For this discussion, you are asked to review the student learning outcomes for this course and discuss how you met these outcomes. The intention here is to provide you an opportunity to “reflect” on the learning achieved during this term and how you successfully met these learning outcomes. If you do not feel you successfully met the objective, discuss your plans to successfully complete the objective in the future.

Upon completion of this course, the student should be able to:

1. Critically analyze current practice to formulate researchable problems.

2. Evaluate research as the basis for decision-making to improve outcomes through translation into evidence-based practice. 

3. Synthesize an understanding of the research process through development of a proposal to address a nursing problem or focus area identified in nursing practice.

4. Investigate ethical issues related to the conduct of scientific research, including informed consent, data management, data analysis, and protection of human subjects.

5. Explore national and international initiatives and research priorities.

Elaborate 1 post for each article (article#1  and  article#2). Please, see attached articles from my peers. 

THIS IS A TURNITIN ASSIGNMENT. FREE OF PLAGIARISM.

In your reply posts, provide a recommendation as to how your peers can further address the major environmental problem and political issue that they described using a minimum of two scholarly references formatted per APA style.

Reflect on the current roles of advanced practice nurses in healthcare as the care providers at the front line of disease management and health promotion in primary care and many other specialty settings. What do you think are some effective tactics for APN strategic positioning regarding pay equality? Should APNs position themselves as lower-cost providers who provide better care or push for comparable worth, same service and same pay?

Below is an article that provides great practical information that highlights how provider productivity is calculated in the clinical setting, which is important to know as future nurse practitioners.

Calculating Your Worth: Understanding Productivity and Value- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093517/ 

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease (AD) (Moore, Shpiner, & Luca, 2019). PD has been traditionally considered as a pure movement disorder secondary to focal degeneration of dopaminergic neurons in the substantia nigra, but, in recent years, the clinical phenotype has been better illuminated, showing that PD is a multisystem neurodegenerative disorder with motor and non-motor features. Among motor symptoms and signs, the cardinal ones (bradykinesia, rest tremor, and rigidity) are mainly the loss of dopaminergic neurons, but those involving posture, balance, and gait are largely secondary to degeneration of nondopaminergic pathways and significantly contribute to impairment and disability in advanced PD patients (Moore, Shpiner, & Luca, 2019). Nonmotor features result from multiple neurotransmitter deficiencies in the central and peripheral nervous system and include psychiatric such as: depression, apathy, hallucinations, and delusions. Autonomic includes constipation, orthostatic hypotension, and urinary and genital disturbances. Cognitive impairment such as: involvement of executive functions, memory, sleep disorders, olfactory dysfunction, and pain that together contribute to worsening the quality of life and patient’s disability (Moore, Shpiner, & Luca, 2019).

  Cardinal motor features of Parkinson’s disease (PD) include bradykinesia, rest tremor, and rigidity, which appear in the early stages of the disease and largely depend on dopaminergic nigrostriatal denervation (Moore, Shpiner, & Luca, 2019). Intermediate and advanced PD stages are characterized by motor fluctuations and dyskinesia, which depend on complex mechanisms secondary to severe nigrostriatal loss and to the problems related to oral levodopa absorption, and motor and nonmotor symptoms and signs that are secondary to marked dopaminergic loss and multisystem neurodegeneration with damage to nondopaminergic pathways (Moore, Shpiner, & Luca, 2019). Nondopaminergic dysfunction results in motor problems, including posture, balance and gait disturbances, and fatigue, and nonmotor problems, encompassing depression, apathy, cognitive impairment, sleep disturbances, pain, and autonomic dysfunction. There are a number of symptomatic drugs for PD motor signs, but the pharmacological resources for nonmotor signs and symptoms are limited, and rehabilitation may contribute to their treatment (Moore, Shpiner, & Luca, 2019). 

  Pharmacological therapy is based on levodopa and dopamine agonists and is very successful in the early stages of the disease, when dopaminergic symptoms and signs are predominant and long term motor complications still have not developed, but other treatment strategies are necessary as time passes (Hajj, 2018). Long term levodopa-induced motor complications include motor fluctuations and dyskinesia and affect almost all PD patients at some point during the disease course, with relevant implications in global health status (Hajj, 2018). Despite various pharmacological approaches, as well as more invasive strategies including devices and functional neurosurgery, being available to manage such complications, many patients remain significantly disabled, and a fully satisfying management of motor complications is still an unmet need of PD therapy. Nonmotor symptoms and signs are integral to PD at onset and throughout the disease course, but to date their treatment is largely unsatisfactory (Hajj, 2018).

References

Hajj, R. (2018). Parkinson Disease Therapies and Drugs. Pathology, Prevention and Therapeutics of Neurodegenerative Disease, 151–158. doi: 10.1007/978-981-13-0944-1_13

Moore, H., Shpiner, D. S., & Luca, C. C. (2019). Management of Motor Features in Advanced Parkinson Disease. Clinics in Geriatric Medicine. doi: 10.1016/j.cger.2019.09.010

COLLAPSE

Heart Failure

Pathophysiology is a vital discipline in medicine and is generally useful for diagnosis and patient care. The disease-related to pathophysiology is heart failure. Wright and Thomas (2015) explain that pathophysiology in the management of heart failure ensures that patients are optimized on a maximum tolerated dose of medicine to treat heart failure with reduced ejection fraction. Heart failure is a complex clinical syndrome whereby the heart is not able to attain the metabolic demands of the body. The reasons underlying the mismatch can be multifactorial. However, the various pathological conditions make the treatments and management of the condition to be complex. Therefore, pathophysiology is essential in minimizing the burden on the condition. Heart failure is on the increase for the past decade leading to the heightening of the adult population to around 1% to 2%. The male population is the greatest affected gender, with an estimated 33% of men above 55 years old having the condition as compared to the 28% in women (Farmakis et al., 2015). Pathophysiology seeks to redress the balance through initiating contemporary measures. However, the measures have become damaging to the diseases and can lead to worsening cardiac output that can result in additional stress to a failing heart. 

 References

Farmakis, D., Parissis, J., & Filippatos, G. (2015). Acute heart failure: epidemiology, classification, and pathophysiology. Oxford Medicine Online, 2(1), 2-10. doi:10.1093/med/9780199687039.003.0051

Wright, P., & Thomas, M. (2018). Pathophysiology and management of heart failure. Clinical Pharmacist, 2(1), 1. doi:10.1211/cp.2018.20205742