Policy

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 A mid-term Policy Impact / Healthcare Narrative Interview will be due.  The interviewee must be someone who has had health problems, or works with someone with health problems that impact their life expectations. The interviewee may be a family member, but not the student themselves! If you choose to interview a patient, do not violate any HIPAA policies or collect any protected health information (PHI). And if you choose to interview someone under 18, parents must be present during the interview and questions may be reworded as needed to be age appropriate for the child or parent.  

 

Use the interview Template attached below and follow APA grammar and formatting as close as possible for the midterm interview. 

The template provides a title page to fill in, an introductory section, questions to ask the interviewee, and your own reflective summary and analysis.  You may add more questions as needed. While an in-person interview is most common, to accommodate busy schedules, the questions may be asked and answered via telephone, and even email. But you must document the appropriate title page information to validate your interview. 

Due to the nature of interviewing, the interview content may use informal phrases and be written in first or third person, at the student’s discretion. Word count of the student and interviewee responses only is expected to be 1,000-1,500, and does NOT include references, title page, or the questions provided in the template. 

BJ week 5

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Repost with template BJ week 5

Créate a reply to the following discussion as a DNP student, use at least 400 words, and different (from post) scholarly references no older than 5 years old

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Reply to Will

Nursing practice must be grounded in mid-range theories to promote quality improvements and ensure evidence-based, patient-centered care. One such middle-range theory that can be instrumental in developing a proposed quality improvement project is the Empowered Holistic Nursing Education (EHNE) Theory, created by Dr. Katie Love. This theory emphasizes the integration of holism and empowerment within nursing education to enhance professional practice, cultural competence, empathy, and overall patient care outcomes. The EHNE Theory is a midrange theory that I would implement as it is relevant to nursing when considering quality improvement initiatives aimed at addressing the growing concerns related to the lack of holistic perspectives of health providers within healthcare practice (Love, 2019).

In addition to the EHNE Theory incorporating experiential learning and reflective practices, it also emphasizes nurse empowerment as a key component of effective education (Patton, 2020). For a person to experience transformational learning, they must have various experiences within their nursing education, which can facilitate a growth mindset and, ultimately, a change in their worldview (Patton, 2020). By fostering holistic and culturally competent approaches, this theory addresses gaps in nursing education where task-oriented clinical training often overshadows empathy and holistic care (Love, 2019).

In order for the EHNE theory to be effective, nurses must be educated on how to recognize relevant experiences and build on them for future patient care situations. The ability of a nurse to be successful is contingent on their ability to view a patient as a complete whole. That is understanding that the patient’s mind, body, and spirit are all interconnected in regard to their care. Understanding these concepts helps nurses develop resilience, emotional well-being, and empathetic skills to better care for their patients and themselves.

This theory aligns well with the DNP Essential I, which emphasizes integrating nursing science with other disciplines to improve healthcare outcomes (American Association of Colleges of Nursing [AACN], 2006). Essential II is also addressed since the EHNE Theory promotes educational models that promote resilience, empathy, and cultural competence, which have been identified as key elements of quality improvement initiatives (AACN, 2006). Essential VIII is also relevant as it emphasizes the importance of developing, implementing, and evaluating interventions that improve healthcare outcomes.

The EHNE theory focuses on a nurse’s experiential learning and emphasizes reflective practice in order to provide a robust framework for developing quality improvement initiatives that enhance their ability for patient-centered care through empathy and cultural competence (Love, 2019). This is especially relevant to those populations that are marginalized and vulnerable. By implementing the EHNE Theory, nurses can further leverage their experiential learning, thereby increasing their empathy, resilience, cultural competence, and patient care outcomes.

References

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice.https://www.aacnnursing.org/DNP/DNP-Essentials

Love, K. (2019). Empowered holistic nursing education as the philosophical framework for an RN-BS program: A six-year impact evaluation study. Nursing Education Perspectives, 40(6), 358-360. https://doi.org/10.1097/01.NEP.0000000000000500

Patton, C. M. (2020). Phenomenology for the holistic nurse researcher: Underpinnings of descriptive and interpretive traditions. Journal of Holistic Nursing, 38(3), 278-286. https://doi.org/10.1177/0898010120919554

Pathophysiology Adventure Part 2 response TL

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My chosen condition is Major Depressive Disorder ; (MDD) is a complex mental health condition characterized by persistent sadness, anhedonia, and cognitive impairment. The pathophysiology of MDD is multifactorial, involving neurotransmitter imbalances, structural brain changes, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Dysfunction in serotonin, norepinephrine, and dopamine pathways contributes to mood disturbances, while neuroimaging studies reveal structural abnormalities in the prefrontal cortex, hippocampus, and amygdala (Malhi & Mann, 2018). Additionally, chronic stress and inflammation play a role, as elevated levels of cortisol and inflammatory markers such as C-reactive protein (CRP) have been linked to depressive symptoms (Kennis et al., 2020). Genetic predisposition and environmental factors, such as adverse childhood experiences (ACEs), also contribute to MDD development.

       MDD presents with a range of symptoms, including persistent low mood, fatigue, sleep disturbances, appetite changes, psychomotor agitation or retardation, and suicidal ideation. The disorder can lead to severe complications, including an increased risk of suicide, social withdrawal, impaired occupational functioning, and co-occurring conditions such as anxiety disorders and substance abuse (American Psychiatric Association [APA], 2022). Risk factors for MDD include a family history of depression, exposure to chronic stress, low socioeconomic status, and coexisting medical conditions such as diabetes and cardiovascular disease (Cuijpers et al., 2021). Women are at a higher risk, particularly during pregnancy and postpartum, due to hormonal fluctuations and psychosocial stressors.

     Diagnosis of MDD relies on clinical criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which requires the presence of at least five depressive symptoms for a minimum of two weeks, with significant impairment in daily functioning (APA, 2022). Standardized tools such as the Patient Health Questionnaire-9 (PHQ-9)and Hamilton Depression Rating Scale (HAM-D) are commonly used to assess symptom severity. Laboratory tests, including thyroid function tests and vitamin B12 levels, help rule out medical conditions that may mimic depressive symptoms (Goldstein-Piekarski et al., 2022). In cases of treatment-resistant depression, neuroimaging studies, such as magnetic resonance imaging (MRI), can assess structural abnormalities or coexisting neurological conditions.

      MDD manifests differently across the lifespan, with variations in symptomatology and risk factors. In children and adolescents, irritability and behavioral issues may predominate over classic depressive symptoms, with increased academic difficulties and social withdrawal (Maughan et al., 2021). Among pregnant and postpartum women, MDD can contribute to negative maternal and fetal outcomes, including preterm birth and impaired mother-infant bonding (Woody et al., 2022). In older adults, MDD often presents with somatic symptoms, cognitive decline, and an increased risk of suicide, particularly in elderly men. Recognizing these variations is crucial for accurate diagnosis and appropriate treatment across different age groups.

Case Study: Major Depressive Disorder (MDD)

Patient Profile:

  • Name: Maria Lopez
  • Age: 42 years old
  • Gender: Female
  • Ethnicity: Hispanic
  • Occupation: Elementary school teacher
  • Marital Status: Divorced, single mother of two children (ages 10 and 13)
  • Medical History: No major medical conditions, history of gestational diabetes.
  • Family History: Mother had depression, father died by suicide at age 50.
  • Social History: Limited social support, financial stress, recently lost her mother to cancer.

Presenting Symptoms:

  • Maria reports persistent low mood and lack of interest in daily activities for the past six weeks.
  • Fatigue and difficulty concentrating at work, affecting her ability to teach.
  • Sleep disturbances: Wakes up early and cannot fall back asleep.
  • Appetite changes: Decreased appetite with unintentional weight loss of 8 lbs.
  • Feelings of guilt about being a “bad mother.”
  • Passive suicidal thoughts but denies active intent or plan.

Assessment Findings:

  • Appearance: Unkempt, minimal eye contact.
  • Affect: Flat.
  • Speech: Soft, slow response.
  • Thought Process: Logical but preoccupied with feelings of worthlessness.

Diagnostic Workup:

  • PHQ-9 Score: 19 (indicative of moderate-to-severe depression).
  • TSH, T3, T4: Normal (rules out hypothyroidism).
  • CBC: Mild anemia.
  • Vitamin B12/Folate: Normal.
  • Urine Toxicology: Negative for substance use.

Diagnosis:

Major Depressive Disorder (MDD), Moderate to Severe

Treatment Plan:

  1. Pharmacological Management:
    • Initiate Selective Serotonin Reuptake Inhibitor (SSRI) (e.g., Sertraline 50 mg daily).
  2. Psychotherapy:
    • Cognitive Behavioral Therapy (CBT) for cognitive restructuring.
    • Supportive therapy for grief processing.
  3. Lifestyle Modifications:
    • Encourage structured daily routines and social engagement.
    • Recommend mild exercise (walking, yoga).
  4. Follow-up and Monitoring:
    • Weekly follow-ups for the first month.
    • Safety plan for suicidal ideation.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).American Psychiatric Publishing.

Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2021). The effects of psychotherapies for major depression in adults on remission, recovery, and improvement: A meta-analysis. JAMA Psychiatry, 78(3), 294-302. https://doi.org/10.1001/jamapsychiatry.2020.3673

Goldstein-Piekarski, A. N., Williams, L. M., Humphreys, K. L., & Gotlib, I. H. (2022). Neurobiological markers of depression: Insights from neuroimaging and genetics. Molecular Psychiatry, 27(3), 1378-1394. https://doi.org/10.1038/s41380-021-01255-7

Kennis, M., Gerritsen, L., van Dalen, M., Williams, A., & Cuijpers, P. (2020). Prospective biomarkers of major depressive disorder: A systematic review and meta-analysis. Molecular Psychiatry, 25(2), 321-338. https://doi.org/10.1038/s41380-019-0585-z

Maughan, B., Collishaw, S., & Stringaris, A. (2021). Depression in childhood and adolescence. Journal of Child Psychology and Psychiatry, 62(5), 447-468. https://doi.org/10.1111/jcpp.13299

Woody, C. A., Ferrari, A. J., Siskind, D. J., Whiteford, H. A., & Harris, M. G. (2022). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 314, 1-11. https://doi.org/10.1016/j.jad.2022.02.075Links to an external site.

Create a Reply for a discussion using APA 7 format, and scholarly references no older than 5 years.

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Please ensure that the Reply includes more than 200 words of scholarly articles and that the plagiarism level remains below 20%.

Using Telemedicine and Remote Monitoring Technologies in APRN Practice
Telemedicine platforms and remote monitoring technologies have significantly impacted the practice of APRNs, improving medication adherence, therapeutic responses, and adverse effects management. These digital health solutions allow APRNs to monitor patients remotely, offer timely interventions, and enhance pharmacological care at a higher quality.

Remote Access to Medication Compliance and Therapeutic Responses

Telemedicine platforms allow APRNs to evaluate adherence through electronic medication dispensers, mobile applications, and digital pill bottles that log patients’ medication ingestion in real time. These technologies provide valuable data that enables APRNs to intervene when a patient misses a dose or departs from the prescribed regimen. Researchers have found that electronic adherence monitoring may improve medication adherence, especially in chronic diseases like hypertension, diabetes, and heart failure. (Patel et al., 2021).

At-home monitoring devices like wearable sensors and diagnostic devices allow for assessing therapeutic responses. For example, continuous glucose monitors (CGMs) give real-time blood glucose levels, enabling APRNs to adjust insulin therapy quickly. Blood pressure monitors and pulse oximeters, in a comparable way, assist APRNs in monitoring cardiovascular and respiratory conditions, which can allow for changes in pharmacological interventions based on objective data (Morris et al., 2020). As a result, APRNs can offer individualized care, limiting hospitalizations through RPM.

Alerts for Possible Adverse Drug Effects

Remote monitoring helps catch adverse drug effects. Digital health technologies (e.g., wearable electrocardiograms [ECGs] and smartwatch-based arrhythmia detection) are also capable of passively detecting medication-induced cardiac abnormalities (e.g., QT prolongation). RPM devices can also alert APRNs when physiological changes suggest adverse effects, such as changes in blood pressure, oxygen saturation, or weight. For instance,  smart scales and hydration sensors were also used to monitor patients on diuretics for dehydration and electrolyte imbalances (Takahashi et al., 2022). The principle of these individuals being able to make early modifications to treatment to accommodate adverse reactions to medications ultimately ensures patient safety.

The Effect on pharmacological Interventions and APRN Practice

Telemedicine and RPM have made pharmacological treatment more efficient, including proactive treatment instead of merely reactive treatment. These technologies enable APRNs to perform virtual medication reconciliations with patients, mitigating risks associated with polypharmacy and drug interactions. In addition, telehealth meetings aid in teaching patients how to use their medication, enabling them to participate in their healthcare (Kruse et al., 2021).
Remote monitoring adds a layer of reach from an APRN practice perspective that helps us assess the complete picture of our patients from other settings. It enhances patient involvement and compliance, especially for those with physical restrictions or living in remote areas. However, we must address data security, patient privacy, and technology issues for equitable healthcare delivery (Morris et al., 2020).

Conclusion

Telemedicine and remote monitoring technologies have revolutionized APRN practice by improving medication adherence, therapeutic monitoring,  and detecting adverse drug effects (ADEs). These technologies significantly enhance the quality of pharmacological care, enabling APRNs to provide care in a timely and efficacious way while promoting patient-centered health care. As the digital health arena continues to unfold, APRNs should allow themselves to evolve towards a more well-evolved stance by advocating for integrating these technologies into routine care and continuing education opportunities to help shift toward contemporary care delivery models.

References

Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2021). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 11(8), e045104. https://doi.org/10.1136/bmjopen-2020-045104

Morris, M. E., Adair, B., Miller, K., Ozanne, E., Hansen, R., Pearce, A. J., Santamaria, N., & Said, C. M. (2020). Smart technologies to enhance social connectedness in older people who live at home. Australasian Journal on Ageing, 39(1), e36-e42. https://doi.org/10.1111/ajag.12794

Create a Reply for a discussion using APA 7 format, and scholarly references no older than 5 years.

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Please ensure that the Reply includes more than 200 words of scholarly articles and that the plagiarism level remains below 20%.

Telemedicine Platforms and Remote Monitoring Technologies

APRNs are increasingly leveraging telemedicine and remote monitoring technologies to enhance patient care by tracking medication adherence, evaluating treatment effectiveness, and identifying adverse reactions. These technological advancements allow for real-time data collection, enabling early intervention and informed clinical decisions regarding medication management. By integrating these tools into practice, APRNs can provide continuous monitoring, improve patient engagement, and optimize treatment outcomes.

Telemedicine platforms allow APRNs to conduct virtual consultations, enabling direct communication with patients about their medications. These interactions help address concerns, clarify instructions, and reinforce the importance of adherence. Digital pill dispensers, mobile health applications, and wearable devices further support medication adherence by sending reminders and tracking missed doses. Wearable technology, such as smartwatches and continuous glucose monitors, provides real-time data on patients’ health, allowing APRNs to intervene promptly when adherence issues arise (Zhou et al., 2021).

Remote patient monitoring (RPM) plays a crucial role in assessing therapeutic responses. By continuously collecting and analyzing patient-generated data, APRNs can monitor blood pressure, glucose levels, heart rate, and other key health indicators. This approach allows for timely adjustments in medication regimens based on real-time patient data rather than relying solely on periodic in-person visits. For instance, connected blood pressure monitors have been linked to improved hypertension management because they provide continuous updates on a patient’s condition, reducing the risk of complications from poorly controlled blood pressure (Gupta et al., 2020).

Another significant advantage of RPM is its ability to identify potential adverse drug reactions early. Continuous monitoring enables APRNs to detect abnormal vital signs or other indicators of adverse effects, allowing for immediate intervention before complications escalate. This proactive approach improves patient safety and reduces hospital readmissions. Additionally, wearable technology and RPM systems facilitate early detection of medication-related side effects, enabling APRNs to adjust dosages or switch medications as needed.

The integration of remote monitoring technologies significantly impacts APRN practice by shifting medication management from a reactive to a proactive approach. Instead of adjusting treatment based on intermittent clinical visits, APRNs can now rely on real-time patient data to make timely and informed decisions. This shift enhances the personalization of pharmacological interventions, ensuring that treatment plans are continually optimized based on actual patient responses rather than estimates.

Despite its benefits, the use of telemedicine and RPM presents certain challenges. The continuous flow of patient data requires APRNs to manage a higher workload, as they must monitor alerts and respond quickly to potential concerns. Issues related to data accuracy, patient privacy, and technology usability must also be addressed to ensure that remote monitoring remains effective. Training for APRNs, investment in secure and user-friendly technology, and clear guidelines for managing patient data are essential for overcoming these challenges.

In conclusion, telemedicine platforms and remote monitoring technologies have transformed the way APRNs monitor medication adherence, therapeutic responses, and adverse effects. These innovations enhance patient engagement, improve safety, and allow for more personalized treatment plans. However, for their successful integration into APRN practice, healthcare systems must address the associated challenges, ensuring that these technologies remain reliable, secure, and effective in supporting high-quality patient care.

References
Gupta, A., Scott, K., & Dukewich, M. (2020). Innovative technology using remote patient monitoring devices in chronic disease management. Journal of Nurse Practitioners, 16(2), 144–148. https://doi.org/10.1016/j.nurpra.2019.09.013

Zhou, L., Bao, J., Setiawan, I. M. A., Saptono, A., & Parmanto, B. (2021). The mHealth app usability questionnaire (MAUQ): Development and validation study. JMIR mHealth and uHealth, 9(4), e23630. https://doi.org/10.2196/23630

Approaches to Health Management: Sexuality

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A father of a 17-year-old wants to know whether his child is sexually active.

  • What will you tell him?
  • What if the child is 14 years old?
  • What if the child is 11 years old?
  • What is your state law regarding parental notification?

Peds Clinical Experience

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Describe your clinical experience for this week.

  • Did you face any challenges, any success? If so, what were they?
  • Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
  • Mention the health promotion intervention for this patient.
  • What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
  • Support your plan of care with the current peer-reviewed research guideline.

Nursing Pharmacology

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In  what ways can APRNs utilize telemedicine platforms and remote  monitoring technologies to remotely access patients’ medication  adherence, therapeutic responses, and potential adverse effects? How  does remote patient monitoring impact the delivery of pharmacological  interventions and APRN practice?

Please review the rubric before posting to ensure a maximum of  points. APA format is mandatory. At least two appropriate references  should be used. The usage of “IA” is not approved and violates academic  integrity.

I recommend at least 500 words (2 pages) for the initial post and a minimum of 150 words for every response. 

Neurocognitive Medications discussion

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neurocognitive medications