Reflective Journal – DNP 830

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Reflective Journal – DNP 830

This reflective journal essay aims to demonstrate individual perspectives about the course, DNP 830. It provides the breakthroughs and difficulties experienced during the course in achieving course objectives and the competencies provided by the American Association of Colleges of Nursing’s (AACN) Essential of Doctoral for Advanced Nursing Practice. These essentials are core to every advanced nursing practice role. The course offered opportunities to develop these core competencies aligned with the AACN essentials through the various course activities.

Reflective Journal - DNP 830

 

Reflection

This reflective journal demonstrates the individual learning experiences throughout the course, strategies adopted to achieve course objectives, and knowledge gained. It summarizes the weekly reflections and the competencies gained through the weekly course activities. Throughout the course, the following essentials were accomplished:

Essential I: Scientific Underpinnings for Practice

The DNP course presented multiple challenges and complexities, besides opportunities to advance knowledge and skills on DNP essentials. The course was demanding and required high-level engagement, especially in completing weekly assignments that align with the scientific underpinnings of practice. From identifying healthcare issues affecting the patient to PICOT-D question development, literature search and evaluation, and the development of annotated bibliography, this student developed an understanding of scientific knowledge development and the process of scientific research aimed to develop knowledge and intervention to improve patient outcomes. It was my first time developing a PICOT-D question because, previously, this nurse scholar was required to develop PICO or PICOT question. It was challenging at first to understand how to integrate the “D” or data element in the PICIOT question, but the instructor feedback and the PICOT-D question template guided the nurse scholar to successfully develop a PICOT-D question.

All weekly assignments were aligned with the first essential. This nurse scholar discovered high-level elements of the research process but experienced challenges with the literature search and evaluation. This course required using quantitative research only to support the PICOT-D elements and proposed intervention. It is easier when both qualitative and quantitative sources are used because it requires a robust search of databases to establish quantitative sources only. However, it was an opportunity to discover and learn more about different types of quantitative research designs and how to identify them based on the methodology adopted. The research process allowed this nurse scholar to link the research question or PICOT-D question to evaluated research methodologies and outcomes and discover how the sources identified supported or informed current research. The weekly course resources, including reading materials, discussions, and learning activities reinforced the understanding of this course competency.

Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking

The primary aim of the research is to influence change by generating deeper insights into a research problem and developing new thinking approaches to address situations for more desirable futures or outcomes. This nurse scholar is required to identify a quality improvement opportunity or a research opportunity focusing on the patients. This course provides materials and resources that supported the identification of the patient’s health issue through the weekly assignments, discussions, and readings. This nurse scholar developed the skills and capacities required to catalyze, enable, and promote systems-level change. The course combines collaborative leadership and systems insights critical for quality improvement and system thinking needed to develop effective action and solutions in complex situations, enabling systems change. Collaborative leadership calls for effective communication skills for the successful development of quality improvement initiatives to enhance patient quality and safety. Although the process was challenging for this nurse scholar, it enhances career preparedness, particularly enabling change.

Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice

Evidence-based practice is a requirement in current practice to ensure informed nursing decisions. The DNP course was practice-based, and learners are required to practice per evidence-based practice. The course activities, from developing a PICOT-D question to literature evaluation and review align with this essential, which requires the DNP to search for the best available evidence and use it in practice to solve a patient health issue. The learner is responsible for understanding nurse practice and increasing clinical and leadership skills through research translation into standard care. The course offers valuable insights into adopting the evidence-based practice to improve care systems and examine patient outcomes for the selected patient population. In disseminating best practices, this nurse scholar reviewed quantitative data, sorting out studies that are relevant and accurate to support the quality improvement initiative.

Conclusion

This reflective journal sought to offer individual experiences with the DNP course and the strategies adopted to accomplish the course objectives and attain the core competencies per the AACN’s essentials. Despite the numerous challenges experienced during the course, this nurse scholar accomplished essentials I, II, and II. The competencies developed will help advance career and ability to care for patients at the highest level.

 
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 Hospital-based Violence Intervention Programs

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 Hospital-based Violence Intervention Programs

Annotated Bibliography

Bonne, S., Hink, A., Violano, P., Allee, L., Duncan, T., Burke, P., … & Dicker, R. (2022). Understanding the makeup of a growing field: A committee on trauma survey of the national network of hospital-based violence intervention programs. The American Journal of Surgery, 223(1), 137-145. https://www.sciencedirect.com/science/article/abs/pii/S000296102100413X

 Hospital-based Violence Intervention Programs

The article addresses hospital-based violence intervention programs, their implementation, and their effectiveness in addressing IPV. The authors identify the programmatic components of existing HAVI and assess program and service hurdles to implementation to inform the American College of Surgeons Committee on Trauma (ACS-COT) on how trauma centers might collaborate on this project most effectively. The researchers discovered that hospital-based violence intervention programs successfully address IPV but struggle with funding, hiring enough staff, and gaining buy-in. The study offers insights into the implementation of HAVI programs and the factors that should be considered in the process. The findings are evidence-supported and consistent with other studies reviewed by the authors, enhancing their validity and reliability. However, there are limitations to the study. The sample size adopted in the study is inadequate and limits generalization. Also, only 38 participants, all HAVI members, were invited, resulting in a selection bias in the study. Future studies should concentrate on finding ways to increase HVIP implementation, funding, and data gathering. The article supports the intervention by providing information on how hospital-based violence intervention programs can prevent IPV and suggestions on how they can be made better.

Halliwell, G., Dheensa, S., Fenu, E., Jones, S. K., Asato, J., Jacob, S., & Feder, G. (2019). Cry for health: a quantitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse. BMC health services research, 19(1), 1-12. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4621-0

The authors explored hospital-based advocacy’s impact on home-based violence, including IPV. In addition to examining the impact on improving support access, health outcomes, and cost-effectiveness, the authors examined how an advocacy approach benefited domestic violence survivors in a hospital context. By working with survivors who were less obvious to community IDVA programs, hospital IDVAs helped with earlier intervention. The researchers found that hospital IDVAs increased referrals from medical services and made additional health resources accessible, and hospital survivors were more likely to report abuse reductions and cessations. However, for hospital survivors, there were no changes in health outcomes. In this case, hospital survivors’ odds of staying safe increased by a factor of two if they made more than five contacts with an IDVA or used at least six resources or programs over a more extended period and the cost of accessing services by survivors reduced. The methodology adopted supports the thesis and the research purpose, bolstering the quality of the research study. Also, the findings are reported in other studies reviewed in this article, implying consistent results, hence high reliability and validity. However, the evaluation design and the data quality had limitations. The researchers’ non-experimental methodology caused them to overstate the effectiveness of the intervention. The approaches employed to estimate cost also limited the analysis because it relied on patient collection. The effectiveness of the intervention should be the subject of further study, often using an experimental methodology. Nonetheless, the study supports the effectiveness of the hospital-based approaches as an intervention to addressing IPV by demonstrating with specificity the usefulness of hospital-based advocacy interventions for treating domestic violence and abuse.

Olson, C., Aboutanos, M., Thomson, N., Vincent, A., & Kevorkian, S. (2022). Adapting Hospital-based Intimate Partner Violence Programs to the COVID-19 Pandemic. Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 11(1), 3-8. https://www.researchgate.net/profile/Nicholas-Thomson-2/publication/360294052_Adapting_Hospital-based_Intimate_Partner_Violence_Programs_to_the_COVID-19_Pandemic/links/62a0e4b36886635d5cc9c908/Adapting-Hospital-based-Intimate-Partner-Violence-Programs-to-the-COVID-19-Pandemic.pdf

The author investigated how hospital-based advocacy programs or interventions have affected domestic violence during the Covid-19 pandemic. The researchers looked into how the EMPOWER program modified intervention and community case management procedures to assist patients during the pandemic. The findings indicate patients had access to a range of services through EMPOWER, including crisis intervention (84%), emotional support (89%), victim rights (53%), and advocacy for patients while they were undergoing medical treatment (49%). The victims noted the following dangers and risks: A total of 30% of patients reported the presenting domestic violence incident to the police, 19% of patients seeking advocacy services claimed the perpetrator used a weapon, including a firearm, against the victim, and 8% of patients were forced to move or become homeless as a result of domestic violence. The study depicts accurate findings of similar programs outside the study, demonstrating high validity and reliability. However, given that chosen patients are enrolled in the particular program or services, the study suggests a selection bias. Therefore, applying the findings outside of the research context would be challenging. Future studies should examine the program’s effectiveness and potential for expansion into other contexts. Despite the limitations, the article is relevant to the research paper because it offers insightful information about one illustration of a hospital-based intervention to deal with IPV and victims of violence.

Yount, K. M., Cheong, Y. F., Khan, Z., Bergenfeld, I., Kaslow, N., & Clark, C. J. (2022). Global measurement of intimate partner violence to monitor Sustainable Development Goal 5. BMC public health, 22(1), 1-14.

Authors seek to measure intimate partner violence to monitor sustainable development 5 (to eliminate violence against women, including IPV). This goal prompts states to monitor IPV to eliminate it successfully. The authors performed a measurement-invariance assessment of standardized IPV items. Data was collected through the Demographic and Health Surveys (DHS) from Lower-/Middle-Income Countries (LMICs). 18 IPV items were administered and analyzed on two item sets, lifetime physical IPV and controlling behaviors. The article’s findings indicate varying national physical IPV and controlling behavior rates. Also, both tests had similar national rankings based on prevalence. Physical IPV items, including slapping, twisting, chocking and controlling behaviors like meeting female friends and contacting family, warranted cognitive testing to enhance their psychometric properties. This article has high reliability and validity because the findings are consistent with those of other research articles reviewed in this article. The findings are related to the PICOT-D elements as they offer items to measure IPV. However, the results are limited to the seven selected physical-IPV and five controlling-behavior items analyzed. Therefore, these findings cannot be extended to other IPV items.

Troisi, G. (2018). Measuring intimate partner violence and traumatic affect: Development of VITA, an Italian scale. Frontiers in psychology, 9, 1282.

The authors investigate measurements for IPV and traumatic affect. The authors seek to develop and assess tools or instruments to identify post-traumatic affectivity. Developing these instruments would help IP victims and services recognize and respond to IPV with higher sensitivity and structure. The authors investigated a self-report instrument to detect post-traumatic affect intensity due to IPV. A 28-item set was identified and administered to 302 IPV victims. The article adopted explorative and confirmatory analysis to measure the items. Findings indicate that the instrument could help clinicians and researchers investigate the affective state intensity of IPV victims. It could help address clinical practice and therapeutic intervention planning. These findings are reported in other studies, increasing the reliability and validity of the article. The study is also relevant and supports the PICOT-D elements by providing insights into IPV and traumatic affect measurement. However, the tool does not consider the women’s emotional reaction’s complexity after trauma, and the sample was not entirely discriminant of a clinical sample.

References

Bonne, S., Hink, A., Violano, P., Allee, L., Duncan, T., Burke, P., … & Dicker, R. (2022). Understanding the makeup of a growing field: A committee on trauma survey of the national network of hospital-based violence intervention programs. The American Journal of Surgery, 223(1), 137-145. https://www.sciencedirect.com/science/article/abs/pii/S000296102100413X

Halliwell, G., Dheensa, S., Fenu, E., Jones, S. K., Asato, J., Jacob, S., & Feder, G. (2019). Cry for health: a quantitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse. BMC health services research, 19(1), 1-12. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4621-0

Olson, C., Aboutanos, M., Thomson, N., Vincent, A., & Kevorkian, S. (2022). Adapting Hospital-based Intimate Partner Violence Programs to the COVID-19 Pandemic. Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 11(1), 3-8. https://www.researchgate.net/profile/Nicholas-Thomson-2/publication/360294052_Adapting_Hospital-based_Intimate_Partner_Violence_Programs_to_the_COVID-19_Pandemic/links/62a0e4b36886635d5cc9c908/Adapting-Hospital-based-Intimate-Partner-Violence-Programs-to-the-COVID-19-Pandemic.pdf

Troisi, G. (2018). Measuring intimate partner violence and traumatic affect: Development of VITA, an Italian scale. Frontiers in psychology, 9, 1282.

Yount, K. M., Cheong, Y. F., Khan, Z., Bergenfeld, I., Kaslow, N., & Clark, C. J. (2022). Global measurement of intimate partner violence to monitor Sustainable Development Goal 5. BMC public health, 22(1), 1-14.

 

 

Appendix A

Table 1: Primary Quantitative Research – Supports Element of PICOT-D Question


APA Reference (Include the GCU permalink or working link used to access the article.)		 Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary Research Design Research Methodology

·         Setting/Sample (type, country, number of participants in study)

·         Methods (instruments used; state if instruments can be used in the DPI Project)

·         How were the data collected?

 Interpretation of Data

(State p-value: acceptable range is p= 0.000 – p= 0.05)

 Outcomes/
Key Findings(Succinctly states all study results applicable to the DPI Project.)		 Limitations of Study and Biases Recommendations for Future Research

 

 Explanation of How the Article Supports Your Proposed PICOT-D Question (P.C.O.T or D)
Yount, K. M., Cheong, Y. F., Khan, Z., Bergenfeld, I., Kaslow, N., & Clark, C. J. (2022). Global measurement of intimate partner violence to monitor Sustainable Development Goal 5. BMC public health, 22(1), 1-14.

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12822-9

 The paper aimed to conduct the first robust, global psychometric evaluation of items established to measure IPV in the DHS DVM Quantitative Descriptive Research The researchers administered the Demographic and Health Surveys (DHS) to 36 lower-Middle-Income countries (LMICs) between 2012-2018. The surveys had 18 IPV items.

The surveys were administered to large, nationally-representative samples of households and randomly selected women of reproductive age (15-49 years).

 National rates of physical IPV (5.6–50.5%) and controlling behavior (25.9–84.7%) varied. The article’s findings indicate varying national physical IPV and controlling behavior rates. Also, both tests had similar national rankings based on prevalence. Physical IPV items, including slapping, twisting, chocking and controlling behaviors like meeting female friends and contacting family, warranted cognitive testing to enhance their psychometric properties. The results are limited to the seven selected physical-IPV and five controlling-behavior items analyzed. Therefore, these findings cannot be extended to other IPV items. The analyses should be replicated for high-income countries (HICs).

Future research surveys should be completed before or after (2012-2018).

Larger national samples would help future research minimize sampling errors and bolster statistical power.

 The findings are related to the PICOT-D elements as they offer items to measure IPV.
Troisi, G. (2018). Measuring intimate partner violence and traumatic affect: Development of VITA, an Italian scale. Frontiers in psychology, 9, 1282. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01282/full The study aimed to investigate measurements for IPV and traumatic affect and develop and assess tools or instruments to identify post-traumatic affectivity.

This study emphasizes emotional factors maintaining the violent relationship in particular guilt, shame, fear, and terror.

 

 Correlational Quantitative Research Design The sample included 32 Italian women (M: 30.63; SD: 18.5 years).

The recruitment was online, via mailing lists and social networks.

The participants were grouped randomly into two congruous subsamples, A and B.

A 28-item set was identified and administered.

The data was collected using the VITA Scale and the IPV Check List.

 A factorial structure composed of four factors (guilt, shame, fear, and terror), consistent with theoretical scales and a good internal consistency (Cronbach’s alphas from 0.80 to 0.90) emerged The authors investigated a self-report instrument to detect post-traumatic affect intensity due to IPV.

Findings indicate that the instrument could help clinicians and researchers investigate the affective state intensity of IPV victims. It could help address clinical practice and therapeutic intervention planning.

 The tool does not consider the women’s emotional reaction’s complexity after trauma, and the sample was not entirely discriminant of a clinical sample. A clinical sample should be adopted to confirm the results.

Future researcher should determine if the instrument is sensitive to changes in the therapeutic process with women who are IPV victims.

A more in-depth investigation of violence consequences for women’s emotional experience is needed to refine the scale’s content validity.

 The study is relevant and supports the PICOT-D elements by providing insights into IPV and traumatic affect, including guilt, shame, fear, and terror, measurement.

 

Table 2: Primary Quantitative Research – Supports Intervention Directly


APA Reference (Include the GCU permalink or working link used to access the article.)		 Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary Research Design Research Methodology

·         Setting/Sample (type, country, number of participants in study)

·         Methods (instruments used; state if instruments can be used in the DPI Project)

·         How were the data collected?

 Interpretation of Data

(State p-value: acceptable range is p= 0.000 – p= 0.05)

 Outcomes/
Key Findings(Succinctly states all study results applicable to the DPI Project.)		 Limitations of Study and Biases Recommendations for Future Research

 

 Explanation of How the Article Supports the Intervention for Your Proposed PICOT-D Question
Bonne, S., Hink, A., Violano, P., Allee, L., Duncan, T., Burke, P., … & Dicker, R. (2022). Understanding the makeup of a growing field: A committee on trauma survey of the national network of hospital-based violence intervention programs. The American Journal of Surgery, 223(1), 137-145. https://www.sciencedirect.com/science/article/abs/pii/S000296102100413X The study’s aim is to identify the programmatic components of existing HAVI programs and to understand program and service barriers to implementation, to inform the ACS-COT as to the best way trauma centers can partner in this work. The study design adopted a survey provided by the American College of Surgeons Committee on Trauma Twenty-eight Health Alliance for Violence Intervention member programs participated in the survey.

The survey instrument by the Hospital Based Violence Intervention Program was used to collect the data.

The researchers submitted the survey via Qualtrics.

 Well-funded programs received equal or over $300,000 every year and low-funded programs received less. The researchers found that Hospital Based Violence Intervention program were effective in addressing IPV, but face funding, adequate staffing, and buy-in problems. The sample size was small.

The study had a selection bias as only 38 members were invited, all who were members of the HAVI.

 Future research should focus on exploring opportunities to expand the implementation, funding, and data collection of HVIPs. The article offers evidence on how hospital-based violence intervention program can help address IPV and insights into how these programs can be improved.
Halliwell, G., Dheensa, S., Fenu, E., Jones, S. K., Asato, J., Jacob, S., & Feder, G. (2019). Cry for health: a quantitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse. BMC health services research, 19(1), 1-12. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4621-0 The study aimed to explore how an advocacy approach supported domestic violence survivors in a hospital setting, explore impact on enhancing support access, health outcomes, and cost effectiveness. Causal-Comparative research design The researchers invited independent Domestic Violence Advisors (IDVA) in five UK hospitals.

The researchers collected case-level data at initial referral and case closure from survivors accessing hospital (T1 N = 692; T2 N = 476) and community IDVA services (T1 N = 3544; T2 N = 2780).

 Survivors who had accessed a hospital IDVA service were two times more likely to report feeling safer at case closure (AOR = 2.03, 95% CI 1.18 to 3.49)

Accessing six or more resources / programmes increased safety by one and a half times AOR = 2.38, 95% CI 1.41 to 3.87) and odds of achieving this outcome increased progressively with a greater number of support days provided by the IDVA (AOR = 2.00, 95% CI 1.00 to 1.01).

Survivors who had accessed a hospital IDVA service were more likely to report no change or feeling less safe at exit if they had experienced suicidal ideation or behaviors at the point of initial referral (AOR = 2.00, 95% CI 0.28 to 0.74).

feelings of safety were increased in line with more intensive support in terms of more frequent contact with a community IDVA (AOR = 1.45, 95% CI 1.12 to 1.89) and access to a range of resources / programs (AOR = 1.82, 95% CI = 1.43 to 2.31)

 Hospital IDVAs assisted with earlier intervention by working with survivors who were less noticeable to community IDVA programs.

Hospital IDVAs enabled access to more health resources and saw an increase in referrals from medical services. Abuse reductions and cessations were more frequently reported by hospital survivors.

In terms of health outcomes, there were no differences found for hospital survivors.

If hospital survivors made more than five contacts with an IDVA or used at least six resources or programs over a longer period of time, their chances of remaining safe improved by a factor of two.

Hospital survivors used healthcare services on average for £2463 each in the six months prior to IDVA intervention, while community survivors used healthcare services for £533 each.

 Limitations were linked to the evaluation design and data quality.

The researchers used a non-experimental design that led to an over-statement of intervention effectiveness.

The resources used to estimate cost limited analysis because it was based on patient collection.

 Further research should seek to determine the efficacy of the intervention, typically adopting an experimental design. This study offers concrete evidence on the effectiveness of hospital-based advocacy intervention for addressing domestic violence and abuse.
Olson, C., Aboutanos, M., Thomson, N., Vincent, A., & Kevorkian, S. (2022). Adapting Hospital-based Intimate Partner Violence Programs to the COVID-19 Pandemic. Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 11(1), 3-8. https://www.researchgate.net/profile/Nicholas-Thomson-2/publication/360294052_Adapting_Hospital-based_Intimate_Partner_Violence_Programs_to_the_COVID-19_Pandemic/links/62a0e4b36886635d5cc9c908/Adapting-Hospital-based-Intimate-Partner-Violence-Programs-to-the-COVID-19-Pandemic.pdf The aim of the study is exploring the impact of a hospital-based advocacy program or intervention on intimate partner violence during the Covid-19 pandemic.

The researchers investigated the EMPOWER program and how it adapted intervention and community case management practices to serve patients during the Pandemic.

 Descriptive research design 67 enrollees in the services participated in the study.

The researchers evaluated EMPOWER case logs on remote crisis intervention, safety planning, ongoing counselling, case management, and community-based referrals.

 Victimization types identified included IPV (61%), physical assault (40%), and sexual violence (35%). Around 28% of patients had a prior history of IPV or DV. Around 49% of patients were assaulted by their partner/spouse, 41% were assaulted while on a date Through EMPOWER, patients were given access to a variety of services, such as crisis intervention (84%), emotional support (89%), victim rights (53%), and advocacy for patients while they were receiving medical treatment (49%). The following safety and risk factors were mentioned by victims: Domestic violence caused 8% of patients to move or become homeless, 19% of patients seeking advocacy services claimed the perpetrator utilized a weapon, including a firearm, against the victim, and 30% of patients reported the presenting domestic violence incident to the police. The paper does not discuss limitations to the study.

Based on the analysis, a selection bias is likely given that selected patients are enrollees to the specific program or services, and it would be difficult to generalize the results outside the research setting.

 Future research should seek to determine the effectiveness of the program and how it can be adopted in other settings. The study provides valuable insights into an example of a hospital-based intervention to address IPV and victims of violence.

 

 

 
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Transformational Leadership

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Transformational Leadership

Professional nursing organizations I currently participate in

I am a member of the American Nurses Association (ANA). I joined ANA to access the many professional development opportunities and the support for nurses across the country the organization offers. Through ANA, I have achieved high standards of nursing practice, including ensuring a safe and ethical work environment, advocating for nurses’ health and wellness, and health care problems impacting the nursing profession and patients. My professional values and career goals align with the ANA mission to promote and improve the quality of health care for every individual. Additionally, ANA understands and promotes the power of nursing and its relevance in the healthcare system and drives ethical obligations for every member, a reason I became a member.

Transformational Leadership

Nursing certifications or continuing education that (graduate degree) might fit into my future plans

I currently hold the CCRN certification, a specialty nurses’ certification that allows nurses to offer direct care to critically ill adult patients irrespective of their geographical location. It is vital to continuing excellence in acute or critical care nursing. I plan to change it to CCRN_K because I’m changing roles from ICU to supervision. The CCRN_K is also suitable and appropriate as I seek membership in the American Organization of Nurse Executives (ANOE), which involves nurses who design, facilitate, and manage care. The organization offers leadership development opportunities and advocacy to advance nursing practice, something I wish to be a part of.

Aspects of the TEACH values discussed that would most benefit my work environment if adopted

Transformational leadership skills are essential in my practice as I intend to drive change and inspire new approaches to doing things, and harness team members’ creativity to address areas that need change. Transformational leadership skills will be critical in my supervisory role in the dynamic healthcare environment. I am open to new ways of thinking and ideas, inspire people to see and do things differently by broadening their minds, committed to active listening, tolerate intelligent risks, and willing to accept responsibility. I believe in teamwork and trust my team members to deliver and inspire everyone’s participation in the course of action.

The aspect of the TEACH values that would be more influential and beneficial in my work environment would be teamwork. Teamwork aligns with the skill set of transformational leaders (Ree & Wiig, 2019). I have to adopt teamwork skills to ensure team members are emotionally committed to the team’s responsibilities. Moreover, I am committed to adopting innovative ways of working as a team and improving team processes to ensure a better experience of teamwork and team viability. I will encourage team members to ensure the ongoing development of values and skills to encourage leadership in them. Every team member has to demonstrate leadership ability and lead actions and changes. Embracing teamwork best practices will ensure increased confidence and greater team cohesion, which is positive and needed for the team’s success (Ree & Wiig, 2019). To ensure teamwork, I will build a diverse and inclusive team, clearly define each member’s roles and responsibilities, cultivate trust within the team, promote clear and frequent communication, promote autonomous decision-making, and ensure team meetings are productive through active participation. I will focus on individual requirements and establish strong relationships with team members to help achieve the team’s objectives. I will enhance intrinsic motivation associated with low burnout and increased engagement with the team’s activities. Additionally, I will respect every team member’s values, personality, and background and demonstrate compassion, trust, and empathy. I will also create a sense of collective identity for the team to encourage collaboration and teamwork.

Reference

Ree, E., & Wiig, S. (2019). Linking transformational leadership, patient safety culture and work engagement in-home care services. Nursing Open, 7(1), 256–264. https://doi.org/10.1002/nop2.386

 
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Classical Argument: Health-Promoting Self-Care in Nursing

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Classical Argument: Health-Promoting Self-Care in Nursing

The healthcare environment is challenging and pressuring for nurses, impacting their health and well-being. Nurses have in-depth knowledge regarding health-promoting behaviors and practices, but they continue to report high overweight and obesity levels and mental health issues. Contributing factors include work-related stress, heavy workloads, shift work, poor engagement and communication, increasing patient health demands, and working overtime, which leaves nurses with little time to practice self-care.

Classical Argument: Health-Promoting Self-Care in Nursing

 

Lack of self-care is linked to unhealthy nurses, physically and psychologically, which negatively impacts nursing practice and patient outcomes. It is also related to health-risk behaviors like excessive alcohol consumption, smoking, and substance use. However, health-promoting self-care impacts nurses’ health and well-being, nursing practice, and overall institutional and patient outcomes. Therefore, adopting self-care strategies such as emotional regulation, self-compassion, mindfulness, healthy eating patterns, regular physical activity, staying connected, and continued individual and professional growth would help minimize the adverse effects of poor health-promoting self-care.

Background

Self-care is related to any intentional effort to activity to cater to one’s mental, physical, and spiritual well-being. Nurses spend extended periods caring for others, and they can forget about themselves, which is detrimental to their and other people’s health (Ross et al., 2019). The American Nurses Association completed a survey that indicated the increased urgency to improve nurses’ health, especially in nutrition, safety, life quality, and physical activity. About 70% of the nurses surveyed admitted prioritizing patients’ needs, safety, health, and wellness before theirs (Purdue University Global, 2021). Also, 77% of the nurses reported being at a significant risk level for work-related stress (Purdue University Global, 2021). To care for others, nurses should first care for themselves because compassion fatigue is associated with poor health-promoting self-care. Nurses’ health impact patient care in all healthcare settings.

The nursing field can be traumatic for nurses because of increased exposure to trauma, suffering, and pain, ending up traumatized without realizing it most of the time. However, the Code of Ethics recognizes self-care as a nurse’s responsibility because when nurses are not caring for themselves, they cannot care for their patients (Purdue University Global, 2021). In addition, the American Nurses Association Code of Ethics posits that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to other individuals (Purdue University Global, 2021).

Nurses are responsible for promoting their health and safety, preserving their character and integrity’s wholeness, maintaining competence, and ensuring personal and professional growth through continuing education and training. Self-care is considered a self-management tool for nurses to reduce the stress from working in the healthcare environment. Lack of self-care is linked with burnout, poor physical and mental health, depression, weight gain or extreme weight loss, unhealthy eating patterns, demoralization, back injury, and reduced job satisfaction (Williams et al., 2022). More attention is needed to enhance self-care in nurses because self-care helps minimize stress, replenish nurses’ compassion capacity and ability to care for others, and improve the quality of care.

(Classical Argument: Health-Promoting Self-Care in Nursing)

Self-Care Minimizes Stress

Self-care serves as a stress management tool, helping nurses reduce work-related stress. Adopting self-care practices like mindfulness, self-compassion, and emotional regulation can help nurses reduce stress and attend to their physical, mental, emotional, and spiritual needs (Hofmeyer et al., 2020). In this case, nurses should perceive self-care as integral to preventative care. Although individual factors can impact an individual’s ability to cope, control themselves, tolerate uncertainties, and resilience, self-care helps acquire and sustain these positive aspects of life. Per Hofmeyer et al. (2020), control is critical to an individual’s well-being. Still, work-related factors beyond a nurse’s control can disrupt the power to self-regulate and the need for control, adding to work-related stress.

Self-care begins with self-awareness, understanding how difficult events, uncertainties, and powerlessness impact oneself. For instance, it is normal to feel anxious, sad, and grief in difficult situations or crises, begging individuals to accept their vulnerability and learn how to self-regulate to control emotions and feelings attached to such conditions. In this case, self-regulation, self-compassion, and mindfulness allow nurses to focus on the positives rather than the negatives and uncertainties, accept situations, especially those that cannot be changed, like the death of a patient, and find meaningful ways to cope with the nursing environment, which helps reduce stress (Hofmeyer et al., 2020). Additionally, self-care builds resilience, allowing nurses to manage stress, maintain their health and well-being, and respond appropriately and effectively when facing crises and uncertainties. Self-efficacy, mindfulness, and emotional regulation strengthen psychological resilience.

Self-Care Replenishes Nurses’ Compassion Capacity and Ability to Care for Others

The ANA Code of Ethics highlight that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to others. Poor health-promoting self-care is associated with burnout and compassion fatigue, leading to poor patient outcomes and the risk of medical errors. Nursing care relies on empathy and compassion; the more burned out or stressed a nurse is, the more their capacity to offer kindness and compassion suffers (Monroe et al., 2021). Nurses often show empathy and compassion to their patients daily without a chance of replenishing them. However, nurses should learn and be able to extend empathy and compassion to themselves because failure to invest in themselves puts their and patients’ health and well-being at risk.

Moreover, nurses tend to be difficult on themselves when they make a mistake, and they do not console or talk to themselves as they would talk to a patient or a friend. Nurses are overly critical and judgmental of themselves, which, according to Hofmeyer et al. (2020), stimulates the sympathetic nervous system, activating a stress response that is harmful to an individual’s health and well-being. Engaging in self-care strategies, including having enough sleep, healthy eating patterns, regular physical activity, mindfulness, and social connections, can help replenish nurses’ compassion capacity and ability to care for others.

Therefore, nurses must practice self-compassion and understand their needs before helping others. Nurses should also learn to talk kindly to themselves because kind self-talk is linked to increased compassion capacity and pro-social behaviors like kindness, empathy, and altruism, helping them communicate better with colleagues, patients, and their families (Hofmeyer et al., 2020). In addition, acting with kindness and compassion helps reduce patient suffering and distress.

(Classical Argument: Health-Promoting Self-Care in Nursing)

Self-Care Improves the Quality and Safety of Care

Nurses caring for themselves and bringing the effects to the workplace helps promote safe and high-quality care. Nurses with self-compassion have better physical and psychological health, motivation, happiness, relationship-building, and perspective-taking, which are linked to better health outcomes (Hofmeyer et al., 2020). In addition, self-compassionate nurses report decreased anxiety, depressive symptoms, fear of failure, shame, and rumination, implying a greater capacity to work for others.

On the contrary, stressed, burned out, overwhelmed, and unsatisfied nurses are more likely to be involved in medical errors, including medication administration errors that negatively impact the quality of care and patient safety (Hofmeyer et al., 2020). Therefore, adopting self-care strategies like seeking a therapist’s support, taking breaks, engaging colleagues to stay connected, and maintaining physical activity can help reduce burnout, stress, and feeling confused, overwhelmed, frustrated, and angry, increasing nurses’ capacity to promote quality and safe care.

Opposition and Barriers to Implementing Self-Care

Implementing self-care requires commitment, planning, and joint efforts of nurses and hospital administrators. There are multiple factors presented as hindering nurses from implementing self-care to ensure a healthy workforce. A survey reported that nurses complained about insufficient time and overwork as barriers to implementing self-care activities (Wolters Kluwer, 2020). Most nurses are overworked with poorer health and well-being and lack time to participate in healthy habits. Additionally, nurses reported a lack of facilities and resources and other commitments as reasons for not engaging in self-care. About 25% of nurses point to lack of access to a gym, exercise classes, changing facilities, showers, and lack of refrigerators or microwaves as barriers to implementing self-care (Wolters Kluwer, 2020). Over 50% of nurses stressed outside commitments like family responsibilities and school activities as interfering with the ability to live more healthily.

Refutation

These barriers are genuine concerns about the nurses’ ability and capacity to implement self-care. The barriers are true across the board, but there are ways to encourage nurses to embrace healthy habits and self-care, like eating healthy and exercising regularly. Leadership and peer support can help guide and adopt healthier practices. Leaders can expand opportunities for nurses to have more breaks and provide facilities like gyms, showers, and refrigerators to store healthy food snacks (Wolters Kluwer, 2020). Allowing breaks at the facility would help schedule time for self-care practices like establishing supportive connections with colleagues and exercising.

(Classical Argument: Health-Promoting Self-Care in Nursing)

Conclusion

Health-promoting self-care can help improve nurses’ health and well-being, reduce stress, replenish nurses’ compassion capacity and ability to care for others, and improve the quality and safety of care. Conversely, poor health-promoting self-care is associated with increased nurses’ stress, burnout, lack of job satisfaction, compassion fatigue, chances of making medical errors, and decreased motivation. Nurses can adopt self-care strategies, including mindfulness, emotional regulation, self-compassion, regular physical activity, healthy eating patterns, personal and professional growth, and maintaining connectivity to promote health and well-being. Self-care is multifaceted, and improving self-care should address intrinsic and extrinsic motivators.

References

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse education today, 94, 104503. https://doi.org/10.1016/j.nedt.2020.104503

Wolters Kluwer. (2020). Nurses and self-care: Factors influencing healthy behaviors during COVID-19. https://www.wolterskluwer.com/en/expert-insights/nurses-and-selfcare-factors-influencing-healthy-behaviors-during-covid19/

Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of psychiatric nursing, 35(2), 189–194. https://doi.org/10.1016/j.apnu.2020.10.003

Purdue University Global. (2021, April 28). The importance of self-care for nurses and how to put a plan in place. https://www.purdueglobal.edu/nursing/self-care-for-nurses/

Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2019). Nurses and health-promoting self-care: Do we practice what we preach? Journal of nursing management, 27(3), 599–608. https://doi.org/10.1111/jonm.12718

Williams, S. G., Fruh, S., Barinas, J. L., & Graves, R. J. (2022). Self-Care in Nurses. Journal of radiology nursing, 41(1), 22–27. https://doi.org/10.1016/j.jradnu.2021.11.001

 
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Business Education Paper – Create Welcome Message

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Business Education Paper – Create Welcome Message

(Business Education Paper – Create Welcome Message) Supply Chain Management Course

Hello, MBA students.

Welcome to the Supply Chain Management Course, I will teach this semester. I have engaged many students before you, some of whom have graduated and become supply chain managers at various companies. I have taught this Supply Chain Management for the past ten years, and I believe I have the right knowledge and experience to help you succeed. My classes are highly interactive and engaging; therefore, I expect active, passionate, committed students who are willing to learn.

Business Education Paper - Create Welcome Message

General Overview of Course Content

Multiple learning resources are available for students on the institution’s website, including books, articles, course notes, and presentations. I expect students to engage in these materials regularly to expand their knowledge of course concepts and help complete course discussions, assignments, and quizzes. Your performance will be evaluated through discussions, assignments, and small quizzes to ensure high engagement that students are expected to complete to measure their grasp and understanding of course concepts. Throughout the course you will be required to:

  1. Identify the elements of a supply chain.
  2. Describe the challenges of coordinating a supply chain.
  3. Explain the role of the supply chain in enabling business competitiveness.
  4. Recommend a framework for supply chain management.
  5. Analyze contemporary trends and issues in effective supply chain management.

Current Trends or Issues in Supply Chain Management the Course Will Cover

Supply chain management (SCM) is a critical element in the business world, widely influenced by globalization and other changes in the business environment. The supply chains are increasingly becoming complex, especially with new technologies and innovations. Companies seek innovative strategies to manage their supply chains more effectively and efficiently and cultivate resilient supply chain operations. Current trends in supply chain management include artificial intelligence and automation, primarily driven by the need to streamline and optimize supply chain processes and automate humdrum and repetitive tasks (Dash et al., 2019). Also, the concept of Supply Chain as a Service is experiencing a trajectory in supply chain management as companies embrace the idea of outsourcing supply chain operations to external actors that will manage the whole process from procurement to delivery (Lopienski, 2021). You will also learn about circular supply chain as a current trend that is gaining trajectory in SCM. Businesses are embracing the idea of a closed-loop supply chain, which encourages material reusing and recycling to achieve sustainable and efficient supply chains (Lahane et al., 2020). You learn about other current trends during the course, and I also encourage you to research more.

(Business Education Paper – Create Welcome Message)

Course Policies and Expectations

The course has critical policies on attendance, participation, tardiness, missing homework and assignments, academic integrity, and classroom activities. There are points for attendance and participation to encourage learners to participate in course activities actively. There are also consequences for failing to attend at least a third of the classes, including online. Lateness is discouraged, especially concerning deadlines for discussions, assignments, and quizzes. Points will be deducted for discussion and assignments submitted late. Points will be deducted for missing homework and assignments. Students should ensure academic integrity by avoiding plagiarism. You are encouraged to participate in all class activities to increase your chances of success.

Contact Information and Communication Preferences

You can contact me through [Phone Number] or [Email]. I prefer using email for questions and other inquiries about the course.

Examples of how Key Course Takeaways Will Help Students in their Current or Future Professional Lives

Succeeding in this course is paramount to your current and future professional lives. For instance, students are expected to identify supply chain elements, describe the challenges of coordinating a supply chain, and analyze contemporary trends and issues in effective supply chain management. Understanding the supply chain elements will help you, as a supply chain manager or having a role in the supply chain, properly design supply chain strategies that support the business strategy. Also, understanding and describing the challenges of coordinating a supply chain will help you develop interventions and solutions to increase lead times and cost-effectiveness and reduce the risk of recalls and lawsuits. Understanding and analyzing current trends will help students adapt to constant disruption in supply chain management and develop strategic plans that consider current trends and their influence on the company’s future.

References

Dash, R., McMurtrey, M., Rebman, C., & Kar, U. K. (2019). Application of artificial intelligence in automation of supply chain management. Journal of Strategic Innovation and Sustainability, 14(3), 43-53. https://articlegateway.com/index.php/JSIS/article/view/2105

Lahane, S., Kant, R., & Shankar, R. (2020). Circular supply chain management: A state-of-art review and future opportunities. Journal of Cleaner Production, 258, 120859.

Lopienski, K. (2021). What Is Supply Chain as a Service? A Complete Guide.

 
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Week 5 Interprofessional Collaboration Discussion

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 Week 5 Interprofessional Collaboration Discussion

How My Facility Promotes Interprofessional Collaboration During Times of Patient Transitions

Interprofessional collaboration is critical in helping patients transition into various healthcare services by establishing seamless and robust patient care pathways. Patients, especially older and those experiencing chronic conditions requiring constant engagement with providers, experience multiple and concurrent transitions in different situations and healthcare settings. Interprofessional collaboration ensures a healthy and safe transition for clients and their family members. Healthy patient transitions encompass relationship well-being, role mastery, and subjective well-being (Zielińska-Tomczak et al., 2021). Therefore, promoting interprofessional collaboration during patient transition is imperative to ensure healthy transitions.

 Week 5 Interprofessional Collaboration Discussion

To promote interprofessional collaboration during patient transitions, the organization fosters the development of professional partnerships among interdisciplinary professionals, subjective norms like appropriate legal regulations, and perceived behavioral controls, including increased practitioner awareness regarding the qualification of team members and interpersonal skills that can promote or impede the patient transition process. Patient-centered partnerships between healthcare team members utilize combined knowledge and skills to enhance patient transition and improve patient care (Zielińska-Tomczak et al., 2021). Collaboration between physicians, nurses, and pharmacists is emphasized at the organization to ensure high-quality health services and patient transition achieves its desired objective.

The Role of The Nurse in Patient Transitions

The transition points are vulnerable points for patients, caregivers, and family members that can increase the risk of poor health outcomes. Nurses understand regulatory requirements, can access core information regarding how patients will manage at home and other recommended healthcare settings, and establish expectations regarding the effective transition from hospitals to home health settings and other institutional settings (Elliott & DeAngelis, 2017). Moreover, nurses are central to care coordination activities at the various transition points and can enhance healthcare delivery by improving transitions. Nurses interact closely and more frequently with patients, families, or caregivers at vulnerable points, learning information vital to successful transition planning (Camicia & Lutz, 2019). Nurses develop and evaluate transition plans and identify and communicate any barriers to successful transitions. Such barriers include a lack of family or caregiver capacity to effectively offer care for the post-discharge and limited financial ability to pay for out-of-pocket expenses of PAC. Nurses identify and communicate the information to interprofessional teams during patients’ hospital stay to ensure the transition plan caters to these patient and family needs. Nurses also help ensure the care settings the patient is transitioning to match the patient’s needs to avoid unnecessary readmissions (Camicia & Lutz, 2019). Conclusively, nurses ensure safe, timely, and efficient patient transitions across various care settings by promoting effective information transfer and informing optimal collaboration and coordination.

(Week 5 Interprofessional Collaboration Discussion)

Gaps In this Process Related to Quality of Care

Communication failure, lack of a single point person to promote care continuity, incomplete information transfer, limited access to critical services, and inadequate patient and family education are barriers to quality of care identified to hinder successful patient transitions (Earl et al., 2020). Communication failure can occur due to heavy workloads because of working overtime and increased patient needs, burnout, and lack of collaboration between physicians, nurses, and pharmacists. Home-based care points can experience limited access to critical services and resources to ensure optimal care. Inadequate or lack of patient and family education implies that family members or caregivers lack the capacity and knowledge to care for the patient at home effectively. Improved collaboration between healthcare staff, patients, and families can help close these gaps.

References

Camicia, M., & Lutz, B. J. (2019). Nursing’s role in successful transitions across settings. Stroke, 47(11), e246-e249.

Earl, T., Katapodis, N., & Schneiderman, S. (2020). Care transitions. In Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices [Internet]. Agency for Healthcare Research and Quality (US).

Elliott, B., & DeAngelis, M. (2017). Improving patient transitions from hospital to home: Practical advice from nurses. Nursing2022, 47(11), 58-62. https://www.nursingcenter.com/journalarticle?Article_ID=4376841&Journal_ID=54016&Issue_ID=4376671

Zielińska-Tomczak, Ł., Cerbin-Koczorowska, M., Przymuszała, P., & Marciniak, R. (2021). How to effectively promote interprofessional collaboration?–a qualitative study on physicians’ and pharmacists’ perspectives driven by the theory of planned behavior. BMC health services research, 21, 1-13.

 
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Resources Needed to Successfully Write your Doctoral Project

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Resources Needed to Successfully Write your Doctoral Project

Resources Needed to Successfully Write your Doctoral Project

A doctorate project is part of the doctoral program, requiring rigorous research in the specific field. The paper should contribute to scholarly research and knowledge on the specific topic. This project requires original research grounded on current literature to ensure reliability and validity. Multiple resources are needed to successfully write a doctorate project, including research articles, journal entries, and various data collection tools.2 Conducting primary research requires first-hand data collection using tools like official records, interviews, survey results, and unanalyzed statistical data.2 These resources provide raw data and information, including immediate impressions of participants.

(Resources Needed to Successfully Write your Doctoral Project)

The doctorate project should be founded on current literature, and there are multiple resources to obtain current research studies, including medical databases like Medline, the Cochrane Library, PubMed, and EMBASE. Primary resources or current literature include books, brochures, journals, and case studies to support the research setting, context, problem, literature review, methodology and design justification, and other details in the document.1 Peer-reviewed articles are preferred for doctorate projects but can also be supported by government publications, professional organizations publications, capstones such as other dissertations, doctorate studies, project studies, and trade journal articles.1 Peer-reviewed journal articles are preferred for high relevance, accuracy, credibility, internal validity, and rigor. Non-peer-reviewed journal articles are also credible but often adopted as supplemental support for industry-specific evidence and arguments.1 Examples of non-peer-reviewed journal articles include Harvard Business Review, Nursing in Practice, and Teaching and Learning.

(Resources Needed to Successfully Write your Doctoral Project)

References

Walden University. Evidence-Based Arguments: Types of Sources to Cite in the Doctoral Capstone. 2023. https://academicguides.waldenu.edu/formandstyle/writing/arguments/sources

University of Maryland. The research process: Research resources. 2023 https://www.umgc.edu/current-students/learning-resources/writing-center/online-guide-to-writing/tutorial/chapter4/ch4-06/

 
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 Income and Mortgages Mind Map

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 Income and Mortgages Mind Map

(Income and Mortgages Mind Map)

Comparison of Providers for Home Mortgages

The three selected providers of home mortgages AmeriSave Mortgage Corporation, PenFed Credit Union, and PNC bank. AmeriSave Mortgage Corporation offers multiple types of loans, including Conventional jumbo, FHA, VA, USDA, fixed-rate, adjustable-rate, rate-and-term, cash-out and streamline refinancing, and home equity line of credit (HELOC). The loans are available throughout the United States. Its minimum credit score is 620 for conventional loans, 700 for jumbo loans, 600 for FHA loans, 600 for VA loans, and 600 for USDA loans (Ostrowski, 2023). Downpayments are 3 percent for conventional, 3.5 percent for FHA, 0 percent for USDA, and 0 percent for VA (Ostrowski, 2023). Advantages of acquiring this mortgage include the availability of prequalification and customized rate quote in a few minutes and not needing a hard credit pull in most scenarios, transparent pricing and fee structure, and time to close an average of 25 days.

 Income and Mortgages Mind Map

PenFed offers multiple mortgage selections and has an open membership charter, implying that anyone can apply for the loan. Sample mortgage rates are not on the website. It has a minimum credit score of 620 for all its available loans, including Purchase, Refinance, Home Equity, Jumbo, Fixed, Adjustable, and VA (Metzger, 2023). The minimum downpayment is 3% (Metzger, 2023). Advantages attached to this mortgage selection include multiple loan products, including low-down-payment options for first-timers and HELOCs. PenFed also has a lender credit, based on the loan amount, for purchase mortgages, and its mortgage rates and fees are low than for other lenders.

(Income and Mortgages Mind Map)

PNC bank is available online and offline and offers multiple loan products, including conventional mortgages, FHA, VA, USDA mortgages, jumbo mortgages, grants and specialty mortgages, and HELOCs. The minimum credit score is 620, and the minimum down payment is 3% (Mortgage Reports, 2023). The best features attached to this mortgage selection include competitive rates and fees and a strong-branch network. However, the customer services scores are mid-range compared to the other lenders. Nonetheless, its mortgage rates are lower than some major competitors, including Well Fargo, Freedom Mortgage, and Rocket Mortgage. For instance, in 2021, its average 30-year interest rate was 3.08%, compared to Wells Fargo’s 3.14%. The median total loan costs were $3,820, and the median origination fee was $1,110.

Figure 1: Mind Map

(Income and Mortgages Mind Map)

Analysis

AmeriSave Mortgage Corporation is the lender of choice for a home mortgage because of its flexibility and offering rate-and-term, cash-out and streamline refinancing, and loans can be closed in days. The application fee is $500, and the underwriting fee is $295 (Ostrowski, 2023). It suits people looking for less common loan types, such as non-QM mortgages. AmeriSave offers multiple loan products, including conventional, jumbo, FHA, VA, USDA, fixed-rate, adjustable-rate; rate-and-term, cash-out and streamline refinancing; home equity line of credit (HELOC). It has great flexibility in its minimum credit score across the various loan products, including 620 for conventional loans; 700 for jumbo loans; 600 for FHA loans; 600 for VA loans; 600 for USDA loans (Ostrowski, 2023). The minimum down payment also varies across the loan products, including 3 percent for conventional, 3.5 percent for FHA, 0 percent for USDA, 0 percent for VA. Its loan services are also available across the United States. AmeriSave’s HELOC has a variable-rate line of credit that allows individuals to tap up to $249,900 of their home’s equity during a 10-year draw period and repay the loan over the next 10-year period (Ostrowski, 2023). HELOC is suitable for individuals making large purchases.

References

Metzger, P. (2023, January 20). PenFed Credit Union Mortgage Review 2023. https://www.nerdwallet.com/reviews/mortgages/penfed-credit-union-mortgage-loans

Mortgage Reports. (2023). PNC Mortgage Review for 2023. https://themortgagereports.com/47799/pnc-mortgage-lender-review

Ostrowski, J. (2023). AmeriSave Mortgage Corporation Review 2023. https://www.bankrate.com/mortgages/reviews/amerisave-mortgage-corporation/

 
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Focus SOAP Note: ADHD

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Focus SOAP Note: ADHD

Patient Verification

Name: K.T.

DOB: November 29th, 2013

Minor: Yes

Accompanied by: Mother

Demographic: 9-year-old African American

Gender Identifier Note: Female

SUBJECTIVE:

CC: “I’m depressed.”

Understanding ADHD - Symptoms, Causes, and Treatments

HPI:

A 9-year-old African American female presented at the clinic accompanied by her mother. The patient states she feels depressed. The mother also states the patient has been complaining of feeling depressed. The mother reports that patient was diagnosed with ADHD in 2020 at the age of 7 years. The mother is away most of the time because of her job. Her sister is also away, while she is at home with her brothers, who she claims are mean to her most of the time. The patient states she felt lonely because she has no one to play with or talk to. She has five friends in school who are foreigners from different countries. The patient states she does not want to go to school and does not feel like getting up in the morning to go to school. The mother reports the patient is always crying, and she does not want it to get worse, hence the reason they came for evaluation. The patient is struggling in school, especially in math, and her grades are low. However, she is respectful in class, and she loves art and writing, drawing, painting, and sketching but finds it very hard to learn new subjects. She has problems with concentration. Painting and sketches make her less sad. The patient reports that she does not express her feelings in school but in her head. The mother reports patient has problems sleeping and decreased appetite. The client denies suicidal and homicidal thoughts and intent to hurt others. However, she has sometimes made her lips bleed twice and sometimes slapped herself on the wrist.

Social Hx: Mother, 38 years, has a history of bipolar 1 disorder with borderline traits and PTSD. Patient has 3 siblings, two brothers and one sister. Sister has a history of anxiety and she is not around most of the time. Mother is also not around mostly due to her job. Parents are divorced, and dad, 41, has no visitation right or custody.

Legal Hx: Denied.

Medical Hx: Denied.

Surgical Hx: Denied

Psychiatric Hx: Patient has history of ADHD. Mother has a history of bipolar 1 disorder with borderline traits and PTSD. Sister has a history of anxiety

Psychiatric medication use: Denied.

Substance Abuse history: Denied.

ROS:

General: Denies weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. Reports decreased appetite.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports difficulties concentrating and paying attention.

Musculoskeletal: Denies muscle, back pain, joint pain, or stiffness.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating, No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE

Vital Signs

Temp: 98.3 F

BP: 117/59

HR:71

R: 18; non-labored

O2: 96% room air

Pain: Negative

Ht:4ft, 7 inches

Wt.: 71.2 lbs.

BMI:17.9

BMI Range: Healthy Weight

Physical Exam: General appearance: The patient appears to be healthy and well-fed. She routinely engages in discussion with the medical personnel; however, she easily gets distracted and abruptly leaves the subject under discussion. The mother steps in to assist with replying.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: Although the patient’s heartbeat and rhythm are regular, there are murmurs and other sounds coming from her chest. The patient’s heart rate is constant and capillaries refill in two seconds.

Musculoskeletal: Normal range of motion. Regular muscle mass for age. No signs of swelling or joint deformities.

Respiratory: No wheezes and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, tone is good, and speech is clear.

Psychiatric: The patient’s fast switching from one discussion or topic to another indicates inattentiveness. Patient is easily distracted, yet occasionally appears to pay attention to the mother and the practitioner.

Neuropsychological testing: Patient has difficulties executing functions where he is required to prioritize, plan, inhibit behavior, and attend to processing speed, especially schoolwork.

ASSESSMENT

MSE: K.T. underwent a mental health assessment. The patient was dressed appropriately for the setting and the season. Despite being highly talkative, she remained seated during the interview, was compliant, and displayed no signs of discomfort. The patient denied having hallucinations, suicidal or homicidal thoughts, paranoia, insomnia, appetite loss, or auditory or visual hallucinations.

DSM5 Diagnosis

  1. F90.9. Attention-Deficit hyperactivity disorder (Confirmed):

Attention-deficit/hyperactivity disorder (ADHD), a chronic mental health condition that frequently worsens as people age, affects millions of children. ADHD’s enduring symptoms include hyperactivity, impulsive behavior, and difficulties paying focus. For those with ADHD, especially children, common issues include low self-esteem, troubled relationships, and lack of involvement (Magnus et al., 2017). Impulsivity, disorganization, poor time management, difficulty setting priorities, difficulty focusing, difficulties multitasking, excessive activity and restlessness, poor planning, and a low threshold for irritability are some symptoms of ADHD.

The patient reported experiencing depressive, lonesome, and melancholy feelings, typical of many ADHD patients. The DSM-5 diagnostic criteria for people with ADHD include five or more inattention symptoms, several of which must have appeared before the age of 12, several of which must have appeared in two settings, evidence that the symptoms impair or negatively affect social or academic functioning, and symptoms that do not only coexist with another psychotic disorder (Magnus et al., 2017). The patient demonstrates continuous loss of focus and attention and has previously been diagnosed with ADHD. The patient claims to be depressed and exhibits many symptoms of depression. However, ADHD patients also report decreased appetite, symptoms resembling sleep deprivation, and are more likely to engage in non-suicidal and suicidal self-harm, which may account for the patient’s bleeding lips and slapping of oneself. The primary diagnosis, according to the examination, is ADHD.

  1. F32.9 Major Depressive Disorder

A prolonged sense of sadness and passivity are two features of depression. All depressive disorders have the symptoms of sadness, emptiness, or irritability, as well as other physical and mental changes that significantly restrict the patient’s capacity to function (Chand et al., 2021). Patients who are depressed have noticeably lower interest in or excitement for nearly all endeavors for the majority of the day, essentially every day. According to the DMS-5 criteria, a diagnosis requires five of the following symptoms: trouble sleeping, loss of intrigue or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, problems concentrating or listening attentively, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood (Agostino et al., 2021). The patient claims to feel down, melancholy, and lonely. Moreover, the patient has trouble falling asleep and has less desire to eat. The patient disputes any suicidal thoughts. Many depressive symptoms are present in the patient; however, the diagnosis was ruled out because the patient did not exhibit a protracted state of sadness.

  1. F41.9. Generalized Anxiety Disorder

Excessive, exaggerated anxiety and worry about everyday events without an apparent reason are characteristics of generalized anxiety disorder (GAD) (Munir et al., 2021). 3.1% of the population, or more than 6.8 million people, are affected. Although it can begin at any age and progress gradually, the risk is most between the ages of five and middle age. Biological variables, family history, life events, and other stressors all contribute to GAD, despite the exact caause being unknown (Toussaint et al., 2020). Looking for symptoms like excessive, persistent worry and tension, unrealistic views of problems, restlessness or a feeling of being “edgy,” difficulty focusing, quickly becoming exhausted, increased crankiness or irritability, trouble sleeping, and muscle tension can help diagnose general anxiety disorder. Individuals with GAD frequently see doom coming and worry excessively about everyday occurrences like going to work. GAD is diagnosed when a person has uncontrollable worrying, which K.T. does not have.

PLAN

Pharmacologic interventions:

  • Start Venlafaxine 18.75-75 mg/day; may increase to 150 mg/day after 4 weeks

Psychotherapy

Behavioral psychotherapy: With the use of behavioral therapy and the appropriate medication, it is possible to improve ADHD symptoms while enhancing executive function, lowering anxiety, and reducing hyperactivity (Magnus et al., 2017).

Psychosocial interventions: Psychosocial therapies, including applied relaxation interpersonal psychotherapy, short-term psychodynamic psychotherapy, and social skills instruction, can assist in lessening the symptoms of ADHD and anxiety (Magnus et al., 2017).

Cognitive therapy: Cognitive-behavioral therapy helps reduce anxiety and restlessness sensations that arise when performing tasks, improve focus and time management, and improve mood (Lopez et al., 2018).

Patient education

  • Talk to the patient and parent about risks and benefits of medication, including non-treatment, probable side effects.
  • Discuss with patient and parent when to stop medication, how to recognize, and when to report adverse events.
  • Talk to the patient and parent about the dangers of combining prescription pharmaceuticals with OTC, illicit, or natural substances.
  • Educate patient and parent to develop structured daily routines, daily schedule, and minimize changes.
  • Engage patient in skills training.
  • Encourage patient and parent to make time for exercise every day.
  • Educate the patient to accept herself and her limitations and to interact with people that accept her.
  • Teach patient to create a system for prioritizing the day and create deadlines for activities.
  • Advice parent to create more time to spend with patient.

Follow-up: Patient should follow-up after one week for psychotherapy.

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing). In: StatPearls [Internet]. StatPearls Publishing.

Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018). Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 3(3), CD010840. https://doi.org/10.1002/14651858.CD010840.pub2

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2017). Attention deficit hyperactivity disorder (ADHD).

Munir, S., Takov, V., & Coletti, V. A. (2021). Generalized Anxiety Disorder (Nursing). StatPearls [Internet].

Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of affective disorders, 265, 395-401.

 
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Discussion Post Change Agent

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Discussion Post Change Agent

How I see yourself as a change agent guiding others to move from a process focus to outcomes focus

Change is rapid, disruptive, and expected in the nursing environment. Most changes are adopted to improve healthcare processes and their efficiency to optimize outcomes, which is the primary focus of most healthcare organizations today. As care delivery becomes more patient-centered, there is a shift to outcomes rather than processes because patients are more concerned about their health outcomes than the processes adopted to achieve them. Therefore, I see myself as a change agent when I advocate for my patients and adopt positive changes like technology and evidence-based practice that are shaping the efficacy of the healthcare system (Charlotte Davis, 2019). I encourage reception to change because it is imminent and often unpredictable.

Discussion Post Change Agent

I collaborate and communicate with my team to identify barriers and actors affecting the efficiency and effectiveness of healthcare processes and people. I invite collective and meaningful engagement to develop solutions or interventions to improve processes and people to optimize patient and organizational outcomes. I also engage the public, colleagues, and policy-makers regarding healthcare policies that can help address issues such as understaffing, resource acquisition and availability, healthcare affordability, healthcare access, and adverse events that impact patient and organization outcomes (Rafferty, 2018). Driving these changes helps efforts to improve patient outcomes, including safety, satisfaction, and experience.

I am a registered nurse and see myself as an educator in the field, educating my patients, colleagues, and new nurses throughout my daily shifts. I like sharing information that can help improve service delivery and patient outcomes. I engage colleagues and patients on factors affecting care and perform environmental screening to identify these factors and potential solutions. I emphasize patient education because it is the best preventative measure that seeks to empower patients to take control of their health and advocate for themselves. I educate patients regarding healthy habits and lifestyles and attitudes towards treatment adherence and seeking healthcare services proactively.

(Discussion Post Change Agent)

The rationale behind the change from process to outcomes

Many healthcare actors, especially patients, financiers, and health insurance companies, adopt outcome measures rather than process measures to evaluate the performance of healthcare organizations and practitioners. The healthcare reforms have seen a shift to patient-centered, holistic care, value-based systems, and high-reliability organizations, all of which appreciate outcomes, the byproduct of effective and efficient processes and people (Pantaleon, 2019). There is also an emphasis on the relationship between healthcare services and health outcomes. This shift is behind the change from process to outcome.

References

Charlotte Davis, B. S. N. (2019). Change agents wanted. Nursing Made Incredibly Easy.

Pantaleon L. (2019). Why measuring outcomes is important in health care. Journal of veterinary internal medicine, 33(2), 356–362. https://doi.org/10.1111/jvim.15458

Rafferty A. M. (2018). Nurses as change agents for a better future in health care: the politics of drift and dilution. Health economics, policy, and law, 13(3-4), 475–491. https://doi.org/10.1017/S1744133117000482

 
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