my brother’s wife, Tessa, to stay with her when she’s having a bad day, but Tessa’s pregnant and won’t be able to do that once the baby comes. I don’t want to put Mom in a nursing home, but she can’t be alone, she can’t always come here, and the cost of a home health aide is more than I make some days.

St. Francis Health Services

Urgent Care Nurse:

This isn’t political, but the situation with health insurance is getting worse, not better. I see so many people in the Urgent Care clinic with complaints that should have been addressed by a primary care giver — but the person doesn’t have a primary care giver. We’re seeing complications from undiagnosed or untreated diabetes. Hypertension. I’ve had two people in the last year who came in for general aches and pains and were in stage IV cancer. There’s no need for a lot of these problems to get so bad, but people can’t afford insurance and so they don’t see a doctor unless they’re sick.

Jordan City Hall

County Social Worker:

Something people don’t really ever address is how to deal with the day to day costs of chronic health conditions. I have people who are really living paycheck to paycheck and they don’t know how to pay for their prescriptions. Or there are people who have hypertension and take their meds, but they don’t have a primary care physician. There are so many things I could mention, but the short version is that there are a lot of people who need help in managing chronic conditions.

Armatage

Residential Housing

Neighborhood Council Member:

This is a pretty working-class neighborhood. I mean, people are doing well, but there’s a mix of everyone here and that’s the way we like it. If you look at the business directory, you can see that we’ve got a good range of services and businesses in what is essentially a residential neighborhood. Admittedly, it would be nice to have some kind of clinic for everyday health concerns, but really, how many neighborhoods have something like that. We do have a local dentist, a chiropractor, and a massage studio. Oh, and a mental health clinic.

Residential Housing

Resident:

Something that I don’t think anyone knows is that several of the homes in this neighborhood have lead paint and lead in the plumbing. I only learned about this when I was doing some research into the situation in Flint. Apparently, in the Minneapolis, service lines to residential properties installed prior to 1930 were usually made out of lead piping. And, if that isn’t unnerving enough, service lines are the responsibility of the property owners. Service lines that are made of lead can’t be repaired; they can only be replaced — which costs a fortune. But the main issue, in my opinion, is that most people have no idea if their home has these service lines and they have no idea whether or not their home drinking water has any lead in it at all. You’d think after the issues in Flint that we’d be talking about this, but apparently not.

Armatage Elementary School

School Principal:

I know this is something a lot of communities are dealing with, but the vaccination situation is suddenly an issue. We’ve never had a problem before, but I’ve had several parents inquiring about vaccination exemptions. I share the information I have about vaccination requirements, but I think there’s something going on where anti-vaccination information is circulating in the community.

Armatage Community Center

Community Garden Organizer:

This garden is doing so well. We had three applicants for every open space. It would be great, though, if we could expand what we’re doing. It isn’t just about the food, though that’s so important. We’re building community here, too. One of the things I love most about the garden is watching kids come to understand food in a more fundamental way. They start with the garden thinking it’s kind of fun, but the first time they have a meal that is made with food they saw growing is like a revelation for them. They suddenly get it. I don’t think we’re going to get more space, so it would be good to come up with some other ideas for how we can expand.

Red Wagon Pizza

Restaurant Owner:

You know, people say they want healthy choices, but I’ll tell you what — money talks. I tried to put some healthy options on the menu. What a disaster! The stuff didn’t move, when people ordered it, they complained that the portions were too small — the portions were based on meeting with a nutritionist, for gosh sake! Bottom line… it was a total failure. My customers want burgers, bacon, cheese, and fries. And I’ll tell you — you go to the hipster places in this neighborhood — they might be offering microgreens and Portobello mushroom burgers, but those aren’t the things that are keeping the place in the black — not by a long shot.

Bus Stop

Urgent Care Nurse:

I live in this neighborhood and one of the things I wish we had was a clinic or urgent care facility. So often I hear about people having to take city busses to get to a health care provider. There’s nothing available for people who have a sick kid or have something going on themselves. We’re an urban neighborhood, so not everyone drives. That’s fine most of the time, but there are two situations where that can be a problem — when someone’s sick and when someone is trying to do grocery shopping for a family. That’s not easy to do when you depend on the busses.

Penn Avenue Family Dental

Dentist:

This is a very diverse community and there’s a wide range of issues when it comes to people’s dental health. This practice tries to do as much education as possible, but there are still a lot of people who don’t understand how dental health affects other aspects of health. I don’t know what we could do differently, but it would be nice to see more outreach into the community, particularly into some of the immigrant communities, such as the East African immigrants. They’ve come from a country going through decades of civil war and strife — dental care is often the last thing on their minds. It would be nice to help them understand how taking care of their teeth will have wide-ranging benefits.

Pennhurst Cleaners

Developer:

Right now, the whole city is in transition. This neighborhood is a good example of the kinds of issues I’m seeing all over the city. The neighborhood is primarily residential and it’s an old, established neighborhood. You have some people who are trying to address housing affordability and others who are concerned that rental units will bring instability to the neighborhood. What people don’t realize is that change is already happening. They can’t stop change, but they can help direct it.

Cindy’s Barber Shop

Police Representative:

There’s no doubt that violence in this neighborhood has increased in the last several years. I wouldn’t say we have gangs per se, but we’re seeing an uptick in aggravated assaults and other violent crimes. Of course, a lot of that is domestic violence, which is a real shame. Some of these women have gone through so much in their lives — fleeing war and violence in their home country — and they’re still putting up with violence when they get here. Doesn’t seem right, does it?

Conclusion

You have completed the stakeholder interviews. You should now have a better sense of the health and social issues being faced by members of these communities.

The following template must be used for assessment:

Change Proposal

Your Full Name (no credentials)

School of Nursing and Health Sciences, Capella University

NURS-FPX6218 Leading the Future of Health Care

Planning for Community and Organizational Change

Instructor’s Name

Month, Year

Title of Paper

Note: Delete this note and all instructions from the template before submitting your proposal. Use headings to organize your text, rather than bullets.

Summary

Benefits and Implications

Identify the benefits of proposed health care system changes and its implications for a community.

• Consider the goals and potential outcomes of the proposed changes.

• What are the direct benefits of your proposed changes?

• How will improvements in overall health affect the community?

Potential Barriers to Change

Describe potential barriers to change in an organization or community.

• What factors in an organization and community create or contribute to resistance to changes?

• What other factors can create barriers to change?

Articulate strategies for changing barriers into opportunities and resolving conflict.

• What are the drivers of change in organizations and communities?

• How will you communicate with stakeholders and overcome resistance?

• How will you resolve conflict among competing interests?

Stakeholder Communications

Articulate a strategy for helping organizational stakeholders understand and evaluate proposed changes to the existing health care system.

• Who are the key stakeholders in the organization?

• What influence do they have on your proposal?

• Consider the effects of these changes on the organization and the specific information needs of decision makers.

References

List your APA-formatted references here.

Appendix A: Grant Proposal

Need Statement

• Define the problem that this change is addressing.

• Describe the scope of the problem.

o Who is affected? How will you describe this population?

o How many people does this problem affect?

• Identify the barriers you are likely to encounter when implementing this change?

• Identify the sources of information you used to define the need for change.

• Identify any other change initiatives or studies that are addressing this problem.

Program Description

Describe the proposed change initiative and how you plan to implement it. Address the basic questions of who, what, when, where, why, and how.

Goals and Objectives

Describe the goals and objectives of the change initiative.

Program Evaluation

Explain how this change initiative will be evaluated.

• Who will have oversight responsibilities?

• How and how often, will this initiative be evaluated?

• Who is the recipient of the evaluation reports?

• What is the extent of stakeholder involvement in evaluation?

Summary

• Explain why this change is important to the community.

• Explain how the goals and objectives of this change initiative align with those of the funding organization and why their financial support is vital to the success of this initiative.

• Be sure to thank the funding agency for considering and supporting this initiative.

Appendix B: Project Budget

Table directions:

1. Add table rows, as needed, for each budget category.

2. Enter the information (startup, first-year budget figures, other sources of revenue, and justification) for each budget category line item in columns 2–5.

Categories Startup 1st Year Other Sources

of Revenue Justification

Salary and Wages

• Project Manager

• Support Staff

• Other

•

•

Fringe Benefits

•

•

•

Consultation or Contract Services

•

•

•

Equipment

•

•

•

Materials

•

•

•

Travel

•

•

•

Miscellaneous or Other

•

•

•

Total Expenses

High-Alert Medications Independent double checks

Consider a current or former practice area and select a health-related policy that is in place to assure quality and safety. Topics may include patient care policies, drug policies, security and privacy policies, or employee health policies.

In a three-to-six-page scholarly paper, address the following elements. Include a minimum of three scholarly sources, current within 5 years, to support your work. See rubric for specific, required content criteria within each section of the presentation:

Introduction

Policy Background and Purpose

Factors Influencing Policy

Policy Impact and Implications

Conclusion and Recommendations

Title page, pagination, subheadings, body of paper, citation of sources, and reference page must follow APA guidelines as found in the most current edition of the manual.

Rules of grammar, spelling, word usage, punctuation, and sentence and paragraph structure are followed and consistent with formal, scholarly writing as noted in the most current edition of the APA Manual

High-Alert Medications Independent double checks

Module 6: A Health-Related Policy

The prevalence of medication errors within healthcare systems is on the rise. These preventable threats predispose patients to multiple safety issues, including adverse drug reactions (ADRs) or death in severe cases. Therefore, incidence of medication errors in healthcare organizations is a significant performance indicator. Medication error index depicts medical facility’s values for patient’s safety, treatment outcomes, and well-being. For this reason, healthcare organizations focus on reducing incidence of medication errors reported within their system over a specific period. A significantly high percentage of medication errors reported in clinical settings is associated with human/staff mistakes (Chalasani et al., 2023). Thus, healthcare organizations focus on reducing rate of medication errors through policy change. This paper discusses, double nurse verification for high-alert medications (HAMs), which is a health-related policy that should be implemented within contemporary healthcare systems to lower high rates of medication errors.

Policy Background and Purpose

A significantly high number of inpatients are prescribed high-alert drugs, including insulin, chemotherapeutic agents, and heparin. This trend is attributed to increase in the number of inpatients seeking treatment for chronic/terminal illnesses, including cancer, diabetes Mellitus (DM), and cardiovascular disorders (CVDs). High-alert drugs are attributed to heightened risk of predisposing patients to significant harm or death when used incorrectly (van Stralen et al., 2024). However, potential ADRs can be reduced significantly if medication errors are detected early stages of drug administration process. Therefore, the proposed policy aims to ensure approximately 97% of medication errors are detected before they get to the patient.

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The desired medication errors score will be achieved by ensuring double verification in highly critical clinical practices, including pediatric dosing and chemotherapy administration. Other areas that require double verification of the patient’s drug are intensive care units and insulin infusion. According to “The Institute for Safe Medication Practices” (ISMP) two clinicians should very patient’s medication independently to ensure its safety (Bertagnoli et al., 2025). Additionally, medication errors will be reduced through correct calculation of the patient’s dosage, thereby preventing ADRs that might be caused by administering high dosages. Medication errors will also be reduced by ensuring that the patient’s, drug, route, dose, formulation, and time are correct before administering drug. Strengthen accountability within the healthcare system will also play a significant role in reducing medication errors. Lastly, promote a culture of safety will lower medication errors and potential undesired treatment outcomes High-Alert Medications Independent double checks.

Factors Influencing Policy

Multiple factors have contributed to the introduction of the recommended policy, involving double verification of HAMs. The first factor is dramatic increase in number of patients using HAMs in various areas of acute care settings, including neonatal units, intensive care units (ICU), and emergency departments. For instance, insulin therapy and neuromuscular blockers are commonly prescribed to patients admitted in the ICU, emergency department, or NICU (Rochester-Eyeguokan, & Pincus, 2025). HAMs predispose these patients to significantly high risk when they are used incorrectly. Thus, these drugs must be verified by two clinicians before administering them to patients, thereby eliminating potential harm or death. Additionally, complexity of medication regimens influences introduction of double verification policy. Treatment of patients diagnosed with multiple chronic comorbidities involves complex titration protocols. These cases require double verification of the patient’s medication to ensure safe administration, thereby preventing potential safety issues.

Other influencing factors are staff’s high workload, prolonged work schedule, and pressure to provide timely patient care. Increase in number of patients seeking treatment services from the hospital acute care settings exposes staff to high workload. In some cases, clinicians work overtime to meet high demand for quality, timely, and effective patient care. As a result, healthcare providers are exposed to burnout and fatigue, making them skip the second check, which increases risk of medication error (Mert & Kersu, 2025). Therefore, double-checking policy would ensure that the patient’s medication is verified by a second clinician despite the high workload, thereby preventing potential error and related ADRs. Additionally, staff’s overconfidence necessitates implementation of the double-verification policy. In most cases, more experienced nurses feel confident; hence checking the patient’s medication once, increasing risk of medication errors. Thus, the new policy would ensure that highly-experienced nurses confirm the medication with another clinician before administering it, which would prevent potential errors and promote patient safety.

Organizational culture emphasizing on patient safety has also contributed to the adoption of double-verification policy. Contemporary healthcare systems are committed to prioritizing patient safety in various clinical practices (Alrawili et al., 2024). Therefore, double-verification process is recommended since it would ensure compliance with safety standards during drug administration despite pressure associated with high workload. High-Alert Medications Independent double checks Consequently, preventable medication errors will reduce, preventing potential adverse treatment outcomes or deaths.

The last factor is the need to comply with legal and regulatory requirements. State board of nursing standards requires healthcare institutions to comply with safety measures. The Nurse Practice Act (NPA) enforced standardized practice measures and patient safety guidelines to support high-quality care and protect the public from potential harm (Markowitz & Smith, 2024). For this reason, double verification process was adopted to protect patients from harm caused by medication errors. Moreover, this policy provides legal defensibility if medication error occurs within healthcare institutions despite compliance with all reasonable precautions, thereby preventing potential malpractice liability. Protecting patients from potential safety issues/harm through double-verification indicates compliance with accreditation requirements.

Policy Impact and Implications

The implementation of double-verification policy has positive and negative impacts. This policy would ensure compliance with patient safety standards and accreditation requirements, thereby preventing potential malpractice liabilities in the event of drug errors. This policy would also reduce healthcare system’s medication errors by ensuring a pharmaceutical regimen is double-checked by two competent clinicians before being administered to a patient. Another positive impact involves enhancing professional accountability. All healthcare providers involved in drug administration, including physicians and nurses will double check the patient’s drug to ensure correct administration route and appropriate dosage. This process will prevent potential harm/ADRs that might occur if incorrect medication or a higher dosage is administered to the patient. Lastly, double-checking patient’s medication would improve patient/family’s trust, making them satisfied with quality and safety of patient care.

However, double-checking process has some negative effects. First, this policy would result in inefficient workflow in healthcare organizations facing staff shortages since double-checking patient’s medication is time consuming. This process would also delay patient care, increasing likelihood of potential adverse treatment outcomes, particularly in critically ill emergency department patients. Lastly, inconsistent results would be reported across a healthcare organization due to variability in implementation of double-checking policy. Consequently, the new policy would be ineffective in reducing medication errors and related ADRs.

Implementing the new double-checking policy will reflect compliance with ethical standards that advocate for patient safety. This policy further implies that healthcare organizations should focus on continuous education to enhance nurses understanding of dosing and pharmacodynamics principles. Lastly, the new policy is associated with financial implications. Double-checking process aims at preventing medication errors, thereby eliminating potential litigation costs, including expenses associated with extended hospital stays.

Conclusion and Recommendations

Adopting double verification policy would improve safety among patients using HAMs by preventing potential medication errors. Consequently, additional treatment associated with ADRS would be eliminated resulting in cost-effective patient care. However, this policy would only achieve desired outcomes if it is implemented effectively across healthcare institutions. Thus, healthcare facilities should consider the possibility of getting consistent results across their departments and make necessary adjustments to ensure implementation of standardized double-check procedures High-Alert Medications Independent double checks. Additionally, the double-checking process should be monitored regularly to ensure compliance with recommended patient safety clinical practices and quality metrics.

References

Alrawili, W. G. F., Alshammari, M. H. M., Alanezi, H. S., Alrashidi, R. H. I., Al-Ruwaili, G. M. A., & Alanezi, A. L. (2024). The Importance of Patient Safety in Healthcare Institutions. 
Gland Surgery
, 
9
(2), 374-382.
https://www.diabeticstudies.org/index.php/RDS/article/view/427

Bertagnoli, S., Shastay, A., & Jew, R. K. (2025). What Does the Institute for Safe Medication Practices’ Survey Tell Us About the Impact of Shortages on Patient Safety?
The Cancer Journal
, 
31
(5), e0789.
https://journals.lww.com/journalppo/abstract/2025/09000/what_does_the_institute_for_safe_medication.12.aspx?context=latestarticles

Chalasani, S. H., Syed, J., Ramesh, M., Patil, V., & Kumar, T. P. (2023). Artificial intelligence in the field of pharmacy practice: A literature review. 
Exploratory research in clinical and social pharmacy
, 
12
, 100346.
https://www.sciencedirect.com/science/article/pii/S2667276623001270

Markowitz, S., & Smith, A. J. (2024). Nurse practitioner scope of practice and patient harm: Evidence from medical malpractice payouts and adverse action reports. 
Journal of Policy Analysis and Management
, 
43
(2), 420-445.
https://www.proquest.com/openview/3aed36787c569b5bdba81077b43a7ddc/1?pq-origsite=gscholar&cbl=18750&diss=y

Mert, S., & Kersu, Ö. (2025). Investigation of the Relationship Between Stress, Workload, Medical Error Tendency and Perceived Quality of Care in Surgical Nurses. 
Asia Pacific Journal of Health Management
, 
20
(3). 1-7.
https://journal.achsm.org.au/index.php/achsm/article/view/4641

Rochester-Eyeguokan, C. D., & Pincus, K. J. (2025). Current Recommendations for Insulin Therapy in the Hospitalized Patient. 
Critical Care Nursing Clinics
, 
37
(1), 117-131.
https://www.ccnursing.theclinics.com/article/S0899-5885(24)00039-X/abstract

van Stralen, S. A., van Eikenhorst, L., Vonk, A. S., Schutijser, B. C., & Wagner, C. (2024). Evaluating deviations and considerations in daily practice when double-checking high-risk medication administration: A qualitative study using the FRAM. 
Heliyon
, 
10
(4).
https://www.sciencedirect.com/science/article/pii/S2405844024016682
  High-Alert Medications Independent double checks

Nhs-fpx4000 developing a healthcare perspective assessment 1 – The Missing Needle Protector

Ethical Case Study Incident 9: The Missing Needle Protector

In their book on
Principlism
, Beauchamp and Childress proposed a method for guaranteeing that all clients and those under the care of others in care environments have their interests represented and cherished. They offered four bioethical principles, which have since been expanded to five with the inclusion of fidelity. Autonomy, nonmaleficence, beneficence, justice, and fidelity are the new bioethical concepts (Haswell, 2019; Melnyk & Fineout-Overholt, 2019). Autonomy refers to a client’s ability to participate in making choices that influence their management. Beneficence refers to the act of always doing what will benefit the patient. Nonmaleficence, often known as primum non nocere, refers to not causing wilful injury to the patient. Justice entails treating all patients equally and without active discrimination. Finally, fidelity sets out the ethical requirement that the healthcare staff be straightforward and honest. This paper is about an ethical situation in a clinical setting representing what would be seen as an ethical dilemma Nhs-fpx4000 developing a healthcare perspective assessment 1 – The Missing Needle Protector.

The Chosen Scenario and the Facts about the Case in the “Missing Needle Protector”

The ethical scenario chosen in this case is that referred to as “The Missing Needle Protector” (Capella University, n.d.). It is set in a hospital in which Mr E.L. Straight is the Director of Clinical Services. At the same hospital, there is a long serving surgeon by the name of Dr. Cutrite who does full scale operations but has lately been showing worrying signs of incompetence. This is by Mr Straight’s own admission. Despite his physical and mental incapacities lately, Dr Cutrite has been allowed to still perform sensitive major procedures. Mr Straight admits that the surgeon by virtue of having worked at Hopewell hospital “for longer than anyone can remember” was well connected and politically very influential in the organization. It is for this reason that he “didn’t relish crossing swords with Cutrite”.

Concerning the matter of the missing needle protector from a syringe used during a major operation, it would appear that Dr Cutrite left it in the abdomen of a patient that he closed without confirming first with the nurse carrying out instrument count as a “time-out” component. The patient’s name was Mrs. Jameson and she had undergone a major operation in her abdomen. The needle protector that was allegedly left in her abdomen by Dr Cutrite is said to be red-pink and the color of blood and therefore would be very difficult even to see on radiography. She had not yet complained about anything and had even been discharged to go home a few days earlier.

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It is the operating room supervisor that informed Mr Straight of the possible error that they had just discovered while going through instrument pack reconciliation. She told him that they had possibly left a needle protector belonging to a disposable syringe inside the belly of Mrs Jameson. When asked, the scrub nurse that was assisting Dr Cutrite during the procedure admitted to seeing the syringe but did not give much thought to the protective sheath when the final instrument count was done at the end of the procedure.

Three Components of the Ethical Decision Making Model

The above case will now be looked at through the ethical decision-making model comprising of the three steps of moral awareness, moral judgment, and ethical behavior or moral action (Lind & Wakenhut, 2016).

Moral Awareness

This stage has been described as the “I feel” stage and it is the stage in which one feels strongly that there is a moral issue in the situation. It is in this stage that one may start feeling disgusted about what has just happened (Lind & Wakenhut, 2016). Specifically, one asks themselves whether something is wrong, whether a moral principle has been violated, whether there are competing values at work, or whether the profession may lose respect and dignity from the actions of individuals.

At this first stage, one must also feel the proximity they can relate with to those that are affected by the situation and how this influences their moral awareness. Crucially, one must ask themselves if other colleagues in the profession would also detect a moral issue in the situation. Then they need to ask themselves if that will affect their moral awareness in any way. In the above case, it clear that it is the operating room supervisor that has the highest level of moral awareness of all. She discovers what had happened and approaches Mr Straight who is the Director of Clinical Services. Surprisingly, he asks that the patient (Mrs. Jameson be taken back to surgery and not told the exact reason why.

This breaches the bioethical principles of autonomy (informed consent), nonmaleficence and fidelity or honesty (Haswell, 2019; OHRP, 2018; Shah et al., 2021). This lack of ethical or moral awareness of Mr Straight is shared by Dr Cutrite who is the surgeon that left the needle protector in the abdomen of Mrs Jameson; and the Chief of Surgery who appears helpless and does nothing to protect the patient. Mr Straight fears Dr Cutrite and says that he “didn’t relish crossing swords with Cutrite”. Dr Cutrite on the other hand nonchalantly lies that the plastic needle protector was not going to hurt the patient but probably only give her “a little discomfort.”

Moral Judgment

The moral judgment stage is the second stage and is often referred to as the “I ask” stage. This is where one comes up with and assesses the potential choices and what possible outcomes could arise from them. At this stage, every possible solution must be critically assessed before any judgment is made (Lind & Wakenhut, 2016). Some of the questions here are whether the decision taken by the people in authority (Mr Straight, Dr Cutrite, and the Chief of Surgery) was just and fair. In the above case the answer would be negative since they took the matter lightly and even wanted to return the patient to surgery without revealing to her the true reason for that. The other question here would be whether the decision and behavior of those concerned reflect the organizational culture and principles of the hospital in question.

Hospitals operate under strict regulations and policies and therefore it would beat logic to assume that the hospital’s policies condone the kind of moral and ethical breaches that the above three were engaging in. Last but not least, one must ask whether the decision of the three above to not tell the patient the truth and possibly take her back to theatre without informed consent violates the Hippocratic Oath taken by Dr Cutrite. Indeed, it goes without question that it does. The best solution after critical assessment in the above case would have been to recall the patient to the hospital as soon as possible and explain t her truthfully what happened. a formal apology should be offered and the patient asked to give consent for the plastic needle protector to be removed. This “never event” should also be reported to the regulatory bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance or NCQA Nhs-fpx4000 developing a healthcare perspective assessment 1 – The Missing Needle Protector.

Ethical Behavior

This is the “I think I will” and “I act” stage and involves the professional (in this case the operating room supervisor) deciding on her intention to act. It is at this stage that she will decide on what to do and exactly how she would act (Lind & Wakenhut, 2016). This is keeping in mind that the patient had already been discharged and went home without knowing what happened. At this point, it is accepted also that deciding not to act may also be a valid decision. The operating room supervisor should thus think of what they should do and how they intend to act on their decision. Moral courage dictates that she should take the correct and ethical action and inform the patient of what happened. She can also alert the JCAHO and the NCQA privately to protect other patients in future.

Effectiveness of the Communication

Judging from the above engagement among the professionals involved in the above case, it is clear that effective communication is lacking at the above workplace. This is why the Chief of Surgery was not even aware of what had happened until the operating room supervisor approached them all including Dr Cutrite himself and the Director of Clinical Services Mr Straight. The staff communicated ineffectively all the time because they admitted to fearing to correct the long-serving but inept surgeon Dr Cutrite. Under the above circumstances, the organization’s laid down protocols and procedures for sentinel events should be followed to the letter. This was not done. Using effective communication helps in solving ethical dilemmas as per protocol. Not doing so leads to disorganization and harm to the patient as seen in this case.

The lessons the above case provides are that professionalism should be maintained at all times and that there should be no compromise when it comes to morality and ethics in healthcare. In the above case, the staff responsible for the patient’s safety compromised their obligations by fearing to confront Dr Cutrite just because he was “politically very powerful”. The proposed solution will foster professional collaboration in that the institutions concerned will take action against Dr Cutrite and may even revoke his licensure. This will serve as an example and make the others collaborate more effectively as professionals for the benefit of the patients.

Conclusion

The bioethical principles of autonomy, beneficence, nonmaleficence, justice, and fidelity are there to help safeguard the safety and ethical treatment of patients. In the above case, it can be seen how healthcare professionals may violate these and put the patient’s health and life at risk. When faced with such ethical dilemmas, the ethical decision making model comprising of the three steps of moral awareness, moral judgment, and ethical behavior come in handy Nhs-fpx4000 developing a healthcare perspective assessment 1 – The Missing Needle Protector.

References

Capella University (n.d.).
Incident 9: The missing needle protector
.
https://www.capella.edu/

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice.
Journal of Aesthetic Nursing, 8
(4), 177-179.
https://doi.org/10.12968/joan.2019.8.4.177

Lind, G., & Wakenhut, R. (2016). Testing for moral judgment competence. In Lind, G., Hartmann, H.A., & Wakenhut, R. (Eds).
Moral judgments and social education
(pp. 9-12). Routledge.

Melnyk, B.M., & Fineout-Overholt, E. (2019).
Evidence-based practice in nursing & healthcare: A guide to best practice, 4
th
ed
. Wolters Kluwer.

Office for Human Research Protections [OHRP] (January 15, 2018).
The Belmont Report: Ethical principles and guidelines for the protection of human subjects of research
.
https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

Shah, P., Thornton, I., Turrin, D., & Hipskind, J.E. (June 14, 2021). Informed consent.
StatPearls
.
https://www.ncbi.nlm.nih.gov/books/NBK430827/#:~:text=Valid%20informed%20consent%20for%20research,study%20and%20its%20potential%20risks
  Nhs-fpx4000 developing a healthcare perspective assessment 1 – The Missing Needle Protector

NHS-FPX4000 Developing a Health Care Perspective Assessment 2 Instructions: Applying Research Skills – Annotated Bibliography

NR520 APPLIED THEORETICAL FOUNDATIONS, SCIENTIFIC INQUIRY, AND DECISION-MAKING Module 3 Assessment: Project Area of Interest Form Professional Practice Issue

Module 3 Assessment: Project Area of Interest Form Professional Practice Issue

 

Consider your practicum work setting and environment. Complete the following:  

(1)

What issues or problems are you working on or want to work on for your MSN evidence-based practice quality improvement project?
How would the Johns Hopkins model be used to support this project process?
(This is brainstorming.)

Answer

 

 

 

(2)

Thinking about these issues or problems, what internal organization data is currently available, tracked, or reviewed? (What is it that indicated to you that this was an issue or problem? Do not drill down to the details; keep it broad. Do you see patterns developing? Such as between 2-4 am most patients between the ages of 65-85 fall.)

Answer

 

 

(3)

Based on the data that is available, what is done with it? (Are process improvement plans generated? Are there groups of people that work on this? Such as a Root Cause Analysis group? Clinical nurse specialists?  Nurse managers?)

Answer

 

 

(4)

When this issue or problem is improved / positive change occurs, how will you know you have been successful? (What measures? Can be patient-centered, financial, clinical-based?)

Answer

 

 

(5)

Identify why this issue or problem is important to nursing and healthcare. (You should include at least 2 scholarly sources here which include 1 quantitative and 1 qualitative design)

Answer

 

 

(6)

What are the real or potential barriers to you implementing your intervention to the problem? (Identify at least (4) potential barriers.)

Answer

 

 

(7)

Who (inside and outside) can you connect with to refine & develop this work?

Answer

 

 

 

(8)

State your PICO(T) Elements

Answer

P
– (Patient, population, or problem)

I
– (Intervention)

C
– (Comparison with other interventions, if foreground question)

O
– (Outcomes are qualitative or quantitative measures to determine the success of change)

T-
(Time frame)

NR520 APPLIED THEORETICAL FOUNDATIONS, SCIENTIFIC INQUIRY, AND DECISION-MAKING Module 3 Assessment:
Project Area of Interest Form Professional Practice Issue

(9)

From you PICOT elements, state your clinical practice or EBP question.

Answers

 

P
– (Patient, population, or problem)

I
– (Intervention)

C
– (Comparison with other interventions, if foreground question)

O
– (Outcomes are qualitative or quantitative measures to determine the success of change)

T-
(Time frame)

 

(10)

Quantitative Research

 

Reflect upon the nursing professional practice issue of interest that you identified. In addition, consider the intervention that you proposed to improve the issue. Be sure to reference and cite the quantitative scholarly source you identified in item 5 from above. Include the full reference for article (APA Format) and hyperlink to article.

 

With both the issue and the intervention in mind, respond to the following:

 

·        What type of evidence produced through quantitative research would be helpful to better understand the selected practice issue?

·        How might quantitative research findings shape your efforts to improve the issue?

·        Describe an example (real or hypothetical) of a quantitative research design that would provide valuable evidence regarding this issue (may refer to source above related to question 5).

Answers

 

 

 

(11)

Qualitative Research

 

Reflect upon the nursing professional practice issue of interest that you identified. In addition, consider the intervention that you proposed to improve the issue. Be sure to reference and cite the qualitative scholarly source you identified in item 5 from above. Include the full reference for article (APA Format) and hyperlink to article.

 

With both the issue and the proposed practice change in mind, respond to the following:

 

·        What type of evidence produced through qualitative research would be helpful to better understand the selected practice issue?

·        How might qualitative research findings shape your efforts to improve the issue?

·        Describe an example (real or hypothetical) of a qualitative research design that would provide valuable evidence regarding this issue (may refer to source above related to question 5).

Answers

 

 

NR520 APPLIED THEORETICAL FOUNDATIONS, SCIENTIFIC INQUIRY, AND DECISION-MAKING Module 3 Assessment: Project Area of Interest Form Professional Practice Issue

Exploratory analysis essay example

How does nutrition influence longevity of older adults in United States today?

Inquiry question

How does nutrition influence longevity and healthy aging among older adults in the United States today?

Working thesis

Proper nutrition is crucial for increasing the lifespan of older adults in the USA, as it helps reduce the risk of chronic illness, supports overall physical and mental health, and encourages healthy aging. However, challenges such as unequal access to quality diets and limited scientific data prevent fair application of nutritional science to improve longevity.

Part 1: Essay Outline: Explorative Model

Introducing nutrition and aging in the USA context

Highlight the growing population of older adults in the United States.

Define longevity as encompassing both lifespan and healthspan.

Briefly explain why nutrition is crucial to aging research: it influences health, longevity, and the development of age-related diseases.

Present the research question along with the main thesis.

Highlight the essay’s exploratory approach.

Biological mechanisms linking nutrition to longevity

Explain how nutrition affects biomarkers associated with aging.

Describe how inflammation, oxidative stress, and metabolic regulation contribute to biological processes.

Emphasize evidence connecting dietary habits to cellular aging.

Link nutritional adequacy with physiological resilience in later years.

Utilize research that concentrates on biomarkers related to aging.

Exploratory analysis essay example

Key source
: Leitão et al. (2022)

Dietary patterns that promote healthy aging

Explore dietary approaches associated with increased lifespan.

Explore Mediterranean, plant-based, and balanced diet patterns.

Describe the advantages for heart and brain health.

Focus on preventing age-related diseases through proper nutrition.

Highlight the importance of aligning with U.S. dietary guidelines.

GET WRITING HELP HERE

Key sources
: Fekete et al. (2022); Hu (2024)

Dietary diversity and longevity outcomes

Explain what dietary diversity is and why it matters for older adults.

Explore the links between various diets and healthy aging.

Discuss the sufficiency of nutrients and their impact on functional health outcomes.

Reflect on similarities and how this applies to U.S. populations.

Recognize dietary diversity as a changeable factor that can influence longevity.

Key sources
: Molani-Gol et al. (2025); Zhu et al. (2024)

Nutrition, chronic disease, and mortality risk

Examine how diet influences the rate of chronic diseases.

Discuss cardiovascular disease, diabetes, and neurodegenerative conditions.

Describe how nutrition influences the risk of death.

Link dietary quality with independence and extended functional lifespan.

Highlight nutrition strategies that prioritize prevention.

Key sources
: Hu (2024); Fekete et al. (2022)

Nutrition and quality of life in older adults

Explore how nutrition influences physical, mental, and emotional well-being.

Discuss the risks related to malnutrition and undernutrition in older adults.

Consider quality of life as a key factor in longevity.

Highlight gaps in current research.

Emphasize the significance of comprehensive aging outcomes.

Key source
: Arensberg et al. (2023)

Socioeconomic and structural barriers to healthy nutrition

Identify obstacles such as income, food access, and education.

Explore inequalities impacting older adults in the United States.

Analyze the impact of social determinants on diet quality.

Discuss the implications of the policy at both the address and community levels.

Link disparities directly to varying longevity results.

Exploratory analysis essay example

Research gaps and ongoing discussions

Examine the present challenges faced by research on nutrition and longevity.

Emphasize the difficulties in assessing the long-term impacts of diet.

Resolve inconsistencies among different populations and methodologies.

Identify areas that need more research specific to the U.S.

Emphasize the investigatory aspect of the inquiry.

Implications for public health and aging policy

Explore how the findings can guide the development of nutrition programs for older adults.

Assess how it relates to Medicare, SNAP, and community nutrition programs.

Emphasize the importance of preventive nutrition measures.

Emphasize the significance of policy grounded in evidence.

Link nutrition science with healthy aging programs.

Conclusion

Revisit the inquiry question and thesis.

Summarize the main insights regarding nutrition and lifespan.

Highlight the importance of nutrition in prolonging both lifespan and healthspan.

Recognize the existing challenges and areas where further research is needed.

End by highlighting the significance of fair and effective nutritional strategies for aging populations.

Part 2: Two Sources

Sources

Leitão, C., Mignano, A., Estrela, M., Fardilha, M., Figueiras, A., Roque, F., & Herdeiro, M. T. (2022). The Effect of Nutrition on Aging-A Systematic Review Focusing on Aging-Related Biomarkers.
Nutrients, 14
(3), 554.
https://doi.org/10.3390/nu14030554

Molani-Gol, R., Rafraf, M., & Alipour, B. (2025). Association between dietary diversity and healthy aging: a systematic review.
BMC nutrition, 11
(1), 102.
https://doi.org/10.1186/s40795-025-01085-3

Synthesis paragraph

Nutrition is increasingly recognized as essential for healthy aging and longevity in seniors. Leitão et al. (2022) conducted a systematic review showing that diet impacts aging at a biological level, with “nutritional patterns influence inflammation, oxidative stress, and metabolic pathways that are strongly associated with aging-related biomarkers” (p. 554). This biological evidence aligns with population data. Molani-Gol et al. (2025) found that older adults who eat a varied diet, including different food groups and nutrients, generally have better functional health, less frailty, and more positive aging markers. While Leitão et al. (2022) focus on cellular mechanisms of nutrition’s effect on aging, Molani-Gol et al. (2025) show how these processes lead to tangible health benefits. Overall, these studies highlight that diet quality and diversity are crucial for biological aging at the molecular level, supporting longer life and better well-being in later years Exploratory analysis essay example.

References

Arensberg, M. B., Gahche, J., Clapes, R., Kerr, K. W., Merkel, J., & Dwyer, J. T. (2023). Research is still limited on nutrition and quality of life among older adults.
Frontiers in medicine, 10
, 1225689.
https://doi.org/10.3389/fmed.2023.1225689

Fekete, M., Szarvas, Z., Fazekas-Pongor, V., Feher, A., Csipo, T., Forrai, J., Dosa, N., Peterfi, A., Lehoczki, A., Tarantini, S., & Varga, J. T. (2022). Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases.
Nutrients, 15
(1), 47.
https://doi.org/10.3390/nu15010047

Hu F. B. (2024). Diet strategies for promoting healthy aging and longevity: An epidemiological perspective.
Journal of internal medicine, 295
(4), 508–531.
https://doi.org/10.1111/joim.13728

Leitão, C., Mignano, A., Estrela, M., Fardilha, M., Figueiras, A., Roque, F., & Herdeiro, M. T. (2022). The Effect of Nutrition on Aging-A Systematic Review Focusing on Aging-Related Biomarkers.
Nutrients, 14
(3), 554.
https://doi.org/10.3390/nu14030554

Molani-Gol, R., Rafraf, M., & Alipour, B. (2025). Association between dietary diversity and healthy aging: a systematic review.
BMC nutrition, 11
(1), 102.
https://doi.org/10.1186/s40795-025-01085-3

Zhu, Y., An, Q., & Rao, J. (2024). The effects of dietary diversity on health status among the older adults: an empirical study from China.
BMC public health, 24
(1), 674.
https://doi.org/10.1186/s12889-024-18172-y

 

Exploratory analysis essay example

– ESSAY OUTLINE:

Step 1: Write Your Inquiry Question & Working Thesis

At the top of your outline, clearly state:

Your inquiry question (the central research question your essay seeks to answer).

Your working thesis (your current argument or stance on the topic, based on your research so far).

Step 2: Draft Your Essay Outline

Using one of the outline models provided in Week 5: Lesson, structure your essay into sections. Choose the format that best suits your topic and approach. Some possible structures include:

Exploratory or argumentative models (from Week 5: Lesson)

Krause’s outline models (from Week 5: Lesson)

Purdue OWL models (Link hereLinks to an external site.)

-First two paragraphs written with Resources.

Purpose:

This activity will help you practice summary, paraphrase, citation, and weaving techniques by synthesizing two sources into a cohesive paragraph. By completing this exercise, you’ll also have a portion of your upcoming draft written!

Instructions

Step 1: Choose Two Sources

Select two sources related to your essay topic.

Make sure the ideas connect or overlap in some meaningful way.

From one source, choose a quotation.

From the other, create a paraphrase (in your own words).

Step 2: Write a Synthesis Paragraph

Your paragraph should include:

Topic Sentence – Introduce the main idea that connects your two sources.

Quotation and Paraphrase – Integrate both sources smoothly.

Signal Phrases – Introduce each source clearly (include author, year, or article title as appropriate).

Citations – Use correct APA in-text citations.

Commentary – Explain how the two sources connect and how they support your argument or idea.

Concluding Sentence – Wrap up your main point.

Tip: Focus on how the sources talk to each other—agreeing, disagreeing, or adding new insight.

Step 3: Revise Your Paragraph Exploratory analysis essay example

Use this week’s lesson strategies to blend sources smoothly.

Experiment with brackets, ellipses, or other advanced techniques.

Double-check your signal phrases and citation accuracy.

Step 4: Include a Works Cited / References List

Format your entries in APA style to match your in-text citations.

Only include the two sources used in your paragraph.

– NEXT WEEK WILL SUBMIT THE FIRST 3 PAGES, WITH REFRENCES AND ANNOTATED BIBLIOGRAPHY.

PROMPS FOR THE FINAL RESEARCH PAPER.

Purpose:

The purpose of this research paper is to develop an in-depth, college-level argument or analysis that is rooted in your Area of Study/Academic Program. Your paper should take a clear, arguable stance on a topic that is relevant to your discipline, demonstrating thoughtful engagement with credible, academic sources and synthesizing them into a cohesive argument.

Requirements:

Length:

8-10 full Exploratory analysis essay example pages, excluding the annotated bibliography.

Sources:

6-10 credible, college-level sources in an annotated bibliography

Sources must be cited and integrated into the paper effectively and ethically.

Annotations should be at least 150 words per source and summarize and evaluate the source.

Documentation Style:

Follow the disciplinary citation style ( APA format).

Thesis:

The thesis should present an arguable position or make an arguable point.

Ensure it addresses a specific, complex issue within your academic program.

Structure:

Exploratory or argumentative structured essay.

Body paragraphs that support and develop the argument.

Strong topic sentences and clear connections between claims and evidence.

Logical organization and structure throughout.

A well-supported conclusion that reinforces your thesis.

Exploratory analysis essay example

NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

SCENARIO 2

What are the errors (6 total) in the following prescriptions? Rewrite each prescription correctly.

methylphenidate (Concerta) 5 mg BID before breakfast and lunch #60 1 refill

pegloticase (Krystexxa) 8 mg IV infusion once per month #1 0 refill

Ubrelvy 200 mg po prn onset of migraine #12 1 refill

alprazolam (Valium) 0.5 mg po TID #90 0 refill

zolpidem 10 mg qhs #30 6 refills

NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

SCENARIO 2

The medication prescription contains the following errors: Methylphenidate (Concerta): 5 mg for BID for breakfast and lunch, 60 tabs, one refilled. The error entails the frequency of the medication. Concerta is an extended-release product and must only be taken once a day. Thus, the right prescription for Methylphenidate ER (Concerta) is 18 mg, 30 tabs, with one tab daily in the morning for ADHD (Zaric et al., 2023).

Secondly, the Pegloticase (Krystexxa) 8 mg IV infusion is administered once per month without a refill. The ambiguity of Pegloticase dosage should be taken every two weeks and not every month. For Pegloticase (Krystexxa) medication, the correct dosage is 8 mg IV infusion. Secondly, the drug should be administered where the patient has refractory gout, and the dosage will be 8 mg IV every two weeks (Man et al., 2023).

Thirdly was the prescription of a medication program of Ubrelvy 200 mg PO during the onset of migraine consisting of 12 tabs and one refill only. The reason for the medication error is overdosing. Treatment with Ubrelvy should not exceed 100 mg per dose. The recommended correct prescription of Ubrelvy would solely be 100 mg 12 tabs taken one tab PO at the onset of migraine and repeated once in 24 hours (Keenan et al., 2021).

GET A HUMAN-WRITTEN PAPER HERE

Further, the medication involving alprazolam (Valium) 0.5 mg PO TID and 90 tabs is incorrect. Firstly, a mistake in the name of the drug is Valium, which is diazepam and not alprazolam. Hence, in the case of an Alprazolam prescription, the dosage would be 0.5mg and 90 tabs, each administered orally three times a day for anxiety and no refill (Edinoff et al., 2021). Finally, there is the medication with the error Zolpidem 10 mg QID with 30 tabs and six refills. This is because of more refills on Zolpidem and would increase the likelihood of the patient developing drug dependency (Zaric et al., 2023). The correct prescription involves administering Zolpidem 10 mg, 30 tabs with a single tab taken daily before bedtime for insomnia and no refill.

References

Edinoff, A. N., Wu, N., Ghaffar, Y. T., Prejean, R., Gremillion, R., Cogburn, M., … & Kaye, A. D. (2021). Zolpidem: efficacy and side effects for insomnia. 
Health psychology research
, 
9
(1).

Keenan, R. T., Botson, J. K., Masri, K. R., Padnick-Silver, L., LaMoreaux, B., Albert, J. A., & Pillinger, M. H. (2021, April). The effect of immunomodulators on the efficacy and tolerability of pegloticase: a systematic review. In 
Seminars in Arthritis and Rheumatism
 (Vol. 51, No. 2, pp. 347-352). WB Saunders.

Man, K. K., Häge, A., Banaschewski, T., Inglis, S. K., Buitelaar, J., Carucci, S., … & Uebel-von Sandersleben, H. (2023). Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study. 
The Lancet Psychiatry
, 
10
(5), 323-333.

Zaric Kontic, M., Dragic, M., Martinovic, J., Mihajlovic, K., Brkic, Z., Mitrovic, N., & Grkovic, I. (2023). Prolonged Alprazolam Treatment Alters Components of Glutamatergic Neurotransmission in the Hippocampus of Male Wistar Rats—The Neuroadaptive Changes following Long-Term Benzodiazepine (Mis) Use. 
Pharmaceuticals
, 
16
(3), 331.

 

NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

ASSIGNMENT

Submit your Assignment by Day 7 of Week 7 (Sunday night, 11:59 pm ET)

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For your Week 7 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

To Prepare:

Review assignment rubric and case studies. Be sure to thoroughly answer ALL questions.

Explain the problem and discuss how you would address the problem.

When recommending medications, write out a complete prescription for each medication. A complete prescription includes the following information: drug, dose, route, frequency, duration (if applicable), quantity, # of refills and indication for use. An example of a complete prescription is as follows: lisinopril 10mg #30 tabs, take 1 tab PO once daily for high blood pressure, refills: 2.

Answer questions using your required learning resources, clinical practice guidelines, Medscape, etc.

Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

SCENARIO 1

Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy? Name 3 antidepressants you might prescribe for patients with co-existing depression and anxiety (include
complete medication orders
) and include patient monitoring.

 

SCENARIO 2

What are the errors (6 total) in the following prescriptions? Rewrite each prescription correctly.

methylphenidate (Concerta) 5 mg BID before breakfast and lunch #60 1 refill

pegloticase (Krystexxa) 8 mg IV infusion once per month #1 0 refill

Ubrelvy 200 mg po prn onset of migraine #12 1 refill

alprazolam (Valium) 0.5 mg po TID #90 0 refill

zolpidem 10 mg qhs #30 6 refills

SCENARIO 3

Patient TL is experiencing symptoms of daily leg muscle weakness and feet cramping at night. He is currently on metformin 1000 mg po BID, Invokamet 50/500 mg BID with meals, atorvastatin 40 mg po daily and atomoxetine 40 mg po daily. Blood pressure is 118/78 and labs include: BG 90 mg/dL A1c 4.5% sCr 0.9 mg/dL eGFR 101 mL/min/1.73 m² total cholesterol 181 mg/dL LDL 95 mg/dL HDL 57 mg/dL TG 146 mg/dL B12 150 pg/mL CK 505 U/L What is your
working diagnosis
? What would you prescribe for TL and how would you improve his treatment? What would you monitor?

 

SCENARIO 4

When a person uses nicotine, it causes temporary feelings of relaxation and well-being. Nicotine binds to nicotinic receptors in the brain, augmenting the release of numerous neurotransmitters. Name at least three of these neurotransmitters. Patients may self-medicate ADHD, anxiety, and depression by smoking. Is there a medication that could treat ADHD, anxiety, depression, and provide smoking cessation? Write a complete medication order for this medication.
Does the patient need to quit smoking before starting treatment
?

 

NURS_6521_Week7_Assignment_Rubric

NURS_6521_Week7_Assignment_Rubric – NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders.

3 pts

This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

Total Points: 100 NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

When a person uses nicotine, it causes temporary feelings of relaxation and well-being. Nicotine binds to nicotinic receptors in the brain, augmenting the release of numerous neurotransmitters.’

SCENARIO 4

When a person uses nicotine, it causes temporary feelings of relaxation and well-being. Nicotine binds to nicotinic receptors in the brain, augmenting the release of numerous neurotransmitters. Name at least three of these neurotransmitters. Patients may self-medicate ADHD, anxiety, and depression by smoking. Is there a medication that could treat ADHD, anxiety, depression, and provide smoking cessation? Write a complete medication order for this medication. Does the patient need to quit smoking before starting treatment?

 

SCENARIO 4

Nicotine acts upon nicotinic receptors in the brain, thereby causing the discharge of dopamine, norepinephrine, and serotonin. This mechanism can help justify why people provide nicotine to treat diseases like ADHD, anxiety, and depression, among others. These conditions and smoking cessation can be treated with the help of bupropion, which is sold under the name of Wellbutrin SR (Zhang et al., 2023).

A complete prescription for this purpose would be as follows, Bupropion sustained release of 150mg in the pack of 60 tablets. One tablet should be taken orally for the first three days, while one tablet should be taken two times daily for smoking relief, ADHD, and depression and with a single refill (Naguy & Badr, 2022).

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There is no requirement for the patient to stop smoking before they begin the program and take bupropion. In most cases, the second party wishes to quit dates before the two weeks the medication is administered. Supervision during treatment is quite an elaborate process and entails the following. The status of the phenomenon of interest, such as the patient’s mood, anxiety levels, and whether they are smoking, should be assessed frequently (Picciotto & Kenny, 2021). One also has to consider the side effects; for example, one may develop insomnia or agitated feelings during treatment. Also, compliance with the suggested regimen and the drug’s effectiveness should be revisited after 4-6 weeks if the best results are required.

References

Naguy, A., & Badr, B. H. (2022). Bupropion—myth-busting!. 
CNS spectrums
, 
27
(5), 545-546.

Picciotto, M. R., & Kenny, P. J. (2021). Mechanisms of nicotine addiction. 
Cold Spring Harbor perspectives in medicine
, 
11
(5), a039610.

Zhang, H., Gilbert, E., Hussain, S., Veldhuizen, S., Le Foll, B., Selby, P., & Zawertailo, L. (2023). Effectiveness of bupropion and varenicline for smokers with baseline depressive symptoms. 
Nicotine and Tobacco Research
, 
25
(5), 937-944. When a person uses nicotine, it causes temporary feelings of relaxation and well-being. Nicotine binds to nicotinic receptors in the brain, augmenting the release of numerous neurotransmitters.

Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy?

SCENARIO 1

Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy? Name 3 antidepressants you might prescribe for patients with co-existing depression and anxiety (include complete medication orders) and include patient monitoring.

Scenario 1

Antidepressants and other psychotic disorders need close medication monitoring so that high medication efficacy is achieved. Quite frequently, the half-life of a particular drug and distribution volume determines how well the given medication will perform and the result expected from patients. The half-life of constipation is about 2 hours, and buspirone is a non-benzodiazepine anxiolytic (Shin et al., 2024). Should a patient decide to take 15 mg at 8 a.m., the concentration of the drug in his body will halve every 2 hours. Hence, at 2.00 p.m., the drug will have been cleared of six half-lives (15 mg-7.5 mg-3.75 mg-1.875 mg-0.9375 mg-?0.46875 mg-?0.234375 mg). Therefore, the drug’s level in the blood will be (0.234375 mg) minuscule by 2 p.m.

Nevertheless, it should be noted that buspirone is being used as an adjunct drug, which means that it has antidepressant activity and can be prescribed for patients with signs of depression accompanied by anxiety. Other three antidepressants that can be used in the treatment of depression accompanied by anxiety include other drugs such as sertraline, venlafaxine, and escitalopram (Du et al., 2024).

Below are complete prescriptions for each:

Sertraline 50 mg; 30 tabs: Take one tab PO daily for depression and anxiety.

Refills: twice

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Venlafaxine XR 75 mg; 30 tabs: Take one cap PO daily with food for depression and anxiety.

Refills: twice.

Escitalopram 10 mg; 30 tabs

Take one tab of PO daily for depression and anxiety.

Refills: 2.

Depression patients under medication should be monitored regularly to assess for drug side effects and medication outcomes. Patient symptoms would include mood changes and anxiety symptoms. Secondly, the patient should be on close monitoring for Blood pressure levels when under venlafaxine medication due to the increased risk of hypertension. Finally, the patient should be on serotonin syndrome (Browne et al., 2021) Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy?

 

 
References

Browne, P. D., Bolte, A. C., Besseling-van der Vaart, I., Claassen, E., & de Weerth, C. (2021). Probiotics as a treatment for prenatal maternal anxiety and depression: a double-blind randomized pilot trial. 
Scientific reports
, 
11
(1), 3051.

Du, Y., Li, Q., Dou, Y., Wang, M., Wang, Y., Yan, Y., … & Ma, X. (2024). Side effects and cognitive benefits of buspirone: A systematic review and meta-analysis. 
Heliyon
.

Shin, E., Renzi, D., Canales, C., Ravichandran, C., McDougle, C. J., & Thom, R. P. (2024). Buspirone for the treatment of anxiety in Williams syndrome: a retrospective chart review study. 
Expert Opinion on Pharmacotherapy
, 
25
(1), 113-120.

 

NURS_6521_Week7_Assignment_Rubric

NURS_6521_Week7_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy?

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1 pts

Fair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

Total Points: 100 Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy?

Patient TL is experiencing symptoms of daily leg muscle weakness and feet cramping at night. He is currently on metformin 1000 mg po BID, Invokamet 50/500 mg BID with meals, atorvastatin 40 mg po daily and atomoxetine 40 mg po daily.

SCENARIO 3

Patient TL is experiencing symptoms of daily leg muscle weakness and feet cramping at night. He is currently on metformin 1000 mg po BID, Invokamet 50/500 mg BID with meals, atorvastatin 40 mg po daily and atomoxetine 40 mg po daily. Blood pressure is 118/78 and labs include: BG 90 mg/dL A1c 4.5% sCr 0.9 mg/dL eGFR 101 mL/min/1.73 m² total cholesterol 181 mg/dL LDL 95 mg/dL HDL 57 mg/dL TG 146 mg/dL B12 150 pg/mL CK 505 U/L What is your working diagnosis? What would you prescribe for TL and how would you improve his treatment? What would you monitor?

SCENARIO 3

Patient TL reported complaining of daily leg muscle weakness and night foot cramping. Blood tests reveal Vitamin B12 at 150 pg/mL and creatine kinase at 505 U/L. Thus, tentative differential diagnosis includes Vitamin B12 deficiency-related neuropathy and at least suspicion of statin-induced myopathy due to atorvastatin intake (Ruscica et al., 2022).

The Treatment Plan would start with the cessation of atorvastatin for a while to determine its contribution to the development of myopathy. This will be followed with laboratory patient follow-up. Secondly, it’s the introduction of a Vitamin B12 supplementation program. For example, take Cyanocobalamin 1000 mcg/mLm and give 10 vials (Botha, 2022). The doses should be 1 mL IM weekly for 4 weeks, then the continuation of once-monthly injections.

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The patient’s management should entail assessing the CK levels and muscle complaints after discontinuing atorvastatin. Secondly, Vitamin B12 and neuropathy symptoms should be evaluated at least every three months. Lastly, review the patient’s cholesterol and consider challenging with atorvastatin at a lower dose or putting the patient on another statin (Pulipati & Davidson, 2021).

References

Botha, I. (2022). Cyanocobalaminum: Cyanocobalamin, Cobalamin, Vitamin B12, Anti-pernicious anemia factor, Crystamine. In 
Materia Medica of New and Old Homeopathic Medicines
 (pp. 99-102). Cham: Springer International Publishing.

Pulipati, V. P., & Davidson, M. H. (2021). How I treat statin-associated side effects in an outpatient setting. 
Future Cardiology
, 
17
(7), 1249-1260.

Ruscica, M., Ferri, N., Banach, M., Sirtori, C. R., & Corsini, A. (2022). Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications. 
Cardiovascular Research
, 
118
(17), 3288-3304. Patient TL is experiencing symptoms of daily leg muscle weakness and feet cramping at night. He is currently on metformin 1000 mg po BID, Invokamet 50/500 mg BID with meals, atorvastatin 40 mg po daily and atomoxetine 40 mg po daily.