See Below

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Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.

Discussion post ( question to answer)

Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice( PHMNP) area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.

D-Case Study

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due 10-16-23@10am

WK10

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Be sure to provide 5 APA citations of the supporting evidence-based peer-reviewed articles you selected to support your thinking.

Please be sure to follow EACH AND EVERY BULLET POINT.

Make sure to ANSWER EACH QUESTION ACCURATELY.

(TOPIC: In Attachment**)

***Please be sure to include all information from the attachment in the assignment*****

Please use the template attached to complete the assignment.

*****PLEASE VIEW THE VIDEO, AND FOLLOW THE GUIDELINES ATTACHED*********

USE TEMPLATE ATTACHED*****

PLEASE INCLUDE THE FOLLOWING

***INTRODUCTION

***CONCLUSION

***LABS AND THE REASON FOR THEM

***DSM Diagnosis 

https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x01_Neurodevelopmental_Disorders

powerpoint

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1: Title • Title: Understanding Asthma and COPD

• Subtitle: Essential Knowledge for Nurse Practitioners 

2: Introduction

• Brief overview of the importance of Anti-inflammatory Drugs (Glucocorticoids) and Bronchodilators in healthcare. 

• Mention the aim of the presentation: to provide an understanding of different types of Anti-inflammatory Drugs (Glucocorticoids) and Bronchodilators and their clinical applications. 

3: Management of asthma and COPD 

• Classification of asthma severity 

• Classification of COPD (air flow limitation severity)

4: Types of drug treatments

• Detail the two main categories: Oral and Inhaled Anti-inflammatory drugs (Glucocorticoids) and bronchodilators 

• Mention common examples from each category. 

5: Oral Anti-inflammatory drugs (Glucocorticoids, phosphodiesterase-4 inhibitors) and bronchodilators (Methylxanthine)

• Discuss commonly used oral Glucocorticoids like Prednisone, Montelukast, Roflumilast and Theophylline.

• Emphasize their indications, dosages, and monitoring requirements.

6: Inhaled Anti-inflammatory drugs (Glucocorticoids) and bronchodilators (Anticholinergic, b2 adrenergic agonist)

• Explain the use of inhaled drugs such as Beclomethasone, Cromolyn, Ipratropium, Tiotropium, and Albuterol, Salmeterol.

• Describe when and how these are administered (types of inhalation devices, Meter-dose inhalers, dry-powder inhaler, and nebulizers). 

7: Anti-inflammatory drugs (Monoclonal antibodies) 

• Highlight the benefits and considerations (Blackbox warning) of Omalizumab

8: Monitoring and Safety 

• Discuss the importance of regular monitoring therapy. 

• Address safety concerns.

10: Patient Education 

• Provide key points for patient education regarding Anti-inflammatory drugs (Glucocorticoids) and bronchodilators therapy.

• Emphasize compliance.

11: Conclusion 

• Summarize key takeaways from the presentation.

• Reiterate the importance of nurse practitioners’ role in managing Asthma and COPD therapy. 

12 Resources

• Provide references and recommended readings for further learning.

The group PPT should have a minimum of 20 slides and no more than 40 with speaker notes. (Including group members, outline, reference page). Reference and citations must be in APA format 6th or 7th Ed. 

The presentation should be directed to the pharmacological management of the disease. It should include the following: Drug indications, drug classification, generic name and most common brand name, mechanism of action, side effects, drug interactions, use of the drug in different populations and important pearls.

PLEASE CLICK ON LINKS TO ANSWER QUESTIONS

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Assignment: National Patient Safety Goal

This assignment will be done in the classroom with discussion to follow.

1.  Read the following chapter from the book, “Patient Safety and Quality: An Evidence-Based Handbook for Nurses” and provide a brief overview.

https://www.ncbi.nlm.nih.gov/books/NBK2681/

2.  List the National Patient Safety Goals from the Joint Commission’s website appropriate to the long-term care environment and what precautions should the nurse take relative to EACH safety goal? 

https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_alc_jan2022.pdf

3.  From the book, “Patient Safety and Quality: An Evidence-Based Handbook for Nurses,” select one other chapter to read and provide a brief overview.  Apply the main concepts to the long-term care facility environment.  This could be a situation from work or from school or a personal experience. 

http://www.ahrq.gov/qual/nurseshdbk/

4.  Select a Speak Up brochure developed by The Joint Commission. Follow this link to the proper website: https://www.jointcommission.org/topics/speak_up_campaigns.aspx and answer the following questions.

a.  Identify the brochure you chose and the demographic it applies to. Who else can utilize this information?

b.  Why is the brochure you chose important?

c.  What was done well? What could be improved?

d.  How will patient safety be improved from the chosen brochure?

e.  Discuss how current nursing or healthcare-related research supports the information presented in the brochure.

Title

Assignment:  National Patient Safety Goal

Put X in box to correspond with the SLO (s)

Put X in box to correspond with the Competency (s)

Knowledge/Practice/Ethical Comportment

K

P

E

Student Learning Outcome(s)

Patient-Centered Care

Communication Skills

 

Nursing Process

Learning Needs

Technology

Documentation

Informatics

Nursing Judgment

Prioritization

Nursing Judgment

Professionalism

Professionalism

Ethical/Legal

Quality Improvement

Patient Care Concerns

Systems

Safety

x

Patient Complications

Safe Nursing

x

x

x

Teamwork/Collaboration

Communication

Conflict Recognition 

Managing Care 

Managing Care of the Individual Patient

Assign/Monitor 

Where should this assignment be used:

Classroom

X

Clinical Setting

X

Independent Study

X

Online/Web Based

X

Skills Lab

Simulation

 

Revised from Linda Caputi © (What type of assignment is this?)

Patient Care Assignment

Non-Patient Care Assignments

Patient Care

The assignments are related to the student while providing patient care in the clinical setting.
Example:  Concept mapping care for one or multiple patients. 

Thinking Focused
Assignments encourages critical thinking and clinical reasoning and teaches students to think like a nurse.

Patient Focused

The student focuses on specific aspects of patient care such as safety, falls, diabetes, other diseases, etc.

Systems Focused

Assignments help the student understand the clinical world, the nurse’s work therein, and the effect of the system on the nurse and the patient.
Example:  How the system completes medication administration from order to delivery to patient.  

x

x

x

Theoretical and Scientific Foundations of Nursing

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FRAMING A PRACTICE PROBLEM AS A CRITICAL QUESTION WITH MEASURABLE OUTCOMES

Throughout this course you have focused on practice problems to address in applying nursing and interdisciplinary theories, and in the  application of evidence-based practice for quality improvement. This week you begin exploring the components of evidence-based practice by framing a practice problem as a critical question. You will begin a search of the literature for evidence to answer the question and inform a practice change for quality improvement.

Respond to  two of your colleagues  by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues.

PEER #1


Shaunagay Kenney

Week 7 Discussion Main Post

A Critical Question with Measurable Outcomes

Question: Will adding pharmacological interventions to nonpharmacological treatments improve post-traumatic stress disorders in adults?

Article Selection

A total of six articles were discovered and appraised using the “Adapted Rating System for the Hierarchy of Evidence” (Dang & Dearholt, 2017; Fineout-Overholt et al., 2010). The type of article and information that supported the purpose statement were used in the selection process.

Critical Question Explanation

            Post-traumatic stress disorder (PTSD) has long been associated with military members

exposed to combat. Before PTSD was coined, Charles Myers used shell “shock” to describe injured soldiers during World War I (Horwitz, 2018). According to Friedman (2019), PTSD is defined as direct or indirect exposure to a traumatic event where a person is severely traumatized based on that event. According to the National Center for PTSD (2021), 60% of men and 50% of women will experience at least one traumatic event in their lives, 6% of the population will have PTSD at some point in their lives, and about 15 million adults have PTSD during a given year. For most individuals, psychotherapy is a sufficient treatment for PTSD, but not for others. Could pharmacological interventions assist individuals where psychotherapy alone does not work?       

Article Synthesis

            For some individuals, psychotherapy alone does not work. Similarly, pharmacological use alone can be ineffective (Raskind et al., 2018; Rasmusson et al., 2017). However, combining SSRIs or other medications with CBT or other therapies may reduce PTSD symptoms in some individuals (Mithoefer et al., 2019; Wagner et al., 2017). Mithoefer et al. (2019) found that MDMA- assisted psychotherapy effectively treated PTSD. According to Wagner et al. (2017), MDMA increases oxytocin, facilitates openness, and enhances the therapy's effectiveness. In the prolonged exposure and sertraline trial conducted by Rauch et al. (2020), PTSD subjects were given strict instructions on collecting their saliva for testing. They made a ground-breaking discovery about cortisol, finding that cortisol levels were lower in individuals with PTSD than those without PTSD (Rauch et al., 2020). Not only was this discovery made, but following the combination treatment of sertraline and prolonged exposure, significant improvements were noted for one year (Rauch et al., 2019). While combining psychotherapy with some drugs improved PTSD symptoms, others did not.

References

Dang, D., & Dearholt, S. (2017). 
Johns Hopkins nursing evidence-based practice: Model and     guidelines (3rd ed.). Sigma Theta Tau International.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B. & Williamson, K. M. (2010). Critical   

           appraisal of the evidence: Part I. 
American Journal of Nursing, 110(7), 47-52. 

https://doi.org/10.1097/01.NAJ.0000366056.06605.d2Links to an external site.

Friedman, M. J. (2019, October 14). 
PTSD History and Overview. U.S. Department of Veterans Affairs. 

https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.aspLinks to an external site.

Horwitz, A. (2018). 
PTSD: A short history. Johns Hopkins University Press

Mithoefer, M. C., Feduccia, A. A., Jerome, L., Mithoefer, A., Wagner, M., Walsh, Z., Hamilton,     S., Yaza-Klosinski, B., Emerson, A., & Doblin, R. (2019). MDMA-assisted psychotherapy for treatment of PTSD: Study design and rationale for phase 3 trials based   on pooled analysis of six phase 2 randomized controlled trials. 
Psychopharmacology,            236(9), 2735-2745. 

https://doi.org/10.1007/s00213-019-05249-5Links to an external site.

PTSD: National Center for PTSD. (2021, September 10). 
How common is PTSD in adults? U.S.       Department of Veterans Affairs.        

https://www.ptsd.va.gov/understand/common/common_adults.aspLinks to an external site.

Raskind, M. A., Peskind, E. R., Chow, BB., Harris, C., Davis-Karim, A., Holmes, H. A., Hart, K.    L., McFall, M., Mellman, T. A., Reist, C., Romesser, J., Rosenheck, R., Shih, M. C.,           Stein, M. B., Swift, R., Gleason, T., Lu, Y., & Huang, G. D. (2018). Trial of prazosin for     post-traumatic stress disorder in military veterans. 
The New England Journal of         Medicine, 378(6), 507-517. 

https://doi.org/10.1056/NEJMoa1507598Links to an external site.

Rasmusson, A. M., Marx, C. E., Jain, S., Farfel, G. M., Tsai, J., Sun, X., Geracioti, T. D.,    Hamner, M. B., Lohr, J., Rosse, R., Summerall, L., Naylor, J. C., Cusin, C., Lang, A. J.,         Raman, R., & Stein, M. B. (2017). A randomized controlled trial of ganaxolone in   post-traumatic stress disorder
. Psychopharmacology, 234(15), 2245-2257.            

https://doi.org/10.1007/s00213-017-4649-yLinks to an external site.
 

Rauch, S. A. M., Kim, M., Powell, C., Tuerk, P. W., Simon, N. M., Acern, R., Allard, C. B.,         Norman, S. B., Venners, M. R., Rothbaum, B. O., Stein M. B., Porter, K., Martis, B.,            King, A. P., Liberzon, I., Luan Phan, K., & Hoge, C. W. (2019). Efficacy of prolonged        exposure therapy, sertraline hydrochloride, and their combination among combat veterans             with post-traumatic stress disorder. 
JAMA Psychiatry, 76(2), 117-126.             

https://doi.org/10.1001/jamapsychiatry.2018.3412Links to an external site.

Rauch, S. A. M., King, A., Kim, H. M., Powell, C., Rajaram, N., Venners, M., Simon, N. M.,   Hamner, M., & Liberzon, I. (2020). Cortisol awakening response in PTSD treatment:     Predictor or mechanism of change. 
Psychoneuroendocrinology, 118, 1-16.             

https://doi.org/10.1016/j.psyneuen.2020.104714Links to an external site.

Wagner, M. T., Mithoefer, M. C., Mithoefer, A. T., MacAulay, R. K., Jerome, L., Yazar-      Klosinski, B., & Doblin, R. (2017). Therapeutic effect of increased openness:  Investigating mechanism of action in MDMA-assisted psychotherapy. 
Journal of  Psychopharmacology, 31(8), 967-974. 

https://doi.org/10.1177%2F0269881117711712Links to an external site.

PEER # 2

Samir Moneer Nawaf Hamed

 

Critical Question: Nursing burnout and its impact on nurses and patient care.

Nursing burnout is a state of emotional, physical, and mental exhaustion resulting from prolonged and intense stress in the nursing profession. It significantly impacts nurses by causing increased job dissatisfaction, higher turnover rates, and adverse mental and physical health effects (Mudallal et al., 2017). Moreover, burnout has a direct and detrimental impact on patient care, leading to decreased quality, increased medical errors, and reduced patient satisfaction due to compromised nurse-patient interactions and reduced attention to detail (Garcia et al., 2019). Addressing nursing burnout is crucial for maintaining a resilient nursing workforce and ensuring high-quality patient care outcomes.

Synthesis of Scholarly Articles

1. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis

This study comprehensively analyzed existing research and found compelling evidence that burnout among healthcare professionals significantly impairs patient safety. The meta-analysis synthesized data from multiple studies, revealing a strong association between burnout and increased risks of medical errors, compromised quality of care, and adverse patient outcomes, highlighting the critical importance of addressing burnout as a crucial factor in ensuring patient safety in healthcare settings (Garcia et al., 2019).

2. Relationship between nurse burnout, patient and organizational outcomes: Systematic review

This study examined a broad range of studies and revealed a clear and intricate relationship between nurse burnout, patient outcomes, and organizational effects. It found that higher levels of nurse burnout are consistently linked to adverse patient outcomes such as increased mortality rates, longer hospital stays, and decreased patient satisfaction. Additionally, burnout has detrimental organizational consequences, including higher nurse turnover and lower overall workplace performance. This study underscores the interconnectedness of nurse well-being, patient care quality, and organizational success, emphasizing the urgency of addressing burnout to improve healthcare outcomes and workplace environments (Jun et al., 2021).

3. Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries

This study conducted a comprehensive cross-national analysis and identified a consistent and alarming pattern: nurse burnout substantially negatively impacts the quality of patient care across different healthcare systems and countries. The study's findings highlighted that high levels of nurse burnout were associated with lower perceptions of care quality among both nurses themselves and patients. This suggests that addressing nurse burnout is imperative not only for the well-being of healthcare professionals but also for maintaining and improving the quality of care delivered in diverse healthcare settings globally (Poghosyan et al., 2021).

4. Association of resident fatigue and distress with perceived medical errors

This study demonstrates a significant correlation between resident physician fatigue and distress levels and the perception of medical errors. The research findings suggest that higher levels of resident fatigue and distress are associated with increased instances of perceived medical errors. This indicates that addressing the well-being and mental health of healthcare providers, including reducing fatigue and distress, can play a crucial role in improving patient safety and reducing the likelihood of medical errors in healthcare settings, emphasizing the need for interventions and policies aimed at mitigating these factors to enhance patient care quality. (West, 2019)

Value for Stakeholders

Addressing nursing burnout is a moral imperative and a strategic quality improvement initiative. The identified articles provide compelling evidence that nurse burnout directly impacts patient satisfaction, healthcare outcomes, and organizational effectiveness (Mudallal et al., 2017). By investing in interventions to reduce burnout, healthcare organizations can enhance patient care quality, increase staff retention, reduce medical errors, and ultimately improve their bottom line. Moreover, addressing nursing burnout aligns with the mission of healthcare organizations to deliver safe, effective, and patient-centered care, enhancing their reputation and competitiveness in the healthcare industry (Jun et al., 2021).

 

References

Garcia, C. de L., Abreu, L. C. de, Ramos, J. L. S., Castro, C. F. D. de, Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019, August 30). Influence of burnout on Patient Safety: Systematic Review and meta-analysis. Medicina (Kaunas, Lithuania). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780563/

Jun, J., Ojemeni, M., Kalamani, R., Crecelius , M., & Tong , J. (2021, March 26). Relationship between Nurse Burnout, patient and organizational outcomes: Systematic review. International Journal of Nursing Studies. https://www.sciencedirect.com/science/article/abs/pii/S0020748921000742

Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017, January 1). Nurses’ burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry : a journal of medical care organization, provision and financing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/

Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H. (2021, August). Nurse Burnout and quality of care: Cross-national investigation in six countries. Research in nursing & health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908908/#:~:text=Across%20countries%2C%20higher%20levels%20of,quality%20of%20care%20in%20hospitals.

West, C. (2019, September 23). Association of resident fatigue and distress with perceived medical errors. JAMA. https://jamanetwork.com/journals/jama/article-abstract/184625

Respiratory

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Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities, and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. Add questions to paper

CASE STUDY: 
Asthma

 

Patient Profile:

    Miss Winters, age 25, comes to the emergency department with severe wheezing, dyspnea, and anxiety. She was in the ED only 6 hours ago with an acute asthma attack, which resolved with nebulized albuteral treatments.

 

Subjective Data:

-Admits to use of albuterol inhaler several times weekly for the last few months 

-Asthma symptoms occasionally awaken her at night (about 3 times a week), and she has cancelled several outings with her family due to her symptoms

          -Can now only speak in one to three word sentences

          -Is allergic to cigarette smoke

-Began to experience increased shortness of breath and chest tightness when she returned home

-Used albuterol inhaler repeatedly at home without relief

-History of pruritic skin lesions that have come and gone since childhood.

 

Objective Data:

            Physical Examination:

                -Using accessory muscles to breath

             -Audible inspiratory and expiratory wheezing to auscultation with no air movement in lower lobes of l

                     lungs

             -HR = 126/min; Resp = 40/min

             -Areas of dry, scaling skin in antecubital areas bilaterally with evidence of scratching

            
Diagnostic Studies:

                        ABGs: PO2  = 80 mm Hg

                                    PCO2  = 35mm Hg

                                    HCO3  = 24 mEq/L

                                    pH = 7.48

                        PEFR: 150 L/min (Personal best: 400 L/min)

                        Continuous pulse oximetry: 82-85

 

CRITICAL THINKING QUESTIONS:

 

1. Why did Ms. W. return to the ED? Explain the pathophysiology of this second exacerbation of asthma.

 

2. Describe the progression of breath sounds auscultated from early in an asthma attack through very severe respiratory impairment. How do the sounds change as the patient improves?

 

3. What is the significance of her dry, scaling, pruritic skin lesions? What is your diagnosis (no nursing dx please)? How do these types of lesions relate to asthma? What is their physiologic cause ?

 

4. Analyze the ABG. What type of acid-base disorder is present? Why? Is there any compensation?

 

5. Discuss the four categories of asthma diagnosis advocated in the 
Guidelines for the Diagnosis and Management of Asthma from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Which classification best describes Ms. W.'s asthma?

 

6. According to the asthma treatment guidelines from #5: the “Step up-Step down” approach, what is the recommended treatment strategy for a patient currently at Ms. W.’s classification level once this current exacerbation is controlled? When would it be appropriate to reevaluate the interventions and possibly adjust the medications?

 

7. She lost her Peak Flow meter during a recent house move. Why would you want to order a new one for her? How is it used and how can it help increase her ability to control her asthma? Explain the red, yellow, and green zones. What is the significance of her PEFR level on her return to the Emergency Room?

 

Types of Shock

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It is very important to differentiate between the different types of shock since treatment may depend on this. Complete the Comparison Table on the different types of shock. 

PERSONAL LEADERSHIP PHILOSOPHIES

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 Many of us can think of leaders we have come to admire, be they historical figures, pillars of the industry we work in, or leaders we know personally. The leadership of individuals such as Abraham Lincoln and Margaret Thatcher has been studied and discussed repeatedly. However, you may have interacted with leaders you feel demonstrated equally competent leadership without ever having a book written about their approaches.

What makes great leaders great? Every leader is different, of course, but one area of commonality is the leadership philosophy that great leaders develop and practice. A leadership philosophy is basically an attitude held by leaders that acts as a guiding principle for their behavior. While formal theories on leadership continue to evolve over time, great leaders seem to adhere to an overarching philosophy that steers their actions.

What is your leadership philosophy? In this Assignment, you will explore what guides your own leadership. 

To Prepare:

  • Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.
  • Reflect on the leadership behaviors presented in the three resources that you selected for review.
  • Reflect on your results of the CliftonStrengths Assessment*, and consider how the results relate to your leadership traits.

*not required to submit CliftonStrengths Assessment

The Assignment (2-3 pages):

Personal Leadership Philosophies

Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

  • A description of your core values.
  • A personal mission and vision statement.
  • An analysis of your CliftonStrengths Assessment summarizing the results of your profile
  • A description of two key behaviors that you wish to strengthen.
  • A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples.
  • Be sure to incorporate your colleagues’ feedback on your CliftonStrengths Assessment from this Module’s Discussion 2.

Requesting writing tutor

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Answer in 500 words

1. Find two articles (evidence-based) that discuss emerging trends in Nursing Informatics.

a. Conduct a literature review on emerging trends in nursing informatics. 

2. For your post, briefly summarize the important points and/or findings of the articles. 

3. State why your chosen articles are relevant to nursing. 

4. Answer the question: “How can I help my colleagues and patients embrace, understand, and use technologies to manage health?” 

5. Include references in APA format.