Category: Nursing

Personality Disorders Decision Tree Case Study Assignment Example

Decision Tree: Personality Disorders

As described by the American Psychiatric Association (APA) (2013), ‘‘personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment’’. There are different types of personality disorders classified into three clusters. Cluster A individuals are described as the odd or eccentric, cluster B as the dramatic, emotional, or erratic and cluster C as the anxious or fearful. The purpose of this paper is to discuss the case study of a young woman with personality disorder. This Personality Disorders Decision Tree Case Study Assignment Example will explore threes decisions relating to differential diagnosis, psychotherapy and psychopharmacology based on the presented clinical manifestations.

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Decision One

The clinical manifestation presented in the case study are indicative of more than one personality disorder, specifically borderline personality disorder (BPD) and antisocial personality disorder (ASPD). Patients exhibits a fear of abandonment which aligns with BPD. The patient mentioned an interpersonal relationship involvement which she exhibited idolization for the man of her interest, and now is devaluing the man. This is also evident in BPD as outlined by diagnostic criteria set forth by the APA (2013).

My diagnosis for this patient is ASPD, because the client exhibits clinical manifestations of ASPD than BPD. One of the reasons that led me to the diagnosis of ASPD is the client’s lack of remorse. The client stole from a friend, instead of being sorry, client’s blames friend instead. Personality Disorders Decision Tree Case Study Assignment Example. Client exhibits lack of respect for social norm and failure to comply with the law as evidenced by more than one record of arrest. The client fails to upholding financial obligation and is deceitful. Client shows irresponsibility evidenced by inability to keep a job. These presentations are evident in clients with ASPD as outlined in the DSM-5.

The two personality disorders which are classified as cluster B personality disorders by the APA (2013) have clinical manifestations which overlap, thus needs to be ruled out as differential diagnoses for each other. As described on the DSM-5 diagnostic criteria, BPD and ASD have similar features of impulsivity, aggression and manipulative behaviors, which client exhibits in the case study. The differing manifestation between the two  is that in BPD, clients seek out interpersonal relationship, while ASPD client is unable to form any attachment to relationship. Clients with BPD exhibit self-mutilating behaviors and self-aggression, while in  ASPD,  aggression is directed on others. In ASPD clients are egocentric (also seen in narcisstic personality disorder), while BPD clients have a poor image of self Personality Disorders Decision Tree Case Study Assignment Example.

Decision Two

Since the client exhibits symptoms which are synonymous with one more than personality disorder, specifically borderline and antisocial; the best decision is to opt to conduct a psychological testing. This will to further help the practitioner to decipher between the two diagnoses or conclude that patient indeed has the two personality disorders which is a possible occurrence Personality Disorders Decision Tree Case Study Assignment Example. Psychological testing can be in the form of rating scales which includes questionnaires, checklists e.t c. According to Sadock, Sadock and Ruiz (2014), these scales are useful for monitoring patient overtime or to provide a comprehensive assessment information that was not obtained during a routine clinical interview.

There is limited evidence from existing literatures on the effectiveness of medications to target the core symptoms of ASPD. Khalifa et al. (2010) mentions that pharmacological interventions are not to be considered as monotherapy but as adjunctive intervention to target associated symptoms of ASPD such as depression, aggression etc.  The option of Haldol, an antipsychotic medication can be used to address aggression but does not treat the core features of the disorder such as lack of remorse, deceitfulness. Furthermore, the plethora of side effects known to be caused by the medication can increase noncompliance. Psychotherapy can be beneficial, but psychodynamic is not appropriate for this patient because it may require patient to address emotional states. Personality Disorders Decision Tree Case Study Assignment Example. According to Hesse (2010), probing about ‘feeling states’ is unhelpful because the ASPD client may have difficulty accessing such state and may become aggressive when made to confront personal shortcoming.

Decision Three

In decision three, the recommendation is for a group-based cognitive therapy. Latuda an antipsychotic can be used to treat aggression but not the core symptoms of ASPD. Dialectical behavioral therapy will be more appropriate in the client with BPD than in ASPD. The most cited effective psychotherapeutic approach used in ASPD is cognitive behavioral therapy (CBT). Personality Disorders Decision Tree Case Study Assignment Example. This approach helps the client address distorted beliefs about self, others and the world. CBT can be used to enhance social and intrapersonal functioning.

A group setting may be beneficial for these clients as they may be able to learn from others experience or information shared about self. Psychotherapy for ASPD should be met with skepticism, but Hesse (2010) suggested that approaches that includes employing moral reasoning, cognitive behavioral approach, applying a social information processing approach, and planning for relapse prevention should be used. Additionally, the clients need a high level of external structure that includes supervision of the patient and reinforcement of positive social behaviors to yield increased outcomes for ASPD clients (Hesse, 2010). Personality Disorders Decision Tree Case Study Assignment Example.

Ethical and Legal Considerations

Due to the clinical manifestation of ASPD, some clinicians believe that it is hopeless to treat ASPD clients due to their clinical manifestation of aggression, deceitfulness and manipulation. Clients tends to be noncompliant, fueling the clinician’s pessimism. Existence of pessimism can hinder practitioners from upholding the ethical principles to do no harm and to do the best for the patient to full capacity. Hatchet (2015), implores clinicians to turn to published studies to become more aware of treatment options and to avoid expert opinions or clinical myths in regards to treating clients with ASPD.  For these clients, autonomy may be purposely compromised to prevent harm to the patient and to others. This is seen in cases where patient refuse to comply with treatment plan or ordered into treatment and remain in treatment until deemed fit to come out of treatment.

Conclusion

It is essential for the practitioner to be knowledgeable about personality s disorder to effectively care for the patient. The practitioner should explore various options of medication, used to target accompanied symptoms. Psychotherapy, even though some might argue of its effectiveness, should not be ruled out. Assessment tools should be used to guide the clinicians, in diagnosing, especially with disorders that have overlapping symptoms Personality Disorders Decision Tree Case Study Assignment Example.

 

References

American Psychiatric Association. (2013
). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

Khalifa, N., Duggan, C., Stoffers, J., Huband, N., Völlm, B. A., Ferriter, M., & Lieb, K. (2010). Pharmacological interventions for antisocial personality disorder.
The cochrane database of systematic Reviews
, (8). Doi: 10.1002/14651858.CD007667.pub2

Hatchett, G. T. (2015). Treatment guidelines for clients with antisocial personality disorder.
Journal of mental health counseling, 37
(1). Retrieved from Walden University Database

Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)?
Biomed central medicine
,
8
(66). DOI: 10.1186/1741-7015-8-66

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.

 

Assignment: Decision Tree

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.

The Assignment:

Examine
Case 2
:
You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

Which Decision did you select?

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note:
Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Case #2

Anxiety disorder, OCD, or something else?

 

BACKGROUND

Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for.

Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.

His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”

Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.

 

OBJECTIVE

During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.

When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.

 

MENTAL STATUS EXAM

Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.

Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. Personality Disorders Decision Tree Case Study Assignment Example.

 

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 Generalized Anxiety Disorder (GAD)

 Obsessive Compulsive Disorder

 Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)

ANSWER CHOOSEN
:
Obsessive Compulsive Disorder

 

Decision Point Two

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Begin Zoloft 50 mg orally daily

Begin Fluvoxamine immediate release 25 mg orally at bedtime

Begin Fluvoxamine controlled release 100 mg orally in the morning

Discontinue Zoloft and begin Fluvoxamine controlled release 100 mg orally every morning In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this. Zoloft is FDA-approved to treat OCD in children. However, between ages 6 and 12, it should be started at 25 mg orally daily. If starting doses are too high, the child may experience side effects that he associates with the medication and as such, may refuse to take the medication. Starting at too high a dose can result in unfavorable side effects (gastrointestinal side effects are notable in this drug), and we can see that Tyrel is experiencing nausea and decreased appetite. In this case, it is recommended to wait to see if the side effects dissipate. Decreasing the dose to 12.5 mg orally daily for about 3 or 4 days, then going back to 25 mg orally daily may help to overcome the unfavorable side effects. If side effects persist, the PMHNP may need to consider switching to a different medication. Personality Disorders Decision Tree Case Study Assignment Example. Fluvoxamine controlled release is not FDA-approved for use in children with OCD (see “Special Populations: Children and Adolescents” in the Fluvoxamine monograph of Stahl’s
Prescriber’s Guide
for further details). Fluvoxamine 100 mg orally daily may not be tolerated in the morning secondary to the drug’s sigma-1 antagonist properties, which can cause sedation. Dosing of Fluvoxamine should be such that the larger dose is given in the evening to minimize daytime sedation. Personality Disorders Decision Tree Case Study Assignment Example It is also worth noting that nothing in the scenario tells us that the Zoloft will not be effective.

 

ANSWER CHOOSEN:
Begin Fluvoxamine immediate release 25

mg orally at bedtime

Client returns to clinic in four weeks

Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall. Personality Disorders Decision Tree Case Study Assignment Example.

She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.

She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.

 

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Increase Fluvoxamine to 50 mg orally at bedtime

Augment with an atypical antipsychotic such as Abilify

Augment treatment with cognitive behavioral therapy

 ANSWER CHOOSEN:
Increase Fluvoxamine to 50 mg orally at

bedtime

Guidance to Student

In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this. Personality Disorders Decision Tree Case Study Assignment Example.

Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.

At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.

Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Personality Disorders Decision Tree Case Study Assignment Example Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.

Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well.

 

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 31, “Child Psychiatry” (pp. 1253–1268)

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.

“Anxiety Disorders”

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder.
Journal of the American Academy of Child & Adolescent Psychiatry
,
51
(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf

 

McClelland, M., Crombez, M-M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study.
Journal of Pediatric Health Care
,
29
(5), 442–452. doi:10.1016/j.pedhc.2015.03.005

Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press.

  

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

 

SEE ATTACHECD DECISION TREE ASSIGNMENT EXAMPLE

Client returns to clinic in four weeks

Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.

She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while. Personality Disorders Decision Tree Case Study Assignment Example.

Client returns to clinic in four weeks

Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.

She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while. Personality Disorders Decision Tree Case Study Assignment Example.

NURS 8100 Week 11 Discussion 2: Advocating Through Policy Essay

Advocating Through Policy

As noted by Dr. Stanley and Dr. White in this week’s media presentation, professional nurses should be engaging in advocacy efforts to improve health and nursing practice through involvement in the policy process at the institutional, local, state, or federal levels. This array of possibilities for involvement provides opportunities for all nurses, regardless of time, or other possible constraints. Successful policy making is a collaborative effort, and one that commands mutual respect from all involved. Your involvement in policy making can lead to expanded opportunities as both a nurse leader and as a respected member of an interprofessional health care team.

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Note
: This Discussion provides a forum for discussing advocacy opportunities and honing your presentation skills in a small group setting.

To prepare for Advocating Through Policy:

Reflect on the insights offered by Dr. Stanley and Dr. White on engaging in advocacy through the policy process Advocating Through Policy Essay.

Identify a practice issue that is of interest to you and that could benefit from advocacy efforts through the policy process.

Consider the stakeholders and any special interest or professional organizations that would support your issue.

Develop a short, yet persuasive PowerPoint (up to 3 slides) as follows:

Identify the practice issue that would benefit from being addressed through the policy process

Represent the key stakeholders (i.e. use graphical images when possible)

Advocating Through Policy Essay

Propose one strategy for how a nurse could advocate for this issue

The PowerPoint should be succinct, visually appealing, and effective.

By Day 4 of Advocating Through Policy

Post
 your PowerPoint presentation.

Read
 a selection of your colleagues’ postings.

By Day 6 of Advocating Through Policy

Review each group member’s
 PowerPoint presentation and offer constructive feedback on:

Style and quality of the PowerPoint

Persuasiveness

Clarity

Representation of stakeholders, such as additional individuals/groups that could be included

Strategy proposal

Advocating Through Policy Essay

Return
 to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Rubric Detail

Select 
Grid View
 or 
List View
 to change the rubric’s layout.

Name: NURS_8100_Week11_Discussion2_Rubric

Excellent

Good

Fair

Poor

RESPONSIVENESS TO DISCUSSION QUESTIONDiscussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.

Advocating Through Policy Essay

6 
(20%)
 – 6 
(20%)

Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

Advocating Through Policy Essay

CONTENT KNOWLEDGE

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.

6 
(20%)
 – 6 
(20%)

Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.

Advocating Through Policy Essay

CONTRIBUTION TO THE DISCUSSION

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

Advocating Through Policy Essay

6 
(20%)
 – 6 
(20%)

Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING

6 
(20%)
 – 6 
(20%)

Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.

5 
(16.67%)
 – 5 
(16.67%)

Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

4 
(13.33%)
 – 4 
(13.33%)

Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.

0 
(0%)
 – 3 
(10%)

Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.

Advocating Through Policy Essay

Childhood psychosis decision tree – DSM–5 criteria

Guidance to Student

It is not always necessary to procure a consult with a psychologist. However, psychologists by virtue of their advanced training and licensure are able to conduct comprehensive psychological testing on clients more advanced than those tests that could be conducted by the psychiatric/mental health nurse practitioner. In this case, we would like to know if the poor academic performance was the result of an intellectual disability, versus poor premorbid intellectual functioning that is often seen in schizophrenia Childhood psychosis decision tree – DSM–5 criteria.

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In terms of treatment decisions, Clozapine is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). Childhood psychosis decision tree – DSM–5 criteria Clozapine 100 mg would most likely cause significant side effects that both the child and parents would find objectionable, thus making compliance an issue.

Although not FDA-approved for use in children, Lurasidone is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. Therefore, Lurasidone would be the best choice. Childhood psychosis decision tree – DSM–5 criteria. Additionally, Lurasidone may be the preferred antipsychotic, as it appears to have the least impact on body weight and lipid profile.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides. Childhood psychosis decision tree – DSM–5 criteria.

Family interventions are important as well, as they do have a positive benefit on symptom relapse and admission/readmission to the hospital. Family interventions should include teaching about the disease, medications, and anticipatory guidance.

                 Assgn 2 – WK10 (C)

Practicum: Decision Tree

Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia. Childhood psychosis decision tree – DSM–5 criteria.

                                                              
The Assignment:

Examine 
Case 3. 
You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

o
Which Decision did you select?

o
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Childhood psychosis decision tree – DSM–5 criteria.

o
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

 

Decision #2: Treatment Plan for Psychotherapy

o
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

 

Decision #3: Treatment Plan for Psychopharmacology

o
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different Childhood psychosis decision tree – DSM–5 criteria?

.
Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

 

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Case #3

A young girl with strange behaviors

 

BACKGROUND

Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie’s behavior has been difficult to manage, and they don’t know what to do Childhood psychosis decision tree – DSM–5 criteria.

 

SUBJECTIVE

Carrie’s parents report that they have concerns about her behavior, which they describe as sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real. Her behavior is calm and “passive.” Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it’s normal for younger children to have “imaginary friends,” but they feel that at Carrie’s age, she should have grown out of these behaviors. Carrie’s parents report that she has friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also reports that the people on television know when she is home and that they have certain shows “just for her.”

Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carrie’s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were “ok” in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie’s teachers had wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this did not happen. Now they are describing some regrets over this as Carrie seems “more lost than ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.

Carrie’s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also confides that her husband’s grandfather spent “a few years in the nut house.” When you probe further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?”

During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, “I don’t really have any. I don’t like those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states “no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.” When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. “My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I’m into witchcraft or something.”

When you ask Carrie about the homework assignment that you read, she explains that her teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”

 

OBJECTIVE

The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation/retardation apparent.

 

MENTAL STATUS EXAM

Carries is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as “good.” However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange “things that I talk to. They don’t scare me; they come to see me from another world.” No overt paranoia is appreciated. She does report delusions of reference (she believes that the people on TV play programs “just for her” and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation.

At this point, please discuss any additional diagnostic tests you would perform on Carrie.

 

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 Early Onset Schizophrenia

 Schizoaffective Disorder

 Schizotypal Personality Disorder

 

Answer Chosen:  

Early Onset Schizophrenia

 

Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

 

Refer for psychological testing

Begin Clozaril 100 mg orally daily

Begin psychotherapy using a psychodynamic approach

Guidance to Student

It is not always necessary to procure a consult with a psychologist. However, psychologists by virtue of their advanced training and licensure are able to conduct comprehensive psychological testing on clients more advanced than those tests that could be conducted by the psychiatric/mental health nurse practitioner. Childhood psychosis decision tree – DSM–5 criteria In this case, we would like to know if the poor academic performance was the result of an intellectual disability, versus poor premorbid intellectual functioning that is often seen in schizophrenia.

In terms of treatment decisions, Clozapine is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). Clozapine 100 mg would most likely cause significant side effects that both the child and parents would find objectionable, thus making compliance an issue. Childhood psychosis decision tree – DSM–5 criteria.

Although not FDA-approved for use in children, Lurasidone is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. Therefore, Lurasidone would be the best choice. Additionally, Lurasidone may be the preferred antipsychotic, as it appears to have the least impact on body weight and lipid profile.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.

Family interventions are important as well, as they do have a positive benefit on symptom relapse and admission/readmission to the hospital. Childhood psychosis decision tree – DSM–5 criteria. Family interventions should include teaching about the disease, medications, and anticipatory guidance.

 

Answer Chosen:

Refer for psychological testing

 

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Although there are no specific psychometric tests available for schizophrenia, the consulting psychologist administered a comprehensive psychological battery of tests in order to assess personality and cognitive functioning as well as to identify any underlying intellectual disabilities that could account for the difficulty Carrie is having in school. Tests administered included the Minnesota Multiphasic Personality Inventory; Kaufman Adolescent and Adult Intelligence Test; Rorschach test; Whitaker Index of Schizophrenic Thinking (WIST) test; Wide Range Achievement Test – 4th Edition (WRAT-4); and the Millon Adolescent Clinical Inventory (MACI). The consulting psychologist opined that early-onset schizophrenia was strongly suspected in this client. Childhood psychosis decision tree – DSM–5 criteria.

 

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

 

Begin Clozapine 100 mg orally daily

Begin family interventions

Begin Lurasidone 40 mg orally daily

Guidance to Student

Some authorities have suggested that psychodynamic psychotherapies can be effective in the treatment of schizophrenia, especially modern psychoanalysts. Psychotherapy definitely has a place in terms of helping individuals with schizophrenia (especially in the treatment of residual symptoms), but is not considered a first-line treatment for the disorder.

Although not FDA-approved for use in children, Lurasidone (Latuda) is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. In consideration of an antipsychotic, Lurasidone may be the preferred antipsychotic as it appears to have the least impact on body weight and lipid profile.

Haldol should be initiated at 0.5 mg orally daily, with a target dose of 0.05 to 0.15 mg/kg per day for psychotic disorders. It is generally considered to be a second-line drug after second-generation antipsychotics have been attempted/failed. Haldol can also cause significant weight gain and alter lipid profiles significantly.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.

                            Answer Chosen

Begin Lurasidone 40 mg orally daily

Guidance to Student

It is not always necessary to procure a consult with a psychologist. However, psychologists by virtue of their advanced training and licensure are able to conduct comprehensive psychological testing on clients more advanced than those tests that could be conducted by the psychiatric/mental health nurse practitioner. In this case, we would like to know if the poor academic performance was the result of an intellectual disability, versus poor premorbid intellectual functioning that is often seen in schizophrenia Childhood psychosis decision tree – DSM–5 criteria.

In terms of treatment decisions, Clozapine is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). Clozapine 100 mg would most likely cause significant side effects that both the child and parents would find objectionable, thus making compliance an issue.

Although not FDA-approved for use in children, Lurasidone is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. Therefore, Lurasidone would be the best choice. Additionally, Lurasidone may be the preferred antipsychotic, as it appears to have the least impact on body weight and lipid profile.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides Childhood psychosis decision tree – DSM–5 criteria.

Family interventions are important as well, as they do have a positive benefit on symptom relapse and admission/readmission to the hospital. Family interventions should include teaching about the disease, medications, and anticipatory guidance.

 

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 31, “Child Psychiatry” (pp. 1268–1283)

 

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author Childhood psychosis decision tree – DSM–5 criteria.

“Schizophrenia Spectrum and Other Psychotic Disorders”

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia.
Journal of the American Academy of Child & Adolescent Psychiatry
,
52
(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

 

Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology.
Academic Pediatrics
,
16
(6), 508–518. doi:10.1016/j.acap.2016.03.011

 

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools.
International Journal of Psychiatry in Medicine
,
50
(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872

Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press.

 

Required Media

Laureate Education (Producer). (2017b).
A young girl with strange behaviors
[Multimedia file]. Baltimore, MD: Author.
 Childhood psychosis decision tree – DSM–5 criteria.

Developing an Evidence-Based Practice (EBP) Question Essay Assignment

Introduction to the Evidence-Based Practice (EBP) Assignment

As a part of your practicum experience in this course, you will engage in a small-scale Evidence-Based Practice (EBP) Assignment. This project will enable you to apply many of the concepts presented in the Learning Resources; it provides an authentic learning experience to enhance your specialty area knowledge and support your growth as a scholar-practitioner.

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Select the following link for an overview of the full EBP Aassignment.

Document:
 Evidence-Based Practice (EBP) Assignment Overview (Word document)

The document includes due dates. You do not need to submit anything this week, but begin thinking about and planning for this project as soon as possible. You may wish to discuss it with your Practicum Mentor as well. 
Introduction to the Evidence-Based Practice (EBP) Assignment

Practicum: Planning Learning Objectives

The practicum experience allows you to develop and expand your advanced nursing knowledge and skills at the aggregate, organizational, or policy level. During week 1 you will submit two to three individual learning objectives that you wish to achieve during this practicum experience.  You should prepare a set of measurable learning objectives, using Bloom’s Taxonomy. Your Developing an Evidence-Based Practice (EBP) Question Essay Assignment practicum objectives should reflect your interest in expanding knowledge. They are not to include activities related to your DNP project. These objectives will be identified during your mentoring course (NURS 8700P, 8700, 8701).  Practice experiences should be designed achieve specific learning objectives related to the DNP Essentials and specialty competencies (AACN, 2006).

Your practicum objectives should include the following:

Two to three learning objectives using Bloom’s Taxonomy.

Description of how these objectives will expand your advanced nursing knowledge and skills at the aggregate, organizational, or policy level. Developing an Evidence-Based Practice (EBP) Question Essay Assignment.

Relationship of the learning objectives to the DNP Essentials.

NOTE: Learning objectives must be submitted using APA style. Points may be deducted for lack of references, writing style, and APA format. 
Introduction to the Evidence-Based Practice (EBP) Assignment

Submit by Day 7

Ensure that all of the necessary paperwork has been submitted and approved. Remember, final approval for your practicum experience must come from your Instructor, and your practicum may not begin until the required documentation has been submitted and you have received Instructor approval.

Reminder:

Begin keeping track of your practicum hours 
using the provided time log
. This time log needs to include the date, times (start and finish), total hours for the week, a brief description of what you did or observed during each time interval, and the objectives that are being addressed through your practicum activities. You can have more than one objective for each time interval. 
Introduction to the Evidence-Based Practice (EBP) Assignment

In addition, you will submit a journal entry (along with your time log) in Weeks 3, 7, and 11. Journal entries need to connect your previous professional experience with your practice, competencies/concepts in the program, and the literature. 
Introduction to the Evidence-Based Practice (EBP) Assignment

Submission and Grading Information

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

Please save your Practicum using the naming convention “WK1Practicum+last name+first initial.(extension)” as the name.

Click the 
Week 1 Practicum 
link.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK1Practicum+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. 
Introduction to the Evidence-Based Practice (EBP) Assignment

Practicum Learning Objectives Week 1

The practicum experience allows you to develop and expand your advanced nursing knowledge and skills at the aggregate, organizational, or policy level. During week 1 you will submit two to three individual learning objectives that you wish to achieve during this practicum experience.  You should prepare a set of measurable learning objectives, using Bloom’s Taxonomy. Your practicum objectives should reflect your interest in expanding knowledge. They are not to include activities related to your DNP project. These objectives will be identified during your mentoring course (NURS 8700P, 8700, 8701).  Practice experiences should be designed achieve specific learning objectives related to the DNP Essentials and specialty competencies (AACN, 2006). 
Introduction to the Evidence-Based Practice (EBP) Assignment

Your practicum objectives should include the following:

Two to three learning objectives using Bloom’s Taxonomy (4 points)

Description of how these objectives will expand your advanced nursing knowledge and skills at the aggregate, organizational, or policy level. (2 points)

Relationship of the learning objectives to the DNP Essentials. (2 points)

NOTE: Learning objectives must be submitted using APA style. Points may be deducted for lack of references, writing style, and APA format. Developing an Evidence-Based Practice (EBP) Question Essay Assignment.

Practicum: Journal Guidelines

You will submit your Clinical Time Log and Journal located in the Week 1 Learning Resources in Weeks 3, 7, and 11. Journal entries need to connect your previous professional experience with your practice, competencies/concepts in the program, and the literature. Your journal entry should be week-based and sequential so that all journal entries are contained in one file. 
Introduction to the Evidence-Based Practice (EBP) Assignment

Describe the observed activity (1point)

Using an evidence-based approach, analyze the problem, issue, or situation. Address questions posed in the weekly practicum pages if appropriate. (2 points)

Reveal how the real-world might mirror or diverge from program-related evidence, concepts, and/or theories. (2 points)

Time Log submission (1 point)

NURS 8410 Week 1: Developing a Focus in Your Specialty Area

As a nurse and a doctoral student, you have already developed a set of skills and the expertise that have enabled you to contribute to the nursing profession and to those you serve. Yet, your call to advanced practice warrants a deeper understanding of issues and approaches, particularly in your area of specialty practice. To practice at the highest level, you must be able to analyze a health care problem using reasoning, theory, research, and experience. Developing an Evidence-Based Practice (EBP) Question Essay Assignment.

As you move forward in this course, you will create an Evidence-Based Practice (EBP), in which you will evaluate the scientific foundations of a health care issue in your specialty area, apply effective practices, identify and evaluate outcomes, and develop new practice guidelines. This week, you will become familiar with the requirements of the EBP Assignment, which will be completed as part of your practicum experience. To help you prepare for your practicum, this week you reflect on your own potential for professional growth and create learning objectives to guide your experience. The EBP Assignment must be completed during this practicum experience and is not the same as your DNP project that you are developing with the guidance of your DNP faculty chair and committee in the mentoring courses.

Developing an Evidence-Based Practice (EBP) Question Essay Assignment Learning Objectives

Students will:

Formulate a EBP Assignment question incorporating theory, knowledge, research, reasoning, and nursing practice

Assess areas for professional growth within the practicum experience

Looking Ahead
You are required to keep a log of the time you spend related to your practicum experience. You can access your time log from the Welcome page in your Meditrek account. Please make sure to continuously input your hours throughout the term. Time logs are reviewed by your instructors in weeks 3, 7, and 11.

Photo Credit: ERproductions Ltd / Blend Images / Getty Images

Developing an Evidence-Based Practice (EBP) Question Essay Assignment Learning Resources

Note:
 To access this week’s required library resources, please click on the link to the Course Readings List, found in the 
Course Materials
 section of your Syllabus.

Required Readings

Terry, A. J. (2018). 
Clinical research for the doctor of nursing practice 
(3rd ed.). Burlington, MA: Jones & Bartlett Learning Developing an Evidence-Based Practice (EBP) Question Essay Assignment.

Chapter 2, “Developing the Researchable Problem”

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/dnp/Essentials.pdf

Jeffs, L., Beswick, S., Lo, J., Campbell, H., Ferris, E., & Sidani, S. (2013). Defining what evidence is, linking it to patient outcomes, and making it relevant to practice: Insight from clinical nurses. 
Applied Nursing Research
, 26, 105-109.

McCurry, M. K., Revell, S. M. H., & Roy, C. (2009). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. 
Nursing Philosophy, 11
(1), 42–52.

Melnyk, B.M., Fineout-Overhold, E., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: The seven steps of evidence-based practice. 
American Journal of Nursing
, 110(1), 51-53.

Note:
You will access this article from the Walden Library databases. Developing an Evidence-Based Practice (EBP) Question Essay Assignment

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. 
American Journal of Nursing, 110
(3), 58–61.

Note:
 You will access this article from the Walden Library databases.

Tschannen, D., Aebersold, M., Kocan, M., Lundy, F., & Potempa, K. (2015). Improving patient care through student leadership in team quality improvement projects. 
Journal Nursing Care Quality
, 30(2), 181-186.

Note:
 You will access this article from the Walden Library databases.

Vanderbilt University Center for Teaching. (2017) Bloom’s Taxonomy Retrieved from https://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/

Yensen, J. (2013). PICO Search Strategies. 
Online Journal of Nursing Informatics (OJNI)
, 17 (3). Available at http://ojni.org/issues/?p=2860

Document: 
Clinical Time Log and Journal (Word document)

Document: 
Literature Review Matrix (Word document)

Document: 
NURS 8410 Practicum Journal Template (Word document) Developing an Evidence-Based Practice (EBP) Question Essay Assignment

A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female

Practicum: Decision Tree

Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia.

The Assignment:

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Examine Case 3. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)

At each Decision Point, stop to complete the following:

· Decision #1: Differential Diagnosis

o
 Which Decision did you select?

o 
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o 
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

o
 Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

· Decision #2: Treatment Plan for Psychotherapy

o
 Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o 
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o
 Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

· Decision #3: Treatment Plan for Psychopharmacology

o 
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o
 What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o
 Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

. 
Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

Case #3  
A young girl with strange behaviors

 

BACKGROUND

Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie’s behavior has been difficult to manage, and they don’t know what to do.

SUBJECTIVE

Carrie’s parents report that they have concerns about her behavior, which they describe as sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real. Her behavior is calm and “passive.” Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it’s normal for younger children to have “imaginary friends,” but they feel that at Carrie’s age, she should have grown out of these behaviors. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female. Carrie’s parents report that she has friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also reports that the people on television know when she is home and that they have certain shows “just for her.”

Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carrie’s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female. Her grades were “ok” in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie’s teachers had wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this did not happen. Now they are describing some regrets over this as Carrie seems “more lost than ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.

Carrie’s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also confides that her husband’s grandfather spent “a few years in the nut house.” When you probe further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?”

During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, “I don’t really have any. I don’t like those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states “no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.” When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female. “My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I’m into witchcraft or something.”

When you ask Carrie about the homework assignment that you read, she explains that her teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”

OBJECTIVE

The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation/retardation apparent. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

MENTAL STATUS EXAM

Carries is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as “good.” However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange “things that I talk to. They don’t scare me; they come to see me from another world.” No overt paranoia is appreciated. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female. She does report delusions of reference (she believes that the people on TV play programs “just for her” and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation.

At this point, please discuss any additional diagnostic tests you would perform on Carrie.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Early Onset Schizophrenia

Schizoaffective Disorder

Schizotypal Personality Disorder

Answer Chosen:  

Early Onset Schizophrenia

Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Refer for psychological testing

Begin Clozaril 100 mg orally daily. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

Begin psychotherapy using a psychodynamic approach

Answer Chosen:

Refer for psychological testing

RESULTS OF DECISION POINT TWO

· 
 Client returns to clinic in four weeks

· 
 Although there are no specific psychometric tests available for schizophrenia, the consulting psychologist administered a comprehensive psychological battery of tests in order to assess personality and cognitive functioning as well as to identify any underlying intellectual disabilities that could account for the difficulty Carrie is having in school. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female. Tests administered included the Minnesota Multiphasic Personality Inventory; Kaufman Adolescent and Adult Intelligence Test; Rorschach test; Whitaker Index of Schizophrenic Thinking (WIST) test; Wide Range Achievement Test – 4th Edition (WRAT-4); and the Millon Adolescent Clinical Inventory (MACI). The consulting psychologist opined that early-onset schizophrenia was strongly suspected in this client.

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Begin Clozapine 100 mg orally daily

Begin family interventions. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

Begin Lurasidone 40 mg orally daily

Answer Chosen

Begin Lurasidone 40 mg orally daily

Guidance to Student

It is not always necessary to procure a consult with a psychologist. However, psychologists by virtue of their advanced training and licensure are able to conduct comprehensive psychological testing on clients more advanced than those tests that could be conducted by the psychiatric/mental health nurse practitioner. In this case, we would like to know if the poor academic performance was the result of an intellectual disability, versus poor premorbid intellectual functioning that is often seen in schizophrenia.

In terms of treatment decisions, Clozapine is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). Clozapine 100 mg would most likely cause significant side effects that both the child and parents would find objectionable, thus making compliance an issue. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

Although not FDA-approved for use in children, Lurasidone is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. Therefore, Lurasidone would be the best choice. Additionally, Lurasidone may be the preferred antipsychotic, as it appears to have the least impact on body weight and lipid profile.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.

Family interventions are important as well, as they do have a positive benefit on symptom relapse and admission/readmission to the hospital. Family interventions should include teaching about the disease, medications, and anticipatory guidance.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). 
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry 
(11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 31, “Child Psychiatry” (pp. 1268–1283)

American Psychiatric Association. (2013). 
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

· “Schizophrenia Spectrum and Other Psychotic Disorders”

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. 
Journal of the American Academy of Child & Adolescent Psychiatry
, 
52
(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. 
Academic Pediatrics
,
 16
(6), 508–518. doi:10.1016/j.acap.2016.03.011

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. 
International Journal of Psychiatry in Medicine
,
 50
(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872

Stahl, S. M. (2014). 
Prescriber’s Guide: Stahl’s Essential Psychopharmacology 
(5th ed.). New York, NY: Cambridge University Press.

 

Required Media

Laureate Education (Producer). (2017b). 
A young girl with strange behaviors 
[Multimedia file]. Baltimore, MD: Author. A young girl with strange behaviors decision tree case study – Carrie, 13-year-old Hispanic female.

NURS 8100 Week 1 Assignment: Introduction to the Evidence-Based Practice (EBP) Assignment

Introduction to the Evidence-Based Practice (EBP) Assignment

As a part of your practicum experience in this course, you will engage in a small-scale Evidence-Based Practice (EBP) Assignment. This project will enable you to apply many of the concepts presented in the Learning Resources; it provides an authentic learning experience to enhance your specialty area knowledge and support your growth as a scholar-practitioner Introduction to the Evidence-Based Practice (EBP) Essay Assignment.

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Select the following link for an overview of the full EBP Aassignment.

Document:
 Evidence-Based Practice (EBP) Assignment Overview (Word document)

The document includes due dates. You do not need to submit anything this week, but begin thinking about and planning for this project as soon as possible. You may wish to discuss it with your Practicum Mentor as well.

Practicum: Planning Learning Objectives

The practicum experience allows you to develop and expand your advanced nursing knowledge and skills at the aggregate, organizational, or policy level. During week 1 you will submit two to three individual learning objectives that you wish to achieve during this practicum experience.  You should prepare a set of measurable learning objectives, using Bloom’s Taxonomy. Your practicum objectives should reflect your interest in expanding knowledge. They are not to include activities related to your DNP project. These objectives will be identified during your mentoring course (NURS 8700P, 8700, 8701).  Practice experiences should be designed achieve specific learning objectives related to the DNP Essentials and specialty competencies (AACN, 2006). Introduction to the Evidence-Based Practice (EBP) Essay Assignment.

Your practicum objectives should include the following:

Two to three learning objectives using Bloom’s Taxonomy.

Description of how these objectives will expand your advanced nursing knowledge and skills at the aggregate, organizational, or policy level.

Introduction to the Evidence-Based Practice (EBP) Essay Assignment

Relationship of the learning objectives to the DNP Essentials.

NOTE: Learning objectives must be submitted using APA style. Points may be deducted for lack of references, writing style, and APA format.

Submit by Day 7 of Introduction to the Evidence-Based Practice (EBP) Assignment

Ensure that all of the necessary paperwork has been submitted and approved. Remember, final approval for your practicum experience must come from your Instructor, and your practicum may not begin until the required documentation has been submitted and you have received Instructor approval.

Reminder:

Begin keeping track of your practicum hours 
using the provided time log
. This time log needs to include the date, times (start and finish), total hours for the week, a brief description of what you did or observed during each time interval, and the objectives that are being addressed through your practicum activities. You can have more than one objective for each time interval.

In addition, you will submit a journal entry (along with your time log) in Weeks 3, 7, and 11. Journal entries need to connect your previous professional experience with your practice, competencies/concepts in the program, and the literature.

Submission and Grading Information

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

Please save your Practicum using the naming convention “WK1Practicum+last name+first initial.(extension)” as the name.

Click the 
Week 1 Practicum 
link.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK1Practicum+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.

To access your rubric:

Week 1 Practicum Rubric

Check Your Practicum Draft for Authenticity

To check your Practicum draft for authenticity:

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

Submit Your Practicum by Day 7

To submit your Practicum:

Week 1 Practicum

Introduction to the Evidence-Based Practice (EBP) Assignment

Practicum: Journal Guidelines

You will submit your Clinical Time Log and Journal located in the Week 1 Learning Resources in Weeks 3, 7, and 11. Journal entries need to connect your previous professional experience with your practice, competencies/concepts in the program, and the literature. Your journal entry should be week-based and sequential so that all journal entries are contained in one file.

Describe the observed activity (1point)

Using an evidence-based approach, analyze the problem, issue, or situation. Address questions posed in the weekly practicum pages if appropriate. (2 points)

Reveal how the real-world might mirror or diverge from program-related evidence, concepts, and/or theories. (2 points)

Time Log submission (1 point)

NURS 8410: 
Best Practices in Nursing Specialties

The following is an overview of the four Applications that are assigned in this course.

Evidence-Based Practice (EBP) Assignment

Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment (developed in Week 2)

In a 1- to 2-page paper, address the following:

Provide a summary of the selected practice issue in which the outcome is different from what would be expected according to the research literature. (
Note:
The issue you select must be suitable for completing the entire EBP Project.) Introduction to the Evidence-Based Practice (EBP) Essay Assignment.

Application 1 is due by 
Day 7
 of 
Week 2
.

Application 2: Laying the Foundation for New Approaches to Practice (developed in Weeks 4 and 5)

In a 3- to 5-page paper, include the following:

A brief summary of the currency of the science underlying the practices used to address your EBP Assignment issue

Possible causes of the difference in outcomes from what would be expected according to the research literature

The effect the EBP Assignment issue is having in practice

Current research evidence on new practices for addressing the EBP Assignment issue

A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue

Application 2 is due by 
Day 7
 of 
Week 5
.

Application 3: Becoming a Leader in the Translation of Evidence to Practice (developed in Weeks 6 and 7)

Write a 2- to 3-page paper that synthesizes:

Your vision of yourself as a leader—specifically:

How you would continue to increase your knowledge and awareness of financial, economic, and other concerns related to new practice approaches

How translating evidence would enable you to affect or strengthen health care delivery and nursing practice

How you would advocate for the use of new evidence-based practice approaches through the policy arena

Application 3 is due by 
Day 7 
of 
Week 7
.

Application 4: Planning for Change, Implementing and Evaluating EBP Assignments (developed in Weeks 8–10)

Write a 4- to 8-page paper that addresses the following:

Planning for Change

Analyze the impact of implementing change in your practice environment, including the factors that need to be considered regarding stakeholders and end users.

Summarize the methods you would use to ensure that those are adequately addressed.

Implementing EBP Assignments

Identify the desired outcomes of your EBP Assignment.

Describe any macro or micro systems issues that may inhibit implementation and strategies for resolving those issues. Introduction to the Evidence-Based Practice (EBP) Essay Assignment.

Explain how resolving your EBP Assignment issue will improve quality and patient safety.

Evaluating EBP Assignments

Describe evaluation strategies.

Formulate new practice guidelines based on the possible results of the evaluation of outcomes.

Describe, if appropriate, new standards of care relevant to the new practice guidelines.

Application 4 is due by 
Day 7
 of 
Week 10
.

Practicum: Journal Guidelines

You will submit your Clinical Time Log and Journal located in the Week 1 Learning Resources in Weeks 3, 7, and 11. Journal entries need to connect your previous professional experience with your practice, competencies/concepts in the program, and the literature. Your journal entry should be week-based and sequential so that all journal entries are contained in one file.

Describe the observed activity (1point)

Using an evidence-based approach, analyze the problem, issue, or situation. Address questions posed in the weekly practicum pages if appropriate. (2 points)

Reveal how the real-world might mirror or diverge from program-related evidence, concepts, and/or theories. (2 points)

Time Log submission (1 point)

NURS 8410 Week 1: Developing a Focus in Your Specialty Area

As a nurse and a doctoral student, you have already developed a set of skills and the expertise that have enabled you to contribute to the nursing profession and to those you serve. Yet, your call to advanced practice warrants a deeper understanding of issues and approaches, particularly in your area of specialty practice. To practice at the highest level, you must be able to analyze a health care problem using reasoning, theory, research, and experience.

As you move forward in this course, you will create an Evidence-Based Practice (EBP), in which you will evaluate the scientific foundations of a health care issue in your specialty area, apply effective practices, identify and evaluate outcomes, and develop new practice guidelines. This week, you will become familiar with the requirements of the EBP Assignment, which will be completed as part of your practicum experience. To help you prepare for your practicum, this week you reflect on your own potential for professional growth and create learning objectives to guide your experience. The EBP Assignment must be completed during this practicum experience and is not the same as your DNP project that you are developing with the guidance of your DNP faculty chair and committee in the mentoring courses.

Introduction to the Evidence-Based Practice (EBP) Essay Assignment Learning Objectives

Students will:

Formulate a EBP Assignment question incorporating theory, knowledge, research, reasoning, and nursing practice

Assess areas for professional growth within the practicum experience

Looking Ahead
You are required to keep a log of the time you spend related to your practicum experience. You can access your time log from the Welcome page in your Meditrek account. Please make sure to continuously input your hours throughout the term. Time logs are reviewed by your instructors in weeks 3, 7, and 11.

Photo Credit: ERproductions Ltd / Blend Images / Getty Images

Learning Resources

Note:
 To access this week’s required library resources, please click on the link to the Course Readings List, found in the 
Course Materials
 section of your Syllabus.

Introduction to the Evidence-Based Practice (EBP) Essay Assignment Required Readings

Terry, A. J. (2018). 
Clinical research for the doctor of nursing practice 
(3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 2, “Developing the Researchable Problem”

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/dnp/Essentials.pdf

Jeffs, L., Beswick, S., Lo, J., Campbell, H., Ferris, E., & Sidani, S. (2013). Defining what evidence is, linking it to patient outcomes, and making it relevant to practice: Insight from clinical nurses. 
Applied Nursing Research
, 26, 105-109.

McCurry, M. K., Revell, S. M. H., & Roy, C. (2009). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. 
Nursing Philosophy, 11
(1), 42–52.

Melnyk, B.M., Fineout-Overhold, E., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: The seven steps of evidence-based practice. 
American Journal of Nursing
, 110(1), 51-53.

Note:
 You will access this article from the Walden Library databases.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. 
American Journal of Nursing, 110
(3), 58–61.

Note:
 You will access this article from the Walden Library databases.

Tschannen, D., Aebersold, M., Kocan, M., Lundy, F., & Potempa, K. (2015). Improving patient care through student leadership in team quality improvement projects. 
Journal Nursing Care Quality
, 30(2), 181-186.

Note:
You will access this article from the Walden Library databases. Introduction to the Evidence-Based Practice (EBP) Essay Assignment.

Vanderbilt University Center for Teaching. (2017) Bloom’s Taxonomy Retrieved from https://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/

Yensen, J. (2013). PICO Search Strategies. 
Online Journal of Nursing Informatics (OJNI)
, 17 (3). Available at http://ojni.org/issues/?p=2860

Document: 
Clinical Time Log and Journal (Word document)

Document: 
Literature Review Matrix (Word document)

Document: 
NURS 8410 Practicum Journal Template (Word document)

Introduction to the Evidence-Based Practice (EBP) Essay Assignment

Assessing and treating pediatric clients with mood disorders decision tree case study

Assessment

Stahl (2013) argues that one of the best ways of understanding depressive symptoms among the pediatric clients defining them as a continuum. However, in the provided case, a diagnostic decision proves necessary for the purposes of defining the various needs and the reasons behind the treatment.  According to Vitiello (2012), it is important that medical professionals adapt the key screening questions with respect to depression whenever undertaking a psychiatric evaluation Assessing and treating pediatric clients with mood disorders decision tree case study. For instance, the screening interrogations for depression may entail either a sad or irritable mood as well as anhedonia.

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In the current assessment of the pediatric client, it will be important to come up with a connection and a highly confidential relationship with the child. In order to capture or rather bring on board the underlying psychopathology, the best strategy will entail gathering information from as many participants as possible. However, if it will be necessary to prioritize a single information source, the symptoms will have to be internalized in general, and most particularly the depressive ones. Indeed, depressive symptoms tend to be reported frequently by the children when compared to the assigned caregivers or teachers. Assessing and treating pediatric clients with mood disorders decision tree case study.

Poznanski & Mokros (1996) have argued for the need to bring families on board during the process of assessing pediatric clients with mood disorders. They base their arguments on empirical studies that have demonstrated that including family during this kind of assessment and diagnosis in general enhances the process of understanding, preventing as well as treating depressive disorders among children. In the current pediatric diagnosis, the family assessment will take into account quite a number of sociocultural elements that seem to end up influencing the presentation and description together with interpretation of the symptoms. Other than focusing only on problems, positive aspects will also be taken into account, since they will be of great relevance in the process of planning therapeutic approaches.

During the assessment, caution will be taken with regard to the difficulties associated with diagnosing pediatric patients as compared to adolescents and older adults. This is based on the fact that the diagnostic criteria adopted in the current century were purposefully meant for diagnosing the adult population rather than the children. Furthermore, the diagnostic approaches have neglected quite a number of developmental differences that exist between children and adults. Rao (2013) argues that despite the current diagnostic approaches serving the needs of the older adults, there are quite a number of symptoms that demonstrate little applicability among the youths. Some of these symptoms include excessive guilt and suicidal ideation among others. Moreover, recognition of depression among the children and adolescents is quite low as compared to the case of adults. This possibly arises from factors like symptom fluctuations, the reactions of moods and high levels of irritability among others. The diagram illustrates the assessment procedure, retrieved from
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462013000500004

Pharmacokinetic And Pharmacodynamic Processes

According to Magellan Health, Inc. (2013), every pediatric treatment addressing depression should be taken into account developmental aspects such as psychoeducation an family support among other risk behaviors. The current treatment will go the same way, though establishing clear objectives together with patients and their families will be one of the top priorities. This will not only  be meant for the acute treatment with respect to the current episode, but extending to consolidation and maintenance aspects as well as monitoring and preventing the possibilities of new episodes. Assessing and treating pediatric clients with mood disorders decision tree case study.

In the same way depression is managed and treated among the adults, the current pediatric treatment will encompass psychoeducation and support measures which will assist in addressing mild episodes more satisfactory with target on environemtal stressors. The treatments will bring on board physical activities that are particularly meant for symptomatology among the pediatric clients, with lower levels of intervention that have significant effects. However, if the symptoms emerge to be quite intense, the entire treatment process will have to adapt more specific strategies that will facilitate the same.

The pharmacological treatment to be adopted will address both the acute phase and possible cases of relapse and recurrences. The acute case phase will entail therapeutic activities such as crisis stabilization with respect to psychosis, other related cases of suicidal behavior and agitation. Effective management of the pediatric client will require the use of medication while at the same time enhancing social skills and support from the family. The primary objective in this case will be achieving mood stabilization, since this will see the patient realizing his optimal development with respect to emotional, cognitive and social aspects.

Poznanski & Mokros (1996) have argued that the choice of the suggested medication will be based on the available scientific evidence, the state of mood and the availability of either suicidal or psychotic symptoms. Other factors to be brought on board under the same will include how aggressiveness of the client, the potential side effects, patient’s history with regard to drug response as well as the family’s preference. To some extent, adjunctive treatment with bupropion may be adapted, though it will have to be indicated with high more caution basing on the risk that is associated with inducing a manic switch.

In all cases, pediatric patients express significant differences in physiology impacting on such aspects like drug absorption, distribution and metabolism among other related cases of elimination. Assessing and treating pediatric clients with mood disorders decision tree case study. Indeed, is these factors that will determine the medication process to prescribe to the client.

Drug Absorption

According to Bartelink (2006), drug absorption (DA) in pediatric patients is impacted on by the process through which the organ systems mature. The pediatric gastrointestinal tract is characterized by such aspects like high levels of gastric pH, minimized intestinal motility and low rate of bile acid synthesis. There are also those characteristics that speeding up DA such as a thinner stratum corneum and higher water content. This implies that the child will be administered drugs that are in line with the absorption factors of their gastrointestinal tract. For instance, the IM injections will be given through the water-soluble drugs since they do not precipitate at the junction; will dissolve in the system. Since the client has a high surface area to weight, he will be subjected to transdermal absorption. Assessing and treating pediatric clients with mood disorders decision tree case study.

Distribution

The volume of drug distribution significantly varies between children and adults, hence an important factor in determining medication for the client. As a pediatric patient, the client will be administered higher dose of drugs that are water soluble, since the bigger portion of his body weight is water.

Metabolism and Elimination

According to Al-Delaimy (2002), there is significant variation in metabolism and elimination of drugs among children and adults. For instance, the processes of oxidation, reduction and hydrolysis is quite high among pediatric patients as compared to adults, hence subjecting the client to medication that best suit the rate of his phase I metabolism. The same applies to phase II, which entails the processes of hydroxylation and conjugation. In addition to drugs, the client will be recommended for diet and special therapies that will positively alter metabolism and elimination of drugs administered to him.

Medical Decisions

Basing on the client’s pharmacokinetic and pharmacodynamic processes, there are three major decisions that will be made with regard to the medical decisions to prescribe to the child. These will include:

Use of Lithium Mood Stabilizers

The child can be prescribed traditional mood stabilizers by use of lithium medications. The choice of lithium will be based on the available empirical analysis, which has proven that the use of lithium has been effective in controlling mood disorders as well as preventing the recurrences of the same in future Assessing and treating pediatric clients with mood disorders decision tree case study. Therefore, the choice of this medication will be driven by the desire to achieve controlled mood disorders and further prevent the possible recurrences.

Antiseizure Medication

Brown (2000) argued that antiseizure medications were initially developed with the prime objective of combating epilepsy. Therefore, the adoption of antiseizure medication in the provided case will be guided by the positive effect they have always demonstrated on the symptoms of mood disorders. The adoption of this medication will have the objective of achieving mood-stabilization, acute treatment and getting rid of possible future occurrences of the mood disorder. Possibly, this decision will pave way for the adoption of two important drugs; valproate and carbamazepine.

Atypical Antipsychotics

According to Wladysiuk et al (2011), also known as new-generation antipsychotics, these drugs were initially developed with the aim of treating schizophrenia. Fortunately enough, these drugs have emerged more effective when treating mood disorders, just like in the current case of the African child. Similarly, prescribing atypical antipsychotics to the child will be aimed at stabilizing his moods as well as taking care of the associated acute symptoms, through risperidone and ziprasidone

Ethical Consideration

During the entire psychiatric medication, I expect  to come across ethical conflicts which will come into play between assisting the African child fully while at the same time respecting his autonomy optimally. As per the current situation, I will embark on respecting the client’s autonomy even if he may respond to the medication negatively.

 

References

Al-Delaimy, W. (2002). Hair as a biomarker for exposure to tobacco smoke.
 
Tobacco Control, 11
(3), 176. doi:http://dx.doi.org/10.1136/tc.11.3.176

Bartelink, I. H., Rademaker, C. M., Schobben, A. F., & van den Anker, J. N. (2006). Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations. 
Clinical pharmacokinetics
, 
45
(11), 1077-1097.

Brown, M. B. (2000). Diagnosis and treatment of children and adolescents with attention-deficit/hyperactivity disorder.
 
Journal of Counseling and Development : JCD, 78
(2), 195-203. Retrieved from
https://search.proquest.com/docview/219024311?accountid=45049

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from https://www.magellanprovider.com/media/11740/psychotropicdrugsinkids.pdf

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications
(4th ed.). New York, NY: Cambridge University Press.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.),
IACAPAP e-Textbook of Child and Adolescent Mental Health.
Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf

Wladysiuk, M., Araszkiewicz, A., Godman, B., Szabert, K., Barbui, C., & Haycox, A. (2011). Influence of patient co-payments on atypical antipsychotic choice in poland.
 
Applied Health Economics and Health Policy, 9
(2), 101-10. doi:http://dx.doi.org/10.2165/11318840-000000000-00000 Assessing and treating pediatric clients with mood disorders decision tree case study.

NURS 8100 Week 2 Discussion: Unintended Consequences of Health Care Reform Essay

Discussion: Unintended Consequences of Health Care Reform

The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.

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Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Unintended Consequences of Health Care Reform Essay. Yet becoming an accountable care organization may present a number of challenges.

This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered. Discussion: Unintended Consequences of Health Care Reform. Unintended Consequences of Health Care Reform Essay.

To prepare of Discussion: Unintended Consequences of Health Care Reform:

Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.

Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? Unintended Consequences of Health Care Reform Essay. What are the pros and cons associated with becoming an accountable care organization?

With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.

By Day 3 of Discussion: Unintended Consequences of Health Care Reform

Post
 a cohesive response that addresses the following:

In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.

Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession. Unintended Consequences of Health Care Reform Essay.

Read
 a selection of your colleagues’ postings.

By Day 6 of Discussion: Unintended Consequences of Health Care Reform

Respond
 to at least 
two
 of your colleagues in one or more of the following ways:

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library. Unintended Consequences of Health Care Reform Essay.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Note:
 Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.

Return
to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues. Discussion: Unintended Consequences of Health Care Reform Unintended Consequences of Health Care Reform Essay.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources. Discussion: Unintended Consequences of Health Care Reform

Rubric Detail

Select 
Grid View
 or 
List View
 to change the rubric’s layout.

Name: NURS_8100_Week2_Discussion_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

RESPONSIVENESS TO DISCUSSION QUESTIONDiscussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*. Unintended Consequences of Health Care Reform Essay

6 
(20%)
 – 6 
(20%)

Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

Unintended Consequences of Health Care Reform Essay

CONTENT KNOWLEDGE

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course. Discussion: Unintended Consequences of Health Care Reform

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.

6 
(20%)
 – 6 
(20%)

Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.

Unintended Consequences of Health Care Reform Essay

CONTRIBUTION TO THE DISCUSSION

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature. Discussion: Unintended Consequences of Health Care Reform

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

Unintended Consequences of Health Care Reform Essay

6 
(20%)
 – 6 
(20%)

Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas. Discussion: Unintended Consequences of Health Care Reform

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING

6 
(20%)
 – 6 
(20%)

Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints. Discussion: Unintended Consequences of Health Care Reform

5 
(16.67%)
 – 5 
(16.67%)

Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

4 
(13.33%)
 – 4 
(13.33%)

Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints. Discussion: Unintended Consequences of Health Care Reform

0 
(0%)
 – 3 
(10%)

Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints. Discussion: Unintended Consequences of Health Care Reform

Unintended Consequences of Health Care Reform Essay

Issues in Health Care Reform Essay
.

NURS 8100 Week 1: The Health Care System, Part 1

NURS 8100 Week 1 Discussion: Health Care Reform

Discussion: Health Care Reform

After much public and political debate, in March 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama. The PPACA is one of many health care reform efforts that have sought to correct key features of the U.S. health care system such as financing, service delivery, and care coordination. This week, you will examine the passage of PPACA as a milestone along the historical continuum of health care reform in the United States Issues in Health Care Reform Essay.

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To prepare:

Review this week’s Learning Resources and media presentation, reflecting on the evolution of health care in the United States and the public’s response to health care reform efforts historically and currently.

Consider: What principal features of the U.S. health care system helped or hindered the enactment of federal health reform in March 2010? What challenges were encountered? Issues in Health Care Reform Essay.

How do these conditions and/or challenges reflect characteristics of the policy process and the political environment?

By Day 3 of Discussion: Health Care Reform

Post
 a cohesive response that addresses the following:

Analyze at least one important feature of the U.S. health care system that is of particular interest to you. Explain why you think this feature is significant in terms of health policy and reform.

Describe one or more conditions or challenges specifically related to the passing of the PPACA. Explain how this exemplifies the nature of the policy-making process, and evaluate how it could relate to the question of why health reform in the United States has been so difficult.

Read
 a selection of your colleagues’ postings.

By Day 6 of Discussion: Health Care Reform

Respond
 to at least 
two
 of your colleagues in one or more of the following ways:

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Note:
 Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.

Return
 to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

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Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources. Discussion: Health Care Reform

NURS 8100 Week 1: The Health Care System, Part 1

The evolution of health care in the United States has been a roller-coaster story of good intentions that were often buffeted by economic and social change, compromised by special interests, and beset by passionate differences of opinion. The primary goals of health care reform have been fairly consistent: to increase access, lower costs, and improve quality. Many efforts to bring about change, however, have not resulted in policy. Why has this been such a challenge? What barriers have prevented reform efforts from being successful? Exactly how to fix the weaknesses of the current health care system continues to be an issue of public and political debate, and one which continues to be played out in the policy arena. Issues in Health Care Reform Essay.

This week, you will examine the history and evolution of health care and consider how health care financing has been central in shaping the current system. You also will examine provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA)—a groundbreaking attempt at reforming the U.S. health care system by the enactment of new policy.

Looking Ahead
In Week 2, you will begin an assignment that requires you to interview a policy maker Issues in Health Care Reform Essay. Due to the time-sensitive nature of getting on the desired individual’s schedule, you may wish to review this assignment now to begin thinking about who you might like to contact.

Objectives

Students will:

Analyze principal features of the U.S. health care system

Evaluate the policy process in relation to challenges for health care reform

Access online learning resources for professional growth and development

Learning Resources

Required Readings

Bodenheimer, T., & Grumbach, K. (2016). 
Understanding health policy: A clinical approach
 (7th ed.). New York, NY: McGraw-Hill Medical.

Chapter 1, “Introduction: The Paradox of Excess and Deprivation”This chapter introduces the concept of “excess and deprivation”—p eople receiving either too little or too much health care, which contributes to the weakness of the health care system.

Chapter 2, “Paying for Health Care”This chapter discusses the evolution of health care financing, including out-of–pocket payments, individual private insurance, employment-based insurance, and government-financed insurance.

Chapter 3, “Access to Health Care”This chapter focuses on financial and nonfinancial barriers to health care and concludes with influences to one’s health status unrelated to health care.

Chapter 4,“Paying Health Care Providers”This chapter provides information on how physicians and hospitals are paid. Issues in Health Care Reform Essay.

HealthCare.gov. (n.d.). 
Understanding the Affordable Care Act.
 Retrieved from http://www.hhs.gov/healthcare/rights/index.html

Posted by U.S. Department of Health & Human Services, this article provides an introduction to the Patient Protection and Affordable Care Act of 2010 (PPACA).

HealthCare.gov. (n.d.). 
Understanding the Affordable Care Act: About the law.
 Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html

Also posted by U.S. Department of Health & Human Services, this article focuses on specific provisions of the law and outlines how it will increase access to affordable health coverage.

In Week 1 of this course, you are required to subscribe to one of the health information services listed below. In preparation, review these different sites:

Agency for Healthcare Research and Quality. (2010). 
AHRQ PSNet Patient Safety Network
. Retrieved from http://psnet.ahrq.gov/

ModernHealthcare.com. (n.d.). 
Registration is free: The news is invaluable
. Retrieved from https://home.modernhealthcare.com/clickshare/addAccountFree.do

Robert Wood Johnson Foundation. (2011). 
Publications and research
. Retrieved from http://www.rwjf.org/?topicid=1318

The Commonwealth Fund. (2010). 
The Commonwealth Fun
d. Retrieved from http://www.commonwealthfund.org/

The Henry J. Kaiser Family Foundation. (2011). 
New & noteworthy
. Retrieved from http://www.kff.org/

Required Media

Laureate Education, Inc. (Executive Producer). (2011). 
Healthcare policy and advocacy: The policy process.
 Baltimore: Author.

Note: 
The approximate length of this media piece is 11 minutes.

In this media presentation, Dr. Kominski and Dr. Zelman discuss the policy process and provide an overview of the influence of policy on health care practices. Dr. Zelman also discusses the challenges of passing new policy and relates this to health care reform efforts Issues in Health Care Reform Essay.

 

Accessible player
 
–Downloads–
Download Video w/CC
Download Audio
Download Transcript

Optional Resources

Hammer, D., Phillips, B., & Schmidt, T. L. (2010). The intended and unintended consequences of health care reform. 
Healthcare Financial Management
, 
64
(10), 50–55.

Rettenmaier, A. J., & Saving, T. R. (2011, January 5). 
Reforming Medicare: The Affordable Care Act versus the Rivlin/Ryan proposal
. National Center for Policy Analysis. Retrieved from http://www.ncpathinktank.org/pub/ba736

Stephens, J. H., & Ledlow, G. R. (2010). Real health care reform: focus on primary care access. 
Hospital Topics
, 
88
(4), 98–106.

NURS 8100 Week 1 Assignment: Staying Current: Online Resources

Technology is providing increasingly rich and credible resources for staying abreast of the latest trends and issues in health care. Many recognized organizations provide regularly disseminated updates via their websites, and offer this information free to subscribers Issues in Health Care Reform Essay. As you proceed through the DNP program, you will find that receiving these updates will support your professional growth as a scholar practitioner.

To prepare:

Explore the following resources found inthis week’s Learning Resources:

AHRQ Patient Safety Network

Modern Healthcare Alerts

RWJ Nursing News Digest

The Commonwealth Fund

The Henry J. Kaiser Family Foundation

To complete:

Select one service and subscribe to receive e-mail alerts or updates.

Copy and paste your successful subscription notification into a Word document.

By Day 7

Submit
 the 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 
link.

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.

Rubric Detail

Select
Grid View
 or 
List View
 to change the rubric’s layout.

Name: NURS_8100_Week1_Discussion_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

RESPONSIVENESS TO DISCUSSION QUESTIONDiscussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.

Issues in Health Care Reform Essay

6 
(20%)
 – 6 
(20%)

Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

CONTENT KNOWLEDGE

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.

6 
(20%)
 – 6 
(20%)

Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course. Issues in Health Care Reform Essay

CONTRIBUTION TO THE DISCUSSION

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

Issues in Health Care Reform Essay

6 
(20%)
 – 6 
(20%)

Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING

6 
(20%)
 – 6 
(20%)

Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.

5 
(16.67%)
 – 5 
(16.67%)

Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

4 
(13.33%)
 – 4 
(13.33%)

Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.

0 
(0%)
 – 3 
(10%)

Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints. Issues in Health Care Reform Essay

NURS 8100 Week 2 Assignment 1: Issues in Health Care Reform (Interview)

Assignment 1: Issues in Health Care Reform (Interview)

According to the AACN (2006), “Political activism and commitment to policy development are central elements of professional nursing practice” (p. 13). Throughout this course, you will hone the skills and competencies required for this type of involvement in policy.

Research is an essential step in the process of acquiring the skills and competencies, and interviews are one form of research that can serve as a valuable source of information. Issues in Health Care Reform Essay. As such, this Assignment (which you will start this week, and submit by the end of Week 9) provides an opportunity for you to identify a health reform issue of interest and discuss the issue with a state or national politician (or their aide).

To prepare for Assignment 1: Issues in Health Care Reform (Interview):

Identify a state or national politician (state representative or legislator, senator, congressman, governor, etc.), or aide, whom you would like to interview regarding current issues in health care reform.

As soon as possible, contact the individual’s office to request a meeting. Keep in mind that it may be difficult to get on their calendar, so plan accordingly. You may conduct the interview in person or by phone.

In advance of the interview, ask yourself:

What health care policy issue is important to me personally?

What issue do I want to bring to this person’s attention?

With this in mind, develop your list of questions for the interview around your selected health policy issue. In addition, you may wish to include questions related to health care reform:

What are your constituents most concerned about regarding health care reform? Issues in Health Care Reform Essay.

What are the trade-offs associated with recent health care reform policy?

By Day 7 of Week 9 of Assignment 1: Issues in Health Care Reform (Interview)

To complete for Assignment 1: Issues in Health Care Reform (Interview):

Write a 3- to 4-page paper providing a summary and analysis of the interview and the health care reform issues you discussed.

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the 
Publication Manual of the American Psychological Association
 to ensure that your in-text citations and reference list are correct. Due by 
Day 7
 of 
Week 9. Assignment 1: Issues in Health Care Reform (Interview)

NURS 8100 Week 2: The Health Care System, Part 2

As addressed in Week 1, many different policies and reform efforts have influenced health care delivery over the past century. Consider for a moment the health care reform efforts during the 1960s and the implementation of Medicare and Medicaid. How did these reform initiatives become policy? What challenges do these programs face today? What problems did they solve, and what new problems have arisen?

The Centers for Medicare & Medicaid Services (CMS) continue to have a strong influence on the health care system and health care policy through financial incentives and reimbursement policies. For example, to improve continuity of care, Medicare is offering financial incentives to health care providers that become accountable care organizations.

This week, you will have an opportunity for an authentic experience as you bring a health care issue of concern to the attention of your state or national politician. Issues in Health Care Reform Essay. You will also consider the unintended consequences that may arise as a result of reform policy, such as the individual mandate.

Learning Objectives

Students will:

Analyze key health care reform legislation to determine positive results and potential unintended consequences

Assess reform-related issues for health care

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

Learning Resources for Assignment 1: Issues in Health Care Reform (Interview)

Note:
 To access this week’s required library resources, please click on the link to the Course Readings List, found in the 
Course Materials
 section of your Syllabus.

Required Readings for Assignment 1: Issues in Health Care Reform (Interview)

Bodenheimer, T., & Grumbach, K. (2016). 
Understanding health policy: A clinical approach
 (7th ed.). New York, NY: McGraw-Hill Medical.

Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”

Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”

McClellan, M. (2010). Accountable care organizations in the era of health care reform. 
American Health & Drug Benefits, 3
(4), 242–244. Issues in Health Care Reform Essay.

Note:
 You will access this article from the Walden Library databases.

The PPACA of 2010 encourages the formation of accountable care organizations (ACOs) to improve the quality and efficiency of health care delivery. An ACO is a group of health care providers who coordinate care for their Medicare patients and share the financial incentives of health care improvement gains.

Moore, K. D., & Coddington, D. C. (2010). Accountable care: The journey begins. 
Health Care Financial Management, 64
(8), 57–63.

Note:
 You will access this article from the Walden Library databases.

This article provides information on the importance of health care provider organizations taking steps to become accountable care organizations (ACOs) and provides examples of systems that have historically functioned in this capacity. The authors also provide steps for developing and transitioning to an ACO structure.

Institute of Medicine. (2010). 
The future of nursing: Leading change, advancing health.
 Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

This report discusses how nurses can and should play a fundamental role in meeting the challenges of increased demand for health care brought about by the implementation of the 2010 Affordable Care Act. In addition, it stresses the need for nurses to be partners with other health professionals and assume leadership roles in redesigning health care in the United States.

Institute of Medicine. (2010). 
Report brief: The future of nursing: Leading change, advancing health.
 Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

This report brief highlights the four key recommendations from the Robert Wood Johnson and Institute of Medicine 
The Future of Nursing: Leading Change, Advancing Health
report. The recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking. Issues in Health Care Reform Essay

HealthCare.gov. (n.d.). 
Understanding the Affordable Care Act
. Retrieved from http://www.hhs.gov/healthcare/rights/index.html

This website introduces the Affordable Care Act and presents the timeline for implementation of the various provisions of the Act.

HealthCare.gov. (n.d.). 
Understanding the Affordable Care Act: About the law
. Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html

Read the full Affordable Care Act law at this website. An overview of the law is also provided along with an outline of how the Affordable Care Act helps reduce health insurance costs.

Required Media for Assignment 1: Issues in Health Care Reform (Interview)

Laureate Education, Inc. (Executive Producer). (2011). 
Healthcare policy and advocacy: Reforming health care delivery: Accountable care organizations.
 Baltimore: Author.

Note: 
The approximate length of this media piece is 7 minutes.

In this media presentation, Dr. Kathleen White explains the structure of accountable care organizations (ACO) and discusses the benefits and challenges of becoming an ACO.

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Optional Resources for Assignment 1: Issues in Health Care Reform (Interview)

APRN Joint Dialogue Group Report. (2008). 
Consensus model for APRN regulation: Licensure, accreditation, certification & education.
 Retrieved from https://www.aacnnursing.org/Education-Resources/APRN-Education/APRN-Consensus-Model

Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for what, to whom, and how. 
JAMA: Journal of the American Medical Association, 304
(15), 1715–1716.

Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J. (2007). Creating accountable care organizations: The extended hospital medical staff. 
JHealth Affairs, 26,
 w44-w57. doi:10.1377/hlthaff.26.1.w44–57

McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put accountable care into practice. 
Health Affairs, 29
(5), 982–990. Issues in Health Care Reform Essay

Kaiser Health News. (2011). 
Accountable care organization proposed regulations: Resources
. Kaiser Family Foundation. Retrieved from http://www.kaiserhealthnews.org/Stories/2011/March/31/ACO-Documents-In-The-News.aspx Issues in Health Care Reform Essay

Policy process – Agenda Setting

NURS 8100 Week 3 Discussion: Agenda Setting

Discussion: Agenda Setting

A key aspect of the policy process is agenda setting. How do topics get on that agenda? Agenda setting requires the support of stakeholders to move the issue forward. In this week’s media presentation, Dr. Kathleen White outlines the policy process and discusses how to move issues into the policy arena through agenda setting. The ultimate goal is to gain the attention of leadership whether at the organizational, local, state, national, or international level.

ORDER A PLAGIARISM-FREE PAPER HERE

To prepare for NURS 8100 Week 3 Discussion: Agenda Setting:

Review this week’s media presentation, focusing on the insights shared by Dr. White and Dr. Stanley on agenda setting and identification of stakeholders. Policy process – Agenda Setting.

Brainstorm clinical practice issues that you believe are worthy of being on your organization’s systematic agenda.

Who are the stakeholders who would be interested in this clinical practice issue?

By Day 3 of NURS 8100 Week 3 Discussion: Agenda Setting

Post
 a cohesive response that addresses the following:

In the first line of your posting, identify the clinical practice issue you would like to see on your organization’s systematic agenda.

What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?

Read
 a selection of your colleagues’ postings.

By Day 6 of NURS 8100 Week 3 Discussion: Agenda Setting

Respond
 to at least 
two
 of your colleagues providing additional strategies for informing and persuading stakeholders. Include additional research evidence that supports the importance of their identified clinical practice issue.

Note:
 Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.

Return
 to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

NURS 8100 Week 3 Discussion: Agenda Setting Rubric Detail

Select 
Grid View
 or 
List View
 to change the rubric’s layout.

Name: NURS_8100_Week3_Discussion_Rubric

Excellent

Good

Fair

Poor

RESPONSIVENESS TO DISCUSSION QUESTIONDiscussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*. NURS 8100 Week 3 Discussion: Agenda Setting

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.

Policy process – Agenda Setting

6 
(20%)
 – 6 
(20%)

Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*. NURS 8100 Week 3 Discussion: Agenda Setting

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

CONTENT KNOWLEDGE

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course. NURS 8100 Week 3 Discussion: Agenda Setting

6 
(20%)
 – 6 
(20%)

Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course. NURS 8100 Week 3 Discussion: Agenda Setting

Policy process – Agenda Setting

CONTRIBUTION TO THE DISCUSSION

8 
(26.67%)
 – 8 
(26.67%)

Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.

7 
(23.33%)
 – 7 
(23.33%)

Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

Policy process – Agenda Setting

6 
(20%)
 – 6 
(20%)

Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas. NURS 8100 Week 3 Discussion: Agenda Setting

0 
(0%)
 – 5 
(16.67%)

Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING

6 
(20%)
 – 6 
(20%)

Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.

5 
(16.67%)
 – 5 
(16.67%)

Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

4 
(13.33%)
 – 4 
(13.33%)

Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.

0 
(0%)
 – 3 
(10%)

Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.

Policy process – Agenda Setting