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#1 and 2———–read first posts and provide evidenced based supported response

 #1

Evaluate a culture/population of interest to assess a current need.  Examples may include patients in various care environments, gender identity groups, racial identity, ethnic identity, etc. 

As a current armed forces service member, the Veteran population is one that I admire deeply and there are several needs that can be addressed. 

Using the population/culture identified, devise a culturally sensitive response plan that addresses a specific need in that population. What objectives will you meet through this response plan?

Within the Veteran population, the specific need that I will be focusing on is suicide prevention. By creating a culturally-sensitive response plan, it will encompass all members within the veteran population, regardless of age, gender, ethnicity or background. The response plan will be specific, realistic, time-oriented and have attainable goals (Toney-Butler & Thayer, 2020). As a DNP prepared nurse, utilizing a plan is essential for goal setting. The first part of this response plan includes the facilitation of more effective communication between the Veteran and their provider, verbally and non-verbally. In both the outpatient and inpatient community settings, providers should be informally aware of the specific cultural needs related to Veterans. Even if Veterans have not seen combat, due to the prevalence of discrimination, sexual harassment/assault, there still may be underlying internal struggles that can lead to suicidal ideation and the act of suicide. The objective of effective communication will be to know what signs to look for, such as difficulty transitioning to civilian life, giving away belongings, isolation and/or lack of coping mechanisms (Bryan et al., 2012). With the use of resources and interprofessional collaboration, early recognition of behaviors can lead to the implementation of interventions with the goal of reducing the act of suicide through prevention techniques. To be culturally competent during this response plan will require patience, as the military influences expression of emotion to be minimal due to the cultural constrains (Lim, 2016). This, in addition with the Veteran’s personal cultural background, may cause internal conflict and make the situation more complex. 

After reading your textbook, consider the role of the DNP in education. Write an educational intervention plan that addresses your objectives. Using scholarly inquiry, discuss cost-effectiveness, feasibility, and the timeline for implementation of your plan.

To address the objectives listed above, the DNP as an educator can use current evidence-based research to teach Veteran’s self-regulation strategies to be used in stressful or overwhelming situations. This is relatively cost-effective, but is only feasible if the educator has the time to learn such strategies in order to reciprocate the knowledge. If the DNP is not directly involved in care, there can be coordination of other resources and delegation so that such interventions are still delivered to the Veteran. The DNP as an educator is versatile and evolving with the growth of the health care system. Even in quality-centered positions such as administration, the DNP will still have the responsibility to disseminate knowledge to facilitate the highest quality of care possible (Beeber et al., 2019). Another component to the intervention plan is to have an appropriate protocol in place if a Veteran does verbally or non-verbally give cues that they want to commit the act of suicide. This will include immediate contacting of the suicide prevention hotline, presentation to the emergency department and appropriate medication in place such an anxiolytics (with surveillance). Implementing these components of the interventional plan to prevent suicide in Veterans will have to start small and at a local level in order to evaluate effectiveness and accessibility of all necessary resources. If successful of preventing at least one Veteran from committing the act of suicide at the local level through the response and intervention plan as listed above, I find that to be effective in itself. 

References

Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of doctor of nursing practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354-364. https://doi.org/1016/j.outlook.2019.02.006  (Links to an external site.)

(Links to an external site.)Bryan, C., Jennings, K., Jobes, D., & Bradley, J. (2012). Understanding and preventing military suicide.  Archives of Suicide Research. https://doi.org/10.1080/13811118.2012.667321 (Links to an external site.)

(Links to an external site.)Lim, N. (2016). Cultural differences in emotion: differences in emotional arousal level between the East and the West. Integrative Medicine Research, 5(2). https://doi.org/10.1016/j.imr.2016.03.004  (Links to an external site.)

Toney-Butler, T., & Thayer, J. (2020). Nursing process. StatPearls. Retrieved March 02, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK499937/

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#2

HIV Prevalence in the LGBT Population

One of the current needs affecting the LGBT population in the US and across the globe is the prevalence of HIV among the population. Understandably, practices related to the LGBT population have seen an upward trend in HIV incidence. However, the evidence supporting the cause of HIV incidence and how to significantly address it is limited (DiNenno et al., 2018). Consequently, it is imperative to develop a culturally sensitive response plan through individual research to understand HIV in the specific population as applied to care settings and devise a way to address it.

Culturally Sensitive Response Plan

          Several factors are influencing the prevalence of HIV in the LGBT population, especially among gay men and bisexuals. A culturally-sensitive plan is necessary to acquaint with the population and learn how to make an informed decision on screening. Understandably, fear of victimization, need to maintain one’s image and people’s perception, or anticipating negative attitudes may cause a lack of disclosure of a person’s sexual identity or limit one’s openness to their sexual orientation (Schrimshaw et al., 2018). This information provides insight that needs to be explored further through cultural congruence. One-on-one patient conversation with patients and other members of the LGBT population can provide more information on these challenges

          In addition, the provision of care should be tailored to meet clients’ needs, while improving awareness of the importance of HIV screening. The plan is to advocate for health care providers to encourage HIV screening for the LGBT population members during the patient encounter. There are already laid out recommendations by the CDC on how to screen HIV among the LGBT in the US (DiNenno et al., 2017). It is necessary to evaluate how this has impacted the rate of HIV screening for LGBT and how this has impacted HIV prevalence. Specifically, the plan involves increasing public awareness to improve HIV screening through provider-patient education, implementing CDC’s HIV screening recommendations, and evaluating the impact on subsequent HIV screening rates and prevalence. 

Implementation of the Plan

          Now that the plan is set out, the objective would be to reduce HIV prevalence and incidence by promoting behavior change through increased HIV screening among the population. Increasing HIV screening has been established to facilitate lifestyle change and reduced HIV incidence (Shrestha et al., 2020). The core task would be to assume the role of a Doctor of Nursing Practice (DNP) as an educator to guide other health care professionals in providing institutional culturally competent care for HIV patients for the LGBT population. The DNP would take up an educator role guided by enhanced DNP knowledge as well as research to create institutional guidelines for providing care for HIV patients. By utilizing individual and combined research as well as being technology-competent, the DNP can amass a wide range of knowledge regarding the various aspects affecting care delivery for the LGBT, and therefore create guidelines to address care delivery that directly impacts the prevalence of HIV in the population.

Feasibility and Cost-Effectiveness of the Plan

The viability of the study is first enabled by the abilities of a DNP to conduct scientific research and use research evidence in nursing practice. Besides creating policies and institutional guidelines, the DNP assumes a leadership role in educating other professionals on the best practices and guidelines and observing that they are implemented for the desired patient population. As previously mentioned, the desired goal would be increased HIV screening that ultimately reduces HIV prevalence in the LGBT population. Increasing HIV screening among other preventive mechanisms has been proven to be cost-effective (Bernard et al., 2017; Shrestha et al., 2020). Therefore, the plan is economically feasible and effective for implementation. 

References

Bernard, C. L., Owens, D. K., Goldhaber-Fiebert, J. D., & Brandeau, M. L. (2017). Estimation of the cost-effectiveness of HIV prevention portfolios for

            people who inject drugs in the United States: A model-based analysis. PLoS medicine, 14(5), e1002312.

https://doi.org/10.1371/journal.pmed.1002312

DiNenno, E. A., Prejean, J., Delaney, K. P., Bowles, K., Martin, T., Tailor, A., Dumitru, G., Mullins, M. M., Hutchinson, A., & Lansky, A. (2018). Evaluating the

            Evidence for More Frequent Than Annual HIV Screening of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results

            From a Systematic Review and CDC Expert Consultation. Public health reports (Washington, D.C.: 1974)133(1), 3–21.

https://doi.org/10.1177/0033354917738769

DiNenno, E. A., Prejean, J., Irwin, K., Delaney, K. P., Bowles, K., Martin, T., Tailor, A., Dumitru, G., Mullins, M. M., Hutchinson, A. B., & Lansky, A. (2017).

            Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2017. MMWR. Morbidity and

             Mortality Weekly Report. 66(31), 830-832. https://www.cdc.gov/mmwr/volumes/66/wr/mm6631a3.htm

Schrimshaw, E. W., Downing, M. J., Jr, & Cohn, D. J. (2018). Reasons for Non-Disclosure of Sexual Orientation Among Behaviorally Bisexual Men: Non-

            Disclosure as Stigma Management. Archives of sexual behavior, 47(1), 219–233. https://doi.org/10.1007/s10508-016-0762-y

Shrestha, R. K., Chavez, P. R., Noble, M., Sansom, S. L., Sullivan, P. S., Mermin, J. H., & MacGowan, R. J. (2020). Estimating the costs and cost-

            effectiveness of HIV self-testing among men who have sex with men, United States. Journal of the International AIDS Society23(1), e25445.

https://doi.org/10.1002/jia2.25445

# 3 and 4- #1———–read first post, provide evidenced based reponse and ask a question to encourage discourage further discussion

  #3

Evaluate a culture/population of interest to assess a current need.  Examples may include patients in various care environments, gender identity groups, racial identity, ethnic identity, etc.

Heart failure affects millions of people worldwide. The Centers for Disease Control (CDC) report, “…6.2 million adults in the United States have heart failure” (CDC, 2020, para 1).  For African Americans diagnosed with heart failure, the numbers are associated with more significant negative consequences. Blacks are 30% more likely to be diagnosed with heart failure. They are diagnosed at an earlier age and will die from the disease sooner than other races (U.S. Department of Health & Human Services, 2021).

Using the population/culture identified, devise a culturally sensitive response plan that addresses a specific need in that population. What objectives will you meet through this response plan?

Most heart failure patients are often overwhelmed or intimated by education presented in the hospitals. Lower rates of health care literacy are proportionally greater in blacks. Contributing to the black community’s low literacy rates is a belief system where negative topics are not discussed or claimed (A.S., personal communication, March 11, 2021). Lower socioeconomic status, access to healthcare, and a mistrust of the health care system also contribute to lower healthcare literacy rates and subsequent adverse clinical outcomes.

Effective management of this chronic debilitating disease depends on vigilant self-management involving knowledge and adherence of medication regimens, dietary restrictions, daily monitoring of weight, and symptom management. The Measure associated with heart failure addresses patient education and self-care elements by “…copy of written instructions or educational materials are given…” (Heidenreich, et al., 2020 p. 2). There was no requirement to assess learning.

After reading your textbook, consider the role of the DNP in education. Write an educational intervention plan that addresses your objectives. Using scholarly inquiry, discuss cost-effectiveness, feasibility, and the timeline for implementation of your plan.

Even with the emphasis of scientific evidence directing patient care, the combination of skill, formal education, personal integrity, and clinical experience cannot be underplayed. It is the combination of several types of knowledge that leads to the development of a nurse leader capable of positively influencing others in integrating healthcare services to achieve superior clinical outcomes and enhance the patient experience.

Patients are often discharged from health care facilities without proper evaluation of presented discharge materials, particularly instruction involving self-care. The teach-back method of instruction is a method to evaluate the understanding of written instructions. Yen & Leasure (2019) report use of teach-back method of patient instruction is associated with improved patient knowledge of self-care activities.

Associated implementation costs include printing of materials to reinforce the teach-back instruction. A survey would be given before and after instruction. Elements of the survey would include asking if the nurses are using the teach-back method, if the nurse’s evaluation of patient knowledge is improved and if the nurse’s self-confidence in providing instruction to the patients is improved.  The nurses’ instruction and related surveys could be given about six weeks. The desired outcome is that all patients with congestive heart failure receive education using the teach-back method.  Regardless of age, patient care environment, race, ethnicity, or gender identity, all patients would benefit from the verbal exchange of information regarding self-care activities. 

Center for Disease Control (2020). Heart Failure. https://www.cdc.gov/heartdisease/heart_failure.htm (Links to an external site.)

Heidenreich, P., Fonarow, G., Breathett, K.,  Jurgens, C., Pisani, B., Pozehl, B., Spertus, J., Taylor,K.,  Thibodeau, T., Clyde W. Yancy, C., & Boback Ziaeian, B., (2020). 2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure. https://doi.org/10.1161/HCQ.0000000000000099Circulation: Cardiovascular Quality and Outcomes.

US Department of Health & Human Services Office of Minority Health (2021). Heart disease and African-Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=19 (Links to an external site.)

Yes, P., and Leasure, R. (2019). Use and effectiveness of the teach-back method in patient education and health outcomes, 36(6), pp. 284–289. Federal Practitioner

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#4

I have been living in the Rio Grande Valley of South Texas which has a 98% Hispanic population.  One thing I have noticed is that most of my nursing students are first-generation college attendees. One reason for this I believe is that this area is very underserved due to the high poverty rate.  This socio-economic status creates several situations in my students’ education, including a need to learn how to study, a gap in their prior knowledge, and the fact that many must work full-time to meet the daily needs of their families. Additionally, some of my female students are young mothers who also struggle to catch up because many of them dropped out of high school due to early pregnancies.

DNP graduates are exceptionally equipped to function as nursing faculty in varied settings. The creative use of diversely prepared faculty’s educational preparation is essential to bring the alternate and complementary approach to nursing education (Chism,2017). As a DNP, I would like to establish a class free of charge where I could give my students extra information on the availability of funds to help alleviate their financial burden and perhaps allow them to cut back on working hours to support their families.  This class could also be used for tutoring or for assistance in establishing better study habits.        

As a leader, I would like to work with the university to help raise the funds to establish a scholarship program for first-generation college students in the nursing program. I view this as one of my leadership roles where I would work to set up a committee to study the best ways to raise money for this scholarship. The coming years will very likely see shortages in the number of nurses, as well as nursing faculty (Moore, 2017). Students who graduate debt-free from their undergraduate program will have an earlier opportunity to earn a higher education degree. This is one way that I, as a DNP can help alleviate the nursing shortage while helping the Hispanic population students, I work with to enhance their education and ultimately better their lives. 

References

Chism, L.A. (2019). The Doctor of Nursing Practice: A guidebook for role development and professional issues. 4th ed. Jones & Bartlett.

Moore, A. (2017). Nursing shortages: how bad will it get? Nursing Standard (2014+), 31(37), 26. http://dx.doi.org/10.7748/ns.31.37.26.s24

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