Tag: Clinical-Nursing

Week 8 Discussion 700 Patients health literacy essay

The focus of this week was the processes involved in describing and critically analyzing a theory. Using the assigned readings and your professional experience as a starting point, answer the following:

1. Identify a strategy you frequently implement in your daily professional practice (e.g., assess a patient’s health literacy level).

2. Describe the purpose that guides your use of this strategy (e.g., to use best practice strategies to educate a patient regarding lifestyle modifications). Patients health literacy essay.

3. Identify challenges or barriers you often experience when implementing the strategy.

4. Select a theory that has been developed in the literature that addresses the purpose you identified in #2.

5. Describe how the theory could be used as a guide to overcome the challenges or barriers you identified in #3.

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My daily professional practice is characterized by multiple activities involving patient care. One of the basic strategies that I implement on all patients is to assess their level of health literacy. The assessment of patient’s literacy levels involves the administration of specific tests such as a reading skills test that determines the ability of the client to code words. Patients health literacy essay Health literacy describes the capacity of an individual to process, obtain, and understand the health information and services essential for informed decision-making regarding treatment (Beauchamp et al., 2015).  The skills tested include communication and interaction skills, critical analysis, numerical, speaking, listening, writing and reading skills.

The purpose for assessing the health literacy of a patient is to get insights on how to best use practice strategies to educate clients about the modifications of their lifestyles to improve their health outcomes. For instance, I consider this strategy necessary because it orients me to the kind of client I will be dealing with and helps device a customized treatment plan for them that respects their cultural and literacy factors to facilitate effective communication. It also guides me on the type and mode of health education strategies to employ on particular clients Patients health literacy essay. This in turn promotes patient-centered care and facilitates the patient’s involvement in their treatment plan and self-care.

During my daily professional practice, I experience several challenges related to the literacy levels of the client ad their assessment. Dealing with illiterate clients is the biggest challenge since it disables communication between the patient and the providers. Moreover, cultural factors such as language diversity act as barriers to healthcare literacy assessment (Batterham wt a., 2016). The ability of the client to read and write in different languages other than English makes communication difficult and often demands the presence of a translator.  In addition, age affects the practice in that the elderly tend to be less literate compared to the young ones. Furthermore, ethnicity impacts the access of health education and thus undermines the process of implementation. Patients health literacy essay.

Health literacy is associated with the social cognitive theory. This theory focuses on the observation of attitudes, behaviors and emotional reactions that influence the human behavior (Stacey et al., 2015). In this case, health literacy assessment purposes to use best practice strategies to educate a patient regarding lifestyle modifications which begins with behavioral and attitude change. This theory thus guides the practitioner in studying the patient through observation thus devising an appropriate behavioral change plan that suites his capabilities, environment factors and target outcomes of the treatment. It also supports self-efficacy, self-reaction, self-evaluation, and self-observation which promote self-care.

The Social Cognitive Theory can thus be used as guide to overcome the above challenges in many ways. For instance, the observation of the client enables understanding of their cultural factors such as language, beliefs, attitudes and behaviors. This creates a foundation for approaching patients from this cultural setting and also in the formulation of lifestyle modifications that respect their beliefs and are generally culturally sensitive (Wang, 2016). This will help eliminate the cultural challenges associated with the implementation of health literacy assessment strategy. On the other hand, the theory is essential in guiding the practice across all age groups. Observation of the client helps in determining their age and their knowledge regarding health issues. This will in turn guide the nurse in modifying the lifestyle changes of the each age group depending on what they can read and understand. Patients health literacy essay.

References

Batterham, R. W., Hawkins, M., Collins, P. A., Buchbinder, R., & Osborne, R. H. (2016). Health literacy: applying current concepts to improve health services and reduce health inequalities. 
Public health
, 
132
, 3-12.

Beauchamp, A., Buchbinder, R., Dodson, S., Batterham, R. W., Elsworth, G. R., McPhee, C., … & Osborne, R. H. (2015). Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ). 
BMC public health
, 
15
(1), 678 Patients health literacy essay.

Stacey, F. G., James, E. L., Chapman, K., Courneya, K. S., & Lubans, D. R. (2015). A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. 
Journal of Cancer Survivorship
, 
9
(2), 305-338.

Wang, Q. (2016). Why should we all be cultural psychologists? Lessons from the study of social cognition. 
Perspectives on Psychological Science
, 
11
(5), 583-596. Patients health literacy essay.

Abstract Concept of Critical Thinking Essay

This week’s content introduced the processes involved in creating conceptual meaning. In addition, content related to the relationship between concepts and theory development was presented. Using the assigned readings and your professional experience as a starting point, complete the following.

Retrieve a published concept analysis or research study that explores either an abstract or concrete concept. Answer the following questions about the article:

• Why is this an important concept to address?

• What are the defining characteristics of the concept?

Abstract Concept of Critical Thinking Essay

• What is the conceptual meaning of the concept?

• Is the conceptual meaning valid and reliable? Provide a supporting rationale.

• How does, or how might this concept support theory development?

The Abstract Concept of Critical Thinking: Importance, Defining Characteristics, and Conceptual Meaning

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A concept can be described as the thinking behind an idea. This idea itself may be abstract or concrete. In the nursing profession, research is the tool that is used to give rationale for every action that is taken in the process of treating and caring for patients. It is also the basis for all rationale attributed to interventions aimed at disease prevention. This is what has come to be known as evidence-based nursing practice (Foley & Davis, 2017). But for any research to be carried out there must first be a concept developed to guide the research, and point it to the direction that it is supposed to follow to come up with the required answers.  This is the thinking behind the research idea. Critical thinking is one of the concepts in nursing practice that is widely used to guide decisions in day-to-day practice. This paper examines an article that discusses the analysis of this concept as it relates to the nursing profession.

Why is Critical Thinking an Important Concept to Address?

Critical thinking is about questioning everything and oneself before taking any action. In nursing, it is about asking oneself why one is taking the particular action one is about to take. More importantly, it is about the nurse asking themselves whether it is worthwhile to take that particular action and if it will be helpful and beneficial. The concept of critical thinking can be traced back to the early philosophers and thinkers like Plato and Socrates (Von Colln-Appling & Giuliano, 2017). In nursing, therefore, it is a very important concept to address because it is through questioning that evidence-based nursing practice is entrenched.

The Defining Characteristics of Critical Thinking as a Concept

According to Von Colln-Appling and Giuliano (2017), the defining characteristics of critical thinking as a concept are acquisition of knowledge and its application, analysis of present information, informed decision making, and reflection on the decision made. This means for the nurse to be a critical thinker they must first acquire nursing education Abstract Concept of Critical Thinking Essay. This will allow them to analyse information like laboratory results and make informed decisions about what to do in the circumstances. After that they can then reflect on the decision they made and see if it was the best one to make. That is what the concept of critical thinking is about (Von Colln-Appling & Giuliano, 2017),

Conceptual Meaning of Critical Thinking as a Concept

           
Critical thinking as a concept means that the underlying principle is that you do not just accept an argument or a conclusion for the sake of it. Rather, you question the basis and rationale of such arguments and conclusions critically before accepting them. The arguments and conclusions must be not only reasonable, but also “well-thought out” and cogent (Carbogim et al., 2016).

Validity, Reliability, and Support for Theory Development of the Conceptual Meaning of Critical Thinking

The conceptual meaning of critical thinking is indeed reliable and valid. This means that any nursing researcher can ask the same question about it, conduct research on it, and still come out with the same identical results as the one that is being discussed here. The rationale to this is that critical thinking will always be defined by knowledge and its application, analysis of results at hand, rational decision making, and reflection of the same. Any researcher who is using this concept as the basis for their research must come up with or acknowledge these characteristics of critical thinking. Critical thinking as a concept supports theory development in that it provides the conceptual framework for the theory. Abstract Concept of Critical Thinking Essay.

References

Carbogim, F., & Bertaccini de Oliveira, L., & Püschel, V.A. (2016). Critical thinking : Concept analysis from the perspective of Rodger’s evolutionary method of concept analysis.
Revista Latino-Americana de Enfermagem, 24
, e2785. Doi: 10.1590/1518-8345.1191.2785

Foley, A.S., & Davis, A.H. (2017). A guide to concept analysis.
Clinical Nurse Specialist
. Doi: 10.1097/NUR.0000000000000277

Von Colln-Appling, C., & Giuliano, D. (2017). A concept analysis of critical thinking: A guide for nurse educators.
Nurse Education Today, 49
, 106-109. Doi: 10.1016/j.nedt.2016.11.007 Abstract Concept of Critical Thinking Essay

700 Week 5 Discussion Nursing theory perspectives and values essay

This week’s content introduced essential components that contribute to the development of empiric knowledge in the nursing discipline. This week also addressed how we go beyond words and create meaning. Using the assigned readings and your professional experience as a starting point, answer the following:

1. In chapter 7 Chinn and Kramer (Knowledge Development in Nursing: Theory and Process 9th edition) provide four definitions from the nursing literature that emphasize different perspectives and different underlying values that involve nursing theory (pg 156) Nursing theory perspectives and values essay. Add to this list by identifying an additional definition from the nursing literature that expands your understanding of the definition of theory. In your response provide a direct quote from the source, and then paraphrase the direct quote into your own words.

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2. Identify a word that has a common meaning when used in the context of nursing (e.g., hypothermia). After you identify the word, explain how everyday direct and indirect experiences shape perceptions (create meaning) of what the word means to the discipline Nursing theory perspectives and values essay.

Nursing theory must provide basic principles that underpin nursing practice and help in advancing knowledge and research. In clinical practice, nursing theory is practiced at two main levels namely: situation-specific and general levels. In situation-specific levels, theories provide theoretical rationales that guide nursing actions in clinical settings. In general levels, nursing theories promote dedication and orientation to nursing philosophies and perspectives for integration in all aspects of nursing practice. From nursing literature, the definitions which emphasized the various perspectives and values that underlie nursing theory are as follows:

It is a reasonably interlinked set of confirmed hypotheses

This description reveals nursing theory as a specific form of expression that is guided by reasonable rules which need the testing and confirmation of hypotheses using scientific and empiric research methods.

ü  It is a conceptual framework whose invention aims at addressing a specific purpose

This definition emphasizes the aims of creating a theory and reveals the essence of a theory having a purpose.

A creative grouping of knowledge, ideas, and experiences with symbolic representation that strives to explain a particular phenomenon

This definition reveals that a theory should promote understanding of a given phenomenon which can or cannot be directly applied in clinical practice Nursing theory perspectives and values essay

Collection of logical and conceptual principles which act as a central point of reference for an inquiry

Although this definition fails to address a specific purpose for nursing theory or suggest a particular method for theory development

Another definition of theory from nursing literature that expands my understanding is:
theory is an innovative and thorough structuring of ideas which illuminate a purposeful, tentative and systematic view of a phenomenon
(Marañón & Pera, 2015).
 
This definition means that theory cannot be objective to reveal what should be observed. Therefore, it is based on assumptions, ideas, personal judgment and value choices of a theorist to explain specific possibilities and perceptions. Nursing theory perspectives and values essay.

A word with a common meaning when used in the nursing context is caring. In a nursing context, it refers to an act of empathy, concern, and kindness to other people (Norman, Rossillo & Skelton, 2016). It can also mean looking after a person who needs assistance to achieve individual goals or maintain health status. From a sociological context, caring is defined as an act of compassion.

References

Chinn, P. L., & Kramer, M. K. (2014). 
Knowledge Development in Nursing-E-Book: Theory and Process
. Elsevier Health Sciences.

Marañón, A. A., & Pera, M. P. I. (2015). Theory and practice in the construction of professional identity in nursing students: A qualitative study. 
Nurse Education Today
, 
35
(7), 859-863.

Norman, V., Rossillo, K., & Skelton, K. (2016). Creating healing environments through the theory of caring. 
AORN Journal
, 
104
(5), 401-409. Nursing theory perspectives and values essay

Personal and aesthetic knowledge development essay

The focus of this week was uncovering how we develop personal knowledge, and the importance of asking critical questions that underpin meaning and significance. Using the assigned readings and your professional experience as a starting point, answer the following:

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1. Compare and contrast the main attributes of personal and aesthetic knowledge development. In your response describe how both types of knowledge development are important for making advancements in nursing practice.

2. Identify how personal knowledge leads to personal shifts in aesthetic knowing. In your response discuss how asking the critical questions, “What does this mean?” and “How is it significant?” can be used to cultivate aesthetic knowing. Personal and aesthetic knowledge development essay.

Personal knowledge describes the knowledge that we own from self-actualization, reflection, experiences or observations while aesthetic knowledge refers to the perception of the patient with regard to the patient and their needs (Haase et al., 2018). Aesthetic knowledge is characterized by the understanding of sound, taste, smell, look and feel of things by the practitioners which supports questioning and opening up (Leight, 2002). Personal knowing is significant in the establishment of authenticity and creation of therapeutic relationships that promote integrity of practice as well as the wholeness of the practitioner. On the other hand, aesthetic knowing is important in that it develops new understanding of phenomena which helps in the identification of the patients’ needs through new perspectives.

Personal knowledge leads to personal shifts in aesthetic knowing in several ways. For instance, through personal knowledge which offers personal understanding, the nurse is able to understand the patients’ needs through a reflection of their experiences. Additionally, personal knowledge creates a foundation of knowledge that helps in questioning the patient as well as promoting aesthetic reflexivity since it is the knowledge that nurses possess before studying nursing (Campbell et al., 2018) Personal and aesthetic knowledge development essay.

Aesthetic knowing involves the creation of new understanding of phenomenon which makes it an art in nursing. Asking questions encourages the development of new ideas and creations essential in understanding the patients and the patient’s needs. As such, critical questions like “What does this mean?” and “How is it significant?” can be used to cultivate aesthetic knowing. They help in opening up the nurses mind as they try to seek new solutions to problems. They also help determine the relevance of particular phenomenon in healthcare and how they can be used to improve the outcomes of the patient.

 

References

Campbell, T. D., Penz, K., Dietrich-Leurer, M., Juckes, K., & Rodger, K. (2018). Ways of Knowing as a Framework for Developing Reflective Practice among Nursing Students. 
International journal of nursing education scholarship
, 
15
(1).

Haase, K. R., Thomas, R. T., Gifford, W., & Holtslander, L. F. (2018). Ways of knowing on the Internet: A qualitative review of cancer websites from a critical nursing perspective. 
Nursing inquiry
, 
25
(3), e12230.

Leight, S. B. (2002). Starry night: Using story to inform aesthetic knowing in women’s health nursing. 
Journal of Advanced Nursing
, 
37
(1), 108-114. Personal and aesthetic knowledge development essay.

NURS 6051 Wk 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists Essay

NURS 6051: Transforming Nursing and Healthcare Through Technology

 
Wk 3 Discussion:

Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients NURS 6051 Wk 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists Essay.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

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To Prepare:

Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.

Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

 

Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05.

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019. NURS 6051 Wk 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists Essay

Nursing is one professional that cannot survive without collaborative approach. To ensure that there is better quality in service delivery, the nurses must work together with the nursing informatics and technology specialists to ensure a smooth flow in the service delivery (McGonigle & Mastrian, 2017).  Right from when the patient visits the health facility, they are first met by the receptionist who happens to be a medical record expert and they are the ones who directs the patient on where to head next after retrieving their details. The patient is then sent to the triage, which is the most important point for a patient as the assessment by a nurse will reveal several issues including the matter of urgency for the patient treatment. NURS 6051 Wk 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists Essay.

Other issues such as blood pressure, BMI and sugar levels that are important before a patient sees the doctor are monitored within the triage. The results of the same may be indicated on the patient file or in case the system is automated; they will be wired directly to the doctor of the day. The doctor or the clinical officer on duty, then examines the patient and recommends on either medication, further test or ward admission. At this stage, the nurse may take over again in case of admission or wound dressing as per the doctor’s direction NURS 6051 Wk 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists Essay. This is usually the routine taken by the patients on a daily basis and requires expertise collaboration between the nurse and other professionals in order to deliver services in the right manner.

On issues to do with strategy on how these interactions might be improved, technology comes in handy as its effective application may speed up the processes and eliminate the unnecessary delays that may add up costs, or contribute to even the worst cases of loss of life (Macieria et al. 2017). From the admission to the triage up to the doctor’s room, effective online transit of the patient information will eliminate delays and hence smooth delivery of services, patient and healthcare professional’s satisfaction, as well as cost reduction.

With the continued evolution of nursing informatics as a Specialty, the future of nursing seems brighter and most manual chores are eliminated and collaborative interactions are being enhanced, hence improved quality, more productivity and eventually cost reduction (Wang, Kung & Byrd, 2018). With advanced technology, the professional interaction is bound to enter a whole new level where the processes will be executed with minimal time and at the expected quality level hence the overall improvement in the service delivery within the health facilities. NURS 6051 Wk 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists Essay.

 

References

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G.

(2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge

(4th ed.). Burlington, MA: Jones & Bartlett Learning.

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and

potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126 (1), 3–13. doi:10.1016/j.techfore.2015.12.019. NURS 6051 Wk 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists Essay

Crohn’s Disease Evidence-Based Clinical Intervention SOAP note format essay

Your Evidence-Based Clinical Intervention should be submitted in a Microsoft Word document following APA style and should include the following:

**** CROHN’S DISEASE

The medical problem/diagnosis/disease.

Typical presenting signs and symptoms including:

Onset, Characteristics, Location, Radiation, Timing, Setting, Aggravating factors, Alleviating factors, Associated symptoms, Course since onset, Usual age group affected

Concomitant disease states associated with the diagnosis

The pathophysiology of the problem.

Three differential diagnoses and the usual presenting signs and symptoms in priority sequence with rationales.

Reference to at least two current journal articles that show evidence-based practice as how to best treat this disorder related to the primary differential.

The expected outcomes of the intervention.

Algorithms if available.

A typical clinical note in SOAP format.

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Subjective Data

Chief complain- abdominal pain

History of Presenting Illness
-C.K is a 40-year-old African American with Crohn’s disease. She presented to the emergency department with complaints of severe abdominal pains for two days, diarrhea, vomiting and nausea.  The abdominal pain was of sudden in onset, sharp in nature and radiated to all parts of the abdomen. On a scale of 0-10, she rated the pain 5/10. Crohn’s Disease Evidence-Based Clinical Intervention SOAP note format essay. The pain was accompanied with three episodes of diarrhea, nausea and four episodes of vomiting. C.K reported that for the fear of vomiting and diarrhea, she did not eat anything but only drank several glasses of water. The following day, the pain worsened to 9/10 and thus decided to come to the ER.

Medications-
mesalamine 500 mg QID and omacor 900 mg QID

Allergies-
None

Past Medical History- Diagnosed with Crohn’s disease in 2013

Past Surgical History-
none

Personal Socio-economic History
-Married lives with the husband her two children aged 11 and 14. All are in good health. Is a smoker for 30+pack years but does not take alcohol. She denied the use of any other illicit drugs and substances. Her diet generally comprises of small food carbohydrates and proteins but admits to not observing a healthy diet.

Immunization History-UpToDate

Family History- mother is deceased died due to complications from hypertension and type 2 Diabetes Mellitus. Has two sisters, one was diagnosed with hypertension. Father is alive and was diagnosed with schizophrenia.  The paternal grandmother died of leukemia.

Review of Systems

GIT-
denies jaundice, weight loss, anorexia, has nausea, vomiting, diarrhea, and abdominal pain

CNS-
denies dizziness, vertigo, seizures, tremors and paresthesia

Respiratory-
denies wheezing and cough

Crohn’s Disease Evidence-Based Clinical Intervention SOAP note format essay

CVS-
denies chest pains, dyspnea, syncope, palpitations, edema, and PND

HEENT-denies loss of vision, blurred vision, diplopia, eye pain, eye discharge, ear discharge, ear pain, nosebleeds, dysphagia, voice hoarseness, and nasal discharge

Musculoskeletal-denies limb or joint pains, joint swelling, stiffness and muscle weakness

Immunologic-
denies exposure to HIV, urticarial and persistent infections

Endocrine-
denies heat and cold intolerance, polyuria, polydipsia, and polyphagia

Psychiatric-
denies anxiety, depression, suicidal ideation, mental disturbance, paranoia, and hallucinations

Objective Data

General Exam-
middle-aged lady who is obese, alert and oriented in time, place and person

Vital Signs-pulse rate 80bpm, temp-36.5
0
c, respiratory rate-16cycles/min, O
2
Sat-97% on the RA, BP-120/81mmHg, pain score-9/10

Systemic Exam

GIT-
abdomen is soft, non-tender and not distended, no palpable masses has hyperactive bowel sounds on auscultation, has RUQ tenderness on palpation, no splenomegaly

CVS-
normal S1 and S2, no murmur or gallop rhythm, no palpitation, no edema, JV not distended.

Rectal-
no sores or lesions, guaiac positive stool on examining finger

HEENT-
normal conjunctiva, PEBRL, no exudates or hemorrhage, has a normal visual acuity, the ears are normal with no deformities, canals bilaterally clear, intact tympanic membranes, ho hearing loss, no fluid, normal septum and nasal mucosa, no nasal discharge, normal tongue, no exudates or erythema on posterior  pharynx, no masses on the neck, midline trachea, no enlargement.

Respiratory-lungs bilaterally clear on auscultation, normal respiratory effort

Skin-
no lesions, indurations or subcutaneous nodules

CNS-
oriented in time, place and person, memory intact, cranial nerves 11-XII intact, normal reflexes

Musculoskeletal-
deferred gait and posture due to pain, no bone or joint deformities, normal ROM  and strength of all joints, no joint tenderness

Assessment

Laboratory Diagnostic Tests:

Blood Chemistry

Na-136

K-2.9

Cl-103

C02-26

BUN-9

Cr-0.7

Gluc-90

Ca-9.7

Mg-1.3

PO4-2.2

Complete Blood Count

WBC-4.4

Hb- 10.8

Hct-32.8

Plts-311

Total Bili-0.2

AST-13

ALT-22

Alk Phos-87

GGT-52

Lipase-13

ESR-30mm/hr

Radiologic Tests

Abdominal X-ray-
there was several dilated loops of the small bowel with levels of distal gas and air-fluids. This potentially indicates thickening of the walls of the colon to suggest active colitis in a patient diagnosed with Crohn’s disease. There was no central effusion

CT scan of the Abdomen-there was thickening of the mucosa; terminal ileum was consistent with active Crohn’s disease, no fistulas, no bowel obstruction, no abscesses. Crohn’s Disease Evidence-Based Clinical Intervention SOAP note format essay.

Differential Diagnoses

Exacerbation of Crohn’s Disease-C.K presented with diffuse abdominal pain of sudden onset, accompanied by the symptoms of nausea, diarrhea, and vomiting. High chances are that the chronic pain is from Crohn’s disease exacerbation since the use of prednisolone has helped to resolve her history, symptoms, laboratory and radiologic findings (Kalla et al., 2014).  Crohn’s disease has an unknown etiology and can affect any part of the GI tract. Although patients can at times be asymptomatic, in case of exacerbations, patients present with the complaints of abdominal pain, nausea, diarrhea, fever and possible weight loss. The patient’s abdominal imaging also detected an active form of the disease thus the most likely diagnosis.

Obstruction of the Small Bowel-
is also a potential differential since it happens following blockage of the GI contents. A patient presents with complaints of constipation, abdominal pain, reduced appetite, vomiting and nausea following distension of the abdomen and fullness (Paulson & Thompson, 2015). On the contrary, C.K was able to pass stool in this case and never experienced any form of abdominal distension or constipation.  Besides, the likelihood of obstruction of the small bowel to present with guaiac positive stool on examining finger is very minimal. Although the small bowel had dilated loops as revealed by the abdominal x-ray which also occurs in obstruction of the small bowel, the abdominal CT scan was clear that this was thickening of the ileum mucosa, highly suggestive of Crohn’s disease.

Acute Ischemia of the Mesenteric-ischemia of the mesenteric artery happens when there is reduced blood flow following a vasospasm or occlusion that causes hypoperfusion. Patients usually present with severe abdominal pain of rapid onset that is localized in the peri-umbilical region, vomiting, and nausea (Clair & Beach, 2016).  Its risk factors include a hypercoagulability state or obstruction of the small bowel. However, C.K is less likely to have acute mesenteric ischemia since her vital signs were within normal range and her abdominal pain was of sudden onset and localized in the RUQ. Crohn’s Disease Evidence-Based Clinical Intervention SOAP note format essay.

Plan

Immediate Intervention- Starting IV fluids: phenegram12.5mg with 10mls Normal Saline, fentanyl 40mcg to prevent nausea, vomiting, and rehydration (Torres et al., 2017).

Pharmacotherapy- prednisone 60mg for two weeks, the patient will be required to slowly taper the dosage by 10mg every two weeks. The patient will, however, continue with her omega-3 supplements and other drugs for Crohn’s disease (Lichtenstein et al., 2018).

Health Promotion and Disease Prevention-The patient will have to observe a specific diet to prevent exacerbations and help in symptoms alleviation. In this case, the most recommended dietary changes include: avoiding carbonated drinks and foods rich in fiber. Crohn’s Disease Evidence-Based Clinical Intervention SOAP note format essay.

References

Clair, D. G., & Beach, J. M. (2016). Mesenteric ischemia. 
New England Journal of Medicine
, 
374
(10), 959-968.

Kalla, R., Ventham, N. T., Satsangi, J., & Arnott, I. D. (2014). Crohn’s disease. 
Bmj
, 
349
, g6670.

Lichtenstein, G. R., Loftus, E. V., Isaacs, K. L., Regueiro, M. D., Gerson, L. B., & Sands, B. E. (2018). ACG clinical guideline: management of Crohn’s disease in adults. 
American Journal of Gastroenterology
, 
113
(4), 481-517.

Paulson, E. K., & Thompson, W. M. (2015). Review of small-bowel obstruction: the diagnosis and when to worry. 
Radiology
, 
275
(2), 332-342.

Torres, J., Mehandru, S., Colombel, J. F., & Peyrin-Biroulet, L. (2017). Crohn’s disease. 
The Lancet
, 
389
(10080), 1741-1755. Crohn’s Disease Evidence-Based Clinical Intervention SOAP note format essay

Assignment: Evidence-Based Project

Is there a difference between “common practice” and “best practice”?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

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Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest.

Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.

Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: An Introduction to Clinical Inquiry

Create a 4- to 5-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.

Describe how you used keywords to search on your chosen clinical issue of interest.

Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

Provide APA citations of the four peer-reviewed articles you selected.

Part 2: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

The full citation of each peer-reviewed article in APA format.

A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.

A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.

A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.

A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

References

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. 
American Journal of Critical Care
, 
27
(4), 334–337. https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2018727

Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. 
British Journal of Nursing
, 
27
(7), 382–388.
https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2018.27.7.382

Lim, K., Kilpatrick, C., Storr, J., & Seale, H. (2018). Exploring the use of entertainment-education YouTube videos focused on infection prevention and control. 
American Journal of Infection Control
, 
46
(11), 1218–1223.
https://doi-org.ezp.waldenulibrary.org/10.1016/j.ajic.2018.05.002

Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … Cruickshank, M. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. 
Lancet Infectious Diseases
, 
18
(11), 1269–1277.
https://doi-org.ezp.waldenulibrary.org/10.1016/S1473-3099(18)30491-2

Loftus, R. W., Dexter, F., & Robinson, A. D. M. (2018). High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices. 
American Journal of Infection Control
, 
46
(10), 1134–1141. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ajic.2018.04.211

 

Part 1: An Introduction to Clinical Inquiry

Evidence-Based Practice

Theory

Student’s Name

Institution Of Affiliation

Course Name

Date

Introduction

üThe integration of EBP in nursing practice has helped to promote patient safety and health outcomes

üEBP supports clinical decision making with evidence

üIt is the most preferred  approach to  managing patient and clinical outcomes

üWhen correctly applied in every stage, both patients and healthcare providers understand a condition

üEBP integrates a patient’s preferences, values and beliefs with the best available scientific evidence and clinician’s expertise in decision making.

Evidence-based practice is an intense process which integrates a patient’s preferences, clinical expertise and scientific evidence in clinical decision making when providing care. It has greatly contributed to improvements in patient’s safety and health outcomes based on scientific and clinical evidence. Its use in nursing practice has also improved the understanding of both patients and healthcare providers on specific conditions. This EBP project aims at comparing the effectiveness of various disinfection procedures used in infection control in heathcare settings.

 

Clinical Issue

üHospital Acquired Infections are a major issue of public health concern in the US and across the globe

üApproximately 2million HAIs and up to 100,000 associated deaths happen annually in the US

üPoor hand hygiene during patient care is the major cause of HAIs

üPreventing against HAIs requires improvement in hand hygiene practices

Hospital Acquired Infections are a major public health concern in the United States and across the globe. Their occurrence has been associated with poor hand hygiene practices in routine patient care. According to the statistics provided by the World Health Organization, up to 100, 000 deaths and 2 million cases every year are associated with HAIs. However, majority of these cases can be prevented through hand hygiene practices. This calls for the implementation of better infection control strategies and education to the public, healthcare providers and everyone at high risk of infection.

 

Search Methodology

üThe articles were searched for in online scientific databases

ü The search keywords were: infection control, hand hygiene, hand washing, alcohol-based hand rub and hospital acquired infection

üThe search included articles published within the last 5 years,

üGeneral search yielded  twelve  articles but only five met the inclusion criteria

Extensive searches in online scientific databases of CINAHL, PubMed, Medline and EBSCOHost. The searched used keywords such as infection control, hand hygiene, hand washing, alcohol-based hand rub and hospital acquired infection (HAI).  Although thousands of results were found, an inclusion criterion was used to narrow down the search. Therefore, only articles published within the last five years were included and articles that were specific to the use of alcohol-based hand rub and hand washing.

 

Research Databases

üAn online search was conducted in the databases of CINAHL, PubMed, EBSCOHost and Medline

üMedline was freely accessible over the internet and the use of Medical Subject Headings promoted retrieval of data

üThe EBSCOHost database promoted the ability to access internal and external information from a single search box

üPubMed was easy to use since it automatically translated an initial search using Boolean operators to search results

üCINAHL was fast and provided broad content to full-text top nursing journals

An online electronic search was done in the following scientific databases: CINAHL, PubMed, EBSCOHost and Medline.  Medline could easily be accessed over the internet and its procedure to use Medical Subject Headings promoted fast retrieval of data. EBSCOHost database enhanced easier access to internal and external information from a single search box.  PubMed was easy to use as it automatically translated an initial search using Boolean operators to search results. The CINAHL database was also was fast but somewhat challenging to work with although it provided top broad content and full-text nursing journals. NURS 6052 wk 3 assignment Matrix Worksheet Template

 

References

üGrayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. 
The Lancet Infectious Diseases
, 
18
(11), 1269-1277.

üHalm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. 
American Journal of Critical Care
, 
27
(4), 334-337.

üLoftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. 
American journal of infection control
, 
46
(10), 1134-1141 NURS 6052 wk 3 assignment Matrix Worksheet Template.

ü

References

üLim, K., Kilpatrick, C., Storr, J., & Seale, H. (2018). Exploring the use of entertainment-education YouTube videos focused on infection prevention and control. 
American journal of infection control
, 
46
(11), 1218-1223.

üMunoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. 
British Journal of Nursing
, 
27
(7), 382-388.

 

Part 2: Identifying Research Methodologies – Analysis

Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M.,  & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. The Lancet Infectious Diseases, 18(11), 1269-1277.

Relation To The Clinical Issue

This article similarly highlights how Healthcare-Associated infections hinder patient safety, increases mortality and morbidity rates prolong hospital stays and increases medical costs. The researchers further acknowledge compliance of hand hygiene among healthcare providers as a significant strategy to maintain patient safety especially with regards to methicillin-resistant staphylococcus Aureus. However, very few national programs have been sustained and integrated successfully into the national-health structure. Based on the results of the NHHI (National Hand Hygiene Initiative), hand hygiene reduces the risks of healthcare-associated infections which continue to be a major public health concern. NURS 6052 wk 3 assignment Matrix Worksheet Template

Aim of the Study

The study aimed at evaluating the outcomes of the NHHI including its effect on the incidences of healthcare-associated Staphylococcus Aureus and hand hygiene compliance. This study aim was influenced by the background knowledge that a healthcare provider’s compliance with hand hygiene is a significant national strategy for patient safety.

Research Methodology

This was a quantitative longitudinal study where the outcomes of the NHHI eight years after implementation were assessed. The assessment included the extent of hand hygiene guidelines compliance and the hospital’s participation, costs, and association with healthcare-associated Staphylococcus Aureus and educational engagement.

Strengths of Research Methodologies

Wide population data were used to evaluate the clinical impact of NHHI, specific, statistical analysis was done comparisons of proportions (χ² or t-test), with a p-value of 0·05 or less (two-tailed) which was considered to be statistically significant and increased the accuracy of results. Besides, hand hygiene and compliance data were assessed for errors and consistency using a standard process for review and validation. To maximize the validity and accuracy of data, two systems were established including representative hospital samples and the poorly performing sites. NURS 6052 wk 3 assignment Matrix Worksheet Template

Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitizing in infection control. British Journal of Nursing, 27(7), 382-388.

Relation To The Clinical Issue

The article addresses a similar clinical issue by acknowledging Healthcare-Associated Infections as a public health concern for the health sector across the globe according to NICE. Some of the commonly identified infections include surgical, respiratory and urinary tract infections. This calls for the implementation of better strategies to control infections including education, reinforcing knowledge to the public, healthcare providers and individuals at high risk of infections in all areas of nursing practice.

Aim of the Study

The study aimed at evaluating the effectiveness of alcohol-based gel for hand rubs in controlling infections in the clinical setting. The article was specific to renal nursing following a growth in the focus of evidence-based practice.

Research Methodology

The EBP process for clinical decision making was reviewed for effective literature on the effectiveness of alcohol-based gel and the results published recently concerning the findings of the best model.

Strengths of Research Methodologies

The review utilizes the steps of EBP and numerous articles relevant to the review purpose are used to justify the information shared.

General Comment

When compared to approaches that use detergents and disinfectants that can result in pathogen dissemination, alcohol when adequately used is even more effective. Therefore, hand rubs should be at every patient’s bedside, ward entrance and hospital for use after, before and when performing all activities related to care

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. American Journal of Critical Care, 27(4), 334-337.

Relation To The Clinical Issue

The researchers refer to the guidelines by the CDC and WHO which have been driven hand hygiene practices for more than ten years. According to these guidelines, when hands are deeply soiled with body fluids or blood or after visiting the toilet with suspected Clostridium difficile pathogens, the most preferred way to manage and control infections is through Handwashing with soap and water. However, for all other clinical scenarios, the researchers recommend that routine hand hygiene should be maintained with alcohol-based hand rubs. This discussion on infection prevention perfectly resonates with my clinical issue to be addressed.

Aim of the Study

According to the researchers, frequent Handwashing is a major cause of contact dermatitis thus rarely preferred by healthcare providers in clinical settings as a way of managing and controlling infections.  On the other hand, alcohol-based hand rubs are notably effective in bacterial reduction and causes less skin irritation. These perceptions greatly influence the degree of staff compliance to hand hygiene guidelines which ultimately impacts the rates of HAIs. Therefore, the study aimed to determine the impact of ABHRs supplemented by the use of creams and lotions on health outcomes.

Research Methodology

The study was a systematic review of literature that used qualitative methods approach.  The researchers searched the databases of MEDLINE and CINAHL using the keywords ABHR, contact dermatitis, dermatitis, and Handwashing. This search was limited to articles that had been published within the last 10 years. Only original articles were considered NURS 6052 wk 3 assignment Matrix Worksheet Template. The findings were presented in the form of tables to show outcomes and comparisons.

Strengths of Research Methodologies

The comprehensive literature search that was conducted was within the limit of 10 years. This aimed at ensuring that the findings could still be applied to current clinical practice and were in line with the recommended practice guidelines. Besides, the researchers used the following keywords to conduct the literature search: hand hygiene, ABHR, hand washing, dermatitis, and contact dermatitis. This ensured that only studies that were relevant to the clinical issue were addressed.

General Comments

To promote the use of ABHRs and lessen the occurrence of contact dermatitis, nurses should be taught that Handwashing after and before using ABHRs removes emollients and sebum layers thus increasing the risk of contact dermatitis

Loftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. American journal of infection control, 46(10), 1134-1141.

Relation To The Clinical Issue

The article discusses how an increase in the awareness and epidemiology of pathogen transmission can help to expand compliance with intraoperative infection control measures. This was specific to the risk of transmitting Staphylococcus Aureus during operations which are associated with high transmission rates, antibiotic resistance, and virulence. It was also attributed to a significant growth pathogen spread within acute care settings to healthy community dwellers in community settings. The researchers further discuss evidence-based solutions that can be used to address this issue to improve patient safety.

Aim of the Study

The researchers acknowledged Healthcare-Associated Infections to be an overwhelming issue related to antibiotics resistance. It is for this reason that healthcare providers have been urged to ensure compliance with some of the most basic prevention measures to prevent the unnecessary use of antibiotics and prevent infections. The study was specific to reducing the incidence of surgical site infections through the preoperative decolonization of staph Aureus through improvement measures in novel hand hygiene. Therefore, the study aimed to characterize the epidemiology of sequence types  of  Staphylococcus Aureus in the operating environment.

Research Methodology

The study used quantitative research methods where Staphylococcus
Aureus
species that were isolated and collected from three medical centers underwent biofilm absorbance, genome analysis, and API (analytical profile indexing). 274 case pairs were randomly selected using a computer-generated list from a total of three medical centers in the US.  178 species of Staphylococcus Aureus were isolated. Of these, 173 were associated with the possibility of transmissions. The researchers also conducted an assessment on the virulent, antibiotic-resistant and hyper transmissible and strains of staphylococcus Aureus.  Statistical analyses using X
2
tests and Poisson regression with variances were used for statistical analyses.

Strengths of Research Methodologies

The researchers used randomization of study participants and a large study sample which increased chances of applicability of the results to wide-population settings. Besides, randomization helped to establish a cause and effect relationship between the variables that were being studied. The researchers also used conceptual frameworks to list the possible courses of action regarding the concept that was an understudy. When conducting the statistical analyses, χ2 tests were used in examining the possible associations of covariates previously mentioned variates about transmission.

General Comments

Intraoperative strains of Staphylococcus Aureus are pathogenic and hyper-transmissible. To control their spread, compliance with hand hygiene and patient decolonization are essential.

References

Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. 
The Lancet Infectious Diseases, 18
(11), 1269-1277. NURS 6052 wk 3 assignment Matrix Worksheet Template

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. 
American Journal of Critical Care, 27
(4), 334-337.

Loftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. 
American journal of infection control, 46
(10), 1134-1141.

Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitizing in infection control.
British Journal of Nursing, 27
(7), 382-388. NURS 6052 wk 3 assignment Matrix Worksheet Template

Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay

Introduction

This assignment involves making three decisions regarding the treatment choices for an elderly Hispanic man diagnosed with major depressive disorder. According to Cornish (2015), it is important to always utilize evidence-based practice for better health outcomes. For this assignment, the treatment decisions will be based on the latest research evidence. the paper will also discuss ethical aspects likely to affect the treatment of the client.

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Decision Point One

The chosen first decision is for the client to begin taking Effexor XR 37.5mg orally. The reason for choosing the decision is because the efficacy of Effexor in the treatment of depressive symptoms has been demonstrated. The medication works by increasing the amount of neurotransmitters norepinephrine and serotonin in the brain; these neurotransmitters control mood, appetite, sleep, emotions, anxiety, perceptions, and aggression, which are important aspects in depression (Gitlin, 2018) Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.  Another reason why this Effexor was selected is due to its safety among the geriatric population (Higuchi et al, 2016).

By choosing this decision, the expectation was that the depressive symptoms for this client would significantly improve due to the medication’s efficacy in the treatment of depression. Another expectation was that the medication would have minimal or no side effects for this client (Li, 2017).

Nonetheless, the outcome of the decision that was chosen was different from the expected outcome as indicated by the client having no notable change in the depressive symptoms. This can be attributable to the small dose of Effexor XR 37.5mg that was not effective in improving the symptoms (Stahl, 2013).

Decision Point Two

The second decision that was chosen is to have an increased dose of Effexor to 75 mg. this decision was chosen because higher doses of Effexor have been shown to be safe, effective and well-tolerated when it comes to the treating depressive symptoms (Li, 2017).

The expectation of choosing this decision was that there would be symptom remission for this client and that he would tolerate the high dose and have minimal or no side effects. According to Stahl (2013) patients are able to well tolerate higher doses of Effexor like 75 mg per day and the higher doses are effective in treating symptoms of major depressive disorder.

As per the expectations, the client had notable symptom remission after four weeks as reported and as MADRS demonstrated 25% symptom decrease. The reason for the symptom improvement is the efficacy of a higher dose of Effexor (Higuchi et al, 2016). Secondly, just like it was hoped, the client tolerated the increased dose well because no side effects were reported.

Decision Point Three

The third decision that was chosen to have the Effexor dose increased to 112.5 mg orally per day. The reason behind choosing this decision is because evidence indicates that an increased dose of Effexor is more effective due to the increased action of the medication in inhibiting reuptake of norepinephrine and serotonin. Li (2017) performed a study that showed that a dose of 75 mg of Effexor was a selective inhibitor of 5-HT reuptake whereas a higher dose of Effexor acted as an inhibitor or both norepinephrine and serotonin.

Therefore, increase the dose of Effexor to 112.5 mg per day for the client hoped that the symptoms of major depressive disorder for the client would significantly improve and as a result, the client will have complete symptom remission. Evidence shows that an elevated dose of Effexor has better efficacy when it comes to symptom improvement (Bombardier et al, 2014). In addition, it was hoped that the client would tolerate the higher dose of Effexor and hence have no adverse effects.

Ethical Considerations

Treatment of the geriatric population involves various ethical issues. Ethical issues for this client consist of the ability to make decisions and informed consent. For the informed consent, it is important for PMHNP to explain to the client all information about the available treatment options to ensure that the client makes an informed treatment decision (Stark et al, 2018). Nonetheless, at times the older adults have problems when it comes to process and understand information especially when they have mental health problems (Stark et al, 2018). Therefore, the PMHNP should ensure that the client clearly understands the information for him to make informed and independent treatment decision.

Conclusion

The decision that was first chosen for this client is starting Effexor XR 37.5mg due to the medication efficacy in treating depression. Additionally, the medication is safe and well-tolerated among the geriatric population. Nonetheless, with Effexor XR 37.5mg the client did not manifest symptom improvement and as a result, the second decision was increasing the dose to 75 mg. With the increased dose, the client manifested symptom improvement. The last decision was to increase the dose to 112.5 mg with the aim of ensuring complete symptom remission. Ethical issues relevant during the treatment of the client are the ability to make decisions and informed consent.

 

 

References

Bombardier C, Fann J, Wilson C, Allen H, Scott R, Warren A, Brooks L, Warms C, Temkin N & Tate D. (2014). A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: Methods and lessons learned.
J Spinal Cord Med
. 37(3): 247–263.

Cornish F. (2015). Evidence synthesis in international development: a critique of systematic reviews and a pragmatist alternative. 
Anthropology & Medicine
. 22(3), 263-277.

Gitlin M. (2018). Antidepressants in bipolar depression: an enduring controversy.
Int J Bipolar Discord
. 6(25).

Higuchi T, Kamjima K, Nakagome K, Yuko A, Rio I & Imaeda T. (2016). A randomized, double-blinded, placebo-controlled study to evaluate the efficacy and safety of venlafaxine extended-release and a long-term extension study for patients with major depressive disorder in Japan.
Int Clin Psychopharmacology
. 31(1), 8–19.

Li X. (2017). Short-term efficacy and tolerability of venlafaxine extended-release in adults with generalized anxiety disorder without depression: A meta-analysis.
PLoS One
. 12(10), e0185865.

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.).
New York, NY: Cambridge University Press.

Stark A, Hanna K, Stein J, Maier W, Heser K, Wiese B, Mamone S, Hans K, Bock J, Steffi G & Martin S. (2018). A qualitative study on older primary care patients’ perspectives on depression and its treatments – potential barriers to and opportunities for managing depression.
BMC Fam Pract
. 19(2).

 

BACKGROUND INFORMATION

The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

The Assignment

Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

 

Assessing and Treating Adult and Geriatric Clients with Mood Disorders

Introduction

This assignment involves making three decisions regarding the treatment choices for an elderly Hispanic man diagnosed with major depressive disorder. According to Cornish (2015), it is important to always utilize evidence-based practice for better health outcomes. For this assignment, the treatment decisions will be based on the latest research evidence. the paper will also discuss ethical aspects likely to affect the treatment of the client Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

Decision Point One

The chosen first decision is for the client to begin taking Effexor XR 37.5mg orally. The reason for choosing the decision is because the efficacy of Effexor in the treatment of depressive symptoms has been demonstrated. The medication works by increasing the amount of neurotransmitters norepinephrine and serotonin in the brain; these neurotransmitters control mood, appetite, sleep, emotions, anxiety, perceptions, and aggression, which are important aspects in depression (Gitlin, 2018).  Another reason why this Effexor was selected is due to its safety among the geriatric population (Higuchi et al, 2016).

By choosing this decision, the expectation was that the depressive symptoms for this client would significantly improve due to the medication’s efficacy in the treatment of depression. Another expectation was that the medication would have minimal or no side effects for this client (Li, 2017). Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

Nonetheless, the outcome of the decision that was chosen was different from the expected outcome as indicated by the client having no notable change in the depressive symptoms. This can be attributable to the small dose of Effexor XR 37.5mg that was not effective in improving the symptoms (Stahl, 2013).

Decision Point Two

The second decision that was chosen is to have an increased dose of Effexor to 75 mg. this decision was chosen because higher doses of Effexor have been shown to be safe, effective and well-tolerated when it comes to the treating depressive symptoms (Li, 2017).

The expectation of choosing this decision was that there would be symptom remission for this client and that he would tolerate the high dose and have minimal or no side effects. According to Stahl (2013) patients are able to well tolerate higher doses of Effexor like 75 mg per day and the higher doses are effective in treating symptoms of major depressive disorder.

As per the expectations, the client had notable symptom remission after four weeks as reported and as MADRS demonstrated 25% symptom decrease. The reason for the symptom improvement is the efficacy of a higher dose of Effexor (Higuchi et al, 2016). Secondly, just like it was hoped, the client tolerated the increased dose well because no side effects were reported. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

Decision Point Three

The third decision that was chosen to have the Effexor dose increased to 112.5 mg orally per day. The reason behind choosing this decision is because evidence indicates that an increased dose of Effexor is more effective due to the increased action of the medication in inhibiting reuptake of norepinephrine and serotonin. Li (2017) performed a study that showed that a dose of 75 mg of Effexor was a selective inhibitor of 5-HT reuptake whereas a higher dose of Effexor acted as an inhibitor or both norepinephrine and serotonin.

Therefore, increase the dose of Effexor to 112.5 mg per day for the client hoped that the symptoms of major depressive disorder for the client would significantly improve and as a result, the client will have complete symptom remission. Evidence shows that an elevated dose of Effexor has better efficacy when it comes to symptom improvement (Bombardier et al, 2014). In addition, it was hoped that the client would tolerate the higher dose of Effexor and hence have no adverse effects.

Ethical Considerations

Treatment of the geriatric population involves various ethical issues. Ethical issues for this client consist of the ability to make decisions and informed consent. For the informed consent, it is important for PMHNP to explain to the client all information about the available treatment options to ensure that the client makes an informed treatment decision (Stark et al, 2018). Nonetheless, at times the older adults have problems when it comes to process and understand information especially when they have mental health problems (Stark et al, 2018). Therefore, the PMHNP should ensure that the client clearly understands the information for him to make informed and independent treatment decision. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

Conclusion

The decision that was first chosen for this client is starting Effexor XR 37.5mg due to the medication efficacy in treating depression. Additionally, the medication is safe and well-tolerated among the geriatric population. Nonetheless, with Effexor XR 37.5mg the client did not manifest symptom improvement and as a result, the second decision was increasing the dose to 75 mg. With the increased dose, the client manifested symptom improvement. The last decision was to increase the dose to 112.5 mg with the aim of ensuring complete symptom remission. Ethical issues relevant during the treatment of the client are the ability to make decisions and informed consent. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

References

Bombardier C, Fann J, Wilson C, Allen H, Scott R, Warren A, Brooks L, Warms C, Temkin N & Tate D. (2014). A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: Methods and lessons learned.
J Spinal Cord Med
. 37(3): 247–263.

Cornish F. (2015). Evidence synthesis in international development: a critique of systematic reviews and a pragmatist alternative. 
Anthropology & Medicine
. 22(3), 263-277. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

Gitlin M. (2018). Antidepressants in bipolar depression: an enduring controversy.
Int J Bipolar Discord
. 6(25).

Higuchi T, Kamjima K, Nakagome K, Yuko A, Rio I & Imaeda T. (2016). A randomized, double-blinded, placebo-controlled study to evaluate the efficacy and safety of venlafaxine extended-release and a long-term extension study for patients with major depressive disorder in Japan.
Int Clin Psychopharmacology
. 31(1), 8–19.

Li X. (2017). Short-term efficacy and tolerability of venlafaxine extended-release in adults with generalized anxiety disorder without depression: A meta-analysis.
PLoS One
. 12(10), e0185865.

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.).
New York, NY: Cambridge University Press.

Stark A, Hanna K, Stein J, Maier W, Heser K, Wiese B, Mamone S, Hans K, Bock J, Steffi G & Martin S. (2018). A qualitative study on older primary care patients’ perspectives on depression and its treatments – potential barriers to and opportunities for managing depression.
BMC Fam Pract
. 19(2). Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.

NURS 6052 wk 3 assignment Matrix Worksheet Template

 

Use this document to complete
Part 2
of the Module 2 Assessment,
Evidence-Based Project, Part 1: An Introduction to Clinical Inquiry and Part 2: Research Methodologies

 

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Full
citation
of selected article

Article #1

Article #2

Article #3

Article #4

 

 

 

 

Why
you chose this article and/or
how it relates
to the clinical issue of interest (include a brief
explanation of the ethics
of research related to your clinical issue of interest)

 

 

 

 

NURS 6052 wk 3 assignment Matrix Worksheet Template

Brief
description of the aims
of the research of each peer-reviewed article

 

 

 

 

Brief description of the
research methodology
used Be sure to identify if the methodology used was
qualitative
,
quantitative
, or a
mixed-methods
approach. Be specific.

 

 

 

 

 

 

 

 

 

 

A brief description of the
strengths
of each of the research methodologies used, including
reliability
and
validity
of how the methodology was applied in each of the peer-reviewed articles you selected.

 

 

General Notes/Comments

 

 

 

 

 

 

 

 

Matrix Worksheet Template

Matrix Worksheet Template

 

Citation

Article #1

Article #2

Article #3

Article #4

Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. 
British Journal of Nursing, 27
(7), 382-388.

 

 

 

 

Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. 
The Lancet Infectious Diseases, 18
(11), 1269-1277.

 

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs. Handwashing. 
American Journal of Critical Care, 27
(4), 334-337.

 

Loftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus Aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. 
American journal of infection control, 46
(10), 1134-1141.

 

Relations with Clinical Issue and the ethics of research in Relation to the Clinical Issue

The article addresses a similar clinical issue by acknowledging Healthcare-Associated Infections as a public health concern for the health sector across the globe according to NICE. Some of the commonly identified infections include surgical, respiratory and urinary tract infections. This calls for the implementation of better strategies to control infections including education, reinforcing knowledge to the public, healthcare providers and individuals at high risk of infections in all areas of nursing practice.

This article similarly highlights how Healthcare Associated infections hinder patient safety, increases mortality and morbidity rates prolong hospital stays and increases medical costs. The researchers further acknowledge compliance of hand hygiene among healthcare providers as a significant strategy to maintain patient safety especially with regards to methicillin-resistant staphylococcus Aureus. However, very few national programmes have been sustained and integrated successfully into the national-health structure. Based on the results of the National Hand hygiene Initiative, hand hygiene reduces the risks of healthcare associated infections which continue to be a major public health concern.

The article highlights how Handwashing with soap and water is the most preferred way to manage and control infections.

NURS 6052 wk 3 assignment Matrix Worksheet Template

The article discusses how an increase in the awareness and epidemiology of pathogen transmission can help to improve compliance with intraoperative measures for infection control. This was specific to the risk of transmitting Staphylococcus Aureus during operations.

 

 

Aim of Study

To evaluate the effectiveness of alcohol-based gel for handrubs in the control of infections in clinical settings. The article was specific to renal nursing following a growth in the focus of evidence-based practice.

The study aimed at evaluating the outcomes of the National Hand Hygiene Initiative including its effect on the incidences of healthcare associated staphylococcus Aureus and hand hygiene compliance. This study aim was influenced by the background knowledge that healthcare provider’s compliance with hand hygiene is a significant national strategy for patient safety.

To examine the impact of  alcohol based handrubs supplemented with the use of lotions influences health outcomes among healthcare providers

NURS 6052 wk 3 assignment Matrix Worksheet Template

 

 

 

To characterize the epidemiology of Staphylococcus Aureus sequence types in the operating environment.

Research methodology

The EBP process for clinical decision making was reviewed for effective literature on the effectiveness of alcohol based gel and the results published recently with respect to the findings of the best model.

 

However, in a systematic review conducted by

 

 

 

 

 

 

 A longitudinal study where the outcomes of the NHHI eight years after implementation were assessed. The assesment included compliance with hand hygiene and the hospital’s participation, costs and association with heathcare-associated staphylococcus Aureus and educational engagement.

 

 

The researchers searched the databases of MEDLINE and CINAHL using the keywords ABHR, contact dermatitis, dermatitis and Handwashing. This search was limited to the past 10 years.

 

 

 

Staphylococcus
Aureus
species that that were isolated and collected from three academic medical centers underwent biofilm absorbance, genome analysis and analytical profile indexing. An assessment on the virulent, antibiotic-resistant and hyper transmissible and strains of staphylococcus Aureus was done.

 

 

 

Strengths of the Study, reliability and Validity

The review utilizes the steps of EBP and numerous articles relevant to the review purpose are used to justify the information shared.

Wide population data was used to evaluate the clinical impact of NHHI, specific, statistical analysis was done comparisons of proportions (χ² or t test), with a p value of 0·05 or less (two-tailed) considered statistically significant.

A comprehensive literature search that was conducted was within the limit of 10 years. The following key words were used in the literature search: hand hygiene, ABHR, hand washing, dermatitis, and contact dermatitis.

Randomization of study participants, a large study sample which increased chances of applicability to wide-population settings, χ2 tests were used to in examining the possible associations of c covariates previously mentioned variates in relation to transmission.

General Comments

When compared to approaches that use detergents and disinfectants that can result to pathogen dissemination, alcohol when adequately used is even more effective. Therefore, handrubs should be provided at the bedside, ward entrances and hospital for use when the hands are not visibly dirty, after, before and when performing all activities related to care. NURS 6052 wk 3 assignment Matrix Worksheet Template

 

 

 

 

 

The NHHI has been linked to significant improvement in hand hygiene compliance and a reduction in the incidence of HA-SAB. For a sustained central coordination and standardized approach for integration in hospital accreditation standards, several features should be observed.

In order to promote the use of  ABHRs and reduce the prevalence of contact dermatitis, nurses should be taught that Handwashing after and before  using ABHRs removes emollients and sebum layers thus increasing the risk of contact dermatitis

 

 

Intraoperative strains of staphylococcus Aureus are pathogenic and hyper-transmissible. In order to control their spread, compliance with hand hygiene and patient decolonization are essential.

 

 

 

 

References

Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. 
The Lancet Infectious Diseases
, 
18
(11), 1269-1277. NURS 6052 wk 3 assignment Matrix Worksheet Template

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. 
American Journal of Critical Care
, 
27
(4), 334-337.

Loftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. 
American journal of infection control
, 
46
(10), 1134-1141.

Lim, K., Kilpatrick, C., Storr, J., & Seale, H. (2018). Exploring the use of entertainment-education YouTube videos focused on infection prevention and control. 
American journal of infection control
, 
46
(11), 1218-1223.

Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. 
British Journal of Nursing
, 
27
(7), 382-388. NURS 6052 wk 3 assignment Matrix Worksheet Template

NU420M3 Organizational Structure Essay

Explore parts of the organizational structure and how the structure impacts nurse leaders/managers. Analyze how the evolution of healthcare organizations impacts nursing leadership roles. Discuss how nurse leaders can influence organizational structures today.

In nursing, an organizational structure is defined as the way in which the tasks are allocated, supervised, coordinated, and directed to meet the set goals (Benzer et al., 2017). It improves the efficiency of workflow and productivity as well as sets the procedures and rules to govern the activities. These organizations are guided by mission, vision, philosophy, and values of healthcare settings that impact nursing.  The mission describes the purpose of the existence of the organization and reflects on the values held, target customers and the products and services provided NU420M3 Organizational Structure Essay. The vision gives a comprehensive and clear image of the organizations future while the values present the core ethics and principles that the organization abides to. This paper seeks to explore the organizational parts, impacts of the structure, evolution of healthcare organizations and the effects on leadership as well as the influence of the nurse leaders on the structure of the organization in the contemporary society.

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Parts of the organizational structure

Nursing organizations employ particular elements namely degree of formalization, work specialization, centralization or decentralization, span of control, chain of command, and departmentalization to engage workers and management interactions (Brunsson & Olsen, 2018). Their structures are decentralized which allows fast operation, adaptability, and agility with high level of personal urgency. Most of the healthcare institutions employ a hierarchical organizational structure with the high, middle, low and direct level parts. This is characterized by the high-level part held by the top corporate, followed by the middle managerial level, the supervisor level marking the lowest level of administration as well as the direct level with providers that interact directly with the patients.

How the structure impacts nurse leaders/managers?

The structure has increased the flexibility of the leaders which allows them to easily adapt to the changes in healthcare. On the other hand, it has increased the quality of their leadership through informed decision making, effective communication and engagement of teams at different levels of the organizational structure. It has also improved their working environments with clearly described roles and tasks for their positions being spelt clearly to avoid overload and confusion. Furthermore, the working relationships for the leaders have improved due to smooth interaction with the workers and the other leaders. Senior nurse also report increased job satisfaction and influence in senior management team decisions (Lambert et al., 2017).

Evolution of healthcare organizations impacts on nursing leadership roles

The organizational structure supports nurse managers in the assignment of tasks and communication. This is possible through the chain of commands that ensures a hierarchical flow of information within the hospital. Employees are also able to give feedback to the managers which help them in informed decision-making. Moreover, the decentralized organizational structure gives different leadership levels to give their input towards the achievement of the objectives, goals, and vision. The leaders are also able to specialize in their areas of interest since the structure provides a description of the duties and responsibilities of each administration level.

How nurse leaders can influence organizational structures today?

Nurse leaders support flexibility which allows the advocacy of policies that strengthen the organizational structure. They can also create interdisciplinary teams in the organization to promote informed decision-making and collaborative efforts that influence the adoption of new structures that support the changes in the healthcare sector. Moreover, they empower the workers through the creation of awareness to prevent resistance and encourage commitment to better the organization structure (Neubert, Hunter & Tolentino, 2016). This allows the organization to work together towards achieving the set goals.

References

Benzer, J. K., Charns, M. P., Hamdan, S., & Afable, M. (2017). The role of organizational structure in readiness for change: A conceptual integration. 
Health services management research
, 
30
(1), 34-46.

Brunsson, N., & Olsen, J. P. (2018). 
The Reforming organization: making sense of administrative change
. Routledge.

Lambert, E. G., Qureshi, H., Klahm, C., Smith, B., & Frank, J. (2017). The effects of perceptions of organizational structure on job involvement, job satisfaction, and organizational commitment among Indian police officers. 
International journal of offender therapy and comparative criminology
, 
61
(16), 1892-1911.

Neubert, M. J., Hunter, E. M., & Tolentino, R. C. (2016). A servant leader and their stakeholders: When does organizational structure enhance a leader’s influence?. 
The Leadership Quarterly
, 
27
(6), 896-910.

 

Organizational Structure

Organizations, like pyramids, begin with a solid foundation.  This foundation is usually started by the development of mission or vision statements.  It is not unusual for a mission and vision statement to be combined into one broad statement (Darbi, 2012).  A vision statement draws a mental picture of what the organization wants to achieve.  A mission statement is more of an action statement.  These statements are written in a way that captures the organization’s values.  The vision and mission statements define the purpose for the organization.  They also guide all stakeholders to portray themselves with the desired attributes implied in the statements. NU420M3 Organizational Structure Essay  One hospital’s mission statement may be “to continuously improve the health and well-being of the community we serve”, or “to be the partner of choice as we transform healthcare for the people”.

Strategies are the methods that the organization uses to achieve its vision.  The organization’s values will be incorporated into each strategy.  The goals are the intended outcomes from the strategies attempted.  While strategies can be fluid, goals should be consistently focused on the important aspects (Hofstrand, 2016).  The process of developing goals and strategies evolves into the development of a policy and procedure of the organization.

Most organizational designs focus on chains of command with a hierarchy of authority (Hancock & Hanley, 2013).  Organizational designs will also separate staff based on their areas of knowledge (Carroll & Rudolph, 2006).  This is especially demonstrated in any hospital setting as it is divided by medical-surgical units, emergency departments, intensive care units, and so on.  Although they are divided, the groups work interdependently by sharing resources, information systems, and social practices.  Each area of specialty is often led by a shift supervisor who reports to a unit manager, who reports to an area manager, who reports to a nursing director, who reports to a facility administrator, who, finally, reports to an owner or board of directors.

“The ability of nurses to practice in a professional manner may be influenced by the organizational culture of their work environment” (Manojlovich & Ketefian, 2002, p15).  When staffing is low, resources are scarce, and census is high, stress is also elevated which is a fast road to burn out.  Nurse leaders who do not feel supported, respected, or empowered by their organization will fail to provide quality of care and patients will suffer the consequences.  Nursing leaders need opportunities to practice and develop their professionalism.  Nurse leaders should be experienced in their field of expertise and nurtured to be leaders.  They need role models to learn from. NU420M3 Organizational Structure Essay.

On the other hand, nurse leaders also need to be aware of their own values and beliefs and recognize when they are in conflict with those of the organization.  The nurse leader needs to be able to interpret the organization’s strategy and direct it to the front line staff in a way that they will understand (Hancock & Hanley, 2013).  Nurse leaders can be effective and efficient and directly impact patient outcomes (Kavanagh, Cimiotti, Abusalem, & Coty, 2012).  An effective nurse leader could transform a unit from one of poor outcomes to positive.  An effective leader can create a working environment that satisfactorily supports the staff members so they can productively perform in their assignments.

Health and healthcare have evolved through the centuries in attempts to provide higher quality of care and better patient outcomes.  From the earliest days of medicine, thought to be witchcraft, to the days of modern technology, healthcare has evolved.  However, today there is a strain between healthcare organizations and bureaucratic controls (Carroll & Rudolph, 2006).  As the cost of healthcare rises, access to healthcare decreases, and disparities are created.  To address this problem, the United States has developed a value-based healthcare system that is centered on providing high quality of care at the lowest possible cost (Badash, et.al., 2017).  Many legal reforms have been made to transform to effective healthcare systems but over-regulation impedes transitions NU420M3 Organizational Structure Essay.

References

Darbi, W.  (2012, July).  Of mission and vision statements and their potential impact on employee behaviour and attitudes: The case of a public but profit oriented tertiary institution. 
International journal of business and social science, 3
(4), 95-109.  Retrieved from
https://www.ijbssnet.com/journals/Vol_3_No_14_Special_Issue_July_2012/11.pdf

Hofstrand, D.  (2016, August). Vision and mission statements – A roadmap of where you want to go and how to get there. 
Iowa State University extension and outreach, File C5-09,
1-4
.  Retrieved from
https://www.extension.iastate.edu/agdm/wholefarm/html/c5-09.html

Carroll, J. & Rudolph, J.  (2006, December).  Design of high reliability organizations in health care. 
Quality and safety in healthcare, 15
(Suppl. 1), i4-i9.  Doi: 10.1136/qshc.2005.015867

Hancock, L. & Hanley, D.  (2013, February).  From our readers: Nurses leading from the middle. 
American nurse today
,
8
(2).  Retrieved from
https://www.americannursetoday.com/from-our-readers-nurses-leading-from-the-middle/

Manojlovich, M. & Ketefian, S.  (2016, April)  The effects of organizational culture on nursing professionalism: Implications for health resource planning. 
Canadian journal of nursing research, 33
(4), 15-34.  Retrieved from
http://cjnr.archive.mcgill.ca/article/view/1656/1656

Kavanagh, K., Cimiotti, J., Abusalem, S., & Coty, MB (2012, October 22).  Moving healthcare quality forward with nursing-sensitive value-based purchasing. 
Journal of nursing scholarship, 44
(4), 385-395.  Doi: 10.1111/j.1547-5069.2012.01469.x NU420M3 Organizational Structure Essay

Badash, I., Kleinman, N., Barr, S., Jang, J., Rahman, Suraiya, R., & Wu, B.  (2017, February).  Redefining health: The evolution of health ideas from antiquity to the era of value-based care. 
Cureus, 9
(2), e1018.  Doi: 10.7759/cureus.1018 NU420M3 Organizational Structure Essay