Nursing

NURS 6630 Case 13: 8-Year-Old Girl Who Was Naughty
In this case, the study involves an 8-year-old girl who was presented to a pediatrician by her 26-year-old mother. The reasons for hospital visit were due to fever and sore throat. On medical assessment, the patient indicated signs of being negative, defiant and disobedient though she denied both. Besides, the medical diagnosis reveals an Attention deficit hyperactivity disorder (ADHD) inattentive type with a comorbid Oppositional Defiant Disorder (ODD). However, on follow-up visits, it was established that the mother’s behavior was similar to her daughter’s as she is disorganized and her response to the ADHD rating scale significantly revealed a mental health condition (Voris, 2016). As such, the intervention was focused on both the child and the mother. In the case of the child, high doses of stimulants were administered, but it was established to cause insomnia to the child and did not adequately manage the oppositional symptoms. To this effect, the patient was also given guanfacine XR, a 2A selective noradrenergic agonist, to improve oppositional symptoms and to stabilize the patient (Cardinal, 2012). For the subsequent analysis, the practicing nurse in the health facility will take the roles of a physician and conduct a clinical interview for the patient. Moreover, the nurse practitioner will also recommend suitable therapies to respond to the patient’s oppositional symptoms.
Patient Clinical Interview Question
As per the clinical case study, the patient manifest disturbances of activity both at home and in school. Her conditions revealed a diagnosis of a combined type of ADHD as evidenced by her character. It was therefore imperative by the charge nurse to establish the reasons behind her behavior and make a diagnosis using comorbidities manifested by the patient (Rolon-Aroyo, Arnold, Harvey, & Marshall, 2016). However, this could be ascertained by asking the following questions to the patient:
NURS 6630 Case 13: 8-Year-Old Girl Who Was Naughty
What do you hate most in life?
Are you easily angered or irritated at school and home?
How do you cope with frustration and emotional pain in daily life?
These questions indulge the patient to assess for the possibility of anxiety and mood disorder, which might predispose her to ODD. Particularly, the first question helps a nurse to assess the way the child views rules, authority and convey expectations in life. Based on this perspective, the nurse will be able to find out the patient’s reaction to rules, and this will determine her medication adherence. For the second question, the nurse will ascertain patterns of defiance, disobedience, and negativisms to make a diagnosis of ADHD with comorbid condition of ODD (Rolon-Aroyo, Arnold, Harvey, & Marshall, 2016). The third question intends to ascertain the child’s behavior in response to disappointing situations.
Clinical Interview Questions to People in the Patient’s Life
In this case, people close to the patient will be asked questions regarding her patterns of defiant behavior and conduct disorders. The first person to ask question will be her mother followed by her class teacher. These two persons have direct contact with the patient and are in a better position to identify developmental changes in the child. The mother will be asked the following question: Does the child exhibit irritable mood, vindictiveness and defiant behavior at home as she relates to her peers? The above aspects play an important role in establishing oppositional behaviors and impulsivity that arise due to ADHD to help with the diagnosis process prior to therapy (Bezdjian et al., 2011). The school teacher, on the other hand, will be asked the following question: Does the pupil show aggressiveness, truancy, disobedience and have deteriorating grades in the past 8 months? The question will assist to identify the impulsivity as well as the inattentive nature of the child so as to develop a diagnosis on ADHD-combined type.
Physical Examination and Diagnostic Tests
Based on the child’s impulsive behavior, it would be integral for the nurse in charge to investigate mental state examination to reveal psychomotor activity. The physical examination will also constitute an assessment of the child’s attitude towards the examiner and her cognitive functions. The diagnostic tests, on the other hand, would comprise of Electroencephalography, blood biochemistry (specific to thyroid profile) and a Children’s Apperception Test (CAT) (French, 2015). The latter will be used to establish a perception of parental deprivation together with a feeling of a hostile environment by the child. However, MRI of the brain will also be integral for the nurse practitioner to eliminate possible trauma or injuries to the brain.
Differential Diagnoses for the Patient
The primary diagnosis of the patient was combined with comorbid symptoms indicated by frequent temper tantrums in addition to the refusal by the child to comply with rules both at school and home. However, differential diagnoses were as follows;
Comorbidity between ADHD and conduct disorder
Comorbidity between ADHD and oppositional defiant disorder
Comorbidity between ADHD and post-traumatic stress disorder
Nevertheless, from the assessment of the child, the ADHD plus oppositional defiant disorder as the patient has demonstrated the ability to be aggressive, purposefully irritate and bother her little sister, and has hostile, negativist and defiant behavior that has lasted over 6 months.
Pharmacologic Agents
The preferred treatment for the patient’s condition will constitute;
Lisdexamfetamine 5-10 mg daily in the morning
Methylphenidate 10 mg twice daily, which will then be titrated to maximum dosage
Lisdexamfetamine is a pro-drug of d-amphetamine and is used to treat ADHD. According to Briars and Todd (2016), the drug possesses a prolonged pharmacokinetic profile due to its lower liking as well as oral misuse. The drug reaches peak plasma concentration within three hours of administration, which is indicative of its effectiveness. Further, the drug has a bioavailability of over 75%, which also influences its effectiveness. Methylphenidate, on the other hand, is well-absorbed from the gastrointestinal tract and has a short duration of action of between 1-4 hours (Stahl, 2013). Moreover, the molecule achieves its peak duration of action of between 1-4 hours after administration. These pharmacodynamics and pharmacokinetic properties make the drugs preferable in the treatment of ADHD in children.
According to studies, amphetamines work by inhibiting the reuptake of dopamine and norepinephrine into the presynaptic neuron. By doing this, it enhances the rate at which the above monoamines are released into the extraneuronal space (Briars & Todd, 2016). Methylphenidate works by inhibiting the reuptake of catecholamine, principally the dopamine. It similarly acts by norepinephrine and dopamine transporters, leading to enhanced concentrations of the above at the synaptic cleft (Stahl, 2014). Thus, based on the mechanism of action of the two, the methylphenidate will be preferred.
Effect of Ethnicity on Lisdexamfetamine Dosage and/or Contraindications
Studies reveal that pharmacogenetics play an integral role in the dosage adjustment of methylphenidate. The polymorphisms of the gene CYPD26 influence the dosing of any patient with ADHD. In a study conducted on a 6-year-old with a genetic variant of the above gene, the dosage of the drug had to be reduced to 2.5 mg once daily in the morning so as to offset side –effects at the normal dose (Tan-Kan et al., 2016). Specifically, pharmacogenetics testing revealed that the child possessed the CYP2D6*2/*10 isoenzyme. According to other studies, people of Caucasian origins are predisposed to having a variation of the CYPD26 gene, which makes them either slow or intermediate metabolizers. Consequently, they experienced downregulated metabolism of the drug, making it imperative for their methylphenidate dosages to be reduced.
Checkpoint Changes
The patient will be monitored by the mother and through the follow-up visits to the facility to assess adjustment to medications. The child will be evaluated for possible side effects based on the medication regimen. If no side effect is noted, then methylphenidate will continue to be increased depending on the patient’s response. Specifically, the dosage should be tolerated at between 6.9-13.8 mg (Stahl, 2014). However, as already mentioned, the patient will be monitored for tolerability and efficacy so as to determine the optimum dosage.
Lessons Learned
The case study presents a number of lessons that the nurse practitioner can integrate during care. In the first lessons, it is apparent that children suffering from ADHD with comorbid OPP do not have obedience to authority. As such, they may not adhere to the medication regimen administered for their condition. It would be apparent to assist such patients by referring them to psychosocial support to address this challenge. However, patients with ADHD could manifest aggression and impulsiveness, which are also symptoms exhibited by psychosis patients. It will be imperative for a nurse practitioner to undertake various medical investigations to rule out the possibility of psychosis. Apparently, for the ADHD patients, time and route of administrations are of utmost paramount to enhance the efficacy of medications for the patients.
Reference
Bezdjian, S., Krueger, R. F., Derringer, J., Malone, S., McGue, M., & Iacono, W. G. (2011). The structure of DSM-IV ADHD, ODD, and CD criteria in adolescent boys: A hierarchical approach. Psychiatry Research, 188(3), 411–421. http://doi.org/10.1016/j.psychres.2011.02.027
Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The Journal of Pediatric Pharmacology and Therapeutics?: JPPT, 21(3), 192–206. http://doi.org/10.5863/1551-6776-21.3.192
French, W. (2015). Assessment and Treatment of Attention-Deficit/Hyperactivity Disorder: Part 1. Pediatr Ann. 44: 114-120. doi: 10.3928/00904481-20150313-1.
Mager, D. E., & Kimko, H. H. (Eds.). (2016). Systems pharmacology and pharmacodynamics (Vol. 23). Springer.
Rolon-Arroyo, B., Arnold, D. H., Harvey, E. A., & Marshall, N. (2016). Assessing Attention and Disruptive Behavior Symptoms in Preschool-Age Children: The Utility of the Diagnostic Interview Schedule for Children. Journal of Child and Family Studies, 25(1), 65–76. http://doi.org/10.1007/s10826-015-0203-x
Stahl, S. M. (2014). Essential psychopharmacology: The prescriber’s guide, 5th ed. Cambridge, NY: Cambridge Univ. Press.
Stahl, S.M. (2013).Stahl’s Essential Psychopharmacology, 4th ed. New York, NY: Cambridge University Press.
Tan-kam, T., Suthisisang, C., Pavasuthipaisit, C., Limsila, P., Puangpetch, A., & Sukasem, C. (2013). Importance of pharmacogenetics in the treatment of children with attention deficit hyperactive disorder: a case report. Pharmacogenomics and Personalized Medicine, 6, 3–7. http://doi.org/10.2147/PGPM.S36782
Voris, D. S. T. (2016). An exploration of psychotropic treatment of youth diagnosed with serious emotional disturbance within wraparound service delivery. Michigan State University.

Quality Improvement in Nursing Assignment
Course Project Milestone 3 Template
For Use SEPT 2018
Directions: Prior to completing this template, carefully review Course Project Milestone 3 Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this template and save again. This assignment is due by Sunday end of Week 6 by 11:59 p.m. Mountain Time.
Your Name: __________________________
Assignment Criteria Answers:
NOTE: See Milestone 3 Rubric for details required in each area.
Brief Statement of Nursing Care Issue
15 points
Improve: Interventions (3) to Improve Quality
120 points
(40 points each for 3 interventions)
Intervention #1:
Intervention #2:
Intervention #3:
Improve: Professional Article to Support Interventions
75 points
(25 points reference and citation; 50 points summary)
Citation must be included with appropriate intervention above. Do NOT type in this box.
Reference:
Article Summary:
Control:
Control/
Evaluation
90 points
(30 points each for 3 evaluations)
Evaluation for Intervention #1:
Evaluation for Intervention #2:
Evaluation for Intervention #3:
NR392 Course Project Milestone 3 Template.docx 9/2018 CJM/VH 1
A method known as quality improvement is used by healthcare professionals to set goals for their businesses, such as decreasing patient falls or reducing opioid use following surgery.
But what exactly is quality improvement in healthcare?
“Quality improvement is a systematic strategy to improving the quality and safety of healthcare delivery that is guided by data,” stated Debra Sowell, DNP, RN clinical faculty in Southern New Hampshire University’s graduate nursing programs (SNHU).
“Quality improvement focuses on patient-centered treatment that is safe, timely, effective, efficient, and equitable.”
As medical institutions strive to increase efficiency, minimize healthcare costs, and ensure high-quality patient outcomes, improving healthcare quality and safety is becoming a rising emphasis for the nursing industry and healthcare systems as a whole.
Are you enthusiastic about healthcare safety and risk management?
Then you might want to learn more about quality improvement and what it takes to get started or advance in this rapidly increasing area.
What Is Quality Improvement and What Does It Entail?
Dr. Debra Sowell is in charge of the text.
Debra Sowell, Ph.D.
For many years, attempts to improve healthcare quality and safety centered on the individual responsibility of nurses and other medical personnel.
According to Sowell, quality improvement (QI) has made safety and quality a system priority.
“The “shame and blame” game, which used to focus on a single person, has now switched its focus to working environments and complex systems,” Sowell added.
“In the past, QI was limited to the detection of unfavorable events.
Even among the most dedicated doctors who practice the highest standards of care, human mistake is unavoidable today.”
Professionals in the field of quality improvement examine patient and other medical data as well as the processes that are utilized to provide treatment.
They use the data to find areas for improvement and to highlight areas of greatness, according to Sowell.
The purpose of this project is to enhance patient outcomes, increase medical care delivery efficiency, and lower healthcare expenditures.
The subject of quality improvement in healthcare has evolved dramatically in recent years as a result of technological advancements that incorporate medical data-informed decision making.
“The significance of technology cannot be overstated,” Sowell added.
“Manual audits and long hours spent scraping and digging for data were common in the past.
The amount of data we now have at our fingertips might be daunting.
Healthcare quality specialists collaborate with other members of the organization to make effective use of data.”
The way healthcare professionals use accessible data for improvement efforts varies by organization, resulting in a wide range of quality improvement projects in the healthcare industry.
What are some examples of healthcare quality improvement initiatives?
Quality improvement strategies include analyzing patient data to develop a plan to prevent surgical infections or using data-driven ways to reduce the average length of hospital stays, according to Sowell.
Other real-world effects of healthcare quality improvement, according to Sowell, include:
Medication-related side effects are being reduced.
The treatment of sepsis should be improved.
Infections in urinary catheters have decreased.
Reduction in the number of people who have to return to the hospital.
Errors in medicine delivery have decreased.
Documentation of electronic medical records has improved.
Improved inter-departmental coordination of care
The Institute of Medicine (IOM) produced a framework that defines six core goals for patient care, which is used to guide most examples of quality improvement in healthcare.
Patient care should be as follows, according to the framework:
Safe: Preventing patients from suffering injury throughout their medical care.
Effectiveness is defined as providing medical services to patients who can benefit from them while avoiding interventions that are unlikely to improve patient outcomes.
Timely: Reducing appointment and treatment wait times and delays.
Efficient: Using medical equipment, supplies, time, and energy efficiently.
Equitable: Assuring that patient variables such as gender, ethnicity, geography, and socioeconomic status have no bearing on the quality of care provided.
Respecting unique patient preferences and ensuring that patients are valued and included in choices affecting their care are all examples of patient-centered care.
Healthcare quality professionals can improve patient care outcomes and have a substantial impact on the healthcare industry as a whole by using this framework as a guide.
What is the Importance of Healthcare Quality Improvement?
When healthcare systems concentrate on quality improvement, they can affect major change within a medical facility, resulting in everything from cost savings to, most importantly, patient lives saved.
As the COVID-19 pandemic demonstrated, a focus on quality improvement in healthcare can also better prepare an institution to handle a large-scale emergency or medical crisis.
When the epidemic was at its worst, medical systems all around the world employed data analysis and other quality-improvement techniques to change their care practices, reduce patient fatalities and ICU stays, keep more hospital beds open, and assure the safety of all patients and employees.
According to a 2021 study in The BMJ, a poll of 225 quality improvement specialists in the United Kingdom indicated that quality improvement methodologies were frequently implemented throughout the pandemic response.
Quality improvement was significant to 51% of respondents at COVID-19, according to the poll.
Another 49% said their organization’s use of improvement methodologies and approaches grew as a result of the pandemic.
“The importance of healthcare quality and safety has been underlined in recent ongoing health crises like the COVID-19 pandemic, where healthcare workers were pushed to deliver exceptional, quality care while protecting themselves, patients, families, and the community,” Sowell added.
“Learning from these experiences to better prepare for future problem-solving possibilities is a challenge for healthcare quality and safety professionals.”
If you want to make a significant contribution to the future of patient care and safety, a career in healthcare quality improvement may be suitable for you.

Topic 3: Applying Servant Leadership in Practice
Share your written proposal with your manager, supervisor, or other colleague in a formal leadership position within a health care organization. Complete the “Executive Summary Feedback Form” during the exchange and submit the document.
In this assignment, you will propose a quality improvement initiative from your place of employment that could easily be implemented if approved. Assume you are
NRS 451 Topic 3 Applying Servant Leadership in Practice
presenting this program to the board for approval of funding. Write an executive summary (750-1,000 words) to present to the board, from which the board will make its decision to fund your program or project. Include the following:
The purpose of the quality improvement initiative.
The target population or audience.
The benefits of the quality improvement initiative.
The inter-professional collaboration that would be required to implement the quality improvement initiative.
The cost or budget justification.
The basis upon which the quality improvement initiative will be evaluated.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the for assistance. Topic 3: Applying Servant Leadership in Practice
Describe the fundamental principles of Present two qualities of servant leadership and explain how they support interprofessional communication in providing patient care.
Describe the characteristics of performance-driven team. Describe the difference between intrinsic and extrinsic motivation and explain why it is important in understanding the types of motivation when it comes to team performance.
Re: Topic 3 DQ 2
In order to accomplish daily goals in the nursing industry, nurses are constantly under pressure. Working together toward a common objective makes a group stronger than the sum of its parts (Dill, 2014). A high-level team can be a challenge for nurse leaders because of communication breakdowns, especially if the team members keep changing over time. With defined goals and a feeling of purpose, a performance-driven team can be maintained by its leaders. The team’s roles and responsibilities are clearly defined, and everyone is on the same page. In order for a team to be successful, there must be a sense of trust and mutual respect among its members. Leadership in a high-performance team must be shared and participatory in order to make the best decisions. A high-performance team has good working practices that allow all team members to be actively involved in the team’s work. The team appreciates the diversity of generation, culture, and thinking in order to form a strong team. The members are adaptable and flexible, which promotes good working relationships (Thomas, 2018). In order to motivate employees, both intrinsic and extrinsic motivation can be used. A person’s desire to engage in a particular activity is fueled by their own personal satisfaction, delight, or curiosity in the activity itself. If you’re interested in working with people, you might consider becoming a nurse.
Intrinsic motivation in nursing is associated with the desire to do good because nursing care is equated to kindness. Extrinsic motivation is the drive within an individual to do something in order to get something else, such as, awards, benefits, wages or the opportunity for promotion. Research shows that nurses who report intrinsic motivation have high levels of burnout compared to those who report both intrinsic and extrinsic motivation (Dill, 2014). Topic 3: Applying Servant Leadership in PracticeIt is therefore important for leaders to understand the types of motivation when it comes to team performance since the quality of services that nurses provide is often dependent on how motivated they are and their own interpretation of how they feel valued (Thomas, 2018). This understanding will provide the leader an opportunity to engage in and build relationships with individual nurses based on the type of motivation reported. This can be achieved by the display of personal interests and investments in the staff’s well-being, which may include rounding on the staff and genuine follow ups that show personal interest in the staff’s welfare (Thomas, 2018). Leaders can also use this knowledge to motivate those around them by ensuring their needs are met and aiding them achieve their full potential and self-actualization (Thomas, 2018). Understanding the differences and working with each individual nurse can help build strong healthy teams that are beneficial to the organization and patients in the long run.
References:
Dill, J. (2014). Nurses motivated by external rewards are more likely to survive on the job. The Conversation. Retrieved from: https://www.google.com/amp/s/theconversation.com
Thomas, J. S. (2018). Nursing Leadership and Management: Leading and Serving. Grand Canyon University. Retrieved from: https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/nursing-leadership-and-management_leading-and-serving_1e.php
Re: Topic 3 DQ 2
To thrive in an expanding health care system, effective teams must be formed throughout the health care system. A performance-driven team in healthcare is the result of nurse leaders who engage their staff, provide opportunities for personal communication, demonstrate genuine investment in their staff’s well-being, and intrinsically motivate individuals to perform at their highest level.
Motivation is a need or drive that propels a person toward achieving a goal. It can be both intrinsic and extrinsic (Verywell Mind, 2019). Intrinsic motivation drives people to engage in a specific behavior because it is personally rewarding and is driven by internal rewards. The act of engaging in the behavior is its own reward. For example, by implementing a lifestyle change such as regular exercise, an individual will begin to feel better as a result of the exercise, which will keep him or her motivated to continue exercising. Extrinsic motivation entails engaging in a behavior or activity in order to earn a reward or avoid punishment. Using the same exercise example, a person may train for a marathon in order to receive a medal for participation. If this is the only motivator, the individual may find it difficult to maintain an exercise regimen after the marathon.
Nursing offers numerous extrinsic rewards, such as a salary, health care benefits, and social status. Under , long-term organizational change in healthcare is possible. Servant nurse leaders can collaborate with motivated interprofessional teams to achieve the best possible patient outcomes. Many factors influence a nurse’s motivation in the workplace. Baljoon et al. (2018) discovered that a nurse’s work motivation is frequently influenced by a variety of personal and organizational factors that are critical in influencing the level of nurses’ work motivation. By understanding these factors and channeling a nurses’ work effort to achieve the organization’s goals, nurse leadership within a servant leadership framework can help nurses stay intrinsically motivated. This effort motivates a high-performing team.
References
Baljoon, R. A., Banjar, H. E., Banakhar, M. A. (2018). Nurses’ work motivation and the factors affecting it: A scoping review. International Journal of Nursing & Clinical Practices 5(277) 1-10. Retrieved from https://doi.org/10.15344/2394-4978/2018/277
Verywell Mind (2019). Intrinisic Motivation [website]. Retrieved from

Future Advanced Practice Nurse
As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal.
In preparation for this course’s practicum experience, address the following in your Practicum Journal:
· Select one nursing theory and one counseling theory to best guide your practice in psychotherapy.
Explain why you selected these theories. Support your approach with evidence-based literature.
· Develop at least three goals and at least three objectives for the practicum experience in this course.
· Create a timeline of practicum activities based on your practicum requirements.
The Institute of Medicine (IOM) proposed in 2010 that states reform their advanced practice registered nurse (APRN) scope-of-practice rules to allow for prescriptive authority and independent practice.
APRNs, notably family nurse practitioners (FNPs), are now acknowledged by a rising number of jurisdictions as trained licensed professionals with the capacity to affect the U.S. healthcare issue.
In 2017, more than 20 states enacted laws expanding the scope of practice and independent prescribing authority of the APRN, increasing the total number of states and the District of Columbia that enable full and autonomous practice to 25.
APRNs work in partnership with or under the supervision of physicians in other states.
APRNs are recognized in healthcare by more than 40 professional medical organizations, including the American Nurses Association (ANA) and the American Association of Nurse Practitioners (AANP).
They also support the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education, which encourages APRNs to take on more responsibilities in the healthcare system.
APRNs, especially FNPs, are a “major part of the solution” to the primary healthcare provider shortfall, according to the Robert Wood Johnson Foundation.
APRNs seek opportunities to practice to the maximum extent of their skills and knowledge, according to the organization, but they frequently confront obstacles.
“A large portion of the public is unaware of or misinformed about the work of APRNs.
According to the group, “a lack of information can cloud regulatory policy decision-making.”
“While APRNs’ area of practice may overlap with that of physicians, they are not physicians; they are nurses.”
The need for APRNs who can perform positions across the United States will continue to grow as the healthcare system in the United States develops.
The online Post-Certificate Master’s in Family (Individual Across the Lifespan) Nurse Practitioner program at Duquesne University prepares nurses to serve as Certified Registered Nurse Practitioners and Family Nurse Practitioners (FNPs).
APRNs can provide primary medical care to people who need it most through the FNP post-online master’s certificate program.
Overcoming Obstacles to Prescription Drugs
Prescriptive authority for advanced practice nurses is not a new concept.
APRNs, including FNPs, have had the education, training, and know-how to prescribe drugs for decades, according to healthcare professionals.
However, as the population ages, primary-care doctors retire, and healthcare access expands, the issue has risen to the fore in the last 20 years or so.
In all 50 states and the District of Columbia, nurse practitioners have some form of prescribing authority.
Nurse Practitioners in full-time practice currently write an average of 23 prescriptions every day.
Prescriptive authority for advanced practice nurses is classified as either independent or limited practice, depending on state regulations:
APRNs with independent or full prescriptive authority can prescribe drugs, devices, health and medical services, durable medical goods, and other equipment and supplies without the involvement or supervision of a physician.
APRNs with limited or limited power must practice and prescribe under the supervision of a physician.
APRNs must work in close physical proximity to a supervising doctor or can create an independent practice that is monitored remotely by a physician, depending on state law.
States with APRN prescribing privileges have their own set of rules.
Applicants for prescriptive authority must, in general, meet the following criteria:
Have a current RN license: RNs that have a current license must have completed the needed continuing education units (CEUs), refresher courses, and practical hours.
RN licenses must be renewed every two years on average.
Graduate from an accredited APRN program: Registered nurses must complete a nationally accredited MSN program, such as Duquesne University’s FNP program.
Coursework in the “three Ps”—advanced physical assessment, advanced pathophysiology, and advanced pharmacology—as well as prescription practice hours, which can be done concurrently with supervised practice hours, are required for academic preparation.
For prescriptive power, many FNP students must also take courses in sickness diagnosis and management.
Obtain national accreditation:
Graduates of Duquesne University’s online APRN program are prepared to take the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Center (ANCC) Family Nurse Practitioner certification exam.
To apply for the proper state prescriptive authority license, follow these steps:
Prescriptive authority licensure is governed by different rules and regulations in each state.
NPs may be required to work under the supervision of a licensed physician for the duration of their career or for a specific amount of time.
Other states allow NPs to prescribe drugs once they have obtained license.
Obtain a registration number from the Drug Enforcement Administration (DEA) in the United States:
Personal information, proof of schooling, and a background check are all required when applying for a DEA registration number, commonly known as a DEA license.
APRNs Respond to the Opioid Epidemic
Despite the numerous safeguards in place to ensure that APRNs have a clear path to prescribing medications, some concerns remain.
As a result, a slew of new laws and restrictions governing opioid prescriptions have been implemented in a number of states.
California and Oregon are two of them, having approved regulations in 2017 clarifying the role of APRNs in prescribing buprenorphine, an opioid used to treat opiate addiction.
APRNs’ prescribing of medicines with misuse potential, such as opioids and benzodiazepines, has also been studied in various research.
There was no link between APRN prescriptions and increased drug misuse in these investigations.
In fact, one study revealed that states with APRNs with autonomous prescribing power write “much fewer opioid and benzodiazepine prescriptions.”
Possible explanations for the significant decrease in opioid and benzodiazepine prescriptions by independent APRNs could be due to education and training, according to the study, “State Variation in Opioid and Benzodiazepine Prescriptions Between Independent and Non-Independent APRN Prescribing States.”
“It’s been argued that APRN training is more holistic, wellness-focused, and less disease-oriented and cure-focused,” according to the study. “As a result, nurses may be more inclined to use non-opioid pharmacologic and non-pharmacologic therapy methods to address pain.”
When it comes to prescription mental health medicines, NPs with full prescribing authority have similar prescribing habits to physicians, according to a separate study published in 2016.
“This shows that nurse practitioners with unlimited prescribing authority do not prescribe controlled medications in bigger quantities or in different ways than their peers,” researchers told Medscape.
Aside from prescriptive authority, APRN advancements include state law uniformity that allows for a broader scope of practice.
Lifting Practice Restrictions for APRNs In 2016, the United States Department of Veterans Affairs (VA) made history by providing APRNs full practice rights.
APRNs can now deliver a full spectrum of medical services across the United States, easing the strain on the VA’s already overburdened healthcare system.
Similar practice uniformity should be written out in state legislation across the country, according to organizations like the Robert Wood Johnson Foundation and the National Academy of Medicine.
Allowing APRNs complete practice power does not imply that they are attempting to fill physicians’ shoes, according to the organization.
According to the organization, APRNs are working to remove regulatory, institutional, and legal hurdles that prevent them from practicing within their scope of practice.
APRNs do not commonly perform surgery, diagnose uncommon diseases, treat high-risk pregnancies, or engage in a range of other complicated medical operations, according to the foundation.
APRNs, on the other hand, refer patients to specialists and other doctors when necessary.
According to the foundation and other professional APRN organizations, such practice restrictions undermine healthcare in the following ways:
Reduced access to care: APRN-physician supervisory sessions divert attention away from required patient appointments and medical procedures.
In most circumstances, medical supervision does not occur in real time, and physicians and APRNs do not share a facility.
That means both the physician and the APRN must set aside time in their schedules to meet in person.
Patients under the care of an APRN may be denied critical medical interventions if their supervising physician is unable to give them.
For example, when a psychiatrist was fired from a behavioral health facility in Massachusetts in 2013, state regulations prohibiting APRN practice precluded ten APRNs from providing care.
Patients were compelled to seek medical help at hospital emergency rooms.
Increased healthcare expenditures: Even though states require APRNs to work under physician supervision, the costs are still borne by the APRNs.
Payment for collaboration is uncontrolled in general, and it can cost APRNs thousands of dollars per year.
In 2009 and 2014, testimony before the Nebraska legislature revealed a wide range of reimbursement costs: one NP compensated her physician supervisor by covering his weekend emergency room shifts, while another NP paid her supervising physician $15,000 per year.
Future Advanced Practice Nurse
APRNs are prepared to serve millions of individuals who need access to great healthcare, but state and federal regulations are standing in their way.
Despite the constraints, experts are optimistic that politicians will pave the way for new legislation that expands the scope of APRN practice.
APRNs in the Future
Susanne Phillips, FNP, author of The Nurse Practitioner’s “30th Annual APRN Legislative Update: Improving access to healthcare one state at a time,” stated the future years would bring even more good changes to prescriptive authority, albeit more slowly than some would prefer.
“Incremental developments provide the possibility to expand access over time as state APRN and nursing organizations and (boards of nursing) strive toward (full practice authority),” she added.
In the United States now, there are over 234,000 NPs practicing, with the majority of them being FNPs.
Since 2007, the number of NPs has more than doubled, according to the AANP.
The figures are predicted to increase by another 35% by 2024.
APRNs who expand their scope of practice are leading the charge to improve healthcare access.
FNPs are the most common type of NP, and they give treatment to patients from birth to old age, including pregnancy.
FNPs have the knowledge and training needed to offer primary care, perform medical exams, and diagnose ailments.
Resources:

Healthcare Systems And Quality Outcomes
Healthcare Systems And Quality Outcomes
To get ready, do the following:
Examine your progress on the Course Project, especially Sections 3 and 4.
Consider how your quality-improvement program might be assessed.
Take into account the following:
Which parties require information about this project?
Why do they require this information?
How would you evaluate the short- and long-term outcomes?
How would you go about analyzing similar processes, such as the one you rebuilt in Section 4?
How should you incorporate an examination of organizational structures into your evaluation?
How would you spot and assess any unforeseen outcomes that might occur?
What measures should the organization employ to assess the quality improvement initiative’s progress and effectiveness?
How would you incorporate the measures and indicators you identified in Section 3 into these metrics?
Are there any more metrics or indications that you believe should be included?
For an interdisciplinary audience, how should the organization track and display data?
What are the benefits of using a dashboard or balanced scorecard?
How could the company build a unified perspective of performance that ties finance and quality together?
Complete the following:
Create a two- to three-page evaluation plan that contains the following information:
An description of the methodology you suggest for assessing the quality improvement program as well as the financial implications
A list of precise metrics that incorporate the measures and indications you’ve already defined, as well as any additional you think are significant.
A suggestion for how the organization should portray data linked to this quality improvement issue for continuing monitoring and determining the initiative’s worth or success.
An explanation of how the company could build a unified perspective of performance that ties finance and quality together.
6th Section
To get ready, do the following:
Begin to create a strategy for implementing your quality improvement initiative, which should include the revised process you defined in Section 3.
Take into account the following:
How would you go about establishing a timeframe for planning, implementing, and assessing this quality improvement strategy?
What are some achievable goals for this project?
What are your daily, weekly, and monthly objectives?
Complete the following:
Write a two- to three-page summary of your quality improvement strategy.
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes is referred to as quality of care.
It is essential for achieving universal health coverage since it is based on evidence-based professional expertise.
As countries commit to achieve Health for All, the quality of care and health services must be carefully considered.
Quality health care can be defined in a variety of ways, but there is a growing consensus that it should include:
Effective – providing individuals in need with evidence-based healthcare services;
Safe – preventing harm to those who are receiving care; and
Individual preferences, requirements, and values are taken into account when giving care.
To get the benefits of high-quality health care, health services must meet the following criteria:
Timely – minimizing wait periods and, in some cases, potentially damaging delays;
Equitable – delivering high-quality treatment regardless of gender, race, geographic location, or socioeconomic background;
Integrated – delivering care that includes the complete range of health services throughout a person’s life;
Efficient – making the most of available resources while minimizing waste.
Health Care Quality Measures: What Are They and How Do They Work?
Structure, process, and outcome measures are the three types of measures used to assess and compare the quality of health-care organizations.
This classification method is known as the Donabedian model, and it was named after the physician and researcher who created it.
Measures to Strengthen the Structure
Consumers can get a sense of a health care provider’s capability, procedures, and processes for providing high-quality care by looking at structural indicators.
Consider the following scenario:
The use of electronic medical records or medication order input systems by the health-care organization.
The number or percentage of physicians who are board-certified.
The provider-to-patient ratio.
Measurements of the Process
Process measurements describe what a provider does to maintain or improve a patient’s health, whether they are healthy or have been diagnosed with a medical illness.
These metrics are usually based on widely established clinical practice guidelines.
Consider the following scenario:
The number of people who receive preventive services (such as mammograms or immunizations).
The proportion of diabetics who had their blood sugar checked and managed.
Process measures can help consumers understand what kind of medical care they can expect for a specific ailment or disease, and they can help to improve health outcomes.
Process measurements make up the majority of health-care quality measures used in public reporting.
Measures of Success
The influence of a health-care service or intervention on a patient’s health condition is reflected in outcome metrics.
Consider the following scenario:
The number of people who died as a result of surgery (surgical mortality rates).
The number of surgical complications or infections acquired in the hospital.
Although outcome measurements appear to be the “gold standard” for assessing quality, they are the result of a variety of circumstances, many of which are beyond the control of providers.
These issues can be accounted for using risk-adjustment methods, which are mathematical models that correct for different features within a population, such as patient health status.
The science of risk adjustment, on the other hand, is still developing.
Better risk-adjustment procedures are needed, according to experts, to reduce the reporting of misleading or even erroneous information about health-care quality.

BIO 220 Grand Canyon Week 6 Discussion 1
Study the following articles:
.ehow.com/info_8259688_plants-animals-around-volcanoes.html”>http://www.ehow.com/info_8259688_plants-animals-around-volcanoes.html .nps.gov/sucr/naturescience/index.htm”>http://www.nps.gov/sucr/naturescience/index.htm
Based on the above articles and your understanding of ecosystems and populations from this course, explain how volcanoes both destroy and rejuvenate ecosystems. Make a prediction about how the succession of plants and animals will unfold as the landscape at Sunset Crater Monument recovers from the volcanic eruption. What are other geological risks that could have positive and negative impacts?

MKT 315 Topic 5 Benchmark Marketing Plan Analysis and Presentation: Part 2 – Product or Service and Price
The purpose of this assignment is to conduct research related to how a specific company utilizes information related to consumer behavior, product mix or service processes, and pricing to create marketing plans that will meet business needs including their specified marketing objectives.
Review:
Review the following topic materials.
Topic 3: “Consumer Purchasing Decisions”
Topic 4: “What Is a Product?” “What Is a Service,” and “Service Delivery”
Topic 5: “Pricing and Breakeven Analysis”
Part 1:
Continuing in the role of a marketing professional who has been tasked with completing a marketing plan for a client, refer back to the research you completed in the Topic 2 Part 1: Research as a starting point for the assignment. Conduct additional research related to consumer behavior, the company’s specific product or service, and the company pricing strategy, and use it to complete the “Marketing Plan Analysis and Presentation: Part 2 – Research Template.”
Part 2:
Create a 15-20 slide PowerPoint presentation that summarizes your marketing plan analysis based upon the research you have conducted. Slides should address each of the key areas listed below and should include speaker notes that explain how the company could have used what it learned about consumer behavior, product or service, and pricing to help it develop a marketing plan in order to meet the company marketing objectives and business needs. Include a slide at the end of the presentation to cite your research sources.
Company Background:
Company name, vision, and mission.
Company marketing objectives.
Consumer Behavior:
Describe the customer segments and target markets.
Describe characteristics of the target markets that will affect product/service and pricing decisions.
Describe how the company differentiates its product and positions its brand.
Describe a consumer buying behavior model for this company and brand.
Product or Service:
Describe the product mix.
Describe the product lines.
Describe the service processes.
Discuss physical evidence of service, service scape, and ambiance.
Discuss the roles of company employees in service delivery.
Price:
Define the company’s pricing objectives and discuss whether the objectives are profit- or sales-oriented.
Provide example of current company pricing strategies.
Describe pricing tactics (discounts, etc.) that are used to drive short-term demand.
General Requirements:
Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.
Submit the “Marketing Plan Analysis and Presentation: Part 2 – Research Template” and PowerPoint presentation with speaker notes.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
BS Accounting; BS Business Administration; BS Business Analytics; BS Business Information Systems; BS Business Management; BS Entrepreneurial Studies; BS Finance; BS Finance and Economics; BS Hospitality Management; BS Marketing and Advertising; BS Sports Management; BS Supply Chain and Logistics Management
2.1: Demonstrate appropriate research strategies for acquiring information necessary to meet specific business needs.

Critique Two Primary Research Evidence Sources
Critique Two Primary Research Evidence Sources
In this task, you will critique two primary research evidence sources. You will select one quantitative and one qualitative peer-reviewed journal article on a healthcare topic of interest.
Requirements:
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.
Evaluate a primary quantitative research peer-reviewed journal article (suggested length of 3-5 pages) that has healthcare implications by doing the following:
A1. Identify how the researcher addresses the five following areas of the selected journal article, using the attached Evidence Table:
.background or introduction
.review of the literature
.discussion of methodology
. data analysis
. researchers conclusion
A2. Critique whether the evidence presented in each section of the journal article supports the researchers conclusion.
Note: The attached Evidence Table may be used to address A1. A2-A5 may be addressed on the same page under the table.
A3.Explain the protection of human subjects and cultural considerations of the journal article.
A4. Identify strengths and limitations of the study
A5. Describe how the evidence informs nursing practice.
B. Evaluate a primary qualitative research peer-reviewed journal article (Repeat above steps for second article) (suggested length of 3-5 pages)
Depending on the originality of the information offered and their proximity to the source of information, sources are classified as main, secondary, or tertiary.
This distinction varies depending on the subject and field.
In the sciences, research findings may be shared among researchers informally via email, presented at conferences (primary source), and then published as a journal article or technical report (primary source).
The information may be commented on by other academics (secondary sources) and/or properly indexed in a database once it has been published (secondary sources).
Later, the data could be compiled into an encyclopedia or reference book (tertiary sources).
Source
Sources of Information
In science, a primary source is a document or record that contains information about a study, experiment, trial, or research endeavor.
The hypothesis, technique, and results are frequently included in primary sources written by the person(s) who did the research, conducted the study, or conducted the experiment.
Among the primary sources are:
Pilot/prospective research
Cohort studies are a type of research that looks at
Case studies from survey research
Notebooks for labs
Clinical trials and randomized controlled trials (RCTs) are two types of clinical trials.
Dissertations
Sources of Secondary Information
Secondary sources compile, analyze, compare, and assess primary data and studies in order to arrive at conclusions about the current state of knowledge in a discipline or subject.
A bibliography may be included in the sources, which might lead you back to the primary study mentioned in the article.
Secondary sources include the following:
professional news sources, reviews, systematic reviews, meta-analysis newsletters, and reviews
norms and guidelines for practice
monographs entries in nursing or medical encyclopedias clinical care notes patient education information government & legal information
Source
More information on Systematic Reviews and Meta-Analysis can be found here.
Systematic evaluations –
When it comes to answering single queries, systematic reviews are the best option (eg, the effectiveness of tight glucose control on microvascular complications of diabetes).
They’re more scientifically structured than standard reviews, with details on how the authors tried to discover all relevant publications, rate the scientific quality of each study, and weigh data from several studies with contradictory results.
To eliminate publication bias, these reviews take special attention to including all strong research, whether or not it has been published (positive studies are preferentially published).
Source
Meta-analysis is a term that refers to the process of
Meta-analysis is a statistical tool for statistically combining the results of multiple research, which is often used in systematic reviews.
It can be used to calculate an overall estimate of an intervention’s net benefit or harm, even if these effects were not seen in individual trials [9].
Other factors such as diagnostic accuracy, incidence, or prevalence can also be quantified using meta-analysis.

Match the items in the Case Summary column to the Options in the right column by entering the correct corresponding alphabetical letter next to the numbers in the first column. Not all options will be used.
Case Summary Options
1. Shaun is driving home at night from work on a six-lane road, under the speed limit. There are no streetlights. A man is crossing the middle of the street, and Shaun does not see him. Shaun hits the man and kills him. A. MurderB. Voluntary manslaughter
C. Involuntary manslaughter
D. Justifiable homicide
E. Excusable homicide
F. Statutory rape
G. Malice aforethought
H. Necessity
I. Felony murder
J. Suicide
K. Second-degree murder
L. Renunciation
M. Corpus delicti
2. Ruth’s friend Mary asks her to drive her to a convenience store and wait for her. While Ruth waits in the car, Mary shoots and kills the clerk, and robs the store. Mary gets in the car and Ruth drives away.
3. Lisa comes home early from work and finds her husband in bed with her best friend. Lisa grabs a handgun and shoots her friend in the head.
4. Zachary suggested playing Russian roulette with his friend Gary, because he had a handgun and only three bullets. Gary shoots himself in the head and dies.
5. Officer Chan is a city police officer who pulled over a speeding car. Upon asking for license and registration, the driver grabbed a gun out of the glove box and began to turn toward the officer. Officer Chan shot and killed the driver.
6. Ben and Heather have a suicide pact, because their families are preventing them from having a relationship. Ben drives his car, with Heather in the passenger seat, off the cliff. Heather lives and Ben dies.
7. After a fight with his wife, Tom buys a shovel and rope. He tells his wife he wants to drive into the desert to look at the stars. While in the desert, Tom chokes his wife. He digs a hole and buries her in the hole.
8. Andrew abuses his son, Joe, which was noted by Joe’s teachers. Andrew gets extremely drunk one day and beats Joe again. After 3 days, Joe dies from his injuries.
9. Scott murders his wife, then takes a boat out to sea and dumps her body. Can Scott be charged with homicide?
10. Nicole owns two aggressive dogs that consistently get out of the backyard. The dogs attack and kill Nicole’s 80-year old neighbor as she takes her daily walk.
How does your state’s law define kidnapping? What degrees of kidnapping are effective in your state? How do federal kidnapping laws differ from your state’s kidnapping laws? Include references.
How do false imprisonment and abduction laws vary from kidnapping in your state? Include references.
Provide an example of a recent case involving a computer or high-technology crime. What law was broken? When was this law enacted? What was the punishment? Include references.

National Healthcare Issue/Stressor Assignment
National Healthcare Issue/Stressor Assignment
To Prepare for National Healthcare Issue/Stressor Assignment:
Analysis of a Pertinent Healthcare Issue
From a general perspective, healthcare provision involves identifying health problems affecting the populace and developing practical intervention measures. As this happens, policies are made to streamline care delivery as healthcare providers keep learning to improve outcomes. The overall mandate of care providers is to enhance patient safety while striving to optimize quality always. However, everything does not occur smoothly as envisioned since many healthcare stressors affect care delivery and prevent healthcare providers from meeting the set goals. This paper assesses the impacts of nursing shortage as a pertinent healthcare issue at the organizational level and summarizes evidence-based interventions applied by other organizations.
The Nursing Shortage Problem
In practice, healthcare providers should be kept free from exhaustion. The care providers to patient ratio should be manageable such that healthcare providers are not physically and mentally drained. Nursing shortage occurs when the number of patients is high to the extent that care providers cannot provide satisfactory services. The problem creates an environment where care providers are highly dissatisfied and ready to leave (Chang et al., 2017). In response, it has been the cause of 25% nurse turnover in the organization, with 10% of the care providers leaving the profession entirely. This data shows a lack of motivation to continue offering healthcare services irrespective of other measures such as rewards the organization applies to inspire employees.
Undeniably, this proportion of turnover is high and implies two things. Firstly, the organization will continue using massive resources to replace the lost workforce. Doing so leads to a scenario where some areas are underserved since resources are used wrongly. Secondly, turnover increases the healthcare burden to the employees left serving. Since the ones left behind are overworked, they are easily frustrated and can quit too. Eventually, a cycle where patients are underserved and dissatisfied ensues. Such instances reduce the overall quality of care and make it challenging to achieve the set objectives.
Select one current national healthcare issue/stressor to focus on.
Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
Healthcare issue=( Workforce injuries are much more frequent in healthcare )
Analyze , and explain how the healthcare issue/stressor above may impact your work setting.
Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
APA format 1385 words with references and in-text citations.
Format this assessment as a professional report. It may help to look at reports or other documents used within your organization and to follow that formatting. You must still follow APA guidelines for in-text citations and references, and include a title page and reference page.
Within the National Healthcare Issue/Stressor Assignment report:
Describe one critical health issue in your community or state that has grown larger or has the potential to become larger. Be sure to include any statistics available on the health issue. Tip: check your county and/or state health department Web site.
Explain the factors that contribute to this health issue. Consider things such as access to health care services, economics, culture, attitude, education, health care policies, and so on.
Describe any interventions your community or state has put in place to address the health care issue. Include information on how long the interventions have been in place, how the community was made aware of the interventions, and so on.
Describe the scope and role of nursing and public health nursing in the interventions to reduce the health issue.
Recommend evidence-based ways the scope of the interventions could be expanded to increase positive health outcomes. Think in terms of cost, efficiency and access, effectiveness, and the use of both conventional and unconventional interventions.
Assignment: Analysis of a Pertinent Healthcare Issue
The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.
Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.
In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.
To Prepare:
Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.
The Assignment (3-4 Pages):
Analysis of a Pertinent Healthcare Issue
Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:
Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.
Looking Ahead
The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.
By Day 7 of Week 2
Submit your paper.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+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.
Additional Requirements for National Healthcare Issue/Stressor Assignment
Complete your assessment using the following specifications:
Title page and reference page.
Number of pages: 3–4 (not including the title and reference pages).
At least 3 current scholarly or professional resources.
APA format for citations and references.
National Healthcare Issue/Stressor Assignment
STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants
Abstract
Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual’s biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.
Keywords: psychosocial stressors, stress responses, homeostasis, psychosocial interventions, host vulnerability-stressor interactions
INTRODUCTION
noted that the maintenance of life is critically dependent on keeping our internal milieu constant in the face of a changing environment. called this “homeostasis.” used the term “stress” to represent the effects of anything that seriously threatens homeostasis. The actual or perceived threat to an organism is referred to as the “stressor” and the response to the stressor is called the “stress response.” Although stress responses evolved as adaptive processes, Selye observed that severe, prolonged stress responses might lead to tissue damage and disease.
Based on the appraisal of perceived threat, humans and other animals invoke coping responses (). Our central nervous system (CNS) tends to produce integrated coping responses rather than single, isolated response changes (). Thus, when immediate fight-or-flight appears feasible, mammals tend to show increased autonomic and hormonal activities that maximize the possibilities for muscular exertion (, ). In contrast, during aversive situations in which an active coping response is not available, mammals may engage in a vigilance response that involves sympathetic nervous system (SNS) arousal accompanied by an active inhibition of movement and shunting of blood away from the periphery (). The extent to which various situations elicit different patterns of biologic response is called “situational stereotypy” ().
Although various situations tend to elicit different patterns of stress responses, there are also individual differences in stress responses to the same situation. This tendency to exhibit a particular pattern of stress responses across a variety of stressors is referred to as “response stereotypy” (). Across a variety of situations, some individuals tend to show stress responses associated with active coping, whereas others tend to show stress responses more associated with aversive vigilance (, ).
Although genetic inheritance undoubtedly plays a role in determining individual differences in response stereotypy, neonatal experiences in rats have been shown to produce long-term effects in cognitive-emotional responses (). For example, showed that rats raised by nurturing mothers have increased levels of central serotonin activity compared with rats raised by less nurturing mothers. The increased serotonin activity leads to increased expression of a central glucocorticoid receptor gene. This, in turn, leads to higher numbers of glucocorticoid receptors in the limbic system and improved glucocorticoid feedback into the CNS throughout the rat’s life. Interestingly, female rats who receive a high level of nurturing in turn become highly nurturing mothers whose offspring also have high levels of glucocorticoid receptors. This example of behaviorally induced gene expression shows how highly nurtured rats develop into low-anxiety adults, who in turn become nurturing mothers with reduced stress responses.
In contrast to highly nurtured rats, pups separated from their mothers for several hours per day during early life have a highly active hypothalamic-pituitary adrenocortical axis and elevated SNS arousal (). These deprived rats tend to show larger and more frequent stress responses to the environment than do less deprived animals.
Because evolution has provided mammals with reasonably effective homeostatic mechanisms (e.g., baroreceptor reflex) for dealing with short-term stressors, acute stress responses in young, healthy individuals typically do not impose a health burden. However, if the threat is persistent, particularly in older or unhealthy individuals, the long-term effects of the response to stress may damage health (). Adverse effects of chronic stressors are particularly common in humans, possibly because their high capacity for symbolic thought may elicit persistent stress responses to a broad range of adverse living and working conditions. The relationship between psychosocial stressors and chronic disease is complex. It is affected, for example, by the nature, number, and persistence of the stressors as well as by the individual’s biological vulnerability (i.e., genetics, constitutional factors) and learned patterns of coping. In this review, we focus on some of the psychological, behavioral, and biological effects of specific stressors, the mediating psychophysiological pathways, and the variables known to mediate these relationships. We conclude with a consideration of treatment implications.
PSYCHOLOGICAL ASPECTS OF STRESS
Stressors During Childhood and Adolescence and Their Psychological Sequelae
The most widely studied stressors in children and adolescents are exposure to violence, abuse (sexual, physical, emotional, or neglect), and divorce/marital conflict (see ). also provide an excellent review of the psychological consequences of such stressors. Psychological effects of maltreatment/abuse include the dysregulation of affect, provocative behaviors, the avoidance of intimacy, and disturbances in attachment (, ). Survivors of childhood sexual abuse have higher levels of both general distress and major psychological disturbances including personality disorders (). Childhood abuse is also associated with negative views toward learning and poor school performance (). Children of divorced parents have more reported antisocial behavior, anxiety, and depression than their peers (). Adult offspring of divorced parents report more current life stress, family conflict, and lack of friend support compared with those whose parents did not divorce (). Exposure to nonresponsive environments has also been described as a stressor leading to learned helplessness ().
Studies have also addressed the psychological consequences of exposure to war and terrorism during childhood (). A majority of children exposed to war experience significant psychological morbidity, including both post-traumatic stress disorder (PTSD) and depressive symptoms. For example, found that 70% of Kuwaiti children reported mild to severe PTSD symptoms after the Gulf War. Some effects are long lasting: found that 43% of Lebanese children continued to manifest post-traumatic stress symptoms 10 years after exposure to war-related trauma.
Exposure to intense and chronic stressors during the developmental years has long-lasting neurobiological effects and puts one at increased risk for anxiety and mood disorders, aggressive dyscontrol problems, hypo-immune dysfunction, medical morbidity, structural changes in the CNS, and early death ().
Stressors During Adulthood and Their Psychological Sequelae
LIFE STRESS, ANXIETY, AND DEPRESSION
It is well known that first depressive episodes often develop following the occurrence of a major negative life event (). Furthermore, there is evidence that stressful life events are causal for the onset of depression (see , ). A study of 13,006 patients in Denmark, with first psychiatric admissions diagnosed with depression, found more recent divorces, unemployment, and suicides by relatives compared with age- and gender-matched controls (). The diagnosis of a major medical illness often has been considered a severe life stressor and often is accompanied by high rates of depression (). For example, a meta-analysis found that 24% of cancer patients are diagnosed with major depression ().
Stressful life events often precede anxiety disorders as well (, ). Interestingly, long-term follow-up studies have shown that anxiety occurs more commonly before depression (, ). In fact, in prospective studies, patients with anxiety are most likely to develop major depression after stressful life events occur ().
DISORDERS RELATED TO TRAUMA
Lifetime exposure to traumatic events in the general population is high, with estimates ranging from 40% to 70% (). Of note, an estimated 13% of adult women in the United States have been exposed to sexual assault (). The Diagnostic and Statistical Manual (DSM-IV-TR; ) includes two primary diagnoses related to trauma: Acute Stress Disorder (ASD) and PTSD. Both these disorders have as prominent features a traumatic event involving actual or threatened death or serious injury and symptom clusters including re-experiencing of the traumatic event (e.g., intrusive thoughts), avoidance of reminders/numbing, and hyperarousal (e.g., difficulty falling or staying asleep). The time frame for ASD is shorter (lasting two days to four weeks), with diagnosis limited to within one month of the incident. ASD was introduced in 1994 to describe initial trauma reactions, but it has come under criticism () for weak empirical and theoretical support. Most people who have symptoms of PTSD shortly after a traumatic event recover and do not develop PTSD. In a comprehensive review, estimates that approximately 25% of those exposed to traumatic events develop PTSD. Surveys of the general population indicate that PTSD affects 1 in 12 adults at some time in their life (). Trauma and disasters are related not only to PTSD, but also to concurrent depression, other anxiety disorders, cognitive impairment, and substance abuse (, , ).
Other consequences of stress that could provide linkages to health have been identified, such as increases in smoking, substance use, accidents, sleep problems, and eating disorders. Populations that live in more stressful environments (communities with higher divorce rates, business failures, natural disasters, etc.) smoke more heavily and experience higher mortality from lung cancer and chronic obstructive pulmonary disorder (). A longitudinal study following seamen in a naval training center found that more cigarette smoking occurred on high-stress days (). Life events stress and chronically stressful conditions have also been linked to higher consumption of alcohol (). In addition, the possibility that alcohol may be used as self-medication for stress-related disorders such as anxiety has been proposed. For example, a prospective community study of 3021 adolescents and young adults () found that those with certain anxiety disorders (social phobia and panic attacks) were more likely to develop substance abuse or dependence prospectively over four years of follow-up. Life in stressful environments has also been linked to fatal accidents () and to the onset of bulimia (). Another variable related to stress that could provide a link to health is the increased sleep problems that have been reported after sychological trauma (). New onset of sleep problems mediated the relationship between post-traumatic stress symptoms and decreased natural killer (NK) cell cytotoxicity in Hurricane Andrew victims ().