Differences between primary and secondary research and resources and the implications of each in clinical practice.

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Differences between primary and secondary research and resources and the implications of each in clinical practice.

Paper , Order, or Assignment Requirements

Introduction:

A professional portfolio will showcase your knowledge and skills to prospective employers and will increase your marketability as a baccalaureate-prepared nurse. This portfolio will help you, as a nurse, home in on the concepts, strengths, and critical-thinking abilities that define professional nursing practice. Throughout your time at WGU, you have developed skills and knowledge that distinguish your practice as that of a baccalaureate-prepared nurse. Items that display your skills and knowledge will be showcased in this professional portfolio. You should organize your portfolio around the four areas of professional nursing practice: quality and safety, advanced evidence-based practice, applied leadership, and community health. This portfolio will expand on the portfolio you already created in your Professional Roles and Values course.

When you are ready to submit your portfolio for evaluation, please follow the “How to Submit Your Portfolio for Evaluation” document below.

Requirements:

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Complete the following, using the Web Folio Builder (in Taskstream) that you used to create your portfolio in the Professional Roles and Values course:

Note: The Web Folio Builder can be found on the “Folios & Web Pages” link located in the static bar below the WGU logo.

1. Create a professional mission statement (suggested length of 1 paragraph) that includes the following:
? representation of your career goals, your aspirations, and how you want to move forward with your career
? overview of where you would like to focus your time and energies within the profession
a. Reflect on how your professional mission statement will help guide you throughout your nursing career.
2. Complete a professional summary (suggested length of 3–4 pages) that includes the following:
a. Explain how the specific artifacts or completed work or both in your portfolio represent you as a learner and a healthcare professional.
b. Discuss how the specific artifacts in your portfolio represent your professional strengths.
c. Discuss challenges you encountered during the progression of your program.
i. Explain how you overcame these challenges.
d. Explain how your coursework helped you meet each of the nine nursing program outcomes.

Note: Refer to the attachment below titled “Nursing Conceptual Model.”

e. Analyze how you fulfilled the following roles during your program:
• scientist
• detective
• manager of the healing environment
f. Discuss how you have grown professionally since the beginning of your program.

B. Complete the following within the section “Quality and Safety”:
1. Reflect (suggested length of 1 page) on your professional definition of quality and safety developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support your definition from part B1.
2. Discuss the importance of the Institute for Healthcare Improvement (IHI) certificate for your future role as a professional nurse.

C. Complete the following within the section “Evidence-Based Practice”:
1. Reflect (suggested length of 1 page) on your professional definition of evidence-based practice developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support your definition from part C1.
2. Reflect (suggested length of 1 page) on your understanding of evidence-based practice and applied nursing research by doing the following:
a. Discuss how you are able to evaluate current primary research and apply the concepts to your nursing practice, considering the following:
• relevancy and believability of data
• differences between quality improvement and research (places and uses of each)
• differences between primary and secondary research and resources and the implications of each in clinical practice
b. Explain how your experience in the program helped you achieve excellence in evidence-based practice.

D. Complete the following within the section “Applied Leadership”:
1. Reflect (suggested length of 1 page) on your professional definition of applied leadership you developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support the definition from part D1.
2. Summarize (suggested length of 1 paragraph to 1 page) your Learning Leadership Experience task by doing the following:
a. Discuss the importance of professional collaboration for effective nursing leadership.

E. Complete the following within the section “Community Health”:
1. Reflect (suggested length of 1 page) on your professional definition of community and health you developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support the definition from part E1.
2. Summarize (suggested length of 1 page) your Community Health task by doing the following:
a. Discuss what you learned during your Community Health Nursing task.
b. Discuss what you learned led to your community diagnosis.
c. Discuss how your initial focus and diagnosis evolved after working with your population.
3. Discuss the importance of the American Museum of Natural History (AMNH) certificate for your future role as a professional nurse.

F. Provide an appendix to your portfolio by doing the following:
1. Include all the documents, prior assignments, and additional items that are examples of your best work to support your mastery of all sections given in parts B, C, D, and E.
2. Include the following materials:
• the attached “Nursing Conceptual Model”
• a link to the current IHI Course Catalog
3. Provide an updated professional résumé.

Note: If you have a LinkedIn account, you can take a screenshot and include a copy with the rest of your documents.

4. Provide professional references, using one of the following:
• a professional reference questionnaire
• a full letter of recommendation
• a list of four professional references
5. Include a copy of your IHI certificate of completion.
6. Include a copy of your AMNH certificate of completion.

How does teamwork increase patient safety? Provide evidence and rationales to support your decisions.

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How does teamwork increase patient safety? Provide evidence and rationales to support your decisions.

 

according to Buppert (2011), quality improvement and patient safety are inextricably intertwined. A work environ¬ment that sup¬ports teamwork and respect for other
people is essential to promote patient safety and quality of care. Unprofessional behavior is disruptive and adversely impacts patient and staff satisfaction, the
recruitment and retention of healthcare professionals, communication, teamwork and undermines a culture of safety. Unprofessional behavior is therefore unacceptable.
Discussion Question:

How does teamwork increase patient safety? Provide evidence and rationales to support your decisions.

Diagnostic Imaging for Breast Cancer Symptoms

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“The role of diagnostic imaging in the initial investigation of female patients symptomatic for breast cancer, and its subsequent application in the staging process.”




Introduction


Breast Cancer is the term used for cancers found within the breast tissue. Usually breast cancer is the result of a small change in the regulatory cycles that the tissue goes through. Any changes in these can result in malignant growths within the breast tissue. As stated by Breast Cancer Now (2016), “Breast cancer is the most commonly diagnosed cancer in women in the UK” with over 50,000 new cases diagnosed in women each year, in the UK alone, thus approximately 1 in 8 women will be diagnosed with some form of breast malignancy in their lifetime. Furthermore, not all breast cancer occurs in females, in the UK roughly 350 men are also diagnosed with breast cancer each year. The survival rate of breast cancer is quite high at around 90%, states Breast Cancer Care (2016), which highlights how effective treatment currently is. However, it is the most common cause of death in women aged 40-50

. Vaidya, J.S. et al (2012a).

Per

Sestak, I. et al

(2012), there are many factors that can predispose a person to the risk of breast cancer. These include: increasing age, geographical variation, breast density, age at first pregnancy, age at menarche and menopause, family history, genes, previous breast disease, radiation, lifestyle, oral contraceptives and hormone replacement therapy.

As stated by

Vaidya, J.S. et al

(2012a), Breast cancer lumps are usually hard and painless, with an irregular shape. They are approximately 2cm before they are palpable and can be felt. Most lumps are found in the upper outer quadrant of the breast. A lump is the most common symptom but there are other signs and symptoms that can be indicative of breast cancer. These other symptoms include: bleeding from the nipple (rare), change in shape or size, ulceration, swelling in breast or arm due to blockage of lymphatic circulation, peau d’orange which is usually the result of fluid in the dermis and axillary lumps. These symptoms are not present in all cases and are indicative of the different stages and kinds of breast cancer.




Content & Discussion


People with breast cancer symptoms usually undergo what is known as a “Triple Assessment”. A triple assessment comprises of a clinical examination, imaging examinations and pathological evaluation. This assessment process is usually able to diagnose 95% of malignant breast cancers.

Vaidya, J.S. et al

(2012b)


Vaidya, J.S. et al

(2012b) also states that before a clinical examination occurs, the patient’s history is taken into consideration, as this can aid the diagnose or other potential causes of the symptoms. Usually the history that is considered includes: the history of the current complaint, family history of breast or ovarian cancers, HRT and oral contraceptives history, previous diseases and surgeries, allergies and smoking history.


Clinical Assessment of Breast Cancer

As stated before clinical examination is the first step in a triple assessment to diagnose breast cancer. Clinical examination is done to assess dimpling, which is usually an early sign, as it occurs because of the contraction of the ligaments of Cooper. Clinical examination can also distinguish between coarse nodular tissue and an actual lump in the breast tissue. The colour and site of any discharge at the nipple is also recorded and tested for any blood within the discharged fluid.

Vaidya, J.S. et al

(2012b).


Imaging in Diagnosis of Breast Cancer

As stated by

Vaidya, J.S et al (2012b)

, “Both mammography and ultrasonography have important roles in the diagnosis of breast cancer, but the use of other modalities, such as magnetic resonance and infrared imaging, is being developed.”

Mammography can detect over 95% of clinically detectable cancers. However, it does not aid the diagnosis of a patient with a discrete lump. In this case diagnosis relies heavier on cytology and histology. It may also be of use in the detection of cancer in patients with coarse nodular breasts and is particularly useful in dense breast tissues.

Vaidya, J.S. et al (2012b)

Another use for mammography is to accurately assess where the cancer is located. This information can also be used to aid biopsy and surgeries.  Mammography can also reveal that there is an impalpable lump in the other asymptomatic breast which otherwise would have gone undetected.

Vaidya, J.S. et al (2012b)

If a mass is detected on a mammogram, a range of codes are typically used to determine the potential malignancy of the mass. These are defined by Willet, A. et al, for the Association of Breast Surgery (2010) as:

  • M1 – Normal
  • M2 – Benign
  • M3 – Indeterminate/Likely Benign
  • M4 – Suspicion of Malignancy
  • M5 – Highly suspicious of Malignancy.

Another key imaging technique used in the diagnosis of breast cancer is ultrasonography. Ultrasound shows the difference between a cyst or a more solid mass. Therefore, a mass can be confirmed to be a cyst and can be drained using needle aspiration. However, a blood-stained aspirate may be a result of a cancer within the cyst which was previously unidentified. The sensitivity and specificity of ultrasound in the diagnosis of breast lumps has continued to improve with growing technological advances. Benign lumps appear as well-defined masses with no acoustic shadow. Malignant lumps are ill-defined masses, with a varying echogenicity and/or have evidence of microcalcifications within them. Ultrasound is also the preferred imaging method in women under the age of 30, as their breasts tend to be less dense and are therefore radiosensitive.

Vaidya, J.S. et al (2012b).

The

NICE Guidelines (2015),

also state that, “ultrasound evaluation of the axilla should be performed for all patients being investigated for early invasive breast cancer”.

Fine-needle aspiration cytology is also used in breast cancer diagnosis by inserting a small needle into a lump which is located during the examination using ultrasound. The aspirate on the needle is then examined under a microscope by a pathologist which can then diagnose a breast cancer with almost 100% specificity depending on their level of skill and training.

Vaidya, J.S. et al

(2012b)


Imaging in Staging of Diagnosed Breast Cancer

“If the tumour is large and there is extensive lymph-node involvement, preoperative staging is prudent.” Vaidya, J.S. et al (2012b)

As stated by RCR guidelines (2014), the objectives of staging are to: assess the size of a tumour, assess for other involvement of the skin or chest wall, assess multifocality of tumour, to assess the nodal status and to assess for any metastatic spread.

MRI is used in staging any indeterminate lesions. The expense of MRI is now becoming less of an issue as the cost of an MRI breast coil is considered relatively low. The injection of a contrast agent during MRI enables the vascularity of a lesion to be visualised. The downside of this is that a specifically trained team is required to undergo this route of imaging.

Vaidya, J.S. et al

(2012b)


NICE guidelines

(2015), state that MRI is not recommended in the preoperative assessment of patients with invasive breast cancer that has been proven by biopsy or ductal carcinoma in-situ. It should only be offered to those where the extent of metastases is indeterminate, breast density has caused mammography to be indefinite or to assess tumour size to aid surgery for invasive lobular cancer.

Computed Tomography is stated by the RCR Guidelines (2014), to be used with patients who have advanced symptoms and are suspected to have a further progressed cancer. Reasons for request of a CT to stage breast cancer include: bone pain and breathlessness. If the use of CT for staging is used, intravascular contrast media should be employed during the scan. The scan should include the supraclavicular fossa, the chest and the liver.

The RCR Guidelines (2014), state that Photon Emission Tomography should not be used for early stage breast cancer but should be used more to assess metastatic spread. It is also used to assess potentially multi-focal disease or suspected recurrence if a patient has particularly dense breasts.

Axially node status is usually assessed by using US, with the use of fine-needle aspiration or biopsy of any suspicious nodes

. RCR Guidelines

(2014).


Vaidya, J.S. et al

(2012b) also suggest that routine staging in early breast cancer, as the results are usually less than 4%. Thus, these investigations can slow down the otherwise relatively quick treatment and can cause the patient unnecessary anxiety as they await results.


Follow-up and Surveillance after treatment of Breast Cancer

It is suggested by

Vaidya, J.S. et al

(2012b) that patients who have had a mastectomy are at a higher risk of developing cancer in the remaining breast and should therefore undergo regular mammograms for surveillance. They also suggest that colour Doppler ultrasound scanning of a breast that has had a malignant tumour postoperatively is likely to increase the chances of an early diagnosis should there be any recurrence.


RCR guidelines

(2013) state that women who have been treated for breast cancer under the age of 50 should have a yearly mammogram as surveillance follow up. After 50 the guidelines are unclear but it is currently recommended that surveillance mammograms are routinely performed every 2-3 years.


NICE guidelines

(2015), also state that an annual mammography should be offered to all those with early breast cancers, including DCIS until they reach the age for screening. These guidelines recommend that patients of the age for screening should have also annual mammograms for 5 years.

The

NICE guidelines

(2015), further suggest that US nor MRI should be offered in post-treatment surveillance for those who have been treated for DCIS or other early stage breast cancers.



Conclusion

In summary, it is essential that patients presenting symptoms which usually pertain to a breast cancer undergo a thorough assessment, including multiple imaging examinations not just for the diagnosis of the cancer, but also the staging and the follow-up once the cancer has been successfully treated.

Mammography and Ultrasound are the two key imaging techniques that are vital in my opinion within diagnosis. They enable a fast and usually efficient result which can then be used for staging. Ultrasound can be seen to have more benefits as it does not use ionising radiation unlike mammography, but mammography is essential is those patients who have highly dense breast tissue. This is usually postmenopausal patients who tend to be the high-risk group of developing breast cancer.

CT and Ultrasound are mainly used during staging. This stage is vital in patients with more progressive breast cancer, but if the tumour has been caught in the early stages, staging methods can usually be skipped as it is more efficient to immediately commence treatment methods.

Follow-up imaging is also essential as those who have undergone treatment of breast cancer are at higher risk of recurrence in either breast.

In conclusion, imaging is one the most essential tools available in the diagnosis, staging and follow-up of breast cancer. Without the current imaging techniques, we have today the 95% survival rate of breast cancer would likely be nowhere near as high.



Reference List:

  • Breast Cancer Care. (2016).

    Prognosis.

    Available: https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/diagnosed-breast-cancer/diagnosis/prognosis. Last accessed 27th Mar 2017.
  • Breast Cancer Now. (2016).

    Breast Cancer Statistics

    . Available: http://breastcancernow.org/about-breast-cancer/what-is-breast-cancer/breast-cancer-statistics. Last accessed 27th Mar 2017.
  • NICE guidelines. (2015). Early and locally advanced breast cancer: diagnosis and treatment.

    Breast Cancer

    . Last Accessed: 30

    th

    Mar 2017
  • Sestak, I et al. (2012). Breast Cancer: Epidemiology, Risk Factors and Genetics. In: Dickson, J

    ABC of Breast Disease

    . 4th ed. London: BMJ Books. p41-47.
  • The Royal College of Radiologists (2013). Guidance on screening and symptomatic breast imaging. 3

    rd

    ed. London: The Royal College of Radiologists.  Pg.7
  • The Royal College of Radiologists (2014). Recommendations for cross-sectional imaging in cancer management. 2

    nd

    ed. London: The Royal College of Radiologists. P2-4
  • Vaidya, J.S., Joseph, D. & Jones, A. (2012b),

    Fast Facts: Breast Cancer – Diagnosis,

    4th ed. edn, Health Press Limited, Abingdon.  P47-64
  • Vaidya, J.S., Joseph, D. & Jones, A. (2012a),

    Fast Facts: Breast Cancer – Pathophysiology

    , 4th ed. edn, Health Press Limited, Abingdon.  P28-46
  • Willet, A. et al. (2010). Diagnosis and Imaging.Â

    Best Practice Diagnostic Guidelines for Imaging of Symptomatic Patient

    . Department of Health. p 49.

Research a health care organization or a network that spans several states within the U.S.

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Research a health care organization or a network that spans several states within the U.S.

health care organization
Research a health care organization or a network that spans several states within the U.S. (Example: United Healthcare, Vanguard, Banner Healthcare, etc.).
Harvard Business Review Online and Hoover’s Company Records, found in the GCU Library, are useful sources. You may also find pertinent information on your organization’s webpage.
Review “Singapore Airlines Case Study.”
Prepare a 1,000-1,250-word paper that focuses on the organization or network you have selected.
Your essay should assess the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade, and include a strategic plan that addresses issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.

Community Health Project Presentation Custom Essay

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Community Health Project Presentation Custom Essay

•Provide relevant information (demographics, social factors, income, and access to health care) pertaining to your chosen population.
•Present key findings and identify four issues related to selected population.
•Suggest implications for community health nursing.
•Suggest areas of research for the chosen population based on weekly readings and lectures.
•Use bullet points instead of complete sentences.

Professional Code of Conduct

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 Professional Code of Conduct

Locate the ?professional code of conduct,? ?professional standards,? or “ethical code” from your own respective online medical, allied health or nursing association. Analyze your professional code from an ethical perspective by identifying 3 to 5 ethical concepts from your readings and weekly discussions that are reflected in your own professional code of conduct (example: The ICN Code of Ethics for Nurses has four principle elements of professionalism. Within these elements is the duty to “hold in confidence personal information.” This relates to ethical principles of confidentiality that are described in detail throughout Chapter 5 of our text). Feel free to share relevant personal experiences as they relate to your discussion (remember to change names and other patient identifiers).

Include a cover page that contains the title of the paper, your name, course name and date. The manuscript will be double-spaced with 1″ margins on all four sides. The pages are to be numbered consecutively, beginning with the first page of text (insert page numbers on bottom right corner). Please use a 12-pt plain font such as Times New Roman.

The main text should begin on a separate page and be: 3 – 5 double-spaced pages, excluding cover and reference pages. References must be cited in the text and in the reference list using the APA 6.0 (or later) edition format.

Please use the following books as reference:
1)Health Care Ethics, six edition, by Baillie, McGeehan, Garrett& Garrett, 2013.
2)Guide to the code of ethics for nurses (ANA) 2010.

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IN EDUCATION ON

Health Promotion for Substance Misuse: Alcohol

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Table of Contents


Rationale


Epidemiological Statistics


Health Inequalities and Alcohol Dependence


Population Experiencing Severe Disadvantages


Assessment, Plan and Commission of Intervention


Role of Nursing


References

Substance Misuse: Alcohol


Rationale

The term “health promotion” can be defined as the way to develop objectives that address the association of biology, health status, health services, individual behaviour and social factors. It requires careful assessment of the patients with respect to their strengths, weaknesses and past experiences that they have already had in order to improve wellbeing. In this case, the goal is to improve the wellbeing of the consumers of alcohol and helping them to reduce its consumption. Steps to decrease and prevent the use of alcohol and similar drugs can have a magnificent effect on the health and safety in the community (Whiteford, et al. 2013). It is not necessary that all the approaches will work equally. It is shown by the researchers that education on the own can only impact to a small extent against the problems and norms raising due to drinking. To strengthen the impact of education, the culture of the organisation that supports the wellbeing of the consumers of alcohol and the public around that along with the practices and policies that are comprehensive, well-established, well-promoted and clear. An effective policy helps the people to get a clearer idea of what is unacceptable and acceptable. A framework is provided by it for the prevention and early intervention to tackle the potential problems experienced by the public (Williams, et al. 2014). A path is established by it eventually in order to make sure that objectives associated with the public relationships, productivity and safety are achieved. By only having the policies cannot make sure the safety and wellbeing of the population (Williams, et al. 2014).

The resistance can also be created by the process from the top to bottom for establishing the policies. The rights of the citizens are also infringed by the policies sometimes and sometimes these are implemented unevenly and dishonourably but not all the times. The suggestions and highlight of the keys issues encountered in the developments and implementation of the alcohol policies are given in this rationale. It is determined that the implementation of alcohol policies includes several stakeholders (Whiteford, et al. 2013). Therefore, essential information regarding the use of health promotion, preventions of abuse and limitation to the misuse of substance are covered and the role of health nurses and health and safety coalitions in the UK is elaborated.  The responsibility of PHE (Public Health England) is to make sure the harms triggered by the consumption are prevented and reduced as much as possible. The awareness on the effect of dependency on alcohol is provided by PHE. The delivery and commissioning of the intervention that is evidence-based are supported by it in order to address the hazardous impact of alcohol dependency among adults (Williams, et al. 2014).


Epidemiological Statistics

There exist approximately 1.5 million adults in the UK who are having the same level of dependency on alcohol. However, all of those do not require interventions. Some of them will get better with a short intervention. It is defined by the NICE (National Institute for Health and Care Excellence) that consumption of drugs is a pattern that can potentially cause problems like physical illness, depression and road accidents (Williams, et al. 2014). Heavy drinkers can become dependent on the drug usage which is characterised by tolerance, continuous drinking and craving despite the consequences according to NICE (Whiteford, et al. 2013). A report of public by CMO (Chief Medical Officer) states that drinking can be associated with a threat to health independent of the level of consumption. Adults are suggested to keep their drinking within 14 pegs a week in order to prevent liver diseases or even cancer. It was found in an assessment in which 67 factors of disability and death were included that alcohol ranks third on the table to cause disability and death just below obesity and smoking (Whiteford, et al. 2013).

The evaluation of CMO indicated that all alcohols can possibly cause cancer. The risk of cancers like breast, mouth, liver, stomach and bowel can be increased by drinking regardless of the level of consumption. A recent review of CoC (Committee on Carcinogenicity) supported this evaluation on the risk of cancer by alcohol. In addition to that, it is also demonstrated by the epidemiological surveys that there exist strong relation of the attendees to get mental health services with the use of alcohol. It has been reported by a community of mental health patients that over 40% of the problems were related to the alcohol usage last year (Williams, et al. 2014). There exist a strong relation of the suicide with the misuse of alcohol. It was found by the inquiry of National confidential into suicide by the people suffering from mental issues that there was a strong relation of alcohol misuse with 45% of the suicides among them between 2002 and 2011 (Abuse and Administration, 2016).


Health Inequalities and Alcohol Dependence

Even though the potential threat to wellbeing is indicated by the volume of alcohol consumption, the relationship is affected by other factors.

The dependency of alcohol in the UK is more common in men than women with 6% to 2% respectively (Inchley and Currie, 2013. This differences in gender can be same globally and it is one of the key dissimilarities based on gender in social behaviour. The effect of excessive drinking is greater for the ones with lower income and the ones suffering from the deprivations. The reason for this is not easily understandable because people with lower income do not appear to consume alcohol as much as compared to people with higher incomes. The higher risk can be related to the impact of other threats impacting lower socio-economic people (Rehm, et al. 2013). The areas with the highest rate of mortality are situated in North West mostly while the lowest rates are situated in the south of England. The mortalities associated with the alcohol were found to be 53% inclined from the year of 2013 (Rehm, et al. 2013). In Blackpool during the year of 2013, mare 80 death was found to be related with the alcohol per 100,000 population while in Wokingham, Berkshire the figures were 33 per 100,000 (Abuse and Administration, 2016).

Hospital admission rates due to alcohol also vary regionally. For the least deprived docile, the rate of admissions to the hospital are almost 70% lesser in 2013 to 2014. The North West saw the highest number of admissions to hostel caused by alcohol with 551 per 100,000 population while the lowest rate was witnessed in the south-east with 383 (Abuse and Administration, 2016).


Population Experiencing Severe Disadvantages

There is visible incline in the overlap of population experience severe disadvantages such as homelessness, offending behaviours, alcohol and drug misuse and poor mental health (Inchley and Currie, 2013. Alcohol abuse is a more common cause of death among the homeless people makes around 35% of all deaths (Barry, et al. 2013). It was found by a study that life quality in England was even worse than reported by the people with low salaries particularly in terms of mental health (Barry, et al. 2013). Factors related to the alcohol in England are found over several domains in PHOF (Public Health Outcomes Framework) such as improvement in determinants of health, prevention of premature mortality, improvement and protection of health (Barry, et al. 2013).


Assessment, Plan and Commission of Intervention

Wellbeing boards and local councils and health are responsible for planning an intervention to misuse of alcohol.

  • Environmental health
  • Social care
  • Public health
  • Licensing standards
  • Clinical treatment services
  • Housing strategy

Consumers are placed at the heart of intervention by this. Treatment is a crucial way in which the council will plan and deliver interventions (McGorry, Bates and Birchwood, 2013). This comes after the conditions of public health grant. Boards of wellbeing and health will take into account the ways in which services in the hospital are integrated with the standardised systems and will arrange joint funding for the public health (McGorry, Bates and Birchwood, 2013). JSNA (Joint Strategic Needs Assessment): Local data on alcohol harm is provided by the JSNA in order to plan and commission the intervention. It includes commissioning community alcohol treatment services as well as hospital services (McGorry, Bates and Birchwood, 2013. Quality governance guidance for council commissioners of alcohol and drug services: Councils are required to provide quality arrangements during services according to the public health grant. NDTMS: A little or restricted access to the confidential data is provided to the commissioners in order to help planning and improving services. Reports are provided in an annual and monthly basis. Detailed information is provided by them on the clients in drug treatment and structured alcohol from the National Drug Treatment Monitoring System (NDTMS) (McGorry, Bates and Birchwood, 2013.


Role of Nursing

The nurses are required to comply with the guidance provided by NICE on alcohol use. The nurses have to support the people dependent on alcohol in order to sustain fast recovery. The service users need to be engaged in a stable accommodation by the nurses. There might be alcohol dependents who do not seem to be ready for the intervention, nurses should work with the cooperation of other services in order to address the requirements of drinkers resistant to change. Nurses should provide information to the family members as well regarding the treatment. Nurses are entitled to comply with the Care Act 2014 and are required to comply with the guidance provided by the government if there exist safeguarding issues against treatment.

Nurses are required to see their role as health promoters at the time of treatment. The drinking habits of the patients should be assessed by the nurse when it same appropriate at the time of admission. This cannot be done thoroughly enough to make the nurses able to bring effectiveness in the treatments in case the sufferer seems to be excessively addicted to alcohol. The treatment out of the specialist units includes clomethiazole and multivitamins in order to tackle withdrawal by reducing the role of nursing to only dispensing. Serious consequences will trigger if these issues are not addressed properly in the future. The alcohol consumers these days are most likely to be the patients in coming days and the number of them will surely be remarkable.


References

  • Abuse, S. and Administration, M.H.S., 2016. 2015 National Survey on Drug Use and Health.
  • Barry, M.M., Clarke, A.M., Jenkins, R. and Patel, V., 2013. A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries.

    BMC public health

    ,

    13

    (1), p.835.
  • Chesney, E., Goodwin, G.M. and Fazel, S., 2014. Risks of all‐cause and suicide mortality in mental disorders: a meta‐review.

    World Psychiatry

    ,

    13

    (2), pp.153-160.
  • Inchley, J. and Currie, D., 2013. Growing up unequal: gender and socioeconomic differences in young people’s health and well-being.

    Health Behaviour in School-aged Children (HBSC) study: international report from the

    ,

    2014

    .
  • McGorry, P., Bates, T. and Birchwood, M., 2013. Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK.

    The British Journal of Psychiatry

    ,

    202

    (s54), pp.s30-s35.
  • Rehm, J., Shield, K.D., Gmel, G., Rehm, M.X. and Frick, U., 2013. Modeling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union.

    European Neuropsychopharmacology

    ,

    23

    (2), pp.89-97.
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Advantages and disadvantages of expressed,implied,and breach of contract in healthcare

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Advantages and disadvantages of expressed,implied,and breach of contract in healthcare

Create an APA style paper which discusses the advantages and disadvantages of expressed,implied,and breach of contract in healthcare. What are some key aspects of each and how they are effective in healthcare? Please provide examples of each with additional relevant commentary to back up your reason.

Holistic Assessment of Client in Psychiatric Unit

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Holistic Assessment of Client in the Psychiatric Unit of North Vista Hospital


Purpose

This student assessed an 85-year-old female diagnosed with neurocognitive disorder with behavioral disturbances. The mental status assessment interview was conducted in the day room at North Vista Hospital in Las Vegas, Nevada on Saturday, September 21, 2019. The instructor for the clinical day was Ms. Corine Watson.


Demographics


Personal Information

The patient’s initials are J.R. The patient’s race is Caucasian. The patient’s admission date is 9/18/19. The chart states the patient’s medical history and comorbidities are essential HTN, CAD in native artery, angina pectoris, CVA with residual deficit, DVT lower extremities bilaterally, and moderate episode of MDD. The chart states the patient’s surgical history is an artificial knee joint. The chart states the patient has no pertinent family history.


Allergies

The chart states the patient’s allergies are benzodiazepines, cephalosporins (cefdinir), Haldol (haloperidol), sulfa antibiotics, and trimethoprim.


Vital Signs

The chart states that on 9/18/19, the patient’s blood pressure was 132/90 mmHg, and heart rate was 92 bpm. No temperature, respirations, O2 sat, or pain level were in the paper chart.


Labs

The chart states hemoglobin is 11.8 g/dL and hematocrit is 33.7%; both are low, suggesting anemia and risk for stroke which may be significant for the patient because of the history of cerebrovascular accident. Potassium is low at 3.3 mEq/L which may contribute to weakness; the patient uses the assistive equipment for motor function such as a wheelchair. BUN is 7.0 mg/dL and albumin 2.4 g/dL, both of which are low indicating malnutrition and possible impaired liver function. AST (SGOT) is high at 40 units/L suggesting liver disease and acute hemolytic anemia.


Diagnostic Tests

The chart states the patient had a chest x-ray on 9/4/19. The patient’s history is precordial chest pain. The finding was the heart size is normal. The lungs and pleural spaces are clear. Hilar and mediastinal structures are within normal limits. The impression was no acute intrathoracic process.


Commitment Information

There is no Legal 2000 on file.


Review of Systems


Neurological

Alert and oriented to person, place and time. Pupils equal, round, and reactive to light and accommodation. Cranial nerves II-XII grossly intact. No focal deficits. No visual loss, blurred vision, double vision, or sclera. No hearing loss, sneezing, congestion, runny nose or sore throat. No headache, dizziness, or syncope. Oropharynx clear, mucous membranes moist.


Cardiovascular

Trachea midline. Neck supple, full ROM. No chest pain, chest pressure, or chest discomfort. No palpitations. Normal heart sounds. No thrills. Regular rate and rhythm, no murmurs, rubs or gallops.


Respiratory

No shortness of breath, cough or sputum. Lung sounds clear to auscultation. No wheezing, rales, or rhonchi.


Gastrointestinal

No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood in stool.


Urogenital

No burning micturition. No urinary frequency or incontinence. No change in bowel or bladder control. No costovertebral angle tenderness.


Musculoskeletal

No muscle pain, back pain, joint pain or stiffness. Deep tendon reflexes 2+ bilaterally. Flexor plantar response. Moves all extremities spontaneously. No pedal edema


Integumentary

No rash or itching. No lesions.


Immune

No information was obtained.


Activities


Sleep

The chart did not have information on sleep patterns.


Nutrition

The chart states the patient does not have history of anorexia. The student observed the patient is not overweight. The patient stated she had breakfast on the clinical day of 9/21/19 and recalled the items she ate.


Interpersonal

The chart states the patient is married and has a daughter, both whom support her when living at home.


Coping and Stress Management

The chart did not have information on coping and stress management.


Spirituality

The chart states the patient is of Methodist denomination.


Cultural

The patient states she is eager to be discharged.


Substance Abuse and Domestic Violence

The chart states the patient denies tobacco, illicit drugs, and alcohol. The chart states there is no history of substance abuse. The chart states there is no history of domestic violence.


Mental Assessment Findings


Appearance

The patient appeared in good hygiene, mildly disheveled, hair not combed, and clothed in a gown. The patient appeared as stated age.


Motor/Behavior

Student observed patient is sitting in a wheelchair. The patient’s posture was slumped to the side with shoulders slouched inward. The patient had moderately good eye contact, became fleeting sometimes with distractions by looking around a few times but rejoined the interview when student continued asking questions.


Speech

The patient was calm, talking slow and in a low volume. Student observed articulation is decreased.


Mood/Affect

The student observed the patient was sad and facial expression was congruent. The student observed anergia, and the patient did not display anger or irritability.  The student observed affect is congruent with mood.


Orientation

The patient was alert and oriented to person and. The patient stated the correct month but not the correct day or year. The patient did not state what led to being hospitalized.


Cognitive Function

The patient was given a task to subtract 7 from 100. The patient correctly answered, “93, 86, and 79.” The patient stopped there.


Attention Span

The patient recalled two of three objects the student asked the patient to remember after answering two questions to assess recent and remote memory.


Ability to Abstract

The patient did not respond to the student’s request to interpret the parable “People who live in glass houses should not throw stones”. The patient became distracted and shifted attention to others in the surrounding area by looking in their direction. The student regained the patient’s attention by moving on to the next question.


Insight

The patient did not answer when asked to talk about her illness. The patient did not answer when asked to describe her symptoms. The patient did not answer when asked to describe her treatment. The student observed the patient’s eyes pointed downward and head leaned sideway when asked the previously stated three questions. The student asked what the patient’s goals were, and the patient stated her goal was to “go home”.


Judgement

The student asked the patient, “if you found an envelope on the ground that had a stamp on it and was addressed to someone else, what would you do with the envelope?” The patient answered, “I would mail it.”


Content of Thought

The patient stated she is not anyone important, indicating absence of delusions of grandeur. The patient stated she does not believe she is being watched nor does she believe someone is out to get her.


Form of Thought

The patient does not exhibit word salad, clanging, or echolalia. The student observed flight of ideas, loose associations, and tangentiality.


Perception

The patient states she does not see things that other people do not see. The patient states she does hear voices. The patient states the voices tell her to “get better”.


Suicidal Status

The patient states she has had thoughts of harming herself. The patient states she has tried to harm herself. The patient did not state what she has tried to do to harm herself. The patient states that she currently does not have thought of harming herself.


Functional and Chronological Developmental Stage

According to Erik Erikson, the patient is in Stage 8 late adulthood. This stage is defined by ego integrity versus despair. During this phase, older adults reflect on the life they have lived. Ego integrity describes those who feel fulfilled by their lives can face death and aging proudly. Despair describes people who have disappointments or regrets may fall into despair (Varcarolis, 2017).


Patient’s Current Medications


Cymbalta (Trade)/duloxetine (generic)

Cymbalta is an antidepressant and the actions is a serotonin-norepinephrine reuptake inhibitor (SNRI). Common side effects are headache, nausea, and abnormal vision.


Namenda (Trade)/memantine (generic)

Namenda is an anti-Alzheimer’s agent and its action is an NMDA (amino acid derivative) receptor antagonist. Common side effects include dizziness and confusion.


Provigil (Trade)/modafinil (generic)

Provigil is a CNS stimulant and its action is a racemic compound (similar to sympathomimetic action). Common side effects are headache, rhinitis, and dyspnea.


Risperdal (Trade)/risperidone (generic)

Risperdal is an antipsychotic whose action is mediated through both dopamine type 2 (D

2

) and serotonin type 2 antagonism. Common side effects are extrapyramidal symptoms, pseudoparkinsonism, and tardive dyskinesia.


Conclusion

The patient’s diagnosis is neurocognitive disorder with behavioral disturbances and history of major depressive disorder. The chart states once on psychotropic interventions, the patient became more appropriate to the milieu of the unit. The chart states the patient had augmentation of symptoms and decreased ambulatory response with mild change in mental status, and was recommended for continued care in the geri-psych unit. The progress of the patient is evidence that with continued care, the patient can improve the quality of her life. The student would provide education on nonpharmaceutical methods of coping with depression such as being active and exercising, as well as spending time with other people such as trusted friends and relatives (NIMH). The National Institute of Mental Health suggests educating oneself will help the depressed patient feel less alone, that depression affects people in different ways, and it is treatable.

References

Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.

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Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.

 

A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.
Nursing Assignment: Ethical Concerns
Ethical Concerns
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?
In this Discussion, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.
Scenario 1:
A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.
Scenario 2:
A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days.
Scenario 3:
A 12-year-old girl has come in for a routine check-up and has not yet received the HPV vaccine. Her family is very religious and believes that the vaccine would encourage premarital sexual activity.
Scenario 4:
A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.
To prepare:
· Select three scenarios, and reflect on the material presented throughout this course.
· What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
· Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
Questions to be addressed in my paper:
1. The explanation of the health assessment information required for a diagnosis of your selected patients (include the scenario numbers).
2. Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.
3. Summary with Conclusion
REMINDERS:
1) 2-3 pages (addressing the 3 questions above excluding the title page and reference page).
2) Kindly follow APA format for the citation and references! References should be between the period of 2011 and 2016. Please utilize the references at least three below as much as possible and the rest from yours.
Make headings for each question.
RESOURCES:
· Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 23, “Sports Participation Evaluation” (pp. 581-593)

In this chapter, the authors describe the process of a sports participation evaluation. The chapter also states the most common conditions encountered in a sports participation evaluation.
o Chapter 24, “Putting It All Together” (pp. 594-609)

In this chapter, the authors tie together the concepts introduced in previous chapters. In particular, the chapter has a strong emphasis on the patient-caregiver relationship.
o Review of Chapter 16, “Breasts and Axillae” (pp. 350-369)
o Review of Chapter 18, “Female Genitalia” (pp. 416-465)
· Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
o Chapter 6, “Outpatient Charting and Communications” (“Advanced Directives”; pp. 128–129)
o Chapter 9, “Discharging Patients from the Hospital” (pp. 189–207)
· Burger, I. M., & Kass, N. E. (2009). Screening in the dark: Ethical considerations of providing screening tests to individuals when evidence is insufficient to support screening populations. American Journal of Bioethics, 9(4), 3–14.

Retrieved from the Walden Library databases.

This article recommends how physicians should respond when new screening examinations emerge in the marketplace. The authors examine how evidence influences decision making for screening.
· De Jong, A., Dondorp, W. J., de Die-Smulders, C. E., Frints, S. G. M., & de Wert, G. M. (2010). Non-invasive prenatal testing: Ethical issues explored. European Journal of Human Genetics, 18(3), 272–277.

Retrieved from the Walden Library databases.

The authors of this article examine the ethical consequences of non-invasive prenatal diagnostic tests. Specifically, the article describes the effects the tests may have on abortions.
· Rourke, L., Leduc, D., Constantin, E., Carsley, S., & Rourke, J. (2010). Update on well-baby and well-child care from 0 to 5 years: What’s new in the Rourke Baby Record? Canadian Family Physician,56(12), 1285–1290.

Retrieved from the Walden Library databases.

In this article, the authors supply an overview of and evaluate the quality of evidence in the 2009 Rourke Baby Record.
· Womack, J. (2010). Give your sports physicals a performance boost. The Journal of Family Practice,59(8), 437–444.

Retrieved from the Walden Library databases.

This article explains how to conduct a thorough medical history and targeted physical exam. The article revolves around the use of the 4th edition of the Preparticipation Physical Evaluation.
· American Academy of Pediatrics. (2008). Recommendations for preventative pediatric health care (periodicity schedule).

Retrieved from http://www.aap.org/en-us/professional-resources/practice-support/financing-and-payment/Documents/Recommendations_Preventive_Pediatric_Health_Care.pdf

This resource provides recommendations for preventative pediatric health care from infancy through adolescence. The periodicity schedule covers a variety of areas from health history to measurements, developmental/behavioral screenings, physical exams, procedural screenings, and oral health.
· Rourke, L., Leduc, D., & Rourke, J. (2011). Rourke Baby Record. Retrieved fromhttp://rourkebabyrecord.ca/

This website provides information on the Rourke Baby Record (RBR). The RBR supplies guidelines on growth and nutrition, developmental surveillance, physical exam parameters, and immunizations for well-baby and child care.
Answer

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