Reflection on Achievement of Outcomes Concept Map Paper

Reflection on Achievement of Outcomes Concept Map Paper

Reflection on Achievement of Outcomes Concept Map Paper

Completion of this course made me realize some goals and unachieved outcomes. At the beginning of the course, I had set personal goals entailing what I expected to achieve at the end of the course. I drafted a road map with personalized interventions to achieve these goals. My instructor, class resources, online multimedia sources, and evidence-based journals played a key part in the achievement of some goals and completion of the course activities. My outcome achievement so far has been a product of outcomes of other learning activities including the National Organization of Nurse Practitioners (NONP), the MSN Essential VIII, and the general MSN Program Outcome. To break down the outcomes in this reflection, I have achieved the following outcomes in these three competencies

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Achievement of Outcomes

MSN Program Outcome #2: Creating a Caring Environment to Achieve Quality Health Outcomes (Care-Focused): I have completed the assignments so far in outcome number 2. Under this outcome, the ultimate goal was to understand the influences that the environment and lifestyle have on our health. I discussed obesity in my home state, California. This discussion opened changed my understating of childhood obesity and associated adulthood disease risks such as diabetes mellitus and hypertension. To understand the end of quality, I undertook a discussion in week five that explained the impact of culturally sensitive care on quality. Socioeconomic status and culture are social determinants of health that were emphasized. At the population level, I also learned a handful of concepts in disease transmission and epidemiological triangle.  

MSN Essential VIII: Clinical Prevention and Population Health to Improve Health: understanding population health is aimed at improving the ability to establish preventive strategies that will improve health. Disease prevention at the clinical level forms part of the responsivities that nurses provide to our clients. To understand primary prevention disease, I learned about healthy people 2020 goals and how they impact population wellness. I gained much on disease epidemiology by discussing Alzheimer’s disease epidemiology. Screening and prevention strategies for Alzheimer’s disease enabled me to understand the epidemiological burden this illness has, especially on adults. I understood my future role as a nurse practitioner in disease diagnosis and management by discussing community-acquired pneumonia. Determinants of health for CAP patients and the epidemiological triangle in CAP prevention.

NONP Competencies #4: Practice Inquiry Competencies: evidence-based practice is an essential National Organization of Nurse Practitioner Faculties (NONPF) competency (Heinen et al., 2019; Honig et al., 2019). To acquire this competency in relation to disease epidemiology, my broad predetermined objective was to improve my knowledge and skills in the application of evidence-based practice at the population level. I learned about various types of research study methodologies and also adenocyte through practice inquiry and literature search. I believe that am now competent in identifying various methodologies in any research article. This competency will help in future evidence-based projects when I will want to rank my sources and select the highest level of evidence for practice change and improvement. Quality epidemiological data will improve my preventive services for patient education and community care.

In sum, my experience so far has been production having achieved different outcomes in disease epidemiology, population health, and nursing care as I have outlined in my concept map. The process of acquisition of further competencies will build on these achievements. I desire to become a competent nurse practitioner in a hospital and some elements of community care.

References

Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378–2392. https://doi.org/10.1111/jan.14092

Honig, J., Doyle-Lindrud, S., & Dohrn, J. (2019). Avançando na direção de cobertura universal de saúde: competências de enfermeiros de práticas avançadas. Revista latino-americana de enfermagem, 27, e3132. https://doi.org/10.1590/1518-8345.2901.3132

 Appendix A: Week 7: Reflection on Achievement of Outcomes Concept Map

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Week 1: Discussion – Exercise and Discussion Questions from Curley Text Book

Week 1 Discussion:
CHAPTER 1: EXERCISE 1.5
According to the National Cancer Institute, obesity is linked with an increased risk for developing at least 19 different types of cancer; Chapter One discusses the most common cancers associated with obesity which include esophageal, pancreatic, colon and rectal, breast, endometrial, kidney, thyroid, and gallbladder cancers.
The prevalence of obesity in people younger than 18 years old in the state of California is about 17%; this means that for every 100 people in this age group, 17 are obese (Centers for Disease Control and Prevention, 2018). This number is based on self-reported data from the Centers for Disease Control and Prevention (CDC). There are several factors that contribute to childhood obesity, including diet, physical activity levels, genetics, and psychology. Poor diet and lack of physical activity are two of the most important causes of obesity among people younger than 18 years old (Centers for Disease Control and Prevention, 2018). There are certain groups of children who are at a higher risk for obesity in California and across the United States. According to the Centers for Disease Control and Prevention (CDC), these include African American children, Hispanic children, American Indian/Alaska Native children, Asian/Pacific Islander children, and low-income children.
There are many prevention programs in California aimed at addressing the issue of childhood obesity. Some of these programs include physical activity and nutrition education components, while others focus solely on one or the other. It can be challenging to determine which program is best for a particular community or school district, as each community is different and each child has unique needs (Centers for Disease Control and Prevention, 2018). That said, some general guidelines that might be helpful when deciding on a prevention program include looking for programs that are evidence-based, collaborative, and culturally relevant. Additionally, it can be helpful to consider the resources that are available in a community and work with local partners to develop a program that meets the specific needs of that community. These programs are effective as they have been used to reduce the prevalence rates of obesity among children below 18 years of age in the state of California. Also, many families have benefited from these programs.
The state of California has enacted a number of laws designed to decrease obesity. However, it is difficult to measure their effectiveness because obesity is defined in many different ways, and there are many contributing factors. For example, one study found that a statewide ban on trans fats led to a reduction in heart disease rates, despite no change in obesity rates. Other initiatives have included education campaigns and financial incentives for healthful eating. But more research is needed to determine which interventions are most effective at reducing obesity rates.

Reference
Centers for Disease Control and Prevention. (2018c). Adult obesity facts. Retrieved from https://www.cdc.gov/obesity/data/adult.html Links to an external site.

Week 2: Discussion – Epidemiological Methods
Marine Keshishyan submitted Sep 6 at 9:21pm

Hello Class,
Iron Deficiency Anemia
Anemia is described as low hemoglobin concentration in the blood below the normal level of a particular age or sex. Iron deficiency anemia is common afflicting up to 30% of the world’s population (Kumar et al., 2022). This warrants a proper diagnostic tool for IDA to expedite treatment. The diagnosis of IDA is anchored on a complete blood count test and the ferritin levels in serum. The purpose of this paper is to discuss serum ferritin levels as a diagnostic tool for iron deficiency anemia.
Serum Ferritin Level
Ferritin is a positive reactant protein whose level increases in inflammation. Serum ferritin level as a diagnostic tool for IDA focuses on the ferritin levels in the blood. Levels less than 100ug/L and a concomitant inflammation

Week 2: Healthy People 2020 Impact Paper
Healthy People 2020 Impact Paper
Population health addresses and focuses on health outcomes of specific groups based on the geographic distribution in communities, disability, age, or ethnicity, among other factors. The concept of epidemiology is critical in population health as it facilitates the scientific and systematic study of the distribution and occurrence of determinants of diseases among different groups to develop effective strategies for intervention. The Healthy People (HP) 2020 outlines specific objectives regarding specific health issues and provides guidelines and screening tools to help detect the diseases among different populations early onstage for effective treatment. Conducting a comprehensive epidemiological analysis facilitates the identification of prevalence, risk factors, susceptible people or impacts, and effective planning of effective interventions at the state or national level.
Overview, Background, and Significance of the Problem
Dementia is a collective term for the syndrome characterized by significant impairment and decline in cognitive, social, and behavioral functions by affecting an individual’s thinking, remembering, or decision-making capabilities, interfering with daily living activities (ADL). The most common type of dementia is Alzheimer’s disease (AD) which is a condition that causes memory loss and challenges in thinking or solving problems hence interfering with daily activities and routines, and others include cerebrovascular and Lewy body disease (Hwang et al., 2019). Although dementia is more prevalent among the older population, this health condition is not a normal part of aging. Racial and ethnic disparities heighten the risk of dementia; hence minority populations including Hispanics, non-Hispanic whites, African-Americans, Indian, and Alaska natives are more susceptible.
The primary risk factor for dementia is age, and the aging population is growing more racially and ethnically diverse. The prevalence of AD in California among people aged 65 years and above was approximately 660,000, which is 11% of the total rate in the United States of 5.8 million, and 177,345 of this population was from Los Angeles (L.A.) (Ross et al. 2021). The number of Americans living with AD may rise to 16 million by 2030. AD has severe implications on families since, in 2020, approximately 1.6 million caregivers, 60% of whom are female in California, will bear the burden by providing 1, 849 million hours of unpaid care at a value of $24 billion, which impacts their social, emotional and physical well-being (Ross et al. 2021). Alzheimer’s disease and related dementias (ADRD) also affect the healthcare system, with the disease cost amounting to around $4.2 billion in California. The number of deaths associated with dementia in 2017 was approximately 266,957 from AD in the U.S., and 25,017 were in California, precisely 3,994 in L.A (Ross et al. 2021). The mortality rate of AD in California was 47 per 100,000 in 2018, with 16,627 deaths, compared to 37.3 per 100,000 in the United States (Alzheimer’s Association Report, 2020). In 2018, Californians aged 65 to 84 in 2018 identified as Black or African American reported the highest death rates.
Epidemiological Analysis
Descriptive epidemiology entails the organization and analysis of data defining and describing the frequency of disease variation by covering the aspects of time, person, and place and correlating the three components to determine risk factors accurately. By 2050, the number of patients with AD may rise exponentially from 5.8 million to 13.8 million, and 68% of this global increase will be in low and middle-income countries (LMICs) (Zhang et al., 2021). The percentage of people with AD increases rapidly with age since populations within 65-74 years, 75-84 years and above at the percentage rate of 3%, 27%, and 32% AD. An estimated 60% of the population residing in have dementia, and the number may rise to 152 million globally in mid-century in LMICs (Zhang et al., 2021). The lifetime risk for AD is approximately 20% and 10% for women and men at age 45.
Moreover, the incidence of dementia is higher among racial and ethnic minority groups; hence older Black and Hispanics are more at risk for ADRD. Data for Medicare beneficiaries report a diagnosis of ADRD among 13.8% and 12.2% African American and Latino population (Alzheimer’s Association Report, 2020). A behavioral risk factor survey findings show that 11% of Americans aged 45 years and above report cognitive but 54% do not consult healthcare providers (Alzheimer’s Association Report, 2020). Age is a common risk factor for ADRD; hence, the older population comprising adults aged 65 years and above is more susceptible. Women are also at risk for ADRD since out of the 5.2 million people with this health condition, 3.3 million are female (Healthy People 2020, n.d.). The global prevalence of AD is higher in women, 1.17 times more than in men (Zhang et al., 2021). Similarly, people with a family history of ADRD are at a greater risk since 19 new genes heighten the likelihood of contracting late-onset AD.
Application of HP 2020
HP 2020 initiative outlines specific national goals and objectives to reduce health threats and promote healthy lives. One of the goals is to achieve longer, high-quality lives free of diseases, illnesses, injuries, disabilities, or premature deaths (Healthy People 2020, n.d.). Another specific goal of this initiative is to alleviate avoidable disparities, attain equity and establish social and physical environments that influence the health of all populations. The goal is to minimize morbidity and related costs and to improve the quality of life for people with ADRD by promoting healthy behaviors, increasing practical diagnostic tools, and offering social or behavioral resources to support caregivers. The first objective is to increase the number of individuals diagnosed with dementia or their caregivers’ knowledge of diagnosis from 38.3% to 68.2% (Healthy People 2020, n.d.). The significant threats and burden of ADRD to the public health system have prompted its inclusion as a new topic in the HP 2020 initiative.
The recommended guidelines for the AD diagnostic process emphasize dividing the steps to detect, differentiate, diagnose and treat, and healthcare providers utilize various tools and approaches. The mini-mental state examination (MMSE) test is the most commonly used cognitive screening tool that entails 11 questions that healthcare providers may take 10 to 30 minutes to administer (Hwang et al., 2019). The MMSE has a cut-off value of 23/24 out of a possible 30, which indicates good reliability and validity in identifying dementia. The maximum point for the MMSE score is 30, and any points below 24 indicate concerns about dementia, whether mild, moderate, or severe. Age, education, and ethnicity affect interpretation. Early diagnosis of ADRD helps patients seek early treatment and interventions concerning lifestyle changes.
Population Level Planning and Interventions
The Department of public health in California designed and released the Assessment of cognitive complaints toolkit for AD (ACCT-AD) to assist healthcare providers in the primary care setting with an effective instrument to detect and diagnose AD or other mental issues. Utilization of systems such as the behavioral risk factor surveillance system (BRFSS), Medicare current beneficiary survey, or National health and aging trends study (NHATS) will help monitor data mortality rates, ADRD diagnoses, or utilization of services and assess the extent of progress (CDC, 2018). The Healthy Brain Initiative is a program developed in partnership with the Alzheimer’s Association and the Centers for disease control and prevention to enhance cognitive health. The program aims to strengthen knowledge about care planning, improve access to evidence-based interventions and services for people with dementia and emphasize the importance of caregivers. This strategy seeks to enhance the competence of the current workforce through extensive training to empower public health professionals with relevant knowledge on the most appropriate and reliable evidence of dementia for proper detection and treatment and meeting health needs. The outcomes of this program include increased workforce capacity, demand and utilization of dementia-related services, and improved early detection, diagnosis, and professional care (CDC, 2018). Other outcomes are an informed public and people with dementia or their caregivers, and supportive communities. Seeking public feedback using online surveys is an effective strategy to get responses to the effectiveness of the programs, such as an increased awareness of brain health and seeking input on recommendations for improvement.
Conclusion
Identifying prevalence or incidence rates, risk factors, or the burden of a chronic illness facilitates the development of strategies for strategic intervention. Infectious and chronic health diseases such as cancer, diabetes, arthritis, lung cancer, dementia, and osteoporosis are the leading cause of mortality and disability and contribute to a significant burden in healthcare due to costs associated with treatment and management. Dementia is among the leading causes of disability and mortality among older adults, and prevalence has increased exponentially, especially in relation to associated public health costs. Thus, relevant stakeholders at the state and national levels should increase efforts to develop and implement appropriate interventions for population health issues and monitor progress to ensure effectiveness.

References
Alzheimer’s Association Report, (2020). 2020 Alzheimer’s disease facts and figures. The Journal of the Alzheimer’s Association. https://doi.org/10.1002/alz.12068
Centers for Disease Control and Prevention (2018). Healthy brain initiative, state, and local public health partnerships to address dementia: The 2018-2023 road map. Alzheimer’s Association. https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf
Healthy People 2020. (n.d.). Dementias, including Alzheimer’s disease. https://www.healthypeople.gov/2020/topics-objectives/topic/dementias-including-alzheimers-disease
Hwang, A. B., Boes, S., Nyffeler, T., & Schuepfer, G. (2019). Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. In Plos One, 14(7). https://doi.org/10.1371/journal.pone.0219569
Ross, K. L., Beld, M., & Yeh, C. J. (2021). Alzheimer’s disease and related dementias facts and figures in California: Current status and future projections. California Department of Public Health. https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/CDPH%20Document%20Library/Alzheimers%27%20Disease%20Program/151764_Alzheimers_Disease_Facts_and_Figures_Reportv3_ADA.pdf
Zhang, X. X., Tian, Y., Wang, Z. T., Ma, Y. H., Tan, L., & Yu, J. T. (2021). The Epidemiology of Alzheimer’s Disease Modifiable Risk Factors and Prevention. In Journal of Prevention of Alzheimer’s Disease, 8(3). https://doi.org/10.14283/jpad.2021.15

Week 3: Discussion- Epidemiological Methods and Measurements

Hello class,
The difference between cohort studies and randomized controlled trial
The primary difference between the two is that cohort study involves observation where the researcher cannot control the conditions or events. For example, the researcher cannot select the interventions or population, but rather observes what takes place in real-world scenarios (Wang & Kattan, 2020). On the other hand, in randomized-controlled trials, the research controls the experiment to find out casual relationships, for example, between treatment and outcome.
Advantages and disadvantages of cohort studies.
A cohort study gives the ability to observe multiple outcomes associated with either multiple or single exposures. Another advantage is that cohort studies allow researchers to study unusual or rare exposures, which is difficult with other experimental approaches (Camm & Fox, 2018). Additionally, cohort studies are not prone to selection bias since the outcome is not known prior to baseline exposure and exposures are assessed before the occurrence of the outcome.
The first disadvantage of cohort study design is that it is costly and time-consuming. The second limitation is that it requires following a large population and for over a long period (Wang & Kattan, 2020). The third disadvantage is that losses to follow-up can occur, leading to bias in association measures.
Characteristics of a correlational study
• The researcher cannot manipulate any variable since the research is non-experimental. Instead, the research only observes and measures the relationship(Paul, 2019).
• The two correlational variables have a dynamic pattern between them.
• Observes historical patterns and events
Pyramid level and meaning for cohort studies
In the evidence pyramid, cohort studies fall in level III. The highest level of evidence in the pyramid is the systematic reviews and meta-analysis followed by randomized controlled trials at level two. Level three means that cohort studies have a fairly high level of evidence that can be used to make clinical decisions.
References
Camm, A., & Fox, K. (2018). Strengths and weaknesses of ‘real-world’ studies involving non-vitamin K antagonist oral anticoagulants. Open Heart. , 5(1), e000788. https://doi.10.1136/openhrt-2018-000788.
Paul, A. (2019). Descriptive and correlational study of the epidemiological, clinical and etiological characteristics of peritonitis in the surgical department of the HUEH during the period from January 2013 to December 2018: A protocol study. International Journal of Surgery Protocols, 18. 1-14. https://doi.org/10.1016/j.isjp.2019.10.001.
Wang, X., & Kattan, M. (2020). Cohort Studies: Design, Analysis, and Reporting. CHEST, S72-S78.