NURS 511 Advanced Health Assessment Theory Final Open Book Exam

Master of Science in Nursing / Emergency Advanced Health Assessment Theory (NURS 511) Final Open Book Exam
Second Semester 2019-2020 Questions Sheet

Dear Student, find the attached case study, read it carefully and answer related questions using attached “Students Answer Sheet” and upload completed answer sheet on blackboard, you have 48 hours to complete this exam and submit your answers.

Case Study

Henry Brusca is a 68-year-old, married father of 7 who was in relatively good health until 3 weeks ago. At that time, he visited the emergency room with the complaint of “just not feeling right.” His BP on admission was 170/118, so he was admitted to the coronary care unit with the diagnosis of uncontrolled HTN. His BP was controlled with medication, and he was discharged several days later. He is now being seen for follow-up care and management of HTN. Because Mr. Brusca is newly diagnosed with HTN, you will need to complete a history and thorough cardiovascular examination.

Case Study Findings

Biographical data:

■ 68-year-old white male.
■ Married, father of seven grown children.
■ Self-employed entrepreneur; BS degree in engineering.
■ Born and raised in the United States, Italian descent, Catholic religion. ■ Blue Cross/Blue Shield medical insurance plan.
■ Referral: Follow-up by primary care physician.
■ Source: Self, reliable.
Current health status:
■ No chest pain, dyspnea, palpitations, or edema.
■ Complains of fatigue, loss of energy, and occasional dizzy spells.
Past health history:
■ No rheumatic fever or heart murmurs.
■ No history of injuries.
■ Inguinal hernia repair.
■ Left ventricular hypertrophy revealed by electrocardiogram (ECG).
■ Hospitalized 3 weeks ago for HTN.

Accredited BSN Program by AHPGS on February 15, 2018

Page 1 of 4

Accredited University by the ASIC on March 27, 2017

Kingdom of Saudi Arabia Ministry of Education University of Hail College of Nursing

المملكة العربية السعودية وزارة التعليم
جامـعـة حـائل كلية التمريض

Master of Science in Nursing / Emergency Advanced Health Assessment Theory (NURS 511) Final Open Book Exam
Second Semester 2019-2020 Questions Sheet

■ No known food, drug, or environmental allergies.
■ No other previous medical problems.
■ Immunizations up to date. NURS 511 Advanced Health Assessment Theory Final Open Book Exam
■ No prescribed medications except Vasotec 5 mg bid and weekly use of antacid for indigestion. Family history:

■ Positive family history of HTN and stroke.
■ Mother had HTN and died at age 78 of a stroke.
■ Paternal uncle died at age 79 of MI.
Review of systems:
■ General Health Survey: Fatigue, weight gain of 60 lb over past 3 years.
■ Integumentary: Feet cold, thick nails, tight shoes.
■ Head, Eyes, Ears, Nose, and Throat (HEENT): Two dizzy spells over past 6 months. ■ Eyes: Wears glasses, no visual complaints, yearly eye examination.
■ Respiratory: “Short winded” with activity.
■ Gastrointestinal: Indigestion on weekly basis.
■ Genitourinary: Awakens at least once a night to go to bathroom.
■ Musculoskeletal/Neurological: General weakness, cramps in legs with walking.
■ Lymphatic: No reported problems.
■ Endocrine: No reported problems.
Psychosocial profile:

■ States that he does not have time for routine checkups. “I only go to the doctor’s when I’m sick. “Typical day consists of arising at 7 A.M., showering, having breakfast, and then going to work. Returns home by 6 P.M., eats dinner, watches TV till 11:30 P.M., but usually falls asleep before news is over. Usually in bed by 12 midnight.

■ 24-hour recall reveals a diet high in carbohydrates and fats and lacking in fruits and vegetables. Heavy-handed with salt shaker; salts everything. Admits that he has gained weight over the years and is 60 lb overweight. NURS 511 Advanced Health Assessment Theory Final Open Book Exam

■ No regular exercise program. States: “I’m too busy running my business.” Page 2 of 4

Accredited University by the ASIC on March 27, 2017

Accredited BSN Program by AHPGS on February 15, 2018

Kingdom of Saudi Arabia Ministry of Education University of Hail College of Nursing

المملكة العربية السعودية وزارة التعليم
جامـعـة حـائل كلية التمريض

Master of Science in Nursing / Emergency Advanced Health Assessment Theory (NURS 511) Final Open Book Exam
Second Semester 2019-2020 Questions Sheet

■ Hobbies include reading, crossword puzzles, and antique collecting.
■ Sleeps about 7 hours a night, but usually feels he is not getting enough sleep. Lately is more and

more tired. Wife states that he snores.

■ Never smoked. Has a bottle of wine every night with dinner.

■ Works at sedentary job, usually 7 days a week. No environmental hazards in workplace.

■ Lives with wife of 45 years in a two-story, single home in the suburbs with ample living space.

■ Has a large, close, caring family.

■ Admits that running his own business is very stressful, but feels he can handle it alone and doesn’t need anyone to help him.

General Health Survey findings:

■ Well-developed, well-groomed 68-year-old white male, appears younger than stated age. ■ Sits upright and relaxed during interview, answers questions appropriately.
■ Alert and responsive without complaint, oriented x 4 (time, place, situation, and person). ■ Affect pleasant and appropriate.

■ Head-to-toe scan reveals positive arcus senilis, positive AV nicking and cotton wool, extremity changes including thin, shiny skin, thick nails, and edema. NURS 511 Advanced Health Assessment Theory Final Open Book Exam

■ Vital Signs

■ Temperature, 36.6 °C.

■ Pulse, 86 BPM, strong and regular.

■ Respirations, 18/min, unlabored.

■ BP: 150/90 mmHg.

■ Height: 180 CM.

■ Weight: 124 KG.

Cardiovascular assessment findings include:

■ Neck Vessels

■ Positive large carotid pulsation, +3, symmetrical with smooth, sharp upstroke and rapid descent, artery stiff, negative for thrills and bruits.

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Accredited BSN Program by AHPGS on February 15, 2018

Page 3 of 4

Accredited University by the ASIC on March 27, 2017

Kingdom of Saudi Arabia Ministry of Education University of Hail College of Nursing

■ JVP at 30 degrees <3 cm, negative abdominojugular reflux. NURS 511 Advanced Health Assessment Theory Final Open Book Exam

■ Precordium

المملكة العربية السعودية وزارة التعليم
جامـعـة حـائل كلية التمريض

Master of Science in Nursing / Emergency Advanced Health Assessment Theory (NURS 511) Final Open Book Exam
Second Semester 2019-2020 Questions Sheet

■ Positive sustained pulsations displaced lateral to apex, PMI 3 cm with increased amplitude.

■ Slight pulsations also appreciated at LLSB and base, but not as pronounced.

■ Negative thrills; cardiac borders percussed third, fourth, and fifth intercostal spaces to the left of the midclavicular line.

■ Heart sounds appreciated with regular rate and rhythm at apex S1 > S2 and +S4,at LLSB S1 > S2. ■ S2 negative split, at base left S1 < 2 negative split, at base right S1 < 2 with an accentuated
S2, negative for murmurs and rubs.

Questions:

1) What questions might be useful to elicit further details surrounding the Chest pain, using one of the common acronyms in this regard? (5 Marks)

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2) From the subjective information you have obtained from Mr. Brusca’s history, what are his identifiable risk factors for heart disease? Which risk factors are modifiable and which are unmodifiable? (5 Marks)

3) List three priority nursing diagnosis for Mr. Brusca’s case, and cluster subjective and objective data that support each diagnosis. (3 Marks)

4) From the previous data, discuss the main issues of health promotion and disease prevention should the nurse discussed during health history and physical examination? (4 Marks).

5) Considering the relationship of the cardiovascular system to the respiratory system, what respiratory problems might Mr. Brusca have as a result of his cardiovascular disease? (3 Marks) NURS 511 Advanced Health Assessment Theory Final Open Book Exam

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Student Name:
Student ID:
Overall Given Mark:	/ 20

 

Instructions:

Based on the given case study of Mr. Brusca, write your answers on the giving space using this answer sheet and upload it on Blackboard before the 48 hours since begging of the exam. Your exam begins on Friday 01/05/2020 at 10:00 pm and end on Sunday 03/05/2020 at 10:00 pm.

Question Number 1: What questions might be useful to elicit further details surrounding the Chest pain, using one of the common acronyms in this regard? (5 Marks)

Answer:

 

Question Number 2: From the subjective information you have obtained from Mr. Brusca’s history, what are his identifiable risk factors for heart disease? Which risk factors are modifiable and which are unmodifiable? NURS 511 Advanced Health Assessment Theory Final Open Book Exam (5 Marks)

Answer:

 

 

Question Number 3: List three priority nursing diagnosis for Mr. Brusca’s case, and cluster subjective and objective data that support each diagnosis. (3 Marks)

Answer: # Nursing Diagnosis Subjective Data Objective Data 1             2             3

 

 

 

 

 

 

 

 

 

 

 

Question Number 4: From the previous data, discuss the main issues of health promotion and disease prevention should the nurse discussed during health history and physical examination? (4 Marks) NURS 511 Advanced Health Assessment Theory Final Open Book Exam

Answer:

 

 

 

 

 

 

 

 

Question Number 5: Considering the relationship of the cardiovascular system to the respiratory system, what respiratory problems might Mr. Brusca have as a result of his cardiovascular disease? And what are respiratory clinical signs associated with the respiratory problem(s)? (3 Marks)

Answer:

Nurse of the Future Nursing Core Competencies Essay Discussions

The Nurse of the Future Nursing Core Competencies consists of ten essential competencies stemming from nursing knowledge.  Chamberlain College of Nursing (2018) lesson 1 explains how they are a framework for professional nursing practice.  I believe those ten were selected since a strong framework leads to better patient outcomes, patient safety and satisfaction.  “In professional nursing, core competencies are fundamental knowledge, abilities, and skills that enable nurses to provide safe, effective care to other persons in health care settings” (Hood, 2018, p.6).  Of those ten, the two most important to my future nursing practice are patient-centered care and communication.

Patient-centered care is extremely important since we could not be nurses without patients to care for.  In the article “The Role of Patient-Centered Care in Nursing,” it explains how patient-centered care “is seen as a positive movement in the future of health care delivery” (Flagg, 2015. P.76).  I wholeheartedly agree.  How could we not center the care of a patient around them?  I always center care around the patient as well as their family that is involved in their hospital stay.  I work with babies so my communication with the family and interdisciplinary team is how care is centered around the patient.  Nurse of the Future Nursing Core Competencies Essay Discussions. I do this by participating in daily rounds, bedside discussions with family and patient/family weekly meetings.  Communication is how we exchange information.  Without it, we would not know anything about our patients.  Good communication is how we get to know the patients.  Getting to know the patient is how we center care around them.  We also need good communication among the interdisciplinary team.  Everyone needs to be on the same page to keep care centered on the patient and the family providing care for that patient.

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Patient-centered care and communication go hand in hand in my opinion.  That is why they are the most important to my nursing career.  I do however feel that all ten competencies are vital to my future nursing career.  I am committed to building on my established nursing framework by increasing my knowledge base through Chamberlain University RN-BSN program. Nurse of the Future Nursing Core Competencies Essay Discussions.

 

References

Chamberlain College of nursing (2018), NUR351 Transitions in Professional Nursing. Week 1 Lesson 1. Downers Grove, IL. Online Publication.

Flagg, A. J. (2015). The Role of Patient-Centered Care in Nursing. Transformational Tool Kit for Front Line Nurses, Nursing Clinics of North America, 50(1), 75-86. doi:10.1016/j.cnur.2014.10.006

Hood, L. J. (2018). Leddy & Pepper’s Professional Nursing (9th ed.). China: Wolters Kluwer.

 

Nurse of the Future Nursing Core Competencies (graded) -posted 1/5/16

–Now that you have examined the Nurse of the Future Nursing Core Competencies, why do you think that these competencies were selected? Which 2 of the 10 competencies will be most important to your future nursing practice and why?

At first glance of the Nurse of the Future Core Competencies the first thing that came to mind was “what do we need this for?” The more I started to read and comprehend what was being read it was like a light bulb went off.

These are all standards that “we” as nurses work with and by every day. In order to function as a nurse, you have to practice as a Professional, if not it would be difficult for one to trust us with their lives. The care that we provide to our patients would mean nothing if it was not Patient-Centered and focused on Safety. If we cannot keep our patients safe what is the purposed of providing care. Communication is important in everyday life, but it is a HUGE part of caring for our patients, whether it is verbal, non-verbal or physical it gives us an opportunity to develop a trusting rapport with them, not only that, communication offers a sense of healing. In order to help patients with their medical needs we have to have Teamwork and Collaborate with other healthcare professionals. We have to work as a team because we are all trying to accomplish the same goal, helping one get well. As healthcare professionals we function like this day in and day out and it’s a surprise that this plan was developed just a few short years ago. I guess when you are working on bettering something it puts things into perspective and I think that with this NOF NCC it helped to put nursing into a perspective I never thought of. Nurse of the Future Nursing Core Competencies Essay Discussions

All ten of these Core Competencies are very important, needless to say I had a very difficult time finding the 2 that were most important. I find that Communication and Informatics and Technology are the 2 that really engage my mind. I have been in the nursing field for 9 years and have had the pleasure of working with both the pediatric, adult and geriatric population and Communication has always been at the top of the list. It is not until now that I actually realize it. Whether I am working with a non-verbal child or a comatose geriatric patient I find that there are always ways to Communicate that they understand and feel. When administering eye drops to my comatose/non-verbal patients I always touch their eyelids softly and say “ok I am going to give your eye drops in this/ your eyes”, that way the can anticipate they will feel something go into their eyes instead of just going over and dropping fluid in their eyes. One of my patients would actually take a deep breath after softly touching her eyes as if she anticipating it. Information and Technology has allowed nursing to become easier when it comes down to documenting, reading and submitting orders etc. I grew up in the technology era and love that it is incorporated so well within the nursing aspect.

Massachusetts Nurse of the Future Core Competencies: Slides 1-8 (Aug 2010)

http://www.mass.edu/currentinit/documents/NursingCoreCompetencies.pdf Nurse of the Future Nursing Core Competencies Essay Discussions

Interprofessional Collaboration Strategies Essays

In today’s changing healthcare environment, it is more important than ever for professional nurses to be skilled in collaborating with professionals from other healthcare disciplines. What communication strategies can professional nurses use to specifically promote collaboration with other healthcare disciplines and professionals?

 

Communication is one of the key components in health care system. “Effective communication and collaboration among health professional are imperative to provide patient-centered care”. (AANC Essentials Baccalaureate Education.  page 22). In today’s changing healthcare environment, it is important than ever for professional nurses to be skilled in collaborating with professionals from other health disciplines. “Collaboration is based on the complementarities of roles and understanding of these roles by the member of healthcare team”. Interprofessional Collaboration Strategies Essays (Leddy& pepper’s conceptual bases of professional nursing, 9^th  edition  chapter 4 page 94), in order to promote collaboration, professional nurses need to confident, competent for interaction and use of SBAR technique for communication.

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At first,  confident and competent are very important qualities for effective communication. It helps to gain trust, develop rapport, and comfort among health care discipline which improves practice and “influence several aspects such as leadership, decision making, and nursing care plan.”  (Journal of Nursing UFPE   Nov 2017 p 11) Interprofessional Collaboration Strategies Essays

 

Secondly, SBAR ( situation, background, assessment, recommendation) is “technique that provides a structure for communication among healthcare clinician by organizing the delivery of relevant patient information The desired outcome of SBAR communication technique is to structure healthcare information in logical sequences, making communication between healthcare professionals more understood and more efficient”  Communication error leads to an estimate 98,000 death and 17$ billion lost in health care cost annually. (http://procedures.lww.com.chamberlainuniversity.idm.oclc.org/lnp/view.do?pId=2491277 (Links to an external site.) (PP (Links to an external site.))

 

As a conclusion, SBAR technique and confident, competent interactive communication  strategies help to promote collaboration with other healthcare disciplines and professionals

 

Reference

 

AACN The Essentials of Baccalaureate Education (Links to an external site.)

 (Links to an external site.)     Massachusetts Nurse of the Future Nursing Core Competencies (Links to an external site.)

Hood, L. J. (2018). Leddy & Pepper’s conceptual bases of professional nursing(9th ed.). Philadelphia,

Wolters Kluwer Health | Lippincott Williams & Wilkins.

http://procedures.lww.com.chamberlainuniversity.idm.oclc.org/lnp/view.do?pId=2491277 (Links to an external site.) (PP (Links to an external site.))

Journal of Nursing UFPE Nov 2017 page 11

 

Welcome to week 2!  This week we focus on interprofessional collaborations, and as part of that what we use as standardized communication strategies to effectively hand off patient care and patient needs.  What works in your facility?  In past years we have seen a variety of strategies;  SBAR, IPASS the Baton, a number of ways to organize care.  Communication between caregivers is a challenge when we don’t format our dialogue, and when we are intimidated by asking questions of physicians, or other clinical decisions.  What promotes better collaboration in your site?  Have a good week!  Beth Interprofessional Collaboration Strategies Essays

 

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“Communication is an essential element of helping others. Mutual goals cannot be defined or achieved without effective communication.” As stated by L.H. Hood’s (2014) in Leddy & Peppers Conceptual Bases of Professional Nursing, (page 80).

At the facility I work at, we use the SBAR (Situation, Background, Assessment, and Recommendation) and the I Pass the Baton during handoff in the patient room.  Both these processes by which information is clearly and accurately exchanged among team members helps promotes better collaboration. (Hood, 2014). I believe the I Pass the Baton along with computer-aide tool that utilizes the patient’s medical record and assists with the generation of up to date patient information is a great communication strategy that works at the facility that I work.  It provides effective teamwork, promotes continuity, and improves patient safety.  A face to face communication during hand off allows the person who is receiving the patient to ask questions and clarify the plan of care for the patient.

There are usually multiple members of the interdisciplinary team which include the physicians, nurses, pharmacists, social workers, registered dieticians, physical therapists, and speech pathology. I work night shift so I usually have the privilege of working with a few team members. At times, there are communication barriers and in order for effective communication to happen we need to clarify, correct misunderstandings, and respect that each individual has the competent skills capable of ensuring quality of care for the patient. For example I came across a patient who was receiving 2 types of blood transfusions and had an order for an antibiotic in which the patient was allergic to. The physician told the nurse that it was okay to administer the antibiotic and ordered a PRN Benadryl just in case the patient showed an allergic reaction. The first dose was due on my shift; I was not comfortable administering the medication because of the contraindication. I thought to myself what if a reaction did occur, how I would be able to differentiate whether it was from the antibiotic or the blood transfusion. I called the on-call doctor and was able to change the antibiotic. I felt such a relief after communicating with the doctor, patient safety is always a priority. Interprofessional Collaboration Strategies Essays

References

Hood, L.J. (2014). Leddy & Peppers Conceptual Bases of Professional Nursing. Philadelphia, PA: Wolters Klower Health, Lippincott Williams & Wilkins Interprofessional Collaboration Strategies Essays

Assignment: The Impact of Standardized Nursing Terminology

Standardized Nursing Terminology (SNTs)

Rutherford made a recent visit to an L&D unit within a local community hospital. During the visit, she was assessing the application of documentation for nursing care within the hospital’s electronic health records system (EHRs) (Rutherford, 2008). She was interested in the assessment of the recent implementation of SNTs. However, her visit was met with unexpected but intriguing nursing experience Assignment: The Impact of Standardized Nursing Terminology. One of the nurses stated that they used to document their care using SNTss (SNLs), but they did not sufficiently understand why they did so (Rutherford, 2008). Such a statement exhibited a plethora of information concerning the impact of standardized nursing terminology in nursing.

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In this case, the nurses need to be informed about the significance of SNTs in the nursing practice. The utilization of the SNTs in documentation within the nursing care profession is crucial for nursing professionals as well as the direct care nurses (Rutherford, 2008). The benefits of using standard nursing care language/terminology including but not limited to effective communication among the nurses and care providers, increased nurse visibility, improvement of patient care, enhancement of data collection techniques for evaluation of nursing outcomes as well as enhanced adherence to the standards of care (Rutherford, 2008). Therefore, the standardized using language improves the facilitation of assessment of the nurses’ competencies. The SNTs. The effective sharing of information supported by the SNTs assists in the sharing of knowledge during research, administration, and education in the field of nursing (Rutherford, 2008) Assignment: The Impact of Standardized Nursing Terminology.

Nursing organizations have outlined various benefits of implementation of the standardized nursing terminologies in nursing. For instance, in 2015, the American Nurses Association (ANA) described its position statement concerning its support for the application of Standardized terminologies in nursing (ANA, 2015). ANA’s position statement indicated that the use of standardized terminologies, especially in the Electronic Health Record (HER), as well as other informatics, enhances the understanding, coordination, control, and transfer of information among different departments. Therefore, all the nursing facilities were instructed to use the standardized terminologies within the EHRs to minimize communication errors. For inatance, mandatory conversion of data during transfer from one care plan to another was emphasized. The universality of communication reduces the risks of medical errors due to inadequate or wrong interpretation. In this case, the health records need to be recorded, stored, retrieved, and presented in a universal manner that is understood across the nursing profession Assignment: The Impact of Standardized Nursing Terminology. For example, the data from an ultrasound scan should be understood by a nutritionist handling the same patient.

For big data science, the combination of multiple sources of data is facilitated by the efficiency in the application of Standardized Nursing Terminologies in EHRs (Macieira, Smith, Davis, Yao, Wilkie, Lopez, & Keenan, 2017). In this concept, a study conducted by Macieira et al. (2017), found out that only 3 out of 5 sets of Standardized Nursing Terminologies were significantly used in the reviewed articles. The CCC and PNDs were absent in the articles. Therefore, the issue of language played a significant role in influencing the research. Since English was not a common language across the study areas Korea, Spain, and America, the discrepancies in the data were explained as a factor of language differences. However, an analysis of the variables, such as diagnosis, outcomes, and interventions, was related to the use of SNTs (Macieira et al., 2017).

Each type of Standardized Nursing Terminology has its unique benefits as well as advantages. For instance, SNOMED Clinical Terms, also called SNOMED CT is applicable in international health care and included the description, clinical meaning, relationship/link between related concepts within the nursing practice. SNOMED CT is highly applicable in the dissemination of multidisciplinary information and enhancement of clinical testing, quality measurement, as well as research initiatives. However, a significant challenge of SNOMED CT is seen in its reluctance to use the updated maps from CAP, unlike in ANA. Therefore, the SNOMED CT doesn’t purchase the maps leading to inconsistency in communication within the nursing practice (MBL Technologies, 2020) Assignment: The Impact of Standardized Nursing Terminology.

The application of electronic health records combined with standardized terminologies has been observed to have positive impacts on the improvement of the quality of nursing. The standardized languages and use of EHRs improve the quality of nursing documentation and quality of services. The improvement in nursing documentation is favored by the improved accuracy in documenting that is provided by the use of the EHRs (De Groot, Veer, Paans, & Francke, 2020).

The application of the SNTs has been evidenced as a major factor in improving the satisfaction of the nurses. The appropriate use of information technology enhances the efficiency in the nursing practice due to the rapid and straightforward sharing of information. The computer networks are used to records, store, manipulate as well as share medical records and reduce the stress of keeping and updating manual files. However, the technology of using EHRs is quite expensive in terms of training and equipment. Each nurse is expected to be computer literate to operate the EHR systems. Furthermore, extra costs of security should be incurred for the effective implementation of EHR systems. Therefore, data management tools and network security officers should be employed to enhance the security of electronic medical records (Chapman, 2016). Other disadvantages of SNTs include the differences in the international application of the terminologies. Each country has a unique language and culture. Therefore, the differences in interpretation of the SNTs between countries affect the efficiency of multicultural nursing care set up. Such differences jeopardize the quality of health as well as the patients’ safety (Olatubi, Oyediran, Faremi, & Salau, 2019).

In another study, Moen, Hakala, Peltonen, Suhonen, Ginter, Salakoski, & Salanterä (2020), focused upon the assignment of standardized subject heading in an automatic manner to the free-text sentences within the clinical nursing notes. The motivational concept behind the study was the establishment of the support nursing system, where patient documentation for care was developed using computer systems. Such a move was important in assisting the incorporation of suitable headlines that are congruent with the document topics. The study used 676 unique headlines derived from the Finish university hospital. Automatically, an evaluation of the methods was done as well as the analysis of the manual error. The results outlined that the short-term memory was significantly relevant in the selection of the headings. A manual analysis indicated that the predictions were better than the results indicated by the automatic evaluation. The reaearch concluded that appropriate subject headings existed on the sentence level category of the data. Therefore, there was feasibility of the development of the text classification system that would assist in supporting the application of standardized terminologies. Furthermore, such an approach would assist in saving the time for the burses to energy and time on care documents (Moen et al., 2020) Assignment: The Impact of Standardized Nursing Terminology.

References

American Nurses Association. (2015). Inclusion of Recognized Terminologies Supporting

Nursing Practice within Electronic Health Records and Other Health Information Technology Solutions.

Chapman, Y. L. (2016). Nurse Satisfaction with Information Technology Enhanced Bedside

Handoff. Medsurg nursing, 25(5).

De Groot, K., De Veer, A. J., Paans, W., & Francke, A. L. (2020). Use of electronic health

records in relation to standardized terminologies: a nationwide survey of nursing staff

experiences. International Journal of Nursing Studies, 103523.

Macieira, T. G., 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. In AMIA Annual Symposium Proceedings (Vol. 2017, p. 1205). American Medical Informatics Association.

MBL Technologies, 2020. Standard Nursing Terminologies: A Landscape Analysis. [online] Assignment: The Impact of Standardized Nursing Terminology

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Healthit.gov. Available at: <https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf> [Accessed 13 March 2020].

Moen, H., Hakala, K., Peltonen, L. M., Suhonen, H., Ginter, F., Salakoski, T., & Salanterä, S. (2020).

Supporting the use of standardized nursing terminologies with automatic subject heading

prediction: a comparison of sentence-level text classification methods. Journal of the American

Medical Informatics Association, 27(1), 81-88.

Olatubi, M. I., Oyediran, O. O., Faremi, F. A., & Salau, O. R. (2019). Knowledge, perception,

and utilization of SNTs (SNL)(NNN) among nurses in three selected hospitals in Ondo State, Nigeria. International journal of nursing knowledge, 30(1), 43-48.

Rutherford, M. (2008). SNTs: What does it mean for nursing practice.

OJIN: The Online Journal of Issues in Nursing, 13(1), 243-50.

 

Assignment: The Impact of Standardized Nursing Terminology
Among the Resources in this module is the Rutherford (2008) article Standardized Nursing Language: What Does It Mean for Nursing Practice? In this article, the author recounts a visit to a local hospital to view the recent implementation of a new coding system.

During the visit, one of the nurses commented to her, “We document our care using standardized nursing languages but we don’t fully understand why we do” (Rutherford, 2008, para. 1).

How would you respond to a comment such as this one? Assignment: The Impact of Standardized Nursing Terminology

To Prepare:

Review the concepts of informatics as presented in the Resources, particularly Rutherford, M. (2008) Standardized Nursing Language: What Does It Mean for Nursing Practice?
Reflect on the role of a nurse leader as a knowledge worker.
Consider how knowledge may be informed by data that is collected/accessed.
The Assignment:

In a 2- to 3-page paper, address the following:

Explain how you would inform this nurse (and others) of the importance of standardized nursing terminologies.
Describe the benefits and challenges of implementing standardized nursing terminologies in nursing practice. Be specific and provide examples.
Be sure to support your paper with peer-reviewed research on standardized nursing terminologies that you consulted from the Walden Library.

Learning 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/

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. Assignment: The Impact of Standardized Nursing Terminology

Note: You will access this article from the Walden Library databases.

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

Topaz, M. (2013). The hitchhiker’s guide to nursing theory: Using the Data-Knowledge-Information-Wisdom framework to guide informatics research. Online Journal of Nursing Informatics, 17(3).

Note: You will access this article from the Walden Library databases.

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.

Note: You will access this article from the Walden Library databases.

Required Media
Laureate Education (Executive Producer). (2012). Data, information, knowledge and wisdom continuum [Multimedia file]. Baltimore, MD: Author. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6051/03/mm/continuum/index.html

Laureate Education (Producer). (2018). Health Informatics and Population Health: Analyzing Data for Clinical Success [Video file]. Baltimore, MD: Author.

Transcript for video
Analyzing Data for Clinical Success
Program Transcript
GRANT SHEVCHIK: Probably the one disorder/disease where information
technology has had the biggest impact and really done a great job is in the
management of diabetes. Diabetes has a lot of complications too it, a lot of
different things that can go wrong. But on the surface, what you\’re managing for
the most part are numbers. Obviously, information technology is very conducive
to measuring numbers.
So you can pull up Joe, and you can see Joe. And you can see his numbers. You
can see the trend over time. You can see all sorts of things. This was magic. This
was one of the reasons why, way back when, we wanted to get an electronic
record, because we were able to look at that.
But the most important thing is not looking at the numbers in isolation, but looking
at them over time and being able to say to you, hey Joe, you\’re doing a great job.
You went from a hemoglobin A1C of 15. Normal is supposed to be 7. You\’re
down to 9. Most people would be unhappy with you. I\’m ecstatic, because 9 is a
lot better than 15.
By saying it in that fashion, Joe has an incentive to get down to 8. Joe\’s last
doctor never even knew what his A1C was the time before, the time before that.
In the paper chart, the chart was never there when Joe was there.
But it also makes a difference if this person shows up in the emergency room
and needs emergency surgery. Is this diabetic a diabetic under good control? Is
this a diabetic that has a lot of problems?
In the past, all we\’ve done is coded them as being diabetes. And we patted the
doctor on the back and said, good job. You let us know they have diabetes.
Now we\’re really asking for the more specific detail. What else is going on? What
else is there? Having some data is good. But then taking that data and looking
and making it more accurate is a more desirable goal and would make a big
difference in that patient in the long run. Assignment: The Impact of Standardized Nursing Terminology
The advantages of the whole community– meaning patients, physicians, et
cetera– becoming electronic and communicating over the internet via
smartphones, via whatever– that\’s what\’s going to really change medicine,
especially in chronic diseases. If you\’re talking about somebody\’s arthritis, they
need to be able to tell you, where does it hurt? How much does it hurt– that sort
of thing. So it\’s not as straightforward. But if you build effective questionnaires,
you can have questionnaires that the computer is smart enough to answer and
analyze for you.
© 2018 Laureate Education, Inc. 1

Analyzing Data for Clinical Success
So the future is great if you take what\’s out there and available, have the
computer work for you, design effective questionnaires, design effective things,
reach out to patients on a regular basis, know who communicates back to you,
but also know the ones who you\’ve lost. It\’s like anything else. The most
important patients are the ones that somehow got lost to follow-up. They\’re the
ones that are going to come back and be the train wreck. They\’re going to be the
ones that come back and show up in the hospital in the emergency room.
IT mean makes it a whole lot better than it used to be with just paper cards,
where he pull the cards out and see who needs to be reminded this month.
However, you still need to have people on your end, meaning the physician\’s
office end, who\’s looking at this and managing this to be able to make sure that
you\’re communicating with your patients, they\’re getting back to you, and you\’re
seeing what needs to be done.
As we get farther along, and more and more people sign onto a patient portal–
that sort of thing– that\’s where the magic comes in, because now, I can reach out
to all my diabetics through the portal. I can remind 1,000 people in 10 minutes by
just writing what I want to write, and send it all 1,000 of them. We didn\’t have that
ability before.
The part that really makes it easier is we\’re now actually getting to people
through their smartphones. And so we need to use these things that are out
there, the things that are available to us, that we can begin to take advantage
and really reach out to our patients. They love the convenience. And most
importantly, they appreciate that we care.
Analyzing Data for Clinical Success
Additional Content Attribution
FOOTAGE:
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© 2018 Laureate Education, Inc. 2

Analyzing Data for Clinical Success
GettyLicense_457541267.mov
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Suzanne Paone. (n.d.). Copy of IT PROFORMA Templa
Accessible player
Vinay Shanthagiri. (2014). Big Data in Health Informatics [Video file]. Retrieved from https://www.youtube.com/watch?v=4W6zGmH_pOw. Assignment: The Impact of Standardized Nursing Terminology

Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay

Hospital acquired pneumonia

Competition has typically been encouraged within the health care industry as a strategy for increasing value for all stakeholders. To be more precise, competition ensures the provision of better services and products that satisfy the needs of all stakeholders through improving processes and quality while reducing costs. For instance, capital limitations can restrict hospital control approaches such as having overcrowded wards. In the present case (addressing hospital acquired pneumonia), every resource is considered as scarce and subject to competing needs from other health care agendas. Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay. This makes efforts to prevent hospital acquired pneumonia in the midst of providing affordable and high-quality health care services an increasing challenge (Ruggiero, 2015). There is a conflict over whether to advocate for individual patients or equitable distribution of resources to larger populations. This conflict rests entirely on the role of social justice as it applies to the conflicting roles of non-maleficence (do no harm) and beneficence (do good) (Northouse, 2016). In addition, there are three resources of concern to the specific case owing to their scarcity. Firstly, the medical personnel who include nurses are limited in their capacities, skills, geography and time. Implementing strategies for preventing hospital acquired pneumonia are dependent on personnel awareness and their familiarity with the strategies. Having knowledgeable personnel is preferable since they are primed to understand and apply the prevention strategies. Secondly, facilities for delivering medical services are finite. It is not uncommon to have crowded facilities in the hospital. This situation is unlikely to change unless the facilities are expanded, a truly cost intensive endeavor. The facilities limitation can be addressed through making efficient use of the available resources so that high risk patients are isolated from the general populations. Thirdly, money for making changes to the facility is not unlimited. There are competing needs for money and there is a need to conduct a cost-benefit analysis to identify the agendas that have the least costs and most benefits (Joel, 2018). Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay

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References

Joel, L. (2018). Advanced practice nursing: essentials for role development (4^th ed.). Philadelphia, PA: F. A. Davis Company.

Northouse, P. (2016). Leadership: theory and practice (7^th ed.). Thousand Oaks, CA: Sage Publications.

Ruggiero, V. (2015). Thinking critically about ethical issues (9^th ed.). New York, NY: McGraw-Hill Education.

 

Discussion: Organizational Policies and Practices to Support Healthcare Issues
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.
For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue. Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay
To Prepare:
• Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1. NOTE: The national healthcare issue/stressor I addressed in module 1 is “HOSPITAL ACQUIRED PNEUMONIA. So, you are going to use this topic to answer questions related to this discussion.
• Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

Required Readings
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only
Note: Review all, with special attention to “Provision 6” (pp. 23–26). Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

 

Hospital-Acquired Pneumonia

Description of the National Healthcare Issue/Stressor

Hospital-acquired pneumonia (HAP) refers to pneumonia that a patient develops within a hospital setting after at least 48–72 hours after being admitted (Pássaro et al.; 2016). HAP is the second leading hospital-acquired infection and cause of death among critically sick patients. HAP is allied to an elevated rate of mortality and morbidity, as well as increased healthcare costs (Torres-García et al., 2019). According to Min et al. (2018), the incidence of HAP worldwide is 5–20 cases per 1000 admissions. The high prevalence of HAP indicates the need to address the issue.

In my healthcare organization, HAP is common among patients in the ICU, and notably patients who are mechanically ventilated. Similarly, the rate of HAP is also relatively high in patients within the medical-surgical ward and the general ward. In the organization, HAP in all units leads to an increased rate of morbidity and mortality, longer period of hospital stays, as well as increased costs for both the patient and the organization. This is consistent with other organizations where hospital-acquired infections like HAP are associated with a high mortality rate, a prolonged period of hospitalization, as well as higher healthcare costs (Pássaro et al., 2016). Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay

In the organization, the rate of HAP is particularly high among older adults, patients in the ICU, as well as patients with prolonged use of antibiotics and glucocorticoids. The high incidence of HAP among patients with lengthy use of glucocorticoids is allied to the reduced immunity that makes individuals susceptible to infections. Similarly, long-term use of antibiotics is a major risk factor for hospital-acquired pneumonia due to resistance to antibiotics. In my healthcare organization, HAP is associated with an increased rate of mortality, admission to the ICU, and an increased period of hospital stay. Besides, the organization, being a government agency, spends a lot of money on financing the treatment and care of HAP.

Summary of the Two Articles

According to Brett et al., (2019), HAP is allied to elevated morbidity and mortality rate and also increased medical costs. HAP is also a leading factor for transfer to the ICU and results in a prolonged hospital stay. Risk factors associated with HAP include advanced age, a longer period of hospital stay, being a male, dysphagia, numerous comorbidities, as well as chronic obstructive pulmonary disease (Brett et al., 2019). Brett et al. (2019) further indicate that poor oral hygiene causes a buildup of dental disease, which is a significant risk factor in HAP. Accordingly, Brett et al. (2019) explain that improved oral hygiene is effective in decreasing the rate of HAP. Other strategies that can reduce the rate of HAP include early mobilization, effective hand hygiene, proper management of dysphagia, and prevention of viral infections (Brett et al., 2019) Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay.

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Again, Deng et al. (2019) explain that HAP is a very common hospital-acquired infection and a leading cause of death among hospitalized patients. Multi-drug-resistant organisms (MDROs) are attributed to the numerous cases of HAPs, and particularly within the ICU and emergency departments (Deng et al., 2019). Wide usage of broad-spectrum antibiotics is attributable to bacterial resistance, one of the risk factors for HAP.

Strategies used to Address HAP

The study by Brett et al. (2019) demonstrates that interventions such as improved oral care, increased movement, and mobility, as well as dysphagia management, are effective in preventing HAP. The study indicates that improved oral care is an important modifiable risk factor for HAP. Comprehensive oral care facilitated by nurses is effective in preventing HAP as it prevents the buildup of dental plaque, which is a significant risk factor in HAP.

Increased mobilization is also an intervention that can be used in preventing HAP, especially among patients with acute ischemic stroke. The intervention involves turning the patient from “supine position to right and left lateral resting position” after every two hours and passively mobilizing the four limbs. This intervention is effective in reducing the rate of HAP. The mobilization intervention also integrates pre-operative patient education, breathing exercises, as well as pre-operative physiotherapy (Brett et al.; 2019). Brett et al. (2019) further explain that proper management of dysphagia and particularly among post-stroke patients, is essential in reducing the rate of HAP. This intervention includes nurses screening patients for dysphagia and implementing the appropriate interventions. The reason is that dysphagia is the leading cause of aspiration pneumonia. After all, food or liquids can enter the airway when patients have difficulties in swallowing and hence introduce bacteria to the lungs. Therefore, effective management of dysphagia can prevent aspiration pneumonia. Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay.

Preventing and treating infections caused by multi-drug-resistant organisms can go a long way in preventing HAP (Deng et al., 2019). Long-term use of antibiotics is a significant risk factor for HAP as a result of organisms’ resistance to antibiotic therapy. Interventions used to address the issue of multi-drug resistance include relieving the inflammatory reactions among patients, improving organisms’ clearance, reducing the period of mechanical ventilation, treating patients’ immunity, and increasing the success rate of ventilator weaning (Deng et al., 2019).

References

Brett M, Russo P, Cheng A, Andrew S, Rosebrock H, Curtis S, Robinsion S & Kiernan M. (2019). Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: A systematic review. Infection, Disease & Health, 24(4), 229 – 239.

Deng, D., Chen, Z., Jia, L, Bu J, Ye M, Sun L, Gen Y, Wen Z, Chen G & Fang B. (2019). Treatment of hospital-acquired pneumonia with multi-drug resistant organism by Buzhong Yiqi decoction based on Fuzheng Quxie classical prescription: study protocol for a randomized controlled trial. Trials, 20(817).

Min, J. Y., Kim, H. J., Yoon, C., Lee, K., Yeo, M., & Min, K. B. (2018). Hospital-Acquired Pneumonia among Inpatients via the Emergency Department: A Propensity-Score Matched Analysis. International journal of environmental research and public health, 15(6), 1178. https://doi.org/10.3390/ijerph15061178.

Pássaro, L., Harbarth, S. & Landelle, C. (2016). Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control, 5(43 (20). Discussion: Organizational Policies and Practices to Support Healthcare Issues – Hospital Acquired Pneumonia Essay

Torres-García, M., Pérez Méndez, B. B., Sánchez Huerta, J. L., Villa Guillén, M., Rementería Vazquez, V., Castro Diaz, A. D., López Martinez, B., Laris González, A., Jiménez-Juárez, R. N., & de la Rosa-Zamboni, D. (2019). Healthcare-Associated Pneumonia: Don’t Forget About Respiratory Viruses. Frontiers in pediatrics, 7(168).