Impact Health Care Policy

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Impact Health Care Policy

Discuss and support with specific theory and evidence the extent you think nursing research has impacted healthcare policy. Give an example.

Textbook

Mason et al. (2021): Chapters 10, 52

Web Sites

White House Office of Science and Technology Policy
www.whitehouse.gov/administration/eop/ostp

Policy, Politics, and Nursing Practice
http://ppn.sagepub.com/

Health Affairs
www.healthaffairs.org

RAND Corporation’s Projects
www.rand.org/research_areas/

Patient’s Spiritual Needs

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In addition to the topic study materials, use the chart you completed and questions you answered in the Topic 3 about “Case Study: Healing and Autonomy” as the basis for your responses in this assignment.

Answer the following questions about a patient’s spiritual needs in light of the Christian worldview.

  1. In 200-250 words, respond to the following: Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James, or would that mean a disrespect of a patient’s autonomy? Explain your rationale.
  2. In 400-500 words, respond to the following: How ought the Christian think about sickness and health? How should a Christian think about medical intervention? What should Mike as a Christian do? How should he reason about trusting God and treating James in relation to what is truly honoring the principles of beneficence and nonmaleficence in James’s care?
  3. In 200-250 words, respond to the following: How would a spiritual needs assessment help the physician assist Mike determine appropriate interventions for James and for his family or others involved in his care?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

BS in Health Sciences 1.2; BS Nursing (RN to BSN ) 5.2

Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups.

 Rodger’s Process of Concept Development

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Post a response to the following question in the discussion forum, and respond to one of your classmate’s postings for this question. Your initial response and responses to others should be at least 150 words. Respond to your classmate’s requests for feedback. In addition, follow the guidelines provided in the Grading Rubric for Online Discussions-500 Level.

  1. Using Rodger’s evolutionary method for concept analysis, analyze Robson and Troutman-Jordan’s (2014) concept analysis on cognitive reframing https://wilkes.idm.oclc.org/login?url=search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103905950 .

Please use the link.

1. Rodger’s Process of Concept Development

Beth Rodgers first published her evolutionary method for concept analysis in 1989. According to Rodgers, concept analysis is necessary because concepts are dynamic, “fuzzy”, and context dependent, and possess some pragmatic utility purpose. Because phenomena, needs, and goals change, concepts must be continually refined and variations introduced to achieve a clearer and more useful meaning.

Rodgers examined two viewpoints or schools of thought regarding concept development, and showed that the methods of each differ significantly. Rodgers termed these methods “essentialism” and “evolutionary” viewpoints. In her work, she contrasted the essentialist method of concept development as exemplified by Wilson and Walker and Avant with concept development using the evolutionary method.

The evolutionary method of concept development is a concurrent task approach. In it, the tasks may be occurring simultaneously, rather than a sequence of specific steps that are completed before going to the next step. There are several activities involved in the evolutionary method of concept development.

Primary Activities in Rodger’s Process of Concept Analysis:

  1. Identify the concept and associated terms.
  2. Select an appropriate realm (a setting or a sample) for data collection.
  3. Collect data to identify the attributes of the concept and the contextual basis of the concept (i.e. interdisciplinary, sociocultural, and temporal variations).
  4. Analyze the data regarding the characteristics of the concept.
  5. Identify the exemplar of the concept, if appropriate.
  6. Identify hypotheses and implications for further development.

Rodgers defined many terms and explained the process of concept analysis using the evolutionary view. The goal of the concept analysis, to an extent, is to determine how the researcher identifies the concept of interest, terms, and expressions selected.

The goal of the analysis also influences selection of the setting and sample for data collection. For instance, the setting may be a library and the sample might be literature. The sampling might be time-oriented, such as literature from the previous five years. Whatever the case may be, the researcher’s goal is to develop a rigorous design consistent with the purpose of the analysis. The selection of literature from related disciplines may include those that typically use the concept. An exhaustive review includes all the indexed literature using the concept, and may be limited by a time frame, such as several years.

collecting and managing data

A sample across each discipline over time is obtained by employing a randomized process. In collecting and managing data, a discovery approach is preferred. The focus of the data analysis is on identifying the attributes, antecedents, and consequences and related concepts or surrogate terms. The attributes located by this means constitute a “real definition as opposed to a nominal or dictionary definition” (Rogers, 2006, p. 92).

Rodgers defines surrogate terms as ways of expressing the concept other than by the term of interest. She distinguishes between surrogate terms and related concepts by illustrating the surrogate terms are different words that express the concept, whereas “related concepts are part of a network that provide a background” and “lend significance to the concept of interest” (Rodgers, 2006, p. 92).

Identifying an exemplar from the literature, field observation, or interview provides a clear example of the concept. Examples of real cases are preferred over constructed cases. The goal is to illustrate the characteristics of the concept in relevant contexts. To enhance the clarity and effective application of the concept.

The Affordable Care Act

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1 postsRe: Topic 4 DQ 2

The Affordable Care Act (ACA) was put into effect in 2010, it is also referred to as Obama Care. The goal was to make insurance more accessible to those who were previously unable to afford insurance coverage. The ACA prevented insurance companies from denying coverage to people with pre-existing conditions, and it changed the age a child to stay on their parents plan to 26, it also removed benefit limits on insurance, and made preventative care at no cost service to the patient.

The most important role is to provide coverage for all citizens. It allows people to obtain care and not have high out-of-pocket costs. It promotes primary prevention through preventative care. The system also rewards people for having health coverage. Patients are rewarded through tax breaks for providing proof of coverage each year, and physicians are rewarded for meeting goals in patient care.

As a nurse it is our responsibility to make sure patients are properly educated on the services available to them. We can promote primary prevention, through education. We must advocate and provide them the knowledge to make appropriate health decisions and to take initiative of their own care to prevent any unnecessary medical expenses.

Using 200-300 words APA format with references to support the discussion.

What are the most important elements of the Affordable Care Act in relation to community and public health? What is the role of the nurse in implementing this law?

how effective is the use of the influenza vaccine at preventing flu

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how effective is the use of the influenza vaccine at preventing flu

Review the following research questions.

1.  For patients of 70 years and older, how effective is the use of the influenza vaccine at preventing flu as compared to patients who have not received the vaccine?

2.  What is the relationship between alcohol and breast cancer?

 3.  What is the difference in attitudes of male and female college students toward condoms?

Use the above 3 practice studies and address the following:

  • Identify an appropriate research design. (qualitative or quanitative research study)
  • Discuss the strengths and weaknesses of the design/ research question. Long term, short term ramifications of safety and overall the long term goal of the research study. 
  • Provide a rationale for the design you selected. 

please use public choices, no first person writing. please use references in apa style.

Women Health

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Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.

Discussion

Discuss the questions that would be important to include when interviewing a patient with this issue.

When interviewing an adolescent, some prevention and counseling may include questions about:

  • Home
  • Education / Employment
  • Eating
  • Activities
  • Drugs
  • Sexuality, Suicide / Depression, Safety / Violence

Questions I would ask in regard to her vaginal bleeding would include:

When did your last period begin?

How long do your periods last?

What other symptoms do you have with your period? (abdominal pain, headache, bloating, etc.) Is your bleeding irregular in amount or duration?

Do you have bleeding between your menstrual cycles?

Are your breasts tender?

Are you sexually active?

Is it possible that you are pregnant?

Do you have any pelvic pain?

How severe (1-10 scale) is your pelvic pain?

Have you had pelvic inflammatory disease?

Do you have pain with intercourse?

Have you had sex that was painful or rough, or been forced to have sex?

Are you having, or have you had unprotected sex?

Have you had any sexually transmitted disease?

Describe the clinical findings that may be present in a patient with this issue.

Being that this patient’s vaginal bleeding is due to a spontaneous abortion, some of the clinical findings may include vaginal bleeding, abdominal pain, and passage of tissue (Alves, 2020).

 Are there any diagnostic studies that should be ordered on this patient? Why?

Along with beta-hCG measurement and ultrasound, a HGB and HCT should be obtained to rule out acute blood loss anemia.  Since spontaneous abortion can be precipitated by infection, wet mount examination and screening for gonorrhea and chlamydia should be considered (Alves, 2020).

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Differential Diagnosis

  • Ectopic      pregnancy– A      pregnancy in which the fertilized egg implants outside the uterus.  Symptoms include      pelvic pain and vaginal bleeding.
  • Molar      pregnancy- A noncancerous tumor that develops in the      uterus as a result of a nonviable pregnancy. The pregnancy may seem      normal at first, but when symptoms develop they include dark brown to      bright red vaginal bleeding during the first trimester, along with severe      nausea and vomiting (Al-Talib, 2016).
  • Viable      pregnancy with implantation bleeding- When the fertilized egg attaches to      the uterine wall, it may cause bleeding that can last 2-3 days

Primary Diagnosis

  • Spontaneous      Abortion- Spontaneous      abortion is the loss of pregnancy naturally before 20 weeks of gestation      (Alves, 2020).

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

The conventionally accepted regimen for medical management consists of misoprostol 800mcg vaginally, with a repeated dose if needed anytime from 3hrs to 7 days after the first dose.  Premedication with mifepristone 200mg PO 24hrs before the first dose of misoprostol may result in a higher success rate.  Surgical management consists of D&C as needed (Alves, 2020).  Follow up as directed my healthcare professional.

Reference

Al-Talib, A. (2016).  Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a tertiary care hospital in Dammam, Saudi Arabia.  Journal of Family & Community Medicine 23(3), p. 161-165.  doi: 10.4103/2230-8229.189129

Alves, C. (2020).  Spontaneous abortion.  StatPearls.  Retrieved from https://www.statpearls.com/articlelibrary/viewarticle/29399

protocol for a randomized, multicenter trial in children with sickle cell anemia

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Hydroxyurea Optimization through Precision Study (HOPS): study protocol for a randomized, multicenter trial in children with sickle cell anemia Emily R. Meier

Indiana Hemophilia and Thrombosis Center Susan E. Creary

Nationwide Children’s Hospital Matthew M. Heeney

Boston Children’s Hospital Min Dong

Cincinnati Children’s Hospital Medical Center Abena O Appiah‐Kubi

Cohen Children’s Medical Center Stephen C. Nelson

Children’s Hospital and Clinics of Minnesota Omar Niss

Cincinnati Children’s Hospital Medical Center Connie Piccone

Case Western Reserve University School of Medicine Maa-Ohui Quarmyne

Children’s Healthcare of Atlanta Charles T. Quinn

Cincinnati Children’s Hospital Medical Center Kay L. Saving

University of Illinois Peoria John P. Scott

Medical College of Wisconsin Ravi Talati

Cleveland Clinic Children’s Hospital Teresa S. Latham

Cincinnati Children’s Hospital Medical Center Amanda Pfeiffer

Cincinnati Children’s Hospital Medical Center Lisa M. Shook

 

 

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Cincinnati Children’s Hospital Medical Center Alexander A. Vinks

Cincinnati Children’s Hospital Medical Center ;

Adam Lane

Patrick McGann  (  patrick.mcgann@cchmc.org )

https://orcid.org/0000-0001-6198-4785

Study protocol

Keywords: Sickle cell anemia, pharmacokinetics, hydroxyurea, pediatrics

DOI: https://doi.org/10.21203/rs.3.rs-33650/v2

License:   This work is licensed under a Creative Commons Attribution 4.0 International License.   Read Full License

 

Sickle cell disease (SCD)

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Abstract Background : Sickle cell disease (SCD) is a severe. And devastating hematological disorder that affects over 100,000 persons in the United States and millions worldwide. Hydroxyurea is the primary disease- modifying therapy for the SCD. With proven bene�ts to reduce both short-term and long-term complications. Despite the well-described inter-patient variability in pharmacokinetics (PK), pharmacodynamics and optimal dose, hydroxyurea is traditionally initiated at a weight-based dose with a subsequent conservative dose escalation strategy to avoid myelosuppression.

Because the dose escalation process is time consuming. And requires frequent laboratory checks, many providers default to a �xed dose, resulting in inadequate hydroxyurea exposure and suboptimal bene�ts for many patients. Results from a single-center trial of individualized, PK-guided dosing of hydroxyurea for children with SCD suggest that individualized dosing achieves the optimal dose more rapidly and provides superior clinical and laboratory bene�ts than traditional dosing strategies. However, it is not clear whether these results were due to individualized dosing. The young age that hydroxyurea treatment was initiated in the study, or both. The Hydroxyurea Optimization through Precision Study (HOPS) aims to validate the feasibility and bene�ts of this PK-guided dosing approach in a multi-center trial.

multicenter trial comparing standard

Methods : HOPS is a randomized, multicenter trial comparing standard vs. PK-guided dosing for children with SCD as they initiate hydroxyurea therapy. Participants (ages 6 months through 21 years), recruited from 11 pediatric sickle cell centers across the United States, are randomized to receive hydroxyurea either using a starting dose of 20 mg/kg/day (Standard Arm) or a PK-guided dose (Alternative Arm). PK data will be collected using a novel sparse microsampling approach requiring only 10μL of blood collected at 3 time-points over 3 hours. A protocol-guided strategy more aggressive protocols is then used to guide dose escalations and reductions in both arms following initiation of hydroxyurea. The primary endpoint is the mean %HbF after 6 months of hydroxyurea.

Discussion:  HOPS will answer important questions about the clinical feasibility, bene�ts, and safety of PK-guided dosing of hydroxyurea for children with SCD with potential to change the treatment paradigm from a standard weight-based approach to one that safely and effectively optimize the laboratory and clinical response.

Trial registration: ClinicalTrials.gov, NCT03789591. Registered on December 28, 2018.

Background Sickle cell disease (SCD) is a devastating, inherited disorder of hemoglobin, affecting over 100,000 persons in the United States and millions worldwide.1-3 The most severe forms of SCD, primarily HbSS and HbS/β0-thalassemia, account for a majority of the global cases of SCD and are collectively referred to as sickle cell anemia (SCA). Without early diagnosis and appropriate disease-modifying treatment, SCA results in signi�cant morbidity and early mortality. The life-threatening clinical complications of SCA, including acute splenic sequestration crisis and stroke, frequently occur within the �rst decade of life.4,5

Chicago Symphony Orchestra

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MUSC 2101 Concert Reviews

1. Overview a. List all musicians who performed (if it is a group, you do not have to list

individual musicians). Please remember to list all performers, not just the

soloist(s)

b. Where did the concert take place?

c. When did the concert take place?

d. Why did this concert take place? Was it part of a tour? Was it for educational

purposes? Was it a part of a larger concert season? etc…

2. Elements of Music a. List any/all instruments being played during this concert (including voice)

b. What type of music was being performed?

c. What kind of ensemble was on stage? Solo? Duet? Trio? Quartet? Etc…

d. Describe the music being performed using terminology we have discussed in

class.

3. Your opinion of the concert a. What piece(s) did you like? Why?

b. What piece(s) did you not you like? Why?

c. Would you go again? Why/Why not?

pharmaceutical company’s pricing for a non-proprietary drug

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pharmaceutical company’s pricing for a non-proprietary drug

Module 5 Discussion – Price and Distribution Question 1.

Explain how a pharmaceutical company’s pricing for a non-proprietary drug might change if the objective was: (a) profitability, (b) sales volume, or (c) market share.

Please respond to one of your peers’ responses (please refrain from answering “I agree”). Please respond in detail to your peers why you agree or disagree with their answer.

Module 5 Discussion – Price and Distribution Question 2

List and discuss at least five [5] of the pricing strategies covered in the textbook.

Please respond to one of your peers’ responses (please refrain from answering “I agree”). Please respond in detail to your peers why you agree or disagree with their answer.

Module 5 Discussion – Price and Distribution Question 3

In a recent contract negotiation session between a group of physicians and a managed care health plan, the parties disagreed about the level of reimbursement that the physicians would receive for treating subscribers. The physician group is the largest such organization in the community and represents 75 percent of all primary care providers in the area. What sources of power does this group wield in negotiating a managed care contract?

Assessing And Treating Patients With Bipolar Disorder

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he Assignment: 5 pages

Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder (https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_04/index.html) You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

References

Ostacher, M. J., & Hsin, H. (2016). The use of antiepileptic drugs in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 93–98). Elsevier.

Perlis, R. H., & Ostacher, M. J. (2016a). Bipolar disorder. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 48–60). Elsevier.

Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier.