Journal discussion

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Journal discussion

Moral resilience has been defined as “the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks” (Rushton, 2016a, p. 112a). Moral resilience is an evolving concept and other definitions have focused on “the ability and willingness to speak and take right and good action in the face of an adversity that is moral/ethical in nature” (Lachman, 2016, p. 122).

I would like to believe that nurses have innate and learned capacities that can be used to combat the negative of forces of moral distress, burnout, compassion fatigue, and incivility that plagues our nursing profession.

As a result of this one course in Ethics, you have been given some tools to develop critical thinking skills, use ethical decision making models to strengthen and clarify your values. I believe all of you will need to be on an intentional journey to use and leverage these skills to keep your nursing practice resilient and meaningful.

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How do you see yourself cultivating moral resilience within yourself, with your colleagues and the organizations where you will work? What specific interventions can you envision for yourself as you continue your journey in the socialization of becoming a nurse? What contributions do you intend to create to make meaningful and sustainable change in your role as a nurse?

300 words, APA, reference- one professional journal- not older than 5 years

 

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population affected by disabilities

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population affected by disabilities

Chapter 21 Populations Affected by Disabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Most people whose lives do not end abruptly will experience disability. – Nies & McEwen (2015) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Doing a Self-

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Assessment      What comes to mind when you think of someone with a disability? Picture yourself as a person with a disability. Imagine yourself as a nurse with a visible disability, or a client receiving care from a nurse with a disability. Think about living in a family affected by disability. What is the experience of living with disability within your community? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Definitions for Disability Disability is the interaction between individuals with a health condition and personal and environmental factors. – World Health Organization, 2012 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 WHO International Classification of Functioning, Disability, and Health    Disability is an umbrella term covering impairments, activity limitations, and participation restrictions (individual level). An impairment is a problem in body function or structure—activity limitation or participation restriction (micro level). A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role (macro level). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Table 21-1 Characteristic Definition Measurability Illustrations Level of analysis Impairment Disability Physical deviation from May be objective and measurable normal structure, function, physical organization, or development Objective and measurable May be objective and measurable Micro level (e.g., body organ) Individual level (e.g., person) Handicap Not objective or measurable; is an experience related to the responses of others Not objective or measurable; is an experience related to the responses of others Spina bifida, spinal Cannot walk Reflects physical and cord injury, amputation, unassisted; uses psychological and detached retina crutches and/or a characteristics of the manual or power person, culture, and wheelchair; blindness specific circumstances Macro level (e.g., societal) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 National Agenda for Prevention of Disabilities (NAPD) Model Figure 21-1 Reprinted with permission from Pope AM, Tarlov AR, editors: Disability in America: toward a national agenda for prevention, Washington, DC, 1991, Institute of Medicine, National Academy Press. Copyright © 1991 by the National Academy of Sciences. Courtesy National Academy Press, Washington, DC. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Quality of Life Issues       Transportation to a needed service Cost of care Appointment challenges Language barriers Financial issues Migrant/noninsured issues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Models for Disability 1. Medical model—a defect in need of cure through medical intervention 2. Rehabilitation model—a defect to be treated by a rehabilitation professional 3. Moral model—connected with sin and shame 4. Disability model—socially constructed Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Disability: A Socially Constructed Issue   Disability is a complex, multifaceted, culturally rich concept that cannot be readily defined, explained, or measured (Mont, 2007). Whether the inability to perform a certain function is seen as disabling depends on socio-environmental barriers (e.g., attitudinal, architectural, sensory, cognitive, and economic), inadequate support services, and other factors (Kaplan, 2009). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 “Medicalization” Issues  Nurse needs to differentiate … ➢ A person who has an illness and becomes disabled secondary to the illness versus … ➢ A person who has a disability, but may not need treatment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 “Medicalization” Issues (Cont.)  Nurse’s interaction with PWD and families ➢ Approach on an eye-to-eye level ➢ Listen to understand ➢ Collaborate with the person/family ➢ Make plans and goals that meet the other’s needs and draw on strengths and improve weaknesses ➢ Empower and affirm the worth and knowledge of the person/family with a disability ➢ Promote self-determination and allow choices Note: PWD = persons with disabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Historical Perspectives       Long history of institutionalization/segregation Often viewed as sick and helpless In the 20th century, special interest groups emerged to advocate for PWD (e.g., ARC) Tragedies include Hitler’s euthanasia program Deinstitutionalization began in 1960s-1970s Stereotypical images still common in literature and media; these images influence prevailing perceptions of disability Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Historical Context for Disability  Early attitudes toward PWD ➢ Set apart from others ➢ Viewed as different or unusual ➢ Documented in carvings and writings ➢ Infanticide or left to die (not in Jewish culture) ➢ Viewed as unclean and/or sinful ➢ Served as entertainers, circus performers, and sideshow exhibitions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Historical Context  18th and 19th century attitudes ➢ No scientific model for understanding and treating ➢ Disability seen as an irreparable condition caused by supernatural agency ➢ Viewed as sick and helpless ➢ Expected to participate in whatever treatment was deemed necessary to cure or perform  Industrial Revolution stimulated a societal need for increased education ➢ ➢ If not third-grade level = feeble-minded Special schools established in early 1800s Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Historical Context (Cont.)  20th century attitudes ➢ ➢ ➢ ➢ ➢ Special interest groups were formed First federal vocational rehabilitation legislation passed in early 1920s Involuntary sterilization of many with intellectual disabilities ARC (Association for Retarded Children) began to advocate for children with intellectual disabilities—today is Association for Retarded Citizens ARC is “world’s largest community-based organization of and for people with intellectual and developmental disabilities” (ARC, 2009) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Historical Context (Cont.)  20th century attitudes ➢ One of the most horrendous tragedies under Hitler’s euthanasia or “good death” program • Killed at least 5000 mentally and physically disabled children by starvation or lethal overdoses • Killed 70,274 adults with disabilities by 1941 • Over 200,000 people exterminated because they were “unworthy of life” ➢ Deinstitutionalization movement in 1960s and 1970s • Community-based Independent Living Centers established Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Historical Context (Cont.)  Contemporary conceptualization ➢ Stereotypical images remain common in literature and media • Population portrayed as a burden to society or from pity/pathos or heroic “supercrip” perspectives • “just as the paralytic cannot clear his mind of his impairment, society will not let him forget it.” (Murphy, 1990, p. 106) ➢ Societal stigma still exists • Teasing or bullying often occurs in schools • Rehabilitation Act of 1973 and American with Disabilities Act of 1990 prohibit “disability harassment” Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Characteristics of Disability  Americans with Disabilities Act (ADA) of 1990 and Rehabilitation Act of 1973 defined disability according to limitations in a person’s ability to carry out a major life activity. ➢  Major life activities: ability to breathe, walk, see, hear, speak, work, care for oneself, perform manual tasks, and learn U.S. Census Bureau (2006) defines disability as long-lasting physical, mental, or emotional condition that creates a limitation or inability to function according to certain criteria. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Examples of Disabilities        Physical disabilities Sensory disabilities Intellectual disabilities Serious emotional disturbances Learning disabilities Significant chemical and environmental sensitivities Health problems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Measurement of Disability  Survey of Income and Program Participation (SIPP) ➢ Functional activities ➢ Activities of daily living (ADLs) ➢ Instrumental activities of daily living (IADLs)  American Community Survey (ACS) ➢  Surveys for disability limitation in six areas that affect function or activity (sensory, physical, mental/emotional, self-care, ability to go outside the home, employment) Other organizations also collect disability data Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Prevalence of Disability     In 2010, approximately 18.7% of civilian noninstitutional population aged 5 years and older had a long-lasting condition or disability. Of those with a disability, 12.6% had a “severe” disability. Prevalence varies by race, age, and gender. It is important for health care policymakers and health care providers to recognize that the prevalence of disability is increasing. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Prevalence of Disability in Children  Approximately 15.2% of households with children have at least one child with a special health care need (disabling condition). – National Survey of Children with Special Health Care Needs (2009/2010)  A disability is defined by a communication-related difficulty, mental or emotional condition, difficulty with regular schoolwork, difficulty getting along with other children, difficulty walking or running, use of some assistive device, and/or difficulty with ADLs Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Recommendation for the Nurse  Listen to parental concerns ➢ ➢ ➢  “Something is not right” Establishes an important bond with parents Nurse can serve as an intermediary Regularly assess for key developmental milestones ➢ Compare with predicted values ➢ Work with team of resource providers on IEP  Be cognizant of disability within the context of culture and aging Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Legislation Affecting People with Disabilities  Individuals with Disabilities Education Act (IDEA) (1975); reauthorized in 1997, 2004 ➢ ➢ Ensured a free appropriate public education (FAPE) in the least-restrictive setting to children with disabilities based on their needs Parents, students, and professionals join together to develop an Individualized Education Program (IEP), including measurable special educational goals and related services for the child. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Americans with Disabilities Act of 1990 and ADA Amendments Act of 2008  ADA: Landmark civil rights legislation that prohibits discrimination toward people with disabilities in everyday activities ➢ ➢ Guarantees equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications Provides protections to people with disabilities similar to those provided to any person on basis of race, color, sex, national origin, age, and religion Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Americans with Disabilities Act of 1990 and ADA Amendments Act of 2008 (Cont.)  ADA (Cont.) ➢ ➢ Refers to a “qualified individual” with a disability as a person with a physical or mental impairment that substantially limits one or more major life activities or bodily functions, a person with a record of such an impairment, or a person who is regarded as having such an impairment. Qualifying organizations must provide reasonable accommodations unless they can demonstrate that the accommodation will cause significant difficulty or expense, producing an undue hardship. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Ticket to Work and Work Incentives Improvement Act (TWWIIA)    Increases access to vocational services; provides new methods for retaining health insurance after returning to work Increases available choices when obtaining employment services, vocational rehabilitation services, and other support services needed to get or keep a job Became law in 1999, amended in 2008 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Public Assistance Programs  Cash assistance ➢ ➢    Supplemental Security Income—SSI Social Security Disability Insurance—SSDI Food stamps Public/subsidized housing Costs associated with disability ➢ Gaps in employment, income, education, access to transportation, attendance at religious services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Health Disparities in Quality and Access  Disparities are caused by … ➢ Differences in access to care ➢ Provider biases ➢ Poor provider-patient communication ➢ Poor health literacy  Persons with disabilities experience … ➢ ➢  Higher rates of chronic illness Increased risks for medical, physical, social, emotional, and/or spiritual secondary issues People with intellectual disabilities are ➢ Undervalued and disadvantaged Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Systems of Support for People With Disabilities Figure 21-2 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 The Experience of Disability   PWD may be largest minority group in the United States Different experiences, depending on … ➢ ➢ ➢  Temporary disability Permanent disability from accident or disease Disability from progressive decline of a chronic illness Benchmark event is acceptance of the label of “disabled” Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Children With Disabilities (CWD)  Family and caregiver responses ➢ ➢  Redefine image and expectations for child and self Sibling response influenced by age, coping, peer relationships, parents, impact on family Levels of parental adjustment ➢ ➢ ➢ ➢ The ostrich phase Special designation Normalization Self-actualization Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Family Research Outcomes      Established various benefits, amid challenges Families with satisfying emotional support experience fewer potentially negative effects of unplanned or distressing events. Parents may grieve the loss of idealized or expected child over time. Supportive relationship is needed. Empowerment and enabling decision making on behalf of CWD is important. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Knowledgeable Client  A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body. Knowledgeable Nurse  The nurse who has information about the disability and the available community and governmental resources. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Strategies for the CH Nurse       Do not assume anything. Adopt the client’s perspective. Listen to and learn from client. Gather data from the perspective of the client and family. Care for the client and family, not for the disability. Be well informed about community resources. Become a powerful advocate. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Dealing With Ethical Issues     Spiritual perspectives Quality of life (QOL) and justice perspectives Proper use of scientific advances Self-determination, deinstitutionalization, and disability rights Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 37 When the Nurse Has a Disability    Education programs and employers must provide reasonable accommodations for qualified students and nurses. Technical aspects of nursing tend to discriminate; nursing should emphasize “humanistic” capacities. Type of setting influences functionability. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 38 Nurses Can … … become familiar with a variety of ethical frameworks for decision making. … help the patient and family access needed information to make informed decisions. … help educate the public on health care issues. … participate in the development of institutional policies and procedures related to disability. … take a position on an ethical issue. … work to influence government policies and laws. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 39 Chapter 23 Rural and Migrant Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Rural Populations    The largest rural population in history of United States is now. 75% of counties are classified as rural; they contain only 20% of the U.S. population Number/size of rural counties are highest … ➢ ➢ ➢  in the South (35%) in the Midwest and West (23%) in the Northeast (19%) Census data ➢ ➢ ➢ 20% of nation’s children under 18 15% of nation’s elderly More than 50% of nation’s poor Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Rural Populations (Cont.)  Economic base is shifting ➢ ➢ ➢ Agriculture is the “food and fiber system” All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included Poverty in rural areas greater than in urban areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Rural Populations (Cont.)     Poverty continues to be greater in rural America than in urban areas. Aging-in-place, out-migration of young adults, and immigration of older persons from metro areas. Greater diversity among residents: a country of immigrants historically and today. Health disparities exist—rural population more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Health Disparities Among Rural Americans       Only 10% of U.S. physicians practice in rural areas Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings) More often assess their health as fair or poor More disability days resulting from acute conditions More negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates Higher number of unintentional injuries Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Defining Rural Populations  Population size ➢  Rural = towns with population of less than 2500 or in open country [farm/nonfarm] Density ➢ ➢ Rural = fewer than 45 persons per square mile Frontier = less than 6 people per square mile Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Defining Rural Populations (Cont.)  The Rural-Urban Continuum uses population and adjacency to metropolitan areas ➢ Core Based Statistical Areas (CBSAs) • Metropolitan areas = county with at least one urbanized area of 50,000 or more people • Micropolitan area = area contains a cluster of 10,000 to 50,000 persons • Outside CBSAs = noncare areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Describing Rural Health and Populations   Differ in complex geographical, social, and economic areas Disparities include key indicators of health: ➢ Employment ➢ Income ➢ Education ➢ Health insurance ➢ Mortality ➢ Morbidity ➢ Access to care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Rural Health Disparities: Context and Composition  Context: characteristics of places of residence ➢  Geography, environment, political, social, and economic institutions Composition: collective health effects that result from a concentration of persons with certain characteristics ➢ Age, education, income, ethnicity, and health behaviors – Braveman (2010) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Context: Health Disparities Related to Place  A downward spiral may exist: ➢ people leave → services are lost → tax base becomes insufficient → fewer services are provided → long distances to get health care → jobs become scarce and more people leave → the cycle continues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Context: Health Disparities Related to Place (Cont.)     Access to health care (#1 priority) Fewer primary care physicians General health services lacking Health insurance coverage … ➢ Varies according to race and ethnicity; age and residence (rural or urban) ➢ Influences health patterns ➢ May create financial barriers to health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Composition: Health Disparities Related to Persons  Income and Poverty ➢ ➢ ➢ ➢ ➢ One of the most important indicators of the health and wellbeing of all Americans, regardless of where they live. Regional differences—highest in the South Racial and ethnic minorities—rates among rural racial minorities two to three times higher than for rural whites Family composition—female-headed families have highest rates Children—among the poorest citizens in rural America Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Composition: Health Disparities Related to Persons (Cont.)  Health risk, injury, and death ➢  Risk factors ➢    Higher rates of obesity, smoking, sedentary lifestyles, alcohol use, firearms usage, suicide, vehicular accidents; lower rates of seat belt use Age, education, gender, race, ethnicity, language, and culture Education and employment Occupational health risks Perceptions of health (gender, race, ethnicity) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Agricultural Workers  Accidents and injuries caused by: ➢ Environmental conditions ➢ Geographic isolation and working alone ➢ Use of agricultural machinery ➢ Delayed access to emergency or trauma care  Acute and chronic illnesses: ➢ Musculoskeletal discomfort, acute and chronic respiratory conditions, hearing loss, hypertension ➢ Chemical exposure (pesticides, herbicides, etc.) ➢ Secondary conditions related to demanding farm work Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Migrant and Seasonal Farm Workers (MSFW)  Health Disparities ➢ ➢  Poorest health and the least access Low income and migratory status Cultural, linguistic, economic, and mobility barriers ➢ ➢ Minimal or no preventive care • Mobile clinic sites form a central link to health services Migrant Health Program (MHP) bases services on enumeration of MSFW • Migrant and Seasonal Farm Worker Enumeration Profile Study (MSFWEPS) (2000) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 “Thinking Upstream” Concepts applied to Rural Health    Attack community-based problems at their roots Emphasize the “doing” aspects of health Maximize the use of informal networks Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Rural Health Care Delivery System  Health care provider shortages ➢ ➢ ➢ Rural shortages likely to become worse Need to “grow their own” Telemedicine • Cost-effective alternative to face-to-face care • Telehealth includes telephones, fax machines, email, and remote monitoring • Telemedicine permits two-way, real-time, interactive communication between patient and provider Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Rural Health Care Delivery System (Cont.)  Managed care in the rural environment ➢ ➢ Possible benefits: • Potential to lower primary care costs • Improve the quality of care • Help stabilize the local rural health care system Risks • Probable high start-up and administrative costs • Volatile effect of large, urban-based, for-profit managed care companies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Community-Based Care  A myriad of services provided outside the walls of an institution ➢    Home health and hospice care, occupation health programs, community mental health programs, ambulatory care services, school health programs, faith-based care, elder services (adult day care) Community participation in decisions about health care services Focus on all three levels of prevention An understanding that the hospital is no longer the exclusive health care provider Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Home Care and Hospice  Nurse case management and development of local resources ➢ ➢ ➢ ➢ Often hospital based in rural areas Use county extension services as a bridge for outreach services Improve home care for these patients and provide support for their families A partnership between the public health nurse and county extension service could provide support, as well as information groups and caregiving classes, for the important informal provider network. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Faith Communities and Parish Nursing     A strong sense of community, family life, and religious faith Integrating nursing expertise and faith-based knowledge to provide holistic care to members of congregations Involved in case management and coordination of services Collaboration with other organizations to extend limited rural community health resources Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Informal Care Systems     Evolve from self-reliance and self-help traits of rural residents Include people who have assumed the role of caregiver based on their individual qualities, life situations, or social roles Provide direct help, advice, or information Need to identify and combine informal services with formal systems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Rural Public Health Departments Public health nurses are often the core providers of public health services in rural areas. ➢ ➢ Collaboration of services is key—need to develop partnerships with other heath provider agencies. Environmental health, maternal and child health, and communicable disease control are the three highestpriority programs. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Rural Mental Health Care    Lack of specialized mental health providers in rural areas. Most services provided by primary care providers without adequate preparation or support. Perceived stigma prevents individuals from seeking mental health services. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Emergency Services Getting patients from the place of injury to the trauma center within the “golden hour” is frequently not possible because of distance, terrain, climatic conditions, and communication methods. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Emergency Services (Cont.)  Challenges faced by rural EMS systems ➢ ➢ ➢ ➢ ➢ Shortage of volunteers and lower levels of training Training curricula that often do not reflect rural hazards (e.g., farm equipment trauma) Lack of guidance from physicians Lack of physician training and orientation to EMS Also contributing to difficult public access for emergency care: • Low population density • Large, isolated, or inaccessible areas • Sever weather • Poor roads • Lower density of telephone/communication methods Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Emergency Preparedness in Rural Communities  Challenges in rural areas: ➢ ➢ ➢ ➢ Resource limitation • Human, financial, and social capital Separation and remoteness • Longer response times Low population density • Impacts funding Communication • Warning systems often absent or neglected in remote areas; burden on individuals Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Legislation and Programs Affecting Rural Public Health  Programs that augment health care facilities and services ➢ ➢ ➢ ➢ Community Health Centers (CHC) program Migrant Health Clinic (MHC) program and the Migrant Health Program (MHP) Medicare’s Rural Hospital Flexibility (RHF) grant program Primary care cooperative agreements Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Rural Community Health Nursing “CH nursing along the rural continuum” Nonmetropolitan Areas Metropolitan Areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Rural Nursing … … is the practice of professional nursing within the physical and sociocultural context of sparsely populated communities. It involves the continual interaction of the rural environment, the nurse, and his or her practice. Rural nursing is the diagnosis and treatment of a diversified population of people of all ages and a variety of human responses to actual (or potential) occupational hazards or actual or potential health problems existent in maternity, pediatric, medical/surgical and emergency nursing in a given rural area. –– Bigbee (1993), Lee & Winters (2004), Rosentahl (2005), Williams et al. (2012) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Characteristics of Rural Nursing Should rural nursing practice be designated as a specialty or subspecialty area because of factors such as isolation, scarce resources, and the need for a wide range of practice skills that must be adapted to social and economic structures? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Characteristics of Rural Nursing (Cont.)  Positive aspects ➢ ➢ ➢ ➢ ➢ ➢  Ability to provide holistic care Know everyone well Develop close relationships with the community and with coworkers Enjoy rural lifestyle Autonomy and professional status Being valued by the agency and community Negative aspects ➢ Professional isolation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 The newcomer practices nursing in a rural setting, unlike the more experienced nurse, who practices rural nursing. Somewhere between these extremes lies the transitional period of events and conditions through which each nurse passes at her or his own pace. It is within this time zone that nurses experience rural reality and move toward becoming professionals who understand that having gone rural, they are not less than they were, but rather, they are more than they expected to be. Some may be conscious of the transition, and others may not, but in the end, a few will say, “I am a rural nurse.” – Scharff (1998, p. 38) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Rural Health Research  Research agendas must address: ➢ The capacity of rural public health to manage improvements in health ➢ Information technology capacity in rural communities ➢ Developing and monitoring performance standards in rural public health ➢ Developing leadership and public health workforce capacity within rural public health ➢ Interaction and integration of community health systems, managed care, and public health in rural America – Berkowitz, Ivory, & Morris (2002) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Capacity of Rural Public Health to Manage Improvements in Health   Healthy People 2020 objectives and intervention strategies Information Technology in Rural Communities ➢ ➢ ➢ ➢ EHR and reimbursement Preparedness strengthens infrastructure Continuing education and advanced education Telehealth impact on public health • Skills via distance learning? • Costs and infrastructure of IT? • Gaps in epidemiology and surveillance capacity? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Performance Standards in Rural Public Health   National Public Health Performance Standards Program (NPHPSP) describe an optimal level of performance by public health systems regardless of location. Used to improve collaborations among key public health partners, educate participants about public health, strengthen the network of public health partners, identify strengths and weaknesses, and provide benchmarks for public health practice improvements Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Leadership and Workforce Capacity for Rural Public Health     IOM report (2003)—preparing public health workforce for 21st century CDC Public Health Improvement Initiative (2012)—accreditation support Medicaid impact on interaction and integration of community health systems, managed care, and public health New models of health care delivery for rural and frontier areas being tested Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 37
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nursing role and scope

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nursing role and scope

After reading Chapter 8 and reviewing the lecture power point (located in lectures tab), please answer the following questions. Each question must have at least 3 paragraphs and you must use at 3 least references (APA) included in your post.

Additionally, you are expected to reply to two other students and include a reference that justifies your post. Your reply must be at least 3 paragraphs.

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1. Describe a clinical experience that was troubling to you. Describe what bothered you about the experience and what could have you done differently utilizing critical thinking.

2. Describe how patients, families, individual clinicians, health care teams, and systems can contribute to promoting safety and reducing errors.

3. Describe factors that create a culture of safety.

This is due next Sunday, June 23rd at 11:59 pm.

Population affected by disabilities. Rural and migrant health.

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Population affected by disabilities. Rural and migrant health.

1. Define and discuss in your own words the definitions and models for disability.

2. Discuss the difference between illness and disability.

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3. Compare and contrast the characteristics of rural and urban communities.

4. Discuss the impact of structural and personal barriers on the health of rural aggregates.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font , in Turnitin to verify originality. A minimum of 2 evidence-based references besides the class textbook must be used. make sure that the references that you use in your assignment are properly quoted in it. A minimum of 700 words is required.

 

Tags: nursing college community health nursing other

Clinicians & Health Care Teams Contribution to Promoting Safety Questions

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Clinicians & Health Care Teams Contribution to Promoting Safety Questions

1. Describe a clinical experience that was troubling to you. Describe what bothered you about the experience and what could have you done differently utilizing critical thinking.

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2. Describe how patients, families, individual clinicians, health care teams, and systems can contribute to promoting safety and reducing errors.

3. Describe factors that create a culture of safety.

NUR3846 FNU Population Affected by Disabilities Discussion

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NUR3846 FNU Population Affected by Disabilities Discussion

Population affected by disabilities.

Rural and migrant health.

Read chapter 21 and 23 of the class textbook and review the attached PowerPoint presentations. Once done, answer the following questions.

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1. Define and discuss in your own words the definitions and models for disability.

2. Discuss the difference between illness and disability.

3. Compare and contrast the characteristics of rural and urban communities.

4. Discuss the impact of structural and personal barriers on the health of rural aggregates.

Present your assignment in an APA format word document, Arial 12 font. A minimum of 2 evidence-based references besides the class textbook must be used. A minimum of 700 words is required

research paper outline

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research paper outline

Miami Dade College Benjamín León School of Nursing RN-BSN Program NUR4945C Advanced Concepts Practicum Jane Doe Research Project Outline Title: Promoting a Clean Nursing Environment at HealthSouth Rehabilitation Hospital of Miami. Problem Statement: Hospital-acquired infections cost thousands of dollars each year. The CDC reports that there were an estimated 722,000 HAIs in U.S acute care hospitals in 2011. Numerous researches have demonstrated that a clean nursing environment promotes a safe healing process for patients. In addition, it will be beneficial for healthcare providers. A clean nursing environment will lead to a hospital setting free from hospital-acquired infections. Sections must have proper citations Goal statements: 1. HSRHM will decrease the number of hospital-acquired infections during 2017. 2. Healthcare personnel will consistently maintain a clean nursing

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environment. Behavioral Objectives: By the end of the presentation: 1. Healthcare personnel will identify the benefits of maintaining a safe clean nursing environment. 2. Healthcare personnel will validate the need for washing hands before and after every patient encounter. 3. Healthcare personnel will implement efficient and effective cleaning procedures to maintain a clean and healthy nursing environment. Teaching strategies: research and prepare a power point presentation about the importance of maintaining a clean nursing environment for patients and healthcare providers. Evaluation tools: 1. Healthcare personnel will verbalize understanding of the benefits of maintaining a clean nursing environment. 2. Healthcare personnel will demonstrate a proper hand washing technique. Implications for Nursing Practice: Several nurse scholars, including Florence Nightingale, have talked about the impact of the environment on human health and the healing process. Hospitals are places where pathogenic microorganisms exist, and therefore, patients are exposed to those pathogens while being treated for another illness or injury. In the same way, healthcare staff is exposed to those infections. The importance of a hygienic environment has been a basis of nursing care since the nineteenth century, and it is as important today as it was back them (Spruce, 2014). There are ways to achieve compliance with recommendations about reducing HAIs within hospitals. Numerous researches have been done regarding importance of maintaining a cleaning environment in hospitals and guidelines and policies exist that should be followed by healthcare team members to help ensure success. Education of patients and caregivers regarding infection control is also recommended. References Allen, G. (2014). Implementing AORN Recommended Practices for Environmental Cleaning. AORN Journal, 99(5), 570-582. doi:10.1016/j.aorn.2014.01.023 Centers for Disease Control and Prevention. (2016). Hand washing: Clean Hands Save Lives. Retrieved from http://www.cdc.gov/handwashing/ Florida health. (2016) Hand Washing. Retrieved from http://www.floridahealth.gov/programs-and-services/childrenshealth/school-health/hand-washing.html Jacobsen, K. (2014). Introduction to Global Health 2nd edition. Jones & Bartlett Learning LLC. Mayo Clinic. (2016). Hand washing: do’s and don’ts. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/handwashing/art-20046253 Ramphal, L., Sumhiro, S., McCracken, I. M., & Addai, A. (2014). Improving hospital staff compliance with environmental cleaning behavior. Baylor University Medical Center Proceedings, 27(2), 88-91. Spruce, L. (2014). Back to Basics: Surgical Attire and Cleanliness. AORN Journal, 99(1), 138-146. doi:10.1016/j.aorn.2013.10.013 Williams, L., Burton, C., & Rycroft-Malone, J. (2013). What works: a realist evaluation case study of intermediaries in infection control practice. Journal of Advanced Nursing, 69(4), 915-926. doi:10.1111/j.1365-2648.2012.06084.x World Health Organization. (2016). Clean Care is Safer Care. Retrieved from http://www.who.int/gpsc/5may/en/
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Capella University Formaldehyde Environmental Toxins Paper

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Capella University Formaldehyde Environmental Toxins Paper

Write a 3–4-page analysis on the impact of a selected toxin on human health.

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

  • Competency 2: Analyze the impact of contaminants in the environment to human health.
    • Analyze the impact of a toxic substance on human health.
    • Analyze possible sources of exposure to a toxic substance.
    • Analyze what happens when a toxin enters the environment.
    • Analyze the persistency of a specific toxic substance.
    • Analyze government recommendations for a specific toxic substance.

  • Context

    Toxins are substances that can harm a living organism. When air, water, or soil is contaminated by toxins, it can lead to serious health problems. The Assessment 2 Context document provides a brief overview of topics related to toxicity. You may wish to review this document for key concepts and ideas related to this assessment

  • Questions to Consider

    To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

    • What is the role of an environmental health professional?
    • How do professionals define risks associated with environmental toxins?
    • What is an example of one technique people use to detoxify the body? Have you, or would you, use such a technique?
    • How has the federal government made recommendations to protect human health?
    • What is the role of the Consumer Product Safety Commission regarding product safety?
    • What is the role of OSHA regarding workplace safety?
    • Is your own workplace proactive when it comes to hazards?
    • In what ways are you, or could you, become proactive in reducing your own occupational hazards?
    • What are some ways occupational physical, biological, or chemical hazards could be decreased?
    • What are the perceived risks of nanotechnology?
    • How do the views of upstream scientists differ from downstream scientists, with respect to new technology like nanotechnology?
    • What are the differences in scientific approaches to risk assessment?

  • Resources

    SUGGESTED RESOURCES

    The following optional resources are provided to support you in completing the assessment or to provide a helpful context. For additional resources, refer to the Research Resources and Supplemental Resources in the left navigation menu of your courseroom.

    Internet Resources

    Access the following resources by clicking the links provided. Please note that URLs change frequently. Permissions for the following links have been either granted or deemed appropriate for educational use at the time of course publication.

    • CDC. (2014). Agency for toxic substances and disease registry. Retrieved from http://www.atsdr.cdc.gov/
    • United States Department of Labor. (2014). Occupational Safety and Health Administration – OSHA. Retrieved from https://www.osha.gov/

  • Assessment Instructions

    The purpose of this assessment is for you to learn how to summarize and critically evaluate a scientific paper on environmental toxins.To begin, choose a toxin to research. Note: The CDC Web site and other materials listed in the Resources should provide you with a starting point in selecting a toxin.Then, select at least two peer-reviewed articles about your chosen toxin to read carefully. Craft a 3–4-page analysis of the toxin’s impact on human health based on what you have learned. Address the following in your analysis:

    • Highlight the main points presented in the articles you read. What message are the authors trying to convey about that toxin?
    • Describe the possible sources of human exposure to this toxin, and analyze their risk.
    • Analyze what happens when this toxin enters the environment.
    • Analyze the persistency of this toxin.
    • Analyze the federal government’s recommendations for protecting human health from this toxin.
    • Describe what other sources of information say about these toxins.
      • Identify any discrepancies you found in your research.
      • If the authors have different perspectives, how might these differing views affect environmental health?

    Your analysis should follow a logical structure and be evidence based. Use the MEAL Plan to help guide the organization of your analysis:

    • Main Idea: Present the main point or idea that you are making about the environmental toxin you studied.
    • Evidence: What does the research say? Support your statements with evidence from your research and personal experience.
    • Analysis: Summarize main ideas from articles related to the points outlined for this assessment. Compare and contrast the ideas of the authors of the two articles. Identify those ideas and facts that relate directly or indirectly to your main point. Make explicit links between source articles, your personal experience, and your current analysis.
    • Link: Integrate and combine information from the source articles and your personal experience to your main point or idea.

    ADDITIONAL REQUIREMENTS

    Use the APA Paper Template (linked in the Resources under the Required Resources heading) to format your analysis.

    • Written Communication: Written communication should be free of errors that detract from the overall message.
    • Length: This analysis should be 3–4 pages in content length. Include a separate title page and a separate references page.
    • Font and Font Size: Times New Roman, 12-point, double-spaced. Use Microsoft Word.
    • APA Formatting: Resources and in-text citations should be formatted according to APA (6th edition) style and formatting.
    • Number of Resources: You are required to cite a minimum of 2 scholarly resources. You may conduct independent research for resources and references to support your analysis. Provide a reference list and in-text citations for all of your resources, using APA format. You may cite texts and authors from the Resources.
  • Competency 4: Communicate effectively in a variety of formats.
    • Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics.

    ASSESSMENT 2 CONTEXT

    Determining ToxicityToxicity is determined by the following:

    • Observing people during normal use or accidental exposure.
    • Experimental studies using animals.
    • Cellular studies.

    Toxins can be divided into categories based on their potential harm to humans.

    • Carcinogens are substances known to cause cancer.
    • Endocrine disruptors are agents that bind with hormones, blocking their normal function.
    • Teratogens are agents that cause malformation of a fetus through the mother.

    Toxicologists are scientists that study toxins. They determine whether the toxins have any harmful effects on the environment or the human body. Toxicologists often describe toxins as either hazardous or poisonous. Hazardous substances are substances having the capacity to do harm. Poisonous substances are able to kill, injure, or impair living things with a small dose.

    ASSESSING RISK

    After determining that a substance is toxic, toxicologists and other scientists create risk assessment models. Risk assessment involves considering four steps:

    • Identification of the hazard and its potential health effects.
    • Dose-response (amount of pollutant to which a person is exposed).
    • Mode of exposure (inhalation, ingestion, absorption, and injection).
    • Determination of overall risk based on dose response and exposure.

    Cost-benefit analysis can be used to determine if a risk should be taken, and what strategies can be used to regulate and control the risk. In some cases, after a risk assessment, a risk will be determined unavoidable.The Consumer Product Safety Commission (CPSC) is a government agency created in 1972 to address some products that have presented an unreasonable risk of injury. The CPSC requires safety labels, recalls hazardous products, and enforces bans upon them.

    ACCIDENTS

    According to the U.S. Department of Health and Human Services, more than 400 Americans die each day due to injuries caused by accidents (2014). In fact, most people experience a significant injury at least once in their lifetime (Hilgenkamp, 2006). Although not all accidents can be avoided, understanding where the risks are, and taking steps to avoid them, is important to protecting our health.Motor vehicle accidents are the leading cause of death in individuals between 1 and 44 years of age (CDC, 2006). The National Highway Traffic Safety Administration (NHTSA) is charged with increasing safety on the roads by writing and enforcing safety laws. Seat belts, safety seats for children, air bags, and anti-lock brakes are just some of the devices that can make traveling in a motor vehicle safer. We can reduce our risk of a motor vehicle accident by following traffic laws, and always considering what is prudent based on the driving conditions.Accidents can also occur when we are in our homes. Common occurrences involve falls, poisonings, accidental shootings, fires, and power equipment. Young children are particularly at risk, which is why child-proofing a home is so important. Cabinets with toxic materials, medicines, and guns should be locked. Matches and lighters should be kept in a safe place.

    OSHA

    Concerns of hazards in the workplace led to the development of the Occupational Safety and Health Administration (OSHA). OSHA’s mission is to prevent injuries and protect the health of United States workers by ensuring safe and healthful places to work (United States Department of Labor, n.d.). The major areas of concern in the workplace are air contaminants (dust, fibers, gases, and vapors), and physical (temperature, noise, and radiation), biological (pathogens), and chemical (inhaled, absorbed, ingested, or injected) issues.

    References

    CDC. (2006, June 28). Deaths: Preliminary data for 2004. National Vital Statistics Reports, 54(19). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19…Hilgenkamp, K. (2006). Environmental health: Ecological perspectives. Sudbury, MA: Jones and Bartlett.U.S. Department of Health and Human Services. (2014). Healthy people.gov. Retrieved from http://healthypeople.gov/2020/default.aspx

    United States Department of Labor. (n.d.). About OSHA. Retrieved from https://www.osha.gov/about.html

    Environmental Toxins Scoring Guide

    CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
    Analyze the impact of a toxic substance on human health. Does not describe the impact of a toxic substance on human health. Describes the impact of a toxic substance on human health. Analyzes the impact of a toxic substance on human health. Analyzes and evaluates the impact of a toxic substance on human health, providing opinions and supporting evidence.
    Analyze possible sources of exposure to a toxic substance. Does not describe possible sources of exposure to a toxic substance. Describes possible sources of exposure to a toxic substance. Analyzes possible sources of exposure to a toxic substance. Analyzes and evaluates possible sources of exposure to a toxic substance.
    Analyze what happens when a toxin enters the environment. Does not describe what happens when a toxin enters the environment. Describes what happens when a toxin enters the environment. Analyzes what happens when a toxin enters the environment. Analyzes what happens when a toxin enters the environment and assesses the options available to mitigate the risk of potential harm.
    Analyze the persistency of a specific toxic substance. Does not describe persistency of a toxic substance. Describes persistency of a toxic substance. Analyzes persistency of a toxic substance. Analyzes persistency of a toxic substance and discusses impact of the toxin’s lifecycle.
    Analyze government recommendations for a specific toxic substance. Does not describe government recommendations for a specific toxic substance. Describes government recommendations for a specific toxic substance.

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    		 Analyzes government recommendations for a specific toxic substance. Analyzes and evaluates government recommendations for a specific toxic substance, and discusses whether and how the recommendations need updating.
    Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics. Does not write in support a central idea in appropriate format. Does not use correct grammar, usage, and mechanics. Writes in support of an idea with consistent format, but includes major errors of grammar, usage, and mechanics. Writes coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics. Writes coherently, using evidence to support a central idea in a consistently appropriate format, with correct grammar, usage, and mechanics.

peer responses essay

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peer responses essay

 

1—- At my clinical site, one internal method for the dissemination of my EBP project would be a team of people elected by the corporation’s shareholders to represent the shareholders’ interests and ensure that the company’s management acts on their behalf. The head of the board of directors is the chairman or chairperson of the board. The external method for the dissemination of your EBP project who be “The American Nurses Association (ANA), they are a premier organization representing the interests of the nation’s four million registered nurses. ANA is at the forefront of improving the quality of health care for all. One that we, as nurses, practices every day.

It is important to report my results to both of these groups: a) Stakeholders can affect or be affected by the organization’s actions, objectives, and policies. b) On the other hand, ANA knows that recognizing the essential value of nurses is just the start. Nurses work in all health care settings and have a unique perspective given that we serve in so many diverse roles and specialties. As a result, nurses can offer insights and contributions on how to improve health care in this country.

One’s lines of communication need to be robust, monitored, and evaluated. This also relates to organizational influence and responsibilities of an individual, and one also needs to recognize their role and appreciate the roles of others, to change each group.

2——– At the Indian Health Council, it is important to share project results with the staff who are participating in the project and those who are affected by the changes. Change agents often use graphs or statistics to show that the project is making a positive impact on patient care. “Reporting of project results is essential to garner continued support and recognition for the program” (Cullen, Dawson, Hanrahan, & Dole, 2014, p. 285). When staff realize that they played an important role in the project, there is more support for the new project, and staff feel recognized for their hard work. This would be an internal method for sharing the EBP (evidence-based practice) project. Staff can see what is working and may have input to continually improve the project.

When looking at the results for a project on screening, brief intervention, and referral to treatment (SBIRT), staff may take ownership of the project when they see an increase in the number of patients with positive screens getting brief interventions or referrals to treatment. In addition, the project results can be shared with other directors in the clinic, which promotes more support for the project. According to Cherry (2017), an “…effective change agent will understand that a change in one area almost always will affect another group or department…” (p. 311).

An external method for sharing this nurse’s EBP project results might be sharing the results with tribal leaders, other Indian Health Clinics, or sharing the results in a community newsletter. This shows that the clinic is striving to use the best-evidence based practices to improve patient care and safety. Patients, family members, and community leaders can see the positive impact that the project is making on their community. This not only keeps the clinic in business, but it demonstrates that the clinic is providing quality care for its patients. When presenting the project to the community, the must use language that is understandable and culturally sensitive, which demonstrates that the staff at Indian Health Council cares about their patients. Confidentiality and the stigma of going to a behavioral health department can be barriers, so addressing these concerns can change the way the community thinks about counseling or seeking treatment.

When sharing a new project, both the community and staff need information so that everyone understands what the new project is about, but it may need to be disseminated differently. For example, staff may need a written policy and a PowerPoint presentation while the community may get a flier or newsletter explaining the new project. The change agent needs to communicate with leadership and tribal leaders, so that the project is supported. If the project results in positive changes, it may help the change agent obtain more resources to improve the project. For example, if SBIRT is more effective with a behavioral health counselor working out of the medical department, leadership may decide to fund or write a grant for a full-time person in the medical department to help perform counseling and interventions. Who disseminates changes in your practice?

3—–Communication is key to any new or changing initiative and can make or break the success of the project. With this realization, it’s important to outline a plan to communicate our capstone project; in turn, planning for the success of our project. The best way to promote communication of a project is to engage your audience and ensure there is a solid foundation of understanding regarding the project (Krizner, 2019). We can all appreciate that with the ever mounting list of tasks nurses have on their plate, resistance is often a factor when we are tasked with a new project without appreciating why it is needed. Communication can help curb some of this resistance by outlining the goal of the project and how it will help patient outcomes. The way I have and continue to plan for communication is the following.

Internal communication has been a relatively easy task for my project. I feel this is largely due to the strong argument that I made for my project early on; demonstrating it’s validity in research studies and outlining a solid plan for implementation in our department. During my research thus far, I have been able to communicate my project internally by means of email communications, presentations at meetings, and corroboration with other team members. This has allowed for better team collaboration and seemingly allowed for better acceptance by my peers and providers.

External communication has been more informal as my current capstone project is still in its infancies and doesn’t yet have a large “reach” into the community. An external member that I have worked with is meals on wheels, which is a community-based service that provides nutritional services to patient’s homes. For one of my patients, I was able to work with this organization to organize a low sodium diet to a patient suffering from heart failure. In this instance, I was able to work with the manager of our community service and explain the goal of the project and how this dietary need would help facilitate better outcomes for the patient. Through this contact, I was able to establish a line of communication with the manager and have since reached out to her multiple more times with similar patient care needs.

Communication is a constant state and continues to evolve, beyond this, nurses often need to mediate health care-related situations and effective communication skills are essential (as cited in Cherry, 2017). From the examples above, you can see that it has been easier to communicate when an established team has been identified; as is apparent with my immediate department. External communication has been more of a challenge as I’m still learning about new resources that may be beneficial to include with this project. Nonetheless, it is important to continue to leverage strong communication techniques as the project grows and changes. My plan is to summarize the conclusion findings of my study and send them to those stakeholders who have been involved in the project upon its completion.

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4————When disseminating evidence based research there are three questions that need to be answered to be sure that the evidence found is effective to use. The ability to determine if evidence is trustworthy, valuable, and of high-quality is called critical appraisal. The three questions are:

  1. Is the evidence of good quality?
  2. Would the findings apply in the proposed setting? Are the subjects in the study similar to the patients under the nurse’s care, for example?
  3. What are the consequences of the evidence for patients or clients? In other words, what would implementation of practice techniques in the evidence mean for patients or clients? What would be the pros and cons?

ALL PEER RESPONSES SHOULD BE MINIMUM OF 60 WORDS WITH PROPER CITATION AND REFERENCES.

PSCY2003 CUNY Kingsborough Patients with Schizophrenia Paper

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PSCY2003 CUNY Kingsborough Patients with Schizophrenia Paper

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement: