I have to write a reply to each of the texts in the document attached below, they must be 200 words each and include references.

Professor and class,

I have been lucky enough to work with three different EHR systems between clinical and my current job in the ED. I have been able to compare and contrast the pros and the cons between the EHRs’ and their health information systems. Upon starting in my ED a year and a half ago I was originally oriented to the EHR called Cerner. I really enjoyed this EHR as I felt that the HIS worked well at providing safe and efficient patient care. The allergies and current patient medications came up as a “to-do” flag within each patient upon admission. This ensured that the nurse was able to check off what the patient may have already taken that day, or what they may be allergic to before giving a patient a medication. After entering the patients history it was then documented in a place that was easy for the doctors and pharmacy to locate in order to enter and verify medications. This allowed for three different healthcare professionals to verify that this patient would be getting a medication that was safe for them. I now work with the EHR “Epic.” Although I like EPIC a lot, I feel that there are some flaws with it’s HIS system. I did some research, and found a study on the effectiveness of healthcare information systems throughout the city of Neyshabur in 2019. “Despite great effort to develop and utilize HISs and improve their effectiveness in improving patient care, the present study indicated an index of 64.42 out of 100 and reflected that there was still a gap to complete effectiveness” (Mohammadpour et al., 2021). They found many gaps in the staffs’ understanding on how to gather and implement data in order to form safe and efficient interventions for each patient. I find that, with EPIC, it is easier to be quickly inputting data within the ED and forget to acknowledge the patients prior history and allergies as the system does not prompt you to do so (at least with the version of EPIC that we have). With that being said, it is easier for medication errors to happen. I also feel that EPIC does not communicate with the PYXIS (medication administration station) as well as it could. With Cerner it would not let you scan a medication in to give it to a patient if it was not physically ordered within the chart. In Epic it will let the nurse scan any medication into the chart, and will open the medication up under a “non-ordered” medication admin panel. If not paying attention, this could make for a huge medication error in the ED as we mainly pull potentially dangerous medications on override when in emergent situations. Lastly, with Epic patients now have 24/7 access to their health chart. They can view and screenshot their labs, meds, appointments etc. This is exciting for the patient as they are able to easily access appointment changes, and medication requests through all of their HCP. “Astute nurses need to be familiar with these advantages and disadvantages so that they can advise patients correctly” (Chamberlain College of Nursing, 2020). The nurse should be able to properly advise the patient on how to interpret their laboratory values. It is important for the patients to be educated on the need to speak with the HCP after getting new laboratory results before coming to their own conclusions. A struggle that I have seen through my ED is that we will be very busy and start what we call protocols in the waiting room. This is where the nurse draws the patients blood without them being sent to a room yet in order to speed up their care. This ensures we see the sickest patients as soon as possible. The patients will then get these results back while in the waiting room, and google them. This allows some patients extreme health anxiety while in the waiting room, and on the other hand will result in patients leaving without treatment as they feel whatever results they got back were “good enough to go home.” These three things have made the transition from Cerner to Epic negative for me, but I feel as though my nursing supervisor actively works on any complaints that we have regarding the transition we are having as a hospital. Epic has a lot of different versions and updates and through our feedback we are working out all of the “kinks”.  This makes the transition into a new EHR less scary, and more positive, as I always think back to how much technology has the potential to upgrade as we identify areas in need of change. I feel that technology is very important in healthcare as it allows for quick and “easy” access to patient records, but there will always be room for improvements which means that nurses need to be that more cognizant of the potential of errors.

Resources 

Mohammadpour, A., Ghaemi, M. M., Darrudi, R., & Sadagheyani, H. E. (2021). Use of Hospital Information System to Improve the Quality of Health Care from Clinical Staff Perspective. 
Galen medical journal. DOI: 

10.31661/gmj.v10i0.1830

Chamberlain College of Nursing (2020). 
NR361 Information Systems in Healthcare: Downers Grove, IL: Online Publication. 

Discussion

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced health assessment. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.

Course Outcomes

This discussion enables the student to meet the following course outcomes:

• CO 1: Apply advanced practice nursing knowledge to collecting health history information and physical examination findings for various patient populations. (POs 1, 2)
• CO 4: Adapt health history and physical examination skills to the developmental, gender-related, age-specific, and special population needs of the individual patient. (POs 1, 2)
• CO 5: Conduct focused and comprehensive health histories and examinations for various patient populations. (POs 1, 2)

Due Dates

Initial posts are due to the discussion board by Wednesday at 11:59 p.m. MT. Instructor and peer responses are due by Sunday at 11:59 p.m. MT. Students must post on a minimum of two separate days. A 10% late penalty will be imposed for discussions posted after the deadline Wednesday at 11:59 p.m. MT, regardless of the number of days late. NOTHING will be accepted after 11:59 p.m. MT on Sunday (i.e., the student will receive an automatic 0).

Total Points Possible

The total points possible for this assignment is 75.

Preparing the Discussion

Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions.

This week, you will consider assessment questions and appropriate interventions related to social determinants of health. Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being. The nurse practitioner (NP) must assess all facets of clients’ health during a comprehensive health history. Identify the assigned topics listed by the first letter of your first name. For example, if your first name is Gilda then your assigned topic is education access and quality. Select an objective related to your assigned social determinant from the Healthy People website.

First Letter of Your First NameTopicA – EEconomic stabilityF – JEducation access and qualityK – OHealth care access and qualityP – SNeighborhood and built environmentT – ZSocial and community context

Complete the following requirements:

1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
   1. Correctly identify your assigned social determinant. Briefly define the determinant and describe how it impacts healthcare outcomes.
   2. Select an objective related to your assigned social determinant from the Healthy People website linked above. Identify the status of the objective and the population to whom the objective applies.
   3. Provide at least three appropriate questions related to the chosen objective that the NP could incorporate into the health history and interview to assess the client and family.
   4. Identify at least two online, national, or local resources and explain how the resources could help meet the chosen objective for at-risk clients or families.
2. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations.
   1. Cite a scholarly source in the initial post.
   2. Cite a scholarly source in one faculty response post.
   3. Cite a scholarly source in one peer post.
   4. Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
   5. Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
3. Engagement in Meaningful Dialogue:Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice:
   1. Peer Response: Respond to at least one peer on a topic other than the initially assigned topic.
   2. Faculty Response: Respond to at least one faculty post.
   3. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
4. Professionalism in Communication:Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
5. Reference Citation: Use current APA format to format citations and references and is free of errors.
6. Wednesday Participation Requirement:Provide a substantive response to the graded discussion topic (not a response to a peer or faculty), by Wednesday, 11:59 p.m. MT of each week.
7. Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

What matters at the end of life and Palliative care, a  different voice in healthcare. There are two Utube videos above and you  need to pick only one and tell about it. Here is what you can report on:

a) What is the subject that the speaker is covering?

b) Does it effect the ideas that you have already about palliative care?

c) It is very important for someone to think about and be able to  converse about the subject of death and dying if they are considering  working as a nurse in this area. Why would that be?

the  ROLE OF THE RN/APRN IN POLICY-MAKING

Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.

What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?

Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To Prepare:

• Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.
• Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

BY DAY 3 OF WEEK 8

Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.

BY DAY 6 OF WEEK 8

Respond to at least two of your colleagues’* posts by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.