MSN5300 reply 2

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 Reply with 200 words and reference

Differences And Similarities Between Quantitative, Qualitative and Mix Methods Research Studies

Quantitative research study uses numerical gathering and analyze numerical data to establish patterns and relationships between the study variables (Fain, 2020). Through this, the research can test hypotheses and develop casual relationships. Some data collection methods employed in this study included experiments, surveys, and observation using questionnaires or other standard techniques. Since the data is collected and coded numerically, it is analyzed through statistical methods such as ANOVA. Generally, this type of study includes a large sample size, representing the whole population linked to the study problem. This concept helps promote validity and applicability of the findings and taxation into clinical practice. According to Hong et al. (2018), when conducting the critical appraisal of quantitative studies, the researcher can consider the sample size, sampling method, data collection method, study methods, and ethical considerations.  

In contrast qualitative research studies analyze patient expenses and perspectives about phenomena, thus developing a better understanding of the study problem (Fain, 2020). Data is mainly collected through focus groups, interviews, and observation to collect textual data presented as a description of the native. Additionally, this study mainly involves a small sample size since the focus is an overview of individuals’ perspectives on the study problem. Since data is presented in textual or visual forms, it is analyzed through categorizing and coding to identify themes and patterns; qualitative study provides useful data on quality improvement, which can be incorporated into clinical practice. By analyzing patient experiences and perspectives, the researcher can pinpoint areas in clinical practice that equips improvement. The critical appraisal focuses on determining the credibility of a qualitative study by analyzing adherence to ethical considerations, sampling methods, theoretical framework and the possibility of evidence translation into clinical practice.

 Mixed method studies involve elements from quantitative and qualitative studies, thus analyzing the strength of each approach in providing a solution to the study problem (Grove & Gray, 2018). Since this design employs  two methods, data is collected from the same participants in textual and numerical form. This helps promote a better understanding of the study findings and draw a strong conclusion. Ata is then analyzed separately, and the findings are integrated when developing a conclusion. The sampling method in mixed-method studies can vary depending on the researcher’s choice and preference. The evidence gathered from these studies can be translated into clinical practice, thus promoting improved patient outcomes. Critical appraisal of these types of studies may involve analyzing how quantitative and qualitative studies have been integrated, the theoretical framework, ethical consideration, presentation of data in textual and numerical form, and the method of sampling used to involve others.

Pharm C Poly-pharmacy

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Module 01 Content

1.

Top of Form

Many people in the US, particularly the elderly, take more than one prescribed medication. CDC (2014) reported that between 2009 and 2012 nearly 48% of persons asked used at least one prescription drug, 22% used three or more prescription drugs, and nearly 11% used five or more.

In a recent study published by the Mayo Clinic, seven out of 10 Americans take at least one prescription drug. The most commonly prescribed drug is antibiotics — taken by 17 percent of Americans — followed by antidepressants and opioids — each taken by 13 percent of Americans. In addition, findings showed that:

· Even more staggering than the CDC findings, currently more than half of Americans take two prescription medications, and 20 percent of Americans are on at least five prescription medications.

· More women than men receive prescription medications.

· Antidepressant prescriptions are more common among women than men and are most common among women ages 50 to 64.

When people take multiple medications, there is a greater risk of confusion about which medications are taken when they are taken, and what they are being taken for. There is also a higher risk for drug interactions and increased side effects and adverse reactions.

Sometimes because of the sheer number of medications being prescribed, they may be forgotten, become too much of a bother, or a financial burden which can significantly impact client compliance and lead to poor health outcomes.

In this written assignment, you will be interviewing a client who is taking multiple prescribed medications (three or more) and submitting a written paper describing the findings from the interview. You will then develop a Client Teaching Plan. Your instructor will assist you in the selection of the client. You must achieve a “pass” in this assignment to satisfactorily fulfill the requirements for the Pharmacology course.

The three parts of this assignment are:

Interview with a client who is taking multiple medications (polypharmacy). You must prepare the client before the interview by explaining why you are conducting the interview. You can say “My assignment is to find out about the medications you are taking so I can determine if you need more information about what you are taking”. You must always get permission from the client to conduct the interview and you must tell the client how the information will be used. You can say, “I will not be using your name in the information I share and I will be submitting it to my instructor only for this student assignment”. If there is important information that needs to be communicated to you, your doctor, family, or nurse, my instructor will assist me in following up on this”. Tell the client you will take no more than 30-45 minutes for the interview.

There may be a family member or significant other present during the interview. That is fine. Be sure to identify who answered a question and if possible always have the client answer first. Always thank the client (and others) when you complete the interview.

Do not use recording equipment for this interview. Have a notepad and pencil or pen and explain that you will be taking notes. When the interview is over, go to a quiet place and take some time to fill in any information you did not jot down. If you wait, you will not remember.

When setting the environment for the interview, make sure the client (and others) are comfortable and you are comfortably seated facing the client. If possible, interview in a quiet place. Ask questions slowly giving the client time to answer. Pay attention to the client's hearing and ability to respond to the questions. Be sure your non-verbal communication demonstrates you are calm and relaxed.

Use the following interview question guidelines when conducting the interview. Be aware that the client may not be able to answer each of the questions with detailed information. Collect as much information as the client is able and willing to give you. Remember you are the interviewer so you will be collecting information and not making any comments about the information shared by the client except to ask for further clarification if you are not sure what was said or need more detail if it is available.

1. What medications are you taking?

1. Before the interview research each of the medications. In your paper include the reason for each medication, the drug classification, the route of administration, the dose, and possible side effects/adverse reactions.

For the following questions, paraphrase the client's answers for your written paper.

1. How long have you taken each of these medications?

1. Do you know why you are taking these medications?

1. Who told you about the medications and why do you need to take them? Were you able to ask any questions about the medications and if so were they answered so you understood what was said?

1. How do you feel about taking these medications?

1. Are you taking other medication purchased “over the counter” such as in a drug store? If so, what is it and why are you taking it?

1. How and when do you take your medications?

1. Do you have any difficulty taking the medications? If so, what happens and how do you deal with any difficulties?

1. Have you ever felt any uncomfortable feelings and body reactions to taking these medications? If so, what were they and how were they handled?

1. If you had the above reaction, did they take you off the medication and replace it with another medication? Were you told why this happened?

1. Do you have any reason not to take the medications?

1. Have you ever not taken the medication? If so, what was the reason?

Ask a final question about whether the client would like to tell you anything further about their medications.

Write a paper describing your research and findings about the medications being taken and the interview results. Report your findings in a 3-5 page written paper. In your paper include the reason for each medication, the drug classification, the route of administration, the dose, and possible side effects/adverse reactions.

Use accurate and appropriate spelling and grammar and APA Editorial Format for sources used in your written paper.

Develop a teaching plan for this client based on your findings. Based on the findings from the interview, develop a 2-3 page teaching plan to include the following:

1. List one goal for this teaching plan

1. Describe two to three teaching resources that might be used

1. Identify two teaching strategies that can be used based on the client interviewed

1. List specific client instructions regarding the medications what adverse reactions they should be aware of/and what to do

1. Identify at least one factor that may negatively influence adherence to the medications and how it can be overcome

1. If, appropriate, describe how the family might be involved in ensuring the client is on a proper and safe medication regime

Bottom of Form

DB

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Please respond using APA format, and at least 4 scholarly references, due by 09/03/23 12 pm EST

 

Develop a 1- to 2-page case study analysis in which you:

  • Explain why you think the patient presented the symptoms described.
  • Identify the genes that may be associated with the development of the disease.
  • Explain the process of immunosuppression and the effect it has on body systems.

Case study: 

  

A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. Patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg po every Friday morning and prednisone 5 mg po qam. He states that he has had a fever up to 101 degrees F for about a week and admits to chills and sweats. He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After extensive work-up, the patient was diagnosed with Invasive aspergillosis.

W2 R see attachment

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Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .



Ally Carvalho

What are the potential ethical and legal implications for each of the following practice members?


Medical assistant 

The medical assistant engaged in unethical behavior by refilling a prescription without proper authorization. Her action can potentially harm the patient if the medication is no longer appropriate or if there are contraindications.

Her actions violate state laws and regulations related to prescribing and dispensing medications without proper authorization.

Nurse Practitioner

The NP should thoroughly investigate the situation and address any ethical concerns related to patient care, including the appropriateness of the prescription refill and the potential breach of trust. The National Health Care Anti-Fraud Association estimates three percent of all healthcare spending is lost to fraudulent transactions (Haddad Soleymani et al., 2018).

The NP's name was used on the prescription label without their knowledge and it must clarify this discrepancy and ensure compliance with prescription laws and regulations. At this point, the NP doesn't know if this has happened with other patients and it must be addressed.

Medical Director

The medical director has the ethical responsibility to address the situation promptly, ensuring that the practice's standards for ethical and legal behavior are upheld. 

Practice

The practice as a whole has an ethical obligation to provide high-quality, safe patient care. Any lapses in ethical standards may erode trust and confidence. Healthcare professionals must follow structured policies and procedures (Kadivar et al., 2017).

The practice should ensure that all staff members comply with legal requirements regarding prescription renewal. 

 

What strategies would you implement to prevent further episodes of potentially illegal behavior? 

Reinforce the importance of adhering to legal and ethical standards during training and ongoing education for medical assistants. 

Implementing stick protocols for prescription renewals including requiring direct provider authorization and documentation. 

According to the Department of Health and human services (2011), it is important to implement regular audits or checks of prescription practices to identify any irregularities.

Foster a culture of openness, where staff members feel comfortable reporting any ethical or legal concerns without fear of retaliation.

Medicare prescription drug sponsors’ training to prevent fraud, waste, and abuse. (2011). Department of Health and Human Services, Office of Inspector General.

Haddad Soleymani, M., Yaseri, M., Farzadfar, F., Mohammadpour, A., Sharifi, F., & Kabir, M. J. (2018). Detecting medical prescriptions suspected of fraud using an unsupervised data mining algorithm. 
Daru, 
26(2), 209–214. 

https://doi.org/10.1007/s40199-018-0227-zLinks to an external site.

Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A.

(2017). Ethical and legal aspects of patients safety; a ckunucak case report. Journal of Medical Ethics and History of Medicine, 10, 15-.

pn 2 m8 diss

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A nurse at the local Senior Center made the following notation about a client: A 74-year-old female client wearing eyeglasses with bifocal lenses and hearing aid in her left ear. Walks with a shuffling gait, using a cane for support. Wearing house slippers and housedress. States, “My other doctor says I should have my eyes looked at by an expert. It’s been a while, and my eyes seem to be acting up lately. I can’t see so good anymore.” The client states that she takes medication for “sugar” and her blood pressure and has worn glasses for years with the last prescription changed about 3 years ago. “I was a seamstress for many years and quit when I couldn’t see to thread the needles anymore-just in time too. These new materials are too hard to work with!” Denies using any eye drops. Describes vision changes as difficulty seeing well at night, especially if trying to read. Uses a magnifying glass to help when reading. No eye pain or discharge, although eyes sometimes feel “dry and scratchy,” with the left eye being worse than the right. Admits to rubbing eyes but without relief.

Develop a Plan of Care for this patient that includes:

  • 2 Nursing Diagnosis
  • 2 goals for each Nursing Diagnosis
  • Interventions with rationales

Networking

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 Post a brief introduction of yourself to your colleagues. Include an explanation as to how Walden’s vision, mission, goals, and social change initiatives relate to your professional and academic goals and to your becoming a scholar-practitioner. Also include an explanation for how the Walden MSN Program Outcomes and perspectives relate to your professional and academic goals and to your becoming a scholar-practitioner. Finally, explain why networking is important and how it may help you achieve your professional and academic goals 

aswpos2

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Respond to what he wrote, be argumentative with the answers, and polite. References, and at least 2 paragraphs.

 

 

In the last decade, there have been a lot of changes to the model of practice of advanced practice registered nurses (APRNs) in Northern America. During the pandemic, legislative changes enabled nurse practitioners (NPs) in some states to act in the role of medical doctors, thereby empowering them to work to their full scope of practice. This has resulted in a higher quality of care, decreased hospitalization rates, improved access to care, and the creation of an improved working environment for direct care providers (McGilton et al., 2023). For the purpose of this discussion post, the practice agreements, process of certification and licensure as an APRN in North Carolina, the scope of practice of nurse practitioners, how to get Drug Enforcement Administration (DEA) license, and controlled substance prescriptive authority for NPs will be summarized. Also, the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in North Carolina will be explained.

Summary of Findings

Certain criteria need to be met before an individual can be licensed as an Advanced Practice Registered Nurse (APRN) in the state of North Carolina. A lot of information on certification and licensure can be found on 
www.ncbon.com
Links to an external site.
, which is the North Carolina Board of Nursing (NCBON) website. One must hold a North Carolina Registered Nurse license or a compact state license that is valid to practice in North Carolina. A master’s or higher degree in nursing must be completed. Additionally, a national certification as a nurse practitioner must be obtained from one of the nationally accredited credentialling bodies, and a registration with the North Carolina Controlled Substance Reporting System (CSRS) is required for those that have prescriptive authority for controlled substances. The North Carolina CSRS exists through the North Carolina Department of Health and Human Services to collect information on dispensed controlled substance prescriptions and make this information available to prescribers and dispensers (North Carolina Department of Health and Human Services, n.d.).

The scope of practice of an APRN in North Carolina required being educationally prepared, nationally certified, and maintenance of competence. The APRN is required to promote and maintain health; prevent illness and disability; diagnose, treat, and manage acute and chronic illnesses; guide and counsel individuals and their families; prescribe, administer, and dispense therapeutic measures, tests, procedures, and drugs; plan for situations beyond the nurse practitioner's scope of practice and expertise by consulting with and referring to other health care providers as appropriate; and evaluate health outcomes (Office of Administrative Hearing, 2019). According to the North Carolina Board of Nursing (2022), nurse practitioners have the approval to prescribe legend drugs and Controlled Substance Schedules II – V, which is consistent with the scope of practice determined by their educational preparation and national certification. Professionals who prescribe controlled substances must fully comply with both North Carolina’s state and federal rules and regulations. A nurse practitioner who administers, dispenses, or prescribes any controlled substance, must be registered with the federal Drug Enforcement Administration (DEA). In North Carolina, this process requires applying for DEA registration, paying the required fees, completing, and submitting DEA for 106.

In North Carolina, an APRN requires a collaborative practice agreement with a licensed physician. Therefore, upon completing an advanced degree and obtaining licensure, an APRN needs to apply for an ‘Initial Approval to Practice’. What this application entails is an active North Carolina Registered Nurse license; the physician’s name, their license number, or email address; and the practice information. After all these have been submitted and approved, the APRN can begin practicing in North Carolina (North Carolina Board of Nursing, n.d.).

Types of Regulations that Exist and the Barriers that May Impact Nurse Practitioner Independent Practice

From the research findings, there are regulations, and some barriers exist that may impact nurse practitioner independent practice in North Carolina. For instance, the scope of practice laws defines the activities and responsibilities that healthcare professionals are allowed to engage in. In North Carolina, there is a need for physician oversight, and there is a need for physician collaboration. Also, we are required to have collaborative practice agreements with physicians. Collaborative Practice Agreement (CPA) is an agreement between the nurse practitioner (NP) and the primary supervising physician addressing how the NP operates the administrative code or rules in their practice (North Carolina Board of Nursing, 2023). These agreements outline the relationship and level of collaboration between the nurse practitioner and the physician. Components that are included in the collaborative practice agreement are the drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner. Additionally, prescriptive authority is part of the nurse practitioner approval to practice. A nurse practitioner may prescribe controlled substances; however, the supervising physician must have a DEA registration equal to or greater than the DEA registration of the nurse practitioner that he or she supervises. Finally, regulatory bodies exist to set regulations for APRNs. These boards can influence the level of autonomy nurse practitioners have in their practice in North Carolina.

Some of these regulations pose a major barrier that may impact the nurse practitioner’s ability to practice independently. To begin with, the scope of practice restrictions can be very challenging because it limits the ability to provide care independently. Also, due to the collaborative practice agreements that are needed from a physician, we experience a lot of opposition from physician associations and groups. They cite that they have concerns about patient safety and the need for the role of physicians in the health care team. To add to these barriers, there are challenges as to how the public perceives the role and capabilities of nurse practitioners. Patient and public understanding of the role and capabilities of nurse practitioners can influence the acceptance of independent practice. Educating the public about the training and expertise of nurse practitioners is very crucial for acceptance. Nurse practitioners may also face challenges in being recognized by insurance providers and receiving reimbursement for their services at the same rate as physicians. According to Barnes et al. (2017), in a lot of states, nurse practitioners are reimbursed less than the physician rate, varying from 75% to 100% of physician rates. A lot of legislative processes are ongoing to have nurse practitioners receive 100% reimbursement from Medicare. Currently, reimbursement is only provided at about 85% of the physician rate in most states (Bischof & Greenberg, 2021).

All this information did not come as a surprise to me because during this program, we have been required to carry out research findings on related issues. This has enlightened me to the state regulations for the scope of practice of nurse practitioners in my state. I have educated myself on these requirements and learned a lot from my preceptors and senior colleagues in the field of psychiatric mental health. I believe that I am well prepared for all these upon completion of my degree.

Conclusion

The United States is experiencing shortages of primary care providers, and NPs offer the potential to moderate these shortages (Barnes et al., 2017). As advanced practice registered nurses, it is important to stay updated with the latest regulations and developments in our individual states regarding nurse practitioner practice. It is therefore advisable to consult the state Board of Nursing and other relevant authorities for the most current and accurate information for legal practice.

References

Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431–451. 
https://doi.org/10.1177/1077558716649109
Links to an external site.

Bischof, A., & Greenberg, S. A. (2021). Post COVID-19 reimbursement parity for nurse practitioners. Online Journal of Issues in Nursing, 26(2). 
https://doi.org/10.3912/ojin.vol26no02man03
Links to an external site.

McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1). 
https://doi.org/10.1186/s12877-023-03798-1
Links to an external site.

the North Carolina Board of Nursing. (2022). Prescribing. Retrieved August 29, 2023, from https://www.ncbon.com/practice-nurse-practitioner-prescribing#:~:text=Nurse%20Practitioner%20approval%20includes%20prescriptive,educational%20preparation%20and%20national%20certification.

North Carolina Board of Nursing. (2023). Collaborative practice guidelines. Retrieved August 29, 2023 from https://www.ncbon.com/practice-nurse-practitioner-collaborative-practice-guidelines#:~:text=Required%20components%20of%20the%20CPA,performed%20by%20the%20nurse%20practitioner.

North Carolina Board of Nursing. (n.d.). Advanced practice registered nurse. Retrieved August 27, 2023, from 
Advanced Practice Registered Nurse | North Carolina Board of Nursing (ncbon.com)
Links to an external site.

North Carolina Department of Health and Human Services. (n.d.). NC Controlled Substances Reporting System. Retrieved August 29, 2023, from https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/north-carolina-drug-control-unit/nc-controlled-substances-reporting-system

Office of Administrative Hearing. (2019). Scope of practice. Retrieved August 27, 2023, from 
http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0802.html
Links to an external site.

Laboratory for Diagnosis, Symptom and Illness Management

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Case Study 3 & 4 (10 Points) 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Discussion 1 (HealthAssess)

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Describe the findings associated with malignant skin changes (for example: persistent sores, lump or swelling, bleeding lesions, etc.)

Demonstration Speech

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API FORMAT.

They check for plagiarism.

Instructions in attachments.