Nursing

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I need a response to the following peers:

Peer 1

 

Many states are moving toward making changes to existing laws regulating the scope of practice for Advanced Registered Nurse Practitioners (ARNPs) to include independent prescribing authority. Independent prescribing authority refers to the ability to prescribe controlled medications without collaboration with a physician. This is a key component of APRN scope of practice, and an important part of the APRN Consensus Model. Prescription of controlled substances represents significant risks, and understanding these risks is critical in order to provide safe and effective patient care. A primary concern centers on prescription opioid use disorder, affecting patients, health care providers, and the community at large (Chedekel, 2015).

Health professionals who prescribe or handle controlled substances are required to know the Controlled Substance Act regulating practice. This includes knowledge of the schedule of controlled substances, the risk and prevalence of a substance use and addiction disorder, and the treatment guidelines for prescribing controlled substances as well as prevention of prescription drug abuse and misuse. Patient assessment and evaluation of outcomes related to the treatment plan, including a prescriber-patient opioid agreement, are necessary skills for providers prescribing scheduled drugs (Chedekel, 2015).

When it comes to preventing misuse of controlled substance and the risk of a substance use and addiction disorder, we as future APRNs with prescriptive privileges can follow several clinical practices and prescribing practices that can minimize or prevent these consequences. Most importantly, it is essential to understand drug Schedules and to know which drugs are classified according to the Schedules of Controlled Substances. We must also be familiar with the laws and guidelines surrounding prescription of substances within each Schedule (“Florida Board of Nursing » Important Legislative Update regarding HB 423 – Licensing, Renewals & Information,” n.d.).

When writing a prescription, the provider should write the script legibly to reduce the risk for forgery of the document. Sloppy or illegible writing of a prescription can result in a patient or another person altering the dose or number of pills without it being noticed. Because the drugs within Schedule II/IIN require written prescriptions, protection of the actual prescription pad is essential to prevent theft. By keeping it locked up and in a safe place, it is less likely to be stolen and used to forge a prescription for a controlled substance. In cases where electronic prescriptions can be written instead of paper prescription pads, the provider should try to write an electronic prescription or use e-prescribing software to reduce the risk of forgery and falsification (“Florida Board of Nursing » Important Legislative Update regarding HB 423 – Licensing, Renewals & Information,” n.d.).

A nurse practitioner who prescribes controlled substances needs a DEA number associated with a license to practice. The provider should monitor the DEA number to ensure that no one else has tried to use it and that prescriptions written associated with that number were only written by the provider. Often, pharmacists and pharmacy technicians can check a prescriber’s DEA number through the database to verify prescriptions and to determine whether a prescriber has been prescribing controlled substances appropriately. In understanding policies regarding number of refills allowed according to each Schedule, the prescribing provider should follow these guidelines closely, educating staff and colleagues about policies for refills, if necessary (“Florida Board of Nursing » Important Legislative Update regarding HB 423 – Licensing, Renewals & Information,” n.d.).

When considering whether a specific patient needs a prescription for a controlled substance, the nurse practitioner can also potentially prevent misuse and substance abuse by performing thorough patient examinations that assess the patient’s medical history, history of substance use and abuse, and assessing for patient pain levels. The types and amounts of concomitant medications the patient is taking should also be documented. When possible, alternative therapies, including those medications that are not controlled substances or nonpharmacological adjuvant therapies should be employed instead. In extreme circumstances, such as when the patient is acutely intoxicated with a controlled substance or demonstrating an inability to safely utilize a prescription for one of these drugs, the prescribing provider should consult with a specialist for substance abuse treatment and avoid writing the prescription for the controlled substance (Chedekel, 2015).

Peer 2

 

Issues that May Arise with Prescriptive Authority of Controlled Substances

The prescription of controlled substances by nurses is often one of the controversial issues that leads to the revoking of licensure only after the realization of already damaging effects of the same. The CS/CS/CS/SB 614, for instance, is a Florida 2015 law that grants APRNs the freedom to administer, dispense, or prescribe any drug including the controlled substances such as opioids (The Florida Senate, 2020). One of the issues that may arise from this prescriptive authority is the delegation of these duties by APRNs to other individuals or lack of direct examination of the patients before administration, which may lead to licensure revoking (Osborne, 2017). In the case of Heather Alfonso, a Derby APRN, her licenses were revoked and was almost imprisoned for three years for misusing her freedom of prescribing controlled substance (Chedekel, 2015). From the report about Alfonso, there was evident that she would prescribe patient medication even without proper examination by a licensed healthcare giver, and this led to many patient abnormalities until she was noticed (Chedekel, 2015).

How One Can Avoid these Situations

One can avoid these issues by performing comprehensive patient examination before any prescription activity. Also, there is need to follow the strict regulations of using these controlled substances, such as using some of the opioid medications only in the cancer treatments of pain (Soelberg et al., 2017). Lastly, a healthcare giver should always consult extensively if they are unsure that some of the medications they are giving to the patients are the best alternatives.

above is the original homework in case you needed:

 

CS/SB 614 authorizes  an ARNP to prescribe, dispense, administer, or order any drug, which would include controlled substances.

ARNP disciplinary sanctions are added to the bill in s. 456.072, F.S., (Section 5) to mirror a physician’s sanctions for prescribing or dispensing a controlled substance other in the course of professional practice or failing to meet practice standards. Additional acts for which discipline may be taken against an ARNP relating to practicing with controlled substances that are added to the Nurse Practice Act (Section 10) include:

 Presigning blank prescription forms.

 Prescribing a Schedule II for office use.

 Prescribing, dispensing, or administering an amphetamine or sympathomimetic amine drug, except for specified conditions.

 Prescribing, dispensing, or administering certain hormones for muscle-building or athletic performance.

 Promoting or advertising a pharmacy on a prescription form unless the form also states that the prescription may be filled at the pharmacy of your choice.

 Prescribing, dispensing, or administering drugs, including controlled substances, other than in the course of his or her professional practice.

 Prescribing, dispensing, or administering a controlled substance to himself or herself.

 Prescribing, dispensing, or administering laetrile.

 Dispensing a controlled substance listed in Schedule II or Schedule III in violation of the requirements for dispensing practitioners in the Pharmacy Practice Act.

 Promoting or advertising controlled substances.

After reading the following news article http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/

Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations? 

 
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Discussion

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Please no plagiarism and make sure you are able to access all resources on your own before you bid. You need to have scholarly support for any claim of fact or recommendation regarding treatment. APA format also requires headings. Use the prompt each week to guide your heading titles and organize the content of your initial post under the appropriate headings. Remember to use scholarly research from peer-reviewed articles that is current. Please follow the instructions to get full credit for the discussion. Each classmate’s document is attached.

Read your classmates’ postings. Respond to your classmates’ postings.

Respond in one or more of the following ways:

  • Identify an ethical consideration that was not addressed by your colleague and ask a question about this ethical consideration.
  • Suggest an additional mechanism or strategy increase culturally relevant prevention programming and planning with the identified diverse population.
  • Provide your colleague with feedback about how their portfolio section on Diversity and Ethical Considerations could help bring about positive social change.

1. Classmate (S. Danziger)

2. Classmate (R. Campbell)

3. Classmate (J. Herring)

Required Resources

Hage, S., & Romano, J. L. (2013). Best practices in prevention. In R. K. Conyne & A. M. Horne (Eds.). Prevention practice kit: Action guides for mental health professionals (pp. 32-46). Thousand Oaks, CA: SAGE.

Vera, E. M., & Kenny, M. E. (2013). Social justice and culturally relevant prevention. In R. K. Conyne & A. M. Horne (Eds.). Prevention practice kit: Action guides for mental health professionals (pp. 1-59). Thousand Oaks, CA: SAGE.

American Counseling Association (2014). 2014 ACA Code of Ethics. Retrieved from https://www.counseling.org/Resources/aca-code-of-ethics.pdf

County Health Rankings & Roadmaps (2018). How healthy is your community? Robert Wood Johnson Foundation. Retrieved from http://www.countyhealthrankings.org/.

Required Media

Walden Scholars of Change (2016). Giving incarcerated women a second chance. https://www.waldenu.edu/connect/video-and-multimedia/social-change/scholars-of-change/2016-winners/giving-incarcerated-women-a-second-chance

 
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Business Operating Management

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Read the files(lectures), and answer those 3 questions: each question need at least 400 words. (1200+ words in total)

 

  1. Why is it important for business units to continually revise their product or service offering? What new products or services is your employer, or an organization you are familiar with, considering? Recommend some metrics that could be used to measure the performance of the new product or service.
  2. What is project management? What is the definition of a project? What are the basic components of project management? What is the role of a project manager? Can you describe these topics in the context of a project being done within an organization of your choice?
  3. Pick a process in your organization and describe its purpose and steps. Can you determine success criteria for each step in your selected process? What are the inputs and outputs for each step? Are there any timing considerations? Could the process be improved? (Paper Topic)
 
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Discussion

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3 postsRe: Topic 4 DQ 1

Hi Tyler,

With their difference in culture, their thinking is also different in the same health problem. It depends on their cultural background, understanding level, and education. For example, a Native American man may not want to be resuscitated or placed on life support. A woman born in Beijing may be resistant to taking prescribed medication for a condition and may want to use traditional Chinese herbal remedies and acupuncture. Healthcare providers who are unfamiliar with cultural traditions surrounding medical care may have difficulty connecting with the patient or the patient may not feel safe and recognized, which is key to treatment acceptance.

Reference

7 steps to become a more culturally sensitive nurse || EveryNurse.org. (2020, June 19). Retrieved from https://everynurse.org/blog/7-steps-culturally-sensitive-nurse/

 
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Topic 4: Collaboration in Patient Education and Compliance With Older Adults  

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Write a short (50-100-word) paragraph response for each question. This assignment is to be submitted as a Microsoft Word document.

  1. Define negotiation as it applies to patient education.
  2. Explain how the change in the patient’s status through the years has affected patient education.
  3. List the pros and cons of negotiation.
  4. Describe the general conditions that would be included in a patient contract.
  5. Discuss old age and the baby boomer.
  6. List several generational, religious, and cultural differences between the 30-year-old health care professional and the elderly patient.
  7. Explain some of the barriers to patient education of the elderly and discuss their special needs.
  8. List ways to best approach patient education of the elderly.
  9. Discuss some cultural and religious beliefs about death that you have encountered.
  10. Explain why it is important to discuss death and dying with the elderly patient and what the impact is on all involved.
  11. Explain how to teach a patient with a life-threatening illness.
 
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Discussion: Obesity: A Global Health Concern

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Obesity is a continuing challenge for citizens and health care providers in the United States, as you likely know. Obesity can lead to numerous chronic health problems, including heart disease and type 2 diabetes. Childhood diabetes is also increasing at a disconcerting rate, which will lead to an increased health care burden within a few short years. Current estimates set the cost of obesity on the U.S. health care system at $147–$210 billion per year (The State of Obesity, 2016). Think about this week’s media as you take a moment to consider obesity as a burgeoning global challenge.

To prepare for this Discussion:

· Compare rates of obesity in the United States to other developed and also developing countries. Think about how health issues resulting from obesity compare as well.

· Reflect on health promotion and prevention strategies that nurses can implement.

· Contemplate the ethical, cultural, economic, political, and environmental issues a nurse should consider when developing a primary obesity health prevention strategy.

INSTRUCTIIONS FOR DISCUSSION

-Post an obesity health promotion and prevention strategy a nurse could implement for a specific cultural group in the United States.

-Then, modify your message for use in one other country, being sensitive to the cultural nuances of the country you select.

-Describe why you chose to take the approach you did in your strategies and explain any challenges you anticipate a nurse may encounter when trying to implement these strategies.

-Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

I ATTACHED REFERENCES FROM THIS WEEK

 
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Case Studies

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Case Studies* Content

1.

Top of Form

For your case study grade you will be reading two case studies; both will come from the PDF attached – “Dealing with Difficult People”.

Case Study 1 of 2 “Get Past No” – Page 5

Read “Get Past No” (Page 5 of the attached PDF) The scenario is about Marty Spence and outlines the five-step strategy described in the book “Getting Past No: Negotiating with Difficult People” by William Ury.

The only APA requirement I am grading you on is the cover page and reference page; see APA Sample I attached to the assignment list. 5 pages (including Cover page and reference page) minimum.

Please double-space, use Times New Roman 12 point font, with one inch margins.

The purpose of each case is to augment the course content with applications that enable you to apply text materials to a scenario and relate to that problem using what you have learned.

In your own words describe in detail what you learned from the case and strategies outlined. Bottom of Form

Top of Form

Dealing_with_Difficult_People.pdf

 
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Example Project

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Follow the instructions on page 286 of your textbook, and complete the example project which is at the bottom of the page. Create your own example for a project. Follow the instructions, and submit a no less than four-page Word document answering the questions for the project.

Example Project

Create a risk register for your example project. Categorize each risk, list potential causes, and list potential responses for each cause, as shown in Exhibit 10.9.

Describe what each project success measure (from Exhibit 10.1) looks like on your example project. Identify at least three risks to each success measure, determine which are major risks, and for each major risk develop one or more contingency plans. Identify whether the contingency plan is an avoidance plan (reducing the probability of the risk event), a mitigation plan (reducing the impact of the event), or both. Facilitate a discussion with the sponsor and other key stakeholders of your project.

Have them determine the relative importance of their priorities and document them, as shown in Exhibit 10.2. Perform a risk review for your example project. Use at least three types of review, as shown in Exhibit 10.8. Which of these types gave you the most useful information? Why?

 
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Discussion

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The purpose of this visual is to inform people, plastic pollution could be harming us if we eat fish. Since it’s stated that studies show fish off the west coast ingest over 12,000 tons of plastic a year (Surfrider, 2011), this could affect those who eat fish. The visual shows what appears to be sushi wrapped in plastic. The plastic that the sushi is wrapped in has a very thick and wet look and the center of the sushi is stuffed with plastic also. The plastic resembles the plastic bags that we get from grocery shopping because of the wording you can see on the plastic. The sushi does not have a very appetizing look, even with the chopsticks that are laying along side of it. The sushi has a blue center which draws your attention to the words in blue print. The blue wording is in all caps and is also bolded. The bolded text in caps gives viewers an immediate alert. The text brings attention to the eye as it forces you to focus on the blue centered sushi as well. The smaller print below provides details about the image and gives more of a clear understanding of why the sushi is wrapped in plastic. The text also reference a website that’s stated to help turn the tide on plastic pollution.

There are many effective elements considering the Rhetorical situation. To inform was the purpose of the visual, the visual was effective in doing so by first catching the viewers eye by text which went along so well with the visual because it included just enough information to inform you of the what and why. The wording “What goes in the ocean goes in you”, can cause one to pause and think about what does the ocean have to do with me and what goes into it. The message was made clear with a brief explanation of what studies have found. I felt as though the visual elements were presented well. The most effective aspect of the visual was the image itself, the sushi which is fish being wrapped in plastic was a great way to describe plastic pollution and how it can affects us.

The Rogerian model could best be supported with this visual because the issue at hand could have more than one perspective. The Rogerian model allows for an argument to be led from problem to solution, and the visual provided us with the problem of plastic pollution and then it provided us with a solution which was how to turn the tide on plastic pollution by providing a website to visit. What goes in the ocean goes in you would not pose a clear statement from a viewer’s standpoint. However, the visual and information provided presented a problem and a solution to help piece together an understanding of this visual making it very effective.

 
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Discuss The Vulnerabilities Along The Chain-Of-Custody Of Person’s Vote

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You have been hired as a CYBER security analyst to assess the vulnerabilities of the electronic voting machines for the city of Metropolis. Some of the voting machines are connected directly to the Internet, while the majority of them are not. However, some may have WI-FI and/or BLUETOOTH capability. All have some form of removable data devices.

An electronic voting machine is simply just another Internet-of-Things endpoint that requires the same diligence in securing it as would any other network endpoint node.

Discuss the vulnerabilities along the chain-of-custody of person’s vote, from button press, to off site data storage.

 
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