Course Project

Week 1 Course Project: Part 1 – Selecting a Communication Goal

· Link (Word doc):  Week 1 CCC Part 1 Template  (Use this template to complete the assignment.)

Introduction: Communication Change Challenge (CCC) Part 1 The Course Project is about improving your interpersonal communication skills. For this project, you will select a relevant interpersonal communication behavior to work on, attempt to change your behavior or pattern in the communication area you selected; and evaluate your progress and performance. Click on the following link for project examples:

Click on the following link for project examples:

Link: Project Examples

In Part 1 of the project you will select a communication goal or challenge that is related to interpersonal communication. You will work on this challenge for the duration of the session, so take some time to consider what is worthy of the time.

Note: Later in this course, you will be implementing new communication behaviors to rectify your communication challenge. It is critical that you interact with the person or people identified in Part 1E over the next 8 weeks.

Project Timeline The following is a breakdown of what will be covered in each part of the project:

Instructions Take some time to think about challenges you have communicating with other people. These difficulties may involve strangers and acquaintances, friends, family members, or people at school or work. You may identify situations that involve specific individuals or general circumstances. Some examples include having trouble starting a conversation with someone you have never met, saying “no” when your sister asks to borrow money, or avoiding participation in meetings even when you have a question or contribution to the discussion.

Complete the steps in the following framework to identify a goal. Using the template for this week, detail each of the steps to explain how you chose this one communication problem area you intend to change.

1A. “I Can’t” List  What are your “I can’t” communication behaviors? Address verbal, nonverbal, listening, group communication aspects, and cultural differences. Click on and read the sample responses for this section first:

Link: Sample List

Link: Sample Description

Then, write and submit the following for this part:

· Make a list of 4-8 challenges relating to your interpersonal communication that you feel require attention because you “can’t” seem to do these well.

· Describe each “I can’t” behavior in detail. Provide examples to illustrate why you included each behavior in this list.

· Write a 1-2 paragraph description/example for each behavior.

1B. “I Won’t” List What are your “I won’t” communication behaviors? Now read your list of “I can’t” communication behaviors aloud and consider each one carefully. Go back and read each behavior aloud again, but this time, substitute the word “won’t” for “can’t.” (“I won’t ask my friends for favors when I need their help.”)

Be honest with yourself – were there behaviors on your list for which the word “won’t” seemed more accurate than the word “can’t?” Probably so, because there are very few communication behaviors that people are physically unable to do. “Won’t” suggests that an element of choice is involved.

Write and submit the following for this part:

· A list of any statements that you revised to say, “I won’t”

· Explanation for each why it is more accurate than the original “I can’t” statement

· A narrative describing why you feel each statement belong there instead of the original

Eliminate any “I won’t” statements from consideration for this project.

1C. “Don’t Know” List Now go back to your remaining “I can’t” communication behaviors and try substituting, “I don’t know how to” for the words “I can’t.” Instead of saying, “I can’t keep my staff focused on the discussion at hand during meetings,” try saying “I don’t know how to keep my staff focused on the discussion at hand during meetings.”

It is important that you do not take the phrase “I don’t know how to” too literally. You may find that you do know how to do some of the things on your list, but you don’t know how to change from your existing poor habit to an improved communication behavior.

Link: Sample Response

Make a list of any statements you revised to say, “I don’t know how to,” and describe for each why this is more accurate than the original “I can’t” statement. If there are any issues that you still feel belong on your “I can’t” list, include a narrative to describe why.

The “I don’t know how to” items on your list are the ones to consider for this project. These are the ones you can expect to change by taking this course. Select one of these problem areas to work on for the remainder of the course and for the purpose of this report. Describe your process for eliminating additional “I don’t know how to” items to narrow your list to the one issue that you finally selected for the project.

Write and submit the following for this part:

· Your list of issues that more accurately fit the “I don’t know how to” category

· A narrative describing why you feel they belong there instead

· Describe why you left certain issues in the “I can’t” category.

1D. Issue Selection Write and submit the following for this part:

· A narrative describing how you eliminated those that remained in the “I don’t know how to” category to decide on the one issue you selected for your project

1E. Project Statement Write and submit the following for this part:

· A clear project statement of the communication behavior you will address with this project and the person or people with whom you will be communicating for this project

Link: Sample Project Statement

Writing Requirements (APA format)

· Length: 2-2.5 pages (not including title page or references page)

· 1-inch margins

· Double spaced

· 12-point Times New Roman font

· Title page

· References page

Week 2 Course Project: Part 2 – Describing Communication Patterns

· Link (Word doc):  Week 2 CCC Part 2 Template  (Use this template to complete the assignment.)

Introduction: Communication Change Challenge (CCC) In Part 2 of the CCC, your goal is to take an in-depth look at the challenge you selected in Part 1E, which you will work to improve later in the course. It is not time to make any behavior changes yet.

Before you try to repair the problem identified in Part1E, you first need to understand it. Keeping a conversation log for 5-7 days of instances when the communication behavior is most apparent, and reviewing your log for patterns, will lay the foundation for identifying how you will rectify the communication behavior later in the project.

Note: Communication Change Challenge Part 2 is due this week and again next week along with Part 3. This part requires you to observe and analyze your communication patterns and observe the communication behaviors of others for Weeks 2 and 3. It is important that you get started now in order to ensure that you will have sufficient time to observe these patterns and behaviors as they occur. Record daily conversations during these two weeks. You will turn in your work for Part 2 each week. You will have 8 days this week, from Sunday to Sunday, to record your conversations.

Be sure to include specific detailed evidence from your observations that support your identification of a particular pattern for each section. Respond in narrative format for all Behavior Log Review and Evaluation sections.

Project Timeline

2A. Behavior Log Listing List your interpersonal communication goal from Part 1E.

Keep a dated conversation log of specific instances when you exhibited this behavior. Keep this log throughout Weeks 2 and 3.

Think about who, what, where, when, why, and how questions. Record the following:

· To whom you spoke

· What you talked about

· Where you spoke

· When you spoke – the time of the day

· Why you had this conversation

· The circumstances

· How you spoke

Think about your feelings and your nonverbal communication. Did you listen well? Were you delighted, hurried, rude, polite, angry, frustrated, and so forth? Record other important or interesting conversations as well, even if they do not relate to your goal. You need at least 5 entries this week, but you may have many more.

Be sure to include an entry each day from the time you begin monitoring your communication behavior (conversations with others) until the time you conclude 2A. If you do not face your challenge on a particular day, say so. If you face other challenges, perhaps related challenges, on any of these days, include that as well. If you cannot document a conversation about your challenge that day, record another interesting or important conversation. You should have at least one daily entry for your conversation log, and you may have multiple conversations on the same day.

2B. Behavior Log Review and Evaluation – Most Effective Review your log and document patterns of your most effective communication skills. Answer the following questions:

· At what time and under what circumstances did I perform this behavior mosteffectively?

· In what places?

· With whom?

· Under what conditions?

2C. Behavior Log Review and Evaluation – Least Effective Review your log and document patterns of your most effective communication skills your least effective communication skills. Answer the following questions:

· At what time and under what circumstances did I perform this behavior least effectively?

· In what places?

· With whom?

· Under what conditions?

2D. Behavior Log Review and Evaluation – Recurring Communication Review your log and document patterns of your other recurring communication behaviors. Answer the following question:

· What other recurring communication behaviors did I exhibit when I did or did not perform this behavior?

2E. Behavior Log Review and Evaluation – Most Pressing Behavior Review your log and document patterns of your most pressing behavioral pattern. Answer the following questions:

· Is your greatest communication problem the same one you listed in your goal for CCC Part 1 E at the top of your page?

· Do you need to modify your goal for this project? If so, state your new goal by revisiting Part 1E in Week 1.

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Project On Catheter Associated Infection

BENCHMARK- CAPSTONE PROJECT CHANGE PROPOSAL 2

BENCHMARK- CAPSTONE PROJECT CHANGE PROPOSAL 13

Running head: BENCHMARK- CAPSTONE PROJECT CHANGE PROPOSAL 1

Preventing Catheter-Associated Urinary Tract Infections

The United States of America in known for its advanced medical practices and equipment, however, hospital-associated infections (HAIs) have a tremendous impact to the healthcare system. According to Healthy People 2020, Healthcare-associated Infections (HAIs) are related to increasing cost of health care in the United States as well as mortality and morbidity. These types of infections are preventable. Indwelling catheters count for about 80% of urinary tract infections (CDC, 2013). As healthcare professionals and adhering to the principle of nonmaleficence, we are obligated to make efforts to implement strategies to avoid any risks to harm patients. Proper assessment of patients regarding indwelling catheter insertion need, maintenance and care requires the collaboration of the entire interdisciplinary team. Evidenced-based practices (EBPs) have found a relationship between chlorhexidine (CHG) wipes usage and CAUTI reduction. This project’s goal is to provide safe-centered patient care in prevention of CAUTI through utilizing CAUTI Surveillance Bundle and implementing new interventions such as daily Chlorohexidine Gluconate (CHG) bathing for patients with Foley catheter. The author of this proposal will be providing an in-depth investigation into the background problem, discussion of the implementation of CHG wipes instead of regular wipes for perineal care for CAUTI prevention, as well as presenting evidence-based research reviews that support the project and potential barriers to success.

Background

Even though, measures to decrease the incidence of HAIs is the priority of many healthcare organizations, acute care facilities reported 54,500 cases of CAUTIs in the U.S in 2012, which represents a 3 percent fold increase from 2009 (Knudson, para. 1, 2014). Factors associated with the prevalence of CAUTIs is the inappropriate use of indwelling catheters, in addition to improper insertion techniques, and inadequate and poor catheter maintenance (Strouse, 2015). Preventing CAUTI by employing CHG wipes for perineal care has been proven to be effective. By using CHG wipes for perineal care the colonization of bacterial could be eliminated. One key reason for CAUTI is the overgrowth of bacteria that invade the lower urinary tract. CHG wipes have an antiseptic component that inhibits the growth of bacteria in the body (Flores-Mireles, Walker, Caparon, & Hultgren, 2015). The integration of best practices, patient involvement, and ongoing education and training for the nursing and medical staff in CAUTI prevention is imperative.

Problem Statement

The problem at hand is the difficulty that this author’s facility is experiencing in reducing the rates of urinary tract infections (UTIs) despite the implementation of indwell-catheter care bundles. The most common and costly healthcare related infection that prolongs the length of

stay and comorbidity is catheter-associated urinary tract infections (CAUTI). Furthermore, it is

one of those conditions that the Center for Medicaid and Medicare Service (CMS) no longer

reimburses the extra cost of treatment if a patient develops it during hospitalization (CMS, 2012).

Regardless of how hard many organizations put energy to reduce CAUTIs; the U.S. Department

of Health and Human Services indicates CAUTIs rate has increased by 9% between 2010 and

2013 (AHRQ’s, 2008). With all the penalties from CMS and continued effort from hospitals to

implement the best practices to reduce CAUTIs, Foley catheter use and Catheter-associated

Urinary Tract Infections continue to grow (CDC, 2010). Improving the adherence to healthcare policies and procedures in order to help prevent CAUTI needs further revision (see Appendix A). The evidence-based proposal arose from the clinical question in relation to the use of CHG wipes in comparison to regular wipes to decrease bacterial colonization in the external catheter and thereby reducing the incidence of CAUTI. One of safety goals set forth by the Joint Commission, is the reduction in the incidence of CAUTI (The Joint Commission, 2015).

Purpose of Proposal

The project’s purpose is to create consciousness of the devastating health complications associated with CAUTI. This project aims to reduce CAUTI occurrence and the process begins the moment the patient is admitted with orders to insert a urinary catheter, and the process ends with discontinuation of the urinary catheter. By working on the process, we expect to achieve the following:

· Prevent and decrease Catheter-associated Urinary Tract Infections

· Reduce indwelling catheter days

· Improve patients’ outcome, quality of care, and safety

· Decrease CAUTI and urosepsis

· Cut MDRO’s and C. diff that result from antibiotic treatment

· Reduce length of stay (LOS) and readmission

· Decrease cost

· Improve patient satisfaction

CAUTI is not a benign infection. It is important to work on this project because every

patient deserves to receive quality care that is safe, cost effective and is evidenced based.

After reviewing several research articles pertaining to CAUTI prevention, it was concluded by many of the researches that CHG wipe usage help reduce CAUTI rates. The proposed changed would also comply with the EBP guidelines of the American Association of Critical-Care Nurses (AACN, 2017), which support the use of CHG wipes for reduction of bacterial colonization and multi-drug resistant organisms. Lastly, a key objective to this evidence-based proposal for practice is to improve patient outcomes and safe lives.

PICOT Question

As discussed thus far, preventing CAUTIs by utilizing CHG wipes vs regular wipes for perineal care during a patient’s hospitalization was the motive. Considering the environment, engagement, attitude, and culture of the nursing staff was also a determining factor to the change proposal. Upon this author’s decision on the EBP proposal, a thoughtful analysis was conducted on whether independent and dependent variables could be measurable and achievable. The project implementation as a quality improvement initiative is targeted to improve the quality of care delivered to patients (U.S. Department of Health and Human Services, n.d.). To help prevent the incidence of CAUTI, the following components where identified: In adult hospitalized patients with indwelling urinary catheters (P), how does the use of chlorhexidine-impregnated wipes for perineal cleansing(I) compare to regular wipes (C) affect/reduce the incidence of catheter-associated urinary tract infections rates (O) during the time of hospitalization (T).

Literature Research Strategy

As hospitals seek to find measures to prevent the incidence of CAUTI, the strategy of this implementation is to determine if by using CHG wipes for perineal care, the rates of CAUTI could decrease. In order to gather evidence to support the change proposal, multiple search engines were utilized. Searches were conducted through databases such as PudMed, Ovid, CINAHL complete, and accredited nursing journals. The use of filters was utilized to guarantee current and accredited peer review articles. To obtain information specific to the issue of discussion, search words such as, CAUTI, chlorhexidine wipes, CAUTI prevention, infection control measures, and hospital-acquired infections were used. The AACN website was also accessed to search for the most current and up- to- date guidelines pertaining to SICU area. Supporting evidence was analyzed by utilizing a literature review table that helped compared, evaluate, and differentiate between distinct research methods, settings, and sample size studied. Additionally, Google search was used to locate information regarding CMS guidelines and Healthy People 2020 initiatives.

Literature Evaluation

The literature reviewed provided a detailed comparison of research questions and sample populations relevant to the project. The evidence gathered from the peer-reviewed articles undoubtedly supports the implementation of CHG wipe use for perineal care for CAUTI prevention. When CHG wipes were utilized for patient bathing the incidence of HAI was reduced. One of the several articles that supported to use of CHG wipes was the one conducted by Cassir et al. (2015) that found CHG daily cleansing related to a reduced incidence rate of HAI caused by gram-negative bacteria, highlighting the role of the transient gram-negative bacteria in skin colonization in the pathogenesis of HAI. As any other EBP implementation, reduction of CAUTI will require the collaboration of nursing staff, infection control nurse, risk management, and physicians. Although research provides supporting evidence on the use of CHG wipes for CAUTI prevention, this does not substitute the basic principle of good hand hygiene.” Hand hygiene (HH) is an inexpensive and practical measure, it is the cornerstone of nosocomial infection (NI) control” (Martínez-Reséndez, et al., 2014).

Change Theory

Implementing change in the healthcare industry requires a solid foundation in order to achieve success. This author finds the Kurt Lewin three stage change model to be appropriate for CAUTI prevention proposal by employing CHG wipes for perineal care. The Kurt Lewin’s change model is composed of the unfreezing, moving and refreezing stages. The unfreezing stage is providing a rational for change, the moving stage provides information for the need of change, and lastly the refreezing stage is the implementation or reinforcement of the process for change (Rainio, 2009). This model can be broken down to the nursing staff as follows: The unfreezing stage will be the introduction to EBP research and rationale for using CHG wipes for perineal care; the moving stage will focus on the nurses using the new implementation for perineal care, it is also the stage were barriers get addressed, and the refreeze stage will be the evaluation of the EBP proposal success with the aimed of decreasing CAUTI by using the CHG wipes (Rainio, 2009). Regardless of any model utilized, communication and consistency will play a key factor in educating the nurses of the benefits of CHG wipes and mainly patient harm prevention.

Proposal for Implementation and Outcome Measures

The proposal for the use of CHG wipes for perineal care to prevent CAUTI and overall HAI was discussed with the Director of Surgical Services. The conversation brought up key points regarding the effects of CAUTI to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and most importantly the impact of reimbursement from CMS. According to Galiczewski (2016), he cites “CAUTIs are considered preventable and its incidence has reached almost two million cases per year. CMMS in the U.S. has deemed CAUTI a “never event”, limiting government funded reimbursement” (para. 3). Another proposed implementation for the success of this author’s EBP proposal includes continuing in -service nursing education and training as well as a thorough quality improvement CAUTI prevention bundle (see Appendix B for CAUTI bundle). By requiring compliance with indwell catheter care bundles and CHG wipes for perineal care, it is expected to see a decrease of bacterial colonization and subsequently CAUTI prevention. Evaluating the EBP proposal and measuring the outcomes is the concluding step to determine if the implementation was effective and successful. The methods that could be utilized to measure outcomes are; data collection and recording on CAUTI incidences in the hospital, assessment of post-intervention CAUTI rates in the facility, and a readiness inventory tool to assess the nurse’s confidence level (Stevens, Puga & Low, 2012). Charge nurses will be expected to assess the nurses’ catheter insertion techniques and maintenance compliance. The final and most important step will be evaluating the patient’s comfort and care provided during perineal care with CHG wipe usage by means of surveys. The survey will additionally assess on the patient’s knowledge on the use of CHG wipes for CAUTI prevention and if education was provided by the nursing staff regarding reasons, care, and complication of indwell catheters.

Potential Barriers to Implementation and Solutions

Catheter associated urinary tract infections are preventable and should be treated with the seriousness it deserves. However, the evidence-based researched provided this author with insight of what some of the possible barriers would be during the EBP implementation. One key barrier is the lack of nurse driven catheter removal protocols, poor staff engagement and adherence to policies and procedures, the need to further the nursing staff knowledge regarding catheter need, insertion techniques, maintenance and care.

In the instance that the implementation could become obscured, some of the solutions to the implementation could be; revision of plan proposal, re-training staff on the proper use and aseptic insertion techniques, and guidelines on using CHG wipes for perineal care (see Appendix C). Furthermore, leadership and risk management will be consulted and assignation of CAUTI prevention champions will be endorsed. Obtaining the staff’s feedback throughout the implementation will also be measured.

Conclusion

Exercising basic nursing care and advocating for patients can ultimately lead to positive change in patient outcomes. Reviewing institutional policy and procedures and current evidence based research assisted in the development of a tool that helps guide and remind nurses of proper

indications and maintenance of urinary catheters. Implementing training and education for

nursing staff and ancillary staff on proper maintenance of urinary catheters and CHG bathing

supports an efficient change for this project. Lewin’s Change Model and Plan-Do-Study-Act

(PDSA) Improvement Model was incorporated as theoretical frameworks for implementing,

reinforcing, and preserving changes for this project. As a CNL student, I have learned a great

deal from this experience. I’ve learned this journey is a rocky road and need shared

accountability between the leadership, providers, nursing and other ancillary staff. I’ve also

learned:

· CAUTI prevention is a culture change and needs constant attention.

· Not to be afraid to refine the process

· Not to give up

· To continue talking to front line regarding obstacles and removing them

· To keep talking about patient and WHY we are doing this work!

· To focus on patient safety all the time

· To include all providers in education

· Respectful communication is a MUST!

This project’s result is not just CAUTI prevention; it is cost reduction, decrease length of stay,

fall reduction, and delirium prevention. Continuing nursing education and training will allow for nurses to grow within their organization and to practice to their full scope of practice. The nursing workforce is ready to help Americans achieve a healthy lifestyle and to increase patient satisfaction in every encounter.

References

Advance Practice

Advance Practice

Advance Practice

Apply information from the Aquifer Case Study to answer the following discussion questions:

•Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

•Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?

•What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

Do Two pages.

Provide References.

See attached Aquifer Case Study
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Week 2 Discussion Advance

Week 2 Discussion Advance

Week 2 Discussion Advance

Apply information from the Aquifer Case Study to answer the following discussion questions:

• Discuss the Mr. Barley’s history that would be pertinent to his respiratory problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
• Describe the physical exam and diagnostic tools to be used for Mr. Barley. Are there any additional you would have liked to be included that were not? 
• What plan of care will Mr. Barley be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Do 2 pages.

Provide references.

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Safety And Transportation

Subsystem: Safety & Transportation

Module 4

Overview

Communities are composed of the core, which are the people and eight subsystems. A community assessment typically starts with a windshield survey where each of the eight community subsystems are explored. This assignment is focused on helping health professional students explore the relationship of safety and transportation to determinants of health. Mayor Franklin Hill has information about safety and transportation in Sentinel City®. Officer Cooper in Acer Tech has information about neighborhood crime rates.

Learning Objectives

1. Identify safety and transportation features in a specific community

2. Describe how safety and transportation is related to a specific determinant of health

3. Describe the health impact of positive and negative characteristics of a community

4. Use current literature to provide rationale for determinant of health identified related to safety and transportation

Assignment Instructions

1. Review the following resources:

a. Course textbook and/or other assigned readings

b. Determinants of Health

c. Review Table 4 from the FBI 2016 Crime in the United States report at /orders/ucr.fbi.gov/crime-in-the-u.s/2017/preliminary-report/home

2. Meet with Mayor Hill and Officer Cooper to discuss safety and transportation as well as neighborhood crime rates.

3. Enter Sentinel City® and begin the bus tour.

4. As you tour the city, note anything in the assigned neighborhood or entire city related to safety and transportation.

5. Address each of the features in the far-left column and add two additional features. Fill in the each of the remaining columns.

6. For questions, contact your instructor.

References

AACN Public Health Essentials

This assignment addresses the following AACN Public Health Essentials:

· Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety

· Apply systems theory to PHN practice with individuals, families, and groups.

· Essential III: Essential III: Scholarship for Evidence-Based Practice

· Use epidemiologic data and the ecological perspective to identify health risks for a population.

· Essential VII: Clinical Prevention and Population Health for Optimizing Health

· Practice evidence-based public health nursing to promote the health of individuals, families, and groups.

· Essential IX: Baccalaureate Generalist Nursing Practice

· Use basic descriptive epidemiological methods when conducting a health assessment for individuals, families, and groups.

Maternal Newborn ATI Remediation

Maternal Newborn ATI Remediation

Maternal Newborn ATI Remediation

There are 4 topics that require  4 PDFs attachments to be completed.

 – Ante/Intra/Postpartum and Newborn Care – 

1- Fetal Assessment During Labor: Identifying the Steps of Leopold Maneuvers(Active Learning Template – Nursing Skill, )

2- Postpartum Disorders: Manifestations of a Vaginal Hematoma(Active Learning Template – Basic Concept, )

3- Prenatal Care: Evaluating Client Understanding About Physiological Changes Related to Pregnancy(Active Learning Template – Basic Concept, )

Pharmacological and Parenteral Therapies:

4-Medical Conditions: Reportable Findings for Magnesium Sulfate(Active Learning Template – Medication, )

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I Need This Paper By Sept 2

I Need This Paper By Sept 2

I Need This Paper By Sept 2

Write a 750-, 1000 word rhetorical analysis essay of public document . This public document is the center for disease control’s CDC website on Attention Deficit / Hyperactivity Disorder ADHD found at http::/www.cdc.

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I Need This Paper By Sept 2

I Need This Paper By Sept 2

I Need This Paper By Sept 2

Write a 750-, 1000 word rhetorical analysis essay of public document . This public document is the center for disease control’s CDC website on Attention Deficit / Hyperactivity Disorder ADHD found at http::/www.cdc.gov/ncbddd/adjacent/facts.html . Your analysis should include at least two scholarly sources outside of class texts

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Ethical And Legal Implications Of Prescribing Drugs

Ethical And Legal Implications Of Prescribing Drugs

Ethical And Legal Implications Of Prescribing Drugs

Ethical And Legal Implications Of Prescribing Drugs

Ethical And Legal Implications Of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

Scenario 1:

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

Scenario 2:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Scenario 3:

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

Scenario 4:

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.

To prepare:

• – Review Chapter 1 of the Arcangelo and Peterson text, as      well as articles from the American Nurses Association, Anderson and      Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.
• – Select one of the four scenarios listed above.
• – Consider the ethical and legal implications of the      scenario for all stakeholders involved such as the prescriber, pharmacist,      patient, and the patient’s family.
• – Think about two strategies that you, as an advanced      practice nurse, would use to guide your ethically and legally responsible      decision-making in this scenario.

With these thoughts in mind:

Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario.

– This work should have Introduction and conclusion

– This work should have at 3 to 5current references (Year 2012 and up)

– Use at least 2 references from class Learning Resources

The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

4. Mayoclinic.com

Required Readings

**Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

• Chapter 1, “Issues for the      Practitioner in Drug Therapy” (pp. 3–14)
  This chapter introduces issues relating to drug therapy such as adverse      drug events and medication adherence. It also explores drug safety, the      practitioner’s role and responsibilities in prescribing, and prescription      writing.
• Chapter 59, “The Economics      of Pharmacotherapeutics” (pp. 1009-1018)
  This chapter analyzes the costs of drug therapy to health care systems and      society and explores practice guideline compliance and current issues in      medical care.
• Chapter 60, “Integrative Approaches to      Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036)
  This chapter examines issues in individual patient cases. It explores      concepts relating to evaluation, drug selection, patient education, and      alternative treatment options.

**Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125.

Note: Retrieved from the Walden Library databases.

This article explores issues relating to prescription drugs, specifically the frequency in which drugs are prescribed to patients. It also examines factors to consider before beginning drug therapy plans with patients.

**Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746.

Note: Retrieved from the Walden Library databases.

This article examines issues that nurses encounter when reporting errors in medical settings. It also outlines the role of ethics and the responsibility of nurses to notify all individuals who are impacted by a medical error.

**American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

This article outlines ethical standards in the nursing profession and identifies nine provisions of care that must be adhered to by all nurses.

**Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28. Retrieved from /orders/americannursetoday.com/medication-errors-dont-let-them-happen-to-you/

This article examines factors that lead to medication errors as well as consequences of these errors on patients and nurses. It also recommends methods for avoiding and eliminating medication errors.

**Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Retrieved from August 23, 2012, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

**Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

**Institute for Safe Medication Practices. (2012). ISMP’s list of error-prone abbreviations, symbols, and dose designations. Retrieved from http://www.ismp.org/Tools/errorproneabbreviations.pdf

This website provides a list of prescription writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

**Byrne, W. (2011). U.S. nurse practitioner prescribing law: A state-by-state summary. Medscape Nurses. Retrieved from http://www.medscape.com/viewarticle/440315

**Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

Nursing Standardized Simulation

Nursing Standardized Simulation

Nursing Standardized Simulation

SCENARIO OVERVIEW

Jesus Garcia is a 28 years who was directly admitted to the medical unit on Tuesday evening with a diagnosis of dehydration. Fifteen days ago, Jesus underwent a partial colectomy with creation of a transverse colostomy. Jesus’ girlfriend Virginia has been taking care of him since discharge and reports that Jesus has resisted participation in colostomy care. Virginia needs to return to her full-time job and is concerned with how Jesus will manage without her at his side

REVIEW PRIOR TO SIMULATION

In order to prepare for the simulation, you are required to complete the pre-briefing questions below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation.

Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.

Questions

1. What are common signs and symptoms of dehydration?

2. What are complications you may see as a result of poor nutrition?

3. Describe nursing care and interventions for a client with a colostomy

PLEASE USE APA FORMAT AND INCLUDE REFERENCES LESS THAN 5 YEARS OLD

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