. In 1,500-2,000 words, describe the teaching experience and discuss your observations.

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The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Co

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

Note: This is an individual assignment. In 1,500-2,000 words, describe the teaching experience and discuss your observations. The written portion of this assignment should include:

  1. Summary of teaching plan
  2. Epidemiological rationale for topic (TYPE 2 DIABETES)
  3. Evaluation of teaching experience
  4. Community response to teaching
  5. Areas of strengths and areas of improvement

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

Indications for Breast-Cancer Screening

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Indications for Breast-Cancer Screening

CM is a 43-year-old female who presents with concerns regarding two painless right-breast lumps that she detected four months ago. She missed an appointment for evaluation by her primary-care provider at that time and presents today with reportedly no change in these findings since that time. There has been no breast discharge, bleeding, overlying skin changes, lymphadenopathy, or fevers; she denies recent or past breast trauma. She did, however, undergo a stereostatic breast biopsy three years ago that demonstrated atypical lobular hyperplasia, and there is a known family history of breast cancer (mother, diagnosis at age 48). Current review is significant for a 10-pound weight loss due to diminished appetite over the last two months. Amenorrheic x three years; no current hormonal-replacement therapy or previous oral-contraceptive use; had levonorgestrel implantation at age 28, removed at age 33 and has only used condoms since, but nothing now as she is not sexually active. Indications for Breast-Cancer Screening
This case is meant to highlight indications for breast-cancer screening and to outline the standard evaluation of a female who presents with a breast mass.

Learning objectives for the case:

• Distinguish between the common types of breast masses.
• Know the guidelines for breast-cancer screening.
• Explain the reasoning behind the standard diagnostic approach to a patient with a breast mass.

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Also review with following in order to adequately answer the questions in regard to the case above:

• Epidemiology: what is the latest information regarding Breast Cancer?
• Clinical considerations: what are the considerations you should explore in regard to this disorder (e.g. most common presenting symptom, less common symptoms, physical exame findings, testig to order (with rationale) – which is most recommended in regard to this case and why.
• Review the TMN classification system. Indications for Breast-Cancer Screening
• Review the SEER staging system as an alternative rating system for epidemiology reporting.
• Explain the Risk factors for developing breast cancer. What risk factors does this patient have for breast cancer?

After completing your Case Studi and reviewing the guidelines for breast-cancer screening, answer the following Discussion Board questions using the latest evidenced based guidelines:

• Discuss the questions that would be important to include when interviewing a patient with this issue, including any risk factors she may have.
• Describe the clinical findings that may be present in a patient with this issue.
• Are there any diagnostic studis that should be ordered on this patient? Why?
• List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
• Discuss your management plan for this patient, including pharmacologic therapies, tess, patient education, referrals, and follow-ups.

please use references in apa style and can not use reference no later than five years ago.  Indications for Breast-Cancer Screening

Health Promotion In The Prenatal And Infant Population

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Health Promotion In The Prenatal And Infant Population

Case 1

G.K. is a family nurse practitioner in the health department of a large city. She is responsible for following up with infants and children who have been referred to the health department. Most of her referrals come from the hospital upon discharge of an infant going home to a potentially high-risk environment.

G.K. follows up with each child to ensure he or she is in a safe environment and is growing and developing adequately. She provides education and support to the parents so they can anticipate and respond appropriately to the challenges of raising children. Health Promotion In The Prenatal And Infant Population

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Questions for the case

Define and describe the following influences that can affect individual’s potential for growth:
• genetic factors
• prenatal and postnatal exposures
• nutritional factors
• environmental factors
• life style
• health care practices.

Once you received your case number; answer the specific question on the table above. Then, continue to discuss the 2 topics listed below for your case:

  1. Describe the relationship between culture and growth and development. Assess whether all growth and development milestones should be applied to all children regardless of cultural background.
  2. Design a teaching plan for parents regarding injury prevention during infancy. In your teaching plan you must include the home of an infant injury proof.

Your initial post should be at least 550 words, formatted and cited in current APA style with support from at least 3 academic sources.  Health Promotion In The Prenatal And Infant Population

The DNP Project: Developing The DNP Essentials

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The DNP Project: Developing The DNP Essentials

PICOT Question:

In adult oncology patients at an infusion Center at Queens Hospital Center, does the implementation of a music therapy program compared to current practice, impact pain scores during chemotherapy over 8-10 weeks?

Which DNP Essentials could be demonstrated in your scholarly project?

The DNP programs are specially designed to uplift the students’ practice knowledge and system leadership skills. Implementing new knowledge is necessary for continuous improvement (Riner, 2015). The DNP degree is a terminal degree in nursing practice and prepares the students to be translational leaders to implement innovations to practice settings. The capstone DNP project is an evidence-based practice implementation that will improve patient outcomes. The project outcome can potentially influence the policies at the organizational and system-level (Diegel-Vaceka, & Yonkaitis,2022). The DNP Project: Developing The DNP Essentials

The DNP project is the summative evaluation of all the essential skills learned during this program. My scholarly project demonstrates important DNP essentials, such as scientific underpinnings and organizational and system leadership to improve the nation’s health and advanced nursing practice. The DNP student also used analytical methods, information technology, and interpersonal collaboration for improving patient care and healthcare advocacy skills. The DNP student appreciated the benefits of building up the essential skills throughout the course, which empowered her to build up the final DNP project.

Does your project idea consist of breadth and depth of knowledge within a defined area?

The project’s idea of implementing music therapy as an adjunct pain management strategy will be an excellent addition to the current practice. This idea emerged after studying the epidemiology of poorly controlled cancer pain at local, state, national, and global levels. The DNP student identified many adverse effects of narcotics, and many patients are reluctant to take drugs with the fear of overdosing and adverse effects. The DNP student spent almost two years of in-depth research on this topic and identified the benefits of music on pain. The student discussed intervention effectiveness with many content experts, read hundreds of articles, and found robust research evidence to support the therapeutic use of music intervention to reduce cancer pain.

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Is there the potential for innovation and creativity to affect an outcome?

The DNP student will be identifying which genre of music is more popular among the participants, which will assist in including more music from those popular genres in the future. Another creative option to improve the outcome is to bring music artists and play music for a group with the active involvement of patients and provide opportunities for the patients to sing along. Another creative idea that emerged from one of the top stakeholders is to compose music albums by talented hospital employees and make their streaming music for this purpose.

 What areas of expertise and passion do you bring that you can build on? What skill sets do you need to develop to implement your DNP project successfully?

As a nurse practitioner in pain management, I am very passionate about learning about the complex multi-dimensional phenomenon of pain and its impact on the physical, emotional, and social domains of a patient’s life. The DNP student got excellent opportunities to develop many essential skills and is in working progress. I need to work on my system leadership skills and information technology consistently.

Please provide your instructor and student colleagues with an update on the implementation phase of your DNP Project. Share any successes, challenges, or barriers you experienced this week. The DNP Project: Developing The DNP Essentials

The project implementation plan is made. The DNP student gets ready for the implementation by printing the consent forms and assessment tools, procuring music therapy equipment, and arranging the list of therapeutic music. Prepared the educational session content and handouts.

Even though the DNP program is an advanced doctoral clinical practice degree, the number of graduates in system leadership in a clinical setting is limited. This recommends more studies to identify the future opportunities for the DNP graduates in clinical settings (Beeber et al., 2019).

References

Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of Doctor of Nursing Practice-prepared nurses in practice settings (Links to an external site.). Nursing Outlook, 67(4), 354-364. https://doi.org/10.1016/j.outlook.2019.02.006

Diegel-Vaceka, & Yonkaitis, C. F. (2022). A Novel Approach to Fostering Academic-Practice Partnerships: The DNP Project Executive Summary. The Journal of Nursing Education, 61(3), 156–158. https://doi.org/10.3928/01484834-20211128-03 (Links to an external site.)

Riner. M.E. (2015). Using Implementation Science as the Core of the Doctor of Nursing Practice Inquiry Project. Journal of Professional Nursing, 31(3), 200–207. https://doi.org/10.1016/j.profnurs.2014.11.002

I NEED A COMMENT FOR THIS DISCUSSION BOARD WITH AT LEAST 2 PARAGRAPHS AND USE AT LEAST 3 SOURCES WITH NO LATER THAN 5 YEARS The DNP Project: Developing The DNP Essentials

Patient with Depression Assignment

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Patient with Depression Assignment

Can you write on patient with depression and follow the exemplar and Rubric

 

  • elect a patient that you examined during the last 2 weeks who presented with a disorder other than the one present in your selected case for Week 5.
  • Conduct a Comprehensive Psychiatric Evaluation on this patient using the template provided in the Learning Resources. There is also a completed exemplar document in the Learning Resources so that you can see an example of the types of information a completed evaluation document should contain. All psychiatric evaluations must be signed, and each page must be initialed by your Preceptor. When you submit your document, you should include the complete Comprehensive Psychiatric Evaluation as a Word document, as well as a PDF/images of each page that is initialed and signed by your Preceptor. You must submit your document using SafeAssign. Patient with Depression Assignment
    Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies.
  • Develop a video case presentation, based on your evaluation of this patient, that includes chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis, including differentials that were ruled out.
  • Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.

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Assignment

Record yourself presenting the complex case for your clinical patient. In your presentation:

  • Dress professionally and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • Present the full case. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis including differentials that were ruled out.
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value. Patient with Depression Assignment

Be succinct in your presentation, and do not exceed 8 minutes. Address the following:

  • Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?
  • Objective: What observations did you make during the interview and review of systems?
  • Assessment: What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis and why?
  • Reflection notes: What would you do differently in a similar patient evaluation?

RUBRIC

 

The student provides an accurate, clear, and complete description of the chief complaint and history of present illness.

 

the student provides an accurate, clear, and complete description of past psychiatric, substance use, medical, social, and family history.

The student provides an accurate, clear, and complete discussion of results from most recent mental status exam and observations made during interview and review of systems.

 

The student provides an accurate, clear, and complete discussion of diagnostics with results

The student provides an accurate, clear, and complete diagnosis with three (3) differentials.

The response clearly, accurately, and thoroughly follows the Comprehensive Psychiatric Evaluation format to document the selected patient case.

Presentation style is exceptionally clear, professional, and focused.

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.) Patient with Depression Assignment

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

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Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. 

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13. Patient with Depression Assignment

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical) Patient with Depression Assignment

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc. Patient with Depression Assignment

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

Assessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. Patient with Depression Assignment

 

 

Case Study Mercy Hospital

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Case Study Mercy Hospital

Write a brief introduction about Mercy’s current state (1 page long, double space, Times New Roman, 12) and attach your work save this in Word. doc.

 

Mercy Hospital, started in 1895, is a 143-bed hospital in a small community of 37,000 people. Mercy Hospital is located on a small hill in the center of the town surrounded by upper and upper-middle class homes on the hill and low-income neighborhoods at the base of the hill and surrounding a main street of shops, restaurants, and services.  The main buildings consist of dark red brick with two floors in the center and wings out to each side.  Several additions had been added to the rear of the building in the 1960’s.

The dingy green halls are lined with long windows overlooking the lawns.  Few changes have occurred to renovate the hospital in the last twenty years.  Most of the patient rooms hold four patients each, except the section of private rooms set aside for those who can afford them.  The operating suite occupies on wing of the top floor.  There is a small pediatric unit and small maternity unit, both appear to be stuck in the 1950’s.  There are no security devices on the doors to these units.

As one walks through the halls, it is not unusual to see patients lying alone on stretchers, patient care technicians and nurses gather in nursing stations while patient call lights go unanswered, and soiled linens dropped on the floor.  Physicians give directions to nurses who refuse to follow their orders.  Families can be seen caring for family members because there is no one else who seems to care.  While a simple electronic medical record system was installed, it is not used by physicians or nurses who state it is too difficult to use and they do not have time to learn. Case Study Mercy Hospital

A stop at the Pharmacy indicates that many medications are misplaced on the shelves, there is a backlog of prescriptions to fill, and there is no system for managing unit dosing for patient safety.  The electronic system for managing patient prescriptions has been installed but is not used reportedly because “there is just not enough time and it is too difficult.”  Several pharmacy technicians work in the pharmacy to help in filling prescriptions and transporting them to the units.  However, there is no evidence that these technicians have been trained in a formal program or have passed the national pharmacy technician exam.

Further along, the Central Service Department provides sterile supplies to the units.  Unfortunately, it is obvious there is no system for cataloging or rotating the supplies. This leads to outdated sterile equipment and often inadequate supplies when requested by the units.  Cleaning products used for equipment meets the requirements for type; however, it is being mixed improperly so as to be too weak for adequate disinfection.  Because this is handled in the Central Service Department, it becomes an issue throughout the hospital.

The dietary department provides adequate meals for patients but is known to confuse patient diets.  Families complain that their family members who only eat kosher food have been routinely given products that are not approved.  Cultural insensitivities are common from lack of translators, to biased comments, to outright cultural slights.  Patients and staff also complain of the poor quality of the food prepared, that it is often over cooked, under cooked, or simply bland.  The kitchen have passed the Department of Health inspections for cleanliness but lack updated equipment to streamline service and delivery.

The laboratory lacks adequate qualified staff to manage the required laboratory tests.  Inspection of the blood bank shows that normal blood banking procedures are lacking, refrigeration is inadequate, and labeling is inadequate.  Equipment is outdated.  Spilled blood and other bodily fluids are observed on lab tables.  Samples are lying about the lab, some labeled and some without.  Refrigeration temperatures for blood are adequate. Case Study Mercy Hospital

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Sentinel events occur often including:  Surgical and nonsurgical invasive procedures on the wrong patient, wrong site, or wrong body part, unintended retention of a foreign object in a patient after surgery, blood transfusion reaction involving administration of blood or blood products having major blood group incompatibilities (ABO, Rh, other blood groups.)  In addition, patient fall rate and medication errors occur much too often.  These were all noted by the latest visit of the Joint Commission.  The Nursing Director states that this was all just an over zealous visit team.  However, the visit was stimulated as a result of regular reports that are required on sentinel events.

The Human Resource department occupies a small room, little more than a closet on the first floor.  The HR manager has been with the hospital for 25 years, during which time he has maintained a low profile and accomplished little to enhance the conditions or benefits of the staff.  His main objective is to make it through a few more years until retirement.  Staff morale, which is at an all time low, does not seem to be a concern to the department.  Staff benefits have not changed in the last 15 years, with few, if any, raises, no increases in healthcare benefits, and limited contributions to retirement accounts.

The Nursing Director has also been with the hospital for over 25 years and demonstrates little leadership skills, and has made no attempt to improve nursing conditions or professional development for almost as long. She has an authoritarian management style and tends to manage from a position of fear.  On questioning, she is not well informed about current regulations or policies.  Having grown up in the community, attended nursing school at a local diploma nursing program, and beginning her first job at Mercy Hospital, the Nursing Director appears a fixture at Mercy and rules with an iron fist.  This leaves no room for nursing staff involvement in governance or any incentive to engage in evidence based practice. Therefore, standardized practices such as wound care, tracheotomy care, etc, have not been updated for many years.  The management of the nursing department has resulted in many of the staff feeling bullied.  This has led to a high turn over rate especially among the new graduate employees.  The nurses who have stayed have become complacent and “just put in their time.”  When the nurses do not agree with doctors’ orders, they do not question them but rather simply refuse to carry the orders out.   Staffing on most units is very minimal. Usually one RN manages the unit with one or two patient care technicians.  Because the RN is the only one who can give medications, assess patients, provide most treatments, and interact with other departments, medications and treatments are often late and mistakes are made.  The patient care technicians appear to resent the position of the RN and do little to work as a team. Case Study Mercy Hospital

The finance department sits next to admissions.  It is as dysfunctional as other parts of the hospital, with losses in revenue due, not only to a reduction in patients, especially those with insurance, but due to poor systems of insurance billing and coding. In addition, hospital acquired infections and fall rates have affected the income from Medicare.  An electronic health care system to manage billing does not exist.  Payments to vendors consistently run 60 -90 days late, and some as much as 180 days.  Salaries have not been raised in years and while staff is often required to work overtime, no additional pay beyond the usual salary is provided.

The Office of the Chief of Medicine is a bit further down the hall and appears to be the only cheery place in the hospital. The Chief of Medicine is a portly gentleman in his fifties who has been with the hospital for several years, having moved to the community from a nearby urban center. He had grown up in the community and moved away for some time after medical school to specialize in surgery.  He was wooed back to the community to help Mercy Hospital turn itself around after multiple issues with their Joint Commission review.  A sense of loyalty to his home town and a deep sense of caring for the community led him to take on this monumental task.  Since coming to Mercy, the Chief of Medicine has been met with continual barriers from staff, the board of directors, and even patients.  Services are limited and outdated, patient safety and quality is poor, staff is ineffective, and morale is at an all time low.  He is faced with patient care technicians playing cards while patients go uncared for, supplies that are often in short supply because of theft, and systems that do not exist in any part of the hospital.

Current bed occupancy is at 60%.  No new service lines have been added in recent years.  Technology based services such as CTs, specialized sonography, and technology based diagnostics and surgery are not available at the hospital, requiring patients to travel over 30 miles for the service.  The emergency department is often full, being used by the community for routine medical care.  Without outpatient clinics, vulnerable populations flock to the emergency department for a variety of illnesses and routine care. The emergency department becomes as much of a place for social gathering as for care. Case Study Mercy Hospital

A new for-profit hospital, owned by a major medical corporation, has opened approximately thirty miles from Mercy. While inconvenient for most of the community, it offers a much fuller range of services including high tech diagnostics and surgery.  Being new, the hospital has bright walls and shiny floors. Most rooms are singles and a few doubles. The hospital accepts most insurance policies and medicare but otherwise, payment for services is due at the time of service. While families in the community of Mercy are still loyal to their hospital, the improved services available are a definite draw.  This is having a negative impact on the revenue stream for Mercy Hospital.

Nursing homework help

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Many consider Kurt Lewin’s ‘changing in three steps’ (unfreezing, changing, and refreezing) to be the classic or fundamental method to change management. Scholars have criticized Lewin for oversimplifying the change process, while others have defended him against such accusations. The model’s foundational significance, on the other hand, has remained uncontested. Kurt Lewin is commonly regarded as the “founding father” of change management, with his unfreeze–change–refreeze (CATS) strategy seen as the “basic” or “classic” approach to, or classic “paradigm” for, change management (Cummings et al., 2015). In the healthcare industry, change is unavoidable. Almost two-thirds of all change programs fail in health care for a variety of reasons, including poor planning, unmotivated employees, inadequate communication, or excessively frequent changes. From the bedside to the boardroom, all healthcare professionals have a responsibility to play in achieving effective change. Using best practices developed from change theories can assist increase the likelihood of success and subsequent development in practice.  Nursing homework help

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Building on Lewin’s original theory, Lippitt developed the Phases of Change Theory, which includes the following stages of change:

Increasing awareness of the need for change

Create a connection between the system and the change agent.

Define a difficulty with change.

Establish change objectives and a strategy for achieving them.

Make the necessary adjustments.

Staff accepts the modification; the situation is now stable.  Nursing homework help

Redefine the change agent’s relationship with the system (Barrow & Toney-Butler, 2020). Lippitt’s seven-phase theory may be more equivalent to the nursing process; there is a slight difference between the two, but Lewin’s contains three basic processes. Nursing is frequently far more complicated than the three levels. Looking back on my experiences as a critical care nurse, some circumstances were less complicated, but the majority were complex on numerous levels. Because these people are in critical condition, the issues that need to be addressed are as well. It appears that getting stuck in the Moving phase after three steps would be simple. My preceptor has not had the opportunity to use any of these theories.

Reference

Barrow, J. M., & Toney-Butler, T. J. (2020). Change Management. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459380/

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Cummings, S., Bridgman, T., & Brown, K. G. (2015). Unfreezing Change as Three steps: Rethinking Kurt Lewin’s Legacy for Change Management. Human Relations, 69(1), 33–60. Sagepub. https://doi.org/10.1177/0018726715577707 Nursing homework help

Discussion: Examining Nursing Specialties

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Discussion: Examining Nursing SpecialtiesYou have probably seen one or more of the many inspirational posters about decisions. A visual such as a forked road or a street sign is typically pictured, al

Discussion: Examining Nursing Specialties

You have probably seen one or more of the many inspirational posters about decisions. A visual such as a forked road or a street sign is typically pictured, along with a quote designed to inspire.

Decisions are often not so easily inspired. Perhaps you discovered this when choosing a specialty within the MSN program. This decision is a critical part of your plan for success, and you no doubt want to get it right. This is yet another area where your network can help, as well as other sources of information that can help you make an informed choice.

To Prepare:

  • Reflect on your decision to pursue a specialty within the MSN program, including your professional and academic goals as they relate to your program/specialization. my specialization is acute care nurse practitioners (ACNP)

Week 8 Assignment Course 6050

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Week 8 Assignment Course 6050

The Assignment: (2–4 pages)

Create an interview transcript of your responses to the following interview questions:

  • Tell us about a healthcare program, within your practice (Mental Health). What are the costs and projected outcomes of this program?
  • Who is your target population? Week 8 Assignment Course 6050
  • What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?

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  • What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
  • What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
  • Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

********Please include 4-5 referenced scholarly articles**********

Explain how privacy laws benefit the student, the school, and the school nurse.

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School nurses confront numerous legal issues in their daily work. It  is important to know the standards of nursing practice specific to the  state of licensure, as well as legal limitations and res

School nurses confront numerous legal issues in their daily work. It  is important to know the standards of nursing practice specific to the  state of licensure, as well as legal limitations and responsibilities of  the school nurse.

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Role of the School Nurse

It is the position of the National Association of School Nurses  that the professional registered school nurse is the leader in the  school community to oversee school health policies and programs. The  school nurse serves in a pivotal role to provide expertise and oversight  for the provision of school health services and promotion of health  education. Using clinical knowledge and judgment, the school nurse  provides health care to students and staff, performs health screenings,  and coordinates referrals to the medical home or private health care  provider. The school nurse serves as a liaison between school personnel,  family, community and healthcare providers to advocate for health care  and a healthy school environment (American Nurses Association &  National Association of School Nurses, 2011).

Reference

American Nurses Association & National  Association of School Nurses. (2011). Role of the school nurse.  Retrieved from  http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/smid/824/ArticleID/87/

You are the parent of two teenagers and an active PTA member at their  school. The principal approached you about an upcoming professional  gathering for middle- and high-school nurses in your district. She asked  you to make a short presentation on school health privacy and how it  can affect nurse-student care within the teen population, where personal  health issues and privacy concerns often collide.

Preparation

Research and gather information about the issues facing school  nurses in your state of licensure, as well as state and federal privacy  laws that govern your school health privacy information. You will also  need to learn about the legal limitations and responsibilities of the  school nurse.

Directions

Create a 6–8-slide PowerPoint presentation that examines the  privacy issues unique to nurses serving the high-school age population.  Address the following:

  • Describe the types of health and wellness issues that can affect  adolescents in their high-school years. Be sure you think beyond the  usual things and really research the types of issues that are affecting  young people today.
  • Explain how privacy laws can impact the school nurse in regard to patient safety and health outcomes for adolescents.
  • Explain how privacy laws benefit the student, the school, and the school nurse.
  • Recommend two specific evidence-based ethical strategies  regarding health and wellness privacy communications in a school  environment.

Use the notes section of each slide to expand your points and cite  your supporting evidence. Also, include a title slide and a reference  slide that lists the resources you used in this assessment.

Be creative. Consider your intended audience.

Additional Requirements

Your presentation should meet the following requirements:

  • Written communication: Written communication should be free of errors that detract from the overall message.
  • References: Include a reference slide with a  minimum of three references; a majority of these should be peer-reviewed  sources. All resources should have been published within the last 5  years.
  • APA format: Resources and citations should be formatted according to current APA style and formatting.
  • Length: 6–8 slides.