Creating a Culture of Evidence-Based Practice

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Creating a Culture of Evidence-Based Practice

Creating a Culture of Evidence-Based Practice

An abundance of evidence can be found on almost any medical issue or health topic. Often, the availability of information is not the concern, but rather nurses struggle with how to convey the evidence to others and change practices to better reflect the evidence. Deep-rooted organizational cultures and policies can make some resistant to change, even to changes that can vastly improve the quality, effectiveness, and efficiency of health care. However, there are many strategies that nurses can employ to bring about changes to practice.

In this Discussion, you focus on how to create an organizational culture that supports evidence-based practice.

To prepare:

  • Review the information in this week’s Learning Resources. Examine the various suggestions for promoting an organizational culture that embraces the use of EBP.
  • Reflect on your own organization’s (or one in which you have worked) support of evidence-based practice. Examine how culture and policies impact the adoption of changes to practice based on evidence. What barriers exist?
  • Consider the models and suggestions for promoting evidence-based practice featured in this week’s Learning Resources. Identify models and suggestions that would work well in your organization.
  • Reflect on the significance of evidence-based practice in health care. What responsibility do nurses have to promote EBP and change practices to better reflect evidence and research findings?
  • Reflect on how nurses can disseminate findings from evidence-based practice research.

By Day 3

Post an evaluation of your organization’s use of EBP and how it is furthered or hindered by organizational culture and policies. Describe how you could disseminate the findings. Propose a strategy for strengthening the culture of EBP within the organization. Discuss a nurse’s responsibility to further the use of EBP, providing a rationale supported by specific information from the Learning Resources.

Required Readings

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

  • Chapter 30, “Disseminating Evidence: Reporting Research Findings”In this chapter, the focus is on actually reporting on the research findings and how to determine the best approach for reaching the desired audience. The chapter also includes tips on how to organize the information and describes what is usually included in such reports.

Aitken, L. M., Hackwood, B, Crouch, S., Clayton, S., West, N., Carney, D., & Jack, L. (2011). Creating an environment to implement and sustain evidence based practice: A developmental process. Australian Critical Care, 24(4), 244–254.

Retrieved from the Walden Library databases.

This article describes a multi-dimensional EBP program designed to generate sustainable improvement in patient care and patient outcome. The text details the program’s strategies for implementation along with achievements and lessons learned.

Barnsteiner, J. H., Reeder, V. C., Palma, W. H., Preston, A. M., & Walton, M. K. (2010). Promoting evidence-based practice and translational research. Nursing Administration Quarterly, 34(3), 217–225.

Retrieved from the Walden Library databases.

In this text, the authors highlight established systems and structures designed to supply staff with resources to translate research and deliver EBP. Additionally, the article explicates a multitude of initiatives designed to disseminate evidence to the point of care.

Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222–230.

Retrieved from the Walden Library databases.

This article provides several models for implementing evidence-based practice within an organization. It introduces four different phases through which an implementation should progress, and provides examples of each.

Estrada, N. (2009). Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting. Worldviews on Evidence-Based Nursing, 6(4), 200–209.

Retrieved from the Walden Library databases.

In this article, the authors detail a survey design study conducted to determine the relationship between a learning organization’s characteristics and the beliefs of registered nurses with respect to EBP. In addition, the study examines the impact of EBP beliefs on registered nurses’ implementation of EBP.

Fineout-Overholt, E., Williamson, K. M., Kent, B., & Hutchinson, A. M. (2010). Teaching EBP: Strategies for achieving sustainable organizational change toward evidence-based practice. Worldviews on Evidence-Based Nursing, 7(1), 51–53.

Retrieved from the Walden Library databases.

The authors of this text suggest multiple strategies for integrating the EBP paradigm at the organizational level. The text provides rationale for why educators should also consider change at the individual level as an effective conduit for disseminating the EBP paradigm at the organizational level.

Munten, G. van den Bogaard, J., Cox, K., Garretsen, H., & Bongers, I. (2010). Implementation of evidence-based practice in nursing using action research: A review. Worldviews on Evidence-Based Nursing, 7(3), 135–157.

Retrieved from the Walden Library databases.

This text reviews 21 action research studies to determine what is known about using action research to implement evidence-based practice. The authors explicate the promising features and flaws that were common across the action research studies they used.

c. Discuss how your initial focus and diagnosis evolved after working with your population.

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Create a professional mission statement (suggested length of 1 paragraph) that includes the following:●   a representation of your career goals, your aspirations, and how you want to move f

1.  Create a professional mission statement (suggested length of 1 paragraph) that includes the following:

●   a representation of your career goals, your aspirations, and how you want to move forward with your career

●   an overview of where you would like to focus your time and energies within the profession

a.  Reflect on how your professional mission statement will help guide you throughout your nursing career.

2.  Complete a professional summary (suggested length of 3–4 pages) that includes the following:

a.  Explain how the specific artifacts or completed work or both in your portfolio represent you as a learner and a healthcare professional.

b.  Discuss how the specific artifacts in your portfolio represent your professional strengths.

c.  Discuss challenges you encountered during the progression of your program.

i.  Explain how you overcame these challenges.

d.  Explain how your coursework helped you meet each of the nine nursing program outcomes. 

Note: Refer to the attachment “Nursing Conceptual Model.” 

e.  Analyze how you fulfilled the following roles during your program:

•   scientist

•   detective

•   manager of the healing environment

f.  Discuss how you have grown professionally since the beginning of your program. 

B.  Complete the following within the section “Quality and Safety”:

1.  Reflect (suggested length of 1 page) on your professional definition of quality and safety developed in Professional Roles and Values, including any necessary changes to your definition.

a.  Discuss how the program assisted you in developing your professional definition.

b.  Identify the artifacts in your portfolio that support your definition.

i.  Explain how these artifacts support your definition from part B1. 

Note: The artifacts should be attached within the portfolio. 

2.  Discuss the importance of the Institute for Healthcare Improvement (IHI) certificate for your future role as a professional nurse. 

C.  Complete the following within the section “Evidence-Based Practice”:

1.  Reflect (suggested length of 1 page) on your professional definition of evidence-based practice developed in Professional Roles and Values, including any necessary changes to your definition.

a.  Discuss how the program assisted you in developing your professional definition.

b.  Identify the artifacts in your portfolio that support your definition.

i.  Explain how these artifacts support your definition from part C1. 

Note: The artifacts should be attached within the portfolio. 

2.  Reflect (suggested length of 1 page) on your understanding of evidence-based practice and applied nursing research by doing the following:

a.  Discuss how you are able to evaluate current primary research and apply the concepts to your nursing practice, considering the following:

•   relevancy and believability of data

•   differences between quality improvement and research (places and uses of each)

•   differences between primary and secondary research and resources and the implications of each in clinical practice

b.  Explain how your experience in the program helped you achieve excellence in evidence-based practice. 

D.  Complete the following within the section “Applied Leadership”:

1.  Reflect (suggested length of 1 page) on your professional definition of applied leadership you developed in Professional Roles and Values, including any necessary changes to your definition.

a.  Discuss how the program assisted you in developing your professional definition.

b.  Identify the artifacts in your portfolio that support your definition.

i.  Explain how these artifacts support the definition from part D1. 

Note: The artifacts should be attached within the portfolio. 

2.  Summarize (suggested length of 1 paragraph to 1 page) your Learning Leadership Experience task by doing the following:

a.  Discuss the importance of professional collaboration for effective nursing leadership. 

E.  Complete the following within the section “Community and Population Health”:

1.  Reflect (suggested length of 1 page) on your professional definition of community and population health you developed in Professional Roles and Values, including any necessary changes to your definition.

a.  Discuss how the program assisted you in developing your professional definition.

b.  Identify the artifacts in your portfolio that support your definition.

i.  Explain how these artifacts support the definition from part E1. 

Note: The artifacts should be attached within the portfolio. 

2.  Summarize (suggested length of 1 page) your Community and Population Health task (STIs) by doing the following:

a.  Discuss what you learned during your Community Health Nursing task (STIs).

b.  Discuss what you learned led to your community diagnosis ( Nursing Diagnosis Statement: Sexually transmitted infections are common among adolescent individuals living in Florida).

c.  Discuss how your initial focus and diagnosis evolved after working with your population.

DO WHAT YOU CAN. THERE ARE SOME SECTIONS YOU WILL NOT BE ABLE TO QUITE ANSWER SUCH AS THE ARTIFACTS. DO THE BEST YOU CAN. THANK YOU. 

Identifying Research Components

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Identifying Research ComponentsWeek 4 TasksUse the Week 4 research template to complete the following assignment tasks.Choose the assigned research articles from W2 Project. Describe the sample with

Identifying Research Components

Week 4 Tasks

Use the Week 4 research template to complete the following assignment tasks.

  • Choose the assigned research articles from W2 Project. Describe the sample with demographics, data collection process, and identification of variables; sampling design; instruments, tools, or surveys.
  • Summarized the discussion about the validity and reliability of the instruments, tools, or surveys.
  • Discussed legal/ethical concerns.
  • NOTE: If a component is absent, student receives a zero for that component.

Submission Details

  • Cite all sources in APA format.
  • Name your document SU_NSG3029_W4_Project_LastName_FirstInitial.doc.
  • Submit your template to the Submissions Area by the due date assigned.

Research article from week 2 

Bortz, A., Ashkenazi, T., & Melnikov, S. (2015). Spirituality as a predictive factor for signing an organ donor card.Journal of Nursing Scholarship, 47(1), 25-33. doi: 10.1111/jnu.12107

Dinkel, S., & Schmidt, K. (2015). Health education needs of incarcerated women. Journal of Nursing Scholarship, 46(4), 229-234. doi: 10.1111/jnu.12079

Practicum Professional Development Objectives: Progress Appraisal

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Practicum Professional Development Objectives: Progress Appraisal

Week 6 – Discussion

Top of Form

Practicum Professional Development Objectives: Progress Appraisal

In Week 1, you developed your practicum professional development objectives. How have your experiences thus far in the practicum contributed to your growth as nurse leader-manager or nurse informaticist? What difficulties, if any, have you experienced, and how might this affect the achievement of your objectives?

In this Discussion, you assess your progress toward fulfilling your practicum professional development objectives and consider how you could enhance or alter your activities to achieve your aims.

To prepare:

  • Reflect on the practicum professional development objectives you developed and outlined in your Practicum Professional Experience Plan in Week 1.
  • Keeping in mind the practicum activities you have engaged in thus far, consider the following questions:
    • How have these activities helped to promote your professional development?
    • Are you satisfied with your progress toward meeting your objectives? If not, what will you do to ensure you achieve them before the end of your Practicum Experience? As a reminder, you must complete all of your practicum hours on or before Day 5 of Week 11.
    • What challenges or unexpected opportunities have arisen at your practicum site? How has this affected your professional development?
  • Think about the experiences you may have in the forthcoming weeks. Do you foresee any particular challenges on the horizon? If so, what is your plan for addressing those challenges?
  • Think about the time you have spent with your Preceptor. How has this time enhanced or changed your understanding of the role and functions of the nurse leader-manager or nurse informaticist?

By Tuesday 04/04/2017, post a minimum of 250 -550 words in APA format with 3 scholarly references from the list below. Include the level one headings as numbered below:

1)      An assessment of your progress toward achieving your practicum professional development objectives, including how your involvement in specific practicum activities has contributed to your development.

2)      Explain what you will do to ensure you achieve your objectives by the end of your practicum.

3)       Summarize challenges or unexpected opportunities that have arisen, as well as any challenges that you anticipate may arise. Explain how you will address those challenges.

4)      Finally, summarize what you have learned about the role and functions related to your specialization (Nursing Informatics) through time spent with your Preceptor.

Required Readings

    Cipriano, P. F., & Murphy, J. (2011). The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 286–289.

    Note: Retrieved from the Walden Library databases.

“Technology tools will continue to revolutionize how we plan, deliver, document, review, evaluate, and derive the evidence about care” (p. 289). This article examines how nurses can use information technology to transform nursing and redesign the health care system. It focuses on the use of technology to promote quality and notes that technology can also be used to address challenges in education, research, leadership, and policy.

    McKimm, J., & Swanwick, T. (2009). Setting learning objectives. British Journal of Hospital Medicine, 70(7), 406–409.

    Note: Retrieved from the Walden Library databases.

 This article clarifies the terminology associated with learning objectives and explains how learning objectives relate to professional development and the transformation from novice to expert. It also introduces common pitfalls when setting learning objectives and provides suggestions for avoiding them.

    Murphy, J. (2011). The nursing informatics workforce: Who are they and what do they do? Nursing Economic$, 29(3), 150–153.

    Note: Retrieved from the Walden Library databases

    The author examines the nursing informatics workforce, explaining that professionals in this well-established specialty area can play an integral role in transforming health care.

    Sørensen, E. E., Delmar, C., & Pedersen, B. D. (2011). Leading nurses in dire straits: Head nurses’ navigation between nursing and leadership roles. Journal of Nursing Management, 19(4), 421–430.

    Note: Retrieved from the Walden Library databases.

“Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity” (p. 421). In this article, the authors examine how individuals in key professional roles negotiate between and apply nursing and leadership skills.

  Warm, D., & Thomas, B. (2011). A review of the effectiveness of the clinical informaticist role. Nursing Standard, 25(44), 35–38.

    Note: Retrieved from the Walden Library databases.

 The authors investigate the application of specialized knowledge and expertise to facilitate the appropriate use of emerging technologies in clinical settings. They argue for informaticists’ involvement in strategic development and delivery of information management and technology initiatives to promote patient-centered outcomes.

    Wilkinson, J. E., Nutley, S. M., & Davies, H. T. O. (2011). An exploration of the roles of nurse managers in evidence-based practice implementation. Worldviews on Evidence-Based Nursing, 8(4), 236–246.

    Note: Retrieved from the Walden Library databases.

 In this article, the authors examine the role nurse managers should play in leading and facilitating evidence-based practice.

  Armstrong, P. (2013). Bloom’s taxonomy. Retrieved from http://cft.vanderbilt.edu/teaching-guides/pedagogical/blooms-taxonomy/

    Vanderbilt University provides this overview of Bloom’s taxonomy. This site also presents the original and updated versions of the taxonomy along with verb suggestions for each level.

    Clark, D. (2013). Bloom’s taxonomy of learning domains. Retrieved from http://www.nwlink.com/~donclark/hrd/bloom.html

This article addresses three domains of learning: cognitive, affective, and psychomotor.

University of Central Florida, Office of Experiential Learning (n.d.). Writing SMART learning objectives, Retrieved from http://explearning.ucf.edu/registered-students/tips-for-success/writing-smart-learning-objectives/195

  This blog post focuses on the distinction between learning outcomes and objectives. Consider this information as you develop your practicum professional development objectives this week.

 The University of North Carolina at Charlotte, Center for Teaching & Learning. (2013). Writing objectives using Bloom’s taxonomy. Retrieved from http://teaching.uncc.edu/articles-books/best-practice-articles/goals-objectives/writing-objectives-using-blooms-taxonomy

    This resource outlines elements of Bloom’s Taxonomy.

Required Media

    Laureate Education (Producer). (2012a). Professional behavior in the practicum setting [Interactive media].

    Note: Retrieved from the Walden Library databases.

In this audio presentation, Dr. Jeanne Morrison discusses topics that demonstrate professional behavior in the practicum setting, such as dressing professionally, punctuality, and communication.

    Laureate Education (Producer). (2012b). Professional best practices [Interactive media].

    Note: Retrieved from the Walden Library databases.

In this audio segment, Dr. Jeanne Morrison provides an overview of best practices and tips for students engaged in the Practicum Experience. She discusses what activities are included in practicum hours, the importance of staying in touch with your Preceptor, and strategies for dealing with stress.

    Laureate Education (Producer). (2012c). Professionalism and the practicum experience [Interactive media].

    Note: Retrieved from the Walden Library databases.

What is the Practicum Experience all about? What are the roles of the Faculty Member and the Preceptor? In this media presentation, Dr. Jeanne Morrison discusses these and other critical aspects of the Practicum Experience. She also provides an overview of the professional demeanor expected of all students throughout the Practicum Experience.Bottom of Form

Describe the two organizations you selected and explain why you chose them.

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Submit a 2- to 3-page paper, double-spaced, that addresses the following:

Submit a 2- to 3-page paper, double-spaced, that addresses the following:

  • Describe the two organizations you selected and explain why you chose them.
  • Summarize how your local organization compares to the local competitor, state averages, and national averages using the benchmark data from the three Compare sites in this week’s Resources.
  • Identify and describe any factors that can explain differences in performance measures. Find one scholarly article that could explain the differences.
  • Explain how these differences in performance measures might impact nursing practice.
  • Analyze the effect of publicly reported data on the quality and safety of care for ONE of the following organizations. Select hospitals, nursing homes, OR home health agencies, and analyze the effect of the data listed under that organization:
    • For Hospitals:
      • Patient Survey Results
      • Timely and Effective Care
      • Readmissions, Complications, and Deaths
      • Use of Medical Imaging
      • Linking Quality to Payment
      • Medicare Volume
    • For Nursing Homes:
      • Overall Rating
      • Health Inspections
      • Staffing
      • Quality Measures
    • For Home Health Agencies:
      • Quality of Patient Care
      • Patient Survey Results
  • Finally, address how this would not happen without standardized data.
  • Clinical quality measures (CQMs) are tools that help to measure and track the quality of care provided in hospitals, nursing homes, and home health care. These measures were developed by the Centers for Medicare and Medicaid (CMS) and use data to examine the ability to deliver high-quality care. CQMs are used to measure many aspects of patient care, including clinical processes, health outcomes, patient safety, and adherence to clinical guidelines. Measuring and reporting CQMs helps to ensure that a health care system is delivering safe, timely, efficient, effective, equitable, and patient-centered care. Hospital Compare collects this data from participating hospitals, nursing homes, and home health care agencies across the United States. The data is reported on the websites with links provided so that the information can be reviewed by prospective patients, insurers, and the public. As nurses, many of us participate in the implementation of the “core measures” in our facility and may recognize when we have a “fall out” or do not meet that standard. In this Assignment, a review of your facility and another that you consider comparable or a competitor to your own will facilitate the nurses’ role in quality improvement and patient safety issues that impact the clinical setting.For this Assignment:
    • Explore at least one of the CMS Compare sites provided in this week’s Resources.
    • Select two local organizations using benchmark data to focus on for this Assignment.
    • Compare the performances of these two organizations to each other and to state and national averages.
    • Find one scholarly article that could explain the differences you observed.

Describe the health policy issue: Identify the issue and explore its background

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Health policy paper

Write a research paper of 5-6 pages of content without counting the title page and reference pages. It will contain 3-4 peer reviewed articles and 6-7 other outside sources (credible websites or agencies).  

The purpose of this assignment is for you to identify an issue of concern for your role as an advanced nurse practitioner and to formulate a potential policy change to address that issue. 

The issue must be related to the topic of Obesity in children and adolescents. The policy you consider may be somehow in reaction to the previous topic or something larger that is still related to that issue. Here is a list of a few topics to consider:

  • Child and elder care
  • Civil rights
  • Domestic violence
  • Drug abuse/addiction
  • HIV/AIDS
  • Homelessness
  • Native American and migrant workers’ health
  • Long-term care
  • Immigration/illegal aliens
  • Legislative issues affecting advanced practice nursing
  • Barriers to practice
  • Access to care

These paper should have the following APA headings:

  • Describe the health policy issue: Identify the issue and explore its background
  • Legislation Type: Identify the type of legislation, such as state and federal, scope of practice, reimbursement, loan repayment, or others that relate the issue of concern
  • Review of Literature: Review of a minimum of 3–4 peer-reviewed articles and 6–7 other outside sources.
  • Current Policy: Describe the current policy that deals with the health policy issue and specify how it impacts nursing or healthcare.
  • Aspects of Proposed (or Changed) Policy: Describe the specific aspects of your proposed policy or the change you would do to the previous policy and how it would impact nursing or healthcare.  Explain possible methods of addressing the issue; as well as goals and options for changes
  • Who Benefits and Who Supports: Identify the individuals who would benefit from the policy change and explain where support for the change would be found. Risks and benefits of the changes
  • Impact of Policy Change on Nursing and Healthcare: Describe the impact of the policy change on nursing practice and health care.
  • Analysis of Policy and Influence on My Practice : Explain the policy from your point of view and how this will influence your practice.

APA format 1 page long 3 references 1 from Walden University Library Please have done by Thursday 3/28/19 at 7pm ESTWhen developing a curriculum, it is important to understand not only what needs to

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APA format 1 page long 3 references 1 from Walden University Library Please have done by Thursday 3/28/19 at 7pm ESTWhen developing a curriculum, it is important to understand not only what needs to

APA format 1 page long 3 references 1 from Walden University Library 

Please have done by Thursday 3/28/19 at 7pm EST

When developing a curriculum, it is important to understand not only what needs to be taught, but the type of learners you will be attempting to teach. The choosing of content and concepts for a course or curriculum, the involvement of the learner, and methods for assessment and evaluation can all be determined when using theories to develop a curriculum (Billings and Halstead, 2016, pp 211). More importantly, learning theories provide an explanation of the interaction between student and faculty, the environment set up for learning, and the subject being taught (Billings and Halstead, 2016, pp 211).

            For the course project, our group has chosen Moses Cone Hospital as our setting. It is a Level II trauma center in Greensboro, North Carolina (Cone Health, 2019). The proposed program our group would like to begin at this facility is one directed to educating the registered nurses on how to properly treat the pain of pediatric patients in their facility. This education could be completed with simulations, competencies, online modules, and group discussions. A group member works at this facility and has observed this as an educational opportunity for the staff members.

            The learning theory I chose for this discussion with our group project in mind was the situated learning and situated cognition theory. This theory has a goal of “bringing the real world into the academic setting” (Billings and Halstead, 2016, pp 216). The implications for nursing education for this theory allows for learning experiences including “case studies, role play, simulation, and learning in a clinical setting to immerse students in real-life situations” (Billings and Halstead, 2016, pp 216).

One study found that after a three-month period using situated learning for newly graduated nurse practitioners increased their confidence and competency levels, along with decreasing stress (Chen, Chen, Lee, Chang, & Yeh, 2017). Our program could help increase the knowledge and confidence of those pediatric nurses caring for children with pain. Another study showed that “on-site clinical practicums have been thought to provide a varied experience in learning to nurses. However, there is an inconsistency to clinical opportunities available during these practicums” (Onda, 2012). Clinical simulations of scenarios or patient cases can help the nurses feel comfortable with situations when they arise with patients if they did not see them during their practicum.

In conclusion, developing a curriculum that will satisfy the needs of every nurse that needs or desires the education will not be an easy task. With so many different types of theories to base the education off of, picking the most appropriate could be seen as a challenge. As for our group project, I feel that the situated learning theory would work in a favorable way for the curriculum we are developing for those nurses at Moses Cone Hospital.

References

 Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.

Chen, S., Chen, S., Lee, S., Chang, Y., & Yeh, K. (2017). Impact of interactive situated and simulated teaching program on novice nursing practitioners’ clinical competence, confidence, and stress. Nurse Education Today, 55, pp 11-16. https://doi.org/10.1016/j.nedt.2017.04.025.

Cone Health. (2019). The Moses H. Cone Memorial Hospital. Retrieved from https://www.conehealth.com/locations/moses-cone-hospital/.

Onda, E. (2012). Situated Cognition: Its Relationship to Simulation in Nursing Education. Clinical Simulation in Nursing, 8(7) pp 273-280. https://doi.org/10.1016/j.ecns.2010.11.004.

WEEK 2: YOU DECIDE – Please read entire assignment. No plagiarism (a turnitin report will be appreciated) & APA for citing. The report must be 750 words with strategies & recommendations.

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You Decide

WEEK 2: YOU DECIDE – Please read entire assignment. No plagiarism (a turnitin report will be appreciated) & APA for citing. The report must be 750 words with strategies & recommendations.

Scenario Summary

You are the new Chief Executive Officer (CEO) of Middlefield Hospital. Middlefield Hospital is a 450-bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the full array of inpatient and outpatient services. The hospital enjoys a reputation for quality care in the area.

As the new CEO, you have learned that the hospital’s employee turnover rate exceeds 20%, and there are over 100 nursing vacancies. You have also learned the following facts that may be impacting these workforce shortages:

A new hospital has recently opened in your market area that has produced competition for Middlefield Hospital.

Employee morale has deteriorated over the last 12 months.

Essex University (a local college) is considering eliminating its nursing degree program because there is continual difficulty in recruiting well qualified instructors.

Your Role/Assignment

The board of directors has asked that you provide a 750-word report detailing your strategies and recommendations to overcome the workforce shortages and to improve employee morale. The strategies and recommendations should be as specific as possible and include the resources needed for implementation. Your primary text and journal/website research must be used as a reference to support your analysis.

Available Resources

Review the points of view of the following people to obtain further insights on this assignment.

Key Players

Dr. Rusty Gates â Internist

I have been admitting patients to Middlefield Hospital for 5 years. However, I recently moved my practice to the new hospital across town. The new hospital has much better facilities and the technology is state of the art. The staff appear much more invested in the quality of patient care and my patients seem happier.

Eileen Wright â Board Member for Middlefield Hospital

From my perspective, the employee morale at Middlefield has declined over the last 12 months. More and more employees are leaving Middlefield to go to the new hospital, and we have staffing shortages in most areas. The director of nursing is a great leader, but he is having difficulty retaining nursing staff. I am not sure what to do, but I don’t want the reputation of the hospital to suffer.

Anne Teaks â Registered Nurse for Middlefield Hospital

I have worked for Middlefield Hospital for 22 years. This hospital has always been committed to high quality in patient care. These nursing shortages have occurred many times through the years, and we will get through this one as well. I don’t like that we are short of staff on many shifts, but we all have to pitch in and make sure our patients get the care they need.

You Decide

Activity

Submit your strategy and recommendation report.

CASE STUDY 1: Cardiovascular

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 PLEASE COMPLETE BY EVENING THANK YOU!CASE STUDY 1: CardiovascularAnswer each question in detail.  Please be very clear as to which case study and which question you are answering.  You should numb

 PLEASE COMPLETE BY EVENING THANK YOU!

CASE STUDY 1: Cardiovascular

Answer each question in detail.  Please be very clear as to which case study and which question you are answering.  You should number your answers according to the case study questions.

Mr. J.L is a 62-year-old male who is scheduled to have coronary artery bypass surgery. His father died of a myocardial infarction (MI) at 65 years of age. Mr. J.L. has recently quit smoking. His cholesterol is 220 mg/dL with an HDL of 40 mg/dL. You are the nurse caring for Mr. J. L.

Critical Thinking Questions:

  • 1.  What will you do to prepare Mr. J.L. for surgery?
  • 2.  What assessments will you perform for Mr. J.L. when he is awaiting surgery?
  • 3.  What will be two priority nursing diagnoses in the postoperative period?
  • 4.  What are three key nursing interventions? Provide a rationale for each.
  • 5.  When he is transferred out of critical care, what complications will you monitor for Mr. J. L.?

CASE STUDY 2: Cardiovascular

On routine exam of an otherwise healthy 78-year-old man, you note a systolic murmur. 

Critical Thinking Questions:

1) What are the possible etiologies of this murmur?

2) What happens normally during systole and what could cause a murmur during systole?

3) What are the associated symptoms?

4) Describe how would you distinguish the differences between the patient having an aortic stenosis or mitral regurgitation?

5) How is a murmur diagnosed and how is it treated?

Discussion Board Grading Rubric

The original post should be approximately 200-300 total words. 

Please make sure that each answer has a complete APA reference from your textbook or other MPI materials and includes a page number.

Category

Point Values

Fully met  8-10pts

Partially met 5-7pts

Not met 0-4pts

Content

200-300 words

Post is original and answers the question using course textbook and shows nursing knowledge base. Student has responded to 2 classmates. 

Entry provides answers the question but does apply knowledge base as outlined in textbook

Entry does not answer the question and lacking information from text. Little or no nursing knowledge base.

Fluency

Good grammar, sentence structure, and spelling.

Entry has more than 2-3 grammatical and spelling errors.

Entry contains one or more serious grammatical and spelling problems.

APA

APA reference of student text

Improper use of APA format  

Student cited text

No use of APA format and word count guidelines.

Use of online resource

Application to career

100-200 words

Application to career by specifying relevant Nursing interventions and patient education.

Student attempted to apply to career but did not correctly state relevant interventions or patient education

Answers are irrelevant to the issue in discussion. No interventions or patient education provided.

Admission diagnosis: altered mental status.

/in /by

Patient history: The patient has history of traumatic brain injury secondary to motor vehicle accident and with cognitive and physical deficits spasticity / hemiplegia of left side of the body . A

Patient history: The patient  has history of traumatic brain injury secondary to motor vehicle accident and with cognitive and physical deficits spasticity  / hemiplegia of left side of the body .

Admission diagnosis: altered mental status.

Discharge diagnosis summary: AMS / possible acute toxic encephalopathy, and SIRs.

Ola was 40yrs he presented to the hospital with Altered mental status, he was lethargic and not following commands in hospital. She was admitted for AMS (altered mental status) .he was Keppra loaded as she appeared post-ictal . placed on seizure precaution with neuro checks overnight in the ICU and he improved and was transferred to floor. His mentation continued clear. Blood cultured drawn 12-22 returned positive for staph epidermidis times 2 -> most likely contaminant. He did meet SIRS( Systemic Inflammatory Response Syndrome) criteria with CBC < 4 and heart rate > 90, although upon review of his medical record his leukocytosis is chronic. he was given dose of vancomycin and BCx redrawn with NGTD -> ID evaluated patient and antibiotic were deescalated . TSH elevated normal T4.

Date: ________ Student Name: ____________________________ Clinical Site/Unit: ___________________________

Clinical Site Instructor:__ ____________________________Previous Shift Report: ____________________________

Client Initials: _______ Client age: _______   Gender: _____________ Height: __________ Weight: ______________

Allergies: ______vicodin __________________________ Code Status: _________________ Transfer Status: ______________

Marital Status: _____________ Religion: _________________ Occupation: ___________________________________

Cultural Background: ____________________________     Primary Language: _______________________________

Diet/Nutrition: ____________________________   Activity: _______________________________ Fall Risk: Yes / No

Use of (type/amount/frequency): Alcohol: _____________ Tobacco (pack years): ______________________________

Medical Diagnosis(s):

Admitting Diagnoses to Acute Care Facility

1._____altered mental status _______________________________ 2.______________________________________

Primary Diagnoses for Admission to TCU/LTC

1._____acute toxin encephalopathy ________________________________ 2.____ Systemic Inflammatory Response Syndrome_________________________________

3._____sepsis ______________________________4.______stap.epidermis _______________________________

Secondary Diagnoses

                                                1.____chronic pain __________________________________ 2._______ _____________________________

3.________traumatic brain injury _______________________________ 4._confusion__________________________________

Surgical History 1.______________________________________ 2.___________________________________

                                                3._______________________________________ 4.___________________________________

Treatments: _______________________________  IV/Tubes/Ostomies: ______________________________________

Dressings/Wounds: (type & location) ___________________________________________________________________

Oxygen: (delivery method & amount) _______________________________ Dialysis: ___________________________

Recent LAB Results:

Why is this lab significant for this client’s condition? If the lab result was abnormal, include what the NURSE needs to monitor for or do related to the abnormal lab result under the significance column.

Date          Test                     Normal Value                   Client Value                       Significance

          Wbc           4-10                    4.1 ________________________________________________________________________________________________________________________________RBC                    3.80 -5.40            4.95 ____________________________________________________________hematocrict 35.0- 47.0            37.5

Mcv           80-100                76    

______________________________________________________

MCH  2                 7-34 –                                                     22

___________________________________________________________________________________________________

PLT

___________________________________________238________________________________________________________

Recent Diagnostic tests: (list X-rays, CT scans, MRIs, ECGs, Ultrasounds, Cardiac Catheterizations, etc.)

List the test, the test result, and include an explanation of the significance of the results in relation to the medical treatment, other diagnostics, and nursing considerations/interventions for your client. ____________________________________________________________________________________________________________________

PATHOPHYSIOLOGY:

For the primary admitting diagnosis to the acute care facility and primary diagnosis for the TCU/LTC, provide a 3-5 sentence explanation of the pathophysiology of the problem. Then complete an ATI template for the above four diagnoses (4 total).  Use the “Active Learning Template: Systems Disorder” template from ATI Active Learning templates.  Complete, print, and attached to paperwork

PATHOPHYSIOLOGY CONTINUED:

For the top two secondary diagnoses, write a 1-2 sentence explanation of pathophysiology of the diagnosis and explain how this secondary diagnosis may impact your client’s condition during this hospitalization. 

If your client is post-surgical, what problems or complications could possibly occur? What nursing assessments would you need to include in your post-operative or post-procedure monitoring

PATHOPHYSIOLOGY CONTINUED:

 4 secondary diagnoses, write a 1-2 sentence explanation of pathophysiology of the diagnosis and explain how this secondary diagnosis may impact your client’s condition during this hospitalization. 

                    Medication

(Include dose, time, route, & frequency)

       Classification

What nursing considerations should

you include with this medications?

Buspar  15mg

Baclofen 20mg

Cymbalta 30mg

Levetiracetam 1000mg

Omeprazole 20mg

Robafen 100mg /5ml

Senna 8.6mg

Tizanidine hcl 2mg

Xarelto 20mg

Oxycodone HCL 5mg

ibuprofen

Medication Data Sheet

List all scheduled medications for your shift

Drug Name and Classification, Normal Adult Dose, Route & Schedule

Indications for Use and Expected Actions

Side Effects/ Adverse Reactions

Drug and Food Interactions

Nursing Administration Considerations

Client education &

Evaluation of Medication Effectiveness

Ticagrelor

Atorvastin

Pantoprazole

HumLIN  insulin regular

Diclofenac

NURSING PROCESS

Write 2 complete Nursing Diagnoses based on your client problems you noted on your assessment for this day.

Nursing Diagnosis #1:

___________________________________________________________________________________________________

Client Goal: ________________________________________________________________________________________

List 2 priority nursing interventions related to this diagnosis with the rationale for each intervention.

1.       _______________________________________________________________________________________________

Rationale: _________________________________________________________________________________________

Outcome Assessment: ________________________________________________________________________________

2: _________________________________________________________________________________________________

Rationale: _________________________________________________________________________________________

Outcome Assessment: ________________________________________________________________________________

Nursing Diagnosis #2:

__________________________________________________________________________________________________

Client Goal: ________________________________________________________________________________________

List 2 priority nursing interventions related to this diagnosis with the rationale for each intervention.

1.       ______________________________________________________________________________________________

Rationale: _________________________________________________________________________________________

Outcome Assessment: ________________________________________________________________________________

2. ________________________________________________________________________________________________

Rationale: ________________________________________________________________________________________

Outcome Assessment: ________________________________________________________________________________

Post-Clinical Education:

Provide the group with education on a topic you learned about preparing for your client/clinical packet.  For example a medical diagnosis, intervention, medication, lab value, treatment method, etc.  Use this space to write your speaking notes and reference(s).