Expert Answers

 Explain a workplace situation at your place of employment, either with peers, administrators, or the facility, that made you uncomfortable. Identify potential policies a professional nurse might introduce/implement that would improve the situation; they may be institutional, local, state, federal, or organizational statements (such as the ANA). Would the application of some form of technology be beneficial?  The sky is the limit here! 

Choose one multisystem dysfunction. Describe pathophysiological changes, abnormal findings, and symptoms of the chosen dysfunction. How does it affect the patient's activities of daily living?   Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to "RN-BSN Discussion Question Rubric" and "RN-BSN Participation Rubric," located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

Explain the modifiable and nonmodifiable risk factors for osteoporosis. How can a nurse support the patient in managing the health condition and restore the patient to optimal health? Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to "RN-BSN Discussion Question Rubric" and "RN-BSN Participation Rubric," located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

1) Explain your personal nursing philosophy, your view of health, your growth in critical thinking, and your future role as a nurse. Include your view of health and your thoughts on your future role as a nurse.  2)  Provides a thoughtful, descriptive personal nursing philosophy. Includes multiple details to support their thoughts and reasons. 

chapter 10 legal and ethical

Respond to two of your colleagues by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination. Peer 1 Marie Myrtha Cajuste Disseminating Evidence-Based Practice: Strategies and Overcoming Barriers Ensuring the dissemination of evidence-based practice (EBP) is a requirement for moving healthcare systems to be more effective, safer, and efficient. Evidence-based practice can be propagated further by transmitting the findings and strategy of EBP to all healthcare professionals within Adventhealth Hospital, where I work in the Orthopedic department. They will then contribute to the collective knowledge base and promote best practices, thus ultimately advocating for the implementation of EBP interventions. Nevertheless, the successful dissemination of information will only happen when its scope has been well thought out, various strategies have been considered, and the barriers have been countered. Preferred Dissemination Strategies Unit-level or Organizational-level Presentations Presentation-level techniques at the unit or unit level transmit the evaluation results and create acceptance and implementation in the healthcare organization. In this way, EBP presentations, being a form of active engagement, promote within the learning community and pave the way for a dialog with colleagues about broader applicability. By creating content that is precisely right for the organization's needs and situation, these presentations will enhance the level of acceptability and the adoption of scientifically proven approaches. Poster Presentations at Professional Conferences The chance of disseminating the EBP findings among a wider audience through poster presentations at local, regional, and national professional forums is an excellent opportunity. Thus, as visual displays, they are the best medium for short and concise communication of research findings, methodology, and the subsequent implications for practice (Gallagher-Ford et al., 2011). Similarly, poster presentations have the advantage of providing networking opportunities between other professionals, which could result in possible collaborations and the creation of shared knowledge Least Preferred Dissemination Strategies Podium Presentations at National Conferences While podium presentations are a form of national conferences that may have more expansive dissemination power, they are least attractive because of complex preparation and may cause stress or fear (Melnyk, 2012). Also, the level of competitiveness among these conferences may sometimes make it challenging to secure a podium presentation slot. Publication in Peer-reviewed Journals Publishing in peer-reviewed journals is one good strategy to inform widely, as it makes way for publications with a permanent record of EBP findings. Although the publication process is lengthy and the most detailed, it involves many re-reads and submissions, which are sometimes rejected (LoBiondo-Wood & Haber, 2021). This approach may seem initially intimidating to newbies who physically disperse the EBP information and those with little research experience (Melnyk et al., 2017). Potential Barriers and Strategies to Overcome Them Limited Resources and Time Constraints The most significant obstacle that hampers the dissemination of evidence-based practices is the absence of proper resources, working in conjunction with a lack of time. In healthcare, professionals perform multi-tasking activities, and sometimes, they have less time to spare for other essential tasks such as giving presentations and writing publications (VanLeeuwen et al., 2021). Organizations may set aside the designated time and money to envision the difficulty of implementing EBP dissemination. Moreover, when working with co-workers or establishing a multidisciplinary team, one can use joint effort to relieve the load and see the variety of perspectives. Organizational Culture and Resistance to Change Change in established ways of doing things and incorporation of new knowledge-based techniques can be confronted within organizational settings. In this regard, creating an atmosphere where everyone embraces ongoing learning, being innovative, and evidence-based practices becomes an absolute key to overcoming the challenge (Melnyk, 2012). It will come about by influencing decision-makers, endless learning opportunities, and the input of prominent stakeholders in the process Limited Dissemination Skills and Confidence Some healthcare workers are newcomers or lack social competence beyond what is needed to successfully translate the evidence to their endeavor. To address this barrier, technology is used to conduct workshops and identify mentors in skills like public speaking, poster design, or scientific writing (Ayoubian et al., 2020). Similarly, working with proven researchers and seeking guidance from educational facilities can be essential tools to strengthen dissemination efforts. In conclusion, spreading evidence-based practice will tremendously contribute to a rise in healthcare quality and the implementation good practices. Appropriately choosing the aiding communication strategy that suits the interest of Adventhealth Hospital's organizational structure will help encounter the possible barriers in advance, which will further help the healthcare providers employ their expertise about the BPE effectively and be part of the accumulated knowledge (VanLeeuwen et al ., 2021). Developing a culture that embeds life-long learning in research, collaboration, and evidence-based approaches is vital to efficient communication tactics. References Ayoubian, A., Nasiripour, A. A., Tabibi, S. J., & Bahadori, M. (2020). Evaluating facilitators and barriers to implementing evidence-based practice in the health services: A systematic review. Galen Medical Journal, 9, e1645. Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. &  Stillwell, S.B. (2011). Evidence-based practice step-by-step:  Implementing an evidence-based practice. American Journal of Nursing, 111(3), 54-60. https://oce.ovid.com/article/00000446-201103000- 00031/HTML Links to an external site.  LoBiondo-Wood, G., & Haber, J. (2021). Nursing research E-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences. Melnyk, B. M. (2012). Achieving a high-reliability organization through implementing the ARCC model for systemwide sustainability of evidence-based practice. Nursing Administration Quarterly, 36(2), 127–135. doi:10.1097/NAQ.0b013e318249fb6a https://oce.ovid.com/article/00006216-201204000-00006/HTMLLinks to an external site. Newhouse, R. P., Dearholt, S., Poe, S., Pugh, L. C., & White, K. M. (2007). Organizational change strategies for evidence-based practice. Journal of Nursing Administration, 37(12), 552–557. doi:0.1097/01.NNA.0000302384.91366.8f https://oce.ovid.com/article/00005110-200712000-00009/HTMLLinks to an external site. VanLeeuwen, C. A., Veletsianos, G., Johnson, N., & Belikov, O. (2021). Never?ending repetitiveness, sadness, loss, and "juggling with a blindfold on:" Lived experiences of Canadian college and university faculty members during the COVID?19 pandemic. British Journal of Educational Technology, 52(4), 1306-1322. Peer 2  Scott Owens Disseminating strategies for evidence-based practice in the nursing profession continues to be the guiding factor for patient care. Nursing culture has begun using evidence-based practice as the foundation for treatment of patients using a wholistic approach that is rooted in evidence-based practice. The promotion of science and practice of implementation evaluation in public health requires a collaborative, multifaceted, multicomponent, and multisite approach with diverse participants, stakeholders, and partnerships (Jack, L. Jr., 2018). This requires a complex mix of individual, familial, organizational, economic, environmental, and other contextual factors that contribute to the success of interventions put in place (Jack, L. Jr., 2018). In doing so you must connect with those around you in different aspects of your workplace or community and provide information that is concise and relative to your objective in a manner that is easily understood and practiced by your audience. The two dissemination techniques I chose for the discussion are creating toolkits of training materials and curricula for community members and hosting health promotion events at health fairs and school functions (Schroeder, S. & Bauman, S., 2019). I chose hosting health promotion events at health fairs and school functions due to the ability to distribute information to many people in one area without traveling to multiple locations with just a few participants at each location. Also, people who attend health fairs already have an interest in improving their lifestyle and therefore are more willing to follow current recommendations. To relay my health promotion objectives based on evidence-based practice to participants I would provide both written and verbal information to connect with stakeholders with multiple learning styles. This would include posterboard presentations, Verbal explanation of information provided to them orally using a power point presentation as well as pamphlets of information (Schroeder, S. & Bauman, S., 2019) that participants can take with them to review at a later time. Two disseminating strategies I would not use as part of my community health project would be Publishing program or policy briefs and Publishing project findings in national journals and statewide publications. I would likely not use these options as I am presenting to community members, and they would not likely retain the information provided using these strategies. One problem area I could see as a hurdle with my presentation would be related to presenting health information to students at a school function related to students following health promotion objectives. To overcome this hurdle, I would present the information with information and details that would help the students relate to the information and I would involve the students by asking questions related to the information presented and reward feedback for right answers. References: Jack L., Jr (2018). Promoting the Science and Practice of Implementation Evaluation in Public Health. Preventing chronic disease, 15, E163. https://doi.org/10.5888/pcd15.180645 Schroeder, S. & Bauman, S. (2019, August). Methods of Dissemination for Community Health Programs. Retrieved from https://www.ruralhealthinfo.org/toolkits/rural-toolkit/6/dissemination-methods.

Respond to at least two of your colleagues who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.  Peer 2  Erika Cepero Medications Used in the Geriatric Population for Sleep In older adults, Ramelteon is a melatonin receptor agonist that is FDA-approved for treating insomnia. It is similar to melatonin, which is available over the counter (Jaqua et al., 2023). Trazodone is a medication that can be used off-label by older adults to treat insomnia, although it is used mainly for anti-depressive properties. This drug is classified as a serotonin modulator and functions by boosting serotonin levels in the brain to enhance mood and alleviate anxiety. In addition to its antidepressant properties, trazodone is also used to treat insomnia and can help older adults who have difficulty sleeping. It is used for sleep at low levels, and at higher levels, it has anti-depressive properties (Fagiolini et al., 2023).  Insomnia, a common sleep disorder, can be distressing and affect a person's overall quality of life. While medication is the most straightforward approach for treating insomnia, non-pharmacological interventions such as cognitive behavioral therapy (CBT) are to be tried first if appropriate. CBT is a form of talk therapy that helps individuals address the thoughts, behaviors, and emotions that may contribute to their sleep difficulties. It is a safe and effective approach that can help people establish healthy sleep habits and improve their overall sleep quality (Camino et al., 2022). Recent studies have provided evidence that the use of ramelteon is a safe and low-risk option for the treatment of older adults. This medication has been proven to have minimal risks of side effects and adverse reactions such as headaches, dizziness, or nausea. These findings make ramelteon a viable option for older adults who may be at a higher risk of experiencing negative side effects from other sleep medications (Jaqua et al., 2023).  Compared to other medications, trazodone is known to cause more severe side effects. These side effects may include QT prolongation (a heart condition that can be life-threatening), hypotension (low blood pressure), anticholinergic effects (symptoms such as dry mouth, blurred vision, and difficulty urinating), torsades de pointes (an abnormal heart rhythm), and an increase in suicidal thoughts. Despite the potential for these side effects, trazodone can be beneficial for older adults who struggle with insomnia. The medication is known to induce sedation, which can help clients fall asleep and stay asleep throughout the night. Additionally, trazodone has been shown to alleviate depressive symptoms, which can often contribute to sleep disturbances. Overall, while trazodone may come with some risks, its benefits can outweigh the potential downsides for certain individuals (Fagiolini et al., 2023).  Clinical practice guidelines are available for the treatment of insomnia, which recommend CBT for patients diagnosed with insomnia. Concerning medications, the guidelines do not recommend one medication over another but do give a recommendation and evidence for specific drugs that can be used. Based on the guidelines, in the elderly population, the efficacy of ramelteon compared to no therapy in adult patients is limited, and similarly, the efficacy of trazodone compared to no treatment is also limited (Sateia et al., 2017).   References Camino, M., Satorres, E., Delhom, I., Real, E., Abella, M., & Meléndez, J. C. (2022). Mindfulness-based Cognitive Therapy to Improve Sleep Quality in Older Adults with Insomnia. Psychosocial intervention, 31(3), 159–167. https://doi.org/10.5093/pi2022a12 Fagiolini, A., González Pinto, A., Miskowiak, K. W., Morgado, P., Young, A. H., & Vieta, E. (2023). Trazodone in the Management of Major Depression Among Elderly Patients with Dementia: A Narrative Review and Clinical Insights. Neuropsychiatric disease and treatment, 19, 2817–2831. https://doi.org/10.2147/NDT.S434130 Jaqua, E. E., Hanna, M., Labib, W., Moore, C., & Matossian, V. (2023). Common Sleep Disorders Affecting Older Adults. The Permanente journal, 27(1), 122–132. https://doi.org/10.7812/TPP/22.114Links to an external site. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med, 13(2):307–349. Peer 1 Faustina Keke Main Post Prescribing for Older Adults with Schizophrenia FDA-Approved Drug for Schizophrenia in Older Adults Antipsychotic prescription drugs are crucial for treating schizophrenia in every age category, and effectiveness in older adult can often be comparable to younger patients (Zolk et al., 2022). One of the FDA-approved drugs for the treatment of schizophrenia in older adults is aripiprazole, an atypical antipsychotic. Off-Label Drug for Schizophrenia in Older Adults In broad terms, antipsychotic drugs are approved for the medical management of schizophrenia, and several possess been recommended for the treating of at least one phase of bipolar disorder. An off-label drug for the treatment of bipolar disorder in older adults with schizophrenia is risperidone, which is a second-generation antipsychotic medication (Wang et al., 2021). The approved starting dose is 0.25 to 0.5 mg. Novel or enhanced adverse reactions of off-label indications have been identified, and the FDA has authorized three new atypical (iloperidone, asenapine, and paliperidone) for the treatment of schizophrenia and bipolar disorder. The FDA additionally approved the formerly off-label functions for on-label use: For example, risperidone and aripiprazole were licensed to treat behavioral disturbances associated with autism spectrum disorders (Wang et al., 2021).   Nonpharmacological Intervention Alternatively, a combination of pharmacotherapy and psychosocial modalities is more likely to treat psychotic symptoms while carrying the lowest risk of major side effects when compared to pharmacological therapy alone. Nonpharmacological treatment of schizophrenia includes family therapy, cognitive-behavioral therapy, and psychoeducation (Tampi et al., 2019). Psychosocial interventions, for example cognitive behavioral social skills training (CBSST), may prove effective. CBSST, for instance, employs group therapy to enhance cognition and behavior coping skills, capacity for problem-solving, and interpersonal functioning with the goal to cater for neurocognitive shortcomings. Patients can also be empowered with coping skills (Stevovi? et al., 2022). Risk Assessment to Inform Treatment Decision-Making Older adults are at a higher risk of adverse effects of antipsychotics due to age-related alterations in pharmacokinetics that raise the distributed volume and half-life of antipsychotic drugs (Zolk et al., 2022). Therefore, lower starting drug doses are recommended for older adults. Aging alters the permeability of the blood-brain barrier, which increases the availability of the drug in the brain. Aging also causes pharmacodynamic changes that lower the number of dopaminergic neurons as well as D2 receptor density in the brain. Advanced age elevates the risk for adverse effects like tardive dyskinesia, metabolic syndrome, parkinsonism, and falls, which means that older adults should be monitored for drug side effects (Tampi et al., 2019). Risks and Benefits of Aripiprazole Aripiprazole is effective in treating schizophrenia because it improves negative and positive symptoms. The risks associated with aripiprazole include interaction with allergy medications, drowsiness, an elevated risk of hyperglycemia, fainting, difficulties cooling off the body, an increased risk of compulsive behaviors such as gambling, headaches, weight, and appetite changes, and increased production of saliva, among others (Preda & Shapiro, 2020). The tablets also contain phenylalanine and sugar, which may not be ideal for patients with phenylketonuria and diabetes. It may also take at least two weeks before the full effects of the medication are felt. Risks and Benefits of Risperidone Risperidone is beneficial in treating the positive and negative symptoms of schizophrenia. Risks associated with risperidone include increased appetite that causes weight gain. Risperidone is contraindicated in older adults with dementia because it may cause stroke, pneumonia, a fast or irregular heartbeat, and heart failure (Correll & Kane, 2020). Clinical Practice Guidelines for Schizophrenia The American Psychiatric Association has published clinical practice guidelines for the treatment of schizophrenia, which recommend that schizophrenia should be treated with pharmacological and nonpharmacological interventions such as psychoeducation and CBT (Keepers et al., 2020). Patients should be monitored for side effects, and effectiveness of treatment. Patients who respond well to medications should continue using them. Medication-related side effects warrant a reduction in drug dosage. References Correll, C. U., & Kane, J. M. (2020). Ranking antipsychotics for efficacy and safety in schizophrenia. JAMA Psychiatry, 77(3), 225-226. https://doi.org/10.1001/jamapsychiatry.2019.3377Links to an external site. Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M., Walaszek, A., Buckley, P., Lenzenweger, M.F., & (Systematic Review). (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 177(9), 868-872. https://doi.org/10.1176/appi.ajp.2020.177901Links to an external site. Preda, A., & Shapiro, B. B. (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia. Expert Opinion on Drug Safety, 19(12), 1529-1538. https://doi.org/10.1080/14740338.2020.1832990Links to an external site. Stevovi?, L. I., Repišti, S., Radoji?i?, T., Sartorius, N., Tomori, S., Kulenovi?, A. D., Popova, A., Kuzman, M.R., Vlachos, I.I., Statovci, S., & Jovanovi?, N. (2022). Non-pharmacological interventions for schizophrenia—analysis of treatment guidelines and implementation in 12 Southeast European countries. Schizophrenia, 8(1), 10. https://doi.org/10.1038/s41537-022-00226-yLinks to an external site. Tampi, R. R., Young, J., Hoq, R., Resnick, K., & Tampi, D. J. (2019). Psychotic disorders in late life: a narrative review. Therapeutic Advances in Psychopharmacology, 9, 2045125319882798. https://doi.org/10.1177/2045125319882798Links to an external site. Wang, J., Jiang, F., Yang, Y., Zhang, Y., Liu, Z., Qin, X., Tao, X., Liu, T., Liu, Y., Tang, Y. L., Liu, H., & Cotes, R. O. (2021). Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey. BMC Psychiatry, 21(1), 375. https://doi.org/10.1186/s12888-021-03374-0Links to an external site. Zolk, O., Greiner, T., Schneider, M., Heinze, M., Dahling, V., Ramin, T., Grohmann, R., Bleich, S., Zindler, T., Toto, S., & Seifert, J. (2022). Antipsychotic drug treatment of schizophrenia in later life: Results from the European cross-sectional AMSP study. The World Journal of Biological Psychiatry: the official journal of the World Federation of Societies of Biological Psychiatry, 23(5), 374–386. https://doi.org/10.1080/15622975.2021.2011403Links to an external site.

See docs

Due in 12 hours Do you think there is a correlation between care coordination and the quality of patient care delivered? Do you think care coordination can reduce hospital readmissions, improve quality of life, and curb health care expenditures? Provide examples. Support all responses using at least one scholarly source other than your textbook. Use national guidelines and evidence-based research when applicable. Students may enhance responses with an example, either from personal experience or from the media, which illustrates and supports ideas.  All sources must be referenced and cited using the correct APA format (including a link to the source).

what are your thoughts about the opportunities and challenges related to achieving the 2021 National Patient Safety Goal of, reducing the risk of health care associated infections, in your work environment?