Walden NRNP6540 Week 1: Assessment of Older Adults

Walden NRNP6540 Week 1: Assessment of Older Adults

CASE Study for Module 1 (6540)                                                                                     

History

The patient was an 85-year-old, Caucasian female admitted as a permanent resident to a long-term care facility following the death of her spouse (her primary caregiver) 35 days prior to referral to physical therapy. Her primary diagnosis on admission was Alzheimer’s disease, with a Clinical Dementia Rating (CDR) Scale score of 3, indicating severe dementia. Past medical history included: hypertension, coronary artery disease (CAD), inferior wall myocardial infarction, pernicious anemia, hyperlipidemia, reflux esophagitis, recurrent urinary tract infections, and anxiety. With a height of 63 inches, and weight of 135.2 pounds, her body mass index (BMI) was 23.9. Medications26 upon admission are listed in Table 1. Two days after the physical therapy evaluation, the patient’s primary care physician reduced her Risperdal dosage to 1 Mg bid in an attempt to reduce akathisia or restlessness which may have been causing her to experience the urgent need to move and not sit down. Walden NRNP6540 Week 1: Assessment of Older Adults

Medications Prescribed upon the Patient’s Admission to the Nursing Home

The patient was a retired beautician whose previous hobbies included knitting, gardening, and reading novels. She was a nonsmoker and rarely drank alcoholic beverages. Prior to admission, she required minimal assistance from her spouse with basic ADLs. She did not use an assistive device, but required supervision with all mobility-related activities. She had not fallen at home, prior to admission. While she was homebound in her single-family, rural home, caregivers were able to take her to medical appointments. All care was provided by her spouse without home health assistance. Walden NRNP6540 Week 1: Assessment of Older Adults

She had no previous care from physical therapists.

The patient was referred to physical therapy for evaluation and intervention 35 days after admission, following 2 noninjurious falls. The first fall, unwitnessed, occurred in the living room area of the facility at 10:35 AM, 9 days prior to the physical

therapy evaluation. Urinalysis done the day after the fall ruled out a urinary tract infection (UTI) as a possible cause of the fall. The second fall, 7 days after the first, occurred in the patient’s semi-private room while she was attempting to walk around her bed at 3:10 PM. Nursing reported the patient wandered throughout the day, often to the point of exhaustion. Nursing staff verbally prompted her to sit or lie down to rest frequently during the day, as she was unable to recognize the need to do so on her own. As many as 8 times a day, facility staff observed her falling asleep while standing holding the hallway railings or leaning on furniture.

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Nursing staff and primary care physician noted that the patient became agitated and anxious, and had tried to leave the facility several times to look for her husband, not remembering his death. At other times, with no signs of agitation, she willingly took part in group activities (coffee socials, musical programs, pet therapy, and visits with children’s groups) and received daily one-on-one visits from the activities director. She enjoyed weekly visits from her 3 daughters and sons-in-law and many grandchildren.

NRNP_6540 Week 1: Assessment of Older Adults

As patients age, they are more likely to develop health issues. While some of these health issues are normal changes due to aging, some of them are abnormal and require further evaluation. Consider a 92-year-old patient who has been diagnosed with several disorders, including obstructive sleep apnea, hypertension, mild chronic anemia, restless leg syndrome, and osteoporosis. Despite these disorders, he can independently perform all basic activities of daily living, walk a quarter mile without difficulty, and pass functional and cognitive assessments. However, he did report that he fell a few times and had lost his way while driving to a familiar location (Carr & Ott, 2010). As an advanced practice nurse caring for geriatric patients, you will likely encounter patients like this. While he can pass the basic assessments, the report of falls and confusion might indicate underlying issues of immobility, sensory deprivation, and/or cognitive dysfunction that require further attention. To identify these potential underlying issues and distinguish between normal and abnormal changes due to aging, healthcare providers use a variety of assessments. These assessments are a key tool in the care of geriatric patients.

This week, you examine assessment tools and evaluation plans used to assess geriatric patients presenting with potential issues of immobility, sensory deprivation, and cognitive dysfunction. Walden NRNP6540 Week 1: Assessment of Older Adults

Reference:
Carr, D. B., & Ott, B. R. (2010). The older adult driver with cognitive impairment: “It’s a very frustrating life.” Journal of the American Medical Association303(16), 1632–1641. 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915446/

Learning Objectives

Students will:

  • Analyze assessment tools used to assess older adults
  • Design evaluation plans for patients with immobility, sensory deprivation, and/or cognitive dysfunction
  • Identify immunization requirements related to health promotion and disease prevention for older adults

Learning Resources

Required Readings (click to expand/reduce)

 

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Changes with aging. In Advanced practice nursing in the care of older adults (2nd ed., pp. 2–5). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Health promotion. In Advanced practice nursing in the care of older adults (2nd ed., pp. 6–18). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Exercise in older adults. In Advanced practice nursing in the care of older adults (2nd ed., pp. 19–24). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Comprehensive geriatric assessment. In Advanced practice nursing in the care of older adults (2nd ed., pp. 26–33). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Symptoms and syndromes. In Advanced practice nursing in the care of older adults (2nd ed., pp. 34–94). F. A. Davis.

Centers for Disease Control and Prevention. (2020). Recommended adult immunization schedule for ages 19 years or older. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf

Coll, P. P., Costello, V. W., Kuchel, G. A., Bartley, J., & McElhaney, J. E. (2019). The prevention of infections in older adults: Vaccination. Journal of the American Geriatrics Society, 68(1), 207–214. https://doi.org/10.1111/jgs.16205

Hartford Institute for Geriatric Nursing. (2020). General assessment series. In Try This: Series. Author. https://consultgeri.org/try-this/general-assessment

U.S. Preventive Services Task Force. (n.d.). Information for health professionals. Retrieved June 8, 2020 from https://www.uspreventiveservicestaskforce.org/uspstf/information-health-professionals

U.S. Preventive Services Task Force. (2019). Appendix III. USPSTF LitWatch process. https://www.uspreventiveservicestaskforce.org/uspstf/procedure-manual-appendix-iii-uspstf-litwatch-process

 

Recommended Reading (click to expand/reduce)

 

Goldberg, C. (2019). Role of physical exam, general observation, skin screening and vital signs. https://meded.ucsd.edu/clinicalmed/assets/docs/Vital%20Signs%20and%20Introduction%20to%20the%20Exam.pdf

 

Recommended Media (click to expand/reduce)

 

Engage-IL (Producer). (2017m). Geriatric health promotion and disease prevention [Video]. https://engageil.com/modules/geriatric-health-promotion-and-disease-prevention/

Note: View the Geriatric Health Promotion and Disease Prevention video module available in this free course. If you choose to view the Engage-IL media, you will need to create a free account at the Engage-IL website. 

Engage-IL (Producer). (2017w). The process of aging [Video]. https://engageil.com/modules/the-process-of-aging/

Note: View the Process of Aging video module available in this free course. Walden NRNP6540 Week 1: Assessment of Older Adults

 

Discussion: Evaluation Plan

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario.

Photo Credit: LIGHTFIELD STUDIOS / Adobe Stock

To prepare:

  • Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
  • Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
  • Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
  • Consider immunization requirements that may be needed for this patient. Walden NRNP6540 Week 1: Assessment of Older Adults

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By Day 3

Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.

Read a selection of your colleagues’ responses.

By Day 6

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

  • Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
  • Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
  • Explain other health promotion considerations for patients in this population or with related issues.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link, and then select Create Thread to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

 

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

 

Name: NRNP_6540_Week1_Discussion_Rubric

Grid View

List View

Excellent

Point range: 90–100        Good

Point range: 80–89          Fair

Point range: 70–79          Poor

Point range: 0–69

Main Posting:

 

 

 

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. Walden NRNP6540 Week 1: Assessment of Older Adults

40 (40%) – 44 (44%)

Thoroughly responds to the discussion question(s).

 

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

 

No less than 75% of post has exceptional depth and breadth.

 

Supported by at least 3 current credible sources.

35 (35%) – 39 (39%)

Responds to most of the discussion question(s).

 

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

 

50% of the post has exceptional depth and breadth.

 

Supported by at least 3 credible references.

31 (31%) – 34 (34%)

Responds to some of the discussion question(s).

 

One to two criteria are not addressed or are superficially addressed.

 

Is somewhat lacking reflection and critical analysis and synthesis.

 

Somewhat represents knowledge gained from the course readings for the module.

 

Post is cited with fewer than 2 credible references.

0 (0%) – 30 (30%)

Does not respond to the discussion question(s).

 

Lacks depth or superficially addresses criteria.

 

Lacks reflection and critical analysis and synthesis.

 

Does not represent knowledge gained from the course readings for the module.

 

Contains only 1 or no credible references.

Main Posting:

 

 

 

Writing

6 (6%) – 6 (6%)

Written clearly and concisely.

 

Contains no grammatical or spelling errors.

 

Further adheres to current APA manual writing rules and style.

5 (5%) – 5 (5%)

Written concisely.

 

May contain one to two grammatical or spelling errors.

 

Adheres to current APA manual writing rules and style.

4 (4%) – 4 (4%)

Written somewhat concisely.

 

May contain more than two spelling or grammatical errors.

 

Contains some APA formatting errors.

0 (0%) – 3 (3%)

Not written clearly or concisely.

 

Contains more than two spelling or grammatical errors.

 

Does not adhere to current APA manual writing rules and style.

Main Posting:

 

 

 

Timely and full participation

9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

 

Posts main discussion by due date.

8 (8%) – 8 (8%)

Posts main discussion by due date.

 

Meets requirements for full participation.

7 (7%) – 7 (7%)

Posts main discussion by due date. Walden NRNP6540 Week 1: Assessment of Older Adults

0 (0%) – 6 (6%)

Does not meet requirements for full participation.

 

Does not post main discussion by due date.

First Response:

 

 

 

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

 

Responds to questions posed by faculty.

 

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic, may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic, lacks depth. Walden NRNP6540 Week 1: Assessment of Older Adults

First Response:

 

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

 

Response to faculty questions are fully answered, if posed.

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

 

Response is effectively written in Standard, Edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

 

Response to faculty questions are mostly answered, if posed.

 

Provides opinions and ideas that are supported by few credible sources.

 

Response is written in Standard, Edited English.

4 (4%) – 4 (4%)

Response posed in the discussion may lack effective professional communication.

 

Response to faculty questions are somewhat answered, if posed.

 

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the discussion lack effective communication.

 

Response to faculty questions are missing.

 

No credible sources are cited.

First Response:

 

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

 

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

 

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

 

Does not post by due date.

Second Response:

 

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

 

Responds to questions posed by faculty.

 

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic, may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic, lacks depth.

Second Response:

 

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

 

Response to faculty questions are fully answered, if posed.

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

 

Response is effectively written in Standard, Edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

 

Response to faculty questions are mostly answered, if posed.

 

Provides opinions and ideas that are supported by few credible sources.

 

Response is written in Standard, Edited English.

4 (4%) – 4 (4%)

Response posed in the discussion may lack effective professional communication.

 

Response to faculty questions are somewhat answered, if posed.

 

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the discussion lack effective communication.

 

Response to faculty questions are missing. Walden NRNP6540 Week 1: Assessment of Older Adults

 

No credible sources are cited.

Second Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

 

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

 

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

 

Does not post by due date.

Total Points: 100

Name: NRNP_6540_Week1_Discussion_Rubric

DDHA 8800 Fuzzy Decision Making in Healthcare Administration paper

DDHA 8800 Fuzzy Decision Making in Healthcare Administration paper

When uncertainty exists, how does one evaluate the universe of possible outcomes?

Unfortunately, there is no one steadfast rule on how to anticipate what a correct decision might be. However, there are a set of tools and practices that healthcare administration leaders can use to help make the best decision possible given data for a particular set of circumstances. One such example is that of fuzzy decision making, wherein a healthcare administration leader attempts to wrap human expertise around a set of guidelines to enhance workflow and performance. While not all circumstances may lend themselves to fuzzy decision making, understanding what these tools are is a useful practice when managing a health services organization.

For this Discussion, review the resources for this week. Reflect on the concept of fuzzy decision making for healthcare administration practice. Consider how you, as a current or future healthcare administration leader, may engage in fuzzy decision making for your health services organization . DDHA 8800 Fuzzy Decision Making in Healthcare Administration paper

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Post a description of how you would define fuzzy decision making for healthcare administration practice. Then, explain how you might implement fuzzy decision making to evaluate decisions when uncertainty exists. Provide an example where fuzzy decision making might be important for your work or life, and explain why. Be specific and provide

Albright, S. C., & Winston, W. L. (2017). Business analytics: Data analysis and decision making (6th ed.). Stamford, CT: Cengage Learning.

  • Chapter 6, “Decision Making Under Uncertainty”
  • Chapter 7, “Sampling and Sampling Distributions”

Ekin, T., Kocadagli, O., Bastian, N. D., Fulton, L. V., & Griffin, P. M. (2015). Fuzzy decision making in health systems: A resource allocation model. JEuro Journal on Decision Processes, 1–23.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. DDHA 8800 Fuzzy Decision Making in Healthcare Administration

NRNP – 6665 Week 10: Somatic Symptom-Related Disorders

NRNP – 6665 Week 10: Somatic Symptom-Related Disorders

NRNP – 6665 Week 10: Somatic Symptom-Related Disorders

Patients with somatic symptom-related disorders suffer from disproportionate feelings, thoughts, or behaviors related to physical symptoms. These disorders may manifest as excessive anxiety given the severity of a diagnosis or as pain or symptoms that don’t have a specific physical cause and are then attributed to psychological factors. Although it may be easier for some to understand and accept a physical diagnosis, somatic symptom-related disorders demonstrate the amazing connection between mind and body.

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This week, you will explore the relationship between cognitive and physical symptoms in somatic symptom-related disorders. NRNP – 6665 Week 10: Somatic Symptom-Related Disorders

Learning Resources

Required Readings (click to expand/reduce)

 

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Chapter 13, “Psychosomatic Medicine”
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

Chapter 72, “Somatoform and Other Related Disorders”
Required Media (click to expand/reduce)

 

Osmosis. (2017, April 3). Somatic symptom disorder – causes, symptoms, diagnosis, treatment, pathology [Video]. YouTube. https://youtu.be/oVO7tZS2ZdI

KeltyMentalHealth. (2014, November 5). Body talk: Stories of somatization. [Video]. YouTube. https://www.youtube.com/watch?v=3wycDLD0Bxo

The Feed SBS. (2015, April 30). Conversion disorder. [Video]. YouTube. https://www.youtube.com/watch?v=bwQAkgq7-e8

 

Assessing, Diagnosing, and Treating Patients With Somatic Symptom-Related Disorders

Effectively treating patients with somatic symptom-related disorders begins with comprehensive assessment and understanding of the symptoms and duration of the patient’s complaints. As a practitioner, you will need to listen to your patients and know what questions to ask in order to elicit the information that will allow you to determine the most effective diagnosis. You will have to do this while understanding that there could be more than one disorder contributing to the symptoms that are disrupting their daily lives. When you believe you have established the diagnosis, you must then consider a course of treatment that will work best for a particular patient. For the same disorder, both pharmacological and nonpharmacological treatments may be considered depending on the needs of the patient.

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Photo Credit: Photographee.eu / Adobe Stock

There is no Assignment due this week. You should spend this week reviewing the Learning Resources on somatic symptom-related disorders and preparing for your final exam, which you will take next week.

What’s Coming Up in Week 11?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Week 11, the final week of the course, you will consider disruptive, impulse-control, and conduct disorders. By the end of the week, you will also complete your final exam, which covers material from Week 7 through Week 11. NRNP – 6665 Week 10: Somatic Symptom-Related Disorders

Next Week

Module 3: Assessing, Diagnosing, and Treating Neurocognitive, Neurodevelopmental, Dissociative, Somatic Symptom-Related, Disruptive, Impulse-Control, and Conduct Disorders

In Module 3, you will continue to apply the knowledge that you have gained throughout your program as you practice assessing, diagnosing, and formulating treatment plans for a variety of mental health disorders that are found across the lifespan. Week 7 covers neurocognitive disorders, which describe diminished mental functioning due to causes such as brain injury and degenerative disorders. In Week 8, you will turn to neurodevelopmental disorders, which encompass a variety of disorders that occur due to abnormalities in the developmental trajectory. Dissociative disorders are the focus of Week 9, which involve a significant disconnect between thoughts and feelings and reality. Somatic symptom-related disorders, which occur when patients encounter disproportionate reactions to physical symptoms, will be explored in Week 10. In the last week of the course, you will explore disruptive, impulse-control, and conduct disorders, which are all rooted in a lack of self-control. The effective PMHNP will have a command of these disorders in order to prepare for the certification exam and be able to recognize them in the practice setting.

What’s Happening This Module?

Module 3—Assessing, Diagnosing, and Treating Neurocognitive, Neurodevelopmental, Dissociative, Somatic Symptom-Related, Disruptive, Impulse-Control, and Conduct Disorders—is a 5-week module that continues to focus on assessment, diagnosis, and treatment plans for a variety of disorders the PMHNP will need to identify to be an effective practitioner.

What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7, Weeks 7–11
Assignment: Study Guide Forum Submit your Assignment by Day 7 of Week 8.
Assignment: Controversy Associated
With Dissociative Disorders Submit your Assignment by Day 7 of Week 9.
Final Exam Complete by Day 7 of Week 11. NRNP – 6665 Week 10: Somatic Symptom-Related Disorders

NURS FPX 4040 Technology in Nursing Annotated Bibliography

NURS FPX 4040 Technology in Nursing Annotated Bibliography

NURS FPX 4040 Technology in Nursing Annotated Bibliography

Description

Write a 4-6 page annotated bibliography where you identify peer-reviewed publications that promote the use of a selected technology to enhance quality and safety standards in nursing.

Before you begin to develop the assessment you are encouraged to complete the Annotated Bibliography Formative Assessment. Completing this activity will help you succeed with the assessment and counts towards course engagement. NURS FPX 4040 Technology in Nursing Annotated Bibliography

 

Assessment 3 Instructions: Annotated Bibliography on Technology in Nursing

Top of Form

Bottom of Form

  • PRINT
  • Write a 4-6 page annotated bibliography where you identify peer-reviewed publications that promote the use of a selected technology to enhance quality and safety standards in nursing.

Before you begin to develop the assessment you are encouraged to complete the Annotated Bibliography Formative Assessment. Completing this activity will help you succeed with the assessment and counts towards course engagement.

Rapid changes in information technology go hand-in-hand with progress in quality health care delivery, nursing practice, and interdisciplinary team collaboration. The following are only a few examples of how the health care field uses technology to provide care to patients across multiple settings:

    • Patient monitoring devices.
    • Robotics.
    • Electronic medical records.
    • Data management resources.
    • Ready access to current science.

Technology is essential to the advancement of the nursing profession, maintaining quality care outcomes, patient safety, and research.

This assessment will give you the opportunity to deepen your knowledge of how technology can enhance quality and safety standards in nursing. You will prepare an annotated bibliography on technology in nursing. A well-prepared annotated bibliography is a comprehensive commentary on the content of scholarly publications and other sources of evidence about a selected nursing-related technology. A bibliography of this type provides a vehicle for workplace discussion to address gaps in nursing practice and to improve patient care outcomes. As nurses become more accountable in their practice, they are being called upon to expand their role of caregiver and advocate to include fostering research and scholarship to advance nursing practice. An annotated bibliography stimulates innovative thinking to find solutions and approaches to effectively and efficiently address these issues. NURS FPX 4040 Technology in Nursing Annotated Bibliography

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

    • Competency 3: Evaluate the impact of patient care technologies on desired outcomes.
      • Analyze current evidence on the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team.
      • Integrate current evidence about the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team into a recommendation.
    • Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.
      • Describe organizational factors influencing the selection of a technology in the health care setting.
      • Justify the implementation and use of a selected technology in a health care setting.
    • Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.
      • Create a clear, well-organized, and professional annotated bibliography that is generally free from errors in grammar, punctuation, and spelling.
      • Follow APA style and formatting guidelines for all bibliographic entries.

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Preparation

To successfully complete this assessment, perform the following preparatory activities:

    • Select a single direct or indirect patient care technology that is relevant to your current practice or that is of interest to you. Direct patient care technologies require an interaction, or direct contact, between the nurse and patient. Nurses use direct patient care technologies every day when delivering care to patients. Electronic thermometers or pulse oximeters are examples of direct patient care.  technologies. Indirect patient care technologies, on the other hand, are those employed on behalf of the patient. They do not require interaction, or direct contact, between the nurse and patient. A handheld device for patient documentation is an example of an indirect patient care technology. Examples of topics to consider for your annotated bibliography include:
      • Delivery robots.
      • Electronic medication administration with barcoding.
      • Electronic clinical documentation with clinical decision support.
      • Patient sensor devices/wireless communication solutions.
      • Real-time location systems.
      • Telehealth.
      • Workflow management systems. NURS FPX 4040 Technology in Nursing Annotated Bibliography
    • Conduct a library search using the various electronic databases available through the Capella University Library.
      • Consult the BSN Program Library Research Guide for help in identifying scholarly and/or authoritative sources.
      • Access the NHS Learner Success Lab, linked in the courseroom navigation menu, for additional resources.
    • Scan the search results related to your chosen technology.
    • Select four peer-reviewed publications focused on your selected topic that are the most interesting to you.
    • Evaluate the impact of patient care technologies on desired outcomes.
      • Analyze current evidence on the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team.
      • Integrate current evidence about the impact of a selected patient care technology on patient safety, quality of care, and the interdisciplinary team into a recommendation.

Notes

    • Publications may be research studies or review articles from a professional source. Newspapers, magazines, and blogs are not considered professional sources.
    • Your selections need to be current—within the last five years.

Annotated Bibliography

Prepare a 4–6 page annotated bibliography in which you identify and describe peer-reviewed publications that promote the use of your selected technology to enhance quality and safety standards in nursing. Be sure that your annotated bibliography includes all of the following elements:

    • Introduction to the Selected Technology Topic
      • What is your rationale for selecting this particular technology topic? Why are you interested in this?
      • What research process did you employ?
        • What databases did you use?
        • What search terms did you use?
        • Note: In this section of your bibliography, you may use first person since you are asked to describe your rationale for selecting the topic and the research strategies you employed. Use third person in the rest of the bibliography, however.
    • Annotation Elements
      • For each resource, include the full reference followed by the annotation.
      • Explain the focus of the research or review article you chose.
      • Provide a summary overview of the publication. NURS FPX 4040 Technology in Nursing Annotated Bibliography
        • According to this source, what is the impact of this technology on patient safety and quality of care?
        • According to this source, what is the relevance of this technology to nursing practice and the work of the interdisciplinary health care team?
        • Why did you select this publication to write about out of the many possible options? In other words, make the case as to why this resource is important for health care practitioners to read.
    • Conclusion/Recommendation
      • How would you tie together the key learnings from each of the four publications you examined?
      • What organizational factors influence the selection of a technology in a health care setting? Consider such factors as organizational policies, resources, culture/social norms, commitment, training programs, and/or employee empowerment.
      • How would you justify the implementation and use of the technology in a health care setting? Consider the impact of the technology on the health care organization, patient care/satisfaction, and interdisciplinary team productivity, satisfaction, and retention.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

    • Assessment 3 Example [PDF].

Additional Requirements

    • Written communication: Ensure written communication is free of errors that detract from the overall message.
    • Length: 4–6-typed, double-spaced pages.
    • Number of resources: Cite a minimum of 4 peer-reviewed resources.
    • Font and font size: Use Times New Roman, 12 point.
    • APA: Follow APA style and formatting guidelines for all bibliographic entries.

Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final capstone course. NURS FPX 4040 Technology in Nursing Annotated Bibliography

Discussion: Common Sense, Science, Beliefs, and Critical Thinking

Discussion: Common Sense, Science, Beliefs, and Critical Thinking

If you are like most people, you probably have opinions on just about everything. Have you ever thought about your opinions and whether they are based on common sense, your personal beliefs, or science? Does it make a difference? How do common sense, personal beliefs, and science factor into the ability to think critically and into being a scholar-practitioner? How does the perseverance of personal beliefs influence one’s ability? In this Discussion, you explore the answers to these questions and learn how to use evidence to balance common sense, beliefs, and science. Discussion: Common Sense, Science, Beliefs, and Critical Thinking

To prepare:

  • Review this week’s Learning Resources, focusing on the concepts of critical thinking and belief perseverance.
  • Think about the differences between and among common sense, science, and beliefs.
  • Consider how the differences between common sense and science and the connections between common sense and beliefs relate to critical thinking and to being a scholar-practitioner in your area(s) of interest.
  • Identify at least one strategy you might employ (or have employed) to ensure that you think critically in the presence of your personal belief system.

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BY DAY 3

Post an explanation of the relationships between and among common sense, science, personal beliefs, and critical thinking. Next, explain the role each of these four elements plays in the practice of scholarship. Then, provide your own definition of belief perseverance and explain how it influences critical thinking. Finally, share at least one strategy that you might employ to ensure that you think critically in the presence of your personal belief system.

Learning Objectives

Students will:

  • Analyze the relationships among common sense, science, personal beliefs, and critical thinking
  • Analyze the role common sense, science, personal beliefs, and critical thinking play in the practice of scholarship
  • Analyze the influence of belief perseverance on critical thinking
  • Analyze critical thinking strategies
  • Evaluate academic writing

Photo Credit: [P2007]/[Digital Vision Vectors]/Getty Images

Learning Resources

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

REQUIRED READINGS

Douglas, N. L. (2000). Enemies of critical thinking: Lessons from social psychology research. Reading Psychology, 21(2), 129–144.
Note: Retrieved from the Walden Library databases. Discussion: Common Sense, Science, Beliefs, and Critical Thinking

 

Friedman, S. (2004). Learning to make more effective decisions: Changing beliefs as a prelude to action. The Learning Organization, 11(2/3), 110–128.
Note: Retrieved from the Walden Library databases.

 

Elder, L., & Paul, R. (2013). Becoming a critic of your thinking. Retrieved from http://www.criticalthinking.org/pages/becoming-a-c…

 

Foundation for Critical Thinking. (2013). The Critical Thinking Community. Retrieved from http://www.criticalthinking.org/

 

Foundation for Critical Thinking. (2013). The Role of Socratic Questioning in Thinking, Teaching, and Learning. Retrieved from http://www.criticalthinking.org/pages/the-role-of-…

NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

Assessment 3 Instructions: Disaster Recovery Plan

  • PRINT
  • Develop a disaster recovery plan to lessen health disparities and improve access to community services after a disaster. Develop an oral presentation, 6 pages, for the Vila Health system, city officials, and the disaster relief team. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

Professional Context

Nurses perform a variety of roles and their responsibilities as health care providers extend to the community. The decisions we make daily and in times of crisis often involve the balancing of human rights with medical necessities, equitable access to services, legal and ethical mandates, and financial constraints. In the event of a major accident or natural disaster, many issues can complicate decisions concerning the needs of an individual or group, including understanding and upholding rights and desires, mediating conflict, and applying established ethical and legal standards of nursing care. As a nurse, you must be knowledgeable about disaster preparedness and recovery to safeguard those in your care. As an advocate, you are also accountable for promoting equitable services and quality care for the diverse community. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

Nurses work alongside first responders, other professionals, volunteers, and the health department to safeguard the community. Some concerns during a disaster and recovery period include the possibility of death and infectious disease due to debris and/or contamination of the water, air, food supply, or environment. Various degrees of injury may also occur during disasters, terrorism, and violent conflicts.

To maximize survival, first responders must use a triage system to assign victims according to the severity of their condition/prognosis in order to allocate equitable resources and provide treatment. During infectious disease outbreaks, triage does not take the place of routine clinical triage.

Trace-mapping becomes an important step to interrupting the spread of all infectious diseases to prevent or curtail morbidity and mortality in the community. A vital step in trace-mapping is the identification of the infectious individual or group and isolating or quarantining them. During the trace-mapping process, these individuals are interviewed to identify those who have had close contact with them. Contacts are notified of their potential exposure, testing referrals become paramount, and individuals are connected with appropriate services they might need during the self-quarantine period (CDC, 2020).

An example of such disaster is the COVID-19 pandemic of 2020. People who had contact with someone who were in contact with the COVID-19 virus were encouraged to stay home and maintain social distance (at least 6 feet) from others until 14 days after their last exposure to a person with COVID-19. Contacts were required to monitor themselves by checking their temperature twice daily and watching for symptoms of COVID-19 (CDC, 2020). Local, state, and health department guidelines were essential in establishing the recovery phase. Triage Standard Operating Procedure (SOP) in the case of COVID-19 focused on inpatient and outpatient health care facilities that would be receiving, or preparing to receive, suspected, or confirmed COVID- 19 victims. Controlling droplet transmission through hand washing, social distancing, self-quarantine, PPE, installing barriers, education, and standardized triage algorithm/questionnaires became essential to the triage system (CDC, 2020; WHO, 2020).

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This assessment provides an opportunity for you to apply the concepts of emergency preparedness, public health assessment, triage, management, and surveillance after a disaster. You will also focus on evacuation, extended displacement periods, and contact tracing based on the disaster scenario provided.

Demonstration of Proficiency – NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Analyze health risks and health care needs among distinct populations.
    • Describe the determinants of health and the cultural, social, and economic barriers that impact safety, health, and disaster recovery efforts in a community. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment
  • Competency 2: Propose health promotion strategies to improve the health of populations.
    • Present specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve disaster recovery efforts.
  • Competency 3: Evaluate health policies, based on their ability to achieve desired outcomes.
    • Explain how health and governmental policy affect disaster recovery efforts.
  • Competency 4: Integrate principles of social justice in community health interventions.
    • Explain how a proposed disaster recovery plan will lessen health disparities and improve access to community services.
  • Competency 5: Apply professional, scholarly communication strategies to lead health promotion and improve population health.
    • Organize content with clear purpose/goals and with relevant and evidence-based sources (published within 5 years).

Preparation

When disaster strikes, community members must be protected. A comprehensive recovery plan, guided by the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework, is essential to help ensure everyone’s safety. The unique needs of residents must be assessed to lessen health disparities and improve access to equitable services after a disaster. Recovery efforts depend on the appropriateness of the plan, the extent to which key stakeholders have been prepared, the quality of the trace-mapping, and the allocation of available resources. In a time of cost containment, when personnel and resources may be limited, the needs of residents must be weighed carefully against available resources.

In this assessment, you are a community task force member responsible for developing a disaster recovery plan for the Vila Health community using MAP-IT and trace-mapping, which you will present to city officials and the disaster relief team.

To prepare for the assessment, complete the Vila Health: Disaster Recovery Scenario simulation.

In addition, you are encouraged to complete the Disaster Preparedness and Management activity. The information gained from completing this activity will help you succeed with the assessment as you think through key issues in disaster preparedness and management in the community or workplace. Completing activities is also a way to demonstrate engagement.

Begin thinking about:

  • Community needs.
  • Resources, personnel, budget, and community makeup.
  • People accountable for implementation of the disaster recovery plan.
  • Healthy People 2020 goals and 2030 objectives.
  • A timeline for the recovery effort.

You may also wish to:

  • Review the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework, which you will use to guide the development of your plan:
    • Mobilize collaborative partners.
    • Assess community needs.
    • Plan to lessen health disparities and improve access to services.
    • Implement a plan to reach Healthy People 2020 goals or 2030 objectives.
    • Track community progress.
  • Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

Instructions – NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

Every 10 years, The U.S. Department of Health and Human Services and the Office of Disease Prevention and Health Promotion release information on health indicators, public health issues, and current trends. At the end of 2020, Healthy People 2030 was released to provide information for the next 10 years. Healthy People 2030 provides the most updated content when it comes to prioritizing public health issues; however, there are historical contents that offer a better understanding of some topics. Disaster preparedness is addressed in Healthy People 2030, but a more robust understanding of MAP-IT, triage, and recovery efforts is found in Healthy People 2020. For this reason, you will find references to both Healthy People 2020 and Healthy People 2030 in this course.

Complete the following:

  1. Develop a disaster recovery plan for the Vila Health community that will lessen health disparities and improve access to services after a disaster. Refer back to the Vila Health: Disaster Recovery Scenarioto understand the Vila Health community.
    • Assess community needs.
    • Consider resources, personnel, budget, and community makeup.
    • Identify the people accountable for implementation of the plan and describe their roles.
    • Focus on specific Healthy People 2020 goals and 2030 objectives.
    • Include a timeline for the recovery effort.
  2. Apply the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework to guide the development of your plan:
    • Mobilize collaborative partners.
    • Assess community needs.
      • Use the demographic data and specifics related to the disaster to identify the needs of the community and develop a recovery plan. Consider physical, emotional, cultural, and financial needs of the entire community.
      • Include in your plan the equitable allocation of services for the diverse community.
      • Apply the triage classification to provide a rationale for those who may have been injured during the train derailment. Provide support for your position.
      • Include in your plan contact tracing of the homeless, disabled, displaced community members, migrant workers, and those who have hearing impairment or English as a second language in the event of severe tornadoes. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment
    • Plan to lessen health disparities and improve access to services.
    • Implement a plan to reach Healthy People 2020 goals and 2030 objectives.
    • Track and trace-map community progress.
      • Use the CDC’s Contract Tracing Resources for Health Departmentsas a template to create your contact tracing.

Describe the plan for contact tracing during the disaster and recovery phase.

Graded Requirements

The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point:

  • Describe the determinants of health and the cultural, social, and economic barriers that impact safety, health, and recovery efforts in the community.
    • Consider the interrelationships among these factors.
  • Explain how your proposed disaster recovery plan will lessen health disparities and improve access to community services.
    • Consider principles of social justice and cultural sensitivity with respect to ensuring health equity for individuals, families, and aggregates within the community.
  • Explain how health and governmental policy impact disaster recovery efforts.
    • Consider the implications for individuals, families, and aggregates within the community of legislation that includes, but is not limited to, the Americans with Disabilities Act (ADA), the Robert T. Stafford Disaster Relief and Emergency Assistance Act, and the Disaster Recovery Reform Act (DRRA).
  • Present specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve the disaster recovery effort.
    • Consider how your proposed strategies will affect members of the disaster relief team, individuals, families, and aggregates within the community.
    • Include evidence to support your strategies.
  • Organize content with clear purpose/goals and with relevant and evidence-based sources (published within 5 years).
    • Develop your presentation with a specific purpose and audience in mind.
    • Adhere to scholarly and disciplinary writing standards and APA formatting requirements.

MUST INCLUDE !!!!!

  1. Provides a concise, accurate description of the determinants of health and the cultural, social, and economic barriers that impact safety, health, and disaster recovery efforts in a community. Clearly describes the interrelationships among these factors.

 

  1. Explains how a proposed disaster recovery plan will lessen health disparities and improve access to community services. Provides clear insight into how principles of social justice and cultural sensitivity help to ensure health equity for individuals, families, and aggregates in the community.

 

  1. Explains how health and governmental policy impact disaster recovery efforts. Articulates the logical policy implications for community members linked to specific policy provisions.

 

  1. Presents specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve disaster recovery efforts that are well-supported by with relevant and credible evidence. Articulates the implications and potential consequences of proposed strategies.

 

  1. Organizes content with clear purpose/goals. support main points, assertions, arguments, conclusions, or recommendations with relevant and evidence-based sources (published within 5 years). NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

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VILA HEALTH Disaster Recovery Scenario (NHS-FPX-4060 Assessment 3: Disaster Recovery Plan)

For a health care facility to be able to fill its role in the community, it must actively plan not only for normal operation, but also for worst-case scenarios which could occur. In such disasters, the hospital’s services will be particularly crucial, even if the specifics of the disaster make it more difficult for the facility to stay open.

In this scenario, you will resume your role as the senior nurse at Valley City Regional Hospital. Like many facilities within the Vila Health network, Valley City Regional serves as the primary source of health care for a wide area of North Dakota. As such, it is even more imperative than usual that it stay open and operational in all situations. Doing this means planning and preparation.

The administrator of the hospital, Jennifer Paulson, wants to talk to you about disaster preparedness and recovery at Valley City Regional. But first, you should read some background information about events in Valley City in the past few years, including the involvement of the hospital.

ARTICLE:

HOPE FOR THE BEST, PLAN FOR THE WORST

Op-ed by Anne Levy, Valley City Herald

Valley City has had a great year, growing on a number of fronts. But all of our growth and success exists in the shadow of the recent past, a case of recent wounds slowly healing and fading to scars.

No one who was in Valley City two years ago will ever forget the catastrophic derailment of an oil-tanker train and the subsequent explosion and fire. While fatalities were fewer than they could have been, six residents of our city lost their lives. Nearly two hundred were hospitalized, and much of the city was temporarily evacuated. Several homes near the railroad tracks were leveled, and our water supply was contaminated by oil leakage for several months.

Life has resumed, and we have begun to thrive again, in our fashion. But the nagging feeling recurs: When the disaster struck, were our institutions properly prepared? No one wakes up in the morning expecting a train derailment, of course. But responsible institutions think about things that could go wrong within the realm of possibility, and make a plan. Many individuals performed brave, inspired, selfless service in the chaos of the derailment, but it is clear in retrospect that much of the work was improvised, disorganized, and often circular or at cross-purposes.

For the first two hours of the crisis, the Valley City Fire Department was caught unprepared by the damage to the city water supply caused by the explosion, which was more extensive than had been considered possible. The Fire and Police departments had trouble coordinating radio communications, and a clear chain of command at the scene between departments was painfully slow to emerge. The hospital was woefully understaffed for the first six hours of the crisis, taking far too long to find a way to bring additional staff and resources onto the scene. The city health department was unacceptably dilatory in testing the municipal water supply for contaminants.

A call from the Herald’s offices to City Hall confirmed that the city’s disaster plan is over a decade old, and is unfortunately myopic both in the events it considers as possible disasters and in the agencies it plans for. It is of utmost importance to the future of our city that this plan be revised, revisited, and expanded. All city agencies should review their own disaster plans and coordinate with the city for a master plan. The same goes for crucial non-government agencies, most especially the Valley City Regional Hospital. Of course, this all exists in the shadow of budget cuts both at city hall and the hospital. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

The sun is shining today, without a cloud in the sky. This is the time to make sure we are ready for the next storm, so to speak, to hit our city. No one knows what the next crisis will be or when it will come. But we can count on the fact that no one will get up that morning expecting it. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

 

FACT SHEET:

Valley City, ND, Demographics. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

Population: 8,295 (up from 6,585 in 2010 census)

Median Age: 43.6 years. 17.1% under age 18; 14.8% between 18 and 24; 21.1% between 25 and 44; 24.9% 46 – 64; 22% 65 or older.

Officially, residents are 93% white, 3% Latino, 2% African-American, 1% Native American, 1% other.

—additionally, unknown number of undocumented migrant workers with limited English proficiency

Special needs: 204 residents are elderly with complex health conditions; 147 physically disabled and/or use lip-reading or American Sign Language to communicate.

Note that the Valley City Homeless shelter runs at capacity and is generally unable to accommodate all of the city’s homeless population. Also, the city is in the midst of a financial crisis, with bankruptcy looming, and has instituted layoffs at the police and fire departments.

Valley City Region Hospital Fact Sheet

105-bed hospital (currently 97 patients; 5 on ventilators, 2 in hospice care.)

NOTEWORTHY: Both of VCRH’s ambulances are aging and in need of overhaul. Also, much of the hospital’s basic infrastructure and equipment is old and showing wear. The hospital has run at persistent deficits and has been unable to upgrade; may be looking at downsizing nursing staff.

 

Jennifer Paulson

Administrator, Valley City Hospital

Hello, thanks for stopping by. I hope you’re settling in well.

I’d been planning on talking to you about disaster planning in the near future anyway, but now it looks like it’s a lot more urgent. I’m not sure if you’ve heard, but the National Weather Service says we’re going to be at an elevated risk for severe tornadoes in Valley City this season. I’m taking that as a clear sign that it’s time we get serious about disaster planning. And it’s not just me… The mayor just called me and asked the hospital to check our preparedness for a mass-casualty event, given recent qualms about the way the derailment was handled. For instance, did you see that op-ed in the paper about disaster planning?

Anyway. My particular concern is patient triage in the near term and recovery efforts over the next six months. As I work on a more formal response to the Mayor about where we’re at for this threat, I’d appreciate it if you could do some research and planning on this matter. Even if we dodge the bullet on these tornadoes, there’ll be something else in the future. We need to stop putting it off and get serious about our disaster planning.

What I’d like for you to do first is take some time to talk to a good cross-section of people here at the hospital about what happened last time, and about our disaster plan in general. Make sure you get people from administration as well as frontline care staff; after all, problems can be visible in one area but not another a lot of times. So spread it around! Since you weren’t here for the train crisis, I think you’re in a unique position to have a fresh, unbiased outlook on it. Actually, first you might find it useful to take a look at the hospital fact sheet, just to brush up on our basics here.

After you’ve looked at the fact sheet and done some talking to people, I’d like you to swing back by and we’ll talk about next steps.

Thanks!

 

Kate McVeigh

RN

Hey there! Yeah, I think I have a minute or two to talk about the derailment. Wow. It’s crazy. I guess that’s been a while, but it still feels like it just happened. It’s all so vivid!

I was on shift when it happened, so I was here for the whole thing. The blast, the first few injuries, and then the wave. I think I was working for 16 hours before Heather, the former head nurse, told me to leave before I passed out.

I just remember a big jumble. We had waves of people coming in before we were really aware of what we were up against. Someone actually brought out the disaster plan but it was kind of useless. Just a bunch of words about using resources wisely and what have you, no concrete steps or plan. And then people started pouring in and we started treating them and there just wasn’t time to figure out how to make that stuff about using resources wisely into an actual, concrete plan. I mean, of course it’s good advice to use your damned resources wisely in an emergency! But just saying that doesn’t help. Without a plan, we were just working our way through a line, or really more like a crowd, without any thought of triage or priorities or anything. You knew as you were doing it that it was bad, but what could you do? There was always a next person to help.

You know what would have been useful in that damn disaster plan? Strict, functional checklists and lists of steps and such. Concrete plans for a chain of command. Clear lists of what to do and what our priorities should have been. And I’m just talking doctor and nurse time here, as far as waste goes. I know we had critical problems with supplies and such, but I was too focused on patient care to really know what was going on there. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

  1. I have to go do rounds. Good luck. Yikes. I’m all anxious just thinking about that again.

 

Megan Campbell

RN

Oh, I remember the night of the derailment really well. I’ll never forget it. I was off that night, out for dinner with my family. Heard the boom and the word spread through the Pizza Hut about what had happened pretty quickly. I kept expecting a call telling me to come in to the hospital, but none ever came. After maybe ten minutes of that, I figured I’d better just come in on my own. It was pretty clear there were going to be a lot of people moving through the hospital.

I guess that was a little bit of a failure, but it’s nothing compared to what I saw when I showed up at the hospital. I just hustled into the ER and started helping out. It wasn’t clear who was in charge, and nobody was making any decisions. People just started piling in with burn wounds, smoke inhalation, blunt trauma from the explosion, you name it. And we were just dealing with them first-come, first serve, more or less. Just working our way through the room while people kept coming in and piling up. I knew that this wasn’t the right way to be doing this – heck, we all knew – but the room was too chaotic for anyone to take a second and say “stop” and impose some kind of systematic approach. I don’t know for sure if any lives were lost because of the muddle, but I know people with some very serious injuries suffered a lot longer than they needed to while we were treating people with minor sprains and contusions who’d just happened to get to the ER a little earlier.

Hope this helps!

 

Courtney Donovan

M.D.

I can’t say that I feel great about the state of disaster planning here at the hospital. I know we keep talking about doing something, but it never seems to get any further than talk. I mean, no offense, but I think this is the third time since the derailment that someone has tried to talk to me about lessons learned. There’s a point where just that repetition makes it clear that no lessons have been learned.

But just to be a good sport: The big lesson from the derailment is that our staff is intelligent, resourceful, energetic, and flexible. That’s the good news. Stuck with a horrific situation and a disaster plan that I’d describe as “aspirational,” we got through a very rough event. It was more painful than it needed to be, since we had to improvise most of it and improvisation is never the most efficient way to do things. But we provided real help to people and I think we kept the loss of life admirably low. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

But god. There was no structure, no thought to anything. I tried to get the nurses to perform some triage, but they were too busy reacting to the latest mini-crisis to pop up in front of them. I don’t blame them, of course! I tried to give some orders, but then like the nurses I was always pulled in to sit with the next patient, and someone else would come out and countermand whatever I’d said, and it just went on like that all night.

On a personal level, I know I pushed myself too hard that night. I mean, with good reason, but still. I was exhausted and loopy after 14 hours or so, and it’s just luck that I didn’t make any serious medical errors. I’m not the only one who put it all out there. I know most of the medical staff were in bad shape towards the end, too. I guess that’s always going to be a risk, but I think we could have planned our operations a little better. If we’d been more thoughtful about what we were doing, maybe we wouldn’t have needed to grind ourselves down so far.

You know what else? I’ve never felt good about our long-term check-ins afterwards. People who had recurring problems related to the derailment came in, but neither we at the hospital or anybody in public health did enough to check in with people on an ongoing basis in the months after the disaster. Even when we were having those water contamination issues! People forget about that–the derailment disaster really continued for months afterwards as the cleanup went on.

I hope you’re serious about taking this information and turning it into something useful. For god’s sake, please don’t just write it all down and keep it on your laptop this time. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

 

Mike Horgan

Associate Director Hospital Operations

I have been screaming about the need to update our disaster plan for years. I was screaming about it before the train incident, too, but nobody would listen then. I figured people might listen afterwards, but that hasn’t been the case, at least so far. If I’m talking to you about this right now, maybe it’s a good sign.

Look. I respect the heck out of Jen Paulson, she’s been a great hospital administrator. But she’s also got a lot on her plate, and is never, ever able to properly take a step back and look at the big picture. Not her fault, it’s a systemic thing.

And all of our disaster-planning problems are systemic. The disaster plan as it exists is basically a binder full of memos, each memo just being something I or Jen or someone else went and wrote down after we’d had a conversation about what to do if there was a catastrophic snowstorm or what have you. At best, it works as a bunch of notes that you could use to build a real disaster plan out of. As something you could act on in a crisis? No way. And we proved that in the train incident.

One thing that makes me crazy about all of this: in all of our conversations, we act like we here at the hospital can cook up a plan on our own that’ll get us through anything. But that’s just crazy. We can and should have a plan. But when the stuff hits the fan, we’re not on our own and we can’t work from a plan that pretends we are. We interface directly with first responders: the fire department, the EMTs, and the police and sheriff’s departments. Our plan needs to coordinate with them. We saw that in spades on the night of the train explosion. We barely had functional communication with any of the other agencies for the first few hours of the crisis! People were being brought over by the ambulance load and just kind of dumped off so that they could go pick up the next wave! There was a serious problem with understandably panicked people crowding the hospital, mostly trying to find out where their loved ones were and if they were OK, and it was three in the morning before we had police here doing crowd control.

So if you’re helping Jen work on an improved disaster plan: First, thank you. Second, please, PLEASE reach out to people at other agencies around town and work out some joint-operation protocols for next time.

 

Andrew Steller

Hospital CFO

Well, welcome to the house of gripes.

Sorry. It’s just that this is kind of a tough stretch, since the budget realities we’re facing make everything extra difficult and fraught. Believe me, I understand the importance of planning for the next disaster. It’s just that this is one more thing that our shortfalls are going to make really, really difficult.

It’s looking pretty likely that we’re going to need to cut our nursing staff pretty soon. Aside from the day-to-day problems that’ll cause, it’ll have a huge impact in a disaster. But it’s worse than that. Impact from a disaster doesn’t just happen in the midst of the crisis. It lingers, just like we saw with the derailment. And we’re going to have a hell of a time in that aftermath phase if we’re dealing with a reduced workforce and reduced resources.

I mean, think about who gets impacted when something major happens. The impact, especially long-term, doesn’t affect everyone equally. Think about any kind of special-needs population: people who don’t speak English, people with grave health problems who need ongoing care, people with serious economic problems… Those people are going to be affected up-front at least as much, if not more than, the baseline population, but then their recovery is going to be that much harder. That’s a reality that’s been borne out over and over. You see it with health impact, economic impact, even physical impact. If you were a little bit behind before, you’ll be a bit further behind after. We need, as both a moral and legal imperative, to provide equal access and service for all of the different parts of a diverse community. And again, we’ll be facing that situation with reduced capacity. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan Assignment

Another thing that’s going to be a factor in our post-disaster recovery is government. Does FEMA step in? How long do they stay? Is there a disaster declaration, with some recovery funding? How about at the state level? Who’s coordinating all of this? This sort of thing requires a ton of communication and collaboration with governmental entities at all levels. We like to pretend we’re autonomous in these situations but we aren’t at all. There’s always a minefield of government funding and health policy to dig through as we try to put ourselves back together.

Sorry to be the voice of gloom and doom here. This stuff isn’t impossible, but god knows it’s difficult.

 

Anthony Martinez

Director, Facilities

Hey there.

Disaster planning, huh? Yeah, it’d be good to have a disaster plan. It’s hard to do in real life, when you’re trapped by the realities of a budget cycle. You know? Whatever we plan, whatever we think is the right thing to do for the long term, there’s also this reality that Vila Health HQ expects us to hit certain monetary targets and we have to not only factor that into any idea about disaster planning, but also have to focus on hitting those targets rather than sitting down and, you know, making a plan.

I try to do things in my own way as much as I can. For critical supplies in the building, I work to build as much of a cushion as the budget process will allow. Same for critical facilities; if we can financially make it work to make something redundant, I do it. It’d be great if this was more formally planned out and not a case of me stashing away a cache of saline solution when I can, but you deal with the reality you have and not the reality you wish you had.

This is all a response to that damn derailment, of course. God, that was a mess. I was new to this position then, still trying to clean up the disaster I’d stepped into. My predecessor, well, Ed Murphy was a great golfer but not much of a long-term thinker. Across the board, we had enough supplies for the next week’s normal operations and nothing more. Ed had read some book about just-in-time inventory and was all excited about how efficient that could make us. And that kind of efficiency’s great if you’re running an assembly line, but it doesn’t work so well if you have a hospital and something unexpected comes up, like an oil train jumping the tracks and blowing up. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

I’d just started to build up some surplus supplies when that happened, nowhere near enough. We burned through supplies at a terrifying rate that night. Especially bandages and blood plasma. It didn’t help that the floor staff were just running around like crazy trying to treat people as they came in, not putting any thought into prioritizing who got what. I’m not blaming them, they were doing the best they could in a tough situation. But it meant that we were out of plasma for a while until Jackie Gifford from Fargo Methodist drove in with a truckload of replacements for us. It was like that all night, making frantic calls to hospitals and agencies all over the area, trying to get supplies. And keeping an eye on the fuel situation for the hospital generator, since the fire took out power for half the town.

God, what a mess. Took us six months to clean all that up. So disaster planning? Yeah, I’m all for it.

RIVERBEND CITY

Follow-up Report

Meet with Jennifer to report your findings.

Visit each icon to continue.

Jennifer Paulson

Administrator, Valley City Hospital

Thanks for talking to everyone! I bet you heard a lot.

I’d like you to take some time to sit and think about what you’ve heard and seen, and try to knit it all together into some overall conclusions that we can use to work up a plan to be ready for the next disaster.

Ultimately, I’d like you to be able to present a compelling case to community stakeholders (mayor and city disaster relief team) to obtain their approval and support for the proposed disaster recovery plan. I’d like you to use MAP-IT, and work up an approach supported by Healthy People 2020, and put it all into a PowerPoint. We’ll save the PowerPoint deck and the audio of its accompanying presentation at the public library so that the public can access it and see that we’re serious. Ideally, I’d like this to be used as a prototype for other local communities near Valley City, and possibly other facilities in the Vila Health organization. NHS-FPX-4060 Assessment 3: Disaster Recovery Plan

Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried. Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

—Carl Rogers, from On Becoming a Person

Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

This client-centered perspective is the cornerstone of humanistic-existential therapy, which requires therapists to “attempt to receive clients with curiosity and openness, endeavor to grasp their subjective world, and believe that clients are the experts on their own experience” (Wheeler, 2014, p. 373). As the psychiatric-mental health nurse practitioner, it is important to understand that the effectiveness of this approach is dependent on your relationship with clients, as well as your beliefs on holism and human nature. Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

This week, you compare humanistic-existential therapy with other approaches and justify its use with individual patients.

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

Learning Objectives

Students will:

  • Distinguish between humanistic-existential psychotherapy and other types of psychotherapy
  • Justify the use of humanistic-existential psychotherapy approaches with individual patients

Walden NRNP 6645 Week 7 Humanistic–Existential Therapy Learning Resources

Required Readings (click to expand/reduce) 

  • For reference as needed

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.

  • Chapter 7, “Experiential Family Therapy” Walden NRNP 6645 Week 7 Humanistic–Existential Therapy=[

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

  • Chapter 6, “Humanistic-Existential and Solution-Focused Approaches to Psychotherapy”
Required Media (click to expand/reduce) 

Grande, T.  (2019, January 9). Theories of counseling – Existential therapy [Video]. YouTube. https://www.youtube.com/watch?v=YvAvc2aWup0

PsychotherapyNet. (2009, June 29). James Bugental live case consultation psychotherapy video [Video]. YouTube. https://www.youtube.com/watch?v=Zl8tVTjdocI

ThinkingallowedTV. (2010, September 20). James Bugental: Humanistic psychotherapy (excerpt) – A thinking allowed DVD w/ Jeffrey Mishlove [Video]. YouTube. https://www.youtube.com/watch?v=mjDNKGIvWPQ

Optional Media

Biophily2. (2016, October 4). Abraham Maslow, Rollo May, Carl Rogers – Existential psychology II (1962) [Video]. YouTube. https://www.youtube.com/watch?v=oTTqKNI7wDo

Bugental, J. (2008). Existential-humanistic psychotherapy [Video].  https://waldenu.kanopy.com/video/existential-humanistic-psychotherapy

Assignment: Comparing Humanistic-Existential Psychotherapy with Other Approaches

 

Photo Credit: motortion / Adobe Stock

Understanding the strengths of each type of therapy and which type of therapy is most appropriate for each patient is an essential skill of the psychiatric-mental health nurse practitioner. In this Assignment, you will compare humanistic-existential therapy to another psychotherapeutic approach. You will identify the strengths and challenges of each approach and describe expected potential outcomes.

To prepare:

  • Review the humanistic-existential psychotherapy videos in this week’s Learning Resources.
  • Reflect on humanistic-existential psychotherapeutic approaches.
  • Then, select another psychotherapeutic approach to compare with humanistic-existential psychotherapy. The approach you choose may be one you previously explored in the course or one you are familiar with and especially interested in. Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

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The Assignment

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

  • Briefly describe humanistic-existential psychotherapy and the second approach you selected.
  • Explain at least three differences between these therapies. Include how these differences might impact your practice as a PMHNP.
  • Focusing on one video you viewed, explain why humanistic-existential psychotherapy was utilized with the patient in the video and why it was the treatment of choice. Describe the expected potential outcome if the second approach had been used with the patient.
  • Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://academicguides.waldenu.edu/writingcenter/templates ). All papers submitted must use this formatting. Walden NRNP 6645 Week 7 Humanistic–Existential Therapy

By Day 7

Submit your Assignment.

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 7 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To participate in this Assignment:

Week 7 Assignment

Walden NRNP 6645 Week 7 Humanistic–Existential Therapy Rubric Detail

 

Select Grid View or List View to change the rubric’s layout

Excellent 

90%–100%

Good 

80%–89%

Fair 

70%–79%

Poor 

0%–69%

Develop a 2- to 3-page paper comparing humanistic-existential therapy to another psychotherapeutic approach of your choice. Be sure to address the following: ·  Briefly describe humanistic-existential psychotherapy and the second approach you selected.
23 (23%) – 25 (25%)
The response includes an accurate and concise description of humanistic-existential psychotherapy and your selected approach. Walden NRNP 6645 Week 7 Humanistic–Existential Therapy
20 (20%) – 22 (22%)
The response includes a description of humanistic-existential psychotherapy and your selected approach.
18 (18%) – 19 (19%)
The response includes a somewhat vague or inaccurate description of humanistic-existential psychotherapy and your selected approach.
(0%) – 17 (17%)
The response includes a vague and inaccurate description of humanistic-existential psychotherapy and your selected approach, or is missing.
·   Explain at least three differences between humanistic-existential psychotherapy and the approach you selected. ·   Include how these differences might impact your practice as a PMHNP.
23 (23%) – 25 (25%)
The response includes an accurate and clear explanation of three differences between humanistic-existential psychotherapy and your selected approach. The response includes a thoughtful and throrough explanation of how the differences between humanistic-existential psychotherapy and your selected approach might impact your practice as a PMHNP. Walden NRNP 6645 Week 7 Humanistic–Existential Therapy
20 (20%) – 22 (22%)
The response includes an accurate explanation of three differences between humanistic-existential psychotherapy and your selected approach. 

The response includes an explanation of how the differences between humanistic-existential psychotherapy and your selected approach might impact your practice as a PMHNP.

18 (18%) – 19 (19%)
The response includes a somehwat vague or inaccurate explanation of three differences between humanistic-existential psychotherapy and your selected approach. 

The response includes a somewhat vague or inaccurate explanation of how the differences between humanistic-existential psychotherapy and your selected approach might impact your practice as a PMHNP.

(0%) – 17 (17%)
The response includes a vague and inaccurate explanation of three differences between humanistic-existential psychotherapy and your selected approach, or is missing. 

The response includes a vague and inaccurate explanation of how the differences between humanistic-existential psychotherapy and your selected approach might impact your practice as a PMHNP, or is missing.

·   Explain why humanistic-existential psychotherapy was utilized with the client in the video and why it was the treatment of choice. ·   Describe the expected potential outcome if the second approach had been used with the client. ·   Support your response with at least three peer-reviewed, evidence-based sources from the literature. PDFs are attached.
32 (32%) – 35 (35%)
The response includes a thorough and accurate explanation of why humanistic-existential psychotherapy was utilized with the client and why it was the treatment of choice. The response includes a thorough and accurate description of the expected potential outcome had the second approach been used with the client. The response is supported by at least three peer-reviewed, evidence-based sources from the literature that provide strong support for the rationale provided. PDFs are attached.
28 (28%) – 31 (31%)
The response includes an accurate explanation of why humanistic-existential psychotherapy was utilized with the client and why it was the treatment of choice. 

The response includes a description of the expected potential outcome had the second approach been used with the client.

The response is supported by three peer-reviewed, evidence-based sources from the literature that provide appropriate support for the rationale provided. PDFs are attached.

24 (24%) – 27 (27%)
The response includes a somewhat vague or incomplete explanation of why humanistic-existential psychotherapy was utilized with the client and why it was the treatment of choice. 

The response includes a somewhat vague or incomplete description of the expected potential outcome had the second approach been used with the client.

The response is supported by two or three peer-reviewed, evidence-based sources from the literature. Resources selected may provide only weak support for the rationale provided. PDFs may not be attached.

(0%) – 23 (23%)
The response includes a vague and inaccurate explanation of why humanistic-existential psychotherapy was utilized with the client and why it was the treatment of choice, or is missing. 

The response includes a vauge and incomplete description of the expected potential outcome had the second approach been used with the client, or is missing.

The response is supported by vague or inaccurate evidence from the literature, or is missing.

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
(5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineates all required criteria.
(4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 

Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 

Purpose, introduction, and conclusion of the assignment are vague or off topic.

(0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. 

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
(4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 

Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)
Contains 3 or 4 grammar, spelling, and punctuation errors. Walden NRNP 6645 Week 7 Humanistic–Existential Therapy
(0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
(5%) – 5 (5%)
Uses correct APA format with no errors.
(4%) – 4 (4%)
Contains 1 or 2 APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains 3 or 4 APA format errors.
(0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100

Evidence Based Practice Worksheet

Due DateSubmit the completed RRL Worksheet by Sunday, 11:59 p.m. MT at the end of Week 6.PointsThis assignment is worth 200 points.Assignment Directions:1. Read over each of the following directions, the required Reading Research Literature worksheet, and grading rubric.2. Download and complete the required Reading Research Literature (RRL) worksheet (Links to an external site.)Links to an external site..3. Download or access the required article. The required article must be used.O’Connor, M., Tanner, P. , Miller, L.,  Watts, K., & Musiello, T. (2017). Detecting distress: Introducing routine screening in a gynecological cancer setting. Clinical Journal of Oncology Nursing, 21(1), 79-85. Retrieved from  https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx? Links to an external site.(Links to an external site.)Links to an external site.4. You must use the grading rubric to ensure you are meeting all grading criteria of the worksheet.5. You are required to complete the worksheet using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad.6. Use correct grammar, spelling, punctuation, and in-text APA formatting.7. Submit the completed Reading Research Literature Worksheet to the Week 6 Assignment.**Academic Integrity Reminder**College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment. Please see the grading criteria and rubrics on this page.Please see the grading criteria and rubrics on this page.NOTE: Please use your browser’s File setting to save or print this page.ReferencesAmerican Association of Colleges of Nurses (AACN). (2008). Executive summary: The essentials of baccalaureate education for professional nursing practice (2008). Retrieved from http://www.aacnnursing.org/Education-Resources/AACN-EssentialsQuality and Safety Education for Nurses (QSEN). (2018). Quality and safety education for nurses competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/#evidence-based_practice

ACG3357 Rasmussen Accounting CVP and Break-Even Analysis

ACG3357 Rasmussen Accounting CVP and Break-Even Analysis

ACG3357 Rasmussen Accounting CVP and Break-Even Analysis

READ FIRST – This is the second part of a course project. I have attached Module 2 (the first part of the project), as you will need the information in there.)

 

This week you will analyze and classify the costs of your cookie company and evaluate contribution margin.

Review your Project Submission from Module 02 (see the attached powerpoint) where you developed a cost card for your cookie and made a list of potential overhead costs. ACG3357 Rasmussen Accounting CVP and Break-Even Analysis
Create an Excel spreadsheet as outlined below. Be sure that your completed spreadsheet has answers to all the questions below.

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  1. In a table, on the first tab of the spreadsheet, classify your costs as variable, fixed, or mixed. Note: Now that you have a more robust understanding of costs you may need to add some overhead costs to your list. Think about both the ecommerce costs as well as the production facility costs.
  2. On the second tab of your Excel spreadsheet, prepare a high-low analysis of your electric costs using the following data. What is your fixed cost of electricity? What is the variable cost of electricity?
Month Kilowatt Hours Used Electric Costs
January 1866 $230
February 1439 $202
March 1146 $197
April 1046 $190
May 996 $182
June 1760 $225
  1. On the third tab of your spreadsheet prepare a daily contribution margin income statement based on your cost card from Module 01. Note: You must make some realistic assumptions about your fixed costs, sales level, and selling and administrative costs. Be sure to list all your assumptions. What is the contribution margin ratio for your cookie?
  2. On the fourth tab of your spreadsheet, calculate the break-even in number of cookies per day. What is the break-even in sales dollars each day? How many cookies must you sell to earn a daily profit of $100? Does this seem realistic? ACG3357 Rasmussen Accounting CVP and Break-Even Analysis

Pulmonary Function and Electrolytic Imbalance

Pulmonary Function and Electrolytic Imbalance

Discussion 1   Luna

Pulmonary Function and Electrolytic Imbalance

Question 1

According to the case study information, how would you classify the severity of the D.R. asthma attack?

D.R. is experiencing moderate persistent asthma based on the National Asthma Education and Prevention Program (NAEPP). This classification scheme uses a patient’s clinical presentation and lung capacity measured before treatment to estimate the severity of an asthmatic episode. A moderate persistent asthma classification ranks second in severity and requires daily attacks that interfere with daily activities. Patients experience nighttime symptoms more than once a week and the peak flow rate ranges between 60% and 80% of normal readings (Henderson, 2019). Also, medications used previously for asthma attacks may prove ineffective in relieving the symptoms. The patient’s presentation is consistent with these requirements and a moderate persistent classification. Pulmonary Function and Electrolytic Imbalance

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Question 2

Name the most common triggers for asthma in any given patient and specify in your answer which ones you consider applied to D.R. in the case study.

Triggers initiate immuno-response mechanisms in respiratory organs which results in asthmatic episodes. Some common triggers include allergens, respiratory infections, and pharmaceutical compounds. Allergens refer to substances whose inhalation triggers immune responses despite their harmlessness. Some people’s genetic makeup predisposes them to such responses when exposed to dust, smoke, pollen, animals, latex, foods like nuts, and insect stings. Contact with these compounds results in inflammation and asthma attacks whose severity varies with the amount and period of exposure (Henderson, 2019).

Similarly, respiratory infections trigger asthma as well. These infections contribute to disease morbidity and mortality through consistent stimulation of inflammation with disregard for compliance with asthma prescriptions. This stimulation takes the guise of cellular damage resulting from pathogenic invasion of respiratory organs. The body’s immune response targets leukocytes, antibodies, and protective compounds at invaded sites to eliminate exogenous threats. Respiratory organs, which are hypersensitive to such material, react by exhibiting different behaviors including constrictions that hinder normal physiological mechanisms and present asthmatic attacks. Examples of such infections include colds, flu, pneumonia, COVID-19, and tuberculosis (Henderson, 2019).

D.R’s asthma attacks resulted from a secondary respiratory infection. The second condition is evidenced by the presentation of additional symptoms inconsistent with common asthma episodes. Nocturnal cough, chest tightness, and wheezing are the most common presentations since more than 30% of patients report one of the three (Narendra & Hanania, 2018). Tachypnea and reduced peak flow rates are consistent with asthma symptoms. However, some of D.R’s clinical presentations suggest a second condition. Symptoms like watery eyes, congested nose, and post-nasal drainage prevail in the common cold than in asthma. More than half of common cold patients complain of both watery eyes and stuffed noses while less than 5% of asthma patients report similar presentations (Narendra & Hanania, 2018). This prevalence suggests that D.R. is suffering from the common cold as well, which triggers moderate persistent episodes.

Question 3

Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.

Multiple factors attribute to the asthma condition and its development is a product of environmental factors and genetic make-up. Numerous susceptibility genes are responsible for the impaired inflammatory regulation and hyperresponsiveness of respiratory organs. For example, the FCER1B genes responsible for high-affinity immunoglobin receptors, interleukins, and the monocyte-stimulating factor participate in immune response, and their manipulation can cause dysregulation of inflammatory compounds while the ADAM33 gene has a stimulating effect on airway smooth muscles that cause bronchoconstriction during episodes (Henderson, 2019). Activation of such genes by environmental stimuli results in the asthma condition. These genes could run in D.R’s family and are responsible for his condition.

Fluid, Electrolyte, and Acid-Base Homeostasis

Question 1

Based on Ms. Brown’s admission’s laboratory values, could you determine what type of water and electrolyte imbalance she has?

Ms. Brown is experiencing hypertonic dehydration. The condition resulted from reduced hydration despite sustained excretion of water for two days. Diabetes mellitus worsened water loss given its dehydration properties through elevated blood sugar levels (Damanik & Yunir, 2021). Ms. Brown’s high serum glucose, which is four times the normal range, is the most probable cause of dehydration. In addition, Ms. Brown is experiencing metabolic acidosis. The low blood pH indicates increased serum acidity, disqualifying alkalosis as a possible diagnosis. Similarly, low partial pressure of carbon dioxide and low serum bicarbonate concentration eliminates respiratory acidosis as a diagnosis. Hypernatremia, hyperchloremia, and hyperkalemia are effects of the patient’s uncontrolled blood sugar and symptoms of metabolic acidosis.

Question 2

Describe the signs and symptoms of the different types of water imbalance and described the clinical manifestation she might exhibit with the potassium level she has.

Several symptoms accompany water imbalance including constipation, general malaise, and lethargy. Urination frequency and amount reduce and urine adopts a strong smell and a dark yellow coloration. Patients may experience dry mouth and eyes. Ms. Brown may present additional symptoms given her elevated potassium levels, including diarrhea, chest pain, and arrhythmia. Her muscles may feel weak and numb. If persistent, hyperkalemia can cause vomiting, nausea, and confusion (Damanik & Yunir, 2021).

Question 3

In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?

Ms. Brown requires several interventions and one of them is diabetic therapy. The patient’s blood glucose is at 412 mg/dL, which is above the normal 100 mg/dL threshold indicating impaired homeostatic mechanisms of glucose (Kong et al., 2019). Given a previous diabetes diagnosis, a glucose control intervention is the most appropriate involving administration of insulin. Biguanides and Sulfonylureas pharmaceuticals are also applicable in leveling serum glucose. In addition, the patient requires rehydration treatment to address dehydration evidenced by the hypernatremia presentations. This intervention involves the intravenous infusion of 20 to 30 mL/kg of Ringer’s lactate solution in the first 2 hours and adjusting this rate with patient outcomes. Administration of oral rehydration solution is an option if the patient’s capacity for ingestion is unaltered as determined by a physician through a physical evaluation. These steps will improve the patient’s health.

Question 4

What do the ABGs from Ms. Brown indicate regarding her acid-base imbalance?

Arterial blood gases reveal the nature of an acid-base imbalance. Ms. Brown’s readings indicate metabolic acidosis because her arterial pH is 7.3 which is below the normal minimum of 7.35 (Gooch, 2019). A pH reading above 7.45 would imply an alkalosis. Low pH and low partial pressure of carbon dioxide eliminate respiratory factors as a cause of Ms. Brown’s condition. Respiratory causes would have elevated carbon dioxide, serum bicarbonate, and a basic pH. The metabolic cause is confirmed by her low bicarbonate levels.

Question 5

Based on your readings and your research define and describe Anion Gaps and their clinical significance.

Anion gap refers to the difference in charge between positively and negatively charged ions (Heireman et al., 2018). Salts dissociate into ions when they dissolve into electrolyte solutions like serum and extracellular fluid. Depending on the solutes, the solution can contain more cations than anions. Examples of positively charged ions include hydrogen ions, potassium, and sodium ions. Bicarbonate ions are the most common anions in serum. If every cation is matched to an anion, any remnant ions constitute the anion gap. Normal anion gap ranges between 10 and 13 mEq/L and deviations from this range indicate electrolytic derangements (Heireman et al., 2018). Ms. Brown’s anion gap, which sums up to 25 mEq/L suggests an acidosis. A low anion gap below 10 mEq/L would have indicated a deficiency of hydrogen ions. Such insights provide additional information for the diagnosis and correction of acid-base irregularities

 

References

Damanik, J., & Yunir, E. (2021). Type 2 Diabetes Mellitus and Cognitive Impairment. Acta Medica Indonesiana, 53(2).

Gooch, M. D. (2019). Acid–Base Imbalances. In A Guide to Mastery in Clinical Nursing. https://doi.org/10.1891/9780826150325.0003

Heireman, L., Mahieu, B., Helbert, M., Uyttenbroeck, W., Stroobants, J., & Piqueur, M. (2018). High anion gap metabolic acidosis induced by cumulation of ketones, L- and D-lactate, 5-oxoproline and acute renal failure. Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine, 73(4). https://doi.org/10.1080/17843286.2017.1358504

 

 

Discussion 2 Brito

 

Pulmonary Function

                                                                 Classification of severity of D.R. asthma attack

Because J.D is having symptoms daily for the past 3 days including nights and his peak flow rate has been between 60-80% I would classify his asthma as moderate persistent.

                                              Clinical manifestation of asthma and which ones apply to D.R.

Some of the most common manifestation of asthma include wheezing, dyspnea, chest tightness, cough, anxiety, tachypnea, and tachycardia.  Some triggers of asthma vary in age.  For example, asthma during childhood is triggered by atopy which is a genetic tendency to develop allergic diseases like rhinitis and eczema.  This means that the immune response is heightened to common allergens and food allergies (American Academy of Allergy, Asthma and Immunology, 2022).  The cause in adults varies atopy is more common in those with mild to moderate disease; if they have severe disease atopy is not the cause.  Individuals that have high eosinophil (where production of IGE responds to allergens but does not mean these people have allergies) levels (Dlugasch, 2020).  I have come to believe that D.R. might be experiencing a nocturnal trigger which can be related to the circadian rhythm.  To explain:  cortisol levels and epinephrine decrease, and histamine levels increase; these changes cause bronchoconstriction.

                                             Factors that might be the etiology of D.R. being an asthmatic patient.

Because the case study did not provide any medical history of the patient and the only medication we know he is on is an albuterol inhaler there are many factors why the patient is an asthmatic and these include: having a blood relative with asthma (parent or sibling), having atopic dermatitis, obesity, smoking or exposure, exposure to pollution and exposure to occupational triggers (Mayo Clinic, 2022).

 

Fluid, Electrolyte and Acid-Base Homeostasis

 

                                        What type of water and electrolyte imbalance does Ms. Brown have?

Ms. Brown seems to have excessive sodium, this can happen if her dietary intake is high in sodium products such as processed foods, canned foods, corticosteroid disorder or near drowning in salt water.  Her electrolyte imbalance include: sodium – normal range is 135-145 mEq/L and her level is currently 156 mEq/L.  Serum potassium – normal range is 3.5-5 mEq/L and her level is 5.6 mEq/L and serum chloride – normal range is 98-108 mEq/L and her level is 115 mEq/L.

                                                 Clinical Manifestations of water imbalance and hyperkalemia

Ms. Brown is experiencing hypernatremia which is high serum sodium levels.  Patient might be experiencing some type of water loss which can occur with extra-renal conditions such as gastroenteritis, vomiting, prolong nasogastric drainage, burns and excessive sweating (National Center for Biotechnical Information, 2022).  People may experience dehydration, thirst, fatigue, irritability, restlessness, altered mental status, dry mouth, tachycardia, headache, lethargy, and decreased urine output.

                                                                     Clinical Manifestations of hyperkalemia

            Hyperkalemia can affect severe body systems in which potassium plays key functions like the nervous system, cardiac, respiratory, and GI.  Hyperkalemia makes things excitable.  In the neuromuscular system it causes paresthesia, muscle craps, weakness, fatigue, hyperreflexia, and anxiety.  In the Cardiovascular system it causes EKG changes and dysrhythmias.  In the respiratory system it causes diaphragm weakness and in the GI system it causes nausea and vomiting, diarrhea, and cramping (Dlugasch, 2020).

What does the ABG from Ms. Brown Indicate?

Her ABG indicates that she is in Metabolic Acidosis hence, they symptoms the patient is presenting with.  In metabolic acidosis toxins from the body build up along with kidney failure and ingestion of certain drugs or toxins, such as methanol or large doses of aspirin.

References

Dlugasch, L. (2020). Applied Pathophysiology. In Applied Pathophysiology for the Advanced Practice Nurse (p. 97).

Mayo Clinic. (2022, 5 21). Retrieved from https://mayoclinic.org