The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.

Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To Prepare

• Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
• Reflect on situations in which children should be prescribed drugs for off-label use.
• Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

Interactive media piece:

African American child suffering from Depression:

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from peers in class
• Mother notes decreased appetite and occasional periods of irritation
• Client reached all developmental landmarks at appropriate ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression).

Write a 1-page narrative in APA format that addresses the following:

• Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
• Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

1. Evidence-Based Solution
2. Nursing Intervention
3. Patient Care
4. Health Care Agency

Module 06 Course Project – Final Submission

• Clinical staff members are not washing their hands between patients.
• Employee attacks patients while under the influences of narcotics.

It’s time to put your two compliance plans all together into one report. Be sure to implement your instructor feedback and proofread all your work one last time. In addition, check the requirements in the original assignment.

Be sure to write a summary statement and insert it at the end of the project before the References Page. (See the outline below.) In your summary statement, describe your own journey in working on this project. Explain how this project has strengthened your understanding of compliance rules and regulations.

Your final plan should include the following. Note the overview at the beginning and the summary statement at the end. Remember to check details to insure that your plans will be understood by all employees at a large medical facility where you are the Compliance Officer.

• Cover Page
• Overview of Compliance
• First Compliance Plan
  • Policies
  • Procedures
  • Monitoring Tools
• Second Compliance Plan
  • Policies
  • Procedures
  • Monitoring Tools
• Summary Statement
  • How this project has strengthened your understanding of compliance rules and regulations.
• References Page
  • At least twelve research references for both compliance plans.

Review the Institute of Medicine (IOM) report: “The Future of Nursing: Leading Change, Advancing Health,” focusing on the following sections: Transforming Practice, Transforming Education, and Transforming Leadership.

Write a paper of 750-1,000 words about the impact on nursing of the 2010 IOM report on the Future of Nursing. In your paper, include:

The impact of the IOM report on nursing education.

The impact of the IOM report on nursing practice, particularly in primary care, and how you would change your practice to meet the goals of the IOM report.

The impact of the IOM report on the nurse’s role as a leader.

Cite a minimum of three references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Students should review the rubric prior to beginning the assignment to become familiar with the criteria and expectations for successful completion.

Communication and Education to Promote Change

Who provides formal and informal leadership within your practicum setting? What power and/or authority do these individuals hold? How has this influenced planning for and implementing change in the past?

In this Discussion, you analyze the dynamics of your practicum setting with attention toward developing political acumen, which can be highly beneficial in your effort to facilitate evidence-based change. You also consider the need for education and methods that could be used to promote knowledge integration among various stakeholders. As you probe these issues, your goal is to develop strategies for building alliances that would support the successful implementation of the change you are proposing for your practicum experience.

To prepare:

• How      would you describe the distribution of formal and informal power, as well      as authority, within your practicum setting? Think about the constellation      of professional roles. Which ones are most salient for the change you are      proposing? Who holds each of these roles? Who else within the organization      might have political clout and be able to serve as an ally? What approach      would you take to build productive alliances and generate buy-in for your      proposed change?
• How      do you anticipate that this change would cascade through the environment?      What strategies would you employ to generate wide-scale interest and      investment in your proposed change, as well as the education necessary for      successful adoption? Evaluate specific structures related to      communication, training, organizational culture, and other factors that      relate to the implementation of sustainable change.
• What      kinds of issues related to organizational structure and culture or      interpersonal dynamics could pose a challenge for creating buy-in and/or      promoting knowledge integration?
• In      addition to reviewing this week’s Learning Resources, be sure to speak      with individuals in your practicum setting and conduct additional research      to enrich your thinking for this Discussion.

By tomorrow Wednesday 3/20/19  2 pm write a minimum of 550 words essay in APA format with at least 3 references (see list or required readings below). Include the level one headers as numbered below: 

Post a cohesive response that addresses the following:

1) Based on the specifics of your practicum experience and evidence from the literature, what strategies would you employ to communicate with and educate various stakeholders?

2) How would you engage the support of those with power and authority? Explain how this would facilitate the successful implementation of your proposed evidence-based change.

3) What are potential challenges for knowledge integration? How might you address those challenges?

Required Readings

White, K. M., & Dudley-Brown, S.(2016). Translation of evidence into nursing and health care practice. (2nd ed.) New York, NY: Springer Publishing Company.

· Review Chapter 7, “Translation of Evidence to Improve Clinical Outcomes”

· Review Chapter 13, “Interprofessional Collaboration and Practice for Translation”

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

· Review Chapter 6, “Translation of Evidence for Leadership”

This chapter addresses the pivotal role of leadership in the translation of evidence into practice.

American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf

Use the information in this report to guide the formulation of goals for your practicum experience.

Bleich, M. R. (2011). IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health, 34(3), 169-170. doi:10.1002/nur.20433

​IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health by Bleich, M. R., in Research in Nursing & Health, Vol. 34/Issue 3. Copyright 2011 by John Wiley & Sons – Journals. Reprinted by permission of John Wiley & Sons – Journals via the Copyright Clearance Center.

Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M., & Denis, J. (2016). Nursing unit leaders’ influence on the long-term sustainability of evidence-based practice improvements. Journal of Nursing Management, 24(3), 309-318. doi:10.1111/jonm.12320

Nursing Unit Leaders’ Influence on the Long-term Sustainability of evidence-based practice improvements by Fleiszer, A.; Semenic, S.; Ritchie, J.; Richer, M.; Denis, J., in Journal of Nursing Management, Vol. 24/Issue 3. Copyright 2016 by John Wiley & Sons – Journals. Reprinted by permission of John Wiley & Sons – Journals via the Copyright Clearance Center.

Greene-Ryan, J. (2016). Creating a community of transformation. Nursing Management, 47(5), 18-21. doi:10.1097/01.NUMA.0000482496.59946.8c

Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal Of Advanced Nursing, 69(3), 664-674. doi:10.1111/j.1365-2648.2012.06053.x

Kotter, J. P. (2007). Leading change: Why transformation efforts fail. Harvard Business Review, 85(1), 96-103. Retrieved from https://cb.hbsp.harvard.edu/cbmp/pl/57319806/57319860/3d20a24aeeedc7a83d2a918c5013078c

In this foundational reading, Dr. John Kotter discusses errors commonly made as organizations undergo change, and he recommends steps leaders can take to help avoid them.

Nelson-Brantley, H. V., & Ford, D. J. (2017). Leading change: a concept analysis. Journal Of Advanced Nursing, 73(4), 834-846. doi:10.1111/jan.13223

Rose, R., Adams, F., & Johnson, S. (2016). Nurse Led, Nurse Driven Service Lines: How Nurse Leaders Are Navigating Change. Nurse Leader,14195-197.doi:10.1016/j.mnl.2016.03.007

Salmela, S., Eriksson, K., & Fagerström, L. (2012). Leading change: a three-dimensional model of nurse leaders’ main tasks and roles during a change process. Journal of Advanced Nursing, 68(2), 423-433. doi:10.1111/j.1365-2648.2011.05802.x

Sherrod, B., & Goda, T. (2016). DNP-Prepared leaders guide healthcare system change. Nursing Management, (9). 13.