Category: Health Care and Life Sciences : Nursing

These assignments allow the student to learn how to do distinct types of notes that the PMHNP might be called upon to write during their career.  Therapy notes are meant to be brief and often follow the Data, Assessment, Plan (DAP) format. 
D- Data= This section should include what behaviors were observed during the therapy Focus of the session, topics discussed, and what the client tells you about the problem and symptoms. Relate to diagnosis, use quotes, and include specific details (frequency, severity, duration, etc.) and impact on functioning. Include the status of risk issues, if any (substance abuse, danger to self/others, etc.) 
A- Assessment= Therapist thoughts and assessment of client progress and the medical necessity for treatment. Assess barriers to progress or regression. Describe unusual appearance, thinking, and/or behavior. Note changes to diagnosis. 
P- Plan= What did you do? What do you plan to do? Include therapist in-session Interventions (ex.  “Cognitive reframing, “taught progressive relaxation”), referrals, and homework assigned. Include reminders for planned actions for future sessions and changes to the treatment plan (ongoing lack of progress should lead to a change in the treatment plan. 
Important: Therapy notes are not a part of the regular patient chart. However, they should be released to patients if it is determined that the contents could be psychologically harmful. 
Example Behavioral Therapy Note 
D- Met with M for 45 minutes via virtual session. Today she reports that she is in training at Amazon, which is going well. She reports that she is anxious about the 2-hour bus ride and that her work hours are overnight, so she is coming/ going in the dark. She is also worried about having too many badges to scan at work and is afraid she will ‘mess up.’  She states she was anxious about finding her way in the large building, but there are markings on the floor to guide her and after a few days, she feels more at ease. She does not want to return to community college now that she has found this employment that is not a seasonal job.  
A- Monica has improved her anxiety symptoms and seems proud of her progress and accomplishments with the new job. We discussed her past patterns of putting pressure on herself and overthinking. She has already overcome one obstacle by navigating the large building and can use the same skills for the other stressors that cause her anxiety at this new job.  
P- HW: Breathing and mindfulness techniques when feeling anxious and speaking up politely if feeling overwhelmed at the new job. Talk with the grandmother about not going back to college—next session in 1 week. 

Re write this like sample that attached noNo cover page needed. Please make sure you document your discussion regarding common side effects with the patient
Subjective
CH 53 yrs
Subjective note
REASON FOR EVALUATION/CONSULTATION/TREATMENT:. Psychiatric follow-up evaluation for medication management and supportive behavioral therapies..
SOURCES OF INFORMATION:. Patient. Chart.
RELEVANT LABORATORY/STUDY RESULTS:. None performed prior to this visit.
SCOPE OF INTERVIEW AND CONSENT: The patient was examined, the chart was reviewed; including all available medical notes, laboratory results, available imaging and current medication management. The Family/Patient/Staff was interviewed and collateral information was obtained. Treatment was provided (after obtaining informed consent), including supportive and behavioral therapies; medication review and management after assessing risks, benefits and alternative treatments. Patient/Responsible party understands risks, benefits and alternative treatments, the reasoning behind medications being chosen as well as how to take them and what to do and how to contact the physician and staff in an emergency situation.
HPI: Here for follow up of attention deficit and GAD.
“I’m doing really good and I don’t think I need the Adderall anymore. Maybe it’s because I’m getting older.” Following with endocrinologist Dr. Do regularly and PCP Dr. Meric. Will request labs to our office. Taking Armorall 110 mcg. Managing well with very infrequent Ativan use. Prefers to DC stimulant. Working great.” Reports stability in symptoms; mood noted to be good; energy is good. Acknowledges annual follow up with PCP and labs. Denies insomnia. Taking Armour Synthroid, Testosterone, benzo for emergencies. CURES checked
Objective
Objective note
RECENT MEDICAL HISTORY CHANGES: None. No issues with substance abuse, alcohol, tobacco or IVDA reported.
REVIEW OF SYSTEMS: Patient denies any GI related symptoms including nausea, vomiting, diarrhea or constipation. Patient also denies headaches as well as visual and hearing changes. Patient denies cough, chills or fever. Denies as well rashes, skin dryness or skin discoloration. Patient denies any urinary symptoms such as urgency, burning or frequency. The rest of the ten point review was unremarkable..
CLINICAL GLOBAL IMPRESSIONS – GLOBAL IMPROVEMENT (CGI-I). 4 = No change.
MENTAL STATUS EXAMINATION: Speech is normal, well modulated, with regular rate and rhythm. Patient is euthymic. Attitude is appropriate to this setting. Thought process is linear and goal directed. The patient’s perception of reality is normal with no delusions or hallucinations noted or reported. Patient is alert and oriented in all four spheres. The patient’s memory is intact. Attention span is intact. Reality testing is intact. Patient’s insight and judgment is intact. The patient appears calm and cooperative….
Observations
FUNCTIONAL STATUS
No functional status recorded
COGNITIVE STATUS
No cognitive status recorded
Assessment
Assessment note
DIAGNOSIS AS PER DSM V: H/o ADD and GAD
DECISION MAKING CAPABILITIES:. Patient is able to give informed consent. Patient has been educated and is aware of the diagnosis, prognosis as well as treatment plan.
Strengths:
1. Stable housing
2. Supportive primary support
Weaknesses:
1. Chronic disorder.
2. Weight management.
Screenings/Interventions/Assessments
No screenings/interventions/assessments recorded
Diagnoses attached to encounter
No diagnoses attached
Plan
Plan note
RECOMMENDATIONS AND TREATMENT PLAN:. Patient is stable . Not feeling need for Adderall and has self-stopped. POC as follows: 1. Disontinue Adderall 10 mg BID; not taking; self-stopped 2. Continue Ativan 0.5 mg PRN QOD extreme anxiety only. 10 tabs. Using intermittently.INFORMED CONSENT:. Informed consent has been obtained from the patient / responsible party. A full explanation of risks, benefits as well as alternative treatments has been given. We have reviewed black box warnings, special circumstances (i.e. driving/operation heavy machinery/avoiding combining with alcohol/sedating medications). FDA approved indications as well as off label use which is the standard of care in the community; special considerations for pregnancy and breast feeding if applicable, and is evidence based and the recommendations have been accepted for Ativan. THERAPY PROVIDED:Provided supportive, individual, psychotherapy, addressing individual’s identified treatment goals, utilizing a combination of cognitive-behavioral and insight-oriented modalities, as appropriate. Will continue to monitor for identified risk factors, and/or safety issues, medication compliance and side-effects. Psycho-educational services were provided to assist the patient to identify triggers and warning signs associated with a relapse of acute symptoms. Plan of care discussed with patient. RETURN TO CLINIC IN: 6 weeks or sooner if needed by pt. Will re-assess on next visit looking at efficacy and potential side effects.. ….
Medications/Prescription orders attached to encounter
No medications attached
Lab orders
 Add Print
No lab orders
Imaging orders
 Add Print
No imaging orders

See attached instructions with rubric.
I am not sure if you are familiar with any Electronic Health Record systems used in hospitals – my hospital uses Meditech. But you may write about any electronic health record system that you can find the most pertinent information about online, for this assignment. I know that one of the questions in the rubric asks when my facility began using this program – I do not know. Make any date up please. If you have any additional questions please reach out!! TYSM.

Write a 3–5 page executive summary that justifies the operating budget you prepared in Assessment 2 (attached)
Preparation:
The financial department has reviewed your unit’s operating budget and has asked you to submit an executive summary that provides support for your budget proposal. Your challenge is to position your unit favorably within an environment of competing demands for limited funding.
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
Consider the operating budget you developed in Assessment 2.
How would you justify your budget to executive leaders?
How would you link your budget to the organization’s goals and objectives?
How would you propose to meet productivity goals while staying within budget?
Requirements: Write an executive summary of the operating budget you prepared in Assessment 2 that makes a compelling case for why funds should be allocated for your budget. (Guiding questions attached)
Outline a strategic plan that ensures profitability and fiscal success.
Present a plan to meet staff productivity goals, while staying within budget parameters.
Justify equipment and service costs.
Analyze department, unit, or project alignment with the organization’s mission and goals.
Write clearly and concisely, using correct grammar and mechanics.
Integrate relevant and credible sources of evidence to support your assertions, correctly formatting citations and references using current APA style.
Additional Notes:
Negotiating budgets and communicating financial needs to stakeholders are vital skills for nurse leaders. Given today’s numerous constraints on funding and a highly competitive environment, the ability to win support for your budget proposals hinges on being able to present a compelling argument based on well-documented needs, accurate financial information, and a justifiable business case.
This assessment provides an opportunity for you to examine the mission and goals of a health care organization, in order to justify a budget proposal. A persuasive argument requires thoughtful justification and rationale for the expenses required to support your proposal. A proposal that supports the organization’s mission and goals strengthens your argument and is much more likely to get you what you need.
In every health care organization, dollars are scarce and the budget process is carefully scrutinized at every level. Nurse leaders must be business-savvy. They must be able to make a compelling case for why every budget line item and every dollar on a budget supports the mission and goals of the unit and the organization. This means that nurse leaders must be able to think in terms of the business of health care and be able to present a business proposal or plan with thorough and thoughtful justification and rationale for expenses. The business plan should present accurate, factual data and costs, and should also be concise and clearly organized.

Please respond to each discussion post (a total of 2 responses). Each response should include additional information in response to the discussion post such as recommendation and other choices of treatment. Please note, you are responding directly to the person by name such as Hi James, or Hi Jane, etc.
Instructions:
Length: at least 135 words each response, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
The entire paper should not be in APAP format but the in-text citation and reference should be in APA format.

Submission Type:
A written report in APA 7th ed. format, 10-12 pages in length. Details below.
Details:
CASE Study: The purpose of this assignment is to evaluate the value of health information technology in the prevention and detection of errors, as well as analysis of unintended consequences and human factors through quality improvement strategies.
Review the following video and documents on the case study. *
RaDonda Vaught speaks out l GMA [Video file]. Retrieved from https://www.youtube.com/watch?v=ryphwWHAgQELinks to an external site.. (4:56).
Harrington, L. (2022). The RaDonda Vaught case: A critical conversation on nursing practice and technology. AACN Advanced Critical Care, November 8, 2022. doi: The RaDonda Vaught Case: A Critical Conversation on Nursing Practice and Te…: EBSCOhostLinks to an external site.
State of Tennessee vs. RaDonda Vaught: Discovery request response. Available at https://s3.documentcloud.org/documents/6785652/RaDonda-Vaught-DA-Discovery.pdfLinks to an external site. Note pages 5-6, 50-51.
Apply one of the Quality Improvement Models discussed in the course, or choose an approach from the literature, or the one used in your workplace to analyze the case.
Summarize the case in one paragraph, highlighting the role of HIT.
Describe briefly the model chosen for the analysis.
Provide a rationale for using the selected model over other options.
Follow the model steps and processes to identify the quality, safety, security, privacy, and unintended consequences issues in the case.
List interprofessional team members who may be consulted on this process and their expected role.
Design strategies for your workplace to mitigate the issues identified from the case. 
Provide at least one visual of the process and proposed changes (i.e., flow chart, process map, data quality, pareto chart, control chart, data visualization).
Identify changes if needed to policies, EHR, equipment, and other HIT applications.
Create a communication/transition plan.
Develop a staff education plan on changes.
What change theory would be best for this program?
What educational deliver method (s) would be most effective? 
Compose metrics for evaluating the plan in each of the learning domains:
Cognitive
Psychomotor
Effective
Reflect on the ramifications of criminalizing the nonintentional reporting of mistakes on your own advanced practice, the nursing profession, and Quality Improvement practices. 
Submit the written report in APA 7th ed. format, 10-12 pages in length, not including title page, the 1-page reflection and references. Use headers to distinguish the sections of the paper.
 *Note: There are gaps in information available to the public on this case. For the purposes of this project, you may devise realistic responses and fill in the gaps, missing, or incomplete information as appropriate. 
Excellent writing is expected including following the MEAL plan. This means your first Main idea sentence covers the whole paragraph and does not have a citation. You then follow with Evidence or cited content, then Analysis of your evidence (no citations), and finally a Link out or closing your paragraph (no citations). Paragraphs are generally 5 sentences in length to accommodate the MEAL plan.
Refer back to my previous announcement for lots of writing tips. Please follow them.
My recommendation for this paper is to use PDSA for your quality improvement model. This is commonly used in the health care setting. Remember, this is NOT planning a project, doing it, etc.  Instead, it is small tests of change. Here are some resources:
https://www.ihi.org/resources/how-to-improveLinks to an external site.
https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.htmlLinks to an external site.
https://voice.ons.org/news-and-views/oncology-research-quality-improvement-evidence-based-practiceLinks to an external site.
https://voice.ons.org/news-and-views/oncology-research-quality-improvement-evidence-based-practiceLinks to an external site.
After your Title (centered and Bold) should come your introduction to the paper. Do Not use the heading introduction. This introduction tells the reader what they will find in the body of the text.
Your first main heading (centered and bold) should be Quality Improvement Model. You will address each of the four components after a brief paragraph that tells the reader what they will find in this section. Level 2 headings are not necessary.
Your second main heading (centered and bold) should be Mitigation Strategies. You will address each of the six components after a brief paragraph that tells the reader what they will find in this section. Level 2 headings are not necessary. Note that the visual for “A” will be described and then referred to (See Appendix A) and place there using APA formatting. You can also briefly describe your communication plan in “C” and put a table or other graphic in the appendix (See Appendix B).
Don’t forget a conclusion (heading centered and bold) with no new information thus no citations.
Your references, writing, and graphics need to be in APA 7th edition.

Discussion
After exploring the Module 5 Lesson please discuss where you see barriers or gaps within your organization surrounding the concepts of standardized terminology and meaningful use.
As an advanced practice nurse, how can you support a change to decrease or eliminate these potential barriers or gaps?

Using the course materials and other research materials, present a formal and robust definition of spirituality in relation to and for the purposes of health care.  Use lecture and other materials to explore and address the various issues and challenges that defining spirituality presents.
definition of spirituality using course materials and beyond, and apply that definition to an element of practice or theory in the area of the student’s interest or responsibility. This
a formal and robust definition of spirituality in relation to and for the purposes of health care
Topic: Spirituality in cancer patients

MASTERS LEVEL ONLY
APA 7
3 or more citations/references needed from American scholarly journal of medicine, no cover page needed
You are working as a psychiatric nurse practitioner in an outpatient setting. A 72-year-old Asian female is scheduled today for an initial intake. She broke her hip and was in rehab for six weeks. While she was living at the nursing home, she had restraints applied due to her attempts to remove the dressing on her hip. Her son is with her during the intake because, at times, she presents as disoriented. The chief complaint follows: “It has been difficult to come to see you in the office. My spiritual beliefs will not allow me to take medication every day.”
What are the therapeutic concerns regarding the need to establish a relationship with this elder?
What factors will you consider regarding the plan of care? Be sure to address the potential for the patient to become uncooperative (i.e., needing restraints)
What are the cultural, ethical, and spiritual concerns you need to keep in mind?
How would you arrive at a diagnosis (including a differential diagnosis) and the possible need for medication genetic testing (include specific medication options)? 

For this assessment, you will report on the information that you collected in your interview, analyzing the interview data and identifying a past or current issue that would benefit from an interdisciplinary approach. This could be an issue that has not been addressed by an interdisciplinary approach or one that could benefit from improvements related to the interdisciplinary approach currently being used. You will discuss the interview strategy that you used to collect information. Your interview strategy should be supported by citations from the literature. Additionally, you will start laying the foundation for your Interdisciplinary Plan Proposal (Assessment 3) by researching potential change theories, leadership strategies, and collaboration approaches that could be relevant to issue you have identified. Please be certain to review the scoring guide to confirm specific required elements of this assessment. Note that there are differences between basic, proficient and distinguished scores.
Summarize an interview focused on past or current issues at a health care organization.
Identify an issue from an interview for which an evidence-based interdisciplinary approach would be appropriate.
Describe potential change theories and leadership strategies that could inform an interdisciplinary solution to an organizational issue.
Describe collaboration approaches from the literature that could facilitate establishing or improving an interdisciplinary team to address an organizational issue.
Communicate with writing that is clear, logically organized, and professional, with correct grammar and spelling, and using current APA style.