 How Healthcare reform is impacting primary care https://www.ajmc.com/contributor/sophia–bernazzani/2016/03/how–healthcare–reform–is–impactingprimarycare 

•  Healthcare reform 101: What the health is going on in 2018? https://www.youtube.com/watch?v=cwTWhwWLzHQ  

•  Healthcare Transformation and Changing Roles for Nursing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/pdf/ornur3612.pdf 

Frequently when the shortage of primary care providers is mentioned with regard to healthcare reform, insurance companies and other institutions forget to factor in the impact nurse practitioners can have on increasing access. How do you think we can improve this understanding of the nurse practitioner role?

APA format 1 page long 3 references please use one from the reference and 1 from walden university library.  Due 9/14/19 by 9pm EST

 

Online Environment

 A significant challenge for online learning environments is to create a sense of community between peers and instructors. One method to achieve this is for instructors to share their authentic selves and stories with their students (Bristol & Zerwekh, 2011). Discussion forums offer the opportunity for instructors and learners to demonstrate their individuality without face-to-face interaction. Andragogy, or the study of adult learning, says that adults learn best when the content is relevant to their lived experience and when there is the opportunity for interaction between peers (Bradshaw & Hultquist, 2017). Relationship building is also crucial for instructor satisfaction, as well.  Smith and Crowe (2017) found that instructors were more satisfied when they had the opportunity to get to know their students. For the reasons above, utilization of video presentation of the instructor and use of discussion forum will allow a more personal experience of the online learning environment.

Classroom Management

            Nursing students are busy people who juggle many demands at once: family, work, and school, among other things. Students generally do not participate in optional ungraded assignments because of their time constraints (Bristol & Zerwekh, 2011). One strategy for classroom management is to decrease the feeling that students are doing busywork. This requires giving credit, in the form of points toward their grade, for their efforts.

            In order to head off problems with netiquette, the nurse educator needs to lie out expectations for interacting in the online environment. This can include basic recommendations such as using a professional writing style that does not include short-hand or abbreviations (Bristol & Zerwekh, 2011). In the online environment, incivility is increasingly a problem that interferes with learning. Social media sites are often the forum for incivility between instructor and student. De Gagne, Yamane, Conklin, Chang, and Kang (2018) recommend implementing policies and guidelines in order to avoid unprofessional conduct in the nursing school environment.

References

Bradshaw, M. J., & Hultquist, B. L.  (2017). Innovative teaching strategies in nursing and

            related health professions (7th ed.). Burlington, MA: Jones and Bartlett.

Bristol, T. J., & Zerwekh, J. (2011). Essentials of e-learning for nurse educators. Philadelphia,

            PA: F. A. Davis Company.

De Gagne, J. C., Yamane, S. S., Conklin, J. L., Chang, J., & Kang, H. S. (2018). Social media

use and cybercivility guidelines in US nursing schools: A review of websites. Journal Of Professional Nursing, 34(1), 35–41. https://doi-org.ezp.waldenulibrary.org/10.1016/j.profnurs.2017.07.006

Smith, Y. M., & Crowe, A. R. (2017). Nurse Educator Perceptions of the Importance of

Relationship in Online Teaching and Learning. Journal of Professional Nursing, 33(1), 11–19. https://doi-org.ezp.waldenulibrary.org/10.1016/j.profnurs.2016.06.004

  

SOAP NOTE SAMPLE FORMAT FOR MRC

  

Name:  LP

Date: 

Time: 1315

 

Age: 30

Sex: F

 

SUBJECTIVE

 

CC:  

“I am having vaginal itching and pain in   my lower abdomen.”

 

HPI:  

Pt is a   30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after   unsuccessful self-treatment of vaginal itching, burning upon urination, and   lower abdominal pain. She is concerned   for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with   urination has been present for 3 weeks, and the abdominal pain has been   intermittent since months ago. Pt has   tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms,   including urgency or frequency. She   describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10   at times. 200mg of PO Advil PRN   reduces the pain to a 7/10. Pt denies   any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but   denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any   vaginal irritants. She reports that   she is in a stable sexual relationship, and denies any new sexual partners in   the last 90 days. She denies any   recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well   as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also   takes Advil for. She reports her last   PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP   smear result. Pt denies any hx of   pregnancies. Other medical hx includes   GERD. She reports that she has an Rx   for Protonix, but she does not take it every day. Her family hx includes the presence of DM   and HTN. 

 

Current Medications: 

Protonix   40mg PO Daily for GERD

MTV OTC   PO Daily

Advil   200mg OTC PO PRN for pain

 

PMHx:

Allergies:  

NKA & NKDA

Medication Intolerances: 

Denies

Chronic Illnesses/Major traumas

GERD

Hospitalizations/Surgeries

Denies

 

Family History

Father-   DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal   grandparents without known medical issues; 1 brother and 3 other sisters   without known medical issues; No children.

 

Social History

Lives   alone. Currently in a stable sexual   relationship with one man. Works for   DEFACS. Reports occasional alcohol   use, but denies tobacco or illicit drug use.

 

ROS

 

General 

Denies   weight change, fatigue, fever, night sweats

Cardiovascular

Denies   chest pain and edema. Reports rare palpitations that are relieved by drinking   water

 

Skin

Denies   any wounds, rashes, bruising, bleeding or skin discolorations, any changes in   lesions

Respiratory

Denies   cough. Reports dyspnea that accompanies the rare palpitations and is also   relieved by drinking water

 

Eyes

Denies corrective   lenses, blurring, visual changes of any kind

Gastrointestinal

Abdominal   pain (see HPI) and Hx of GERD. Denies   N/V/D, constipation, appetite changes

 

Ears

Denies   Ear pain, hearing loss, ringing in ears

Genitourinary/Gynecological

Reports   burning with urination, but denies frequency or urgency. Contraceptive and STD prevention includes   condoms with every coital event. Current stable sexual relationship with one man. Denies known historic or recent STD   exposure. Last PAP was 7/2016 and normal. Regular monthly menstrual cycle   lasting 3-4 days. 

 

Nose/Mouth/Throat

Denies   sinus problems, dysphagia, nose bleeds or discharge

Musculoskeletal

Denies   back pain, joint swelling, stiffness or pain

 

Breast

Denies   SBE

Neurological

Denies   syncope, seizures, paralysis, weakness

 

Heme/Lymph/Endo

Denies   bruising, night sweats, swollen glands

Psychiatric

Denies   depression, anxiety, sleeping difficulties

 

OBJECTIVE

 

Weight   140lb 

Temp -97.7

BP 123/82

 

Height 5’4”

Pulse 74

Respiration 18

 

General Appearance

Healthy   appearing adult female in no acute distress. Alert and oriented; answers   questions appropriately. 

 

Skin

Skin is   normal color for ethnicity, warm, dry, clean and intact. No rashes or lesions   noted.

 

HEENT

Head is   norm cephalic, hair evenly distributed. Neck: Supple. Full ROM. Teeth are in   good repair.

 

Cardiovascular

S1, S2   with regular rate and rhythm. No extra heart sounds. 

 

Respiratory

Symmetric   chest walls. Respirations regular and easy; lungs clear to auscultation   bilaterally.

 

Gastrointestinal

Abdomen   flat; BS active in all 4 quadrants. Abdomen soft, suprapubic   tender. No hepatosplenomegaly.  

    

Genitourinary

Suprapubic   tenderness noted. Skin color normal   for ethnicity. Irritation noted at   labia majora, minora, and perineum. No ulcerated lesions noted. Lymph nodes   not palpable. Vagina pink and moist   without lesions. Discharge minimal,   thick, dark red, no odor. Cervix pink   without lesions. No CMT. Uterus normal size, shape, and consistency.  

 

Musculoskeletal

Full   ROM seen in all 4 extremities as patient moved about the exam room.

 

Neurological 

Speech   clear. Good tone. Posture erect. Balance stable; gait normal.

 

Psychiatric

Alert   and oriented. Dressed in clean clothes. Maintains eye contact. Answers   questions appropriately.

 

Lab Tests

Urinalysis   – blood noted (pt. on menstrual period), but results negative for infection

Urine   culture testing unavailable

Wet   prep – inconclusive 

STD   testing pending for gonorrhea, chlamydia, syphilis, HIV, HSV 1 & 2, Hep B   & C 

 

Special Tests- No ordered at this   time.

 

Diagnosis 

 

Differential Diagnoses

• 1-Bacterial Vaginosis (N76.0)
• 2- Malignant neoplasm of female genital organ,         unspecified. (C57.9)
• 3-Gonococcal infection, unspecified. (A54.9)

Diagnosis

o Urinary   tract infection, site not specified. (N39.0) Candidiasis of vulva and vagina.   (B37.3) secondary to presenting symptoms (Colgan & Williams, 2011) &   (Hainer & Gibson, 2011). 

 

Plan/Therapeutics

 

• Plan:  
  • Medication – 

§ Terconazole cream 1 vaginal application QHS for 7 days for   Vulvovaginal Candidiasis; 

§ Sulfamethoxazole/TMP DS 1 tablet PO twice daily for 3 days   for UTI (Woo & Wynne, 2012)

• Education – 

§ Medications prescribed. 

§ UTI and Candidiasis symptoms, causes, risks, treatment,   prevention. Reasons to seek emergent care, including N/V, fever, or back   pain. 

§ STD risks and preventions. 

§ Ulcer prevention, including taking Protonix as prescribed,   not exceeding the recommended dose limit of NSAIDs, and not taking NSAIDs on   an empty stomach. 

• Follow-up         – 

§ Pt will be contacted with results of STD studies. 

§ Return to clinic when finished the period for perform   pap-smear or if symptoms do not resolve with prescribed TX.

            

Write a 5 paragraph essay with the following components:

Introduction:

a.       Hook/Grabber:

question

statement

data/fact

Background info on the topic

Thesis Statement: inform the reader about what your essay will be about; last sentence of the intro para.

Body Paragraphs:

2 paragraphs containing the pros of the use of cellphones

1 paragraph containing the cons of the use of cellphones

Building Main Points:

Organize with the use of topic sentences that illustrate the main idea of each paragraph.Offering a brief explanation of the history or recent developments of topic within the early body paragraphs can help the audience to become familiarized with your topic and the complexity of the issue.

Paragraphs may be ordered in several ways, depending upon the topic and purpose of your argument:•General to specific information• Most important point to least important point . Weakest claim to strongest claim

• Countering the Opposition:
• Addressing the claims of the opposition is an important component in building a convincing argument. 
• It demonstrates your credibility as a writer –
• you have researched multiple sides of the argument and have come to an informed decision.
• It shows you have considered other points of view – that other points of view are valid and reasonable
• Effective Counter Arguments:
• Consider your audience when you address the counterargument.
• Conceding to some of your opposition’s concerns can demonstrate respect for their opinions.
• Remain tactful yet firm:   Using rude or deprecating language can cause your audience to reject your position  without carefully considering your claims.
• Counterarguments may be located at various locations within your body paragraphs.You may choose to:•build each of your main points as a contrast to oppositional claims.•offer a counterargument after you have articulated your main claims.

Conclusion:

• Your conclusion should reemphasize the main points made in your paper.
• You may choose to reiterate a call to action or speculate on the future of your topic, when appropriate. 
• Avoid raising new claims in your conclusion.

  

Evidence-based practice proposal topic for this capstone project is Drug Induced Mental Disorders. Consider the clinical environment in which you are currently working or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. Examples of the integration of community health, leadership, and an EBP can be found on the “Educational and Community-Based Programs” page of the Healthy People 2020 website.

Write a 700-word description of your proposed capstone project topic. Make sure to include the following:

1. The problem, issue, suggestion, initiative, or educational need that will be the focus of the project

2. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.

3. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.

4. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.

5. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.

6. A proposed solution to the identified project topic

You are required to retrieve and assess a minimum of 8 peer-reviewed articles for this project. 

Prepare this project topic “Drug Induced Mental Disorder” according to the guidelines found in the APA Style Guide; and abstract or thesis is required.