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Evolving Practice of Nursing and Patient Care Delivery Models

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Evolving Practice of Nursing and Patient Care Delivery Models

Running head: Evolving Practice of Nursing Evolving Practice of Nursing and Patient Care Delivery Models Name

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Institutional Affiliation 1 EVOLVING PRACTICE OF NURSING 2 Evolving Practice of Nursing and Patient Care Delivery Models Healthcare systems have experienced significant changes since the implementation of the Affordable Care Act. New disbursement models have shifted healthcare from one individual to shared responsibility. Patients pay less for healthcare as long as they meet the eligibility criteria where the government and the insurance companies pay for healthcare. Consequently, care delivery models are changing from cost-based to quality based. Systems focus more on the quality of healthcare services offered as well as the overall health of the population. The government is funding communities so that they can improve the provision of care they receive. These new developments are slowly changing the role of nursing healthcare delivery (Quill & Abernethy, 2013). Consequently, nurses must adapt quickly to these changes by keeping up with the changes in the healthcare systems. Nurses are critical to the implementation of changes in healthcare delivery. However, this means that they have more work to do despite the fact that their numbers are almost four times more than that of physicians (Spross, 2014). The healthcare systems will require that nurses take up the role of leadership. Nevertheless, they need not develop the real leadership skills because they will work in collaboration with the physicians. Nurses will also need to learn how to balance the quality of healthcare they provide to patients and accounting for their services even with the changes in the disbursement of funds. When nurses practice at their highest level, this impacts positively in the patients as well as the whole care delivery system. The Affordable Care Act is slowly influencing change in the care delivery models so that they are no longer hospital-based but instead, healthcare focuses on primary care organizations (Quill & Abernethy, 2013). Such organizations include the Accountable Care Organizations, nurse-managed health clinics, and the medical homes. The shifting of healthcare from hospitals to these care organizations necessitates a continuum of care by the nurses. Fewer jobs will, therefore, be available in the acute care hospitals while more opportunities will EVOLVING PRACTICE OF NURSING 3 present themselves to the community-based organizations. The effectiveness of care delivery and cost reduction will depend solely on the availability of registered nurses as the primary care providers. The implementation of the new healthcare delivery models will benefit both the organizations and the patients. The healthcare providers will transition from high-cost medical facilities to institutions of high value (Spross, 2014). Working in the care based organizations will enable nurses to create relationships with their patients as well as their families. The result will be the efficient delivery of care at a reduced cost because it will reduce the rates of readmission. Patient satisfaction will also increase. The Kaiser Foundation is well known for its utilization of nurses in the provision of care to patients (Kelley & Morrison, 2015). The result has been a reduction in overall costs, increased patient satisfaction, and provision of quality care. These new delivery models have added the role of nurses to include patient discharge from hospital care to home-based care. These will enable the nurses to provide efficient care and follow-up for patients with chronic disease like diabetes, heart illnesses, and cancer among others (Kelley & Morrison, 2015). Nurses can offer professional advice while the patients have adequate time to recover. EVOLVING PRACTICE OF NURSING 4 References Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755. Spross, J. A. (2014). Conceptualizations of Advanced. Advanced practice nursing: An integrative approach, 27. Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), 1173-1175.
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M5: Chapter 11 – Assignment

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M5: Chapter 11 – Assignment

Cognitive Theories & Models

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A theory termed the “Peak and Decline Model” describes aging and creativity in a restrictive sense, basing the theory on what has been observed in the past among persons that are famous for one reason or another. The theory states that humans age, reaching a personal critical age at which they are at their peak, and, due to this fact they produce their personal best work. The model states that most people are at their personal best in their late 30’s. This is when the cognitive and intellectual processes come together to make people the most creative that they will ever be. Presented as evidence to this theory are the many people that are famous throughout the past, such as Albert Einstein and the theory of relativity. In every field of human endeavor, whether it be the sciences, arts, engineering, or any other field, again and again the pattern repeats itself. Since there is so much evidence of achievement in this narrow span of years of age, from the thirties to the early forties in which so many have achieved so much that there was very little evidence to dispute this theory.

The more modern theory about how aging and creativity develop is termed the “Life Span Developmental Model”. This model or theory describes how the evolution of creativity in people can vary. The basic belief is that there is a disconnection of creativity and the aging process. As it states, in the past there was little chance for someone to develop their creativity throughout their lives into advanced adulthood or later life, because rarely did persons live long enough to express that creativity. In the future, there will be more opportunities for elderly to express this creativity into later life so as to give credence to this theory.

So here we have two opposing theories that have two completely different outcomes as far as the expression of creativity at different ages. This could be an interesting argument as to which side has better evidence and which side can explain creativity and aging more accurately in the future.

Instructions:

Give an example, such as a famous person, for each theory that supports each theory. Be sure to be specific about your example.
Consider what you have learned so far about the aging process and cognition. Pick one of the theories or models described and describe a biological process that can support that theory or model. Be specific about the process and then the outcome that would explain the chosen theory.
Finally, consider if the Life Span Developmental Model were suddenly the accepted model – what types of changes in society can you imagine happening. Name at least two changes that you could imagine occurring and give the direct rationale for the change.
Your paper should be:
One (1) page or more.
Use factual information from the textbook and/or appropriate articles and websites.
Cite your sources – type references according to the APA Style Guide.

DISCUSSION BOARD

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DISCUSSION BOARD

You are interviewing Tom Stone, a 17-year-old who was admitted to a psychiatric unit after a suicide attempt. How would you best respond to each of the following patient requests and behaviors?

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a.“I would feel so much better if you would sit closer to me and hold my hand.”
b.“I will tell you if I still feel like killing myself, but you have to promise not to tell anyone else. If you do, I just can’t trust you, ever.”
c.“I don’t want to talk to you. I have absolutely nothing to say.”
d.“I will be going home tomorrow, and you have been so helpful and good to me. I want you to have my watch to remember me by.”
e.Tom breaks down and starts sobbing.
Each initial discussion post must be between 300-400 words. You will be graded on grammar and writing style. You must use one acceptable reference source (Wikipedia is not permitted and your text book is considered as an acceptable source). Reference must be in APA format (you can go to purdue owl online if you have questions or use bibme.org)

Chapter 20 – Assignment

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Chapter 20 – Assignment

Chapter 20 – Nursing Management – Staffing Staffing Table Your job is to fill in the following chart or at least

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describe what assignments each person will have during the day shift today. This is normally Mary’s job, but you are helping her out since she will probably be pretty busy today. The charge nurse usually only takes one or two patients along with the rest of their duties, but since she will be with a new grad and an LPN, you are anticipating that she will be busy. Is her being busy sound like a reasonable projection? It will be your choice what type of staffing model you utilize such as primary, team or modular nursing. Mary, RN (Charge Nurse) John, RN (New grad) Sarah, LPN (LPN) Mary has been an RN for 7 years and has worked in several different units throughout the hospital. John has been a nurse for only one month. Sarah has been an LPN for the past 3 years and has not done her IV certification course. Amy, CNA (CNA) Amy has been an assistant for the past 5 years. Patient #1: A 47-year-old woman admitted from the recovery room at 2:15am after an emergency open cholecystectomy. Vital signs are stable; she is experiencing postoperative nausea and vomiting. She is receiving intravenous morphine on a PCA pump and antibiotics IV every 6 hours. She is also on a maintenance IV drip. The T-tube is draining a moderate amount. Patient #2: A 20-year-old woman admitted two days ago with abdominal pain, fever and nausea. She had a endoscopic cholecystectomy last night and is due for her first bandage change this afternoon. | Mary, RN John, RN Sarah, LPN Amy, CNA Patient #3: A 76-year-old man in respiratory isolation to rule out tuberculosis. Third morning sputum for AFB is needed. Vitals are stable; and he is independent of his iADL’s but has some physical limitations that he is appreciative of help. Patient #4: An 60-year-old man with congestive heart failure (CHF). This patient is a DNR. Family is present with the client. Respirations are shallow; blood pressure is beginning to decline at the end of the last shift. Patient #5: A 60-year-old woman admitted 3 days ago with left lower lobe pneumonia. She is receiving intravenous antibiotics, oxygen at 3 Liters N/C. She spiked a fever to 39.5 C. overnight; acetaminophen was administered. She receives piggyback antibiotic every 6 hours. Patient #6: An 82-year-old man admitted 10 days ago with a urinary tract infection. The infection resolved. He is now waiting for long-term care placement. He requires assistance with ADL’s and ambulates with assistance also. | Mary, RN John, RN Sarah, LPN Amy, CNA Patient #7: A 36-year-old woman scheduled for a bowel resection at 10:00am She is NPO and has an intravenous maintenance infusion running. Bowel preparation is complete and preoperative teaching is done. The consent needs to be signed and the operating room checklist must be completed. Her pre-medications must also be administered when called by the OR. Patient #8: A 55-year-old man in the cardiac interventional lab having an angiography done. He will be prescribed bed rest on return and will have a sandbag on his groin to prevent bleeding while his heparin level is monitored during the day. His vital signs and groin site will be checked frequently when he returns. |
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Essentials of Nursing Research MODULE 1

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Essentials of Nursing Research MODULE 1

Module 1: Introduction to Nursing Research and Evidence Based Practice

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Overview
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N494: Essentials of Nursing Research

N494 Essentials of Nursing Research introduces the steps of the research process and the role of research in the practice of professional nursing. The methods and analytical tools required to critically evaluate nursing research literature are emphasized. Quantitative and qualitative approaches are highlighted. The focus of this course is developing the foundations for accessing and analyzing current nursing research literature to enable the professional nurse to apply research to current practice and issues. The skills of using technology to locate research information are developed, and the essential role of databases is explored. An understanding of ethical research practices is explored. This course prepares students to be critical consumers of evidence based research, and serves as a foundation for graduate-level nursing research courses.

Course Goals:

By the conclusion of this course, student will be able to:

Articulate the role of research in the development of nursing knowledge and evidence based practice
Describe the basic concepts, techniques, and methodologies underlying the research process and their application in the study of nursing problems.
Identify researchable clinical nursing problems with the purpose of improving patient outcomes
Use information technology to retrieve hierarchical levels of evidence that addresses clinical questions.
Utilize effective critical thinking and written communication skills in the critique of research for applicability to nursing practice.
Integrate research findings into nursing practice to meet the changing needs of clients and professional nursing.
Describe current research priorities in nursing.
Identify legal, ethical and cultural considerations in research that involves human subjects.
Prerequisites:

N493
Required Textbook:

Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: a guide to best practice (3rd ed.) Philadelphia, PA: Wolters Kluwer Health. ISBN: 978-1-4511-9094-6
American Psychological Association. (2009) Publication manual of the American Psychological Association (6th ed.). Washington, D.C.: American Psychological Association. ISBN: 978-1433805615.
Module 1: Introduction to Nursing Research and Evidence Based Practice
Goals

After completing this module, you will be able to do the following:

Describe the link between research and the development of an evidence-based practice for nursing.
Analyze your role in research and evidence based practice as a professional nurse.
Trace the evolution of nursing research from the time of Florence Nightingale into the twenty-first century.
Predict future trends and priorities in nursing research.
Differentiate among the ways of acquiring nursing knowledge (tradition, authority, borrowing, trial and error, personal experience, role modeling, intuition, reasoning, and research) that you use in practice.
Describe the major national initiatives whose focus is to increase the use of evidence based practice.
Identify the 7 steps for the evidence based practice process.
Formulate a clinical foreground question related to nursing practice in PICOT format.
Identify corresponding research designs and other types of evidence that would best address the clinical question.
Compare and contrast information resources, databases and search strategies.
Perform a literature search to find evidence relevant to a clinical question.
Perform a rapid critical appraisal of the evidence available to answer a clinical question.
Overview

This module provides an overview of nursing research, the history of research, and the significance of research evidence for nursing practice. Research methodologies and their importance in generating an evidence-based practice for nursing are explored. Current trends and events in healthcare and the nursing profession are examined in the context of the evolution of nursing research.

The module explains importance of nursing research in developing an evidence-based practice and the nurse’s role in research is addressed. The past, present, and future of nursing research are explored, including the scientific accomplishments in the profession over the last 150 years. The ways of acquiring knowledge in nursing are discussed, including the significance of research in developing nursing knowledge. The module describes the components and steps of the evidence based practice process, reasons for implementing evidence based practice and major healthcare initiatives whose focus is to increase the use of evidence based practice. Strategies for developing searchable clinical questions and conducting a literature review for relevant evidence to answer clinical questions are explored. Research designs, types of evidence and key questions that are part of the rapid critical appraisal process are identified are discussed.

Read

Melnyk & Fineout-Overholt – Chapters 1, 2 and 3
Worksheet: Question Templates for Asking PICOT Questions
Application Case Study: Chapter 3: Finding Relevant Evidence to Answer Clinical Questions
Related Resources:

Introduction to Nursing Research Joanna Briggs Institute for Evidence Libraries (www.joannabriggs.org)
Agency for Healthcare Research and Quality (AHRQ)
National Guideline Clearinghouse (NGC)
The Cochrane Collaboration
Association of Colleges of Nursing position statement regarding participation of nurses in research based on their educational preparation. AACN Position Statement on Nursing Researc.pdf
Introduction to Evidence Based Practice
The Cochrane Collaboration and Cochrane Reviews
The Institute for Healthcare Improvement (IHI) Triple Aim
The Institute of Medicine Roundtable on Evidence-Based Medicine (IOM)
Preventative Services Taskforce (USPSTF)
Patient Centered Outcomes Research Institute
Magnet Recognition Program by the American Nurses Credentialing Center (ANCC)
Goals Alignment

University Mission Goals:

Demonstrates professional performance through research by using evidence-based research
Program Goals:

Professional Behavior/Ethics: Develop a personal values system and value-based behaviors that include the capacity to make and act upon ethical judgments
Research and Evidence-Based Practice: Use research findings and other evidence in designing, implementing, and evaluating care that is multidimensional, high quality, cost-effective and leads to improved patient outcomes
Course Goals:

Articulate the role of research in the development of nursing knowledge and evidence-based practice.
Describe the basic concepts, techniques, and methodologies underlying the research process and their application in the study of nursing problems.
Identify researchable clinical nursing problems with the purpose of improving patient outcomes.
Use information technology to retrieve hierarchical levels of evidence that addresses clinical questions.
Utilize effective critical thinking and written communication skills in the critique of research for applicability to nursing practice.
Integrate research findings into nursing practice to meet the changing needs of clients and professional nursing.
Describe current research priorities in nursing.
Identify legal, ethical and cultural considerations in research that involves human subjects.
Professional Standards

AACN Baccalaureate Essentials:

Scholarship for evidence-based practice
Inter-professional communication and collaboration for improving patient health outcomes
Baccalaureate generalist nursing practice
IOM Core Competencies:

Patient-centered care
Evidence-based practice
Quality improvement
Module 1: Assignment
Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.

Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3. Consider the course discussions so far and any insights gained from it.

4. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.

Assignment:

Identify a clinical question related to your work environment, write the question in PICOT format and perform a literature search on the identified topic.

Purpose

To enable the student to identify a clinical question related to a specified area of practice and use medical and nursing databases to find research articles that will provide evidence to validate nursing interventions regarding a specific area of nursing practice.

Review the Application Case Study for Chapter 3: Finding Relevant Evidence to Answer Clinical Questions as a guide for your literature search.

Guidelines

Identify a clinical question related to your area of clinical practice and write the clinical foreground question in PICOT format utilizing the worksheet tool provided as a guide.
Describe why this is a clinical problem or an opportunity for improving health outcomes in your area of clinical practice. Perform a literature search and select five research articles on your topic utilizing the databases highlighted in Chapter 3 of the textbook (Melnyk and Finout-Overholt, 2015).
Identify the article that best supports nursing interventions for your topic. Explain why this article best supports your topic as you compare the article to the other four found in the literature search.
Please submit an APA formatted essay of 1000 to 1500 words in length. There should be a minimum of five scholarly sources to support your topic.

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Recommendation for Practice – Summary of the Evidence Practice Paper

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For this assignment you will identify an area of nursing practice in which you would like to make a change. You will initiate this inquiry by writing a PICOT question. Based on the question, you will develop a practice problem paper in which you define the problem you have identified, describe the prevalence of the problem, describe the significance of the problem to patients and nurses, and discuss how you plan to address the problem/make the practice change including the use of an evidence-based practice model and through a focused literature search, you will use knowledge gained in this assignment in preparation for your voice-over PowerPoint presentation at the end of the semester.

In order to support your argument you need to use at least 3 current references (within the past 5 – 8 years) from the professional literature. Include at least one interprofessional references. These references can come from professional journals and reputable websites (American Heart Association, March of Dimes and Center for Disease Control.

Rubric
Evidence Paper

Evidence Paper

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeIntroduction

1.5 pts
The presentation includes an introduction to a nursing problem or issue. The problem or issue is adequately defined and its significance described fully. Appropriate references are used to support the significance of the problem. These should be current and should include the three articles that you reviewed for the evidence table and three articles which are relevant to the problem.

1.0 pts
There is an identification of a nursing problem or issue, but it is not well defined and/or its significance is not well stated. The references used in the introduction include the 3 articles reviewed from the evidence table but the other references (3) are not from professional sources or not relevant to the topic.

0.0 pts
Central problem not identified.

1.5pts

This criterion is linked to a Learning OutcomeRecommendations for Practice/Research

5.0 pts
Specific recommendations for practice and research are made. The inclusion of an EBP model to guide the change process was clearly stated. The support for the recommendations is made clear.

2.5 pts
Recommendations for practice are not clearly described. The phases of an EBP model were not clearly stated and did not support the recommendations for practice change

0.0 pts
Recommendations may be present but is likely to be only a few lines of summary and no EBP model was described. Recommendations demonstrate serious inadequacy.

5.0pts

This criterion is linked to a Learning OutcomeGuideline/Policy/ Protocol

2.5 pts
The evidence and the recommendations are explored and supported by the evidence reviewed in the evidence table.

1.5 pts
There is some presentation of the evidence but the recommendation is not fully supported by the evidence reviewed in the evidence table.

0.0 pts
The recommendation for practice is not supported by the evidence reviewed in the evidence table.

2.5pts

This criterion is linked to a Learning OutcomeAPA/Grammar

1.0 pts
Demonstrates full control of APA format and style including proper citation format. Virtually free of sentence level errors: grammatical, typographical, and word

0.5 pts
Adequately adheres to APA forms and style including proper citation format, with likely deviations and lapses. May contain some consistent patterns of sentence level error: grammatical, typographical, and word choice. Pervasiveness of error does not impede comprehension.

0.0 pts
Presentation demonstrates serious inadequacy in APA/grammar

1.0pts

Total Points: 10.0

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REQUIREMENTSschool Nursing research school nuyrsing account_balance FAU bookmark NGR 6812-001: Nurs Rsrch Evidnc-Based Prac

Nursing’s Impact on Legislation

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Nursing’s Impact on Legislation

There are many political issues of interest to nursing ranging from societal issues, to moral/values issues, to

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regulatory issues. The beliefs and experiences of nurses lead to diverse opinions related to many of these political issues.

In this assignment, you will examine a selected political issue and the role of nurses in politics.

Tasks:

Consider the political issues described in your textbook. Examine the related ethical issues and how nursing could impact legislation.

In a 3- to 4-page essay, post your response to the following case:

Select an example from your reading this module, of a political issue that is also a health issue.

Discuss the political and health concerns surrounding the selected issue.
Identify the ethical issues that policy makers should be aware of when developing legislation about the selected issue.
Discuss the impact the nursing profession could have on this issue if nurses became familiar with the issue and reached out to policy makers.
Support your findings with examples and scholarly references. Apply APA standar

Compare EHRs

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Compare EHRs

It is important for the nurse to understand there are different types of products offered by different vendors.

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Comparing the advertisements on their respective websites is important to the nurses’ use of technology.

Tasks:

Search the Internet for at least two different EHR vendors. How do these products compare as they are advertised on the websites? Answer this question and support your rationales.

In a 3- to 4-page essay, post your response to the following:

Search for the EHR vendors.
Analyze the vendors’ advertisements on the websites.
Compare and contrast the vendors with your rationales as to their efficacy as advertised and add which one would be the best for your workplace.
Support your findings with examples and scholarly references. Apply APA standards to citation of sources.

Holistic Health

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Holistic Health

Analyze the Social Theories of Aging as delineated in chapter 8 of Andrews & Boyle. Based on your experience in caring for an elderly client, as a RN or as a nursing or sociology student, give examples of any clinical applications, of one or more of these theories, which you have observed in your practice. Support your response with at least one scholarly journal reference. APA format reference should not be more than 5 years

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