Aquifer Groin Pain

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Question

Essay Elements:

One to three pages of scholarly writing in paragraph format, not counting the title page or reference page

Brief introduction of the case

Identification of the main diagnosis with supporting rationale

  • Identification of at least two additional differential diagnoses with brief rationale for why these were ruled out

Diagnostic plan with supporting rationale or references

  • A specific treatment plan supported by recent clinical guidelines

Please refer to the rubric for point value and requirements. In general, these elements must be covered as per the rubric.

  • You are working with Dr. Nayar at an inner-city office adjacent to a small hospital. He has asked you to see Andrew, a 17-year-old male with right scrotal pain, who was brought in by his mother.

Dr. Nayar tells you, “Andrew is the third child of Ms. Deborah Hailey, a single mother who works as a home attendant and is also a patient of mine. Before you go into the room, let’s look at the chart to review his history. I have known him since his birth and have been seeing him regularly for health care maintenance. His last visit was more than a year ago for a sports preparticipation physical. He has been a good student but had behavioral issues during his early teenage years. His mother really struggled with this as Andrew is quite different from her other two children. I provided some counseling to the family to help them adjust to and manage Andrew’s issues.”

  • You take a look at the problem list in Andrew’s medical chart.

Problem list:

  • Viral gastroenteritis at age 1 year; Upper respiratory infection at age 5 years; Appendectomy at age 12 years; Behavioral concerns at age 14 year

You enter the exam room and find Andrew lying down looking very uncomfortable on the exam table. His mother, Ms. Hailey, is sitting next to her son, visibly worried and anxious.You introduce yourself and say, “I understand you are not feeling well. Would it be okay if I get some information about how you’re feeling? First, I would like to talk with you and your mom; then I would like to talk to you by yourself for a bit.

  • “Ms. Hailey interjects, “He had similar pain a few months ago and it was relieved without any treatment.” She looks worried, “I hope he didn’t hurt himself while playing.”

Andrew does not have increased urinary frequency, dysuria, urethral discharge, abdominal pain, or vomiting.

  • Ms. Hailey says, “Could you tell me what is going on with Andrew?”

You respond, “Well, I have to ask Andrew a few more questions and then examine him before we can make a reasonable assessment. Can you please excuse us for now and I will call you back as soon as we are done.”

After obtaining information about his pain you want to inquire whether he is sexually active. He tells you he has one partner and uses condoms most of the time. He reports no penile discharge.

You ask him if he would like to have his mother in the room while he is being examined. He tells you that he is fine without her being there.

HPI:

Andrew is a 17-year-old male, sexually active with one female partner, who presents with a four-hour history of severe right groin pain with radiation to the right scrotum and associated nausea but no vomiting, fever, or urinary symptom. The patient reports a similar episode six to nine months ago that resolved spontaneously. Physical exam finds a swollen, erythematous right scrotum with an exquisitely tender right testicle, no masses, a negative Prehn sign, an absent cremasteric reflex on the right, absent blue dot sign, and no transillumination of the scrotum.

The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes:

Epidemiology and risk factors: 17-year-old well male, sexually active with a female partner

Key clinical findings about the present illness using qualifying adjectives and descriptive language:

Acute onset four hours ago

Severe right groin pain with radiation to right scrotum

Associated nausea but no vomiting, fever, or urinary symptoms

Previous similar episode that resolved spontaneously

Sexually active

Swollen, erythematous right scrotum

Exquisitely tender right testicle

No masses

Negative Prehn sign

Absent cremasteric reflex on the right

Absent blue dot sign

  1. No transillumination of the scrotum
  2. Physical Exam

Vital signs:

  • Temperature is 37 C (98.7 F)
  • Pulse is 90 beats/minute
  • Respiratory rate is 14 breaths/minute
  • Blood pressure is 130/82 mmHg
  • Weight is 65.8 kg (145 lbs)
  • Height is 175 cm (69 in)
  • Body Mass Index is 21 kg/m2
  • Pain score is 10/10
  • General: In moderate to severe discomfort.
  • Head, eyes, ears, nose, and throat (HEENT): No conjunctival icterus or pallor.
  • Cardiac: Regular, Normal S1 and S2. No pleural rubs, murmurs, or gallops.
  • Lungs: Clear to auscultation bilaterally.

Abdomen: No distension. Active bowel sounds; There is no guarding or rebound tenderness. No rigidity. No palpable masses or hepatosplenomegaly.

Back: No costovertebral angle or spine tenderness.

Extremities: Femoral and pedal pulses are strong and equal.

Genitourinary: Swollen and erythematous right scrotum. His right testicle is exquisitely tender, swollen, and has no palpable masses. Elevation of the testis results in no reduction in pain (negative Prehn sign). The left scrotum and the testicle are normal. Epididymis and other scrotal contents were within normal limits. The scrotum does not transilluminate. Cremasteric reflex is present on the left side but absent on the right. There is no penile discharge, inguinal lymphadenopathy, or hernias.

DIFFERENTIAL DIAGNOSIS:Trauma (H), testicular torsion (F), epididymitis (A), and torsion of the testicular appendages (G) are the four most likely diagnoses at this point.

  • Causes of groin pain:

Andrew displays all the classic physical findings for testicular torsion.

  • Andrew’s tenderness is not localized to the upper pole of the testis, making torsion of the testicular appendages less likely.

Absence of a cremasteric reflex, Prehn sign, and the lack of systemic signs of infection makes epididymitis unlikely in Andrew’s case.

  • Diagnosing Testicular TorsionColor Doppler ultrasonography can confirm testicular torsion if pain is less severe and the diagnosis is in question. If testicular torsion is present, intratesticular blood flow is either decreased or absent which appears as decreased echogenicity, as compared with the asymptomatic testis. In addition, the torsed testicle often appears enlarged.

Treatment of Testicular TorsionThere are two approaches to treating torsion of the testis.Nonsurgical approachManual detorsion of the torsed testis may be attempted, but it is usually difficult because of acute pain during the manipulation. This nonoperative distortion is not a substitute for surgical exploration.If the maneuver is successful, orchiopexy (surgical fixation of both testes to prevent retorsion) must still be performed. This should be done in the immediate future, preferably before the patient leaves the hospital.If full manual reduction of torsion cannot be performed or if there is doubt about the diagnosis and reason to suspect torsion, the scrotum must be explored.Surgical approachThe testis must be unwound at operation and inspected for viability. If it is not viable, it should be removed. If the testis is viable then orchiopexy should be performed to prevent recurrence. Whether the affected testis is removed or conserved, the contralateral one should undergo orchiopexy as the risk of recurrence on the other side is otherwise high.

SWRK 6204 social determinants of health

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QUESTION

THE PAPER HAS TO BE THE SAME TOPIC AS MY DISCUSSION POST WHICH IS RIGHT BELOW.

Social determinants of health (SDOH) are non-medical factors that influence health outcomes (NEJM Catalyst, 2017). They include conditions in which people are born, grow, live, work, and age; including factors and systems that shape our daily lives (NEJM Catalyst, 2017). Some factors include political systems, social policies, social norms, development agendas, and economic policies and systems. These factors may be influenced by socioeconomic factors, environmental conditions, cultural norms, and access to resources. Medical Social Work practice acknowledges the significance of these determinants in shaping health outcomes and seeks to address them to improve overall health and well-being.

As far as intervention goes, Medical Social Workers address social determinants by helping patients connect to appropriate services and supports. This may involve providing information about available community resources, assisting with applications for social assistance programs, coordinating with housing agencies, or facilitating access to mental health services. By addressing these determinants, Medical Social Workers aim to improve patients’ overall well-being and reduce health disparities.

In my opinion, the underserved population is individuals with developmental disabilities (IDD). According to Slashcheva, et al., 2016, “patients with IDD will experience a patchwork form of uncoordinated health care that leaves them without adequate access to essential health care services.” Individuals with developmental disabilities are four times more likely to report poor health and healthcare services than any other population (Slashcheva, et al., 2016). This population is underserved in many ways, for example: medically, dental care, lack of service providers, and residential facilities get backlash from the communities in which homes exist to care for medically fragile patients. Some individuals are also taken advantage of by primary caretakers and providers, often clients cannot even advocate for themselves. According to Slashcheva, et al., 2016, and according to the Health Resources and Services Administration (HRSA), “populations can be considered medically underserved if its Medical Indes Underservice score is less than 62.0.” The score also takes into account the various features of a population, including age, poverty, mortality rate, and clinical density, which means how many clinicians in a specific practice such as mental health, primary care, or dentistry exist in a given geographical area or patient population (Slashcheva, et al., 2016).

Advocacy is vital in Medical Social Work practice, especially when addressing systemic problems that contribute to health inequalities (Bullock, K., et. al., 2021). It is imperative job for Medical Social Workers to advocate for policy changes, improved access to healthcare services, and increased funding (Bullock, K., et. al., 2021). Advocacy efforts may help Medical Social Workers to strive and create a more equitable healthcare system for patients with IDD and may help address the underlying causes of health and healthcare disparities (Bullock, K., et. al., 2021).

In conclusion, by addressing social determinants such as socioeconomic status, access to healthcare, and social support networks, Medical Social Workers may help patients eliminate barriers to health and well-being, with the result of possibly reducing disparities among underserved populations.

Resources:

Gehlert, S., & Browne, T. (Eds.). (2019). Handbook of health social work (3rd ed.). Wiley.

Bullock, K., Damiano, S., & Sinclair, S. (2021, April 24). Social workers can lead the way in addressing health inequities.Links to an external site. Center to Advance Palliative Care. https://www.capc.org/blog/social-workers-can-lead-…

NEJM Catalyst. (2017, December 1). Social determinants of health (SDOH).Links to an external site. Innovations in Care Delivery. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0312 Links to an external site.

Slashcheva, L., Rader, R., & Sulkes, S. B. (2016). Would People with Intellectual and Developmental Disabilities Benefit from Being Designated “Underserved”?. AMA Journal of Ethics, 18(4), 422–429. https://doi.org/10.1001/journalofethics.2016.18.4.pfor1-1604.

U.S. Department of Health and Human Services. (n.d.). Social determinants of health.Links to an external site. https://health.gov/healthypeople/priority-areas/so…

BY DAY 7

Submit a 4- to 5-page paper in which you:

  • Identify the population(s) affected by the health issue you selected (e.g., racial/ethnic identity groups, people who identify as LGBTQ+, religious communities, older adults). Explain how this population is discriminately affected by the health issue you selected.
  • Explain the primary determinants of the health issue. Then, explain how these determinants contribute to the disparities in care for the population.
  • Explain what specific social work interventions you might implement to address this health issue, reduce or eliminate disparities, and improve health outcomes.
  • Explain the advocacy roles a medical social worker might play in addressing the disparities in health care for the health issue and population you selected.

Use the Learning Resources and additional research to support your Assignment. Make sure to provide APA citations and a reference list.

Health & Medical Question

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Question

YOU WILL NEED EXPERIENCE IN EXCEL!

PLEASE READ ALL THE INSTRUCTIONS CAREFULLY AND ANSWER ALL 6 STEPS

EXCEL SHEET / TWO PAGE MANUSCRIPT / ALL 6 STEPS COMPLETED 

We are conducting a environmental scan on fall prevention programs in the Windsor Essex Area, Onterio, Canada.

This is Masters level course, at a Canadian University!

There are various approaches as to why and how to conduct an environmental scan. Although approaches could include creating and utilizing a survey, leading focus groups, or conducting interviews, they do not necessarily fit within the time from of a weekly assignment.

Implemented as part of their environmental scan strategy, Diouf et al. (2016) conducted a structured search on Google and social media platforms such as Facebook and Twitter. Although engaging people on social media platforms would be interesting, it may require more detailed research and ethics board clearance. Therefore, this assignment will focus on Google (or you may suggest an alternative search engine; have it approved in advance). Note: the steps below are very similar to ones you may see for a systematic review for example – Cornell University Library A Guide to Evidence Synthesis: Steps in a Systematic Review, link: https://guides.library.cornell.edu/evidence-synthesis/steps 

Step One:

You will need to decide (as a group) on what you specifically wish to conduct an environmental scan. For example, do you intend to complete a scan on fall prevention programs in general, or do you want to look at something more specific. It is suggested that you approve your scan topic with the instructor, but this is not mandatory.

We are conducting a environmental scan on fall prevention programs in the Windsor Essex Area, Onterio, Canada.

This is Masters level course, at a Canadian University!

Step Two:

Develop your key search terms. Your search strategy may be informed by a list of key terms you would use for your chosen topic, but it may also be informed by asking a group of other individuals (independently) what they would enter into a Google search to gather corresponding information.

For your search strategy, you will also have to determine your search location. For example, if you are searching within Windsor-Essex, you may repeat each of your search terms for Windsor, Belle River, Tecumseh, La Salle, and Essex. Please note, you do not need to stay specifically within Windsor-Essex for this assignment, you may choose, for example, to search for resources in the area of Eindhoven, Holland.

When developing search terms, it is advantageous to first think of the key terms such as falls and assessments. Then you want to think of alternative terms that you could use in a search just as: falling, faller, test, examination, etc. You want to develop a list of different key words and combinations that you can use for your search. In other words, you would not complete just a one-step search of “fall prevention in Windsor, Ontario” – you will want to run multiple searches with a variety of key search terms. It will be important to record the different searches you attempt and include this in your write up. (note, there are ways to search utilizing parameters – or you may want to explore the advanced search options through Google – but the assignment is also to help you experience what an older adult or loved one might experience as they attempt to search and navigate the online world to find community resources). 

Step Three:

Conduct the search(es). Personally, I like to record for each search the number of results in the amount of time (typically in the top left corner area of the google search). I then like to have either an excel of word document where I can copy and paste the links of websites yielded from the search. You will need to independently review each website for continued inclusion in the study. It is recommended that you create a flowchart that indicates the number of searches initially found by the Google search (check out the PRISMA Flow Diagram as a potential example – see http://prisma-statement.org). It is important to determine the eligibility criteria that will be required for a website to be included in a full review. For example, resources may need to involve the older adult (senior) population, fall prevention program, and be within the geographical location. But maybe an exclusion criteria is an individual in a wheelchair (which you would probably want to justify).

Step Four:

Once the website/resource is retrieved, you will need to extract the data. It may be beneficial to develop a Microsoft word table, or excel spreadsheet, to assist with the data extraction. For example, you may develop a data extraction form that includes listing each of the following: website url, name of organization, contact information (phone number, address, office hours), programs offered, target audience, referral, equipment and partner organization, costs, and transportation options. What is the relevant information you want to pull from the website in order to learn about the community resources related to your environmental scan that you decided in step one.

How do you know when you have enough data? The term we use is saturation (discussed during live lecture). 

Step Five:

Determine how you think it would be best to display the data/information gathered as part of this environmental scan. If an older adult was to refer to the product of your environmental scan as an information resource, what may be the best format and display? Knowledge Translation to non-academic audiences is an important consideration. How you display your findings as an information resources will become an appendix for your weekly assignment. You may also wish to add screenshots of your Google search, and the excel document as part of your appendices. 

Step Six:

For the purpose of this weekly assignment, write a two-page brief in the form of a manuscript. This means, your paper should have a title, introduction, methods, results, discussion, recommendations, and conclusion, references (but the references should follow the format of the module and should be extra to the two pages). No abstract is needed, but a title is advisable. As noted above, the results of the scan should be displayed in an appendix, thus, your results section in the briefing may only be a few sentences. As for the recommendations please consider the strengths and gaps found as a result of your environmental scan.

Note: a title page for the individual weekly assignment is not necessary.

Text/Format Specifics: Single spaced typed, Calibri 12-point font, 1 inch margins, page numbers as the bottom centred.

References within text should be numerical in order of appearance, with square [1] brackets. Formatting for references:

[1] Ronholm, E., Pittman, R., Suboni, P., Otte, G., & Coene, W. (2024). Title of article. Journal Name, Vol (issue): Pg-Pg.

[2] Wrigley, T., & Fenway, R. (2024: Pg-Pg). Chapter Title. Book Title. Editors. Location

[3] Heart & Stroke Canada: www.heartandstroke.ca Last visited on: Jan. 8th, 2024

Florida SouthWestern College What were the results of the study

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Question

Response 1: 

  • What were the results of the study?
  • The results of the study Using a Fall Prevention Checklist to Reduce Hospital Falls: Results of a Quality Improvement Project brought awareness to errors being made. The first error identified in the study was that the bed alarm was not being set on the proper zone. The second error identified was proper signage missing from the patient’s room. Identifying these errors allowed the nursing staff to see where they could improve and allowed them to educate further. The pilot period of this study took place from February to March. During the pilot period, it was noted that there were no incidences of falls. The QI team identified that there was a decline in falls when compared to previous months (Johnston & Magnan, 2019). 
  • Did the findings support the research question?
  • The research question proposed focused on whether there would be an impact on units using the fall prevention checklist versus those that were not. The findings from the study did support the research question. There was a sharp decline in falls during the pilot period compared to months prior. The QI team was able to draw this conclusion but did share that they could not identify if it was the physical checklist that decreased incidents of falls or if it was that having the checklist reminded the nursing staff to be more alert of what interventions need to be in place to promote patient safety. 
  • Describe any limitations found in the study.
  • The study took place from February 12-March 8 which is a short period to collect data. The nursing staff collected data from 13 days and 13 nights. During this time 90 fall prevention checklists were collected. The QI team distributed questionnaires to gather the nursing staff’s opinions regarding the checklist. The perspective of those participating in an aspect of a study allows researchers to understand the subject of interest (Polit & Beck, 2022). The questionnaire was distributed to the 37 staff members that participated. Of the 37 staff members who were a part of the pilot study, only 14 of those nursing staff members completed the questionnaire. The low rate of returns of the questionnaire affects the percentages found from the study as they are from less than half of those who participated in the checklist change-of-shift report. The article shares that it raises the question of whether or not only those who were in favor of the checklist took the time to complete the questionnaire (Johnston & Magnan, 2019). 
  • Identify the level of evidence 
  • This study would fall under level 2 evidence. Level 2 evidence is quasi-experimental and quantitative (Dang et al., 2021). For quality study, this would be classified as a good quality rating. The study concluded that the fall prevention checklist contributed to fewer incidents of falls. The study included limitations such as a short study period and a smaller sample size. The study gathered feedback from the nursing staff who were willing to participate in the pilot period. The study took place in 2018 which means that a follow-up could be done. The data collected was appropriately displayed through the use of graphs, percentages, and tables. The study lacks diligence. The study did not indicate that the QI team or authors were seeking opportunities from other sources for evidence. The short and small study as well as lack of evidence from other sources indicates that the study should be repeated for more definitive answers. 

Response 2:

  • What were the results of the study? Describe the findings. 

            The study’s results were focused on defining and clarifying the concept of compassion fatigue specifically within the discipline of palliative care nursing. The concept analysis method by Walker and Avant was used to differentiate compassion fatigue from related concepts like burnout, secondary traumatic stress, and vicarious traumatization, and to provide a clear definition relevant to palliative care nursing. The analysis highlighted that palliative care nurses are particularly susceptible to compassion fatigue due to their constant exposure to suffering, death, and the associated stressors. The proposed definition encompassed the multifaceted nature of compassion fatigue, considering emotional, psychological, intellectual, professional, physical, social, and spiritual domains. The findings illustrated compassion fatigue’s development over time and its impact on nurses’ ability to provide compassionate care, potentially leading to job dissatisfaction, burnout, and even leaving the profession (Cross, 2019).

  • Did the findings support the research question(s)? Describe how.

           The findings supported the research question by offering a detailed exploration of compassion fatigue within palliative care nursing. This clarity is important for recognizing the symptoms and implementing strategies to mitigate its effects, thereby improving patient care and keeping skilled nurses in this vital, and important field. The study’s differentiation of compassion fatigue from similar concepts and its focus on palliative care nursing specifically address the need for recognition and understanding of this phenomenon in the discipline (Cross, 2019)

  • Describe any limitations identified in the study.

          The study had limitations, including the restriction of the literature search to English-language sources, potentially omitting relevant international research on compassion fatigue. Also, the focus on databases mainly related to helping professions might have limited the scope of literature reviewed. These limitations suggest the possibility of a broader scope of research on compassion fatigue that was not captured in this analysis. (Cross, 2019)

  • Identify the level of evidence as found in Dang et al, p 295-296.  You should use the following pdf files for level determination and quality. Levels of evidence are also explained in your Dang et al book on pages 121-123.

         According to the hierarchy of evidence as outlined by Dang et al., (2022) this concept analysis can be classified as a Level VII evidence, which includes evidence from the opinion of authorities and, or reports of expert committees. This is because the analysis synthesizes definitions and attributes of compassion fatigue from existing literature and expert opinion rather than presenting primary research findings or experimental data. While valuable for its in depth exploration and clarification of the concept, the study’s conclusions are primarily based on synthesized insights and analyses rather than empirical data.

Discussion post 7

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QUESTION

Please write a one paragraph response to each person (1. Lyndsay, 2. Ripsime, 3. Cristina, 4. Julie) (include in-text citations and references).

1. Lyndsay 

“Fennimore (2024) discusses career planning after the pandemic. The article went through how school changed during the pandemic to an online format. The students were to study certain materials beforehand then during class there was a general discussion and then the instructor could to breakout rooms for groups of students to discuss different materials.

Romano et al. (2024) discusses collaboration in teaching between nursing and physical therapy. The students learned more when PT educators participated in classroom discussions. “Analysis of written responses revealed five themes: appreciation of an outside expert perspective, enhanced self-efficacy with patient mobility skills, opportunity for interprofessional collaboration, satisfaction with the learning experience, and conflicting information” (Romano, 2024).

Legge et al. (2023) discusses the sue of virtual simulation to prepare for the NCLEX. 86 students enrolled in a foundation nursing course where simulation would replace clinicals.

Reference

Fennimore, L., (2024). Introducing APRN Roles to First-Year Nursing Students: Pandemic and Beyond. Journal of Nursing Education, 63(2):135–136. https://doi.org/10.3928/01484834-20231205-09Links to an external site.

Legge, T., Holthaus, A., Hallmark, B., Allexander, K., (2023). Preparing for the Next Generation NCLEX Using a Virtual Simulation. Journal of Nursing Education, 2023;0(0):1–5, https://doi.org/10.3928/01484834-20230713-01

Romano, D., Collier, R., Komor, T., Sprague, L., (2024). Exploring Interprofessional Collaboration in Teaching Between Nursing and Physical Therapy. Journal of Nursing Education, 2024;0(0):1–3. https://doi.org/10.3928/01484834-20240130-03“

2. Ripsime,

“The Journal of Nursing Education typically focuses on issues related to nursing education, including innovative teaching strategies, curriculum development, and assessment methods. One nursing journal that I read was on the topic of clinical stress and clinical performance in pre-licensure nursing students. The journal discussed how stress levels in pre-licensure nursing students affect their clinical performance, including factors such as patient care, decision-making, and communication skills. The journal mentioned investigating interventions and support systems implemented to decrease clinical stress and enhance performance. This includes mentorship programs or stress management workshops (Welch, S., 2023).

Another journal that I read was on the topic of the value of peer mentorship as an educational strategy in nursing. The journal investigated how peer mentorship contributes to the academic and clinical success of nursing students. This may include improvements in academic performance, clinical skills acquisition, and overall satisfaction with the educational experience. It also discussed exploring how peer mentorship aids in the transition from student to practicing nurse. Topics may include the development of confidence, competence, and the ability to navigate the complexities of the professional nursing role (Anderson, T., 2019). 

References:

Anderson, T. (2019, March 22). Daily Medical News, free CME and clinical guidance. Journal of Nursing Education. https://journals.healio.com/doi/10.3928/01484834-2…

Welch, S. (2023, January 1). Clinical Stress and Clinical Performance in Prelicensure Nursing Students: A Systematic Review. Journal of Nursing Education. https://journals.healio.com/doi/10.3928/01484834-2…“

3. Cristina,

“In the realm of healthcare, it’s essential to grasp the differences between protocols, standards of care delivery, and policies across practice, state, and federal levels.

Protocols are detailed plans guiding clinical procedures, ensuring consistency in patient care within institutions.

Standards of care delivery set benchmarks for acceptable performance, safeguarding patient interests and upholding system integrity.

Policies are broader rules governing healthcare aspects, established by government bodies or professional organizations to ensure compliance with legal and ethical standards.

Considering stakeholder perspectives, providers often express frustration with administrative burdens imposed by policies, as noted in “Policy & Politics in Nursing and Health Care” (J., M. D., B, G. D., Freida, H. O., & T., O. E.,2015).

This perception underscores the need for policymakers to streamline administrative processes, enabling providers to focus more on patient care, ultimately enhancing the quality of healthcare delivery.

References:

Austin, A., & Wetle, V. (2016). The United States Health Care System: Combining Business, Health, and Delivery (3rd ed.). Pearson Education (US). https://online.vitalsource.com/books/9780134297927Links to an external site.

J., M. D., B, G. D., Freida, H. O., & T., O. E. (2015). Policy & Politics in Nursing and Health Care (7th ed.). Elsevier Health Sciences (US). https://online.vitalsource.com/books/9780323241441Links to an external site.“

4. Julie,

Protocol in healthcare is as simple as certain guidelines that are followed in a certain setting within the healthcare system. An example of that would be protocols that are followed when performing a surgery or administering a heparin drip. Protocols help outline the behavior towards certain administrations as well as creates a framework for consistency and reference.

Standard of care delivery is the expertise or lack of in skill set of a healthcare provider. It is the measure of competency of a provider at a level of training. This is important because it creates an expectation and a baseline for the quality of care that should be given and the basis of the capability of the one who is giving the care. 

Policies are principles of action that are proposed or implemented by the government or a healthcare organization. Poliocioes in healthcare be at the practice, state, or federal level and they are important in determining the quality of care and eligibility for the services and the standards of care in the healthcare services.

Perspective: 

Patients often perceive health care as deceptive. They feel that they are made to be dependent not he health care system due to lack of knowledge or clear understanding and in turn the healthcare system takes advantage of the dependency by deceiving them. Mostly it is believed the deception is to continue to to take the patients money and to keep them in an ill state so that the patient always needs the healthcare system. 

Payers such as insurance companies, grants, government programs, etc have often perceived that the healthcare system is not tight enough and allows room for a lot of fraudulence. Payers can also collide with the perspective of patients because patients can also be payers if they are without financial assistance. They too feel that their is fraudulence and not enough protection. Also that the healthcare system overcharges in comparison to other nations. They feel that because there is a need the healthcare system takes advantage and operates from a place of greed.  

State Specific Guidelines for Prescribing Controlled Substances & Medical Devices

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QUESTION

Preparing the Assignment

The State Specific Guidelines for Prescribing Controlled Substances & Medical Devices assignment is worth 125 points and will be graded on the quality of required components as summarized in the directions and grading criteria/rubric.

Follow the directions and the grading criteria located in the rubric closely. Any questions about this assignment may be posted under the Q & A Forum or emailed to your faculty.

  1. The document provided should be used and your answers provided within the table provided on this document Links to an external site..

Sources/links should be obtained directly from the state’s regulatory organization(s).

  1. It is recommended that you keep a copy of this assignment to provide to potential employers or your Board of Nursing to demonstrate your knowledge of your state laws.
  2. Requirements:

Guidelines and recommendations for your state:
In response to the opioid epidemic, individual states have developed and adopted voluntary guidelines or recommendations for the treatment of acute and chronic non-cancer pain. Based on research done on the state where you will practice clinically, include the following: 

Provide the name of your practicing state’s organization, group or task force that created guidelines or recommendations for pain management therapies and education.

Briefly describe an overview of its development and include a web address where this information can be found. If your state does not have guidelines, discuss a federal guideline. (Note: you may need to contact your state’s board of nursing, pharmacy, or medicine if you cannot locate it on your own).

Some states have multiple organizations or initiatives (ex: Ohio) in place to combat the opioid epidemic and advocate for safer opioid prescribing. Explore whether your state has other resources, groups or organizations where prescribers can reference best practices for pain management treatment. If applicable, provide a brief overview of the group’s recommendations or initiatives. If your state does not have another state-specific resource, discuss the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention.

  1. Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response. (This question is worth 13 points. 5 points for when opioids are appropriate, 5 points for a safe duration of use, and 3 points for a current edition APA formatted reference.)
  2. State specific laws on controlled substance prescribing for the nurse practitioner:
    Research your state laws on advanced practice nurses’ authority to prescribe controlled substances. Based on research done on the state where you will practice clinically, include the following: 

Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe controlled substances in your state.

Discuss the provisions of the law, rule, code, or statute with regard to the following: 

  1. Conditions or limits on prescribing schedule I-V controlled substances.

Requirements (if any) in documentation for treating acute and chronic pain.

Are there specific requirements for advanced practice nurses to reference the state’s prescription drug monitoring database before prescribing a controlled substance? If so, what are they?

State Prescription Drug Monitoring Program (PDMP):
Research your state’s PDMP* and provide the following information: 

  1. Name of the state’s program.
  2. Website for the state PMDP.
  3. Discuss the registration requirements and process.
  4. Discuss the standards and procedures for the access and review of database information.
  5. State specific laws on medical devices prescribing for the nurse practitioner:
    Research your state laws on advanced practice nurses’ authority to prescribe medical devices.  These are also called Durable Medical Equipment (DME). Based on research done on the state where you will practice clinically, include the following: 

Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe medical devices or DME in your state.

Discuss the provisions of the law, rule, code, or statute regarding the following: 

Conditions or limits on prescribing medical devices or DME.

  1. Requirements (if any) in documentation needed to support order of medical devices or DME.
  2. Rubric

State specific guidelines and recommendations (35%):

  1. QUESTIONPointsProvide the name of your practicing state’s organization, group or task force that created guidelines or recommendations for pain management therapies and education.5Where you found this information (weblink): 5Overview of your state’s guideline development with web address. 6Locate federal guidelines and provide a link to federal guidelines you could use in practice as a NP6Provide a brief overview of the group’s recommendations or initiatives (provide link to where you found information).6Provide a brief overview of the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention (provide link to where you found information).6Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response. (This question is worth 10 points. 4 points for when opioids are appropriate, 4 points for a safe duration of use, and 2 points for a current edition APA formatted reference.)10Total44
  2. State specific laws on controlled substance prescribing for the nurse practitioner (28%):
  3. QUESTIONPointsIdentify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe controlled substances in your state. Link to where you found law, rule, code, or statute for your state.5What does the law, rule, code, or statute say?6Conditions or limits on prescribing schedule I-V controlled substances.6Requirements (if any) in documentation for treating acute and chronic pain. If your state has no requirements for this, confirm with a link of where you found this information. 6Are there specific requirements for advanced practice nurses to reference the state’s prescription drug monitoring database before prescribing a controlled substance? Yes or No6If yes, what are they? If not, how would they be helpful?6Total35
  4. State Prescription Drug Monitoring Program (PDMP) (19%):

QUESTIONPointsName of the state’s program.6Website for the state PMDP.6Discuss the registration requirements and process.6Discuss the standards and procedures for the access and review of database information.6Total24

State specific laws on medical devices prescribing for the nurse practitioner (18%):

QUESTIONPointsLink to where you found law, rule, code, or statute for your state regarding prescribing DME in your state.5What does the law, rule, code, or statute say regarding prescribing DME in your state?6Conditions or limits on prescribing medical devices or DME.6Requirements (if any) in documentation needed to support order of medical devices or DME.5Total22

Discussion week #5

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Question

1. Using the criteria presented in week 2, critique the theory of Self-Efficacy using the internal and external criticism evaluation process.

The idea of self-efficacy was initially presented by Bandura in 1977. According to Bandura, human motivation and conduct are controlled by thought, and this involves three different kinds of expectations: those of the circumstance, those of the outcome, and those of perceived self-efficacy. Regarding the first, it is believed that outcomes are a result of outside events rather than a person’s actions; the second relates to beliefs about the outcomes that a particular behavior will produce; and the third suggests the idea that a person possesses the abilities to carry out actions that contribute to the achievement of expected outcomes.

Perceived self-efficacy in nursing staff has an impact on how well they carry out care-related tasks, how much effort they put into them, and how persistent and committed they are to them.3.It follows that when nursing staff members believe they are ineffective, the quantity and quality of their care-related actions will decrease, which will have a detrimental effect on the patient’s health goals being met.4However, other research, like that conducted by Llor Lozano et al., notes that improved communication abilities and self-efficacy are linked to decreased emotional tiredness and depersonalization as well as increased job satisfaction.

Conversely, nursing care ought to be organized, standardized, and focused on completely meeting the needs of the patient, client, or topic of care. This calls for the possession of the knowledge and abilities necessary to deliver high-quality, person-and family-centered healthcare.10Given its impact on recuperation and hospital stays, we should also emphasize in the context of healthcare the application of professional principles and ethics, with a focus on humanized and sensitive care. Nonetheless, other studies note that a technical approach has been applied in educational procedures while educating human resources, ignoring these factors.

From the perspective of perceived self-efficacy in students and/or professionals when providing care, instruments like the Caring Efficacy Scale, used in this study, widely address aspects of humanized care (HC), including the relationship with the patient, adequate treatment, sensitivity, and the value of human dignity.13, 14Bandura argues that people plan and carry out their actions based on how they perceive their abilities, which emphasizes the importance of doing research from the caregiver’s point of view.

In order to give patients with assistance that is focused on their needs and experiences, humanized care (HC) in nursing seeks to take a complete approach to patient care rather than concentrating only on the patient’s medical condition. HC improves patient pleasure, expedites healing, and fortifies the therapeutic alliance between caregivers and those receiving care. HC can also help to improve patient experiences and overall health outcomes by identifying and meeting patients’ emotional, social, and spiritual needs.

References ;Canova-Barrios  CJ, Figueira-Teuly J, Ayllon J, Miranda ML, Barraud M. Perceived Self-Efficacy to Provide Humanized Care Among NursingStudents and Staff in Buenos Aires, Argentina. Rev. chil. enferm. 2023;5(1):10-22. https://doi.org/10.5354/2452-5839.2023.69713

            The effect of self-care nurturance using the theory of modeling and role-modeling on self-efficacy in stroke patients. (2023). retrived from.  https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=161901111&sDiscussion Week #5

by Milagros Fuentes Rodriguez – Saturday, January 27, 2024, 1:19 PM
Number of replies: 2
Self-efficacy theory is one of the most important psychological theories about conduct improvement, and it has its basis built on self-advancement. Self-efficacy has been classified as the believes in one’s ability to arrange and accomplish a series of actions required to achieve proposed goals. Studies show that self-efficacy is a key component on the maintenance of physical activity behavior (Baretta et al., 2019).
Nowadays, changes in lifestyle and health promotion are basic needs for the actual human society. While promoting new healthy lifestyle behaviors, self-efficacy becomes in one of the most important factors influencing people’s lifestyle changes. In general, self-efficacy refers to the overall belief in one’s ability to succeed (Abbasi et al., 2021).
There are multiple external and internal factors that determine the degree of self-efficacy an individual possess. Individuals with high levels of confidence can motivate themselves toward obtaining proposed goals that they believe they can achieve. Self-efficacy has been considered as that self-confidence a person has about their capabilities to pursue set up goals. It is said that having high levels of self-confidence may be linked to positive outcomes including changes in behavior, adopting a healthier lifestyle, reducing stress, and creating a better quality of life. To determine self-efficacy, an individual must have the chance for self-evaluation or the ability to compare owns’ output to some criteria of evaluation. This comparison process gives the opportunity to judge performance capability and establish self-efficacy expectation.
There are two components on this theory: self-efficacy expectations and outcome expectations. Self-efficacy expectation judgment is about personal ability to accomplish a given task, whereas outcome expectations are self-judgments about a given task and the possible results. An example of this is seen in older adults who are on rehabilitation. They may believe that they can perform the exercises and activities involved in the rehabilitation process, but they may not believe that performing the exercises will result in improvement of functional abilities. Some others tend to think that resting will lead to recovery. However, outcome expectations on this case will have a direct impact on performance.
Finally, it is important to recognize that self-efficacy and outcome expectations may not be the only predictors of behavior. Other factors that may influence behavior includes genetic predispositions and anxiety. Also, self-efficacy and positive self-believes can change at any time in life affecting our behavior and will directly impact the outcomes.
References:
Abbasi, F., Ghahremani, L., Nazari, M., Fararouei, M., & Khoramaki, Z. (2021). Lifestyle in Female Teachers: Educational Intervention Based on Self-Efficacy Theory in the South of Fars Province, Iran. BioMed Research International, 2021https://8821w1uwj-mp02-y-https-doi-org.proxy.lirn….
Baretta, D., Sartori, F., Greco, A., Marco D’Addario, Melen, R., & Steca, P. (2019). Improving Physical Activity mHealth Interventions: Development of a Computational Model of Self-Efficacy Theory to Define Adaptive Goals for Exercise Promotion. Advances in Human – Computer Interaction, 2019, 11. https://8821w1uwj-mp02-y-https-doi-org.proxy.lirn….
Smith, Mary-Jane., PhD-RN and Liehr, Patricia-R., PhD-RN-Middle-Range-Theory-for-Nursing_-Third-Edition-Springer-Publishing-Company http://www.stikespanritahusada.ac.id/wp-content/up…

Implementation Plan

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QUESTION

Incorporating a screening tool into the electronic medical record system to address social determinants of health using a screening tool will enable us to ask the right questions about the problems these patients are facing. I believe that providing patients with this kind of assistance will help them reach their full potential.

My company Northwell health is planning an EHR merge to EPIC in 2025. Year 2025 is the proposed time we are using.

Correct use of spelling and word usage on the slides

Clarity, organization, and logical flow of ideas on slides

Alignment between information on slides and narrative presentation

APA format (current edition) for citing and referencing sources on the slides

Congruence with APA mechanics of style where appropriate (abbreviations, capitalization, italics, numbers)

No direct quotes are used within the assignment

A minimum of 4 scholarly sources, current within five years, are integrated within the assignment

The length of the assignment meets the criteria:

Minimum of 10 slides in length;

Maximum of 14 slides in length.

(Not including title or reference slides

Policy Project Evaluation Plan TemplatePolicy Project Evaluation Plan Template

  • PURPOSE
  • Every successful project needs to establish a project implantation plan, budget, and evaluation plan prior to the beginning of the project. The purpose of developing a project implantation plan, budget and evaluation plan is to outline how you intend to plan, budget, evaluate and monitor your project and how you will use the results of the evaluation to improve the project. As the nurse leader of a successful change project, you must have a clear understanding of the problem and what the opportunities are for improvement. With that in mind, it is vital that an implementation, plan, budget, and evaluation plan of the project are established early. Good plans are necessary to for the successful achievement of the project outcomes. The purpose of this assignment if to have you develop an implementation plan, budget and evaluation plan to guide your project.
  • Background:
  • Please use the Policy Project Outcomes and Evaluation Template to create your proposed project evaluation.
  • Create a Gantt Chart
    Background: What is your schedule for your project? There are many ways to present a schedule. For this project, you are expected to develop project timelines using a Gantt chart for key deliverables created in excel. The week 5 lesson contains a tutorial to follow to develop your Gantt chart. The Gantt chart, named after Henry Gantt, clearly shows the start and completion dates for all major project activities and subtasks. The Gantt chart is straightforward, easy to understand, and simple to change. It provides a snapshot of the project, and one can immediately identify task durations and distinguish tasks dependent upon other tasks to be completed before they are started. Understanding all dependencies is critical for the project manager who is responsible for time, budgets, and resource allocation. Please refer to the information below on the project schedule, formative and summative evaluation criteria, outcomes, and budget prior to completing the templates
  • Complete the Policy Project Outcomes and Evaluation Template.

Background:FORMATIVE EVALUATION CRITERIA AND DATA COLLECTION
What evaluation criteria will you use to ensure that your planned change/policy occurred as you planned? Formative (sometimes referred to as process) evaluation is performed throughout the planned change/policy process to determine whether the change has been implemented as you intended. Without intermittent formative evaluation, you will not know if the intervention did or did not cause the intended outcome because you will not know whether it was implemented. Consider how you will know whether the change is being implemented; this may be by audit. At what point(s) in time will you collect this data using your evaluation tool and under what conditions?SUMMATIVE EVALUATION CRITERIA AND DATA COLLECTION
What evaluation criteria will you use to determine if your practice change (i.e., practice change/policy) has produced the effect in the outcome that you desire? Summative (sometimes referred to as impact) evaluation is at the end. Remember that you are looking for a change in the selected outcome. What tool are you using to evaluate your outcome?OUTCOMES
How will you analyze your results to determine if your selected intervention produced the outcome that you desire?Please use the Policy Project Outcomes and Evaluation Template to create your proposed project evaluation.

Complete the Policy Project Budget Template.

Background:One of the keys to project success is completing the project within a budget. In order to develop a realistic budget, consider the following questions: · What resources, including human resources and support, financial support, data resources, and materials, will you need for your project? What is your proposed budget for your project? · Does your project budget account for all cost factors and span the life of the project?ADDRESSING VARIANCE WITHIN BUDGETED AND ACTUAL EXPENSES
Once the planned change project is underway, the advanced practice nurse will be responsible for managing the cost of the initiative. To facilitate this process, the nurse will note the actual expenses incurred for the necessary resources. When the actual cost differs from the projected cost, a variance occurs. Any variance that occurs between the projected and actual budget must be analyzed. As revenue and expenses deviate from the projected numbers, adjustments in the budget may be required.Please use the Healthcare Policy Project Budget Template to create your proposed budget

Rubric:

Policy Project Evaluation Plan Template

Distinguished presentation of information evidenced by all of the following covered in a comprehensive and concise manner:

Evaluation Plan includes the following:

oFormative and Summative outcome measures are included.

oFor every outcome measure is the current baseline.

oFor every outcome measure is a source of data.

oFor every outcome measure is a method of evaluating the outcome.

oFor every outcome measure is an indicator of success.

Gantt Chart:

Distinguished presentation of information evidenced by all of the following areas covered in a comprehensive and concise manner:

Gantt chart shows all major project tasks using Excel.

All tasks are labeled.

  • Policy Project Budget Template:

Distinguished presentation of information evidenced by all of the following areas covered in a comprehensive and concise manner:

The budget plan contains a detailed budget and has been reviewed with the mentor. The budget is detailed enough to allow for variance analysis later in the project.

The patient is a 34-year-old male who comes to the clinic with complaints of redness and itchiness in both eyes..

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QUESTION

To prepare:

Review this week’s Learning Resources, including the Focused SOAP Note Template.

Select a patient who you saw at your practicum site during the last 3 weeks. With this patient in mind, consider the following:

Subjective: What details did the patient provide regarding his or her personal and medical history?

Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any morbidities and psychosocial issues.

Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority and include their ICD-10 code for the diagnosis. What was your primary diagnosis and why?

Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.

Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

Patient Information:

Initials, Age, Sex, Race

S.

CC (chief complaint): A brief statement identifying why the patient is here, stated in the patient’s own words (for instance “headache,” not “bad headache for 3 days”). 

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache,” the LOCATES for the HPI might look like the following example:

Location: Head

Onset: 3 days ago

Character: Pounding, pressure around the eyes and temples

Associated signs and symptoms: Nausea, vomiting, photophobia, phonophobia

Timing: After being on the computer all day at work

Exacerbating/relieving factors: Light bothers eyes; Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications: Include dosage, frequency, length of time used, and reason for use; also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Include a QUESTION of what the allergy is (e.g., angioedema, anaphylaxis, etc.). This will help determine a true reaction vs. intolerance.

PMHx: Include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed.
 

Soc & Substance Hx: Include occupation and major hobbies, family status, tobacco, and alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: Identify illnesses with possible genetic predisposition, and contagious or chronic illnesses. Reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

Surgical Hx: Prior surgical procedures.

Mental Hx: Diagnosis and treatment. Current concerns: (Anxiety and/or depression).History of self-harm practices and/or suicidal or homicidal ideation.

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Reproductive Hx: Menstrual history (date of LMP), pregnant (yes or no), nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination. Pregnancy. Last menstrual period (MM/DD/YYYY).

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

REPRODUCTIVE: Not pregnant and no recent pregnancy. No reports of vaginal or penile discharge. Not sexually active.

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

O.

Physical exam: From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format (i.e.) General: Head: EENT: etc. 

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidence and guidelines)

A.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

P. 

Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. 

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s treatment of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection, a discussion related to health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Week 7 discussion feedback

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QUESTION

Week 7 

Question 1: How can reflective practice help nurses navigate and address instances of incivility in their work environment? Use proper APA references 

Question2: give a feedback to this two post with a paragraph per post, use reference for each paragraph 

Reply to Junie:  
     Incivility in the workplace often results from rudeness, arrogance, and bullying of staff members from senior staff within the workplace, causing a hostile environment (Craft et al., 2020). Incivility evolves from job insecurities, increased diversity, and personal misunderstandings (Craft et al., 2020). My caregiver partner and I were assigned duties in the surgery ward with the chief nurse a while back. However, there was an assigned nurse at the time. So when she reported back to her post and found us, she started insulting and accusing us of being after her job. The abuse had escalated within no time, making the situation embarrassing.  This situation made me feel disrespected and agitated. The same was true for my partner because she retaliated and became aggressive towards the nurse. They became aggressive at each other to the point of physical altercation. The already nearing colleagues stopped this fight because the uncomfortable commotion was affecting the patients in the wards.

     Taskaya and Aksoy (2020) state that workplace incivility promotes significant harm to an individual’s health and those around them and even influences the productivity level of the staff. Such was the situation where most of the staff started launching their complaints against some of the colleagues who had bullying tendencies. At this point, work productivity within the wards was low, thus affecting the patients’ caregiving services and recuperating process. The most strategic way of curbing workplace incivility is introducing educational intervention activities, essential in enhancing interpersonal communication (Howard & Embree, 2020). This allows individuals to understand the existing uncivil behaviors and identify the most suitable ways of curbing such behaviors in future incidences. Furthermore, it enhances the art of following set guidelines and accepting changes made, thus respecting the authorities, remembering that all nurses are a team, and ensuring patients’ recovery is the goal. 

References
Craft, J., Schivinski, E. L., & Wright, A. (2020). The grim reality of nursing incivility. Journal for Nurses in Professional Development, 36(1), 41-43. DOI: 10.1097/NND.0000000000000599

Howard, M. S., & Embree, J. L. (2020). Educational intervention improves the communication abilities of nurses encountering workplace incivility. The Journal of Continuing Education in Nursing, 51(3), 138–144. https://doi.org/10.3928/00220124-20200216-09

Ta?kaya, S., & Aksoy, A. (2021). A bibliometric analysis of workplace incivility in nursing. Journal of Nursing Management, 29(3), 518-525. https://doi.org/10.1111/jonm.13161

Reply to Veronica: 

    Everybody may have good days or bad days. Still, when it happens at the workplace, it can create some situations that one nurse can avoid or does not show her emotions, but the other might show it up, unable to manage their feelings, which can put the healthcare team at a compromise. I witnessed the situation at the post-anesthesia care unit (PACU). In this PACU unit, nurses and CRNAs have worked together for several years and have an excellent professional team. However, it was a hectic workday, with many surgeries, and the unit needed more staff; we could not take our lunches by 3 pm. When a PACU nurse, T., was receiving a patient after surgery from the operation room (OR) to BAY #9 and was getting a report from an S., CRNA. At the end of the report, the CRNA made a general joke unrelated to the nurse, and it was not bullying, just a joke to cheer up Nurse T, but it triggered her differently. Nurse T. became agitated and screamed to the CRNA that other unit nurses got to Bay #9 in bewilderment. The situation was shocking for everybody. I felt so bad for the CRNA, the patient, and Nurse T, who was driven by negative emotions. The patient, who had just woken up after the surgery, became very confused, unknowing what was going on. The S., CRNA, is a friendly and intelligent young CRNA who got upset and felt terrible that he, somehow, unintentionally provoked this situation. Nurse T. could not hold emotions, started crying, and failed to care for her patient.  Nurse T, a single mother with two little kids trying to work more hours and pick up extra shifts, was stressed and overwhelmed by her daily life.  

    The charge nurse told Nurse T. to step back and took over the patient’s care. Nurse T. was unable to work and finish the shift. The situation negatively impacted the workplace culture and quality of patient care by delaying patient care and compromising the safety of the patient’s care. All PACU nurses, being initially understaffed that day, were more stressed, which decreased their work satisfaction. S., CRNA might have feelings of being disconnected and not making any jokes when giving reports to T, RN. The PACU manager had a meeting with Nurse T., and since then, she has been trying to manage her emotions and self-care to balance work and days off with her parents babysitting her kids. The PACU unit staff is still tight together and has an excellent team to take care of patients. However, everybody involved made some conclusions to avoid such a situation. 

    One of the strategies for a healthy work environment is that the entity should implement the Pathway for Fostering Organizational Civility Framework, which consists of several steps to create a healthier and more civil workplace culture. Clark (2019). According to Mabona et al. (2022), a healthy work environment is crucial in attaining good patient and societal outcomes and optimal entity performance. Also, nurses must improve their self-management skills to prevent or avoid workplace violence or conflict and to enhance emotional intelligence. According to Al-Hamdan et al. (2021), one study revealed that nurses’ emotional intelligence was positively and significantly correlated with nurse-to-nurse collaboration and linked to benefits for nurses by improving job satisfaction, better nursing retention, improved quality of patient care and magnified healthcare efficiency and productivity.