FALL PREVENTION IN THE HOSPITAL SETTING

FALL PREVENTION IN THE HOSPITAL SETTING

They have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

  1. Background
  2. Problem statement
  3. Purpose of the change proposal
  4. PICOT
  5. Literature search strategy employed
  6. Evaluation of the literature
  7. Applicable change or nursing theory utilized
  8. Proposed implementation plan with outcome measures
  9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
  10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created

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

This assignment uses a rubric. Please USE THE RUBRIC FOR PROPER COMPLETION OF THIS ASSIGNMENT.

Literature Evaluation Table

Student Name: Yavaunee Jackson

Change Topic (2-3 sentences):

Falls is a national issue, with many interventions in place the statics related to falls has not indefinitely decreased. Through research and fall prevention efforts and studies on present efforts and potential interventions; I plan to understand how to implement changes in the hospital setting and to better equip and educate nursing staff on assessment of fall prevention.

Criteria Article 1 Article 2 Article 3 Article 4

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Radecki, Bethany Reynolds, Staci Kara, Areeba

APPLIED NURSING RESEARCH ; OCT 2018, 43 p114-p119, 6p.

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Huey-Ming Tzeng1

Huey-Ming Tzeng1

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Votruba, Lisbeth1,2 (NURSE) Graham, Bridget3 (NURSE) Wisinski, Jeana4 (NURSE) Syed, Ayesha5 (NURSE)

Nursing Economic$. Jul/Aug2016, Vol. 34 Issue 4, p185-189. 5p. 1 Chart.

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Cangany, Martha

Clinical Educator, Post-Surgical Unit, Orthopedic/Neuroscience Unit, and Liaison, Carmel Inpatient Unit, Franciscan Health, Indianapolis, IN

Source:

MEDSURG Nursing (MEDSURG NURS), Nov/Dec2018; 27(6): 379-382. (4p

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Article Title and Year Published

Inpatient fall prevention from the patient’s perspective: A qualitative study*(2018)

A Multihospital Survey on Effective Interventions to Prevent Hospital Falls in Adults. (Dec 2017)

Video Monitoring to Reduce Falls And Patient Companion Costs For Adult Inpatients.

(Jul/Aug 2019)

Preventing Falls: Is No Toileting Alone the Answer?

(NOV/DEC 2018

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

Falls are one of the most common adverse events in hospitals and can lead to preventable patient harm, increased length of stay, and increased healthcare costs. There is a need to understand fall risk and prevention from the patients’ perspectives; however, research in this area is limited.

Aim: The aim of this study was to describe the patient’s perspective of fall prevention in an acute care setting to aid in the design of patient centered strategies

A multihospital, cross-sectional design explored the underlying grouping structure of the nurse perceived effectiveness items of preventive interventions in acute hospital settings. Twenty-one highly effective interventions to prevent fall injuries were identified. The specific aim of this study was to evaluate the effectiveness of remote video monitoring with a dedicated tele sitter in order to reduce falls, as well as to reduce patient companion usage in the inpatient adult population What affects do integrating a “fall bundle” have on patient safety and does utilizing a “no bathroom alone” policy help to decrease the amount of falls?
Design (Type of Quantitative, or Type of Qualitative) A qualitative study was designed to describe the patient’s perspective of their own fall risk and of the fall prevention interventions implemented by nursing staff. The study was reviewed and approved by the local Institutional Review Board (protocol #1407636143).   All adult patients admitted to one of the three study units during the intervention stage were eligible to be selected for video monitoring with NURSING ECONOMIC$/July-August 2016/Vol. 34/No. 4 187 the exception of those meeting exclusion criteria. Patients with behavioral restraints and those at risk for harm to self or others were excluded from the stud This study was compromised of taking a nursing unit with a high fall risk and slowly over 3 years integrating a fall bundle into the fall prevention program. Using these methods to assess if there would be a decrease in fall related to specific interventions. Nurses on the unit where educated comprehensively on new interventions.
Setting/Sample The study was conducted in a large, urban, tertiary care, academic health center in the Midwest. The facility has been designated as a Magnet Hospital for excellence in nursing services and high-quality clinical outcomes for patients. Participants were selected from non-intensive care inpatient units. The facility screens all inpatients for fall risk on admission and every shift. In addition to universal fall risk prevention measures, additional interventions are matched to patient specific etiology to mitigate fall risk. Interviews took place over a period of seven weeks starting October 2014. Data collection was interrupted for a period of five months due to personal leave and was completed in March 2016. Design. An exploratory, cross-sectional study was conducted at five nonprofit health systems located in the Midwest region of the United States from July 2011 through February 2012. It included 68 critical care, step-down, and noncritical acute care units for adult inpatients. Unit types included medical, surgical, combined medical-surgical, telemetry, oncology, orthopedics, cardiac, behavioral, women’s health/delivery, rehabilitation, and geriatric units (Tzeng & Yin, 2013). This study was approved by each health system’s institutional review board (IRB). Each IRB waived documentation of consent. This research study took place in a 350-bed urban, not for-profit, Magnet ®-designated hospital. The intervention took place in three inpatient, adult units including a critical care/intermediate unit, a neuroscience unit, and a senior adult unit. Approval was obtained from the institutional review board to conduct the research with a waiver of consent. Consent for video monitoring was included in the organization’s general consent for treatment. 43-bed post-surgical unit in a not-for-profit healthcare setting in the midwestern United States
Methods: Intervention/Instruments . Interviews were audiotaped and conducted in the patient’s private room using a standardized open-ended interview approach (Turner, 2010). The interview guide was developed by the investigators with input from local and national experts in fall prevention. The guide was designed to elicit patient awareness/perceptions of fall risk and prevention interventions. Interviews were transcribed verbatim and checked for accuracy The survey tool used in this study, The Injurious Fall Risk Factors and Fall Prevention Interventions Survey, was developed by the authors (Tzeng & Yin, 2013). Its development was based on previous studies and guidelines related to fall prevention (American Geriatrics Society and British Geriatrics Society Panel on Prevention of Falls in Older Persons, 2011; Currie, 2008; GrayMiceli, 2008; Shever et al., 2011; Titler, Shever, Kanak, Picone, & Qin, 2011; Tzeng & Yin, 2008a, 2008b). Authors sought input from 11 clinical or content area experts on the initial version of the survey tool The intervention phase of this prospective, descriptive study took place over a 9-month period. During the intervention phase, a dedicated tele sitter was added to the central monitoring unit (CMU) 24/7 to observe up to 12 patients at high risk for falls in three adult inpatient units as an alternative to using a patient companion. The tele sitter workstation was located in the CMU, at a workstation adjacent to the hospital’s two current cardiac monitor technicians (CMTs). During previous construct The initial intervention was the use of a fall bundle (yellow blanket, yellow socks, yellow armband, yellow magnet to be placed outside the door) for all patients scoring 51 or greater on the MFS. This fall bundle included visual cues to identify a patient as high risk for falling, and to increase awareness and communication among caregivers who interact with patients
Analysis Transcript analysis was guided by constant comparative methods (Kolb, 2012). During open coding, the team, which consisted of a CNS and a physician, read all transcripts repeatedly to gain a general understanding of the data. The team individually analyzed the transcripts for emerging themes. Together, the team iteratively refined the themes to reflect meanings in the data. Data were processed using SPSS 19.0 statistical software for Windows (SPSS Inc., Chicago, IL). Data from completed or partially completed surveys were included in the analysis; missing values in the partially completed surveys were kept as missing. Authors conceptualized information collected in the “Effectiveness” column captured nurses’ levels of agreement between their prior knowledge and their perceptions of the effectiveness of specific interventions. Agreement between prior knowledge and perceptions could be established through observation and clinical experience. Because nurses’ agreement precedes their know-how (e.g., knowing how to implement fall prevention interventions), exploratory factor analysis was completed on the items in the “Effectiveness” column. The skewness and kurtosis values of effectiveness intervention items on a 5-point scale were acceptable; absolute skewness values for all items were less than 2.00 and absolute kurtosis values were less than 2.42. Therefore, these items were treated as continuous variables . Baseline data were collected in the 9 months prior to the intervention phase of this study on the three study units. The baseline data included falls per discharge and the number of 1:1 patient companion hours per month. A fall was defined as an unplanned descent to the floor with or without injury. During the 9 months of the intervention phase while video monitoring was in progress, data on falls per discharge and 1:1 patient companion hours continued to be collected. In addition, the tele sitters kept paper logs recording the patients monitored, admission date, time to video monitoring, discharge date, and reason(s) the patient was monitored. They also logged their interventions, which included verbal redirections via microphone to the patients and calls to care providers on their personal communication dev Throughout this multi-year project as interventions were added gradually to nurses’ toolkit for fall prevention and safety, a steady decline in the number of falls occurred. Within 3 years, the unit consistently met and exceeded the National Database for Nursing Quality Indicators (NDNQI) benchmark for similar units (see Figure 1). Falls declined from 4.45 to 1.53 falls per 1,000 patient days (approximately 70% decrease). Falls with serious injury declined as well; for the year ending this inquiry, they remained at zero. The most drastic reduction in falls occurred after implementation of a no toileting alone program in 2013 for patients in the first 24 hours after a surgical procedure. This intervention was followed by implementation of the same program for all patients who were at high risk for falling
Key Findings

previous investigations focusing on patients’ perceptions of their own fall risk have found that patients do not perceive their risk accurately (Shuman et al., 2016; Sonnad, Mascioli, Cunningham, & Goldsack, 2014). Twibell, Siela, Sproat, and Coers (2015) found more than half of the patients who were considered at risk of falling as assessed by nursing did not believe that they were likely to fall. Contradictory to this, in our sample, most patients were aware that they were identified as a fall risk.

Despite a lack of evidence supporting the effectiveness of bed and chair alarms to prevent falls, they are often used in fall prevention programs (Hempel et al., 2013; Sahota et al., 2014). Our patients identified the alarms as part of the fall prevention plan, but most viewed the alarm as a useful alert for nurses when a patient was out of bed rather than a reminder to wait for help

Twenty-one highly effective interventions to prevent fall injuries were identified. Ten were related to improving patients’ surrounding environment, and four of these environment modification-related interventions focused on patient pathways. Eleven were related to increasing RN staff vigilance, and four of these vigilance-related interventions focused on providing assistive devices or appropriate footwear. The 21 highly effective preventive interventions were not ranked as having the most frequently used interventions in practice. This difference suggests the need to address priorities of resource allocation as related to making effective interventions to prevent fall injuries feasible and available to nursing staff (e.g., timely housekeeping in patient rooms, storing sufficient and free-assistive devices in the units for patient use). The number of falls decreased significantly from 85 to 53 (p< 0.0001, 95% CI) comparing 9 months of baseline data to 9 months of intervention data on the three units. Table 1 demonstrates the overall decrease of patient falls including all adult inpatients on the three study units; those who were video monitored and those who were not. This represented a 35% decrease in falls. Of the 828 patients selected for video monitoring, 13 (1.6%) experienced a fall. During the same time period there were 40 falls (1.7%) among the 4,213 adult patients admitted who were not selected for video monitoring. Patient companion hours decreased 10% from an average of 1,930 hours per month to an average of 1,735 hours per month during the study period. The average length of time for Throughout this multi-year project as interventions were added gradually to nurses’ toolkit for fall prevention and safety, a steady decline in the number of falls occurred. Within 3 years, the unit consistently met and exceeded the National Database for Nursing Quality Indicators (NDNQI) benchmark for similar units (see Figure 1). Falls declined from 4.45 to 1.53 falls per 1,000 patient days (approximately 70% decrease). Falls with serious injury declined as well; for the year ending this inquiry, they remained at zero. The most drastic reduction in falls occurred after implementation of a no toileting alone program in 2013 for patients in the first 24 hours after a surgical procedure. This intervention was followed by implementation of the same program for all patients who were at high risk for falling
Recommendations More research is needed to develop and validate an inpatient self-assessment tool that may help the patient recognize both their overt and covert risk factors and become a more active and accepting participant in the plan. For future research, additional data collection and analysis (e.g., one-way ANOVA, multiple regression analyses with binary predictors) is needed to explore differences in RN staff perspectives on effectiveness and frequency of use of fall injury preventive interventions across, but not limited to, rural and urban areas, health systems and hospitals, and specialties and acuity levels of units (e.g., long-term care and skilled nursing home facilities). Differences in perspectives across nursing staff and nurse managers/executives, and nursing providers and other types of providers (e.g., physicians, physical therapists, occupational therapists, nutritionists, pharmacists) also warrant investigation. Findings of these additional analyses may help nurse executives and researchers identify essential interventions relevant to characteristics of settings beyond ones included in universal fall precautions. Universal fall precautions are meant to keep the patient environment safe regardless of fall risks and hospital areas. For example, maintaining a call light within reach is one of the keys (Agency for Healthcare Re This study suggests the use of remote video monitoring is a safe tool for fall prevention. While there was a decrease in 1:1 sitter usage, there was no corollary increase in falls. In fact, falls decreased 35%. . An area for further study is accurate criteria for selecting the most appropriate patients for video monitoring. Implications for further study could also include investigating the most appropriate length of shift for a tele sitter and the most effective telesitter-topatient ratio. Results of this project affirmed the need to assure patient safety during toileting. Nursing staff should acknowledge the importance of patient safety related to toileting when patients are of high risk for falling and remain with these patients while toileting. They also should discuss the rationale for this strategy with patients
Explanation of How the Article Supports EBP/Capstone Project This article takes into account the patient’s perspective on falls and risk they identify in themselves and how even with education from staff patients still have little understand on the proper use of bed alarms, and things out in place as fall precautions. It also takes into account patient thoughts on what makes them not adhere to fall precautions and how they view interventions placed by staff and how useful they think they are. This article based off a study of nurses and current fall prevention methods and their effectiveness is essential because it uses the perspective of healthcare workers that are on the frontlines of patient care. I also scrutinizing current practices and allows for new ideas to be formulated about old practices and opening doors for new interventions. Video Monitoring is a fairly new intervention In the prevention of patient falls. I think it is relevant as it looks into the implications and differing risk associated with patient fall, the implementation of video monitoring on some units could help with cost needing to pull less staff for 1:1 sitters for patient safety thus increasing the amount of staff available on shift to properly assist patients. Also have one person watch multiple individuals on constant and recorded video allows for education and quicker response times. This study focused on nursing staff lead interventions and assessment of fall risk patients. With the implementation of a “fall bundle”, technology and the no bathroom alone policy supports the finding that toileting Is a high risk activity for patients.
Criteria Article 5 Article 6 Article 7 Article 8

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Ji Hyun ParkJung Tae Son

Journal of Korean Academy of Fundamentals of Nursing

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Enishi, T.1 tetsuya-e@umin.org Yamasaki, N.Matsumoto, A.Higuchi, T.Takeuchi, M.Kashima, M.Yoshioka, S.Nakamura, M.Nakano, S.2

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Gygax Spicer, Joan

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Julie David Maria Ojeda James O. Adefisoye Winifred Pardo

Nursing & Health Sciences Research Journal, Vol 1, Iss 1, Pp 7-18 (2018)

Library & Knowledge Services and Nursing & Health Sciences Research Departments, 2018.

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Publisher Information:

Article Title and Year Published

Structural Analysis of Variables related to Fall Prevention Behavior of Registered Nurses in Small-to-Medium Sized Hospitals.

(2018)

Annals of Physical & Rehabilitation Medicine. (2018)

The Got-A-Minute Campaign to Reduce Patient Falls with Injury in an Acute Care Setting.

(2017)

An Exploration of the Association of Patient Characteristics and Pharmacological Treatments to Inpatient Falls among Patients At-risk for Falling during Hospitalization

(2018)

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study How does the fall prevention behaviors of nurses affect patient falls? Falls are one of the major causes of mortality and morbidity in older adults, which needs a practical fall risk assessment tool to predict future falls. Recent researches suggested various functional tests produce more power than a single test in many aspects. So, we aimed to determine whether combined functional tests could increase predictive ability of future falls, especially recurrent-falls, which may result in stronger adverse impacts.

How does skills and knowledge of nursing staff and patient population affect falls? Which fall prevention practices should be used? How should a standardized assessment of fall risk factors be conducted? How should staff assess and manage patients after a fall? The focus was falls with minor or greater injury.

H: Implementing a bundle based off evidence based best practice will decrease the number of falls

The purpose of this study was to describe and compare patient characteristics and pharmacological treatments between patients who fell and patients who did not fall, among a sample of patients deemed to be at-risk for falling during hospitalization. Additionally, the study aimed to identify independent predictors of falls among patients at-risk for falls during hospitalization.
Design (Type of Quantitative, or Type of Qualitative) Qualitative Retrospective qualitative study A qualitative study of three hospitals implementing falls prevention programs described the real-world journey (Ireland, Kirkpatrick, Boblin, & Robertson, 2013) Observational cross-sectional study
Setting/Sample Participants were 382 nurses from 13 hospitals who responded to the structured self-reported questionnaire. The research model was based on previous study of fall prevention, theory of planned behavior, and the health belief model Retrospective study carried out with stroke hospitalized patients. Thirty-four stroke patients who fell and 34 stroke patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with fall. The control subjects were matched for age, height, body weight, body mass index (BMI), and primary diagnosis. Potential variables related to fall risk factors were collected from medical records. A conditional logistic regression was performed to calculate odds ratios using SPSS. Clinical data were collected from January to December 2016. “An unexpected displacement of the body to a lower level than the initial The setting was a medical-surgical unit with average daily census of 35 patients in a safety-net hospital. A safety-net hospital provides a significant level of care to low-income, uninsured, and vulnerable populations (National Association of Public Hospitals and Health Systems, n. d  A convenience sample of all patients with a Morse Fall Scale of >45 over a 1-year period, was extracted from electronic medical records.
Methods: Intervention/Instruments Structured questionnaire This was a prospective cohort study (N = 875) among residents of Hangu area of Tianjin, China, who were ≥ 60 years old. Falls were ascertained after one year. Meanwhile, sociodemographic information, medical history and physical performance data were also collected. The Timed Up and Go Test (TUGT), walking speed (WS) and grip strength (GS) are more recommended as tests targeting on balance, mobility and muscle strength by many studies. Therefore, we selected these three tests to clarity our hypothesis.

The research team naming themselves the “stumble stoppers” which was an interprofessional team of nurses, pharmacy personnel, and a physical therapist reviewed evidence-based practice (EBP) recommendations in the literature. A 5- year review (2008-2012) of EBSCOhost to search English-language peer-reviewed journals for studies with the search terms nursing, adult, patient fall, and hospital identified over 150 articles. Team members realized they did not have the skills to evaluate the studies. Following Stevens’ (2012) recommendations, they focused on evidence summaries, including systematic reviews and other forms that integrated all research on a given topic into a single, meaningful whole.

They started by personalizing the data of patients who had already fallen rather than giving statistics where nurses seemed to disassociate from their day to day work. They let nurse read these patients stories reflect, had one on one meetings. Discussion was had on current fall prevention efforts and practices, and interventions where added to put into practice, commitment letters were signed to the nurses and their patients to increase the use of fall prevention practices. These practices included conducting patients centered rounds, debriefing patients and family after a fall ad being transparent fall data in the form of a fall board.

Descriptive statistics of demographic characteristics and medication classes were generated to compare those who fell to those who did not fall. To examine significant predictors of falls, logistic regression (univariate and multivariable) were employed
Analysis The modified model generally showed higher levels than recommended level of model fit indices and acceptable explanation. Of 17 hypothetical paths, 14 were supported. Predicting variables explained 51.6% of fall prevention behavior.

The mean age was 67.1 years; 58.6% were women. According to ROC area, the cutoff point of TUGT, GS and WS of falls is 10.31 s, 0.3742 kg/kg and 0.9467 m/s, respectively. Therefore we defined good performance on the tests as “+”, and poor performance as “− ” with the cutoff point.

A simple tool using TUGT, GS and WS has better predictive power on future falls. Based on this result, individuals who show poor ability in TUGT and WS but have good grip strength ought to be more concerned about the high-risk of future falls, especially the likelihood of recurrent-falls.

At the start of year 1, the patient injury fall rate was 1.21/1,000 patient days. At year 2, the patient injury fall rate was 0.66/1,000 patient days; the patient injury fall rate at year 3 was 0.15/1,000 patient days. To examine significant predictors of falls, logistic regression (univariate and multivariable) were employed
Key Findings The fall prevention behavior of nurses showed a direct influence of fall prevention expectations, fall prevent threats, perceived behavioral control for fall prevention, and intention to prevent falls and an indirect of influence of patient safety culture, attitude toward fall prevention, and the subjective norm. Nutrition status, evaluated with modified fall score at admission, was significantly associated with fall risk (odds ratio = 3.11, 95% CI: 1.18–9.94). There were no statistically significant differences in the other candidate factors (e.g. sarcopenia, activities of daily living, and rehabilitation intervention) between the two groups. The Got-A-Minute Campaign was effective in facilitating accountability for practice. The change has been sustained for 36 months, and many of the practices are now routine care for patients on the project unit. Patient falls and fall prevention remain complex phenomena for every acute care setting The sample consisted of 4,978 valid patient records. White non-Hispanics constituted 60% of the falls group but only 24% of the non-falls group. A larger proportion of those who fell received antiemetics or insulin compared to those who did not fall. Univariate regression analysis found that race and 39 medication classes were independently associated with falls. Multivariable regression analysis showed that race and 11 medication classes were associated with the odds of falling.
Recommendations  Findings show a need to identify a range of barrier factors to increase the benefits of fall prevention behavior and enhance the perceived control of fall prevention so that nurses will be able to promote fall prevention behavior in hospitals. Also, it is critical to increase awareness of patient safety culture among nurses. Our findings demonstrated that nutrition status was associated with fall risk in stroke hospitalized patients. Further studies are needed to reveal that nutritional intervention can contribute to falls prevention in stroke patients The Got-A-Minute Campaign has proven successful. Keeping the core team of Stumble Stoppers together was difficult as time passed. Implementing and sustaining changes in practice takes time and compensating for turnover and replacement of core team members was a challenge. Although the Stumble Stoppers understood the fall prevention program was not time-limited, the continuous effort required to support and sustain the initiative was not appreciated fully until 36 months into the initiative White patients were more likely to fall than patients of other races. New associations were found between the odds of falling and antiprotozoal, diagnostic agents, and gastrointestinal agents. Prospective studies are needed to determine the predictive accuracy of these factors. Bedside practitioners should understand the mechanism and onset of action of medications so that individualized safety precautions may be implemented. By including classes of medications as part of fall-risk assessment, patient safety may be optimized, and falls avoided in this high-risk population.
Explanation of How the Article Supports EBP/Capstone Nurse behavior can be a direct barrier to patient safety efforts. An unwillingness to adapt to new efforts for patients safety. Identifying behaviors that enhance patient safety is important so that awareness and education on the critical need for diligent patient safety efforts. Through this study researchers looked at stroke patients who fell post hospital stay. I currently work on a Neurology unit where we see many stroke patients. Falls in this area can be very high as patients have limitations secondary to disease process and cognitive shortcomings as well that make it difficult to keep them safe with current fall prevention efforts.

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Comparative Essay Nursing

Comparative Essay Nursing

Concept Analysis Compassion Fatigue and Effects Upon Critical Care Nurses

Belinda Jenkins, BSN, RN, CEN; Nancy A. Warren, PhD, RN

Walker and Avant’s method of concept analysis was used to delve into the initial understanding of compassion fatigue, a relatively new concept being explored with critical care nurses and other health care professionals. The term was originally used in 1992 involving research exploring burnout experienced by critical care nurses when a trend emerged where nurses appeared to have lost their “ability to nurture.” The term has since been used synonymously with secondary traumatic stress disorder. Two important goals exist for this article: First, theoretically to conduct a concept analysis of compassion fatigue, thereby providing information for critical care nurses to understand the concept as a universal human experience. Second, from a caring perspective, identifying the effects related to critical care nurses provides an opportunity to address physical and somatic consequences of compassion fatigue that will ultimately become important to nursing practice, education, and research. Key words: burnout, compassion fatigue, secondary traumatic stress

T HE PROCESS that will be followed withinthis article is the model developed and implemented by Walker and Avant.1 Eight stages are outlined within the model, and a brief explanation is provided of each. The first stage of the model is to select a concept. Con- cept selection is very important and should be one of interest to the authors or related to the actual work of the authors. This concept should be manageable yet not too broad. Sec- ond, the authors should determine the aims or purposes of the analysis. This section should answer the question why is this concept im- portant to the authors. Third, identification of the uses of the concept that you can discover

Author Affiliations: Belmont University, Nashville, Tennessee (Ms Jenkins); and Department of Nursing, University of Tennessee, Martin (Dr Warren).

The authors have disclosed that they have no signif- icant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Nancy A. Warren, PhD, RN, De- partment of Nursing, University of Tennessee, 136 H Gooch Hall, Martin, TN 38238 (nwarren@utm.edu or belinda.jenkins@pop.belmont.edu).

DOI: 10.1097/CNQ.0b013e318268fe09

in the literature supports the definition of the concept. During this stage, through available literature, dictionaries, thesauruses, and col- leagues, the authors will identify possible uses of the concept. The review of literature will provide the evidence-based foundation for the analysis. During the fourth stage, the defin- ing attributes will be determined. Through the literature reviews regarding the concept, all the similar characteristics emerge. Fifth, a model case is identified. The model case pro- vides the reader an example of the defining at- tributes of the concept; this can be provided in a borderline, related, contrary, invented, or illegitimate case. These are provided in the sixth stage. The seventh stage includes identification of the antecedents and conse- quences. Antecedents are defined by Walker and Avant as those events or incidents that must occur or take place prior to the occur- rence of the concept, and consequences are defined as those events or incidents that occur as a result of the occurrence of the concept. The last stage defines the empirical referents, which are defined as classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself. The goal of this article was

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Compassion Fatigue 389

2-fold: Theoretically, to conduct a concept analysis of compassion fatigue, thereby pro- viding an understanding of the concept as a universal human experience and, from a car- ing perspective, identifying the effects related to critical care nurses by addressing physical and somatic consequences of compassion fa- tigue that will ultimately become important to nursing practice, education, and research. Perhaps, an ongoing dialogue regarding com- passion fatigue and the effects upon nurses in the critical care unit may facilitate actions to identify and prevent compassion fatigue.

PERSONAL AIMS OF CONCEPT ANALYSIS

Reflecting upon the experiences of the au- thors personally gained throughout our nurs- ing career, we believe that we have felt the effects of compassion fatigue and witnessed nursing coworkers showing the effects as well. Past nursing experiences have included time in high-stress environments, where mo- ments in time were crucial, and decisions made immediately affected the outcome of the patient—life or death. Past intensive care unit experiences where seeing uncooperative patients, interstaff conflicts, dying patients, and those patients affected by massive trauma on a daily basis lead to those effects. Over time, fatigue takes a toll upon critical care nurses. The outcomes have involved sleepless nights and still visualizing the faces of the in- jured or dead when trying to sleep, particu- larly if the deceased were young and in the prime of life, or worse yet, a young child. But as one sees those faces of the injured, not in a haunting sense, one reviews one’s perfor- mance and wonders what more could have been done. What could have been done dif- ferently, and would different actions have led to a difference in the outcome of the patient becomes a consuming question. We have also felt emotionally and physically drained after a 12-hour work shift and still tired before arriv- ing at work the next night after resting all day. While feeling and living these emotions, a con- cept to identify with the emotions was nonex- istent. As health care professionals, while tak-

ing care of others, critical care nurses and health care staff tend to lose sight of taking care of themselves. In exploring compassion fatigue and the potential affect upon critical care nurses, perhaps an enhanced awareness and understanding of compassion fatigue can be gained or at least ignite the conversations of others who have had similar experiences.

LITERATURE REVIEW

Taber’s dictionary defines compassion fa- tigue as “cynicism, emotional exhaustion or self-centeredness occurring in a health care professional previously dedicated to his or her work and clients2(p499); compassion as deep awareness of the pain and suffering of oth- ers: empathy; and fatigue as an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at the usual level, and as the condition of an organ or tissue in which its response to stimulation is reduced or lost as a result of overactivity. This definition can cross the lines for many disci- plines and be used to describe compassion.

A phrase that does loosely describe compas- sion fatigue is feeling the pain of the world, with German philosophers addressing this state as “weltschmertz.”3 While compassion fatigue has risen in nursing research only re- cently, nurses have felt the concept world- wide. Some researchers noted that persons who work with the suffering end up suffer- ing themselves, particularly when working with the suffering over time.4,5 While com- passion fatigue is noted more in the litera- ture relating to health care workers, it crosses over into other disciplines. The concept has been addressed in social workers, paramedics, law enforcement personnel, and lawyers. A lack of empirical studies was noted; however, the “clinical” law literature has raised aware- ness of the responses of attorneys working with difficult or traumatized clients who be- gan to feel countertransference and identifica- tion with the victims who were being repre- sented. Increased awareness of this concept has prompted the need for additional train- ing in law schools to assist professionals to

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390 CRITICAL CARE NURSING QUARTERLY/OCTOBER–DECEMBER 2012

prepare for the intense, face-to-face, and highly personal relationships that evolve from the attorney-client relationships. Police offi- cers also reported a greater number of psycho- logical distress and posttraumatic stress symp- toms than mental health care professionals.3-6

Law enforcement officers face stress in vari- ous ways, from working shift work to the na- ture of the job itself as in continuous exposure to violence and suffering. Figley4 propounded that emergency responders and crisis work- ers were at great risk for compassion fatigue. Emergency workers and critical care nurses absorbed the traumatic stress of the victims who were being assisted, particularly if the outcome of the nursing interventions still re- sulted in death. Furthermore, the nurse’s pri- mary focus is on preserving the life of the patient at all costs, so addressing the ensu- ing reactions to death and the reaction of the family members may be distressing and at op- posite ends of the spectrum of preservation of life at all costs. Critical care nurses may suffer their own grief at losing a patient after giv- ing all of their self to the preservation of life, yet family members may require communica- tions regarding critical interventions provided by nurses and supporting health care work- ers. While family members are stressed by the critical care environment and fear related to the many tubes and monitors, the critical care nurses may be stressed and fatigued by family members’ presence and ensuing questions re- garding what happened. Because the nurses are so involved with the physical care of the patient, they frequently have inadequate time to response to family members’ emotional needs, thus adding more stress to a complex situation. Family members may have unrealis- tic goals and expectations of the critical care nurses and assign blame tacitly or overtly to the nurses for the loss of their loved one while in the trust of the nurses.

Compassion fatigue has been described as a natural consequence of caring between 2 people, one who has been traumatized (the critical care patient) and the other who is affected by the first’s traumatic experience (the critical care nurse). It can have a sud-

den onset compared with burnout, which is a gradual progression caused by repeated ex- posure to chronic stressors. Caregivers tend to focus most of the attention to the per- son who is directly involved in the incident and fail to pay attention to their own needs. Compassion fatigue may change the personal and professional lives of the most caring of health care workers, social workers, and per- sonal support workers alike. These changes were noted as difficulty concentrating, intru- sive imagery, loss of hope, exhaustion, and irritability, which many critical nurses seem to have experienced.7,8

In review of the literature, defining charac- teristics emerge repeatedly that describe com- passion fatigue. Dr Charles Figley, PhD, has studied the effects of compassion fatigue. In his studies, Dr Figley found many common characteristics that occur prior to compas- sion fatigue. In 2001, Figley developed an al- gorithm for compassion fatigue, which flows from left to right when printed. The algorithm is called the compassion fatigue process, with the left side of the chart presenting the care- giver exposed to suffering, empathic ability, and concern for the patients. These 3 charac- teristics lead the nurse to respond; however, the critical care nurse may feel detachment or, conversely, feel a sense of satisfaction with the care provided. Over time, this leads to a residual compassion stress. If this continues, then the repeated exposure can possibly lead to the caregiver feeling compassion fatigue from prolonged exposure to suffering and de- mands of caring for another person.

Whatever discipline, whether a critical care nurse, physician, social worker, emer- gency responder, law enforcement officer, or lawyer, the defining antecedent that is most evident is the continuous and repeated expo- sure to stressors. This repeated exposure can lead to emotional exhaustion. Working long hours, with gradual results and exposure to sensitive information can have an emotional toll on the caregiver.8,9 When caregivers ex- perience compassion fatigue, the end result can also be a loss of empathy and a deper- sonalization. Depersonalization refers to the

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Compassion Fatigue 391

process where the client is viewed as less than human. In a national study of persons experiencing compassion fatigue, one-third reported having experienced high levels of depersonalization. Whenever a person is ex- periencing depersonalization, a dramatically increased risk of incorrectly interpreting in- formation that is disclosed to the caregiver becomes apparent. Often when compassion fatigue is experienced, a change in ethical and clinical values appears. For critical care nurses, evidence of compassion fatigue can be lack of appropriate documentation in the chart, or noting that the patients’ best inter- ests are not readily apparent in the nursing care. Negative feelings toward the patient can lead to substandardization of care.

Compassion fatigue is a progressive and fi- nal end result that evolves over time. Empir- ical referents that are present after the nurse has prolonged, and continuous and intense, contact with patients will experience symp- toms both of mental and physical traits. The mental symptoms include feelings of burnout, absence of energy, accident proneness, and emotional breakdown feelings.9,10 Emotion- ally, the person with compassion fatigue will be irritable, emotionally overwhelmed, with desensitization and lack of enthusiasm for pa- tient care. The physical symptoms can in- clude weight loss/gain, loss of strength, re- duce output, diminished performance, loss of endurance, and an increasing in physical com- plaints such as stomach pains and headaches. Spiritually, the person with compassion fa- tigue will experience a lack of spiritual aware- ness or lethargy.

RELATED CONCEPTS

In the literature review, related concepts were often noted and should be presented within this article. Along with compassion fa- tigue, a term that is often used interchange- ably is secondary traumatic stress, which is secondary traumatic stress as the result of knowledge about a traumatizing event expe- rienced by another and the subsequent stress resulting from helping or wanting to help

the traumatized person. Secondary traumatic stress may be nearly identical to posttrau- matic stress disorder, where secondary trau- matic stress resulted from effects happening to those emotionally affected by the trauma of another person; posttraumatic stress disor- der only exists when the person is directly affected by trauma and by being in harm’s way.11,12

Burnout is another closely related concept that is often described within the same lit- erature as compassion fatigue. Shakespeare mentions burnout within the lines of the play The Passionate Pilgrim, written in 1599, as demonstrated by the words “She burn’d with love, as straw with fire flameth . . . . She burn’d out love, as soon as straw outbur- neth . . . .”13(p159) Burnout has been described as a prolonged response to chronic emotional and interpersonal stressors on the job and de- scribed with the term “burnout,” which en- compasses the physical, emotional, and men- tal exhaustion caused by long-term involve- ment in emotionally demanding situations. Burnout develops gradually over time and pro- gressively worsens, with symptoms includ- ing fatigue, illness, disillusionment, cynicism, anger, difficulty sleeping, and a sense of help- lessness and/ or hopelessness.

Emotional contagion is defined as an af- fective process in which an individual observ- ing another person experiences emotional re- sponses parallel to that person’s actual or anticipated emotion.4,13 “Vicarious trauma- tization” is a term closely related and of- ten used interchangeably with compassion fa- tigue. The construct of vicarious trauma states that the psychological distress that occurs over prolonged exposure to trauma actually changes the cognitive aspect of perspective of the caregiver related to such life issues as in- timacy, trust, safety, self-esteem, and control. Nurses experiencing vicarious traumatization no longer feel grounded in the world around them; they begin to question the meaning of life, risk losing a sense of purpose, and hope- lessness may ensue.

The above-mentioned related concepts were found in the literature and used

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392 CRITICAL CARE NURSING QUARTERLY/OCTOBER–DECEMBER 2012

interchangeably. The concepts are all used to across a continuum to address the effects upon the critical care nurses as well as the persons receiving the care.

DEFINING ATTRIBUTES

The repeated characteristics that occur de- scribing critical care nurses and compassion fatigue include the following attributes: • Depersonalization • Reduced output/endurance/diminished

performance • Loss of empathy • Poor judgment

ANTECEDENTS AND CONSEQUENCES

Antecedents were specifically defined as events or incidents that must occur or be in place prior to the occurrence of the concept.1

Antecedents that have been identified reflec- tive of critical care nurses and compassion fatigue include, but are not limited to: • Caregiver exposed to suffering • Continuous and intense contact with pa-

tients • High-stress exposure • High use of self within one’s work

Consequences as events or incidents that occur as a result of the occurrence of the con- cept are defined.1 The following were identi- fied as consequences directly resulting from compassion fatigue that effects critical care nurses: • Loss of empathy • Increase loss of work days due to physical

complaints, stomach pains, headaches • Weight gain/loss • Accident proneness • Emotional breakdown

MODEL CASE

The following is a model case regarding a critical care nurse that contains all the at- tributes:

Nurse A works in a critical care unit of a medium- volume clientele hospital. The critical care unit on average admits 5 to 6 patients a day and for the local area is known for the trauma care provided. Nurse A works as the weekend charge nurse and is currently working her sixth 12-hour shift due to a colleague who is currently out for medical leave and desperately needing to supplement her income. While the critical care is very busy, nurse A is attentive to her patients’ needs and serves each patient with her skills and attends to the emotional and physical needs of each. Three nights ago dur- ing nurse A’s shift, a motor vehicle collision (MVC) with multiple trauma victims arrived. Nurse A, be- ing the charge nurse, assisted in each of the unit rooms and provided additional support to the nurs- ing staff. The victims included a mother and her 3 younger children ranging in ages from 13 to 19 years. The 2 older children were from out of town and home from college for a visit with their mother and younger sibling. The mother and the 2 older children died, and the youngest child was in crit- ical condition and later sent by helicopter to an area trauma center. Nurse A listened to the younger child ask about the mother and about the 2 older siblings. Nurse A was empathetic to the questions and was feeling sadness and concern for the oth- ers involved in the MVC. Since that night, nurse A has had trouble sleeping, having nightmares, and replaying the night over in her head. Nurse A does not call her patients by name anymore, she refers to them as “belly pain in room 3” or as “drunk guy in room 4,” and she makes cynical remarks about her patients in the nurse’s station. Since that night, her work performance has been less than optimal. Nurse A has been making charting mistakes, writ- ing on the wrong chart, and caught herself before making a critical medication error. When assessing a patient during the early morning, nurse A told a 35-year-old patient who was having a myocardial infarction that he probably had indigestion from food slipped in by a family member. When she is off work, she cares for her elderly mother and is currently raising her grandchildren after taking custody from their mother who cannot stop her current drug habit.

The attributes in the aforementioned model case evidenced by nurse A represent traits of experiencing depersonalization. She is no longer calling her patients by their name but by “belly pain in room 3 or drunk guy in room 4.” She is working her sixth 12-hour

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Compassion Fatigue 393

shift, so her endurance levels are subpar. Her work performance is no longer optimal, as ev- idenced by charting mistakes and a near miss on a medication error. Nurse A is making poor judgment skills by dismissing the chest pain as indigestion.

The following is a borderline case, with an explanation to follow:

Nurse B also works in the same critical care unit as a relief charge nurse. Nurse B has worked for the past 4 nights and was working when the above- mentioned MVC case came in. Nurse B took care of the 13-year-old young teen who was flown to the area level 1 trauma center. Nurse B was very atten- tive in her care of the young patient and assisted the flight crew upon arrival. Nurse B has been off for 3 days now and is returning to work. Nurse B has stated that she is still tired and does not feel well and has a headache. She also states that she has not been sleeping well since the last night she worked. Upon arrival of her shift, she has taken re- port from the day shift nurse, and all her rooms are full. Nurse B’s charge nurse asks for report on her patients and she just says “all the same, just a differ- ent day.” Nurse B sticks her head in each room, not addressing the patient’s needs, and rolls her eyes when a family member wants to talk to her about her loved one. Nurse B then takes all her patients charts and finds a quiet area to review and evalu- ate what still needs to be done. Nurse B realized that some of her patients were missing laboratory work, and intravenous antibiotics have not been hung as of yet. Nurse B knows by hospital protocol that intravenous antibiotics must be hung within 4 hours of the doctor’s order, and she has less than 1 hour to get the medications hung. Nurse B settles in for the night and proceeds with her patient care.

This is a borderline case in that nurse B is experiencing depersonalization, by not giv- ing the report on each of her patient, just states “ all the same, just a different day.” Nurse B is performing at subpar work perfor- mance by not addressing her patients’ needs and by rolling her eyes at patient family mem- bers. Nurse B is not experiencing bad judg- ment skills or making mistakes in providing care. Not making mistakes is what defines this model as a borderline case.

The following is an example of a contrary case and will be discussed after the example:

Nurse C also works in the same critical care unit and works as a staff nurse. She has worked there for the past year after graduating from nursing school. Nurse C is exposed to the same working conditions but only works her three 12-hour shifts per week as scheduled. She is juggling the same workload and institutional requirements as nurse A but does not have the responsibilities of a charge nurse. Nurse C loves her job and feels tremendous satisfaction each day when she goes home. Nurse C feels a sense of rewardment, knowing that she has helped each of her patients improve in some way. Nurse C has a smile on her face; she calls each patient by his or her name and addresses him or her when she enters into the room. She does not mind spending extra time talking with family member present and writes down phone numbers and is willing to call family members if the need should arise. Nurse C has a connection with her patients, and she takes pride in sharing the pain that her patients have but sparks feelings of kindness, tenderness, and gen- tleness along with understanding of the patients’ direct needs. Nurse C feels an overwhelming sense of reward when a patient suffers less because of the selfless care she has provided during her shift. Nurse C feels that any negative experiences are far less than the positive experiences she has at work and feels a tremendous satisfaction with her job and looks forward to caring for the next patient.

While nurse C has the same repeated expo- sure as the model case, she is flourishing in the same environment. She is having mean- ingful experiences with her patients and fam- ily members and looks forward to assisting the next patient. In compassion fatigue, the nurses will gradually distance themselves; this is not the case in the contrary example pro- vided.

EMPIRICAL REFERENTS

In Dr Figley’s research, the lack of a mea- surement instrument for compassion fatigue became readily apparent and from that re- search a scale was developed. Originally, this scale was called the Compassion Fatigue Stress Test, but with noted close proximity to other concepts, a revision of the scale was de- veloped. Several revisions have taken place but the Professional Quality of Life Scale,

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394 CRITICAL CARE NURSING QUARTERLY/OCTOBER–DECEMBER 2012

Version 5 (ProQOL 5), is the final and most current scale. The ProQOL 5 is a questionnaire that includes 30 questions with the answers scaled to respond: 0 equals never and 5 equals very often. The questions in the ProQOL 5 range from “I believe I can make a difference in my work” to “because of my [nursing], I have felt ‘on edge’ on certain things.” The ProQOL 5 rates the participant as either com- passion satisfaction or compassion fatigue.10

All of the research indicated the importance of determining those critical care nurses who are vulnerable to compassion fatigue and to quickly address the symptoms. Knowing who is vulnerable can lead to preventing compas- sion fatigue among the critical care nurses.

NURSING IMPLICATIONS FOR CRITICAL CARE NURSES

Prolonged exposure that consists of contin- uous and intense contact with patients expe- riencing life or death trauma, serious illnesses, and sudden critical events in the critical care unit can lead to compassion fatigue. The criti- cal events require nurses to stay on guard and perform at optimal levels continuously for a minimum of 12-hour shifts and ensuring that patients have the best outcomes becomes a cumulative process. If the stress that follows is not addressed appropriately, then the nurses may evolve to a state where the results are be- yond the nurses’ endurance level, the energy expended has surpassed the restored reserve, and recovery power is lost.

Research clearly supports that working with patients who are in pain, suffering, at the end of life, or may have been coded and expired may take an added toll on the physical and mental health of nurses. The experiences of critical care nurses who have had a patient expire in the critical care unit may differ from the experiences of nurse who had a patient expire in other hospital settings.14 Unlike the typical medical-surgical settings, critical care unit nurses may experience death from se- vere, sudden, traumatic events, which require quick, yet thorough, interventions. Initially, family members may not be allowed to remain

in the room with the seriously injured patient. When allowed to visit, family members may see more sophisticated, intimidating equip- ment connected to the patient than would be seen in other areas of the hospital. Family members may be reluctant to touch or com- municate verbally with the patient because of the many tubes and monitors. Nurses, on the contrary, have the difficult task of overseeing the patient and equipment, while providing communications to the family. While the fam- ily members are stressed, the nurse maybe just as stressed, or more so, because of interacting with both the patient and family. Given the complexity of factors that may influence the outcome of the patient, especially if the out- come is death, nurses may feel compassion fatigue. While it is unrealistic to expect criti- cal care nurses to address every aspect of the family needs, when death occurs as the out- come, nurses may begin to respond by com- passion fatigue and return to the old nagging questions of “ What could I have done better?” Nurses began to second-guess their responses or become hypercritical of the care provided.

Native American’s have a saying that each time you heal someone, you give away a piece of yourself until, at some point, you will re- quire healing.13 When compassion fatigue is apparent in the critical care unit, chronic ab- senteeism, high workers’ compensation costs, high turnover rates, and interpersonal con- flicts between nurses are evidenced. Healing from compassion fatigue takes time and dedi- cation among the staff to recognize the effects of compassion fatigue. Employers should take time to educate themselves about compassion fatigue and its effects, teaching the staff by continuing education to overcome the every- day stressors that nurses in the critical care setting deal with routinely on a daily basis. Strategies should be introduced to help heal our healers.

Nurses at all levels must support each other, respect the contributions of all involved in patient care, and reach out to others, particu- larly nurses in need of nurturing and renewal. Evidenced-based practice is required to iden- tify the most pressing issues affecting the

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Compassion Fatigue 395

occurrence of compassion fatigue and iden- tify the association between personal stres- sors, professional stressors, and workplace stressors that contribute to specific negative behaviors. This valuable information may be used in educational programs both to pre- pare new graduates for the exposure to suf- fering and to provide treatment programs and supportive measures to prevent compassion fatigue. Positive beliefs about self, a healthy self-concept, understanding other people and their cultures, continuing to address needs, and listening to what the mind and body are telling one are just a few ways to begin to

avoid compassion fatigue. Self-awareness and balance are keys to maintaining health and the ability to assist in the healing of others.

In conclusion, the intent of the authors with this initial report is to provide an avenue of beginning dialogue in the hopes of finding an- swers. Critical care nurses may be reluctant to deal with the emotions associated with com- passion fatigue; perhaps, many may even find difficulty admitting they are suffering from the symptoms. Stressors associated with compas- sion fatigue may be reduced, perhaps, signifi- cantly if appropriate and timely interventions are identified and provided.

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14. Ruysschaert N. (Self) hypnosis in the prevention of burnout and compassion fatigue for caregivers: the- ory and induction. Contemp Hypn. 2009;26(3):159- 172. doi:10.1002/ch.382.

15. Warren N. Critical car family members satisfaction with bereavement experiences. Crit Care Nurs Q. 2002;25(2):54-60.

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msn 593 week 2

msn 593 week 2

What are 5 questions you would ask the mother next?

1. How high was the temperature and how was it taken (eg, rectal, temporal, axillary, or not taken at all, just by touch)?

2. Any home meds given for fever or is the patient taking any medication OTC or prescribed?

3. How much is the patient feeding and wetting diapers daily?

4. Any recent exposure to anyone sick or does patient attend daycare?

5. How many times did the patient have diarrhea in a day and describe stool for any blood and color?

What additional signs/symptoms would alert you that this infant may need to be transferred to the ER?

-Dehydration

– Failure to Thrive

-Continuous vomiting and labs as indicated

-Any child with fever and petechiae and who appears very ill.

According to Burns ,Dunn, Brady, Starr, Blosser, & Garzon (2017) symptoms that would prompt emergency care include: a change in or new rash, duskiness, cyanosis, or mottling of the skin. Coolness of the extremities, poor feeding or vomiting, irritability, cries with positional changes, difficulty in comforting or arousing, seizure activity and bulging anterior fontanelle.

What are your top 3 differential diagnoses

1. Rotavirus

2. Acute Gastroenteritis

3. Bacterial Gastroenteritis

Rotavirus has an acute onset of fever, vomiting and watery diarrhea occur 2 to 4 day later in children <5 years old, especially those between 3 to 24 months old (Burns et al., 2017).

Reference

Burns, C. E., Burns, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017). Pediatric primary care(6th ed.). St. Louis, MO: Elsevier.

Week 2 Discussion Question

Contains unread posts

Shana Henderson posted Mar 12, 2019 3:06 PMSubscribe

A 6 month old male patient presents to your clinic with his mother. The mother’s chief complaint is that the baby has had a fever and diarrhea for several days and is not nursing as much as usual. The infant is quiet and warm, lung sounds are clear, heart sounds normal. No medical history, born healthy at 39 weeks 5 days via uncomplicated vaginal delivery, he is exclusively breast fed and is up-to-date on his vaccinations.

5 questions to you would ask the mother?

1. How high was the temperature and what have you been giving to treat the temperature?

2. Anyone else in the family sick?

3. Does the child attend daycare?

4. How many episodes of diarrhea does the child have per day? Is there any blood in the diarrhea?

5. How many wet diapers per day are you changing?

What additional signs/symptoms would alert you that this infant may need to be transferred to the ED?

Additional signs and symptoms that would alert me that the infant may need to be transferred to the ED would include a high fever >39C, the infant is lethargic or difficult to arouse, the infant is not producing any tears/dry mucus membranes, persistent vomiting, tachycardia, increased or decreased respirations, decreased urine output, poor muscle tone, delayed capillary refill, pale cool skin, irritability, sunken eyes and sunken fontanelles.

Top 3 differential diagnosis:

1. Viral gastroenteritis

2. Bacterial gastroenteritis

3. Parasitic gastroenteritis

Gastroenteritis in children is a major cause of morbidity in the United States (Churgay, C., & Aftab, Z., 2012). It is defined as the onset of diarrhea in the absence of chronic disease, with or without fever or pain. It is common in children under the age of 5. The rotavirus is the number one cause of diarrhea and hospitalization in young children. After rotavirus, bacteria such as salmonella and shigella are also responsible for acute gastroenteritis in children under 5 years of age. A small percentage of gastroenteritis are caused by parasites such as Giardia intestinalis and Cryptosporidium. It is important that children who are suffering from acute diarrhea be treated as soon as possible to prevent dehydration. Oral rehydration should be the initial treatment if the child is mildly dehydrated. If oral hydration can be tolerated, commercially prepared oral hydration would be appropriate, as long as the child is not vomiting. The caregiver should start out by giving small amounts of liquid then increase as the child tolerates it. In cases where the child has severe dehydration, the infant should be taken to the ER where intravenous fluids can be administered and the child can be monitored for hemodynamic stability (Cochran, W., 2017). Prevention of gastroenteritis starts with proper hand washing. It is important to teach children and caregivers how to properly wash their hands and inform them to avoid improperly stored food as well as contaminated water.

Reference:

Gastroenteritis in Children – Children’s Health Issues. (n.d.). Retrieved from /orders/www.merckmanuals.com/home/children-s-health-issues/digestive-disorders-in-children/gastroenteritis-in-children

Gastroenteritis in Children: Part 1. Diagnosis. (n.d.). Retrieved from /orders/www.aafp.org/afp/2012/0601/p1059.pdf

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Comparing Existential-Humanistic Therapy To Other Types Of Therapy

Comparing Existential-Humanistic Therapy To Other Types Of Therapy

Humanistic Therapy To Other Types Of Therapy

Cognitive- Behavioral Therapy (CBT) is a therapeutic intervention that challenges irrational and destructive cognitive distortions. The idea is that by identifying, challenging, and restating irrational thoughts into rational ones, the individual will be able to do so quickly on his or her own.  He or she would be able to modify thoughts, which directly would modify the emotions and behaviors associated with such thoughts (Epstein and Baucom, 2002).

According to Hawley et al. 2017, positive change in one’s attitude, thoughts, and emotions results in an improvement in one’s behavior and intimately, improvement in depressive symptoms. Since CBT is a short-term psychotherapy, it is usually expected to show positive outcomes in six to twenty sessions. Often Interpersonal Psychotherapy is used with Cognitive Behavioral Therapy for optimal results in symptom severity and frequency of depression (Keisler, 1996).

The existential-humanistic approach to psychotherapy reflects a dynamic middle ground between circumspection and optimism, struggle and possibility, and realism and capacity for change (Schneider, 2016). The humanistic-existential approach also emphasizes holism, self-actualization, facilitative communication, and the therapeutic relationship, all of which would benefit the patient in addiction recovery. The humanistic perspective views human nature as basically good, with the potential to maintain healthy, meaningful relationships and to make choices that are in the best interest of oneself and others. It focuses on personal responsibility and individual freedom. The humanistic-existential theory shows us that humans are complex beings with unique experiences, thoughts, and behaviors that all deserve respect. When that element is present, relationships can be built, and that creates the foundation for change.

K.C. is a 22-year-old female with a history of depression for about 2 years and has been on antidepressants the whole time. The patient has been laid off her job due to the ongoing COVID 19 pandemic, as a result, she lost her insurance and has been unable to afford her prescription medication. The patient scored 12 on a PHQ-9 score from her initial score of 9 about 6 weeks ago with a slight weight gain. The patient is positive about her recovery and has been current on her medication prior to the event listed above. Through the help of her caseworker, she was able to get insurance and was referred to counseling sessions to aid in her recovery. CBT has been known to be one of the best therapeutic approaches for depression, PTSD and anxiety. CBT can be completed in a short amount of time. Also, CBT is highly structured enabling it to be provided in different formats, including in groups, self-help books, and computer programs. Skills learned in CBT are practical and can be incorporated in everyday life. The challenges noted in CBT include the need for commitment as an individual undergoing the therapy, it’s pretty structured that it may not be suitable for clients with complex mental health needs. CBT has also been known not to address underlying conditions leading to the present diagnosis and also failure to address wider problems in systems or families.

For purposes of this paper, Esi is a girl who has no underlying mental health condition but fell into depression after recently breaking up with her long term boyfriend during this COVID 19 pandemic. He broke up with her because he felt she gained too much weight and is no more attractive. She feels worthless and now has low self-esteem. She is not dealing with it well and was referred to psychotherapy by an associate. I believe the humanistic-existential therapy would be a useful psychotherapy approach for her. This because it is optimistic and looks at potential in people to become great and not the lack thereof. It focuses on individual behavior and is person-centered counseling. The limitation lies in the fact that people who are afraid are unable to confront their inner selves. I chose the humanistic-existential therapy because of the way it allows clients to see the potential in them and makes clients believe that no matter what it is, there is good in them and deserves respect and this is what I believed Esi needs to hear to build her self-esteem up.

Reference:

American Psychological Association. (2017). Ethical principles of psychologists and code of

Conduct. http://apa.org/ethics/code/index.html

Epstein, N., & Baucom, D.H. (2002). Enhanced Cognitive-Behavioral Therapy for Couples: A

Contextual Approach.

Kiesler, D. J. (1996). Wiley series in clinical psychology and personality. Contemporary

Interpersonal theory and research: Personality, psychopathology, and

psychotherapy. John Wiley & Sons.

Schneider, K.J. (2016). Existential-humanistic psychotherapy. (In The Professional Counselor’s

 

Desk)

 

Stebnicki, M.A. Ed: 2nded.). New York, NY: Springer Publishing

 

Company.

 

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

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Comparing Existential-Humanistic Therapy To Other Types Of Therapy

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PICOT PowerPoint Presentation

PICOT PowerPoint Presentation

Develop a change project and to implement this project in the field. To review the early steps in the research process, we have developed a mini-practice research assignment to prepare you. During this lesson, you will use the PICOT questioning format/formula to develop an answerable research question. All elements are listed below:

  • P: Population/disease (age, gender, ethnicity, disorder)
  • I: Intervention or variable of interest (exposure to a disease, risk behavior, prognostic factor)
  • C: Comparison (a placebo or “business as usual” such as no disease, absence of risk factor, or prognostic factor B)
  • O: Outcome (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)
  • T: Time (the time it takes to demonstrate an outcome; e.g., the time it takes for the intervention to achieve an outcome or how long participants are observed)

Prepare an evidence-based practice (EBP) PowerPoint presentation on a topic of your choice that is relevant to advanced nursing practice education, leadership, quality improvement, or change.

Your presentation should include:

  1. Identification of an advanced practice nursing issue or practice problem of concern
  2. Design a research question using the PICOT format
  3. A brief literature review and findings related to best practices with at least three scholarly resources cited in APA (6th ed.) format
  4. Plan, Do, Study, Act Process that could be used
  5. Any implications that the investigation might have for nursing practice

Remember is for Nursing related topic.

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ADDITIONAL INSTRUCTIONS FOR THE CLASS

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  • Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

  • Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

  • APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

  • Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

  • LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

  • Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

  • Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Nurs 6630

Nurs 6630

Nurs 6630

Question 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?

a) order herpes simplex virus (HSV) antibody testing

b) Order a blood urea nitrogen (BUN) and creatinine STAT

c) Prescribe lidocaine 5%

d) Prescribe hydromorphone (dilaudid) 2mg

Question 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

a) Increase the dose of lamotrigine (Lamictal) to 25mg twice daily

b) Ask if the pt has been taking the medication as prescribed

c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient

d) Order a CBC to assess for an infection

Question 22

An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do?

a) order an X-ray because it is possible that she dislocated her hip

b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon

c) Order naproxen because she may havarthritis and chronic pain is not uncommon

d) Order morphine and physical therapy

Question 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP?

a) Orders liver function tests

b) Educate the patient on avoiding grapefruits when taking this medication

c) Encourage this patient to keep fluids to 1500ml/day until the swelling subside

d) Order BUN/Creatinine test

Question 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?

a) Prescribe estrin FE 24 birth control

b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain

c) Prescribe desvenlafaxine (Pristiq) 50mg daily

d) Prescribe Risperdal 2mg TID

Question 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

a) “the SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”

b) “the SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”

c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex”

d) “the SNRI can increase neurotransmission to descending neurons”

Question 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

a) Venlafaxine (Effexor)

b) Duloxetine (Cymbalta)

c) Clozapine (Clozaril)

d) Phenytoin (Dilantin)

Question 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels

b) It will induce synaptic changes, including sprouting

c) It will act on the presynaptic neuron to trigger sodium influx

d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain

Question 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition?

a) Venlafaxine (Effexor)

b) Armodafinil (Nuvigil)

c) Bupropion (Wellbutrin)

d) All of the above

Question 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

a) Methylphenidate (Ritalin)

b) Viloxazine (Vivalan)

c) Imipramine (Tofranil)

d) Bupropion (Wellbutrin)

Question 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

a) Pregabalin (Lyrica)

b) Duloxetine (Cymbalta)

c) Modafinil (Provigil)

d) Atomoxetine (Strattera)

Question 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?

a) Pregabalin (Lyrica)

b) Gabapentin (Neurontin)

c) Duloxetine (Cymbalta)

d) B and C

Question 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

a) Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog”

b) Targeting the patient’s symptoms with anticonvulsants that inhibits gray matter loss in the dorsolateral prefrontal cortex

c) Mzatching the patient’s symptoms with the malfunctioning brain circuits and neurotransimitters that might mediate those symptoms

d) None of the above

Question 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

a) “SSRIs only increase norepinephrine levels”

b) “SSRIs only increase serotonin levels”

c) “SSRIs only increase serotonin and norepinephrine levels”

d) “SSRIs do not increase serotonin or norepinephrine levels”

Question 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

a) Antipsychotics

b) Lithium

c) SSRI

d) Naltrexone

Question 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

a) “Naltrexone may be an appropriate option to discuss”

b) “there are many medicine options that treat Kleptomania”

c) “Kevin may need to be prescribed antipsychotics to treat this illness”

d) “Lithium has proven effective for treating kleptomania”

Question 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

a) Anticonvulsant mood stabilizers can eradicate limbic irritability

b) Atypical antipsychotics can increase subcortical dopaminergic stimulation

c) Stimulants can be used to decrease frontal inhibition

d) Opioid antagonists can be used to reduce drive

Question 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

a) It will prevent feelings of euphoria

b) It will amplify impulse control

c) It will block testosterone

d) It will redirect the patient to think about other things

Question 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

a) “Compulsive internet use can be treated similarly to how we treat people with substance use disorders”

b) “internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences”

c) “When it comes to internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods”

d) “there are no evidence-based treatments for internet addiction, but there are behavioral therapies your daughter can try”

Question 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs”, he says. Which statement best describes the neurobiological parallels between food and drug addiction?

a) There is decreased activation of the prefrontal cortex

b) There is increased sensation of the reactive reward system

c) There is reduced activation of regions that process palatability

d) There are amplified reward circuits that activate upon consumption

Question 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

a) Histamine 2 receptor antagonist

b) Benzodiazepines

c) Stimulants

d) Caffeine

Question 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

a) Avoiding prescribing the patient a drug that blocks H1 receptors

b) Prescribing the patient a drug that acts on H2 receptors

c) Stopping the patient from taking medicine that unblocks H1 receptors

d) None of the above

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Professional Capstone And Practicum Reflective

Professional Capstone And Practicum Reflective Journal

Students maintained and submitted weekly reflective narratives throughout the course to explore the personal knowledge and skills gained throughout this course. This assignment combines those entries into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

This final submission should also outline what students have discovered about their professional practice, personal strengths and weaknesses that surfaced during the process, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and, finally, how the student met the competencies aligned to this course.

The final journal should address a variable combination of the following, while incorporating your specific clinical practice experiences:

  1. New practice approaches
  2. Interprofessional collaboration
  3. Health care delivery and clinical systems
  4. Ethical considerations in health care
  5. Practices of culturally sensitive care
  6. Ensuring the integrity of human dignity in the care of all patients
  7. Population health concerns
  8. The role of technology in improving health care outcomes
  9. Health policy
  10. Leadership and economic models
  11. Health disparities

While APA style 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.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

2.3:     Understand and value the processes of critical thinking, ethical reasoning, and decision making.

4.1:     Utilize patient care technology and information management systems.

4.3:     Promote interprofessional collaborative communication with health care teams to provide safe and effective care.

5.3:     Provide culturally sensitive care.

5.4:     Preserve the integrity and human dignity in the care of all patients.

JOURNAL ENTRIES 7

Journal Entries

BERI SUNJO

Grand Canyon University

NRS 493

12/19/2020

Journal Entries

Week #1

New Practice Approaches

I have learned and gone through different peer reviewed articles which has enabled me to become competent and familiar with new practice approaches in nursing practice. So much has changed in the 21st century as nurses and healthcare workers in general have adopted evidence based strategies in solving eminent and persistent diseases. An example is where use of hand hygiene to decrease chances of getting hospital acquired infection is implemented in different hospitals (Patelarou et al., 2017). Other conditions such as obesity, asthma, and diabetes have evidence based strategies to tackle them. Nurses and healthcare practitioners are also focusing more on patient based strategies as diseases and health concerns are different which helps them treat conditions appropriately. The use of statistics to improve healthcare outcomes has also been improved in the 21st century as nurses evaluate patient outcomes using statistics which helps them to devise new methods that are relevant to certain conditions and patients based strategies in healthcare.

Inter-professional Collaboration

I have observed and experienced a lot when it comes to inter-professional collaboration. I believe that as a nurse, I need to always partner with other professionals in the organization to ensure that I achieve and improve patient care. An example is where information technology professional’s partners with nurses to come up with relevant technology to for example improve safety of the patients in the wards (Kristensen, Nymann & Konradsen, 2015). I have also learned that collaboration makes work easier and improves quality of care that is given by professions in care. Accountability and transparency also comes with inter-professional collaboration as nurses and other professionals have to work together to ensure that an objectives is achieved.

Health Disparities

I have learned that health disparities need to be advocated for by nurses for patients to receive quality healthcare irrespective of their economic, social, and political orientation in the society. This can be done through lobbying federal and state governments to increase resource allocation which will consequentially improve buying of drugs and improvement in health facilities in vulnerable areas and populations such as immigrants and refugees as well as African American communities and other minority groups in America (Knipe et al., 2020). I have also noted that wealthy people are always faced with chronic diseases such as diabetes, obesity, and heart conditions because of the foods and lifestyle they live compared to poor people whose prevalence of these diseases are not prevalent as seen among economically stable persons in America.

Ethical Considerations in Healthcare

Observing ethical code of conduct in healthcare is relevant in ensuring that patients’ rights are not crossed and nurse’s relevance of decisions they make during care of the patients. An example is where I have learned that patient’s informed consent is crucial and legally binding before a procedure can be performed on the patients (Suleiman, 2019). Privacy and confidential of information is also crucial ethical conduct that nurses need to have with the information of patients as when they leak it without patients consent they can be sued an pay for damages an even their license revoked. I have also learned to be accountable for my actions as a nurse that makes me become more responsible and concentrate on doing what is right for the patient. Non-maleficence, fidelity, beneficence, normative ethics are some of the ethics that I have learned that they exist in the nursing practice and they are important in observing if a nurse wants to improve patient outcomes.

Population Health Concerns

My reflective journal for this week is on population healthcare concern. Despite the expanding literature on the importance role public policy plays in influencing the broader determinants of the public’s health, profound differences exist among jurisdictions in the attention placed by the State – as represented by public health authorities and agencies – upon such activities. In this reflective journal we examine the dominant public health models of Canada and USA The Canadian public health communities are focused upon individualized approaches to risk management. In contrast, the US public health scenes are more oriented toward broader approaches to health determinants. We argue that the extent to which governments, public health agencies and public health workers concern themselves with public policy approaches to address broader determinants of health depends upon the particular model of health adhered to within each jurisdiction. And whether a health model is adopted depends upon the ideological and political context within which a nation is situated. Canada represents a situation where concerted effort to influence governmental Population Health Concerns policy directions by the public health community could reap significant benefits

The role of Technology in improving Healthcare Outcomes

The role of technology in improving health care outcomes. A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research.

Health Policy

Healthcare policies are relevant in addressing healthcare concerns in the society and in the country in this case America. I have learned so much about healthcare concerns which include different policies which include Medicare, Medicaid, and affordable care act which were enacted to improve healthcare outcomes. I have also learned a lot about the importance of advocacy as a nurse which enables governments to increase resource both physical and financial in healthcare sectors or come up with health policies that are meant to improve health conditions of patient populations. However, health policies are not just enacted at national and state levels only but even at the workplace. An example is where at the place I work, there is a policy not to smoke tobacco or drink alcohol at the workplace. This ensures that there is reduction of conditions that are associated with alcohol and smoking related lifestyles

Practices of culturally sensitive care

Being sensitive t cultural orientation of the patients is one of the strategies that is used by health professionals to increase quality of patient care. I have learned that as a nurse, it is always good to be sensitive about culture and language that patients speak so that one can resonate well with patients for them to feel comfortable. Studies show that patients recover faster or pen up to health professionals when they know that they are from their culture or that they understand their cultural diversity. This means that as a healthcare professional, one need to develop listening skills, be aware of cultural diversity, and stop making assumptions which might lead to judgment from the patients.

Ensuring the integrity of human dignity in the care of all patients

Privacy, confidentiality, and respect are some of the issues that patients expect from nurses and other health care professionals when attending to them to ensure that they preserve their dignity in their care. Through beneficence and non-maleficence ethics, nurses should always ensure that they give patients human dignity required (Winter, 2018). Through continuum of care, nurses and healthcare professionals can also ensure that they give their patients human dignity through quality of care to ensure their safety in hospital. Effective communication and being sensitive to older patient needs is an expression of human dignity from nurses.

Health care delivery and clinical systems

I have learned about the clinical systems importance in storing and manipulating patient data. This is essential as it enables people to come up with treatment plans and diagnostic tools in nursing which eases work and improves patient’s outcomes. Healthcare delivery system comprise of social expectations, budget, technology, and structure of healthcare and how this can be utilized to improve community healthcare (Miller et al., 2020). I have learned that this is essential as it enables organizations to make informed decisions in healthcare. One of the clinical systems that I have come to learn about and is widely used by the clinicians is electronic health records which are essential in manipulating healthcare data.

Leadership and economic models

There are different leadership skills that I have learned that exist in the nursing profession. They include servant leadership, democratic, and transformative leadership. However, I prefer to use democratic leadership skills as it involves team work and inter-professional collaboration which is essential in ensuring that there is achievement of goals and objectives of the organization collectively (Duncan, 2019). I have also established that economic models are essential in achieving success in leadership in healthcare. Education and continued working hard to gain experience are relevant to one improving their leadership and economic skills in the healthcare organization.

References

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient

safety. Saudi medical journal38(12), 1173.

Duncan, M. (2019). Integrated care systems and nurse leadership. British journal of community

nursing24(11), 538-542.

Knipe, D., Evans, H., Marchant, A., Gunnell, D., & John, A. (2020). Mapping population mental

health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis. Wellcome Open Research5(82), 82.

Kristensen, N., Nymann, C., & Konradsen, H. (2015). Implementing research results in clinical

practice-the experiences of healthcare professionals. BMC health services

research16(1), 48

Patelarou, A. E., Kyriakoulis, K. G., Stamou, A. A., Laliotis, A., Sifaki-Pistolla, D.,

Matalliotakis, M., … & Patelarou, E. (2017). Approaches to teach evidence-based practice among health professionals: an overview of the existing evidence. Advances in medical education and practice8, 455.

Suleiman AlMakhamreh, S. (2019). Ethical Considerations for Health Care in Social Work in

Jordan: What Could Bring Joy to Elderly Refugees in Times of Despair?. Ethics and Social Welfare13(4), 409-423.

Miller, K. E., Singh, H., Arnold, R., & Klein, G. (2020). Clinical decision-making in complex

healthcare delivery systems. In Clinical Engineering Handbook (pp. 858-864). Academic Press.

Winter, S. F. (2018). Human dignity as leading principle in public health ethics: a multi-case

analysis of 21st century German health policy decisions. International journal of health policy and management7(3), 210.

1

Journal Entries

BERI SUNJO

Grand Canyon University

NRS 493

12/19/2020

1

Journal Entries

BERI SUNJO

Grand Canyon University

NRS 493

12/19/2020

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Professional Capstone And Practicum Reflective Journal

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ADDITIONAL INSTRUCTIONS FOR THE CLASS

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  • Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

  • Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

  • APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

  • Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

  • LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

  • Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

  • Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Transition to Professional Nursing

Transition to Professional Nursing

Module 3 Assignment: Information Retrieval Paper – Part 1

This Module you will begin to develop an Information Retrieval Paper. This Assignment focuses on identifying appropriate evidence-based nursing practices related to specific problems you may identify as you work in the healthcare/workplace setting.

The goals of an Information Retrieval Paper are to (1) practice using APA format, (2) summarize and examine the strengths and limitations of research articles, and (3) prepare you for the Nursing Research Course where you will write a research paper using the skills you have learned completing this Information Retrieval Paper.

As a part of your Information Retrieval Paper, you will begin development of a research question using PICO format. Chapter 10 of the Role Development text book explains PICO. Be sure to develop your research question and then just below your research question delineate what the P, I, C, and O components of your question are.

For this Module 3 Assignment you will prepare a Title Page in proper APA format for your Information Retrieval Paper, identify three peer-reviewed articles, and summarize each article using APA format.

It may be helpful to look at the outline for the entire paper before you begin this Module’s Assignment. Assignments in this Module plus in Module 4 and 5 will address the Information Retrieval Paper.

Resources

APA Module*

http://isites.harvard.edu/icb/icb.do?keyword=apa_exposed (This is also printable. Follow instructions in the tutorial.)

Scholarly Writing Tips*

(*Available in the Resource section of this module)

MS Word Tutorial for Beginners:

/orders/www.youtube.com/watch?v=a_ddFubJ3tc

Choose the tutorials you need.

Review your course readings, lecture, and your Module 2 Resources before completing this module’s Assignment.

Performance Objectives

· Identify a clinical problem in your workplace setting.

· Develop an appropriate research question using PICO criteria and format.

· Summarize 3 peer-reviewed, evidence-based articles/literature related to your clinical problem and research question.

· Apply a decision-making framework to a clinical problem situation.

· Use correct grammar, punctuation, and APA format expected in writing professional papers.

Rubric and PICO Format

Use this rubric to guide work on the Module 3 assignment, “Information Retrieval Paper, Part 1.”

Research question must be stated in PICO format. See Chapter 10 of the Role Development textbook for the formatting. Be sure to address all four PICO components of the question.

Task

Accomplished Proficient Needs Improvement

Part 1: Problem Identification Research Question Rationale for Question

Must be constructed in the PICO format.

(Total 25 points)

Identifies a clinical problem in the workplace that would be under a nurse’s control. (10. points)

Develops an appropriate research question using the 4 stated criteria from assignment (5 points)

Question is stated in PICO format. Problem, Intervention, Comparator, and Outcome is clearly stated. (5 points)

Clearly explains a rationale for the selection of a research question.(5 points)

Clearly identifies a clinical problem in the workplace.(7 points)

Develops an appropriate research question using 3 criteria from assignment.(3 points)

Question is stated in PICO format but problem, intervention, comparator, and/or outcome is not clearly stated. (3 points)

Explains the rationale for the selection of a research question. (2 points)

Does not clearly identify a clinical problem in the workplace.(0-5 points)

Uses none or 1 or 2 criteria in composing a research question.(0-2 points)

Did not use PICO format at all when delineating the research question.

(0 points)

Provides no rationale for the selection of a research question.(0 points)

Part 2: Title Page Components using UT Arlington College of Nursing Title Page Format

(Total 12.5 points)

Develops title page components in College of Nursing Title Page Format using APA format with no errors. (12.5 points) Develops title page components in APA format with no more than 3 errors. (7.5points) Does not use College of Nursing Title Page Format or creates title page with more than 3 errors. (0 pts)

Part 3: APA References and Summaries

Summarize peer-reviewed, evidence-based literature related to a clinical problem. (Total 25 points)

Apply a decision-making framework to a clinical problem situation. (Total 12.5 points)

Use correct grammar, punctuation, and American Psychological Association (APA) format in writing professional papers. (Total 25 points)

Clearly and concisely summarizes 3 professional, peer-reviewed articles that address a research question. (25 points)

Effectively applies a decision-making framework in selecting articles related to a clinical problem situation.(12.5 points)

Consistently uses correct mechanics and APA format in writing professional papers (0-2 errors). (25 points)

Summarizes 3 professional, peer-reviewed articles that address a research question. (15-22.5 points)

Applies a decision-making framework in selecting articles related to a clinical problem situation.(7.5 points)

Uses correct mechanics and APA format in writing professional papers (3-8 errors). (15-22.5 points)

Summarizes 1 or 2 professional, peer-reviewed articles that address a research question.(0-12.5 points)

Selects articles, but does not apply a decision-making framework.(2.5point)

Does not use correct mechanics and/or APA format in writing papers (more than 8 errors). (0-12.5 points)

Preview of Information Retrieval Paper Criteria

In this module’s assignment, you will take the initial steps in composing an Information Retrieval Paper that you will complete during Part B of the course. Because the paper will be submitted in sections, may want to look at the entire paper in the table below.

APA Format Elements Timeline
Title Page in APA format Completion Timeline

APA format

Citations in the body of the paper

Headings

Applicable each time sections are submitted

Writing style

Grammar

Spelling

Paragraphs of at least three well-written sentences

Organization and flow

Applicable each time sections are submitted
Content Criteria Timeline

Introduction:

Identification of clinical problem in a workplace setting

Research question stated correctly

PICO format

Rationale for question

To Be Completed Module 3

Summary of 3 peer-reviewed articles

Overview: Where did you search? How did you decide on the 3 articles?

3 article summaries

To Be Completed Module 3

Critical Analysis

Completeness of analysis

To Be Completed Module 4

Conclusion

Synthesis of key points for the 3 articles

To Be Completed Module 5

Reference Page

Alphabetized

Sources cited in APA format

References complete

To Be Completed Module 5
   

Part 1: Research Problem and Question using PICO Format

A. In the space below, identify the clinical problem in the workplace setting that will serve as the focus of your information retrieval paper. Make sure that the problem is one that would be under your complete control as a nurse.

Clinical Problem (Type in box below)

B. In the space below, compose a preliminary research question about the clinical problem that you identified in the workplace. Use this criteria in composing a preliminary research question:

– Question must relate to a clinical problem in the workplace.

– Question cannot be answered with a simple yes or no.

– The issue to be studied is under your complete control as a nurse.

– The question is open ended.

Delineate the PICO components of your question.

· State your question

· Then under the question

P (problem) =

I (intervention) =

C (comparator) =

O (outcome) =

Preliminary Research Question and Identified PICO Criteria (Type in box below)

C. Compose a rationale that explains why you chose the research question. (Type in box below)

Rationale for Selecting the Research Question (Type in box below)

D. After completing this portion of the Assignment, go to this module’s Discussion, and follow the directions for sharing your research question. After receiving feedback from your colleagues, revise your research question, if necessary, in the space provided.

Revised Research Question (Type in box below)

E. Complete after participating in the Module 3 Discussion. Type your revised Research Question in the box provided below.

Part 2: Title Page Components

In this part of the Assignment, you will record the parts of the title page for your Information Retrieval Paper by typing into the text boxes in the graphic organizer that follows the instructions chart.

Content Criteria
Section or Section Title Description How-To and Tips
Use APA: The Easy Way, Second Edition.

· 1” margins all around

· Font – Times New Roman, 12 pt

· Double-spaced

· See APA: The Easy Way for formatting of paper.

· Professional grammar, spelling, and punctuation, and paragraphs composed of at least 3 well-written sentences each

· Select File – Page Setup…

· Select Format – Font…

· Select Format – Paragraph…

· Select View – Header and Footer…

(Refer to the MS Word “Help and How To” links if you need help with any of these tasks.)

The short title should be in upper- and lower-case, or “Title Case.”

· See “Scholarly Writing Tips”

Entire paper

· Just below Header, include a “running head” as shown below, left-justified: (Replace “CAPITALIZED ABBREVIATED TITLE” with an abbreviated version of your paper’s title.)

Running head: CAPITALIZED ABBREVIATED TITLE

· Title in upper half of page, centered, upper- & lower-cased letters (Title Case)

· Title is content of unique paper, not assignment title.

· Submitted by, Student name, RN

· The following information centered, 1-2 inches from the bottom of the page: (Fill in course, faculty details.)

In partial fulfillment of the requirements of

Course name and number

Faculty name, credentials

Submission date

APA: The Easy Way. Second Edition, Pages 7 & 48.

The running head appears only on the title page, and includes the words “Running head.”

You can access the complete UTA directions and an example title page at http://www.uta.edu/nursing/APAFormat.pdf

Your finished Title Page should resemble the Title Page right after this grid. See next page.

Title Page: UT Arlington College of Nursing Format

Running head: TITLE IN ALL CAPS 1

Title of Paper

Submitted by

Your name, RN

In partial fulfillment of requirements of

Course name and number

Faculty name and credentials

Submission date

Part 3: APA References and Summaries

· Select three peer-reviewed, evidence-based articles that address your research question.

· Compose an overview about your choice of the three articles. Answer these questions:

· Where did you search for articles?

· How did you decide what articles to include?

· Post references to the three articles in APA format.

· Summarize the article and how it addresses your research question.

Overview

Where did you search for articles? How did you decide what articles to include?

Article 1

In the space below, post the reference for the first article in correct APA format.

In the space below, write a summary paragraph in APA format. Use scholarly writing to describe the article, the decision-making framework you used to select the article, and how it addresses your research question. Use professional writing style.

Article 2

In the space below, post the reference for the second article in correct APA format.

In the space below, write a summary paragraph in APA format. Use scholarly writing to describe the article, the decision-making framework you used to select the article, and how it addresses your research question. Use professional writing style.

Article 3

In the space below, post the reference for the third article in correct APA format.

In the space below, write a summary paragraph in APA format. Use scholarly writing to describe the article, the decision-making framework you used to select the article, and how it addresses your research question. Use professional writing style.

Submitting Your Assignment:

(Save all assignment documents in MS Word 2007 version and later. MS Word 2010 is recommended. Open Office and Office 360 documents are to be saved as MS Word 2010 or Word 2013 before uploading into Blackboard for grading)

· Click the word Assignment in the Module 3 folder.

· Click on the words Information Retrieval Paper, Part 1. The assignment submission document will open.

· Go to 2. Assignment Materials-Submission. Click Browse and navigate to your Desktop where you saved your paper. Select the final version of your paper to upload from your computer.

· When you’ve selected your paper, click Attach Files and your saved assignment document should appear in the submission box just above the Attach Files button.

· Click Submit at the bottom of the Assignment Submission screen and your saved document assignment will appear the gradebook with a green exclamation point that alerts your Academic Coach that your assignment is ready for grading.

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N3345 Transition to Professional Nursing

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N3335 Health Promotion Across the Lifespan

N3335 Health Promotion Across the Lifespan

N3335 Health Promotion Across the Lifespan

N3335 Health Promotion Across the Lifespan

N3335 Health Promotion Across the Lifespan

Overview: Health Risk Assessment and Health Promotion Contract

Go to the website /orders/www.virginiamason.org/home/body.cfm?id=149 and complete the Health Risk Assessment. You will NOT submit the online results of the HRA for grading. (The HRA will ask for some information such as blood pressure and cholesterol levels, but if you do not know that information, you may click “I don’t know.”)

For each section of the Health Risk Assessment in the document below, provide a substantial summary of your results from the HRA taken online. In each section’s summary, be sure to include any additional information of your health and lifestyle that might play a role in your overall wellness.

You will contract to change/improve one health behavior during this course. Your Health Risk Assessment can give you guidance on your choice, but you do not have to choose to work on the area in which you scored lowest on your Health Risk Assessment.

Part of the contract requires you to evaluate your current “stage of change” according to the stages described by Zimmerman, Olsen, and Bosworth in the article, “A ‘Stages of Change’ Approach to Helping Patients Change Behavior.” ( www.aafp.org/afp/20000301/1409.html .)

You will be tracking your progress toward the goals in your contract by completing journal entries for four weeks, then analyze your motivation, successes, and obstacles in the final week of the course.

Objectives:

· Devise a personal Health Promotion contract to be used for the duration of the course.

· Discuss the Stages of Change model in relation to health behavior changes for others and self.

Rubric

Use this rubric to guide your work on the assignment, “Health Risk Assessment and Health Promotion Contract.”

Task Accomplished Competent Needs Improvement

Health Risk Assessment

(Total 50 points)

 

All sections include thorough summaries of the online HRA results, with additional details of your health and lifestyle that might play a role in your overall wellness (ie. “I don’t drink or smoke” is not considered a substantial explanation)

(50 points)

At least 5 sections completed thoroughly, with substantial summaries and additional details, but not all sections completed thoroughly with substantial detail

(35 points)

At least 2 sections completed thoroughly, with substantial summaries and additional details, or no sections completed thoroughly.

(15 points)

Health Promotion Contract

(Total 50 points)

Student must submit HP Contract to pass this course

 

All 5 sections completed, including measurable goals, correct target dates, and reasonable rewards, etc…

Each item inserted in the correct field on the template (goals, dates, rewards, etc…)

(50 points)

All sections completed, but not all goals are measureable, dates are missing or all not inserted in the template, missing some or all rewards

(35 points)

Minimal sections addressed completely or correctly, or no sections addressed

(15points)

Please note: If your goals are not measurable, your Journal Analysis grade also will be affected. Your goals must be measurable so that you can analyze whether you did or did not meet your goals later in the course.

Health Risk Assessment

When you receive the results of your online Health Risk Assessment, use them (and any other information about your own health and lifestyle that play a role in your overall wellness) to summarize the results thoroughly in each section below. Summary of each section must be substantial and include details to receive credit.

Blood Pressure/Cholesterol/Diabetes

Weight

Food

Tobacco and Alcohol

Well Being

Activity

Heart Health

Health Promotion Contract

Your goals should be written in SMART goal format, meaning they should be Specific, Measurable, Attainable, Realistic, and Timely. Please go to these two websites for more detailed information on SMART goal format: http://www.cooperinstitute.org/2011/12/goal-setting-sample-tool/

http://www.scholastic.com/teachers/top-teaching/2016/01/setting-almost-smart-goals-my-students

Identify one goal to work toward during this course, knowing that you will be journaling about your progress in your journaling assignment, four times a week for four weeks.

An example of a goal that is NOT in SMART goal format is: I will walk more often.

An example of a properly formatted SMART goal is:

I, (student name), will walk for 30 minutes, three times a week by 10/1/16. (The date inserted here should be the Saturday of Module 4 for your course.)

Your SMART goal:

1. I, [Name]

agree to

by [date: [Saturday of Module 4]

2. I will use the following tools to monitor my progress:

The weekly assignment Journal and (at least one other tool)-

[chart, graph, scales, etc., as appropriate for your goal]

3. To reach my final goal I have devised the following schedule of goals and

rewards [Need two mini-goals and your final goal (as written above in #1) and also list rewards for all. Be sure that your mini goals match your final goal, meaning they are in alignment with and will help you achieve your final goal. As in the example goal of walking, then both mini goals should address walking – see highlighted area below].

You should have a total of 3 goals, 3 dates, and 3 rewards in the template below.

GOALS TARGET DATE REWARD

Mini goal example:

I will walk 10 minutes twice a week

Mini goal end date Take time to get a manicure
Mini goal #1: write your specific measurable mini goal here-

Saturday, Module 2 of your course

Insert target month/day/year

 

Write your reward here:
Mini goal #2: write your specific measurable mini goal here-

Saturday, Module 3 of your course

Insert target month/day/year

Write your reward here:
Final goal (as written in SMART goal organizer above): write your specific measureable Final Goal here-

Saturday, Module 4 of your course

Insert target month/day/year

Write your reward here:

4. I am currently in the _______________________ Stage of Change (Must be a stage of change from the five stages of change article in last week’s readings) because:

[Concisely, but with substance, discuss why you think you are in this stage].

5. _____________________________________ ___________________

[Your email address indicates your signature] [Date]

Module 1: Health Risk Assessment and Health Promotion Contract

insert month/day/year

PAGE

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COMMENT THOMAS DQ2

COMMENT THOMAS DQ2

I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120  WORDS

Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP project. Why? Has your mentor used either theory, and to what result?

 

The first change theory is Lewin’s Change Theory. This theory is very widely used in nursing. This theory has three stages the unfreezing stage, moving stage, and refreezing stage. The theory has driving and resistant forces and for the theory to be successful the driving forces have to overcome the resistant forces. The other change theory is Rogers’ Change Theory. This theory has 5 stages and they are awareness, interest, evaluation, implementation and adoption.(Oguejiofo,2017) It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially. Both of these theory’s are widely used in nursing and both require nurses that want the change or who are willing to make the change. My mentor has used the Lewin’s change theory recently. The hospital already has hourly rounding but she just introduced new paperwork that has to be signed every hour. The unfreezing period she just explained how the new way will be better and she showed the nurses how it will be easier because the techs can also sign the sheet. The moving stage she let the nurses tell her how they feel about the whole situation and letting them express what they think will work. The final stage is refreezing and during this stage she went around for the first week making sure the nurses get this in their daily habit. I believe this theory makes more sense to my EBP because there are a lot of nurses that will be the driving force to make this happen and less people being the resistant force. So, it will be more likely to succeed.

References:

 

Oguejiofo,N. September 26, 2017. Change Theories in Nursing. /orders/bizfluent.com/about-5544426-change-theories-nursing.html

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ADDITIONAL INSTRUCTIONS FOR THE CLASS

Who We Are 

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  • 1. Click on “Order Now” on the main Menu and a new page will appear with an order form to be filled.
  • 2. Fill in your paper’s requirements in the “PAPER INFORMATION” section and the system will calculate your order price/cost.
  • 3. Fill in your paper’s academic level, deadline, and the required number of pages from the drop-down menus.
  • 4. Click “FINAL STEP” to enter your registration details and get an account with us for record-keeping and then, click on “PROCEED TO CHECKOUT” at the bottom of the page.
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  • Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

  • Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

  • APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

  • Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

  • LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

  • Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

  • Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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