Assignment Prompt & Instructions
**files (4)**
– ## APA_7_Professional_Paper_Template_June_20203.docx
– ## Outline2.docx
– ## APA7professional-annotated-compressed.pdf
– DecisionMakingProcessPaperDue.docx
**## APA_7_Professional_Paper_Template_June_20203.docx**
TITLE OF YOUR PAPER 1
**Title of Your Paper**
Your Name
Gateway Technical College
**Abstract**
The abstract is a brief summary of your paper and generally around 250 words. Consult your course syllabus or your instructor for specific details.
**Title of Your Paper**
The main text of your paper begins here. Consult with your assignment details in regard to section headings and other requirements.
**References**
Enter your reference citations in alphabetical order by author or title. Include hanging indents where the first line is flush to the left margin and the second and additional lines are indented by a half-inch.
**## Outline2.docx**
2
**Population Health and Emerging Healthcare Systems: Psychiatric ED Boarding and Divert Decisions**
Erika Brito
Florida National University
Decision Making
Dr. Nora Hernandez-Pupo
September 18, 2026
**Population Health and Emerging Healthcare Systems: Psychiatric ED Boarding and Divert Decisions**
I.
**Introduction**
1.
**Background:** Psychiatric ED boarding, the de facto stage of care that occurs when a decision is made to admit a patient but no bed is available, is a stage of care that is influenced by decreasing bed capacity (Rojas-Velasquez, 2026; Lindenfeld et al., 2025).
2.
**Statement of the Problem:** Long psychiatric ED boarding creates problems with patient safety, placement, and timely access to appropriate psychiatric care, necessitating a coordinated framework to guide divert decisions (Hoffmann et al., 2025; Schulte et al., 2026).
3.
**Thesis Statement:** Coordination of Tanner's Clinical Judgment Model, shared decision-making, and transformational leadership can be used to guide placement and divert decisions and support equitable outcomes.
II.
**Body**
**First Topic: Scope and Significance of Psychiatric ED Boarding**
**Point A: Causes and Extent of the Problem**
1. The number of psychiatric beds in short-term acute care hospitals (STACs) decreased nationally between 2011 and 2023, while the number of total inpatient psychiatric beds was relatively stable (Lindenfeld et al., 2025).
2. Approximately one in three pediatric mental-health ED visits resulting in admission or transfer involved boarding for more than 12 hours (Hoffmann et al., 2025).
**Point B: Impact Across Levels of Nursing Practice**
1. Boarding surfaces structural gaps that bedside staff, managers, and APNs must navigate together (Rojas-Velasquez, 2026).
2. Boarded youth and guardians report higher levels of stress and disturbed sleep (Hong et al., 2025).
**Second Topic: Decision-Making Models Relevant to the Problem**
**Point A: Bedside and Advanced Practice Models**
1. Tanner's Clinical Judgment Model uses noticing, interpreting, responding, and reflecting to structure nursing clinical judgment during changing patient conditions (Connor et al., 2022; Haanes, 2026).
2. Shared decision-making involves integrating patient preferences, autonomy, and communication into mental health care, where clinically appropriate (Hormazábal-Salgado et al., 2024).
**Point B: Leadership-Level Model**
1. Transformational Leadership is associated with increased RN-perceived quality of care, with varying degrees of association (Alanazi et al., 2023).
**Third Topic: Application, Comparison, and Funding Implications**
**Point A: Comparative Application Across Levels**
1. The bedside nurse would use Tanner's model to re-evaluate suicide risk, behavior, symptoms, safety concerns, and changes in condition during boarding.
2. Shared decision making, where clinically appropriate, would be used to include patient preferences and individualized clinical considerations in disposition planning.
3. The nurse manager would use transformational leadership to create standardized boarding and diversion protocols, escalation criteria, communication pathways, and staff education.
**Point B: Benefits, Limitations, and Funding Source**
1. Reducing prolonged boarding may mitigate risks of prolonged waiting, such as functional decline and restraint, but more research is required to assess the effectiveness of specific interventions (Schulte et al., 2026).
2. Any framework should consider documented differences in psychiatric ED boarding rates for children and adolescents.
3. SAMHSA's Community Mental Health Services Block Grant provides a potential funding source for crisis-service initiatives, with a 5% set-aside for crisis services of at least $219 million from FY2021 to FY2024 (U.S. Government Accountability Office, 2025)..
III.
**Conclusion**
**Point A**
1. Psychiatric ED boarding is an ongoing cross-level problem in both the pediatric and older adult populations, which is linked to a reduction in bed capacity and a lack of diversion options.
2. Targeted funding and comparison and prioritization of the three models can offer a structured approach to enhance placement decisions, patient safety and coordination between levels of nursing practice.
**References**
Alanazi, N. H., Alshamlani, Y., & Baker, O. G. (2023). The association between nurse managers' transformational leadership and quality of patient care: A systematic review.
_International Nursing Review_,
_70_(2), 175–184. PubMed. https://doi.org/10.1111/inr.12819
Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgement in nursing: An evolutionary concept analysis.
_Journal of Clinical Nursing_,
_32_(13–14), 3328–3340. Wiley Online Library. https://doi.org/10.1111/jocn.16469
Haanes, G. G. (2026). Extending Tanner’s framework: The digital clinical judgment model for nursing education.
_BMC Nursing_,
_25_(1), 546. PubMed Central. https://doi.org/10.1186/s12912-026-04703-y
Hoffmann, J. A., Foster, A. A., Gable, C. J., Carlin, K. E., Pergjika, A., Burkhart, K., Schultz, T. R., Mullins, S., Edemba, D., & Saidinejad, M. (2025). Pediatric Mental Health Boarding in US emergency departments, 2018-2022.
_Journal of the American College of Emergency Physicians Open_,
_6_(4), 100180. PubMed. https://doi.org/10.1016/j.acepjo.2025.100180
Hong, V., Harness, J., Cranford, J., Cervantes, V., Czyz, E., Bailey, J., Burke, N., Malas, N., & Rogers, A. (2025). The impact of psychiatric boarding in the emergency department: A mixed-methods study.
_Hosp Pediatr_,
_15_(6), 491–500. https://doi.org/10.1542/hpeds.2024-008065
Hormazábal-Salgado, R., Whitehead, D., Osman, A. D, & Hills, D. (2024). Person-centred decision-making in mental health: A scoping review.
_Issues in Mental Health Nursing_,
_45_(3), 294–310. PubMed. https://doi.org/10.1080/01612840.2023.2288181
Lindenfeld, Z., Cantor, J. H., McCullough, C. M., Bather, J. R., & McBain, R. K. (2025). Inpatient psychiatric bed capacity within CMS-certified U.S hospitals, 2011–2023: A cross-sectional study.
_PLOS Medicine_,
_22_(7), e1004682. https://doi.org/10.1371/journal.pmed.1004682
Rojas-Velasquez, D. (2026). The wait for “geripsych”: Prolonged boarding of older adults awaiting inpatient psychiatry.
_Journal of Hospital Medicine_,
_21_(8), 943–945. PubMed Central. https://doi.org/10.1002/jhm.70326
Schulte, V. P., Guasch, C., Landerholm, A., & Rojas-Velasquez, D. (2026). Emergency department boarding for psychiatric hospitalization in older adults: Placement challenges and associated risks.
_The Western Journal of Emergency Medicine_,
_27_(3), 572–578. PubMed. https://doi.org/10.5811/westjem.61704
U.S. Government Accountability Office. (2025).
_U.S. GAO – behavioral health: Federal activities to support crisis response services_. Behavioral Health: Federal Activities to Support Crisis Response Services. https://www.gao.gov/products/gao-25-107586
**## APA7professional-annotated-compressed.pdf**
https://apastyle.org
Hi, APA Styler!
Thank you for using the APA Style annotated sample professional
paper for guidance when wri�ng your paper or assignment.
This sample paper PDF contains annota�ons that draw aten�on
to key APA Style content and forma�ng such as the �tle page,
headings, in-text cita�ons, references, and more. Relevant
sec�ons of the seventh edi�on of the Publication Manual are also
provided for your reference.
You can find this sample paper and many other resources in the
seventh edi�ons of the Publication Manual and Concise Guide to
APA Style.
Please use discount code STYLEPAPER15 for 15% off APA Style
print products with free shipping in the United States.
Happy wri�ng!
APA_PM7_Ch2-BLueline.indd 50 8/1/19 7:01 PM
50 • PAPER ELEMENTS AND FORMAT
Sample Papers
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Sample Professional Paper
abstract, 2.9;
section labels, 2.28
keywords, 2.10
professional
title page, 2.3
APA_PM7_Ch2-BLueline.indd 51 8/1/19 7:01 PM
Sample Papers • 51
Sample Professional Paper (continued)
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
narrative citation, 8.11;
paraphrasing, 8.23
parenthetical citation
of a work with one
author, 8.17
parenthetical citation
for works with the
same author and
same date, 8.19
parenthetical citation
of multiple works, 8.12
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
title, 2.4, Table 2.1
running head, 2.8
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52 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
parenthetical citation of
multiple works, 8.12
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
narrative citation used
to paraphrase methods
from two studies, 8.23
long paraphrase, 8.24
APA_PM7_Ch2-BLueline.indd 53 8/1/19 7:01 PM
Sample Papers • 53
Sample Professional Paper (continued)
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
Level 1 heading after
the introduction, 2.27,
Table 2.3, Figure 2.5
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
italics used for anchors
of a scale, 6.22
statistics presented
in text, 6.43
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
en dash used in a
numerical range, 6.6
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54 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
Level 1 heading, 2.27,
Table 2.3, Figure 2.5
statistics presented in
text, 6.43
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
table called out in
text, 7.5; table
numbers, 7.10
APA_PM7_Ch2-BLueline.indd 55 8/1/19 7:01 PM
Sample Papers • 55
Sample Professional Paper (continued)
footnote callout, 2.13
referring to a previous
footnote, 2.13
footnote in page
footer, 2.13
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
figure called out in
text, 7.5; figure
numbers, 7.24
Level 1 heading, 2.27,
Table 2.3, Figure 2.5
parenthetical citation
of multiple papers by
the same author, 8.12
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APA_PM7_Ch2-BLueline.indd 56 8/1/19 7:01 PM
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56 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
percent symbol
repeated in a range,
6.44
parenthetical citation
of multiple works, 8.12
parenthetical citation
of a work with two
authors, 8.17
Level 3 heading, 2.27,
Table 2.3, Figure 2.5
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
APA_PM7_Ch2-BLueline.indd 57 8/1/19 7:01 PM
Sample Papers • 57
Sample Professional Paper (continued)
Level 3 heading, 2.27,
Table 2.3, Figure 2.5
parenthetical citation
of two works, 8.12
“see also” citation, 8.12
parenthetical citation
of a work with one
author, 8.17
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
quotation marks used
to indicate an ironic
comment, 6.7
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58 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
journal article reference
without a DOI, 10.1
journal article reference,
10.1
reference list, 2.12,
Chapter 9; section
labels, 2.28
letters used after the
year for multiple works
with the same author
and year, 9.47
book reference, 10.2
APA_PM7_Ch2-BLueline.indd 59 8/1/19 7:01 PM
Sample Papers • 59
Sample Professional Paper (continued)
journal article
reference with missing
issue number, 9.26
title ending with a
question mark, 9.19
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60 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
table number, 7.10
figure number,
7.24
table title, 7.11
figure title, 7.25
table note, 7.14
figure note,
7.28
**DecisionMakingProcessPaperDue.docx**
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**DecisionMakingProcessPaperDue.docx**
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**## APA_7_Professional_Paper_Template_June_20203.docx**
TITLE OF YOUR PAPER 1
**Title of Your Paper**
Your Name
Gateway Technical College
**Abstract**
The abstract is a brief summary of your paper and generally around 250 words. Consult your course syllabus or your instructor for specific details.
**Title of Your Paper**
The main text of your paper begins here. Consult with your assignment details in regard to section headings and other requirements.
**References**
Enter your reference citations in alphabetical order by author or title. Include hanging indents where the first line is flush to the left margin and the second and additional lines are indented by a half-inch.
**## Outline2.docx**
2
**Population Health and Emerging Healthcare Systems: Psychiatric ED Boarding and Divert Decisions**
Erika Brito
Florida National University
Decision Making
Dr. Nora Hernandez-Pupo
September 18, 2026
**Population Health and Emerging Healthcare Systems: Psychiatric ED Boarding and Divert Decisions**
I.
**Introduction**
1.
**Background:** Psychiatric ED boarding, the de facto stage of care that occurs when a decision is made to admit a patient but no bed is available, is a stage of care that is influenced by decreasing bed capacity (Rojas-Velasquez, 2026; Lindenfeld et al., 2025).
2.
**Statement of the Problem:** Long psychiatric ED boarding creates problems with patient safety, placement, and timely access to appropriate psychiatric care, necessitating a coordinated framework to guide divert decisions (Hoffmann et al., 2025; Schulte et al., 2026).
3.
**Thesis Statement:** Coordination of Tanner's Clinical Judgment Model, shared decision-making, and transformational leadership can be used to guide placement and divert decisions and support equitable outcomes.
II.
**Body**
**First Topic: Scope and Significance of Psychiatric ED Boarding**
**Point A: Causes and Extent of the Problem**
1. The number of psychiatric beds in short-term acute care hospitals (STACs) decreased nationally between 2011 and 2023, while the number of total inpatient psychiatric beds was relatively stable (Lindenfeld et al., 2025).
2. Approximately one in three pediatric mental-health ED visits resulting in admission or transfer involved boarding for more than 12 hours (Hoffmann et al., 2025).
**Point B: Impact Across Levels of Nursing Practice**
1. Boarding surfaces structural gaps that bedside staff, managers, and APNs must navigate together (Rojas-Velasquez, 2026).
2. Boarded youth and guardians report higher levels of stress and disturbed sleep (Hong et al., 2025).
**Second Topic: Decision-Making Models Relevant to the Problem**
**Point A: Bedside and Advanced Practice Models**
1. Tanner's Clinical Judgment Model uses noticing, interpreting, responding, and reflecting to structure nursing clinical judgment during changing patient conditions (Connor et al., 2022; Haanes, 2026).
2. Shared decision-making involves integrating patient preferences, autonomy, and communication into mental health care, where clinically appropriate (Hormazábal-Salgado et al., 2024).
**Point B: Leadership-Level Model**
1. Transformational Leadership is associated with increased RN-perceived quality of care, with varying degrees of association (Alanazi et al., 2023).
**Third Topic: Application, Comparison, and Funding Implications**
**Point A: Comparative Application Across Levels**
1. The bedside nurse would use Tanner's model to re-evaluate suicide risk, behavior, symptoms, safety concerns, and changes in condition during boarding.
2. Shared decision making, where clinically appropriate, would be used to include patient preferences and individualized clinical considerations in disposition planning.
3. The nurse manager would use transformational leadership to create standardized boarding and diversion protocols, escalation criteria, communication pathways, and staff education.
**Point B: Benefits, Limitations, and Funding Source**
1. Reducing prolonged boarding may mitigate risks of prolonged waiting, such as functional decline and restraint, but more research is required to assess the effectiveness of specific interventions (Schulte et al., 2026).
2. Any framework should consider documented differences in psychiatric ED boarding rates for children and adolescents.
3. SAMHSA's Community Mental Health Services Block Grant provides a potential funding source for crisis-service initiatives, with a 5% set-aside for crisis services of at least $219 million from FY2021 to FY2024 (U.S. Government Accountability Office, 2025)..
III.
**Conclusion**
**Point A**
1. Psychiatric ED boarding is an ongoing cross-level problem in both the pediatric and older adult populations, which is linked to a reduction in bed capacity and a lack of diversion options.
2. Targeted funding and comparison and prioritization of the three models can offer a structured approach to enhance placement decisions, patient safety and coordination between levels of nursing practice.
**References**
Alanazi, N. H., Alshamlani, Y., & Baker, O. G. (2023). The association between nurse managers' transformational leadership and quality of patient care: A systematic review.
_International Nursing Review_,
_70_(2), 175–184. PubMed. https://doi.org/10.1111/inr.12819
Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgement in nursing: An evolutionary concept analysis.
_Journal of Clinical Nursing_,
_32_(13–14), 3328–3340. Wiley Online Library. https://doi.org/10.1111/jocn.16469
Haanes, G. G. (2026). Extending Tanner’s framework: The digital clinical judgment model for nursing education.
_BMC Nursing_,
_25_(1), 546. PubMed Central. https://doi.org/10.1186/s12912-026-04703-y
Hoffmann, J. A., Foster, A. A., Gable, C. J., Carlin, K. E., Pergjika, A., Burkhart, K., Schultz, T. R., Mullins, S., Edemba, D., & Saidinejad, M. (2025). Pediatric Mental Health Boarding in US emergency departments, 2018-2022.
_Journal of the American College of Emergency Physicians Open_,
_6_(4), 100180. PubMed. https://doi.org/10.1016/j.acepjo.2025.100180
Hong, V., Harness, J., Cranford, J., Cervantes, V., Czyz, E., Bailey, J., Burke, N., Malas, N., & Rogers, A. (2025). The impact of psychiatric boarding in the emergency department: A mixed-methods study.
_Hosp Pediatr_,
_15_(6), 491–500. https://doi.org/10.1542/hpeds.2024-008065
Hormazábal-Salgado, R., Whitehead, D., Osman, A. D, & Hills, D. (2024). Person-centred decision-making in mental health: A scoping review.
_Issues in Mental Health Nursing_,
_45_(3), 294–310. PubMed. https://doi.org/10.1080/01612840.2023.2288181
Lindenfeld, Z., Cantor, J. H., McCullough, C. M., Bather, J. R., & McBain, R. K. (2025). Inpatient psychiatric bed capacity within CMS-certified U.S hospitals, 2011–2023: A cross-sectional study.
_PLOS Medicine_,
_22_(7), e1004682. https://doi.org/10.1371/journal.pmed.1004682
Rojas-Velasquez, D. (2026). The wait for “geripsych”: Prolonged boarding of older adults awaiting inpatient psychiatry.
_Journal of Hospital Medicine_,
_21_(8), 943–945. PubMed Central. https://doi.org/10.1002/jhm.70326
Schulte, V. P., Guasch, C., Landerholm, A., & Rojas-Velasquez, D. (2026). Emergency department boarding for psychiatric hospitalization in older adults: Placement challenges and associated risks.
_The Western Journal of Emergency Medicine_,
_27_(3), 572–578. PubMed. https://doi.org/10.5811/westjem.61704
U.S. Government Accountability Office. (2025).
_U.S. GAO – behavioral health: Federal activities to support crisis response services_. Behavioral Health: Federal Activities to Support Crisis Response Services. https://www.gao.gov/products/gao-25-107586
**## APA7professional-annotated-compressed.pdf**
https://apastyle.org
Hi, APA Styler!
Thank you for using the APA Style annotated sample professional
paper for guidance when wri�ng your paper or assignment.
This sample paper PDF contains annota�ons that draw aten�on
to key APA Style content and forma�ng such as the �tle page,
headings, in-text cita�ons, references, and more. Relevant
sec�ons of the seventh edi�on of the Publication Manual are also
provided for your reference.
You can find this sample paper and many other resources in the
seventh edi�ons of the Publication Manual and Concise Guide to
APA Style.
Please use discount code STYLEPAPER15 for 15% off APA Style
print products with free shipping in the United States.
Happy wri�ng!
APA_PM7_Ch2-BLueline.indd 50 8/1/19 7:01 PM
50 • PAPER ELEMENTS AND FORMAT
Sample Papers
E
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M
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N
T
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&
F
O
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A
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Sample Professional Paper
abstract, 2.9;
section labels, 2.28
keywords, 2.10
professional
title page, 2.3
APA_PM7_Ch2-BLueline.indd 51 8/1/19 7:01 PM
Sample Papers • 51
Sample Professional Paper (continued)
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
narrative citation, 8.11;
paraphrasing, 8.23
parenthetical citation
of a work with one
author, 8.17
parenthetical citation
for works with the
same author and
same date, 8.19
parenthetical citation
of multiple works, 8.12
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
title, 2.4, Table 2.1
running head, 2.8
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52 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
parenthetical citation of
multiple works, 8.12
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
narrative citation used
to paraphrase methods
from two studies, 8.23
long paraphrase, 8.24
APA_PM7_Ch2-BLueline.indd 53 8/1/19 7:01 PM
Sample Papers • 53
Sample Professional Paper (continued)
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
Level 1 heading after
the introduction, 2.27,
Table 2.3, Figure 2.5
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
italics used for anchors
of a scale, 6.22
statistics presented
in text, 6.43
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
en dash used in a
numerical range, 6.6
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APA_PM7_Ch2-BLueline.indd 54 8/1/19 7:01 PM
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54 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
Level 1 heading, 2.27,
Table 2.3, Figure 2.5
statistics presented in
text, 6.43
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
table called out in
text, 7.5; table
numbers, 7.10
APA_PM7_Ch2-BLueline.indd 55 8/1/19 7:01 PM
Sample Papers • 55
Sample Professional Paper (continued)
footnote callout, 2.13
referring to a previous
footnote, 2.13
footnote in page
footer, 2.13
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
figure called out in
text, 7.5; figure
numbers, 7.24
Level 1 heading, 2.27,
Table 2.3, Figure 2.5
parenthetical citation
of multiple papers by
the same author, 8.12
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56 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
percent symbol
repeated in a range,
6.44
parenthetical citation
of multiple works, 8.12
parenthetical citation
of a work with two
authors, 8.17
Level 3 heading, 2.27,
Table 2.3, Figure 2.5
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
APA_PM7_Ch2-BLueline.indd 57 8/1/19 7:01 PM
Sample Papers • 57
Sample Professional Paper (continued)
Level 3 heading, 2.27,
Table 2.3, Figure 2.5
parenthetical citation
of two works, 8.12
“see also” citation, 8.12
parenthetical citation
of a work with one
author, 8.17
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
quotation marks used
to indicate an ironic
comment, 6.7
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APA_PM7_Ch2-BLueline.indd 58 8/1/19 7:01 PM
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58 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
journal article reference
without a DOI, 10.1
journal article reference,
10.1
reference list, 2.12,
Chapter 9; section
labels, 2.28
letters used after the
year for multiple works
with the same author
and year, 9.47
book reference, 10.2
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Sample Papers • 59
Sample Professional Paper (continued)
journal article
reference with missing
issue number, 9.26
title ending with a
question mark, 9.19
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60 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
table number, 7.10
figure number,
7.24
table title, 7.11
figure title, 7.25
table note, 7.14
figure note,
7.28
**DecisionMakingProcessPaperDue.docx**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/decisionmakingprocesspaperdue-docx-10611943)
**## APA_7_Professional_Paper_Template_June_20203.docx**
TITLE OF YOUR PAPER 1
**Title of Your Paper**
Your Name
Gateway Technical College
**Abstract**
The abstract is a brief summary of your paper and generally around 250 words. Consult your course syllabus or your instructor for specific details.
**Title of Your Paper**
The main text of your paper begins here. Consult with your assignment details in regard to section headings and other requirements.
**References**
Enter your reference citations in alphabetical order by author or title. Include hanging indents where the first line is flush to the left margin and the second and additional lines are indented by a half-inch.
**## Outline2.docx**
2
**Population Health and Emerging Healthcare Systems: Psychiatric ED Boarding and Divert Decisions**
Erika Brito
Florida National University
Decision Making
Dr. Nora Hernandez-Pupo
September 18, 2026
**Population Health and Emerging Healthcare Systems: Psychiatric ED Boarding and Divert Decisions**
I.
**Introduction**
1.
**Background:** Psychiatric ED boarding, the de facto stage of care that occurs when a decision is made to admit a patient but no bed is available, is a stage of care that is influenced by decreasing bed capacity (Rojas-Velasquez, 2026; Lindenfeld et al., 2025).
2.
**Statement of the Problem:** Long psychiatric ED boarding creates problems with patient safety, placement, and timely access to appropriate psychiatric care, necessitating a coordinated framework to guide divert decisions (Hoffmann et al., 2025; Schulte et al., 2026).
3.
**Thesis Statement:** Coordination of Tanner's Clinical Judgment Model, shared decision-making, and transformational leadership can be used to guide placement and divert decisions and support equitable outcomes.
II.
**Body**
**First Topic: Scope and Significance of Psychiatric ED Boarding**
**Point A: Causes and Extent of the Problem**
1. The number of psychiatric beds in short-term acute care hospitals (STACs) decreased nationally between 2011 and 2023, while the number of total inpatient psychiatric beds was relatively stable (Lindenfeld et al., 2025).
2. Approximately one in three pediatric mental-health ED visits resulting in admission or transfer involved boarding for more than 12 hours (Hoffmann et al., 2025).
**Point B: Impact Across Levels of Nursing Practice**
1. Boarding surfaces structural gaps that bedside staff, managers, and APNs must navigate together (Rojas-Velasquez, 2026).
2. Boarded youth and guardians report higher levels of stress and disturbed sleep (Hong et al., 2025).
**Second Topic: Decision-Making Models Relevant to the Problem**
**Point A: Bedside and Advanced Practice Models**
1. Tanner's Clinical Judgment Model uses noticing, interpreting, responding, and reflecting to structure nursing clinical judgment during changing patient conditions (Connor et al., 2022; Haanes, 2026).
2. Shared decision-making involves integrating patient preferences, autonomy, and communication into mental health care, where clinically appropriate (Hormazábal-Salgado et al., 2024).
**Point B: Leadership-Level Model**
1. Transformational Leadership is associated with increased RN-perceived quality of care, with varying degrees of association (Alanazi et al., 2023).
**Third Topic: Application, Comparison, and Funding Implications**
**Point A: Comparative Application Across Levels**
1. The bedside nurse would use Tanner's model to re-evaluate suicide risk, behavior, symptoms, safety concerns, and changes in condition during boarding.
2. Shared decision making, where clinically appropriate, would be used to include patient preferences and individualized clinical considerations in disposition planning.
3. The nurse manager would use transformational leadership to create standardized boarding and diversion protocols, escalation criteria, communication pathways, and staff education.
**Point B: Benefits, Limitations, and Funding Source**
1. Reducing prolonged boarding may mitigate risks of prolonged waiting, such as functional decline and restraint, but more research is required to assess the effectiveness of specific interventions (Schulte et al., 2026).
2. Any framework should consider documented differences in psychiatric ED boarding rates for children and adolescents.
3. SAMHSA's Community Mental Health Services Block Grant provides a potential funding source for crisis-service initiatives, with a 5% set-aside for crisis services of at least $219 million from FY2021 to FY2024 (U.S. Government Accountability Office, 2025)..
III.
**Conclusion**
**Point A**
1. Psychiatric ED boarding is an ongoing cross-level problem in both the pediatric and older adult populations, which is linked to a reduction in bed capacity and a lack of diversion options.
2. Targeted funding and comparison and prioritization of the three models can offer a structured approach to enhance placement decisions, patient safety and coordination between levels of nursing practice.
**References**
Alanazi, N. H., Alshamlani, Y., & Baker, O. G. (2023). The association between nurse managers' transformational leadership and quality of patient care: A systematic review.
_International Nursing Review_,
_70_(2), 175–184. PubMed. https://doi.org/10.1111/inr.12819
Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgement in nursing: An evolutionary concept analysis.
_Journal of Clinical Nursing_,
_32_(13–14), 3328–3340. Wiley Online Library. https://doi.org/10.1111/jocn.16469
Haanes, G. G. (2026). Extending Tanner’s framework: The digital clinical judgment model for nursing education.
_BMC Nursing_,
_25_(1), 546. PubMed Central. https://doi.org/10.1186/s12912-026-04703-y
Hoffmann, J. A., Foster, A. A., Gable, C. J., Carlin, K. E., Pergjika, A., Burkhart, K., Schultz, T. R., Mullins, S., Edemba, D., & Saidinejad, M. (2025). Pediatric Mental Health Boarding in US emergency departments, 2018-2022.
_Journal of the American College of Emergency Physicians Open_,
_6_(4), 100180. PubMed. https://doi.org/10.1016/j.acepjo.2025.100180
Hong, V., Harness, J., Cranford, J., Cervantes, V., Czyz, E., Bailey, J., Burke, N., Malas, N., & Rogers, A. (2025). The impact of psychiatric boarding in the emergency department: A mixed-methods study.
_Hosp Pediatr_,
_15_(6), 491–500. https://doi.org/10.1542/hpeds.2024-008065
Hormazábal-Salgado, R., Whitehead, D., Osman, A. D, & Hills, D. (2024). Person-centred decision-making in mental health: A scoping review.
_Issues in Mental Health Nursing_,
_45_(3), 294–310. PubMed. https://doi.org/10.1080/01612840.2023.2288181
Lindenfeld, Z., Cantor, J. H., McCullough, C. M., Bather, J. R., & McBain, R. K. (2025). Inpatient psychiatric bed capacity within CMS-certified U.S hospitals, 2011–2023: A cross-sectional study.
_PLOS Medicine_,
_22_(7), e1004682. https://doi.org/10.1371/journal.pmed.1004682
Rojas-Velasquez, D. (2026). The wait for “geripsych”: Prolonged boarding of older adults awaiting inpatient psychiatry.
_Journal of Hospital Medicine_,
_21_(8), 943–945. PubMed Central. https://doi.org/10.1002/jhm.70326
Schulte, V. P., Guasch, C., Landerholm, A., & Rojas-Velasquez, D. (2026). Emergency department boarding for psychiatric hospitalization in older adults: Placement challenges and associated risks.
_The Western Journal of Emergency Medicine_,
_27_(3), 572–578. PubMed. https://doi.org/10.5811/westjem.61704
U.S. Government Accountability Office. (2025).
_U.S. GAO – behavioral health: Federal activities to support crisis response services_. Behavioral Health: Federal Activities to Support Crisis Response Services. https://www.gao.gov/products/gao-25-107586
**## APA7professional-annotated-compressed.pdf**
https://apastyle.org
Hi, APA Styler!
Thank you for using the APA Style annotated sample professional
paper for guidance when wri�ng your paper or assignment.
This sample paper PDF contains annota�ons that draw aten�on
to key APA Style content and forma�ng such as the �tle page,
headings, in-text cita�ons, references, and more. Relevant
sec�ons of the seventh edi�on of the Publication Manual are also
provided for your reference.
You can find this sample paper and many other resources in the
seventh edi�ons of the Publication Manual and Concise Guide to
APA Style.
Please use discount code STYLEPAPER15 for 15% off APA Style
print products with free shipping in the United States.
Happy wri�ng!
APA_PM7_Ch2-BLueline.indd 50 8/1/19 7:01 PM
50 • PAPER ELEMENTS AND FORMAT
Sample Papers
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abstract, 2.9;
section labels, 2.28
keywords, 2.10
professional
title page, 2.3
APA_PM7_Ch2-BLueline.indd 51 8/1/19 7:01 PM
Sample Papers • 51
Sample Professional Paper (continued)
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
narrative citation, 8.11;
paraphrasing, 8.23
parenthetical citation
of a work with one
author, 8.17
parenthetical citation
for works with the
same author and
same date, 8.19
parenthetical citation
of multiple works, 8.12
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
title, 2.4, Table 2.1
running head, 2.8
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52 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
parenthetical citation of
multiple works, 8.12
Level 2 heading in the
introduction, 2.27,
Table 2.3, Figure 2.4
narrative citation used
to paraphrase methods
from two studies, 8.23
long paraphrase, 8.24
APA_PM7_Ch2-BLueline.indd 53 8/1/19 7:01 PM
Sample Papers • 53
Sample Professional Paper (continued)
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
Level 1 heading after
the introduction, 2.27,
Table 2.3, Figure 2.5
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
italics used for anchors
of a scale, 6.22
statistics presented
in text, 6.43
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
en dash used in a
numerical range, 6.6
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54 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
Level 1 heading, 2.27,
Table 2.3, Figure 2.5
statistics presented in
text, 6.43
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
table called out in
text, 7.5; table
numbers, 7.10
APA_PM7_Ch2-BLueline.indd 55 8/1/19 7:01 PM
Sample Papers • 55
Sample Professional Paper (continued)
footnote callout, 2.13
referring to a previous
footnote, 2.13
footnote in page
footer, 2.13
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
figure called out in
text, 7.5; figure
numbers, 7.24
Level 1 heading, 2.27,
Table 2.3, Figure 2.5
parenthetical citation
of multiple papers by
the same author, 8.12
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56 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
percent symbol
repeated in a range,
6.44
parenthetical citation
of multiple works, 8.12
parenthetical citation
of a work with two
authors, 8.17
Level 3 heading, 2.27,
Table 2.3, Figure 2.5
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
APA_PM7_Ch2-BLueline.indd 57 8/1/19 7:01 PM
Sample Papers • 57
Sample Professional Paper (continued)
Level 3 heading, 2.27,
Table 2.3, Figure 2.5
parenthetical citation
of two works, 8.12
“see also” citation, 8.12
parenthetical citation
of a work with one
author, 8.17
Level 2 heading, 2.27,
Table 2.3, Figure 2.5
quotation marks used
to indicate an ironic
comment, 6.7
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58 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
journal article reference
without a DOI, 10.1
journal article reference,
10.1
reference list, 2.12,
Chapter 9; section
labels, 2.28
letters used after the
year for multiple works
with the same author
and year, 9.47
book reference, 10.2
APA_PM7_Ch2-BLueline.indd 59 8/1/19 7:01 PM
Sample Papers • 59
Sample Professional Paper (continued)
journal article
reference with missing
issue number, 9.26
title ending with a
question mark, 9.19
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60 • PAPER ELEMENTS AND FORMAT
Sample Professional Paper (continued)
table number, 7.10
figure number,
7.24
table title, 7.11
figure title, 7.25
table note, 7.14
figure note,
7.28
**DecisionMakingProcessPaperDue.docx**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/decisionmakingprocesspaperdue-docx-10611943)