The Field of Nursing Discussion

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The Field of Nursing Discussion

The field of nursing has changed over time. In a 750-1,000 word paper, discuss nursing practice today by addressing the following:

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Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
Identify a patient care situation and describe how nursing care, or approaches to decision-making, differ between the BSN-prepared nurse and the ADN nurse.
Discuss the significance of applying evidence-based practice to nursing care and explain how the academic preparation of the RN-BSN nurse supports its application.
Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required

Obesity Case Study and Discussion Question

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Obesity Case Study and Discussion Question

The case scenario provided will be used to answer the discussion questions that follow.

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Case Scenario

Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2–3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control with sodium restriction. He current works at a catalog telephone center.

Objective Data

Height: 68 inches; Weight 134.5 kg
BP: 172/96, HR 88, RR 26
Fasting Blood Glucose: 146/mg/dL
Total Cholesterol: 250mg/dL
Triglycerides: 312 mg/dL
HDL: 30 mg/dL
Critical Thinking Questions

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.
Ranitidine (Zantac) 300 mg PO at bedtime.
Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.
The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

Assess each of Mr. C.’s functional health patterns using the information given. (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance.)
What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.

Benchmark EBP Project Diagnostic Tools For Treatment Of Diabetes

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Benchmark EBP Project Diagnostic Tools For Treatment Of Diabetes

Details:

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Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

In a paper of 750-1,000 words, summarize the main idea of the research findings for a specific patient population. Research must include clinical findings that are current, thorough, and relevant to diabetes and the nursing practice.

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

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

Please see Rubrics for question bellow

Benchmark – Evidence-Based Practice Project—Paper on Diabetes

1
Unsatisfactory 0-71%
0.00%

2
Less Than Satisfactory 72-75%
75.00%

3
Satisfactory 76-79%
79.00%

4
Good 80-89%
89.00%

5
Excellent 90-100%
100.00%

80.0 %Content

30.0 %Research or Evidence-Based Article Identified. Article Focuses on a Specific Diabetic Intervention or New Diagnostic Tool.

Research or evidence-based article not identified.

Research or evidence-based article identified but does not address a specific diabetic intervention or diagnostic tool.

Research or evidence-based article identified that focuses on a specific diabetic intervention or diagnostic tool in general.

Research or evidence-based article identified that focuses on a specific diabetic intervention and a diagnostic tool.

Research or evidence-based article identified that focuses on a specific diabetic intervention or diagnostic tool in a comprehensive manner, allowing all criteria of assignment to be fully addressed.

50.0 %Summary of Article Includes the Following Content: Discussion of Research Performed Clinical Findings, and Significance to Nursing Practice.

Content is incomplete or omits most of the requirements stated in the assignment criteria. Does not demonstrate an understanding of the basic principles. Does not demonstrate critical thinking and analysis of the overall program subject.

Content is incomplete or omits some requirements stated in the assignment criteria. Demonstrates shallow understanding of the basic principles only a surface level of evaluation is offered, methods are described but flawed or unrealistic and strategies are discussed, but incomplete.

Content is complete, but somewhat inaccurate and/or irrelevant. Demonstrates adequate understanding of the basic principles. Reasonable but limited inferences and conclusions are drawn but lack development. Supporting research is inadequate in relevance, quality, and/or currentness.

Content is comprehensive and accurate, and definitions are clearly stated. Sections form a cohesive logical and justified whole. Shows careful planning and attention to details and illuminates relationships. Research is adequate, current, and relevant, and addresses all of the issues stated in the assignment criteria.

Content is comprehensive. Presents ideas and information beyond that presented through the course, and substantiates their validity through solid, academic research where appropriate. Research is thorough, current, and relevant, and addresses all of the issues stated in assignment criteria. Final paper exhibits the process of creative thinking and development of proposal. Applies framework of knowledge, practice and sound research. Shows careful planning and attention to how disparate elements fit together.

15.0 %Organization and Effectiveness

5.0 %Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

5.0 %Paragraph Development and Transitions

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

5.0 %Format

3.0 %Language Use and Audience Awareness (includes sentence construction, word choice, etc.)

Inappropriate word choice and lack of variety in language use are evident. Writer appears to be unaware of audience. Use of ‘primer prose’ indicates writer either does not apply figures of speech or uses them inappropriately.

Some distracting inconsistencies in language choice (register) and/or word choice are present. The writer exhibits some lack of control in using figures of speech appropriately.

Language is appropriate to the targeted audience for the most part.

The writer is clearly aware of audience, uses a variety of appropriate vocabulary for the targeted audience, and uses figures of speech to communicate clearly.

The writer uses a variety of sentence constructions, figures of speech, and word choice in distinctive and creative ways that are appropriate to purpose, discipline, and scope.

2.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)

No reference page is included. No citations are used.

Reference page is present. Citations are inconsistently used.

Reference page is present. Citations are inconsistently used.

Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.

In-text citations and a reference page are complete. The documentation of cited s

Evidence-Based Practice Project— Intervention Presentation on Diabetes

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Evidence-Based Practice Project— Intervention Presentation on Diabetes

Details:

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Based on the summary of research findings identified from the Evidence-Based Project—Paper on Diabetes that describes a new diagnostic tool or intervention for the treatment of diabetes in adults or children, complete the following components of this assignment:

Develop a PowerPoint presentation (a title slide, 6-12 slides, and a reference slide; no larger than 2 MB) that includes the following:

A brief summary of the research conducted in the Evidence-Based Project – Paper on Diabetes.
A descriptive and reflective discussion of how the new tool or intervention may be integrated into practice that is supported by sound research.
While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

French Canadian And German Heritage discussion

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French Canadian And German Heritage discussion

Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Culture Larry Purnell,

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PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Overview/Heritage ▪ Over 50 million Americans are of Germans heritage. ▪ The first wave of German immigrants came to the USA for religious freedom. ▪ The second wave arrived between 1840 and 1860 and was fleeing political persecution, poverty, and starvation. ▪ Many worked as indentured servants. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Overview/Heritage ▪ The 1930s and 1940s saw a third wave because of the rise of fascism in Germany. ▪ Germans receive a stronger education than Americans. ▪ The German undergraduate degree is equal to the American master’s degree, except for nursing which is at a lower level than that of the USA. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ German is the official language of Germany. ▪ German is a low-contextual language, with a greater emphasis on verbal than nonverbal communication. ▪ A high degree of social approval is shown to people whose verbal skill in expressing ideas and feelings is precise, explicit, and straightforward. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ For traditional Germans, sharing one’s feelings with others often creates a sense of vulnerability or is looked on as evidence of weakness. ▪ Expressing fear, concern, happiness, or sorrow allows others a view of the personal and private self, creating a sense of discomfort and uneasiness. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ “Being in control” includes harnessing one’s emotions and not revealing them to others. ▪ Newer generations are more demonstrative in sharing their thoughts, ideas, and feelings with others. ▪ In families where the father plays a dominant role, little touching occurs between the father and children. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Affection between a mother and her children is more evident. ▪ Germans generally are careful not to touch people who are not family or close friends. ▪ Most individuals place a high value on privacy. People may live side by side in a neighborhood and never develop a close friendship. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Germans would never consider dropping in on another German neighbor because this behavior is incongruent with their sense of order. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Even looking into a room from the outside is considered a visual intrusion. ▪ Eye contact is maintained during conversations, but staring at strangers is considered rude. ▪ A closed door requires a knock and an invitation to enter, regardless of whether the door is encountered in the home, business, or in-patient facility. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ To focus on the present is to ensure the future. ▪ The past, however, is equally important, and Germans often begin their discussions with background information. ▪ There are rarely good excuses for tardiness, delays, or incompetence that disturbs the “schedule” of events. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Those in authority, older people, and subordinates are always addressed formally. ▪ Younger generations or the more acculturated may be less formal in their interactions. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Traditional families view the father as head of the household. ▪ In the USA, the husband and wife are more likely to make decisions mutually and share household duties. ▪ Older people are sought for their advice and counsel, although the advice may not always be followed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Helping parents or grandparents to remain in their own home is important to families. ▪ Prescriptive behaviors for children include using good table manners, being polite, doing what they are told, respecting their elders, sharing, paying attention in school, and doing their chores. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Prescriptive behaviors for adolescents include staying away from bad influences, obeying the rules of the home, sitting like a lady, and wearing a robe over pajamas. ▪ Restrictive and taboo behaviors for children include talking back to adults, talking to strangers, touching another person’s possessions, and getting into trouble. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Restrictive and taboo behaviors for adolescents include smoking, using drugs, chewing gum in public, having guests when parents are not at home, going without a slip (girls), and having run-ins with the law. ▪ One’s family reputation is considered part of a person’s identity and serves to preserve one’s social position. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Because families are concerned about their reputations in the community, an unwed mother taints their reputation and may result in the family being ostracized by others. If marriage follows the pregnancy, less sanctioning occurs. ▪ The fact that pregnancy existed before marriage creates a stigma for the woman, and sometimes for the child, that may last the rest of their lives. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Many older gays and lesbians may fear exposure because of the extreme discrimination homosexuals experienced in Nazi Germany. ▪ Younger generations of gays and lesbians are less likely to fear exposure of their sexuality. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Workforce Issues ▪ For Germans being on time is important. ▪ Business communication should remain formal: shaking hands daily, using the person’s title with the last name, and keeping niceties to a minimum. ▪ Employees are not addressed by their first names. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Common German cultural individualist is values include a. Timeliness and sharing emotions. b. Timeliness and direct communication. c. Smooth inexact communication and readily sharing emotions. d. Readily sharing emotions and present orientation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B German and German Americans value direct communication and timeliness in work and in social engagements. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Biocultural Ecology ▪ Germans range from tall, blond, and blue-eyed to short, stocky, dark-haired, and brown-eyed. ▪ Common health conditions for German Americans include cardiovascular disease, stomach cancer, muscular dystrophy, hereditary hemochromatosis, sarcoidosis, Dupuytren’s disease, peyronie’s disease, cystic fibrosis, hemophilia, and cholelithiasis. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German High-Risk Health Behaviors ▪ Smoking and excessive alcohol consumption remain high-risk behaviors for most Germans. ▪ Most individuals enjoy the outdoors, fresh air, and exercise. ▪ Sports are played for exercise and the pleasure of participating in group activities. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Nutrition ▪ Food is a symbol of celebration for Germans and is often equated with love. ▪ Children are rewarded for good behavior with food. ▪ Real cream and butter are used. ▪ Gravies, sauces, fried foods, rich pastries, and sausages are only a few of the culinary favorites that are high in fat content. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Nutrition ▪ Foods are also fried in butter, bacon fat, lard, or margarine. ▪ Traditional food preparation methods use highfat ingredients that add to nutritional risks. ▪ Garlic and onions are eaten daily to prevent heart disease. ▪ Those who are ill receive egg custards, ginger ale, or tomato soup (without cream) to settle their stomach. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Nutrition ▪ Ginger ale or 7-Up relieves indigestion and settles an upset stomach. ▪ After gastrointestinal illnesses, a recuperative diet is administered to the sick family member beginning with sips of ginger ale over ice. ▪ Coddled eggs, a variation of scrambled eggs prepared with margarine and a little milk, is used for recuperation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Pregnancy and Childbearing Practices ▪ Heterologous artificial insemination, use of contraceptive pills, and unnatural contraception are forbidden among strict Catholic Germans. ▪ Therapeutic or direct abortion is forbidden as the unjust taking of innocent life. ▪ Prescriptive practices during pregnancy include getting plenty of exercise and increasing the quantity of food to provide for the fetus. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Pregnancy and Childbearing Practices ▪ Restrictive practices during pregnancy include not stretching and not raising the arms above the head to minimize the risk of the cord wrapping around the baby’s neck. ▪ Prescriptive practices for the postpartum period include getting plenty of exercise and fresh air for the baby. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ Death is a transition to life with God. ▪ Because illness is sometimes perceived as a punishment, the duration and intensity of the dying process may be seen as a result of the quality of the life led by the person. ▪ Careful selection of the clothes to be worn by the deceased and the flowers that represent the immediate family is important. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ The body of the deceased is prepared and “laid out” in the home where support from family and friends is readily available ▪ A short service is held in the home before the body is taken to the church, where family and friends can attend a funeral service. After the church services, the body is taken to the cemetery for burial. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ After a short graveside service, the minister invites everyone at the graveside service to go to the home of the deceased for food. ▪ The viewing provides an opportunity for family, friends, and acquaintances to view the body. ▪ Crying in public is permissible among some families, but in others the display of grief is private. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ A tradition of wearing black or dark clothing when attending a viewing or a funeral may be expected of both family and friends. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Spirituality ▪ Major religions among Germans include Roman Catholicism, Methodism, and Lutheranism. ▪ Other religions, such as Judaism, Islam, and Buddhism, have substantial membership. ▪ Prayers are often recited at the bedside with all who are present joining hands, bowing their heads, and receiving the blessing from the clergy. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Spirituality ▪ Family and other loved ones are also sources of support in difficult times. ▪ Home, family, friends, work, church, and education provide meaning in life for individuals of German heritage. ▪ Family loyalty, duty, and honor to the family are strong values. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practices ▪ In traditional families, the mother usually ensures that children receive check-ups, get immunizations, and take vitamins. ▪ Women in the family often administer folk/home remedies and treatments. ▪ German Americans use a variety of over-thecounter drugs, believing that individuals are responsible for their own health. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practices ▪ Common, natural folk medicines include roots, herbs, soups, poultices, and medicinal agents such as camphor, peppermint, and spirits of ammonia. ▪ Folk medicine includes “powwowing,” use of special words, and wearing charms. ▪ Many value being stoic when experiencing pain. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practices ▪ Mental illness may be viewed as a flaw, resulting in this group being slow to seek help because of the lack of acceptance and the stigma attached to needing help. ▪ Physical disabilities caused by injury are more acceptable than those caused by genetic problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-Care Practices ▪ Blood transfusions, organ donation, and organ trans-plants are acceptable medical interventions unless a religious choice contradicts them. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practitioners ▪ Health-care providers hold a relatively high status among Germans. ▪ This admiration stems from the love of education and respect for authority. ▪ Most individuals accept care from either gender. Some younger and older, more traditional women prefer intimate care from a same-sex health-care provider. Transcultural Health Care: A Culturally Competent Approach, 4th Edition French Canadian Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ More than 2.2 million people of French Canadian descent reside in the United States. ▪ Nowadays, French speaking Canadians, unlike those of the 19th century living in the USA, may have been raised within the French culture but descended from a variety of ethnicities. ▪ The Multiculturalism Canada Act of 1988 provides guidelines for implementing policies regarding multicultural diversity. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Before the latter half of the 18th century, most French immigrating to Canada were Catholics. ▪ French Protestants tended to come directly to the United States. ▪ After the French Revolution, more Catholics sought shelter in the US, most coming via Canada settled in the New England states and later dispersed throughout the United States. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ The Métis, descendants of Native Americans and Europeans, are mainly, though not entirely, Frenchspeaking. ▪ Another major portion of Canada’s French-speaking population are the Acadians who are the descendants of the early French colonists. ▪ Canadians whose first language is French are called Francophones. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Canada has become an increasingly diverse society composed of various ethnocultural groups with more than 100 different languages as mother tongue. ▪ Much like that of the US, interethnic marriage patterns have dramatically changed from a multiethnic society to multiethnic individuals. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Canada has two official languages, French and English. ▪ In many homes in the US and in Canada English and French may be used equally. ▪ The French-speaking population may lack sufficient knowledge of the English language to access the workforce and other material. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Among French Canadians, a conversation may be conducted with high voice crescendos, which do not necessarily mean anger or violence. ▪ Volume can increase with the importance and the emotional charge invested in the content of the message. ▪ French Canadians encourage sharing thoughts and feelings. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Using hand gestures for emphasis when speaking is common. ▪ Facial expressions for men and women of all ages are a part of communication, often replacing words. ▪ Spatial distancing for differs among family members, close friends, and the public. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ When in the intimacy zone, people may touch frequently and converse in close physical space; however, they tend to avoid physical contact in public. ▪ When greeting another person, men usually shake hands. ▪ Close female friends and family members may greet each other with an embrace. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Maintaining eye contact is an important French Canadian value. ▪ Most French-speaking Canadians have a past, present, and future orientation in their worldview. ▪ More traditional people, and many from rural backgrounds, attach primary importance to living in the present. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Until the late 1970s, women and children took the father’s surname. ▪ Today, under Quebec law, a woman keeps her maiden name throughout her lifetime, although in other parts of Canada this practice is decided between the spouses. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Québécois family of two spouses and two children may well include four different surname combinations: one child may have the father’s surname or the mother’s surname alone or a hyphenated or non-hyphenated surname composed of those of the father and mother. For a second child, the surnames are the same, but in reverse order. ▪ The decision for using surnames rests entirely with the parents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The Métis in Canada are a. Mostly English Speaking. b. Mostly speak an indigenous dialect. c. Descendants of Native Americans and Europeans. d. Descendents of French and Arabic. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C a. Descendants of Native Americans and Europeans. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Many older people with a strong religious background maintain a future worldview regarding life after death. ▪ Many of the younger generation reject past traditions and attempt to maintain a balance by enjoying the present, working, and planning for their future. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Traditionally, in French-speaking Canadian families, the man was seen as the moral authority and responsible for material wellbeing, such as economic provider and purveyor of affection and security. ▪ The woman served as the family mediator and social director as well as being responsible for household activities, child care, and health care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ With more women working, family roles are becoming more egalitarian. ▪ French Canadians have always attributed great value to family relationships and obligations. ▪ Research reports that Francophones are less committed than Anglophones to with respect to marriage, sexual activity, and non-married parenthood. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ The greatest source of pride for French Canadian families is to see their children well established with a good education. ▪ The French Canadian family is more nuclear and autonomous than its counterpart in France. ▪ French-speaking Canadian family is known for its closeness, and some families are a “closed” family system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Traditionally, the Catholic Church dictated the parameters of sexual behavior for French Canadians. ▪ There is a growing trend for couples to live together without marrying. ▪ Many young couples answer that they cannot financially afford to get married. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ In 1996, the Canadian government extended health, relocation, and other job benefits to same-sex partners of federal employees. ▪ The Ontario Court of Appeals ruled that samesex couples must be treated as common-law couples under the Family Leave Act. ▪ Canada is one of the few countries in the world where same-sex marriage is legalized. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Opportunities for Francophone nurses to function successfully outside Quebec and in the US are limited if they have not mastered the English language. ▪ Because Francophone culture is more collevistic than individualistic, some may initially have difficulty adapting to an environment where autonomous decision-making is required. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Canadians of French descent are white or Caucasian; however, Francophones, as a linguistic group, represent a mosaic of ethnocultural characteristics, including racial differences prompted by acculturation, adoption, and the children of mixed marriages. ▪ Assess individuals for biological risks according to their racial and cultural heritage. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Higher incidences of prostate and breast and ovarian cancers have been seen among Francophones. ▪ A high rate of suicide and suicidal ideation, particularly among Francophone adolescents and young adult males, is seen in Canada. It is unknown if this extends in the US. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Genetic and hereditary diseases include spastic ataxia Charlevoix-Saguenay type, cystic fibrosis, tyrosinaemia, cytochrome lipase deficiency, familial chylomicronemia resulting from the lipoprotein lipase (LPL) deficiency, hyperlipoproteinemia type I which has been traced to migrants from the Perche region of France. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ An increased incidence of cystic fibrosis and muscular dystrophy occurs among Frenchspeaking Canadians. ▪ Sickle cell anemia is also higher among Francophones than the general population. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Health Behaviors ▪ Misuse of alcohol, tobacco, marijuana, and psychotropic drugs are major health problems. ▪ Tobacco and alcohol use is highest among French-speaking males and is associated with masculine sex roles, higher self-esteem, and an external locus of control. ▪ The rate of individuals who do not exercise on a regular basis has increased over the last decade. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ For French Canadians, food is associated with hospitality and warmth. Food is part of all meetings and celebrations. ▪ Common vegetables enjoyed by French Canadians include potatoes, turnips, carrots, asparagus, cabbage, lettuce, cucumbers, and tomatoes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Meat choices are mainly beef, pork, and poultry. Lately, however, lamb has gained popularity. ▪ In Acadia, due to the proximity of the coastal areas, fresh fish and seafood are part of the diet. ▪ Common foods include fricot (stew made with a special spice called summer savory). ▪ French Canadians do not escape the overall trend toward being overweight. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Until the middle of the 20th century, French Canadians maintained high fertility rates, which is uncommon for a population living in an industrialized country. ▪ This phenomenon, called the “revenge of the cradles,” has never been explained. ▪ The number of children per family has been declining since the mid-1960s. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Effective contraception and family planning methods such as the pill, intrauterine devices, and tubal ligation have become available to all women. ▪ The pill remains the primary reversible method for birth control. ▪ On the basis of relative frequency, tubal ligation and vasectomy follow the pill as nonreversible methods of fertility control. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Diaphragms, foams, and creams are not commonly used for birth control, partially because perceptions imply that women are not supposed to, or do not like to, touch their genitals. ▪ The beliefs that condoms reduce the level of sexual feeling during intercourse, or that contraception is not a man’s responsibility, are inversely proportionate to the age of men. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Few French Canadians practice natural childbirth. ▪ Men are welcomed and encouraged to be in the delivery room with their wives. ▪ Breastfeeding has regained importance after years of bottle feeding. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ In Canada, maternity and paternity leaves are available with pay for a period ranging from 6 to 20 weeks. ▪ Although the movement used in washing a floor resembles that of an exercise aimed at strengthening the perineal muscles, this activity in the past was associated with the onset of labor and early or preterm deliveries. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ French Canadians do not differ from Canadians and others of European origins on issues related to death and death rituals. Expectations are closely related to Christian religious practices, in particular, those of the Roman Catholic Church. ▪ Whether one is an active church-goer or not, religious funerals are the norm. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Cremation is an acceptable practice. ▪ Supports for those who have lost a family member include openly acknowledging the family’s right to express grief, being physically present, making referrals to appropriate religious leaders, and encouraging interpersonal relationships. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ While most French Canadians identify themselves as Roman Catholic and are baptized at birth, they may or may not remain active church members. ▪ Older adults are more inclined to use prayers for finding strength and adapting to difficult physical, psychological, and social health problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ In times of illness and tragedy, French-speaking Canadians use prayer to help recovery. ▪ Many of the younger generation are not strongly influenced by religious values, beliefs, and faith practices. ▪ The younger generations turn towards spirituality rather than religion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Canada’s ensures free, universal health coverage at any point of entry into the system. ▪ Many people in the upper socioeconomic classes call on their family physicians instead of the local community service centers. ▪ Many lower socioeconomic individuals many do not seek health care until their health becomes a crisis situation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ French-speaking Canadians have joined the current trend toward over-the-counter drug use. ▪ Language differences may be a barrier to accessing health care. ▪ French-speaking subjects rate acute pain as more intense than chronic pain, and more affectively laden than the English-speaking subjects. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck ▪ On issues of death and dying, which religion most influences French Canadian’s decision making? ▪ Baptist ▪ Methodist ▪ Catholic ▪ Islamic Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C The Catholic religion has the most influence on decision making for death and dying issues for French Canadians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ As a cultural group, French Canadians have no official proscriptions against receiving blood or blood products. ▪ The decision to donate or receive an organ is an individual decision without cultural influence for French Canadians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Health-care providers hold a favorable status in the eyes of French Canadians, especially among older people. ▪ The universal health insurance system in Canada makes the folk practitioners less appealing. ▪ Professionals throughout Canada are vigilant in trying to avoid exploitation by traditional and folk healers, who are viewed as practicing outside the law.
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Chamberlain Our Future Leaders in Nursing discussion

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Chamberlain Our Future Leaders in Nursing discussion

conference coverage WHAT SKILLS WILL THE N Carol Huston – a brave new nursing world K eynote speaker at the

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conference, American nursing professor and former president of the international honour society of nursing, Sigma Theta Tau, Carol Huston, painted a picture of a brave new nursing world in 2020, in her opening presentation, Preparing nurse leaders for 2020. She outlined eight leadership competencies every nurse leader would need in the 2020. The first was a global perspective. “Every health care issue has to be looked at from a global perspective. We used to think pandemics were confined to developing countries. We now know they are just one short flight away.” There was a more urgent need for international standards for basic nursing education. The nursing shortage was one of the most serious threats to global health, she said, and it would get significantly worse before it got better. Nurse migration was a global problem. (See news p7.) The second leadership competency was better use of technology to connect people. Technology had driven so many changes already in health care but knowledge and information acquisition and distribution was going to multiply exponentially. “Forty percent of what we know today will be obsolete in three years,” Huston said. She listed a range of technological developments that would have a major impact on health care in the next 20 years. By 2030 diagnostic body scans, which could identify underlying pathology, would become part of showering. Improvements in body scanning technology would mean there would be no need for invasive surgery or tests. “Nano bots” circulating in the blood stream would identify disease processes and begin to repair them. Gene therapy would mean what was now untreatable would be treatable and could see cancer abolished completely 14 within two decades. Stem cell therapy would eliminate the need for organ transplants “as we will grow new organs. It is predicted we will be able to grow heart, kidneys and livers by 2020. There are already clinical trials underway growing new teeth – instead of dentures you would grow you own new teeth.” Merging of the human and the machine would advance significantly and by 2020 there would be pancreatic pacemakers for diabetics and the technology to enable blind people to see and deaf people to hear. Robotics would continue to develop, with physical service robots which could wash patients and help feed and carry patients. There was the potential for the use of robots in therapeutic roles. Paro, a robotic seal developed in Japan, responded to patting by closing its eyes and moving its flippers and was already being used as a therapeutic device for those with autism and Alzheimers. Kansei (emotion) robots are being developed and are programmed so key words trigger facial expressions. Robotic simulation for nursing education provided a safer environment for students and mannequins could now cry, sweat, and become cyanotic. “The challenge for nurse leaders in 2020 will be how much simulation is too much? How important is human contact to learning the art of professional nursing?” Huston said. Other areas of development would be digital records of health care history, the continued development of biometrics, with confidentiality protected by biometric signatures, the increasing use of “smart” objects, including a bed that could call a nurse if the patient was attempting to get out of bed, or a coverlet which could take a patient’s vital signs as they lay in the bed. “Nursing leaders will have to balance technology and the human element. I’m not worried about the science of nursing but I am a little worried about the art of nursing. Technology can supplement but not replace nursing care,” Huston said. The third leadership competency was expert decision-making skills rooted in both empirical science and intuition. She referred to “wicked” problems, ie those with no right answers. Clinical decision support software packages will, with provider input of data, come up with a list of differential diagnoses and best practice. There would be increasing numbers of tools to help decision makers, including the opportunity to buy information and advice from expert networks of thinkers. Nurse leaders with both right brain and left brain skills were needed and Huston suggested that nurse leaders should surround themselves with people with a different brain dominance from their own. The fourth leadership competency was the development of organisational cultures which emphasised quality patient care and worker and patient safety. “There has been an inordinate amount of money spent on medical errors but we haven’t seen that greater reduction in error rates. Part of the reason is how health care systems are created.” If as much energy was focused on fixing the underlying processes which caused errors as was focused on blame, much more would be learnt. “I’m not absolving individual health providers. We must find a balance between creating safer health care systems and individuals’ responsibility for the care they provide.” Being politically smart was the fifth leadership competency. “Nurses are the largest group of health care professionals but they are not always an integral part of health care decision making. This has something to do with how women are socialised to view power and with how they have been controlled by outside forces, notably medical and administrative. Politics can be defined as the art of using power effectively. In 2020 nursing input will be needed more than ever. Nurses must use their political skills to solve problems such as workforce shortages, turnover rates, reforming broken health care systems and bringing nursing education entry levels up to that of other professions,” Huston said. Team building skills Nurse leaders of 2020 must also have highly developed collaboration and team building skills. The key to leadership success in 2020 would be the ability to integrate the priorities of industrial age leadership, with its emphasis on productivity, and relationship age leadership. “Health in 2020 will be characterised by highly educated, multidisciplinary experts and this will complicate, not ease teamwork. The key will be to create teams of experts, not expert teams. The nurse leader will have to be a team builder.” The nurse leader of 2020 must be visionary and proactive in response to an environment which will be increasingly characterised by chaos and change. “Health care organisations in the 21st century will be in a state of constant, dramatic change and will be more fluid, more flexible and more mobile. Nurse leaders in 2020 will be experts in addressing resistance KAI TIAKI NURSING NEW ZEALAND > JULY 2010 > VOL 16 NO 6 to change and helping followers work through that change.” The final leadership competency was ensuring leadership succession, given the average age of a nurse in the United States is 47. “We must do a better job of mentoring the newest members of our profession.” She explained the “Queen Bee Syndrome”, a characteristic of female occupations – “the nurse leader who has had to struggle to get to the top and is so embittered by the struggle she thinks every nurse should have to go through that to get to the top.” Huston said mentoring and nurturing was the key to advancement in traditionally male occupations. She referred to “demographic invisibles”, ie those people not even considered for leadership roles because of their ethnicity, gender, age or nationality, and “stylistic invisibles”, ie those who didn’t fit the stereotype of a leader. “Nursing education programmes must be much more open about where the next generation of leaders is going to come from. Education and management development programmes must ensure nurse leaders have the skill set and competencies to be successful.” Huston said the ability to achieve a balance between old and new skills, technology and the human element, national and international perspectives, empirical science and intuition, productivity and relationship, and using power wisely for the benefit of self and others, would be critical for future nurse leaders. “We must be proactive in identifying, preparing and supporting our nursing leaders to address the realities in 2020.” • Huston’s second presentation on the last day of the conference, was a light-hearted look at her own nursing leadership journey and examined her mistakes and what she learnt from them. • PRISON NURSES WORK IN UNIQUE PRIMARY HEALTH CARE ENVIRONMENT P rison nurses provide primary health care nursing services to around 8680 prisoners in the unique and challenging environment of the country’s 20 prisons, the Department of Correction’s clinical director Debbie Gell told the conference. Prisoners, on the whole, were not a healthy group, with a high prevalence of mental illness, communicable and chronic diseases and up to 70 percent of prisoners were alcohol and drug dependent, she said. “The prison environment is not very conducive to supporting health needs and this is compounded by isolation and worries about home and family,” Gell said. The average length of stay was nine months, with some remand prisoners staying just a few days, so nurses had to get positive health messages across within short timeframes. Nursing practice was also affected by security con- cerns, with prisoners having to be escorted to health clinics or to hospital by custodial staff, sometimes up to three. Nurses on medication administration rounds had to be accompanied by custodial staff and a round always involved myriad locked gates. There are 280 prison nurses and last year they were involved in 200,000 nursing consultations. Gell outlined a “typical” day in the life of a prison nurse, with the aid of videos of nurses talking about their work. Nursing clinics were held in prison health centres and included immunisation, sexual health clinics, dental health and chronic care management. In large prisons, doctors visited daily but care was led by nurses with the support of doctors. “Prison nurses see a wide variety of presentations from serious traumatic injuries to minor injuries, alcohol and drug withdrawal, sexually transmitted infections to sport injuries. They can encounter very complex self-harm behaviours. They need excellent assessment skills, for example they must assess whether a prisoner’s severe abdominal pain is genuine or a way of securing a drug drop at the emergency department.” Each prisoner underwent a “reception health triage” when first arriving in prison and then a full health assessment within 24 hours to seven days of arrival. “The full assessment is a great opportunity to engage prisoners to look at their own health. Nurses are dealing with a high-needs population who are usually in prison for a relatively short period of time. Nurses must use that time effectively to help improve the prisoner’s health and hopefully the health of the prisoner’s family and wider community,” Gell concluded. • ASTHMA ASSESSMENT TOOL PROVING ITS WORTH The three-day conference programme featured a plethora of speakers, including five plenary speakers. As well as Carol Huston, Michal Boyd and Debbie Gell, the other two plenary speakers were MidCentral District Health board clinical nurse specialist community, Denise White, and respiratory programme manager at Harbour Health Primary Health Organisation in Auckland, Wendy McNaughton. McNaughton spoke about the web-based asthma assessment and decision support tool, GASP (giving support to asthma patients) she was instrumental in developing and which enables health professionals to follow the New Zealand Guidelines on asthma. She introduced her presentation with a rundown of international and national asthma statistics, including that there are 300 million sufferers worldwide, New Zealand is second only to the United Kingdom for asthma prevalence, asthma is the most common chronic condition among children, that in 2007 asthma was one of the top three avoidable hospital admissions in the Waitemata DHB region and that there are huge disparities between Mâori and non-Mâori asthma rates. She said more than 300 GASP nurses had completed a two-day, New Zealand Qualifications Authority-accredited course based on the Asthma Foundation’s course but with sections on critical thinking and how to establish nurse-led clinics added. Two GASP audits of 205 patients ranging in age from five to 64, had revealed a 76 percent decrease in hospital admissions, a 58 percent decrease in exacerbations and a 46 percent decrease in use the of oral steroids. McNaughton “implored” the government to fund nurse-led respiratory clinics. KAI TIAKI NURSING NEW ZEALAND > JULY 2010 > VOL 16 NO 6 continued on p16 15 conference coverage HE NURSE LEADERS OF 2020 NEED? Copyright of Kai Tiaki Nursing New Zealand is the property of New Zealand Nurses Organisation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. EVIDENCEBASED CARE SHEET Budgeting Principles What We Know › A budget is a financial forecast that estimates expenses and revenue for a specified period of time, typically 1 year. A budget is developed based on a set of assumptions regarding what can and cannot be achieved with a specific set of resources in a defined period of time; the more accurate a projected budget is, the better the healthcare organization can efficiently utilize its resources(3,5) • Expenses include all monies paid out by the healthcare organization.(5)The two main types of expenses are – employment costs (e.g., salaries, wages, overtime costs, benefits)(5) – The greatest expenses in a healthcare organization are related to personnel because health care is very labor intensive(3) – non-salary expenses (e.g., supplies, equipment, equipment repairs, travel costs)(5) • Revenue is the income the organization receives for services provided(5) –For healthcare organizations, revenue is provided by payments made by private insurers, Medicare, Medicaid, and patients • Each nursing unit is a cost center and has an operating budget. Nursing budgets are developed and managed by nurse managers and typically account for a large share of the expenses of a healthcare organization(3,5) › The three most common types of budgets are the • personnel budget, in which personnel needs are managed to prevent under- or overstaffing(3) • operating budget, in which the costs of supplies are managed(3) • capital budget, in which the long-term costs of the organization are managed(3) – Physicians play a dominant role in the capital budgeting process(4) Authors Hillary Ittner, RN, MSN Cinahl Information Systems, Glendale, CA Tanja Schub, BS Cinahl Information Systems, Glendale, CA Reviewers Alysia Gilreath-Osoff, RN, BSN, CEN, SANE Cinahl Information Systems, Glendale, CA Nursing Executive Practice Council Glendale Adventist Medical Center, Glendale, CA Editor Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems, Glendale, CA › The four most common budgeting methods are • incremental budgeting, which is performed by multiplying current expenses by a certain figure (e.g., the consumer price index) to project the budget for the following year(3) • zero-based budgeting, in which the manager examines and justifies all current activities and expenses to prioritize spending for the following year(3) • flexible budgeting, in which the budget adjusts up and down based on the needs of the organization. This type of budgeting is useful in healthcare organizations because it can fluctuate based on changes in patient census and staffing needs.(3) (For more information, see Evidence-Based Care Sheet: Flexible Budgeting ) • performance budgeting, in which the outcomes of services are used as the basis for budgeting (3) › Nurse managers who are in charge of budgeting must • balance the competing priorities of containing costs and ensuring quality of care(3) –After a budget is created, it must be continuously assessed to verify that costs are remaining within the budgeted limits. Variances are created when there is a discrepancy between expected budget expenditures and actual expenditures; nurse April 20, 2018 Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206 managers must work to eliminate any variances and remain on budget. Variances can be created when nursing hours exceed the number required by the patient census(3) – The following factors influence variance analysis:(3,5) – Differences in the mix of staff and staff salaries. For example, payroll for registered nurses will cost more than payroll for medical assistants (for more information, see Evidence-Based Care Sheet: Nursing Skill Mix ) – Ranges in staff salaries – Differences in the levels of staff needed to provide care on night and weekend shifts – Incongruity between the number of staff members working on a unit and the number actually needed (e.g., there might be too many nurses working during a period of low patient census) – Changes in work practices and workload; workload is the volume of work in a specific department (for more information, see Evidence-Based Care Sheet: Nursing Workload Measurement ) – Lack of control regarding ordering goods and services and irregular purchasing patterns (e.g., fluctuating levels of stock and supplies) • have a thorough understanding of fiscal planning/financial analysis(3) –Fiscal planning in health care requires nurse managers to – identify of long- and short-term unit needs and document and communicate these to administrators(3) – verify that unit goals are congruent with organizational goals(3) – have knowledge of factors that influence healthcare reimbursement(3) – be flexible in financial goal-setting(3) – be creative and have the ability to motivate others(3) – provide opportunities for staff members to participate in budgeting activities(3) – recognize and effectively report to administrators if cost containment activities prevent the achievement of organizational goals(3) – ensure that cost containment does not impact patient safety(3) – role-model leadership(3) – ensure that patient care documentation is clear and complete to facilitate reimbursement(3) – effectively plan personnel needs(3) –Many nurses report that financial planning is difficult, most often because they lack formal education in budget planning and forecasting(2,3) – Researchers in Korea developed a financial-analysiseducation plan for nurses based on the following six key components: “Understanding the need for financial analysis, introduction to financial analysis, reading and implementing balance sheets, reading and implementing income statements, understanding the concepts of financial ratios, and interpretation and practice of financial ratio analysis” (Lim et al., 2015). Learning objectives and course content topics were developed based on these components(2) • demonstrate knowledge of budgeting methods(3) –Budgeting requires – assessment of budgetary needs(3) – determining long- and short-term goals(3) – developing the budget(3) – monitoring and analyzing expenditures(3) – evaluating the budget throughout the fiscal year(3) –Programme Budgeting and Marginal Analysis (PBMA) is a toolkit used in the U.K., Australia, New Zealand, and Canada to assist managers with decision-making regarding the most effective use of resources and with the setting of priorities in health care(1,7) – Senior and middle managers who took part in PBMA at a children and women’s tertiary care facility in Canada reported that PBMA implementation was a good experience and an improvement over previous practice(6) What We Can Do › Become knowledgeable about budgeting principles so you can accurately assess your organization’s fiscal goals and participate in developing a fiscally responsible budget; share this information with your colleagues › Adhere to the principles of the accounting method used in your facility and collaborate with others to successfully meet facility budgeting responsibilities › Learn about budgeting conflicts in your facility so you can participate in successful resolution › Communicate details regarding the budget to your colleagues and promote commitment in meeting your healthcare organization’s fiscal goals. Be prepared to • defend your budget • negotiate details of your budget • resolve budget challenges and conflicts • perform a variance analysis for your budget Coding Matrix References are rated using the following codes, listed in order of strength: M Published meta-analysis SR Published systematic or integrative literature review RCT Published research (randomized controlled trial) R Published research (not randomized controlled trial) RV Published review of the literature RU Published research utilization report QI Published quality improvement report L Legislation C Case histories, case studies PGR Published government report G Published guidelines PFR Published funded report PP Policies, procedures, protocols X Practice exemplars, stories, opinions GI General or background information/texts/reports U Unpublished research, reviews, poster presentations or other such materials CP Conference proceedings, abstracts, presentation References 1. Edwards, R. T., Charles, J. M., Thomas, S., Bishop, J., Cohen, D., Groves, S., … Bradley, P. (2014). A national Programme Budgeting and Marginal Analysis (PBMA) of health improvement spending across Wales: Disinvestment and reinvestment across the life course. BMC Public Health, 14, 837. doi:10.1186/1471-2458-14-837 (R) 2. Lim, J. Y., & Noh, W. (2015). Key components of financial-analysis education for clinical nurses. Nursing and Health Sciences, 17(3), 293-298. doi:10.1111/nhs.12186 (R) 3. Marquis, B. L., & Huston, C. J. (2015). Fiscal planning. In Leadership roles and management functions in nursing: Theory and application (8th ed., pp. 204-234). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. (GI) 4. Mukherjee, T., Al Rahahleh, N., Lane, W., & Dunn, J. (2016). The capital budgeting process of healthcare organizations: A review of surveys. Journal of Healthcare Management, 61(1), 58-77. (RV) 5. Sherman, R., & Bishop, M. (2012). The business of caring: What every nurse should know about cutting costs. American Nurse Today, 7(11), 32-34. (GI) 6. Smith, N., Mitton, C., Hiltz, M. A., Campbell, M., Dowling, L., Magee, J. F., & Gujar, S. A. (2016). A qualitative evaluation of program budgeting and marginal analysis in a Canadian pediatric tertiary care institution. Applied Health Economics and Health Policy, 14(5), 559-568. doi:10.1007/s40258-016-0250-5 (R) 7. Tsourapas, A., & Frew, E. (2011). Evaluating ‘success’ in programme budgeting and marginal analysis: A literature review. Journal of Health Services Research & Policy, 16(3), 177-183. doi:10.1258/jhsrp.2010.009053 (RV)
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Shadow Health Tina Jones HEENT Lifespan

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Shadow Health Tina Jones HEENT Lifespan

LifespanActivity Time: 26 min

Tina’s eight-year-old cousin comes in with a fever and sore throat. What is your differential diagnosis? What assessments and tests would you perform and why?

Student Response: Model Note: Differential diagnosis includes viral pharyngitis, strep throat, influenza, cold, and sinusitis. To rule out strep, a rapid strep is indicated. Palpation of the cervical lymph nodes may demonstrate enlarged, tender, cervical lymph nodes. Visualization of the throat also gives clues to the diagnosis. White pus pockets and petechiae on the palate are classic signs of strep throat. Erythema alone may indicate viral infection or postnasal drip. If purulent discharge is noted in the posterior pharynx assess for nasal discharge and palpate the appropriate sinuses for the patient’s age. If palpation elicits pain and purulent nasal discharge is reported over the last 7-10 days, consider sinusitis. A negative rapid flu test would rule out influenza.  Shadow Health Tina Jones HEENT Lifespan

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Tina’s 76-year-old great aunt comes into the clinic for a visit and you find that she frequently asks you to repeat what you say. During the Rinne test, you find that air conduction is greater than bone conduction in her left ear. What is your differential diagnosis? What additional assessments would you perform?

Student Response:  

Model Note: Differential diagnosis includes sensorineural hearing loss and anatomical defects. Sensorineural hearing loss is common in old age and can be caused by heredity, diabetes, cerebrovascular disease, excessive noise, ototoxic medications, hyperlipidemia, hypothyroidism, and renal failure. Assessments should include a history of hearing impairment and ear injuries. It is important to inquire about chronic ear infection or other trauma that leads to anatomical abnormalities. An analysis of Tina’s great aunt’s medications and past medications can be used to rule out ototoxicity. Fasting glucose levels and Hgb A1C can be tested to rule out diabetes. TSH and T4 levels can rule out hypothyroidism. GFR or creatinine levels can rule out renal failure. Triglycerides, cholesterol, HDL, and LDL levels can be used to rule out hyperlipidemia. A neurological assessment should be completed to rule out cerebral ischemia. If no concrete diagnosis is made, the hearing loss should be attributed to old age. Shadow Health Tina Jones HEENT Lifespan

NSG-533-IKC – Advanced Pharmacology Module V: Pain Management Discussion

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NSG-533-IKC – Advanced Pharmacology Module V: Pain Management Discussion

State Legal Requirements for CRNP Prescriptive Authority

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Course Outcome: Fulfill legal requirements for writing prescriptions as a CRNP in this Commonwealth of Pennsylvania in accordance with § §  21.283—21.287 (relating to CRNP).
  • Link: http://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter21/subchapCtoc.html&d=reduce
  • The link provided for the Pennsylvania Code outlines the legal requirements that govern nurse practitioners in Pennsylvania. Although each state may vary somewhat with regards to its requirements, the basic framework is provided. Each student should take some time to familiarize themselves with these requirements and determine if the requirements in their own state may vary.
  • If there are any questions or comments, please post as necessary. This Section is Not Graded
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Introductions

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Please introduce yourself to the class.
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Unread for topic Introductions:(48)
Pawn Johnson-Hunter
Sep 7, 2020 1:30 AM

Module I: GI Topics Discussion

 

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Proton pump inhibitors are a class of novel drugs that are the most potent acid suppressors on the market today.  Since omeprazole’s introduction in 1990, they have been clinically proven to be better than H2RAs.  Over the past decade their use has been scrutinized because of several harmful disease associations.

  • C. difficile infection: FDA’s analysis of over 28 studies revealed that patients taking PPIs were at a 1.4-2.75 times greater risk of developing an infection
  • Fractures: FDA reviewed several studies and have concluded that PPIs in high doses, multiple daily doses, and/or continued therapy for longer than a year increase a person’s risk of osteoporosis related fracture
  • Magnesium: PPIs may decrease magnesium level, which can lead to muscle spasms, arrhythmias, seizures, and fatigue.  This typically occurs after long-term administration of PPIs, usually longer than a year.  Treatment may require magnesium replacement and PPI discontinuation
  • Dementia: Although several theories exist to possibly explain the mechanism, the association needs to be validated in large cohorts and tested in case-control studies. For now, it is probably safe to say a causal link is plausible. NSG-533-IKC – Advanced Pharmacology Module V: Pain Management Discussion
  • H. Pylori infection causes gastritis, PUD, gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma and the association between the presence of H. pylori and NSAIDs and an increased incidence of PUD is well documented.

How would you handle a patient who wants to begin long-term PPI use?

What would your discussion with them entail?

In what patients or disease states would you not recommend PPI use?

What if H. Pylori is found to be present?

 

The following FDA warning appears in the clopidogrel package insert: “Drug interactions: Co-administration of Plavix with omeprazole, a proton pump inhibitor that is an inhibitor of CYP2C19, reduces the pharmacological activity of Plavix if given concomitantly or if given 12 hours apart. ” Plavix (clopidogrel) [package insert] Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership Bridgewater, NJ. 2009.

Evidence-based guidelines such as those provided by the AGA state: “PPI therapy does not need to be altered in concomitant clopidogrel users as there does not appear to be an increased risk for adverse cardiovascular events”. (Strong recommendation, high level of evidence) Am J Gastroenterol 2013; 108:308–328; doi:10.1038/ajg.2012.444.

This leaves the provider to make a professional decision.

You may wish to read the portion of clopidogrel’s package insert [link below] regarding pharmacogenomics as well as the article found in Medscape [link below] regarding genetics in pharmacotherapy before answering the last question. Pharmacogenomics is, and will become, an increasingly bigger part of care as we move forward.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020839s044lbl.pdf
https://www.medscape.com/viewarticle/888159_2

 

After reviewing the package insert for clopidrogel and available evidence regarding this combination, what would you recommend if a patient is taking esomeprazole and clopidrogel together?

 

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
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Kelly Miskovsky
Sep 8, 2020 2:26 PM

Module II: Diabetes/Endocrine Topic Discussion

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Must post first.

Often we see a great deal of misinformation in the care of patients with diabetes, and often this misinformation is centered around the role and choice of medications.  Many patients, especially newly diagnosed patients, are prescribed medications that do not fit into the scheme of the ADA / AACE guidelines / best evidence based practices – for instance, starting on Januvia (sitagliptin) or Jardiance (empagliflozin) or Byetta (exenatide) as initial monotherapy without a compelling indication or reason.

In this discussion, please talk about how patients get put on these medications and why/how they should be transitioned to more evidence based treatments.

  • Is it okay to start a patient on a drug (particularly an oral drug) other than metformin as an initial drug?  Please cite possible circumstances where this could be reasonable.
  • What anti-diabetic medications have compelling evidence for use in select populations, possibly as initial therapy, and is this benefit a “class” effect?
    • (eg. SGLT2Is – Patients with type 2 diabetes and a high risk of cardiovascular disease had reduced risk of a cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke relative to those randomized to receive placebo)
  • How can patients and practitioners be convinced to change their behavior and opt for more evidence based approach to therapy?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
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Unread for topic Module II: Diabetes/Endocrine Topic Discussion:(2)
Dianne Cohen
Sep 19, 2020 11:19 PM

Module III: Men’s and Women’s Health Discussion

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Must post first.

Consider the following scenarios:

LW is a 32 year old female patient who comes to your medical clinic for primary care.  She has been on hormonal contraceptives for years, although she’s just been married and has stopped her pills in hopes of becoming pregnant.  Her PMHx includes obesity, HTN (diagnosed 3 years ago), familial hypercholesterolemia, and PCOS.  Her current medications are as follows: Metformin 2000 mg PO daily, Lisinopril 10 mg PO daily, rosuvastatin 5 mg PO daily, and a multivitamin.

GD is an 82-year-old patient is taking 2 mg of terazosin for BPH every morning. He comes in complaining of dizziness, generalized muscle weakness and persistent lower urinary tract symptoms (LUTS).

How should you advise these patients and manage their medications?  What was the process you went through to assess the current medications and to recommend an updated regimen?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
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Unread for topic Module III: Men’s and Women’s Health Discussion:(6)
Gisselle Mustiga
Sep 21, 2020 9:52 PM

Module IV: Psychiatric Disorders (Depression, Anxiety, Sleep) Discussion

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Must post first.

Benzodiazepines are commonly prescribed medications for several indications, including anxiety and sleep disorders. Let’s discuss their use in our health care systems and the impact on our patients.
Things to consider might include (just getting you thinking):

Safety: How could the side effect profile affect your patients?
Efficacy: Are benzodiazepines efficacious for anxiety and sleep?
Use: Are they under or over prescribed? How can we ensure safe use of these medications?

Consider the following cases:

KT is a 24 year old female completing her studies. While home for spring break, she presents to her primary care physician because she has been worried about her academic, professional, and personal future since class restarted in late August. She is constantly worried about passing all of her exams and that she is going to be the only one of her friends that graduates school without a ring on her finger.

  • How would you help her assuming she meets the criteria for GAD?

WD is a 49-year-old male who suffered a myocardial infarction one week ago. Upon discharge, it was noted that WD appeared depressed. At a follow-up visit with his physician a week later, WD met criteria for a diagnosis of major depressive disorder. His past medical history includes: treatment refractory hypertension, diabetes mellitus (type II), and severe uncontrolled narrow angle glaucoma

  • How would you help him assuming he meets the criteria for MDD?

JM is a 42 year old female who was referred for management of insomnia. She reports that she is unable to sleep at all during the week (difficulty going to sleep and staying asleep) and sleeps all day on Sunday. She currently takes temazepam (Restoril) 30 mg HS (recently increased from 15mg). She also experiences depression due to an abusive relationship with her boyfriend as well as her current lack of employment. She reports poor sleep hygiene (reads and watches TV in bed), drinks 6-8 cups of coffee throughout the day and does not pay attention to how late she eats or exercises.

  • What non-pharmacological and pharmacological therapies would you recommend for JM?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
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Unread for topic Module IV: Psychiatric Disorders (Depression, Anxiety, Sleep) Discussion:(15)
Pawn Johnson-Hunter
Sep 27, 2020 9:54 PM

Module V: Pain Management Discussion

 

Must post first.

There are hundreds of opioid conversion calculators available online, though they are not all of good quality.  I would like to direct you to one of the opioid conversion calculators that I find to be most useful and evidence based.  Locate http://opioidcalculator.practicalpainmanagement.com/ and evaluate the following case using the calculator as necessary. Discuss your approach to the overall case and results of your calculation.

  • A 79 year old white male is taking hydrocodone/APAP 10/325 for lower back pain (pt diagnosed with degenerative disc disease several months ago). The physician had written a prescription for Vicodin® 10/325  i-ii Q4-6h prn pain with a quantity of 120.  Her expectation was that this would last the patient for one month.  The patient is now requesting refills about every 10-14 days.  He states he has been taking 2 tabs Q4h (12 tablets per day) because “the pain is so bad I just can’t stand it!”.
    • What is the problem with the way the patient is taking this medication versus the way it was prescribed
    • Based on your assessment, it is determined this patient should be converted to extended release morphine for better, more consistent pain control. Perform this conversion and provide an appropriate recommendation (drug, dose, frequency).
Migraine is a major neurological disease that affects more than 36 million men, women and children in the United States. There is no cure for migraine. Most current treatments aim to reduce headache frequency and stop individual headaches when they occur. Let’s look at a case example:
  • CM is 20 years old female with severe, prolonged 2 to 3 day migraines twice per month. She has difficulty sleeping and is mildly anxious. She occasionally utilizes an inhaler for asthma.
    • Provide an evaluation of CM’s condition including non-pharmacological interventions and treatment options
    • Is Cm a candidate for prophylactic therapy, and if so, what option would be best suited to her?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section. 
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Kelly Miskovsky
Oct 15, 2020 9:39 AM

Module VI: Bone and Joint Disorders Discussion

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Must post first.

Calcium and Vitamin D supplementation are essential to bone health and the management of osteopenia and osteoporosis.  In the past few years, information regarding the potential risks of too much calcium (such as cardiovascular disease and/or events) have been emerging.

  • Using an article from a medical journal, evaluate and discuss the risks and benefits of calcium supplementation for a patient with a bone disease.
  • What would you recommend for is a 59-year-old postmenopausal woman with a T-score of − 2.3. Her past medical history is unremarkable and she only takes a multivitamin with additional calcium and vitamin D. Her family history is remarkable for a mother who had osteoporosis and died of breast cancer and a father who has diabetes
Gout is a common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big toe joint). Although there is no cure for gout, it can be effectively treated and managed with medication and self-management strategies
  • A 45-year-old white man presents to your office complaining of left knee pain that started last night. He says that the pain started suddenly after dinner and was severe within a span of 3 hours. He denies any trauma, fever, systemic symptoms, or prior similar episodes. He has a history of hypertension for which he takes hydrochlorothiazide (HCTZ). He admits to consuming a great amount of wine last night with dinner
    • Provide an evaluation of the patient including possible risk factors and treatment options, including non-pharmacologic interventions
    • Would this patient be a candidate for prophylactic therapy?
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Unread for topic Module VI: Bone and Joint Disorders Discussion:(10)
Kelly Miskovsky
Oct 12, 2020 1:28 PM

Module VII: Respiratory Tract Infections

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Must post first.

When faced with a choice between 2 or more possible answers, using a “STEPS” analysis may be a useful clinical decision making tool.  The goal is to provide information for each agent and compare the results to aid in your decision.

S:  safety – are there any serious drug interactions?  Possible serious side effects or adverse drug reactions?

T – tolerability – consider any adverse drug effects or side effects that may be concerning to the patient such as:  diarrhea, headaches, rash, etc.

E – efficacy – is one agent more efficacious than the other for the infection?

P – price – does the patient have insurance?  will cost inhibit adherence or access to the medication?

S – simplicity – which regimen is simpler?  Once a day dosing will likely have better adherence rates than three times a day dosing.  Also, three days of an antibiotic may be preferable to 7-10 days.  Depending on the drug you choose, the frequency and duration will vary.

Here’s an example table

Drug 1 Drug 2
Safety Moderate drug interactions No drug interactions / serious ADRs
Tolerability Diarrhea Diarrhea, headaches
Efficacy Similar Similar
Price/Preference $100/7 days $30/3 days
Simplicity 7 days, once daily dosing 3 days, BID dosing

1.  Which one would you choose and why?

2.  Identify the available treatment strategies for CAP in an adult outpatient with comorbidities. Create your own “steps” analysis comparing the use of the available treatment regimens. Be prepared to compare and contrast your ideas with your classmates.

Reference:  Evaluating the safety and effectiveness of new drugs

 

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section. 
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Unread for topic Module VII: Respiratory Tract Infections:(5)
Anna McMullen
Oct 19, 2020 2:11 PM

Module VIII: Skin and Soft Tissue/UTI Discussion

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Must post first.

Often infections have several treatment possibilities, depending on both patient specific and disease specific characteristics.  Below is a very short case, and I want you as a class to compare and contrast the listed treatment options.  The focus will be on safety and efficacy of the regimens, all considered possible choices by the Infectious Disease Society of America’s treatment guidelines for Acute Uncomplicated Cystitis.

HT is a 31 year old female with acute, uncomplicated cystitis and no known drug allergies.  She has no significant PMH or medications.  Her urine culture shows a susceptible E. coli (susceptible to all treatments listed below).  Please compare the safety and efficacy of the following options.  What would make you choose one over another?

1.  nitrofurantoin 100 mg po BID x 7 days

2.  TMP/SMX DS (160 mg/800 mg) po BID x 3 days

3.  levofloxacin 250 mg po daily x 3 days

4.  cephalexin 500 mg po q12hrs x 7-14 days

I want you all to discuss and add to or dispute each other’s thoughts and ideas.

 

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section. 
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Unread for topic Module VIII: Skin and Soft Tissue/UTI Discussion:(8)
Kelly Miskovsky
Oct 26, 2020 10:14 AM

Module IX: Respiratory Disorders

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Must post first.

JR is a 56 yo man with h/o asthma, HTN and hyperlipidemia. He presents to the ER today with h/o shortness of breath for 45 minutes at rest. He reports that he was feeling well and in his usual state of health until about an hour ago, when he smelled something burning. 20 minutes later, he began to feel short of breath and was wheezing. He tried using his albuterol inhaler without success, so he proceeded to the ER. Upon arrival, he was tachycardic, tachypneic, wheezing, using accessory muscles and hypertensive. His last admission for an asthma attack was 2 months ago. He denies a recent cold or URI and says the albuterol usually helps him when he feels an attack coming on and tends to use it on a daily basis. He generally has wheezing and shortness of breath on a daily basis. JR reports poor sleep due to waking about 2 times a week for shortness of breath. He has 2 cats, which sleep next to him on his pillow and he lives in an apartment complex. JR does not smoke, but his neighbor smokes. JR is a carpenter by occupation. He monitors his peak flow once a week at home. He reports that his peak flow generally runs about 325 L/min and his personal best is 480 L/min. His current peak flow is 175 L/min.

Medication Prior to Admission:

Albuterol MDI 2 puffs BID-QID PRN

Salmeterol Diskus 1 inhalation QID

Ipratropium bromide MDI 2 puffs QID

Lovastatin 20 mg po HS

Lisinopril 10 mg po QD

Questions:

  1. Classify JR’s asthma severity and control based on signs and symptoms prior to this most recent exacerbation and visit to the ED.
  2. Classify JR’s exacerbation severity based on PEF and symptoms.
  3. Identify the various triggers in JR’s life that may exacerbate asthma and prevent control.
  4. Which step should JR have been on prior to ER based on severity and current medications?
  5. Which medications are dosed incorrectly and/or inappropriate for JR’s asthma severity?
  6. Would a short-burst of oral corticosteroid be indicated at this time? If so, what dose and duration?
  7. How would you assess that JR is well-controlled?
  8. If JR is well-controlled, how would you step down in therapy?

 

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
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Unread for topic Module IX: Respiratory Disorders:(2)
Anna McMullen
Nov 17, 2020 4:25 PM

Module X: Hypertension/Heart Failure Discussion

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Must post first.

A 50yo African American woman presents to clinic feeling tired for the last 3 months.  She also has trouble breathing when walking 2-3 blocks.  She sleeps on 2 pillows at night to help with her breathing.  PMH:  HTN, arthritis.  Physical exam: edema present in both feet.  Medications:  HCTZ 12.5mg daily, verapamil SA 120 mg daily, ibuprofen 200 mg BID for arthritis in knee.  Vitals:  height 5’2″, 63kg, BP 134/84, HR 78, EF 30% per echocardiogram.  Her labs are normal including a creatinine of 1.1.  She denies chest pain or palpitations.  Her EKG reveals normal sinus rhythm with no evidence of ischemia or recent acute coronary syndrome.

  1. How would you classify her heart failure?
  2. What changes (modifications, additions, deletions) to her medications do you recommend that will:
    • Improve her symptoms?
    • Impact long term outcomes?
  3. What monitoring parameters do you recommend?
  4. What non-pharmacologic recommendations do you have?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.

 
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Unread for topic Module X: Hypertension/Heart Failure Discussion:(10)
Gisselle Mustiga
Nov 8, 2020 11:40 PM

Module XI: IHD Discussion

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Must post first.

Bill is a 58yo male recently diagnosed with stable angina.  He has been experiencing chest pain about 2-3 times per week for the last month.  His chest pain typically occurs while walking, which he does about 3 times each week.  He has no other significant past medical history, takes no medications, has no drug allergies, and does not smoke.  His BP is 122/74, HR 72.  His labs are all normal.  His fasting lipid profile is Total Cholesterol 175, HDL 45, LDL 90, TG 125.  Waist circumference is 30”, and BMI is 24.  His family history is unremarkable.

  1. What risk factors are present and are they modifiable?
  2. What are the goals of therapy?
  3. What medication(s) do you recommend to prevent Bill from experiencing angina-related chest discomfort and to increase exercise capacity?
  4. What do you recommend to treat acute episodes of stable-angina-related chest discomfort?
  5. What additional medications can improve outcomes (e.g. decreased cardiovascular mortality, non-fatal MI, cardiac arrest, etc.) in a patient like Bill who has stable angina?
  6. What is your drug therapy monitoring plan?
  7. What patient education should you provide?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
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Unread for topic Module XI: IHD Discussion:(14)
Augusta Ibeh
Nov 17, 2020 1:27 PM

Module XII: Dyslipidemia/VTE/Stroke Discussion

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Must post first.

A 44-year-old woman has a 10-year history of type 2 diabetes. She is a nonsmoker with well-controlled hypertension. She is on :

-dietary management

-metformin 1000mg BID

-omega-3 1000mg  ii BID

lisinopril/hydrochlorothiazide 20/25 QD.

She has a family history of diabetes.

BP 134/78, BMI of 36.0, HbA1C 7.5%

FLP: LDL–C 95 mg/dL, triglycerides 350 mg/dL, and HDL–C 38 mg/dL

  1. Based upon the case information and the patient’s lipid profile, describe your approach to therapy using each of the currently available guidelines:
    • 2013 ACC/AHA Blood Cholesterol Guidelines for ASCVD Prevention
    • 2014 NLA Recommendations for Patient-Centered Management of Dyslipidemia
    • 2016/2017 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for Additional LDL-lowering
  2. Now that you have compared and contrasted the various approaches, how would you educate the patient on the medications you have chosen?

NOTE: If recommending therapy provide drug, dose and rationale please.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
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Unread for topic Module XII: Dyslipidemia/VTE/Stroke Discussion :(17)
Shante Hunt
Nov 22, 2020 7:54 PM

Opioid Case Group Discussion

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Group/section restrictions.

Patient rounds involve various disciplines coming together to discuss the patient’s condition and coordinate care. They are used as an educational tool and also help keep everyone on the same page when it comes to the treatment plan. The following case is found in the textbook (Pharmacotherapy: Principles and Practices. Chisholm-Burns et al, eds.  5th edition.  McGraw-Hill.  New York 2019. ISBN-978-1-260-01944-5; Chapter 34. “Patient encounter”). After reading the assigned chapters, resources identified in Dynamed and Evidence based practice guidelines, please present the case to your peers. This will be your initial post. Please be sure to address all the questions and your responses are well researched and include supporting, evidence based guidelines such those of the WHO, CDC, APS, etc.

You will then provide an evaluation of TWO peer submissions of the same case. These response posts / evaluations shall include a complete response (with references) either endorsing or refuting the post you are evaluating based upon your research and references (including the text). The response posts / evaluations will have one additional step; you will assign a rating to each of your TWO peers  initial post using a five star rating system.

  • 5 STARS = Excellent
  • 4 STARS = Above Average
  • 3 STARS = Average
  • 2 STARS = Below Average
  • 1 STAR = Poor

Rate the post by clicking on the number of stars you think the post deserves in the Ratings area of a user’s post. You can give a maximum of five stars. [Ratings: ☆☆☆☆☆]

In essence, you will have three posts total. Your initial post and a two response posts (one for each of two classmates you are grouped with).

Part 1:

HPI:  A 78-year-old man who is to undergo a left above the knee amputation due to a limb abscess

PMH: Peripheral artery disease for 18 years; cardiomyopathy, benign prostatic hypertrophy for 13 years

FH: Mother had osteoporosis; father had diabetes

SH: Lives with wife; has two grown children

Meds: Aspirin 81mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; pantoprazole 40 mg daily; tamsulosin 0.4 mg daily

Pain Assessment: Patient rates pain as 8 on a scale of 0 to 10.

  • Based on the type of injury, what type of pain is this patient likely to experience?
  • What type of pain management regimen would you suggest in the postoperative period? Explain your answer

Part 2:

Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 55 mg of morphine/24 hours with adequate pain control; however, he developed redness and itching on his neck that is believed to be due to the morphine.

Current Meds:  Morphine PCA; aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily; heparin 5000 units twice daily until discharged home. He will be discharged to a skilled nursing facility for rehabilitation therapy.

You would like to convert him to a combination preparation of hydrocodone and APAP for as-needed pain relief.

  • What dosing regimen would you suggest?
  • What would your monitoring plan include for this patient?
  • How would you assess pain response?
  • The patient is concerned about the redness and itching that he developed while on morphine. Would you document this as an allergic reaction?
  • What other interventions or education may be necessary at this time?

Part 3:

The patient was discharged to a skilled nursing facility and is receiving physical therapy and occupational therapy 6 days each week.

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home, hydrocodone/acetaminophen 5/325 mg every 6 hours as needed for pain.

Pain Assessment: Patient reports pain of 7 out of 10; worse with movement.

Physical therapy notes indicate patient is unable to complete therapy goals due to complaints of pain.

  • Based on this information, what would you recommend to optimize pain control?
  • Prescribers play a critical role in prescription drug misuse and abuse prevention. What steps can be taken to identify signs of dependence and abuse and what education can you provide to the patient regarding the negative effects of medication misuse?

Part 4:

The patient has been at the skilled nursing facility for 4 weeks and is making progress toward rehabilitation goals; however, he complains that his leg is throbbing and feels like pins and needles. As a result, he requests to rest several times during her therapy sessions. During unit rounds, his therapist inquires whether her previous pain medication should be reordered.

Pain Assessment: 4 out of 10

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home,

  • What additional recommendations would you have at this time regarding pain management?
  • Are there any other therapeutic issues that should be addressed?

NURS 6053 Review of Current Healthcare Issues – covid 19

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NURS 6053 Review of Current Healthcare Issues – covid 19

The national healthcare issue selected for analysis is the nursing shortage. The nursing shortage is an ongoing problem that healthcare systems deal with daily, especially in this COVID-19 era. The nursing shortage is a significant issue that is highly prevalent around the country; one experienced in various and individual workplaces. According to Haddad and Toney-Butler (2020), the nursing shortage causes numerous issues of concern; shortages are due to a lack of potential educators, high turnover, and inequitable workforce distribution.

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The nursing shortage is an ongoing and widespread problem with no definitive solution found yet. Some contributory factors are the growing baby boomer populations with an increased need for health services and the aging of baby boomer nurses with the same population retiring.  Significant factors contributing to the nursing shortage are the fast nursing turnover rates, management issues, job-related stress, job dissatisfaction, and the failure to nurture new nurses. Marshall and Broome (2017) contend that looming faculty shortages are among the nursing workforce’s biggest threats. Nursing shortage negatively impacts patient care and needs to be addressed to promote positive patient outcomes because nursing shortages lead to errors, higher morbidity, and mortality rates. Hospitals with high patient-to-nurse ratios experience burnout, dissatisfaction Haddad and Toney-Butler, 2020).

The nursing shortage is one of the most significant stressors experienced in place of employment currently. A majority of the nursing staff are dissatisfied with the new management and the leadership style of their way or the highway. This attitude/ management style contributes to the nursing shortage and has resulted in many nursing staff always calling off from work repeatedly at current employment; many have transferred out or outrightly resigned. Nurses are floated to different units with no inherent experience.  NURS 6053 Review of Current Healthcare Issues – covid 19

The COVID-19 has also substantially contributed to this already problematic issue with nurses experiencing burnout. Job dissatisfaction among nurses contributes to costly labor disputes, high turnover, and risk to patients; thus, the administration has now come up with plans/policies to reverse the current trend. New nurses are being hired and offered competitive salaries for retention. Internal initiatives have been provided, such as referral bonuses, retention, and annual bonuses, a nursing/administration committee established as a bridge between nurses and the administration. Also, flexible schedules have been offered; nurses can now choose to work 12 or 8 hours, which was a significant contention point. In this manner, the issue of the nursing shortage was addressed at the current place of employment.

Higher salaries alone will not be enough to attract and retain nurses or mitigate nursing shortages.  Nurses desire to be part of the decision-making process; nurses desire a stress-free suitable working environment. Improving nurses’ work environment may lead to lower job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers (Nantsupawat et al., 2017).

References

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing.

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International nursing review, 64(1), 91-98.

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Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

  • Review the Resources and select one current national healthcare issue/stressor to focus on.
  • Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting. NURS 6053 Review of Current Healthcare Issues – covid 19

By Day 3 of Week 1

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

By Day 6 of Week 1

Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

response

Great job on your discussion post! I appreciate you highlighting the importance of the national healthcare issue on the nursing shortage. One aspect of the nursing shortage that can be overlooked, is the effects of a recession on the demand for nursing supply (Johnson et al., 2016). Variations in patient loads are difficult to predict, and hospitals are not paid for empty beds (Johnson et al., 2016). When patient loads are low, hospitals bear the costs for excess staffing (Johnson et al., 2016).

To minimize financial risk, some hospitals employ temporary nurses to substitute regularly employed RN positions (Johnson et al., 2016). It is my opinion that this factor it is not applicable to current events of the critical nursing shortage, in relation to the global pandemic COVID-19. However, as this factor is dependent upon economic status, I do believe it is something to consider, with the future uncertainty of our national economic state.

In further consideration of the nursing shortage, nurses comprise one of the largest sections of the health profession, and are a critical part of healthcare (Haddad et al., 2020). It is anticipated in 2022 that more registered nurse positions will be available than any other profession in the United States, with a projected 11 million additional nurses needed to avoid further shortage (Haddad et al., 2020).  There are numerous issues of concern related to causes of the nursing shortage (Haddad et al., 2020).

Some reasons include, the aging population and aging work force, nurse burnout, violence in the healthcare setting, and staffing ratios (Haddad et al., 2020). However, this is not only a national issue. The nursing shortage is becoming an international problem, as there remains a lack of skilled nurses in Europe and Asia, as well as North America, which is ultimately a main factor in determining the world health policy (Marć et al., 2019). Some recommendations to recruit and retain nurses include, implementing mechanisms regulating salary, improving working and employment conditions, and incorporating technological and mobile innovations into the provision of lifelong learning (Marć et al., 2019).

Where I work is, the issue of nursing shortage is a prevalent issue. I appreciate the recommendations you made to help remedy this serious situation. I agree that improving the job environment as well as including nurses in the decision-making process are great strategies to implement. Have you experienced any difficulties with the nursing shortage issue at your work place? NURS 6053 Review of Current Healthcare Issues – covid 19

References:

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls

[Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/

Johnson, W. G., Butler, R., Harootunian, G., Wilson, B., & Linan, M. (2016). Registered nurses:

The curious case of a persistent shortage. Journal of Nursing Scholarship, 48(4), 387-

396. https://doi.org/10.1111/jnu.12218

Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing

shortage – A prospect of global and local policies. International Nursing Review, 66(1),

9-16. https://doi.org/10.1111/inr.12473

 

 

response 2

Great post discussing nursing shortage issues throughout our country. I also discussed this as my national stressor. I feel that a lot of facilities and health-care organizations are suffering due to a lack of staffing. Lack of staffing leads to deficits in patient care. You highlighted Covid-19 and nurse burnout. I feel this is something that is coming to light and showing health-care organizations just how hard nurses work and how much more they have poured into their work throughout this pandemic. The pandemic has exacerbated the levels of nurse burnout experienced throughout our country.

Nantsupawat et. al (2016) conducted a study related to nurses experiencing job dissatisfaction, burnout and intention to leave. In this study it was found that nurses who work in better environments experienced less dissatisfaction. You also cited this article and how to address this issue. I have to agree with the authors in saying policy makers and managers need to take action. The nursing shortage and experience of burnout are not new topics in the health-care world. Many articles have been posted throughout the years regarding the nursing shortage and providing ideas to address the issues. While researching, I discovered a fact sheet from the American Association of Colleges of Nursing. Rosseter (2017) states that enrollment into nursing programs is not meeting the expectations of the demand for RN and APRN prepared nurses. We must start by encouraging enrollment into nursing programs. Just like the national campaign to encourage girls to become interested in STEM, I feel there should be a national campaign to interest children and teens in health care and nursing.

 

References

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O., Thienthong, H., & Poghosyan, L. (2016, November 24). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. Retrieved December 05, 2020, from https://onlinelibrary.wiley.com/doi/full/10.1111/inr.12342

Rosseter, R. (2017, May). Fact Sheet: Nursing Shortage. Retrieved December 04, 2020, from https://www.ic4n.org/wp-content/uploads/2020/01/Nursing-Shortage-Factsheet-2017.pdf. NURS 6053 Review of Current Healthcare Issues – covid 19

Discussion: Organizational Policies and Practices to Support Healthcare Issues

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Discussion: Organizational Policies and Practices to Support Healthcare Issues

Healthcare organizations have moved away from prioritizing patient outcomes to a focus on efficiency and decreasing costs (Kelly & Porr, 2018). This shift in principle can be hard on the nursing staff because it can cut staffing and resources needed to provide proper patient care. Even though there is clear evidence showing that bachelor-prepared nurses are linked with better patient outcomes and decreased mortality, hospitals do not prioritize hiring nurses with a Bachelor of Science in Nursing (BSN) degree. An Institute of Medicine report (IOM) questioned the proper preparation of nurses. It encouraged education programs to make sure students were taught the importance of patient-centered care, evidence-based practice, quality improvement, and information technology (Giddens et al., 2015). These areas are addressed in BSN programs, not in an Associate Degree in Nursing (ADN) program.  Discussion: Organizational Policies and Practices to Support Healthcare Issues

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          One reason that healthcare organizations are not embracing the push for BSN-prepared nurses is the current shortage of Registered Nurses (RNs) that is expected to only increase due to the Baby Boomers aging (American Association of Colleges of Nursing [AACN], 2020). If healthcare organizations required a BSN degree as a hiring requirement, there would be no way they could staff their facilities. Spetz (2018) reports that the IOM recommendation for nurses to improve care and patient outcomes is to hold a BSN degree or higher. Healthcare policy is written for efficiency, and trying to hire only BSN-prepared nurses is not efficient due to the low percentage of RNs holding their BSN (Angel, 2020). The needs of staffing seem to outweigh the evidence that nurses that hold BSN degrees have better patient outcomes.

          Healthcare organizations could change their policies to encourage hiring a higher percentage of BSN-prepared nurses, which would improve patient outcomes, which would ultimately decrease costs. The policy could also be changed to encourage nurses that hold an ADN degree to go back to school for their BSN with tuition reimbursement and increased wages upon graduation. Over a five to ten-year span, an organization could dramatically increase the percentage of nursing staff with a BSN degree integrating these policies, with the outcome all healthcare providers want, superior patient outcomes.

References

American Association of Colleges of Nursing. (2020). Nursing shortage. Retrieved December 14, 2020, from https://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet.pdf

Angel, L. (2020). Best practices and lessons learned in academic progression in nursing: A scoping review. Journal of Professional Nursing, 1–7. https://doi.org/10.1016/j.profnurs.2020.08.017

Giddens, J., Keller, T., & Liesveld, J. (2015). Answering the call for a bachelors-prepared nursing workforce: An innovative model for academic progression. Journal of Professional Nursing, 31(6), 445–451. https://doi.org/10.1016/j.profnurs.2015.05.002

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/OJIN.Vol23No01Man06

Spetz, J. (2018). Projections of progress toward the 80% bachelor of science in nursing recommendation and strategies to accelerate change. Nursing Outlook, 66(4), 394–400. https://doi.org/10.1016/j.outlook.2018.04.012

Discussion: Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue. Discussion: Organizational Policies and Practices to Support Healthcare Issues

To Prepare:

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

By Day 6 of Week 3

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

response

great discussion post. It is proven that bachelorette nurses (BSN) bring economic and professional benefits to hospitals and other health care institutions. Among the many benefits of BSN nurses is a 10% decrease in overall mortality rates, and patients have a 5% greater risk to survive near misses or high-risk complications (O’brien, Knowlton, & Whichello 2018). There are also financial benefits for hospitals to staff with BSN nurses such as decreased readmission rates and higher patient satisfaction ratings which directly correspond with compensation (O’Brien, Knowlton, & Whichello). Even though there are clearly proven benefits of staffing with BSN nurses most hospitals have not obtained the 80% BSN ratio by the year 2020. There are many barriers to nurses returning to school the ones that I debated myself were financial affordability, family obligations, and career advancement. hospital leaders and administrators need to be cognizant of limitations such as but not limited to tuition reimbursement, age of nursing staff, and formulate a list of professional opportunities for post-bachelor graduation (Sarver, Seabold & Kline 2020). With my current employer, there are tuition reimbursement opportunities however, there is no list of potential professional opportunities that would be exclusive to BSN nurses and there is currently no financial benefit for having a BSN over an ADN degree. Do you feel hospitals and other health care institutions would have a greater success rate of nurses returning to school if they were more transparent? Discussion: Organizational Policies and Practices to Support Healthcare Issues

References:

O’Brien, D., Knowlton, M., & Whichello, R. (2018). Attention Health Care Leaders: Literature Review Deems Baccalaureate Nurses Improve Patient Outcomes. Nursing Education Perspectives, 4, 2. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NEP.0000000000000303

 

Wendy L., S., Kelly, S., & Melissa, K. (2020). Building a Foundation of Evidence to Support Nurses Returning to School: The Role of Empowerment. Nursing Education Perspectives, 41(5), 285–290. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NEP.0000000000000704