Category: Nursing

Current environmental forces (i.e., physician shortage) that may impact the role of the human resource manager

To prepare
 for this Discussion, research current environmental forces (i.e., physician shortage) that may impact the role of the human resource manager. Based on your research, select an environmental issue related to regulation, policy, politics, economics, or patient demographics that impacts the role of the human resource manager in a health care setting of your choice.

Post
 a comprehensive response to the following:

Provide a brief explanation of your selected issue and then describe a strategy to enhance two of the following in your selected healthcare setting:

Workforce planning

Employee recruitment

Employee retention

__________
ORDER A PLAGIARISM-FREE PAPER NOW
____________

 

RESOURCES

 

Chapter 3, “The Strategic Management of Human Resources”

Human resources (HR) management includes both strategic and administrative tasks. This chapter addresses workforce recruitment and retention, the environmental forces influencing human resources management, and the key responsibilities of the HR management staff. The author discusses methods of employee compensation, evaluation, and key issues pertaining to HR management in the health care setting.
Course Text
: 
Career Opportunities in Health Care Management: Perspectives From the Field

Chapter 5, “Summary and Conclusions About the Profession”

This chapter addresses issues of satisfaction, mentoring, and educational preparation as well as challenges faced by health care managers.

Appendix A, “Resources for Learning More About Healthcare Management”

The common acronyms, organizations, and web addresses that health care managers should know are provided in Appendix A.

Appendix D, “Getting a Job In Healthcare Management”

How do you get a job as a health care manager? The authors provide answers to frequently asked questions related to various positions in health care management.

Bureau of Labor Statistics Occupational Outlook Handbook

http://www.bls.gov/ooh/

Search for “Medical and Health Services Managers.” Review the nature of the work, training, job outlook, and estimated earnings for health services managers.

NURS 6650 FINAL EXAM STUDY GUIDE – QUESTIONS AND ANSWERS

The final exam will cover the following topics, which relate to psychotherapy with groups and families:

Foundations of Group Work and Types of Groups

Group Processes

Cognitive Behavioral Therapy for Groups

Group Therapy for Addiction

Group Therapy with Children and Adolescents

Group Therapy with Older Adults

LET’S SIT YOUR ONLINE EXAM – ORDER NOW

Wheeler, K. (Eds.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
. New York, NY: Springer Publishing Company.

Chapter 11, “Group Therapy” (pp. 407-428)

Chapter 12, “Family Therapy” (pp. 429-468)

Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565-596)

Chapter 17, “Psychotherapy with Children” (pp. 597-624)

Chapter 18, “Psychotherapy with Older Adults” (pp. 625-660)

 

Yalom, I. D., & Leszcz, M. (2005).
The theory and practice of group psychotherapy
(5th ed.). New York, NY: Basic Books.

 

Chapter 1, “The Therapeutic Factors” (pp. 1-18)

Chapter 2, “Interpersonal Learning” (pp. 19-52)

Chapter 3, “Group Cohesiveness” (pp. 53-76)

Chapter 5, “The Therapist: Basic Tasks” (pp. 117-140)

Chapter 8, “The Selection of Clients” (pp. 231-258)

Chapter 9, “The Composition of Therapy Groups” (pp. 259-280)

Chapter 11, “In the Beginning” (pp. 309-344)

Chapter 12, “The Advanced Group” (pp. 345-390)

Chapter 13, “Problem Group Members” (pp. 391-428)

 

Video
Leading Groups with Adolescents
by Janice DeLucia-Waack, PhD & Allen Segrist, PhD

NURS 6650 FINAL EXAM STUDY GUIDE – QUESTIONS AND ANSWERS

Assignment: Application: Leadership Concept Analysis

Assignment: Application: Leadership Concept

Analysis:

Topic:

 
Employee recruitment and selection

Write a 2 (page count does not include title and reference page) paper that includes the following:

Section 4: Application to nursing (e.g., implications or consequences for nursing leaders)

Instructions: My topic for this assignment is Employee Recruitment and Section…write a 2 page paper on Application to nursing in regards to Employee recruitment and selection…(i.e) Include implication or consequences for nursing leaders.

Thanks

questions and an

Pathophysiological mechanisms of chronic asthma and acute asthma exacerbation essay assignment paper

Assignment: Asthma

Complications of asthma can be sudden. Consider the case of Bradley Wilson, a young boy who had several medical conditions. He appeared in good health when he went to school, returned home, and ate dinner. However, when he later went outside to play, he came back inside wheezing. An ambulance took him to the hospital where he was pronounced dead (Briscoe, 2012). In another case, 10-year-old Dynasty Reese, who had mild asthma, woke up in the middle of the night and ran to her grandfather’s bedroom to tell him she couldn’t breathe. By the time paramedics arrived, she had passed out and was pronounced dead at the hospital (Glissman, 2012). These situations continue to outline the importance of recognizing symptoms of asthma and providing immediate treatment, as well as distinguishing minor symptoms from serious, life-threatening symptoms. Since these symptoms and attacks are often induced by a trigger, as an advanced practice nurse, you must be able to help patients identify their triggers and recommend appropriate treatment options. For this reason, you need to understand the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Pathophysiological mechanisms of chronic asthma and acute asthma exacerbation essay assignment paper.

ORDER A PLAGIARISM-FREE PAPER NOW

To Prepare

Review “Asthma” . Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.

Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation.

To Complete

Write a 2- to 3-page Pathophysiological mechanisms of chronic asthma and acute asthma exacerbation essay assignment paper that addresses the following:

Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation.

Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.

Construct two mind maps—
one for chronic asthma
and
one for acute asthma
Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your pathophysiological mechanisms of chronic asthma and acute asthma exacerbation essay assignment paper

Essay Assignment Papers: Psychotherapy With Personality Disorders

Since personality represents who someone is at the deepest level, it is understandable that many people with personality disorders resist the idea that they have a fundamental dysfunction with their personality. Even when clients acknowledge that their personality problems are at the heart of their interpersonal problems, they often find it difficult to change. As the mental health professional, how do you overcome this challenge and effectively counsel these clients?

ORDER A PLAGIARISM-FREE PAPER NOW

This week, as you explore psychotherapy with personality disorders, you examine therapeutic approaches to treating clients with personality and interpersonal problems. You also develop a client termination summary for a client who may be ready to complete therapy.

Discussion: Therapy for Clients With Personality Disorders

Clients with personality disorders often find it difficult to overcome their problems and function in daily life. Even when these clients are aware that they have a dysfunction with their personality and are open to counseling, treatment can be challenging for both the client and the therapist. For this Discussion, as you examine personality disorders, consider therapeutic approaches you might use with clients.

Essay Assignment Papers: Psychotherapy With Personality Disorders Learning Objectives

Students will:

Analyze therapeutic approaches to treating clients with personality disorders

To prepare:

Review this week’s Learning Resources and reflect on the insights they provide.

Select one of the personality disorders from the DSM-5.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking 
Submit!

By Day 3

Post
 a description of the personality disorder you selected. Explain a therapeutic approach (including psychotropic medications if appropriate) you might use to treat a client presenting with this disorder, including how you would share your diagnosis of this disorder to the client in order to avoid damaging the therapeutic relationship. Support your approach with evidence-based literature.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to at least 
two
 of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.

Quiz: Final Exam – Essay Assignment Papers: Psychotherapy With Personality Disorders

Learning Objectives

Students will:

Assess knowledge of concepts, principles, and theories related to the psychotherapy of individuals

This exam will cover the following topics from the Wheeler textbook, which relate to psychotherapy of individuals:

Supportive and Psychodynamic Psychotherapy

Interpersonal Psychotherapy

Humanistic-Existential and Solution-Focused Approaches to Psychotherapy

Psychotherapy With Children

Psychotherapy With Older Adults

Termination and Outcome Evaluation

By Day 7

Complete
 the Final Exam. Prior to starting the exam, you should review all of your materials. There is a 2-hour time limit to complete this 75-question exam. You may only attempt this exam once. Essay Assignment Papers: Psychotherapy With Personality Disorders.

Environmental health issues paper

Most environmental health issues involve a variety of elements with overlapping or distinct causes, stakeholder groups, and solutions. Selecting an important, specific element of the issue is essential when formulating realistic ways to address and improve the environmental issue. This specific aspect of the issue is known as the problem and can be defined in a concise problem statement. The problem statement includes the purpose of the problem-solving effort, defines its scope, and states the specific objective of the problem-solving effort in the form of a question.

The three elements of the statement are—explaining how things should be; identifying a significant gap; and asking a question about one major way to improve the current situation. For example:

The food you purchase should be free from levels of pesticide residues that are hazardous to human health, but many commercially used pesticides have not been tested using newer techniques to detect harm that they may cause during prenatal development or childhood. Should the EPA require that pesticides used on food crops be reevaluated using the new tests to ensure that children are fully protected, and if so, which tests?

Employees who work with lead have a right to expect that their health will be protected if their workplace adheres to the OSHA lead standard, but the OSHA lead standard has not been updated since 1978, despite a great deal of new epidemiologic and toxicologic research about lead toxicity. Should the OSHA lead standard be revised, and if so, what should the new provisions be?

Consumers often trust that products and services that they purchase are safe unless they are advised otherwise. Recently, nail salons have been the focus of worker safety initiatives because they use hazardous chemicals such as methacrylates, acetates, toluene, and formaldehydes. Are consumers adequately protected from hazardous chemicals when they receive services in nail salons?

The process of developing a problem statement is extremely useful because you will choose a defined focus, which will guide the rest of the work leading to a proposed solution to the problem.

For this assignment:

Choose a specific aspect of the topic that you selected last week as your problem.

Define the environmental or occupational problem affecting human populations that you will analyze for your final project.

Write your problem statement in 2–3 sentences in a Microsoft Word document. These sentences should be questions that you intend to explore in your research paper.

Justify, in 3 to 5 double-spaced pages, why you chose to focus your analysis of this multifaceted issue to the specific problem as stated in your problem statement.

Case Study: Epidemiological Measures Of MMR Vaccine

Understanding health risks and interpreting them correctly is an important function for anyone involved in public health. Often, the results of epidemiological studies are reported in the media as “known facts,” when indeed that is not the case. Such is the situation for the reported association between vaccinations and the risk of autism.

For this Case Study Assignment, you will analyze and interpret the epidemiological evidence for a possible association between vaccination with the measles/mumps/rubella (MMR) vaccine and the occurrence of autism

ORDER A PLAGIARISM-FREE PAPER

Using the information provided in the case study, complete Sections B, C, and D (pp. 5–10), typing your answers into a separate document.

Be sure that your completed document contains your responses to all questions from Sections B, C, and D of the case study.

PICOT Statement Paper: Problem of Hypertension

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.  
A literature review analyzes how current research supports the PICOT
, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word PICOT Statement Paper: Problem of Hypertension review that includes the following sections:

1.Title page

2.Introduction section

3.A comparison of research questions

4.A comparison of sample populations

5.A comparison of the limitations of the study

6.A conclusion section, incorporating recommendations for further research  Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

ORDER A CUSTOM-WRITTEN PAPER NOW

This PICOT Statement Paper: Problem of Hypertension assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this PICOT Statement Paper: Problem of Hypertension assignment to Turnitin. Please refer to the directions in the Student Success Center.

PICOT Statement Paper: Problem of Hypertension

Practice Problem/Issue and PICOT Question

Hypertension adds to the passing of many individuals all through the world, yet there is as yet poor administration of the condition. Setting up compelling control measures could essentially control the quantity of passings around the world. To control and administration hypertension successfully, it is imperative to recognize and deal with the way of life hazard factors related with the condition as that brings down circulatory strain. What’s more, it is crucial to perform standard screening, discussing adequately with patients, checking patients all the time, and holding fast to treatment. Specifically, it is conceivable to avert and control the condition viably through way of life changes (slim down and frequently captivating in work out) as these serves to altogether direct pulse (Dua et al,2014). Evidenced based solution for patients with hypertension is to lower DBP and SBP below levels in which medication will be started. There should be an alternative drug from a different class to take care of a patient.

PICOT Question

For male grown-ups between the ages of 40 and 70 with hypertension, and with various co-morbidities, will the adjustment in way of life (drawing in routinely in exercise and eating more beneficial and adjusted suppers), contrasted with patients who utilize prescription to treat/deal with their hypertension, help to control their pulse and diminish the danger of creating cardiovascular illnesses in their recuperation period inside a half year. The period will be sufficiently long to make a patient to be capable not to experience the ill effects of hypertension and to likewise lessen the dangers that the people will ordinarily go through(Howes,2013).

Intervention

The primary technique for intercession for a patient with hypertension it is with no uncertainty to put them under prescription, so they can get cured. That is the most secure path as it will influence the patient to have the capacity to deal with themselves as far as how they to think, what they eat and even the exercises that they attempt to participate in (Dua et al,2014). The age of the patients will likewise imply that the patients are given solution that can manage them in the most helpful ways and which they can acknowledge all in all. The medication that can be given for this situation is one that can decrease the cruelty of a medication. The nursing intervention for patients with hypertension is assessing the headache pains that a patient is experiencing and checking the blurred vision in every four hours until it goes away. Another nursing intervention is for a nurse to educate a patient on how they consult with their doctor before medication is stopped.

Comparison

The fundamental contrasting option to contrast with the mediation will have with do with influencing the patient to get the opportunity to do a considerable measure of activities. That is one thing that will make the licenses to have the capacity to manage the issue of hypertension and since practices have been demonstrated that they work, it will then be simple for the patient to recuperate from the hypertension and what will imply that they will get cured from such an infirmity. Toward the end, all will have ended up being sure as the patient will have the capacity to get the coveted medication(Howes,2013). Patient care to those with hypertension is to first educate, measure the blood pressure and even give advice Education will entail modifying the behavior of a patient which is related to smoking, alcohol intake and how to manage stress.

Outcome

In this exploration and managing a patient, it is with most likely that there are things that are being tended to and which are there to have the capacity to manage the way a patient gets the chance to react to pharmaceutical or even exercise. The cerebral pains that are regularly seen in patients with antagonistic hypertension combined with the measure of considerations are the conditions that are to be wiped out in the patients that have hypertension. The numerous unfavorable occasions in the patients will get diminished because of the patients having the capacity to be under pharmaceutical or notwithstanding sharing in practices that are useful for their wellbeing (Dua et al,2014). Healthcare agency for caring for patients with hypertension can be the likes of Intrepid USA Healthcare Services which gives Hypertension Management Program that helps patients get and have a maintained blood pressure that is healthy. Nursing practice for patients with hypertension will be the likes of minimizing the cost of therapy, including a patient in making of decision and even implementation of treatment plans step by step. PICOT Statement Paper: Problem of Hypertension

 

 

References

Dua, S., Bhuker, M., Sharma, P., Dhall, M., & Kapoor, S. (2014). Body Mass Index Relates. to Blood Pressure Among Adults. 
North American Journal of Medical Sciences
, 
6
(2), 89–95. http://doi.org/10.4103/1947-2714.127751

Howes, F., Warnecke, E., &Nelson, M. (2013). Barriers to lifestyle risk factor assessment and management in hypertension: A qualitative study of Australian general practitioners.
Journal of Human Hypertension
,
27
, 474-478 doi:10.1038/jhh.2013.9

PICOT Statement Paper: Problem of Hypertension

DNP Project Proposal – Utilizing Nursing Education and Intervention as a Method to Decrease Emergency Department (ED) Visits for Headache

DNP Prospectus

Title: Management and prevention of type 2 diabetes

 

INSTRUTIONS:  DNP Project Proposal (20–35 pages, plus references) is a detailed plan for carrying out the DNP Project. The Proposal builds on the approved Premise and will be presented to the DNP Project Committee in written form .

1.Abstract

2.Table of contents

3. Section 1: Nature of the Problem

4:Introduction

ORDER A CUSTOM-WRITTEN PAPER NOW

5:Background

6:Problem Statement

Provide a one- to two-paragraph statement that establishes the relevance of this problem:

1.     Summarize preliminary, supporting evidence that provides justification that this problem is meaningful and relevant to the local setting as well as the broader field of nursing practice, citing key scholarly sources.

2.     Explicitly state the gap in nursing practice or problem that will be your focus of this doctoral project

7: Problem Statement

8: Purpose Statement; 

9: Project Question

10: Framework for the Project

11: Implications for Social Change

How this will impact social change? Does this project support the mission of Walden University to promote positive social change?

12: Definition of Terms

13: Assumptions

14: Scope and Delimitations

15: Limitations

16: Significance

17: Summary

18: References

Use APA format for this prospectus. Include a minimum of five APA-formatted peer-reviewed references for all citations in the Doctoral Project Prospectus.

 

DNP Project Proposal – Utilizing Nursing Education and Intervention as a Method to Decrease Emergency Department (ED) Visits for Headache

Abstract

The practice problem identified is headache sufferers are not adequately getting their headaches controlled.  They are utilizing the emergency room for pain control which only gives them immediate control but not long-term control.  The emergency rooms are becoming overcrowded.  Controlling headache patients pain will help keep them out of the emergency room and help to decrease the overcrowding of the emergency rooms.   Controlling the headache pains will also help decrease costs to consumers and the healthcare system.  Case managers can help not only educate these patients, but they can increase better continuity of care and be able to provide feedback to the physicians.  The better educated these patients are, the less likely they are to go to the emergency room.  The practice problem question to be answered is to examine if an education plan along with a plan of care with primary care provider and network, will assist in increasing headache control and ultimately keep these patients out of the emergency rooms.  The purpose of this project will be to implement an education protocol for headache patients to evaluate usage of the emergency department for headache pain control. Models that will be useful for this project are Pender’s Health Promotion Model and the Health Belief Model.  These models will help to evaluate individuals and how they interact and behave in order to be able to change their behavior and help them to control their headache pain. This protocol can be included for provider’s and case managers within a clinically integrated network so that a greater number of patients can be managed effectively to decrease emergency room visits.  The expected results will be this educational protocol will help patients control their headaches better and will assist in decreasing emergency room visits.  The implications of this project will include increased control on headaches, decrease emergency room visits from headaches, and better quality of life for headache patients.

Utilizing Nursing Education and Intervention as a Method to Decrease Emergency Department (ED) Visits for Headache

 

 

 

Table of Contents

Section 1: Nature of the Problem …………………………………………………………3

Introduction……………………………………………………………………………………………………. 3

Background……………………………………………………………………………………………………. 3

Problem Statement…………………………………………………………………………………………… 4

Purpose Statement…………………………………………………………………………………………… 6

Project Question……………………………………………………………………………………………… 6

Framework for the Project………………………………………………………………………………… 7

Implications for Social Change………………………………………………………………………….. 7

Definition of Terms…………………………………………………………………………………………. 8

Assumptions…………………………………………………………………………………………………… 9

Scope and Delimitations…………………………………………………………………………………… 9

Limitations……………………………………………………………………………………………………. 10

Significance………………………………………………………………………………………………….. 10

Summary………………………………………………………………………………………………………. 10

Section 2: Background and Context……………………………………………………………………… 12

Introduction………………………………………………………………………………………………….. 12

Literature Search Strategy………………………………………………………………………………. 12

Concepts, Models and Theories……………………………………………………………………….. 13

Systematic Literature Review Related to Methods…………………………………………….. 15

Role of the DNP Student……………………………………………………………………………….. 15

Role of the Project Team………………………………………………………………………………… 15

Summary………………………………………………………………………………………………………. 16

Section 3: Methodology………………………………………………………………………………………. 17

Introduction………………………………………………………………………………………………….. 17

Project Design and Methods…………………………………………………………………………… 17

Exclusion Criteria………………………………………………………………………………………….. 18

Inclusion Criteria…………………………………………………………………………………………… 18

Data Analysis………………………………………………………………………………………………… 18

Protection of Human Rights……………………………………………………………………………. 19

Summary………………………………………………………………………………………………………. 19

References…………………………………………………………………………………………………………. 21

 

 

 

 

 

Section 1: Nature of the Problem

Introduction

The healthcare field is forever changing; therefore, nurses need to be on top of new and improved evidence-based practice.  Evidence-based research needs to be done to maintain patient safety and best possible outcomes. One issue that should be investigated is how to manage chronic headaches effectively. Patients with chronic headaches take up resources, time and space in the emergency room. According to Migraine Research Foundation (2017) migraines are a prevalent neurological disease which affects 38 million people in the United States and one billion worldwide.  These patients typically have a hard time with the management of their headaches once they start.  Most patients will go through their plan of care, if they have one, and then end up in the emergency department (ED) for pain management when all else fails.  Coming up with an educational plan, to educate these patients will help decrease emergency department visits and have better patient outcomes at home.

Background

In a review of emergency room visits within Sentara Quality Care Network, for inappropriate emergency department visits, headaches were noted as the number one reason for visits.  Decreasing the emergency department visits for headaches will be a start to providing these patients with appropriate care for better outcomes.  The practice setting would take place with case managers in an outpatient setting, over the phone or at the patient’s home.  This writers’ clinical setting for this project takes place with Clinical Integrated Network of approximately 3,000 physicians.  This network has contracts with several self-ensured entities and an insurer in making sure that they are giving the best care possible.  This network has case managers who call and visit with patients to make sure that they are following their treatment plan. These case managers can look in their database to see which patients have been discharged from the emergency and for what. They can identify which patients, once discharged, will benefit from this protocol.  They can then begin using this new educational protocol as part of their case management and be able to track them to make sure they are staying out of the emergency room.  The trigger for the case managers will be when the patients visit the emergency department for a complaint of a headache.  These case managers will be able to poll those who have visited the emergency department within the next six months with a questionnaire.  They will work closely with the patients as well as the providers to make sure that the protocol is being followed in which they will include the triple aim; right care, right place and right cost.  This education will help the patients to receive the best possible evidence-based care and will have a better quality of life.

Problem Statement

Within the United States, there is an overuse of the emergency department (ED).  According to the Center for Disease Control and Prevention (CDC) (2017), there are approximately 130.4 million emergency department visits per year.  According to Weiss, Wier, Stocks, and Blanchard (2014), there were over 131 million emergency department visits in 2008. This report shows that there has not been much of a decrease in emergency department visits over the last nine years.  Patients are using the emergency department for primary care issues which hinder the emergency department’s ability to be available and ready for the sick patients that truly need the emergency department care.  According to Lucado, Paez, and Elixhauser (2011), there were over 3 million emergency department visits where patients complain of headaches as the first line diagnosis; also, there were 2.5 million emergency department visits where a headache was the secondary diagnosis. Headaches are approximately 4.5 percent of all emergency department visits.  According to Minen, Loder, and Friedman (2014), there are over 800,000 emergency department visits for migraine patients annually.  According to Smitherman, Burch, Sheikh, and Loder (2013), the third leading cause of emergency department visits was head pain. This evidence shows that there has been a slight increase in emergency department visits for headaches. According to Skinner, Blanchard, and Elixhauser (2014), there was a one percent increase from 2006-2011 in emergency department visits for headaches.  Headache patients are using the emergency room more than they should.  The emergency room has a high number of emergency room visits each year which is causing overcrowding in the emergency rooms. There needs to be a way to get the non-emergent visits out of them and back to their primary care or educate them to care for themselves at home.  Headaches are the number one diagnosis in the population served by the Network.   Getting these patients, the right tools, education, and treatment plan will be essential to keeping these patients out of the emergency room.

Purpose Statement

The purpose of this quality improvement project is to examine the effect of a targeted intervention by a Nurse Care Manager on the repeated use of the emergency department for treatment of a headache.  This doctoral project will aim to implement structured patient counseling, based on a treatment protocol, and measure the rate of return visits to the emergency department for a headache.  It is proposed that the number of emergency department visits will decrease by ten percent for headache/migraine patients in an insured population.  A study done by Martinez et al. (2015), found that migraine patients who received a brochure and read the brochure have improved migraine control.  Education will be the most important to help these patients manage their migraines at home.  They need long-term management, and the emergency departments’ primary concern is to decrease a visit to the emergency department for treatment of a headache.  Developing an education plan that works will be the primary goal.

Project Question

The guiding practice question that will be addressed to identify the gap for headache patients. The question for this project will be:  For adult patients, aged 30-65, patients presenting to the emergency department with headaches, will an education protocol decrease return of emergency department visits by 10 percent within three months compared to the previous six months?  This project will be a quality improvement initiative based on evidence focused on a specific issue or need. The issue is that headache patients use the emergency department for headaches, which is not an emergency. Patients do not have a plan or may not be educated on managing their symptoms/disease.  This project aligns with other scholarly project conducted by doctoral prepared nurses because it is an application of evidence-based practice.  This project will evaluate current literature within the last five years, peer-reviewed journal articles, case studies as well as randomized control studies to support this change in practice.   Institutional Review Board approval will be obtained, data will be collected from this health system using a retrospective chart review regarding the number of patients that utilize the emergency department for headaches.

Framework for the Project

The theoretical framework that was chosen for this project was Pender’s Health Promotion by Nola Pender. This theory supports a positive dynamic state rather than the absence of disease.  Pender’s Health Promotion Model will be able to support and help change the patients’ behavior.  According to Khodaveisi, Omidi, Farokhi and Soltanian (2017) the Pender’s Health Promotion Model was used to plan for and change behaviors successfully for nutritional education.  There will be no way to get rid of headaches completely; we can effectively manage them with appropriate behavior changes and education.  This model has four assumptions and thirteen theoretical statements. According to Nursing Theory (2016), the major concept of this theory is the individual characteristics and experiences and prior behavior.  Changing the current educational level and behavior will help to control headaches.  Health Belief model is another theoretical framework in which will help support this change because this model focuses on behavior change as well.  According to Jones et al. (2014), they found that HBM will achieve optimal behavior change successfully if perceived barriers, benefits, and self-efficacy were targeted.  Nursing Theories (2012) stated that the Health Belief Model addresses someone’s behavior.

Implications for Social Change

The implications for social change that this project will prove that headache patients who suffer from headaches, to become better controlled so that they will be able to live a better quality of life. Many of these patients who suffer from uncontrolled headache pain miss many days of work and family time alike.  According to Serrano et al. (2013), they found that loss of productive time was costly and increased more rapidly with the patients that had a chronic migraine. Using structured education can help improve headache control. Braschinsky et al. (2016), found that general practitioners can improve headaches with structured education. Utilizing education means that these headache patients would have a chance to have better control, better life outcome and overall better quality of life.

Definition of Terms

Chronic Headache
is defined as headaches from time to time for a long period of time (Mayo Clinic, 2017).

Cluster Headache
is defined as a cyclical patterns or clusters which awakens patient in the middle of the night with intense pain in or around one eye on one side of the head (Mayo Clinic, 2017).

Education
is defined as the process of receiving information. (Merriam-Webster.com, 2017).

Emergency Department
is defined as a department in the hospital for the medical and surgical care of patients arriving at the hospital in need of immediate care. Emergency department is also called emergency room or ER. (MedicineNet.com, 2017).

Headache
will include a chronic headache, migraine, tension-type headache, and cluster headache.

Management
is defined as the process of dealing with or controlling things or people. (Merriam-Webster, 2017).

Migraine headache
is defined by severe throbbing or pulsating sensation and often accompanied by other symptoms, nausea, vomiting, and extremely sensitivity to light and sound, which can be disabling in nature. (Mayo Clinic, 2017).

Nurse Case Management
is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and serves to meet the individual’s and family’s comprehensive health care needs that is led by a nurse. (ANCC, 2017).

Tension-Type Headache
is defined as a diffuse, mild to moderate pain in your head that often described as a tight band feeling around head.  (Mayo Clinic, 2017).

Assumptions

The assumptions for this project are if patients receive appropriate headache education, then headache patients will have better pain control and will decrease the utilization of the emergency departments. Headache education is defined as headache diary, identifying triggers, when to use certain medications, side effect, and purpose of the medication and when to call your provider. The systematic literature review indicates that there is a correlation between headache education and better headache pain control. Martinez et al. (2015) found that migraine patients who received an educational brochure and read the brochure have improved migraine control. This includes the concept of self-efficacy and will empower the patient to control their disease.

Scope and Delimitations

The scope of this doctoral project will be to identify headache patients through their visit to the emergency department. The patients identified will be contacted by case managers; there will be a questionnaire that will be used to gain information regarding their management of their headaches.  After the completion of this questionnaire, the case managers will implement a nurse-driven headache protocol which will help to manage the patient’s headaches more effectively.  Managing these headaches more effectively will decrease Emergency Department visits as well as allow these patients to have a better quality of life. With these patients not using the emergency department, this will also start to decrease the usage of emergency departments leaving more space, time and resources for those that need it.

Limitations

There are limitations for this project. The first limitation is that there is no control group and may be prone to bias.  The evaluation of symptom improvement is completely subjective. The researcher acknowledges that headache control can be complex and include other associated factors. The control of a headache as well can be associated with other factors which are not taken into consideration in this study. Study participants may or may not follow through the education given.

Significance

The significance of this issue is that patients are going to the emergency departments and they are just providing a quick fix for the moment. These patients need long term fixes and should be able to control their headaches for a longer period. Developing an educational plan for headache patients will be the key to ensure that they are taught what steps they need to take, what their plan of action is and therefore will be able to control their headaches at home. While keeping these patients at home for treatment will also help decrease emergency department visits, it will also decrease insurance costs and any potential out of pocket costs for the patient.  According to Stokes et al. (2011) found that chronic migraine had an increased amount of total medical costs then episodic migraines and that therapies that reduce headache frequency should be important to reducing headache related costs.

Summary

When designing a Doctoral project, the first step is to outline the problem statement, purpose, and question.  One problem that is identified was the lack of adequate headache control, which leads to poor quality of life, increase in emergency rooms visits and increase in medical costs.  According to Stokes et al. (2011) found that migraines had a total increase in medical costs.  Nature of the problem, significance to the nursing profession as well as the implications for social change will also be discussed.   Overall, giving patients more control of their headaches will lead to them having a better quality of life.

 

DNP Project Proposal – Utilizing Nursing Education and Intervention as a Method to Decrease Emergency Department (ED) Visits for Headache