Describe  the most challenging leadership/management that nurses are currently experiencing in today evolving health care industry.

• Write a 250-300 word paper using APA Format.
• Use at least THREE references
• References must not be less than FIVE years.

1-A.G

Childhood asthma is a frequent clinical occurrence associated with respiratory impairments and airway inflammation, which requires immediate treatment and long-term care. The discussed disorder can considerably worsen overall health conditions, reduce the quality of life, and increase the risk of life-threatening implications. The provided asthma-associated case study can be beneficial for reviewing short-term and long-term treatment options efficient for treating the given patient. Furthermore, one’s potential education can be ultimately useful for achieving sufficient treatment outcomes as well as organizing appropriate preventive and therapeutic actions.  

   The provided clinical case exemplifies moderate persistent asthma that requires immediate intervention. It is evident that short-acting beta2-adrenergic agonists (SABA), systemic and inhaled corticosteroids, as well as anti-inflammatory medications, can provide quick symptomatic relief by reducing such aberrations as wheezing and bronchoconstriction present in the reviewed patient, normalizing respiration, and improving overall health. Furthermore, such drugs as inhaled steroids, leukotriene modifiers, nedocromil, cromolyn sodium, and methylxanthine can assist in providing long-term asthma control, stabilizing respiratory functions, and preventing possible asthma exacerbations and inappropriate lung growth in children (Woo & Robinson, 2015). It is estimated that a combination of SABAs and inhaled corticosteroids is useful for managing acute asthmatic exacerbations and maintaining normal respiratory functions (Arcangelo & Peterson, 2013). The beta2-adrenergic agonists like albuterol and levalbuterol are capable of exerting “their bronchodilatory effects through β2 adrenoceptors (β2ARs) located on airway smooth muscle (ASM) cells” and providing significant airway relaxation by activating the aforementioned receptors, whereas the steroid medications are efficient in decreasing airway inflammation and airway hyperresponsiveness by lessening the number of circulating inflammatory mast cells and eosinophils in the respiratory tract (Billington, Penn, & Hall, 2017, p. 23). Furthermore, the use of inhaled corticosteroids can be also beneficial for relieving airway obstruction, normalizing respiratory functions, asthma control, and minimizing the risk of asthmatic exacerbations. 

   Patient education is important for achieving sufficient treatment outcomes. Patients, as well as their caregivers, have to be aware that adherence to the prescribed treatment regimen and recommendations, reporting adverse effects, and regular physical evaluation along with cooperative communication with a physician can assist in stabilizing the patient’s condition and preventing asthma progression. Therefore, asthma is a severe acute or chronic respiratory abnormality that requires competent treatment and care. It is estimated that inhaled SABA, as well as inhaled and systemic corticosteroids, are efficient for achieving short-term therapy goals, whereas leukotriene modifiers, methylxanthines, and anti-inflammatory agents demonstrate normal heir efficacy in providing long-term asthma control and maintaining normal respiratory functioning. Lastly, a patient’s teaching is a critical component of successful medication. 

2-michael V.

The short-term option for this child diagnosed with asthma will be bronchodilators to quickly relieve his symptoms by opening swollen airways that are limiting breathing (Saglani, Fleming, Sonnappa, & Bush, 2019).  Long-term options include Inhaled corticosteroids, Leukotriene modifiers, Long-acting beta agonists, and Combination inhalers. Corticosteroids are the first line of treatment for severe acute asthma, because of the inflammatory process.  Steroids control airway inflammation through a number of mechanisms, such as reducing the number and activation of lymphocytes, eosinophils, mast cells, and macrophages; suppressing the production of cytokines, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor, adhesion molecules, and inducible enzymes, including nitric oxide synthase and cyclooxygenase-2.  The step-up approach involves beginning with low-dose treatment and increasing intensity at subsequent visits if control is not achieved (Bateman et al., 2019). When selecting the medication and dosage, the provider must take into account the risk to the patient, severity of disease, and potential for impairment.

The goal of asthma treatment is to decrease symptoms and reduce airway inflammation and hyperreactivity.  Healthcare provider should develop written asthma action plan with the patient and his mother for self-management, so they know how to recognize the severity of its symptoms (peak flow) and what to do (Bateman et al., 2019).  Patient should be educated on ways to control exposures to allergens.  An allergy test will be a good plan to identify the patient’s allergy (Bateman et al., 2019).  The patient may need a referral to a pulmonologist if symptoms are uncontrolled with the current regiment.  Pulmonary function testing may be necessary in this child’s case.

References

Bat

Response Post #1

Culture is defined as customary beliefs, social forms, and material traits of a racial, religious, or social group (Webster, 2019). Competence suggests having the capacity to function effectively as an individual and an organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities (CDC, 2015). In healthcare, it is very important to be aware of different culture backgrounds. It helps with not only being able to communicate effectively but also knowing what diseases, sickness, etc. that the person is at greatest risk for. For example, in the treatment of depression, compared with white Americans, black and Latino patients are actually less likely to receive treatment (Ball et al., 2019).

The patient I was given is a 14 year old biracial male living with his grandmother in a high-density public housing complex. For the purpose of obtain a health history with this particular patient it is important to consider everything about this patient. The patients age, sex, ethnicity, living conditions, etc. will all need to be taken into account. This particular age group are reluctant to talk and have a definite need for confidentiality (Ball et al., 2019). It is important that adolescent patients be given the opportunity to speak to you privately about concerns or issues that they may have (Ball et al., 2019). It is meaningful that you let the patient know the limits of confidentiality and that if any information provided suggests that an adolescence safety or others safety may be at risk, that its grounds to “break” confidentiality (Ball et al., 2019). Prior to the office visit, there a previsit questionnaires and screeners that the patient can fill out and this sometimes helps allow the patient to write down concerns or have a choice of concerns (Ball et al., 2019). Then based off the answers, it can help you ask appropriate questions during the interviewing process.

Based off of the patients age, ethnicity, and living conditions I would use the HEEADSSS screening tool. This screening tool assess the home environment, education/employment, eating, activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Ball et al., 2019). Questions that can be asked needs to be open ended questions such as …

Tell me about where you live?

How are you liking school?

What do you like to do, any activities in school or out of school?

Do you ever hang out with your friends outside of school? What do you like to do? Are you ever in situations that make you uncomfortable? Have you ever tried drugs or alcohol?

In order to assess for suicide/depression, there are screening tools. The screening questions may include asking about sleep disorders, appetite/eating behavior change, feelings of “boredom”, emotional outbursts and highly impulsive behavior, hopeless/helpless feeling, history of family with depression or suicide, suicidal ideation, history of psychosocial/emotional trauma, or those who are gay, lesbian, bisexual, or transgender youth (BCC Hospital, 2019).

Response Post # 2

Diversity and Health Assessments

The human behavior, ideas, attitudes reflect the manner of cultural competency of different patients. These behaviors are their culture, which affects their belief in their treatments. The socioeconomic, spiritual, lifestyle and other cultural factors are changed to one group or a subgroup of the individual, in which the patient-centered care and cultural competence have an overlapping concept (Ball et al., 2019). Poverty and inadequate education disproportionately affect various cultural groups which they have higher rates of dying from an illness compared to those that are educated and economically advantageous. The mode of communication of an individual has a different meaning for different people, which include the use of speech, body language, and space (Ball et al., 2019). An example is a Spanish meet with eye contact in the conversation, Asians, middle eastern cultures may be rude or immodest, and Americans may let the eye wander and say understanding of the communications.

The respect model is an essential consideration in the effectiveness of cross-cultural communication, whether it is verbal, non-verbal, or written. The example of a patient-centered communication on a patient who is a 40-year-old black male recent immigrant from Africa without health insurance is to connect on a social level. The practitioner will verbally acknowledge and legitimatize the patient’s feelings, which reassures the availability of help for them. The practitioner can give particular emphasis to the patient working together to address health problems, especially to resolve health insurance issues for the patient. The practitioner can provide explanations clearly by often checking for understanding. It is essential to respect the patient cultural beliefs, for this is one way of establishing the trust of working to the patient.

In asking questions to the patient, it should have a conceptual structure on evidenced-based guidelines. One of the techniques when asking the issue is the PICO (problem, intervention, comparison, and outcome) acronym. The practitioner can begin to ask what their clinical issues are? How long does their illness going on? What is their previous intervention or exposure related to the disease? Is there any difference in their condition when they take the previous treatments: What is the aggravating factor that causes the problem? These questions can answer the history of the present illness of the patient. The United States Preventive Services Task Force (USPSTF) makes recommendations about clinical preventive services such as screenings, counseling, and preventive medications. The practitioners make their clinical decisions and recommendations based on the excellent quality of scientific pieces of evidence. However, evidence alone is never meant to replace experience and intuition (Dains Baumann, & Scheibel, 2019). The task force also makes its recommendations on benefits based on matrix and grades. So, the practitioner can make their decision to help the patient based on the grading system, and certainty of benefit depends on their assessments to the patient.

The diversity in healthcare is to ensure the best possible care adequately provides all backgrounds, beliefs, ethnicities, and perspectives to a patient with a variety of healthcare providers. An example of this is the case of asthma in the United States that ethnicities share a disproportionate burden of the disease. According to Melton, Graff, Homes, Brown, & Bailey, 2014) that there are disparities result of activities (work & school) among African-American because of a variety of factors which include communication of patient and provider and literacy to healthcare. An individual with higher educational attainment has a higher understanding of their health status. Their culture influences their beliefs to take the medication which African-American have a fear of making the ICS and less knowledge about asthma that they will develop a decreased tolerance of the drug (Melton, Graff, Homes, Brown, & Bailey, 2014).

The social history and family history of the patient are essential to assess to determine the support system available to the patient. The practitioner can ask the patient if he is married, where is his family member; and what is the family member’s status in life (If they are healthy or suffering also from illnesses). For example, if the patient has asthma, then the practitioner can ask if he is a smoker and drinks alcohol that may aggravate the disease. If he has any allergies that may trigger the illness. However, requesting a complicated social history can also be performed by a social worker that the patient can get a benefit or support from different agencies. The practitioner can treat the medical condition of the patient in which a medication can be prescribed; the drug can be adjusted; an additional medication can be prescribed to prevent the exacerbation of the disease. Lastly, the own patient understanding of the treatment is essential to assess to ensure compliance with the procedure. The practitioner can ask the patient by their knowledge of the treatment.

Write a Respond to two of these #1&2 case studies using one or more of the following approaches:

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.
• Each must have at least 2 references no more than 5 years old using APA Format  

Competencies for Nurse Leaders

Using the Vestal article, “Managing Your Talent Forward,” consider the following points for this discussion:

• How are you developing your DNP leadership skills in your DNP project?
• How do you envision that your leadership skills will transform organizations and systems?
• What does it mean to you to manage your talent forward?

Your initial post should be succinct and demonstrate clarity of thought and precision in writing. Support your discussion with at least two references other than the required readings. Use appropriate and accurate APA formatting.

Course Closure and Reflection

A final step in each part of your DNP program is an evaluation of each course, reflection on what you have learned, and consideration for how you can apply this new knowledge and skills to your professional practice.

For your initial post to this discussion, write a brief evaluation of what you have learned in this course and how you will apply your new knowledge and skills to your professional career and development as a DNP-prepared nurse professional.

• Identify at least two areas of new knowledge that you have acquired.
• Discuss how and where you might apply the new knowledge to your current (or future) nursing practice.
• Discuss what you have learned as a result of this course about your own strengths and weaknesses in nursing management.
• Discuss the knowledge gaps that still exist related to the content in this course. How will you fill those gaps?

Prepare a genogram for the client you selected. The genogram should extend back by at least three generations (great grandparents, grandparents, and parents).

Please redo the genogram needs to be more uniformed