TO PREPARE

• Refer to the “Population-Focused Nurse Practitioner Competencies” in the Learning Resources, and consider the quality measures or indicators advanced practice nurses must possess in your specialty.
• Refer to your “Clinical Skills Self-Assessment Form” you submitted in Week 1 and consider your strengths and opportunities for improvement.
• Refer to your Patient Log in Meditrek; consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.

In 450–500 words, address the following:

Learning From Experiences

• Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
• Reflect on the 3 most challenging patients you encountered during the practicum experience. What was most challenging about each? 
• What did you learn from this experience? 
• What resources were available?
• What evidence-based practice did you use for the patients?
• What would you do differently? 
• How are you managing patient flow and volume?  How can you apply your growing skillset to be a social change agent within your community?

Communicating and Feedback

• Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
• Answer these questions: How am I doing? What is missing? 
• Reflect on the formal and informal feedback you received from your Preceptor. 

Please see attachment for instructions. 

LITERATURE REVIEW: THE USE OF CLINICAL SYSTEMS TO IMPROVE OUTCOMES AND EFFICIENCIES

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technological trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

· Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.

· Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”

· Identify and select 4 peer-reviewed research articles from your research.

· For information about annotated bibliographies, visit 

https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographiesLinks to an external site.

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

· Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.

· Include an introduction explaining the purpose of the paper.

· Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

· In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.

· Use APA format and include a title page.

· Use the Safe Assign Drafts to check your match percentage before submitting your work.

LEARNING RESOURCES

Required Readings

· McGonigle, D., & Mastrian, K. G. (2022). 
Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

· Chapter 14, “The Electronic Health Record and Clinical Informatics” (pp. 293–316)

· Chapter 15, “Informatics Tools to Promote Patient Safety, Quality Outcomes, and Interdisciplinary Collaboration” (pp. 323–349)

· Chapter 16, “Patient Engagement and Connected Health” (pp. 357–378)

· Chapter 17, “Using Informatics to Promote Community/Population Health” (pp. 383–397)

· Chapter 18, “Telenursing and Remote Access Telehealth” (pp. 403–432)

· Benda, N. C., Veinot, T. C., Sieck, C. J., & Ancker, J. S. (2020). 

Broadband internet access is a social determinant of health!Links to an external site.
. 
American Journal of Public Health, 
110(8), 1123-1125. https://doi.org/10.2105/AJPH.2020.305784 

· Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M., Collins, S. …Bates, D. W. (2017). 

Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study


 Download Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study
. 
Critical Care Medicine, 45(8), e806–e813. doi:10.1097/CCM.0000000000002449

· HealthIT.gov. (2018c). 


What is an electronic health record (EHR)

?Links to an external site.
 Retrieved from 
https://www.healthit.gov/faq/what-electronic-health-record-ehr

· Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). 

Leveraging interactive patient care technology to Improve pain management engagementLinks to an external site.
. 
Pain Management Nursing, 19(3), 212–221. 

· Sieck, C. J., Sheon, A., Ancker, J. S., Castek, J., Callahan, B., & Siefer, A. (2021). 

Digital inclusion as a social determinant of healthLinks to an external site.
. 
NPJ Digital Medicine, 
4(1), 52.  https://doi.org/10.1038/s41746-021-00413-8 

· Skiba, D. (2017). 

Evaluation tools to appraise social media and mobile applicationsLinks to an external site.
. 
Informatics, 4(3), 32–40. 

· Sharma, P., & Patten, C. A. (2022). 

A need for digitally inclusive health care service in the United States: Recommendations for clinicians and health care systemsLinks to an external site.
. 
Permanente Journal, 
26(3). https://doi.org/10.7812/TPP/21.156 

Psychiatric Diagnosis and DSM 5 Diagnostic Criteria	History of Present Psychiatric Illness (Presenting signs & symptoms/ Previous Psychiatric Admission / Outpatient Mental Health Services)

CON
CEPT MAP

Pathophysiology – (to the cellular level)

Medical Diagnosis

Clinical Manifestations (all data subjective and objective: labs, radiology, all diagnostic studies) (What symptoms does your client present with?)

Complications

Treatment (Medical, medications, intervention and supportive)

Risk Factors (chemical, environmental, psychological, physiological and genetic)

Nursing Diagnosis

Problem statement: (NANDA)

Related to: (What is happening in the body to cause the issue?)

Manifested by: (Specific symptoms)

	General Appearance
Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane) Basic Grooming and Hygiene (clean, disheveled and whether it is appropriate attire for the weather)	Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest), posture (slouched, erect), any noticeable mannerisms or gestures	Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise)
	Manner and Approach
Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness)	Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing). Coping and stress tolerance.	Speech (normal rate and volume, pressured, slow, loud, quiet, impoverished) Expressive Language (no problems expressing self, circumstantial and tangential responses, difficulties finding words, echolalia, mumbling) Receptive Language (normal, able to comprehend questions,
	Orientation, Alertness, and Thought Process
Recall and Memory (recalls recent and past events in their personal history). Recalls three words (e.g., Cadillac, zebra, and purple) Orientation (person, place, time, presidents, your name)	Alertness (sleepy, alert, dull and uninterested, highly distractible) Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)	Concentration and Attention (naming the days of the week or months of the year in reverse order, spelling the word “world”, their own last name, or the ABC's backwards)
Thought Processes (loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization). Values and belief system	Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications)	Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong)

	Mood and Affect
Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry). Affect or how they felt at a given moment (comments can include range of emotions such as broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation.	Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset) Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful, pessimistic, optimistic)	Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected) Impulsivity (poor, effected by substance use) Anxiety (note level of anxiety, any behaviors that indicated anxiety, ways they handled it)

Lab	Range	Value	Reason Obtained

Risk Assessment: Suicidal and Homicidal Ideation (ideation but no plan or intent, clear/unclear plan but no intent) Self-Injurious Behavior (cutting, burning) Hypersexual, Elopement, Non-adherence to treatment	Discharge Plans and Instruction: Placement, outpatient treatment, partial hospitalization, sober living, board and care, shelter, long term care facility, 12 step program

Teaching Assessment and Client / Family Education: (Disease process, medication, coping, relaxation, diet, exercise, hygiene) Include barriers to learning and preferred learning styles

Mr. Rivera is a 72-year-old patient with end stage COPD who is in the care of Hospice. He has a history of smoking, hypertension, obesity, and type 2 Diabetes. He is on Oxygen 2L per nasal cannula around the clock. His wife and 2 adult children help with his care. Develop a concept map for Mr. Rivera. Consider the patients Ethnic background (he and his family are from Mexico) and family dynamics. Please use the concept map form provided.