This week, you will dive more in depth into special patient populations. You will look at considerations for older adult clients, women of reproductive years, children and adolescents, and those who are most likely to struggle with medication adherence. You will also practice the act of prescribing.

The Practicum Assignment, due this week, is a requirement in order to progress from this course; however, no point value is associated with the assignment. An incomplete will be submitted as the final grade if the practicum assignment is not completed.

Assignment 1

To complete this Assignment, you will choose a case study for a patient population for special consideration during prescribing practices. You will consider the specific patient and determine the appropriate medication to prescribe, based on the patient specifics and medication attributes in various case studies. You will construct a 4- to 5-page paper in which you determine the medication, the dosing, necessary patient education, and potential side effects. You will also indicate why the other medications would not be appropriate, as well as any necessary labs or diagnostics that might be needed. You will develop a plan to enhance medication adherence for the nonadherent patient.

Construct a paper concerning your assigned vulnerable population patient case. In your paper include the following:

· Determine which medication would be most appropriate to prescribe from the assigned vulnerable population patient case medication choices.

· Explain your rationale for choosing this medication. Explain why the other medications listed are not appropriate for this patient.

· Explain the dosing schedule for the specific patient including the therapeutic endpoint.

· Provide necessary education to the patient to review risks, benefits, and potential side effects of the medication.

· Describe any necessary labs or additional diagnostics needed prior to prescribing this medication.

· Explain how you might monitor efficacy or side effects of the medication.

· Include any additional collaboration or education to others that would be necessary for this patient. Consider family members, home health care, primary care providers, etc.

· What would you need to include in your assessment for a patient who may become nonadherent with your prescribing plan for your scenario? What are alternative treatment solutions based upon how you assessed? Describe your new treatment plan.

This Assignment requires a minimum of  five (5) peer-reviewed, evidence-based scholarly references outside of course resources.

Note: You will need to include the APA style formatting.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

Special Considerations for Patient Population Cases:

· Patient 1: 82-year-old male presenting with cognitive decline. He had always been a very active individual. Over the past year, he has become less active in the community. Previously, he played cribbage weekly with friends at the local senior center but has been struggling with the math involved with the game and no longer attends the weekly card game. He had also volunteered as a crossing guard for the local public school. He quit doing that after he took the wrong turn to get home and drove around the town feeling lost. He acknowledges he is “sensitive” to this and can be irritable towards his children when they bring up these concerns. He was diagnosed with mild neurocognitive disorder after completing neuropsychological testing. Of the following medications, which would be the most appropriate to prescribe? Explain why you chose this medication. What would be the dosing schedule for this patient? Provide education to the patient and review risks, benefits, and potential side effects of the medication. In addition, explain why the other medications listed are not appropriate for this patient.  Med List: lorazepam, olanzapine, memantine

· Patient 2: 76-year-old female who recently moved from her home to an assisted living. After 1 week of moving in, she has become extremely confused. Staff have attempted to re-orient her, and she struggles to focus on what they are saying. She is only oriented to self. She has become very agitated and has even thrown breakable objects in her room. Her family is concerned stating she is “out of it.” The PCP ordered labs and UA. Labs are unremarkable outside of mild leukocytosis and positive dipstick analysis for nitrite and red blood cells.  Med List: valproate, alprazolam, trimethoprim

· Patient 3: A 33-year-old female that is 6 weeks postpartum. She presents with depressed mood, sadness, easily emotional, difficulties with sleep even when the infant is sleeping. She has lost weight and has a poor appetite. You note psychomotor retardation. She has limited interests in hobbies or bonding with the infant. Her partner is concerned and reports she is typically active and “bubbly” and enjoys the outdoors. She is diagnosed with major depressive disorder, with postpartum onset. She denies suicidal ideation, homicidal ideation, or infanticidal ideation. No psychotic symptoms are present. She is nursing the infant and wants to continue this hoping it will assist with bonding with the infant.  Med List: lithium, paroxetine, sertraline

· Patient 4: 10-year-old male who comes in with his father. He has been diagnosed with generalized anxiety disorder. He has constant worries that he cannot control. He feels nervous and tense. He is easily irritable. He struggles to settle down or relax. He is also quite fidgety and restless. He and his father are interested in medications to manage these symptoms.  Med List: quetiapine, duloxetine, fluoxetine

· Patient 5: 27-year-old male with a diagnosis of schizophrenia. He has been hospitalized three (3) times in the past 1 year due to symptoms. When symptomatic, he becomes disorganized and paranoid. He will respond to auditory hallucinations. He will scream out at night after seeing a shadow in his room. He has delusions that the CIA is poisoning food and will not eat for multiple days. He has unintentionally hurt his mother after “slapping” food out of her hand, as he did not want her to ingest the “poisoned food.” Symptoms are treated very well with paliperidone, but he struggles to remember to take it.  Med List: paliperidone palmitate, clozapine, lamotrigine

 

 

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals

 

Synthesis and Recommendations Tool

Appendix H

 

 

 

 

 

EBP Question:
Strength	Number of Sources (Quantity)	Synthesized Findings With Article Number(s) (This is not a simple restating of information from each individual evidence summary—see directions)
Level	Overall Quality Rating (Strong, good, or low)
Level I · Experimental studies
Level II · Quasi-experimental studies
Level III · Nonexperimental, including qualitative studies
Level IV · Clinical practice guidelines or consensus panels
Level V · Literature reviews, QI, case reports, expert opinion

 

 

 

 

 

Where does the evidence show consistency?

Where does the evidence show inconsistency?

Best evidence recommendations (taking into consideration the quantity, consistency, and strength of the evidence):

Based on your synthesis, select the statement that best describes the overall characteristics of the body of evidence.

☐ Strong & compelling evidence, consistent results Recommendations are reliable; evaluate for organizational translation. ☐ Good evidence & consistent results Recommendations may be reliable; evaluate for risk and organizational translation. ☐ Good evidence but conflicting results Unable to establish best practice based on current evidence; evaluate risk, consider further investigation for new evidence, develop a research study, or discontinue the project. ☐ Little or no evidence Unable to establish best practice based on current evidence; consider further investigation for new evidence, develop a research study, or discontinue the project.

 

 

 

 

 

 

 

 

 

See Chapter 11, Lessons from Practice, for examples of completed tools.

 

Directions for use of the Synthesis and Recommendations Tool

Purpose:

This tool guides the EBP team through the process of synthesizing the pertinent findings from the Individual Evidence Summary (Appendix G), sorted by evidence level, to create an overall picture of the body of the evidence related to the PICO question. The synthesis process uses quantity, strength (level and quality), and consistency to generate the best evidence recommendations for potential translation.

Overall quality rating and the total number of sources:

Record the overall quality rating and the number of sources for each level (strong, good, or low), ensuring agreement among the team members.

Synthesized findings:

This section captures key findings that answer the EBP question. Using the questions below, generate a comprehensive synthesis by combining the different pieces of evidence in the form of succinct statements that enhance the team’s knowledge and generate new insights, perspectives, and understandings into a greater whole. The following questions can help guide the team’s discussion of the evidence:

· How can the evidence in each of the levels be organized to produce a more comprehensive understanding of the big picture?

· What themes do you notice?

· What elements of the intervention/setting/sample seem to influence the outcome?

· What are the important takeaways?

Avoid repeating content and/or copying and pasting directly from the Individual Evidence Summary Tool. Record the article number(s) used to generate each synthesis statement to make the source of findings easy to identify.

Using this synthesis tool requires not only the critical thinking of the whole team but also group discussion and consensus building. The team reviews the individual evidence summary of high- and good-quality articles, uses subjective and objective reasoning to look for salient themes, and evaluates information to create higher-level insights. They include and consider the strength and consistency of findings in their evaluation.

Where does the evidence show consistency/inconsistency?

EBP teams must consider how consistent the results are across studies. Do the studies tend to show the same conclusions, or are there differences? The synthesized evidence is much more compelling when most studies have the same general results or point in the same general direction. The synthesized evidence is less compelling when the results from half the studies have one indication, while the findings from the other half point in a different direction. The team should identify the points of consistency among the evidence as well as areas where the inconsistency is apparent. Both factors are important to consider when developing recommendations or determining the next steps.

 

Best evidence recommendations:

In this section, the EBP team takes into consideration all the above information related to the strength, quantity, and consistency of the synthesized findings at each level to generate best practice recommendations from the evidence. Consider:

· What is the strength and quantity of studies related to a specific evidence recommendation?

· Is there a sufficient number of high-strength studies to support one recommendation over another?

· Are there any recommendations that can be ruled out based on the strength and quantity of the evidence?

· Does the team feel the evidence is of sufficient strength and quantity to be considered a best evidence recommendation?

Recommendations should be succinct statements that distill the synthesized evidence into an answer to the EBP question. The team bases these recommendations on the evidence and does not yet consider their specific setting. Translating the recommendations into action steps within the team’s organization occurs in the next step (Translation and Action Planning Tool, Appendix I).

Based on the synthesis, which statement represents the overall body of the evidence?

Choose the statement that best reflects the strength and congruence of the findings. This determination will help the team to decide the next steps in the translation process .

When evidence is strong (includes multiple high-quality studies of Level I and Level II evidence), compelling, and consistent, EBP teams can have greater confidence in best practice recommendations and should begin organizational translation

When most of the evidence is good (high-quality Level II and Level III) and consistent or good but conflicting, the team should proceed cautiously in making practice changes. In this instance, translation typically includes evaluating risk and careful consideration for organizational translation.

The team makes practice changes primarily when evidence exists that is of high to good strength. Never make practice changes on little to no evidence (low-quality evidence at any level or Level IV or Level V evidence alone). Nonetheless, teams have a variety of options for actions that include but are not limited to, creating awareness campaigns, conducting informational and educational updates, monitoring evidence sources for new information, and designing research studies.

The exact quantity of sources needed to determine the strength of the evidence is subjective and depends on many factors, including the topic and the amount of available literature. The EBP team should discuss what they consider sufficient given their knowledge of the problem, literature, and setting

 

 

 

 

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

How do effective nurse leaders and others approach problem solving and decision making in organizations? As suggested in this week’s Learning Resources, systems theory provides a valuable way to assess situations and prepare to address problems.

 

For this week’s Discussion, you identify an issue or process that could be improved and apply knowledge and strategies related to systems theory.

 

Note: You may find it helpful to view the Assignment instructions and use the same problem for this Discussion.

 

To prepare:

 

• Review the information presented in this week’s Learning Resources on systems theory and the difference between open and closed systems.
• Reflect on the practices and processes with which you are familiar in your organization. Identify one problematic issue or process that could be improved.
• Consider the problem from a closed-system perspective. Then think about how the issue or process you selected could be addressed by viewing it from an open-system perspective. How would the transition from a closed- to an open-system view help you and others to address the problem and improve outcomes?

 

Post (1) a description of the problem that you identified in your selected organization. (2) Explain the problem from a closed-system perspective. Then, (3) describe how the problem could be addressed by viewing it from an open-system perspective, and (4) explain how this modification would help you and others improve health care outcomes.

 

 

 

 

.

 

Readings

 

• Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
  • Review Chapter 7, “Strategic and Operational Planning”

    See especially Figure 7.1 on page 147.

  • Chapter 8, “Planned Change”
    • Organizational Change Associated With Nonlinear Dynamics (pp. 172–176)

      Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.

  • Chapter 12, “Organizational Structure”
    • “Organizational Culture” (pp. 274–276)

      There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management.

• Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf

  This article addresses the importance of systems-based practice (SBP) in health care workplaces. The authors state that SBP knowledge is one of six core competencies that physicians have to know in order to provide safe and proper care for their patients.

• Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology. FoNS 2014 International Practice Development Journal 4 (1) [2].

  Except from Abstract: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enables everyone to flourish. When units within health care organizations recognize their interdependence, they can create an interdisciplinary practice through systems integration.

• Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838.
  Retrieved from the Walden Library databases.

  In this article, the authors examine the effects of nursing services delivery theory in large-scale organizations. Among other benefits, this theory supports multilevel phenomena and cross-level studies, and it can guide future research and the management of nursing services.

 

 

• Glennister, D. (2011, July). Towards a general systems theory of nursing: A literature review. Paper presented at the 55th Annual Meeting of the International Society for the System Sciences, Hull, United Kingdom. Retrieved from http://journals.isss.org/index.php/proceedings55th/article/viewFile/1717/569
• Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems theory. Retrieved from http://www.hayajneh.org/a/readings/Systems-Theory.pdf

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now

Starting with the precursor substance tyrosine or tryptophan, identify and briefly describe each chemical step required to create each neurotransmitter.

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now