Benners Novice to Expert Theory Discussion

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Question

Provide positive feedback to this post with one paragraph per post Use and cite proper APA references.

Anthony: Advanced nursing practice has many roles and opportunities, such as Certified Registered Nurse Anesthetist, Nurse Practitioner, and Clinical Nurse Specialist. A theory that an advanced nurse may consider is Benner’s novice-to-expert theory. Depending on previous experiences and exposures, as a registered nurse moves into the role of advanced nurse practice, they are moving through this theory of novice to expert. Benner’s theory states that nurses move from novice to expert in stages based on their education and experiences (Sterner et al.,2021). This movement is not always linear, and the fact that the nurse starts as a novice or advanced beginner and then chooses to move into an advanced nurse practice as an expert seems to make perfect sense for those interested in that growth (Kerr & Macaskill, 2020). The advanced practice nurse may start in their new role as a novice or advanced beginner, especially if it is a new specialty. However, since the role is different from the scope of practice of the registered nurse, there will be a time of learning and becoming more competent as an advanced nurse, as described in Benner’s theory.

There is a current healthcare issue in the hospital setting. It is regarding the disproportionate number of novice and beginner nurses to expert nurses at the bedside. Due to the pandemic, there has been a large migration of expert nurses away from the bedside. This has left a massive void of knowledge, experience, and competency in acute situations at the bedside. The novice nurse needs experience and exposure to these critical events to know how to respond or what to expect. Unfortunately, some of the preceptors are also novices or sometimes an advanced beginner themselves, so the training is limited to their knowledge and experience. As clinical educators, we have our work cut out for us in the hospital right now. I think Benner’s theory explains the movement from novice to expert well. It reminds us in an advanced practice role to think of ways to help novice nurses advance with exposure to grow their clinical judgment. One effective way is the use of high-fidelity simulation in scenarios that are emergencies at the bedside. This allows the nurses to work through these situations in a safe, realistic environment (Sterner et al., 2021). Clinical nurse specialists are invaluable in hospitals to help fill knowledge and experience gaps for this novice workforce.

References

Kerr, L., & Macaskill, A. (2020). The journey from nurse to advanced nurse practitioner: applying concepts of role transitioning. British journal of nursing, 29(10), 561–565.

Sterner, A., Ramstrand, N., Palmér, L., & Hagiwara, M. A. (2021). A study of factors that predict novice nurses’ perceived ability to provide care in acute situations. Nursing Open, 8(4), 1958-1969.

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Hannah: Middle range theory can be defined as a theory that helps guide nursing interventions to increase the healthcare outcome by enhancing the care given. The theory is developed by defining what health concern is going on with the patient, why it happened, how it happened and how we can diagnose and treat it. Conti O’Hare’s theory was based off ethics and beneficence. She viewed patients and family members as equal partners in the patient’s healthcare outcome Im, E. O. (2021).

I intend to practice using the guidelines of current data produced from EBP. I do not feel as though I would be successful with research or development that correlates with other theories in this field. I intend to go into a family practice setting and treat patients with the most up to date information. I feel that the middle range theories such as Conti O’Hare’s will be useful in how I help provide care to patients. Improving health outcomes is not only based off how much knowledge I have or what treatments are given but also with the patient being compliant with their part of treatment as well.

One healthcare issue that came to my mind is access to care. There is a large population in the world that either is uninsured or has Medicaid insurance, underinsured. I have seen many times patients struggle to get access to care, medications, procedures etc. due to insurance coverage. Unfortunately, many practices do not accept Medicaid patient panels due to the small reimbursement fees. While I understand the financial aspect of this, it is still the patient who suffers. I work for a clinic where 90% of our patient population has Medicaid. We never turn anyone away from being seen for their inability to pay. The problem in our clinic is the lack of providers and nursing staff. We have such a huge patient population that sometimes we struggle to see patients in the timeframes that insurance says we should.

The middle range theory that I selected can be applied to the healthcare problem mentioned above by providing access to care. The theory aims to provide better health outcomes. When patients have better access to care their healthcare outcomes improve. For example, diabetes management. If glucose levels are controlled by compliance with medication regimens and regular check-ups to the provider, it helps prevent other comorbidities associated with diabetes Nowakowska, M, et al., (2019).

Reference

Im, E. O. (2021). Different types of theories by level of abstraction in nursing: A discussion paper. Research and Theory for Nursing Practice, 35(1), 50-66. DOI: 10.1891/RTNP-D-20-00038

Nowakowska, M, et al., (2019). The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC medicine, 17(1), 145. https://doi.org/10.1186/s12916-019-1373-y.

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Jose: A perfect theory that will be applied in advanced nursing practice is Dorothea Orem’s Self-Care Deficit Theory. This theory postulates that people have a natural ability for self-care, and nursing should focus on helping individuals meet their self-care needs. Probably, one of the attractions Orem’s theories has for many nurses is its utility in practice. This is highly evident in the writings of Kinlein (1977, pp. 1-195) and Bromley (1980). As a future nurse practitioner, the importance of Orem’s theory to the practice I am pursuing is highly significant. It accentuates the importance of patient education and empowerment, which lines up with my objective of encouraging patient autonomy and self-management, mainly in chronic disease supervision.

A current healthcare matter is the incorrect control of hypertension, patients with this condition without responsible care of it makes it prevalent and leading to other diseases such a cerebral vascular accident, heart attacks, kidney problems, aneurysms, dementia, heart failure, among others. Patients with this condition constantly come back to their medical doctors or NPs with aggravated condition due to lack of responsibility and bad decisions on illegal drugs, tobacco, alcohol consumption, high sodium and saturated fat diet, and not proper monitoring on medication, among other issues.

Orem’s Self-Care Deficit Theory can be applied to take care this issue. According to the theory, nurses should assess patients’ ability to perform self-care and identify any deficits. For patients with chronic diseases, this could require evaluation of their knowledge about their condition, their ability to follow medication administration, and their skills in lifestyle changes such as diet and exercise. Nurses can give education and support to improve patients’ self-care abilities, by that means promoting better disease management and health outcomes. According to Orem’s self-care model, the client’s power of agency is impaired, in the sense that the patients are not able to manage all their self-care needs because of multiple deviations in their health state. To compensate for the self-care deficits experienced by these clients, the nurse enters into a collaborative relationship with the patients to identify their assets and deficits and determine the therapeutic self -care demands brought about by changes in their developmental needs as well as changes in their health state (Orem, 1980).

References

Bromley, B. (1980). Applying Orem’s self-care theory in enterostomal therapy. American Journal of Nursing, 80(2), 245-250.

Kinlein, M. L. (1977). Independent nursing practice with clients. New York: J.B. Lippincott Company.

Orem, D.E. (1980). Nursing: concepts of practice (2nd ed.). New York: McGraw-Hill Book Company.

Correct my annotated bibliography.

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QUESTION

.COMPLETE THE ATTACHED DOCUMENT AND THEN PROCEED TO CREATE THE ANNOTATED BIBLIOGRAPHY.

For this assessment, complete your annotated bibliography with 10 scholarly, empirical research sources, published within the last five years.

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. INTRODUCTION

Annotated bibliographies serve as an overview of the  research. They help with summarizing and organizing key points from the  research literature so that the role of the published research can be  critically evaluated against the research topic. It is an important step  prior to embarking on the literature review. A good annotated  bibliography will help bridge main ideas from the research and your own  independent ideas related to your research topic.

In this course,  the annotated bibliography is the next step in the course project after  the literature search. Your annotated bibliography will contribute to  the research question as you use it to build the literature review.  Addressing each source specifically and in detail allows key aspects to  emerge. Furthermore, it enables the understanding of each researcher’s  point of view. A complete annotated bibliography should result in clear  themes that inform the research topic.

For this assessment, you will complete your annotated bibliography with 10 scholarly, empirical research sources, published within the last five years.

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.

.OVERVIEW

Before completing this assessment, ensure that you have finalized your Research Topic Template (ATTACHED)  and your research organization tool. Your topic should include  psychological concepts and a population. Populate your research  organization tool with 5-10 scholarly, empirical research sources.  Completing the media pieces will enhance your understanding.

You  have a choice to create a literature map as outlined in the course text  or use the research organization tool provided through the Capella  library’s Staying Organized & Keeping Track: Research Tools page.

This  assessment consists of an annotated bibliography. However, it is  important to see the trajectory of your work. Developing the research  topic, the literature search question, and dissecting the literature are  all part of understanding how you develop your annotated bibliography.

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.INSTRUCTIONS

Use the media pieces to understand the components of the annotated  bibliography. Make sure to number each source. Include 10 scholarly  research sources, published within the last five years, for this  assessment. Make sure to apply proper APA style and formatting. You will  submit your annotated bibliography, research topic template, and your  research organization tool of choice, as a single submission, but  separate files.

NOTE: Your assessment will be returned if the topic template and research organization tool are not submitted.

Number each source.

Include a minimum of 10 empirical research sources.

Apply  current APA formatting. Each annotation should include the citation of  the source, just as it would appear in the reference list.

Identify the journal’s impact factor. (See Psychology PhD Library Research Guide: Source Quality.)

Identify the research question.

Identify the research problem that the author or authors hoped to resolve.

Identify the methods the authors used to investigate the research question.

Provide a summary of the findings.

Evaluate the work.

You  can do this by addressing the arguments and counter arguments from  research and that were made in the research study, or discussing the  value that the research study findings have for the field—how it  advances the knowledge base. Also, consider the strengths and areas were  the research could expand.

Finally, discuss how the study supports your research topic.

To successfully complete this assessment, make sure to:

Finalize your research topic template. Check to make sure that the template has all sections filled out and that the topic has been narrowed as much as possible.

Finalize your research organization tool. At this point it should include 10 research articles. You  have a choice to create a literature map as outlined in the course text  or use one from the Capella library’s Staying Organized & Keeping  Track: Research Tools page.

Understand the components of the annotated bibliography. Revisit the media to understand what you need to know. Make sure to include the content that has been outlined above.

Note:  your literature review will require 20 sources because you will need to  include theoretical research sources. You may exceed 10 sources for  this assessment but you must include no fewer than 10.

The annotated bibliography assessment should contain 6–8 pages, including the cover page.

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.COMPETENCIES

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

Competency 1: Determine the scientific merit of the professional literature.

Identify and describe the research problem that the author(s) hope to resolve.

Evaluate the research.

Discuss how the study supports the research topic.

Competency 2: Apply theoretical and research findings from the discipline of psychology to professional and academic activities.

Restate the research question in the article.

Identify the methods used to investigate the research question.

Summarize the research findings.

Competency 3: Apply ethical principles and standards of psychology to academic and professional activities.

Identify the source of the article as a peer-reviewed journal article reporting research.

Competency 5: Communicate psychological concepts effectively using the professional standards of the discipline.

  • Convey  purpose, in an appropriate tone and style, incorporating supporting  evidence and adhering to organizational, professional, and scholarly  writing standards.
  • Exhibit proficiency in writing and use of APA (7th edition) style. Include a minimum of 10 scholarly research articles. Include the research topic template and the literature matrix._
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  • ________________________________________________________________________________
  • FEEDBACK
  • .
  • Please read carefully the recommendation from the professor.
  • General Feedback: Do NOT change your topic, but rather work from the feedback.
    Any changes you make to subsequent submissions should be highlighted. In addition, you might need to use the comment section as well.
    You  have some information to work from in the document and the rubric. You  may find using your free Grammerly Premium account will be helpful with  editing. You can get the free premium account using your official  Capella email. You also may find the videos that I have posted in the  “Announcements” section helpful–there are videos targeted to many of the  specific assignments (or components of assignments). I strongly advise  you to take advantage of them because they contain course corrections  for common errors on submissions.
    Bear in mind that you only get  three attempts, so take your time to understand the feedback and address  it all. Also, do not assume that you are to only address the comments,  you need to check throughout for errors, and you will need to address  the bigger picture..

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  • .
  • .FEEDBACK FOR EACH COMPETENCY FAILED   (THIS IS WHAT NEEDS TO BE CORRECTED )

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Competency 2 FAILED: Apply theoretical and research findings from the discipline of psychology to professional and academic activities.

  • Feedback:  Restates the research question incompletely or inaccurately. The  research questions are not always explicitly identified and stated in  your summaries. Your summaries tend to be a bit brief, so more depth and  detail would be helpful here.

Competency 2 FAILED: Identify the methods used to investigate the research question.

  • Feedback: Identifies the methods used to investigate the research question incompletely or inaccurately. 

At  a minimum, you need to discuss (and name) the type of methodology  (quantitative/qualitative) and subtype (experimental,  quasi-experimental, phenomenological, ethnographic, etc) for each study.  A little bit of detail about the procedure (including materials and  participants) here would also be very helpful. 

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Competency 3 FAILED: Identify the source of the article as a peer-reviewed journal article reporting research.

Feedback:  Identifies the article as a peer-reviewed journal article but does not  describe the reported research. You do a nice job identifying the  journals in your references. Unfortunately, there needs to be a bit more  detail about the journals in the entries in terms of their quality  (like peer review status or Eigenfactor). This is unusual in scientific  writing–typically we do not include this information in formal papers  (and you will not include it in your literature review). But it is  helpful to keep this information in mind as you evaluate the literature  and articles that you find and decide what to include in your paper.

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Competency 5 FAILED: Convey  purpose, in an appropriate tone and style, incorporating supporting  evidence and adhering to organizational, professional, and scholarly  writing standards.

Feedback: Conveys

purpose in an appropriate tone or style but there is insufficient 

supporting evidence and/or minimal adherence to applicable writing 

standards. Exhibit proficiency in writing and use of APA (7th edition) 

style. Include a minimum of 10 scholarly research articles. Include the 

research topic template and the literature matrix.

Introduction philosophy

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QUESTION

Write a paper in which you REC
one or two of the following arguments (if two, make sure they both fall under the same topic
heading, e.g., ‘Freedom and Determinism’), in accordance with the instructions given below:
Numerical Identity over Time for Persons
1. Lynne Rudder Baker’s argument on p. 127 against the psychological continuity theory of
personal identity.
2. Lynne Rudder Baker’s argument on p. 128 against the non-branching psychological
continuity theory of personal identity.
3. Lynne Rudder Baker’s argument on p. 129 that ‘this weaker relation than identity is not
what we are interested in in ordinary cases of survival’.
4. Lynne Rudder Baker’s argument on pp. 130-131 against the soul theory of personal
identity over time.
Freedom and Determinism
5. The argument, via the Frankfurt-style example, against the Principle of Alternative
Possibilities (presented in the Carroll and Markosian reading)
6. The objection to Volitional Indeterminism given on p. 68 (presented in the Carroll and
Markosian reading)
7. The ‘pass the salt’ objection to Libertarian Agent Causation given on p. 74- 75 (presented
in the Carroll and Markosian reading)
8. Sider and Conee’s argument(s) against one or more of the five soft determinist definitions
of ‘free action’ that they consider on pp. 128 133.
Knowledge and Skepticism
9. Jonathan Vogel’s argument against what he calls the ‘Moorean view’, in his paper
‘Skepticism and Inference to the Best Explanation’ (posted in the paper topics folder on
Canvas, not assigned). Be sure to explain the Moorean view.
10. Jonathan Vogel’s argument for the claim that the real world hypothesis is a better
explanation of your sensory experiences than the isomorphic skeptical hypothesis, in his
paper ‘Skepticism and Inference to the Best Explanation’ (posted in the paper topics
folder, not assigned). Be sure to say what those hypotheses are.
Propose your own topic
11. An argument of your choice, drawn from a passage in one of the readings assigned on the
syllabus. Write a brief proposal, submit the proposal to your TA by Tuesday, March 5,
and receive approval from your TA. (It is entirely up to your TA to decide whether or not
to approve your proposal.) Your proposal should take the following form:
The argument that I would like to REC is presented in a passage in [name
the reading] that begins with the sentence “[enter first sentence of chosen
passage here]” on page [XX] and ends with the sentence “[enter last

2

sentence of chosen passage here]” on page [YY]. The conclusion that is
argued for in this passage is that [state conclusion here].
You should cut and paste this text into an email that you send to your TA. But don’t
forget to fill in the blanks! Don’t choose a passage that has already been reconstructed in
the text.)
For each of these topics, it will be almost impossible to write a decent paper if you read just the
sections indicated in the prompt. To understand the issues well enough to write good paper,you
will need to understand the larger context in which the relevant argument is embedded; and to do
that, you will need to read the entire paper or chapter, probably more than once.
REC-ing an argument:
R: Reconstruct. Put the argument into standard form, so that it fits a valid pattern and captures as
much of the author’s reasoning as is compatible with its being relatively brief and compact. You
should try not to leave out important pieces of reasoning, but you should also avoid making your
reconstruction overly long and complicated. These are competing pressures, so you just have to
strike a good balance. Often, a good reconstruction has only two premises. Display the pattern
that it fits, in symbols, to the right of your reconstruction, in words. Here is an example:
1. Anything that is maximally great exists in reality. All P1s are P2s
2. God is maximally great. m is a P1
3. If God exists in reality, then theism is true. If m is a P2, then A.
— ——
? Theism is true. A
E: Explain. For each premise in your reconstruction, mention it by name (its number) and devote
at least one sentence to explaining why that premise might seem plausible, at least initially. Also,
if there are any unfamiliar terms or phrases in the premise, take this chance to explain what they
mean. If the logical structure of the argument is somewhat complex, you may wish to explain
informally why the intended conclusion really does follow from the given premises.
C: Criticize. After you’ve motivated each of the premises, focus on one particular premise,
mention it by name, and attack it: i.e., present, in detail, what you take to be the most powerful
reason(s) for thinking that the given premise is not true, or for thinking that the premise is less
plausible than the advocate of the argument took it to be.
If space permits, you may (i) discuss a potential response to your criticism that could be given by
an advocate of the argument, (ii) a reply to that response, (ii) attack another premise in the
argument, (iii) suggest a different argument that is immune to the criticisms you’ve raised, or
make other relevant and useful philosophical point. But the bulk of your paper should be
structured around RECing an argument. Avoid free-form, stream-of-consciousness expostulating.
Use the Cederblom and Paulsen text for more detailed guidelines on the DOs and DON’Ts of
reconstructing arguments. Some highlights:
• Be sure that you’ve correctly identified the main conclusion of the argument in
question.
• Be sure that your reconstruction fits a valid pattern.
• Be sure that your reconstruction (in words) really does match the pattern (in symbols)
that you’ve written out.

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• Be sure that none of your arguments contains any idle premises, i.e. premises that are
not needed to make the argument valid. (If a premise is idle in a given argument, then
you could simply delete that premise and the argument would still be valid. Such a
premise is doing no work.)
• Be sure that the premise you attack is not just obviously false a ‘sitting duck’. It
should have some appeal; it should be the sort of premise that begins to seem doubtful
only after you’vecriticized it.
Length. Your paper should be 5 double-spaced pages long (assuming a reasonable type face
and size and reasonable margins), NOT INCLUDING ANY QUOTATIONS OR NUMBERED
RECONSTRUCTIONS. This means the paper should include 5 pages of ordinary text in
paragraph form written by you. Most of that should be focused on a critical evaluation of an
argument.
Grading. You will be graded on the clarity and mechanics of your writing, on how well your
paper is organized, and most importantly, on how well you’ve explained and critically evaluated
an argument. Again, the critical component will be weighted the most heavily of the three: the
more original, insightful, and convincing your criticism of a premise, the better your grade will
be. There is no mechanical recipe for coming up with interesting criticisms: it takes a lot of time,
hard thinking, and creative spark.
Some rough guidelines
A range: excellent mechanics, extremely clear and accurate explanation of an argument,
unusually insightful/creative/original/persuasive critical points these must go beyond anything
that has been said in lecture, discussion section, or the readings, and must be sufficiently
interesting and non-obvious that it would take some hard-thinking to come up with them
B range: good mechanics, very solid explanation of an argument with few or no mistakes of fact
or terminology, critical points that are on-target, relevant, and persuasive though maybe not
quite so dazzling as what one would find in an ‘A range’ paper.
C range: some problems with mechanics OR some errors or lack of clarity in explaining an
argument OR an off-target or unconvincing critical evaluation.
D range and below: two or more of the following: serious mechanical problems, major errors or
obscurity in explaining an argument, badly off-target or obviously unconvincing critical
evaluation
Outside Sources and Citations
You are not expected to consult outside sources in writing your paper. You are permitted to do
this, but a better way to spend your time is to get clear on what you think about the issues, and
about how to express your own thoughts as clearly and precisely as possible. Any sources you do
consult must be cited at the end of the paper, and any ideas or terminology that you take from the
outside source must be indicated in footnotes. Failure to appropriately cite outside sources brings

ST Thomas University advanced pathophysiology Discussion

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QUESTION

Discussion 1: Hematopoietic Case Study

Thaiz 

  • Contributing factors to develop Iron deficiency anemia

    Iron deficiency anemia is a prevalent condition characterized by insufficient iron stores leading to impaired red blood cell production. J.D., a 37-year-old woman, presents with symptoms indicative of iron deficiency anemia, including intermenstrual bleeding, menorrhagia, fatigue, weakness, and urinary frequency. Her medical history suggests several contributing factors predisposing her to Iron deficiency anemia (Warner & Kamran, 2023).

    Childbirth is a recognized risk factor for IDA due to significant blood loss during delivery. J.D.’s recent childbirth and multiparity, with four pregnancies in four years, increase her vulnerability to iron depletion, as each pregnancy imposes additional demands on iron reserves (Demuth, 2018).

  •     Additionally, chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for osteoarthritis management can lead to gastrointestinal bleeding and subsequent iron loss (Malik et al., 2023).

Reasons for constipation and/o dehydration

    Constipation and dehydration in J.D. could be related from long-term NSAID use, which can irritate the gastrointestinal tract and disrupt fluid balance. Furthermore, increased urinary frequency and mild incontinence may result from NSAID-induced bladder irritation or diuretic therapy for hypertension management (Malik et al., 2023).

Vitamin B12 and Folic Acid in Erythropoiesis

    Vitamin B12 and folic acid are vital for the normal development of the RBCs during the erythropoiesis, and deficiencies in these vitamins can impair red blood cell production, leading to megaloblastic anemia (Dlugasch & Story, 2024). Given J.D.’s symptoms, deficiencies in vitamin B12 and folic acid should be considered in the diagnostic evaluation.

Clinical Symptoms and signs for Iron deficiency anemia

    Clinical manifestations suggestive of iron deficiency anemia include fatigue, weakness, pallor, and dyspnea. Additional symptoms related to iron deficiency may include pica, brittle nails, and hair loss. Physical examination findings consistent with iron deficiency anemia include pallor of the conjunctiva, nail beds, and mucous membranes that is the most important clinical sign, but this can be evident when the values of the hemoglobin are between 7-8 g/dL (Warner & Kamran, 2023).

    Laboratory evaluation confirms the diagnosis of IDA in J.D. with low hemoglobin (Hb) and hematocrit (Hct) levels, decreased serum ferritin levels, and microcytic, hypochromic red blood cells on peripheral smear.

Appropriate Recommendations and Treatments

    Management of iron deficiency anemia focuses on replenishing iron stores and addressing underlying causes, such as gastrointestinal bleeding. Oral iron supplementation is the first-line treatment for mild to moderate iron deficiency anemia, typically with ferrous sulfate or ferrous gluconate. Iron supplementation should be taken without food to increase absorption. Low gastric pH facilitates iron absorption. Rapid response to treatment is often seen in 14 days. (Warner & Kamran, 2023).

    Counseling on proper iron supplementation administration is essential to enhance absorption and minimize gastrointestinal side effects. Additionally, addressing contributing factors such as NSAID use and menstrual bleeding is crucial to prevent iron deficiency anemia recurrence (Warner & Kamran, 2023).

    In conclusion, J.D. presents with symptoms consistent with iron deficiency anemia, with multiple contributing factors identified in her medical history. Prompt diagnosis and appropriate management are essential to alleviate symptoms and prevent complications associated with iron deficiency. By addressing underlying causes and initiating iron supplementation, J.D. can achieve restoration of iron stores and improvement in her overall health and well-being.

References

Demuth, I. M. (2018). Iron supplementation during pregnancy- a cross-sectional study undertaken in four German states. BMC pregnancy and childbirth, 18(1), 491. https://doi.org/10.1186/s12884-018-2130-5

Dlugasch, L., & Story, L. (2024). Applied Pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.

Warner, M. J., & Kamram, M. T. (2023, August 7). Iron deficiency anemia. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK448065/

Malik, T. F., Gnanapandithan, K., & Singh, K. (2023, June 5). Peptic ulcer disease. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/30521213

Discussion 2 : W.G Case Study. Cardiovascular

Thaiz G

Modifiable and non-modifiable risk factors for patients at risk for developing coronary artery disease and patients diagnose with acute myocardial infarction

    Acute myocardial infarction is a life-threatening condition characterized by the occlusion of coronary arteries leading to myocardial ischemia and necrosis. Mr. W.G., a 53-year-old man, presented with chest discomfort progressing to a crushing sensation, radiating to his neck and jaw, suggestive of acute myocardial infarction. Understanding modifiable and non-modifiable risk factors for coronary artery disease and acute myocardial infarction is crucial in managing patients like Mr. W.G.

    Modifiable risk factors for coronary artery disease and acute myocardial infarction include smoking, hypertension, dyslipidemia, diabetes mellitus, obesity, physical inactivity, and poor diet (Arnett et al., 2019). Non-modifiable risk factors include age, male gender, family history of premature CAD, and genetic predisposition (Arnett et al., 2019). Mr. W.G.’s age and male gender represent non-modifiable risk factors, while lifestyle factors such as smoking and diet may contribute to his risk for coronary artery disease and acute myocardial infarction.

Findings in the EKG compatible with Acute Coronary Event

    Electrocardiogram (EKG), findings consistent with acute myocardial infarction include ST-segment elevation or depression, T-wave inversion, and pathological Q waves (Thygesen et al., 2018). The presence of ST-segment elevation in contiguous leads, such as leads II, III, and aVF, is indicative of inferior wall acute myocardial infarction, which can manifest as chest discomfort radiating to the neck and jaw, as described in Mr. W.G.’s case.

Specific laboratory test to confirm the Acute Myocardial Infarction

    To confirm acute myocardial infarction, cardiac troponin levels are the most specific laboratory test (Thygesen et al., 2018). Cardiac troponins are highly sensitive and specific markers of myocardial injury, with elevated levels indicating myocardial necrosis. Troponin levels typically rise within 3-4 hours of symptom onset and remain elevated for several days, making them ideal for diagnosing acute myocardial infarction.

Increase of Temperature in patients with Acute Myocardial Infarction

    Mr. W.G.’s increased temperature post-MI is likely due to the inflammatory response triggered by myocardial necrosis. Body temperature could increase by more than 1 °C as soon as the first 4 to 8 h after onset of symptoms, peak in the first to second day with an average of 37.5 °C, and decrease in the fourth to fifth day after admission. Inflammation mediators, such as interleukins (IL)-1, IL-6, IL-8, tumor necrosis factor-?, and interferon-?, are released and pass through the blood?brain barrier to influence the temperature regulatory center in the hypothalamus. Prostaglandin E2, which is released afterward, plays an essential role in the development of fever. Fever may persist for several days post-MI as part of the acute inflammatory phase (Chen et al., 2023).

Pain in Acute Myocardial Infarction

    The pain experienced by Mr. W.G. during his MI is attributed to myocardial ischemia and subsequent necrosis. Ischemia leads to the release of pain mediators, such as bradykinin and prostaglandins, stimulating pain receptors in the myocardium. Additionally, ischemia-induced acidosis and stretching of ischemic myocardial fibers contribute to the sensation of pain, often described as pressure, tightness, or squeezing, as Mr. W.G. experienced (Chen et al., 2023).

    In summary, acute myocardial infarction is a critical condition with modifiable and non-modifiable risk factors. Diagnosis relies on clinical presentation, EKG findings, and cardiac troponin levels. Post-MI fever is attributed to the inflammatory response, while pain results from myocardial ischemia and necrosis. Providing comprehensive explanations to patients like Mr. W.G. is essential for understanding their condition and facilitating optimal management and recovery.

References

Arnette, D. K., Blumental, R. S., Buroker, M. A., & Goldberger, A. D. (2020). Correction to: 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 141(4), 177–182. https://doi.org/10.1161/cir.0000000000000755Links to an external site.

Chen, S.-H., Chang, H.-C., Chiu, P.-W., Hong, M.-Y., Lin, I.-C., Yang, C.-C., Hsu, C.-T., Ling, C.-W., Chang, Y.-H., Cheng, Y.-Y., & Lin, C.-H. (2023, August 4). Triage body temperature and its influence on patients with acute myocardial infarction – BMC cardiovascular disorders. BioMed Central. https://bmccardiovascdisord.biomedcentral.com/arti…

Thygesen, K., Jaffe, J. S., Chaitman, A. S., Bax, B. R., & Morrow, J. J. (2018). Universal definition of myocardial infarction. European heart journal. https://pubmed.ncbi.nlm.nih.gov/179512Links to an external site.

Reply to post from Thaiz Del Carmen Guerra RodriguezReply

The Carbon Cycle

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QUESTION

Part 1: Overview of the Carbon Cycle

The carbon cycle is a complex system with interactions between the different components of the Earth System. In this homework, you will learn how carbon is moved between the different reservoirs naturally, and how human activities are changing the cycle.

Volcanic eruptions (0.6 GT/year)

Dissolution of atmospheric carbon in surface ocean (90 GT/year

Photosynthesis on land (110 GT/year)

Release of carbon from surface ocean to atmosphere (90 GT/year)

Leaf fall to soil (60 GT/year)

Uptake of carbon from surface ocean by ocean life (10 GT/year)

Respiration from life on land (i.e., plants, 50 GT/year)

Downwelling (mixing) from surface to deep ocean (96.2 GT/year)

Respiration from soil (59.4 GT/year)

Upwelling (mixing) from deep ocean to surface ocean (105.6 GT/year)

Runoff of soil to surface ocean (0.6 GT/year)

Dead ocean life sinking to deep ocean (10 GT/year)

Deposition of sediment from deep ocean to rock (0.6 GT/year)

1.The diagram above shows the reservoirs of the carbon cycle with the mass of carbon in Gigatons. Using PowerPoint or the “Draw” feature in Microsoft Word, draw labelled arrows between the relevant reservoirs to represent the sinks and sources listed in the table above. Save your PowerPoint slide as an image (watch the tutorial video if you need help) and insert the image in the space below.  (13 points)

2. 

[Insert your completed carbon cycle diagram here. ]

3.Ignoring the solid Earth, which of the reservoirs has the longest residence time and which has the shortest residence time? What are the residence times of carbon in each of these? (4 pts)

Longest

Reservoir:

Residence time:

Shortest

Reservoir:

Residence time:

4.Your diagram currently represents how the carbon cycle operated before humans started affecting the atmosphere. Is the carbon cycle at a steady state today (as in the year 2024)? How do you know? (2 pts)

5.What extra arrows would you need to draw on the diagram to represent human activities that affect the carbon cycle? Where would they flow from and to? Describe at least two. (2 pts)

6.What effect do you think these additional fluxes will have on the size of the different carbon reservoirs? (2 pts)

Part 2. Interactive Carbon Cycle Simulation for “Business as Usual”

In this step, you will use an online carbon cycle simulation to observe how human activities are impacting the flux of carbon through the Earth System.  You will need to “ESS15_W24_HW5_CarbonCycle.xlsx” file and this link for the website.

1.For the first simulation, you will use the lesson Carbon Cycle and keep the parameters of fossil fuel use and net deforestation at their pre-set values of 2%/yr and 1 GT/yr, respectively.

This simulation will show you what the future carbon cycle will look like if we continue the “business as usual” pathway of using fossil fuels and deforestation at our current global rates.

Familiarize yourself with the carbon system diagram on the right. The main reservoirs of carbon are labeled, and their initial sizes are shown. For example, in year 2010, the size of the terrestrial plants carbon reservoir is 700 GT and the size of the atmosphere is 720 GT. As you progress through each decade of the simulation, these values will change, and we will keep track of this information in our spreadsheet.

Begin the simulation by clicking the green “run decade” button.

At each decade interval, fill in the corresponding data table in the Excel spreadsheet. Complete the simulation through the year 2120. (5 pts)

*Hint: the sizes of the soil, ocean surface, and deep ocean reservoirs do not change, but rather show the +XX GT change. In your table, start with their initial values for 2010, and then add formulas for the following decades. For example, with the surface ocean you can do: = 1000+XX, or deep ocean: =38000 + YY where XX and YY are the respective increases in those reservoirs per decade of the simulation. This way the math is done for you automatically on your Excel table.

2.Using the collected data, make a plot of the different reservoir sizes in GT (atmosphere, surface ocean, deep ocean, soil, and plants) from 2010 to 2120. Put the deep ocean on a secondary y-axis (watch this video for help). Insert your figure below. Be sure to include appropriate axes labels and units, a legend, and a title. (5 pts)

3.Calculate the rate of change in the size of each of the reservoirs from 2010 to 2120.

where t is the current time step (ex: year 2030) and t-1 is the previous time step (ex: year 2020). The atmosphere’s rate of change is started for you.

Make a figure for the rate of change for each reservoir and insert your figure below. Be sure to include appropriate axes labels and units, a legend, and a title. (15 pts)

4.What do you observe in the rate of changes in the different carbon reservoirs over time? Are they all the same? Or do some change more/less than others? In at least one paragraph, discuss your observations. (5 pts)

5.Calculate the amount the carbon emissions (in percent) that end up in each reservoir for each decade. This can be done by first determining the change in the reservoir’s sizes after each decade. Then divide these values by the total emissions of carbon at the time step (column G, “Smokestack”). For example, if the atmosphere changed by 10 GT and the total emissions were 100 GT, the percent of the total emissions that ended up in the atmosphere at that time step would be 10%. Remember that Excel acts as a calculator, so you can type formulas in a cell and drag!

Make a graph of the results and insert your figure here. Be sure to include the appropriate axes labels and units, a legend, and a title. (15 pts)

6.What do you observe about where carbon ends up in the Earth System through time in this scenario? Do all the reservoirs “accept” the same amount of carbon or are some different? Is the amount of carbon ending up in each reservoir the same at every time step or does it change? In at least one paragraph, discuss your results. (5 pts)

Part 3. Interactive Carbon Cycle Simulation for a “Drawdown” Scenario

1.For the second simulation, you will change the lesson to “Curb Emissions” and reduce the parameters of fossil fuel use and net deforestation at to -4%/yr and -4 GT/yr, respectively.

Press “RESET” to set these parameters. This simulation will show you what the future carbon cycle will look like if make drastic cuts to our carbon emissions by stopping fossil fuel use and deforestation. 

      Begin the simulation by clicking “run decade”. At each decade interval, fill in the corresponding data table in the       Excel spreadsheet. Complete the simulation through year 2100.

      Using the collected data, make a plot of the different reservoir sizes from 2010 to 2100. Insert your figure below.      Be sure to include appropriate axes labels and units, a legend, and a title. Put the deep ocean on the secondary      y-axis (10 pts)

2.Compare and contrast the differences in the carbon reservoirs with this curb emissions scenario and the “business-as-usual” scenario. (5 pts)

3.Continue running the curb emission scenario out into the far future (2500). You do not need to record the data. While you do this, pay attention to the different reservoir sizes and to the atmospheric CO2 concentration. Describe what happens to carbon in the Earth System in the future. Where does the carbon that had been emitted to the atmosphere prior to 2010 end up? Is this a slow or fast process? (5 pts)

4.From what you have witnessed in this “curb emissions” scenario, explain the concept of “climate inertia”. Use the internet if you need to and cite your sources (links are acceptable). (5 pts)

5.With the concept of “climate inertia” in mind, why is it important that we begin curbing carbon emissions as soon as possible? (2 pts)

6.In one paragraph, summarize what you learned from this homework activity. (2 pts)

answer the questions below

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QUESTION

1. Identify a health professions role needed in the care of the patient in this case. Explain your rationale for why the role you selected is needed.

  • Reply to an existing post: In your reply to someone else’s post, discuss how the role that was posted is also needed by family members of the patient and needed by the other health care providers on the team.

Case Scenario Involving a Patient with Diabetes:

You have just been assigned to the new innovative clinic at LECOM. Three practices will be in one building! Medical students, pharmacy students, and dentistry students will collaborate together on an interprofessional team to improve patient outcomes. The following patient has been referred to your clinic for care. Included, you will find three documents:

      1. A note from his prior physician who referred him to your clinic because of his complex medical needs and history of non-compliance.
      2. A note from the last time he went to a dentist
      3. His recent medication fill history from the pharmacy

Physician note: 9/15/15

HPI:

A 55 year old white male presented to the office complaining of being thirsty all the time and waking up at night to go to the bathroom. Patient has not been to an ophthalmologist in 5 years. Last year he did have a glucose reading over 200 mg/dL but denied having been diagnosed with diabetes. He is also a professional gambler and is upset because he frequently has to leave the table to urinate and reports occasional blurred vision. This is hurting him financially after he lost a huge hand in poker because he had to go so bad.

PMH:

Hypertension

Hyperlipidemia

Medication History:

Atorvastatin PO 10 mg daily

Metoprolol succinate PO 25 mg daily

Fish Oil 1,200 mg PO once daily

Lisinopril 20 once daily

Social History:

1 pack per day smoker for 10 years

Drinks 1-2 Budweisers a day after work to relax

Family History:

Mother died of a heart attack 15 years ago

Father is living in an assisted living facility currently with DM2 and Hyperlipidemia

Brother is still alive and suffers from seizures

Physical Exam

Vital signs:

Height 6’0’’ Weight 220 lb BP 132/78 mm Hg

Pulse 86 bpm RR 17 bpm Temp 97.4 F

Constitutional: Patient is A&O X3, well-nourished, well-developed and well-groomed

Head: The skull is normocephalic, atraumatic and without masses, patient’s facial expression is normal, no facial drooping, there is symmetry of the nasolabial folds

Eyes: Sclera is white and conjunctiva is pink, pupils are equally round and reactive to light

Ears: Otoscopic examination of external auditory canals and tympanic membranes is normal; there is a good cone of light.

Nose: Slight irritation of nasal mucosa with clear discharge

Mouth: Thin, milky white coating on buccal mucosa; lips are dry and pale pink; dentition indicates excess plaque and a purple discoloration of the gums.

Throat: Tongue is dry and midline with thin white coating

Neck: The neck is supple; trachea is midline; thyroid is not enlarged and no palpable nodules

Respiratory: The patient is relaxed and breathes without effort. Patient is not cyanotic and does not use accessory muscles for respiration. The chest expands symmetrically upon inspiration. There are no crackles, wheezes, rhonchi, stridor or pleural rubs.

Cardiovascular: Upon palpation of the chest, there are no heaves, lifts or thrills. The rate is normal, the rhythm is regular, S1 and S2 are normal, there are no murmurs, no gallops, and there are no rubs.

Foot exam: Skin is dry and cracked at the heel; negative for signs of infection, laceration or ulceration; faint bilateral pulses present, SWM results: 6/10 left foot and 5/10 right foot

Labs: Taken Sep 20, 2015, fasting sample

2. Select and identify one person on the team in the video below who displayed the least able to work on a team. Why did you select this person? What specific actions, attitudes, or behaviors did the individual display that interfered with effective teamwork?

  • Reply to an existing post: In your reply to someone else’s post, apply from the required reading in module 3, at least one principle of good interdisciplinary teamwork that could also improve his or her teamwork skills and justify your selection.

3.In analyzing this scenario, there were many steps in Sydney’s care where there was either a lack of communication or miscommunication. Which one do you feel was the most significant communication error impacting his care? Why? – Defend your selection. Apply one strategy from the content in this module that should be implemented to ensure that such events do not happen again.

      • Reply to an existing post: In your reply to someone else’s post, provide a second strategy that ensures that such events don’t happen again and describe your reasoning for your selection.

Case Scenario:

A 32-year-old male, Sydney Worthington, was in a nursing home undergoing regular physical therapy. The nurse reported to his mother that Sydney almost fell twice during therapy last week, and was caught by the therapist. The nurse also reported that Sydney almost stumbled into her arms 3 days ago. His current medications include 200 mg phenytoin and 2000 mg levetiracetam, for control of seizures.

Past medical history includes a motorcycle accident nine years ago, that caused traumatic brain injury resulting in Sydney going into a coma. After Sydney came out of his coma, he was placed in the nursing home for long-term rehabilitation. He suffered a seizure at that time and was treated with phenytoin. He was then prescribed phenytoin orally, 100 mg once a day for maintenance. Six years later, when blood levels of phenytoin were tested, they were too low and the physician prescribed increased doses, up to 200 mg a day. This caused lethargy, and impaired balance and gait. His mother took Sydney to see a neurologist, who prescribed a different anti-seizure medication since phenytoin has adverse cardiovascular effects. The neurologist ordered the nursing home staff to administer levetiracetam 500 mg once a day along with phenytoin 200 mg/day, and slowly increase levetiracetam to 1000 mg a day. Once the patient was receiving 1000 mg/day of levetiracetam, the phenytoin was to be decreased to 100 mg/day. After levetiracetam was increased to 1000 mg twice a day, phenytoin was to be discontinued. These orders were faxed to the nursing home.

After 3 weeks, Sydney was being given 1000 mg/day levetiracetam, plus phenytoin 200 mg/day. When Sydney’s mother asked the nurses why the dose of phenytoin was not being decreased as the neurologist had recommended, the nurses indicated that the orders were not clear on how to decrease phenytoin. The mother contacted the neurologist’s office requesting that the order be redefined and sent to the nursing home, which was done immediately.

After 11 days, when his mother was informed by the nurse that Sydney lost his balance and nearly fell twice, she examined his medication chart and realized that for the past 11 days, Sydney was being given levetiracetam 1000 mg twice a day, in addition to phenytoin 200 mg/day, which was clearly not what the neurologist had ordered. The nursing staff had consulted with their on-site physician who never saw Sydney but had only looked at his chart.

4.Make an Original Post: Is this a breach of the patient’s confidentiality? Why? – Explain your rationale why this is or is not a breach.

  • Reply to an existing post: In your reply to someone else’s post, please explain how confidentiality (or lack thereof) in this scenario can affect a patient-provider relationship and potentially affect the health of the patient.

Case Scenario:

A student caring for actual patients (pharmacy student on a pharmacy practice experience/dental student working in a dental school-related clinic/medical student on a clinical rotation), posts negative comments about a patient/customer on his/her Facebook page with the privacy setting set to “friends.” Although the patient’s name was not posted, specific physical characteristics and medical, drug, and dental problems were included in the post.

LW AND MW MANAGEMENT

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QUESTION

LW 1COMPLETE DISCUSSION

Explain how HRISs are changing how companies manage their compensation and benefit plans.

LW 2 REPLY TO DISCUSSION

Human Resource Information Systems (HRISs) have significantly impacted how companies manage their compensation and benefit plans by introducing efficiency, accuracy, and strategic decision-making. HRISs automate compensation and benefits processes, reducing manual errors and ensuring accuracy in data management. Automated calculations and systems ensure that employees receive accurate compensation, including salary, bonuses, and benefits. HRISs centralize employee data, including compensation and benefits information, in a single, accessible platform. Centralization facilitates easy retrieval of data, enabling HR professionals to make informed decisions based on real-time information. HRISs streamline the administration of compensation and benefits by providing a unified platform for managing various elements such as salary structures, incentives, and healthcare plans. This streamlining reduces administrative burden, allowing HR teams to focus on more strategic aspects of compensation planning. HRISs offer customization features, allowing companies to tailor compensation and benefit plans to meet the diverse needs of their workforce. Integration between HRISs and payroll systems ensures seamless processing of compensation, benefits, and tax-related information. HRISs revolutionize compensation and benefits management by introducing automation, centralization, customization, and data-driven decision-making, ultimately contributing to more efficient, strategic, and employee-centric HR practices. Thoughts?

LW 3 REPLY TO DISCUSSION

Professor,

  • Employee Identification: Employee name, employee ID, department, job title, hire date, and location.
  • Base Salary: The fixed amount of compensation paid to employees for their work.
  • Variable Pay: Additional compensation that varies based on performance, such as bonuses, commissions, or profit-sharing.
  • Overtime Pay: Compensation for hours worked beyond standard working hours.
  • Allowances: Additional payments made to employees for specific purposes, such as travel allowances, housing allowances, or meal allowances.
  • Incentives: Monetary rewards given to employees for achieving specific goals or targets.
  • Benefits Enrollment: Data related to employee enrollment in benefits programs, such as health insurance, retirement plans, and stock options.
  • Salary Structures: Information on salary ranges, pay grades, salary bands, and any other structures used to determine employee compensation.
  • Salary Surveys: External market data on salary benchmarks, compensation trends, and industry standards.
  • Performance Ratings: Evaluation data on employee performance, ratings, and merit increases.
  • Payroll Information: Data related to payroll processing, including pay periods, tax withholdings, and deductions.
  • Compensation Policies: Documentation of the organization’s compensation policies, guidelines, and procedures.
  • Historical Compensation Data: Data on past compensation decisions, changes, and trends.
  • Legal Compliance Data: Information on legal and regulatory requirements related to compensation, such as minimum wage laws and pay equity regulations.
  • Employee Demographics: Data on employee demographics such as age, gender, education level, and years of experience.
  • Cost of Living Data: Information on the cost of living in different geographic areas to adjust compensation accordingly.
  • Market Competition Data: Analysis of compensation practices of competitors and peers in the industry.
  • Employee Feedback: Feedback from employees on compensation satisfaction, preferences, and concerns.
  • Compensation Budget: Financial data related to compensation expenses and budget allocations.
  • Equity Analysis: Analysis of compensation disparities and fairness across different employee groups.
  • Salary Forecasts: Projections of future compensation trends and costs.
  • Job QUESTIONs: Detailed QUESTIONs of job roles and responsibilities to determine appropriate compensation levels.
  • Performance Metrics: Key performance indicators (KPIs) used to evaluate employee performance and tie it to compensation decisions.
  • Compensation Committee Decisions: Records of decisions made by the compensation committee regarding compensation policies and practices.
  • Employee Turnover Data: Data on employee turnover rates and reasons for leaving, may impact compensation strategies.
  • Compensation Communication: Documentation of how compensation decisions are communicated to employees to ensure transparency and understanding.

MW 4 COMPLETE DISCUSSION

Consider the Twenty-First Century Vision Statements. After reading all 12 vision statements, answer the following questions to begin this week’s discussion.

  • Which of the vision statements are, in your judgment, effective and which are not?
  • Based on their vision statements, for which of these companies would you work for?
  • Whose vision would turn you away? Why?
  • How would you explain your preferences and dislikes with regard to these visions?

MW 5 REPLY TO DISCUSSION

Of the reasons discussed in this chapter concerning why visions fail, which are applicable to Mentor Graphics?

Vision concerns the future state of the organization, an aspiration that can mobilize the energy and passion of the organization’s members. Visions answer the question, “What do we want to achieve?” Visions describe an ultimate goal (Kolowich, 2019)

Below are the visions of Mentor Graphics.
“Build Something That People Will Buy.”
“Beat Daisy”
“Six Boxes”
“Five Boxes”
“10X Imperative”
“Changing the Way the World Designs Together.”
“Our current short-, medium-, and long-term vision is to build things people will buy.”

Looking at the visions, I can’t see what this company is making or what it wants to achieve. These visions are too complex, abstract, and difficult for customers to understand. Thus, I think they have failed to convey the company’s vision. Kotter (1996) perfectly shows that conveying the vision is an important factor in success or failure that affects organizational change. Palmer, et al., (2009) also argue that vision fails when there is little or no participation from other employees because consensus formation involving activities to develop and spread the vision is needed.

MW 6 REPLY TO DISCUSSION

After reading the case study, I understand that Mentor Graphics made many strategic mistakes that became costly for the company. This just reminds me of the Blockbuster situation, where they had a great vision statement but did not follow through or adjust and ended up bankrupt.

Mentor Graphics first had several visions through the years. Started with ” Build Something That People Will Buy,” then moved to ” Beat Daisy” to go to ” Six Boxes” and ” 10X Imperative” to finish with ” Changing the Way the World Designs Together.” The visions, to begin with, needed to be more specific and appealing. The employees or customers didn’t understand their visions or see themselves in that. You are not saying much when you put ” Six Boxes” as the vision statement. A vision is what you want to see after assessing the current situation. However, their visions needed to reflect their current situation. To say ” Beat Daisy” is insufficient as a statement and one that everyone will be energized by.

Their visions do not strengthen the company. The end proves this to be true. ” Beat Daisy”: what was the assessment that brought them to that statement? Was it just that they were falling behind the competition, and that became the company statement? To come up with a statement to win a contest will only drive the company into a ditch. Mentor Graphics had the same situation, they won the competition and did not have anything else to fall on to move forward.

Mentor Graphics did not feel the need to readjust as they realized that one unit was dragging the company. Just like Blockbuster strayed away from its vision, which was ” To be the global leader in rentable home entertainment by providing outstanding service, selection, convenience, and value.” Had they actually followed their vision, they should have bought Netflix when they had a chance to continue that outstanding service and convenience to the customers. But they did not, and the rest is history.

My point in this case is that it seemed to me that they should have assessed the current situation before looking at the future state. Had they done an assessment, ” Beat Daisy” might not have been their statement. The data provided some information that suggested taking another route for that change

MW 7

LOG IN AND COMPLETE WEEK 3 ASIGNMENT, ONLY COMPLETE WHAT COUNTS AS A GRADE. MAKE SURE YOU GET A GOOD GRADE BECAUSE MY OTHER TUTORS HAS BEEN FAILING MY ASSIGNMENTS.

Log into Mcgraw Hill (employment law)

marywilliams1958@yahoo.com

Snow@2018

Biology Question

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QUESTION

Congressional Testimony.This paper should center on antibiotic resistance (possibly in relation to the microbiome), or sleep/circadian biology in society. These areas concern questions of science, human and ecological health, and government regulatory policy.

For that reason, your paper will follow the form not of the traditional essay, but of a legislative
congressional hearing. A legislative congressional hearing is an event used to gather and
analyze information in the early stages of making or changing public law. Members of Congress
listen to testimonies from experts, members of the public for whom the issue is of special
relevance, or other policy makers.
Your first task in this paper is to write a neutral one-page QUESTION of the problem at hand that
Congress is interested in acting upon. This should be a straightforward statement of the
problem without the voicing of any particular opinion, should be in the third person, and should
narrow and define the issue. Rather than choosing “the microbiome” for example, think of an
issue such as the regulation of probiotic supplements. To use a real example, many
congressional hearings have been held on the issue of stem cell technologies, with members of
Congress interested in making laws to ban human reproductive cloning or ban the use of human
embryonic stem cells. What issue will your made-up experts be responding to?
Your framing of the problem on page one will then lead into two mock testimonials, each of 3
pages in length, for a hearing on the role of government in addressing that problem. You will
have to invent people (biological scientists, affected citizens, social scientists, social activists,
historians, epidemiologists, philosophers, bioethicists etc.) to speak to the issue from a
particular point of view. You could also choose a real-life person, if you have an idea of what
their perspective would be (you still make up their argument, don’t use their words). You will
use the readings from class as sources to provide the substance of what these speakers say, as
well as your own ingenuity and thoughtfulness to come up with proposed solutions to the
problems they are addressing.

The congressmen/women wish to hear from the specialists they’ve invited regarding:
? what the nature of the problem is from the specific perspective of the speakers’ expertise
? what the evidence is for causes of the problem
? and what kinds of government interventions are implied by the definition and causal
explanation of the problem.
Each testimony should state “the problem” as the speaker sees it/defines it, give arguments for
what is causing the problem, and then propose actions for the Federal government to take that
specifically address these proposed causes. (For example, if a speaker says that over-
prescription is causing antibiotic misuse, and the evidence given relates to medicine, then the
proposed interventions should follow logically and address not just the problem of antibiotics
generally, but how to intervene in antibiotic use in the medical realm; or, if a speaker addresses
the overuse of air conditioning in response to heat, the intervention should be specific to the
problem, to specific agencies or regulators who can have impact on appliance use). If
appropriate, a testimony can criticize other viewpoints, and strengthen its own position by
saying why other approaches are misguided. Or the two speakers may agree, it is up to you.
Look at examples to get a sense of the general rhetorical form: obviously, though, you will need
to be shorter and more concise to fit your evidence and argument into 3 pages per testimony.

General Grading Rubric: Unlike your long answers on the exams, which are not really graded
on organization or style, this assignment will take into account the clarity, creativity and
organization of your writing. The paper is worth 20% of your grade for the class, and these are
the four categories of assessment that will be used to reach that grade:
1. Grammar, spelling, and sentence structure. These are the technical building blocks of a
good paper. Check your sentences to make sure each one is grammatically correct, of a
reasonable length, and that it flows coherently with the sentence before and the sentence
after. Run-on sentences, unclear referents (it not being clear what “it” refers to), and non-
sequiturs are frequent errors. Another common error is using a word because it sounds
right (or sounds important) without actually looking it up to see if its usage is correct. Use
the Oxford English Dictionary, a resource available to you through the library website to
double-check your word choice, but use straightforward language when possible. Often,
reading your paper out loud to yourself or a friend can help you find those sentences that
are awkward or difficult to understand: if it is hard to read out loud, it will be hard for anyone
to read to themselves. All these points are true regardless of which topic you choose.
2. Overall organization and paragraph structure. Make sure your paragraphs have topic
sentences, that the material in each paragraph belongs together, and that the paragraphs
move in a logical order. If you choose the Congressional Hearings, then testimonies should
have an introduction, a body, and a conclusion. The material should be clear, and clearly
communicated. State your case, then make your case, then sum up your case. Remember
you are trying to persuade someone to take action, and to believe your version of the facts.
No paragraph should contain more than 7 sentences, and paragraphs should be roughly the
same length as one another. If you are writing a plot make sure you are building a fictional
world but starting with a basis that is well-situated in concrete facts learned in class
(supported through citations from class material) and that there is internal logic and
consistency to the world you imagine. Make sure that you provide a QUESTION of your new story and plot synopsis, in which you describe the characters, setting, and what happens in the story, as well as explaining the big themes the plot would explore. What has changed and what is still the same in your new vision in comparison to these earlier works?

3. Concreteness and use of relevant resources. When writing on the Congressional Hearings,
avoid extremely general statements, even in your opening and closing paragraphs. For
example, “Man has for all time…”, “ People have always…”, “Society is changing,” etc.
Always be precise, ground your statements by referring to specific times, places, people,
things or facts; alternately, offer a specific example to illustrate a general statement. “For
example” should be your friend. It can often be very helpful to actually quote a portion of a
text to illustrate your point, but do not overuse direct quotes keep them short and use them
at key points. All facts or quotes should be cited using a (name, date, p#) format. You
must reference at least 3 different class readings in each testimony, for a total of 6 different
class readings. For your story, you also want to create a specific, detailed world with key
memorable characters and a clear plot relevant to issues around either antibiotic resistance
or sleep/circadian rhythms; you need to show that you have mastered the material you are
‘playing’ with in your fictional account, so make sure to illustrate your knowledge about
science and societal issues at the heart of your story by using clear facts or quotes from the
articles of interest (make sure to reference at least 6 articles from class).
4. Quality of Analysis. How convincing, well-reasoned, and original are the observations put
forward in the testimonies? Or, how are the class materials mobilized in the making of a
new story? If the paper describes the facts but does not interpret them, this is reportage
rather than analysis. Is the author able to make something new and original out of the
materials provided? Important: does the explanation of the problem match the intervention
suggested or the future envisioned? How specific and well thought-out is the intervention or
the future scenario?

Emphasis on #4.

Please provide an outline to me before working on it.

DNP project

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Question

1.Project Title

Improving diabetes management in black Americans through cultural competency training

2.Select if your project is using a translational science model or a theoretical framework and change model. Identify the model used. (translational science model or a theoretical framework)

This project will use a translational science model. Specifically, the Awareness-to-Adherence Model will be utilized.

3.Provide a problem statement (no less than 5-6 fully structured sentences) to explain the issue/problem you are addressing. Please describe current practice/process leading to the issue. Provide any reports or currently available data to document the need identified by primary decision maker(s) at practicum site. NOTE: in this section, you must include in-text citations with your evidence-based intervention.

Black Americans suffer worse diabetes control and higher complication rates compared to other racial groups, with average HgbA1c levels 0.5-1% higher (Assari, 2018). Socioeconomic factors partly drive this disparity but also reflect gaps in cultural competency among healthcare providers (Amuta et al., 2020). Implementing cultural competency training for providers at ABC Clinic, where 38% of our diabetic patients are Black American. This aims to improve cross-cultural communication and treatment adherence in this population. Our clinic’s average HgbA1c for Black patients was 8.1% in 2022 compared to 7.2% for White patients, indicating poor diabetes control.

4.Provide a brief Question, using in-text citations/references, to support the need for change from both a global and practicum site perspective.

Racial disparities in diabetes outcomes are well-documented globally and match patterns observed at our clinic (Goff et al., 2020). Enhancing providers’ cultural competency through training interventions has improved minority health outcomes (McGregor et al., 2019). This evidence supports the need for and potential benefits of implementing a cultural competency program at our site.

5.What is the purpose of your proposed project? Begin your formal purpose statement by stating:

The proposed DNP assignment goals are to enhance diabetes management, as measured with the aid of HgbA1c degrees, amongst Black American patients through implementing a cultural competency education application for healthcare providers at ABC Clinic over a 3-month.

6.Provide your one-sentence PICOT question below. Be clear and concise. Note: your population cannot be students or faculty; your intervention cannot be educational and your time frame must be 8-12 weeks.

How does enforcing cultural competency education for healthcare vendors compared to no training in Black American adults affect HgbA1c tiers over 3 months?

7.Fully describe the population (keep in mind students and /or faculty are not allowed) of your proposed project. What is your anticipated participant size? What inclusion and exclusion criteria will be used to identify your population?

The populace will be healthcare carriers (physicians, nurses, medical assistants) worrying for Black/African American adults with diabetes at ABC Clinic. The predicted sample length is 50 carriers. Inclusion criteria consist of direct care companies for diabetic patients. Exclusion standards include the non-scientific body of workers and carriers not treating diabetic sufferers.

8.You are required to have a minimum of 5 contemporary research articles s (<5 years old) to support your practice problem and evidence-based practice intervention. A minimum of 2 articles should be related to your practice problem and a minimum of 3 articles related to your evidence-based intervention. Please provide a full listing (APA formatted) of the evidence you have to support the EBP intervention you will implement.

Amuta-Jimenez, A. O., Jacobs, W., & Smith, G. (2020). Health disparities and the heterogeneity of Blacks/African Americans in the United States: why should we care? Health promotion practice, 21(4), 492-495.

Assari, S. (2018). Health disparities due to diminished return among black Americans: Public policy solutions. Social Issues and Policy Review, 12(1), 112-145

McGregor, B., Belton, A., Henry, T. L., Wrenn, G., & Holden, K. B. (2019). Improving behavioral health equity through cultural competence training of health care providers. Ethnicity & disease, 29(Suppl 2), 359.

Goff, L. M., Moore, A., Harding, S., & Rivas, C. (2020). Providing culturally sensitive diabetes self-management education and support for black African and Caribbean communities: a qualitative exploration of the challenges experienced by healthcare practitioners in inner London. BMJ Open Diabetes Research & Care, 8(2).

Paguio, J. A., Golbin, J. M., Yao, J. S., Eala, M. A., Dee, E. C., & Yu, M. G. (2022). Self-reported cultural competency measures among patients with diabetes: a nationwide cross-sectional study in the United States. The Lancet Regional Health–Americas, 7.

9.Explain the intervention you will implement to address the issue identified based on the needs of the practicum site. Remember, educational only interventions are not allowed. The intervention should be based on the translational science model you have chosen. You must provide an overview of the intervention so the reader(s) will be able to duplicate the intervention on their own. (Include or attach any relevant documents, if available such as protocols, procedures, guidelines, etc. that you will implement).

A cultural competency training program will be implemented, consisting of interactive online modules focused on implicit bias, cultural awareness, cultural knowledge, and cross-cultural skills. Additionally, providers will engage in open dialogue sessions to facilitate perspective-taking. Relevant training materials on cultural competency from resources such as Think Cultural Health will be utilized.

10.Given you only have 8-10 weeks to implement your project, discuss the project’s feasibility. Will you be able to accomplish everything you want to do as far as implementation in 8-10 weeks? What barriers might you have and how will you overcome them?

While limited to 8-10 weeks for implementation, the online and dialogue components can realistically be completed in this timeframe. Potential barriers like scheduling or technical problems would be proactively troubleshooted. Short-term assessments will determine the feasibility of longer-term sustainment.

11.Fully explain your plans for data collection to measure the impact of your intervention. Include a concise Question of the measurable outcome you identified in your PICOT question. Provide the name of the tool/instrument you will use (if applicable) and discuss its validity and reliability with in-text citations from supporting literature. Additionally, fill out the chart below to concisely convey your measurable outcomes and the name(s) of the valid/reliable survey instrument/tool(s) you will use

To measure the impact of the cultural competency training intervention, the primary data that will be collected is HgbA1c levels from the medical records of Black American adult patients with diabetes at our clinic. The measurable outcome identified in the PICOT question is a change in average HgbA1c levels among this patient population after the intervention is implemented. HgbA1c provides an objective measure of serum glucose control over the previous 3 months. Reduced HgbA1c indicates improved diabetes management. No additional tool or instrument must be utilized as HgbA1c lab values will be directly extracted from patients’ medical records. HgbA1c testing is considered a valid and reliable method for assessing glycemic control, with performance meeting National Glycohemoglobin Standardization Program standards (Paguio et al., 2022). Average HgbA1c levels will be calculated for Black American diabetic patients at baseline before intervention implementation and at the 3-month conclusion of the project. Medical records data will be extracted and deidentified before analysis. The comparison of averages pre- and post-intervention will determine the impact on diabetes outcomes.

12.Measurable Outcome(s) as identified in the PICOT question

HgbA1c levels (average for Black American diabetes patients at the clinic)

13.Data collection process pre- and post-intervention

Medical records will be used to collect HgbA1c levels at baseline before intervention implementation and at 3 months post-implementation.

14.Explain your plan for data analysis. Identify the statistical test(s) you will use to bring meaning to the final data you collect at the completion of your project

Paired samples t-tests will be used to analyze changes in average HgbA1c levels pre-and post-intervention. Statistical significance will be set at p < .05.

week 4 discussion feedback

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Question

Give a positive feedback to each of this post with one paragraph. post #1Junie: 

    Person-centered care, often referred to as ‘patient-centered care,’ revolves around respecting the individual’s preferences, ensuring physical comfort and safety, providing emotional support, and offering timely access to appropriate care but lies at the core of ethical and practical practice in the nursing profession. This approach places the person receiving care at the center of the healthcare experience rather than taking a one-size-fits-all stance; person-centered care considers each person’s unique situation, values, cultures, beliefs, and preferences. The goal is to provide care and treatment genuinely responsive to that individual as a whole person. As a future nurse practitioner, applying principles of person-centered care and cultural humility will be instrumental in delivering compassionate, quality health outcomes for all patients.

    Several vital principles define person-centered care. First and foremost is treating each person with dignity and respect, recognizing their intrinsic worth as a human being. It also involves encouraging active participation in health-related decisions to empower patients. Good communication is imperative, with providers openly discussing a person’s medical condition and treatment options in a way they can understand. People need to be well-informed so they can be involved in choosing the path that fits best for their lives. Additionally, person-centered care aims to be coordinated, considering all aspects of a person’s well-being and supporting them with medical and psychosocial needs (Coyne et al., 2018).

    As an advanced practice nurse, I will uphold these person-centered ideals. I will need to see each patient as a holistic individual rather than just a medical condition. I must gain a deep understanding of their diverse values, beliefs, preferences, and lived experiences. I foster open, honest communication so patients feel comfortable sharing relevant information. Treatment plans should be tailored specifically for that person whenever possible. I will strive to establish caring, trusting relationships where patients are true partners in their healthcare (Delaney, 2018). 

    Cultural humility and person-centered principles will be crucial to my practice approach. Every person’s culture influences how they view health, illness, and medical care. As a provider, I have much to learn from each unique culture. Practicing cultural humility means approaching each patient interaction with curiosity, respect, and lack of presumption. It acknowledges that while I hold clinical expertise, patients are the true experts of their lives and cultures. I can recognize any biases and avoid assumptions by maintaining an attitude of humility and ongoing self-reflection. I aim to ensure that all treatment decisions fully respect and incorporate each person’s cultural perspectives (Clay, 2018).

References
Coyne, I., Holmström, I., & Söderbäck, M. (2018). Centeredness in healthcare: a concept synthesis of family-centered care, person-centered care, and child-centered care. Journal of Pediatric Nursing, 42, 45-56. https://doi.org/10.1016/j.pedn.2018.07.001 

Delaney, L. J. (2018). Patient-centered care as an approach to improving health care in Australia. Collegian, 25(1), 119-123. https://doi.org/10.1016/j.colegn.2017.02.005
Clay, A. M. (2018). From Patient-Centered Care to Person-Centered Care: Intersectionalities, Disparities, and Holistic Care. University of California, Davis.

post#2 Hannah: 

    After reading about person-centered care, I learned that it places importance on both the provider and the patient in the plan of care. It also helped me differentiate between that and patient-centered care (American Association of Colleges of Nursing [AACN], n.d.). Person-centered care to me means looking at the whole picture around the diagnosis. What contributing factors may be present. The example given in the reading showed that the patient’s environment and social environment contributed to her condition. Person-centered care looks at the diagnosis and develops the care plan for how we can maintain and/or prevent and educate the patient to their active participation.

    I think it is important to have a good history of your patients. When you know your patient then you can really be able to practice holistic nursing. Holistic nursing can be tailored to each patient as an individual based on their history, environment, and other things that may influence their health. I will make the best of the time I am allotted with each patient to review their charts, past medical history, social history to understand the “behind the scenes” of the patient. This will allow me to try and develop a treatment plan that works best for that specific patient. Not all people are dealt the same hand of cards in life. There are many factors that play a part in someone’s healthcare, and everyone should always keep that in mind. I can use my own self-reflection on how my healthcare changed in my life from my access to care, down to my environment. I was born and raised in a small town in Northern Pennsylvania. When I moved to Florida, it showed me such a beautiful new world. To me, this was experiencing Culture Humility, and going through nursing school I learned the various different ways each culture views healthcare and how treatment may be altered.

Reference

American Association of Colleges of Nursing. (n.d.). Person-centered care. Retrieved September 22, 2022, from https://www.aacnnursing.org/5B-Tool-Kit/Themes/Person-Centered-Care

Khan, S. (2021, March 9). Cultural humility vs. cultural competence- and why providers need both. Healthcity. https://healthcity.bmc.org/policy-and-industry/cul…

post #3 Samantha: 

    Person-centered care means creating a plan for the person as an individual and not just a plan based on their diagnosis. While treating the disease or diagnosis is essential, we want to treat the person, not just the disease. Collaborating with the patient and those around the patient, taking their cultural background and beliefs into consideration, respecting their individuality and autonomy, making sure their basic needs are being met, staying compassionate, and staying flexible are all behaviors nurse practitioners can do to make person-centered care happen. These things will all help comfort the patient and make them feel they are being treated as a person, not just a disease or diagnosis.

    I will apply holistic nursing principles by meeting my patient’s social, physical, spiritual, and psychological needs. Holistic nursing goes along with person-centered care in that we must treat our patients with respect and dignity, as a whole person, and not just one diagnosis.

    I will apply the principles of cultural humility by planning the patient’s care around their cultural beliefs. It’s essential to acknowledge a patient’s culture and realize they know themselves best when providing care, so they know they’re being treated as individuals, not just as a number or exciting case. Learning from people with different world views, beliefs, and values will help us become more compassionate and empathetic providers. I believe that treating patients with cultural humility requires us to put our beliefs aside for a moment to provide the best care to our patients, which leads to better outcomes for them.

    Applying self-reflection principles and debriefing at the end of each day can help us learn, grow, and become better nurse practitioners. Reflecting on how the day went and receiving patient feedback can help increase patient satisfaction and outcomes by learning from different scenarios, good or bad. As described in our lesson from this week, using Gibbs’s reflective cycle model can aid advanced practice nurses in pinpointing strengths, finding areas where improvement is needed, and applying actions to develop their practice (Chamberlain University College of Nursing, 2024). Using this in our everyday practice is critical for professional growth. It will help patients feel more included in their care because their provider reflects on what they did great and what they could do better.

Reference:

Chamberlain University College of Nursing. (2024). NR581NP-17548. Week 4: Cultural Care [Online lesson]. https://chamberlain.instructure.com/courses/137784…