Unit 7 Discussion

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QUESTION

Palliative Care

Case Study

Mr. Brown, who was your eighth-grade science teacher, has been a patient in your practice for many years. Several years ago, he was diagnosed with cancer and has been undergoing treatments. He recently was told that his cancer was no longer responding to treatments and that his condition is terminal. Mr. Brown, along with his wife and daughter, have scheduled an appointment to discuss palliative care and what can be expected. Although Mr. Brown’s death is not imminent, his care needs clearly will continue to increase, and they will continue until his eventual death from the disease. The disease process is typically accompanied by an increasing level of pain, which is of great concern to Mr. Brown and his family. The meeting today is intended to determine whether the patient and the family feel that palliative care is appropriate.

Case Questions

What are some open-ended questions that can be asked to explore the need for palliative care?

The decision is made to proceed with palliative care, and a plan to manage pain is being developed in partnership with Mr. Brown and his family. What does total pain management entail, and why is managing total pain important to the well-being of Mr. Brown and his family?

How should Mr. Brown’s spiritual well-being be evaluated, and why is it part of total pain management?

As you learn that Mr. Brown’s level of pain has increased since his treatments ended, you suggest the use of opioids for pain management. Mr. Brown’s daughter expresses concern about the use of opioids to manage pain, stating, “Aren’t opioids bad? I hear about people dying from opioid abuse on the news all the time.” What information should you provide to assuage the daughter’s concern?

As the disease process progresses, the patient begins to demonstrate signs of dyspnea, including confusion and anxiety. What treatment should be initiated, and what are important considerations when initiating this treatment?

Yansakusah

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QUESTION

The objective of this assignment is to compose a clear, concise, and patient-centered email message to communicate important healthcare information or follow-up instructions to a patient. Students will demonstrate effective communication skills, including clarity, empathy, and professionalism, while adhering to privacy and confidentiality regulations.

Instructions

1. Choose one of the scenarios provided below.

2. Consider the intended audience of the email (patient – layperson; health and reading literacy levels, any potential cultural or linguistic considerations).

3. Create an email response to the scenario which you have chosen.

4. Include the following:

  • Subject Line: Create a concise and descriptive subject line that captures the purpose of the email.
  • Greeting: Begin the email with a warm and personalized greeting addressing the patient by their preferred title and name.
  • Introduction: Provide context for the email, briefly explaining the reason for the communication and any relevant background information.
  • Main Message: Clearly communicate the main message of the email, whether it’s appointment details, test results, medication instructions, or other healthcare information. Use plain language and avoid medical jargon to ensure patient understanding.
  • Instructions or Recommendations: If applicable, include clear and actionable instructions or recommendations for the patient to follow, such as scheduling an appointment, adhering to medication regimen, or seeking further medical attention if necessary.
  • Closing: Conclude the email with a polite closing statement expressing appreciation for the patient’s attention and cooperation.
  • Signature: Include a professional signature with the sender’s name, title, and email for further assistance or inquiries.
  • Language and Tone: Use a patient-centered and empathetic tone throughout the email, demonstrating understanding and support for the patient’s healthcare needs and concerns.
  • Privacy and Confidentiality: Ensure that the email message complies with privacy and confidentiality regulations, such as HIPAA (Health Insurance Portability and Accountability Act), by refraining from including sensitive personal health information in the email body or subject line. Be cautious by sharing actual diagnostic information, diagnoses, etc.
  • Proofreading: Review the email for spelling, grammar, and formatting errors to ensure clarity and professionalism.

disc 5 (Issues and trends in nursing)

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QUESTION

The media portray many images of nursing, some favorable and some unfavorable.

Does media portrayal of nursing affect how patients perceive nurses as authority figures? Why or why not? Think about nursing stereotypes and discuss the ways you can influence the public image of nursing.

Discuss the various roles nurses can play that support the real image of nursing. Think about community health care and preventive services for all, but especially the underserved.

  • In order to receive full credit, you will need to clearly respond to both parts of the question using subtitles or bullets AND cite at least one scholarly reference in your response. se Credible and Scholarly Resources
  • Since this is a course about issues and trends in nursing, we want to learn how to identify what those issues are. If you try to google sources for the discussion posts, you will not always find the correct answers.

Using the library to research articles will be helpful for this class. We want the best evidence to support our discussion posts. Support what you say with examples and connect it to the concepts we are learning and provide evidence (textbook, articles, research, etc.) to support what you are saying in initial and peer posts. 

Hint: The textbook and online presentations as well as the resources provided each week will assist you in answering the discussion prompts. It is advisable to use control F (or command F on Mac) to search for key terms if using the electronic textbook or the index for a hard copy textbook.

Answering the Initial Prompt Completely and On Time

Make sure to answer the prompt thoroughly, providing details and specifics. In order to do this, it will help you if you label each part of the prompt with a heading/question separately if applicable. 

Professional Issues in Nursing: Challenges and Opportunities

Author: Carol J. Huston

Publisher: Wolters Kluwer Health

Edition: 6th

Publication Manual of the American Psychological Association

Author: American Psychological Association

EVIDENCE-BASED PROJECT, PART 4 (A)

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Question

EVIDENCE-BASED PROJECT, PART 4: RECOMMENDING AN EVIDENCE-BASED PRACTICE CHANGE

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.

Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

Consider the best method of disseminating the results of your presentation to an audience. 

  • The Assignment: (Evidence-Based Project)
  • Part 4: Recommending an Evidence-Based Practice Change
  • Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

Describe the current problem or opportunity for change. Include in this Question the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.

Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

Quality and safety in healthcare and nursing practice- JUST CULTURE

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QUESTION

JUST CULTURE

As an alternative to a punitive system, application of the Just Culture model, which has been widely used in the aviation industry, seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix the system issues.

– American Nurses Association, 2010

Mistakes happen. There is no way to avoid all mistakes, so how might your practice change if the reporting of mistakes was welcomed, versus penalized? How might this lead to a better understanding of quality improvement and safety needs? How might patient safety be improved?

For this Discussion, consider the role of just culture in your organization. Reflect on your experience with just culture and consider how this model might support patient care.

Reference:

American Nurses Association. (2010). Just culture [Position statement]. https://www.nursingworld.org/~4afe07/globalassets/…

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

TO PREPARE:

  • Review the Learning Resources for this week, and reflect on your experiences with just culture.

Consider how just culture connects to quality and safety. What is the role of the DNP-prepared nurse in promoting just culture in organizations and nursing practice? 

There is no way to avoid all mistakes

How might your practice change if the reporting of mistakes was welcomed, versus penalized??

How might this lead to a better understanding of quality improvement and safety needs?

How might patient safety be improved?

Consider the role of just culture in your organization

Reflect on your experience with just culture and consider how this model might support patient care.

Post an explanation of whether your organization uses a just culture

Explain how this might impact quality and safety for your healthcare organization, and why

What is the DNP-prepared nurse’s role in supporting a just culture environment in a healthcare organization?

NURS 6630C: Psychopharm

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QUESTION

Select a vulnerable patient from the list provided.

Consider age, birth-assigned sex, FDA approvals, and risk and side-effect consideration.

  • Select the most appropriate medication for your selected patient based upon the information provided
  • Conduct research through the FDA website
  • Patient selected: 16-year-old male with a diagnosis of major depressive disorder, severe. He has seen a therapist weekly for the past 6 months and has had minimal change in symptoms. He has expressed thoughts of wanting to die
  • *Create a Medication Guide for a patient. In your guide, you should provide the following specific instructions for the patient:

Describe the chosen classification of medications, from the classification category, for your chosen vulnerable patient. Explain your rationale for your choice.

  • Explain what dose you would start the chosen medication with and the frequency.

Discuss how the medication works to treat their symptoms.

  • Explain how long they should take the medication.

Discuss the typical or common side effects of the medication.

Explain the urgent or emergent considerations for the patient taking the medication.

The Medication Guide should also include:

  • Directions you would provide the patient on how to take the prescribed medication
  • Instructions on what the patient should do if a medication dose is missed
  • List of any other medications, over-the-counter medications, and/or supplements/herbals the patient should avoid while taking the prescribed medication
  • List of foods the patient should avoid when taking this medication
  • Date when the patient should return for follow-up visit with you
  • Discussion about the legal and ethical considerations for the medication being prescribed
  • Answers in consideration of Social Determinants of Health on how you would:

Assist the patient who cannot not afford to pay financially for the medication you are recommending/prescribing; and/or

  • Has difficulty with transportation that impacts their ability to present for regular appointments with you
  • Discuss how financial hardship and lack of transportation could relate to Social Determinants of Health, as well as why they are important considerations for you as a prescriber.. 

Procedures and Evidence

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QUESTION

Discussion

Step 1: Read the following case study:

A nurse has an order to complete a procedure on a patient. After reading the procedure, the nurse notices that it is not best practice and it has not been updated for 6 years. The nurse takes this issue to the nurse leader (charge nurse) and the nurse manager (unit manager).

Step 2: Your first post is based on the first letter of your last name. For example, if your last name is Smith, you would answer the nurse manager question. Please review the differences in these roles before posting.

The First Letter of your NameQuestion to AnswerA – M

What would you do as a nurse leader if your policy or procedure conflicts with the most recent evidence? Describe your response to this nurse. 

Why is it important to update policies and procedures? What are the risks if they are outdated?

What is your role as a nurse leader in assuring policies or procedures are up to date? 

N – Z

What would you do as a nurse manager if your policy or procedure conflicts with the most recent evidence? Describe your response to this nurse. 

Why is it important to update policies and procedures? What are the risks if they are outdated?

What is your role as a nurse manager in assuring policies or procedures are up to date? 

Your discussion post should look like:

Paragraph one: What would you do as a nurse leader or nurse manager (depending on your last name) if your policy or procedure conflicts with the most recent evidence? Describe your response to this nurse. 

Paragraph two: Why is it important to update policies and procedures? What are the risks if they are outdated?

Paragraph three: What is your role as a nurse leader or nurse manager (depending on your last name) in assuring policies or procedures are up to date? 

Resources: Where did you find your data?

Week 8 case study 2

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QUESTION

Students should choose one to complete from the following case studies. Note: All case studies are provided as a learning tool for students who wish to have them.

Case 1

A 35-year-old, healthy White male is complaining of right-sided, low back pain for 1 day. The pain began suddenly after lifting a box weighting 35 lbs. at work. The pain radiates down the back of his leg to his right ankle. He has tried ibuprofen and ice without relief. His pain is an 8 out of 10 (with 0 being no pain and 10 being the worst pain). He denies bowel or bladder dysfunction, paresthesia, motor weakness, or fever.

    • Past medical/surgical history: no major medical illnesses; no surgical history; no previous hospitalizations.
    • Social history: has smoked 1 pack of cigarettes a day for 15 years.
    • Medications: none.
    • Allergies: no known drug allergies.
    • Vital signs: temperature 98.7°F; pulse 90 beats per minute; respirations 18 per minute; blood pressure 126/78 mmHg; pulse oximeter 100%.

Physical examination revealed a well-nourished adult male without any acute distress. Significant right paraspinal tenderness at L4–L5 was present with no midline tenderness. Straight leg raise was positive at 30° to the right lower extremity. Straight leg raise was negative to the left lower extremity. The remainder of musculoskeletal examination was unremarkable (e.g., deep tendon reflexes, strength, and sensation). Other systems examinations were unremarkable (e.g., heart, lungs, etc.).

Answer the following questions based on the Case 1.

  1. What are your differential diagnoses? What are subjective and objective findings consistent with the various differentials for low back pain?
  2. Would you consider imaging for this patient? If so, what imaging would be recommended and why?
  3. What are the red flags of low back pain?
  4. What are treatment strategies for this patient? What education would be provided to the patient?
  5. When should you refer this patient to a specialist?

leadership DB V

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QUESTION

Overview

Workplace violence against nurses is a major challenge for healthcare leaders. Common types of violence such as physical harm, sexual abuse, aggression, mobbing and bullying can occur from patients, family and co-workers.

For this discussion, you will use information from your assigned readings, the self-paced tutorial and the literature to discuss the following in a discussion board post.

What impact does workplace violence have on nurses, other clinical staff and the organization as a whole? Be specific and provide rationale.

How is workplace violence addressed in your organization, i.e. policies, protocols, training. Be specific. Is it sufficient? What else could be done?

  • What are the legal and ethical implications for the nurse leader if workplace violence occurs on their unit(s)?
  • Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.
  • Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”

Points: 30

References:

Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.

Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.

FSU discussion

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QUESTION

A 79-year-old male remarks on his first visit that he has noticed a gradual decrease in vision in both his eyes since last year. His old medical record has not yet arrived at your office. He states that since he moved from Florida a year ago, he has not had an eye examination and does not yet know an ophthalmologist. He is having difficulty carrying on his activities of daily living that involve his sight. He states that he cannot recognize people at some distance until they come quite close and he is often frightened by his perception of strangers speaking to him. Watching television and reading are becoming increasingly difficult for him. He states that glare is a problem and notes that a few times he almost tripped over something on the floor. He still drives his car in the local community. He asks if you think he may have a cataract. He says his wife had two cataracts in the past and he remembers her complaining of vision problems which have now resolved.

Vital Signs: BP 128/84; HR 82; RR 18; BMI 24.

Chief Complaint: Decrease in my vision; glare is very bothersome!

Discuss the following:

1) What additional subjective data are you seeking to include past medical history, social, and relevant family history?
2) What additional objective data will you be assessing for?
3) What are the differential diagnoses that you are considering?
4) What laboratory tests will help you rule out some of the differential diagnoses?
5) What radiological examinations or additional diagnostic studies would you order?
6) What treatment and specific information about the prescription that you will give this patient?
7) What are the potential complications from the treatment ordered?
8) What additional laboratory tests might you consider ordering?
9) What additional patient teaching may be needed?
10) Will you be looking for a consult?