Group Management for Just Culture

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The concept of a fair and just culture refers to the way an organization handles safety issues. Humans are fallible; they make mistakes. In a just culture, ‘hazardous’ human behavior such as staff errors, near–misses and risky actions are identified and discussed openly in hopes of finding ways to improve processes and systems—not to identify and punish the individual.

—Pepe & Caltado, 2011

This Discussion examines the opportunities of managers in working with groups to promote change that facilitates the delivery of safe, high–quality care.

To Prepare

Review the information on just culture presented in the Learning Resources.

For this discussion, you will use the Regulatory Decision Pathway found in Russell, K. A. & Radtke, B. K. (2014).

Examine an adverse event at the unit level in your organization or one with which you are familiar and apply the Regulatory Decision Pathway.

Compare the findings of the Regulatory Decision Pathway to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?

Think about how a nurse leader–manager may use just culture as a framework to create or maintain a focus on accountability and outcomes throughout a group. What actions could be taken if a systems–related error was made or if an error resulted from risky behavior?

How might role conflict and/or ambiguity have contributed to the situation?

Post a description of an adverse event in your organization and your analysis of the issue using the Regulatory Decision Pathway. Explain how role conflict or ambiguity might have influenced this situation. Apply the principles of just culture as you explain how you, as the group’s manager, would handle the situation.

http://sidneydekker.com/wp-content/uploads/2013/01/JustCultureCritique.pdf
http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

Below is a paper to use as reference!!!!!!!!!

PLEASE USE THIS AS A REFERENCE ONLY.

Adverse Event

        Adverse events are a part of the healthcare environment and how an event is dealt with can affect patient safety.  The regulatory pathway and just culture are a means of improving the quality of care and safety culture (Russell & Radtke, 2014).  Health care employees need to trust in their organization that an adverse event can be reported so that the organization and employee can learn from the event, and that it is not just a means to place blame.


        An adverse event that took place in the cardiac catheterization lab was a procedure was done on the wrong patient.  A patient that was to have a pacemaker instead ended up having a diagnostic catheterization.  This event involved a patient identification issue by the nurse.  The hospital’s patient identification policy and time out policy were not adhered to by the nurse and then the catheterization team.   The incident was reported to the state, and there were several event meetings with the nurse and physician.  As a result of the investigation, all staff in the catheterization lab were re-educated to the patient identification and time out policy.  All staff had to sign an individual affidavit that they understood the policy.  The nurse was given a written warning.  This event would not have happened if the nurse and catheterization team had adhered to policy.

Regulatory Decision Pathway

Using the regulatory decision pathway, the nurse did not intend to harm the patient deliberately. The nurse asked the patient if she was Ms. X and the patient said yes. The identification policy is to check the patient’s identification band for name and medical record number against a second identifier. This was not done. There were no significant circumstances involving the system that led to the error. The nurse did not conceal the error or falsify the record. The nurse did not disregard or consciously take a substantial risk. She thought she had the correct patient. There were no similar or serious errors by this nurse. A reasonably prudent nurse would not have done the same in similar circumstances as the patient identification policy would have been adhered to. According to the regulatory decision pathway, this was at-risk behavior by the nurse (Russell & Radtke, 2014).

        The catheterization team which included the physician, nurse, physician assistant, and technician contributed to this adverse event.  The team did not follow the time out process policy where everything stops, and patient identification is reconfirmed with other parameters.  Again, following the regulatory decision pathway, the catheterization team demonstrated at-risk behavior.  At-risk behavior involves unsafe practice and carelessness which is shown by the nurse and catheterization team not adhering to policy (Russell & Radtke, 2014).

Role Conflict

The cardiac catheterization lab is very fast-paced, and the nurses can feel the stress of the workload. The procedure area and recovery room was very busy and crowded that day. Role conflict could have contributed to the situation as there is constant pressure to keep moving. Role conflict could have contributed in the time-out process not taking place in the procedure room. Nurses have to initiate the time out process when the physician arrives, and some physicians are not very cooperative in the process. Since the adverse event, patient identification and the time out policy are strictly adhered to.

Just Culture

Quality improvement and work environment improvement are a part of just culture (Lockhart, 2015). Just culture is safety issues, improving processes, and not about punishing individuals (Pepe & Cataldo, 2011). As the group’s manager using the principles of culture, I would have done firm counseling stressing the significance of the incident, but as this was the nurse’s first risky behavior, I would not have done a formal written warning with the threat of being fired if it happens again. Doing a staff meeting and re-educating the policies was appropriate. Patient identification and the time out process are now part of the cardiac catheterization lab’s monthly quality assurance surveys. All new employees are well educated in the two policies and must sign an attestation that they understand by the end of orientation. This adverse event led to improved processes in the cardiac catheterization lab which is the goal of just culture (Pepe & Cataldo, 2011).

References

Lockhart, L. (2015). Does your organization have a just culture? Retrieved from http://www.NursingMadeIncrediblyEasy.com doi-10.1097/01.NME.0000457286.16594.92

Pepe, J., & Cataldo, P. J. (2011). Manage risk, build a just culture. Health Progress. Retrieved from http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

Russell, K. A. & Radtke, B. K. (2014). An evidence-based tool for regulatory decision-making: regulatory decision pathway. Journal of Nursing Regulation, 5(2), 5-9. https://class.waldenu.edu/bbcswebdav/institution/USW1/201810_27/MS_NURS/NURS_6201/readings/USW1_NURS_6201_Russell.pdf

Diseases Illnesses And Disorders

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Question 1. You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?

Moist and smooth

Moist and rough

Dry and smooth

Dry and rough

Question 2. Question : You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?

Tenderness

Cool temperature

Ecchymosis

Nodules

Question 3. Question : A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Question 4. Question : A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain?

Rheumatoid arthritis

Osteoarthritis

Fibromyalgia

Polymyalgia rheumatica

Question 5. Question : Heberden’s nodes are commonly found in which one of the following diseases?

Rheumatoid arthritis

Degenerative joint disease

Psoriatic arthritis

Septic arthritis

Question 6. Question : A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with:

Contact dermatitis

Impetigo

Larva migrans

Scabies

Question 7. Question : An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which one of the following is a risk factor for osteoporosis?

Obesity

Late menopause

Having an aunt with osteoporosis

Delayed menarche

Question 8. Question : Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?

Conclude that these are lesions she has had for a long time.

Wait for her to mention them before asking further questions.

Ask how she acquired them.

Conduct the visit as usual for the patient.

Question 9. Question : A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain?

: Age over 50

Pain at night

Pain lasting more than 1 month or not responding to therapy

Pain that is bilateral

Question 10. Question : The Phalen’s test is used to evaluate:

Inflammation of the median nerve

Rheumatoid arthritis

Degenerative joint changes

Chronic tenosynovitis

  1. Question : Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?

The presence of bowel sounds in the scrotum

Being unable to palpate superior to the mass

A positive transillumination test

Normal thickness of the skin of the scrotum

Question 2. Question : You are examining a newborn and note that the right testicle is not in the scrotum. What should you do next?

Refer to urology

Recheck in six months

Tell the parent the testicle is absent but that this should not affect fertility

Attempt to bring down the testis from the inguinal canal

Question 3. Question : A 50-year-old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. His past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than six beers a week, and denies using any illegal drugs. His mother has high blood pressure and arthritis and his father died of lung cancer in his sixties. On examination, his blood pressure is 130/80 and his pulse is 80. His cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but on his digital rectal examination you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?

Internal hemorrhoid

Prostate cancer

Anorectal cancer

Rectal polyp

Question 4. Question : A 15-year-old high school football player is brought to your office by his mother. He is complaining of severe testicular pain since exactly 8:00 this morning. He denies any sexual activity and states that he hurts so bad he can’t even urinate. He is nauseated and is throwing up. He denies any recent illness or fever. His past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. On examination, you see a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. His blood pressure is 150/100, his pulse is 110, and his respirations are 24. On visualization of the penis, he is circumcised and there are no lesions and no discharge from the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left but is normal on the right. By catheter you get a urine sample and the analysis is unremarkable. You send the boy with his mother to the emergency room for further workup.

Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Question 5. Question : Which is true of prostate cancer?

It is commonly lethal.

It is one of the less common forms of cancer.

Family history does not appear to be a risk factor.

Ethnicity is a risk factor.

Question 6. Question : Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?

Phimosis

Paraphimosis

Balanitis

Balanoposthitis

Question 7. Question : A 12-year-old is brought to your clinic by his father. He was taught in his health class at school to do monthly testicular self-examinations. Yesterday, when he felt his left testicle, it was enlarged and tender. He isn’t sure if he has had burning with urination and he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last three days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure and his mother is healthy. On examination, you see a child in no acute distress. His temperature is 100.8 and his blood pressure and pulse are unremarkable. On visualization of his penis, he is uncircumcised and has no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings, and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this child most likely have?

Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Question 8. Question : The most common cause of cancer deaths in males is:

Lung cancer

Prostate cancer

Colon cancer

Skin cancer

Question 9. Question : Important techniques in performing the rectal examination include which of the following?

Lubrication

Waiting for the sphincter to relax

Explaining what the patient should expect with each step before it occurs

All of the above

Question 10. Question : Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?

Decreased testosterone levels

Psychological issues

Abnormal hypogastric arterial circulation

Impaired neural innervation

Question 1. Which of the following is true of human papilloma virus (HPV) infection?

Pap smear is a relatively ineffective screening method.

It commonly resolves spontaneously in one to two years.

It is the second most common STI in the United States.

HPV infections cause a small but important number of cervical cancers.

Question 2. Question : Which of the following is the most effective pattern of palpation for breast cancer?

Beginning at the nipple, make an ever-enlarging spiral.

Divide the breast into quadrants and inspect each systematically.

Examine in lines resembling the back and forth pattern of mowing a lawn.

Beginning at the nipple, palpate vertically in a stripe pattern.

Question 3. Question : A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise, his examination is normal. He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia?

Breast cancer

Imbalance of hormones of puberty

Drug use

Question 4. Question : Which of the following represents metrorrhagia?

Fewer than 21 days between menses

Excessive flow

Infrequent bleeding

Bleeding between periods

Question 5. Question : What does a KOH (potassium hydroxide) prep help the nurse practitioner diagnose?

Herpes zoster infections

Yeast infections

Herpes simplex infections

Viral infections

Question 6. Question : Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?

This is most likely due to lack of lubrication.

This is most likely due to atrophic vaginitis.

This is most likely due to pressure on an ovary.

Psychosocial reasons may cause this condition.

Question 7. Question : A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis?

Breast tissue

Fibrocystic disease

Breast cancer

Lymph node

Question 8. Question : Which of the following is true regarding breast self-examination?

It has been shown to reduce mortality from breast cancer.

It is recommended unanimously by organizations making screening recommendations.

A high proportion of breast masses are detected by breast self-examination.

The undue fear caused by finding a mass justifies omitting instruction in breast self-examination.

Question 9. Question : A 23-year-old computer programmer comes to your office for an annual examination. She has recently become sexually active and wants to be placed on birth control. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes, and her father has high blood pressure. The patient denies using tobacco but has four to five drinks on Friday and Saturday nights. She denies any illegal drug use. On examination, you see a mildly obese female who is breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you see dark, velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have?

Peau d’orange

Acanthosis nigricans

Hidradenitis suppurativa

Question 10. Question : Which of the following is true of women who have had a unilateral mastectomy?

They no longer require breast examination.

They should be examined carefully along the surgical scar for masses.

Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer.

Women with breast reconstruction over their mastectomy site no longer require examination.

Question 1. A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about three days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, three days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over fifty years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative.His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending.

What diagnosis for abdominal pain best describes his symptoms and signs?

Acute diverticulitis

Acute cholecystitis

Acute appendicitis

Mesenteric ischemia

Question 2. Question : Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for two days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

Bleeding from a diverticulum

Bleeding from a peptic ulcer

Bleeding from a colon cancer

Bleeding from cholecystitis

Question 3. Question : A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for twelve hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was the night before and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one-third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular examinations are normal.

What is the most likely cause of his pain?

Acute appendicitis

Acute mechanical intestinal obstruction

Acute cholecystitis

Mesenteric ischemia

Question 4. Question : Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?

His spleen is definitely enlarged and further workup is warranted.

His spleen is possibly enlarged and close attention should be paid to further examination.

His spleen is possibly enlarged and further workup is warranted.

His spleen is definitely normal.

Question 5. Question : Diminished radial pulses may be seen in patients with which of the following?

Aortic insufficiency

Hyperthyroidism

Arterial emboli

Early “warm” septic shock

Question 6. Question : A 42-year-old florist comes to your office, complaining of chronic constipation for the last six months. She has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems (ROS), you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination, she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons.

What is the best choice for the cause of her constipation?

Large bowel obstruction

Irritable bowel syndrome

Rectal cancer

Hypothyroidism

Question 7. Question : A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of sixteen, but is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?

Intermittent claudication

Chest pressure with exertion

Shortness of breath

Knee pain

Question 8. Question : You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient’s pain make you concerned for this disease process?

Thigh

Knee

Calf

Ankle

Question 9. Question : A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?

Femoral pulse, popliteal pulse

Dorsalis pedis pulse, posterior tibial pulse

Carotid pulse

Radial pulse, brachial pulse

Question 10. Question : Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant (LUQ) pain. On examination of this area, a rough grating noise is heard. What is this sound?

It is a splenic rub.

It is a variant of bowel noise.

It represents borborygmi.

It is a vascular noise.

Question 1.A 30-year-old woman with a history of mitral valve problems states that she has been “very tired.” She has started waking up at night and feels like her “heart is pounding.” During the assessment, the nurse practitioner palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse practitioner also auscultates a blowing, swishing sound right after S1. These findings would be most consistent with:

heart failure.

aortic stenosis.

pulmonary edema.

mitral regurgitation.

Question 2. Question : A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse practitioner suspects:

hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Question 3. Question : A patient complains that while studying for an examination he began to notice a severe headache in the frontotemporal area of his head that is throbbing and is somewhat relieved when he lies down. He tells the nurse practitioner that his mother also had these headaches. The nurse practitioner suspects that he may be suffering from:

hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Question 4. Question : A patient tells the nurse practitioner that he is very nervous, that he is nauseated, and that he “feels hot.” This type of data would be:

objective.

reflective.

subjective.

introspective

Question 5. Question : The most important reason to share information and offer brief teaching while performing the physical examination is to help:

the examiner feel more comfortable and gain control of the situation.

build rapport and increase the patient’s confidence in the examiner.

the patient understand his or her disease process and treatment modalities.

the patient identify questions about his or her disease and potential areas of patient education.

Question 6. Question : A patient says that she has recently noticed a lump in the front of her neck below her “Adam’s apple” that seems to be getting bigger. During the assessment, the finding that reassures the nurse practitioner that this may not be a cancerous thyroid nodule is that the lump (nodule):

is tender.

is mobile and not hard.

disappears when the patient smiles.

is hard and fixed to the surrounding structures.

Question 7. Question : A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse practitioner suspects that he has:

Cushing’s syndrome.

Parkinson’s syndrome.

Bell’s palsy.

had a cerebrovascular accident (stroke).

Question 8. Question : The temporomandibular joint is just below the temporal artery and anterior to the:

hyoid.

vagus.

tragus.

mandible.

Question 9. Question : During an examination of a patient’s abdomen, the nurse practitioner notes that the abdomen is rounded and firm to the touch. During percussion, the nurse practitioner notes a drum-like quality of the sound across the quadrants. This type of sound indicates:

constipation.

air-filled areas.

the presence of a tumor.

the presence of dense organs.

Question 10. Question : A patient tells the nurse that he is allergic to penicillin. What would be the nurse practitioner’s best response to this information?

“Are you allergic to any other drugs?”

“How often have you received penicillin?”

“I’ll write your allergy on your chart so you won’t receive any.”

“Please describe what happens to you when you take penicillin.”

Question 11. Question : A patient’s thyroid is enlarged, and the nurse practitioner is preparing to auscultate the thyroid for the presence of a bruit. A bruit is a:

low gurgling sound best heard with the diaphragm of the stethoscope.

loud, whooshing, blowing sound best heard with the bell of the stethoscope.

soft, whooshing, pulsatile sound best heard with the bell of the stethoscope.

high-pitched tinkling sound best heard with the diaphragm of the stethoscope.

Question 12. Question : After completing an initial assessment on a patient, the nurse practitioner has documented that his respirations are eupneic and his pulse is 58. This type of data would be:

objective.

reflective.

subjective.

introspective.

Question 13. Question : A patient tells the nurse that she has had abdominal pain for the past week. What would be the best response by the nurse?

“Can you point to where it hurts?”

“We’ll talk more about that later in the interview.”

“What have you had to eat in the last 24 hours?”

“Have you ever had any surgeries on your abdomen?”

Question 14. Question : A teenage patient comes to the emergency department with complaints of an inability to “breathe and a sharp pain in my left chest.” The assessment findings include the following: cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with:

bronchitis.

a pneumothorax.

acute pneumonia.

an asthmatic attack.

Question 15. Question : The inspection phase of the physical assessment:

yields little information.

takes time and reveals a surprising amount of information.

may be somewhat uncomfortable for the expert practitioner.

requires a quick glance at the patient’s body systems before proceeding on with palpation.

Question 16. Question : The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse practitioner?

“It is unusual for a small child to have frequent ear infections unless there is something else wrong.”

“We need to check the immune system of your son to see why he is having so many ear infections.”

“Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear.”

“Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.”

Question 17. Question : The nurse practitioner would use bimanual palpation technique in which situation?

Palpating the thorax of an infant

Palpating the kidneys and uterus

Assessing pulsations and vibrations

Assessing the presence of tenderness and pain

Question 18. Question : The patient’s record, laboratory studies, objective data, and subjective data combine to form the:

database.

admitting data.

financial statement.

discharge summary.

Question 19. Question : When preparing to perform a physical examination on an infant, the examiner should:

have the parent remove all clothing except the diaper on a boy.

instruct the parent to feed the infant immediately before the exam.

encourage the infant to suck on a pacifier during the abdominal exam.

ask the parent to briefly leave the room when assessing the infant’s vital signs.

Question 20. Question : The nurse practitioner notices that an infant has a large, soft lump on the side of his head and that his mother is very concerned. She tells the nurse practitioner that she noticed the lump about 8 hours after her baby’s birth, and that it seems to be getting bigger. One possible explanation for this is:

hydrocephalus.

craniosynostosis.

cephalhematoma.

caput succedaneum.

Question 21. Question : When examining an infant, the nurse practitioner should examine which area first?

Ear

Nose

Throat

Abdomen

Question 22. Question : When preparing to examine a 6-year-old child, which action is most appropriate?

Start with the thorax, abdomen, and genitalia before examining the head.

Avoid talking about the equipment being used because it may increase the child’s anxiety.

Keep in mind that a child this age will have a sense of modesty.

Have the child undress from the waist up.

Question 23. Question : The nurse practitioner is assessing a patient’s skin during an office visit. What is the best technique to use to best assess the patient’s skin temperature?

Use the fingertips because they’re more sensitive to small changes in temperature.

Use the dorsal surface of the hand because the skin is thinner than on the palms.

Use the ulnar portion of the hand because there is increased blood supply that enhances temperature sensitivity.

Use the palmar surface of the hand because it is most sensitive to temperature variations because of increased nerve supply in this area.

Question 24. Question : Percussion notes heard during the abdominal assessment may include:

flatness, resonance, and dullness.

resonance, dullness, and tympany.

tympany, hyperresonance, and dullness.

resonance, hyperresonance, and flatness.

Question 25. Question : The nurse practitioner is assessing a patient for possible peptic ulcer disease and knows that which condition often causes this problem?

Hypertension

Streptococcus infections

History of constipation and frequent laxative use

Frequent use of nonsteroidal anti-inflammatory drugs

Question 1: You are participating in a health fair and performing cholesterol screens. One person has a cholesterol level of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?

Ethnicity

Alcohol intake

Gender

Asthma

Question 2. Question : You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?

Upright

Upright, but leaning forward

Supine

Left lateral decubitus

Question 3. Question : You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this?

Normal

Prehypertension

Stage 1 hypertension

Stage 2 hypertension

Question 4. Question : How should you determine whether a murmur is systolic or diastolic?

Palpate the carotid pulse.

Palpate the radial pulse.

Judge the relative length of systole and diastole by auscultation.

Correlate the murmur with a bedside heart monitor.

Question 5. Question : A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an electrocardiogram (ECG) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this.Which of the following symptoms would be more common in this patient’s age group for an AMI?

Chest pain

Syncope

Pain radiating into the left arm

Pain radiating into the jaw

Question 6. Question : On examination, you find a bounding carotid pulse on a 62-year-old patient. Which murmur should you suspect?

Mitral valve prolapse

Pulmonic stenosis

Tricuspid insufficiency

Aortic insufficiency

Question 7. Question : Which of the following correlates with a sustained, high-amplitude point of maximal impulse (PMI)?

Hyperthyroidism

Anemia

Fever

Hypertension

Question 8. Question : A 68-year-old woman with hypertension and diabetes is seen by the nurse practitioner for a dry cough that worsens at night when she lies in bed. She has shortness of breath, which worsens when she exerts herself. The patient’s pulse rate is 90/min and regular. The patient has gained 6 lbs over the past two months. She is on a nitroglycerine patch and furosemide daily. The explanation for her symptoms is:

Kidney failure

Congestive heart failure

Angiotensin-converting enzyme (ACE) inhibitor induced coughing

Thyroid disease

Question 9. Question : When listening to a soft murmur or bruit, which of the following may be necessary?

Asking the patient to hold their breath.

Asking the patient in the next bed to turn down the TV.

Checking your stethoscope for air leaks.

All of the above.

Question 10. Question : You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely?

Emphysema

Asthma exacerbation

Severe left heart failure

Cardiac tamponade

Question 1. Question : A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?

Asthma

COPD

Bronchiectasis

Heart failure

Question 2. Question : A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer.She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.

Pneumonia

COPD

Pleural pain

Left-sided heart failure

Question 3. Question : A patient with long-standing COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?

Percuss the lower border of the liver.

Measure the span of the liver.

Order a hepatitis panel.

Obtain an ultrasound of the liver.

Question 4. Question : A fifty-five-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should be considered because of her gesture?

Bronchitis

Costochondritis

Pericarditis

Angina pectoris

Question 5. Question : When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?

Bronchitis

Simple asthma

Cystic fibrosis

Heart failure

Question 6. Question : Is the following information subjective or objective? Mr. Mazz has shortness of breath that has persisted for the past ten days; it is worse with activity and relieved by rest.

Subjective

Objective

Question 7. Question : All of the following are implicated in causing chronic cough except:

Chronic bronchitis

Allergic rhinitis

Acute viral upper respiratory infection

Gastroesophageal reflux disease

Question 8. Question : A mother brings her infant to you because of a “rattle” in his chest with breathing. Which of the following would you hear if there is a problem in the upper airway?

Different sounds from the nose and the chest

Asymmetric sounds

Inspiratory sounds

Sounds louder in the lower chest

Question 9. Question : Which of the following is consistent with good percussion technique?

Allow all of the fingers to touch the chest while performing percussion.

Maintain a stiff wrist and hand.

Leave the plexor finger on the pleximeter after each strike.

Strike the pleximeter over the distal interphalangeal joint.

Promoting Health Care

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THIS IS A 2 PART ASSIGNMENT. THE ORGANIZATION THAT I NEED THIS TO BE ON IS : Regional One Health, located in Memphis, TN. The quality improvement issue is RN/nurse Retention.

Project: Promoting Health Care

Section 3: Quality Measurement and Assessment

This week you continue working on Section 3 of your Course Project, which was introduced in Week 6. Through your work in previous weeks of this course, you have likely gained critical insights into the organization that serves as the focus for your quality improvement plan. Integrating this knowledge of the organization into your plan for addressing a quality improvement issue is essential for successfully facilitating change.

As you deepen your analysis of your selected organization, consider how the information presented in this week’s Learning Resources relates to strategic priorities as well as to the uniquely collaborative and competitive dynamic that binds organizations in health care.

To prepare:

Think about the quality improvement issue that you are addressing and the associated plan that you are developing. Consider the following:

What is the overall purpose, or aim, of doing this work?

What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?

What value would this work add to the organization?

How would this work improve practice and create outcomes with impact?

Review Chapter 7 of the Sadeghi, Barzi, Mikhail, and Shabot course text. Consider how addressing this quality improvement issue would align with the organization’s mission, vision, values, and strategic goals and objectives. How does it relate to regulatory issues, and other matters that are significant for the organization? If you notice a misalignment, use this as an opportunity to refine your focus.

With this in mind, continue to hone your development of this Assignment, integrating the concepts addressed here into Section 3.

To complete:

Write a 3- to 5-page paper that includes:

An introduction to your quality improvement plan, including the overarching aim of this initiative and an explanation of how it aligns with the mission, vision, values, and strategic goals and objectives of the organization, as well as regulatory issues and other matters that are significant for the organization

An overview of the current situation with regard to this quality improvement issue in the organization

A description of measures and indicators

A presentation on data related to this issue, including:

Actual historical and current data and/or a description of the methods that you would use to collect and analyze the data

Methods for collecting and analyzing data in the future, including when you would do this

A description of realistic, evidence-based targets

Be sure to cite evidence from the literature to justify your selection of the measures and indicators, as well as the performance targets. This section of the Course Project serves as the Portfolio Assignment for this course.

Due by Day 7 of Week 8.

Section 4: Quality Improvement Strategies

Through your work on Section 3 of the Course Project, you have examined the gap between current performance and evidence-based targets and considered how addressing this gap relates to organizational priorities and large-scale aims for quality improvement.

In this section of the Course Project, you begin to think about quality improvement strategies that could help to bridge this gap. As noted in the Sadeghi, Barzi, Mikhail, and Shabot text, this is referred to as performance-driven planning.

Since the publication of the Institute of Medicine’s report “Crossing the Quality Chasm,” a good deal of attention has been paid to the need to examine processes that contribute to outcomes (Ernst, Wooldridge, Conway, Dressman, Weiland, Tucker, and Seid). As the USAID has noted, interventions “will not create the desired outcome to improve the quality of care unless the overall process of care delivery is also improved.” Therefore, attention to process redesign is a central aspect of cultivating strategies for improvement.

To prepare:

Refer to the modified Donabedian model (access, structure, process, outcome, and patient experience) presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text.

Recall the performance targets that you identified for Section 3 (in Week 6). What does the recommendation that performance-driven planning should “begin with the end in mind” suggest given your established goals?

Review the information presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text, and think about how you would assess the organization’s strengths and weaknesses related to the performance gaps you identified in Section 3 (Week 6).

Based on the above, start to think of specific evidence-based strategies that could be implemented to close/minimize the performance gaps you have identified. Consider both interventions (what) and processes (how). Focus on strategies that are supported by the latest research and could create systems-level change. These may be tentative for now, but be sure to identify at least one that specifically lends itself to a change in process (i.e., practice, protocol, pathway, activity).

Additional instructions for Section 4 are presented next week. To complete this Assignment, you will create a process map and write a paper describing quality improvement strategies. This Assignment is due by Day 7 of Week 8.

PART 2 OF THIS ASSIGNMENT:

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional resources.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 8 Discussion

Project 1: Promoting Health Care Quality

Section 3: Quality Measurement and Assessment

By Day 7

Review the complete Assignment description presented in Weeks 6 and 7. Submit Section 3.

Submission and Grading Information

To submit your completed Project for review and grading, do the following:

Please save your Project using the naming convention “WK8Proj1+last name+first initial.(extension)” as the name.

Click the Week 8 Project Rubric to review the Grading Criteria for the Project.

Click the Week 8 Project link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Proj+last name+first initial.(extension)” and click Open.

If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.

Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 8 Project 1 Rubric

Check Your Project Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Project 1 draft and review the originality report.

Submit Your Project by Day 7

To submit your Project:

Week 8 Project 1

Project 2: Promoting Health Care Quality

Section 4: Quality Improvement Strategies

Throughout this course you have been considering the relationship between structure, process, and outcomes as it relates to health care quality. Looking at outcomes, alone, may not tell the “whole story.” For instance, if you are concerned with improving fall rates, evaluating the process—related activities or practices—can help you identify factors that contribute to outcomes and develop strategies for improving them.

For this section of your Course Project, you create a process map to examine a current process related to your quality improvement issue. You will use the results of the process mapping to redesign a process to help minimize or close the performance gap(s). As you proceed, keep in mind the importance of maintaining a patient-centered focus so the patient experience is not negatively affected by any changes in process.

To prepare:

Review the instructions provided in the Learning Resources for creating a process map.

With your quality improvement issue in mind, as well as the other work you have completed on your Course Project thus far, think about how creating a process map could help you to better understand your quality improvement issue and redesign an associated process.

Create a process map using Microsoft Word or PowerPoint.

Refine the strategies for promoting systems-level change to minimize or close the performance gap(s) that you began to think about in Week 7. As part of this, identify a way to redesign at least one process based on your analysis of the process map that you have created.

To complete:

Write a 2- to 3-page paper in which you describe quality improvement strategies that you selected related to your quality improvement issue.

Finalize your process map, which will be submitted along with the paper.

By Day 7

Submit your paper and process map.

Submission and Grading Information

To submit your completed Project for review and grading, do the following:

Please save your Project using the naming convention “WK8Proj2+last name+first initial.(extension)” as the name.

Click the Week 8 Project Rubric to review the Grading Criteria for the Project.

Click the Week 8 Project link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Proj+last name+first initial.(extension)” and click Open.

If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.

Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 8 Project 2 Rubric

Psychiatric Psychotherapy with Individuals Practicum – Client Termination Summary

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Learning Objectives

Students will:

· Develop client termination summaries

To prepare:

· For guidance on writing a Client Termination Summary, review pages 693–712 of the Wheeler text in this week’s Learning Resources.

· Identify a client who may be ready to complete therapy.

                                                       The Assignment

With the client you selected in mind, address the following in a client termination summary (without violating HIPAA regulations):

· Identifying information of client (i.e., hypothetical name, age, etc.)

· Date initially contacted therapist, date therapy began, duration of therapy, and

date therapy will end

· Total number of sessions, including number of missed sessions

· Termination planned or unplanned

· Presenting problem

· Major psychosocial issues

· Types of services rendered (i.e., individual, couple/family therapy, group therapy,

etc.)

· Overview of treatment process

· Goal status (goals met, partially met, unmet)

· Treatment limitations (if any)

· Remaining difficulties and/or concerns

· Recommendations

· Follow-up plan

· Instructions for future contact

· Signatures

PLEASE DO NOT FORGET TO INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES

                                                       Learning Resources

Required Readings:

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

Chapter 18, “Psychotherapy With Older Adults” (pp. 625–660)

Chapter 20, “Termination and Outcome Evaluation” (pp. 693–712)

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

McGuire, J. (2009). Ethical considerations when working with older adults in psychology. Ethics & Behavior, 19(2), 112–128. doi:10.1080/10508420902772702

Swift, J. K., & Greenberg, R. P. (2015). What is premature termination, and why does it occur? In Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes (pp. 11–31). Washington, DC: American Psychological Association. doi:10.1037/14469-002

Descriptive Statistics

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To prepare:

Review the Statistics and Data Analysis for Nursing Research chapters assigned in this week’s Learning Resources. Pay close attention to the examples presented, as they provide information that will be useful when you complete the software exercise this week. You may also wish to review the Research Methods for Evidence-Based Practice video resources to familiarize yourself with the software.

Refer to the Week 4 Descriptive Statistics Assignment page and follow the directions to calculate descriptive statistics for the data provided using SPSS software. Download and save the Polit2SetA.sav data set. You will open the data file in SPSS.

Compare your data output against the tables presented in the Week 4 Descriptive Statistics SPSS Output document. This will enable you to become comfortable with defining variables, entering data, and creating tables and graphs.

Formulate an initial interpretation of the meaning or implication of your calculations.

To complete:

Complete the Part I, Part II, and Part III steps and Assignment as outlined in the Week 4 Descriptive Statistics Assignment page.

Part I

Using the Polit2SetA data set, run descriptive statistics on the following variables: respondent’s age (age) and highest school grade completed (higrade). Create a frequency distribution for the variables: race and ethnicity (racethn) and currently employed (worknow). Create a table (in APA format) summarizing the results, using the below table shell as a model. Write a paragraph summarizing the information in the table.

Table 1. Demographic Data (N = 30)

n % M (SD)

Age (in years) 30 15(2.4)

Highest School Grade Completed 29 11(1.2)

Race and Ethnicity

Black, Not Hispanic 14 (46.67)

Hispanic 8 (26.67)

White, Not Hispanic 6 (20.0)

Other 2 (6.66)

Currently Employed

Yes 27 (90)

No 3 (10)

Note. Differences in sample size are due to missing data.

Follow these steps when using SPSS:

  1. Open Polit2SetA data set.
  2. Click on Analyze, then click on Descriptives Statistics, then Descriptives.
  3. Click on the first continuous variable you wish to obtain descriptives for (respondent’s age), and then click on the arrow button and move it into the Variables box. Then click on highest school grade completed and then click on the arrow button and move it into the Variables box.
  4. Click on the Options button in the upper-right corner. Click on mean, standard deviation, minimum, maximum, and skewness.
  5. Click on Continue and then click on OK.

To run the frequency distribution in SPSS, do the following:

  1. Click on Analyze, then click on Descriptive Statistics, then Frequencies.
  2. Click on the first categorical variable you wish to obtain a frequency for (race and ethnicity), and then click on the arrow button and move it into the Variables box. Then click on currently employed, and then click on the arrow button and move it into the Variables box. Click on the Statistics button in the upper-right corner, then in the Dispersion box click on Minimum and Maximum.
  3. Click on Continue and then click on OK.

Assignment: Create a table (in APA format) summarizing the results, using the below table shell as a model. Write a paragraph summarizing the information in the table.

Part II

For the variables respondent’s age (age) and highest school grade completed (higrade) create a histogram with a normal curve displayed over the histogram.

To create a histogram for respondent’s age in SPSS, do the following:

  1. Click on Graphs, then on Legacy Dialogs, then Histogram.
  2. Click on the variable respondent’s age and then click on the arrow button and move it into the Variables box. Click on the Display Normal Curve button, which is right below the Variables box.
  3. Click on OK.

To create a histogram for highest school grade completed in SPSS, do the following:

  1. Click on Graphs, then on Legacy Dialogs, then Histogram.
  2. Click on respondent’s age in the Variable box and click the arrow to move it back to the box on the left that contains all the variables.
  3. Click on the variable highest school grade completed and then click the arrow button and move it into the Variables box. The Display Normal Curve button should alredy be on.
  4. Click on OK.

Assignment: Using the data obtained when you ran the descriptives and the histograms, determine whether the data skewed. If so, is it a positive or negative skew?

Part III

Using the Polit2SetA data set, run descriptive statistics on the variable “Family Income Prior Month, all sources” (Income).

Follow these steps when using SPSS:

  1. Click on Analyze, then click on Descriptives Statistics, then Descriptives.
  2. Click on Family Income Prior Month, all sources, and then click on the arrow button and move it into the Variables box.
  3. Click on the Options button in the upper-right corner. Click on mean, standard deviation, minimum, maximum, S.E. Mean (standard error of the mean), and skewness.
  4. Click on Continue and then click on OK.

Assignment: Using the descriptive statistics for Family Income Prior Month, all sources (Income), answer the following questions:

  1. What is the mean income in this sample?
  2. What is the standard deviation?
  3. What is the standard error of the mean?
  4. Compute a 95% confidence interval around the mean. (Use 1.96 for the 95% CI and get the standard error from the descriptive statistics table). The formula is as follows:

95% CI = [mean ± (1.96 ´ SE)]

  1. Compute a 99% confidence interval around the mean. (Use 2.58 for the 99% CI and get the standard error from the descriptive statistics table). The formula is as follows:

99% CI = [mean ± (2.58 ´ SE)]

  1. Which interval is wider? Explain.

Review the corresponding Week 4 Descriptive Statistics Exercises SPSS Output document that has the SPSS output for the above problems. Compare your output with the output in the file.

REFERENCES

aureate Education, Inc. (Executive Producer). (2011). Research methods for evidence-based practice: Quantitative research: Data analysis. Baltimore, MD: Author.

Polit, D. (2010). Statistics and data analysis for nursing research (2nd ed.). Upper Saddle River, NJ: Pearson Education Inc.

· Chapter 1, “Introduction to Data Analysis in an Evidence-Based Practice Environment”

Policies Reflection

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To prepare:

Review Chapter 3 of Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.

In the first assignment, you reflected on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation. Refine as necessary using any feedback from your first paper.

Contemplate how existing laws or regulations may affect how you proceed in advocating for your proposed policy.

Consider how you could influence legislators or other policymakers to enact the policy you propose.

Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended.

To complete:

Part Two will have approximately 3–4 pages of content plus a title page and references. Part Two will address the following:

Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.

Explain how existing laws or regulations could affect your advocacy efforts. Be sure to cite and reference the laws and regulations using primary sources.

Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.

Summarize obstacles that could arise in the legislative process and how to overcome these hurdles.

Case Study

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You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign.

Questions

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.

Obstetrics Comprehensive Patient Assessment

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When completing practicum requirements in clinical settings, you and your Preceptor might complete several patient assessments in the course of a day or even just a few hours. This schedule does not always allow for a thorough discussion or reflection on every patient you have seen. As a future advanced practice nurse, it is important that you take the time to reflect on a comprehensive patient assessment that includes everything from patient medical history to evaluations and follow-up care. For this Assignment, you begin to plan and write a comprehensive assessment that focuses on one female patient from your current practicum setting.

To prepare

Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor.

Think about the details of the patient’s background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care.

To complete

Write an 8- to 10-page comprehensive assessment that addresses the following:

Age, race and ethnicity, and partner status of the patient

Current health status, including chief concern or complaint of the patient

Contraception method (if any)

Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem)

Review of systems

Physical exam

Labs, tests, and other diagnostics

Differential diagnoses

Management plan, including diagnosis, treatment, patient education, and follow-up care

References

Learning Resources

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.

Chapter 5, “Gynecologic Anatomy and Physiology” (pp. 77-93)

This chapter explores female anatomy and physiology with a focus on the female reproductive anatomy. It also describes the physiology of the menstrual cycle, including the hormonal feedback system and the ovarian and endometrial cycles.

Chapter 6, “Gynecologic History and Physical Examination” (pp. 95-133)

This chapter identifies the core knowledge and skill base required for obtaining a gynecologic health history and performing physical examinations such as pelvic and breast exams.

Chapter 7, “Periodic Screening and Health Maintenance” (pp. 135-149)

This chapter explores preventive health services for women such as screening tests, counseling, immunization, and chemoprevention. It also compares screening recommendations from organizations such as the U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, and American Cancer Society.

Chapter 13, “Intimate Partner Violence” (pp. 303-322)

This chapter defines intimate partner violence (IPV) and describes the epidemiology and health effects of IPV. It also examines screening tools for assessing IPV and strategies for managing patients experiencing IPV, particularly pregnant women, adolescents, and older women.

Chapter 14, “Sexual Assault” (pp. 327-349)

This chapter examines strategies for identifying sexual violence and providing care to women who are victims of sexual violence. It explores potential health consequences of sexual violence on women, including physical injury, spread of sexually transmitted diseases, and unintended pregnancy.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

Chapter 6, “Care of the Well Woman Across the Life Span”

“Primary Preventive” Health Care for Well Women” (pp. 301-303)

This section examines social, mental, and physical issues that affect women during different stages of their lives. It also examines the provider’s role in prevention and care.

“Care of the Well Woman: Health Assessment and Screening for Women of Childbearing Age” (pp. 303-310)

This section provides a list of health information for the health care provider to address during well-woman examinations, as well as an immunization schedule for women across the life span.

“Care of the Well Woman: Health Assessment and Screening During Menopause” (pp. 338-349)

This section explains the physiologic changes that occur during menopause, including health issues that are likely to present. It also examines treatment and management options related to diet, exercise, sleep, and sexual comfort. Chapter 8, “Primary Care in Midwifery and Women’s Health”

“Care of the Woman: Prevention of Osteoporosis” (pp. 576-584)

This section explores factors that increase risks of osteoporosis in women, particularly postmenopausal women. It also provides strategies for identifying risk factors of osteoporosis and diagnosing and treating the condition.

“Care of the Woman in Need of Smoking Cessation” (pp. 471-475)

This section outlines factors that impact successful smoking cessation. It also describes treatment options and patient education strategies for women in need of smoking cessation.

U.S. Department of Health and Human Services. (2012b). Screening tests and vaccines. Retrieved from http://www.womenshealth.gov/screening-tests-and-vaccines/screening-tests-for-women/

This article provides guidelines for recommended screening tests for women. The guidelines are categorized by age and type of test.

Nursing Care Models

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PLEASE FOLLOW EXACT DIRECTIONS

TEXTBOOK READING ATTACHED. PLEASE READ & CHOOSE NURSING CARE MODEL FROM PROVIDED READING.

This assignment is worth 200 points.

Directions

1.Read your text, Finkelman (2016), pp- 111-116.

2.Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability.

3.Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how and what led you to identify the particular model.

4.Write a 5-7 page paper.

5.You are required to complete the assignment using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page.

6.Review and summarize two scholarly resources (not including your text) related to the nursing care model you observed in the practice setting.

7.Review and summarize two scholarly resources (not including your text) related to a nursing care model that is different from the one you observed in the practice setting.

8.Discuss your observations about how the current nursing care model is being implemented. Be specific.

9.Recommend a different nursing care model that could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific.

10.Provide a summary/conclusion about this experience/assignment and what you learned about nursing care models.

11.Write your paper using APA format using Microsoft Office 2010 or later.

12.Submit your paper no later than 11:59 p.m. MT on Sunday by the end of Week 5.

Political Analysis and Strategies

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Reaching out a Solution This assignment is designed to assist you in developing a thoughtful process for advocating about an issue as a nurse, from identifying a problem that needs to be solved through articulating a process for doing so.

This assignment consists of answering each of the questions listed below from the “Political Analysis and Strategies” chapter of your course textbook. Write each question as a new topic area; then follow with a paragraph or two to answer the question. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources, if any used. This project should be no longer than 4 pages.

Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet. Reflect on the following questions outlined in the “Political Analysis and Strategies” chapter:

•What is the issue?

•Is it my issue, and can I solve it?

•Is this the real issue or merely a symptom of a larger one?

•Does it need an immediate solution, or can it wait?

•Is it likely to go away by itself?

•Can I risk ignoring it?

•What are the possible solutions? Are there risks to these solutions?

•What steps would you need to take in order to solve the issue?

•Does anyone else at the school need to be involved in the solution?

•Where is the power leverage in the school to reach the preferred solution? Reaching a solution requires the use of power vested in the nurse.

Review Box 9-1 (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.