Tag: Clinical-Nursing

NR 509 WEEK 8 APEA 3P EXAM

A 3 year-old presents with a history of fever and cough over the past 24 hours. Findings on exam reveal: temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40 breaths/minute. Tachypnea in this child is most likely related to

When percussing the lower posterior chest, begin by:

The palpation technique used to assess respiratory expansion of the chest is placing the hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand medially and grasping a small fold of skin between the thumbs. Then:

When trying to differentiate between hemoptysis or blood streaked material, which one of the following observations is correct?

When percussing the chest in a patient who has left sided heart failure, the sound emanated would be:

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The line that extends through the inferior angle of the scapula when the arms are at the sides of the body is the: NR 509 WEEK 8 APEA 3P EXAM

A condition associated with a chronic cough that produces copious amounts of purulent sputum is most likely:

A patient who walked into the examination room, may be observed to be sitting and leaning forward in his chair. Lips were pursed during exhalation and arms are supported on the table. This position could be consistent with patients who have:

Breath sounds heard over the periphery of the lung fields are:

When percussing the posterior chest, which one of the following techniques would be omitted?

When auscultating breath sounds in a patient who has left sided heart failure, the breath sounds are:

Breath sounds consisting of a full inspiratory phase and a shortened and softer expiratory phase normally audible over the hilar region of the chest are termed:

An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is suggestive of: NR 509 WEEK 8 APEA 3P EXAM

One of the anterior thoracic landmarks is the costal angle. It is located nr 509 week 8 apea 3p exam

Atypical respiratory symptoms associated with gastroesophageal disease (GERD) may include all of the following except:

On auscultation of the chest, if the patient says “ninety-nine” and it is clearly heard, this is indicative of:

Respiratory effort in the neonate is …..at birth as a result of:

Adventitious breath sounds, such as crackles, are:

Breath sounds heard on chest over the hilar region are nr 509 week 8 apea 3p exam

Breath sounds consisting of a full inspiratory and expiratory phase with the inspiratory phase usually being louder and normally heard over the trachea and larynx are……..

Pain from pleurisy may be refer to the:

When performing a respiratory assessment on a 4-year-old child, further evaluation is ……..in the presence of:

Which technique best determines whether the tissues in the chest are …….or solid?

Breath sounds ……over the periphery of the lung fields are quiet and wispy during the inspiratory phase …..by a short, almost silent expiratory phase. These breath sounds are …….

A patient who presents with a long history of cigarette smoking exhibits a dry to productive cough with dyspnea and weight loss. These symptoms could be consistent with:

The hilar region of the lungs describes:

The anterior surface landmark on the thorax that is denoted by a hollow U-shaped depression just above the sternum and between the clavicles is termed the:

Factors that aggravate costochondritis may include: NR 509 WEEK 8 APEA 3P EXAM

To locate the twelfth rib, palpate:

To document chest findings located between the scapulae, which one of the following terms would be used?

The midaxillary line:

Retractions are ……in all the following areas except the:

When examining a patient for chest expansion, begin by:

Question:

The lower tip of the scapula is located:

A patient presents with a productive cough. Which one of the following descriptions of the mucus is correct?

Diminished breath sounds should be………

When inspecting the chest for respiratory effort, which one of the following is not part of the inspection?

The angle of Louis is a useful place to start counting ribs. This landmark is located:

When auscultating breath sounds, use the diaphragm of the stethoscope by placing it initially on the:

The line that bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acromioclavicular joints is the:

When palpating the thorax, a crackling, popping noise under the skin is …… On auscultation, a sound similar to hair being …..between the fingers is noted. These symptoms could be consistent with:

To document chest findings located below the scapulae, which one of the following terms would be used?

A 37-year-old female has audible stridor. This type of stridor is consistent with: nr 509 week 8 apea 3p exam

When percussing the right upper posterior area of the chest, a dullness replaces the resonance sound usually heard in the lung. This sound would be suggestive of:

Orthopnea is typically ……with all of the following conditions except nr 509 week 8 apea 3p exam

Stridor heard louder in the neck than over the chest wall indicates:

Increased anteroposterior diameter of the chest, purse-lipped breathing, and dyspnea with talking, suggest: NR 509 WEEK 8 APEA 3P EXAM

The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels is the:

Which one of the following infants should be seen immediately by the nurse practitioner? NR 509 WEEK 8 APEA 3P EXAM

NR 509 APEA EXAM – NEUROLOGY

Question 1:
 Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with:

Question 2:
 Which of the following neurological assessment findings indicate the need for further evaluation?

3:
 An example of proximal weakness is:

4: A female patient complains of weakness in her hand when opening a jar. This finding could be suggestive of which type of weakness pattern?

5: A patient presents with an altered level of consciousness. He/she is considered in a stuporous state if he/she: NR 509 APEA EXAM – NEUROLOGY.

6: One way to assess cerebellar function would be to have the patient:

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7: Hypesthesia refers to:

8: When conducting a neurologic exam, which one of the following assessments is not considered part of the mental status assessment?

detailed explanations…

9: A mother reports to the nurse practitioner that her teenager might be taking drugs because earlier today the teenager had a mild seizure and now has an unstable gait and is beginning to complain of shortness of breath. These symptoms might be consistent with a possible overdose of:

10: An ischemic stroke is:

11: By placing the patient in the supine position, the nurse practitioner raises the patient’s relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as:

Question 12: The level of consciousness that refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep is ….

Question 13: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates a steady posture?

14: An older adult presenting with signs of undernourishment, slowed motor performance, and loss of muscle mass or weakness suggests: NR 509 APEA EXAM – NEUROLOGY.

15: Postural tremors appear when the affected part is:

16: A discriminative sensation that describes the ability to identify an object by feeling it is:

17: When evaluating a patient for weakness of the upper extremities, bilateral distal weakness is noted. This finding could be suggestive of:

18: When observing for thenar atrophy of the hands, a typical observation is:

19: Fasciculations in atrophic muscles suggest:

20: The part of the brain that controls most functions in the body and is responsible for breathing, heart rate, and articulate speech is the:

21: Assessing the neurological status of a child with a ventriculoperitoneal shunt should include:

22: What geriatric condition is characterized by normal alertness but progressive global deterioration of cognition in multiple domains?

23: An abnormal or unpleasant sense of touch is termed:

24: When eliciting deep tendon reflexes in the knee, the nurse practitioner notes an abnormal reflex in the right knee. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine?

25: When evaluating a patient for weakness of the upper extremities, bilateral proximal limb weakness without sensory loss is noted. This finding could be suggestive of:

26: The term used to describe involuntary muscle spasms and twisting of the limbs is:

27: A 40-year-old male presents with complaints of headaches. History reveals headaches that occurred daily for about 4-6 weeks. He had relief for 6 months but now they are recurring. These are most likely:

28: Which of the following symptoms may be associated with a tumor of the eighth cranial nerve?

29: When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a comatose patient:

30 : A female patient complaints of weakness in both arms when transferring the wet clothes from the washer and placing them in the dryer. This finding could be suggestive of which type of weakness pattern? NR 509 APEA EXAM – NEUROLOGY

31: Which developmental area is predominantly …..by lead poisoning?

32: A form of aphasia in which the person has word-finding difficulties for speaking and writing is …..

33: A patient presents with an altered level of consciousness. He/she is …..in an obtunded state if he/she:

34: With the patient lying supine, the nurse practitioner places her hands behind the patient’s head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is a positive:

35: Which of the following procedures should NOT be performed in a comatose patient?

36: The term used to describe a distortion of any sense, especially that of touch, is:

37: Winging of the scapula can be noted in patients with all of the following conditions except:

38: Resting tremors refer to those tremors that disappear:

39: A patient is instructed to stand, close both eyes, and extend both arms forward with the palms facing upward for 20-30 seconds. If the forearm drifts downward, this would indicate:

40: A progressive disorder of the nervous system that affects movement is known as:

41: While assessing the trigeminal nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a:

42: When assessing the cranial nerves, the nurse practitioner uses the tongue blade to gently stimulate the back of the throat on each side. A unilateral absence of the gag reflex is noted. This finding could be suggestive of a unilateral lesion in which cranial nerve?

43: On examination of the adult patient, symptoms of flexed posture, tremor, rigidity, and shuffling gait are …… These findings are consistent with: NR 509 APEA EXAM – NEUROLOGY

44: Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals are consistent with:

45: A sudden brief lapse of consciousness with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with:

46: Physical exam of a well two-week-old infant reveals a little dimple with a small amount of hair just above the sacral area. This could be:

47: Persistent blinking after glabellar tap and difficulty walking heel-to- toe are common in:

48: An example of distal weakness is:

49: A teenager presents with signs of being gleeful, somewhat drowsy, and unable to focus. On examination , B/P 90/65, pupils constricted, and speech slurred. These symptoms are consistent with:

50: An 8-month-old with a significant head lag would suggest the need for:

51: Symptoms of a subdural hematoma include:

52: Assessment findings in an infant with increased intracranial pressure would include:

53: When evaluating the sensory system, testing the posterior columns tract would include assessing sensations of:

54: The term used to describe low back pain with nerve pain that radiates down the leg is:

55: A form of aphasia in which the speech is confluent, slow, with few words and laborious effort and inflection and articulation are impaired but words are meaningful, is …..

56: Symmetric weakness of the distal muscles of the legs suggests a: NR 509 APEA EXAM – NEUROLOGY

57: Symmetric weakness of the proximal muscles of the legs suggests a:

58: Dysarthria refers to:

59: Walking on the toes and heels may reveal:

60: When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite side. This term is:

61: An infant with fetal alcohol syndrome would:

62: Involuntary movements of the body that are slower and more twisting and writhing than choreiform movements, and have a larger amplitude are suggestive of:

63: An example of symmetric weakness is:

64: Anesthesia refers to:

65: When assessing an elderly patient for delirium, the recommended instrument with the best supportive data is the:

66: An indication that there is a malfunction of a ventriculoperitoneal (VP) shunt in an older child would be the presence of a:

67: When assessing abdominal cutaneous reflexes, the nurse practitioner strokes the lower abdomen, the localized twitch is absent. This finding could be suggestive of a pathologic lesion in which segmented level of the spine?

68: While assessing the cranial nerves, the nurse practitioner touches the cornea lightly with a wisp of cotton. This maneuver assesses which cranial nerve? NR 509 APEA EXAM – NEUROLOGY

69: The level of consciousness that refers to the patient that arouses from sleep only after painful stimuli is ……

70: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of:

71: Hypalgesia refers to:

72: Which choice is least likely to be an example of asymmetric weakness?

73: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates head movements?

74: When comparing two sides of the body for symmetric sensation a symmetrical distal sensory loss would be suggestive of : nr 509 apea exam

75: A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner should take is:

76: The principal muscles ……when closing the mouth are …..by which Cranial nerve?

77: The best method of detecting cognitive impairment or mental retardation at an early age is by:

78: When trying to determine the level of consciousness in a patient whose level of consciousness is ….., a lethargic patient: NR 509 APEA EXAM – NEUROLOGY

79: When eliciting deep tendon reflexes in the ankle, the nurse practitioner notes an abnormal reflex in the right ankle. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine?

80: The term used to describe the absence or loss of control of voluntary muscle movements is:

81: With the adult patient lying supine, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Dorsiflexion of the big toe was ….. This is a positive:

82: The part of the peripheral nervous system that regulates muscle movement and response to the sensations of pain and touch is the:

83: The part of the brain that coordinates all movement and helps maintain the body upright in space is the: nr 509 apea exam

84: The part of the brain tissue that consists of neuronal axons that are …..with myelin is the:

85: A patient complains of experiencing symptoms of nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event. These symptoms are most likely …..

86: The patient has his eyes ….and an area on his right leg is briefly …..by the nurse practitioner. The patient is i…..to open his eyes and point to the area that was …… This is an example of the discriminative sensation …….:

87: Hyperesthesia refers to:

88: A patient who is being …..for frequent headaches, mentions that the headache worsens with coughing, sneezing, or when changing positions. Increasing pain with these maneuvers may be suggestive of:

89: The term used to describe an abnormal tremor consisting of involuntary jerking movements, especially in the hands is: nr 509 apea exam

90: Which one of the following assesses pain, temperature, and sensation using the distal and proximal areas testing pattern?

91: The part of the brain that maintains homeostasis is the:

92: An example of tandem walking is having the patient:

93: The central nervous system extends from the medulla into the:

94: A patient is unable to identify the smell of an orange. This inability could reflect an abnormality in cranial nerves: NR 509 APEA EXAM – NEUROLOGY

95: When assessing the patient’s sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is:

96: When evaluating the six cardinal directions of gaze, a loss of conjugate movements is ….when the patient looks to his left. This finding could be consistent with damage to which cranial nerve?

97: Dysarthria refers to:

98: Disorders of speech fall into three groups that affect all of the following except the:

99: Unilateral weakness in cranial nerve V (CN V) would be suggestive of a: nr 509 apea exam

100: The most common cause of viral encephalitis in children is:

101: The principal muscles ….when closing the mouth are …..by which Cranial nerve?

102: Intention tremors appear with movement and:

103: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates a steady posture?

104: Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with:  nr 509 apea exam

105: A patient experiences difficulty rising from a sitting position without arm support. This would be suggestive of:

106: Common physical findings in a young child with cerebral palsy include which one of the following?

107: A teenager is being ….for possible acute marijuana usage and appears intoxicated. Findings consistent with marijuana intoxication could include:

108: When eliciting deep tendon reflexes in the triceps, the nurse practitioner notes an abnormal reflex in the right triceps. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine?

109: The central nervous system extends from the medulla into the: nr 509 apea exam

110: Which nerve runs from the spine through the neck, the axilla, and into the arm? NR 509 APEA EXAM – NEUROLOGY

LINGO software

Premier Consulting’s two consultants, Avery and Baker, can be scheduled to work for clients up to a maximum of 160 hours each over the next four  (4) weeks. A third consultant Campbell has some adminstrative assignments already planned and is availble for clieents up to a maximum of 140 hours over the next four (4) weeks. The company has four (4) clients with projects in process. The estimated hourly requirments for each of the clients over the four-week period as follows:

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CLIENT                         HOURS

A                                      180

B                                      75

C                                      100

D                                      85

Hourly rates vary form the consultant-client combinations and are based on several factors, including project type and consultants” experince. The rates( dollars per hour) for each consultants-client combination are as follows: LINGO software

 

CLIENT

CONSULTANTS                            A              B                    C                   D

AVERY                                        100             125               115              100

BAKER                                         120             135             115               120

CAMPBELL                                  155             150            140               130

 

a) Develop a network representation of the problem.

b) formulate the problem as linear program, with the optimal solution providing the hours each consultant should be scheduled for each client to maximize the consulting firm’s billings. What is the schedule and what is the total billing?

c)New information shows that Avery doesn’t have the experince to be scheduled for client B. If this consultingnassignment is not premitted, what impact does it have on total billings? What is the revised scheduled?

 

To solve problem using LINGO software.

Strategic Points Quantitative Study Extraction

In the prospectus, proposal, and dissertation there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. These points, which provide a guide or vision for the research, are present in almost any research study. The ability to identify these points is one of the first skills required in the creation of a viable doctoral dissertation. In this assignment, you will identify and evaluate 10 strategic points in a published quantitative research study.

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General Requirements:

Use the following information to ensure successful completion of the assignment:

Review the Casteel dissertation.

Locate and download “Modified 10 Points Template.”

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

APA style is required for this assignment. Strategic Points Quantitative Study Extraction

You are required to submit this assignment to Turnitin.

Directions:

Using the “Modified 10 Points Template,” identify each of the 10 strategic points in this quantitative dissertation.

Complete the “Evaluation” section of the template by addressing the following questions (250-500 words) with regard to the 10 strategic points in the study:

 Discuss the key points in the literature review and how the author used this section to identify the gap or problem addressed in the study.

Describe the variables under study and how they are a key component in this quantitative research study. You are not expected to understand the differences between variables at this point, but should be able to identify how they inform the problem, purpose, research questions and data collection instruments.

Describe the problem and how it informed the research questions under study.

Describe the quantitative design used and why it is appropriate for the identified problem and research questions. Support your response with a peer-reviewed citation from a research source. Strategic Points Quantitative Study Extraction

Assess the appropriateness of the instruments used to collect data and answer the research questions as well as to address the stated problem.

Discuss how the problem statement informed the development of the purpose statement in this study. Strategic Points Quantitative Study Extraction

NRS-410V Module  1 Assess Your Knowledge Of Foundational Concepts

Anatomy

Backward effects of left-sided heart failure include:

A.    Pulmonary congestion

B.     Jugular vein distention

C.     Dependent edema in the legs

D.    Bounding pulses

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Anatomy

In performing a physical assessment, the nurse notes the patient has a “barrel” configuration to the chest. This is a consequence of:

A.    Reduced intrapleural pressures

B.     Bronchial airway expansion

C.     Increased vital capacity

D.    Increased residual lung volume

 

Anatomy

Ausculation of the chest reveals bilateral fine crackles in the bases bilaterally, indicating:

A.    Right-sided heart failure

B.     Left-sided heart failure

C.     Pneumonia

D.    Acute respiratory distress syndrome

 

Biology

The signs and symptoms of anemia are all related to what common pathophysiologic feature of the condition? NRS-410V

A.    Increased oxygen consumption by tissues

B.     Decreased blood oxygen content

C.     Vasodilation

D.    A shift in the oxyhemoglobin dissociation curve

 

Biology

In addition to hypertension, preeclampsia is characterized by:

A.    Nausea and vomiting

B.     Fatigue and lower back pain

C.     Protein in the urine and edema

D.    Retinal changes and rates in the lungs

 

Biology

Common manifestations of bacterial pneumonia include all of the following except:

A.    Fever

B.     Productive Cough

C.     Tachypnea

D.    Hyperinflation

 

Biology

Closed drainage systems work to re-expand a lung after pneumothorax by:

A.    Re-establishing the normal negative intrapleural pressure.

B.     Creating a positive pressure in the pleural space

C.     Removing excess fluid from the pleural space so that there is room for lung expansion.

D.    Pulling oxygen into distal air sacs to re-expand lung tissue

 

Biology

Patients with chronic renal failure usually exhibit:

A.    Bradycardia

B.     Hypokalemia

C.     Hypocalcemia

D.    Hematomas

 

NRS-410V Biology

The diet of a patient in end-stage kidney disease is restricted in all of the following except:

A.    Fluid

B.     Potassium

C.     Protein

D.    Calories

 

Anatomy

Which of the following is true of the biological functions of progesterone?

A.    Progesterone is the most important hormone associated with pregnancy.

B.     Progesterone directs male sexual characteristics.

C.     Levels of progesterone increases if the egg is not fertilized.

D.    Levels of progesterone remain stable if the egg is not fertilized.

 

Anatomy

Which of the following is true of the biological functions of testosterone?

A.    Testosterone is not secreted by the ovaries.

B.     Testosterone is needed for development of female secondary sexual characteristics.

C.     Testosterone stimulates ovulation.

D.    Testosterone is needed for development of male secondary sexual characteristics.

 

Anatomy

Which of the following is true of the biological functions of estrone?

A.    Estrone is required for proper development of male secondary sexual characteristics.

B.     Level of estrogen degreases if the egg is not fertilized.

C.     Estrone is required for proper development of female secondary sexual

characteristics.

D.    Estrone affects only the reproductive organs.

 

Biology

What is the function of hemoglobin?

A.    Hemoglobin is the protein in red blood cells that is responsible for carrying oxygen to the cells of the body.

B.     Hemoglobin is a lipid in red blood cells that is responsible for carrying oxygen to the cells of the body.

C.     Hemoglobin is a protein in white blood cells that is responsible for carrying oxygen to the cells of the body.

D.    Hemoglobin is a protein in red blood cells that is not responsible for carrying carbon dioxide to the cells of the body.

 

NRS-410V Biology

Why is heat an effective means of sterilization?

 

A.    Heat is an effective means of sterilization because it destroys the proteins of microbial life forms, including fungi, bacteria, and viruses.

B.     Heat is an effective means of sterilization because it destroys the proteins of anaerobic microbial life forms, including fungi, bacteria, and viruses.

C.     Heat is an effective means of sterilization because it destroys the lipids of microbial life forms, including fungi, bacteria, and viruses.

D.    Both (B) and (C).

 

Chemistry
:

List the enzymes whose levels are elevated in the blood serum following an MI.

A.    CPK, LDH, AST, and SGOT

B.     LDH, AST, and SGOT

C.     CRE, AST, and ALT

D.    None of the above

 

Chemistry

What is the physiological function of gluconeogenesis?

A.    Gluconeogenesis is production of glucose from noncarbohydrate molecules in times when blood glucose levels are low. This ensures proper function of brain and red blood cells, which only use glucose as fuel.

B.     Gluconeogenesis is production of glucose from noncarbohydrate molecules in times when blood glucose levels are high. This ensures proper function of brain and white blood cells, which only use glucose as fuel.

C.     Gluconeogenesis is production of glucose from carbohydrate molecules in times when blood glucose levels are low. This ensures proper function of brain and red blood cells, which only use glucose as fuel.

D.    None of the above

 

Chemistry

What effect does glycogen metabolism have on glucose levels?

A.    Glycogen metabolism traps glucose within liver cells and increases storage of glucose in the form of glycogen. These processes decrease blood glucose levels.

B.     Glycogen metabolism traps glucose within liver cells and increases storage of glucose in the form of glycogen. These processes increase blood glucose levels.

C.     Glycogen metabolism releases glucose within liver cells and increases storage of glucose in the form of glycogen. These processes decrease blood glucose levels.

D.    None of the above

 

NRS-410V Chemistry

Carbon monoxide binds tightly to the heme groups of hemoglobin and myoglobin. How does this affinity reflect the toxicity of carbon monoxide?

A.    Since carbon monoxide binds the heme groups of hemoglobin, it is easily removed or replaced by oxygen. As a result, the effects of oxygen enhancement result in what divers call the “bends.”

B.     Because carbon monoxide binds the heme groups of hemoglobin, it is easily removed or replaced by oxygen. As a result, the effects of oxygen deprivation result in suffocation.

C.     Because carbon monoxide binds tightly to the heme groups of hemoglobin, it is not easily removed or replaced by oxygen. As a result, the effects of oxygen deprivation result in suffocation.

D.    None of the above

 

Pathophysiology

Which of the following may be a reason to order an ABG on a patient?

A.    The patient suddenly develops shortness of breath

B.     An asthmatic is starting to show signs of tiring

C.     A diabetic has developed Kussmaul’s respirations

D.    All of the above

 

Pharmacology

How do sulfa drugs selectively kill bacteria while causing no harm to humans?

A.    Folic acid is a vitamin required for the synthesis of a coenzyme needed to make the amino acid methionine and the purine and pyrimidine nitrogenious bases for DNA and RNA and folic acid is produced by humans.

B.     Sulfa drug binds to the enzyme, no product is formed, folic acid is made and the biosynthesis of methionine and nitrogenous bases increases.

C.     Humans are not harmed because they do not synthesize their own folic acid. It is obtained in the diet.

D.    None of the above

 

NRS-410V Pharmacology

What occurs when glycogen metabolism is stimulated by insulin?

A.    Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis.

B.     Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also stimulates removal of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase.

C.     Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also stimulates uptake of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase.

D.    All of the above

 

Pharmacology

What is the medical application of cortisone? Cortisone is used to treat:

A.    Rheumatoid arthritis, asthma, gastrointestinal disorders, and a variety of skin conditions.

B.     Kidney disease, high blood pressure, and osteoporosis.

C.     Muscle disorders, tuberculosis, and thyroid disorder.

D.    All of the above

 

Anatomy

Oxygen saturation is likely to be lowest when an asthmatic with a diagnosis of pneumonia is positioned:

A.    In a high Fowler position

B.     Lying on the left side

C.     Lying on the right side

D.    Lying supine with the head of the bed flat

Chemistry

Laboratory test results indicative of thrombocytopenia, in addition to a low platelet count, would be:

A.    Increased PT

B.     Prolonged bleeding time and poor clot retraction.

C.     Increased aPTT

D.    Decreased RBC count.

 

Pharmacology

The purposes of epinephrine injection include all of the following except:

A.    Stabilizing mast cell membranes.

B.     Relaxing bronchial smooth muscle.

C.     Supporting arterial blood pressure.

D.    Blocking histamine receptors.

 

NRS-410V Pharmacology

Therapeutic interventions focused on increasing the oxygen supplied to the heart and decreasing the heart’s demand for oxygen include:

A.    Antiplatelet drugs

B.     Anticoagulants

C.     Morphine sulphate

D.    Thrombolytic drugs

 

Pharmacology

An intervention that would contribute toward the healing of a peptic ulcer is:

A.    Steroid administration

B.     Blocking or neutralizing of acid secretion

C.     Surgical removal of the ulcer

D.    Intravenous nutritional support

 

Pharmacology

Aspirin and NSAIDs are causative factors for the development of peptic ulcer disease because they:

A.    Increase acid secretion

B.     Allow proliferation of H. pylori

C.     Damage the mucosal barrier

D.    Alter platelet aggregation

 

Pharmacology

Your patient is interested in trying medication to improve low mood/depression. All of the following medications might be appropriate except:

A.    Selective serotonin reuptake inhibitors

B.     Amitriptyline

C.     Serotonin and norepinephrine reuptake inhibitors

 

D.    Benzodiazepines

NRS-410V

Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment
.

Improving a Fall Prevention Program in a Clinical Environment

Falls are very important and preventing these falls are the most important goal and plan for every patient’s safety that encounters healthcare settings.  There are many ways in preventing falls such as new trainings, new bed alarm tones and even hourly rounding. Daily improving to bedside reporting is another suggestion this field of study. Failing to increase measures in implementing change can lead to death and or longer hospitalization stays.  Detecting problems early and adjusting to change will help with improvement of falls. Patients will build confidence and a trusting relationship that will help secure a solid foundation for the healthcare setting.

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Background

University of Louisville Hospital is a Level Trauma 1 Center in the state and nearby surrounding states.  Admissions records over 3,000 patients a year and half of them are from outside of the county. Decreasing patients falls is the most important.  In order to promote this proposition we need to set up teams that are willing to work together and communicate. University of Louisville hospital has had a total of 45 falls this year from January thru May.  According to research, falls have been around for over 50 plus years.  Incident reports are avoided when these happen the best thing is adverse events. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Healthcare facilities need to make sure they understand the interventions and not focus on the quantity of falls which is very important. Inpatient fall rates range from 1.7 to 25 falls per 1,000 patient days, depending on the care area, with geropsychiatric patients having the highest risk (NCBI, 2007).  Falls inpatient has increased in some facilities. The facility that I am employed at fall cases have decreased through interventions and hourly rounding.  Falls may never be fixed but we can all work together to decrease the chances and give the proper teachings.

 

Problem Statement

           
According to research falls have been around for over 50 plus years.  Incident reports are avoided when these happen the best thing is adverse events. Falls in hospital are associated with excess financial and opportunity costs (Oxford Academic, 2008).  The majority of falls in healthcare facilities are patients over 70 years of age and the youth between 18-39 years of age. Falls inpatient has increased in some facilities and this is why interventions are needed. Falls can be very costly towards everyone’s pockets and also their health.  Prolonged hospital and even injuries such as fractures and death can occur if proper precautions are not in place. Liabilities can also occur which can cost the hospital more funds than actually receiving to improve better care.   Consequently, various hospitals falls, prevention programs have been implemented in the last decades (BMC Health Services Research, 2006). Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Fall cases have decrease over time at the facility that I am employed at and this was all through hourly rounding and building a rapport with you patients.  We as a team can always help fix the issues at hand, falls may never be completely solved but they can be decreased through teamwork and dedication. Falls may never be fixed but we can all work together to decrease the chances and survival rates through proper teachings and statistical facts.

 
Change Proposal

           
In order to promote safety and prevent falls within all healthcare facilities the plan of care that promotes, reassurance, full assessment and communication. The purpose to change fall prevention strategies in our facility is to decrease falls and provide advance care through evidence based research. The proper education and research will introduce more expected outcomes. There will be some challenges and barriers that may interfere with this intervention.  There will be multiple ways that this research will be used in order to be successful.  Encouraging engagement and participation will affect the quality improvement process such as implementing small scale demonstrations which are less difficult to manage. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Small-scale demonstrations or small tests of change also allow you to refine the new processes, demonstrate their impact on practices and outcomes, and build increased support by stakeholders (AHRQ, 2017). It is important to understand that many changes will be made along the way and learning from these experiences will help with adding change to any obstacles that take place.

 

PICOT

PICOT is used to help people clarify answers for any problems they may encounter. This will be used in research and evidence based practices that can be used and implemented on a daily basis. The P in PICOT stands for the population or specific cohort that is included in the study.  The I in PICOT stand for the interventions that are used for in treatments during this study.  The C in PICOT stands for the comparison in the study of research. The O in PICOT stands for the objectives in the research study. The T stands for the time frame which is not always included in the Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment study.

The inpatient population such as the sick and elderly (P) for the study of prevention in falls in an inpatient setting. The intervention (I) for this study and intervention of falls is the revision of the post debriefing forms and training for bedside report along with hourly rounding. The comparison (C) in this study is to reduce the risk for falls such as hourly rounding and improved training for staff. The outcome (O) for this study is to reduce falls in an inpatient facility. The time frame (T) in this study would be decreasing of falls over a three to six month period.

 

Literature Search

           
Falls can be related to intrinsic and extrinsic factors. Intrinsic factors are disorders, mental problems anything that is preventable through health. Extrinsic factors are made up of environmental things such as spills, rugs, and cluttered areas. All falls are important and it’s even more important to understand the causes.  Morse falls scale is very important and our hospital uses this scale for every patient that is admitted to the hospital. Medical errors are another way falls can occur.  Nurses or even ancillary staff may forget to give a patient a call light and patient may have to use the restroom and attempt to get up and fall. Making sure that the patient has worked with physical therapy and communication has been documented and transcribed accurately. Identifying those at risk allows targeted assessment and intervention such as a review of medications and environmental modifications (BMC Medicine, 2004). Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Falls can be very costly towards everyone’s pockets and also their health.  Prolonged hospital and even injuries such as fractures and death can occur if proper precautions are not in place. Liabilities can also occur which can cost the hospital more funds than actually receiving to improve better care.   Consequently, various hospitals falls, prevention programs have been implemented in the last decades (BMC Health Services Research, 2006).  Coming up with reasoning to why a person fall is the leading answer to the problem.  Every patient is different and their reasons are going to be different as well so making sure that the proper assessment is given then falls should be prevented.

 

Literature Evaluation

Information that was collected from journals and articles to help promote fall preventions in an inpatient facility has been very beneficial. There are so many issues that can relate to falls such as bad lightening, shoes are not flat, irregular eye exams and even clothing that’s  not fitting appropriately can help with falls.  Understanding the causes of falls is very important and factual. The older population tends to have a higher risk for falls then that of the youth population. Falls also occur often among older people in hospital and the sickly ill patients. Our hospital uses the Morse Falls scale to assess every patient that is admitted into our doors which is part of a detail assessment of the patient.  Medical errors are another way falls can occur which is caused by either shortage of nurses, work overload or even lack of education.  Nurses or even ancillary staff may have times where they may not give the patient a call light and then the patient may attempt to get up and fall which can lead to death or even broken bones.  It’s also relevant that patients have worked with ancillary staff such as physical therapy and other therapies that play a role in activities of daily living. Communication is very important and vital information that has to be documented and transcribed accurately; if not, then many errors can occur. There are many suggestions such as bed alarming sounds changing and a new call light sound becoming more distinct giving that familiar sound to focus on the patient. Orienting the patient through assessments every 2-4 hours throughout shift depending on level of consciousness will help with fall preventions. Fall rates will decrease in our inpatient medical surgical and progressive care units. Focusing on post fall forms will help after the revision take place and orienting all staff new and old will help with the these goals of safety and reliability. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Coming up with reasoning to why a person fall is the leading answer to the problem.  Every patient is different and their reasons are going to be different as well so making sure that the proper assessment is given then falls should be prevented.

Patient engagement is another suggestion if it’s going to prevent falls in the future.  Introducing safety huddles have been suggested to reduce fall in hospitals which helps with communication and knowing each patient. Intentional rounding will help with patients that are at higher risk of falling. Falls inpatient has increased in some facilities. The facility that I am employed at fall cases have decreased through interventions and hourly rounding.  Falls may never be fixed but we can all work together to decrease the chances and give the proper teachings.  Falls seem to be one of the most major problems in older adults.  In the United States one in three people aged 65 or more living in the community fall at least once a year (BMJ, 2006).  Research and clinical programs in hospital fall prevention should pay more attention to study design and the nature of interventions (Wiley Online Library, 2015).  Research will be very beneficial to the hospital and the elderly population. Collecting all information on the patient will help with eliminating falls. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.
 

Nursing Theory

Nursing theories are very important when implementing evidence base practices.    There will be two change theories that will be factored in this healthcare setting. Model and role model theory has it’s concept from Piaget’s Theory of Cognitive Development. Erickson’s theory helps nurses care for their patients by recognizing each individual’s uniqueness, and focusing on the individual patient’s needs (Nursing Theory, 2016).
 
 It is also a self-care method of nursing, which means it is based on the patient’s perceptions of the environment, and adapts based on individual stressors for that patient (Nursing Theory, 2016). Understanding the patient in order to maintain safety measures will help reach goals and also allow the patient to feel secure.

           
Next theory that can help with the improvement of this research will be the novice to expert theory.  Patricia Benner developed a concept known as “From Novice to Expert.” This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences (Nursing Theory, 2016).  She was based off of clinical experience through learning the patient over time. This Theory had five levels novice, advance beginners, competent, proficient, and expert. Different levels of skills will show the changes that need to take place in the healthcare facilities (Nursing Theory, 2016).  Both theories are both beneficial in learning the patient’s cognitive skills and also building a confidence in each individual allowing them to heal and be safe. Changes are instilled in both theories and depending on the changes in the future. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

 
Implementation

           
Medicines have side effects understanding these effects and communicating with your doctor along with the nurse the feelings that you are experiencing will help prevent any cases of falls.  Nurse need to make sure that the call light is in reach and they give the proper teaching of what medicine they are giving their patient along with an understanding.  Routine rounding is very important in the hospital which can be shared amongst the nurse and nursing assistant.  Blood pressure medications are one of the most serious falls because of the dizziness that it can cause.  Making sure the patient has proper footwear can also prevent falls, non skid socks and even slippers will help. Making sure the patient has a bed alarm under the patients and patients are aware of the call light being in reach. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Collecting all information on the patient will help with eliminating falls.  We as nurses need to make sure that patients with the need for assistance devices need to be close to the nurse station and teachings on falls every hour when rounding. Patient that are on many prescriptions need to understand that side effects can really cause falls and that’s not good. Bring the entire team together and communicate will help with fall preventions. Making sure that a checklist is in place will help with less falls and more awareness. The Morse falls scale will help with understanding the risk of falls per patient.  Making sure you understand the goal and also include everyone in the plan with an open mind will help with the benefits of the research project. Educational presentations would be presented to the healthcare and ancillary staff. This would be to help staff get a clearer perspective and also more education on fall preventions. A revision of the post fall briefing form adding more detail information will be applied to help with teamwork.

 

Potential Barriers

           
Changes brought to the surface will be one of the most difficult challenges on the units at work. This will have a big impact on the implementation strategies.  Lacking structural guidelines and trainings can prevent falls from decreasing. Communication lacking between therapist and staff on each individualized patient can also prevent a change from occurring. Considering time is another barrier that can occur with falls and patient’s timing, how often they’re getting up and the time they’re falling. Physicians will not look at this situation as important as diagnosis which is another barrier that can prevent changes to occur. Interference of parents and visitors can also be a hindrance of growth within the plan of care of the patient. Some older people considered using assistive devices, such as walking frames, as a stigma, because they believe that using such aids is a sign of weakness and reflects a change in one’s self image (BMJ Open, 2015). One HCP perceived that older people normalized falls and consider them to be part of the normal ageing process. He felt that older people disregarded falls because they believed they were inevitable in old age (BMJ Open, 2015). Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Living situations outside of the facility is another barrier that can occur which the design of the house and the inadequate space for assistive devices.  Admitting weaknesses and balance issues is another difficult task to get through, patients tend to be in denial of any issues they may be having. We as nurses and healthcare staff need to make sure that we have the knowledge and skills in managing falls in order to deliver a safe environment.

 
 

References

O., D., P., A., G., L., . . . G. (2008, October 01). Systematic review and meta-analysis of studies

using the STRATIFY tool for prediction of falls in hospital patients: How well does it work? | Age and Ageing | Oxford Academic. Retrieved from
https://academic.oup.com/ageing/article/37/6/621/40889

Section 4: Ways to Approach the Quality Improvement Process. (2015, November 16). Retrieved from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Bühler, H., Geest, S. D., & Milisen, K. (2006, June 07). Falls and consequent injuries in

hospitalized patients: Effects of an interdisciplinary falls prevention program. Retrieved from
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-6-69

 

Papaioannou, A., Parkinson, W., Cook, R., Ferko, N., Coker, E., & Adachi, J. D. (2004, January

21). Prediction of falls using a risk assessment tool in the acute care setting. Retrieved from
https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-2-1

 

Oliver, D. (2007, January 11). Strategies to prevent falls and fractures in hospitals and care

homes and effect of cognitive impairment: Systematic review and meta-analyses. Retrieved from
https://www.bmj.com/content/334/7584/82

 

Oliver, D., Hopper, A., & Seed, P. (2015, April 27). Do Hospital Fall Prevention Programs

Work? A Systematic Review. Retrieved from
https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1532-5415.2000.tb03883.x

 

“Patricia Benner Novice to Expert – Nursing Theorist.” 
Biographies of Nursing Theorists and Their Work – Nursing Theory
, 2016, nursing-theory.org/nursing-theorists/Patricia-Benner.php.

 

“Helen Erickson – Nursing Theorist.” 
Environmental Theory – Nursing Theory
, 2016,
www.nursing-theory.org/nursing-theorists/Helen-C-Erickson.php
.

 

Loganathan, Annaletchumy, et al. “Barriers Faced by Healthcare Professionals When Managing Falls in Older People in Kuala Lumpur, Malaysia: a Qualitative Study.” 
BMJ Open
, British Medical Journal Publishing Group, 1 Nov. 2015, bmjopen.bmj.com/content/5/11/e008460. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Professional Capstone and Practicum

Details This is a writing-intensive course. The

professional capstone practicum project offers

students the opportunity to propose a resolution

to an issue or problem significant to nursing

practice within a clinical environment. Students

identify, design, and propose an evidence-based

solution within a health care organization with

guidance from faculty and a preceptor in the

field. The proposal must reflect synthesis and

integration of course content and professional

practice. Development of the capstone project

is guided by the baccalaureate program student

learning outcomes. Practice immersion hours: 100.

Prerequisites: NRS-430V, NRS-429VN, NRS-434VN,

NRS-427VN, NRS-433V, PHI-413V, NRS-451VN,

NRS-410V, and NRS-440VN.

Credit Hours 6.0

PreRequisites NRS-430V, NRS-429VN, NRS-434VN, NRS-427VN,

NRS-433V, PHI-413V, NRS-451VN, NRS-410V, and

NRS-440VN

coRequisites None

Course Add-Ons Additional Material

Other

Optional: Publication Manual of the American

Psychological Association

For additional information, the following is

recommended: Current version of the Publication

Manual of the American Psychological Association.

GCU has made APA templates and other resources

available within the Student Success Center as

well as in the GCU Library. However, be aware that

a more complete APA Manual can be purchased at

your own expense. To order the APA manual, please

visit the American Psychological Association.

http://apa.org

Other

The Practice Immersion Experience

Review the "The Practice Immersion

Experience" resource to familiarize yourself

with the requirements for course assignments

and programmatic course components required to

successfully complete this course and the RN-toBSN program of study.

Electronic Resource

Guidelines for Undergraduate Field Experiences

Review the Guidelines for Undergraduate Field

Experiences resource in the Student Success

Center. This material contains important

information for your clinical experience,

including evaluation guidelines, the Clinical Site

Visit Application, and the Clinical Hour Tracking

Sheet for BSN Students Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Electronic Resource

Nursing and Health Sciences Research Guides

View "Nursing and Health Sciences Research

Guides," located on the Grand Canyon

University website. This is a discipline-specific

research guide to assist you with your research.

In particular, seek out the "Evidence-Based

Practice (EBP)" tab in the LibGuide for

highly specific information pertinent to the

capstone project.

http://libguides.gcu.edu/Nursing

Electronic Resource

Evaluating Websites

View "Evaluating Websites," located on

the Grand Canyon University website. This tutorial

will explain how to evaluate websites for content

that you can trust.

http://tutorials.gcumedia.com/

evaluatingWebTutorial/interactiveIndex.html

Other

Practice Immersion Clinical Tools

The attached document contains all three

required Practice Immersion Clinical Tools. The

"Practice Immersion Clinical Evaluation

Tool – Student" will be completed by the

student’s Course Mentor and the faculty at the

course conclusion. The "Practice Immersion

Clinical Evaluation Tool – Mentor" will be

completed by the student and submitted to the

course faculty at the course conclusion. The

"Practice Immersion Clinical Evaluation Tool

– Agency" will be completed by students and

validated by faculty in regards to the clinical

site, and will also be submitted to course faculty

at the course conclusion.

Electronic Resource

Qualified Mentor/Preceptor Summary Form

Review the "Qualified Mentor/Preceptor

Summary Form" resource, located in the

Student Success Center. Use the "Qualified

Mentor/Preceptor Summary Form" as part of the

Topic 1 Course Mentor Identification and Approval

Process assignment requirements.

Other

Field Experience Site Information Form

Use the "Field Experience Site Information

Form" as part of the Topic 1 Course Mentor

Identification and Approval Process assignment

requirements.

Other

Practicum Hours Requirements for Washington

Registered Nurses

If you are a registered nurse in Washington, your

practicum experience must include a minimum of 50

hours in a community health setting.

Other

NRS-490 Course Objectives

During this course, the student will: Work

constructively with patients, communities,

organizational leadership, and other change

agents to improve practice within health care

settings. Apply Healthy People 2020 principles

in nursing practice. Synthesize nursing knowledge

and concepts into an evidence-based change

proposal for an issue or problem relevant to

nursing practice and population health outcomes.

Identify resources required to implement a

clinical change in nursing practice. Communicate

information and strategies to stakeholders in

order to implement and sustain an evidence-based

change proposal. Determine reliable methods to

measure the effectiveness of an evidence-based

change proposal project in achieving the intended

outcomes.

Topics

Topic 1: Change Proposal Subject

and Purpose Identification 1

Duration: 7 days

Description:

The first step in developing an evidence-based practice change

proposal is to identify an issue or problem to address. In this topic,

students will learn what resources are required and what skills they

will need to employ in order to create and deliver a robust capstone

practicum proposal.

Objectives:

1. Identify problems, issues, and opportunities to improve patient

care, patient outcomes, and organizational procedures within a

clinical practice setting.

2. Examine a health care clinical problem or an organization issue and

its implications to nursing practice.

3. Determine evidence-based solutions that address patient-care or

clinical practice quality problems or issues.

4. Analyze health care clinical problems and organizational issues

utilizing the PICO(T) process

5. Demonstrate values consistent with the role of a nursing

professional through fundamental knowledge and advanced skills.

Topic Material:

Other

6. Individual Success Plan

Review this resource to familiarize yourself with the requirements for

the Individual Success Plan (ISP) assignment in this topic.

Website

7. Optional: GCU Library Webinar Sign Up

For additional information, the following is recommended: Review

the webinar information offered by the GCU Library. From the

"Webinars & Workshops: Webinar Calendar" page, select

the "Category" tab and scroll down to the Nursing and Health

Sciences selection. Webinar participation is optional.

Electronic Resource

8. Guidelines for Undergraduate Field Experiences

Review the Guidelines for Undergraduate Field Experiences resource

in the Student Success Center. This material contains important

information for your clinical experience, including evaluation

guidelines, the Clinical Site Visit Application, and the Clinical Hour

Tracking Sheet for BSN Students.

Electronic Resource

9. Qualified Mentor/Preceptor Summary Form

Review the "Qualified Mentor/Preceptor Summary Form"

resource, located in the Student Success Center. Use the

"Qualified Mentor/Preceptor Summary Form" as part of the

Topic 1 Course Mentor Identification and Approval Process assignment

requirements.

Other

10. Field Experience Site Information Form

Use the "Field Experience Site Information Form" as part

of the Topic 1 Professional Capstone and Practicum Documentation

assignment requirements.

Other

11. Practicum Hours Requirements for Washington Registered Nurses

If you are a registered nurse in Washington, your practicum experience

must include a minimum of 50 hours in a community health setting.

Other

12. Scholarly Activity Summary

You may use the "Scholarly Activity Summary" resource to

help guide the preparation of the Scholarly Activities assignment, due

in Topic 10.

Electronic Resource

13. Adopting Evidence-Based Practice in Clinical Decision making: Nurses’ Perceptions, Knowledge, and Barriers

Read “Adopting Evidence-Based Practice in Clinical Decision making:

Nurses’ Perceptions, Knowledge, and Barriers,” by Majid, Schubert,

Luyt, Zhang, Theng, Chang, and Mokhtar, from the Journal of the Medial

Library Association (2011).

Electronic Resource

14. Nurses, Information Use, and Clinical Decision Making – the Real World Potential for Evidence-Based Decisions in

Nursing

Read “Nurses, Information Use, and Clinical Decision Making – the Real

World Potential for Evidence-Based Decisions in Nursing,” by Thompson,

Cullum, McCaughan, Sheldon, and Raynor, from the BMJ website (2004).

Electronic Resource

15. Evidence-Based Practice or Practice-Based Evidence: What’s in a Name?

Read "Evidence-Based Practice or Practice-Based Evidence: What’s

in a Name?" by McKeon and McKeon, from International Journal of

Athletic Therapy & Training (2015).

Electronic Resource

16. Nurses, Information Use, and Clinical Decision Making – the Real World Potential for Evidence-Based Decisions in

Nursing

Read "Nurses, Information Use, and Clinical Decision Making – the

Real World Potential for Evidence-Based Decisions in Nursing,"

by Thompson, Cullum, McCaughan, Sheldon, and Raynor, from the BMJ

Journals website (2004).

Gradable Items Details Points Possible

Assignment Professional Capstone and Practicum

Documentation

The Professional Capstone and Practicum

course requires students to

select a course mentor. This mentor is

not a preceptor, but an

individual who will guide students as

they work to complete the

practice immersion hour requirements

for this course. Students are not

required to "shadow" their

mentor.

The course mentor should be someone who

can provide professional

development knowledge and guidance and

who possesses a genuine

interest in working with students to

further their academic goals.

Selection, approval, and retention of a

course mentor must be

completed as soon as possible at the

start of this course, as this

individual will be working with the

student on each assignment that

10.0

Gradable Items Details Points Possible

incorporates practice immersion hours.

Working with a course mentor is

mandatory.

Once a course mentor has agreed to

serve in the role, you must

complete and submit the following

required documentation so that

practice experiences can begin in a

timely manner:

Field Experience Site Information Form

Qualified

Mentor/Preceptor Summary Form Mentor’s

license,

certification, and resume/curriculum

vitae

The student is responsible for

obtaining all signatures for the

paperwork submission. Course faculty

will approve all sites and

mentors according to student learning

needs and specific course objectives.

Do not initiate new work on practiceimmersion-hour-based course

assignments until your course

instructor has approved your course

mentor.

Once a course mentor is approved,

students should contact the mentor

within 1 week of receiving the approval

notification. Students are

encouraged to make an appointment to

meet with their mentor in person

and arrange to review the NRS-490

course objectives and the Individual

Success Plan (ISP).

For more specific information on the

course mentor process and roles

and responsibilities, refer to Section

Three of the Guidelines for

Undergraduate Field Experiences

resource.

Assignment Individual Success Plan (ISP)

Planning is the key to successful

completion of this course and your

overall program of study. The

Individual Success Plan (ISP)

assignment

requires early collaboration with the

course faculty and your course

mentor. You will need to establish a

plan for successful completion of

25.0

Gradable Items Details Points Possible

(1) deliverables associated with weekly

course objectives, (2),

required practice immersion hours, and

(3) deliverables associated

with your capstone project.

Access the "Individual Success

Plan" resource in the Topic

Materials. Read the information in the

resource, including student

expectations and instructions for

completing the ISP document.

Use the "Individual Success

Plan" to develop a personal

plan for completing your practice hours

and how topic objectives will

be met. Include the number of hours you

plan to set aside to meet your goals.

A combination of 100 supervised

clinical hours in community health

and leadership areas will be obtained

through the application of the

objectives listed in the Guidelines for

Undergraduate Field

Experiences manual.

Practicum immersion experiences are

required in a community health

setting. Community-based settings

should encourage community

integration and involvement; expand

accessibility of services and

supports; promote personal preference,

strengths, dignity; and empower

people to participate in the economic

mainstream.

According to HealthyPeople.gov,

educational and community-based

programs and strategies are designed to

reach people outside of

traditional health care settings. These

settings may include schools,

worksites, health care facilities, and

communities. Community health

and leadership practice immersion can

occur in the same site and in

conjunction with the evidence-based

project in the NRS-490 course.

If you are a registered nurse in

Washington, your practicum

experience must include a minimum of 50

hours in a community health setting.

Gradable Items Details Points Possible

Students should apply concepts from

prior courses to critically

examine and improve their current

practice. Students should also

integrate scholarly readings to develop

case reports that demonstrate

increasingly complex and proficient

practice.

Consider the challenges you expect to

encounter as you continue the

practice hour and competency

requirements throughout this course.

How

might you overcome these challenges?

You can renegotiate these deliverables

with your faculty and mentor

throughout this course and update your

ISP accordingly.

Once your ISP has been developed and

accepted by your course

faculty, you will have your course

mentor sign it at the beginning of,

and upon completion of, each assignment

that incorporates practice

immersion hours. You will track all

course practice immersion hours in

the ISP.

APA format is not required, but solid

academic writing is expected.

You are not required to submit this

assignment to Turnitin.

Assignment Professional Capstone and Practicum

Reflective Journal and Scholarly

Activities

Throughout the course, students will

engage in weekly reflection and

scholarly activities. These assignments

are presented in Topic 1 to

allow students to plan ahead, and

incorporate the deliverables into

the Individual Success Plan if they so

choose.

The weekly reflective journals and

scholarly activities will not be

submitted in LoudCloud each week; a

final, culminating submission will

be due in Topic 10. No submission is

required until Topic 10.

Professional Capstone and Practicum

Reflective Journal

0.0

Gradable Items Details Points Possible

Students are required to maintain

weekly reflective narratives

throughout the course to combine into a

final, course-long reflective

journal that integrates leadership and

inquiry into current practice

as it applies to the Professional

Capstone and Practicum course. This

course-long journal assignment will be

due in Topic 10.

In each week’s entry, you should

reflect on the personal knowledge

and skills gained throughout the

Professional Capstone and Practicum

course. Your entry should address a

variable combination of the

following, dependent on the specific

practice immersion clinical

experiences you encountered that week:

New practice approaches

Intraprofessional

collaboration Health care delivery and

clinical systems

Ethical considerations in health care

Population health

concerns The role of technology in

improving health care

outcomes Health policy Leadership and

economic

models Health disparities

In the Topic 10 submission, each of the

areas should be addressed in

one or more of the weekly entries.

This reflection journal also allows

students to outline what they

have discovered about their

professional practice, personal

strengths

and weaknesses that surfaced,

additional resources and abilities that

could be introduced to a given

situation to influence optimal

outcomes, and finally, how they met

competencies and course objectives.

Scholarly Activities

Throughout the RN-to-BSN program,

students are required to

participate in scholarly activities

outside of clinical practice or

Gradable Items Details Points Possible

professional practice. Examples of

scholarly activities include

attending conferences, seminars,

journal club, grand rounds, morbidity

and mortality meetings,

interdisciplinary committees, quality

improvement committees, and any other

opportunities available at your

site, within your community, or

nationally.

You are required to post one scholarly

activity while you are in the

BSN program, which should be documented

by the end of this course. In

addition to this submission, you are

required to be involved and

contribute to interdisciplinary

initiatives on a regular basis.

In Topic 10, you will submit a summary

report of your scholarly

activity. You may use the

"Scholarly Activity Summary"

resource to help guide this assignment.

Discussion

Question

Topic 1 DQ 1

Identify two GCU Library scholarly

databases that will help you find

the best research articles to support

your EBP proposal. Discuss why

these two databases are better than

Google Scholar or a general

Internet search.

5.0

Discussion

Question

Topic 1 DQ 2

The Institute of Medicine has stated a

goal that 90% of practice be

evidence-based by 2020. According to

HealthyPeople.gov, the United

States is currently at approximately

15%. Discuss two barriers that

might hold nursing practice from

achieving this goal, and suggest ways

in which identified barriers may be

addressed.

5.0

Participation 15.0

Topic 2: Change Proposal Subject

and Purpose Identification 2

Duration: 7 days

Description:

The first step in developing an evidence-based practice change

proposal is to identify an issue or problem to address. In this topic,

students will learn what resources are required and what skills they

will need to employ in order to create and deliver a robust Capstone

practicum proposal.

Objectives:

1. Identify problems, issues, and opportunities to improve patient

care, patient outcomes, and organizational procedures within a

clinical practice setting.

2. Examine a health care clinical problem or an organization issue and

its implications to nursing practice.

3. Determine evidence-based solutions that address patient-care or

clinical practice quality problems or issues.

4. Analyze health care clinical problems and organizational issues

utilizing the PICO(T) process

5. Demonstrate values consistent with the role of a nursing

professional through fundamental knowledge and advanced skills.

Topic Material:

Other

6. Capstone Project: Developing a Question

Review "Capstone Project: Developing a Question" to assist

you in developing a Capstone Project appropriate to the course and the

RN-to-BSN overall program of study.

Other

7. Project Topic Checklist

Access the “Project Topic Checklist” resource to complete an

assignment in this topic.

Website

8. Optional: GCU Library Webinar Sign Up

For additional information, the following is recommended: Review

the webinar information offered by the GCU Library. From the

"Webinars & Workshops: Webinar Calendar" page, select

the "Category" tab and scroll down to the Nursing and Health

Sciences selection. Webinar participation is optional.

Electronic Resource

9. Adopting Evidence-Based Practice in Clinical Decision making: Nurses’ Perceptions, Knowledge, and Barriers

Read “Adopting Evidence-Based Practice in Clinical Decision making:

Nurses’ Perceptions, Knowledge, and Barriers,” by Majid, Schubert,

Luyt, Zhang, Theng, Chang, and Mokhtar, from the Journal of the Medial

Library Association (2011).

Electronic Resource

10. Nurses, Information Use, and Clinical Decision Making – the Real World Potential for Evidence-Based Decisions in

Nursing

Read “Nurses, Information Use, and Clinical Decision Making – the Real

World Potential for Evidence-Based Decisions in Nursing,” by Thompson,

Cullum, McCaughan, Sheldon, and Raynor, from the BMJ website (2004).

Gradable Items Details Points Possible

Assignment Capstone Project Topic Selection and

Approval

In collaboration with your approved

course mentor, you will identify

a specific evidence-based practice

proposal topic for the capstone

project. Consider the clinical

environment in which you are currently

working or have recently worked. The

capstone project topic can be a

clinical practice problem, an

organizational issue, a quality

improvement suggestion, a leadership

initiative, or an educational

need appropriate to your area of

interest as well as your practice

immersion (practicum) setting. Examples

of the integration of

community health, leadership, and an

EBP can be found on the

"Educational and Community-Based

Programs" page of the Healthy

People 2020 website.

Write a 500-750 word description of

your proposed capstone project

topic. Make sure to include the

following:

The problem, issue, suggestion,

initiative, or educational

need that will be the focus of the

project The setting or

context in which the problem, issue,

suggestion, initiative, or

educational need can be observed. A

description providing a

high level of detail regarding the

problem, issue, suggestion,

initiative, or educational need. Impact

of the problem,

issue, suggestion, initiative, or

educational need on the work

environment, the quality of care

provided by staff, and patient

outcomes. Significance of the problem,

issue, suggestion,

initiative, or educational need and its

implications to

nursing. A proposed solution to the

identified project

topic

50.0

Gradable Items Details Points Possible

You are required to retrieve and assess

a minimum of 8 peer-reviewed

articles. Plan your time accordingly to

complete this assignment.

Prepare this assignment according to

the guidelines found in the APA

Style Guide, located in the Student

Success Center. An abstract is not

required.

You are required to submit this

assignment to Turnitin. Please refer

to the directions in the Student

Success Center.

Assignment Topic 2 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 2 DQ 1

During your practicum, determine what

clinical problem or issue the

organization is facing. Discuss two

implications for nursing.

5.0

Discussion

Question

Topic 2 DQ 2

What is the main issue for your

organization in addressing a solution

to evidence-based nursing practice?

Discuss what might be the first

step in addressing and resolving this

issue.

5.0

Participation 15.0

Topic 3: Evidence-Based Practice

Proposal Development Plan 1

Duration: 7 days

Description:

The next step in developing an evidence-based practice proposal is to

search the literature for support and evaluate the level of evidence.

In this topic, students will learn what resources are required and

what skills they will need to employ in order to create and deliver a

Capstone Project proposal with a high level of evidence.

Objectives:

1. Evaluate evidence-based research and other appropriate resources to

inform the development of a change plan.

2. Identify strategies for logistical implementation of proposed

solutions.

3. Demonstrate the ability to evaluate levels of evidence into a

concise format.

4. Integrate evidence, clinical judgment, interprofessional

perspectives, and patient preferences in planning, implementing,

and evaluating outcomes of care.

Topic Material:

Electronic Resource

3. Science of Improvement: Steps in the PDSA Cycle

Read “Science of Improvement: Steps in the PDSA Cycle,” located on the

Institute for Healthcare Improvement website.

Website

8. Change Theory

Explore this website: Change Theory.

Website

9. Nursing Theory

Explore this website: Nursing Theory. This website provides

information on leading nursing theories.

Website

10. Nursing Theories

Explore this website: Nursing Theories. This website provides

information on leading nursing theories.

Electronic Resource

11. Asking Focused Questions

Read “Asking Focused Questions” on the Centre for Evidence-Based

Medicine website.

Electronic Resource

13. Formulating a Researchable Question: A Critical Step for Facilitating Good Clinical Research

Read “Formulating a Researchable Question: A Critical Step for

Facilitating Good Clinical Research,” by Aslam and Emmanuel, from the

National Center for Biotechnology Information website (2010).

Electronic Resource

14. Research Questions, Hypotheses and Objectives

Read “Research Questions, Hypotheses and Objectives, by Farrugia,

Petrisor, Farrokhyar, and Bhandari, from the National Center for

Biotechnology Information website (2010).

Gradable Items Details Points Possible

Assignment PICOT Statement Paper

Review the Topic Materials and the work

completed in NRS-433V to

formulate a PICOT statement for your

capstone project.

A PICOT starts with a designated

patient population in a particular

clinical area and identifies clinical

problems or issues that arise

from clinical care. The intervention

should be an independent,

specified nursing change intervention.

The intervention cannot require

a provider prescription. Include a

comparison to a patient population

not currently receiving the

intervention, and specify the timeframe

needed to implement the change process.

Formulate a PICOT statement using the

PICOT format provided in the

assigned readings. The PICOT statement

will provide a framework for

your capstone project.

In a paper of 500-750 words, clearly

identify the clinical problem

and how it can result in a positive

patient outcome.

Make sure to address the following on

the PICOT statement:

Evidence-Based Solution Nursing

Intervention

Patient Care Health Care Agency Nursing

Practice

Prepare this assignment according to

the guidelines found in the APA

Style Guide, located in the Student

Success Center. An abstract is not

required.

This assignment uses a rubric. Please

review the rubric prior to

beginning the assignment to become

familiar with the expectations for

successful completion.

You are required to submit this

assignment to Turnitin. Please refer

to the directions in the Student

Success Center.

75.0

Gradable Items Details Points Possible

Assignment Topic 3 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 3 DQ 2

Name two different methods for

evaluating evidence. Compare and

contrast these two methods.

5.0

Discussion

Question

Topic 3 DQ 1

Submit a summary of six of your

articles on the discussion board.

Discuss one strength and one weakness

to each of these six articles on

why the article may or may not provide

sufficient evidence for your

practice change.

5.0

Participation 15.0

Topic 4: Evidence-Based Practice

Proposal Development Plan 2

Duration: 7 days

Description:

The next step in developing an evidence-based practice proposal is to

search the literature for support and evaluate the level of evidence.

In this topic, students will learn what resources are required and

what skills they will need to employ in order to create and deliver a

Capstone Project proposal with a high level of evidence.

Objectives:

1. Evaluate evidence-based research and other appropriate resources to

inform the development of a change plan.

2. Identify strategies for logistical implementation of proposed

solutions.

3. Demonstrate the ability to evaluate levels of evidence into a

concise format.

4. Integrate evidence, clinical judgment, interprofessional

perspectives, and patient preferences in planning, implementing,

and evaluating outcomes of care.

Topic Material:

Electronic Resource

3. Science of Improvement: Steps in the PDSA Cycle

Review “Science of Improvement: Steps in the PDSA Cycle,” located on

the Institute for Healthcare Improvement website.

Website

8. Change Theory

Explore this website: Change Theory.

Website

9. Nursing Theory

Explore this website: Nursing Theory. This website provides

information on leading nursing theories.

Website

10. Nursing Theories

Explore this website: Nursing Theories. This website provides

information on leading nursing theories.

Electronic Resource

11. Asking Focused Questions

Review “Asking Focused Questions” on the Centre for Evidence-Based

Medicine website.

Other

12. Literature Evaluation Table

Review the "Literature Evaluation Table" resourced to assist

you in completing the Literature Evaluation Table assignment.

Electronic Resource

14. Formulating a Researchable Question: A Critical Step for Facilitating Good Clinical Research

Read “Formulating a Researchable Question: A Critical Step for

Facilitating Good Clinical Research,” by Aslam and Emmanuel, from the

National Center for Biotechnology Information website (2010).

Electronic Resource

15. Research Questions, Hypotheses and Objectives

Read “Research Questions, Hypotheses and Objectives, by Farrugia,

Petrisor, Farrokhyar, and Bhandari, from the National Center for

Biotechnology Information website (2010).

Gradable Items Details Points Possible

Assignment Literature Evaluation Table

In nursing practice, accurate

identification and application of

75.0

Gradable Items Details Points Possible

research is essential to achieving

successful outcomes. Being able to

articulate the information and

successfully summarize relevant

peer-reviewed articles in a scholarly

fashion helps to support the

student’s ability and confidence to

further develop and synthesize the

progressively more complex assignments

that constitute the components

of the course change proposal capstone

project.

For this assignment, the student will

provide a synopsis of eight

peer-reviewed articles from nursing

journals using an evaluation table

that determines the level and strength

of evidence for each of the

eight articles. The articles should be

current within the last 5 years

and closely relate to the PICOT

statement developed earlier in this

course. The articles may include

quantitative research, descriptive

analyses, longitudinal studies, or

meta-analysis articles. A

systematic review may be used to

provide background information for

the purpose or problem identified in

the proposed capstone project.

Use the "Literature Evaluation

Table" resource to complete

this assignment.

While APA style is not required for the

body of this assignment,

solid academic writing is expected, and

in-text citations and

references should be presented using

APA documentation guidelines,

which can be found in the APA Style

Guide, located in the Student

Success Center.

This assignment uses a rubric. Please

review the rubric prior to

beginning the assignment to become

familiar with the expectations for

successful completion.

You are not required to submit this

assignment to Turnitin.

Assignment Topic 4 Practice Hours Completion

Statement NRS-490

0.0

Gradable Items Details Points Possible

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

Discussion

Question

Topic 4 DQ 2

Compare and contrast two change

theories, and determine which theory

makes the most sense for implementing

your specific EBP project. Why?

Has your mentor used either theory, and

to what result?

5.0

Discussion

Question

Topic 4 DQ 1

Why is understanding the health care

system at the local level

important to consider when planning an

EBP implementation? Conduct

research and solicit anecdotal evidence

from your course mentor that

you will take into consideration for

your own change project.

5.0

Participation 15.0

Topic 5: Evidence-Based Practice

Proposal Project Development and

Implementation Plan 1

Duration: 7 days

Description:

Students need to be able to process and formulate an evidence-based

and financially feasible solution to a clinical problem or issue.

Working through the element of plan development requires them to

assess and address the challenges, barriers, and other facets of

change proposal implementation in the real world. The content in

this topic will enable students to better understand the cultural

environment(s) surrounding a change project and lead them through

the steps of how to go about successful implementation of a strategic

plan. A change or nursing theory must be used to support rational for

proposed implementation plan.

Objectives:

1. Identify objectives, strategy, and measurable outcomes of the

evidence-based practice proposal.

2. List steps needed to implement each strategy in a change proposal.

3. Outline the resources needed to develop and implement a change

proposal.

4. Describe methods for obtaining necessary support from key

stakeholders.

5. Develop a plan to evaluate the effectiveness of the change proposal

project.

6. Evaluate the role of information sources and technologies impacting

the delivery of care within an adequate environment of care.

7. Develop appropriate change plans that promote health and prevent

disease.

Topic Material:

Gradable Items Details Points Possible

Assignment Topic 5 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 5 DQ 1

Stakeholder support is necessary for a

successful change proposal

project implementation. Consider your

internal stakeholders, such as

the facility, unit or health care

setting where the change process is

situated, and your external

stakeholders, like an individual or

group

5.0

Gradable Items Details Points Possible

outside the health care setting. Why is

their support necessary to the

success of your project, and how you

will go about securing that support?

Discussion

Question

Topic 5 DQ 2

Technology is integral to successful

implementation in many projects,

through either support or integration

or both. Name at least one

technology that could improve the

implementation process and the

outcomes of your EBP project. Do you

plan to use this technology? If

not, what are the barriers that prevent

its use?

5.0

Participation 15.0

Topic 6: Evidence-Based Practice

Proposal Project Development and

Implementation Plan 2

Duration: 7 days

Description:

Students need to be able to process and formulate an evidence-based

and financially feasible solution to a clinical problem or issue.

Working through the element of plan development requires them to

assess and address the challenges, barriers, and other facets of

change proposal implementation in the real world. The content in

this topic will enable students to better understand the cultural

environment(s) surrounding a change project and lead them through

the steps of how to go about successful implementation of a strategic

plan. A change or nursing theory must be used to support rational for

proposed implementation plan.

Objectives:

1. Identify objectives, strategy, and measurable outcomes of the

evidence-based practice proposal.

2. List steps needed to implement each strategy in a change proposal.

3. Outline the resources needed to develop and implement a change

proposal.

4. Describe methods for obtaining necessary support from key

stakeholders.

5. Develop a plan to evaluate the effectiveness of the change proposal

project.

6. Evaluate the role of information sources and technologies impacting

the delivery of care within an adequate environment of care.

7. Develop appropriate change plans that promote health and prevent

disease.

Topic Material:

Gradable Items Details Points Possible

Assignment Literature Review

While the implementation plan prepares

students to apply their

research to the problem or issue they

have identified for their

capstone change proposal project, the

literature review enables

students to map out and move into the

active planning and development

stages of the project.

A literature review analyzes how

current research supports the

PICOT, as well as identifies what is

known and what is not known in

the evidence. Students will use the

information from the earlier PICOT

Statement Paper and Literature

Evaluation Table assignments to develop

a 750-1,000 word review that includes

the following sections:

Title page Introduction section A

comparison

of research questions A comparison of

sample

populations A comparison of the

limitations of the study

A conclusion section, incorporating

recommendations for further

research

Prepare this assignment according to

the guidelines found in the APA

Style Guide, located in the Student

Success Center. An abstract is not

required.

This assignment uses a rubric. Please

review the rubric prior to

beginning the assignment to become

familiar with the expectations for

successful completion.

You are required to submit this

assignment to Turnitin. Please refer

to the directions in the Student

Success Center.

100.0

Assignment Topic 6 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

0.0

Gradable Items Details Points Possible

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

Discussion

Question

Topic 6 DQ 1

After discussion with your mentor, name

one financial aspect, one

quality aspect, and one clinical aspect

that need to be taken into

account for developing the evidencebased practice project. Explain

how your proposal will directly and

indirectly impact each of the aspects.

5.0

Discussion

Question

Topic 6 DQ 2

Now that you have completed a series of

assignments that have led you

into the active project planning and

development stage for your

project, briefly describe your proposed

solution to address the

problem, issue, suggestion, initiative,

or educational need and how it

has changed since you first envisioned

it. What led to your current

perspective and direction?

5.0

Participation 15.0

Topic 7: Change Proposal Project

Evaluation and Dissemination Plan 1

Duration: 7 days

Description:

Students need to learn how to evaluate the outcomes. Did they prove

what they set out to prove and learn how to develop data to support

it? Was there significance in the change as compared to the status

prior to implementation? The content in this topic requires them

to formulate information and to communicate it in an understandable

and professional manner; adding synthesis of new knowledge to the

profession

Objectives:

1. Identify methods to evaluate a proposed solution.

2. Describe variables and outcomes to be assessed pre- and postproject implementation.

3. Utilize appropriate tools such as basic statistics to evaluate

project outcomes.

4. Summarize plans for disseminating evidence.

5. Use communication and collaboration skills to deliver high-quality,

evidence-based, patient-centered care.

Topic Material:

Gradable Items Details Points Possible

Assignment Topic 7 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 7 DQ 1

Describe one internal and one external

method for the dissemination

of your EBP project results. For

example, an internal method may be

the hospital board, and an external

method may be a professional

nursing organization. Discuss why it is

important to report your

results to both of these groups. How

will your communication

strategies change for each group?

5.0

Discussion

Question

Topic 7 DQ 2

In order to evaluate an evidence-based

practice project, it is

important to be able to determine the

effectiveness of your change.

Discuss one way you will be able to

evaluate whether your project made

5.0

Gradable Items Details Points Possible

a difference in practice.

Participation 15.0

Topic 8: Change Proposal Project

Evaluation and Dissemination Plan 2

Duration: 7 days

Description:

Students need to learn how to evaluate the outcomes. Did they prove

what they set out to prove and learn how to develop data to support

it? Was there significance in the change as compared to the status

prior to implementation? The content in this topic requires them

to formulate information and to communicate it in an understandable

and professional manner; adding synthesis of new knowledge to the

profession

Objectives:

1. Identify methods to evaluate a proposed solution.

2. Describe variables and outcomes to be assessed pre- and postproject implementation.

3. Utilize appropriate tools such as basic statistics to evaluate

project outcomes.

4. Summarize plans for disseminating evidence.

5. Use communication and collaboration skills to deliver high-quality,

evidence-based, patient-centered care.

Topic Material:

Gradable Items Details Points Possible

Assignment Topic 8 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Gradable Items Details Points Possible

Discussion

Question

Topic 8 DQ 2

Not all EBP projects result in

statistically significant results.

Define clinical significance, and

explain the difference between

clinical and statistical significance.

How can you use clinical

significance to support positive

outcomes in your project?

5.0

Discussion

Question

Topic 8 DQ 1

Based on how you will evaluate your EBP

project, which independent

and dependent variables do you need to

collect? Why?

5.0

Participation 15.0

Topic 9: Evidence-Based Practice

Proposal Project 1

Duration: 7 days

Description:

Content in this topic will enable students to pull together the

assignment and discussion/reflective components they have been working

on throughout the course and result in the production of the evidencebased practice proposal Capstone Project utilizing a professional

format and product through a presentation.

Objectives:

1. Produce a comprehensive and professional change initiative

presentation.

2. Integrate acquired knowledge and skills into professional practice.

3. Examine the implementation of evidence-based research in nursing

practice.

4. Analyze research findings for the enhancement of evidence-based

practice in the clinical setting.

5. Apply leadership concepts, skills, and decision making in

the provision of high-quality nursing care in a collaborative

interprofessional setting.

6. Analyze the impact of organizational and environmental factors on

health care delivery and practice.

7. Demonstrate leadership and communication skills to effectively

implement change initiatives for nursing practice.

Topic Material:

Website

2. The Cochrane Collaboration Website

Explore The Cochrane Collaboration website. In particular, familiarize

yourself with information for “Practitioners, Providers and

Policymakers,” which offers numerous resources on evidence-based care.

Electronic Resource

5. Presenters’ Corner

View "Presenters’ Corner" on the Western Institute of

Nursing website.

Other

6. Practice Immersion Clinical Tools

The attached document contains all three required Practice Immersion

Clinical Tools. The “Practice Immersion Clinical Evaluation Tool

– Student” will be completed by the student’s Course Mentor and

the faculty at the course conclusion. The “Practice Immersion

Clinical Evaluation Tool – Mentor” will be completed by the student

and submitted to the course faculty at the course conclusion. The

“Practice Immersion Clinical Evaluation Tool – Agency” will be

completed by both faculty and student in regards to the clinical site,

and will also be submitted to course faculty at the course conclusion.

Gradable Items Details Points Possible

Assignment Benchmark – Capstone Project Change

Proposal

In this assignment, students will pull

together the change proposal

project components they have been

working on throughout the course to

create a proposal inclusive of sections

for each content focus area in

the course. At the conclusion of this

project, the student will be

able to apply evidence-based research

steps and processes required as

the foundation to address a clinically

oriented problem or issue in

future practice.

Students will develop a 1,250-1,500

word paper that includes the

following information as it applies to

the problem, issue, suggestion,

initiative, or educational need

profiled in the capstone change

proposal:

Background Problem statement Purpose of

the

change proposal PICOT Literature search

strategy

employed Evaluation of the literature

Applicable

change or nursing theory utilized

Proposed implementation

plan with outcome measures

Identification of potential

barriers to plan implementation, and a

discussion of how these could

be overcome Appendix section, if

tables, graphs, surveys,

300.0

Gradable Items Details Points Possible

educational materials, etc. are created

Review the feedback from your

instructor on the Topic 3 assignment,

PICOT Statement Paper, and Topic 6

assignment, Literature Review. Use

the feedback to make appropriate

revisions to the portfolio components

before submitting.

Prepare this assignment according to

the guidelines found in the APA

Style Guide, located in the Student

Success Center. An abstract is not

required.

This assignment uses a rubric. Please

review the rubric prior to

beginning the assignment to become

familiar with the expectations for

successful completion.

You are required to submit this

assignment to Turnitin. Please refer

to the directions in the Student

Success Center.

Assignment Topic 9 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 9 DQ 2

Sustaining change can be difficult, as

there are many variables that

can affect implementation. One critical

component of EBP is to ensure

that practice change is part of an

organization’s culture so it will

5.0

Gradable Items Details Points Possible

continue to impact outcomes over time.

Name two potential barriers

that may prevent your EBP change

proposal from continuing to obtain

the same desired results 6 months to a

year from now, and your

strategies for overcoming these

barriers.

Discussion

Question

Topic 9 DQ 1

Discuss one personal strength and one

weakness you have regarding

professional presentations. Name one

method for improvement for each

of these, and discuss why it is

important for you to work on these

skills if you want to present your

findings in a more formal setting.

5.0

Participation 15.0

Topic 10: Evidence-Based Practice

Proposal Project 2

Duration: 7 days

Description:

Content in this topic will enable students to pull together the

assignment and discussion/reflective components they have been working

on throughout the course and result in the production of the evidencebased practice proposal Capstone Project utilizing a professional

format and product through a presentation.

Objectives:

1. Produce a comprehensive and professional change initiative

presentation.

2. Integrate acquired knowledge and skills into professional practice.

3. Examine the implementation of evidence-based research in nursing

practice.

4. Analyze research findings for the enhancement of evidence-based

practice in the clinical setting.

5. Apply leadership concepts, skills, and decision making in

the provision of high-quality nursing care in a collaborative

interprofessional setting.

6. Analyze the impact of organizational and environmental factors on

health care delivery and practice.

7. Demonstrate leadership and communication skills to effectively

implement change initiatives for nursing practice.

Topic Material:

Website

2. The Cochrane Collaboration Website

Explore The Cochrane Collaboration website. In particular, familiarize

yourself with information for “Practitioners, Providers and

Policymakers,” which offers numerous resources on evidence-based care.

Electronic Resource

5. Presenters’ Corner

View "Presenters’ Corner" on the Western Institute of

Nursing website.

Other

6. Practice Immersion Clinical Tools

The attached document contains all three required Practice Immersion

Clinical Tools. The "Practice Immersion Clinical Evaluation Tool

– Student" will be completed by the student’s Course Mentor and

the faculty at the course conclusion. The "Practice Immersion

Clinical Evaluation Tool – Mentor" will be completed by the

student and submitted to the course faculty at the course conclusion.

The "Practice Immersion Clinical Evaluation Tool – Agency"

will be completed by both faculty and student in regards to the

clinical site, and will also be submitted to course faculty at the

course conclusion.

Other

7. Scholarly Activity Summary

You may use the "Scholarly Activity Summary" resource to

help guide the preparation of the Scholarly Activities assignment.

Gradable Items Details Points Possible

Assignment Benchmark – Professional Capstone and

Practicum Reflective Journal

Students are required to maintain

weekly reflective narratives

throughout the course to combine into

one course-long reflective

journal that integrates leadership and

inquiry into current practice

as it applies to the Professional

Capstone and Practicum course.

In your journal, you will reflect on

the personal knowledge and

skills gained throughout this course.

The journal should address a

variable combination of the following,

depending on your specific

practice immersion clinical

experiences:

New practice approaches

Intraprofessional

collaboration Health care delivery and

clinical systems

Ethical considerations in health care

Population health

concerns The role of technology in

improving health care

outcomes Health policy Leadership and

economic

100.0

Gradable Items Details Points Possible

models Health disparities

Students will outline what they have

discovered about their

professional practice, personal

strengths and weaknesses that

surfaced, additional resources and

abilities that could be introduced

to a given situation to influence

optimal outcomes, and finally, how

the student met the competencies

aligned to this course.

While APA style is not required for the

body of this assignment,

solid academic writing is expected, and

in-text citations and

references should be presented using

APA documentation guidelines,

which can be found in the APA Style

Guide, located in the Student

Success Center.

This assignment uses a rubric. Please

review the rubric prior to

beginning the assignment to become

familiar with the expectations for

successful completion.

You are required to submit this

assignment to Turnitin. Please refer

to the directions in the Student

Success Center.

Assignment Scholarly Activities

Throughout the RN-to-BSN program,

students are required to

participate in scholarly activities

outside of clinical practice or

professional practice. Examples of

scholarly activities include

attending conferences, seminars,

journal club, grand rounds, morbidity

and mortality meetings,

interdisciplinary committees, quality

improvement committees, and any other

opportunities available at your

site, within your community, or

nationally.

You are required to post one scholarly

activity while you are in the

BSN program, which should be documented

by the end of this course. In

addition to this submission, you are

required to be involved and

10.0

Gradable Items Details Points Possible

contribute to interdisciplinary

initiatives on a regular basis.

Submit, as the assignment, a summary

report of the scholarly

activity, including who, what, where,

when and any relevant take-home

points. Include the appropriate program

competencies associated with

the scholarly activity as well as

future professional goals related to

this activity. You may use the

"Scholarly Activity Summary"

resource to help guide this assignment.

While APA format is not required for

the body of this assignment,

solid academic writing is expected, and

in-text citations and

references should be presented using

APA documentation guidelines,

which can be found in the APA Style

Guide, located in the Student

Success Center.

You are not required to submit this

assignment to Turnitin.

Assignment Practice Hours Documentation

LoudCloud will be used to document and

follow the status of your

practice immersion hours throughout

this course. Students must be able

to document a minimum of 100 practice

hours in association with this

course to fulfill the total required

practice hours in the RN-to-BSN

program. Please review the Practice

Hours Portfolio Required Elements

below, then review the Guidelines for

Undergraduate Field

Experiences resource for details on

what may or may not qualify

as practice hours.

Practice Hours Portfolio Required

Elements

The Practice Hours Portfolio will

include all of the following elements:

Individual Success Plan signed off by

course mentor.

Comprehensive clinical log of hours

applied to program learning

5.0

Gradable Items Details Points Possible

outcomes. Student evaluations (final).

Course mentor

evaluations (final). Faculty approvals

of the Individual

Success Plan and documented practice

immersion hours. (Student is

responsible for obtaining approvals.)

Course mentor’s approval of the

Individual Success Plan and

documented practice immersion hours.

(Student is responsible for

obtaining approvals.)

Assignment Practice Immersion Clinical Evaluation

Tools Submission

Submit the completed "Practice

Immersion Clinical Evaluation

Tool" to your course faculty by

the end of the course, as it is

required to successfully pass the

course.

0.0

Assignment Topic 10 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 10 DQ 2

Discuss why EBP is an essential

component of the practice of a

BSN-prepared RN. Identify two ways in

which you will continue to

integrate evidence into your practice

and encourage it within your

work environment. What obstacles could

challenge this plan, and what

5.0

Gradable Items Details Points Possible

steps will you take to minimize their

impact?

Discussion

Question

Topic 10 DQ 1

Dissemination of EBP and research, such

as presenting results at a

conference or writing an article for a

journal, is an important part

of professional practice. Identify one

professional journal and one

nursing or health care conference where

you might present your

project. Discuss why each of your

choices is the best option for you

to disseminate your new knowledge.

5.0

Participation 15.0

Grade Scale

Letter

Grade

GPA Value Minimum Maximum Interpretation

of Level of

Performance

A 4.0 95.0 100.0 Superior;

outstanding

scholarship

A- 3.7 92.0 94.99 Superior;

outstanding

scholarship

B+ 3.3 90.0 91.99 Superior;

outstanding

scholarship

B 3.0 87.0 89.99 Above average; good

work

B- 2.7 84.0 86.99 Average standard

performance

C+ 2.3 80.0 83.99 Average standard

performance

C 2.0 76.0 79.99

D 1.0 72.0 75.99 Below standard

F 0.0 0.0 71.99 Failure

I 0.0 0.0 Course work is

incomplete

W 0.0 0.0 Authorized

withdrawal; no

credit

– 0.0 0.0

– 0.0 0.0

Policies

pdf (15)

For student policies, please refer to the University Policy Handbook Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment

NR 509 Week 3 Quiz

A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The FNP examined her hand and will expect a fracture if the girl complains:

A patient has been diagnosed with osteoporosis and asked the FNP “what is osteoporosis?” The FNP explains to the patient that osteoporosis is defined as:

Patient states, “I can hear a crunching or grating sound when I kneel”. She also states “that it is very difficult to get out of bed in the morning because of stiffness and pain in my joints”. The FNP should assess for signs of what problem? NR 509 Week 3 Quiz.

When taking the history on a patient with a seizure disorder the FNP assesses whether the patient has an aura. Which of these would be the best question for obtaining this information?

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The FNP is teaching a class on osteoporosis prevention to a group of post menopausal women. A participant shows that she needs more instruction when she states I will:

The FNP is performing a neurological assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork the FNP notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patella. Given this information what would the FNP suspect?

And 80-year-old woman is visiting the clinic for a check up. She states “I can’t walk as much as I used to”. The FNP is observing from motor dysfunction in her hip and should have her:

The FNP is testing the function of cranial nerve XI. Which of these best describes the response the FNP should expect if the nerve is intact? The patient: NR 509 Week 3 Quiz.

A 50-year-old woman is in a clinic for weakness in her left arm and leg that she noticed for the past week. The FNP should perform which type of neurologic examination?

During the neurological assessment of a healthy 35-year-old patient the FNP asks him to relax his muscles completely. The FNP then moves each extremity through full range of motion. Which of these results would the FNP expect to find?

A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The FNP tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift and posture is known as

A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasm’s. The FNP should suspect:

A professional tennis player comes into the clinic complaining of a sore elbow. The FNP will assess for tenderness at the:

The FNP suspect that a patient has carpal tunnel syndrome and wants to perform the Phalens test. To perform this task the FNP should instruct the patient to:

During the history a patient tells the FNP that “it feels like the room is spinning around me”. The FNP would document this as: nr 509 week 3 quiz

The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception the FNP decides to complete the test as quickly as possible. When the FNP applies the sharp point of a pin on his arm several times he is only able to identify these as one very sharp prick. What would be the most accurate explanation for this?

An 85-year-old patient comments during his annual physical that “he seems to be getting shorter as he ages”. The FNP should explain that decrease height occurs with aging because:

A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for a while, and then gets worse again if he sits for long periods of time. The FNP should assess for other signs of what problem? NR 509 Week 3 Quiz.

When the FNP asks a 68-year-old patient to stand with feet together and arms at his side with his eyes closed he starts to sway and moves his feet farther apart. The FNP would document this finding as:

During an assessment of the cranial nerves the FNP finds the following asymmetry when the patient smiles or frowns, uneven lifting of eyebrows, sagging of lower eyelids, and escape of air when the FNP presses against the right path cheek. This would indicate dysfunction of which of these cranial nerves? nr 509 week 3 quiz

The FNP is teaching a class on osteoporosis prevention to a group of postmenopausal women which of these actions is the best way to prevent or delay bone loss in this group?

In obtaining a history on a 74 year old patient the FNP notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold thing. With this information what should the FNP‘s response be?

During a history of a 78-year-old man his wife states that “he occasionally has problems with short-term memory loss and confusion. He can’t even remember how to button his shirt”. In doing the assessment of his sensory system which action of the FNP‘s is most appropriate?

While obtaining a history of a 3 month old infant from the mother the FNP asks about the infants ability to suck and grass the mothers finger. What is the FNP assessing? nr 509 week 3 quiz

The FNP is doing an assessment on a 29-year-old woman who visits the clinic complaining of always dropping things and falling down. While testing rapid alternating movements the FNP notices that the woman is unable to pat both her knees. Her response is very slow and she misses frequently. What should the FNP suspect? NR 509 Week 3 Quiz.

Counselor Ethics and Responsibilities Essay Paper

Introduction

According to the American Counseling Association (2014), “The primary responsibility of counselors is to respect the dignity and promote the welfare of clients” (p.4). In order to uphold this responsibility, counselors must “respect and safeguard the client’s right to privacy and confidentiality” (ACA, 2014, p.4). Counselors are expected to explore and make an effort to understand the various cultural backgrounds of their clients (ACA, 2014, p.4). In addition, it is important for counselor to be aware of “their own cultural identities and how these affect their values and beliefs about the counseling process” (ACA, 2014, p.4).This summary will focus on my personal values, as a counselor and how I plan to incorporate principles of ethical practice in order to maintain clients’ rights. Counselor Ethics and Responsibilities Essay Paper. The responsibilities to warn and protect will also be explored as well as the role of client record keeping.

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Counselor Values

           
Abortion has been and will always be a world-wide issue in which I strongly disagree. I feel that there are thousands of women that struggle with child-bearing and they would give anything for an opportunity to love and raise an unwanted child. We have all made unwise decisions and I understand that some women feel that abortion is the only option due to their financial, relationship, and socioeconomic statuses. However, if pregnancy is a result of the unwise decisions made, I do not feel that the unborn child should have to suffer. I do believe that no sin is greater than the other but I do not believe that God gave women the gift of bearing children just for it to be abused. After witnessing several women struggle with fertility issues, I have gained a sincere passion for adoption. Counselor Ethics and Responsibilities Essay Paper. Although some women feel that it would be even harder to give up a child once they have went through all the pain and labor, I strongly believe that it would be the best option as opposed to abortion.

Extramarital affairs is another common issue in today’s society. I do not feel that it is morally appropriate for spouses to have affairs outside of their marriages. A sacred vow was made before God and many family and friends. It is impossible for marriages to be perfect and spouses will not always agree with one another. However, a commitment was made to love, honor, and protect until death separates that two. As a child, I watched my mother put up with infidelity from my step-father. I was my mother’s self-esteem slowly deteriorate and she began to blame herself for his behavior. I felt that my step-father should have been an adult and effectively communicated his concerns and issues with my mother. I know that all things happen for a reason and sometimes God places specific people in our lives only for a season. Nonetheless, I feel that the cheating spouse should have enough respect for his/her mate to honestly admit that he/she is not happy so that a decision can be made of whether or not to work on or terminate the marriage.

As a counselor, it is important for me to be aware of my “own values, attitudes, beliefs, and behaviors” and I must “avoid imposing” them on my clients (ACA, 2014, p.5). If I had a 19 year-old client that asked me to help her change her parents’ attitudes about her desire to have an abortion, I would first explain to her that I am not in an appropriate position to attempt to change he parents’ thoughts and beliefs. Counselor Ethics and Responsibilities Essay Paper. I would be willing to offer neutral support in a group session with my client and her parents but I would refrain from forcing my beliefs on either of them. Although I strongly disagree with abortions, I will not discriminate against or treat my client disrespectfully.

If I were counseling a couple where both spouses were having affairs and enjoyed not being monogamous, I would most likely consider referring one of the clients to a different counselor. The American Counseling Association (2014) suggests that a counselor appropriately adjusts or withdraws from a role if “it becomes apparent that the counselor may have to perform potentially conflicting roles” (p.6). In this specific situation, I feel that each spouse should engage in individual counseling sessions in order to focus on the factors that resulted in the marital strain as well as the reason why each of them have a desire to have sexual relations with other people. In order to provide effective and adequate counseling to this couple, I feel that it would be best for them to have their own individual counselor. Counselor Ethics and Responsibilities Essay Paper. This will allow me to protect my client’s privacy as well as minimize or avoid any harm that could arise (ACA, 2014, p.4).

Client Rights

           
Counselors must have the responsibility of maintaining clients’ rights. This can be done by following the principles of ethical practice. “These principals are the foundation for ethical behavior and decision making” (ACA, 2014, p.3). Autonomy refers to “the right to control the direction of one’s life” (ACA, 2014, p.3). As a counselor, I must allow my clients to be in control of their own lives and their treatment process. Counselor Ethics and Responsibilities Essay Paper. I will offer support and guidance as each of my clients work towards achieving the goals that they have set for themselves without imposing my thoughts or beliefs on them. Nonmaleficence refers to “avoiding actions that cause harm” (ACA, 2014, p.3). As a counselor, I am aware that my thoughts and opinions can cause more harm than help which is why I will refrain from doing so. I will not discriminate against any of my clients and I am aware that I must terminate the counseling relationship if it is causing harm to the client (ACA, 2014, p.6). Beneficence refers to “working for the good of the individual and society by promoting mental health and well-being” (ACA, 2014, p.3). As a counselor, I will be very involved in my community and will devote some of my time to volunteering and educating those who are unaware of mental health issues and its effects. The American Counseling Association (2014) states that “counselors are encouraged to contribute to society by devoting a portion of their professional activities for little or no financial return” (p.4). I will also keep my clients’ best interest at heart. I understand that I must empower them to independently obtain and maintain a successful life.

Justice refers to “treating individuals equitably and fostering fairness and equality” (ACA, 2014, p.3). According to the American Psychological Association (2010), Counselors “must exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices” (p.3-4). Counselor Ethics and Responsibilities Essay Paper. In order to show justice within my practice, I will treat each client with the utmost respect and I will provide equal and quality services to each of them despite our differences in values and beliefs. I will only practice within the scope of my expertise and will respond appropriately if faced with a case that is beyond my level of competence (NAADAC, 2011). Fidelity refers to “honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships” (ACA, 2014, p.3). Counselors must establish relationships of trust with their clients (APA, 2010, p.3). In order to gain their trust, I will “uphold professional standards of conduct, clarify my professional roles and obligations, accept appropriate responsibility for my behavior, and seek to manage conflicts of interest that could lead to exploitation or harm (APA, 2010, p.3).

All counselors “must uphold the same ethical standards” about confidentiality and clients’ rights “even though each state imposes different legal limits” on the counselor’s ability to do so. “The first step in protecting the rights of clients is the informed consent document” (Callanan, Corey, Corey, & Corey, 2015, p.154). Callanan et al. (2015), stated that “informed consent involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it” (p.154). Informed consent “is integral to the formation of a balanced and healthy therapeutic relationship” (Fisher & Oransky, 2008, p.576). In addition, it “emphasizes the patient’s role in making treatment decision, increasing a sense of ownership over the process” (Fisher & Oransky, 2008, p.576). Counselor Ethics and Responsibilities Essay Paper. The informed consent process allows counselors to meet the ethical requirements to “disclose to clients the risks, benefits, and alternatives to treatment” (Callanan et. al., 2015, p.155).

Counselors are responsible for discussing information about fees, payment options and plans (APA, 2008, p.582).  Clients should be informed “of the percentage of therapy costs covered by their health insurance and any limitations their health plan may put on the number of sessions it will cover” (APA, 2008, p.582). According to Callanan et. al, (2015), “Informed consent form should state that the managed care company may request a client’s diagnosis, results on any tests given, a wide range of clinical information, treatment plans, and perhaps even the entire clinical record of a client” (p.157). Counselor Ethics and Responsibilities Essay Paper. Clients have a right to privacy and confidentiality and counselors may only disclose information with “appropriate consent or with sound or ethical justification” (ACA, 2014, p.7). Counselors providing services “must include in their informed consent procedure requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)” (APA, 2008, p.584). “HIPAA regulations cover any clinical practice or healthcare provider that electronically creates or receives protected health information (PHI) from insurance companies” (APA, 2008, p.584). Each client must receive a Notice of Privacy Practices, “which includes a document detailing patients’ rights to access and amend their PHI, restrict uses and disclosures, and to receive an accounting of disclosures made by the provider to others during the past 6 years” (APA, 2008, p.584). All credentialing boards require counselors to incorporate informed consent into their practice. Counselor Ethics and Responsibilities Essay Paper. This allows the boards to ensure that counselors are displaying and maintaining ethical conduct in order to provide competent and quality services.

Responsibility to Warn and Protect

           
The duty to warn refers to circumstances that requires counselors to make an effort to contact the identified victim that a client has threatened to seriously harm or notify the law enforcement of the threat (Callanan et al., 2015, p.223). The duty to protect refers to situations where counselors have “a legal obligation to protect an identified third party who is being threatened” (Callanan et al., 2015, p.223). The duty to warn requires disclosure of confidential information to the individual being threatened; the duty to protect provides alternatives in order to maintain the client’s confidentiality (Callanan et al., p.223). Counselors must keep in mind that the utilizing the duty to warn can cause inappropriate breaches of confidentiality that could negatively affect the therapeutic relationship. Counselor Ethics and Responsibilities Essay Paper. In addition, an individual’s safety is not guaranteed (Callanan et al., 2015, p.223). In order to determine my responsibilities to warn and protect, I would thoroughly access the severity of the situation presented. I would also consider the client’s mental state at that particular time. It is important for me to find out if my client has a thought out plan to implement. If I feel that my client is very capable of harming someone or themselves, I would first reach out to my supervisor for further instructions. Counselor Ethics and Responsibilities Essay Paper.

 

Client Record-Keeping

           
Counselors have an important responsibility of keeping adequate records on their clients. Adequate records allow counselors to provide high-quality and effective services for clients. It also allows a client to maintain continuity of care if he/she is transferred from one counselor to another. Counselors are protected by quality documentation because it indicates that adequate care was provided. From a legal perspective, accurate and detailed records can provide exceptional support and defense against certain malpractice or liability claims (Callanan et al., 2015, p.166). Counselor Ethics and Responsibilities Essay Paper.

Conclusion

In conclusion, counselors have important responsibilities in their therapeutic relationships with their clients. They must conduct themselves in an ethical and legal manner. Counselors must keep in mind that “client welfare and trust in the profession depend on a high level of professional conduct” (ACA, 2014, p.19). Counselors are entitled to their values and beliefs but they must respect those of their clients even if they differ (Shallcross, 2010). Counselors must “respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination” (APA, 2010, p.4). By doing this, counselors are able to provide quality care to their clients and have a powerful impact on their lives. Counselor Ethics and Responsibilities Essay Paper.
 

References

American Counseling Association. (2014). 
2014 ACA code of ethics
 [PDF Document]. Retrieved

on May 31, 2016 from http://www.counseling.org/docs/ethics/2014-aca-code-of-

ethics.pdf?sfvrsn=4

American Psychological Association. (2010).
Ethical principles of psychologists and code of

            Conduct
[PDF Document]. Retrieved on May 31, 2016 from https://www.apa.org/ethics/

code/principles.pdf

Callanan, P., Corey, C., Corey, G., Corey, M.S. (2015). 
Issues and ethics in the helping

professions
(9
th
 ed.). Stamford, CT: Cengage Learning.

Fisher, C.B., & Oransky, M. (2008). Informed consent to psychotherapy: Protecting the dignity

and respecting the autonomy of patients.
Journal of Clinical Psychology, 64
(5), 576-588.

doi:10.1002/jclp.20472. Retrieved on May 31, 2016 from http://eds.b.ebscohost.com.lope

s.idm.oclc.org/ehost/detail/detail?sid=88e8647f-26e5-45de-a9c5-2b0ec1f1d757%40sessi

onmgr106&vid=0&hid=111&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRI#d

b=a9h&AN=31735126 Counselor Ethics and Responsibilities Essay Paper

Fisher, M. A. (2008). Protecting confidentiality rights: The need for an ethical practice model.

            American Psychologist, 63
(1), 1-13. doi:10.1037/0003-006X.63.1.1. Retrieved on May

31, 2016 from http://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/detail/detail?sid=3971

b742-0d62-4c2e-aa10-a6cab9180407%40sessionmgr4004&vid=0&hid=4203&bdata=Jn

NpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=pdh&AN=2007-19520-001

National Association of Alcohol and Drug Abuse Counselors. (2011). 
Ethical standards of

alcoholism and

drug abuse counselors 
[PDF Document]. Retrieved on May 31, 2016

from http://www.naadac.orgassets/1959/naadac_code_of_ethics_brochure.pdf

 

Shallcross, L. (2010). Putting clients ahead of personal values. Retrieved on May 31, 2016, from

 

 

Putting clients ahead of personal values

 

Access and review the “Counselor Ethics and Responsibilities   Assignment Guidelines.” Complete the paper according to the   assignment guidelines.

Include at least six scholarly resources in addition to the textbook   in your paper.

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

This assignment uses a rubric. Please review the rubric prior to   beginning the assignment to become familiar with the expectations for   successful completion.

You are required to submit this assignment to Turnitin. Please refer   to the directions in the Student Success Center.

This assignment meets the following CACREP Standards:

2.F.1.b. The multiple professional roles and functions of     counselors across specialty areas, and their relationships with     human service and integrated behavioral health care systems,     including interagency and interorganizational collaboration and consultation.

2.F.1.c. Counselors’ roles and responsibilities as members     of interdisciplinary community outreach and emergency management     response teams.

2.F.1.d. The role and process of the professional counselor     advocating on behalf of the profession.

2.F.1.e. Advocacy processes needed to address institutional and     social barriers that impede access, equity, and success for clients.

2.F.1.l.
 
Self-care strategies appropriate to the     counselor role.

5.C.2.a. Roles and settings of clinical mental health counselors.

This assignment meets the following NASAC Standards:

15) Understand the variety of insurance and health maintenance     options available, and appreciate the importance of helping clients     access those benefits.

Below is textbook (must use for a reference) Attached is a sample assignment of how it should look please do not use.

The template for the assignment and the expectation. 

textbook; https://viewer.gcu.edu/UWUHRK Counselor Ethics and Responsibilities Essay Paper.

NR 509 Week 2 Quiz

A mother brings her two month old daughter in for an examination says “my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?” The FNP‘s best response would be:

During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from:

The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to: NR 509 Week 2 Quiz

When examining the face, the FNP is aware that the two pairs of salivary gland‘s that are accessible to examination are the _____ glands

A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____

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When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the:

The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland

A patient says that she has recently noticed a lump in the front of her neck below her “Adams apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:

The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient’s:

The FNP is aware that the four areas in the body were lymph nodes accessible are the: nr 509 week 2 quiz

A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by:

The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?

A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:

A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next: NR 509 Week 2 Quiz

A patient’s vision is ……as 20/80 in each eye. The FNP interprets this finding to mean that nr 509 week 2 quiz

When performing the corneal light reflex assessment, the FNP notes that the light is …..at 2 o’clock in each eye. The FNP should

The FNP is performing the diagnostic positions test. Normal findings would be which of these results? nr 509 week 2 quiz

During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?

A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this?

The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient?

The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?

During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings

During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. NR 509 Week 2 Quiz. These findings are reflective of:

The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus?

The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy: NR 509 Week 2 Quiz

Multi-Generational Workforce Essay

Imagine that you manage a department in a specific health care service, facility, or other health sector-related occupation of your choice. In this scenario, the age of the employees in your department spans four generations and conflict is brewing between them. It is affecting performance, shift scheduling, and cooperation with other departments.

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Identify 
leadership and operational strategies that can be leveraged to overcome these conflicts and improve performance.

Write
 a 3- to 4-page proposal about how you plan to resolve these conflicts.

Include the following:

Explain the situation that you and your department are facing.

Propose key strategies that you believe will resolve the conflict.

Provide and evaluation of your own leadership style and determine what changes need to be made to be a more effective leader Multi-Generational Workforce Essay.

Cite
 at least 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

Format
your assignment according to APA guidelines Multi-Generational Workforce Essay.