The World Health Organization and the Centers for Disease Control and Prevention (CDC) sites list the major determinants of health services utilization.Complete the following for this assignment:Select and analyze 1 determinant of health within the concept of its impact to the U.S. health care system. Describe the health care demand and supply as it relates to your chosen determinants. What will be your recommendation on how to reduce or eliminate this determinant?Ensure that you integrate economic terms, frameworks, and models throughout your review.

see attachments and follow instructions closely for the exercised

Develop a data table that illustrates one or more underperforming clinical outcomes in a care environment of your choice. Write an assessment (3–5 pages) in which you set one or more quantitative goals for the outcomes and propose a change plan that is designed to help you achieve the goals.Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, it is recommended that you complete the assessments in this course in the order in which they are presented.SHOW LESSKnowing what is the best practice for our patients is very important in providing safe and effective care. Understanding best practices can help nurses identify areas of care that need to be improved. To identify areas of need, nurses must use evidence from various sources, such as the literature, clinical practice guidelines (CPG), professional organization practice alerts or position papers, and protocols. These sources of evidence can also be used to set goals for improvement and best practices with an eye toward improving the care experience or outcomes for patients.The challenge facing many care environments and health care practitioners is how to plan for change and implement changes. For, if we cannot effectively implement changes in practice or procedure, than our goals of improving care will likely amount to nothing. This assessment focuses on allowing you to practice locating, assessing, analyzing, and implementing change strategies in order to improve patient outcomes related to one or more clinical goals.This assessment will take the form of a data table to identify areas for improvement and to set one or more outcome goals, as well as a narrative describing a change plan that would help you to achieve the goals you have set.By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.Competency 2: Develop change strategies for improving the care environment.Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.Justify the specific change strategies used to achieve desired outcomes.Competency 3: Apply quality improvement methods to practice that promote safe, equitable quality of care.Explain how change strategies will lead to quality improvement with regard to safety and equitable care.Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care improvement outcomes.Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.Communicate change plan in a way that makes the data and rationale easily understood and compelling.Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.One area in health care that it is necessary to consider is the environment in which the nurse works. It is important that this environment evolves and changes so that all patients are adequately supported. For this assessment, you will develop a change strategy to improve the health care environment. These changes can be rooted in a desire to improve clinical outcomes and data related to assessment accuracy, drug administration, disease recovery rates, or another relevant metric or outcome. A key skill for master's-level nurses is to be able to evaluate clinical data and create a change plan to help drive improvements in the data to reach set goals.As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.SHOW LESSThe assessment will be based on one or more outcomes that you would like to see improve. Think about experiences you have had working on setting goals for outcomes or using data to identify areas of need. Part of achieving your goal will be your ability to implement change in pursuit of improving outcomes. The Vila Health: Using Evidence to Drive Improvement simulation may be helpful in this regard.Where do you look for resources and evidence to help you get started when treating a specific condition?Where do you look for resources and evidence to help you get started when setting clinical goals?When there are no guidelines or policies for setting clinical goals, where do you look for resources and evidence to help you get started?How do you use these resources and evidence to begin constructing evidence-based treatment, or developing evidence-based goals?What data do you plan to use as a basis for setting improved outcome goals?What care environment do you envision using as the context of your assessment?How would change models, strategies, or theories need to be applied to help ensure achievement of your outcome goals?Which change models, strategies, or theories seem to be the best fit for your goals and environments. Why?Suggested ResourcesThe resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MSN-FP6021 – Biopsychosocial Concepts for Advanced Nursing Practice I Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.AssessmentKomenan, K., Elidjé, E. J., Ildevert, G. P., Yao, K. I., Kanga, K., Kouamé, K. A., . . . Kanga, J. (2013). Multifocal buruli ulcer associated with secondary infection in HIV positive patient. Case Reports in Medicine, 2013, 1–4. Retrieved from https://www.hindawi.com/journals/crim/2013/348628/SHOW LESSBiopsychosocialScaramuzzo, L. A., Gordils-Perez, J., & Cullen, P. M., (2014). Getting patients active: Using national data to drive practice. Clinical Journal of Oncology Nursing, 18, 41–43.ChangeEads, V., & Maruzzella, G. (2016). The clinical nurse as an agent of change. Medsurg Nursing, 25(3), 173–175.Heinig, M. J. (2010). Using data to drive and shape change. Journal of Human Lactation, 26(4), 359–361.Nundy, S., Mishra, A., Hogan, P., Lee, S. M., Solomon, M. C., & Peek, M. E. (2014). How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study. The Diabetes Educator, 40(6), 806–819.Evidence and Goal SettingAhrens, S., & Johnson, C. S. (2013). Finding the way to evidence-based practice. Nursing Management, 44(5), 15–19.Taylor, M. V., Priefer, B. A., & Alt-White, A. C. (2016). Evidence-based practice: Embracing integration. Nursing Outlook, 64(6), 575–582.View the simulation Vila Health: Using Evidence to Drive Improvement | Transcript.PathophysiologyLi, Y., Lu, Z., Zhang, X., Yu, H., Kirkwood, K. L., Lopes-Virella, M. F., & Huang, Y. (2015). Metabolic syndrome exacerbates inflammation and bone loss in periodontitis. Journal of Dental Research, 94(2), 362–370.Mocan Hognogi, L. D., & Simiti, L. V. (2016). The cardiovascular impact of visfatin - An inflammation predictor biomarker in metabolic syndrome. Clujul Medical, 89(3), 322–326.PharmacologySharmila, V., & Babu, T. (2015). Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease. Indian Journal of Pharmacology, 47(2), 232–233.Course Files and TemplatesAPA ModuleAPA Style Paper Template [DOCX].APA Style Paper Tutorial [DOCX].Guiding Questions: Change Strategy and Implementation [DOC].ScenarioConsider the current environment. This could be your current care setting, the care settings presented in the Vila Health: Using Evidence to Drive Improvement or Vila Health: Concept Maps as Diagnostic Tools media, or a care setting in which you are interested in working.For the setting that you choose you will need to have a data set that depicts sub-optimal outcomes related to a clinical issue. This data could be from existing sources in the course (Vila Health: Using Evidence to Drive Improvement), a relevant data set that already exists (a data set from the case study you used as a basis for your Concept Map assessment, or from your current place of practice), or an appropriate data set that you have created yourself. (Note: if you choose to create your own data set, check with your instructor first for approval and guidance.)After you have selected an appropriate data set, use your understanding of the data to create at least one realistic goal (though you may create more) that will be driven by a change strategy appropriate for the environment and goal.Potential topics for this assessment could be:Consider ways to help minimize the rate of secondary infections related to the condition, disease, or disorder that you focused on for your Concept Map assessment. As a starting point you could ask yourself, "What could be changed to facilitate safety and minimize risks of infection?"Consider how to help a patient experiencing traumatic stress or anxiety over hospitalization. As a starting point you could ask yourself, "How could the care environment be changed to enhance coping?"Once you determine the change you would like to make, consider the following:What data will you use to justify the change?How can the team achieve this change with a reasonable cost?What are the effects on the workplace?What other implementation considerations do you need to consider to ensure that the change strategy is successful?How does your change strategy address all aspects of the Quadruple Aim, especially the well-being of health care professionals?Once the change strategy is implemented, how would you evaluate the efficiency and effectiveness of the care system if the desired outcomes are met?InstructionsYour assessment submission should include a data table that illustrates the current and desired states of the clinical issue you are attempting to improve through your application of change strategies. Additionally, you will need to explain the rationale for your decisions around your chosen change strategies, as well as how the change strategies will be successfully implemented. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your change strategy addresses all of them. You may also want to read the Change Strategy and Implementation scoring guide and Guiding Questions: Change Strategy and Implementation to better understand how each grading criterion will be assessed.Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.Justify the specific change strategies used to achieve desired outcomes.Explain how change strategies will lead to quality improvement with regard to safety and equitable care.Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.Communicate the change plan in a way that makes the data and rationale easily understood and compelling.Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:Assessment 2 Example [PDF].Additional RequirementsLength of submission: 3–5 double-spaced, typed pages, not including the title and reference pages. Your plan should be succinct yet substantive.Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that supports your goal setting, proposed change strategies, quality improvement, and interprofessional considerations. Resources should be no more than five years old.APA formatting: Use the APA Paper Template linked in the Resources. An APA Template Tutorial is also provided to help you in writing and formatting your analysis. No abstract is required.CRITERIA THAT MUST BE MET PLEASE!!!!:-Develops a data table that accurately reflects the current and desired states of one or more clinical outcomes. Identifies areas of ambiguity or uncertainty where additional data could help to improve clarity.-Proposes change strategies that will help to achieve the desired state of one or more clinical outcomes. Acknowledges potential difficulties and discusses how those challenges will be met.Justifies the specific change strategies used to achieve desired outcomes. Impartially considers other perspectives.-Explains how change strategies will lead to quality improvement with regard to safety and equitable care. Identifies assumptions upon which the explanation is based.-Explains how change strategies will utilize interprofessional considerations to ensure successful implementation. Identifies assumptions upon which the explanation is based.-Communicates change plan in a way that makes the data and rationale easily understood and compelling. Acknowledges potential difficulties and discusses how those challenges will be met.-Integrates relevant sources to support assertions, correctly formatting citations and references using current APA style. Citations are free from all errors.ATTACHED IS 2 DOCUMENTS WHICH ARE ON OBESITY. THIS ASSIGNMENT MUST BE COMPLETED USING THIS DATA AND ADDITIONAL RESOURCES AS WELL, EVIDENCE BASED, DOI PREFERRABLY. PLEASE ENSURE TO GO OVER THE ATTACHED DOCUMENTS TO COMPLETE THIS AND ENSURE IT IS ON OBESITY, FOLLOWING THE INTERVENTIONS ETC PROVIDED IN THE NARRATIVE AND CONCEPT MAP. THANK YOUPLEASE! ALL CRITERIA MUST BE MET AS SPECIFIED ABOVE.AN EXAMPLE IS PROVIDED BELOW FOR REFERENCE AS TO HOW PROFESSIONAL IT SHOULD BE:Change Strategy and Implementation Patients often present with respiratory issues of varying severity; these can range from breathing difficulties to dry or wet coughs. Patients that do present with these issues are admitted to the pulmonary ward to treat the issue at hand. Chronic obstructive pulmonary disorder (COPD) is one of the primary issues among these. Each patient receives treatment based on the severity of his or her condition. The treatment can include prescribing antibiotics, non-invasive ventilation, and pulmonary rehabilitation. Pulmonary rehabilitation involves a program of exercise and education specifically designed to help individuals with pulmonary issues such as COPD (NHS, 2016a). The treatment for COPD is aimed at improving the physical health of patients admitted to the ward. However, it does not take into consideration the mental health of these individuals. There exists a strong positive correlation between COPD and anxiety and depression (Pooler & Beech, 2014), which means that patients who present with COPD are likely to be comorbid with anxiety, depression, or both. Further, COPD patients who are comorbid with depression and anxiety are statistically more likely to be hospitalized; these patients are also likely to require longer periods of hospitalization and face a greater risk of mortality after they are discharged. Considering these factors, it is necessary to address mental health issues simultaneously with physical issues to ensure that these patients can manage their overall health more effectively. Left untreated, both anxiety and depression can lead to significant implications for compliance to medical treatment (Pooler & Beech, 2014). Anxiety and COPD Some of the symptoms associated with COPD overlap with those associated with anxiety. Dyspnea or shortness of breath is particularly distressing for patients and is common to both COPD and anxiety. A COPD patient with anxiety might interpret dyspnea in an exaggerated CHANGE STRATEGY AND IMPLEMENTATION 3 Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. manner, often correlating this symptom with an inability to breathe or even an imminent death (Heslop, Newton, Baker, Burns, Carrick-Sen, & De Soyza, 2013). Anxiety might not be the cause of dyspnea in COPD patients, but it can be viewed as an indicator of acute exacerbation in such patients (Pooler & Beech, 2014). Depression and COPD As mentioned above, there exists a significant correlation between COPD and depression. The effect that depression has on COPD patients is different from the effect produced by anxiety. Depression has been significantly linked to a perceived decrease in quality of life as well as in physical activity. Pooler and Beech (2014) also note that depression is likely to be underdiagnosed and undertreated for individuals with COPD. Patients who suffer from COPD and depressive symptoms are less likely to follow through on their recommended physical therapy. Consequently, their COPD becomes aggravated, requiring them to receive further treatment. For most patients, particularly in cases of acute exacerbation, further treatment would require hospitalization. However, this might cause patients to feel that they are unable to care for themselves; they may experience inferiority or a diminished sense of autonomy. As a result, patients are often stuck within this cycle of deteriorating health, leading to a decline in the state of their mental health. The only effective method to treat patients in such a situation is to address both their physical and psychological issues (Dursunoğlu et al., 2016). Change Strategies Both depression and anxiety require attention from a mental health professional to adequately and effectively help patients. Cognitive behavioral therapy (CBT) has been proven to be an effective method of managing anxiety, depression, and a range of other mental health CHANGE STRATEGY AND IMPLEMENTATION 4 Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. conditions. In a typical CBT session, a patient and a therapist work together to break down one of the patient’s problems into its separate parts. Some of these parts could be how the patient thinks about the problem, how he or she feels physically about it, and how he or she acts in response to it. The patient and the therapist then evaluate these parts and figure out what might be unhelpful or unrealistic as well as the effect that these parts have on each other and on the patient (NHS, 2016b). By identifying these parts, the therapist can figure out a plan of action for the patient to change thoughts and behaviors that are counterproductive. The patient will then be asked to practice these changes in his or her life and report back on whether he or she was able to enact the changes and how effective they were. By using this method, the patient would eventually be able to apply the skills that he or she has learned in the sessions to his or her life. This would help the patient manage his or her issues even after the course of treatment is complete (NHS, 2016b). For example, individuals with COPD and anxiety might be able to better manage their anxiety by not associating shortness of breath with more catastrophic outcomes. However, CBT has certain drawbacks. It requires patients to be willing to confront their emotions and anxieties, which can be uncomfortable. Further, CBT requires patients’ commitment to the process and their cooperation to help themselves get better. The therapy can be guided, but ultimately the outcome of therapy is determined by the patients’ participation (NHS, 2016b). On a practical level, it can be difficult for hospitals to accommodate an adequate number of therapists for patients or to provide an efficient therapist-to-patient ratio. To address this, it would be necessary for group therapy sessions to be conducted in conjunction with one-on-one sessions. This would enable a wider range of individuals to access the necessary treatment for their psychological condition, and it might be less intimidating for CHANGE STRATEGY AND IMPLEMENTATION 5 Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. them if it is a group activity. Further, nurses could be trained in CBT, or those trained in CBT could be hired to facilitate more one-on-one sessions. Patients who are provided with access to these treatment options in addition to the treatment they receive for their COPD will have a higher quality of life and be able to manage both their physical and mental conditions more effectively than before (Howard & Dupont, 2014). Pharmacological interventions can also be used to treat anxiety and depression. Treatment doses vary based on the severity of the disorder and can have a variety of side effects. Most antidepressants are not contraindicated; however, caution is necessary while prescribing certain types such as tricyclic antidepressants. Benzodiazepines have the potential to cause respiratory depression and should not be administered to COPD patients who retain CO2. Standard antidepressants such as selective serotonin reuptake inhibitors can often have side effects such as headaches, tremors, gastrointestinal distress, and either psychomotor activation or sedation. These side effects occur during the initial phase of treatment and can be problematic when coupled with the existing conditions of COPD patients. In contrast, CBT and group therapy are nonpharmacological interventions and would not result in contraindications. It is also difficult to implement the pharmacological treatment of depression and anxiety on the level of policy as the medication and doses required would be based on the needs of individual patients. Further, patients who suffer from COPD might be unwilling to take medication for depression or anxiety along with the medication that they might already be taking. This could possibly result from the stigma that surrounds mental illnesses or the reluctance of patients to accept their diagnosis (Tselebis et al., 2016). Data Table Current Outcomes Change Strategies Expected OutcomesCHANGE STRATEGY AND IMPLEMENTATION 6 Copyright ©2018 Capella University. Copy and distribution of this document are prohibited. Patients who suffer from COPD do not have adequate access to mental health facilities: a) Many COPD patients experience anxiety resulting from dyspnea. b) Patients with COPD are likely to experience depressive symptoms that have been positively correlated with the worsening of COPD symptoms. To ensure that patients receive the care they need, certain measures are necessary: • Therapists should be made available to COPD patients. • Nurses should be trained in CBT, or nurses who are trained in CBT should be hired. • Group therapy sessions should be conducted regularly for COPD patients who are comorbid with anxiety, depression, or both. Patients who suffer from COPD will have adequate access to mental health facilities and will be able to manage both their physical and mental conditions more effectively than before: a) Patients who are comorbid with COPD and anxiety will be able to distinguish between their anxiety and an aggravation of their COPD symptoms (Howard & Dupont, 2014). b) Patients who are comorbid with COPD and depression will be better prepared to manage both their COPD and their depressive symptoms (Dursunoğlu et al., 2016)