Tag: Clinical-Nursing

  • Nursing Fundamentals course development

    Nursing Education

    Introduction:

    The role of the nurse educator requires specialized knowledge and skills. One of the essential competencies necessary for the role is the ability to develop relevant curricula for the preparation of future nurses. It is therefore important that nurse educators comprehend and stay well-informed of trends and issues which may impact nursing education.

    This task is intended to facilitate your ability to develop competency statements and related learning objectives; select relevant learning assessment and evaluation tools; create learning activities that promote critical thinking and reflective skills; and actively engage and support students with diverse learning needs. As an educator, you are also required to demonstrate effective analytical skills in the evaluation of methods used to determine the achievement of program outcomes. In addition, in this task you write an element of an exam. This will help you comprehend different item types and the process involved when you develop items for course exams. These learning activities assist in building an educational foundation between the classroom setting and the clinical setting.

    Scenario:

    The nursing faculty at Hartford University have developed a new BSN curriculum and begun the work of designing and developing individual courses. You are a full-time, tenure-track faculty member assigned to develop courses in level one—the first year of the nursing program. Students at this level have completed all prerequisites for the BSN program.

    You are asked to develop the Nursing Fundamentals course, the first clinical course students engage in once admitted to the BSN nursing program. According to the results of the nursing program entrance exam, the students who will be taking the Nursing Fundamentals course were found to have an equal distribution of visual, auditory, and kinesthetic learning styles. The Nursing Fundamentals course will introduce students to nursing care across the lifespan. It will also provide students with the tools necessary to perform basic nursing care in clinical settings and will provide the framework for future clinical courses (e.g., medical/surgical, pediatric, obstetrics/gynecology, mental health, and community nursing specialties).

    Requirements:

    A. Develop four competency statements specific to the Nursing Fundamentals course that are based on contemporary professional nursing standards and guidelines.

    1. Explain how each of the four competencies you developed aligns with one of the following national nursing standards and guidelines:

    • Commission on Collegiate Nursing Education (CCNE)

    • National League for Nursing (NLN)

    • Quality and Safety Education for Nurses (QSEN)

    2. Create three learning objectives for one of the course competencies that you developed.

    a. Discuss one criterion you will use to select appropriate learning resources to achieve the learning objectives you created.

    3. Discuss one of the following approaches to course design that you will use in developing the Nursing Fundamentals course:

    • traditional

    • contemporary

    • blended

    B. Discuss two of the following types of strategies you will use to evaluate learning outcomes in the Nursing Fundamentals course:

    • portfolio

    • papers and essays

    • role playing

    • oral questioning

    • audio and video recording

    • service learning

    1. Describe one advantage for each of the strategies you will use.

    2. Describe one disadvantage for each of the strategies you will use.

    C. Describe how criterion- and norm-referenced tests will be used in the Nursing Fundamentals course by doing the following:

    1. Discuss how criterion-referenced tests will be used in the Nursing Fundamentals course.

    2. Discuss how norm-referenced tests will be used in the Nursing Fundamentals course.

    D. Discuss construction of test items and responses as it relates to the development of the Nursing Fundamentals course by doing the following:

    1. Discuss advantages of using true-false test items.

    2. Discuss disadvantages of using true-false test items.

    3. Discuss advantages of using multiple-choice test items.

    4. Discuss disadvantages of using multiple-choice test items.

    E. Write one multiple-choice item for one of the learning objectives you created in part A2.

    1. Describe key considerations involved with item stem construction.

    2. Describe key considerations involved with developing response options.

    3. Discuss how posttest reviews may benefit students.

    F. Identify cultural and societal factors that may impact students’ learning in the classroom.

    1. Describe how a student’s cultural and personal background could impact learning in the classroom.

    G. Discuss how to facilitate learning through learning objectives and related activities.

    1. Develop one learning activity to assist learners in meeting one of the learning objectives you created in part A2.

    a. Describe how the learning activity meets the learning objective you selected in part G1.

    2. Explain how the learning activity meets one of the following learning styles of the students in the course:

    • visual

    • auditory

    • kinesthetic

    H. Discuss the importance of creating a learning activity that promotes critical thinking skills.

    1. Identify one of the following critical thinking strategies that you believe will best facilitate the development of self-reflection skills:

    • case study

    • collaborative learning

    • debate

    • concept mapping

    • simulation

    2. Describe how you would implement the selected strategy from part H1 in the classroom to best facilitate the development of self-reflection skills.

    I. Provide one example of a best practice for providing feedback to students in the clinical setting.

    J. When you use sources, include all in-text citations and references in APA format.

    Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

    Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

  • Translation of Research Evidence and Evidence Summary

    Competency 724.8.1: Primary Research – The graduate recognizes basic scientific research concepts and techniques, appreciates the ethics of nursing research, recognizes researchable questions, uses evaluative skills to critique current nursing research, and identifies statistical types.

    Competency 724.8.2: Translation of Research Evidence and Evidence Summary –

    The graduate applies concepts of nursing research to clinical practice situations, conducts reviews of the literature in relation to therapeutic approaches, and recognizes the importance of theoretical models in nursing practice or research.

    Introduction:

    Peer-reviewed research reports are reports reviewed by other credible experts in the field. Nursing, as a profession, uses peer-reviewed primary research reports to make credible and evidence-based practice implications and recommendations in the clinical area.

    In this task, you will collect and analyze 10 research reports (primary research evidence) on one topic of interest to you in nursing practice or healthcare.

    Requirements:

    A. Select a piece of primary research (original research reports) from a research journal that has nursing implications and critique the article (suggested length of 2–3 pages) by doing the following:

    Note: Please notice that you can collect 10 research reports first and then select one of those to complete aspect A of this task.

    1. Identify the article you have chosen in an APA-formatted citation. 2. Design a visual representation (e.g., graph or chart) to show how the researcher

    addressed the five areas of a research report (background information or introduction, review of the literature, discussion of methodology, specific data analysis, and conclusion).

    Note: You may use the following table.

    3. Based on your analysis of the five areas, assess whether the evidence presented in the research report supports the researcher’s conclusion.

    4. Discuss ethical issues that may have arisen for the researcher while conducting the research for the article.

    5. Discuss the type of research used for the study. a. Explain whether or not other types of research would have been appropriate in the

    same situation.

    A1 Article: (indicate primary evidence chosen by way of an APA citation)

    A2 Background or Introduction

    A2 Review of the Literature

    A2 Discussion of Methodology

    A2 Data Analysis

    A2 Researcher’s conclusion

    B. Conduct a literature search to evaluate nursing care or management implications of a nursing intervention by doing the following: 1. Discuss evidence for a nursing care or management problem. 2. Complete the attached matrix to list 10 research sources, in APA format, from

    scholarly journal sources you locate in major medical databases (e.g., CINAHL, PubMed, MedLine, or a hard copy journal).

    Note: In aspect B you should gather 9 more pieces of similar research on the same topic as in aspect A so you have a total of 10 pieces of research to make a practice implication (a minimum of 8 authors should be used).

    Note: You have access to major medical databases within the WGU Library.

    Note: You may submit your completed matrix as a separate attachment to the task or you may include the matrix within your paper.

    Note: Credible sources may include professional journals, research reports, professional Web sites, governmental reports, and presentations from professional meetings. Research articles must not be more than ten years old.

    3. Conduct a review of the 10 peer-reviewed research articles in which you do the following:

    a. Develop an annotated bibliography (suggested length of 2–3 pages) of the articles.

    Note: An annotated bibliography is one that includes not only a brief summary of content for each book or article reviewed, but also contains other relevant comments and information that the candidate believes can be of help for future study. See Web Links below for more information on annotated bibliographies.

    b. Discuss whether the researchers’ evidence collected is adequate to make a recommendation for a practice change.

    c. Identify the tools the researchers chose to use. i. Discuss whether the researchers chose tools that were similar or different.

    d. Discuss whether you believe the tools the researchers chose could have affected their results.

    4. Develop an evidence summary of the articles, identifying at least two key criteria that were used to develop it.

    5. Recommend a specific nursing strategy based on the researcher’s recommendations and evidence you found in your review.

    6. Explain why you believe it is important to use a theoretical model for nursing research.

    C. When you use sources, include all in-text citations and references in APA format.

    Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

    Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

    Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.

  • Minnesota Intervention Wheel

    Prevention of gang violence

    Write a narrative description of your field project by doing the following:

    B. Assessment

    1. Describe the community where you performed your fieldwork by identifying each of the following items:

    • geographical area (e.g., county, city, town)

    • area size

    • population size

    • demographics

    • physical and social environment (use the windshield survey from task 1 of C228)

    2. Discuss the health concern you studied in your fieldwork.

    a. Provide background information in relation to Healthy People 2020 and local public health data that characterizes the health concern.

    b. Provide data from national, state, and/or local levels related to the health concern.

    3. Describe the target population affected by the health concern you studied in your fieldwork, including each of the following components:

    • gender

    • age

    • demographics, including socioeconomic status and educational level

    a. Explain how the health concern is linked to a health inequity/health disparity for the population of interest.

    i. Provide specific data to support the health inequity/disparity conclusion.

    4. Discuss the primary community resources and partners currently involved with the health concern.

    a. Describe how your fieldwork interviews support your chosen health concern, including a summary of the interviews.

    5. Discuss aspects of the population health concern not being addressed despite the efforts of the partners involved.

    C. Outcomes Identification

    1. Explain the desired outcome(s) or goal(s) for improvement related to the health concern.

    Note: This outcome or goal should be in alignment with Healthy People 2020 objective.

    D. Planning

    1. Create a nursing action plan to address the identified population health concern.

    a. Recommend two population-focused specific objectives.

    Note: The recommended objectives should be measurable ones.

    b. Recommend two population-focused specific nursing interventions to improve the health concern.

    Note: Use the attached “Minnesota Intervention Wheel” as an aid in selecting the broad areas for nursing action. Select primary and secondary prevention activities only. For example, explain how you and other nurses might work with the community and your chosen target population of interest to improve the health concern.

    2. Discuss potential public and private partnerships from your field experience that could be formed to implement your recommendations from parts D1a and D1b.

    3. Create a specific timeline for your population-focused nursing interventions.

    E. Evaluation

    1. Explain how you would evaluate the effectiveness of the nursing action plan created in part D.

    a. Identify the measurable tools necessary to perform the evaluation.

    F. Conclusion

    1. Reflect on how your perspective of the community’s health and the national, state, and local efforts toward a healthier population has changed as a result of your fieldwork.

    G. Appendices

    1. Include appendices if necessary (e.g., charts, graphs, copies of any surveys, maps).

    H. When you use sources, include all in-text citations and references in APA format.

    Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

    Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

    Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.

  • routine shaving of the surgical site

    For this assessment, you will select a nursing admission/assessment or patient care/preparation process or procedure (e.g., routine shaving of the surgical site) that is commonly found in your practice setting that you and your colleagues question. You will gather evidence to determine the basis for this process or procedure, provide suggestions based on evidence on how this process or procedure should be changed, and determine possible barriers to implementation of a revised clinical practice guideline.

    Requirements:

    A. Describe a nursing admission/assessment or patient care/preparation process or procedure currently found in your practice setting.

    Note: You must choose a process or procedure that was already in place and you can recommend changes to.

    1. Discuss why the present process or procedure needs to be changed, based on the evidence you have gathered.

    2. Based on your initial investigation of the situation, do the following:

    Note: You may need to ask workplace personnel to complete the following.

    a. Explain who determined the basis for the current process or procedure in your practice setting.

    b. Explain the decision makers’ rationale for instituting or supporting the current process or procedure.

    c. Explain why the decision makers decided to implement the current process or procedure.

    3. Recommend a practice change for the process or procedure you selected.

    a. List five relevant and credible sources to support your suggested practice change.

    Note: Credible sources are less than five years old and may include professional journals, research reports, professional websites, governmental reports, current texts less than five years old, and presentations from professional meetings.

    4. Explain the clinical implications your recommended change might have on patients, based on the relevant and credible sources you listed in part A3a.

    5. Explain the implications your recommended change might have on the practice setting, based on the relevant and credible sources you listed in part A3a.

    6. Discuss how you would involve key stakeholders in the decision to change the process or procedure or to comply with the recommended change.

    B. Write an essay (suggested length of 2–3 pages) in which you do the following:

    1. Discuss the specific barriers you may encounter in applying research to processes and procedures in your practice setting.

    Note: You should distinguish between difficulties you would have interpreting what the research says and synthesizing it into a practice guideline or procedure, rather than just the outside barriers to change.

    2. Identify at least two strategies that you and your team could use to overcome the barriers you discussed in part B1.

    3. Explain how you would implement your recommended process or procedure based on research findings.

    C. When you use sources, include all in-text citations and references in APA format.

    Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

    Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

    Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section

  • Keirsey Temperament personality test

    For this assessment, you will navigate areas of focus that include professional presence, mindfulness practice, and healing environments. These areas of focus will help you to create a professional presence plan that has both personal and professional application. You will be analyzing your inner world (thoughts, beliefs, and values) and your outer world (activities, relationships, and experiences). Each section of this assessment will gauge how you use and interact with those two worlds. To aid you in understanding your inner and outer worlds, you will take the Keirsey Temperament Sorter-II, an online personality test. With the test’s results, you will better understand your strengths and weaknesses and how you can be an effective individual and leader. Authentic leadership requires as much care and understanding for yourself as for those you will serve and lead. Your professional presence plan will integrate your insights, goals, and beliefs into a coherent whole.

    Requirements:

    Note: Be sure to cover each prompt in sufficient detail and support.

    A. Professional Presence

    1. Discuss with substantial details the differences between two models of health and healing (e.g., physical body, body-mind, body-mind-spirit/bio-psycho-social,) as they relate to what it means to be human.

    2. Provide plausible analysis, with substantial support, of the differences between one of the models discussed in part A1 and your professional presence (i.e., current beliefs, attitudes, and actions regarding health and healing).

    3. Provide logical discussion with details of how your professional presence (mindful or distracted) influences your nursing practice.

    B. Personality Preferences

    1. Submit your results from the Keirsey Temperament personality test.

    (myKeirsey Temperament personality test result indicate that my personality type is that of: Guardian).

    For questions 2a and 2b: Please go to Keirsey.com, and under 4 temperaments, read on “Guardian” to help with questions 2a, 2b.

    2a. Provide plausible analysis with substantial details of your test results, including areas that may or may not align with how you view yourself.

    b. Evaluate how the preferences identified by the test align with your relationships, favorite activities, and career choices.

    c. Discuss two potential challenges or barriers (e.g., barriers in communication, decision-making) that could be minimized by your enhanced self-awareness when working with opposite personality types.

    C. Mindfulness Practice

    1. Develop a mindfulness practice plan consistent with your interests, goals, and beliefs by doing the following:

    a. Create two specific goals for each of the four Aspects of your whole person (physical, vital/rhythmic, mental/emotional, and biographical/spiritual body) to maintain balance.

    b. Discuss how you will achieve each of the goals created in part C1a, including how you will adjust to the changing of your whole person.

    D. Healing Environments

    1. Analyze two optimal healing environments in healthcare to identify the common elements of internal, interpersonal, behavioral, and external environments.

    2. Discuss how you intend to apply self-awareness and insights gained from part D1 to promote professional presence in your current healthcare setting.

    E. When you use sources, include all in-text citations and references in APA format.

    Note: When using sources to support ideas and elements in a performance assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the performance assessment.

    Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly.

  • NURS 6630 Week 1: Introduction to Neuroanatomy Assignment: Short Answer Assessment

    Week 1: Introduction to Neuroanatomy

    The human brain is organized into the cerebral cortex, brainstem, subcortical structures, and the cerebellum. These anatomical structures are made of inter-connected elements that create distributed and highly inter-connected circuits. It is in these circuits where cognition, behavior, and affect are processed.

    —Camprodon, J. A., & Roffman, J. L. (2016, p. 6)

    By using a combination of psychotherapy and medication therapy, psychiatric nurse practitioners (PNP) are positioned to provide a very unique type of care to patients with psychiatric disorders. To be successful in this role, you must have a strong theoretical foundation in pathophysiology, psychopharmacology, and neuroscience. This foundation will help you assess, diagnose, and treat patients as you relate presenting symptoms to theoretical neuronal functioning.

    This week, as you begin to study psychopharmacology, you will explore the basic functional unit of the nervous system, the neuron. You will review the structure of the neuron and you will examine the anatomy of the central nervous system and consider the functionality of the different structure and outward (phenotypic) expression of their activities. You will analyze these concepts as you complete your short answer assessment for this week.

    Reference:

    Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.),
    Massachusetts General Hospital psychopharmacology and neurotherapeutics
     (pp. 1–19). Elsevier.

    Learning Objectives

    Students will:

    Describe the functions and structures of the central nervous system

    Describe the different structures that make up the neuron

    Explain the function of neurons in intracellular communication

    Learning Resources

    Required Readings
    (click to expand/reduce)

    Required Media
    (click to expand/reduce)

    Optional Resources
    (click to expand/reduce)

    Assignment

    Practicum Manual Acknowledgment

    The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

    Field Experience: MSN Nurse Practitioner Practicum Manual

    Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

    Optional Discussion Forum: PMHNP Study Support Lounge

    The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge, where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.

    As a peer, you are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like these is a statistically significant predictor of success.

    To Participate in this Optional Discussion:

    PMHNP Study Support Lounge

    Assignment: Short Answer Assessment

    As a psychiatric nurse practitioner, before you can recommend potential pharmacotherapeutics to address a patient’s condition or disorder, you must understand the basic function and structure of the neuron and central nervous system. For this Assignment, you will review and apply your understanding of neuroanatomy by addressing a set of short answer prompts.

    To Prepare:

    Review the Learning Resources for this week in preparation to complete this Assignment.

    Reflect on the basic function and structure of the neuron in relation to the central nervous system.

    Reflect on the inter-connectedness between neurons and the central nervous system, including the pathway and distribution of electrical impulses.

    Reflect on how neurons communicate with each other and review the concept of neuroplasticity.

    Photo Credit: Getty Images/Science Photo Libra

    To complete:

    Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

    In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.

    Answer the following (listing is acceptable for these questions):

    What are the major components that make up the subcortical structures?

    Which component plays a role in learning, memory, and addiction?

    What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?

    In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.

    The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.

    In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.

    By Day 7

    Submit
    your Assignment.

    Submission and Grading Information

    To submit your completed Assignment for review and grading, do the following:

    Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.

    Click the 
    Week 1 Assignment Rubric 
    to review the Grading Criteria for the Assignment.

    Click the 
    Week 1 Assignment 
    link. You will also be able to “View Rubric” for grading criteria from this area.

    Next, from the Attach File area, click on the 
    Browse My Computer
     button. Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click 
    Open
    .

    If applicable: From the Plagiarism Tools area, click the checkbox for 
    I agree to submit my paper(s) to the Global Reference Database
    .

    Click on the 
    Submit
     button to complete your submission.

    Grading Criteria

    To access your rubric:

    Week 1 Assignment Rubric

    Check Your Assignment Draft for Authenticity

    To check your Assignment draft for authenticity:

    Submit your Week 1 Assignment draft and review the originality report.

    Submit Your Assignment by Day 7 of Week 1

    To participate in this Assignment:

    Week 1 Assignment

    What’s Coming Up in Week 2?

    Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

    Next week,
     you will examine how neurotransmitters and receptor theory may impact the function of the central nervous system. You explore medication adherence and consider how it might impact a patient’s treatment goals.

    Practicum – Upcoming Deadline

    In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms,
    you will need to submit your application via
    Meditrek
     .

    For information on the practicum application process and deadlines, please visit the
    Field Experience: College of Nursing: Application Process – Graduate
     web page.

    Please take the time to review the 
    Appropriate Preceptors and Field Sites
     for your courses.

    Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the
    Field Experience: College of Nursing: Student Resources and Manuals
     web page.

    Field Experience: College of Nursing Quick Answers

    Field Experience: MSN Nurse Practitioner Practicum Manual

    Student Practicum Resources: NP Student Orientation

  • NRS-440VN Health Care Delivery Models and Nursing Practice

    NRS-440VN Health Care Delivery Models and Nursing Practice

    Federal Healthcare Law Reform

    A recent federal law that reforms healthcare in the United States would be the Sustaining Excellence in Medicaid Act of 2019 (HR 3253). This bill was introduced into Congress on June 13 2020 and signed into law on August 6 2020. The Michigan representative, Debbie Dingell, introduced and sponsored this bill. The bill seeks to restructure the Medicaid program by providing for some extensions in some of its provisions (KDP LLP, 2019). One of the changes made was allowing the appropriations of Medicaid through to the fiscal year 2024. Another reform in Medicaid authorized in this bill is allowing the state fraud units within the program to consider and examine complaints from the non-institutionalized patients. This reform is important because it eliminates some of the disparities that arise from the ignoring of the complaints from such patients, yet, legally, they qualify for cover under the Medicaid program.

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    Another reform introduced by this bill is extending the Medicaid eligibility for individuals to protect them from spousal impoverishment or poverty. Sometimes, spouses from the lower socioeconomic backgrounds are denied cover given that Medicaid does not extend to them. This bill extends cover to such populations, including those who receive home-based and community-based medical services. In addition to these reforms, this bill repeals the requirements placed for the drug manufacturers to always include the prices for generic drugs when determining the price. It also excludes drug manufacturers from the definition of drug wholesalers to allow rebate calculations.

    This bill affects the nursing practice by adjusting the nurse’s role and responsibility. For instance, since the bill extends Medicaid to cover the spouses and protect them from impoverishment, the nurse should ensure that they educate all patients about the new changes to this bill. A patient may be suffering from spousal poverty which limits their access to quality medical care. The nurse should be able to identify such patients, and educate them about the new changes to help them access quality medical care. Another way this bill affects the nurse’s role and responsibility is that it adds to the role of advocacy in nursing. The nurse should advocate for the non-institutionalized patients whenever they have complaints, and help them appeal to Medicaid in the event of denial of services. The new bill covers the patients and enables them to have their complaints reviewed, hence, increasing their chances of getting social justice. The nurse should be an advocate and help the patients access social justice by helping them lodge complaints.

    How Quality Measures and Pay for Performance Affect Patient Outcomes

    Pay for performance is a reward system that rewards practitioners financially for their performance based on certain criteria in medical practice. It is a performance-based compensation approach that aims to improve the quality and delivery of healthcare services to patients. As such, this model also punishes the practitioners for achieving poor results. For instance, a psychologist whose patient fails to quit smoking at the end of their sessions does not receive the financial rewards associated with her role. In some ways, this model improves patient outcomes because it motivates the physicians and nurses to offer high quality services to their patients to ensure that they receive the financial rewards associated with their roles and criteria used for performance analysis. However, there is a risk to poor patient outcomes associated with this reward system, where it encourages patient dumping. This concept means that those patients with more complicated healthcare issues that have high risks tend to be relegated to the periphery, because the physicians prefer to focus on cases that are likely to be successful, so that they receive their rewards and bonuses (Kyeremateng et al., 2019). This practice leads to negative patient outcomes because those in the periphery suffer from lack of sufficient and timely medical attention.

    A nurse who finds him/herself in such situations should consider applying ethical principles such as non-maleficence, which means to cause least harm. By applying this principle, the nurse would encourage the physicians to admit and attend to patients with complex medical issues. Additionally, the nurse should remind the rest of the practitioners about the Hippocratic Oath, which binds them to the duty to save lives. Patient dumping is a severe violation of this oath and the nurses’ responsibility should be to remind the colleagues about these ethical applications.

    Professional Nursing Leadership and Management Roles

    An emerging nursing leadership role that addresses emerging trends would be knowledge on nursing informatics and the use of technology in nursing (Harris et al., 2019). An emerging trend in healthcare is the use of technology in the practices, which are increasingly requiring nurses to learn and equip themselves with skills in technology. For instance, there are surgical robots used in surgery, and surgical nurses should be conversant with the machines, so that their role in the surgical room is fulfilling. Another example is the use of bedside alert systems which notify the practitioners when a patient leaves their bed unattended, hence, reducing the incidence of patient falls. Therefore, the nurse leaders are tasked with the responsibility of ensuring that the nursing teams are technologically savvy as part of their nursing roles. The nurse leader and manager will ensure the availability of trainings in technology to enhance the nursing team’s professionalism. By doing so, the nurses promote patient health and safety. For instance, the bedside alert systems reduce the incidence of patient falls, and learning how to manage the electronic health records promotes patient health and enhances their professionalism levels since they comply with the HIPAA rules.

    Emerging Trends

               
    An emerging trend in healthcare is the use of medical robots in operations such as surgeries. This practice requires that the medical practitioners learn how to operate the robots in the event the surgeon is unable to continue operating because of an emergency. The nurse also needs to learn how to setup the machine and recognize situations in which the machine malfunctions. Therefore, given this change, the nurses’ roles will change to include technological operations in the healthcare setting. The nurses will be tasked with the responsibility of learning how technological devices work in a hospital because in some emergency situations, the nurse may save a life.

    Another emerging trend in healthcare is the application of telemedicine. Telemedicine is on the rise, given the technological advent in today’s era. Incorporating telemedicine practices in nursing will transform their roles. Telemedicine will enhance the role of the nurse as a communicator because the nurse should be reachable to their client upon request, through the telehealth systems. Since the interaction with the patient is no longer in person, the nurse should enhance their role as a communicator by using clear language, providing timely communication to their patient, and communicating within the shortest time possible, to allow them to tend to other patients.

    Another nursing role that is influenced by telemedicine is the use of technology to deliver nursing care to patients. Just like the medical and surgical robots, nurses will be required to enhance their knowledge on technology and the use of the internet platforms to communicate with patients. It remains critical that the nurse avoids challenges using the devices applied in telemedicine, which could have serious adverse health outcomes for the patients. Therefore, the nurse’s role changes to include those that require the heavy use of technology.

     

    References

    Harris, J., Roussel, L., & Thomas, P. (2016).
    Initiating and sustaining the clinical nurse leader role
    . Jones & Bartlett Learning.

    KDP LLP. (2019).
    Extending Medicaid Funding, the Debt Limit, Membership into the American Legion, and Support For 9-11 Victims, Law Enforcement Officers, and Breastfeeding Moms – KDP LLP
    . Kdpllp.com. Retrieved 12 November 2020, from https://www.kdpllp.com/extending-medicaid-funding-the-debt-limit-membership-into-the-american-legion-and-support-for-9-11-victims-law-enforcement-officers-and-breastfeeding-moms/.

    Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., & Neilipovitz, D. (2019). An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients.
    Critical care research and practice
    ,
    2019
    , 8943972. https://doi.org/10.1155/2019/8943972

    Stewart. (2018).
    Role Development for the Nurse Practitioner
    . Jones & Bartlett Learning.

     

    Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

    Include the following:

    Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.

    Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.

    Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.

    Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

    You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

    Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

    This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. NRS-440VN Health Care Delivery Models and Nursing Practice

    You are required to submit this assignment to LopesWrite. Refer to the 
    LopesWrite Technical Support articles
     for assistance.
     

    Health Care Delivery Models and Nursing Practice

    No of Criteria: 
    9
     
    Achievement Levels: 
    5

    Criteria

    Achievement Levels

    Description

    Percentage

    Unsatisfactory

    0.00 %

    Less Than Satisfactory

    75.00 %

    Satisfactory

    79.00 %

    Good

    89.00 %

    Excellent

    100.00 %

    Content

    80.0

    Current or Emerging Health Care Law or Federal Regulation and Effect on Nursing Practice, Role and Responsibility

    20.0

    Emerging health care law or federal regulation is omitted. The law or regulation presented is not relevant to health care.

    Emerging health care law or federal regulation is incomplete. Effect on nursing practice and nurse role and responsibility is partially described.NRS-440VN Health Care Delivery Models and Nursing Practice

    Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is summarized. There are some inaccuracies.

    Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is described. Some information or detail is needed for clarity.

    Discussion on emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is well-developed.

    Quality Measures Pay for Performance, Patient Outcomes, and Effect on Nursing Practice

    20.0

    Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is omitted.

    Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is incomplete.

    Summary on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. There are inaccuracies or slight omissions.

    Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. Some information is needed for clarity.

    A thorough and insightful discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented.

    Professional Nursing Leadership and Management Roles NRS-440VN Health Care Delivery Models and Nursing Practice

    20.0

    Discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is omitted.

    An incomplete discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is presented.

    A summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.

    A discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. Some detail or information is needed for clarity.

    A well-developed discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. The discussion demonstrates a thorough understanding of the nursing profession in emerging trends and patient care in a diverse health setting. NRS-440VN Health Care Delivery Models and Nursing Practice

    Predict Change in Nursing Roles and Nursing Practice

    20.0

    Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are omitted.

    Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are incomplete. The predictions are unrealistic or lack evidence for support.

    Insert Satisfactory CoA summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are summarized. The predictions are realistic, but there are inaccuracies or slight omissions. ntent 2 Descriptor

    Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are discussed. The predictions are generally supported and realistic. NRS-440VN Health Care Delivery Models and Nursing Practice

    Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are thoroughly discussed. The predictions are based on evidence and highly relevant to emerging trends.

    Organization, Effectiveness, and Format

    20.0

    Thesis Development and Purpose

    5.0

    Paper lacks any discernible overall purpose or organizing claim.

    Thesis is insufficiently developed or vague. Purpose is not clear.

    Thesis is apparent and appropriate to purpose.

    Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

    Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

    Argument Logic and Construction

    5.0

    Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

    Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

    Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

    Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

    Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. NRS-440VN Health Care Delivery Models and Nursing Practice

    Mechanics of Writing (includes spelling, punctuation, grammar, language use)

    5.0

    Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

    Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

    Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

    Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

    Writer is clearly in command of standard, written, academic English.

    Paper Format (use of appropriate style for the major and assignment)

    2.0

    Template is not used appropriately, or documentation format is rarely followed correctly.

    Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

    Appropriate template is used. Formatting is correct, although some minor errors may be present.

    Template is fully used; There are virtually no errors in formatting style.

    All format elements are correct.

    Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) NRS-440VN Health Care Delivery Models and Nursing Practice

    3.0

    Sources are not documented.

    Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

    Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

    Sources are documented, as appropriate to assignment and style, and format is mostly correct.

    Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

    Total Percentage  
    100 NRS-440VN Health Care Delivery Models and Nursing Practice

  • NURS 6630 week 5 Assignment: Assessing and Treating Patients With Bipolar Disorder

    Week 5: Therapy for Patients With Bipolar Disorders

    Marcus, an 18-year-old high school senior, presents with symptoms of difficulty sleeping and feeling sad, which result in an initial diagnosis of depression. His mother later reports, however, that Marcus exhibits symptoms of irritability and risk-taking behaviors. (His little brother reported to his mother that they were driving over 90 miles an hour on the highway.) After further evaluation, Marcus’ psychiatric nurse practitioner diagnoses him with bipolar disorder.

    Cases like this are not uncommon with bipolar disorder, as initial assessments rarely provide all the information needed. In your role, as a psychiatric nurse practitioner, you must develop strategies for properly assessing and diagnosing these patients because treatments for bipolar disorder are significantly different than treatments for depression or other mood disorders.

    This week, as you examine bipolar therapies, you explore the assessment and treatment of patients with bipolar disorder. You also consider ethical and legal implications of these therapies.

    Learning Objectives

    Students will:

    Assess patient factors and history to develop personalized plans of bipolar therapy for patients

    Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring bipolar therapy

    Synthesize knowledge of providing care to patients presenting for bipolar therapy

    Analyze ethical and legal implications related to prescribing bipolar therapy to patients across the life span

    Learning Resources

    Required Readings
    (click to expand/reduce)

    Medication Resources
    (click to expand/reduce)

    Required Media
    (click to expand/reduce)

    Optional Resources
    (click to expand/reduce)

    Assignment: Assessing and Treating Patients With Bipolar Disorder

    Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.

    To prepare for this Assignment:

    Review this week’s Learning Resources, including the Medication Resources indicated for this week.

    Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy.

    The Assignment: 5 pages

    Examine
     Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder.
     You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

    At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

    Introduction to the case (1 page)

    Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

    Decision #1 (1 page)

    Which decision did you select?

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Decision #2 (1 page)

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Decision #3 (1 page)

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Conclusion (1 page)

    Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Note:
     Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

    Reminder
    : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at

    https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

    By Day 7

    Submit
    your Assignment.

    Submission and Grading Information

    To submit your completed Assignment for review and grading, do the following:

    Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.

    Click the 
    Week 5 Assignment Rubric 
    to review the Grading Criteria for the Assignment.

    Click the 
    Week 5 Assignment 
    link. You will also be able to “View Rubric” for grading criteria from this area.

    Next, from the Attach File area, click on the 
    Browse My Computer
     button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click 
    Open
    .

    If applicable: From the Plagiarism Tools area, click the checkbox for 
    I agree to submit my paper(s) to the Global Reference Database
    .

    Click on the 
    Submit
     button to complete your submission.

    Grading Criteria

    To access your rubric:

    Week 5 Assignment Rubric

    Check Your Assignment Draft for Authenticity

    To check your Assignment draft for authenticity:

    Submit your Week 5 Assignment draft and review the originality report.

    Submit Your Assignment by Day 7 of Week 5

    To participate in this Assignment:

    Week 5 Assignment

    What’s Coming Up in Week 6?

    Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

    Next week,
     you will continue to build on your assessment and treatment skills as you examine patients presenting with signs and symptoms consistent with anxiety and PTSD. You will also complete your Midterm Exam.

    Next Week

    To go to the next week:

    Week 6

  • NRS-440VN Topic 1 DQ 2

    Explain how health care reform has helped shift the focus from a disease-oriented health care system to one of wellness and prevention. Discuss ways in which health care will continue this trend and explain the role of nursing in supporting and facilitating this shift. In replies to peers, provide an example of wellness and prevention initiatives your organization or specialty area has in place.

    Lippincott Nursing center, (2010) indicated that the Institute of Medicine (IOM) report The Future of Nursing fundamentally symbolized a change in the delivery of the care system. There has been a shift in the method of health care delivery from sick or disease-oriented to wellness and prevention. The vision of IOM is to see the practice of nursing making changes in their mode of care to one that intentionally focus on wellness and disease prevention.

    According to Global Health, (2020) describes wellness as some key features that are both preventative also holistic, wellness is achieved when patients actively choices to make changes to their lifestyles. Nurses play a critical role in making this process a success, through educational initiatives patients will be empowered to take an active role in achieving wellness, this will improve the patient physical, mental spiritual, emotional, and social wellbeing. For example, the patient will be educated about the importance of improving physical health and things they can do to prevent aliment such as exercise, sleep and having a balanced diet. Another focus of the nurse is to engage in assisting patient in proactively getting involved in having preventative measure taken to identify any illness for example screening for breast cancer that will facilitate early treatment if same exist; or avoid smoking or stop if you have not already started, the use of condoms to prevent sexually transmitted diseases. Adopting these changes and more will see the improvement in the health of the population also enhance the quality of life and a sense of wellbeing.

     

    References

    Global Wellness. (2020). 
    What is wellness. 
    Retrieved from. 

    Home

    Lippincott Nursing Center. (2020). 
    Wellness promotion The Institute of Medicine’s Future of Nursing Report: Are Nurses Ready. 
    Retrieved from. 
    https://www.nursingcenter.com

     

     

    Topic 1 DQ 2

    The health care reform is changing and focusing its attention more on prevention than disease-oriented management.   The reason for that being is previously the focus was on disease-oriented health care system but due to the vast number of individuals living with a chronic disease. The chronic disease not only affects health and quality of life, but it is also the major driver of health care and therefore resulting in increased health insurance costs (Shiu, 2012).The health care reform shifting towards wellness and prevention is to keep health insurance more affordable.Since chronic diseases have been found to raise the cost of healthcare, the prevention of chronic disease will help lower health care.It minimizes frequent hospitalizations. Providing proper and adequate education to the public will help spread awareness.

    Primary care should be the foundation of healthcare. Before, there has been a transition in healthcare from focusing on disease-oriented etiologies to examining the interacting influences of factors rooted in culture, race/ethnicity, policy, and environment. Such a transition called for person/family-focused and community-oriented primary care services to be provided in a continuous and coordinated manner in order to meet the health needs of the population. Tha advancement in technology also helps in the primary care where in there has been more diagnostic tests whch helps in identifying diseases before it happens. (Shiu,2012). IOM Future of Nursing Report and Nursing

     

    Shiu, L. (2012). The impact of primary care:the focused review. 
    Scientifica Cairo
    .doi: 
    10.6064/2012/432892

  • Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder

    Bipolar Therapy

    Client of Korean Descent/Ancestry

    BACKGROUND INFORMATION

    The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

    Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

    She weights 110 lbs. and is 5’ 5”

    SUBJECTIVE

    Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”

    You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

    Genetic testing reveals that she is positive for CYP2D6*10 allele.

    Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.

    MENTAL STATUS EXAM

    The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

    The Young Mania Rating Scale (YMRS) score is 22

    RESOURCES

    § Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

    Decision Point One

    Select what you should do:

    Begin Lithium 300 mg orally BID

    Begin Risperdal 1 mg orally BID

    Begin Seroquel XR 100 mg orally at HS

    https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_04/index.html

    Assignment: Assessing and Treating Patients With Bipolar Disorder

    Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.

    To prepare for this Assignment:

    Review this week’s Learning Resources, including the Medication Resources indicated for this week.

    Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy.

    The Assignment: 5 pages

    Examine
     Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder.
     You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

    At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

    Introduction to the case (1 page)

    Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

    Decision #1 (1 page)

    Which decision did you select?

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Decision #2 (1 page)

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Decision #3 (1 page)

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Conclusion (1 page)

    Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.