Identify the grade or level of recommendation for the three recomendations identified and describe what the assigned grade or level means.

Discussion Question

Clinical practice guidelines use available evidence to develop recommendations that guide practice to improve patient care.

Select a clinical practice guideline, based on your area of interest, from one of the web sites below or another site. Describe the following information from the guideline you selected.

Identify the name of the clinical guideline and date developed
Identify the population
Identify 3 recommendations found in the guideline
Identify the grade or level of recommendation for the three recomendations identified and describe what the assigned grade or level means.
How can you use the information from the guideline in your practice?
Suggested Clinical Practice Guideline sites:

https://www.guidelinecentral.com/summaries/specialties/nursing/

https://www.ena.org/practice-resources/resource-library/clinical-practice-guidelines

https://www.uspreventiveservicestaskforce.org/BrowseRec/Index

https://guidelines.ecri.org/

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Describe the characteristics of the people you see in Sentinel Town®.

Basic Windshield Survey – Rural
Enter Sentinel Town® via the link to begin your virtual experience by taking a tour by car of Sentinel Town®. Since this is your first tour, select the slowest speed and stay in the car the entire time at least once before getting out of the car.

As you take the tour, write down your observations, specifically those that align with the following demographics and/or subsystems listed in the left-hand column of the rubric.

Describe the characteristics of the people you see in Sentinel Town®.
What are the race/ethnicity distribution, age ranges, and gender mix?
Are there signs of poverty or wealth? What are they?
Who do you see on the streets?
Parent with child, teens, couples, disabled persons?
Are there homeless persons, beggars, etc.?
Is there anyone in the city you would not expect to see?
Are there dogs on or off leash? Are there other animals?
Are there churches and other formal religious buildings?
What are their denominations?
Compile your observations addressing each item listed in the first column of the rubric. You are encouraged to add other relevant observations that may not be listed in the first column.

Select a target population of interest and discuss relevant demographic data and health status indicators for this population group. Identify major health concerns for this target population. Include a discussion of major health concerns in relation to a global health issue.

Reading and Resources

Harkness & DeMarco (2016) Read Chapters 1 & 2
Read all Sentinel City information available at the top of the course homepage.
Visit QSEN: Quality and Safety Education for Nurses
Read the Report: The Future of Nursing: Leading Change, Advancing Health
Read the Report: The Future of Public Health
Review Final Project Requirements
Watch the Henry Street Settlement: 120 Years in 4 Minutes Video
View this 9 minute video entitled Community Assessment Windshield Survey, to help you see what types of things to look for when you conduct a windshield survey in the Sentinel City simulation
Additional Instructions:

All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.
Submission Option

Instruction

Paper

4 to 6-page paper. Include title and reference pages.

Note: Title and reference pages/slides do not count towards the count requirements.

Attachments areaPreview YouTube video Henry Street Settlement: 120 Years in 4 MinutesPreview YouTube video Community Assessment Windshield SurveyCommunity Assessment Windshield SurveyReplyReply allForward

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Describe at least one state regulation related to general nurse scope of practice.

Develop a 9- to 10-slide PowerPoint Presentation that addresses the following:

Describe the differences between a board of nursing and a professional nurse association.
Describe the geographic distribution, academic credentials, practice positions, and licensure status of members of the board for your specific region/area.
Who is on the board?
How does one become a member of the board?
Describe at least one federal regulation for healthcare.
How does this regulation influence delivery, cost, and access to healthcare (e.g., CMS, OSHA, and EPA)?
Has there been any change to the regulation within the past 5 years? Explain.
Describe at least one state regulation related to general nurse scope of practice.
How does this regulation influence the nurse’s role?
How does this regulation influence delivery, cost, and access to healthcare?
Describe at least one state regulation related to Advanced Practice Registered Nurses (APRNs).
How does this regulation influence the nurse’s role?
How does this regulation influence delivery, cost, and access to healthcare?

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What questions yielded the most information? Why do you think these were effective?

Exercises:

Complete the ShadowHealth© Conversation Concept Lab and Digital Clinical Experience Orientation
Complete the ShadowHealth© Health History assignment
After you have achieved at least 80% on the assignment(s) download, save and upload your LabPass document to the dropbox.

Professional Development

Write a 500-word APA reflection essay of your experience with the Shadow Health virtual assignment(s). At least two scholarly sources in addition to your textbook should be utilized. Answers to the following questions may be included in your reflective essay:
What went well in your assessment?
What did not go so well? What will you change for your next assessment?
What findings did you uncover?
What questions yielded the most information? Why do you think these were effective?
What diagnostic tests would you order based on your findings?
What differential diagnoses are you currently considering?
What patient teaching were you able to complete? What additional patient teaching is needed?
Would you prescribe any medications at this point? Why or why not? If so, what?
How did your assessment demonstrate sound critical thinking and clinical decision making?

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Identify a patient care situation in which you describe how nursing care or approaches to decision-making may differ based upon the educational preparation of the nurse (BSN vs ADN).

Type of paperEssay (Any Type)

SubjectNursing

Number of pages3

Format of citationAPA

Number of cited resources3

Type of serviceWriting

1. Discuss the difference in competencies between nurses prepared at the ADN level vs BSN level. 2. Identify a patient care situation in which you describe how nursing care or approaches to decision-making may differ based upon the educational preparation of the nurse (BSN vs ADN).

Additional Service

i

Progressive delivery

With progressive delivery, you have an additional deadline by which you have to provide a first half of the paper for the customer. The customer may evaluate this work and add his or her commentary.

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Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest for the Assignment.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
****PART 2 AND 3 ARE ATTACHED****

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Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weights 110 lbs. and is 5’ 5”

SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.

MENTAL STATUS EXAM

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES

§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

The Assignment

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
Decision #2What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Why were they different?Explain any difference between what you expected to achieve with Decision #1 and the results of the decision.

Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.

In your introduction please be sure and discuss background information on the patient.

In your decision trees you need to discuss all therapies presented as well as why you didn’t select them. You also should be more specific with the evidence you provide. 
Please also be sure to provide an ethical consideration/conclusion at the end of your essay.

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Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.

Research Paper

Search course materials, including your text and the Internet, to find a spreadsheet program that will assist you in completing this assignment. The spreadsheet and calculations are to be attached at the end of the paper as an appendix after the Reference page.

Case Study: You are assessing the payer–patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).
Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).
Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.
Compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days.
Assess the information for areas of improved reimbursement of at least 20% or more.
Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.
Propose a best strategy with justification and rationale based on effective decision-making tenets.
The body of the resultant paper should be 10 pages. Spreadsheets demonstrating the accounts receivable analysis will be attached as appendices, and there will be at least 7 relevant peer-reviewed academic or professional references published within the past 5 years. Also attach appropriate fee schedules.

For a resource guide on using the online library to search for references, click here.

Please submit your assignment.

Your assignment will be graded in accordance with the following criteria. Click here to view the grading rubric

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Summarize the policies the office should have for patient’s without appointments, managing patients’ wait time, and registering patients

Read the scenario below and complete what follows.

Scenario
You just accepted a role as medical administrator at a podiatrist medical office. There are many responsibilities associated with this position including managing the office, patient registration, insurance verification/referrals, and scheduling following up appointments. As you navigate through your first day at work, the waiting room is full and a patient with a severe foot infection is seeking treatment without an appointment. As part of your new position and responsibilities, you will be required to review, assess, and participate in all medical administrative duties that will support this patient.

As the new medical administrator, you have will complete an encounter form of the new patient with a severe foot infection.
Complete the steps below:

Patients Information in EHR System
Describe the process for entering the patient’s information in the Electronic Health Record. Summarize the importance of this process being accurate
Appointment Follow-up
Outline the steps for following-up with the patient after their appointment
Identify Patient Waiting Room Improvements
Outline improvements that should be made to the waiting room that help assist the patients
Describe Patient Relation Improvement Techniques and Policy Creation
Summarize the policies the office should have for patient’s without appointments, managing patients’ wait time, and registering patients

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Identify and briefly describe two issues or concepts associated with the breakdown of teamwork in this scenar

Effective patient care, safety, and experience is dependent upon the work and effort of numerous healthcare departments and workers including but not limited to medical practitioners, nurses, medical assistants, medical laboratory technicians, coding and billing specialists, and medical administrative assistants. Proper communication, respect, and teamwork is necessary for a clinic to operate efficiently and effectively.

Please read the following patient scenario:

You witnessed a coworker’s (Michael – who works in your department) interaction with another coworker, Flora, who works in a different department. Michael was very rude, disrespectful, and mad because he was arguing that Flora didn’t communicate important patient information to your department and caused a patient to have an extended wait time. Flora was obviously disturbed and hurt by this interaction and you know it wasn’t her fault, but rather Michael’s.

Please discuss the following concepts in 1-2 pages:

Identify and briefly describe two issues or concepts associated with the breakdown of teamwork in this scenario.
How would you use internal customer service skills, tools, and techniques to resolve this issue?
How can good and poor internal customer service affect patient experience and outcomes?

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