Generalized Anxiety Disorder

10 Exemplars

Exemplar I: NR503 Population Health, Epidemiology & Statistical Principles Week 3

The prevalence of underweight, overweight and obesity in children and adolescents from Ukraine

The main objective of this study was to determine the prevalence of obesity, overweight and underweight in Ukrainian children. The study took the format of a cross-sectional design where a representative sample of 13,739 was taken for the children. Measures taken from the children included body weight and height and the Body Mass Index (BMI) obtained from these. Results were interpreted based on standards of the US Center for Disease Control (CDC) International Obesity Taskforce (IOTF) and the World Health Organization (WHO).Results indicated that 12.1% of children are underweight, 17.6% overweight and 12.6% obese among children aged 12 to 18 years. More of the young populations are obese than the old in the country. The prevalence of overweight and obesity among Ukrainian children is higher than the average for Europe that stands at 30%. However, compared to the US, 18.5% obesity in children, Ukraine children are less obese. Included in the article are measures that would help reduce the prevalence of overweight at a national level (Dereń et al., 2018).

This article is relatively relevant to an average reader in the US. While it does not indicate the impact of the high rate of overweight and obesity, it shows that the US leads the world in cases of obesity and overweight. It has the capacity to influence group decision making more than individual based decisions. The article left out the most relevant information such as factors that have contributed to the high rate of overweight and obesity among children in Ukraine. Another important information that would have been included in the article are measures to control the overweight epidemic at an individual level (Dietz et al., 2015). Another important information would be methods to determine one’s weight status to determine if they are safe or not.



Dereń, K., Nyankovskyy, S., Nyankovska, O., Łuszczki, E., Wyszyńska, J., Sobolewski, M., & Mazur, A. (2018). The prevalence of underweight, overweight and obesity in children and adolescents from Ukraine. Scientific reports, 8(1), 3625. (Links to an external site.)

Dietz, W. H., Baur, L. A., Hall, K., Puhl, R. M., Taveras, E. M., Uauy, R., & Kopelman, P. (2015). Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet, 385(9986), 2521-2533.

Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

AACN MSN Essentials

· Essential I: Background for Practice from Sciences and Humanities

NONPF Core Competencies

· Scientific Foundation Competencies

· Technology and Information Literacy Competencies

I have learned a lot of understanding and knowledge of epidemiological and statistical concepts.  It is stated in the course overview, “epidemiology is an important tool in the Advanced Practice Nurse (APN) arsenal for providing effective and fiscally responsible healthcare to individuals and populations.”  With that being said, this course has given me the necessary tools and knowledge to meet the MSN Essential II and NP Core Competencies #2.  Program Outcome #4 is regarding quality improvement and safety, the integration of scholarship into practice, and promoting the health of populations through prevention (AACN, 2011).  I was able to achieve Program Outcome #4 through the case studies presented each week.  Each case required a list of possible differentials to include pathophysiology, etiology, and treatment options.  Each case required critical thinking and the use of current research.  Quality improvement and safety were promoted with evidenced-based research offering current evidenced-based treatment options to incorporate into daily practice.

Exemplar II: NR 505 Advance Research Methods Week 5

The research PICO question;

P = How effective is the incorporation of massage therapy compared to the sole use of opioids in the management of chronic pain among the elderly with chronic non-cancer pain seeking help in a primary healthcare setting?

I = Intervention—Massage therapy and opioid prescription

C = Control or Comparison— what is the effectiveness of massage therapy versus Opioid use for chronic pain.

O = Outcome — The acceptable pain level will less than 3.

T = Time Frame – 3 months


The quantitative research approach that provides a summary of data gathered to support generalizations will be used. This approach allows for a broader study by taking a big number of subjects allowing generalization of results and also allowing for a greater level of accuracy and objectivity (Choy, 2014). For the study design to provide summaries of data that support generalizations, a few variables are tested on many cases using highly rigid prescribed procedures to ensure validity and reliability. Finally, keeping a distance from the subjects and ensuring they are unknown to him/her, the research can avoid personal bias (Choy, 2014). The research aims at studying the effectiveness of incorporation of massage therapy in pain management and the exclusive use of opioids, in primary health care. Consequently, we need measurable numerical descriptions of effectiveness rather than narratives and verbatim information given by a qualitative research approach (Choy, 2014). This will help create a highly precise relational model between the method of pain management used and the level of pain control achieved.

The experimental design where the researcher manipulates the independent variable in some independent groups will be used in the study. The primary use of the experimental research design is to understand the causal relationship (Salazar, Crosby & DiClemente, 2015). Another hallmark of the experimental research design is the random selection of participants to be included in the groups available in the research making the treatment distributed among the participants (Harriss & Atkinson, 2015). Due to the repeatability of the experimental research design, results can be checked and verified for validity. The experimental design also allows for many variations that allow the researcher to tailor their experiment while still maintaining the design validity. The relative freedom of an experimental method may lead to results that are not applicable in real life situation if the researcher engages in too many hypotheticals (Harriss & Atkinson, 2015). Also, ethical considerations are very vital when the experimental methodology is applied in human subjects hence is not highly popular in health research (Bromley, Mikesell, Jones & Khodyakov, 2015).

Data quality is defined by validity, reliability, objectivity, integrity, relevance and completeness. To ensure the integrity of data, there will be a random selection of participants to avoid researcher bias. Careful provision of the treatments by first treating the administers will ensure the validity of data. To ensure generalizability, a relatively large number of participants will be recruited. Consistency in recording results will ensure the completeness of data.



Bromley, E., Mikesell, L., Jones, F., & Khodyakov, D. (2015). From subject to participant: Ethics and the evolving role of community in health research. American Journal of Public Health105(5), 900-908.

Harriss, D. J., & Atkinson, G. (2015). Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med36(14), 1121-1124.

Salazar, L. F., Crosby, R. A., & DiClemente, R. J. (2015). Research methods in health promotion. John Wiley & Sons.

Choy, L. T. (2014). The strengths and weaknesses of research methodology: Comparison and complimentary between qualitative and quantitative approaches. IOSR Journal of Humanities and Social Science19(4), 99-104.


Chamberlain Program Outcomes

· PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)

AACN MSN Essentials

· Essential VI: Health Policy and Advocacy

NONPF Core Competencies

· Scientific Foundation Competencies

· Policy Competencies

Exemplar III: NR 507 Advanced Pathophysiology Week 3

Sickle cell anemia is a disorder that causes the oxygen-carrying red blood cells to misshapen, distort, become rigid and at times take a crescent shape. It is a genetic disease in which in the sixth amino acid of the beta globin chain, valine is replaced by glutamic acid. The valine replacing glutamic acid has the ability to fit in the hydrophobic pocket of the hemoglobinmolecule causing the hemoglobin in red blood cell to polymerize and form hemoglobin tetramers recognized by long stiff fibers (Rivera, Veneziani, Ware & Platt, 2016). The sickle cell disease occurs when a child inherits the sickle cell gene from both parents.

The hemoglobin polymerization is either triggered by acidosis or hypoxia that causes the increased rigidity of red blood cells making them become crescent-shaped. Further, the deformed cell may cause vaso-occlusion in small blood vessels when they adhere to the endothelium that slow blood flow in larger vessels (Steinberg et al., 2014). Further, the deformed cells are susceptible to hemolysis cause anemia. The sickle cell state is an inflammation resulting from the abnormal activation of granulocytes and monocytes precipitated by cold, stress, extreme exercise acidosis, dehydration, and infections among other factors.

One of the hallmark symptoms in the patient is the episodic pain where she complains of abdominal pain and severe chest pain. The second sign is the high temperature that the patient reports to have had during her exercise. Jaundice is also an indicator of sickle cell (Steinberg et al., 2014). The low blood pressure and the history of sickle cells confirm that she has the disorder.

Pain is the major sign of sickle cell anemia and is referredto as crises. It normally develops when the crescent shapes red blood cells block small blood vessels in the chest, joint, andabdomen. Lasting for weeks and varying in intensity is the major indicator that the pain is caused by sickle cell. Sickle cell anemia increases individual susceptibility to infections that can cause fevers in the patient. Long lasting sickle cells episodes can cause a deficiency in nitrous oxide as hemoglobin and arginase are released from lysed blood cells and scavenge on it (Steinberg et al., 2014). The deficiency in nitrous oxide may cause thrombosis or pulmonary vasoconstriction hence blood pressure problems.

One important teaching to give the patient is on the importance of prevention of infections through hygiene and avoiding exposure to germs. They should be advised to take plenty of water as dehydration increases risk. They should avoid temperature extremes, do regular but not extreme physical exercise and avoid the uncontrolled use of over the counter drugs as they may affect their kidneys (Steinberg, 2016).



Rivera, C. P., Veneziani, A., Ware, R. E., & Platt, M. O. (2016). Sickle cell anemia and pediatric strokes: computational fluid dynamics analysis in the middle cerebral artery. Experimental Biology and Medicine, 241(7), 755-765. (Links to an external site.)

Steinberg, M. H. (2016). Overview of sickle cell anemia pathophysiology. In Sickle Cell Anemia (pp. 49-73). Springer, Cham.

Steinberg, M. H., Chui, D. H., Dover, G. J., Sebastiani, P., & Alsultan, A. (2014). Fetal hemoglobin in sickle cell anemia: a glass half full?. Blood, 123(4), 481-485.


Chamberlain Program Outcomes

· PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused)

· PO #4: Integrate professional values through scholarship and service in health care (Professional identity)

AACN MSN Essentials

· Essential VIII: Clinical Prevention and Population Health for Improving Health

NONPF Core Competencies

· Independent Practice Competencies

· Policy Competencies

· The purpose of the MSN program is to equip students with skills to integrate findings from different fields including nursing, public health, genetics, nursing, biopsychological fields to improve the quality of care delivered in diverse settings. This course improves the ability of nursing professionals to use available knowledge in these fields to respond to the specific needs of patients under their care. Throughout the course, I have learned and practised different aspects that not only makes me able to respond to the needs of the given patient but also create a holistic approach to dealing with health challenges in the community.

· Among the most important aspects that we went through in class are Evidence-Based Practice (EBP) and the utility of research knowledge in patient care. EBP involves the explicit, judicious and conscientious use of the most current research findings to make decisions on patient care (Solomons, Spross & Lamb, 2017). It involves the integration of patient values, clinical expertise accumulated through experience and most appropriate evidence from research to make decisions about patient care. I have acquired the skills and knowledge necessary to allow me to assess patients, ask clinical questions, acquire evidence and appraise it before applying and evaluating it in the clinical setting. While EBP gives an opportunity to reduce cost and time used in care among other benefits, the most important is the allowance for tailor making care to make it patient centered.

· Through EBP, the specific needs of individual patients are integrated with their values and desired outcomes. This is patient-centred Care and leads to improved healthcare quality and reduced hospital stay. Patient-centred healthcare involves encouraging the active collaboration in making decisions among the different stakeholders of patient care including family to ensure customized care is provided (Elwyn et al., 2014). Patient-centred goals are hence aligned with the vision, mission and quality improvement goals of healthcare. Patient-centred care focuses on both the emotional and physical comfort of patients (Hack et al., 2017). Chief Benefit of this integration includes improved healthcare outcomes and reduced stay in hospitals.

· Nursing not only involves the integration of different fields in EBD to provide both patient-centred care and enhance the health of the society. In this course, different fields including genetics, psychology, social science, biology and others were used as the basis for understanding different conditions and create solutions. This integration improves the quality of healthcare delivered by the nurse to increase health quality in the society.


· References

· Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275. (Links to an external site.)

· Hack, S. M., Muralidharan, A., Brown, C. H., Lucksted, A. A., & Patterson, J. (2017). Provider behaviors or consumer participation: How should we measure person-centered care?. International Journal of Person Centered Medicine, 7(1), 14-20. (Links to an external site.)

· Solomons, N. M., Spross, J. A., & Lamb, G. (2017). Influence of Nurse Social Networks on Evidence-Based Practice (EBP): Results of an Exploratory Study.


Exemplar IV: NR 508 Advanced Pharmacology Week 5

For Maria who is at risk of developing diabetes mellitus, there are several treatment goals to help regulate and reduce the chances of occurrence.  Maria is at the pre-diabetes stage of the disease and risks getting the disease with symptoms that may impede her quality of life.  The first goals are to lower the fasting plasma glucose from 179mg/dl to the normal range of less than 110 mg/dl to 90mg/dl. The second is to lower the HgbA1C percentage from 7.4% to normal ranges of 4% to 5.6%. The third goal is to reduce the TSH levels to 5.5 and below.  The final goal is to reduce Maria’s weight to lower the chances of getting diabetes and the consequences that come with it.

Maria should get the first line of diabetes management drugs. Metformin is the first line of diabetes medicine and is often given to first time users.  Metformin is an antihyperglycemic agent that improves the patient’s tolerance to glucose through several ways that lower basal and postprandial plasma glucose (Chaudhury et al., 2017).  First, metformin decreases intestinal absorption of glucose hence making the amount reaching the bloodstream from the intestines low (Lipska et al., 2015).  It also reduces hepatic glucose production hence lowers the amount of glucose coming from the liver by glycogen breakdown.  Thirdly, metformin increases cell insulin sensitivity by increasing peripheral uptake and utilization (Chaudhury et al., 2017).  It further does not cause hypoglycaemia.  The patient would also be given sulfonylureas which act by increasing the production of insulin (Chaudhury et al., 2017).

For patients using metformin, several points of teaching are important to regulate blood sugar and ensure no negative impacts.  The first point is on the dosage of the drug where the patient should adhere to the amount and frequency of the drug prescribed by the doctor (Chaudhury et al., 2017).  Secondly, there is a need to teach the patients on when to take medicine in relations to their food intake and exercise regime.  The thirdpoint, the patient should be taught on the possibility of side effects including those related to the alimentary canal such as indigestion, bloating, diarrhea and stomach pain. Other symptoms that may develop are headache, chest pain, rash and muscle pain(Chaudhury et al., 2017). Finally, there is a need to teach what to do in case of overdose and the consequent poisoning of the individuals.

If Maria was having an initial HbgA1C of 10.2mg/dl and fasting glucose of 305 mg/dl, there would be a need to  change the drug to insulin. Insulin will break down the excess sugar in the blood and lower it hence reduce the possibility of negative consequences (Chaudhury et al., 2017).





Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S., Chada, A., … & Kuriakose, K. (2017). Clinical review of antidiabetic drugs: Implications for type 2 diabetes mellitus management. Frontiers in endocrinology, 8, 6. (Links to an external site.)

Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., & Steinman, M. A. (2015). Potential overtreatment of diabetes mellitus in older adults with tight glycemiccontrol. JAMA internal medicine, 175(3), 356-362.



Chamberlain Program Outcomes

· PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing).

AACN MSN Essentials

· Essential VII: Interprofessional Collaboration for Improving Patient and

Population Health Outcomes.

NONPF Core Competencies

Health Delivery Systems Competencies

Exemplar V: NR 509 Advanced Physical Assessments Week 4

The Cardiovascular System


Also known as the circulatory system, the cardiovascular system is responsible for the transportation of blood containing nutrients and other substances including electrolytes, hormones, carbon dioxide and blood cells throughout the body. The circulatory system includes different components and is linked to the lymph transporting lymphatic system (Feher, 2017). Due to its importance as part of the body, the cardiovascular system needs to be thoroughly taken care of through substantive assessment not only during periods when people are unwell but also when health to ensure normal functioning.

Structure and Function

In general, the cardiovascular system can be described as being composed on the heart, blood vessels, and blood. The heart that is located in the chest is the system that pumps blood through a blood vessel to all the [parts of the body. The heart is made of cardiac muscles that aid in the movement that result in the pumping of blood throughout the body. The pumping of blood is an involuntary action aided by the pacemaker (Feher, 2017). Moreover, the heart is divided into four chambers, two atrium, and two ventricles. While atrium receives blood from the body parts, ventricles pump blood out.

Blood vessels carry blood from the heart to all the parts of the body and back. Arteries are blood vessels that carry blood from the heart to body parts while veins carry blood from all body parts back into the heart. Due to the low pressure of blood in veins compared to arteries, the former have valves that prevent backflow of blood. Among the most important major blood vessels include the pulmonary artery and vein that take oxygen from the lungs, the hepatic artery and vein that take nutrients from the alimentary canal and the coronary artery and vein that circulate blood to heart muscles (Feher, 2017). Joining arteries and veins are microscopic blood vessels called capillaries that supply blood to tissues and cells.

Blood is the fluid that is pumped through blood vessels by the heart and carries oxygen, nutrients, cells, electrolytes and waste substances throughout the body. The major components of blood are plasma and blood cells. Plasma is 92% water and is the fluid within which ions, hormones, glucose, proteins, blood cells, and carbon dioxide are found (Hillegass, 2016). On the other hand, the blood cells are different and specialized for certain functions. Red blood cells have hemoglobin to carry oxygen. White blood cells fight disease-causing pathogens and platelets aid in clotting.

Subjective data

Collections of subjective data on the circulatory system include asking for common symptoms. These include the presence of chest pain, its location, intensity, type, duration, radiation, when it occurs and with and without exertion (Hillegass, 2016). Also associated symptoms such as sweating, nausea, anxiety, and shortness of breath should also be considered. Assessment on the shortness of breath including whether it occurs when bending, after waking up, while site, or when one cough (King, 2017). Other symptoms that should be considered include irregular heartbeats, pain, numbness and tingling sensation on extremities. Skin changes to pallor, hair loss, visible veins, lower leg ulceration, and cold skin, should also be assessed.

Apart from symptoms, one should also ask for other risk factors including personal history of heart disease, diet and weight history, use of alcohol, illicit drugs, and smoking. Also the history of type 2 diabetes and a family history of heart diseases should be assessed. Information on usual daily activities such as long standing or sitting duration, bleeding disorders should also be gathered (King, 2017). History of other related diseases including diabetes and hypertension should also be considered.

Objective Data

The collection of objective data on the cardiovascular system involves the measurement of vital signs. The first is blood pressure measurement where normal rates should be between 120/80mmhg and 140/90 mmHg (King, 2017). The second is the pulse rate, and quality was normal for a person at rest should be between 60 and 100 beats per minutes. The respiratory rate should also be measured with an adult expected to have 12 to 20 breaths per minute. Secondly, the general appearance of the patient should be checked. First, the mucous membrane should be checked for pallor as normal should be pink to red. Extremities should be checked for clubbing or cyanosis. The patient should also be observed for pulsation, and retractions while sited or lying down (King, 2017). Examination of blood vessels in the neck to ensure that the corticoid artery has a local and brisk pulsation. The internal jugular vein should also be soft and with undulating pulses.

Special Examination Techniques

Auscultation is one technique used to examine the heart using a stethoscope. The assessment should occur with the patient sited, lying on the back with head lifted and lying on the left. The examiner should listen to all the four sounds including the lab, dib, ventricle gallop and the fourth (King, 2017). The examiner should also listen to murmurs that occur when there is a turbulent blood flow that can either be caused by defects in the chambers of the valve and changes in blood viscosity.

Adapting the Examination

Infant/ Pediatric

The heart and blood vessels of children are not fully developed and which makes the assessment different from that of adults. First, due to the fact that the child’s body has a low surface for the heart to pump blood, the pressure and rates are lower than those of a normal adult (King, 2017). In conduction auscultation, the examiner must consider the third heart sound as normal since their cardiac output is high while it in adults is vertical gallop.

Pregnant Women

Pregnancy increases the work of the heart as a woman has to pump more blood to replenish the increased nutritional and waste disposal needs of the body. Moreover, hormone changes may result in increased blood pressure and other changes in the cardiovascular system that may result in changes in the physical examination (Hillegass, 2016). Moreover, to protect the mother and her unborn child, frequent physical examinations are recommended including measuring blood pressure and conduction auscultation. For a pregnant woman, the breast may be large. The breast must be displaced to the left when checking for displacement.


There are age-related cardiac changes such as reduced arterial compliance and the diastolic dysfunction of the left ventricle. Also, one should check for nausea/vomiting, dyspnea and diaphoresis in the elderly suspected with myocardial infarction. Further, systolic blood pressure increase with age as the rigidity of blood vessel walls increases. Other factors that may increase with age include respiratory rate. Body temperature, on the other hand, tends to reduce with age. These should be considered during physical examination to ensure the quality of data collected and escape misdiagnosis (Hillegass, 2016). Also, knowing other medical conditions that may affect readings.

Heart Failure

Also known as congestive heart failure, this is a condition that comes when the heart muscles do not pump blood sufficiently as it should. The condition is caused by different factors including the narrowing or blocking of blood vessels, high blood pressure and accumulation of plague on blood vessels (Karlström et al., 2016). These factors involve making the heart too weak and stiff making it difficult to pump blood out. The disease can be chronic or acute depending on the cause (Inamdar & Inamdar, 2016). The symptoms of heart failure include fatigue and weakness, swelling especially on the legs, ankles, and feet, shortness of breath, reduced the ability to work of exercise, wheezing and persistent cough. Other signs of the disease include the decrease in alertness and chest pain in case the heart failure is caused by a heart attack (Hillegass, 2016). While heart failure has no cure, those affected normally lead enjoyable lives by management using drugs and lifestyle changes.

Objective data for Heart Failure

The first objective data collected for people with heart failure is auscultation. The presence of the third heart sound, ventricular gallop, indicate that the heart is struggling to pump blood and hence positive for heart failure (Yancy et al., 2017). There is also jugular venous distension among people with heart failure. There is also displaced cardiac apex among people with congestive heart failure. Others include pitting peripheral edema due to volume overload, pulmonary rales, venous distension and hepatojugular reflux (Inamdar & Inamdar, 2016). Chest radiography is recommended when one suspects the presence of heart failure. Intestinal edema and venous congestion indicate positive for heart failure.


As one of the most important body systems responsible for transportation, the circulatory system requires a constant assessment to ensure its health. The system is made of the heart that pumps blood, blood vessels which carry blood and blood containing plasma and blood cells, which may be affected by different conditions leading to ill health. In collecting subjective data, both the history of previous disease and symptoms are taken into account. Objective data mainly involve auscultation to feel the functionality of the heart and blood vessels. Due to the changes involved in old age and pregnancy, physical assessment needs be changed to accommodate these populations. One of the major disease affecting the cardiovascular system is heart failure that involves the ineffective working of the heart muscles hence inability to effectively pump blood. Upon auscultation, patients with heart failure have a ventricular gallop, show venous distension and at times peripheral pitting edema.



Feher, J. J. (2017). Quantitative human physiology: an introduction. Academic press.

Hillegass, E. (2016). Essentials of cardiopulmonary physical therapy. Elsevier Health Sciences.

Inamdar, A., & Inamdar, A. (2016). Heart failure: diagnosis, management, and utilization. Journal of clinical medicine5(7), 62.

Karlström, P., Johansson, P., Dahlström, U., Boman, K., & Alehagen, U. (2016). Time since heart failure diagnosis influences outcomes more than age when handling heart failure patients: Results from the UPSTEP study.

King, D. (2017). U.S. Patent Application No. 15/228,494.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., … & Hollenberg, S. M. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Journal of the American College of Cardiology70(6), 776-803.


Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care).

AACN MSN Essentials

· Essential IX: Master’s-Level Nursing Practice

NONPF Core Competencies

· Independent Practice Competencies

Exemplar VI: NR510: Leadership and Role of the Advanced Practice Nurse Week 1

According to Hain and Fleck, (2014), Nursing Practice (NP) in the US is affected by five major barriers. The first barrier is the state licensure system that provides for varying regulation of NPs across different states. The lack of adoption of full practice laws by at least two-thirds f states in the US has significantly reduced the ability of NPs to practice. The second barrier is the belief by physicians that they are better equipped to handle patients than nurses that diminishes the role of the NP. Thirdly, there are restrictive payer policies that limit the ability of NPs to practice independently. Again, while most states allow the prescription of essential drugs by NPs, most do not provide for follow up in acute care. Finally, there is the challenge of job satisfaction which prompts the intent to terminate work by most NPs (Hain & Fleck, 2014.

The barriers to APN practice are not new in any way to me as I have experienced, heard and read about them many times. Most common being the physician-related issues where most doctors in the organization I worked belittled the role of nurses and any attempt to help the patient in their absence was critically discouraged. Melnyk et al., (2014) noted that most nurses are either looking for new jobs or working and not satisfied. Consequently, there are very few nurses who are seeking advanced degrees in the US. While I have never been directly involved in legislative level nursing, I once collaborated with a colleague who was and noted that these barriers are real. However, they do not motivate me from becoming an APN.

These barriers are restraint of trade that interferes with the ability of nurses to fairly compete with other healthcare professionals, primarily physicians, in offering healthcare. Further, they reduce the ability of the healthcare system to provide quality healthcare to members of the public. Nurse ought to work in unison to outdo these barriers not only to save their professionals but also advance the quality of care offered by the healthcare system. One way of doing this is by incorporating patient-centered care and evidence-based practice.



Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). (Links to an external site.)

Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing, 11(1), 5-15.


Chamberlain Program Outcomes

· PO #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility)

AACN MSN Essentials

· Essential II: Organizational and Systems Leadership

NONPF Core Competencies

· Leadership Competencies

Exemplar VII NR 511 Differential Diagnoses and Primary Care Week 6

H& P Findings

The patient is a 56 year-old Caucasian female who presents with generalized fatigue that is worsening since onset two to three months ago. The constant fatigue is progressively worsening and does not subside even after sleeping eight hours at night. The problem is aggravated by exertion but there is no identifiable relieving factor. Although the patient denies pain, she has missed work for two weeks due to inability to wake up out of her bed. The patient’s child is 24 years old and has a history of bipolar depression. She is currently taking Prozac 20mg, daily vitamin B-complex, and Bisoprolol-HCTZ, calcium, and vitamin D3. She drinks on occasion and is a non-smoker. She has an allergy to iodine dyes.

On reviewing her symptoms, the patient denies having had fevers, chills or any recent illness. However, she has weight has increased +5lb for the past six months. There are no visual changes on eyes or diplopia, n lymph tenderness or swelling, no chest pain, ear pain or rhinorrhea. As a child she had tonsilectoctomy and has no current sleep apnea or snoring. The GIT is okay with no constipation or N/V/D. There also no skin, hair or nail changes and the endocrine system is fine with no challenges of polydipsia, polyuria or cold intolerance. However, her psych is worsening as seen by depressive symptoms as she thinks she is unproductive. She denies suicidal thoughts. Also, the musculoskeletal system is weak with intermittent muscle cramping in calves.

Physical showed most vital signs normal including temp 98.2, R- 16, BP- 146/95, p-74, weight-180 pounds, height -5’7. The head is Normocephalic, and atraumatic, eyes PERRLA, ears are intact with light reflex and tympanic membrane gray. The nasal drainage is clear without swelling on nasal turbines and nares patent. The neck is also supple without palpable masses and lymphadenopathy; abdomen soft, BS active and non-tender. The skin is dry, no ridging of the nails. Strength full throughout musculoskeletal and DTRs 2+ at biceps, 1+ at the ankles and knees.


Hypothyroidism- This is a disorder characterized by reduction in the amount of circulating free thyroid hormones (TH) which interjects energy metabolism. This can have great affect on all major organ systems within the body. . Its major clinical manifestations are fatigue, lethargy, cold intolerance, slowed speech and intellectual function, slowed reflexes, hair loss, dry skin, weight gain, and constipation. It is more prevalent in women than men. The body needs suitable circulating thyroid hormones, T3 and T4, to determine the body’s metabolic rate. Thyroid-stimulating hormone (TSH) regulates the thyroid gland to release these hormones. When T$ is low, this causes the thyroid to enlarge due tot the increase of TSH. When TSH is high, the thyroid received a signal to stop secreting T3 and T4, this leads to hypothyroidism. hypothyroidism involves dysfunction of the thyroid gland itself, decreasing its ability to synthesize TH (McCance & Huether, 2014). There are many reasons for hypothyroidism including Hashimoto’s disease (an autoimmune disorder), iodine deficiency, trauma, injury or surgery to the thyroid gland, inflammation, medications, and tumors (Biondi & Wartofsky, 2014). Positive findins for this patient include fatigue, constipation, cold intolerance, dry skin, weight gain DTRs diminished in lower extremities, female, signs of depression. Negatives for this patient include, no history or family history, no mass or enlarged thyroid.

Major depressive disorder (MDD)- MDD is from neurotransmitter deficiency, such as serotonin, norepinephrine, and acetylcholine, in the brain (Lee & Kim, 2017). When there is a decrease in neurotransmitters, patients can experience a wide variety of negative emotional experiences, ranging from sadness to decreased interest in activities they typically enjoy. These feelings can be accompanied by multiple symptoms such as insomnia or sleep disturbances, loss of appetite and body weight. Functional ability and concentration can also be compromised. These depressive episodes may happen suddenly or gradually and continue for weeks or even months (Lee & Kim, 2017). Positive findings for this patient include, Fatigue, no energy for daily activities, hx of depression, weight gain, gradually getting worse. Negative findings for this patient include negative self-assessment of being depressed and currently on medication for depression

Anemia- fatigue is a classic symptom of anemia. In this disease, the patient’s body lacks enough healthy red blood cells to carry oxygen to body tissues. Due to the inadequacy of oxygen in muscles tissue, they are not able to carry out their functions normally. The muscle tissue change from aerobic to anaerobic respiration which results in the buildup of lactic acid (Prochaska et al., 2017). The lactic acid is the primary cause of fatigue. Positive findings for this patient include fatigue and dry skin. Negative findings for this patient include, no family history and no tachycardia



· Hypothyroidism

· Major depressive disorder (MDD)

· Anemia

Additional Tests

The patient’s subjective and objective finding warrant the need for labs to check the thyroid function. These labs include, serum TSH and free T4 (FT4) level. Primary hypothyroidism is indicated if the TSH level is elevated and the T4 level is low. Other needed test include CBC, vitamin B12, and ferritin to rule out anemia. Lastly, the Patient Health Questionnaire-9 (PHQ-9) to measure the severity of depression should be completed.




Biondi, B., & Wartofsky, L. (2014). Treatment with thyroid hormone. Endocrine Reviews, 35(3), 433-512.

Lee, H., & Kim, Y. (2017). Pathophysiology and Treatment Strategies for Different Types of Depression. Understanding Depression, 167-176. doi:10.1007/978-981-10-6580-4_14

Prochaska, M. T., Newcomb, R., Block, G., Park, B., & Meltzer, D. O. (2017). Association Between Anemia and Fatigue in Hospitalized Patients: Does the Measure of Anemia Matter?. Journal of hospital medicine, 12(11), 898.

McCance, K.L., & Huether, S.E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed., pp.1488). St. Louis, MO: Mosby.


Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

AACN MSN Essentials

· Essential V: Informatics and Healthcare Technologies

· Essential IX: Master’s-Level Nursing Practice

NONPF Core Competencies

· Quality Competencies

· Reflection

· The past eight weeks have presented several new learning opportunities that have given me a wide variety of experience. My preceptor was very educated and allowed me to have a lot of hand on experience. She was also open with sharing her knowledge with me.

· Gaps in Patient Experience

· There is a wide range of age group populations. However, I this clinical site does not see patients under 12. Throughout completing the 125 credit hours. While I feel as if I was able to see a wide variety of patients with multiple complications as well as a variety of different age groups, I do have gaps in seeing pediatric patients. Also, my preceptor just started doing pap smears my last week of practicum, so I only got to see a small amount of women health patients, nor did I get to perform a pap smear solo. My plan is to find a women’s health and pediatrics rotation site for Sept and November. This will assist me with getting the hours as well as the patient experience that is needed to be more well-rounded in my practice. For the July session, I will be continuing on with the same preceptor.

· Progression in Clinical

· My progression in this course has been great in my opinion. My well-rounded nursing background has contributed to this. While my specialist is in Labor and Delivery/Women’s health. I also have some experience in the adult world. However, this experience is allowing me to touch up on my adult assessment skills. My self-made goals for this session were to be able to independently assess, diagnose, and treat a patient correctly. I was able to meet these goals 100% by week 4 with the assistance of my preceptor and the way she allowed me to perform independently which pushed me to critically think. I hope to become even better with assessment findings, as well as treatment plans and medication management. I will achieve these outcomes by continuing to ask questions and expanding on different patient interactions when the opportunity present itself.

· Areas of Weakness

· My area of weakness is with diagnoses. I seem to find a diagnosis that is very close to the correct one or at times, missing one of the dual diagnoses or stating the complete diagnosis. At times my diagnoses do not always coincide with my preceptors diagnoses and plan. The site that I am at see’s a lot of patients with acute symptoms. When prescribing medications for these patients that usually have multiple chronic diseases, I do not always think about the drug interactions for the medications that I am suggesting prescribing against the medications they are currently on. My preceptor has shown me different ways of identifying these interactions, so I hope to be better with this next semester. There seems to be multiple possibilities with medications and diagnosis, and I was lacking in choosing the correct ones.

· NONPF Competencies

· After reviewing the National Organizations of Nurse Practitioner Faculties (NONPF) competencies, my weaknesses were noted. I will discuss two areas in which I still need to improve on. Billing, and quality side of care. Billing and coding and is something new to me, as I have never been required to do it in the past. While this was overwhelming in the beginning, I am now competent with CPT and ICD-10 codes. At this clinical setting, the practitioners bill and code the same as well as have a billing clerk that works for them to ensure they are not missing anything as well as coding correctly to prevent fraud. While this site has a clerk, it is still extremely important for reimbursement to take full advantage of your skills with billing and coding. As practitioners, we are anticipated to be talented to properly assess patient affairs in favors to access, cost, quality, and safety (Thomas et Al., 2014). In order to ensure that my patients always receive the best care possible, these will be influences to note going forward. The next competency section “Quality Competencies” number 1 through 4 is the second one I have chosen to speak about. This entails applying the best quality evidence to improve clinical practice (Thomas et Al., 2014). This was applied in this current class through my clinical practice guideline (CPG) on Allergic Rhinitis. Exposing myself to more situations and obtaining further clinical experience will assist with my clinical strength.

· Conclusion

· Overall, I am very satisfied with the involvements that I have encountered during the past 8 weeks. I am excited to apply all that I have learned in NR 601.

· References

· Thomas, A., Crabtree, M.K., Delaney, K., Dumas, M., Kleinpell, R., Marfell, J…Wolf, A. (2014). Nurse practitioner core competencies content a delineation of suggested content specific to the NP core competencies 2014. NP Core Competencies Content Work Group. Retrieved from…/NPCoreCompsContentFinalNov20.pdf

Exemplar VIII: NR 601 Primary Care of the Maturing and Ageing Family Week 2

In healthcare, some issues cause many controversies. One of the issues is polypharmacy. The issue affects many people as they seek to cure their illnesses and the individuals that are most at risk are the elderly. The term has several definitions. One definition is that polypharmacy is the use of additional medications other than the clinically prescribed or the use of several medications to treat a single condition. In some cases, the definition of polypharmacy is the chronic prescription of a number of drugs to patients suffering from multiple chronic illnesses (Hovstadius, & Petersson, 2012).

Polypharmacy is an issue that needs urgent consideration because of its effects on people, especially on their health. Several risk factors can lead to polypharmacy. One factor is age. The elderly are most likely to have polypharmacy because of the numerous ailments that they experience. The numerous diseases need different medications for effective treatment and therefore the situation might lead to polypharmacy. The other risk factor is multiple providers. Patients that receive care from multiple providers might experience polypharmacy. The reason for the situation is that the providers can prescribe different kinds of medication to treat the same conditions leading to polypharmacy.

Another risk factor is self-medication. People that self-medicate tend to use different medications to try to cure their illness. The situation leads to polypharmacy especially with numerous use of over-the-counter medication and herbal medicine to try to find a cure for a persistent ailment. Healthcare providers can prevent polypharmacy by taking several action steps. According to Scott, Hilmer, Reeve, Potter, Le Couteur, Rigby, & Jansen (2015), one of the action steps is patient education. The providers should take time to educate their patients on the dangers of polypharmacy and give them advice on the steps that they should take to prevent the occurrence of polypharmacy. The other action step is medication therapy management. The providers should conduct a review of the kinds of medication taken by patients on a yearly basis together with other professionals to help prevent the occurrence of polypharmacy.

An additional action step to prevent polypharmacy is using an electronic prescription. Providers can have a system that offers prescriptions to patients and therefore prevent a situation where there is the prescription of numerous medications. In addition, providers can present information showing the occurrence of polypharmacy in the elderly and ways to prevent it. An example of how my clinical preceptors has addressed polypharmacy is by educating the patient and family on the issue of polypharmacy and its effects on patients. Also, during intake, the Medical Assistant questions the patient at every visit on what medications they are taking, including OTC medications and provides reason as to why this information is important. In conclusion, polypharmacy is a situation that can lead to health complications, especially in elderly patients. It is essential to understand all the aspects of the topic to prevent its occurrence.



Hovstadius, B., & Petersson, G. (2012). Factors leading to excessive polypharmacy. Clinics in geriatric medicine, 28(2), 159-172

Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., & Jansen, J. (2015). Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine, 175(5), 827-834


Chamberlain Program Outcomes

· PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)

AACN MSN Essentials

· Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes

NONPF Core Competencies

· Ethics Competencies

· In general, this course has made me focus on the MSN program outcome, MSN essentials, nurse practitioner competency as well as ethic competencies.  Through the help of the course, I am able to offer positive health outcome by use of compassionate, collaborative, evidence-based practice advanced nursing practices (Buppert, 2018). Through the objective of the course I have learned over the past seven weeks, I am in the right position to advocate for the patient’s wellbeing. As a result of advocating for quality care for the patient, I have been able to build a trusting relationship. Promoting evidence-based practice for the patient has improved the patient care outcome.

· The course has enabled me to use patient-centered and culturally sensitive techniques in the course of providing care.  Involving and considering responsive cultural strategies while offering care is important and justify the patient’s interest.  Another aspect provided under masters essential is the integration of the clinical prevention as well as population health concept in the delivery of the advanced culturally vital as well as linguistically relevant health education, interventions, and communication strategies.  This courses provided various data related to different ethnic and age groups to form health education intervention.

· This course has helped to apply the ethical principle in the course of making a decision.  As a nurse practitioner, using the facet of autonomy while the delivery of the services is essential. Taking away the independence denies the patient right to take part in decision making (Blomberg et al. 2016).  The decision made by the nurse while providing the care to the patient might lead to harm.  As such, the nurse practitioner should be aware of the ethical dilemma or consequences the whole case carries. Therefore, assessing risk is essential.  As a nurse practitioner, I will thoroughly assess the treatment or any other intervention before delivering care. One thing I am always careful with is to take consideration of the patient’s ethical principle such as race, religious beliefs and age.  The care should be offered holistically on an individual basis and not by using assumptions.

· ​

· References

· Blomberg, K., Griffiths, P., Wengström, Y., May, C., & Bridges, J. (2016). Interventions for Compassionate nursing care: A systematic review. International Journal of Nursing Studies, 62, 137-155. doi:10.1016/j.ijnurstu.2016.07.009

· Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Burlington,  MA: Jones & Bartlett Learning.

· Melnyk, B. M., & Fineout-Overholt, E. 2. (2015). Evidence-based practice in nursing & Healthcare: A guide to best practice(2nd ed.). Philadelphia, PA: Lippincott Williams &             Wilkins.


Exemplar IX: NR 602 Primary Care of the Childbearing and Childbearing Family Week 3

Sick Child Clinical Case Presentation

· My Case Study this week is pertaining a 12-year-old boy whose mother brought him to the Clinic because she is concerned that he is eating all of the time, drinking large amounts of fluid, and urinating various times in a single day. She reports that he also wets the bed every night and has had a few daytime accidents as well. She has quite recently chalked it up to the antihistamines he is on for his ceaseless hypersensitivities making him extremely parched; yet she feels that it is improving. She reports that the patient has “consistently been like this,” however the duration has begun to concern her.

The patient’s height is 60 inches, which puts him at 65% on the growth graph; weight is 87 pounds, which puts him at 50% on the growth chart; his BMI is 17; he is at Tanner stage 2. The patient has no complaints, other than his history of hypersensitivities, his mom expresses that he has no issues. He was born full-term without any inconveniences with delivery.

Mother reports that he had a few ear diseases when he was a baby and child, however, has not had one in over a year. He has watery, bothersome eyes on the off chance that he misses a portion of his antihistamine prescription and that he will cough a considerable amount during that time. Mom states it clears up immediately when he is back on his medicine routinely. He has never had tonsillitis or some other diseases including the throat. The majority of his ailments have consistently been identified with ear contaminations and hypersensitivity indications. He has no cardiovascular issues, no stomach issues, however, his mother said that when he was a newborn child he had lactose intolerance issues, yet expresses that he is by all accounts able to tolerate at this point. He has never had a urinary tract disease and never complains that it hurts when he pees. He has had no broken bones or cuts.

Upon physical test, his head was symmetrical with ordinary designed hair all through. His eyes were average with no seepage, pink conjunctiva, and white sclera. His nose was bright, septum midline. His mouth was pink and moist, tonsils 1+ without erythema or exudate, oropharynx pink with some proof of cobblestoning, yet no current postnasal drip. Bilateral ear cannel clear, no cerumen, the two TMs magnificent dim and versatile, all structures noticeable, with some proof of slight scarring to both. No lymphadenopathy noted, neck supple. S1 and S2 present without any mumbles, rubs, or gallops; ordinary rate and beat. Breath sounds clear in all fields. Stomach delicate, marginally round, normoactive bowel says in all quadrants, no delicacy to palpation. Full ROM in all limits without any disfigurements noted; Skin perfect, pink, warm, dry. There were no lab or diagnostic test available as this was the initial visit for the above mentioned concerns.


Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

AACN MSN Essentials

· Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes.

NONPF Core Competencies

· Ethics Competencies

· With the experience I have heard in regards to the clinical field in this course, I have listened to an understanding that there are many ways of providing patient-centered care that is of high quality. Every encounter with a patient should mainly focus on the provision of holistic care that is safe. A good instance that i saw to be outstanding in the class is in regards to a patient who had an experience of a viable experience after many years of experiencing infertility as well as various miscarriages. With the assistance of current guidelines and evidence-based practices related to care, we were in a position to provide a healthy environment that is safe and fostering a discussion of the various concerns that the patient had. It was an engaging task since it required emotional and empathy support to make her feel confident. With the application of a holistic approach, we successfully addressed here social, physical, spiritual, and emotional needs (Greutmann, 2018).

· MSN Essential VII

·             The session brought about a big opportunity of having a taste of collaboration and its importance among all the providers of health care. The office looked quite different in terms of the organization in comparison to my past clinical experience. A nurse practitioner would share an office with a representative of the patient service whose work was scheduling and insuring during the day (Reeves, 2017). A medical assistant was also situated in the same room. Having all the professionals in one room enhances cohesive communication in regards to what’s best for patients in comparison to my past clinical setting.

·            Every day at 9. 00 am, there would be a meeting whereby all the professionals would meet and discuss any issue that was challenging and chat the way forward on how they would enhance collaboration to provide the best outcome possible. According to my understanding, this was a good organizational setting since I had never had such an encounter in the past, and it looked like the best way to approach any health care problems. With such an approach, they would attend to many patients as possible in comparison to the previous setting.

· # 8 Ethics Competencies

· Applying ethical principles is crucial in the making of decisions.This is an important course that has helped me in making sure that the nursing ethical principles are part of my decision making process. An important aspect of inpatient care is the incorporation of patient autonomy. Through patient autonomy, I was able to allow my patients to make their decisions. This builds trust among patients and gives them the will to follow advice relate to health care recommendations and advice. My current hospital focuses on ICARE, which stands for Integrity, Comparison, Respect, and Excellence.

· All the decisions made by nursing professionals can be of harm to patients, and thus, they need to be aware of all the ethical consequences, which are regarded as another competency that is ethical, which is a type of malfeasance (Buppert, 2017). I do make sure that I am thorough in what I do in regards to treatment, keeping I mind that the treatment might have an adverse effect. Thus the need for patient follows- up.

· I have experienced many problems with other practitioners who had made me quite cautious during patient treatment. One complex fact that I have adopted best during the course I how to deal with any patient who fails to adhere treatment of advice due to her religious beliefs or ethnic background even though they must be a consideration. It is, therefore, crucial to provide holistic care and also not make assumptions in regards to patients.


· References

· Buppert, C. (2017). Nurse practitioner’s business practice and legal guide. Jones & Bartlett Learning.

· Greutmann, M., Theile, G., & Tobler, D. (2018). Holistic Care and Palliation. In Heart Failure in Adult Congenital Heart Disease (pp. 241-250). Springer, Cham.

· Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6).


Exemplar X: NR 603 Advanced Clinical Diagnosis and Practice Across the Lifespan Practicum Week 6

Obsessive-Compulsive Disorder (OCD)

It is a common disorder that results from severe instances of trauma or stress and it entails the exhibition of hyperactivity in case of occurrence of the former. In many cases, the causative situation may a sort of emotional response to stress, multiple reactions to the deep distresses degeneration into post-traumatic illness signs (American Psychological Association, 2017). Usually, symptoms occur within days or months of the occurrence of the traumatizing incident, exceptional cases taking years before a patient experiences the indicators. Experts group signs and symptoms into four, the first category involving frequent remembrance of the traumatizing event(s), while the second one entails avoidance of reminders of the unfortunate incident. The third is associated with non-jovial mood as a result of remembrance of the undesirable incident, whereas the last one has to do with hyperactivity. In rare instances, however, individual culprits may encounter alienation in addition to reporting multiple instances of nightmares and avoidance of symptom triggers, a significant one being traveling.

Major Depressive disorder (MDD)

It is clinical depression that affects a culprit’s moods and behaviors, often extending to interference with physical activities, the most common of the undertakings being sleep and appetite. Notably, patients exhibit a general tendency towards a loss of interest in activities that they enjoyed previously. The encouraging bit is that medications assist persons with the disorder to manage symptoms therein for a relatively normal life.

Usually, patients show a wide range of signs and symptoms, and the diagnosis criteria entail possessing at least five of all the possible manifestations. Some of the indicators include sadness and irritability for the better part of the day, a loss of interest in formerly favorite pursuits, sudden weight gain or loss, and a general feeling of restlessness (Healthline Media, 2019). Others may be unusual tiredness and a lack of energy, a feeling of worthlessness or guilt, concentration challenges, inability to make sound decisions, and unfortunate thoughts regarding harming oneself or suicide.

The surprising bit is that the disorder’s exact cause remains unknown, scientists being left to speculate and research on triggers. Some of the activates include excessive drug and alcohol use, certain severe medical conditions, and some medication types, primary care often involving the use of antidepressants that control the production of the brain chemical responsible for the control of moods. The common drugs applied in the management of the condition include fluoxetine and citalopram, their major benefits over others being that they have low incidences of side effects.

Generalized Anxiety Disorder (GAD)

It is a common anxiety disorder that differs from having a phobia about an occurrence and affects about 3% of the American adult population. Other interesting patterns include the fact that it mainly affects persons between childhood and middle age, women having a higher likelihood of suffering from the disorder, which is twice as much as that of men. The disorder entails a general feeling of unease regarding life in general as opposed to the fear of specific items and animals (Gregory, 2019). The worrying bit is that a person suffering from the disorder has a likelihood of suffering from other mental illnesses as such persons constantly live with concerns about anything and everything.

The disorder may manifest both physically and mentally, some of its symptoms being constant anxiety, relaxation inability, unexplained tension, avoiding stressing circumstances, and inability to concentrate. Others include frequent feelings of dread, inability to control emotions, fatigue, and stomach upsets. Just like the preceding case, the exact cause of the disorder is not known, speculation being that it is caused by a combination of genetic and behavioral elements. Some identifiable triggers include tobacco and cocaine, medications and therapy serving to reduce the incidences of the disease. Physicians’ intervention aside, certain personal practices may mitigate the problem, some of them being daily exercise, partaking well-balanced diet, and stress management methodologies.


American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. American Psychological Association, 1-119.

Genetics, I. O. C. D. F., Arnold, P. D., Askland, K. D., Barlassina, C., Bellodi, L., Bienvenu, O. J., … & Camarena, B. (2018). Revealing the complex genetic architecture of obsessive-compulsive disorder using meta-analysis. Molecular psychiatry, 23(5), 1181.

Gregory, C. (2019). Generalized Anxiety Disorder (GAD): What is GAD? Why do I have it? How do I cope? PSYCOM. Retrieved from (Links to an external site.)

Healthline Media (2019). Major Depressive Disorder (Clinical depression). Healthline. Retrieved from (Links to an external site.).


Chamberlain Program Outcomes

· PO #4: Integrate professional values through scholarship and service in health care (Professional identity)

AACN MSN Essentials

· Essential III: Quality Improvement and Safety

· Essential IV: Translating and Integrating Scholarship into Practice

NONPF Core Competencies

Health Delivery Systems Competencies

The course has recorded positive outcomes as key lessons are learnt from the entire practice. The key nursing competencies that were supposed to be observed during the class were perfectly integrated leading to the creation of a dominant practice that mainly focuses on the interest of the public which is a key matter of concern in this case.

Master’s Program Outcome #4: Integrating professional values via scholarship and the provision of service in healthcare

The healthcare delivery systems are perfectly described to depict positive appearances. The course perfectly applies organizational practices that focus on the creation of clear structures that would lead to the better delivery of services. The activity entails effective collaboration with other medical practitioners to ensure that the complex systems are simplified to create a better operational network that the company could apply to create advanced systems that works positively for the healthcare systems of the country (Arnott, 2017). The knowledge base is important in the creation of policies that focus on the interest of creating better systems for the health care sector in the country.

Healthcare changes work at improving the existing systems to ensure that advanced practices are perfectly embraced by the company. It is a practice that entails effective coordination that focus on the interest of the sector alone (Arnott, 2017). The course explained the importance of skill application in basic company activities such as negotiation, partnering and consensus building which plays an effective role in the promotion of order and understanding within the current societal set up. Partnering with other sectors to ensuring that better services are provided is a key element of the practice that was taught during the entire course.

Master’s Essential IV: Transforming and incorporating scholarship into practice

The minimization of the risks that patients often face while seeking medical assistance within the healthcare facilities is a key matter of concern. The captures ensure that perfect practices that taught to the nursing practitioners to ensure that they offer better services that focuses on the interest of the public which is a key matter of concern that needs to be perfectly addressed as the course teaches the importance of having better systems (Taylor, 2015).. This is a perfect practice that entails the emulation of practices that focus on the interest of the public which is a key matter of concern.

The course plays an important role in facilitating the general improvement of the healthcare sector which is a key matter of concern that needs to be perfectly addressed when the interest of the public is being highlighted. Ensuring that the diverse healthcare needs of the public are addressed is a key practice that leads to the reduction of complicated practices that may fail to positively reflect on the interest of the patients (Arnott, 2017). The improvement process is promoted through effective collaborative practices that focuses on the interest of the general public which is a key matter of concern that ought to be clearly addressed.

The course provides a detailed evaluation on the impact of healthcare delivery systems on the stakeholders, patients and the providers which is a key matter of concern (Taylor, 2015). The evaluation ensures that the existing systems are perfectly aligned to reflect on the interest of the people which is a key matter of concern that needs to be perfectly aligned with the interest of the healthcare systems. Ensuring that key evaluation tools are implemented are key matter of concern that needs to be clearly addressed as it reflects on the necessity of making necessary adjustments within the healthcare systems of the country.

Nurse Practitioner Core Competency #7: Health Delivery System Competencies

The course evaluates the perfect organizational structures within the healthcare settings that needs to be aligned to ensure that the interest of the healthcare providers are addressed. This is a key activity that reflects on the interest of the people in a complicated manner. The practice entails coming up with a framework that may fail to reflect on the interest of the people. Ideally, the development of major practices are reflected positively with the recommended structures that the healthcare sector may prefer and apply in its daily operations based on the final outcome that comes with the process.

Collaboration is a key practice that leads to the positive development of company practices. The activity comes with the implementation of measures that focuses on the interest of the company. Coming up with collaborative strategies with other medical practitioners is the duty of a nurses. Through the course proper elaborations are made on the perfect practice (Taylor, 2015). Through the course one understands the strategies that the healthcare sector needs to clearly observed as it reflects on the needs of the people in a positive way. The elimination of the limitations is a key measure that comes with the process that needs to be perfectly analyzed.


Taylor, H. (2015). Assessing the nursing and care needs of older adults: A patient-centred approach. Oxford: Radcliffe Pub.

Arnott, J. (2017). Introduction to community nursing practice. Maidenhead: McGraw Hill Open University Press.

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