PATHOPHARMACOLOGICAL FOUNDATIONS FOR ADVANCED NURSING PRACTICE
Leadership Concepts and Theories – The graduate evaluates leadership practices that support accountability and integrity within an organization.
Systems Theory and Change Theory – The graduate relates systems theory and change theory to the design, delivery, and evaluation of healthcare.
Role Development and Effective Inter-professional Teams – The graduate analyzes effective leadership strategies within the context of the inter-professional team.
Business and Economic Principles and Practices – The graduate identifies the impact of business and economic principles and practices, and regulatory requirements on the provision of healthcare.
Contemporary Healthcare Leadership Issues – The graduate analyzes the impact of contemporary healthcare trends and practices on the delivery of healthcare.
As an advanced practice nurse, it is important to diagnose, treat, and evaluate patients who have chronic disease. A nurse must understand how pathology, treatment, regimens, and psycho-social issues affect patients and the care they receive. Disease management is more than just monitoring a medication or treatment; it is evaluating the disease process from the micro to macro level. As a nurse with an advanced degree, you will be expected to assess patients and individual and population responses to chronic illness.
For this assessment, you will investigate pathopharmacological issues related to a specific disease process. You may choose to investigate traumatic brain injury, depression, obesity, asthma, or heart disease. As part of this assessment, you will analyze the various impacts the disease process has on the patients, their families, and populations at a local, national, and international level.
A. Investigate one of the following disease processes: ASTHMA
1. Analyze the pathophysiology of the disease process you selected in part A.
2. Discuss the standard of practice for the selected disease process.
a. Discuss the evidence-based pharmacological treatments in the state of Oklahoma and how they affect management of the selected disease in your community.
b. Discuss clinical guidelines for assessment, diagnosis, and patient education for the selected disease process.
c. Compare the standard practice for managing the disease within your community with state or national practices.
3. Discuss characteristics of and resources for a patient who manages the selected disease well, including access to care, treatment options, life expectancy, and outcomes.
a. Analyze disparities between management of the selected disease on a national and international level.
4. Discuss four factors (e.g., financial resources, access to care, insured/uninsured, Medicare/Medicaid) that contribute to a patient being able to manage the selected disease
a. Explain how a lack of the factors discussed in part A4 leads to an unmanaged disease process.
i. Describe characteristics of a patient with the selected disease that is unmanaged.
B. Analyze how the selected disease process affects patients, families, and populations in your community.
1. Discuss the financial costs associated with the selected disease process for patients, families, and populations from diagnosis to treatment.
C. Discuss how you will promote best practices for managing the selected disease in your current healthcare organization.
1. Discuss three strategies you could use to implement best practices for managing the selected disease in your current healthcare organization.
2. Discuss an appropriate method to evaluate the implementation of each of the strategies from part C1.
D. When you use sources, include all in-text citations and references in APA format.
Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.
Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.
Note: No more than a combined total of 24% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.
Example of paper: As follows
Investigated Disease Process
? Investigate one of the following disease processes – asthma.
? The competency of the course is for graduate to evaluate
high-volume/high prevalence, high impact disease
processes thus students should focus on the
disease as a whole and in the general adult population
? As part of this assessment, you will analyze the various impacts the disease process has on the patients, their families, and populations at a local, national and international level.
? So basically here, all you need to do is provide an introduction of your selected disease.
? This is where you analyze the pathophysiology of the disease process you selected in part A. BE SURE to discuss, not only the macro changes associated with the affected organs/organ system, but, also, the cellular and functional changes. In terms of cellular changes for example, if your disease state was asthma, you would have to explain about the inflammation cascade to truly grasp the pathophysiology.
? You are required to sufficient evidence in the analysis to show an understanding of the disease, its effect on the body, its progression through the selected disease process.
? A good place to start is your text in the course of study: McCance, K.L., Huether, S.E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th Ed.). St. Louis, Missouri: Mosby Elsevier. ISBN: 978-0-323-08854-1
A2. Standard of Practice
? Here, you are required to discuss the standard of practice for your selected disease process. I would recommend discussing Standards of Practice for your institution.
? Standard of practice is a consensus of what healthcare providers actually do for certain disease states on a day to day basis in hospitals and clinics in which you work. Many times the physicians/healthcare providers will base their standards of practice on clinical guidelines, thus resulting in the same guidelines. However, this is not always the case.
? Standards of Practice may be found in protocols or via interviews with personnel (ie: Cardiologist-for heart failure, Psychiatrist-for depression) at your institution (hospital or clinic) within your local area.
? For A2, we recommend you discuss Standards of Practice for your hospital/clinic also in terms of assessment, diagnosis, treatment, and patient education so that you can later compare to clinical guidelines (A2c). Referencing both in terms of assessment, diagnosis, treatment (pharmacological and non-pharmacological), and patient education/follow-up care will allow you to provide a good/consistent comparison for later in A2c.
A2a. Pharmacological Treatments
? You are required to discuss the evidence-based pharmacological treatments in your state and how they affect management of the selected disease in your community.
? You should discuss the current pharmacological treatments of the selected disease process based on current evidence-based practice.
? Including names and classes of medications, mechanism of actions, possible side
effects, and monitoring parameters would be good ways to add details to your paper
? If there is a method/guideline/algorithm for how the pharmacological treatment is
selected for your disease state, this would definitely be a good area to add/include
? Regarding “how they affect the management of the selected disease in your community,” reflect on the psychological, social, and economical effects of the medications on the patient and does it affect other aspects of treatment for the disease state? Think about any possible practitioner-related barriers that may present when attempting to adhere to the pharmacological guidelines. These are questions for you to consider as you provide your discussion. In addition, information can be obtained from your county or state health department, as well as from local hospitals and health care organizations. They don’t necessarily have to be published data, although, that would be the most preferable source. Definitely contact their records department and let them know that you are a graduate student working on a research project. They would be glad to assist you.
A2b. Clinical Guidelines
? This item requires that you discuss clinical guidelines (guidelines that assist the health care professional to consistent practice) in terms of assessment, diagnosis, and patient education for your selected disease process.
? To be able to answer this task requirement, you have to understand that Clinical guidelines (aka National Standards of Practice) are the golden standard of care. They are established by various organizations for certain disease states and are based on examination of evidence (clinical trials) within the paradigm of evidence-based medicine (i.e.; The American College of Cardiology Foundation-ACCF/American Heart Association-AHA compiles the clinical guidelines for heart failure/heart disease). A healthcare provider is obligated to know the medical guidelines of his or her profession, and has to decide whether or not to follow the recommendations of the guideline for an individual treatment. Clinical guidelines identify, summarize, and evaluate the highest quality evidence and most current data about prevention, assessment, diagnosis, patient education, treatment/therapy including medications, follow-up care, prognosis risk/benefit and cost-effectiveness. Some guidelines contain decisions or algorithms to be followed. Guidelines integrate identified decision points and respective courses of action with the clinical judgment and experiences of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use. ***Please note that the task requirement only asks for the discussion on assessment, diagnosis, and patient education.***
? Example of Heart Asthma Clinical Guidelines:
A2c. Comparing Standard Practice of Disease Management
? In this rubric item, you are required to compare the standard of practice for managing the disease in your community (ie: your institution-which you should have done in A2 already) with state or national practices (If you go with national practice you have already done this in A2b, thus you would only have to provide a discussion on the similarities/differences between standard of practice and national practice/clinical guidelines). Remember A2c gives you the option to compare your institution’s standard of practice against that of state OR national (clinical) guidelines.
? We recommend using the information you gathered in A2, A2a, and A2b to provide the discussion here for A2c. Use your information in A2 (your institution’s standards of practice) and compare it with A2b (clinical/national guidelines) in terms of assessment, diagnosis, patient education. You can also use information in A2 (your institution’s standard of practice) and compare it with A2a in terms of pharmacological treatments. Even if it is the same state that and point out why they are the same, give examples. If they differ, point out why they differ and provide discussion. It is ok if they are the same. Many institution want to meet the golden standard (national practice/clinical guidelines) so they will adopt the clinical guidelines as their standard of practice. However, remember in your discussion that you cannot simply state they are the same. Your discussion must be robust and as detailed as possible. You can state that they are consistent but remember to point out where and how they are the same ie: if assessment is the same, what tools or approach do they both use; if treatment differs, what do they do differently, why, what are the benefits of the different approaches, etc. In your comparison, you should discuss any inconsistency/consistency. If they differ in diagnosis, be sure to pinpoint how it differs and provide discussion on how that may affect disease management.
? Details and supporting data would be great inserts. For example: In comparing this author’s standard of practice at XYZ hospital, the standard of practice at XYZ hospital aligns with the National guidelines for CHF. One aspect of how they coincide is within pharmacological management. Due to the data from the FAMOUS TRIALS, XYZ hospital has also adopted the use of ace-inhibitors in their treatment algorithm to decrease morbidity/mortality. Another aspect in which XYZ Hospital’s standards of practice is the same as national guidelines in within patient education. Here both XYZ hospital and National Guidelines provide patient education in a multidisciplinary manner. Etc……
? For state information, contact your state department of health or any local
organization specific to your disease. Researching to see what is available or most often used in your state are great ways to provide information. Call your state board of pharmacy to see if they have any state prescriptive trends for your disease state they could share.
A3. Managed Disease Process
? You should discuss characteristics of and resources for a patient who manages the selected disease well, including access to care, treatment options, life expectancy, and outcomes.
? Most revisions are due to omission of discussion on either access to care, treatment options available, life expectancy, and the likely outcomes of a patient who is managing the disease well.
? The discussion may include information about how a patient managing the disease would present, what their quality of life is like, and what it takes for the patient to have a managed disease.
? You do not need to choose just one patient to talk about. In general describe well managed patients in terms of access to care, treatment options, life expectancy, outcomes, characteristics and resources for those patients.
? You may also discuss any family support or other resources involved in managing the disease.
? Try to think of characteristics that actually contribute to/enable the patient to manage their disease well. For example, compliant, determination, people with greater support system, etc…. Which type of practitioner does a patient with a well-managed disease most likely have access to? Describe what access to care (think about specialist vs. generalist, skill-level of providers, availability of service to the patient), treatment options (what is the range of options like for someone who can afford more?), and life expectancy looks like for a well-managed patient. How does that improved outcome look like? Are there any data to support life expectancy or outcomes? These are just a few things to consider as you provide your discussion.
? This is a two part task. You should analyze disparities that exist between management of the selected disease on the national and international level.
? For national disparity, think about how different climates within the US may affect asthma, how gender, ethnic backgrounds, age, rural vs. urban areas may affect management.
? On an international level, you should look up management of your disease state in 2 to 3 different countries and compare and contrast the strategies of management (assessment, diagnosis, treatments, patient education, prevention, follow-up care, etc) in the different countries.
? Be able to answer questions such as how does the strategy in managing heart failure differ in Europe versus the strategy of managing heart failure in the United States? To be able to provide this information, you need to look up the actual guidelines in a couple other countries and compare it to the clinical/national guidelines within the United States. For heart failure, here is a link that may help you get started: https://www.escardio.org/Guidelines-&-Education/Clinical-Practice-Guidelines/ESC-Clinical-Practice-Guidelines-list/listing.
? You should be specific in your discussion. You should not make generalized statements like grouping third world countries together. Which third world country and for instance how does that country diagnose differently?
? As for international sources, take a look at medical journals published in other countries i.e. The Lancet Global health, British Medical Journals, Canadian Medical Association Journals, etc.
? Another great way to find information is to perform a Google, PubMed/Medline, or CINAHL (cumulative index for nursing and allied health literature) search with “European CHF guidelines” or “China asthma guidelines” to see if there are any international medical websites as well as articles with such information.
? Information from World Health Organization alone will not be enough to meet the requirements for this task.
? Here is an example of comparing disparities in management of obesity: “Although assessment for, as well as diagnosis and treatment of obesity is very similar in the UK as the United States, one slight difference is in the increased level of health promotion found in the United Kingdom. An experiment was conducted (“New Study,” 2014) which consisted of displaying strong visual health prompts in many of the UK’s grocery stores. Displays of large cut-outs of health professionals and bright large slogans promoting healthy food choices were strategically placed next to the healthier foods (“New Study,” 2014). Another disparity in the UK compared to the United States involved the discontinuation of sibutramine (Reductil). The European Medicines Agency found that the cardiovascular risks outweighed any benefits for weight loss.” As you can see the disparities in management of obesity between UK and US are within promotion and treatment.
A4. Managed Disease Factors
? This item in the rubric requires that you discuss three or four factors that contribute to a patient being able to manage the disease well.
? Your discussion should include three or four of those factors listed in parenthesis (financial resources, access to care, insured/uninsured, Medicare/Medicaid). If your discussion does not include these factors you will not get full points and will most likely have to revise.
? The information may seem redundant. Remember to note the perspective from which you are to provide the discussion. So basically you are discussing one end of the spectrum (well managed) in A4 regarding those factors in parenthesis and then go to talk about the other end of the spectrum (unmanaged disease for A4a) in regards the same factors in parenthesis. To prevent being redundant, you can chose one aspect of those factor to speak about in a well-managed patient and then speak about another aspect of that factor in the unmanaged patient. For example, for financial resources, you could break that down into 2 aspects: compliance and level of education. You could talk about financial resource and relating it to compliance in a well-managed patient for A4 but then talk about financial resource and relating it to the low level of education for an unmanaged patient in A4a. Then do the same for access to care, insured/uninsured, Medicare/Medicaid. It is all about how you present the information while relating it to what the task requirement is asking.
A4a. Unmanaged Disease Factors
? Here, you should explain how the factors discussed in part A4 contribute to a patient not being able to manage the selected disease.
? Your discussion should again reference those factors in parenthesis: financial resources, access to care, insured/not insured, Medicare Medicaid
A4ai. Unmanaged Disease Characteristics
? In this rubric item, you should describe the characteristics of a patient who does not manage the selected disease well.
? You should provide a description of a patient with characteristics (personal or disease specific) of an unmanaged disease process. Personal characteristics may include an asthma patient living or working in poor conditions, lack education, may not be motivated to participate in care. Characteristics related to disease may include patient suffering frequent exacerbations, care is more likely provided with emergency room visits, more likely to be hospitalized, multiple comorbidities.
B. Patients, Families, and Populations
? You should analyze how this disease affects patients, families, and populations in your local community. You may, for example, discuss, but are not limited to, how the disease affects the patient’s ability to work and what implications that has for the family and the community.
? You may also discuss, but are not limited to, how the patient’s family is affected by managing the disease (e.g., multiple family members caring for the patient, multiple family members having the disease, amount of family resources being contributed to managing the disease), and how that changes the family dynamic and/or community.
? In additional to the emotional/psychological aspect of the disease for the patient and family, be able to connect the dot between or on how chronic illness really impacts the healthcare crisis. For example, a patient with chronic illness starts to miss work days for the individual then it rolls over for family members who also have to miss work and now become care takers for the sick family member. Not only is there lost income for the patient, the caretaker (family), there is unproductivity at work due distraction of sick family member. So the missed work days really compound. This becomes a huge issue because the individual and their caretakers are no longer contributing (paying taxes) to the healthcare fund but are using and dwindling the healthcare fund/resources provided by healthy productive taxpayers. And if there is a greater number of the population sick then those healthy the fund is going to be depleted faster than it can be replenished. Do you think that is an issue? What does it mean for the population/economy? And how do we as healthcare providers contribute to resolve that issue? We recommend being able to provide a substantial discussion of the domino effects of missed work days from the individual patient, to families (for example parents of children with asthma) and then the economy/community/population as a whole. Statistics supporting the financial aspect would be good details as well as expanding your discussion.
? You should discuss the financial costs associated with the selected disease from diagnosis to treatment. What is the financial cost of the disease for patients, families, and populations? Make sure to include this in your discussion. You may discuss, but are not limited to, out-of-pocket expenses for patient and family, medical insurance costs for families and communities, government program costs.
? healthcarebluebook.com and goodrx.com are good places to start looking for fair healthcare costs and prescription prices respectively.
? Ensure you include cost from diagnosis to all treatment options available for disease state. You can also call local providers’ offices to find out pricing of procedures as it applies to your disease state. For example, what does it take to be diagnosed with a disease??? Usually a doctor’s visit and labs or tests. So you will have to research and look that up. Then you go into treatment cost so you would have to discuss about the cost for all the treatment options available for your disease. Providing actual dollar amounts and breaking down the cost is recommended because it really puts things into perspective when there is an actual number associated with it. You may also reflect on the cost to the individual, family and population on the loss of income and the effects of that in your discussion as well. Some information can be readily obtained by contacting the Billing/Records Dept. of any local health care facility or hospital. They are usually eager to assist when you let them know that you are a graduate student working on a research paper. Your local and state health department is yet another source for this information.
C. Best Practices Promotion
? Discuss how you will promote best practices for managing the disease in your current health care facility (your place of employment).
? Promote means to “contribute to the progress or growth of, support, or actively encourage.” So before you can implement strategies or plans, what do you think would be an appropriate way to support or actively encourage management of disease as a whole within your institution? One common way is to educate. Who is it that we need to educate and how do we educate? Be creative here and think of ways you can deliver that education. Examples of education may include one to one or one to many.
C1. Implementation Plan
? Identify three strategies to implement best practices for managing your selected disease in your current health care organization (place of work).
? For some of you who have very specialized patient population, it does not necessarily ask you to identify how you would manage the disease within your own patient population. Rather, you are required to identify strategies that you would implement in managing the disease within you organization as a whole.
? Examples may include, but are not limited to, nursing education (conducting seminars), collaboration between healthcare leaders (different disciplines), new policies (designing and implementing new protocols), providing new service(s), staff involvement with community (For example, getting your coworkers to volunteer to provide an hour of one on one weekly/biweekly support for patients with your disease).
? Be creative here and think outside the box. This task requirement really prepares you for your future capstone project.
C2. Evaluation Method
? Discuss an appropriate method to evaluate the implementation of each of the strategies you developed in part C1.
? You may discuss what steps you would need to take in evaluating the effectiveness of your strategies once they have been implemented. How would you measure the outcome?
? For example, an implementation method for obesity may be to implement a policy change in charting technique. This implementation would require physicians to calculate and dictate a BMI on every patient and to insert this pertinent information in an easy to visualize place in the electronic medical record. The evaluation method for the aforementioned implementation method would be to conduct chart reviews of physician office visit notes to see if identification of obesity and BMI calculations were determined in the electronic medical record. Once you have listed your evaluation method, give details as to what you would do or address the information found from that evaluation method.
? Be sure to be descriptive and robust in your discussion on how you will carry out each strategy and how you will evaluate (ie: utilizing surveys for those involved) and measure the effectiveness of each strategy.
? When you use sources, which you most definitely will in the completion of this task, include all in-text citations and references in APA format.
? List in APA 6th edition Format
? Many online sites to help with this APA format: https://owl.english.purdue.edu/owl/resource/560/01/
? This performance assessment CANNOT be done in power point presentation
? Do not combine answers or task requirements. Keep your format in the same chronological order as the task requirements. This allows ease for evaluator to identify your answers and grade your paper. In addition, it will keep you focused on what information is needed as you write your paper. Answer one section, then move onto the next.
? It is always a good idea to restate the question while you are answering and providing your discussion. This will allow you to keep your answer/discussion focused.
? Break up the task requirement and ensure you answer every part of the question.
? This research paper is considered a high stakes performance assessment and it is at the evaluator’s discretion whether the paper will pass. We are not allowed to proofread the paper. Course mentors are here to help provide you with interpretation of the task requirement and get you on the right track, once you have identified which task requirement you are having trouble with.
? Directions for the Author must be read before reading this document. Rubrics will only help you understand how your work will be graded.
? Do not skip the course of study, information provided in one disease state may be carried over/applied to another disease state. Reading through all the links provided as well as all the case studies his highly recommended.
? This performance assessment DOES require researching OUTSIDE the course of study
? Some answers may be similar. Remember: RESTATING is always better than having to revise.
? Information derived from the interviews is acceptable to include as an in-text citation, however, it cannot be included in the bibliographic reference page provided on the last page of the document.
? There is a 22 page requirement for the PA, however, the primary objective is that you answer what is being asked with expert perspective and providing great detail/substantial discussion
? No more than 24% of paper may be cited. Please reach out to CWE for help with paraphrasing.
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