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DNP Residency/DNP Project Hourly LogStudent Name:_____Emlyne St.Helen__________________ DNP Project Advisor:_Pamela Biernacki______________________________Content Expert/Site:__Riverside health system DateHours (#)Cumulative HoursDescription of Scholarly Activities: Record all activities taken to meet course objectives and analysis of progress toward goalsIdentify the DNP Essential(s) that applies to your scholarly activity1/15/1911DNP hours- review what will be done for this semester residency. Discuss the proctor role in the IPEC – class.II, I1/22/1922Leadership- role of NPs in organization. How to encourage Nps to be more involved. Empowering Nps and PAs. Encourage more involvement in committees, encourage leadership in such committees.II1/29/1933Improving Geriatric care- Birdsong imitative- use of electronic such as tablet to help geriatric patients with cognitive impairment and behavioral symptoms-Tablet will be placed in where it is accessible to the patient, patient will be taught how to use tablet. This can be used as a behavioral intervention. I,III1/21/1911Residency objectives- what I want to accomplish during this residency period. I1/28/1922Article on caring for patients with dementia with behavioral disturbances – the screamer, the aggressor, the wanderer. Different behavioral interventions that can be utilized. Also reviews medications that can be utilized for treatment of these behavioral symptoms. I,III2/5/1911E-portfolioII2/6/1911Meeting with advisor- Get the IRB application started. Discuss residency objectives to include researching on designing education program for care staff. I2/7/1911Leadership: how Nps can take a role in mentoring new NPs in the work place. How to improve the on boarding experience for new NPs as they assume their role in new organization.II2/8/1955Book- Patient comes second- this book is based on leadership in healthcare. It takes a different approach to leadership. To obtain great patient satisfaction ratings by creating exceptional teams. All employers has to be motivated or driven for a higher purpose, they have to be equipped with the tools to make them successful and to become leaders themselves. A good leader should embrace the organization’s mission (why are we here), vision (where we aspire to go) and values (the rules we live by). There should be a good work life balance. (Create a fun environment, find joy in what you do, important to know that we spend more time at work than with our family). As an aspiring leader- Choose a mentor- learn from others who are more experienced.II2/19/1988Rounds with pharmacist- Reviews medications, make recommendationsReview psychotropic medications, review nursing, and physician documentations, makes recommendation for gradual dose reductions. Or make recommendations for trial of other medications or adjustments pending lab results.VI2/23/193.503.50Effective treatment of Opioid use disorder: Educating and Empowering advanced nurses during an epidemic. ( mostly psychiatric Nurse practitioners)- How to treat opioid use disorder.Identify key morbidity and mortality associated with heroine and prescription opioid use in recent years. Identify pharmacological and psychotherapeutic treatment options for patients with opioid use disorder and select the best treatment options based on patients’ needs. Detail at least one way to increase access to treatment for opioid use disorders in the settings or community where you work as a psychiatric nurse. Know what the SBRIT monitor means ( Screening, brief intervention and referral to treatment)Learn to partner with patients during treatment so that they can learn to cope and strive in treatment of substance use disorder.The US has a problem of Opioid epidemic - clinician has to collaborate with the patient- safety is an effective treatment. Neurobiology and Neurochemistry of substance use disorder- substance use disorder is a disease of the brain it is not a moral flaw but a disease. Different aspects of Physical ROS that can be used to identify patients with possibly substance use disorder.VII2/23/192.252.25Effective treatment of Opioid use disorder: How mental health nurses can identify individuals with opioid use disorders. How to formulate a partnership with patients for better outcome. Look at this disorder as a disease of the brain and how genetic, environmental and social stations can impact an individual with substance use disorder. Know where resources in community is, where you can refer the patients for aide/ support. VII2/24/1922Leadership Article: Transforming culture through resiliency and teamwork- support positive relationships and value each team member. In 2014, many of nurses at Duke Raleigh Hospital experienced stress, had low resilience and some were burned out. Improvement of safety culture depends on the resilience of nurses and other healthcare staff. Building resilience in team members will promote a culture of safety for patients, families and staff.Build positivity- to build resilience develop ways to enhance positivity in the workplace- focus on emotions that support happiness in the work place. Enhance team training which can improve interprofessional communication and organizational learning from errors and near misses. Team strategies and Tools to Enhance Performance and Patient Safety ( TeamSTEPPS)- this is a EPB program designed to enhance communication and teamwork. This focuses on: Leadership, communication, Situation monitoring, mutual support. Resilience has to be an interperfessional effort. Organization must also make resilience intentionalII2/24/1922Article: (leadership): Safety culture: A journey to zero. Interprofessional collaboration drives culture change. Every team member in the Good Shepard Hospital from the executive leadership, made a commitment to be the safest healthcare organization they could be. (High reliability organization (HRO) ) – they adhere to the five HRO principles – Preoccupation with failure – 1) always think that something is wrong, then validate that it is right.2. Sensitivity to operations- Be aware of internal and external factors in the team, technology, and environment. 3. Reluctance to simplify: have a questioning attitude and challenge assumptions.4. Commitment to resilience: Bounce back from mistakes before they cause more damage5. Deference to expertise- Identify who is the expert or has the most experience in the situation. Interprofessional partnerships- this drove greater improvement – from unit-based to house-wide high reliability safety coach meetings. They were able to decrease serious safety events by 60% since 2014, increased hospital safety event reporting rate from 3.7- 6.6 an improved agency for healthcare research and quality culture of safety survey from 64% to 94% II, VII, VI2/25/1922Article- The psychiatric Mental health advanced practice registered nurse workforce: charting the future. There is a demand for psychiatric providers, clinicians whose scope of practice includes all essential psychiatric services, such as assessment, diagnosis, psychotherapeutic/ psychotherapy interventions and psychotropic medication treatment. The PMH APRN workforce faces significant challenges owing to barriers and facilitators to growth of the specialty. These factors conspire to limit the supply.Recommendations: Provide leadership in the workforce planning on the state level. Establish PMH NP residencies. Encourage curriculum innovationsEstablish a workforce to track PMH APRN practice. Encourage retiring PMH APRNs to move to academia to teach the next generation of psychiatric nurses.Address the need for preceptors to maintain high- quality programs. VIII, II2/25/1933Dealing with the older adult the question of whether they have capacity to make important decision arises, especially in persons with dementia. Consequently examinations have to be done to determine capacity. Capacity lecture - Capacity Informed consent vs competencyCapacity- ability to give informed consent to a particular treatment as a particular time. Informed consent- the ability to communicate and understand the risks, benefits and alternatives to treatment. Competency is the legal determination requiring a court hearing. It is a global assessment of the ability to manage one’s affairs and take care of one’s self. Requires the appointment of a Guardian. -all adult is presumed to be capable of making an informed decision unless proven otherwise. The decision of capacity is not made solely on a particular clinical diagnosis. The state of Virginia requires two providers to determine incapacity. This is done by attending physician and the 2nd reviewer or capacity reviewer such as a licensed physician or a psychologist. In the case of an unconscious patient or patient is experiencing profound impairment of consciousness- the capacity reviewer is not required. Capacity evaluations needed – to activate an advanced directive or medical power of attorney. To obtain a medical detention order or judicial authorization. To obtain an emergency custody order. When no capacity to make medical decisions- medical power attorney / advanced directive the designated agent will provide consent and make treatment decisions. Virginia Statutory Substitute decision Makers Order of priority Guardian Spouse ( unless divorce action pending) Adult child Parent Adult brother or sister Any other relative in descending order.Someone who has exhibit special care for patient Patient care committeeTwo physicians who do not practice in the same business entity and who are not an agent, director or employee of any healthcare provider involved in the patient’s care. Judicial approval of involuntary treatment-Emergency custody order (transport to ED)- this is for transportation only – this is granted by the courts. Bring person to facility for evaluation. ( good for 8 hours) if calm at the end of 8 hours it is void Temporary detention order ( TDO) – involuntary inpatient psychiatric treatment. Required for psych evaluation, and treatment – requires notification to CSD- requires evaluation for CSB before petition for TDO can be granted. – Duration 72 hours – prior to expiration – judge / special justice will conduct a committee hearing – determine whether treatment is necessary. Medical detention order ( MDO) – no capacity, to treat emergency condition to avoid harm injury or death. CSB petition not required. Valid for 24 hours. Judicial Authorization ( JA) VII2/27/1922The clinical evaluation- Getting cozy with CapacityWhen to consider incapacity-When a patient is refusing reasonable treatment i.e from your experience and can ask colleagues- most people appear that the proposed treatment or benefits outweighs risks.When a patient is agreeing to treatment with significant risk. Patient has signs of serious cognitive problems- lack of orientation to person, place, time or SITUATION. Has hx of illness like dementia, mental retardation, brain injury, schizophrenia that is known to affect cognition. Family or close friends have expressed concerns about their thinking. Age of 85 or older -57% have dementia by then and in hospital it is even greater. -Can’t state a decision.Higher capacity required for more important decisions- Refusing high benefit/ low risk treatments IV in hospital. Consenting to low benefit high risk treatmentUse of the MOCA test –cognitive test which help determine capacity- cut off score of 18 provides the best 75% sensitivity – scores of 23 and above can presume capacity and scores of 17 and below can presume incapacity. VII2/27/1922Leadership: discussion on how to enhance and improve provider engagement in work place that will help to increase provider satisfaction and help to possibly reduce provider turnover. Steps that can be taken to help in recruiting process II2/28/1922What is Dementia- Presented by Dr. David B. Reuben – UCLA Alzheimer’s and Dementia care- how to revolutionize care for dementia patients. What is dementia and what is not dementia – how to make the diagnosis. Consequences of dementia and how to manage dementia. Dementia can be is called the “ Gray plague”- early onset dementia and before age 65ys and anything after that is late onset dementia. Alzheimer’s disease is just one kind of dementia and there are other types. Dementia- Chronic decline in memory and leads to loss of at least one other cognitive function- aphasia, apraxia, agnosia, executive function.- has to affect daily life- if it is not affect daily life or daily function- it may not necessarily be dementia. Delirium- acute confusion- this is not dementia- this resolves and it is preventable- happens a lot in hospital and can be due to confusion. Depression- can look like dementia- especially in the older adults- cannot focus, memory isn’t good- do well on formal testing. Mild cognitive impairment (MCI) – when testing is done they will have memory deficits and this is not sufficient to interfere with daily function- may or may not represent a transition stage for a person with dementia. 10-15% of these patients with MCI- can progress to dementia each year. 50/50 chance can progress to dementia – no medication for that. Normal aging is not dementia- function is preserved- do well with multiple choice questions. This can be tested by- screen test. Pretty accurate at saying something is wrong but they don’t make the diagnosis- Do three item recall- This is one of the ways we test this. Clock drawMMSE- Mini mental status examNext step is a clinician examination. More in-depth examination.Neurophysiological testing- several hours. Blood test and imaging test- r/o medical condition that can cause it. Imaging- CT, MRI, CAT, PET scanMost common cause of dementia- ADSecond most common – Vascular dementia – causes strokes, large or small Dementia with Lewy body can be close to Parkinson’s disease with Dementia ( can be sensitive to certain medications) Frontotemporal dementia – no very much memory problems but changes in personality very aggressive or very passive ( can be very withdrawn) Mixed dementia- AD and VD happens in the same patientRisk- people who develop depression in late life Also if family has early onset dementiaReduced risk- Medittarian diet ExerciseAlzheimer’s Disease Apathy in AD is very commonLoss of languageVisuospatial 3 stages – Preclinical, MCI, ADOther symptoms- psychosis Depressive symptoms Agitation or aggressionSuspicious- people are stealing from them – especially caregivers and infidelity (common behavioral symptoms) Survival is 9-12 years. Managing the disease and managing the patient – medications, behavioral therapies and pharmacological interventions and complications. Supporting caregivers. Early in the disease get the patient involved After that family and caregiver- this is a family affair- everyone is involve in care- therefore caregiver should have support because caregiver burnout can be terrible. Caregivers- over 50% develops depression- the more knowledgeable caregivers are the better care the patient can get. Resources – AD association. III, VII, VI2/28/1944Evidence- based synthesis program- systematic evidence review of Non- pharmacological interventions for behavioral symptoms of dementia.Key findings- How do non-pharmacological treatments of behavioral symptoms compare in effectiveness with each other, with pharmacological approaches, and with no treatment? Cognitive/ emotion-oriented interventions-Reminiscence therapy- discussion of past activities, events and experiences with other persons or in a group. Simulated presence therapy (SPT) – this involves the use of audiotapes made by family members containing a scripted conversation about cherished memories about the patient’s life.Validation therapy: give individual opportunity to resolve unfinished conflicts by encouraging and validating expressions of feelings. Sensory Stimulation interventions:Acupuncture:- no good quality evidence indicating benefit or harm of this procedureAromatherapy: Consist of fragrant oils for plants and has been used to promote sleep and reduce behavioral symptoms. Insufficient evidence to indicate effectiveness of this. Light therapy- this improves circadian disturbances in the sleep- wake cycles experienced by individuals with dementia. Massage and touch: Music therapy Snoezelen multisensory stimulation therapy: MSS- combines therapeutic use of light, tactile surfaces, music and sensory deprivation. Transcutaneous electrical nerve stimulation ( TENS)- non- invasive analgesic technique that is most often used for pain control and occasionally for neurological and psychiatric conditions.Behavior management techniquesThis includes wide range of behavioral interventions such as functional analysis of specific behaviors, token economics, habit training, progressive muscle relaxation, communication training, behavioral or cognitive- behavioral therapy, and various types of individualized behavioral reinforcement strategies.Other psychosocial interventions:Animal- assisted therapy Exercise Various interventions targeting a specific behavioral symptomWandering: visual barriers – mirrors, floor grids, camouflage of doors or doorknobs and concealment of view through door windows. Agitation: aromatherapy, thermal bath, calming music, and hand massage- shows decrease in agitation. Other social contact, environmental modification, caregiver training and behavior therapy show no effect on agitation. Inappropriate sexual behavior: effectiveness of non-pharmacological intervention- minimal.VII,VIII, III3/1/1966I’m Still Here- A New Philosophy of Alzheimer’s Care- Effectively manage the 4 A’s agitation, apathy, anxiety, and aggression. The 5 keys for meaningful communication. The 7 rules of relationship building. Reconnect through art, music, film and poetry.Embracing Alzheimer- treatment people living with dementia as people instead of patients. Appreciate their capabilities as well as their losses. The writer advocate treating people with dementia as people first then as people living with an illness- advocates including people living with AD in society- The skills and capabilities of people living with AD that don’t diminish over time, or do so more slowly, provide windows for connection and communication. Through those windows lie opportunities to establish and build new and vibrant relationships that can sustain us and them over time, supporting both care and well-being. Certain memories are still there whilst others are more compromised, focus on the memories that’s still there.Know and understand brain regions that one must understand to reach the person behind AD. The regions that are affected most and those that hold promise for building strong relationships.Visual and dramatic arts museum exhibitions, music, theater, film and the circus arts, touch people living with AD. Support people living with dementia- by enabling independence. Various behavioral approaches to manage behavioral symptoms of AD. These approaches can be used by families and caregivers as well as care providers- who care for people living with dementia. VI3/3/1988The 36-Hour Day. A Family Guide to Caring for People Who Have Alzheimer’s Disease, Related Dementias and Memory Loss. What is dementia The person with dementia Where to seek support. Where to get medical care for the person with dementiaCharacteristics of behavioral symptoms of dementiaHow to manage behavioral interventions. Problems with independent living Problems which arises with daily care to include meals, exercise, personal hygiene, and safety. How to cope with impairment of sensory and false ideas - such as delusions, hallucinations, paranoia- belief that people are stealing things, thoughts of infidelity, suspicion, anger and other mood disorder problems. Resources for outside help, support groups, and agencies. Financial and legal issues that must be addressed. How to make special arrangement if caregiver become ill. Avoid caregiver burnoutPlacement into memory care or nursing homes. VI3/22/198Conference- Experiencing and practicing positive states: hope, joy, calm and laughterHope can reduce stress, pain, anxiety and sadness by normalizing cortisol, the adrenal hormone associated with stressPower of Positivity- this is linked to mental and physical health outcomes- mind-body connection. ( wound study, cold and flu study) Successful stress management is KEYHope and optimism- belief system- the future holds promise, you can find the pathways to achieve your desired goals and motivate yourself to use those pathways. You can achieve your goals even if obstacles arise- flexibility is key.Hope and physical health- more hopeful people tend to read, retain and use health- related information more. They are also engaged in more preventative behaviors.Hope is also related to better adjustment to chronic illness, severe injury, and handicaps i.e injuries, spinal cord injuries, fibromyalgia, etc.-hope and mental health- hope is related to instances of positive moods and thoughts. High hope college students report feeling more inspired and energized. They have higher self- esteem and less likelihood for depression. They cope more effectively with stress, facing challenges head- on rather than using avoidance.In the face of setbacks they are less likely to use cognitive distortions and will adjust or change their goals if a current goa seems unattainable.Joy can be enhanced by practicing what happy people do differently.Importance of attaining calming states through mental habits and mindfulness. Humor and laughter can improve health and wellbeing.I, VI, VII3/23/196Spring provider Conference at Riverside- continuing education offered Game changing Advances in Endoscopic Oncology and Interventional Endoscopy, an overview of the New Frontier.Orthopedic Sub specialization Current concepts in Treatment of Rotator Cuff Tears and Shoulder Arthritis.Social Media and provider Risks Medinsur Risk ManagementPharmacist presentation- on the use of cannabinoidsVII, VI, 3/31/197.5Understanding Neurocognitive disorders - CEUKey differences between the left and right cerebral hemispheresVerbal and non-verbal impairments due to stroke Cognitive impairments characteristic of common forms of traumatic brain injury The cognitive domains affected by the most common forms of dementia Alzheimer’s dementia, vascular dementia, frontotemporal dementia, Lewy body dementia, Parkinson’s dementia, Huntington dementia.Strategies to protect the aging brainVII, III, I4/4/193Continuing education- Management of psychiatric disorders in the elderly Managing aggressionPrescribing antipsychotics and other psychotropic medications rming responsible party and discussing treatment plan How to avoid malpractice law- suits.VII4/5/191Leadership- meeting to discuss how to include Advanced practice providers (APP) as leaders in the organization. How to empower APPs to become better leaders as they mentor new APPs in the work place. II,VI4/11/199Conference- The Gut-Brain Connection Concepts of the Gut-brain axis and its implication for health and diseaseMicrobes and their metabolites communicate with the body and the brain.Microbiome-gut brain axis influences the development of neurodegenerative, neuropsychiatric and neurodevelopmental Disorders.Microbial metabolites regulate immune and metabolic pathways in the body and this may impact risk of allergies, autoimmune disease, obesity and diabetes.Ecology of the oral microbiome impacts both gut and systemic health, discussed implications for modern- day oral health care.Potential microbial and gut health disruptors as well as therapeutic strategies to improve gut and brain health – to become ecosystem engineers. Ways in which the highly complex gut-brain scientific research has been oversold and misinterpreted by the lay press. Identified red flags of pseudoscience to become a healthy skeptic.Medication/ stress management- the part that the vagus nerve plays in the brain- gut axis as it plays an important role in the maintenance of intestinal homeostasis, the regulation of food intake and the modulation of inflammation. - Vagal nerve is the pathogenesis of obesity, psychiatric disorders and other stress-induced and inflammatory disease. How to utilize the information from this seminar to improve patient and patient outcomesI, III, VI, VII4/15/193Managing the neuropsychiatric manifestation of Parkinson’s disease. An update for pharmacist and nurses.Use of off label of medications in PD.Prevalence of neuropsychiatric symptoms (NPS) in PD and impact of burden of the disease.Current treatment options for various NPS.The role of nurses and pharmacist in managing NPS of PD NPS in PD- anxiety, depression, psychosis, dementia. Caregiver burden and care. Cost As disease progresses- there will be increase in morbidity and decrease outcome of life- is due to NPS. PD is more common in men than women and is more common in people of western culture than in Asian and Africans. Sleep- may be excessive daytime sleepiness in people with PD. High rate of Hyposmia in PD patients – they act out their dreams. Anxiety usually occurs before diagnosis of PD Depression is high in PD – anhedonia, apathy Rate of suicide is high in this population but the risk factors are not very different than that of the general population. The MOCA is a good rating scale for PD – there is attentional problem than language problem.PD- impulse control and sleep disorders are high. Impulse control- gambling, hypersexual and alcohol use this is about 60% Sleep problems – good sleep assessment is important in this population. RLS is common PD- psychosis- prevalence rate 60% - can be due to medication use to treat PD – visual hallucinations very common- illusions high as well. Individuals with Psychosis and dementia has higher care cost and higher incident of being placed in a nursing home. There is some evidence that CBT may be helpful for treatment of Anxiety in PD There is little evidence of effective medication treatment for anxiety in PD – some SSRIs can be used. SSRIs- increase falls and fractures and metabolic problems. Some drugs that should be avoided includes Paxil- can cause falls. Benzos can be used for short term management of insomnia and REM sleep disorder. Note Pramipexole may have some antidepressant benefits. Cholino inhibitors – helps with cognitive improvement Antiepileptic drugs has been use to manage behavioral disturbances such as aggression but there is no evidence to support use SSRIs has shown to be effective. Trazodone best evidence of effectiveness in this population. Can add an antipsychotic medication if disruptive symptoms persist Seroquel low dose and titrate up Clozapine low dose and titrate up as indicated Pimavanserin 34mg FDA approved – no effect on dopamine- there for no effect on movement Clozapine- has shown to be effective for PD off label. Frontline providers to assess PD Neurology and psychiatryNeuropsychiatric Pharmacist- monitor and make recommendation for medication adjustmentsEducate members of care team and family caregiversAssist with medication assess and to enhance drug therapy VII, VI, I4/20/1912IPEC- class- I had the opportunity to be part of the interprofessional virtual case of a geriatric patient this semester (IPEC). I was the proctor for two teams, one team consist of four members and the second team consist of five members. The team composition included students from various schools such school of medicine, pharmacy and nursing. The team members had to collaborate to care for a geriatric patient with multiple medical problems. This exercise helps improve quality and quantity of health professional relationship. It also enhances students’ knowledge and skills by facilitating collaboration as students worked together to care for the patient. This simulation provides students with virtual case that will be similar to what they will be exposed to in their profession. Students utilized the knowledge acquired from the classroom as well as evidence base research to provide substantive responses and rationale to responses. The case was about a geriatric patient with multiple medical problems. The teams took a holist approach in caring for that patient. It was interesting to observe how the team of students work together to develop a treatment plan for the patient. The team of students from various discipline collaborate with each other to develop a personalized treatment plan for the patient. As a practicing NP we are constantly involved in this type of work. We have to collaborate with individuals from various specialty or profession to provide care for our patients. Over all I think it was a very good activity because it facilitates the development of interprofessional relationships. The students benefit from it and learnt a lot from each other. VI4/23/196Continuing Education: Understanding and Treating Generalized Anxiety and related anxiety disorders: Generalized anxiety includes long-lasting and often overwhelming worry- apprehensive expectation occurring majority of the time The condition often coexists with depression, PTSD, Fear-based disorders, OCD and perfectionism, illness anxiety disorder, substance use and insomnia. How to utilize cognitive-behavioral and exposure-based interventions.-use of interpersonal approaches to reduce anxiety among clients in medical, dental and behavioral settings. Strategies to outline and develop a treatment plan for a person with generalized anxiety or related conditions that combines key evidence-based interventions. 1.Cognitive behavioral therapy- understanding cognitive distortion Untwisting negative thoughts Cognitive restructuring Mindfulness- based anxiety reduction Non-judgmental awareness, developing habitual mindful states.2. Exposure- based therapy for fear and obsessions- how it works 3. Interpersonal approaches- Motivational interviewing Words that reduce anxiety Managing realistic anxiety 4. PharmacotherapySRIs, pregabalin, Benzodiazepines, and newer drugs.5. Complementary therapies -herbals -Relaxation-based methods-nutrition 6. Lifestyle modification. VII, I, VIII4/26/196Book: Management and Leadership in Nursing and Health Care. An Experimental Approach 3rd edition. Managing your way through change and coming out a winner are the philosophic foundations are the goals of this book. A nurse manager’s success in any situation is framed and grounded in expectations and goals given a specific environment at a particular point in time. Management and leadership- the management process- planning, organizing, motivating, controlling. Theories of management and leadership-General system theory. Classic organization theory and non-classic organization theory.Non-classic organization theory forms the basis of contemporary leadership models and assumes that people must be motivated to fulfill themselves within the organization. Non-classic organization theory employs a situational approach to leadership and sees an organization as a system that is composed of human and material resources working as one unit towards goal accomplishment.Knowing self- identifying the manager’s view of a problem or goal as well as the unique environment are aspects of knowing self. A manager must be aware of personal beliefs such as stereotypes, halo horn effects and implicit personality groupings. With this insight the manager can reduce the impact of self-perceptions on others. This enables manager to respond to unique characteristics of people and things in a system rather than to the effects of past experience, which usually are not present reality.Types of leadership- Situational leadershipTransactional and transformational l leadership.Leadership effectiveness- a leader’s behavior or influence over an individual or group can be either successful or unsuccessful. Leadership is successful if the desired goal is reached.Power- types, Position power and personal power. Position power- this is derived from the organization, manager who influence a group to accomplish a goal because of his or her position in an organization. Personal power derives from followers – it flows up to a manager and is the extent to which followers respect and are committed to their leader. Personal power is informal and positional power is formal power.Conflict resolution- Conflict is a clash or struggle that occurs when one’s balance among feelings, thoughts, desires and behavior is threatened. Constructive conflict resolution is an important aspect of managerial responsibility some approaches- management by objectives, work environment should facilitate conflict resolution.II5/1/196Continuing education: The habits of people least likely to develop Alzheimer’s DiseaseLifestyle has an important role in who remains cognitively intact, who develops mild cognitive impairment and who develops Alzheimer’s disease ( AD)Describe how AD can be diagnosed- use of cognitive test such as mini-mental status exam and Montreal cognitive Exam. History obtained from family or caregiver can all play a part in diagnosing AD. CT and MRI- shows changes structural changes in the brain. -some modifiable factors that can increase the risk of developing AD.-Chronic inflammation -Metabolic Syndrome -Insufficient sleep -Statins -Major depression -Cerebrovascular disease Pharmaceutical treatments have limitations- there is no cure but ACE inhibitors such as Aricept can potentially slow down progress in mild to moderate stages, Namenda is approved for moderate to advanced stages. Habits of people least likely to develop Alzheimer’s disease -The right dose of physical Activity -the right dose of sleep - the right ways to protect the brain from metabolic syndrome - the right nutrients -the right forms of social engagement -the right kind of care for caregivers-the right amount of stress-the right way to develop cognitive reserve VII, I5/4/196Continuing Education: Remembering, Forgetting and Protecting the Aging Brain. Key points- who develops memory loss and advances in protecting the aging brain decades before the onset of cognitive decline. Know how to distinguish between impairment of short-term, working and long-term memory- Short term memory – remembering what happened recentlyWorking memory- Remember what to do next. Long-term memory- the memories of our lives – protecting long term memory- Caffeine and glucose Physical activity Restorative sleep Neurocognitive activities Habit-based memories Habits are critical for brain health-Reprograming the habit brain Take care of these Major depression Addictive habits Obsessive-compulsive habits Posttraumatic habits.Advances in prevention – most dementias takes decades to develop Cognitive domains Reducing inflammation and protecting the aging brainNeuroprotective nutrients Neuroprotective exercise Neuroprotective sleep Neuroprotective mental activitiesVII, ITotal Hours 137.25 ................
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