Tag: Clinical-Nursing

Reduction of Fall Rates for Post-Operative Patients Sample essay

3- two

Write a narrative of 750‐1,000 words that presents the research support for the projects problem and proposed solution.

Problem Statement: Reduction of Fall Rates for Post-Operative Patients

Make sure to do the following:

1. Include a description of the search method (e.g., databases, keywords, criteria for inclusion and exclusion, and number of studies that fit your criteria).

2. Summarize all of the research studies used as evidence. The essential components of each study need to be described so that readers can evaluate its scientific merit, including study strengths and limitations.

3. Incorporate a description of the validity of the internal and external research.

It is essential to make sure that the research support for the proposed solution is sufficient, compelling, relevant, and from peer‐reviewed professional journal articles.

These are the references used in assignment 2

Everhart D, Schumacher, J.R., Duncan R.P., Hall A.G., Neff, D.F., & Shorr, R.I. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics. Health Care Management Review. 39(4), 352–360.

Kobayashi, K., Kei, A., Yuko, I., Yusuke, S., Nagao, Y., & Shiro, I. (2018). Characteristics of falls in orthopedic patients during hospitalization. Nagoya Journal of Medical Science. 80(3), 341–349.  Reduction of Fall Rates for Post-Operative Patients Sample essay.

Luzia, M., Victor, G., & Lucena, F. (2014). Nursing diagnosis risk for falls: Prevalence and clinical profile of hospitalized patients. Revista. Latino-Americano. Enfermagem. 22(2), 262–268.

Mata, L., Cissa, A., Gabrielle, P., & Moraes, T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study. Revista Latino-Americano Enfermagem. 25(2904).

Shida, D., Wakamatsu, K., Tanaka, Y., Yoshimura, A., Kawaguchi, M., Miyamoto, S. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40. BioMed central Cancer. 15(799), 1–6.

Vitor, A., Moura, L., Fernandes, L., Botarelli, F.R., Araújo, J., & Vitorino, I. (2015). Risk for falls in patients in the postoperative period. Cogitare Enferm. 20(1), 29–37.

 

Reduction of Fall Rates for Post-Operative Patients

Name

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Institution

Date

Reduction of Fall Rates for Post-Operative Patients

Description of the Search Method

A comprehensive bibliographic search was performed using various electronic databases such as PubMed, Wiley library databases, EbscoHost, Web of science, Google Scholar and CINAHL. The purpose of performing bibliographic search was to locate the relevant and quality research articles to be used in the study topic. Reference lists of the retrieved research articles were also analyzed and any article in the list that was found to have met the inclusion criteria of this study was searched. In addition, to conduct the search, the PICO was broken down into difference terms as indicated below:

In post-operative patients (P), what are the evidence-based practice nursing interventions (I), when compared to no interventions (C), that can reduce the fall rate (O)?

The keywords used during the search included fall rates, fall prevention, patient falls, nursing interventions, and safety and inpatient falls.

The inclusion criteria include peer-reviewed research studies; studies published between 2014-2019; studies investigating fall rates among inpatients; and studies published in English language. Reduction of Fall Rates for Post-Operative Patients Sample essay.

Summary of Research Studies used as Evidence

According to Mata et al (2017) falls sustained during hospitalization results to increased length of hospital stay, complications and even increment of the healthcare costs. Luzia et al (2014) further explains that falls in inpatients can result to trauma of fractures that further reduce the quality of life and the ability of the patient to perform activities of daily living. Vitor et al, (2015) explains that the inpatients are unfamiliar with the hospital setting and this increases the probability of the patients sustaining falls. The reason is that the hospital setting is completely different with the home setting where facilities like toilet and bathrooms are located in completely different locations, as well as electricity switches; this can lead to confusing among post-operative patients and thus increase their risk for falls and the subsequent injuries.

Shida et al, (2015) opines that post-operative patients normally try to achieve their mobility and regain independence in order to be able to return to performing the normal activities of daily living. post-operative period is also characterized with pain which hinders the patient in so many aspects such as walking properly. This shows that surgeries increase the risk of fall for the patients because of the associated physical weakness. Reduction of Fall Rates for Post-Operative Patients Sample essay. This is the reason post-operative patients are at an increased risk for falls. Everhart et al (2014) further explain that patient fall in healthcare setting represent a major patient safety concern.  Kobayash et al (2018) majority of patients undergoing surgeries need special circumstances that enable them to adapt to the perioperative period in order to reduce the risk of fall.  This is supported by Victor et al (2014) who exlians that patients in hospitals especially those within the postoperative during are predisposed to a number of complications and one of the complications is the risk for falls. Accordingly, falls rate among the common adverse incidents that occur among the inpatients.

Everhart et al (2014) conducted longitudinal study in an acute care hospital while Kobayash et al (2018) prospectively used a database within the institution’s incident reporting system. Luzia et al (2014) conducted a cross-sectional study with a sample of 174 patients. The data collection was done using a computerized nursing care prescriptions system and then statistical data analysis was done. Mata et al (2017) used quantitative and cross-sectional method and used 257 adult patients. The data collection was done utilizing sociodemographic and clinical questionnaire. Shida et al (2014) used the QoR-40 and questionnaire to assess the patients’ postoperative recovery. Vitor, et al (2015) used a quantitative approach to perform a descriptive cross-section study. Reduction of Fall Rates for Post-Operative Patients Sample essay.

Validity of the Internal and External Research

The validity of the studies that were selected to be used in this proposal was addressed using different kinds of validity that include convergent validity, face validity, and content validity. According to Dini et al., 2014) these are the key elements used to assure quality in research. Reliability was achieved by examining the consistency of the studies. Various tools used to text the consistency included instruments like Cronbach’s alpha and KMO Bartlett’s test (Dini et al., 2014). However, in some studies the author developed own tools to collect the data while other authors used data collection tools that reliability and validity has been validated. Finally, rigor of the research ensured the validity of the research. This was achieved by performing a wide literature review to locate all available relevant studies and research on the study topic. Tools such as McMaster appraisal checklists and CASP were also used to rate all the articles included in this study to further ensure their quality (Dini et al., 2014). Reduction of Fall Rates for Post-Operative Patients Sample essay.

 

References

Dini, A.P., Alves, D.F.D.S., Oliveira, H.C. and Guirardello, E.D.B., 2014. Validity and reliability of a pediatric patient classification instrument. 
Revista latino-americana de enfermagem
, 
22
(4), pp.598-603.

Everhart D, Jessica S, Duncan P, Hall A, Neff D & Shorr R. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics.
Health Care Manage Rev
. 39(4), 352–360.

Kobayashi K, Kei A, Yuko I, Yusuke S, Nagao Y, & Shiro I. (2018). Characteristics of falls in orthopedic patients during hospitalization.
Nagoya J Med Sci
. 80(3), 341–349.

Luzia M, Victor G & Lucena F. (2014). Nursing Diagnosis Risk for falls: prevalence and clinical profile of hospitalized patients. Rev.
Latino-Am. Enfermagem
. 22(2), 262–268.

Mata L. Cissa A, Gabrielle P & Moraes T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study.
Rev Lat Am Enfermagem
. 25(2904).

Shida D, Wakamatsu K, Tanaka Y, Yoshimura A, Kawaguchi M, Miyamoto S, et al. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40.
BMC Cancer
. 15(799), 1–6.

Vitor A, Moura L, Fernandes L, Botarelli FR, Araújo J & Vitorino I. (2015). Risk for falls in patients in the postoperative period.
Cogitare Enferm
. 20(1), 29–37. Reduction of Fall Rates for Post-Operative Patients Sample essay

Mental Health in the Juvenile Justice System Essay

My personal research interest is the improvement of mental health care for juveniles within the justice system.  According to the National Alliance on Mental Illness (NAMI, 2019), a majority of the population within the juvenile justice system suffers from mental illness.  NAMI explains that most of these mental health disorders are not appropriately addressed and recidivism rates are high (NAMI, 2019).  Additional research data is indicated to determine the reasons for the system’s failure to assist in the treatment of these mental health disorders.  Research is also indicated in order to investigate potential solutions to this problem.  Juvenile delinquents with mental illness comprise an incredibly vulnerable population, and this population’s protection is a multifaceted challenge that advanced practice nurses may be able to help ensure. Mental Health in the Juvenile Justice System Essay

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Mental health care in the juvenile setting is an important issue with a substantial public health impact. According to a case study described by Burriss, Breland-Noble, Webster, and Soto (2011), an adolescent male suffering from bipolar disorder was repeatedly court ordered to be placed in a detention facility from which he continued to run away.  After approximately one year, during which the juvenile committed other crimes, his mental illness was diagnosed.  The adolescent began participating in a Juvenile Mental Health Court, where he was mandated to receive outpatient treatment and made great advances in his education and interpersonal relationships. This case study indicates that screening for mental health in juvenile detention settings is in need of improvement.  It is probable that the continued criminal activity of the subject in the case study was related to the impulsivity of the manic state of bipolar disorder.  Without a treatment for the disorder, behavior change is extremely difficult.  The case also indicates that traditional detention may not be as effective as outpatient court-based approaches for the rehabilitation of mentally ill juveniles.  Psychiatric nurses may be able to help with the creation and coordination of Juvenile Mental Health Courts (Burriss et al., 2011).  According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2019), in the state of Florida, there is no Juvenile Mental Health Court.  Therefore, the expansion of Juvenile Mental Health Courts indicates a possible means for nurses to become involved in the improvement of mental health treatment in the juvenile justice system.

However, for many children and adolescents, rehabilitation involving an outpatient Juvenile Mental Health Court may not be possible, and they may spend significant time in traditional detention settings.  As I have observed in the clinical setting, children with mental illness benefit from empathetic interactions in a therapeutic milieu setting.  I have shadowed in the Summer Treatment Program at the Nova South Eastern University Center for Children and Families, a day treatment program designed for children with ADHD and other behavioral disorders.  Throughout the day, positive behavior is reinforced by empathetic staff members.  All staff members go through a rigorous training and are supervised by Masters level counselors or Clinical Psychologists. By the end of treatment, even the most disruptive children exhibit behavioral improvements from participating in this positive environment.  However, mentally ill children in a juvenile detention center are monitored by prison staff who lack training regarding mental illness.  Melnikov, Elyan-Antar, Schor, Kigli-Shemesh, and Kagan (2017) created a workshop designed to decrease the stigma of mental illness among prison staff.  This workshop was shown to be successful in decreasing the stigma of mental illness, leading to more positive interactions between staff and prisoners (Melnikov et al., 2017).  While this study was not conducted in a juvenile setting, it illuminates the potential positive impact of such a program.  According to NAMI (2019), children in detention centers are four times more likely to commit suicide than children outside of the justice system.  This statistic indicates that this vulnerable population is in great need of quality mental health care, and at a minimum requires empathetic staff members who will not worsen their conditions. Mental Health in the Juvenile Justice System Essay.

In addition to workshops that may improve prison staff perspectives regarding mental illness, other interventions may benefit incarcerated youth.  Winters and Beerbower (2017) describe mindfulness meditation as a possible therapy for these vulnerable individuals who have likely been exposed to trauma that may impact developmental processes.  Mindfulness is a potential means of preventing future participation in criminal activity and facilitating brain development (Winters & Beerbower, 2017).  Additional research is indicated to explore this potential for a simple, cost-effective intervention that could improve mental health treatment within juvenile detention facilities or in outpatient court coordinated mental health programs.

In conclusion, several children and adolescents within the justice system suffer from mental illness.  While in detention facilities, individuals with mental health disorders may go untreated or even undiagnosed, likely contributing to increased rates of suicide.  Furthermore, the cause of many criminal acts may be tied to mental health disorders, and to not offer appropriate treatment is to criminalize mental illness and criminalize those vulnerable populations who are unable to access mental health services.  Nurses and advanced practice nurses can research various interventions in order to make positive changes for this population.  For example, nurses can investigate and implement improved mental health screening processes in the justice system. Mental Health in the Juvenile Justice System Essay.  In addition, nurses can be involved in increased planning, research, and advocacy surrounding the use of Juvenile Mental Health Courts.  Advanced practice nurses can implement workshops for staff members to decrease stigma and increase understanding of mental health disorders, and they can initiate mindfulness treatment for incarcerated juveniles.

 

References

Burriss, F. A., Breland-Noble, A. M., Webster, J. L., & Soto, J. A. (2011). Juvenile mental health courts for adjudicated youth: role implications for child and adolescent psychiatric mental health nurses.
Journal of Child and Adolescent Psychiatric Nursing, 24,
114-121. doi: 10.1111/j.1744-6171.2011.00276.x

Melnikov, S., Elyan-Antar, T., Schor, R., Kigli-Shemesh, R., & Kagan, I. (2017). Nurses teaching prison officers: A workshop to reduce the stigmatization of prison inmates with mental illness.
Perspectives in Psychiatric Care
,
53,
251-258. doi: 10.1111/ppc.12165

National Alliance on Mental Illness. (2019).
Juvenile justice.
Retrieved August 30, 2019, from https://www.nami.org/Learn-More/Mental-Health-Public-Policy/Juvenile-Justice. Mental Health in the Juvenile Justice System Essay.

Substance Abuse and Mental Health Services Administration. (2019).
Juvenile mental health treatment court locator.
Retrieved August 30, 2019, from https://www.samhsa.gov/gains-center/mental-health-treatment-court-locator/juveniles.

Winters, D. E., & Beerbower, E. (2017). Mindfulness and meditation as an adjunctive treatment for adolescents involved in the juvenile justice system: Is repairing the brain and nervous system possible?
Social Work in Health Care, 56:7,
615-635. doi: 10.1080/00981389.2017.1316341 Mental Health in the Juvenile Justice System Essay

Bedside shift reporting nursing care Essay

Bedside nursing care

My personal research interest is the use of bedside nursing care as standard practice for change of shift reporting to address sentinel events in the adult inpatient setting in neurosurgery unit. Traditionally, change of shift reporting has been conducted in the nurses’ station when all nurses leave the inpatients unattended to discuss the shift events. However, this practice has been faulted for creating opportunities for sentinel events as concerns quality of care and patients’ safety when the patients are left unattended. The concern about the quality of care and patients’ safety is heightened by the fact that discussing all the patients’ cases takes much time. In fact, it is not uncommon for change of shift reporting in the nurses’ station to take an hour or more (Ofori-Atta, Binienda & Chalupka, 2019). Ofori-Atta, Binienda and Chalupka (2019) place the issue into perspective, showing that approximately 330,000 patients’ in the USA suffer from a preventable harm every year with the harm causing sentinel event when they are left unattended contributing to their death. Bedside shift reporting nursing care Essay. These statistics are significant when it is considered that thousands of inpatients receive daily care across the nation and they experience shift changes during their stay. If left unattended, the patients have a higher probability of experiencing a preventable error that does not necessarily result in death but could cause an injury to the patient and costly to address (Ofori-Atta, Binienda & Chalupka, 2019). As a result, change of shift reporting in nurses’ station presents opportunities for sentinel events when inpatients’ are left unattended.

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Given the concerns about change of shift reporting in nurses’ station, the proposal is made for bedside shift reporting to be adopted as standard practice in adult inpatient setting in neurosurgery unit. The change is anticipated to create a patient-centered care approach that improve the quality of care and patient safety. In this case, bedside shift reporting would entail the on-coming and off-going nurses discussing the case details at the side of each patient at the end of the shift. For that matter, the patient and family members are included in the reporting process with the opportunity to make direct inputs even as they are observed and not left unattended for long periods of time (Baldwin & Spears, 2019). In essence, the proposed approach creates an environment in which nurses, clinicians, patients and families work together to improve care safety and quality in neurosurgery units. Through including patients in discussions about their health status and ensuring that they are not left unattended for long, the proposed change ensures that patients do not worry about their safety when making hospitalization decisions. Bedside shift reporting nursing care Essay. Still, it is important to note that even with the proposed change being implemented, opportunities for sentinel events are not totally eliminated from the neurosurgery unit. That is because human element, organizational process flaws and other healthcare aspects create the potential for errors. However, as a stopgap, the proposed solution makes credible effort in ensuring patient safety and improving care quality in neurosurgery units (Dorvil, 2018).

Care transitions at shift change in neurosurgery units create the potential for care errors. Bedside shift reporting can reduce the risk of these errors occurring through offering a three-way verification system that lets the off-going nurse, on-coming nurse and patient/family to verify the care approach. The nurses can also take the opportunity to assess the case, check for adverse events (such as pressure ulcers), and observe the patient’s general appearance. Also, the patient and family members can take the opportunity to ask questions about his/her health status, and set both short-term and long-term objectives with the nurses. Bedside shift reporting nursing care Essay. Through this approach to shift reporting, communication is improved and nurse accountability is ensured in neurosurgery units (Kerr, Lu & McKinlay, 2014). Besides that, nursing personnel are primary care givers and the first line of defense when addressing care quality and patient safety. Bedside shift reporting ensures that the value of nurses as the first line of defense can be leveraged as an integral part of the care plan. This particularly takes advantage of the fact that nurses are accountable for communication that occurs at shift change, such that communicating at the bedside allows the nurse to verify information about prescribed medication, plan of care, physical assessment findings, and health history. Also, it helps in building partnerships between the patients and nurses, with nurses becoming more aware of nursing care issues thus enabling them to plan and prioritize their efforts (Vines et al., 2014).

It is clear that bedside shift reporting in neurosurgery units offers some unique advantages that include saving time, streamlining pertinent information, and improving nurse efficiency. In addition, it ensures accountability and improves nurses’ teamwork through opportunities for working together. Besides that, it standardizes shift reporting format thus reducing incidences of miscommunication. With improved communication, on-coming nurses can prioritize their efforts based on need. Patients similarly benefit by learning about care plan and objectives, getting reassurance, reducing anxiety, and improving satisfaction (Ofori-Atta, Binienda & Chalupka, 2019). Still, bedside shift reporting raises some concerns. Bedside shift reporting nursing care Essay. First, presence of third parties in the room can hinder communication efforts. Secondly, disclosing new information that has not been discussed with the patient could be detrimental. Thirdly, it could interfere with the patients’ sleep patterns. Fourthly, it limits the contribution of patients with sensory and cognitive limitations. Fifthly, it increases reporting time when lengthy clarifications are required. Finally, there is a lack of privacy thus leading to potential violations of HIPAA. Despite the limitations, the rewards from bedside shift reporting is an opportunity for meaningful change in inpatient care for neurosurgery units (Ofori-Atta, Binienda & Chalupka, 2019).

 

 

References

Baldwin, K. & Spears, M. (2019). Improving the patient experience and decreasing patient anxiety with nursing bedside report.
Clinical Nurse Specialist
, 33(2), 82-89.

Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability.
Nursing Management,
49(6), 20-25.

Kerr, D., Lu, S. & McKinlay, L. (2014). Towards patient-centred care: perspectives of nurses and midwives regarding shift-to-shift bedside handover.
International Journal of Nursing Practice
, 20(3), 250-257. Bedside shift reporting nursing care Essay.

Ofori-Atta, J., Binienda, M. & Chalupka, S. (2019). Bedside shift report: implications for patient safety and quality of care.
Nursing,
45(8), 1-4.

Vines, M., Dupler, A., Van Son, C. & Guido, G. (2014). Improving client and nurse satisfaction through the utilization of bedside report.
Journal for Nurses in Professional Development
, 30(4), 166-173. Bedside shift reporting nursing care Essay.

Working With Children and Adolescents Versus Adults Sample Essay

Explain why a developmental assessment of children and adolescents is important.

Describe two assessment instruments and explain why they are used for children and adolescents but not adults.

Describe two treatment options for children and adolescents that may not be used when treating adults.

Explain the role parents play in assessment and treatment

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Importance Of Developmental Assessments Of Children And Adolescents

Developmental assessments of pediatric clients form a vital part of holistic care which is a major goal of psychiatric nursing. When conducting psychiatric evaluations, developmental assessments are used to gauge the likelihood of any deviations from normal development physically, psycho-sexually, socially or emotionally (American Psychiatric Association, 2013).  Based on the outcomes of an assessment, mental health practitioners can institute early interventions for any deviations noted. Developmental assessments are also essential since some adolescents and children can present in clinical settings with behaviors consistent with disabilities in development (American Psychiatric Association, 2013). Working With Children and Adolescents Versus Adults Sample Essay. By using these assessments, mental health practitioners can determine whether such disability is as a result of trauma, environmental factors or genetics. When identified early, the right referrals can be made to promote a child’s development and well-being.

Assessment Instruments For Adolescents and Children

           
The use of assessments instruments in adult and pediatric populations is vital in ensuring that the criterion for a specific diagnosis has been met. Generally, the most commonly used instruments for diagnoses are questionnaires and interviews (Sadock, Sadock & Ruiz, 2014). However, there exists a huge difference between the assessment instruments used for adults and pediatric clients. This is attributed to the fact that the details captured in pediatric assessments are obtained from additional sources such as caregivers, parents, and teachers other than just the pediatric client. Assessment instruments used for pediatric clients should be simple, brief, specific and sensitive. Assessment instruments that are specifically used for pediatric clients and cannot be used for adult patients are the National Institute of Mental Health Interview Schedule for Children Version IV and Dominic-R (Hargrave & Arthur, 2015). The former can be used in clinical settings with children between 6-17 years in either a parent or child format. The child format is suitable for children aged 9-17 years of age which the parental format can be used for pediatric clients aged 6-17 years old(Sadock, Sadock & Ruiz, 2014). On the other hand, the Dominic-R assessment instrument uses the images of a child named Dominic to depict several symptoms and can be used for children aged 6-11 years. Even though the behavioral and emotional content it illustrates is based on DSM-III-R, these details can be incorporated with the clinical details of the DSM-IV. Working With Children and Adolescents Versus Adults Sample Essay.

Treatment Options For Adolescents and Children

           
Play therapy has proven to be a highly effective and successful treatment option among pediatric patients with ADHD, depression, and PTSD. This form of therapy utilizes a play model that is nondirective to promote an environment that is safe and enhances the growth of a child (Blanco et al., 2015). Working With Children and Adolescents Versus Adults Sample Essay. The other treatment option used for children and adolescents is trauma-focused cognitive behavioral therapy. According to de Arellano, et al., (2014), trauma-focused CBT is a preferred empiric treatment model for pediatric clients who have undergone some form of trauma.

Parent’s Role In Assessment and Treatment

           
Adolescents and children are heavily reliant on the participation of direct caregivers and parents in care for more successful health outcomes. Parents are relied on by clinicians to obtain exact information on the symptoms that a child presents with, past medical, surgical, psychosocial and family history (American Psychiatric Association, 2013). It is also worth mentioning that, rarely do children or adolescents initiate psychiatric evaluations. Therefore, to comprehensively understand the reasons for evaluation, clinicians can only collect information through interviews with caregivers or parent. However, information shared by children or adolescents should not be ignored since they tend to understand their concerns, thoughts, and feelings better. Working With Children and Adolescents Versus Adults Sample Essay.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Blanco, P. J., Muro, J. H., Holliman, R., Stickley, V. K., & Carter, K. (2015). Effect of child-centered play therapy on performance anxiety and academic achievement.
Journal of Child and Adolescent Counseling
,
1
(2), 66-80.

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60-72.

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

de Arellano, M. A. R., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: Assessing the evidence.
Psychiatric Services
,
65
(5), 591-602. Working With Children and Adolescents Versus Adults Sample Essay

NU420M1 transformational leadership theory and research Sample essay

NU420M1 Leadership Theory and Research

Name

Institution

Nursing leadership entails advocacy, action, decision making, and critical thinking. Quality healthcare delivery is promoted by effective leadership skills. Nursing leadership theories merge the desires, abilities, and enthusiasm to promote service delivery and bring change in the organization. There exist multiple nursing leadership theories including the transformational, service leadership theory, Laissez-Faire Leadership, democratic and autocratic among others. This paper seeks to explore the transformational leadership theory, its main concepts and application in moral, productivity, financial decision, training, and ethical conduct. NU420M1 transformational leadership theory and research Sample essay.

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Transformational leadership theory is characterized by the imposition of changes required in an organization through teamwork, creation of visions to direct the changes, inspiration and execution in collaboration with committed members of a group (Fischer, 2016). It provides motivation, enhances job performance and improves the morale of the followers through role modelling, collective identity, and connection with their sense of identity, challenging accountability and responsibility, ownership, und understanding of the weaknesses and strengths. These are meant to align the organizational staff with the activities that promote performance. In general, this theory enhances commitment and motivation of the followers towards the right behaviors that achieve shared visions. It creates positive change and valuable with the aim of developing leaders from followers as the end goal. NU420M1 transformational leadership theory and research Sample essay.

The main concepts of transformational leadership theory include idealized influence, inspirational motivation, intellectual stimulation and individualized consideration. Inspirational motivation guides nursing leaders in the creation of visions to the followers (Masood & Afsar, 2017). Leaders act as role models to the followers who emulate their actions. They also enhance self-efficacy among followers. Another concept is intellectual stimulation NU420M1 transformational leadership theory and research Sample essay. It entails taking risks, soliciting the ideas of followers and challenging of assumptions. This concept recognizes the innovation, creativity and stimulation of followers. A collaboration with followers helps in creating new innovative ways and approaches that promote the resolution of issues in the organization. An example of this concept is seen where the leader promotes independent thinking and autonomy of the followers.

Idealized influence engages ethical behaviors. Leaders have high ethical conduct and moral standards which are emulated by their followers. Great respect in the leaders enhances trust and consequently, a sense of mission and vision is provided to the followers. For example, leaders enhance fairness and justice in the institution which enables the followers to co-exist harmoniously in the workplace. On the other hand, individualized consideration entails mentorship, coaching and guidance of followers through attending to their unique needs. For instance, a leader supports a creative follower to enhance their talent and skills by facilitating their training.

The application of the transformational theory is evident in various areas of a healthcare organization. Through the motivation and inspiration of followers, increased productivity is observed in the organization. Development of new ways and approaches of problem resolution through creativity and innovation promotes productivity. Moreover, role modelling encourages moral and ethical conduct through leadership guidance. Notably, promotion of independent thinking, innovation, creativity creates room for training in the organization as the leaders seeks to advance the skills, abilities and professionalism of the followers (Harrison, 2017). Since the end goal of the transformational leadership theory is to create leaders from followers, it is evident that it promotes organizational training towards effective leadership. On the other hand, the financial aspect of an organization is influenced by the management capabilities of a leader.  In this case, transformational leadership emphasizes on financial changes that propel the organization towards successful achievement of its financial goals. NU420M1 transformational leadership theory and research Sample essay.

References

Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. 
Journal of Advanced Nursing
, 
72
(11), 2644-2653.

Harrison, C. (2017). 
Leadership theory and research: A critical approach to new and existing paradigms
. Springer.

Masood, M., & Afsar, B. (2017). Transformational leadership and innovative work behavior among nursing staff. 
Nursing Inquiry
, 
24
(4), e12188. NU420M1 transformational leadership theory and research Sample essay.

Local, State, or Federal Health Policy Analysis Paper

This assignment is an analysis of local, state, or federal health policy.

1.Select a state health policy reform innovation

2.Discuss the rationale for the policy, how it was adopted (e.g., federal waivers, passage by state legislature), the funding structure, and (to the extent statistical data are available) its impact. ethical outcome based on evidence.

3.Examples of state innovations include Maryland’s hospital rate setting, Vermont’s single payer system, and Massachusetts’ health reforms

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Submission Requirements:

The paper is to be formatted per current APA style, 5 pages in length, excluding the title, abstract and references page. Local, State, or Federal Health Policy Analysis Paper.

Incorporate a minimum of 5 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

Journal articles and books should be referenced according to current APA style.

 

Policy analysis

Policy continues to play a key role in how the government responds to the health agenda. However, like any other political objective, health policy in the USA continued to remain in continuous flux such that policies that initially received much political support facing considerable opposition later on in time, with the reverse being equally true. This state of flux is exemplified by Affordable Care Act (ACA) that was enacted in 2010 and still remains operation. But from its inception, ACA has had considerable support and has faced strong opposition. Currently, Congress must decide on how to proceed with the debate. They have the option of eliminating ACA and replacing it with a different health policy or revising ACA with a focus on the contentious aspects of the legislation to make it more acceptable to a wider political audience (Tripati, 2018). The present paper analyzes ACA as a health policy and the polarizing debates surrounding the legislation. Local, State, or Federal Health Policy Analysis Paper.

ACA was conceptualized as a policy that enabled the government to increase the number of Americans with health insurance (uninsured Americans were 47 million at the time the bill was passed) through making health insurance more affordable and expanding access to care. The legislation achieved these objectives through expanding Medicaid eligibility and creating new market places where Americans who previous did not have health insurance could acquire coverage directly from insurers. In fact, it expanded insurance coverage in three ways. Firstly, it expanded Medicaid through broader Medicaid eligibility to include Americans who earned up to 138% of the federal poverty level. Secondly, present opportunities for small insurers to take up the slack from large insurers through targeting employers with less than 51 personnel. Thirdly, offering premium subsidies to buy health insurance coverage for persons who earned less than 401% above the federal poverty level. In addition, ACA mandated new approaches that sought to improve health care quality and reduce costs; including reducing costs for some experimental delivery models and Medicare services (Tripati, 2018).

Since its enactment and operationalization, ACA has improved health care in the USA. First, it has reduced the number of uninsured Americans. Despite rollout problems, ACA has enabled a sizeable number of previously uninsured Americans to obtain coverage. Statistics indicated that 22.8 million Americans registered for new insurance between 2013 and 2015 while 5.9 million lost health insurance coverage. The total number of uninsured Americans was reported at 25.8 million, down from 42.7 million. Secondly, it offers an effective incentive for enrollment through mandating that most adults must be covered, with failures subjected to fines interpreted as lawfully imposed taxes. Local, State, or Federal Health Policy Analysis Paper. Thirdly, it helped in stabilizing the insurance marketplace through offering tax credits that helped low-incomes earners to buy insurance coverage.  Fourthly, it reduces the payments made to providers through cost containment strategies that cuts the money that medical providers receive from Medicare to reduce spend over growth reported for Medicare. Fifthly, it has facilitated health care cost containment, although not taking into accounted the reduced coverage by insurers, higher drug prices, higher out of pocket costs, and recession. Sixthly, it has improved health care quality through creating new government entities, commissions, boards and agencies that are responsible for managing health care practice, although this has attracted regulatory compliance costs. Finally, it has shifted health care away from care based on volume of services towards care based on value. Overall, ACA has three objectives. The first objective is to reduce health care costs, improve care quality, and reduce the number of uninsured Americans (Glassman, Giedion & Smith, 2017). Local, State, or Federal Health Policy Analysis Paper.

Despite being the most monumental change in health care policy in the USA since the passage of Medicare and Medicaid in 1965, ACA implementation has been marked by unexpected twists and turns, and controversies that include delays in key provisions and court challenges. In fact, since its enactment, ACA has been associated with numerous claims concerning its success and failures from those who support and oppose it. The views expressed in these debates have been sensational and colored the political persuasion. A point that these debates often overlook is that there is a distinction between health care access and affordability. Health care insurance is a financial mechanism that facilitates health care affordability while access refers to the actual process of getting the required care. ACA has been instrumental in narrowing the gap between health care access and affordability, an overall trend that overlooks some cases to the contrary. To be more precise, it has made insurance available for an additional 20 million Americans who previously did not have insurance. This information often overlooks the fact that as more people receive insurance, there are 6 million Americans who previously had insurance but lost coverage in the ACA regime. Besides that, the increase in insurance coverage has largely been reported in Medicaid expansion at 13 million to imply that middle and working class Americans (constituting 40% of the American population) have not received much support, especially those who earn more than 400% above the federal poverty level. The result is that health care access has been uneven with the Americans enrolled in Medicaid hindered by narrow networks while those not enrolled in Medicaid facing high out of pocket costs (Belland, Rocco & Waddan, 2016).

It is clear that ACA has results in a net rise in the number of insured Americans, mainly through expanding Medicaid. The cost reductions associated with ACA remain arguable achievements while care quality appears not to have improved. Also, diminished health care access has been reported. With a new American president, ACA is facing critical analysis that takes a renewed look at its actual gains and losses. Some of the legislators in Congress are pushing for ACA to be revised to address its shortcomings while others are calling for the legislation to be repealed and replaced. This has resulted in many proposals being presented to improve, repair, replace or repeal ACA (Geyman, 2018). Local, State, or Federal Health Policy Analysis Paper

Regardless of how the political debate proceeds and the decisions made by Congress, the results are likely to have far reaching consequences. Replacing ACA implies that the 251.6 million Americans with health insurance (as well as the 26 million Americans without insurance) face an uncertain future. The number of insured Americans would drop to 231.9 million if ACA is repealed but not replaced. Average out of pocket costs would also increase by $4,200. This decision would also eliminate the revenue programs under ACA and increase the federal deficit by $33.1 billion every year. Replacing ACA with a single payer plan would increase federal spending by $1 trillion and national spending by $435 while ensuring that all American have insurance coverage, although undocumented immigrants would not enjoy this privilege. Replacing ACA with the American Health Care Act (AHCA) would reduce enrollment for insurance by 14 million and increase federal deficit by $38 billion. Repealing ACA with no replacement would result in 12 million lacking insurance coverage with enrollment declining by 25% most of whom would be healthy and young Americans (Geyman, 2018). Local, State, or Federal Health Policy Analysis Paper

As the political debate continues over how to handle ACA and policy makers weight their options ahead, it is evident that political tensions exist that extend to their objectives. For instance; should they reduce costs and federal deficit, or expand coverage to ensure that all Americans can access high quality care; should they preserve choices among most patients who may not require comprehensive coverage, or protect the sickest Americans who require the most expensive health care; and minimize cost by shifting it to the states and consumers or limit the cost liability for the federal government. Making decisions about these options or striking a balance across the options will involve value and political calculation about what they intend the American health care system to look like in terms of key objectives.

 

 

References

Belland, D., Rocco, P. & Waddan, A. (2016).
Obamacare Wars: Federalism, State Politics, and the Affordable Care Act
. Lawrence, KS: University Press of Kansas. Local, State, or Federal Health Policy Analysis Paper

Geyman, J. (2018).
Crisis In U.S. Health Care: Corporate Power Vs. The Common Good
. New York, NY: Copernicus Healthcare

Glassman, A., Giedion, U. & Smith, P. (eds.) (2017).
What’s In, What’s Out: Designing Benefits for Universal Health Coverage
. Washington, DC: Center for Global Development.

Tripati, A. K. (2018).
Obamacare Trumpcare Explained: Obamacare-Trumpcare Pro’s and Con’s
. New York, NY: SureShot Books Publishing LLC. Local, State, or Federal Health Policy Analysis Paper

N508 Theory and Research

Module 7 Assignment

Explore the National Institute of Nursing Research (NINR) website: http://www.ninr.nih.gov/ Review their publication Bringing science to life: NINR strategic plan (2011, p. 7) to identify the current priorities for nursing research.Do you agree with the priorities or would you recommend addition or elimination of some of the priorities? What effect do the nursing research priorities have on nursing researchers?

What criteria must be met in order to consider a practice, evidence-based? Provide examples. Explain the role quality plays in evidence-based practice?

Based on the information you’ve learned to this point, write a research proposal that relates to the topics you chose for a previous assignment. Be sure to include the following information in your proposal:

Hypothesis

Theory

Design model

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Method

Anticipated results

Potential Dissemination Avenues

The assignment should be between 1500 and 2000 words in length and contain at least two scholarly sources, in addition to the textbook and provided material. Please submit your assignment in one APA formatted document N508 Theory and Research

Advanced Nurse Practitioner Role Essay

Advanced nursing practice is regulated by state licensure which tends to vary from one state to another especially in regards to full practice authority/autonomous practice. In this context, full practice authority involves allowing nurse practitioners to assess, diagnose, order and interpret tests and manage patients accordingly under an exclusive licensure authority (Hain & Fleck, 2014). Advanced Nurse Practitioner Role Essay However, approximately only a third of the country has adopted and issued licenses for full practice authority. Other nurse practitioners either have reduced licensure and practice or restricted licensure and practice. According to Hain & Fleck (2014), this means that, for nurse practitioners to engage in some elements of practice, they ought to be supervised, in the form of a delegation or team management. Advanced Nurse Practitioner Role Essay

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Another challenge is that most physicians strongly believe that since they undergo a more rigorous form of training as compared to nurse practitioners, NPs cannot provide safe, quality care as physicians do (Hain & Fleck, 2014). Therefore, NPs have failed to gain the support of and collaborate with physicians in clinical settings for best practice and good health outcomes. Although both NPs and physicians have a common goal of improving health outcomes and access to care, the barriers to a successful collaboration impede the attainment of these goals (Hain & Fleck, 2014).  This can be attributed to lack of knowledge on the scope of training and practice of nurse practitioners.

For more than half a century, nurse practitioners have continuously been providing acute, primary and special care. According to the AANP, the roles of NPs have expanded to include administration in professional-level and executive-level positions (Goolsby & DuBois, 2017).  Similarly, the role of AANP as a professional organization for more than 270,000 qualified NPS has expanded to include legislative leadership at different levels of government, health policy advancement, research and education and the establishment of standards which promote excellence and best practice. Advanced Nurse Practitioner Role Essay

References

Goolsby, M. J., & DuBois, J. C. (2017). Professional organization membership: Advancing the nurse practitioner role.
Journal of the American Association of Nurse Practitioners
,
29
(8), 434-440.

Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign.
OJIN: The Online Journal of Issues in Nursing
,
19
(2). Advanced Nurse Practitioner Role Essay

N508 Module 6 Assignment

Question

N508 Theory and Research

Module 6 Assignment

Locate a nursing study that examines the effects of an intervention. Provide a summary of the study, focusing primarily on the intervention. Was the development and implementation of the intervention described in detail? Based on a theoretical framework? Did the design of the study promote investigation of the effects of the study—for example, was there comparison of experimental and control groups? Were there variables that could have impacted the findings that were not part of the intervention? Was there evidence of efforts to monitor the safety of participants? Are there any ways that the study could have been improved?

Locate a nursing study that utilizes some aspect of the internet (for instance, for recruitment, delivery of an intervention, or completing online assessments. What challenges did the researchers face, and how were these challenges overcome (or not)? How could future research efforts be improved?

Using your computer’s office tools, develop a pie, bar, or plot chart to represent the following population estimates:

Population                         Percentage

European American                         20

African American                             30

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Native American                              20

Hispanic American                           30

The assignment should be between 1500 and 2000 words in length and contain at least two scholarly sources, in addition to the textbook and provided material. Please submit your assignment in one APA formatted document. N508 Module 6 Assignment

SOAP Note Template

SUBJECTIVE DATA:

Patient Initials: _____    Age: _____      Gender: _­­­­__

Chief Complaint (CC):

History of Present Illness (HPI):

O
nset:

L
ocation:

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D
uration:

C
haracteristics:

A
ggravating factors:

R
elieving factors:

T
reatments/Therapies:

S
everity:

Medications:

           

Allergies:

SOAP Note Template

Past Medical History (PMH):

            

Past Surgical History (PSH):

 

OB/GYN History:

            Menstrual History:

Age at menarche –

LMP-

Menstrual Pattern

Duration of flow-

Amount of flow-

Associated pain with menses-

Intermenstrual bleeding-

Menopause-

Contraception:

Current method and satisfaction-

Previous methods, complications, and reasons for discontinuation- SOAP Note Template

 

Cervical and vaginal cytology:

Most recent Pap –

History of abnormal pap smears-

Infections:

No history of STIs, vaginitis, or PID (if this is true for your patient)

Fertility/infertility:

      
1.

Sexual History: (example)

Heterosexual, mutually monogamous relationship

No concerns with libido or orgasm. Has experienced intermittent dyspareunia x 1 month.

No history of sexual abuse or assault

Denies sexual intercourse in the last 7 days. SOAP Note Template.

Obstetric history: (example)

G1P1001

Denies maternal, fetal, or neonatal complications

Personal/Social History:

 

Health Maintenance:

(include things such as vitamin supplementation, diet, exercise routine, seatbelt use sunscreen use, firearms in the household, last pap and results, sigmoidoscopy/colonoscopy, bone densitometry, lipid analysis, glucose, or thyroid testing) SOAP Note Template

Immunizations History:

 

Significant Family History:

(don’t forget to list any family history of breast, ovarian, or uterine cancer)

Review of Symptoms:

General:

Skin:

HEENT:

Neck:

Breasts:

Respiratory:

Cardiovascular/Peripheral Vascular:

Gastrointestinal:

Genitourinary:

Musculoskeletal:

Psychiatric:

Neurological:

Hematologic:

Endocrine:

Allergic/Immunologic:

 

OBJECTIVE DATA:

Physical Exam:

Vital Signs

 

General:

HEENT:

Neck:

Chest:

Lungs:

Heart:

Peripheral Vascular:

Abdomen:

Genital/Rectal:

External Genitalia:

Vulva/Labia Majora:

Bartholin Gland:

Skenes:

Clitoris:

Urethra:

Bladder:

Vagina:

Cervix:

Uterus:

Adnexa:

Rectum:

Musculoskeletal:

Neurological:

Lymph Nodes:

Skin:

Lab/Diagnostic Tests and Results
: (example)

Urine hCG- negative

Pap smear- results pending

Vaginal culture- pending

Urine STD panel- pending

Transvaginal US- pending

SOAP Note Template

 

ASSESSMENT:

Differential Diagnosis (DDx):

 Final Diagnosis:

PLAN:

Referrals-

Further labwork or diagnostics needed??

F/U

Health Promotion:

Disease Prevention:

 

Reflection:

            

References

SOAP Note Template