Category: Nursing

To prepare

• Review the Week 4 Assignment Rubric, provided in the Course Information area.

• Review the AWE Checklist and Additional Resources for your Assignment:

o 2000/3000 AWE Level Assignment Template

o TOP Ten BSN References and Citations

• Review this week’s Writing Resources and Program Success Tools. Revisit the Writing Resources and Program Success Tools from Weeks 1 through 3 as needed. Focus on the QIs at http://www.qualityindicators.ahrq.gov/.

• Choose a QI related to a nursing topic of interest to you. Think about the ways in which following and measuring this crucial health data improve effectiveness and efficiency in your nursing practice. Consider any points that relate your selected topic to the journey ahead in your nursing career.

• Find two articles in the Walden Library to support your scholarly opinion in your paper.

Assignment

Use the Walden Writing Center guidelines titled “Writing a Paper” and “Scholarly Writing: Overview” to do the following:

• Draft a 2- to 3-page paper describing your selected QI in general, and then describe how this QI has the potential to improve the quality, safety, and outcomes of your patients and their families.

• Describe the current data available and leadership’s goal for improvement.

• Draft a solution using 2 sources from professional and scholarly literature to support your proposal.

• Use the 2000/3000 AWE Level Assignment Template in the resources for this week to complete your Assignment.

• Use in-text citations to support your paper. Use essay-level writing skills, including the use of transitional material and organizational frames.

Introduction

Nursing quality involves the improvement of the effectiveness, efficiency, accessibility, and patient safety to those in need. The most critical of nursing quality is patient safety has increased. However, nurses play a significant role in determining the nursing quality to ensure that their practice yields quality care and guarantee patient safety. The purpose of this paper is to describe the ways in which following and measuring Postoperative Respiratory failure health data will improve effectiveness and efficiency in your nursing practice. It will also explain the potential of this the QI to improve the quality, safety, and outcomes in patients and their families.

Postoperative Respiratory Failure

Postoperative Respiratory failure is a critical health data that is used by AHRQ (PSI-11) as an indicator of Patient Safety. It has a higher PSIs rate as compared to other PSIs, making it an effective health data used to measure the patient outcome across a diverse patient population. As a PSIs, Postoperative Respiratory failure determines the level of inpatient safety risks that patients are exposed to during acute care VHA hospitalizations and non-psychiatric (Rajaram, Barnard & Bilimoria, 2015). The PSI is common in veterans with psychotic disorders than those patients who have never had any case of psychotic disorders.

Some potential causes of respiratory failure among patients who have shown signs of psychosis include restriction to aces ambulatory restrictions services, inability to comply with spirometry incentive and any other toileting involving the pulmonary parts of the body. The condition may also be caused as a result of drug interactions with anesthetics taken in response to the remedy the psychotropic condition (Canet, Sabate, Mazo, et al, 2015). Also, the use of antipsychotics or benzodiazepines on an ‘as-needed’ basis in response to insomnia, agitation, or aggression may also cause Postoperative Respiratory failure. Equally, patients with higher levels of cigarette smoking are also at the risk of experiencing Postoperative Respiratory failure (Smith, Zhao & Rosen, 2012).

The Current Data Available and Leadership’s Goal for Improvement

Going by the available literature, Post-operative Respiratory failure is said to be the most common perioperative causes of death especially in adult patients who have undergone thoracic surgery. However, it is important to note that the term respiratory failure brings on board issues such as failures caused by ARDS, pneumonia, and pulmonary emboli (McLean, Diaz-Gil, Farhan, 2015). This broad view has hindered a clear understanding of what postoperative respiratory failure is so as to be well conversant with its causes and then start planning for its prevention.

Postoperative respiratory failure is attributed to the increased cost of care, longer hospital stays, and a high rate of mortality. Ranging between 30 days and five years. The patient factors that are common in patients with PRF smoking are age, past history of using COPD, as well as functional dependence (Winters, Bharmal, Wilson, et al, 2016). The procedural factors associated with PRF include vascular, prolonged and emergency procedures, thoracic, head/neck procedures, and abdominal. The effectiveness preventive measures that can be used to manage PRFs include subjecting the patients to exercises aimed at expanding the lung and discriminative application of nasogastric tubes for patients with abdominal cases (Canet & Gallart, 2014). The patients may also be subjected to a short-acting neuromuscular blockade and advised to practice preoperative smoking behavior and laparoscopic techniques.

Conclusion

In conclusion, patient safety is a key component of nursing quality which can be achieved through the use of PRFs as a PSI. Conversely, nurses must be trained and make their resources available. PRF has become a major patient safety indicators thus increasing the role nurses plays t as they interact with patients, patients’ families and their colleagues in the profession. To facilitate patient safety, nurses monitor patients to ascertain signs of clinical deterioration, near misses, and errors. They also learn the weakness inherent in the care processes to promote high-quality care.

 

 

 

References

Rajaram, R., Barnard, C., & Bilimoria, K. Y. (2015). Concerns about using the patient safety indicator-90 composite in pay-for-performance programs. 
Jama
, 
313
(9), 897-898.

Canet, J., & Gallart, L. (2014). Postoperative respiratory failure: pathogenesis, prediction, and prevention. 
Current opinion in critical care
, 
20
(1), 56-62.

Canet, J., Sabate, S., Mazo, V., Gallart, L., de Abreu, M. G., Belda, J., … & Pelosi, P. (2015). Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. 
European Journal of Anaesthesiology (EJA)
, 
32
(7), 458-470.

McLean, D. J., Diaz-Gil, D., Farhan, H. N., Ladha, K. S., Kurth, T., & Eikermann, M. (2015). Dose-dependent association between intermediate-acting neuromuscular-blocking agents and postoperative respiratory complications. 
The Journal of the American Society of Anesthesiologists
, 
122
(6), 1201-1213.

Winters, B. D., Bharmal, A., Wilson, R. F., Zhang, A., Engineer, L., Defoe, D., … & Pronovost, P. J. (2016). The validity of the Agency for Health Care Research and Quality Patient Safety Indicators and the Centers for Medicare and Medicaid Hospital-acquired Conditions.
Medical care
, 
54
(12), 1105-1111.

Case Study: End of Life Decisions

George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip. After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for amyotrophic lateral sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS.

ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently no cure for ALS, and the median life expectancy is between 3 and 4 years, though it is not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to assist with breathing.

George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually come. He will eventually be wheelchair bound and be unable to move, eat, speak, or even breathe on his own.

In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He imagines his life in complete dependence upon others for basic everyday functions and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia.

 

The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on ”Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview.

Provide a 1,500-2,000-word ethical analysis while answering the following questions:

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?

As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?

What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

Given the above, what options would be morally justified in the Christian worldview for George and why?

Based on your worldview, what decision would you make if you were in George’s situation?

Remember to support your responses with the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required

 

Case Study on Death and Dying

Introduction

Death and dying are a very challenging and bitter part of life, yet the reality of life. The nature of death generally involved deep religious and philosophical questions. Euthanasia is a controversial issue in bioethics (Saybey, 2016). Christian and worldview view death and aspects such as euthanasia differently. This paper will analyze the case study of George, who was diagnosed with amyotrophic lateral sclerosis (ALS), a degenerative disease where the patient eventually loses the ability to speak, move, eat, and breathe, and finally dies. The paper will specifically analyze George’s imminent death and the ethics involved in euthanasia as per Christianity perspective.

 

George’s suffering in light of the Christian narrative, with an emphasis on the fallenness of the world

In Christianity, suffering, and fallenness of the world go hand in hand. This began when God put Eve and Adam in the Garden of Eden where both cared for and nurtured God’s creating. Eve and Adam ate freely and did not experience any suffering until they tasted the fruit that God had warned them against, and this made them be chased from the garden of Eden (Shelly & Miller, 2009). This is where the fallenness of the world began and God separated himself from Eve and Adam following their sinning. Accordingly, according to the Christian narrative, the fallenness of the world was the beginning point of human suffering (Shelly & Miller, 2009). God pronounced a curse upon Eve and Adam and told them they would have to toil to get food. Therefore, human suffering is a curse from God and from that period, life changed.

Therefore, George can link his suffering to being a sinner since God declared sinning as the key cause of suffering. As human beings, we keep sinning from time to time, and often we fall short of God’s will. This can be comparable to the case of George. George might justify his suffering to the sinful nature of human beings (Shelly & Miller, 2009).  As human beings, we never like being subjected to the curse of God because we rejected God first at the Garden of Eden from the start. Human beings have corrupted everything God has given to humanity, and hence human beings served God’s judgment and the suffering that come with the judgment. Therefore, George can console himself in the words that every human being has sinned against God and thus it is expected to suffer (Shelly & Miller, 2009).

 

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?

In Christianity, it is believed that God created everything existing in the world and Jesus came to earth to enable human beings to have a view of God’s image. Therefore, a Christian would interpret what is happening to George as being the will of God. According to Saybey (2016) suffering such as the one George is experiencing are only intended to bring human beings close to God and to make humans ware of Christ’s suffering. The Christian teachings that Jesus died basically changes the view and experience of death. Death is a tragedy and evil, but Jesus conquered death on the cross.  Therefore, death as a defeated enemy in the Christian narrative, human beings also have hope of defeating death and rising again when Christ comes back. The god of Christian is constantly redeeming what is broken and will also redeem human beings from death. This teaches human beings to be close to God and live according to His will. Perceiving suffering as the will of good helps Christians in remaining steadfast in their Christian beliefs, and this makes their Christian faith stronger (Shelly & Miller, 2009). If a Christian believes that suffering may be as a result of the sins of the past, this can give one a chance to repent the sins and go back to God. This indicates that God is an orderly God because He allows suffering to human beings to make them turn back from their sinful ways and experience God’s love. Even though some human beings may view their suffering as a punishment, it is still an indication that God has such a great love for humanity and encourages people to live according to God’s purpose. However, the bottom line is that even after death, Christians have the hope of resurrecting just as Jesus did. These reasons can assist George to evaluate his life and repent and at the same time believe that God has forgiven his sins and his suffering will end after death (Shelly & Miller, 2009). After repenting, George also has the hope that resurrecting again once Christ comes back for the church.

 

As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?

According to the Christian worldview, even in the midst of amyotrophic lateral sclerosis (ALS), George should view his life as precious and a gift from God, and hence it should not be taken away by a human being, but God.  Accordingly, even with this agonizing disease, George is expected to endure pain and all experiences associated with the disease (Shelly & Miller, 2009). A painful experience such as the one George is experiencing should not make a person make a decision to end their lives. In Christianity, people believe that human beings are supposed to hold on to their faith even during painful sufferings.  George is still a valuable human being even in the face of a disabling and devastating disease like amyotrophic lateral sclerosis (ALS). Life is a precious gift from God and since then sin entered the world, suffering is part of everyone’s life.  Therefore, George’s life is still valuable to God and God has a reason why he allowed George to experience amyotrophic lateral sclerosis (ALS). George should try to figure out what God is trying to teach him with the disease and use his current condition and life, for the glory of God. Therefore, George should continue persevering the suffering in the virtue of respecting life and Christian’s teaching regarding the value of life, as being God’s precious gift (Saybey, 2016).

 

What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

The kind of values that the Christian worldview would focus on in deciding regarding is George should opt for euthanasia or not include that suffering is part of life and just like Christ suffered we should accept suffering (Shelly & Miller, 2009). Jesus died on the cross and before His death, he underwent significant suffering and at some point, asked God if it is His will, He should take away the cup of suffering. Therefore, George’s suffering is God’s will and therefore, he should accept the suffering and ask God for sufficient grace to be able to endure the suffering. In addition, God uses suffering to bring humanity closer to Him and make them repent for their sins. Accordingly, George should use the suffering to discover what God wants him to learn and get closer to God (Meilaender, 2013).

As per Meilaender (2013), expectations about life after death largely determine the way an individual welcomes the probability of death. If Christians view everything and especially suffering and death as per God’s will and the final hope of life after death and Jesus’ resurrection, this can assure a person that God is in control of everything. In this regard, George should view his life and sickness and God’s working in his life and being His will. Moreover, God has a purpose for our lives regardless of the suffering and only God is the giver of life.

 

Given the above, what options would be morally justified in the Christian worldview for George and why?

The morally justified option would be for George to continue living until God takes away his life. Therefore, euthanasia is not an option for George according to the Christian’s view. According to Christianity, human life is precious and a gift from God and hence taking human life and interfering with the process of God is unacceptable and morally wrong. In addition, Christian views suffering as part and parcel of life and also the plan of God and thus it is morally wrong to interfere with the plan of God (Shelly & Miller, 2009). Therefore, suffering and pain of a terminally ill person should be accepted by Christians just as Christ accepted his suffering on the cross.

My Decision if in George’s Situation?

Even though I am a Christian, if I was in George’s situation and facing the imminent suffering and disability associated with amyotrophic lateral sclerosis (ALS), I would consider voluntary euthanasia.  Even though voluntary euthanasia is against Christianity, it is difficult to watch individuals suffer as a nurse and personally I would not want to experience such pain and suffering if there is an option of euthanasia (President’s Commission, 1981). Even if it is not morally right to choose euthanasia, the Bible states that God is forgiving and there is no single sin that cannot be forgiven.

Conclusion

Christianity views life as a gift from God and only God has the power to take away life. Suffering is part of life and God’s plan to bring his creation close to Him. A human being should, therefore, accept suffering and similarly, George should accept the suffering that comes with amyotrophic lateral sclerosis (ALS). Therefore, according to Christianity, it is not morally upright for George to consider voluntary euthanasia.

 

References

Meilaender G. (2013). Bioethics:
A Primer for Christians
, 3rd Edition. Michigan: Eerdmans.

Saybey B. (2016). Definitions of death: brain death and what matters in a person.
J Law Biosci
. 3(3), 743–752.

Shelly J & Miller A. (2009).
Called to Care: A Christian Worldview for Nursing
2nd Edition, Illinois: IVP Academic.

The United States. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1981). Defining death: a report on the medical, legal and ethical issues in the determination of death.

Post a 3-paragraph response (of at least 350 words) to one of the following options. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Use the writing resources and the Week 4 Discussion Rubric to develop your post.

Reflect on your readings from this week, and then address one of the following options:

Option 1

According to Ma, Shang, & Bott (2015), it is critical that contemporary nurses have strong leadership and collaboration skills to improve health care. Reflect on the expertise that you expect to acquire with your education at Walden. Envision yourself taking the lead to improve patient care in your practice setting. Describe the knowledge and skills needed to achieve your professional goals.

OR

Option 2

Use the website, http://www.qualityindicators.ahrq.gov/ , found in the Learning Resources to do the following:

• Provide a brief definition of quality indicators.

• Choose a particular indicator that either is being addressed or you would like to see addressed at your place of employment (or previous place of employment), and explain your reasons. Describe both the issue and your involvement in it. Alternatively, discuss your leadership’s role and your role in utilizing the indicator to improve health care.

 

 

 

The essence of nursing

Name

Institution

 

 

The essence of nursing

I anticipated that graduating from the nursing education program at Walden will imbue me with strong leadership and collaboration skills to improve health care outcomes. In fact, I expect to gain resource management skills that allow me to acknowledge that nursing resources are scarce and must be well managed for the best outcomes. In addition, I anticipate to improve my proficiency in integrating professional and technological differentiations with nursing specializations to refine professional care in a manner that reflects the existing environmental reality (Finkelman, 2016). In this respect, I expect to acquire management instruments to direct my professional nursing practice to improve efficiency and effectiveness, while concurrently reducing costs.

As a nurse, my professional goals are to improve nursing care in palliative services provision. I expect that completing this education program will allow me to gain and refine nursing professional experiences, knowledge and skills that will enable me to make the best use of interprofessional practice. Through this, I will be able to improve care quality by identifying what I need in terms of competency in order to provide the best possible care (Weiner & Ronch, 2013). In fact, this will allow me to form integrated teams with other health professionals offering palliative care, allowing them tams to communicate, orate and communicate to offer continuous and reliable care (Dang, Rohde & Sulfita, 2017). The capacity to create complementary teams will ensure that the different and complex care needs of patients are address within this modern environment that requires a mix of medical experiences, skills, knowledge and expertise that are then leveraged to offer patient centered care. Through distinguishing myself in the education program, I will be able to lead the complementary teams in ensuring that patients receive the best possible palliative care (Porter-O’Grady & Malloch, 2016). As a result, I will use the knowledge I gain in the nursing education program at Walden to take the lead in improving patient care by directing interprofessional care teams in palliative care settings.

 

 

References

Dang, D., Rohde, J. & Suflita, J. (2017).
Johns Hopkins Nursing Professional Practice Model: strategies to advance nursing excellence
. Indianapolis, IN: Sigma Theta Tau International.

Finkelman, A. (2016).
Leadership and management for nurses: core competencies for quality care
(3
rd
ed.). London: Pearson Education.

Porter-O’Grady, T. & Malloch, K. (2016).
Leadership in nursing practice: changing the landscape of healthcare
(2
nd
ed.). Burlington, MA: Jones & Bartlett Learning.

Weiner, A. & Ronch, J. (2013).
Culture change in long-term care
. New York, NY: Routledge.

Post a 2-paragraph response (of at least 350 words) to either Option 1 or Option 2.

Use the writing resources, writing samples, and Discussion Rubric to develop your post. Reflect on your reading from this week, and then address one of the following:

Option 1

Provide an overview of a Magnet facility. Include an explanation of how Magnet status drives health care change in the institution. Develop and post cohesive paragraphs and use evidence to support your ideas. The practice of writing cohesive paragraphs is essential to good writing. Focus each paragraph on one main idea or goal.

OR

Option 2

Describe the personal contribution a nurse might make in the process of seeking or maintaining Magnet designation. Develop and post cohesive paragraphs and use evidence to support your ideas. The practice of writing cohesive paragraphs is essential to good writing. Focus each paragraph on one main idea or goal.

 

 

 

 

 

 

 

 

 

 

 

Nurses make the difference

Name

Institution

 

 

Nurses make the difference

Option 2

Magnet designation is an award that is accredited to medical facilities under the authority of the American Nurses Credentialing Center. The designation refers to medical facilities that are acknowledged for recognizing and promoting structures of higher operational standards that seek to improve personnel empowerment, retention and job pleasure. In fact, medical facilities with a Magnet designation must offer evidence of having met the set thresholds of professionalism and quality with regards to nursing services provision (American Nurses Credentialing Center, 2018).

Nursing personnel can make meaningful contributions towards achieving and maintaining Magnet designation. This occurs through the nurse ensuring that he or she has access to opportunities, resources and information that would improve the effectiveness and efficiency in completing professional tasks. To be more precise, the nurse should operate at a higher standard of respect, professional independence and assigning worth to the nursing profession while enhancing communication with other stakeholders (Friese et al., 2015).

In addition, the nurse can make a contribution through professional autonomy and independence. Through having greater control of nursing practice that goes beyond routine decision-making, the nurse gains the capacity to engaged in policy making and design as well as setting up internal nursing management frameworks. This creates opportunities for self-growth and allows the nurse to achieve a higher operational standard (Stimpfel, Rosen & McHugh, 2014).

Besides that, the nurse can contribute by creating and maintaining communication platforms that ensure the right stakeholder is at the right plan at the right time to either pass on or receive information. This improves communication effectiveness so that nurses are given a voice in determining excellence within the facility as well as adding value to the facility. Through this contribution, nursing personnel would feel more respective and appreciated since they are allowed to offer views vital to improve care outcomes (Stimpfel, Rosen & McHugh, 2014).

Also, the nurse can contribute through embracing evidence-based practice. This entails using the latest and best available evidence to support care decisions. Through this contribution, the facility would experience reduced operational costs and improved care quality and outcomes. This is based on the awareness that nursing practice can play an important role in meeting the Magnet objective of quality care through integrating evidence into practice (Wilson et al., 2015).

Yet another contribution can occur through shared governance. This presents adaptive and flexible structures ensures that nursing personnel are included in decision-making processes. This allows them to contribute to dispute resolution, setting objectives and goals, controlling the nursing profession, participating in governance activities, ensuring accountability, and controlling resource access and use. Moreover, shared governance allows the nursing personnel to conduct more comprehensive self-appraisals that identify professional practice areas that require improvements for the best care outcomes (Lamoureux et al., 2014).

It is important to note that the American Nurses Credentialing Center acknowledges and designates Magnet medical facilities on the nurses’ contributions through their experiences and quality of care provided since excelling nursing services are linked with favorable outcomes for patients and other stakeholders. The Center particular looks at good nursing performance as an important aspect when credentialing. That is because performance has a direct correlation with outcomes as an intentional incident. This is based on the awareness that good performance will typically be accompanied by favorable outcomes while bad performance will typically be accompanied by unfavorable outcomes. Additionally, nursing personnel contribute through attaining new knowledge, innovations, leadership, and structural empowerment that are reflected in care outcomes (Wilson et al., 2015). In this respect, nurses can make personal contributions in the process of seeking or maintain Magnet designation.

 

 

References

American Nurses Credentialing Center (2018).
ANCC Magnet Recognition Program
. Retrieved from http://www.nurse credentialing.org/Magnet

Friese, C. R., Xia, R., Ghaferi, A., Birkmeyer, J. D., & Banerjee, M. (2015). Hospitals in ‘magnet’ program show better patient outcomes on mortality measures compared to non-‘magnet’ hospitals.
Health Affairs
, 34(6), 986-992, 1-12.

Lamoureux, J., Judkins-Cohn, T., Butao, R., McCue, V., & Garcia, F. (2014). Measuring perceptions of shared governance in clinical practice: psychometric testing of the RN-focused Index of Professional Governance (IPNG).
Journal of Research in Nursing
, 19(1), 69-87.

Stimpfel, A. W., Rosen, J. E., & McHugh, M. D. (2014). Understanding the role of the professional practice environment on quality of care in magnet® and non-magnet hospitals.
JONA: The Journal of Nursing Administration
, 44(1), 10-16. doi:10.1097/NNA.0000000000000015

Wilson, M., Sleutel, M., Newcomb, P., Behan, D., Walsh, J. & Baldwin, K. (2015). Empowering nurses with evidence-based practice environments: Surveying Magnet, pathway to excellence, and non-magnet facilities in one healthcare system.
Worldviews on Evidence-Based Nursing
, 12(1), 12–21.

Submit a minimum 150-word Journal Assignment. Journal about one aspect of the classroom resources (Assignments, Discussions, or assigned readings) that surprised you. Additionally, journal about one or both of the options below:

Option 1

What concerns do you have about managing distractions and obtaining the support you need to be successful? Include how you plan to make certain that you have support, and how you will take personal responsibility for your own success.

Journal: Time Management

The classroom discussions interested me the most as they provided a platform where students can learn from each other and articulate the contents in the course in their own words. However, the discussions were not conducive to cover huge amounts of content (Turner & Hicks, 2015).  Since discussions are dynamically interactive, they helped me to learn, be motivated, complete homework and to prepare for classes. It is surprising that all discussions were productive and enhanced my ability to invent, create, imagine, take risks and dig deeper for different meanings. Perhaps it was because they took place in an environment where fellow classmates and I felt safer to share ideas. The class instructors also had a vital role to play in making the discussions meaningful; they accomplished this by being mindful of the vital conditions associated with interactive teaching (Lin-Siegler, Dweck & Cohen, 2016). Class instructors also provided leading discussions where each student could contribute meaningfully.

As a student, I value every minute of the day to ensure that I get things done in terms of, completing assignments on time, attending classes as scheduled and solving any personal problems which may arise. However, my greatest concern about managing distractions is the ability to pay attention from the beginning to the end of a class session. Besides, I often find difficult to open up and ask for assistance from classmates, educators or class instructors in any areas in classwork that may prove to be difficult. To adequately address these concerns, I plan to develop a culture where I set boundaries and have expectations about everything I do (Alderman & MacDonald, 2015).   I will build a support system of classmates and class instructors who will be able to regularly hold me accountable and observing and to-do-lists.

 

References

Alderman, M. K., & MacDonald, S. (2015). A self-regulatory approach to classroom management: Empowering students and teachers. 
Kappa Delta Pi Record
, 
51
(2), 52-56.

Lin-Siegler, X., Dweck, C. S., & Cohen, G. L. (2016). Instructional interventions that motivate classroom learning. 
Journal of Educational Psychology
, 
108
(3), 295.

Turner, K. H., & Hicks, T. (2015). Connected reading is the heart of research. 
English Journal
, 
105
(2), 41.

For this HIPAA: An Issue of Patient Privacy Essay Assignment, review the following from this week’s Resources:

• Resources on the HIPAA Privacy and Security Rules

• Resources on privacy and security and the use of mobile devices in patient care

• Privacy and Confidentiality Scenario

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As you reflect on the Privacy and Confidentiality Scenario (located in this week’s Resources), consider the following points and write a 2-3-pages proposal addressing privacy issues:

• Identify the issues related to patient privacy and confidentiality in this scenario.

• Describe strategies your organization (or one with which you are familiar) might use to safeguard patient information from the use of mobile devices.

• Discuss the use of mobile devices for patient care in your organization (or one with which you are familiar) and any organizational policies related to mobile devices. Specifically, address the use of text messages to communicate patient care information and explain what happens to a message after it is sent.

• Analyze your personal strategies used to protect patient health information on mobile devices.

• Do your personal strategies adequately protect information in a patient care setting?

• Provide examples of alternate or additional methods that could be used to insure patient privacy and confidentiality is maintained.

Include a minimum of three resources from the professional nursing literature in the assigned course readings and other references in the Walden Library.

Privacy and Confidentiality Scenario

This scenario is based on a true story and due to increased ubiquitous use of mobile technology more incidents such as this will occur. Nurses must fully understand privacy and confidentiality issues and apply the information to various settings and situations to best advocate for the patient. Working in a busy cardiac cath lab provides many opportunities for possible breaches of confidentiality or privacy. Jennifer works in a cath lab and has noticed mobile technology is encroaching on patient confidentiality and privacy. A few months back they were very busy and several patients were in the holding area awaiting procedures. HIPAA: An Issue of Patient Privacy Essay. Jennifer’s coworker, Tim, decided to take a picture of the patients in the holding area and posted it on Facebook to show his friends how busy he was. Jennifer felt very uncomfortable about this and told Tim she really did not think that was appropriate due to the patients in the picture. She also noted the schedule board was in the picture which contained patient initials, procedures, and doctor. Tim said it was nothing, as the patients could not really be identified and pretty much told Jennifer she was being, “Miss. Perfect because she was in school.” As time went by Jennifer noticed it was becoming commonplace for techs and nurses to text information back and forth about cases to the physicians on their personal cell phones. Initials were supposed to be used, but sometimes, patient names would be added by mistake. The physicians loved the convenience and encouraged this behavior. It wasn’t long before patient scheduling via Google was the new tool. This meant all the nurses, techs, and physicians could share a common calendar on Google Calendar and view the schedule in real time. Again, patient initials were to be used and at times full names came through. Every time a patient was added to the schedule a popup on the physician’s, tech’s, and nurses’ personal phones would flash the procedure, time, and patient. Jennifer knew all this was not correct as none of the phones or tools had been approved via the Compliance Officer or Information Technology. The most difficult thing was the unit manager was in agreement with the mobile communications and Jennifer felt she had nowhere to go to stop this potential breach of patient information. HIPAA: An Issue of Patient Privacy Essay.

• Identify the issues related to patient privacy and confidentiality in this scenario.

• Describe strategies your organization uses to safeguard patient information from the use of mobile devices.

• Discuss the use of mobile devices for patient care in your organization and any organizational policies related to mobile devices. Specifically address the use of text messages to communicate patient care information and explain what happens to the message after it is sent.

• Analyze your personal strategies used to protect patient health information on mobile devices.

• Do these strategies adequately protect information in your patient care setting?

 

HIPAA – an issue of patient privacy

Identify the issues related to patient privacy and confidentiality in this scenario.

There are three issues that can be seen in the scenario. Firstly, there is an issue of confidentiality that focuses on the health professionals’ obligation to hold patient information in confidence, especially when they have access to the information. The social media postings violate the confidentiality expectations. Besides that, communicating using the patients’ names rather than initials also violates confidentiality expectations. Secondly, there is an issue of privacy that concerns the patients’ right to make independent decisions on whether and how their personal information should be shared. None of the patients was consulted when the information was shared on social media. Finally, there is an issue of security that concerns that absence of protection protocols that support medical personnel in holding patient information in confidence. The facility is using Google technology which does not provide adequate protection for the information. HIPAA: An Issue of Patient Privacy Essay.

Describe strategies your organization (or one with which you are familiar) might use to safeguard patient information from the use of mobile devices.

There are two strategies for safeguarding patient information from the use of mobile phones. The first strategy is to educate mobile personnel on the need to protect patient information and how the use of mobile phones can violate this need. The second strategy is to mobile devices use policies that punish persons who violate security expectations. Finally, implementing a breach protocol the involves containing and evaluating the scope of the breach, notifying the affected persons, conducting an investigation to identify the nuances of the breach, and remediation (Bromwich, M. & Bromwich, R., 2016) HIPAA: An Issue of Patient Privacy Essay.

Discuss the use of mobile devices for patient care in your organization (or one with which you are familiar) and any organizational policies related to mobile devices. Specifically, address the use of text messages to communicate patient care information and explain what happens to a message after it is sent.

Mobile devices have offered medical personnel new ways for carrying out professional communication, ease access to decision support, and accelerated consultations. In fact, it is not uncommon for medical personnel to communicate among themselves and with patients using text messages that communicate diagnosis, test results, care progress, make and confirm appointments, access medical records, and so on. Although mobile devices offer communication conveniences, they present some concerns with regards to breaching privacy expectations, insecure data storage, and legal liability for failing to obtain the patient’s consent. This is particularly true when the possibility of data hacking and access by a third party is considered (McGonigle & Mastrian 2018). HIPAA: An Issue of Patient Privacy Essay.

Analyze your personal strategies used to protect patient health information on mobile devices.

I implement four personal strategies to protect patient health information on mobile devices. The first strategy is authentication controls that involve locking my devices when not in use and requiring biometrics and passcodes to access secured information. The second strategy is an automatic and remote lock and wipe policy that comes into play if the device is stolen or a loose it. HIPAA: An Issue of Patient Privacy Essay. The fourth strategy is positional awareness whereby I only access patient information away from prying eyes so that no third party unintentionally sees the information. The final strategy involves installing regularly updated security programs that protect the device from malicious programs such as viruses as well as hackers (Maki & Petterson 2013).

Do your personal strategies adequately protect information in a patient care setting?

I do not believe that my personal strategies offer adequate protection of patient information within the care setting. That is because these strategies still has a loophole for breaches. The loophole is that patient information is not typically encrypted. This implies that any person who can intercept the information while being transmitted will be able to view the information. This loophole can be addressed by employing encryption that prevents unauthorized persons from reading the information even if they can access it (Maki & Petterson 2013). HIPAA: An Issue of Patient Privacy Essay.

Provide examples of alternate or additional methods that could be used to insure patient privacy and confidentiality is maintained.

Other than the mentioned strategies, there are two additional strategies that can be applied. The first strategy is to implement a mobile device use policies that controls how the device is used if it contains vital information. The strategy focuses on evaluating applications. At the very least, unsecured and unapproved applications should not be used. The second strategy is to regularly update operating systems, applications and other software. The updates plug previous security vulnerabilities. The mobile device users should be informed of these updates while the more sensitive devices should include options for forced security updates (Davis & LaCour, 2016). HIPAA: An Issue of Patient Privacy Essay.

References

Bromwich, M. & Bromwich, R. (2016). Privacy risks when using mobile devices in health care.
CMAJ
, 188(12), 855-856. doi: 10.1503/cmaj.160026

Davis, N. & LaCour, M. (2016).
Foundations of health information management
. Amsterdam: Elsevier Health Sciences.

Maki, S. & Petterson, B. (2013).
Using the electronic health record: in the health care provider practice
(2
nd
ed.). Mason, OH: Cengage Learning. HIPAA: An Issue of Patient Privacy Essay.

McGonigle, D., & Mastrian, K. G. (2018).
Nursing informatics and the foundation of knowledge
(4th ed.). Burlington, MA: Jones and Bartlett Learning. HIPAA: An Issue of Patient Privacy Essay.

Meaningful Use: Nurses Hold the Key Essay

Reflect on the key role of nurses in implementing meaningful use. Address how two or more of the following five aims of the meaningful use initiative impact or will impact your practice. Also, explain how the five aims depend on an interprofessional approach to patient-centered care in your setting.

1. Improve quality, safety, and efficiency, and reduce health disparities

2. Engage patients and families

3. Improve care coordination

4. Improve population and public health

5. Ensure adequate privacy and security protections for personal health information

Note: Post a 3-paragraph (at least 250–350 words) response. Be sure to use evidence, in-text citations, and essay-level writing skills, including the use of transitional material and organizational frames. Meaningful Use: Nurses Hold the Key Essay.

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Jones, et al (2014), notes that meaningful use supports delivery of efficient, safe and quality care as well as minimizes disparities in healthcare. It was developed as a component of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 (Adler-Milstein & Jha, 2017). Nurses play significant roles in the implementation of meaningful use. Several aims of the meaningful use initiative impact the nursing practice. This paper seeks to examine two meaningful use aims and explain how they depend on an interprofessional approach to patient-centered care setting. Meaningful Use: Nurses Hold the Key Essay.

One of the five aims of meaningful use is to improve quality, safety, and efficiency, and reduce health disparities (Lye et al., 2018). The goal of healthcare system is the provision of quality services to patient to promote recovery. This involves safety which prevent accidents as well as efficiency, which ensures smooth workflow. Additionally, nursing practice seeks to minimize disparities based on gender, social, cultural and economic factors Meaningful Use: Nurses Hold the Key Essay. Another aim is to improve population and public health which is characterized by community empowerment through seminars as well as individual sessions (Lye et al., 2018). These two aims guide the nurses in practice and influence the health outcomes of patients.

The five aims of meaningful use promote collaboration between the public and clinical healthcare. This involves bringing different specialists together to support clinical knowledge and development of standardized data exchange as well as improve patient-oriented prevention of diseases (Washington et al, 2017). For instance, the occupational safety personnel teams up with the healthcare practitioners to create safe environment for patients. Moreover, mental specialists and public health providers come together to share knowledge regarding the patient, family and community empowerment. Meaningful Use: Nurses Hold the Key Essay Consequently, security and protection demands the collaboration between the information technology specialists with the nurse experts to ensure efficiency, confidentiality and privacy of electronic health records (Thompson et al., 2016).

References

Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. 
Health Affairs
, 
36
(8), 1416-1422.

Jones, S. S., Rudin, R. S., Perry, T., & Shekelle, P. G. (2014). Health information technology: an updated systematic review with a focus on meaningful use. 
Annals of internal medicine
, 
160
(1), 48-54. Meaningful Use: Nurses Hold the Key Essay.

Lye, C. T., Forman, H. P., Daniel, J. G., & Krumholz, H. M. (2018). The 21st Century Cures Act and electronic health records one year later: will patients see the benefits?. 
Journal of the American Medical Informatics Association
, 
25
(9), 1218-1220.

Thompson, L. A., Martinko, T., Budd, P., Mercado, R., & Schentrup, A. M. (2016). Meaningful use of a confidential adolescent patient portal. 
Journal of Adolescent Health
, 
58
(2), 134-140.

Washington, V., DeSalvo, K., Mostashari, F., & Blumenthal, D. (2017). The HITECH era and the path forward. 
New England Journal of Medicine
, 
377
(10), 904-906 Meaningful Use: Nurses Hold the Key Essay.

Journal: Observe, Process, Reflect

• Reflect on your course experience. Review material concerning health histories and physical examinations.

• Include the following in your journal entry:

o Think, reflect and record the feelings you have had as you have progressed through this course.

o Examine and record your strengths and weaknesses concerning collecting health histories and performing physical examinations.

o What were areas you felt like you grew the most during this course?

o Compare what you expected to learn versus what you learned in this course.

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Submit a 150-word Journal entry addressing the four areas noted above and in the grading rubric. You may include any other comments or thoughts unrelated to the listed areas.

I strongly feel that this course has presented interesting learning opportunities and has also contributed to improvement of my knowledge and clinical skills. Before the invention of modern technology, it was vital for healthcare providers to perfect their skills and techniques in physical examination since equipment such as x-ray machines, echocardiograms and scanners were not yet existent (Pasterkamp & Zielinski, 2019). It is for this reason that having the ability to obtain an accurate medical history and perform a thorough physical examination is essential to the provision of comprehensive healthcare services to both pediatric and adult patients. This course has greatly contributed to improvement of my health assessment skills. I can be able to gather clues based on spoken information provided by a patient. By conducting comprehensive health assessments, I am able to relate assessment outcomes to the pathophysiology of a disease and make an accurate diagnosis of an illness before instituting the appropriate management (Nelson, Alexander & Molnar, 2015).

One of the areas that I grew the most in this course is conducting physical examinations by using the hand to palpate, a stethoscope to listen/auscultate and eyes to see. The findings in physical examinations proved useful in diagnosing patients’ illnesses. During the course, I was able to develop a habit of updating patient’s historical information and routinely repeating essential parts of physical examination especially during follow-up visits (Fryer & Evans, 2015).  I was able to demonstrate a lot of consideration for the feelings of the patient, the social and cultural backgrounds in history taking and physical examination as they are major social determinants of health Journal: Observe, Process, Reflect.

References

Fryer, N., & Evans, C. (2015). Examination of the newborn: professional issues in practice. 
Examination of the Newborn: An Evidence-Based Guide
, 213.

Nelson, M. R., Alexander, M. A., & Molnar, G. E. (2015). History and examination. 
Pediatric rehabilitation
, 1-11.

Pasterkamp, H., & Zielinski, D. (2019). The history and physical examination. In 
Kendig’s Disorders of the Respiratory Tract in Children (Ninth Edition)
(pp. 2-25). Journal: Observe, Process, Reflect.

Patient-Centered Care-At First Contact Essay

To Prepare

• Choose two of the six dimensions of patient-centered care (PCC), listed below, on which to focus for this Discussion.

• Think about how you might implement the two dimensions you selected into your health interview and assessment process in order to improve quality in patient collaboration and outcomes.

1. Respect for patients’ values, preferences, and expressed needs

2. Coordination and integration of care through collaboration and teamwork

3. Accessibility and free flow of information, communication, and education

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4. Physical comfort

5. Sensitivity to non-medical and the spiritual dimension of care (emotional support)

6. Involvement of family and friends Patient-Centered Care-At First Contact Essay

Post a substantive 3-paragraph response (at least 350 words) discussing the selected dimensions of patient-centered care.

Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Use the writing resources and the Discussion Rubric to develop your post Patient-Centered Care-At First Contact Essay.

• Define the two dimensions of patient-centered care that you selected.

• Describe how your implementation of the two dimensions in your health interview and assessment will improve quality in patient collaboration and outcomes.

Dimensions of Patient-Centered Care

Respect of patient’s preferences, values and expressed needs and involvement of family and friends

Respect for patient’  values, preferences and expressed needs  involves  engaging patients in making decisions on their care, identifying that  patients are persons with their own distinctive preferences and values .According to Tzelepis et al (2015), health care must respectful  the cultural values, preferences and needs of the patient. Patient must feel capable of expressing their perspectives, be engaged in making decisions in accordance to their preferences, and get respectful care. Involvement of family and friends is a principle that addresses the roles that friends and family play in patient experience. Patient-Centered Care-At First Contact Essay. Tzelepis et al (2015) argue that friends and family are involved in patient decision-making and care in accordance to the preferences and care and that care must be responsive to the wishes of friends and family. Friends and friends can improve the relationship between the patient and care provider, enhance exchange of and augment patient contentment.

How implementation of the two dimensions in my health interview and assessment will improve quality in patient collaboration and outcomes

Implementation of patient values, preferences and expressed needs  in my health interview and assessment will  enable me  educe patient expressed needs, values and preferences as a component  of clinical interview, execution of plan of care  and  assessment of care. It will also enhance patient-centered care by involving patients in decisions on their care and support them to set and achieve their individual treatment goals, thus improving outcomes. Implementation of patient values and preferences in health interview and assessment enable providers to communicate patient expressed needs, values and preferences to other individuals taking part in patient care (Kruschke, 2018). Patient-Centered Care-At First Contact Essay.

Implementation of involvement of family and friends in my health interviews and assessment will give them opportunity to provide information, authority to influence patient care decisions and offer their opinions on the type of care they want their patient to receive Patient-Centered Care-At First Contact Essay. Cramm et al (2015) alleges that depending on how serious a condition is, a disease affect the patients as well as friends and family. Mackie et al (2018) argue that healthcare that permits patients and their friends and families to partner and collaborate in provision of care has been suggested to improve quality and patient safety. Patient-Centered Care-At First Contact Essay. Javed and Herrman (2017) assert that it is acknowledged that so as to improve care, it is essential to appreciate patients’ individual experiences along with those of their friends and family, and seek out their involvement in organizing and planning of care

References

Cramm, J., Leensvaart, L., Berghout, M., & Exel, J. (2015).  Exploring views on what is important for patient-centered care in end-stage renal disease using Q methodology.
BMC Nephrology
, 16:74.

Javed, A., Herrman, H. (2017). Involving patients, carers and families: an international perspective on emerging perspectives. 
BJPsych International
, 14(1): 1-4.

Kruschke, C.  (2018).
Leadership Skills for Licensed Practical Nurses Working with the Aging Population
. New York: Springer Publishing. Patient-Centered Care-At First Contact Essay.

Mackie, B., Mitchell, M., & Marshall, A. (2018). The impact of interventions that promote family involvement in care on adult-care wards: An integrative review.
Collegian
, 25(1): 131-140.

Tzelepis, F., Snaason-Fisher, R., Zucca, A., & Fradgley, E. (2015). Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment.
Patient Preference and Adherence
, 9(1): 831-835. Patient-Centered Care-At First Contact Essay.

To Prepare Promoting Nutrition in Older Adults Essay.

• Review the Writing Resources and Program Success Tools.

• Review this week’s Writing Resources and Program Success Tools.

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• Using the Nursing Databases in the Walden Library, seek out a professional article that was published within the past 5 years pertaining to one of the three Discussion options below. Some topics to look for might include:

o Nutrition and age groups

o Abdominal differences

o Reaching a higher level of care

o Health promotion and patient centered care

o Ethics

o Population health

• From the article, pick out three important key points or “take-a-ways.” Be sure to cite and reference the professional article selected along with other sources of evidence. Promoting Nutrition in Older Adults Essay

Post a substantive response (at least 350 words) to one of the following options. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Use the writing resources and the Discussion Rubric to develop your post.

Option One:

• In the text, you read about the various types of nutritional assessments that can be utilized during the health history and assessment process. From a professional article you selected, describe one effective nutritional assessment that can be used specifically for an older individual in outpatient care clinics, hospitals, or long-term facilities. Promoting Nutrition in Older Adults Essay.

Option Two:

• As older adults live longer, they may have more than one chronic disease. Or, they may have a health problem that can lead to another condition or injury if not properly managed. The older adult requires careful nutritional management to ensure proper care and improve or maintain quality of life. From the professional article you selected, describe the unique nutritional needs of this population.

Option Three:

• With the rapid population increase of older adults and the surge in online health information, efforts targeted at older adults and their health literacy are both relevant and crucial to promoting and supporting overall health. From the professional article you selected, describe effective nurse strategies aimed to improving the health literacy of this population. Promoting Nutrition in Older Adults Essay.

Promoting nutrition in older adults

Option Three

Chesser et al. (2016) acknowledges that health literacy plays an important role in nutritional outcomes among adult populations. In fact, it notes that although cost and availability plays a significant role in nutritional outcomes, the significance of nutritional literacy cannot be overestimated. That is because health literacy is concerned with reading, comprehension, numeracy and the capacity to make appropriate decisions on what and when to eat. Cha et al. (2014) adds to the discussion by noting that adult populations with low health literacy levels will report correspondingly low nutritional awareness and outcomes with the reverse being equally true. This awareness highlights the need for nursing personnel to improve health literacy levels among adult populations. This is achieved through three strategies. Promoting Nutrition in Older Adults Essay. The first strategy is the use of low literacy intervention strategy that focus on simplifying the health education material in a less threatening manner to improve comprehension among adult population. Simplifying the education material makes it easier to understand while presenting it in a less threatening manner makes them more receptive (Cha et al., 2014). The second strategy entails raising awareness about the significance of food label use, especially among adult populations who consume packaged foods. This strategy focuses on changing their perception about reading food labels and encourages them to evaluate nutritive values as presented in labels for pre-packaged foods. The final strategy is to create nutritional discussion forums that are moderated by nursing personnel. The discussion forums should be in settings that are affordable and easily accessible to adult populations Promoting Nutrition in Older Adults Essay. The three strategies advocate for the use of pictorial images, teach-back method and plain language that allow for better learning recollection. The strategies are applied with the expectation that the targeted population will use the acquired information to better self-manage their nutrition (Resnick, 2016). In this respect, improving health literacy among adult populations predicts better nutrition quality that improves health behaviors and outcomes through effectively increasing skills and knowledge for informed decision-making concerning healthy food choices Promoting Nutrition in Older Adults Essay.

References

Cha, E S., Kim, K. H., Lerner, H. M., Dawkins, C. R., Bello, M. K., Umpierrez, G. & Dunbar, S. B. (2014). Health literacy, self-efficacy, food label use, and diet in young adults.
Am J Health Behav
., 38(3), 331–339. doi: 10.5993/AJHB.38.3.2

Chesser, A. K., Woods, N. K., Smothers, K. & Rogers, N. (2016). Health literacy and older adults: a systematic review.
Gerontol Geriatr Med
. 2, 2333721416630492. doi: 10.1177/2333721416630492

Resnick, B. (Ed.). (2016).
Geriatric nursing review syllabus: a core curriculum in advanced practice geriatric nursing
(5
th
ed.). New York, NY: American Geriatrics Society. Promoting Nutrition in Older Adults Essay