Tag: Clinical-Nursing

NSG 6020 Week 1 Discussion HISTORY collection

Discussion Question 1

Based on your performance and the expert feedback in your 
HISTORY
 collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.

This week’s case study was quite insightful for me.  There were definitely several questions that I regretfully missed the opportunity to ask my patient.  One question I should have asked Rachael was “Do you have any swollen lymph nodes?” Breast cancer can spread to lymph nodes, so her lymph nodes might be affected. “Malignant cells from a breast cancer may spread directly to the infraclavicular nodes or into the internal mammary chain of lymph nodes within the chest” (Bates, Szilagyi, & Hoffman, 2017, p. 422). Another question I should have asked was “Is the lump movable?” as lumps that are movable are often benign. “Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest cancer” (Bates, Szilagyi, & Hoffman, 2017, p. 438). NSG 6020 Week 1 Discussion HISTORY collection

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Discussion Question 2

Based on your performance and the expert feedback in your 
PHYSICAL EXAM
 collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.

In my assessment of Rachael, I failed to note the consistency of the lumps in her breast.  It is important to note the consistency of any lumps and determine if they are soft, firm, or hard (Bates, et al., 2017).   I also failed to note delimitation. NSG 6020 Week 1 Discussion HISTORY collection Delimitation is describing the boundaries of the lumps.  Noting whether the lumps are well circumscribed or not is another important detail in the breast assessment.  “Assess and describe the characteristics of any nodule: location, size, shape, consistency, delimitation, tenderness, and mobility” (Bates, et al., 2017, p. 438).

Discussion Question 3

Based on your performance on the 
PHYSICAL EXAM
collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text. NSG 6020 Week 1 Discussion HISTORY collection.

One key finding in my physical assessment was a one centimeter right axillary lymph node that was firm but mobile.  To further evaluate this finding, I can completely examine the axillary area.  The text explains exactly how to examine for lymph nodes: “To examine the left axilla, ask the patient to relax with the left arm down and warn the patient that the examination may be uncomfortable. Support the patient’s left wrist or hand with your left hand. Cup together the fingers of your right hand and reach as high as you can toward the apex of the axilla. Place your fingers directly behind the pectoral muscles, pointing toward the midclavicle. Now press your fingers in toward the chest wall and slide them downward, trying to palpate the central nodes against the chest wall. Of the axillary nodes, the central nodes are most likely to be palpable. One or more soft, small (<1 cm), nontender nodes are frequently felt” (Bates, et al., p. 440). If any of the centrally located nodes are large, tender, or hard, or if there is a concerning lesion in the axillary nodes drainage areas, palpate for the other groups of axillary lymph nodes in the pectoral, lateral, and subscapular nodes, as well as re-examine the infraclavicular and supraclavicular nodes (Bates, et al., p. 441.) NSG 6020 Week 1 Discussion HISTORY collection Discussion Question 4 Based on your performance and the expert feedback in your  ASSESSMENT  identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client. A missed category that I missed was the unintentional weight loss experienced by Rachael.  Malignancy is linked to unexplained weight loss Gannavarapu, et al., 2018).  Unintentional weight loss should therefore always be investigated further.  As this patient has hypothyroidism, which is generally associated with weight gain, rather than weight loss, this weight loss is of even greater concern. NSG 6020 Week 1 Discussion HISTORY collection. Discussion Question 5 Based on your performance and the expert feedback in your  ASSESSMENT  of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client One diagnosis I missed was fat necrosis.  Upon exam, if breast dimpling or retraction is seen, this suggests underlying cancer.  Cancer can cause fibrous strands to be attached to the skin and fascia which lie over the pectoral muscles.  This may cause dimpling inward of the skin during contraction of the muscle.  Sometimes, this sign may signify a benign condition such as fat necrosis, but it should always be evaluated further to be sure (Bates, et al., 2014, p. 436.) NSG 6020 Week 1 Discussion HISTORY collection.   Discussion 2 Discussion Question 1 Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain. The first question I missed was does your breast problem come and go? To assist a patient in describing a complaint, a nurse practitioner must know how to ask salient and focused questions to draw out necessary information. It is important to know the particular symptoms that  brought the patient to seek medical help. The second question I missed was when did the problems of your breast start? It is important to ask this history question because identifying when the problem first started and  how it has changed or progressed since the onset helps in the assessment, evaluation and diagnosis process. NSG 6020 Week 1 Discussion HISTORY collection. Discussion Question 2 Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings incorrect assessment of this client. My first error was I did not auscultate required respiratory locations, which would have better identified the patient’s lung pathology. Auscultating the lungs for adventitious sounds, particularly crackles at the bases, which might indicate heart failure while other adventitious sounds could indicate a respiratory rather than cardiac cause. NSG 6020 Week 1 Discussion HISTORY collection. My second error was I did not auscultate lung in the correct order. To get a correct assessment of a patient lung field auscultation needs to be done in the correct order because breath sounds vary in intensity, volume and duration depending from each base of the lung to another. Discussion Question 3 Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text. One key finding is breast lumps found in the right breast through breast examination of the patient. This is a physical exam I will perform at the point of care. Discussion Question 4 Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client. One missed category in my assessment was breast mass/lump, neoplastic. In Rachael’s case, the presence of multiple masses excludes nearly all other diagnoses, Rachael’s family history, and the presence of an axillary lymph node is a must-not-miss NSG 6020 Week 1 Discussion HISTORY collection. It is important to arrive at the correct differential diagnoses for this client because this client’s history meets specific criteria for being  high risk for breast cancer which includes of her age, family history, (first degree relative with breast cancer), personal history (history of ductal hyperplasia), present history, and surgical history (breast biopsy) (16, Goolsby, Grubbs, 2015). Discussion Question 5 Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client. Breast abscess was of the one incorrect diagnosis. It contradicts the fact that Rachael experienced no pain and suffered no trauma also with the breast examination. NSG 6020 Week 1 Discussion HISTORY collection Rachael had no pain, breasts were not red, or warm to touch, and breasts had no swelling, which are general symptoms of breast abscess. The patient also did not have a high temperature or feel unwell. Although any breast mass should be carefully evaluated and usually warrants further testing like biopsy and mammogram (17 Bickley, 2016). NSG 6020 Week 1 Discussion HISTORY collection

Part A

In the first part of this discussion, you are encouraged to think about the language used by both professionals and lay people to refer to individuals with substance use disorders.

Terms like “drunk”, ”junkie”, ”pot head’ and “coke head” may seem obviously derogatory. But what do you think about referring to people as “addicts” or “alcoholics”?

What do you think is the impact of labeling someone as a ”addict, alcoholic, substance-user, or abuser” as opposed to referring to them as ”a person with a substance use disorder”? substance use disorder essay

How might differences in language to to refer to people with substance use disorder, impact how we think about our patients?

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How might these differences in language impact how patients view and think about themselves and how they participate in treatment?

Part B

Next, using what you have learned in the module lectures and in the video, please address the following questions:

Discuss the importance of having a thorough patient assessment (also called a psychosocial assessment or psychosocial history) prior to beginning substance use disorder treatment.

What are some common barriers or obstacles you might expect when attempting to complete an assessment?

What are potential strengths and drawbacks of using one or more validated screening tools as part of the assessment process? substance use disorder essay

While some prefer an open-ended interview approach, what are the advantages of a structured assessment approach?

How does the assessment of a patient connect to the level of care, interventions and counseling methods the counselor chooses?

 

Terminology, screening and assessment

Part A

Question 1.

Although referring to people as addicts and alcoholics is not derogatory, the use of these terms is still discouraged since they inadvertently stigmatize the people who have addictive behaviors since it presents the notion that they are personally culpable for the condition and deserve punishment. In fact, these terms are pejorative. As stigmatizing and pejorative terms, they affect the behavior and perceptions of medical personnel, patients, their family members and the rest of the community. Instead, the individuals with these conditions should be described using the clinical condition and test results. To be more precise, alcoholics should be referred to as persons with alcohol use disorder and addicts should be referred to as persons with substance use disorder (Kelly, Wakeman & Saitz, 2015).

Question 2.

As earlier indicated, labeling someone as an addict, alcoholic, substance-user or abuse stigmatizes the individual since it presents the notion that the individual is personally culpable for the condition and deserves punishment. Referring to the person as a substance abuser or individual with substance use disorder creates the perception that the individual is a victim deserving of respect and care, rather than blame and punishment (Kelly, Wakeman & Saitz, 2015).

Question 3.

The language used to refer to persons with substance use disorder has an impact on how we think about the patient. That is because they affect our behavior and perception. For instance, the use of derogatory and stigmatizing terms creates the notion that the individual made the informed personal choice to have the condition and should be blamed and punished. On the other hand, substance use disorder is a term that would invoke sympathy, showing that the individual should neither be blamed nor punished for having the disorder. As such, the terms used to refer to the individuals with the disorder determine whether they will be blamed or accepted by other stakeholders (Kelly, Wakeman & Saitz, 2015) substance use disorder essay.

Question 4.

The terminologies have an effect on how patient perceive themselves and behave. The use of derogatory and stigmatizing terms reduces the patients’ self-worth and makes them less receptive to treatment since they would consider the condition as a deserved punishment for past vices. In contrast, the use of non-derogatory and non-stigmatizing terms improve the patients’ self-worth, making them feel that they deserve treatment and care. This makes them receptive to treatment as they feel that the condition is an unfortunate incidence that can be corrected through faithfully adhering to the treatment regime (Kelly, Wakeman & Saitz, 2015).

Part B

Question 1.

A thorough patient assessment prior to treatment beginning is important since it serves three functions. Firstly, it determines whether the patient can withstand the stresses of the selected treatment plan or if it is necessary to adopt an alternative treatment approach. This is based on the risk assessment results. Secondly, it determines if it is necessary to modify the treatment plan based on the presented physicals, history and classification system. Thirdly, it determines if the patients require supplementary treatment based on other presenting conditions and how they would affect the treatment plan (Wheeler, 2014) substance use disorder essay.

Question 2.

There are five common barriers to completing an assessment. The first barrier is reliance on technology, other medical personnel and other resources such that their absence hinders the assessment. The second barrier is lack of time and interruptions that make it difficult to conduct a comprehensive assessment. The third barrier is facility/hospital culture that presents policies and standards that could hinder efforts to collect some information. The fourth barrier is lack of confidence that hinders medical personnel from conducting assessments. The final barrier is specialty area that limits medical personnel to conducting assessment in areas in which they specialize (Wheeler, 2014).

Question 3.

Validated screening tools used in assessment processes have some strengths and weaknesses. The strengths of these screening tools include ability to assess several areas, availability in different versions and languages, sensitivity for the targeted condition, and ease of administration. The drawbacks include interpretation complexity as patient demographics (cultural background, education and age) affect scores, inability to detect subtle effects, non-comprehensive approach that ignores potentially important information, and having a narrow scope that does not allow for non-classic cases to be assessed (Wheeler, 2014).

Question 4.

Structured assessment approaches offer some advantages. Firstly, they improve the relevance of the collected information, especially when they use algorithms and prompts. Secondly, they reduce the incidence of missed information. Thirdly, they improve the quality and completeness of clinical documentation. Fourthly, they improve communication between patients and medical personnel substance use disorder essay. Fifthly, they improve implementation of care. Sixthly, they act as real-time visualization tools that provide clarity to the case. Finally, they bring the patient into the discussion early thereby improving the value and quality of the collected information (Wheeler, 2014).

Question 5.

The assessment of a patient is linked to the level of care, intervention and counseling methods chosen. This occurs through evidence-based protocols and guidelines that improve and standardize care by employing guidelines for care that are adapted to meet the unique needs of each case. In fact, the results of the assessment act as input for personalizing the evidence-based care guidelines for each case (Wheeler, 2014). substance use disorder essay

 

 

References

Kelly, J., Wakeman, S. & Saitz, R. (2015). Stop talking ‘dirty’: Clinicians, language, and quality of care for the leading cause of preventable death in the United States.
American Journal of Medicine
, 128, 8–9.

Wheeler, K. (Eds.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(2
nd
ed.). New York, NY: Springer Publishing Company substance use disorder essay.

ihuman HISTORY collection discussion

Discussion Question 1

Based on your performance and the expert feedback in your 
HISTORY
collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain ihuman HISTORY collection discussion.

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One of the questions that I did not ask was, “Does she have any pain anywhere? If so where?” I guess I did not ask this because I assumed the patient wouldn’t be able to verbalize if she were having pain. The mother’s response was “I think she is having pain because she has been fussy, but she can’t tell me where.” I did ask if the patient had been tugging at her hears though. I should have asked this question to the mother and also used the FLACC scale and compare the patient’s facial expression. FLACC scale, for children aged two to seven, assesses a child’s pain based on their facial expression, leg and arm movements, the extent of crying and ability to be consoled (Sickkids Staff, 2009). I also did not ask if the patient was having discharge or bleeding from her ears. Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook explain, “Discharge in the canal without acute otitis externa suggests perforation” (p. 374). Purulent discharge in the ear canal may be sampled for culture and used as a basis for antibiotic selection (Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook, p. 374). This would be important information to have. The drainage would be beneficial to test for sensitivity especially if the ear infection were recurrent.

Discussion Question 2

Based on your performance and the expert feedback in your 
PHYSICAL EXAM
 collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.

 

An error in the physical exam I made was inspecting the eyes with an ophthalmoscope. I should have only assessed the eyes by looking at the conjunctiva to assess hydration. I would not use the ophthalmoscope on a 2-year-old because it would not be necessary for this patient and she would probably not sit still. If it were more serious to assess her eyes I would. Using the ophthalmoscope to visualize the fundus is one of the most challenging skills of physical examination, and one of the most critical when assessing head-ache and changes in mental status (Bickley, p. 238). The other physical examination that I missed was a visual inspection of the chest wall and lungs. Since the patient is having a cough, fever, and runny nose and diagnosis of upper respiratory infection is on my radar I should have chosen this exam in order to assess for retractions. If retractions are present then the patient is working to breathe and maybe in respiratory distress. Abnormal muscle retraction of the intercostal spaces occurs during inspiration, most visible in the lower intercostal spaces (Bickley, p. 319) ihuman HISTORY collection discussion.

Discussion Question 3

Based on your performance on the 
PHYSICAL EXAM
 collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.

 

One key finding that I found was bilateral tympanic membranes with erythema and severe bulging. I visualized this by using the otoscope. The otoscope allows you to visualize the ear canal and drum (Bickley, p. 245). I will start by positioning the patient’s head so that I can see comfortably through the otoscope (Bickley, p. 245). Bickley explains how to inspect the ear using an otoscope as,

“First straighten the ear canal, grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. Insert the speculum gently into the ear canal, directing it somewhat down and forward and through the hairs, if any. Inspect the ear canal, noting any discharge, foreign bodies, redness of the skin, or swelling. Cerumen, which varies in color and consistency from yellow and flaky to brown and sticky or even too dark and hard, may wholly or partly obscure your view. Identify the handle of the malleus, noting its position, and inspect the short process of the malleus. Gently move the speculum so that you can see as much of the drum as possible, including the pars flaccida superiorly and the margins of the pars tensa. Look for any perforations.” (p. 245-246).ihuman HISTORY collection discussion

Discussion Question 4

Based on your performance and the expert feedback in your 
ASSESSMENT
 identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.

 

One of the problem statements that I did not include in my list is the patient being exposed to other sick children at school and a history of the common cold. The presence of sinus and nasal congestion is relevant because otitis media is typically secondary to a cold or sinus infection (Goolsby and Grubbs, p. 131). Signs and symptoms of otitis media commonly are a current or recent history of symptoms consistent with an upper respiratory infection, including nasal congestion, sinus pressure/fullness, or sore throat (Goolsby and Grubbs, p. 132). The patient has symptoms of fever, cough, and runny nose. Upon physical inspection, the patient’s pharynx noted to have erythema and exudate.

Discussion Question 5

Based on your performance and the expert feedback in your 
ASSESSMENT 
of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.

 

One of the diagnoses that I did not consider was influenza. I am not sure why I didn’t include this in my differential diagnosis list. Maybe if the scenario stated which time of year it was I would have considered it. Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook explain,

“Influenza is an acute infection of the respiratory tract caused by influenza virus type A or B. It is usually a self-limited disease that occurs in outbreaks, primarily during the winter months. Influenza is transmitted from person to person through respiratory secretions that contain the virus. These respiratory secretions are spread in the form of droplets that are produced when a person talks, coughs, or sneezes. The virus is detectable and maybe shed in respiratory secretions up to 24 hours before the onset of symptoms. After an incubation period of 1 or 2 days, there is an abrupt onset of symptoms. These symptoms include fever, chills, headache, malaise, myalgia, and loss of appetite. Respiratory symptoms are also present but are usually overshadowed by the severity of the systemic symptoms. Respiratory symptoms include dry cough, nasal congestion with clear discharge, and sore throat. The cough is usually the most prominent of these respiratory symptoms. The patient’s temperature rises rapidly after onset, peaking at 37.7° C to 40° C (100° F to 104° F) in about 12 hours. The fever typically begins to decline on the second or third day but may last as long as 4 to 8 days” (p. 1241).

 

 

Discussion 2

 

Discussion Question 1

(In this week two assignment, I am still figuring out how to navigate iHuman.  The program completely froze up on me after nearly completing it, twice.  It also reported several questions as “missed”, even though I had asked those questions to this patient’s mother.  I am hoping to soon work out the kinks in iHuman and hopefully will not continue to have these difficulties in the coming weeks.)

One of my missed history questions was “How high is her fever?”  I did ask Emma’s mother if she had a fever but failed to ask how high her fever had spiked.  This is important to know as a health care provider, as a low-grade fever and a high fever can dictate very different plans of care (Goolsby & Grubbs, 2015).  Another question I failed to ask was “What treatments has she had for her fever?”  When her mother informed me that she had given Emma Tylenol, I assumed that she had given her Tylenol for her fever, but I should not have assumed this, and should have followed up on the timing and dosage of the Tylenol, as well as the reasoning behind why she had given the Tylenol.  In addition, I should have asked what Emma’s response to the Tylenol was, and whether her fever had responded to it.

Discussion Question 2

The two missed exams reported were eyes and chest wall and lungs- visual inspection.  It is important to check for conjunctivitis in any child with upper respiratory infection symptoms.  It is also important to check for the use of accessory muscle use when breathing in a child with upper respiratory infection symptoms (Bickley, Szilagyi, & Hoffman, 2017).  (Again, I did perform this exam, but must have done something wrong for it to not have registered on iHuman).

Discussion Question 3

One key finding I included was cough.  According to Goolsby and Grubbs (2014), a cough is common complaint, but nonspecific in nature.  A cough is an important defense mechanism and is often the reason why patients seek treatment.  Cough can be a symptom of a mild or serious ailment (Goolsby and Grubbs, 2014).  When a cough lasts less than three weeks, it is classified as acute.  If it lasts three to eight weeks, it is classified as subacute.  A chronic cough lasts eight weeks or longer.  These classifications help to distinguish potential diagnoses.  Performing a thorough history and physical helps to determine possible causes and differentiate between severe illnesses and mild illnesses, such as asthma, COPD, acute or chronic bronchitis, GERD, heart failure, or lower or upper respiratory infections (Goolsby and Grubbs, 2014, p. 211-212).  Taking a thorough medication history will help to exclude a cough that is induced by an ACE inhibitor.  The patient’s prior treatment for cough, whether prescribed or self-treated, should also be recorded.

Discussion Question 4

One missing category in my assessment was an influenza PCR.  I did send a rapid influenza diagnostic test, but I should have also sent an influenza PCR.  An influenza PCR can be more specific than a rapid influenza test and so should have been done.

Discussion Question 5

            
I did not include the possible diagnosis of pertussis.  Pertussis is a cough that is paroxysmal with a “whoop” at the end (Bickley, et al., 2017, p. 923). Due to the increase in pertussis infections, both the CDC and ACOG recommend that women receive the TDaP during pregnancy, between the 27
th
 and 36
th
weeks (Bickley, et al., 2017, p. 937).

Advanced Practice Nursing Role Development Essay

Assignment 1

​​​ Interview Assignment (20 points)

Interview Guide

• The purpose of this assignment is to explore the role of the advanced professional nurse in depth as she /he functions in the context of the institution in which he/she is employed. Compare and contrast the observed /evaluated role to that cited in professional guidelines, theory, and research.

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• Guidelines:

a. Develop an Interview Guide with 10 questions, which reflect the topics reviewed in the course such as: professional expectations, health policy, reimbursement, professional role history, theoretical foundations of research and EBP, ethics in healthcare, leadership, interprofessional collaboration, and/or any other relevant issues that affect the professional role Advanced Practice Nursing Role Development Essay.

b. Using the developed interview guide, schedule an interview with an advanced professional nurse to learn about their role within the health care system. Please include the interview questions in your paper (see APA 6th ed. for guidelines to writing an interview). Prior to the interview, review the mission, vision, and goals of this agency. Does this professional nurse carry out the mission, vision, and goal of the agency and how?

This paper should be 5 pages and NO MORE than 5 pages (excluding title page, abstract, and reference page) and include. Advanced Practice Nursing Role Development Essay.

• Title page

• Abstract

• Introduction

• Interview (include questions)

• Conclusion

• Reference page (minimum of 4 references, excluding your text)

APA 6th ed. is the required format, double-spaced, 12 point font.

 

Abstract

The advanced practice registered nurse has become an important cornerstone in the provision of primary health care in the country. They bridge a very important gap between the physician and the disadvantaged in the society. In a country where health care is one of the most expensive commodities, the APRN has an important role to play in ensuring affordable universal health coverage for all Advanced Practice Nursing Role Development Essay. To achieve this, the advanced practice nurse has very well defined professional roles that fit in well with this objective of primary health care for all. Unfortunately, in the quest to exercise their designated roles the APRNs find themselves facing resistance and limitations both from the system and the healthcare fraternity itself. These frustrations and hindrances are the factors that are threatening to derail the noble objective of having advanced practice nurses, as had been envisioned by the pioneers of the discipline in 1965.

Key words: advanced practice nurse, APRN roles, interview.

The Roles of the Advanced Practice Registered Nurse (APRN) According to Professional Guidelines As Opposed to the Reality on the Ground: An Interview with Lauren O’Connor, PhD, ARNP, ANP-BC

Introduction

The title of APRN refers to a nurse who has undergone extensive advanced training and education at the postgraduate level with at least a masters degree in their specialty. This nurse is registered, certified, and licensed to practice by the state in which they are practicing. The high level of training and education equips the APRN with all the necessary skills to offer the highest level of clinical care to the patient. However, this is an inclusive term that encompasses the different role specialties of the APRN, viz. the certified nurse midwife (CNM), the clinical nurse specialist (CNS), the certified nurse practitioner (CNP), and the certified registered nurse anaesthetist or CRNA (DeNisco & Barker, 2014). Because of their training, the APRN possesses the competence to independently evaluate, diagnose, order and interpret laboratory and non-laboratory tests, treat, and follow up patients. This is what the APRN is trained and qualified to do. However, the situation on the ground is more often than not dissimilar to the picture painted above. Some serious limitations still exist and which hinder and impede the APRN from practicing to the full extent of their abilities and education. These issues are largely to do with recognition and acceptance by the state healthcare system and physician cadres, reimbursement or payment for services rendered, and prescriptive independence (Gordon et al., 2012; DeNisco & Barker, 2014). The first training program for nurse practitioners aiming at equipping them with primary health care skills was in 1965. It was a certificate course. By 1970, tremendous progress had been made such that the course was now being offered as a bachelors and masters degree (Hain & Fleck, 2014) Advanced Practice Nursing Role Development Essay.

The National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee and the APRN Consensus Work Group have outlined the roles of the advanced practice nurse in the
Consensus Model for APRN regulation
, which is a policy guideline (DeNisco & Barker, 2014). These roles are four and they flow from the four designations of the APRN as stated previously. Thus the APRN serves the clinical nurse specialist role, the nurse anaesthetist role, the nurse-midwife role, and the nurse practitioner role. Other roles of the advanced practice nurse have also emerged with the passage of time and include the clinical nurse leader role and the nurse educator role (DeNisco & Barker, 2014). According to the American Nurses Association (ANA, n.d.), though, these four broad APRN roles can be spread out into finer specific roles as follows:

Evaluation, diagnosis, treatment, and follow up of patients at the primary health care level;

Provision of reproductive health care, especially to vulnerable women in ethnic minorities and immigrant populations;

Provision of expert nursing advice and guidance to bedside nurses on the best evidence-based practices (EBPs);

Implementation of pain management and delivery of sufficient and appropriate anaesthesia (nurse anaesthetists) for patients undergoing surgery;

Engaging in continuous knowledge acquisition and development for the betterment of the nursing profession;

Provision of preventive care and promotion of health. Advanced Practice Nursing Role Development Essay.

The APRN also acts as a valuable team member in the health care chain, working in close collaboration with physicians and other clinicians while referring difficult cases as appropriate. This paper looks at the practical discrepancies that are currently present  in terms of what the guidelines indicate are the roles of the APRN and what happens in reality. The views of an experienced and practicing APRN will be sought through interview questions concerning this pertinent matter of professional roles.

Interview

It is not easy to get the real picture of the challenges and limitations that APRNs experience on their role in practice by merely reading literature. For this reason, an interview was found to be one of the most effective ways to get primary unadulterated information on the subject. This was to get a feel of the actual role of the APRN in practice and the factors that impact this role. The telephone interview was scheduled with a practicing APRN. Lauren O’Connor [PhD, ARNP, ANP-BC] is a nurse practitioner who has been practicing the profession for 15 years. She teaches at the university and is an associate professor who has published several hard-hitting peer-reviewed journal articles and opinion pieces. Her pet subjects are full practice authority (FPA) for APRNs, equitable reimbursement for APRNs by payers, and admission rights for nurse practitioners in hospitals. Because of her wide expertise and experience, she is the most suitable person to respond to the questions that touch on the advanced practice nursing role. The vision of her agency is “To be the state leader in the provision of holistic primary health care to marginalised communities and minority groups.” Its vision is “To significantly reduce the prevalence of non-communicable diseases and conditions together with mental health issues like depression in the target population.” And its goal is “To achieve sustainable and affordable primary health care for ethnic minorities and marginalised communities in the catchment area by the year 2025.”

I started by asking Lauren, “What are some of the professional expectations that you would advise the new APRN to look forward to?” She answered that the new entrants should expect a fulfilling and rewarding career that will give them an opportunity to exercise their talents and put to practice their education. However, she cautioned that the advanced practice nurse should expect to find some hurdles here and there; and that it is important for them to anticipate these hurdles so as not to be disillusioned. She went ahead to single out what she termed as the “most challenging” obstacle to the APRN’s role – the lack of recognition of the nurse practitioner in some quarters. Next I asked Dr. Lauren, “Considering the history of the APRN’s professional role, do you think a lot has changed up to the present for the better?” she responded that: Advanced Practice Nursing Role Development Essay.

Since 1965 when the first certificate course for nurse practitioners was started by Loretta Ford and Henry Silver, a lot of water has passed under the bridge. The contemporary APRN is a highly educated health professional capable of managing even the most challenging of ailments. Certainly, the APRN’s role has expanded since then. (L. O’Connor, personal communication, September 12, 2019).

I next asked Dr. Lauren, “What is your view on the professional relationship between APRNs and physicians as at present?” Her answer was that most physicians are working “seamlessly” with advanced practice nurses. However, she noted that there is still a sizeable number of practicing physicians that do not properly understand the role of the APRN. These physicians are the ones frustrating the professional efforts of the nurse practitioners, according to Dr. Lauren. In fact, she says that some of them have gone as far as using their professional bodies to lobby against granting of full practice authority to APRNs in some the states that are still restrictive. Next I asked her, “How bad is the question of selective reimbursement by payers towards APRNs – especially the Centres for Medicare and Medicaid Services or CMS?” Her answer was:

It is quite bad, although slow progress is being made. Many advanced nurse practitioners still have to bill ‘incident-to’ physicians’ services. This means their contribution to the healthcare system remains hidden. Furthermore, their income is reduced as they have to pay the physician whose name they use to bill. (L. O’Connor, personal communication, September 12, 2019).

On health policy I asked her, “Is the federal health policy adequate to empower APRNs, given that the Affordable Health Care Act of 2010 relies on them for the increased primary health care burden?” to this question, her response was straight forward: “No. It is not adequate. What makes it even more ineffective in my opinion are the disparate legislations and regulations of different states that at times do not align with the aspirations of the federal government” (L. O’Connor, personal communication, September 12, 2019). On practice philosophy, I asked Dr. Lauren “Are the current APRNs basing their interventions on the theoretical framework of research and evidence-based practice or EBP?” Her response was simply “Yes. EBP is nowadays the cornerstone of all interventions and therapies.” I then asked her, “Do you feel that you’re sufficiently involved in championing the mission, vision, and goals of the agency that you work for, and how?” Her response was:

Of course. I do this my adopting a Total Quality Management or TQM philosophy. This means I strive to reduce “defects” in my APRN practice to the very minimum. These defects include issues like misdiagnosis, unwarranted prescription of scheduled drugs, and lack of respect for the ethical principle of autonomy. L. O’Connor, personal communication, September 12, 2019) Advanced Practice Nursing Role Development Essay.

The last 3 questions I asked her were, “How are APRNs agents of change in a country of expensive healthcare, with regard to ethics?” “What is the place of APRNs in healthcare leadership?” and “To what extent are APRNs vulnerable to malpractice suits?” Her answers: “APRNs are guided by nonmaleficence; leadership is one of their roles; and they are very vulnerable to suits hence must take individual indemnity cover for the same.”

Conclusion

APRN roles are defined by professional scopes of practice and guidelines. However, there still exists hindering limitations to the full expression of these roles.

References

American Nurses Association [ANA] (n.d.).
Advanced practice registered nurse (APRN): APRNs practice specialty roles
. Retrieved 12 September 2019 from
https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Bloom, L. (2018).
How to write an interview in APA format
. Retrieved 12 September 2019 from
https://work.chron.com/write-interview-apa-format-6612.html

DeNisco, S. & Barker, A. (2014).
Introduction to the role of advanced practice nursing
. Retrieved 12 September 2019 from bit.ly/2mbdGwR

Gordon, J.M., Lorilla, J.D. & Lehman, C.A. (2012). The role of the clinical nurse specialist in the future of health care in the United States.
Perioperative Nursing Clinics
, 7, p. 343-353. Doi: 10.16/j.cpen.2012.06.006

Hain, D. & Fleck L.M. (2014). Barriers to NP practice that impact healthcare redesign.
The Online Journal of Issues in Nursing, OJIN
, 19(2). Doi: 10.3912/OJIN.Vol19No02Man02 Advanced Practice Nursing Role Development Essay

Developmental Assessment and the School-Aged Child

Developmental Assessment and the School-Aged Child sample essay

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

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Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.

Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.

Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Developmental Assessment and the School-Aged Child sample essay.

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

 

Child Developmental Assessment

Child development assessment is the processes of obtaining basic data about their growth and development. The essential aspect of the data being collected include cognitive, language, physically/motor, social-emotional and approaches to learning. Thus, while collecting the information the assessor aims at gaining a record growth in all the areas. Other than growth monitoring, child assessment is also essential in identifying children with special needs that may require extra support (Kaufman, 2018). When the thorough examination is conducted, the assessor identifies a specific need which is vital in determining the interventions required to support the child. Child evaluation also allows the assessor to develop an individualized strategy for a child or group of them in the same age that he/she will use to provide care. Furthermore, the process of assessment involves the parents or guardians of the child thus, developing common ground between the care provider and the parents for providing child support. Thus, Child development assessment cannot be overemphasized.

Human needs vary with age; hence data obtained is different at each age. Also, the mode of assessment used is dynamic. For instance, a 5-year old more of the information obtained is from the parent or the caregiver, unlike the twelve-year-old who can express themselves coherently. Observation is one of the techniques used in the assessment where the care provider gets to interact with the child and draws a conclusion based on their conduct. The other methods include parent ratings, care providers rating, portfolios, and standardized test. However, all the methods are best applicable for different ages. In some situations, there is a need to modify the techniques, for example, reading out the questions on a standardized test for a five-year-old and writing answers for them. The same approach when used on a twelve-year-old they are left to read, interpret and even answer the questions on the test with minimal assistance. Developmental Assessment and the School-Aged Child sample essay.

Ten-year-old Ray was born at 37 weeks with 2600grams via SVD and was NBU for two weeks due to birth asphyxia. He had gained 400grams by the time he was leaving the NBU. Ray was breastfed exclusively for the first 6 months and was weaned with different soft foods gradually. The child could roll over at 4 months and began sitting down at 6. Ray was hospitalized for severe malnutrition for a month while he was 9 months. According to the mother, that delayed his milestone and he only crawled when he was 16 months. The child started walking without support at 19 months. Ray could say four-letter words “mama” and “tata” at 6 months and at 24 months he could say complete simple sentences. He relates well with all other members of the family apart from his elder brother who according to the mother does not give Ray or other children the attention they want. Developmental Assessment and the School-Aged Child sample essay. The child joined a school at 4 years and his performance is average. He is an obedient boy loved by the teacher and other students at school.

Erik Erikson a psychologist classified human development into 8 stages. Ray fits in the 4th stage known as Industry vs. Inferiority which has children between 5-12 years. According to Erik, the basic virtue at this stage is competency (Cherry, 2018). While assessing Ray based on Erik’s theory, the assessor should focus on his ability to read and write. At this stage, he is expected to have cognitive skills mostly natures in school where he can do simple sums. Peer group is vital at this stage and the child will gain self-esteem (Rubin, Bukowski & Bowker, 2015). The care provider is likely to obtain information on Ray’s best friend, the kid he doesn’t like and who he would love to be associated with. That forms the circle where the children he hates make him feel inferior. For the examiner to gain cooperation, he should carry out the assessment when Ray is with his friends.

Child development assessment is vital in determining their welfare. It activity provides opportunities for the care provider to establish any special needs that the kid may require. Moreover, the assessment provides a ground where both the care provider and the parent can chip in together to provide support for the child. However, the needs of the child change with time and hence the mechanisms used in assessing as well as the results (Kaufman, 2018). Psychology theories like that of Erik can be used to determine what is expected of a child at a specific age during evaluation.

References

Cherry, K. (2018). Erik Erikson’s Stages of Psychosocial Development. 
Retrieved Juny
, 
5
, 2018.

Kaufman, A. S. (2018). 
Contemporary intellectual assessment: Theories, tests, and issues
. Guilford Publications.

Rubin, K. H., Bukowski, W. M., & Bowker, J. C. (2015). Children in peer groups. 
Handbook of child psychology and developmental science
, 1-48.

Course Code

Class Code

Assignment Title

Total Points

NRS-434VN

NRS-434VN-O502

Developmental Assessment and the School-Aged Child

100.0

Criteria

Percentage

Unsatisfactory (0.00%)

Less than Satisfactory (75.00%)

Satisfactory (79.00%)

Good (89.00%)

Excellent (100.00%)

Content

80.0%

Comparison of Physical Assessment Among School-Aged Children

25.0%

A comparison of physical assessments among different school-aged children is omitted.

An incomplete comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is omitted or contains significant inaccuracies.

A general comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is generally described. More information or support is needed for clarity or accuracy.

A comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is described. Some information is needed for clarity.

A detailed comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is thoroughly described. Insight is demonstrated into the physical assessment of school age children.

Typical Assessment for a Child of a Specific Age

25.0%

The typical developmental stage of a child between the ages 5 and 12 is not described.

The typical developmental stage of a child between the ages 5 and 12 is summarized. The summary contains significant inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is generally described. The description contains some inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is described. The overall description is accurate. Some information is needed for clarity.

The typical developmental stage of a child between the ages 5 and 12 is accurately and thoroughly described.

Developmental Assessment and the School-Aged Child sample essay

Developmental Assessment of a Child Using a Developmental Theory (Erickson, Piaget, Kohlberg)

30.0%

A child assessment based on a developmental theory is omitted.

A child assessment based on a developmental theory is partially summarized. Partial strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are omitted or are incorrect. There are significant inaccuracies.

A child assessment based on a developmental theory is generally described. General strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are summarized. There are minor inaccuracies.

A child assessment based on a developmental theory is described. Appropriate strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are described. Some information is needed for clarity.

A child assessment based on a developmental theory is thoroughly described. Well-developed strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are all accurate and described in detail.

Organization and Effectiveness

15.0%

Thesis Development and Purpose

5.0%

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

5.0%

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing  (includes spelling, punctuation, grammar, language use)

5.0%

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Format

5.0%

Paper Format  (use of appropriate style for the major and assignment)

2.0%

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

3.0%

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Weightage

100%

Developmental Assessment and the School-Aged Child sample essay

ACE Star Model Of Knowledge Transformation: EBP Change Process

Student’s Name

Institution Of Affiliation

Course Name

Date

ORDER A PLAGIARISM-FREE PAPER HERE

Star Point 1:  Discovery (Identify topic and practice issue)

Identify the
topic
and the
nursing practice issue
related to this topic. (This MUST involve a nursing practice issue.)

Ventilator-Associated Pneumonia (VAP) is a perfect example of healthcare-associated infection (HAI) in healthcare facilities particularly among adult hospitalized patients in ICU settings. As a gradually emerging concept, it remains to be an important problem among critically ill patients that results in serious complications. Therefore, the subject of evaluation is the increasing incidence of ventilator-associated pneumonia (VAP) among adult hospitalized patients under intubation or mechanical ventilation in ICU settings ACE Star Model Of Knowledge Transformation: EBP Change Process.

Briefly describe your
rationale
for your topic selection. Include the
scope
of the issue/problem.

Ventilator-Associated Pneumonia is a leading cause of mortality, morbidity, increased medical costs, prolonged hospital stays and poor health outcomes across healthcare settings in the United States. It particularly occurs among hospitalized patients in the ICU between 48-72 hours after mechanical ventilation or intubation. Its primary characteristics include signs of systemic infection, sputum changes, and continuous infiltration.  As the contributor of half of all the hospital-acquired pneumonia infections, its prevalence has been estimated to be between 8-40% with the highest risk occurring within the 1
st
five days of admission.  It has contributed to a reduction in patient safety and made healthcare organizations inefficient to execute the role of providing high quality, efficient and effective care. This explains why it is vital to define the clinical issue and its causes to develop effective intervention measures to prevent or reduce the incidences of Ventilator-Associated Pneumonia.

Star Point 2:  Summary (Evidence to support the need for a change)

Describe the
practice problem in your own words
and formulate your PICOT question.

Critically ill patients who might be under sedation or unconscious while receiving treatment in the ICU/CCU setting require the support of ventilator machines to breathe properly.  However, using these machines (mechanical ventilation) or intubation for more than 48 hours can lead to ventilator-associated pneumonia (VAP) which is a serious complication among critically ill patients. It is associated with prolonged stays in the hospital, prolonged periods of mechanical ventilation, additional medical costs, increased morbidity, and double mortality risk. Therefore, considering the risks associated with VAP, reduction or prevention should be a priority for nursing care.

PICOT Question
-In adult patients aged 40 years or older under intubation or mechanical ventilation in ICU settings (P) will the use of 0.2% oral chlorhexidine (I) compared to the use of normal saline(C) decrease the rate of Ventilator-Associated Pneumonia(O) from 16% to 10%  within 6 weeks(T)?

List the systematic review chosen from the CCN Library databases. Type the complete
APA reference
for the systematic review selected.

Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. 
JAMA internal medicine
, 
174
(5), 751-761.

List and briefly describe
other sources
used for data and information. List any other
optional scholarly source
used as a supplement to the systematic review in
APA format.

1
.
Alimi, M., Manzari, Z. S., Bagheri Moghadam, A., & Rouhani, H. (2016). Evaluation of the Effects of Oronasal Versus Oral Disinfection with Chlorhexidine on Clinical Criteria of Ventilator-associated Pneumonia.
Evidence-Based Care
, 
6
(3), 19-30.

Zhang, T. T., Tang, S. S., & Fu, L. J. (2014). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator‐associated pneumonia: a meta‐analysis. 
Journal of clinical nursing
, 
23
(11-12), 1461-1475.

Villar, C. C., Pannuti, C. M., Nery, D. M., Morillo, C. M., Carmona, M. J. C., & Romito, G. A. (2016). Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilator-associated pneumonia: a meta-analysis and systematic review.
Respiratory care
, 
61
(9), 1245-1259.

Briefly
summarize
the main findings (
in your own words
) from the systematic review and the
strength
of the evidence
.

One of the major roles of healthcare providers is to prevent patient harm by enhancing safety. Based on the high incidences of VAP, nurses must implement effective measures to promote health outcomes. The rise in VAP infections has been attributed to oral hygiene due to the use of mechanical ventilators and intubation. The findings from the systematic review revealed that 0.2% oral chlorhexidine is effective in preventing VAP among adult patients in ICU settings as compared to normal saline ACE Star Model Of Knowledge Transformation: EBP Change Process. Thus its use should continuously be encouraged in ICU settings and be integrated into the management of patients.

Outline one or two
evidence-based solutions
you will consider for the trial project.

Using 0.2% oral chlorhexidine to maintain oral hygiene is vital in preventing and reducing Ventilator-Associated Pneumonia. 0.2% oral chlorhexidine decreases colonization of the oral cavity by bacteria which are the major pathogens that cause infection. Chlorhexidine decreases the risk of respiratory infections before, during and after intubation or mechanical ventilation.

An alternative solution is the use of normal saline and tooth brushing to maintain oral hygiene. However, there is limited evidence that supports their effectiveness in VAP prevention and related health outcomes. On the other hand, existing evidence recommends it as part of the VAP care bundle that should be given to patients alongside the use of oral chlorhexidine.

Star Point 3:  Translation (Action Plan)

Identify
care standards, practice guidelines, or protocols
that may be in place to
support your intervention
planning (These may come from your organization or the other sources listed in your Summary section in Star Point 2).

The 2003 Centers for Disease Control Guidelines for Preventing Healthcare-Associated Pneumonia and the 2004 CDC Guidelines for the Management of Adults With Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia give recommendations and guidelines that should be followed by healthcare providers to prevent, reduce and manage Ventilator-Associated Pneumonia.

List your
stakeholders
(by title and not names; include yourself) and describe their
roles and responsibilities
in the change process (no more than 5).

Management: development of practice guideline, care protocols, and policies to promote quality, safety and effectiveness in patient care. It also plans for seminars, conferences, and training for staff on basic standard operating procedures ACE Star Model Of Knowledge Transformation: EBP Change Process.

Physicians: directly involved in patient care by recommending ways and procedures to improve patient outcomes

Critical Care Nurses: directly involved in patient care by recommending ways and procedures to improve patient outcomes, coordinate patient care, administer medications and nurse patients.

Patients: Collaborate with all healthcare providers by providing relevant medical information that can be used in decision making at the point of care.

What specifically is
your nursing role in the change process
? Other nursing roles?

Nurses are first-line communication managers who ensure coordination of care with families and other healthcare providers for all patients in the ICU. They administer medications, monitor the patient for potential adverse effects and institute appropriate intervention measures where necessary to safeguard patients from harm.

List your stakeholders by
position titles
(charge nurse, pharmacist, etc.).-
Why are the members chosen
(stakeholders) important to your project?

Critical Care Nurses-4-Should implement the proposed care protocol and guidelines in terms of administration and care coordination with families and other healthcare providers

Critical Care Physicians-3 should ensure that all decisions made in prevention or management of patients with VAP follow the prescribed guidelines and protocol.

What type of
cost analysis
will be needed before a trial?  Who needs to be involved with this?

Before the implementation of a trial, cost-effectiveness analysis and cost-benefit analysis will be needed. The primary costs will be incurred in the training of staff and the purchase of 0.2% oral chlorhexidine. Close to 8 physicians and 10 nurses will undergo the training in the trial period. Besides, there will be ongoing education to sensitize and increase awareness of other staff on the prior trial. This education will be conducted using flashcards, checklists, and brochures ACE Star Model Of Knowledge Transformation: EBP Change Process.

Star Point 4: (Implementation)

Describe the
process for gaining permission
to plan and begin a trial.  Is there a specific group, committee, or nurse leader involved?

The critical care nurse head and the critical care physician head will write to the hospital’s leadership to seek permission to conduct the trial. This should include the clinical problem identified, its impacts on patients, staff and the organization and why change is essential. A detailed description of the proposed intervention measures to be implemented in the change process and the expected outcomes should also be included.

Describe the
plan for educating the staff
about the change process trial and how they will be impacted or asked to participate.

All the staff directly and indirectly involved in the change process will be educated on the change through a training program that will take place for one week. Staff will be asked to participate by availing themselves for training, recommending alternative changes and to propose measures for intervention. Staff will also be asked to provide feedback which will be used to make improvements in other areas of practice.

Outline the
implementation timeline
for the change process (start time/end time, what steps are to occur along the timeline).

17-9-2019 to 13-10-2019-Staff training on change

14-10-2019 to 21-10-2019-Printing sensitization and awareness resources

22-10-2019 to 10-11-2019-Developing guidelines, protocols, and policies on the use of Oral Chlorhexidine to reduce VAP

11-11-2019 to 25-11-2019- Evaluating outcomes in skills and knowledge

List the
measurable outcomes
based on the PICOT.  How will these be measured?

Ventilator-associated pneumonia, duration of mechanical ventilation, mortality, antibiotic prescribing, intensive care unit and hospital length of stay

What
forms
, if any, might be used for recording purposes during the pilot change process. Describe.

During the pilot change process, it will be necessary to use mortality and morbidity forms, epidemiology forms and financial and utilization forms ACE Star Model Of Knowledge Transformation: EBP Change Process. Each of these forms will later be used to compare and measure baseline data and outcome data before and after the pilot change process.

What resources are available to staff (include yourself) during the change pilot?

Funds to facilitate training and purchase of oral chlorhexidine, a fully equipped 12 capacity ICU, wristwatches, pens, booklets, and flash disks will be provided during the change pilot.

Will there be
meetings
of certain stakeholders throughout the trial?  If so, who and when will they meet?

The critical care nurses, physicians and a representative from the hospital’s leadership who are directly involved in the trial will meet daily in the entire trial period to assess the progress made through feedback. The meeting will purpose to provide daily reports that will be used to determine the benefits versus risks of the trial to the patients, healthcare providers, and the organization. Based on this information, decisions on whether or not to continue with the trial and other relevant adjustments will be made.

Star Point 5: (Evaluation)

How will you
report the outcomes
of the trial?

The trial committee will write a detailed report that describes the outcomes and findings, which will later be published in a peer-reviewed journal.

What would be the
next steps
for the use of the change process information?

This information will be used by the organization’s quality improvement committee to implement the proposed change within the organization, to positively influence patient health outcomes, organizational performance, and staff satisfaction.

 

Reference

Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. 
JAMA internal medicine
, 
174
(5), 751-761 ACE Star Model Of Knowledge Transformation: EBP Change Process.

 

Week 6 Assignment: 
EBP Change Process form

ACE Star Model of Knowledge Transformation

Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson.

Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project.  Nurse Daniel serves as an example only to illustrate the change process.

 

Name: _____________________

 

Star Point 1:  Discovery (Identify topic and practice issue)

Identify the
topic
and the
nursing practice issue
related to this topic. (This MUST involve a nursing practice issue.)

 

 

Briefly describe your
rationale
for your topic selection. Include the
scope
of the issue/problem.

 

 

 

Star Point 2:  Summary (Evidence to support need for a change)

Describe the
practice problem in your own words
and formulate your PICOT question.

 

 

List the systematic review chosen
from the CCN Library databases
. Type the complete
APA reference
for the systematic review selected.

 

 

 

 

List and briefly describe
other sources
used for data and information. List any other
optional scholarly source
used as a supplement to the systematic review in
APA format.

 

 

Briefly
summarize
the main findings (
in your own words
) from the systematic review and the
strength
of the evidence
.

 

 

 

Outline one or two
evidence-based solutions
you will consider for the trial project.

 

 

 

 

 

 

Star Point 3:  Translation (Action Plan)

Identify
care standards, practice guidelines, or protocols
that may be in place to
support your intervention
planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

 

 

 

 

List your
stakeholders
(by title and not names; include yourself) and describe their
roles and responsibilities
in the change process (no more than 5).

 

 

 

 

What specifically is
your nursing role in the change process
? Other nursing roles?

 

 

List your stakeholders by
position titles
(charge nurse, pharmacist, etc.).
–
Why are the members chosen
(stakeholders) important to your project?

 

 

 

 

What type of
cost analysis
will be needed prior to a trial?  Who needs to be involved with this?

 

 

 

 

 

 

Star Point 4: (Implementation)

Describe the
process for gaining permission
to plan and begin a trial.  Is there a specific group, committee, or nurse leader involved?

 

 

 

Describe the
plan for educating the staff
about the change process trial and how they will be impacted or asked to participate.

 

 

 

 

 

 

Outline the
implementation timeline
for the change process (start time/end time, what steps are to occur along the timeline) ACE Star Model Of Knowledge Transformation: EBP Change Process.

 

 

 

 

List the
measurable outcomes
based on the PICOT.  How will these be measured?

 

 

What
forms
, if any, might be used for recording purposes during the pilot change process. Describe.

 

What resources are available to staff (include yourself) during the change pilot?

 

Will there be
meetings
of certain stakeholders throughout the trial?  If so, who and when will they meet?

 

 

 

 

 

 

Star Point 5: (Evaluation)

How will you
report the outcomes
of the trial?

 

 

What would be the
next steps
for the use of the change process information? ACE Star Model Of Knowledge Transformation: EBP Change Process

Week 6 Assignment: 
EBP Change Process form

ACE Star Model of Knowledge Transformation

Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson.

Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project.  Nurse Daniel serves as an example only to illustrate the change process.

 

Name: _____________________

 

Star Point 1:  Discovery (Identify topic and practice issue)

Identify the
topic
and the
nursing practice issue
related to this topic. (This MUST involve a nursing practice issue EBP Change Process form.)

 

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Briefly describe your
rationale
for your topic selection. Include the
scope
of the issue/problem EBP Change Process form.

 

 

 

 

Star Point 2:  Summary (Evidence to support need for a change)

Describe the
practice problem in your own words
and formulate your PICOT question.

 

 

List the systematic review chosen
from the CCN Library databases
. Type the complete
APA reference
for the systematic review selected.

 

 

 

 

List and briefly describe
other sources
used for data and information. List any other
optional scholarly source
used as a supplement to the systematic review in
APA format EBP Change Process form.

 

 

Briefly
summarize
the main findings (
in your own words
) from the systematic review and the
strength
of the evidence
.

 

 

 

Outline one or two
evidence-based solutions
you will consider for the trial project.

 

 

 

 

 

 

Star Point 3:  Translation (Action Plan)

Identify
care standards, practice guidelines, or protocols
that may be in place to
support your intervention
planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

 

 

 

 

List your
stakeholders
(by title and not names; include yourself) and describe their
roles and responsibilities
in the change process (no more than 5).

 

 

 

 

What specifically is
your nursing role in the change process
? Other nursing roles?

 

 

List your stakeholders by
position titles
(charge nurse, pharmacist, etc.).
–
Why are the members chosen
(stakeholders) important to your project? EBP Change Process form

 

 

 

 

What type of
cost analysis
will be needed prior to a trial?  Who needs to be involved with this?

 

 

 

 

 

 

Star Point 4: (Implementation)

Describe the
process for gaining permission
to plan and begin a trial.  Is there a specific group, committee, or nurse leader involved?

 

 

 

Describe the
plan for educating the staff
about the change process trial and how they will be impacted or asked to participate.

 

 

 

 

 

 

Outline the
implementation timeline
for the change process (start time/end time, what steps are to occur along the timeline).

 

 

 

 

List the
measurable outcomes
based on the PICOT.  How will these be measured? EBP Change Process form

 

 

What
forms
, if any, might be used for recording purposes during the pilot change process. Describe.

 

What resources are available to staff (include yourself) during the change pilot?

 

Will there be
meetings
of certain stakeholders throughout the trial?  If so, who and when will they meet?

 

 

 

 

 

 

Star Point 5: (Evaluation)

How will you
report the outcomes
of the trial?

 

 

What would be the
next steps
for the use of the change process information? EBP Change Process form

Impact of Ethnicity on Antidepressant Therapy Essay

Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Provide the case number in the subject line of the Discussion thread.

List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

 

List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics Impact of Ethnicity on Antidepressant Therapy Essay. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

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For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.

Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations

 

The Impact of Ethnicity on Antidepressant Therapy

Case 2: Volume 1, Case #7: The case of physician does not heal thyself

Three Questions

Within the last two weeks, how often have experienced sadness, feeling depressed or worthless and hopeless?

The rationale for asking this question is that sadness and feeling worthless and hopeless nearly daily and all day for two weeks or more is an indication of depression (Wang et al, 2017)

Have you been having any suicidal thoughts?

The rationale for asking this question is that the client’s answer to the question will enable the mental healthcare practitioner to rate the severity of the client’s depression (Mark et al, 2016)

How is your sleep? Are you able to sleep well?

The rationale for asking this question is that sleep disturbance is a symptom of depression and also indicates a higher for depression (Wang et al, 2017)

 

People in the Patient’s Life to Ask Questions

Friends

Do you know of life events that seem to be stressing the client?

The rationale for this question is to determine factors that contribute to the resistant depression in the client.

Does the client have reliable friends and family members?

The reason for asking this question is to get information about whether the client has any support system in his life. A reliable support system is very important for effective treatment of depression (Wang et al, 2017)

Appropriate Physical Exams and Diagnostic Tests Impact of Ethnicity on Antidepressant Therapy Essay

The physical and diagnostic examples appropriate for this client include blood tests and CT scan. The blood tests can reveal if the client has any health conditions that may be causing the depressive symptoms (Mark et al, 2016). The tests can test if the client is anemic, or has thyroid disorders; these conditions are associated with depressive symptoms. A CT scan can be used to rule out any brain condition such as a tumor that could be causing the depressive symptoms (Mark et al, 2016).

Differential Diagnosis

Treatment-resistant depression

Schizoaffective disorder

Bipolar disorder

The most probable diagnosis for this client is treatment-resistant depression. The client’s experiences manic and hypomanic symptoms are compatible with symptoms of major depressive disorder. Moreover, the client has used more than two antidepressants of the required period and dose, but there has been no total symptom remission.

Pharmacologic Agents and Dosing

Venlafaxine XR 450 mg: The mechanism of action of this medication is facilitating the activity of neurotransmitters within the CNS by hindering the reuptake of dopamine, norepinephrine, and serotonin. These neurotransmitters are associated with promoting mood improvement. The elimination half-life of venlafaxine is about 72 hours (Ahmed et al, 2019).

Sertraline 250 mg: The mechanism of this medication is through inhibition of SERT transporter and reuptake of dopamine. The elimination half-life of sertraline is between 26-32 hours (Howie et al, 2018).

The recommended medication for this client is Venlafaxine XR 450 mg. The rationale for choosing venlafaxine over sertraline is because venlafaxine acts through many mechanisms (hindering the reuptake of dopamine, norepinephrine, and serotonin) (Ahmed et al, 2019), whereas on the other hand sertraline’s mechanism of action is only by inhibiting reuptake of dopamine.

Contraindications of Venlafaxine

Venlafaxine is contraindicated for individuals with high cholesterol level, cardiovascular conditions, liver problems and hypertension (Ahmed et al, 2019). Some ethnicities have a higher risk of cardiovascular conditions which is a contraindication to using venlafaxine. Ethnicity may also impact the response of a person to treatment Impact of Ethnicity on Antidepressant Therapy Essay.

 

References

Ahmed A, Jenkins G, Rush J, Rung S, Bobo W, Wang R & Mark F. (2019). Pharmacokinetic-Pharmacodynamic interaction associated with venlafaxine-XR remission in patients with major depressive disorder with a history of citalopram/escitalopram treatment failure
.
J Affect Disord
. 1(246). 62–68.

Howie N, Herberg S, Durham E, Grey Z, Hill W, Cray J et al. (2018). Selective serotonin reuptake inhibitor sertraline inhibits bone healing in a calvarial defect model.
Int J Oral Sci
. 10(3), 25.

Mark C, How C & Ping Y. (2016). Major depression in primary care: making the diagnosis.
Singapore Med J
. 57(11), 591–597.

Wang J, Wu X, Lai W, et al. (2017). Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis.
BMJ Open
.7(1) Impact of Ethnicity on Antidepressant Therapy Essay.

NUR-646E Nurse Educator Electronic Portfolio Essay Example

Nurse Educator Electronic Portfolio

Description:

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For this program, you will be creating a working electronic portfolio that can be utilized when trying to obtain a position as a nurse educator. The electronic portfolio will encompass several artifacts from your practicum courses. Use the “Nurse Educator Electronic Portfolio,” resource to guide you in collecting the required artifacts for this. You will submit the completed electronic portfolio in NUR-665E. NUR-646E Nurse Educator Electronic Portfolio Essay Example

Benchmark -Nurse Educator Lesson Plan

Description:

 
As a nurse educator, you will be responsible for creating effective lessons for various settings.

Choose a teaching and learning experience from your clinical setting. You may use the clinical

experience from your Topic 4 discussion response.

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Based on the experience you chose, use the engagement, student learning, and creating effective

learning environment strategies that you have learned in this course to develop a lesson plan on

similar content for two additional settings (such as an asynchronous online session and teaching a nursing student in the clinical setting, etc.). Use the lesson plan examples found in the topic materials to assist you in creating your lesson outlines. .

 

This assignment will be used as an artifact for your electronic portfolio at the end of the course.

Include the following in your outline:

 

Lesson Objectives

 

Timeframe and target environment

 

Three to four teaching strategies-based on Evidence-Based Practice.

 

Activities

 

A summary of the types of assessments you would use in your lesson and why?

 

Provide rationale for the teaching strategies you implemented into each lesson and why they

differ.

 

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 not required to submit this assignment to LopesWrite Benchmark -Nurse Educator Lesson Plan.

 

This assignment benchmarks the following competency:

 

Master of Science in Nursing with an Emphesis in Education

 

6.1: Apply instructional strategies grounded in evidence-based practice and learning theory that meet the unique needs of learners in diverse environments.

 

Nurse Educator Electronic Portfolio

Hello, my name is xxx. I hail from xxxx. I currently stay in xxxx.

Welome to my Teaching-Learning Electronic Portfolio. This is where I will share my individual and professional information and some of my work as a nursing student. Currently, I am enrolled in xxxx University, taking Master of Science in Nursing – Nursing Education cognate.

My career as a nurse professional began many years ago, where I started working as a registered nurse on xxxxx. I performed numerous nursing roles such as medication administration, operate medical equipment, perform patient education, conduct diagnostic tests, monitor patient health, take vital signs, advocate for patients’ wellbeing, and collaborate with the multidisciplinary team to ensure quality patient care. Currently, I work at the Veteran’s Hospital in medical ICU.

I started pursuing my nursing career in the year xxx where I earned my nursing diploma and then in the year xxx, I earned my Bachelor of Science in Nursing degree from xxx university. I then started my Masters nursing studies. I am very satisfied with my career, and very anxious to fulfil my dreams of becoming a Nurse Educator very soon. Benchmark -Nurse Educator Lesson Plan.

 

 

Course Code

Class Code

Assignment Title

Total Points

NUR-646E

NUR-646E-O500

Benchmark -Nurse Educator Lesson Plan

125.0

Criteria

Percentage

1: Unsatisfactory (0.00%)

2: Less Than Satisfactory (80.00%)

3: Satisfactory (88.00%)

4: Good (92.00%)

5: Excellent (100.00%)

Content

85.0%

Lesson Objectives

10.0%

A description of the lesson objectives is not included.

A description of the lesson objectives is incomplete or incorrect.

A description of the lesson objectives is included but lacks details.

A description of the lesson objectives is complete and includes supporting details.

A description of the lesson objectives is extremely thorough and includes substantial details.

Timeframe and Target Environment

5.0%

A statement of the timeframe and the target Environment is not included.

A statement of the timeframe and the target Environment is incomplete or incorrect.

A statement of the timeframe and the target Environment is included but lacks details.

A statement of the timeframe and the target Environment is complete and includes supporting details.

A statement of the timeframe and the target Environment is extremely thorough and includes substantial details.

Teaching Strategies Based on EBP (6.1)

20.0%

A description of the three to four teaching strategies based on EBP is not included.

A description of the three to four teaching strategies based on EBP is incomplete or incorrect.

A description of the three to four teaching strategies based on EBP is included but lacks details.

A description of the three to four teaching strategies based on EBP is complete and includes supporting details.

A description of the three to four teaching strategies based on EBP is extremely thorough and includes substantial details.

Activities

15.0%

A discussion of activities to use to teach content is not included.

A discussion of activities to use to teach content is incomplete or incorrect.

A discussion of activities to use to teach content is included but lacks details.

A discussion of activities to use to teach content is complete and includes supporting details.

A discussion of activities to use to teach content is extremely thorough and includes substantial details.

Benchmark -Nurse Educator Lesson Plan

Assessment Summary

15.0%

A summary of potential assessments for the lesson is not included.

A summary of potential assessments for the lesson is incomplete or incorrect.

A summary of potential assessments for the lesson is included but lacks details.

A summary of potential assessments for the lesson is complete includes supporting details.

A summary of potential assessments for the lesson is extremely thorough and includes substantial details.

Teaching Strategy Implementation and Rationale

20.0%

A rationale for the teaching strategies implemented in the lesson is not included.

A rationale for the teaching strategies implemented in the lesson is incomplete or incorrect.

A rationale for the teaching strategies implemented in the lesson is included but lacks details.

A rationale for the teaching strategies implemented in the lesson is complete includes supporting details.

A rationale for the teaching strategies implemented in the lesson is extremely thorough and includes substantial details.

Group 2Organization and Effectiveness

5.0%

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5.0%

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

Writer is clearly in command of standard, written, academic English.

Format

10.0%

Paper Format (Use of appropriate style for the major and assignment)

5.0%

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5.0%

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Weightage

100%

Benchmark -Nurse Educator Lesson Plan