From the perspective of an LTC provider, what actions could be implemented to help lower the overall industry claims losses for the LTC insurers in order to preserve the availability of LTC policies to the provider’s residents.

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(2)  From the perspective of an LTC provider, what actions could be implemented to help lower the overall industry claims losses for the LTC insurers in order to preserve the availability of LTC policies to the provider’s residents.  Consider that with viable LTC insurance, more consumers can afford expensive LTC services such as assisted living or luxury memory care or nursing facilities.  Consider further that with more consumers insured with LTC, the LTC providers have a more certain source of timely payment than if relying on the individual.  Thus, financial solvency of LTC facilities and financial solvency of LTC insurers may be closely related. 

For this assignment, the student will identify the characteristics that create a culture of safety in health care.

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For this assignment, the student will identify the characteristics that create a culture of safety in health care.  The student will also identify common tools and methods used in the quality improvement process as well as the new nurse’s role in quality improvement.  Finally, the student will reflect on lessons learned from the IHI Open School modules and provide an evaluation of the IHI Open School content and make suggestions for improvement.  It must be written following current APA formatting guidelines and include a title page, appropriate use of headings, and a reference list.  The reference list should contain at a minimum two articles related to a culture of safety and reference the IHI Open School. Use PS101,PS102, PS103, PS104, PS105, QI101, QI102, and QI103.

Please make sure NO PLAGIARISM because it’s being submitted to a plagiarism system to check.  Check grammar and spelling.

Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos.

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  • Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos.
  • Watch the YMH Boston Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.

 

Based on the YMH Boston Vignette 5 video, post answers to the following questions:

  • What did the practitioner do well? In what areas can the practitioner improve?
  • At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
  • What would be your next question, and why?

Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

  • Explain why a thorough psychiatric assessment of a child/adolescent is important.
  • Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
  • Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents/guardians play in assessment.

Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Contrast the key characteristics of traditional leadership with the key features of Complexity Leadership. 

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Contrast the key characteristics of traditional leadership with the key features of Complexity Leadership.  Describe the skill sets needed by nurse leaders in today’s complex healthcare organizations.

Please use the attached Timeline & Outline Project Plan with ROL Template to complete this assignment.

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Please use the attached Timeline & Outline Project Plan with ROL Template to complete this assignment.

Please make sure to use 6-7 Articles within the last 5 years to complete the assignment. Articles must target Home-Based Patients 

VERY IMPORTANT: THE NEW PICOT: Please note that the PICOT has changed DO NOT USE the one in the attached paper. Please use the following NEW PICOT:

• NEW PICOT Question: Among patients requiring health care visits (P) how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)?

*Please note that a draft form of this assignment for faculty feedback prior to final assignment submission is required for this course.*

In week 13, your timeline and outline of your project will be due. At this point, you have been working with your faculty advisor to gather ideas and work through the specifics of your project. The purpose of this assignment is to explain your ideas to ensure you are on the right track before starting on the Timeline and Outline.

INSTRUCTIONS

1. Include your PICO(T) question. State the issue and explain why this issue is of interest.  Include background information showing the need for this project.

2. Show at least some of your review of the literature (ROL) so we can get an idea of how you are synthesizing the information. The more you have the better. You should have some information from your matrix assignment in 816 that you can use here.

3. Next, briefly explain what your project is. Include where you plan to conduct your project, who you plan to collaborate with for your project (who the key participants will be to ensure the success of your project), and approximately how long your project will last.  Also include sampling information, any intervention that you propose as well as the design you will be using.

4. Last, discuss what tools you plan to use for your project. If you will be using a survey to measure the results, you will need to include the name of the survey and identify the creator. If you plan on using an established teaching tool as your intervention, again you will need to identify the originator of that tool. Any established tools will need permission to use before you initiate your intervention

5. Begin to think about the budget that you will need to carry out this project.

6. These are not all the details- if you want more details- review the rubric for the document and see the template below.

7. The Review of Literature MUST be 2 Pages.

8. State why the model and design were chosen.

9. Explain the Data Analysis Software used.

10. Project requires 6-7 Articles within the last 5 years. Must target Home-Based Patients

MY INFORMATION FOR THIS PROJECT

My PICOT Question

• PICOT Question: Among patients requiring health care visits (P) how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)?

Consider a population health topic that rises to the presidential agenda level.

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Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?

Matrix Table and Summary

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Matrix Table and Summary

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Northern Kentucky University

DNP 816 Analysis and Application of Health Data for APRN Practice

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DATE

 

DNP 618 Article Matrix and Analysis

Student Name: XXXXXXXXXXX

PICO Question: In adolescent patients seen in primary care setting (P) what is the effect of Ask Suicide Screening Question toolkit (I)compared to those not screened (C) on preventing self-harming behavior/suicide (O) in 3 months (T)

Search process: Database was searched utilizing Northern Kentucky University Library and the National Library of Medicine. The articles were peer reviewed and published within the last five years. The articles were narrowed down based on the criterial listed.

Search terms: Ask Suicide Screening Questions toolkit, suicide screening and prevention, suicide in patients, how to improve the mental health of patients or students

Databases: MEDLINE, CINHAL

Total number of articles obtained from search results: N = 1767

Number of articles initially excluded based on abstract reading: N= 30 (out of first 100 relevant)

Number of articles reviewed: N= 8

Number of articles excluded based on criteria: N= 1611

Inclusion criteria: must be in English, full text only, publishedin2017orlater, peer-reviewed articles, include adolescent, depression, and suicide as the subject, be discoverable in a reputable database

Exclusion Criteria: Article published prior to 2017, language other than English, no full text link, obtained from a non-reputable source.

Number of systematic reviews or meta-analyses used in Matrix- N = 1

 

 

 

 

 

Author, year; Credentials Article #1

 

 

 

 

Aguinaldo, L. D. (MD), Sullivant, S. (MD), Lanzillo, E. C. (MD), Ross, A. (MD), He, J. P. (MD), Bradley-Ewing, A., Bridge, J. A. (MD), Horowitz, L. M. (MD), & Wharff, E. A (MD) (2021)

Published in General Hospital Psychiatry

Article Focus/TitleValidation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics

 

Research Design/Intervention (describe intervention)Cross-sectional study: Nonintervention
Level of Evidence and model used to grade evidence‘Level IV: Johns Hopkins’.
Evaluation Tool (CASP or others- identify tool used)JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, 8/8
Sample/# of subjects, how recruited, power analysis?Five hundred and fifteen young persons (10-21 years old) who were able to speak with clinic staff in English were surveyed. Overall, 918 patients were screened for inclusion in the study, and after determining that 827 of them were qualified, 525 were formally invited to take part and given the opportunity to do so with their informed consent. Seven patients who were fully engaged in the study after giving their consent attended their outpatient specialty or primary care session but did not complete the study interview for various reasons and were therefore excluded from the analysis. The Research Associate (RA) made a mistake while collecting data via research survey or RED Cap, and as a result, three participants were left out of the analysis. Additionally, the remaining 515 patients were considered..
Data Collection ProcedureAfter receiving written or verbal feedback from patients 18 or older and parents/guardians of those younger than 18, the Suicidal Ideation Questionnaire and Demographic/Clinical Variables Questionnaire were administered.
Instruments and

Reliability/validity

of instruments

Both the SIQ/SIQ Jr. and the ASQ were utilized; the SIQ/SIQ Jr. is a short version of the SIQ, which has been shown to have good reliability (SIQ: r = 0.97; SIQ-JR: r =0.94), validity, and predictive power when compared to the gold standard of the Suicidal Behavior Interview.
Data Analysis- id statistics, LOM, findingsMultivariate binary logistic regression modeling was used to examine associations between ASQ-detected suicide risks and demographic, clinical, and other characteristics . The coefficients of the multivariate logistic regression were exponentiated to calculate the adjusted odds ratios. The level of statistical significance was set at P = 0.05.
ResultsThe ASQ revealed that 45 people out of 335 had considered suicide. Only four people  tested positive on the ASQ. A positive ASQ screen was 11.4 times more likely to be observed in the suicide-at-risk population compared to the general population . When comparing the SIQ/SIQ Jr. to the 4-item ASQ screen, there was substantial agreement between the two measures.
Discussion/

Significance of findings

 

The ASQ appears to be a valid instrument for use in identifying patients at greater suicide risk in pediatric outpatient specialty or primary care clinics, and it compares favorably to the gold standard SIQ/SIQ Jr. This study’s findings provide further evidence that the ASQ has sufficient content validity, supporting the earlier conclusion. The ASQ was created as a primary screening tool to assist doctors in identifying which individuals require further diagnostic workup.
Reliability and Validity of study, limitationsLittle, if any, justification exists to question the veracity of the data presented. This is because the ASQ is being used in both general pediatric practices and those specializing in treating children with mental health issues. Associations with suicide risk as measured by the ASQ were investigated using multivariate binary logistic regression modeling. Both data preparation and analysis were carried out. Appropriate consent was obtained from the patient. The National Institute of Mental Health and the local research institutions both gave their stamp of approval to the study.

Our convenience sample may not be representative of young people in general who seek medical care in more typical outpatient settings, which is one of the study’s weaknesses. Participation in the trial may have affected patients’ responses to suicide risk screenings (i.e., before or after their clinic appointment in outpatient specialty care). Researchers speculate that persistent questioning about suicidal thoughts has worn people down.

Helpful/Reliable

Compared to other articles

The study’s findings were helpful since they confirmed that this screening tool is useful for identifying young people at risk for suicide in an outpatientprimary care context. The authors, however, should have broadened their focus to include metropolitan tertiary care centers..

 

 

 

 

 

 

 

 

 

 

 

 

 

Author, year; Credentials Article #2Farrer, L. M. (Registered Psychologist), Gulliver, A. (Research Fellow), Katruss, N. (Research Assistant), Bennett, K. (credential not identified), Bennett, A. (credential not identified), Ali, K. (PhD research student), & Griffiths, K. M. (Emeritus Professor) (2020).

Published in the British Journal of Guidance & Counselling

Article Focus/Title‘Development of the Uni Virtual Clinic: an online program for improving the mental health of university students’.
Research Design/Intervention (describe intervention)A participatory research method was used for this study. There was reduced burden on university resources thanks to the implementation of evidence-based online therapies for students who were typically underserved or socially isolated.
Level of Evidence and model used to grade evidence‘Level I: (Dearholt et al., 2017)’.
Evaluation Tool (CASP or others- identify tool used)The CASP for qualitative checklist 9/10
Sample/# of subjects, how recruited, power analysis?Four focus groups with undergrads (n = 5, 5, 4, 5) constituted the bulk of the qualitative methodologies used. Twenty persons participated in three sessions of prototype testing, a workshop for student leaders, and an assessment of the pilot UVC. In order to determine what kinds of resources various student groups at the university would benefit from, the project team held a number of in-person talks with representatives from those groups.
Data Collection ProcedureThe present evidence for technologies that promoted the mental health of college students was investigated through systematic reviews. Quantitative and qualitative research approaches were used to investigate the effectiveness of peer-to-peer support interventions, as well as to collect the views and opinions of key stakeholders. Quantitative approaches included a survey of university faculty and staff who were directly involved in student instruction and supervision, and a separate poll of the students themselves.
Instruments and

Reliability/validity

of instruments

Methods including surveys and in-person conversations or focus groups were employed. The researcher can receive a clear picture of the product’s reception, as well as the customers’ real thoughts, opinions, and impressions, thanks to the use of focus groups, which are considered credible. The dependability of surveys is demonstrated by their consistently reproducing comparable results.
Data Analysis- id statistics, LOM, findingsPercentages were used to record all of the information gathered. Positive attitudes about involvement were evident, with all 19 positive questions having average scores above 0, suggesting agreement.
ResultsAll 19 positive questions had average values over zero, suggesting agreement, and the majority of respondents (M = 0.96, SD = 0.24) agreed with the assertion that attitudes toward involvement were typically positive. All 13 of the negative categories were rated below 0, suggesting disagreement. Ratings above 0  , showed the strongest agreement.
Discussion/

Significance of findings

 

The needs of the UVC’s target demographic could not have been met without the use of participatory design methods during development. Universities can play an important role in creating mentally healthy environments to learn and live if UVC’s work to reduce the prevalence of mental health problems among at-risk children and the negative outcomes associated with them is successful.
Reliability and Validity of study, limitationsStudents’ input into the design process helped the team take into account students’ changing needs, the dynamic nature of academic institutions, and the dynamic nature of web design and development approaches to e-mental health care. There were drawbacks to the study, such as the fact that it would add significant time and effort to the content creation and website development processes if end users were included in the  development process. Since disagreements arose frequently concerning the nature and operation of UVC, it was challenging to reach a consensus on the final program.
Helpful/Reliable

Compared to other articles

Validating the promise of Uni Virtual Clinic  to help institutions of higher education better meet the psychiatric needs of their students. The study’s findings were straightforward and simple to comprehend.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author, year; Credentials Article #3‘LeCloux, M. A., Weimer, M., Culp, S. L., Bjorkgren, K., Service, S., & Campo, J. V. (2020)’. The authors credentials are not identified. Published by Elsevier Inc.”
 

Article Focus/Title

The Feasibility and Impact of a Suicide Risk Screening Program in Rural Adult Primary Care: A Pilot Test of the Ask Suicide-Screening Questions Toolkit
Research Design/Intervention (describe intervention)Quasi experiment research design. Ask Suicide-Screening Questions was used to conduct a suicide screening with patients who presented for routine and sick visits; patients who tested positive for suicidal ideation were then subjected to additional screening using the same instrument.
Level of Evidence and model used to grade evidence‘Level III: Johns Hopkins’
Evaluation Tool (CASP or others- identify tool used)CASP for Qualitative checklist, score 9/10
Sample/# of subjects, how recruited, power analysis?The baseline sample included 274 patients. Patients consented electronically. A 2 phased design was used to collected date from patients who presented for routine or sick visit in a rural primary care clinic. Electronic medical records for patients 18 or older were collected, this data was logged and identified by the clinician into spread sheet.

 

 

Data Collection ProcedureAs part of an online survey, patients were asked to complete both the ASQ and a shorter, 5-item Screening Opinions Questionnaire.   The primary care physician  conducted a brief suicide risk assessment using the BSSA as a guide, and then provided disposition planning for patients who screened positive for suicide risk. The patient’s risk profile was then documented in their electronic medical record. In this study, the researcher accessed the EMR to collect data.
Instruments and

Reliability/validity

of instruments

Ask Suicide-Screening Questions (ASQ) questionnaires were utilized. In  young and adult inpatients,  it has shown both high sensitivity  and strong specificity.
Data Analysis- id statistics, LOM, findingsAll data was uploaded to SPSS 26 for analysis. Descriptive statistics were utilized to evaluate the aforementioned viability markers. Chi-square analysis followed by Fisher’s exact test was utilized to evaluate the two time periods’ client testing and suicide risk assessment procedure rates.
ResultsIntervention period reports of suicide risk screening were significantly higher than baseline period reports ( P 0.001). In addition, 6.2% of cases showed signs of suicidal ideation throughout the intervention phase, whereas only 0.7% did so during the baseline phase ( P 0.001).
Discussion/

Significance of findings

 

Preliminary results from this study indicate that the ASQ and BSSA can be helpful in identifying persons in rural areas who are at risk for suicide and are seeking primary care. Rural primary care settings are ideal for implementing suicide risk screening programs.
Reliability and Validity of study, limitationsBefore beginning the study, the  university obtained complete permission from its institutional oversight board for all study methods. The ASQ Toolkit has been found to increase the rate of risk identification in adults receiving primary care, while maintaining the validity and reliability of the research. Pilot in nature, with participants being of the same race seeing the same rural primary care doctor, the study had several inherent limitations. As this was a two-part study, there were additional variations between the study’s initial and final stages.
Helpful/Reliable

Compared to other articles

These results are comparable with those of earlier empirical research, which have shown that suicide risk screening is possible and acceptable to most patients.

 

 

 

 

 

 

Author, year; Credentials Article #4

 

 

 

 

 

 

 

Men, V. Y., Emery, C. R., & Yip, P. S. F. (2021). Credentials are not listed. All the authors have affiliation with Department of Social Work and Social Administration, The University of Hong Kong.

Published in Psycho‐ Oncology Journal

 

Article Focus/Title‘Characteristics of cancer patients who died by suicide’.

 

Research Design/Intervention (describe intervention)Cross-sectional study: No intervention
Level of Evidence and model used to grade evidence‘Level IV: Johns Hopkins’
Evaluation Tool (CASP or others- identify tool used)‘JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, 8/8’.
Sample/# of subjects, how recruited, power analysis?Researchers were able to determine that 14,446 people committed suicide in the years 2003 to 2017 by analyzing data from previous records. The cases were divided into cancer and non-cancer categories based on the provided medical records. Of the 14,446 people who took their own lives, 1,461 (10%) had been diagnosed with cancer before.
Data Collection ProcedureInformation from archives was used,  the Coroner’s Court reports. The cases were divided into cancer and non-cancer categories based on the provided medical records. Details about the victim’s socioeconomic status and the circumstances surrounding the suicide were among the information gleaned from the reports.
Instruments and

Reliability/validity

of instruments

A report from the coroner’s court was used to compile the information. The study variables of interest were compared between the cancer and non-cancer groups using independent t-tests or chi-square testing.
Data Analysis- id statistics, LOM, findingsUnivariate analyses, as well as general and subgroup multiple logistic regressions, were used to compare characteristics of the two cohorts. The level of significance was set at 0.05.
ResultsThe results showed that retired people and those in committed relationships had a far higher chance of being diagnosed with cancer than those who were not. Most people (54.3%) who took their own lives after being diagnosed with cancer did so by leaping from a great height. On the other side,  27.6% of those who committed suicide did so by hanging themselves,  6.6% of them chose toxic methods.
Discussion/

Significance of findings

 

We discovered that cancer-related suicides in Hong Kong are distinct from those induced by other conditions, and these distinctions widen as the patient ages. The senior cancer patient is more likely to commit suicide, more likely to seek help for suicidal thoughts, and less likely to have cognitive and emotional issues. Cancer patients’ quality of life could be greatly enhanced if more attention were paid to determining what factors contributed to their decisions to take their own lives.
Reliability and Validity of study, limitationsThe dataset has excellent validity because of the little potential for misclassification. Those with cancer were compared to those without the disease in order to draw conclusions about their personalities and motivations for taking their own lives.  Suicide was then broken down into its component acts, such as hanging, cutting, driving into a wall, setting fire to oneself, suffocating oneself, and taking other nonviolent means.

Study limitations include the lack of thorough information on the medical history of the cancer patients and the absence of information in the Coroner’s Court reports due to reasons such as the incapacity of family members to submit them. Details on the patients’ cancers, including their types, stages, and diagnosis dates. This study has some limitations, including the authors’ inability to conduct additional analyses exploring suicide decision pathways or the temporal and causal correlations between various risk variables for suicide.

Helpful/Reliable

Compared to other articles

An improvement over previous methods in terms of practicality, accuracy, and dependability, with results that can be trusted even when subjected to statistical analysis, shows the study’s reliability. To my knowledge, this is the first article to directly compare cancer suicide rates to those of other prevalent diseases in the Asian community.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author, year; Credentials Article #5Lindstrom, A. C. (DNP, APRN), & Earle, M. (DNP, RN) (2021).

Published in the Journal of Doctoral Nursing Practice

Article Focus/Title‘Improving Suicidal Ideation Screening and Suicide Prevention Strategies on Adult nonbehavioral Health Units’.
Research Design/Intervention (describe intervention)Randomized control trial.

Targeted intervention that includes nursing education, easier electronic medical record (EMR) workflow for documentation of suicide screening, was needed to improve identification and provide safety of patients at risk for suicidal.

Level of Evidence and model used to grade evidence“Level I: ( Dearholt et al., 2017)’
Evaluation Tool (CASP or others- identify tool used)CASP for qualitative checklist score 8/10
Sample/# of subjects, how recruited, power analysis?In total, 6,229 adults were admitted to the hospital for treatment of non-behavioral health issues. A total of 6,210 people were screened for suicidal ideation. Patients  were chosen at random..
Data Collection ProcedureAn examination of the literature on the early deployment of suicide screening and the results of focus groups with key stakeholders, such as bedside nurses, guided the development of interventions.
Instruments and

Reliability/validity

of instruments

The electronic medical record was modified by adding an additional answer to the suicide screening question and mandating its documentation following focus group discussions, the development of nursing protocols, data on compliance monitoring, nursing education, pre- and post-nursing assessments, and other interventions. The project was greenlit by the IRB, the issue was identified and quantified, potential solutions were evaluated and executed, and a control plan was created to assure the initiative’s long-term viability.
Data Analysis- id statistics, LOM, findingsPatient records were audited to ensure accurate order entry and screening procedures. The audit found that within 24 hours of admission, 76.2% of patients had gotten assistance from a clinician and 82.5% of patients had taken safety actions that were documented.
ResultsWith 91.5% of all registered nurses having completed the program, and with 89.2% of the pretest questions properly answered, it is evident that the trainees entered the program with a solid grounding in the subject matter. Between the two tests, there was a 2.9% improvement in accuracy, with 92.1% accurate answers on the second test. 20.6% more people were screened.
Discussion/

Significance of findings

 

The nurses’ training was extensive, covering everything from patient intake through discharge. In order to improve universal suicide ideation screening and thereby boost patient safety, nurses need access to clear policies, standardized protocols, and education..
Reliability and Validity of study, limitationsThe researchers in this study identified several elements at the medical center where the research was done that contributed to a culture of compliance. Results cannot be generalized to other areas because this study was conducted in only one. What’s more, the study began two months before the hospital encountered the COVID-19 outbreak.
Helpful/Reliable

Compared to other articles

In addition to being a legitimate study, the study’s usefulness stems from the fact that no literature was located on how to enhance screening compliance once a method had been devised.

 

 

 

 

 

 

 

 

 

Summary

Suicide is a significant health problem in the world. The percentage of teenagers experiencing major depressive disorder (MDD) symptoms has nearly doubled, from 8.3% in 2008 to 14.4% in 2018 (Sekharet al., 2021). Thus, screening for suicide risk and suicidal behavior is an essential first step toward preventing suicide in young people. High-risk groups in optimal settings are the focus of effective screening programs. This research focuses on screening for suicide risk in medical settings because of its importance. Although there are a number of tools used to assess whether or not a patient is at risk for suicide ideation or behavior, the Ask Suicide-Screening Questions (ASQ) kit was developed with this particular context in mind.

The articles reviewed in this matrix include two level IV evidence, two-level I evidence, and one level III evidence articles.The two cross sectional studies were valid according to the JBI checklist for cross sectional studies. The quasi and randomized control trials were valid according to CASP checklist. Questionnaires were used in three of the articles and past records were used in two of the articles. Four of the results of the study were reliable. One study was done in before months before Covid 19 and All articles utilized showed suicidal screening is feasible and helps improve patient safety, and more importantly several articles showed utilization of the Ask Suicide-Screening Questions Toolkit has potential to improve suicide risk assessment (LeCloux et al., 2020).

The articles have improved my knowledge on my chosen topic. There is no change been considered at this time. I was able to find sufficient literature, government information, and education on the screening tool I have chosen. However, future studies measuring the impact of suicide risk screening with youth in outpatient specialty and primary care clinics on outcomes such as linkage with mental health services and future suicidal behavior are warranted (Aguinaldo et al., 2021). Gaps in screening of patients with suicidal thoughts exist because of lack of education, clear policies, and protocols for screening in these settings.

 

 

 

 

 

 

 

 

 

 

 

References

Aguinaldo, L. D., Sullivant, S., Lanzillo, E. C., Ross, A., He, J. P., Bradley-Ewing, A., Bridge, J. A., Horowitz, L. M., & Wharff, E. A. (2021). Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics. General hospital psychiatry, 68, 52–58. https://doi.org/10.1016/j.genhosppsych.2020.11.006

https://doi.org/10.1016/j.genhosppsych.2020.11.00

Dearholt, S., Dang, D., & Sigma Theta Tau International. (2012). Johns Hopkins nursing evidence-based practice: Models and

guidelines.  https://libguides.ohsu.edu/ld.php?content_id=16277844

Farrer, L. M., Gulliver, A., Katruss, N., Fassnacht, D. B., Kyrios, M., & Batterham, P. J. (2019). A novel multi-component online intervention to improve the mental health of university students: Randomized controlled trial of the Uni Virtual Clinic. Internet interventions, 18, 100276. https://doi.org/10.1016/j.invent.2019.100276

LeCloux, M. A., Weimer, M., Culp, S. L., Bjorkgren, K., Service, S., & Campo, J. V. (2020). The Feasibility and Impact of a Suicide Risk Screening Program in Rural Adult Primary Care: A Pilot Test of the Ask Suicide-Screening Questions Toolkit. Psychosomatics, 61(6), 698–706. https://doi.org/10.1016/j.psym.2020.05.002

Lindstrom, A. C., & Earle, M. (2021). Improving Suicidal Ideation Screening and Suicide Prevention Strategies on Adult Nonbehavioral Health Units. Journal of doctoral nursing practice, JDNP-D-20-00049. https://doi.org/10.1891/JDNP-D-20-00049

 

Men, V. Y., Emery, C. R., & Yip, P. S. F. (2021). Characteristics of cancer patients who died by suicide: A quantitative study of 15-year coronial records. Psycho-oncology, 30(7), 1051–1058. https://doi.org/10.1002/pon.5634

Sekhar, D. L., Schaefer, E. W., Waxmonsky, J. G., Walker-Harding, L. R., Pattison, K. L., Molinari, A., Rosen, P., & Kraschnewski, J. L. (2021). Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents: A Randomized Clinical Trial. JAMA network open, 4(11), e2131836. https://doi.org/10.1001/jamanetworkopen.2021.31836

Fall 10.2020

DNP Role Assignment

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DNP Role Assignment

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Northern Kentucky University

DNP 802 Role Development

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DATE

 

 

 

 

 

 

 

Introduction

A Doctor of Nursing Practice (DNP) and Doctor of Philosophy in Nursing (PhD) are advanced nursing degrees that involve significant knowledge of the nursing field. PhD-prepared nurses are essential to developing the research base needed to support evidence-based practice and advance nursing knowledge, and DNP-trained nurses play a key role in translating evidence into practice and educating nursing students in practice basics (National Academies of Sciences, Engineering, and Medicine, 2021). In addition, the DNP degree also enables a nursing practitioner to assume leadership roles in healthcare to ensure quality, safe, and satisfying care services are provided to the patient population. While there is a significant difference, it is important to recognize that while the DNP is framed with clinical competencies, it is viewed as separate but equal to research doctorate. This paper will focus on the appropriateness of having a PhD/DNP prepared nurses as a nurse educator at University level.

Background and Significance

Nursing practitioners play a crucial role within the health care delivery system. Rapid changes in healthcare delivery, financial constraints and consumer demand have impacted the practice of all healthcare providers and are critical factors in the emergence of the role of advanced practice in nursing. Nursing education have evolved over the years, however the process of educating and preparing healthcare providers has faced many challenges throughout history (Groccia & Ford, 2020). The education of nursing practitioners has grown to prepare nurses to identify social determinants of health (SDOH), improve population health, and promote health equity (National Academies of Sciences, Engineering, and Medicine, 2021). Nurse educators play a significant role in ensuring that student nurses are adequately prepared to achieve the course outcome and understand the curriculum. Additionally, nurse educators offer inspiration, mentorship and teach the next generation of nurses about the safe approach to future patient care. Having a DNP as a nursing school faculty member is essential because DNP-prepared nurses are well-equipped to fully implement the science developed by nurse researchers prepared in PhD, DNS, and other research-focused nursing doctorates (American Association of Colleges of Nursing, 2022). In addition, the evolving demands of the nation’s complex healthcare environment require the highest levels of scientific knowledge and hands-on experience to ensure high-quality patient outcomes; the Institute of Medicine, the Joint Commission, the Robert Wood Johnson Foundation and other agencies have called for a redesign of the educational programs that prepare today’s health workers (American Association of Colleges of Nursing, 2022).

The DNP Essentials take the current MSN Essentials and expand them to include a focus on population health; The practice doctorate also addresses the gaps previously identified in master ‘s programs such as practice management, health policy, information technology, risk management, utilization and translation of evidence based practice, and advanced diagnosis and management (Flanagan et al., 2021). According to McCauley et al., 2020, BSN prepared nurses without healthcare experience are enrolling in DNP programs to become system leaders and those with health care experience and are enrolling in DNP programs to become APRNs, who better to prepare them than DNP prepared nurses. (Giardino, 2014)

Literature Review

Nurse educators with the DNP degree are trained to develop a connection between nursing education and nursing practice. Bellini et al., (2012) argues that to ensure academic nursing progression and active clinical practice are achieved, nursing schools need to have a DNP or PhD as a faculty member as they tend to have the ability to infuse extensive nursing practice knowledge in the nursing curriculum, and this can make a significant contribution towards elevating the gap between nursing education and the nursing practice. Furthermore, Carollo & Mason (2017) also asserts that DNP prepared nurses tend to be appropriately positioned to offer nursing education to students and to encourage them to assume various role in nursing practice following their significant experience in multiple academic and clinical education settings. This affirms the advantage nursing schools have in utilizing a DNP prepared nurse as a faculty member. Other advantages include educator’ ability to emphasize the use of evidence-based approach, an extensive perspective regarding the systems-based issues, nursing experience and other related aspects which aid in preparing the nursing students for various challenges and rigours within the nursing roles and responsibilities (Carollo & Mason, 2017).

Edwards et al. (2018) also affirm that the National nursing organization advocates that the DNP is the preferred educator to prepare nurses for clinical leadership, practice, healthcare system restructuring and research translation into the clinical setting. This is mainly because, despite their specialty, the DNP also tend to have core competencies that tend to align with clinical leadership, health policy, health finance, organizational systems, informatics and the integration of evidence-based practice. Furthermore, Edwards et al. (2018). also identify that the ability to design and assess an innovative patient care model, cost-effectiveness relating to the patient’s care approach and the influence of the health policies in different healthcare levels holds significant knowledge to prepare new nurses to offer quality, safe and satisfactory health care services. McNelis et al. (2018) also supports the notion by affirming that evidence-based practice tends to be a thread throughout the DNP education, and as a result, it tends to strengthen the implementation of research-based interventions which are often utilized in the improvement of patient outcomes. The knowledge of evidence-based practice and its importance in healthcare delivery may be passed from one nursing generation to another by having DNP as a faculty member (McNelis et al., 2018).

Marrocco & El-Masri (2019) on the other hand argues that the constant increase in the population of DNP graduates in relation to the shortage of PhD-prepared nurses has majorly contributed to hiring DNP into higher education with minimal differentiation in the role of DNP and PhD. Additionally, the shift within the faculty mix is expected to increase and, as a result, create enormous confusion, which may, in future, threaten the PhD education investments if the special mandate between the DNP and the PhD, educations are not adequately addressed. Further, the nursing practice tends to be in need of the DNP to be able to effectively resolve various nursing issues. On the other hand, the nursing practice also tends to be in need of the PhD to be in a position to develop and also perform innovative research within the nursing field (Marrocco & El-Masri, 2019). Thus, the belief that nursing education has the potential to tremendously benefit from the recruitment and incorporation of DNPs is guaranteed if the recruitment tends to identify the role of the DNP in the nursing practice. Furthermore in, research conducted by McNelis et al. (2018) identified that nursing DNP and PhD graduates pointed out that the knowledge attained from the degrees significantly enhanced and increased confidence in relation to their ability to perform research but also had limited confidence in incorporating the achieved research concepts in their teaching. This pointed out that there is a significant need for the DNPs and PhD to be provided with additional academic knowledge to enable them to effectively fulfil the teaching role. In general, to ensure that the essential nursing knowledge is effectively passed from one nurse generation to another, it is important to make sure that the PhD or DNP nurses in nursing schools are offered adequate knowledge to enhance their teaching skills (McNelis et al., 2018).

Swot Analysis

The SWOT analysis below offers an effective presentation of the various strengths and weaknesses that are linked to having a DNP nurse as a faculty member in a nursing school. Additionally, it will also identify the various opportunities and threats which are linked to having DNP as a faculty member and the other benefits or risks that may impact nursing education and the nursing practice.

 

Strengths

· Allows the promotion of evidence-based practice knowledge among new nurses, which contributes to promoting quality care (National Academies of Sciences, Engineering, and Medicine., 2021).

· DNPs tend to have considerable experience within the clinical setting, and this may function as an excellent guide to prepare the new nurses to overcome the various challenges within the nursing practice.

· Having a DNP as a faculty member will ensure that the new nursing students are able to effectively understand the different policies and how they may utilize them to achieve quality and positive health outcomes.

Weaknesses

· If the concept of DNP and PhD is not adequately addressed, they may be increased confusion on the ultimate role each nurse has within the nursing field.

· Increased recruitment of DNP in nursing education may contribute to threatening the future education investment of the PhD as it may be regarded to be irrelevant in the field of nursing (National Academies of Sciences, Engineering, and Medicine., 2021).

 

Opportunities

· Enormous clinical and nursing educational knowledge among the DNP nurses will prepare the new nurses to meet the nursing goals when they are recruited as faculty members.

· Having a DNP as a faculty member in a nursing school also promotes a better understanding of the role that nursing practitioners play within the healthcare delivery system (National Academies of Sciences, Engineering, and Medicine., 2021)

 

Threats

· Increased recruitment of DNP in nursing education will lead to confusion regarding the key role that a DNP plays in the nursing field for new nurses (Zaccagnini & White, 2021).

 

PEST Analysis

Pest analysis has been conducted to offer a prediction of how the role of a DNP as a faculty member in a nursing school will benefit nursing education, the nursing field, and the general healthcare delivery system. The PEST analysis will focus on addressing the various external aspects that will impact the overall performance of the nursing practice.

Political

· The incorporation of DNP nurses as faculty members in a nursing school will influence the effectiveness of the health systems. DNP students develop skills related to policy analysis and policy development. According to Milstead and Short (2019) Nurses study the basics of how bills become laws in the baccalaureate programs , but in graduate school an extension of focus on legislative issues is provided as this help nurses learn to participate in a range of governmental and political activities.

· The laws that govern nursing practice are set by each state and can vary widely. In some states, DNPs have the authority to practice independently, while in others they must have a formal agreement with a physician. The influence of DNPs on these laws can come from advocacy by professional organizations, educational institutions, and the DNPs themselves.

· The role of DNPs as primary care providers has implications for reimbursement policies. NPs, including DNPs, are reimbursed by Medicare and private insurance for the services they provide. However, reimbursement rates for NPs are often lower than those for physicians, and this can be a barrier to the full utilization of NPs in the health care system.

Economic

· Understanding the role of nursing practice aids in promoting effective health systems, health economics and health insurance by contributing to clinical practice.

· Promotes cost-effectiveness through assessing the patient care strategies and quality care improvement teams’ coordination.

· Promotes reduced care costs as the new nurses will be offered adequate nursing knowledge, which contributes to reduced patient stay in hospitals and minimal cases of readmission.

· The significant DNP’s knowledge and experience setting may promote positive patient health outcomes when passed on to new nurses.

 

 

Social

· The new nurses will achieve exposure to evidence-based practice and understand the essentialness of evidence-based practice in the health care delivery.

· Attaining knowledge from DNP nurses will ensure that new nurses are able to differentiate themselves and demonstrate their contribution towards enhancing the health care delivery system.

· DNPs can also advocate for policies and programs that address non-medical factors affecting that impact the health of patients. This includes advocating for affordable housing, access to healthy food, and other initiatives that improve the overall health and well-being of communities.

· DNPs can play a critical role in coordinating care for patients with complex health needs, They can work with other health care providers, social service agencies, and community organizations to address disparities that impact the health of patients. According to Office of Disease Prevention and Health Promotion (ODPHP, n.d.). Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life.

Technological

· Promotes the ability of nursing students to collect and analyse data.

· Promotes the ability to impact media and the nursing profession integrity central to nursing excellence.

· Increase in knowledge and sharing of skills and Advanced Practice philanthropy using access to resources and communication devices.

· DNPs use nursing informatics and the technology of EHRs to support clinical decision making and improve patient outcomes. They have the skills to analyse data from EHRs and other sources to inform clinical decisions and make evidence-based recommendations.

· Nursing informatics provide opportunities for nurses to monitor and track the quality of care they provide and identify areas for improvement by using EHRs to track patient outcomes and monitor clinical performance.

 

Implementation Strategies

The need to have a DNP-prepared nurse be a faculty member in nursing school is crucial in ensuring that the various roles and responsibilities that have constantly increased due to healthcare delivery trends are adequately addressed. Doctoral level knowledge and skills in these areas are consistent with nursing and health care goals to eliminate health disparities and to promote patient safety and excellence in practice (American Association of Colleges of Nursing, 2022). The DNP-prepared nurse is able to emphasize evidence-based practice as the basic approach towards enhancing the quality of health care delivery. Additionally, as a faculty member, a DNP-prepared nurse will have the opportunity of helping nursing students achieve leadership skills, understand the essentialness of evidence-based practice, affect changes in nursing practice, nursing education and government regulations.

Stakeholder Support

For the role implementation to be successful, it is essential to achieve the stakeholders’ support, as this will promote open communication, sharing of ideas and a more collaborative decision-making approach. Having support from both internal and external stakeholders is crucial as it influences the need to have DNP-prepared nurses as faculty members. Attaining individual opinions from both internal and external stakeholders ensures that the role is beneficial to all parties before implementing it (Zaccagnini & White, 2021)

The key stakeholders in the implementation of DNPs (Doctor of Nursing Practice) can include:

· Nurses – DNPs are advanced practice registered nurses (APRNs) who provide high-level care to patients.

· Patients – DNPs are involved in direct patient care and therefore, patients are a crucial stakeholder group in the implementation of DNPs.

· Employers – Health care organizations and hospitals are employers of DNPs, and they play a vital role in the implementation of DNPs by providing resources, support, and recognition of the role.

· Government agencies – Federal and state governments regulate the practice of nursing and have a role in the implementation of DNPs by setting standards and licensing requirements.

· Professional organizations – National and international organizations for nursing, such as the American Nurses Association and Sigma Theta Tau International, play a role in the implementation of DNPs by advocating for the role, promoting best practices, and offering education and professional development opportunities.

· Universities and academic institutions – These institutions play a crucial role in educating and preparing future DNPs, and they also have a role in the ongoing development and recognition of the role.

Financial Implication

Cost-benefit analysis may be used as a tool that identifies the essentials of having DNP-prepared nurses as a requirement for being a faculty member in a nursing school. Essential 11 requires DNP graduates have the ability to evaluate the cost effectiveness of care and use principles of economics and finance to redesign effective and realistic care delivery strategies (American Association of Colleges of Nursing, 2022). DNP prepared faculty members have positive impact on health care costs by making sure that new nurses are provided with adequate nursing practice training. This in turn promotes enhanced patient care, develops a healthy working environment, and establishes a cheerful outlook towards the nursing practice. In general, the financial implication of having a DNP as a requirement for one to be a faculty member in a nursing school tends to outweigh the negative implication within the nursing practice.

Evaluations and Measurement

To determine the essentialness of having a DNP to be a requirement for one to qualify as a faculty member in a nursing school, it is important to utilize dependable a valid tool. This will ensure credibility, hence promoting continuous action as support from the stakeholders. An appropriate approach for evaluating and measuring the requirement for having DNP to be a faculty member is through tracking data. This approach will review nurse-sensitive information which is correlated to patient harm, and poor care services, among other related information. This information tends to be crucial for reporting, intervention and action planning which are crucial to promoting quality care improvement and positive patient outcome.

Summary

DNPs develop a connection between nursing education and the nursing practice. Overall, clinical knowledge changes rapidly, which often leads to a disconnect between the clinical world and the nurse academics. In addition to ensuring nursing academic progression and active clinical practice are achieved, the nursing schools need to have an individual with DNP or PhD as a faculty member as they have the ability to infuse extensive nursing practice knowledge in the nursing curriculum, According to the American Association of Colleges of Nursing (2021), In universities it is increasingly difficult to develop the kind of clinical scholarship and maintain the kind of credibility necessary for first rate programs without a higher level of education among our faculty. Moreover, having a DNP or PhD as a nursing school faculty member is essential and necessary in supervising nursing students during clinical rotations, providing enlightening information to nursing students on the various key aspects to positive healthcare outcomes such as coordination, effective communication, and collaboration.

 

 

 

 

 

 

 

References

American Association of Colleges of Nursing (2022). Fact Sheet: The Doctor of Nursing

Practice. https://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet

Bellini, S., McCauley, P., & Cusson, R. M. (2012). The Doctor of Nursing practice graduate as faculty member. Nursing Clinics of North America, 47(4), 547-556. https://doi.org/10.1016/j.cnur.2012.07.004

Carollo, S., & Mason, A. (2017). Doctor of nursing practice curricula redesign: Challenge, change and collaboration. The Journal for Nurse Practitioners, 13(4), e177-e183. https://doi.org/10.1016/j.nurpra.2016.11.011

Edwards, N. E., Coddington, J., Erler, C., & Kirkpatric, J. (2018). The Impact of the Role of Doctor of Nursing Practice Nurses on Healthcare and Leadership. Medical Research Archives, 6(4). http://journals.ke-i.org/index.php/mra

Flanagan, J., Turkel, M.C., Roussel, L., & Smith, M. (2021). Nursing Knowledge in the

Doctor of Nursing Practice Curriculum. Nursing Science Quarterly. 34(3), 268-274.

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Marrocco, A., & El-Masri, M. M. (2019). Doctor of nursing practice in academia: Lessons from the American experience. Canadian Journal of Nursing Research, 51(2), 51-52. https://doi.org/10.1177/0844562118825326

McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track. Nursing outlook, 68(4), 494–503. https://doi.org/10.1016/j.outlook.2020.03.008

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An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet.

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An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.

Questions:

  1. On the initial home visit by the nurse, what assessments should be made?
  2. The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
  3. During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?

What factors may influence your views?

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Susan Wong Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of abnormal alpha-fetoprotein levels at 16 weeks of pregnancy. She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal problem, so they felt they did not want this information. Reflective Questions 1. As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs? 2. How can you help this couple if they experience a negative outcome in the birthing suite? What are your personal views on terminating or continuing a pregnancy with a risk of a potential anomaly? What factors may influence your views? 3. With the influence of the recent Human Genome Project and the possibility of predicting open spinal defects earlier in pregnancy, how will maternity care change in the future?