Category: Nursing

South nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

Week 1 discussion

Preventative Screening

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

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For this assignment, you will review the latest evidence based guidelines as they pertain to the case below. Discussion of the case is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, case study discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

Janice, a 21 year-old healthy female, presents to her nurse practitioner for her yearly check-up. She is sexually active with her boyfriend and uses condoms most of the time. She has never had a pelvic exam before.

Discuss the recommended screening tests, using the latest evidence based guidelines that the nurse practitioner should perform on Janice.

Discuss the recommended education and counseling that should be included in Janice’s care?

Week 2 discussion

iHuman Case Study – Angela Cortez

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. The iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The iHuman assignments are highly interactive and a dynamic way to enhance your learning. Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

Click here for information on how to access and navigate iHuman.

This week, complete the iHuman case titled “Angela Cortez”.

After completing your iHuman Case Study, answer the following questions using the latest evidenced based guidelines:

Discuss the questions that would be important to include when interviewing a patient with this issue.

Describe the clinical findings that may be present in a patient with this issue.

Are there any diagnostic studies that should be ordered on this patient? Why?

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

Week 3 discussion – south nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

Contraceptive Management

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings, supplemental readings, and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will review the latest evidence based guidelines as they pertain to the case below. Discussion of the case is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, case study discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

Karen, is a 33 year-old G2P2, with a medical history of migraines, for which she takes Imitrex when needed. She has a history of heavy and painful menses each month, lasting approximately 7-8 days. Karen smokes ½ pack of cigarettes per day. Her father has a history of DVT and cardiac disease. Her mother has a history of cervical cancer. Her blood pressure today is 138/76 and her pelvic exam is normal. She is divorced and is sexually active with her new boyfriend. She is currently using condoms for birth control and wants something more reliable. Karen does not desire pregnancy in the near future.

Discuss the contraceptive methods using the latest evidence-based guidelines that Karen would be medically eligible for.

Identify one method that you feel would be most beneficial to Karen and discuss why you selected it.

Are there any methods that you would not recommend for Karen? Why?

Week 4 discussion – South nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

iHuman Case Study – Rachael Hardy

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. The iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The iHuman assignments are highly interactive and a dynamic way to enhance your learning. Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

Click here for information on how to access and navigate iHuman.

This week, complete the iHuman case titled “Rachael Hardy”.

After completing your iHuman Case Study, answer the following questions using the latest evidenced based guidelines:

Discuss the questions that would be important to include when interviewing a patient with this issue.

Describe the clinical findings that may be present in a patient with this issue.

Are there any diagnostic studies that should be ordered on this patient? Why?

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

Week 5 discussion

iHuman Case Study – Pamela Flowers

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. The iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The iHuman assignments are highly interactive and a dynamic way to enhance your learning. Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

Click here for information on how to access and navigate iHuman.

This week, complete the iHuman case titled “Pamela Flowers”.

After completing your iHuman Case Study, answer the following questions using the latest evidenced based guidelines:

Discuss the questions that would be important to include when interviewing a patient with this issue.

Describe the clinical findings that may be present in a patient with this issue.

Are there any diagnostic studies that should be ordered on this patient? Why?

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

Week 6 discussion – south nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

iHuman Case Study – Sonya Phillips

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. The iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The iHuman assignments are highly interactive and a dynamic way to enhance your learning. Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

Click here for information on how to access and navigate iHuman.

This week, complete the iHuman case titled “Sonya Phillips”.

After completing your iHuman Case Study, answer the following questions using the latest evidenced based guidelines:

Discuss the questions that would be important to include when interviewing a patient with this issue.

Describe the clinical findings that may be present in a patient with this issue.

Are there any diagnostic studies that should be ordered on this patient? Why?

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

Week 7 discussion

iHuman Case Study – Erin Davis

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. The iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The iHuman assignments are highly interactive and a dynamic way to enhance your learning. Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

Click here for information on how to access and navigate iHuman.

This week, complete the iHuman case titled “Erin Davis”.

After completing your iHuman Case Study, answer the following questions using the latest evidenced based guidelines:

Discuss the questions that would be important to include when interviewing a patient with this issue.

Describe the clinical findings that may be present in a patient with this issue.

Are there any diagnostic studies that should be ordered on this patient? Why?

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

Week 8 discussion- south nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

LGBT Health Care

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will review and reflect on the LGBT article. This article can be applied to healthcare providers in the multiple care settings. Discussion of the article is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

Discuss any “take-away” thoughts from the article.

How do you plan to make a positive impact on the care of LGBT patients when you become a NP? What attitudes/behaviors/communication/understanding is important for the NP to have?

What specific screenings / interventions will you incorporate into practice when providing care to a LGBT patient?

Week 9 discussion – south nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

Hormone Replacement Therapy

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will review the latest evidence based guidelines as they pertain to the case below. Discussion of the case is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, case study discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

Ms. Martin is a 55-year-old woman who has been on HRT for 4 years. HRT was prescribed because Ms. Martin was experiencing vasomotor symptoms associated with menopause. Her last mammogram was 2 years ago and last pap was 5 years ago. Ms. Martin made an appointment with her nurse practitioner to discuss discontinuing HRT after hearing and reading news reports about the dangers associated with the medication. Except for the HRT, Ms. Martin is taking no medication other than a daily vitamin. She had a tubal ligation after the birth of her third child but has had no other surgeries or history of any medical conditions. Her father had cardiovascular disease and died of a myocardial infarction at 77 years of age. Her mother was diagnosed with breast cancer at 81 years of age. Ms. Martin does not smoke and rarely drinks alcohol. She likes to work in her garden but is not involved in a formal exercise program. She has gained about 10 pounds since menopause.

What evidence-based information will you provide to Ms. Martin regarding her concerns of HRT? Discuss the advantages and risks associated with HRT.

What are your recommendations for Ms. Martin? Will you recommend continuing or discontinuing HRT and why?

What alternative treatments for menopausal symptoms will you discuss with Ms. Martin?

Discuss the recommended screening tests, using the latest evidence based guidelines that Ms. Martin should have.

What health promotion, maintenance, and prevention education would be important to provide to Ms. Martin?

Week 10 discussion – south nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

Prophylactic Hysterectomy

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will review and reflect on the Prophylactic Hysterectomy article. This article can be applied to healthcare providers in the primary care and specialty settings. Discussion of the article is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

Discuss any “take-away” thoughts from the article.

What are the ethical dilemmas to consider with prophylactic surgeries?

Discuss the screenings/interventions/options/education that you would provide to a patient that has a strong family history of ovarian cancer. What if the patient has no health insurance? What resources could you offer to assist the patient?

south nsg6330 – NSG6330 Practicum II Adult Health: Women’s Health Essay Assignment Papers

NURS 347-Final Reflection Paper

• Papers are due by midnight on Monday of final week. No late papers will be accepted.

• Papers must be a minimum of 2 pages (double-spaced) in length. This paper involves your own perspectives, so do not include any references. Strict APA format is not required; however you must follow principles of good writing (no typos, clarity of sentences, attention to grammar, etc.)

• What is a reflective paper?

o A reflective paper gives you the opportunity to reflect back on the experiences and learning you have obtained from this course and to place your learning in context with your past, present, and future practice and experience. Reflecting on your learning helps to facilitate the integration and synthesis of newly acquired knowledge and experience.

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• What should not be included?

o A list or description of what you learned

o An evaluation of the course – that will be done through the course evaluation process.

Reflection Questions (15 points) NURS 347-Final Reflection Paper

• Discuss the advantages and disadvantages of new educational pathways for nurses.

• Discuss experiences and learning in this course on your past, present, and future practice.

• Identify three challenges for improvements in the delivery of quality healthcare.

• Describe your plans for two specific personal contributions to professional nursing practice that you will accomplish during the next ten years.

NURS 347-Final Reflection Paper

Nursing Care Models Paper

Purpose

The purpose of this assignment is to identify nursing care models utilized in today’s various health care settings and enhance your knowledge of how models impact the management of care and may influence delegation. You will assess the effectiveness of models and determine how you would collaborate with a nurse leader to identify opportunities for improvement to ensure quality, safety and staff satisfaction.

Course Outcomes – Nursing Care Models Paper

Completion of this Nursing Care Models Paper assignment enables the student to meet the following course outcomes.

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CO1: Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2)

CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3)

CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7)

CO6: Develop a personal awareness of complex organizational systems and integrate values and beliefs with organizational mission. (PO7)

CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and/or system-wide practice improvements that will improve the quality of healthcare delivery. (PO2, and 3)

CO8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8)

Nursing Care Models Paper Due Dates

Submit by Sunday, 11:59 p.m. MT, end of Week 5.

Rubric

Click to view and download the NR447 Nursing Care Models Paper Rubric (Links to an external site.)Links to an external site..

Points

This Nursing Care Models Paper assignment is worth 200 points.

Nursing Care Models Paper Directions

Read your text, Finkelman (2016), pp- 111-116.

Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability.

Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how and what led you to identify the particular model.

Write a 5-7 page Nursing Care Models Paper that includes the following:

Review and summarize two scholarly resources (not including your text) related to the nursing care model you observed in the practice setting.

Review and summarize two scholarly resources (not including your text) related to a nursing care model that is different from the one you observed in the practice setting.

Discuss your observations about how the current nursing care model is being implemented. Be specific.

Recommend a different nursing care model that could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific.

Provide a summary/conclusion about this experience/assignment and what you learned about nursing care models.

Write your Nursing Care Models Paper using APA format using Microsoft Office 2010 or later.

NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Week 1 discussion

Organizational Foundations

As you strive to grow in your leadership skills and abilities, you will find that the context in which you work influences your motivation and areas of focus. In a similar vein, your commitment to developing professionally can contribute toward organizational effectiveness.

To that end, it is critical to recognize the importance of organizational culture and climate. In particular, through this week’s Learning Resources, you may consider several questions: How do an organization’s mission, vision, and values relate to its culture? What is the difference between culture and climate? Moreover, how are culture and climate manifested within the organization?

For this Discussion, you explore the culture and climate of your current organization or one with which you are familiar. You also consider decisions and day-to-day practices and the way they relate to the organization’s mission, vision, and values.

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To prepare:

Review the information related to planning and decision making in health care organizations presented in the textbook, Leadership Roles and Management Functions in Nursing: Theory and Application. Consider how planning and decision making relate to an organization’s mission, vision, and values, as well as its culture and its climate. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Familiarize yourself with the mission, vision, and values of your organization or one with which you are familiar. Consider how the statements and actions of leaders and others within the organization support or demonstrate the organizational mission, vision, and values. In addition, note any apparent discrepancies between word and deed. Think about how this translates into expectations for direct service providers. Note any data or artifacts that seem to indicate whether behaviors within the organization are congruent with its mission, vision, and values.

Begin to examine and reflect on the culture and climate of the organization. How do culture and climate differ?

Why is it important for you, as a master’s-prepared nurse leader, to be cognizant of these matters?

By Day 3

Post a description of your selected organization’s mission, vision, and values. Describe relevant data, or artifacts, words, and actions of leaders and others in the organization that support, or perhaps appear to contradict the organization’s mission, vision, and values statement. In addition, discuss the organization’s culture and its climate, differentiating between the two. Explain why examining these matters is significant to your role as a nurse leader.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Module 2 discussion

Transitioning From Closed to Open Systems

How do effective nurse leaders and others approach problem solving and decision making in organizations? As suggested in this week’s Learning Resources, systems theory provides a valuable way to assess situations and prepare to address problems.

For this week’s Discussion, you identify an issue or process that could be improved and apply knowledge and strategies related to systems theory.

Note: You may find it helpful to view the Assignment instructions and use the same problem for this Discussion.

To prepare:

Review the information presented in this week’s Learning Resources on systems theory and the difference between open and closed systems. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Reflect on the practices and processes with which you are familiar in your organization. Identify one problematic issue or process that could be improved.

Consider the problem from a closed-system perspective. Then think about how the issue or process you selected could be addressed by viewing it from an open-system perspective. How would the transition from a closed- to an open-system view help you and others to address the problem and improve outcomes?

By Day 3

Post a description of the problem that you identified in your selected organization. Explain the problem from a closed-system perspective. Then, describe how the problem could be addressed by viewing it from an open-system perspective, and explain how this modification would help you and others improve health care outcomes.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 3 discussion

Organizational Structures and Leadership

In most health care settings, it is unlikely that you would hear the terms “ad hoc” or “matrix” as you walk down the hallway. Although it is helpful for any organization to delineate pathways of responsibility and authority in an organizational chart, the lived experience of these structures is most apparent through the inquiries and behaviors people share everyday.

In your own workplace, you may find yourself wondering, who should I turn to when I have a practice dilemma? or Where can I go to learn more about this issue? These questions speak to the intricacies of formal and informal organizational structure and leadership. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

To prepare:

Review the information presented in Chapter 12 of the course text. Focus on the information about formal versus informal structure as well as the types of organizational structures.

Consider the overall structure or hierarchy of your organization or one with which you are familiar. Which organizational structure best describes your organization—line (or bureaucratic), ad hoc, matrix, service line, or flat? Note: It is possible to have a combination of structures in one organization. Is decision making centralized or decentralized in this organization?

What is the role of committees, task forces, and councils in the organization, and who is invited to join? Consider how this relates to formal and informal leadership.

Reflect on how decisions are made within a specific department or unit. Which stakeholders provide input or influence the decision-making process? Assess this in terms of formal and informal leadership.

To support your analysis, consider your own experiences and investigate these matters by speaking with others at the organization and reviewing available documents. Be sure to consider how the concepts of formal and informal structure and leadership relate to one another and are demonstrated in the organization and in the particular department or unit.

By Day 3

Post a depiction of your organization’s formal structure, indicating whether it is best described as line, ad hoc, matrix, service line, flat, or a combination. Describe how decisions are made within the organization and within one department or unit in particular, noting relevant attributes of centralized/decentralized decision making. Explain the influence of formal and informal leadership on decision making within this department or unit.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Discussion – Week 4

Critiquing a Change Effort

As a nurse leader, you need to have the skills and knowledge to collaborate and communicate with those who plan for and manage change. This capacity is valuable in any health care setting and for many different types of change. Furthermore, it is essential to be able to evaluate a change effort and determine if it is promoting improved outcomes and making a positive difference within the department or unit, or for the organization as a whole.

To prepare:

Review Chapters 7 and 8 in the course text. Focus on the strategies for planning and implementing change in an organization, as well as the roles of nurses, managers, and other health care professionals throughout this process.

Reflect on a specific change that has recently occurred in your organization or one in which you have worked previously. What was the catalyst or purpose of the change?

How did the change affect your job and responsibilities?

Consider the results of the change and whether or not the intended outcomes have been achieved.

Was the change managed skillfully? Why or why not? How might the process have been improved?

By Day 3

Post a summary of a specific change within an organization and describe the impact of this change on your role and responsibilities. Explain the rationale for the change, and whether or not the intended outcomes have been met. Assess the management of the change, and propose suggestions for how the process could have been improved.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

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Week 5 discussion

Groups

The dynamic and increasingly complex world of health care often requires nurses to work collaboratively on interprofessional teams. In the group environment, individuals with unique skills and expertise come together to focus on a common goal; however, groups must become cohesive before they can become effective.

Your experiences working with groups—whether you perceive them as positive, negative, or neutral—can be used to facilitate insight and development. Health care, with its focus on interprofessional teamwork and collaboration, offers ample opportunities and an imperative for continuous learning.

For this Discussion, you focus on strategies for facilitating the group process.

To prepare:

Review the information in this week’s Learning Resources regarding the stages of group formation, problematic roles individuals play in groups, and strategies for facilitating and maintaining positive group collaboration. In particular, review Learning Exercise 19.14 of the course text.

Reflect on various groups with which you have been or are currently involved. Select one specific group to analyze for the purposes of this Discussion. Identify the purpose or task that the group is or was meant to perform.

Consider the four stages of group formation (forming, storming, norming, and performing). How would you describe the progression between stages? Is there a stage in which you believe your group is or was “stuck”?

Consider the task or group-building role you normally play in a group setting. How could you apply the information from the Learning Resources to improve your group participation and facilitation, as well as the functioning of the group as a whole?

In addition, think about which individuals within your group (including yourself) may fall into problematic roles such as the Dominator, the Aggressor, or the Blocker. How have you and your group members addressed the enactment of these roles and its impact on interactions? With information from the Learning Resources in mind, what strategies would you apply now or going forward?

By Day 3

Post a description of a group with which you have been or are currently involved. Assess where the group is in terms of the four stages of group formation. If you are reflecting on a past experience, explain if your group moved through all four stages. Describe the task or group-building role you typically play, or played, in this group. Then, explain what strategies you, as a leader, can apply to better facilitate the group process and address any problematic individual roles in the group.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

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Week 6 discussion

Power Dynamics

There is no graded Discussion Board assignment this week; however, a Week 6 optional discussion board is available for your voluntary participation. Bring to mind a nurse whose words, behaviors, or reputation convey power. What is it about this individual that suggests power? How does your perception of this person relate to your view of yourself as a nurse leader and the image you associate with nursing?

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Week 7 discussion

Addressing Barriers to Effective Communication

From moment to moment, a nurse leader’s day involves communication—with patients, families, colleagues, supervisors, and so on.

Think of a particular day you spent working in a health care environment, and consider three or four distinct points in time. For each point of time, consider the following: With whom did you interact? Which forms of communication did you use? What issues were communicated about—did they seem to be light-hearted or sensitive? Straightforward or complicated? How would you describe the pace of the interactions and your work?

As you consider these questions, it becomes clear that communication can be quite complex, with many layers of meaning that shape the experience for everyone involved. How could this awareness help you to understand instances of ineffective communication when they arise? NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

To prepare:

Review the information in Chapter 19 of the course text, as well as the assigned articles.

Reflect on an incident involving ineffective communication within your organization or another health care setting. Consider this incident through the lens of the communication process outlined in Figure 19.1 of the course text.

What barriers contributed to this incident? What other challenges may have influenced this situation?

Using the information presented in the other Learning Resources, consider what could have been done to prevent or address the ineffective communication. Why do you think the use of these strategies would have resulted in better outcome(s)?

By Day 3

Post a summary of an incident involving ineffective communication. Describe communication barriers and other challenges that contributed to the incident. Propose one or more strategies that could have been employed to promote a better outcome. Be sure to refer to elements of the communication process.

Read a selection of your colleagues’ responses.

By Day 6

Respond by critiquing at least two of your colleagues’ postings on two different days using elements of the communication process and recommend additional strategies to overcome the barriers. If you think other factors may have contributed to the situation, provide an analysis with the support of literature.

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Week 8 discussion

The Distinction Between Leadership and Management

Think of the managers you have reported to thus far in your career. Now consider the people you have worked with or know of that you would consider leaders. Based on these experiences, what would you surmise about the responsibilities of managers and leaders and about the distinctions between these two categories in health care settings?

This week’s Learning Resources classify management and leadership (which are often confused in everyday discussion) and explain their significance for health care organizations. As you advance professionally, it is critical to understand the distinctions between management and leadership and how you can apply this knowledge for increasing effectiveness in your workplace.

To prepare:

Review the information in the Learning Resources.

Conduct additional research on your own and select at least two current, credible sources that contribute to your understanding of management and leadership.

Reflect on how the roles of management and leadership differ in supporting the organization to set and achieve goals.

Drawing upon specific examples from a current or previous practice setting, bring to mind someone who seemed to be a leader but not a manager and someone who seemed to be a manager but not a leader (generally speaking, or within a specific circumstance). Be prepared to support your assessment with specific behavioral descriptions found in the literature.

By Day 3

Post an analysis of how management and leadership roles differ in terms of supporting an organization to set and achieve goals. In addition, post descriptions of an individual who demonstrates leadership behaviors but not management behaviors and an individual who demonstrates management behaviors but not leadership behaviors. Provide your rationale, identifying specific characteristics of effective managers and leaders. (Note: Do not identify these individuals by name, position, or location.)

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional research.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 9 discussion

Leadership Style

Throughout your career, you will work with many people who display differing leadership styles. As a nurse leader, it is imperative that you communicate well and get along with those whose leadership style does not align with your preferences. It is also important to understand your own leadership style, as this can prompt insight into how others relate to you and what skills you may need to develop as your leadership responsibilities grow. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

To prepare:

Review the information in the Learning Resources, including the leadership styles identified in Chapter 2 of the course text.

Bring to mind a leader in your organization or one with which you are familiar. Would you describe his or her style as authoritative, democratic, or laissez-faire? Why?

Which characteristics or approaches demonstrated by this person would you integrate into your own leadership style? Which ones would you prefer not to integrate?

Think about how this leader’s style and resulting interactions may impact health care quality and patient outcomes.

By Day 3

Post a description of a leader, distinguishing his or her style as authoritative, democratic, or laissez-faire. Describe the characteristics that inform your perception, and explain which ones you would integrate into your own leadership style, as well as which ones you would prefer not to integrate. Explain at least one potential effect of this leadership style on health care quality and patient outcomes.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 10 discussion

Effective Ethical, Moral, and Legal Leadership

In this ungraded and voluntary discussion board, please post any questions or examples that may help your colleagues better understand an ethical, moral, or legal dilemma. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 11 discussion

Conflict Management Styles

In Week 10, you considered how ethical, moral, and legal dilemmas can provoke internal conflict when a nurse’s values are not in alignment with the apparent demands of a situation or with others’ values, as well as external conflict that can arise as these dynamics are played out. Of course, conflict can also emerge through seemingly simple issues of little consequence—little consequence, that is, except when they are not properly managed.

Nurse leaders need to be familiar with conflict management styles and the impact these styles can have on interpersonal dynamics, and, ultimately, patient care. For this Discussion, you evaluate a situation marked by conflict and consider how conflict management strategies could be applied to promote positive results.

To prepare:

Consider a conflict situation you witnessed or were engaged in within your practice setting. Then, proceed as follows:

Think about who was involved, how it was resolved (if it was), and how it might have been handled more effectively.

Identify the conflict management style(s) employed by various individuals, including ineffective responses or no response to the situation. NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Evaluate your personal response to this conflict.

What do your thoughts and actions in this and other conflict situations reveal about your typical approach to conflict?

By Day 3

Post a description of how you handled or avoided a conflict, as well as the results of your approach. Explain how would you respond to this conflict today and/or what steps you would take to improve your comfort level and skill for managing conflict in the future (including specific conflict management strategies you would use). Explain how conflict management relates to your effectiveness as a leader.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

NURS 6053 – Discussion Essay Assignment Papers – Interprofessional Organizational and Systems Leadership

Utilitarianism Ethical Principle Theory and Bentham’s Felicific Calculus Essay

Choose a contemporary moral issue in our society and apply the ethical principle of Utilitarianism to approve and be in favor of this moral issue. You must pick a moral issue that you strongly agree with and apply the utilitarian claims to back up your arguments. In addition, you must apply Bentham’s Felicific Calculus.

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The paper must be done in MLA format with a minimum of 500 words (quotes are not included in the word count). You must read Chapter 2 and watch the Week 3 Lectures before you do this paper. You must use at least 3 sources from LIRN, in our library. This assignment is due on January 21st, NO LATER than at 11:59 pm. Not applying Utilitarianism or the Felicific Calculus results in an automatic F. Utilitarianism is the ethical theory that the moral worth of an action is only determined by its contribution to overall utility . It is thus a form of consequentialism , meaning that the moral worth of an action is determined by its outcome-the ends justifies the means.

Utilitarianism Ethical Principle Theory and Bentham’s Felicific Calculus Essay

NURS 6053 – Interprofessional Organizational and Systems Leadership

Students in this course prepare to exercise leadership through which they can help to ensure their organization is able to adapt and flourish in the ever-changing world of healthcare. Students explore the impact of healthcare system changes on transforming the nursing profession. They examine and discuss theories related to leadership and management and learn about empowerment strategies that assist master’s-prepared nurses to assume and succeed in leadership roles. Students engage in course assignments that focus on real-world nursing practice applications of theory.

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NURS 6053 – Interprofessional Organizational and Systems Leadership Required Course Readings

The links are for required readings found in the Walden databases 
ONLY
. For all other readings, see your course resources.

Enter your myWalden user name and password at the prompt.

Adams, S. L., & Anantatmula, V. (2010). Social and behavioral influences on team process. 
Project Management Journal, 41
(4), 89–98.

Allmark, P., Baxter, S., Goyder, E., Guillaume, L. and Crofton-Martin, G. (2013), Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways. 
Health & Social Care in the Community
, 21, pp. 59–68. NURS 6053 – Interprofessional Organizational and Systems Leadership

Azaare, J., & Gross, J. (2011). The nature of leadership style in nursing management. 
British Journal of Nursing, 20
(11), 672–676, 678–680.

Benoliela, P.  &  Somecha, A. (2014). The health and performance effects of participative leadership: Exploring the moderating role of the Big Five personality dimensions. 
European Journal of Work and Organizational Psychology
, 23(2), 277-294.

Brunettoa Y., Shacklockb K., et al. (2012). Comparing the impact of leader–member exchange, psychological empowerment and affective commitment upon Australian public and private sector nurses: implications for retention. The International Journal of Human Resource Management, 23(11), 2238-2255.

Chun, J. S., & Choi, J. N. (2014). Members’ needs, intragroup conflict, and group performance. 
The Journal Of Applied Psychology
, 99(3), 437-450.

Cianci, A. M., Hannah, S. T., Roberts, R. P., & Tsakumis, G. T. (2014). The effects of authentic leadership on followers’ ethical decision-making in the face of temptation: An experimental study
. The Leadership Quarterly
, 25(3), 581-594.

Collins, J. C., & Porras, J. I. (1996). Building your company’s vision. 
Harvard Business Review, 74
(5), 65–77.

Disch, J. (2014). Using Evidence-Based Advocacy to Improve the Nation’s Health
. Nurse Leade
r, 12(4), 28-31.

Downey, M., Parslow, S., & Smart, M. (2011). The hidden treasure in nursing leadership: Informal leaders. 
Journal of Nursing Management, 19
(4), 517–521.

Eagar, S. C., Cowin, L. S., Gregory, L., & Firtko, A. (2010). Scope of practice conflict in nursing: A new war or just the same battle? 
Contemporary Nurse, 36
(1/2), 86–95.

Gifu, D., Dima, I. C., & Teodorescu, M. (2014). New communication approaches vs. traditional communication. 
International Letters of Social and Humanistic Sciences
, (20), 46-55.

Graham, S., & Melnyk, B. M. (2014). The Birth of a Healthcare Leadership Academy: Lessons Learned From The Ohio State University. 
Nurse Leader,
 12(2), 55-74. NURS 6053 – Interprofessional Organizational and Systems Leadership

Haynes, J., & Strickler, J. (2014). TeamSTEPPS makes strides for better communication. 
Nursing
, 44(1), 62-63.

Hogg, M. A., Van Knippenberg, D., & Rast, D. E., III. (2012). Intergroup leadership in organizations: Leading across group and organizational boundaries. 
Academy of Management Review, 37
(2), 232–255.

Jennings, B. M., Scalzi, C. C., Rodgers, J. D., & Keane, A. (2007). Differentiating nursing leadership and management competencies. 
Nursing Outlook, 55
(4), 169–175.

Johansen, M. L. (2012). Performance potential. Keeping the peace: Conflict management strategies for nurse managers.
Nursing Management, 43
(2), 50–54.

Johansson, C., Miller, V. D., Hamrin, S. (2014) Conceptualizing communicative leadership: A framework for analyzing and developing leaders’ communication competence. 
Corporate Communications: An International Journal
, 19 (2), 147 – 165.

Kaufman, B. (2012). Anatomy of dysfunctional working relationships. 
Business Strategy Series, 13
(2), 102–106.

Keys, Y. (2014). Looking ahead to our next generation of nurse leaders: Generation X Nurse Managers. 
Journal of nursing management,
 22(1), 97-105.

Leach, L. S., & McFarland, P. (2014). Assessing the Professional Development Needs of Experienced Nurse Executive Leaders.
 Journal of Nursing Administration
, 44(1), 51-62. NURS 6053 – Interprofessional Organizational and Systems Leadership

Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology.
 FoNS 2014 International Practice Development Journal
 4 (1) [2].

Manojlovich, M., & Ketefian, S. (2016). The effects of organizational culture on nursing professionalism: Implications for health resource planning. Canadian Journal of Nursing Research Archive, 33(4).

Manojlovich, M., Harrod, M., Holtz, B., Hofer, T., Kuhn, L., & Krein, S. L. (2015). The Use of Multiple Qualitative Methods to Characterize Communication Events Between Physicians and Nurses. 
Health communication
, 30(1), 61-69.

Marker, D. (2010). Leadership or management? 
Management Quarterly, 51
(2), 31–34.

Martin, M. B. (2014). Transcultural Advocacy and Policy in the Workplace: Implications for Nurses in Professional Development.
 Journal for nurses in professional development
, 30(1), 29-33.

McAlearney, A., Terris, D., Hardacre, J., Spurgeon, P. Brown, C.,  Baumgart, A.,  Nyström, M. (2014). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change.
Quality Management in Health Care
, 23(4), 254-267

Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. 
Journal of Advanced Nursing, 66
(12), 2828–2838. NURS 6053 – Interprofessional Organizational and Systems Leadership

Mitchell, G. (2013). Selecting the best theory to implement planned change. 
Nursing Management – UK
, 20(1), 32-37.

Nelson, W. A., & Gardent, P. B. (2011). Organizational values statements. 
Healthcare Executive, 26
(2), 56–59.

Ortega, A., Sánchez-Manzanares, M., Gil, F., & Rico, R. (2013). Enhancing team learning in nursing teams through beliefs about interpersonal context. Journal Of Advanced Nursing, 69(1), 102-111.

Plath, D. (2013). Organizational processes supporting evidence-based practice
. Administration in Social Work,
 37(2), 171-188.

Rai, G. S. (2013). Job satisfaction among long-term care staff: Bureaucracy isn’t always bad
. Administration in Social Work
, 37(1), 90-99.

Rao, A. (2012). The contemporary construction of nurse empowerment.
 Journal of Nursing Scholarship,
 44(4), 396-402.

Ross, E. J., Fitzpatrick, J. J., Click, E. R., Krouse, H. J., & Clavelle, J. T. (2014). Transformational leadership practices of nurse leaders in professional nursing associations. 
Journal of Nursing Administration
, 44(4), 201-206.

Shirey, M. R. (2013). Lewin’s Theory of Planned Change as a strategic resource. 
The Journal of Nursing Administration,
 43(2), 69-72.

Seyranian, V. (2014). Social Identity Framing communication strategies for mobilizing social change. 
The Leadership Quarterly
, 25(3), 468-486. NURS 6053 – Interprofessional Organizational and Systems Leadership

Spence Laschinger, H. K., & Fida, R. (2014). New nurses burnout and workplace wellbeing: The influence of authentic leadership and psychological capital
. Burnout Research, 
1(1), 19-28.

Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for Evidence-Based Practice: Strategic and Functional Behaviors for Institutionalizing EBP. 
Worldviews on Evidence-Based Nursing
, 11(4), 219-226.

Stoddart, K., Bugge, C., Shepherd, A., & Farquharson, B. (2014). The new clinical leadership role of senior charge nurses: a mixed methods study of their views and experience. 
Journal of Nursing Management
, 22(1), 49-59.DOI: 10.1111/jonm.12008

Tost, L. P. (2015). When, why, and how do powerholders “feel the power”? Examining the links between structural and psychological power and reviving the connection between power and responsibility. Research in organizational behavior, 35, 29-56. NURS 6053 – Interprofessional Organizational and Systems Leadership

Van Keer, R. V., Deschepper, R. D., Huyghens, L. H., Distelmans, W. D., & Bilsen, J. B. (2014). Dealing with cultural diversity during the process of communication and decision-making in the ICU: a literature review.
 Critical Care
, 18(Suppl 1), P24.

Woods, M. (2014). Beyond moral distress preserving the ethical integrity of nurses. Nursing Ethics, 21(2), 127-128.

Zydziunaite, V, & Suominen, T. Leadership styles of nurse managers in ethical dilemmas: Reasons and consequences.
Contemporary Nurse
, 48(2):150-16. NURS 6053 – Interprofessional Organizational and Systems Leadership

NURS521 Virtue Ethics Essay

Respond to one of the following three “news clippings” related to virtue ethics from your Pozgar text. Write a 1- 2 page essay addressing the discussion questions posed for the one you selected. Be sure to clearly identify the news clipping you selected.

Adhere to APA formatting and cite all sources. Review the rubric for further information on how your assignment will be graded.

Due: Sunday, 11:59 p.m. (Pacific time)

Points: 40

Watch the following 3 videos and choose one to address for your assignment.

#1. Wrong-Operation Doctor

Download Script

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Find Out More: You may use these and other outside sources to frame your discussion.

The Pain of Wrong Site Surgery

Judgment Upheld in Arkansas Brain Surgery Lawsuit

National Quality Forum

Assignment Discussion Questions

1. Discuss the issues of integrity in this case.

2. Should criminal charges be considered in this case, if accurately reported? Discuss your answer.

3. Why did you choose to respond to this story?

4. How is integrity displayed in your clinical setting?

#2. Cheney’s Staff Cuts Testimony on Warming

Download Script

Find Out More: You may use these and other outside sources to frame your discussion.

The full story Cheney’s Staff Cut Testimony On Warming

CDC on Air Quality

NURS521 Virtue Ethics Essay Assignment Discussion Questions

1. Discuss how headlines such as this affect your opinion of politicians.

2. At the end of our days, the most basic principles of life–trust and survival–are on trial. What is your verdict, if you believe there was a cover-up?.

3. Why did you choose to respond to this story?

4. How are government and political trust displayed in your clinical setting?

#3. Surgeon Uses Ministry in Medical Practice

Download Script

Find Out More: You may use these and other outside sources to frame your discussion.

The full story: Praying with patients: A Dallas surgeon finds a way to put ministry into practice

Should Your Doctor Pray With You?

South Korean Hospitals Shut Over MERS Fears; 11th Person Dies

Note the picture in this article

NURS521 Virtue Ethics Essay Assignment Discussion Questions

1. Discuss the pressure, if any, placed on the patient to responding to the suggestion of prayer prior to surgery.

2. Describe how you, as the surgeon, or nurse, would address a patient’s religious or spiritual needs if the risks of a complex surgical procedure appear to be threatening.

3. Why did you choose to respond to this story?

4. How is religion or faith displayed in your clinical setting?

NURS521 Virtue Ethics Essay

Family Health – Primary Care : NSG6440

Week 1 – Assignment 2 Discussion

You are a family nurse practitioner working in a community health center. The patient you are about to see is a 3 month old natal female infant for a well-baby check. The child has just been adopted. The mother stays at home with the baby and the father works outside the home. They are covered by private health insurance through the father’s work. The parents own their own home in a suburban area, neither smoke, and they have one dog. Answer the following questions using course resources (texts) and two other evidence based sources (current guidelines and/or scholarly articles that are within a 3-5 year time frame).

What are the components of a well-child check for this 3-month old infant?

Write an educational intervention plan for the parents. What are you going to teach the parents about their baby?

When completing a physical exam for this baby, what would be of particular focus and why?

Week 2 – Assignment 1 Discussion – Family Health – Primary Care : NSG6440

SOAP Note

Each week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using the SOAP Note template.

SOAP Note: Choose one patient from an area of weakness identified from the Week 1 Pre-Predictor Exam and submit a SOAP note of this patient. Remember to remove all forms of patient identification from the SOAP note format. Provide a reference (s) for the differential diagnosis and treatment plan in APA format. The reference should be within a 3-5 year time frame and come from a textbook, guideline,or currently published peer reviwed journal article. Family Health – Primary Care : NSG6440

Submission Details:

Enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

Include the reference number from eMedley in your document.

Submit your SOAP note into the discussion area below by Sunday, October 15, 2017 along with clinical insights about your case.

Respond to two peers with a substantial response that includes supportive references by Wednesday, October 18, 2017.

Week 3 – Assignment 1 Discussion – Family Health – Primary Care : NSG6440

Assignment 1: SOAP Note

Each week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using the SOAP Note template.

SOAP Note: Choose one patient from an area of weakness identified from the Week 1 Pre-Predictor Exam and submit a SOAP note of this patient. Remember to remove all forms of patient identification from the SOAP note format. Provide a reference (s) for the differential diagnosis and treatment plan in APA format. The reference should be within a 3-5 year time frame and come from a textbook, guideline, or currently published peer reviewed journal article.

Submission Details:

Enter your patient encounters into eMedley and complete at least one SOAP note in the template provided. Family Health – Primary Care : NSG6440

Include the reference number from eMedley in your document.

Submit your SOAP note into the discussion area below by Sunday, October 22, 2017 along with clinical insights about your case.

Respond to two peers with a substantial response that includes supportive references by Wednesday, October 25, 2017.

Name:

Pt. Encounter Number:

Date:

Age:

Sex:

SUBJECTIVE

CC:

Reason given by the patient for seeking medical care “in quotes”

HPI:

Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors, pertinent positives and negatives, other related diseases, past illnesses, and surgeries or past diagnostic testing related to the present illness.

Medications:
(List with reason for med )

PMH

Allergies:

Medication Intolerances:

Chronic Illnesses/Major traumas

Hospitalizations/Surgeries

“Have you ever been told that you have diabetes, HTN, peptic ulcer disease, asthma, lung disease, heart disease, cancer, TB, thyroid problems, kidney problems, or psychiatric diagnosis?”

Family History

Does your mother, father, or siblings have any medical or psychiatric illnesses? Is anyone diagnosed with: lung disease, heart disease, HTN, cancer, TB, DM, or kidney disease? Family Health – Primary Care : NSG6440

Social History

Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, and marijuana. Safety status

ROS

General

Weight change, fatigue, fever, chills, night sweats, and energy level

Cardiovascular

Chest pain, palpitations, PND, orthopnea, and edema

Skin

Delayed healing, rashes, bruising, bleeding or skin discolorations, and any changes in lesions or moles

Respiratory

Cough, wheezing, hemoptysis, dyspnea, pneumonia hx, and TB

Eyes

Corrective lenses, blurring, and visual changes of any kind

Gastrointestinal

Abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, and black, tarry stools. Family Health – Primary Care : NSG6440

Ears

Ear pain, hearing loss, ringing in ears, and discharge

Genitourinary/Gynecological

Urgency, frequency burning, change in color of urine.

Contraception, sexual activity, STDs

Female: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx

Male: prostate, PSA, urinary complaints

Nose/Mouth/Throat

Sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain

Musculoskeletal

Back pain, joint swelling, stiffness or pain, fracture hx, and osteoporosis

Breast

SBE, lumps, bumps, or changes

Neurological

Syncope, seizures, transient paralysis, weakness, paresthesias, and black-out spells

Heme/Lymph/Endo

HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, and cold or heat intolerance. Family Health – Primary Care : NSG6440

Psychiatric

Depression, anxiety, sleeping difficulties, suicidal ideation/attempts, and previous dx

OBJECTIVE

Weight BMI

Temp

BP

Height

Pulse

Resp

General Appearance

Healthy-appearing adult female in no acute distress. Alert and oriented; answers questions appropriately. Slightly somber affect at first and then brighter later.

Skin

Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted.

HEENT

Head is normocephalic, atraumatic, and without lesions; hair evenly distributed. Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair
.

Cardiovascular

S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pulses 3+ throughout. No edema.

Respiratory

Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally
.

Gastrointestinal

Abdomen obese; BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly
.

Breast

Breast is free from masses or tenderness, no discharge, no dimpling, wrinkling, or discoloration of the skin
.

Genitourinary

Bladder is nondistended; no CVA tenderness. External genitalia reveals coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A small speculum was inserted; vaginal walls are pink and well rugated; no lesions noted. Cervix is pink and nulliparous. Scant clear to cloudy drainage present. On bimanual exam, cervix is firm. No CMT. Uterus is antevert and positioned behind a slightly distended bladder; no fullness, masses, or tenderness. No adnexal masses or tenderness. Ovaries are nonpalpable. Family Health – Primary Care : NSG6440

(Male: Both testes are palpable, no masses or lesions, no hernia, and no uretheral discharge.)

(Rectal as appropriate: No evidence of hemorrhoids, fissures, bleeding, or masses—Males: Prostrate is smooth, nontender, and free from nodules, is of normal size, and sphincter tone is firm).

Musculoskeletal

Full ROM seen in all four extremities as the patient moved about the exam room.

Neurological

Speech clear. Good tone. Posture erect. Balance stable; gait normal.

Psychiatric

Alert and oriented. Dressed in clean slacks, shirt, and coat. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately.

Lab Tests

Urinalysis—pending

Urine culture—pending

Wet prep—pending

Special Tests

Diagnosis

Include at least three differential diagnosis

Final diagnosis

Evidence for final diagnosis should be
documented
in your Subjective and Objective exams. Family Health – Primary Care : NSG6440

PLAN including education

Plan:

Further testing

Medication

Education

Nonmedication treatments

Follow-up

Week 4 – Assignment 1 Discussion – Family Health – Primary Care : NSG6440

Assignment 1: Grand Rounds

As a major project in this course, you will deliver a Grand Rounds presentation.

The health care topic for this presentation will be decided by your course faculty based on the results of the APEA Pre-Predictor Exam in Week 1. Your presentation will consist of a patient scenario that you experienced in your clinical setting. The format of your presentation can be Microsoft PowerPoint. APA format is also expected, and references should be cited. Include references at the bottom of the slides and a final reference list on the last slide.

Your goal is to:

Provide a case study to go with the diagnosis.

Utilize research articles or other materials to support your findings.

Identify any practice barriers, issues, or problems (including cultural diversity and healthcare literacy).

Discuss best practices for optimal outcomes.

In addition to submitting your presentation, you will also be expected to lead a discussion throughout the week. You will want to keep the presentation interesting, professional, and focused to the topic.

When the week is over, you will update, revise, and complete your presentation on the basis of student comments and instructor feedback.

In Week 1, the instructor will divide the class into groups and assign you a week in which you will be expected to present your case. Some of you will present in Week 4, some will present in Week 7, and the remainder will present in Week 9. Family Health – Primary Care : NSG6440

Those who are not presenting in a given wee – k are responsible for participating in at least two presentations.

For additional details, please see the Grand Rounds assignment page in the week in which you are assigned to present.

Submission Details:

Name your document SU_NSG6440_W4_A1_LastName_FirstInitial.doc.

Week 5 -Assignment 1 Discussion – Family Health – Primary Care : NSG6440

Assignment 1: Discussion

As a family nurse practitioner, you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes in complaining of having difficulty concentrating in school. On exam, you also note that the patient is very thin and frail in appearance and is asking you for diet pills.

What are some initial areas for concern? What screening tools can help lead you closer to your diagnosis?

Describe 1 health promotion strategy you can discuss with the patient.

Be sure to address the following in your plan of care: pharmacological and non-pharmacological (OTC) interventions, labs, follow-up, teaching, and referral/s.

Your work should integrate course resources (text/s) as well as a minimum of two (2) other evidence-based guidelines and/or articles published within 3–5 years.

Submission Details:

Name your document SU_NSG6440_W5_A1_LastName_FirstInitial.doc.

Submit by Saturday, November 4, 2017.

Week 6 -Assignment 1 Discussion – Family Health – Primary Care : NSG6440

Assignment 1: SOAP Note

Each week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using the SOAP Note template.

SOAP Note: Choose one patient from an area of weakness identified from the Week 1 Pre-Predictor Exam and submit a SOAP note of this patient. Remember to remove all forms of patient identification from the SOAP note format. Provide a reference (s) for the differential diagnosis and treatment plan in APA format. The reference should be within a 3-5 year time frame and come from a textbook, guideline, or currently published peer reviewed journal article.

Submission Details:

Enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

Include the reference number from eMedley in your document.

Submit your SOAP note into the discussion area below by Sunday, November 12, 2017 along with clinical insights about your case.

Respond to two peers with a substantial response that includes supportive references

Week 7 -Assignment 1 Discussion – Family Health – Primary Care : NSG6440

Assignment 1: Grand Rounds

As a major project in this course, you will deliver a Grand Rounds presentation.

The health care topic for this presentation will be decided by your course faculty based on the results of the APEA Pre-Predictor Exam in Week 1. Your presentation will consist of a patient scenario that you experienced in your clinical setting. The format of your presentation can be Microsoft PowerPoint. APA format is also expected, and references should be cited. Include references at the bottom of the slides and a final reference list on the last slide.

Your goal is to:

Provide a case study to go with the diagnosis.

Utilize research articles or other materials to support your findings.

Identify any practice barriers, issues, or problems (including cultural diversity and healthcare literacy).

Discuss best practices for optimal outcomes. Family Health – Primary Care : NSG6440

In addition to submitting your presentation, you will also be expected to lead a discussion throughout the week. You will want to keep the presentation interesting, professional, and focused to the topic.

When the week is over, you will update, revise, and complete your presentation on the basis of student comments and instructor feedback.

In Week 1, the instructor will divide the class into groups and assign you a week in which you will be expected to present your case. Some of you will present in Week 4, some will present in Week 7, and the remainder will present in Week 9.

Those who are not presenting in a given week are responsible for participating in at least two presentations.

For additional details, please see the Grand Rounds assignment page in the week in which you are assigned to present.

Submission Details:

Name your document SU_NSG6440_W7_A1_LastName_FirstInitial.doc.

Submit by Saturday, November 18, 2017.

Week 8 – Assignment 1 Discussion – Family Health – Primary Care : NSG6440

Assignment 1: SOAP Note

Each week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using the SOAP Note template.

SOAP Note: Choose one patient from an area of weakness identified from the Week 1 Pre-Predictor Exam and submit a SOAP note of this patient. Remember to remove all forms of patient identification from the SOAP note format. Provide a reference (s) for the differential diagnosis and treatment plan in APA format. The reference should be within a 3-5 year time frame and come from a textbook, guideline, or currently published peer reviewed journal article.

Submission Details:

By Wednesday, November 29, 2017, enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

Include the reference number from eMedley in your document.

Submit your SOAP note into the discussion area below by Sunday, November 26, 2017 along with clinical insights about your case.

Respond to two peers with a substantial response that includes supportive references by Wednesday, November 29, 2017.

Week 9 -Assignment 1 Discussion – Family Health – Primary Care : NSG6440

Assignment 1: Grand Rounds

This week continues the Grand Rounds presentations as assigned by the instructor.

Those who are not presenting this week are responsible for participating in at least two presentations.

Keep in mind the following guidelines while taking part in this assignment:

For those who are presenting, post your presentation to this Discussion Area by Saturday, December 2, 2017. Begin facilitating the discussion and continue to lead it throughout the week.

For those who are participants this week, begin participating on Saturday, December 2, 2017, and continue until the end of the week.

For the presenters:

The Grand Rounds presentation should consist of a patient scenario that you experienced in your clinical setting or a diagnosis that has been covered within the course material prior to this week. This may be presented in Microsoft PowerPoint or Microsoft Word format

Your goal is to:

Provide a case study to go with the diagnosis.

Utilize research articles or other materials to support your findings.

Identify any practice barriers, issues, or problems (including cultural diversity and healthcare literacy).

Discuss best practices for optimal outcomes.

In addition to submitting your presentation, you will also need to lead a discussion. Here are some guidelines:

To prepare for your presentation, rehearse the key points and findings of your research and think about points you can make to initiate the discussion and keep it going.

Develop questions you can ask to initiate the discussion and keep it going.

As you approach the end of the discussion period, ask participants to:

Summarize the discussion.

Draw conclusions from the collective group discussion.

Keep the presentation interesting, professional, and focused to the topic. APA format is expected and references should be cited. If you are presenting on Microsoft PowerPoint, include references at the bottom of the slide(s) and a final reference list on the last slide.

When the week is over, update/revise/complete your presentation based on students’ comments and instructor’s feedback.

For the participants:

Those who are not assigned to present this week should review at least two presentations and participate in the discussion. Here are some guidelines for participation:

Prepare for the discussion by reading the presenter’s submission.

Keep your participation at the level of critical thinking—analyzing, synthesizing, and evaluation. Make connections between what you are learning in this course and what you already know.

Make comparisons, note contrasts, and challenge points of view. Interact with both presenters and other students.

Add to the experience what you might have read about the topic or experienced personally.

Be prepared to substantiate your points of view.

At the end of the week, be prepared to summarize or draw conclusions from the presentation experience.

Week 10 – Assignment 1 Discussion -Family Health – Primary Care : NSG6440

Assignment 1: Evidence-Based Clinical Intervention

By Friday, December 8, 2017, submit your Evidence-Based Clinical Intervention to the Discussion Area.

Your Evidence-Based Clinical Intervention should be submitted in a Microsoft Word document following APA style and should include the following:

The medical problem/diagnosis/disease.

Typical presenting signs and symptoms including:

Onset, Characteristics, Location, Radiation, Timing, Setting, Aggravating factors, Alleviating factors, Associated symptoms, Course since onset, Usual age group affected

Concomitant disease states associated with the diagnosis

The pathophysiology of the problem.

Three differential diagnoses and the usual presenting signs and symptoms in priority sequence with rationales.

Reference to at least two current journal articles that show evidence-based practice as how to best treat this disorder related to the primary differential.

The expected outcomes of the intervention.

Algorithms if available.

A typical clinical note in SOAP format.

Respond to at least two of your classmates’ Evidence-Based Clinical Interventions using the lessons and vocabulary found in the reading. Support your answers with examples and research. Your responses should clarify your understanding of the topic. They should be your own, original, and free from plagiarism. Follow the APA format for writing style, spelling and grammar, and citation of sources.

Week 10 -Assignment 2 Discussion – Family Health – Primary Care : NSG6440

Assignment 2: Reflection

Reflect on the course and what you have learned over the last ten weeks. Write up a brief summary of how you meet each course objective. Include examples from both the course and practicum experiences.

Post your response to the Discussion Area. Include references to support your work. Respond to at least two of your peers providing substantial feedback supported with references. Family Health – Primary Care : NSG6440

NR507 Advanced Pathophysiology Quiz -Exam Questions and Answers

PAR
T 1:

You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg. There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder.

What is the most likely genetic disease that this presents and why?

What is the molecular basis of this disease?

Before, calling the police what should the initial clinician have done?

ORDER A PLAGIARISM-FREE PAPER NOW

The presenting genetic disease is most likely osteogenesis imperfecta (OI), also known as brittle bone disease. OI consists of a diverse group of symptoms related to genetic mutations found in type 1 collagen biosynthesis (Golshani, Ludwig, Cohn, & Kruse, 2016). The Sillence classification system delineates OI based on the severity of the disease. Types II and III are the most severe, are characterized by autosomal recessive inheritance, can cause severe deformity in the neonate, stillbirth, and these patients have a short life expectancy (McCance, Huether, Brashers, & Rote, 2013). Types I and IV are considered less severe forms, are characterized by inherited autosomal dominant trait, and the onset varies in age from childhood to adulthood (McCance et al., 2013). The main characteristics of OI include low bone mass and elevated bone fragility that leads to fractures and deformities (Golshani et al., 2016). The classic manifestations associated with OI are osteoporosis like and include an increased incidence of fractures, triangular facies, possible bony deformations, poor dentition, possible blue sclera, and possible vascular weaknesses (McCance et al., 2013).

To fully understand the disease process, it is important to know what happens at the molecular level in regards to the biosynthesis of type 1 collagen. First, procollagen is created via rough endoplasmic reticulum as triple helix that form two collagen chains, a1(I) and a2(I), which are encoded by the COLIA1 and COILA2 genes (Golshani et al., 2016). Both chains have C and N terminal peptides (Golshani et al., 2016). These chains also have domains with repetitive amino acid sequence that contain glycine by every third amino acid, which permits the triple helix arrangement (Golshani et al., 2016). Once post-translational modifications and folding occurs, the procollagen molecule is carried to the extracellular matrix, cleavage of the terminal propeptides takes place, and the collagen molecule forms (Golshani et al., 2016). When the collagen molecule forms, it forms fibrils via covalent bonding inside and in the middle of triple helix molecules (Golshani et al., 2016). Additionally, the fibrils formed will accumulate and produce type 1 collagen fibers (Golshani et al., 2016).

Upon examination, medical professionals may find evidence of bone fractures in various stages of healing, including fractures of the skull, metaphysis bones, and ribs, leading to the suspicion of child abuse (Golshani et al., 2016). While OI is rare, it should still be included in ones differential diagnosis (Golshani et al., 2016). Evaluation and treatment of OI is established by the presence of clinical manifestations, therefore it is very important clinicians are able to recognize them (McCance et al., 2013). In all types of the disease process, serum alkaline phosphate levels will be elevated (McCance et al., 2013). Another way to evaluate OI is by culturing skin fibroblast collagen via electrophoresis; 95 percent of people tested who have OI show a decreased amount of collagen (McCance et al., 2013). The initial clinician should have questioned the child’s symptoms; diagnosis of OI is distinct when some key elements exist including blue sclera, scoliosis, wormian bones, and a family history (Golshani et al., 2016). Without these features, diagnosis can be difficult (Golshani et al., 2016).

 

 

 

Golshani, K.R., Ludwig, M.R., Cohn, P.L., & Kruse, R. (2016). Osteogenesis Imperfecta.
Delaware Medical Journal, 88
(6), 178-185. http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=27506061&site=eds-live&scope=site

 

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). 
Pathophysiology: The biologic basis for disease in adults and children
 (7th ed.). St. Louis, MO: Mosby.

 

 

PART:

Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved.  He has been blowing his nose quite frequently and “sores” have developed around his nose.  His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.”  She is worried because the lesions are now also on his forearm.  Johnny’s past medical and family histories are normal.  He has been febrile but is otherwise asymptomatic.  The physical examination was unremarkable except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter weeping lesions around the nose and mouth and on the radial surface of the right forearm.  There is no regional lymphadenopathy.

Write a differential of at least three (3) possible diagnoses and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely.

Based upon what you have at the top of the differentials how would you treat this patient?

When would you allow the student back to school? Elaborate on your reasoning?

 

Impetigo is a bacterial skin infection seen in infants and children and is more commonly seen in mid to late summer, especially in climates that are hot and humid(McCance, Huether, Brashers, & Rote, 2013). Impetigo is prevalent in settings like daycare or in crowded areas with poor sanitary conditions (McCance et al., 2013). Impetigo pustules or vesicles may be seen anywhere however, the face and extremities are the more common sites (Allmon, Deane, & Martin, 2015). Predisposing factors for impetigo include anemia and malnutrition however, healthy children are also affected (McCance et al., 2013).

Bullous impetigo
 – Bullous impetigo is a highly contagious bacterial infection caused by
Staphylococcus aureus
and is carried in the anterior nares, the fingernails, and the perineal area (McCance et al., 2013). The pathogen is transmitted via contact with an infected individual or by non-direct contact, such as equipment that is contaminated (McCance et al., 2013). A person becomes infected because the
Staphylococcus aureus
produces exfoliative toxins (ETs) that inoculate into the dermis and epidermis causing blisters to form (McCance et al., 2013). The blisters are usually located around the patient’s nose or mouth however, the hands and other exposed regions such as the extremities can also be affected (McCance et al., 2013). The blisters can amalgamate, forming superficial bullae that can be localized or spread over different areas of the skin (McCance et al., 2013). When the bullae break open, a honey colored crust will form around the area; this crust is a hallmark sign of impetigo (McCance et al., 2013). In bullous impetigo, regional lymphadenopathy is uncommon (McCance et al., 2013).

The treatment of choice for impetigo is antibiotics, either topical or systemic. Topical antibiotics, such as mupirocin or fusidic acid, are recommended for localized areas of impetigo (Watkins, 2013). Topical antibiotics need to be rubbed on the lesions and the skin area around the lesion 3 times a day for 7 to days or until the lesions are healed (Watkins, 2013). If a patient has an allergy to mupirocin or fusidic acid, an alternative antiseptic such as hydrogen peroxide, chlorhexidine, or iodine may be used (Watkins, 2013). If topical antibiotics are ineffective, the lesion should be swabbed to determine the causative pathogen and the pathogens sensitivity to antibiotics (Watkins, 2013). Systemic antibiotics may be needed for severe cases or for those that did not respond to topical antibiotics (Watkins, 2013). Systemic antibiotic options include flucloxacillin and clarithromycin, if the patient is allergic to penicillin (Watkins, 2013). Phenoxymethylpenicillin should be added to the treatment if erysipelas is present (Watkins, 2013). Patients with MRSA or glomerulonephritis need to be referred to a specialist for care (Watkins, 2013). Education should include proper hand hygiene and seclusion of the child’s items that could spread the infection such as wash cloths, linens, towels, clothes, and utensils and glasses used for eating and drinking (McCance et al., 2013). Children should not return to school or daycare until the lesions are completely crusted over and healed, or for at least 48 hours after beginning antibiotics because antibiotics reduce the infection period (Watkins, 2013).

Johnny fits the presentation for impetigo, most likely bullous impetigo, based on his clinical manifestations, especially the lack of lymphadenopathy. However, a diagnosis of nonbullous is also conceivable. I  would start Johnny on topical antibiotics and advise his mother to keep him home until the lesions have healed or for at least 48 hours after starting the antibiotic treatment. I would also educate her on hygiene precautions so the infection does not spread to others. Also, she must thoroughly bathe him with soap and water, carefully removing any crust around the lesions (Watkins, 2013).

Nonbullous impetigo
– Nonbullous impetigo, the more common of the types, is also a highly contagious bacterial infection caused by
Staphylococcus aureus
or group A
Streptococcus pyogenes
. A person can become infected with either pathogen via direct physical contact or via insect bites (McCance et al., 2013). Nonbullous impetigo forms superficial, acute, vesicles with honey like serum; when the vesicle ruptures, yellow to white-brown crust will form (McCance et al., 2013). These lesions can look similar to herpes simplex lesions and therefore a distinction should be made (McCance et al., 2013). Unlike bullous impetigo, it is common to see regional lymphadenopathy in nonbullous (McCance et al., 2013). Treatment and education are the same for both types of impetigo (McCance et al., 2013).

Even though nonbullous is the more common of the two types, based on clinical manifestations, nonbullous does not completely fit the presentation. However, the presentation between the two types is so similar it cannot be fully ruled out.

Herpes simplex virus
– Herpes simplex virus (HSV) are usually caused by two different strains of the virus, HSV 1 and HSV 2 and can occur all over the body (McCance et al., 2013). The only way to distinguish between the two is laboratory testing. HSV type 1 is transmitted via infected saliva (McCance et al., 2013). The first infection is referred to as the primary infection where the virus travels to the dorsal ganglion root and remains latent (McCance et al., 2013). In the secondary phase, reactivation of the virus occurs and the virus travels via peripheral nerves to the original site of infection, where it sheds (McCance et al., 2013). Reactivation of the virus can occur related to stress, skin irritation, fatigue, ultraviolet light, and fever (McCance et al., 2013). HSV-1 lesions present as inflamed, painful vesicles in rash like patterns or clusters and in children are typically located on the lips, in and/or around the nose, on the tongue, and within the mouth (McCance et al., 2013). When the vesicle ruptures, a crust will form over the area (McCance et al., 2013). Lesions can last up to 6 weeks if left untreated (McCance et al., 2013). Generally, topical antivirals can help resolve the lesions in 2 weeks (McCance et al., 2013). Additionally, oral antivirals can be given for acute infections or for daily use as a suppressive therapy (McCance et al., 2013).

Impetigo can be mistaken for herpes simplex virus because their lesions can look similar. However, HSV does not fit the presentation. I do not believe Johnny has HSV.

 

Allmon, A., Deane, K., & Martin, K.L. (2015). Common skin rashes in children.
American Family Physician, 92
(3), 211-216.  http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=26280141&site=eds-live&scope=site

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). 
Pathophysiology: The biologic basis for disease in adults and children
 (7th ed.). St. Louis, MO: Mosby.

 

Watkins, J. (2013). Bullous and non-bullous impetigo.
Practice Nursing, 24
(2), 95-96.  http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=108026722&site=eds-live&scope=site

 

PART 3:

Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 F, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms. 

Write three (3) differential diagnoses?

What are some of the complications of this disease, assume that the top of your differential is the definitive?

Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease?

 

Rubeola
– Rubeola is an acute, viral disease seen in children that is very contagious (McCance, Huether, Brashers, & Rote, 2013). A specific RNA virus containing the paramyxovirus causes rubeola, it is transmitted via droplets from individuals already infected with the virus (McCance et al., 2013). This means Rubeola can be spread via sneezing, breathing, and coughing (Grif Alspach, 2015). The virus can remain on surfaces and in the air for up to 2 hours (Grif Alspach, 2015). Rubeola has an incubation period that lasts 7 to 12 days; during this time, the infected person will not have any symptoms (McCance et al., 2013). The virus is introduced via the respiratory tract where it latches onto alveolar macrophages and dendritic cells, the virus increases in size in the lymphatic tissue, and then advances to systemic disease (McCance et al., 2013). Early symptoms include high fevers (up to 105 degrees), skin rash, koplik spots, conjunctivitis, cough, malaise, and coryza (Grif Alspach, 2015). Approximately 1 to 4 days after being exposed to the virus, a maculopapular rash will appear, it begins on the forehead and spreads to the trunk, extremities, hands, feet and even the palms and soles of the hands and feet (Grif Alspach, 2015). It is important to know that patients are contagious 4 days prior to the development of the rash and 4 days after it begins (Grif Alspach, 2015). Immunocompromised patients may not develop a rash so providers should be able to recognize symptoms without the rash development (Grif Alspach, 2015). The rash will gradually begin to fade, beginning from the head down, and will typically resolve on it’s own within 7 to 10 days (Grif Alspach, 2015). One way to distinguish Rubeola from Rubella is conjunctivitis is present in Rubeola but not in Rubella (Grif Alspach, 2015). Confirmation via lab work can be achieved by serum or swabbing of nasal cavity or oropharyngeal cavity (Grif Alspach, 2015).  Even though most people will resolve the disease on their own, some people can have serious complications such as encephalitis and pneumonia (Grif Alspach, 2015). The best way to prevent Rubeola is through the MMR vaccine (Grif Alspach, 2015). Additionally, hand hygiene is essential in helping to decrease the spread of disease.

Rubella
– Rubella is a communicable disease seen in children and young adults, it is caused by an RNA virus that enters via the respiratory tract and invades the bloodstream (McCance et al., 2013). Rubella is contracted via droplets, maternal-fetus transmission, or contact with nasopharyngeal secretions (Chan, MacFadden, & Leis, 2016). The virus has an incubation period of 14 to 23 days; patients are thought to be contagious one week prior to the onset of the rash and 4 days after the rash begins (Chan et al., 2016). Early symptoms include a low grade fever (which usually presents 1 to 5 days before the rash), possible enlarged postauricular and cervical lymph nodes, sore throat, headaches, cough, and runny nose (McCance et al., 2013). Other clinical manifestations may include arthritis, arthralgias, and cold symptoms (Chan et al., 2016). When the rash develops, it is characterized by pinpoint pink macules; the rash will begin on the head and spread down to the trunk and extremities in 24 hours (Chan et al., 2016). The rash with Rubella is absent on the palms and soles on the hands and feet (McCance et al., 2013). Once someone contracts the disease, a lifelong immunity develops against the disease (McCance et al., 2013). The diagnosis is typically made via lab work (Chan et al., 2016). Preventative treatment for Rubella is vaccination (Chan et al., 2016). Treatment for Rubella is supportive and includes using a vaporizer, fluids, and rest (McCance et al., 2013). Some patients may develop mild encephalitis or peripheral neuritis (McCance et al., 2013). Significant mortality occurs in people who do not vaccinate against Rubella with encephalitis, pneumonia, and croup causing the largest number of deaths related to the disease (McCance et al., 2013).

Chickenpox
– Chickenpox affects most patients in the first decade of their life (McCance et al., 2013). It is spread via airborne droplets and contact with an infected person (McCance et al., 2013). Patients are contagious at least one day prior to the development of lesions and about 5 to 6 days after the lesions appear (McCance et al., 2013). Prodromal symptoms include itching, then vesicles will begin to appear (McCance et al., 2013). Fever may be present, up to 104 degrees and typically lasts 2 to 3 days (McCance et al., 2013). The vesicles usually appear on the face, scalp, or trunk first then will spread to the extremities later (McCance et al., 2013). In chickenpox, the lesions will characteristically heal in various stages therefore macules, papules, and vesicles can all be seen; there can be anywhere from 100 to 300 lesions present and all in different stages of development and healing (McCance et al., 2013). On occasion, vesicles may appear in the mouth, on the palms of hands, soles of feet, pharynx, and conjunctiva (McCance et al., 2013). Complications are unusual in children and more common in adults, complications can include epistaxis, hematuria, varicella pneumonia, and laryngeal edema (McCance et al., 2013). Once someone contracts the virus, immunity is developed (McCance et al., 2013). There is a vaccine to help prevent chickenpox (McCance et al., 2013). For uncomplicated cases, supportive care includes wet dressings, baths, and oral antihistamines (McCance et al., 2013). Oral antiviral medications can be given to reduce symptoms, especially in immunocompromised patients (McCance et al., 2013).

 

Chan, T., MacFadden, D.R., & Leis, J.A. (2016). Rubella in a returned traveller.
CMAJ: Canadian Medical Association Journal = Journal De L’association Medicale Canadienne, 188
(5), 363-366. doi: 10.1503/cmaj.150574  http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=26622002&site=eds-live&scope=site

Grif Alspach, J. (2015). Measles: Eliminated but not eradicated.
Critical Care Nurse, 35
(4), 9-13. doi: 10.4037/ccn2015629.  http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=109826168&site=eds-live&scope=site

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). 
Pathophysiology: The biologic basis for disease in adults and children
 (7th ed.). St. Louis, MO: Mosby

 

 

INSTRUCTOR:

Whitney,

Thank you for your discussion.  The good (maybe) thing about this condition is that as the child grown, the fractures tend to decrease in severity.  Why might a thorough hearing examination be helpful in its diagnosis?

Dr. Winters7382

 

Hi Dr. Winters,

Thank you! One of my article does address the auditory issues that can arise, as well as our text, and I completely missed it! Per Swinnen, De Leenheer, Goemaere, Cremers, Coucke, and Dhooge (2012), skeletal conditions related to OI can improve when the patient enters into adulthood, unfortunately about 50 percent of these patients develop hearing loss sometime during adulthood. Hearing impairment is related to disease of the soft tissue in the ear as well as the middle ear bone (Golshani, Ludwig, Cohn, & Kruse, 2016). Hearing exams should begin in the teen years and continue regularly into adulthood (Golshani et al., 2016). Hearing impairment is usually related to a conductive hearing problem at first and typically advances to mixed hearing loss later; some patients may develop pure sensorineural hearing loss (SNHL) (Swinnen et al., 2012). Conductive hearing loss is usually related to otosclerosis-like lesions, which produce a fixed and thickened stapes footplate (Swinnen et al., 2012). Additionally, conductive hearing loss can also be related to ossicular discontinuity, particularly by atrophied or fractured stapes crura and replaced with fibrous threads (Swinnen et al., 2012). If or when the disease advances to a mixed hearing loss, a CT scan will show pericochlear demineralization (Swinnen et al., 2012). A thorough hearing exam could show middle ear abnormalities and/or conductive hearing loss, which could help lead to the diagnosis of OI.

 

Golshani, K.R., Ludwig, M.R., Cohn, P.L., & Kruse, R. (2016). Osteogenesis Imperfecta.
Delaware Medical Journal, 88
(6), 178-185. http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=27506061&site=eds-live&scope=site

Swinnen, F.R., De Leenheer, E.R., Goemaere, S., Cremers, C.J., Coucke, P.J., & Dhooge, I.M. (2012). Association between bone mineral density and hearing loss in osteogenesis imperfecta.
The Laryngoscope, 122
(2), 401-408. http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=22252604&site=eds-live&scope=site

 

PEER:

Hi Amber,

Thank you for your post! I also had a hard time distinguishing between bullous and non-bullous impetigo. Ultimately, I went with bullous because the patient did not show any regional lymphadenopathy. However, the clinical manifestations are so similar I was not 100 percent sure I chose the correct type. According to Lewis (2016), bullous is less contagious than nonbullous and its lesions are more likely to affect the face, extremities, the trunk, axillae, and perianal areas. Bullous differs from nonbullous in two ways, bullous can affect buccal mucous membranes but rarely causes regional lymphadenopathy (Lewis, 2016). In the clinical setting, a bacterial culture may be obtained from fresh exudate (found under the scab) or a gram stain and culture of blister fluid may be performed (Lewis, 2016). The gram stain will show gram-positive cocci in clusters for
Staphylococcus aureus
and gram-positive cocci in chains for
Streptococcus pyogenes
(Lewis, 2016). The good news, per McCance, Huether, Brashers, and Rote (2013), is that the treatment for both is the same. Therefore, antibiotic therapies chosen have to provide coverage against
Staphylococcus aureus
and
Streptococcus pyogenes
(Lewis, 2016).

 

Lewis, L. (2016). Impetigo.
Medscape.
Retrieved from http://emedicine.medscape.com/article/965254-overview

 

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). 
Pathophysiology: The biologic basis for disease in adults and children
 (7th ed.). St. Louis, MO: Mosby.

 

QUIZ:

Considering the pathophysiology of osteoporosis, which cytokines and hormones decrease receptor activator of RANKL expression?(Points : 2)

IL-4 and transforming growth factor-beta (TGF-ß)

IL-1 and tumor necrosis factor-alpha (TNF-)

IL-11 and glucocorticoids

IL-17 and parathyroid hormone (PTH)

 

Rhabdomyolysis is characterized by (Points : 2)

paralysis of skeletal muscles resulting from impaired nerve supply.

smooth muscle degeneration resulting from ischemia.

lysis of skeletal muscle cells through the initiation of the complement cascade.

release of myoglobin from damaged striated muscle cells.

 

Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula? (Points : 2)

Iatrogenic

Regional

Idiopathic

Osteoblastic

 

Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts? (Points : 2)

ERKs increase the life span of osteoclasts and RANKL decreases the life span of osteoblasts.

ERKs and RANKL increase the life span of osteoclasts and decrease the life span of osteoblasts.

ERKs and RANKL increase the life span of osteoblasts and decrease the life span of osteoclasts.

ERKs increase the life span of osteoblasts and RANKL decreases the life span of osteoclasts.

 

What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon? (Points : 2)

Lateral epicondylitis

Medial tendinitis

Bursitis

Lateral tendinitis

 

 

 

 

Which statement is false about giant cell tumors? (Points : 2)

They are an overexpression of genes including osteoprotegerin ligand (OPGL).

They are malignant, solitary, irregularly shaped tumors.

They are typically located in the epiphysis in the femur, tibia, radius, and humerus.

They are slow-growing tumors that extend over the articular cartilage.

 

What pattern of bone destruction is described as not well defined and not easily separated from normal bone? (Points : 2)

Moth-eaten

Permeative

Geographic

Porous

 

The pain experienced in Legg-Calvé-Perthes disease is referred to as involving (Points : 2)

elbows and upper and lower arms that is aggravated by activity and relieved by rest.

knees, inner thighs, and groin and is described as a continuous ache and relieved by anti-inflammatory drugs.

knees, inner thighs, and groin that is aggravated by activity and relieved by rest.

elbows and upper and lower arms and is described as a continuous ache and relieved by anti-inflammatory drugs.

 

In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis, which is considered the “path of least resistance.” What factor makes this route for bacteria the path of least resistance? (Points : 2)

Cortex of the bone in this area is porous or maze-like.

Blood supply to the metaphysis is easily compromised.

Macrophages and lymphocytes have limited access to the subperiosteal space.

Bacteria usually spread down the medullary cavity of the bone.

 

Molecular analysis has demonstrated that osteosarcoma is associated with (Points : 2)

TP53.

src.

myc.

TSC2.

 

Ewing sarcoma arises from (Points : 2)

bone marrow.

bone-producing mesenchymal cells.

metadiaphysis of long bones.

embryonal osteocytes.

 

Which serum laboratory test is elevated in all forms of osteogenesis imperfecta? (Points : 2)

Phosphorus

Calcium

Alkaline phosphatase

Total protein

 

 

 

 

 

 

The _____ is cartilage that retains the ability to form and calcify new cartilage and deposit bone until the skeleton matures. (Points : 2)

epiphyseal line

physeal plate VIA ENDOCHONDRAL OSSIFICATION

epiphyseal cartilage

metaphyseal plate

 

Osteochondrosis is caused by a(n) (Points : 2)

imbalance between calcitonin and parathyroid hormone.

nutritional deficiency of calcium and phosphorus.

bacterial infection of the bone.

vascular impairment and trauma to bone.

 

An insufficient dietary intake of vitamin _____ can lead to rickets in children. (Points : 2)

C

B
12

B
6

D

 

In latex allergies, which immunoglobulin is associated with an immediate reaction? (Points : 2)

A

E

G

M

 

Chickenpox may be followed years later by (Points : 2)

erysipelas.

cytomegalovirus.

warts (verrucae).

herpes zoster.

 

Cutaneous vasculitis develops from the deposit of _____ in small blood vessels as a toxic response allergen. (Points : 2)

immune complexes

IgE

complement

T lymphocytes

 

Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck? (Points : 2)

Squamous cell carcinoma

Kaposi sarcoma

Malignant melanoma

Basal cell carcinoma

 

Scleroderma is more common in women and is associated with a(n) (Points : 2)

X-linked recessive gene.

X-linked dominant gene.

virus.

autoantibodies.

 

 

Thrush is a superficial infection that commonly occurs in children and is caused by (Points : 2)

Staphylococcus.

Streptococcus.

herpesvirus.

Candida albicans

 

What is the cause of chickenpox? (Points : 2)

Poxvirus

Varicella-zoster virus (VZV)

Adenovirus

Human papillomavirus

 

Which vascular anomaly is a congenital malformation of dermal capillaries that does not fade with age? (Points : 2)

Cutaneous hemangioma

Port-wine (nevus flammeus) stain

Strawberry hemangioma

Cavernous hemangioma

 

What is a common source of tinea corporis? (Points : 2)

Mites

Kittens

Fleas

Ticks

 

Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or wheal with hemorrhagic puncture site?(Points : 2)

Pediculosis

Tinea capitis

Scabies

Rubeola

 

 

 

 

 

 

 

 

 

 

 

 

 

NR507 Advanced Pathophysiology Quiz -Exam Questions and Answers

Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Week 1 -Assignment 2 Discussion

Melynk and Fineout-Overholt (2011) note that there are seven steps to the evidence-based practice (EBP) process. The first step is to cultivate a spirit of inquiry. To encourage this spirit of inquiry, you are asked in this discussion to:

Identify a problem or issue from within your specialty area that you feel needs to be improved upon. The Doctor of Nursing Practice site (http://www.doctorsofnursingpractice.org/resources/dnp-scholarly-projects/) provides many examples of these projects. The list below may help focus your thoughts.

Educational program

Evidence-based healthcare policy change

Evidence-based clinical issue or protocol for specific disease/condition

Discuss the relevance of the issue from your perspective (not the literature at this juncture) in relation to your selected advanced role option.

What piqued your interest about this issue or problem?

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How does it relate to your area of specialization?

What gave you the idea that evidence exists to support this change? See “note” below.

Provide a rationale as to why this will be an evidence-based project to improve outcomes and not generate new evidence (research).

Please remember that the project will not be implemented during this course and no data will be collected. The outcome of this course is to complete a project proposal only. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Week 2 – Assignment 1 Discussion

Melynk and Fineout-Overholt (2011) note that there are seven steps to the evidence-based practice (EBP) process. The first step is to cultivate a spirit of inquiry. To encourage this spirit of inquiry, you are asked in this discussion to:

Briefly describe the problem or issue that you have decided to be the topic for your project proposal in order to orient your classmates and faculty

Indicate how it relates to your area of specialization

State your PICOT question. Indicate in parentheses after each segment, what part of PICOT the preceding words represent. For example: In patients recently discharged from the hospital following care for heart failure (P), do hand-off calls by the nurse to the primary care provider using the SBAR format (situation, background, assessment, recommendation) (I) compared to no calls (C) decrease readmission rates (O) over a one year period (T).

Discuss which process model resonates with you and will help keep you focused during the project. Process models included in your text (Melnyk & Fineout-Overholt, 2011) are:

Clinical scholar model

Stetler model of evidence-based practice

Iowa model of evidence-based practice to promote quality care

Model for evidence-based practice change by Rosswurm and Larrabee

Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model

Provide feedback to your classmates that focuses on:

The use of correct PICOT format for the question to guide the literature search.

Does the question reflect a clinical research question or one appropriate for an evidence-based practice project?

Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing – South University

Week 3 – Assignment 1 Discussion

In this discussion, you will share your search strategies that you have employed to find evidence for your study. For this discussion:

State your PICOT question. Did using the terms used in this question lead you to useful research studies?

What MESH terms have you tried? Did they help you find additional studies? Are you finding MESH terms useful to expand or delimit your search?

Are you finding relevant articles? If not, how did you modify your search to increase productivity?

Indicate which databases you used—those you found useful and those that were not.

What levels of evidence do the studies you are finding represent?

Post any questions or concerns you may have and provide feedback and recommendations to your classmates. Working together and sharing search strategies is very helpful.

Use the Search Tracker to keep track of search terms.

Using the appropriate Rapid Clinical Appraisal (RCA) Tools, appraise one or two articles and add the information to your Evaluation Table to receive feedback from faculty. At this juncture, your table is a work in progress. You will complete it in Week 4. The RCA Tools and Evaluation Table in Word for you to complete can be found in the Week 3 Overview section. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Week 4 – Assignment 1 Discussion

Discuss your experience completing the rapid critical appraisal process.

Was it really “rapid” or was it more of a laborious process?

Did reading the abstract help you make quick decisions about including or excluding the study?

What worked best for you in terms of the approach you decided to use to complete the appraisal and Evaluation Table? What didn’t work?

Post any questions or concerns you may have and provide feedback and recommendations to your classmates. Working together and sharing search strategies is very helpful.

Week 5 – Assignment 1 Discussion

This week the discussion focuses on creating a Synthesis Table(s) as a means to summarize and organize the body of evidence from the Evaluation Table. The Synthesis tables will be included in your formal proposal in the Appendix. In the body of the paper, you will describe the “keeper” studies in narrative format.

For this discussion, include the following:

Share your approach to synthesizing the evidence. What were the variables of interest you identified?

Learning to write in a scholarly fashion requires that you are able to succinctly summarize an article in a sentence or two and cite it appropriately using APA format. In this discussion, practice summarizing 2 articles you have identified from the Synthesis Table as pertinent to your proposal. Include the level of evidence, study design, and evidence of rigor. Use appropriate APA citation in text and references. Incorporate feedback from peers and faculty in your Dropbox assignment for this week. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

In addition to research studies, patient preference and clinical expertise should also be considered. Discuss how you will incorporate these important perspectives into your project proposal.

Week 6 – Assignment 1 Discussion

For this week’s discussion, please address the following:

Briefly describe the clinical issue or problem for your project, the setting, and population of interest to orient classmates and faculty

Write your clinical question

Describe the intervention you plan to test

What type of study will you conduct? Will it be experimental? Quasi-experimental? Provide a rationale for your answer.

Provide feedback on the clinical questions of your colleagues

Week 7 – Assignment 1 Discussion

This discussion will focus on the measurement tools you will use to evaluate change from the intervention. The purpose of this discussion is to fine-tune your thinking about evaluation by receiving feedback from colleagues and faculty. Include in your discussion:

Write a brief description of your project that starts by stating your clinical question and succinctly explaining your planned intervention in order to orient everyone.

Will you need to develop your own evaluation tools or are valid and reliable tools available?

If you create your own tools, what are your thoughts on pilot testing them? How will you go about this?

Will you gather baseline data? Will you use pre- and posttests? How will you measure change?

How will you identify the participants for your study? How does the sampling method chosen further define the type of study you will be doing? Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

How will you ensure confidentiality of study participants?

Week 8 – Assignment 1 Discussion

The discussion for this week will revolve around the analysis phase of your project. Include the following points in your discussion:

Begin with a brief description of your project that includes your clinical question, your planned intervention, the type of study you will conduct and how you plan to evaluate the outcomes.

What type of statistical analysis will be done?

What is a reasonable timeline for your project?

What expenses should be considered? Include both obvious expenses, such as materials, as well as those that are hidden, such as time, which equates to part of your salary.

Will you need to consider a funding source for your project?

Week 9 – Assignment 1 Discussion

Although you will not implement your project during this course, it is important that you understand the various steps that are necessary to do so. As you begin to formulate your strategic plan for implementing your change project, discuss the following specific to your proposed project:

Who are the stakeholders? Please identify them by role or job within the organization, not by name. Can you identify any “champions” or people within your organization that you can convert to champions? Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

What potential barriers do you foresee and what strategies do you envision to prevent or overcome these barriers?

What change theory will you use to guide you?

Week 10 – Assignment 1 Discussion

For this discussion question, you are asked to review the student learning outcomes for this course and discuss how you met these outcomes. The intention here is to provide you an opportunity to “reflect” on the learning achieved during this term and how you successfully met these learning outcomes. If you do not feel you successfully met the objective, discuss your plans to successfully complete the objective in the future.

By the end of the course, the student should be able to:

Demonstrate synthesis of the knowledge and skills acquired in preceding graduate nursing core and specialty curriculum content.

Evaluate current health policy and legal and ethical considerations in addressing the health promotion and disease prevention of a target population.

Integrate this synthesis in the creation of a scholarly project of either an evidenced-based practice proposal or a research proposal that generates new nursing knowledge. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Disseminate significant components of the project through a written paper and oral presentation.

Week 1 assignment 3

Evidence-Based Project Proposal

Project Overview:

Title: Evidence Based Project-Proposal

Description:

As the course progresses over the 11 weeks, learners will develop a scholarly project that demonstrates an application of evidence to practice for substantive change. This project emphasizes critical appraisal and application of evidence-based research, scholarly writing, and critical thinking. The scholarly project will be submitted as a written paper in APA format/style. In addition, learners will present a summary of the final project orally or by creating a PowerPoint presentation.

Learners will select one of the following types of projects related to their specific advanced role specialization and target population:

Educational program

Evidence-based healthcare policy change

Evidence-based clinical issue or protocol

Overview of the Evidence Based Project (EBP):

In Week 1 of the course, students will identify an area of inquiry as a basis for practice change, and in Week 2, write their clinical question in PICOT format that will drive the literature search.

Following approval of the practice change idea and the PICOT question by course faculty, in Week 3 students will begin their literature search and rapid critical appraisal (RCA) using the RCA checklists available in Appendix D of the course text (Melynk & Fineout-Overholt, 2011) and in Word format. The Search Tracker may be useful in organizing and tracking your search. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Your evidence review will be completed in Week 4, resulting in a finished Evaluation Table containing only the “keeper” studies.

In Week 5 you will synthesize the evidence to determine best evidence for your project. Faculty will continue to serve in the role of mentor as the student progresses through the remaining steps of the project.

Weekly submissions will be used to monitor progress in the development of your proposal. It is recommended that upon receiving feedback from faculty on each section, you revise your work and add that section to build your final paper. Doing so as you proceed through the course will avoid last-minute work. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

When you began your study of evidence-based practice it was contrasted with the research process. The underlying goal of EBP is to appraise research and study its application to specific patient populations in order to identify best practices. In order to accomplish this, what must be included within your project is a research study. You will most likely compare pre-intervention data with post-intervention results. In come cases, statistical analysis will be necessary. Your proposal will include plans for this study.

EBP Project Criteria

Students will prepare a formal project proposal using APA format. Below is an outline for the final paper with the weeks where this content will be covered. Each week you will turn in parts of this outline as Dropbox assignments. The week each part will be due is indicated in the outline. After receiving feedback from faculty on each part submitted, it is recommended that you begin building your paper, adding the pieces where they belong. Since you will not be implementing this project, the results section has been omitted. This outline is consistent with the format used for journal articles when reporting results of evidence-based practice projects. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Criteria and organization of final paper

Abstract

Part 1

Introduction – Week 2

Practice issue

Summarize the practice issue in need of change providing background information about the organization (setting) and the perceived significance and severity of the problem

Describe the specific aims of the project – what improved outcomes do you hope to achieve

PICOT question – State your question in PICOT format, labeling each part with P-I-C-O-T in parentheses

Significance – what is the significance of the issue in terms of poor outcomes, cost, etc.

Part 2 – Week 3. 4, & 5

Evidence review and synthesis

List the names of the databases you searched and if limited to a span of time, i.e., less than 5 years old

Summarize “keeper” studies

Summarize the synthesis of the body of evidence. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Part 3 – Week 6

Purpose of the project – include intervention

Theoretical framework

Clinical questions

Part 4 – Week 7

Study design

Setting/sample

Confidentiality

Procedure/intervention

Instruments/scales and measurement of outcomes

Data collection

Part 5 – Weeks 8 & 9

Data analysis

Outcomes expected

Aligning stakeholders

Appendices

Evaluation Table – turned in Weeks 3 & 4

Synthesis Table – turned in Week 5

The paper provides evidence of synthesis of coursework, professional writing, and graduate level scholarship.

Oral or Poster Presentation

In addition to the written paper, students will present a summary of their project by submitting a professional Microsoft PowerPoint presentation. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Criteria:

Organize the presentation to include all required criteria of the EBP project proposal.

Quality of presentation is professional and provides evidence of graduate level scholarship.

This week’s Dropbox Assignment

Keep in mind that this proposal will be developed piece by piece during the course. The Dropbox assignment this week provides you an opportunity to identify the problem or issue within your specialization that is in need of improvement and receive feedback from faculty.

Review the grading criteria listed below as you begin this assignment. Note that you must pass all elements in order to move forward with your proposal development. Faculty will provide feedback either approving or asking that you resubmit prior to further development of your project. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

For this week’s assignment discuss the following:

State your idea for your evidence-based project proposal including the rationale as to how it reflects an EBP project vs. a research project

Very briefly describe the issue you will address, the intervention that you feel has research evidence (this may change later after you complete the literature search), and the expected outcomes

Discuss how this project is relevant to your role specialization

Week 2 assignment 2

Evidence Based Project Proposal

For this week’s Dropbox assignment, you will submit Part 1 of the project proposal in a one-page APA formatted paper (excluding the cover page and reference page). Be sure to reflect on feedback from faculty and classmates from this week’s discussion. Include:

Part 1: Introduction

Summarize the practice issue in need of change providing background information and the perceived significance of the problem. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Describe the specific aims of the project – what improved outcomes do you hope to achieve

State your question in PICOT format, labeling each part with P-I-C-O-T in parentheses

Discuss the significance of the issue in terms of poor outcomes, cost, etc

Week 3 assignment 2

Evidence Based Project Proposal

This week you will begin the submission of Part 2 of the project proposal written in APA format. In a one-page APA paper, write a narrative that describes your search of the literature for evidence, which includes:

List of the names of the databases you searched

If limited to a span of time, i.e., less than 5 years old

Using the appropriate Rapid Clinical Appraisal Tools, appraise one or two articles and add the information to your Evaluation Table to receive feedback from faculty. At this juncture, your table is a work in progress. You will complete it in Week 4.

You will also turn in the Evaluation Table with two studies appraised (see below) and the Search Tracker for feedback on your search strategies.

After receiving feedback from faculty, add what you have completed this week to Part 1 to begin to build your project proposal paper. Keep this in mind when completing this assignment, using a professional writing style in your narrative

Week 4 assignment 2

Evidence Based Project Proposal

This week you will submit the completed Evaluation Table that includes only your “keeper” studies. This will be added to your final paper as an Appendix. You will also turn in the Search Tracker so faculty can see the steps you took to locate the evidence. This will not become a part of your paper, but it is for feedback only should faculty deem that necessary. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Week 5 assignment 2

Evidence Based Project Proposal

For this week’s Dropbox assignment, you will complete Part 2 of your project proposal, the evidence review and synthesis section. This section consists of narrative descriptions of each study that forms the body of evidence. The length of this section will vary based on the number of studies that you include. The paper should be written in a scholarly fashion using APA format. For each article include in the narrative:

Authors’ names, date of publication (included in the citation).

Quality and level of evidence

How significant (or not) the evidence is and why you think so. How are these articles relevant to change practice or policy for your specific practice site and population? If a study is not significant and you have included it, mention how your clinical expertise was involved in this decision.

Your summary the synthesis section should clearly indicate the intervention you plan to use in your project proposal. You will discuss this in greater detail in the next section, but do leave the reader with the understanding of the intervention you chose. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

You will also turn in your completed Synthesis Table(s) that will become part of your Appendix in your final paper.

Week 6 assignment 2

Evidence Based Project Proposal

For your Dropbox assignment this week, you will write Part 3 of your project proposal. In a one- to two-page paper in APA format, include:

Your clinical question

How the clinical question indicates the type of study that will be done (quasi-experimental vs. experimental). Describe the type of study. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Theoretical framework(s) chosen including a rationale for your choice

Week 7 assignment 2

Evidence Based Project Proposal

For your Dropbox assignment this week, you will write Part 4, the Methods section of your project proposal that consists of plans for conducting the study of the intervention and methods of evaluation. Use the titles of each bullet point in your paper.

In a two- to three-page APA formatted paper:

Study design: Briefly describe the study design indicated by the question (experimental, quasi-experimental, descriptive).

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Setting/sample: Briefly describe the setting for the study, who your study participants will be, and how these participants will be chosen. Will random sampling or a sample of convenience be used?

Confidentiality: How will you protect the confidentiality of your participants?

Procedures/intervention: Discuss the intervention you will implement and the procedures you will use in enough detail that others could replicate the study.

Instruments/scales and measurement of outcomes: Describe the instruments you will use to measure changes and whether they are quantitative, qualitative, or of a mixed design. If they have been tested previously, include reliability and validity data. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Data collection: Explain plans for data collection including:

Methods of collection, i.e., interviews, paper and pencil testing, etc.

Testing frequency. Will you gather baseline data prior to the intervention? Will you employ repeated measures such as pre- and posttests?

Week 8 assignment 2

Statistical Analysis

For this week’s Dropbox assignment, you will begin to develop Part 5 of your project proposal: Analyzing change. In your discussion, include the following points:

State your clinical question.

Briefly state the intervention you will implement. While these two items are not typically included in Part 5, doing so will help orient faculty so appropriate feedback can be provided.

What outcomes will be analyzed and how they will be analyzed?

Describe the statistical analysis you will do relating this to the data collection tools you plan to use.

Indicate the types of demographic data you plan to report on your participants as well.

Briefly discuss the outcomes expected should this project be implemented.

After receiving feedback from faculty, incorporate the appropriate content into your project proposal.

Week 9 assignment 2

Evidence Based Project Proposal

For your Dropbox assignment, you will write another part of your Methods section (Part 4) that you began in Week 7. In a paragraph or two in APA format include the following:

Identify your stakeholders by job title and how their participation was key to the project.

Briefly discuss potential barriers to project implementation that stakeholders may present. Include strategies to prevent or address these barriers.

After receiving feedback from faculty, incorporate this paragraph into the Methods section of your paper after the “Procedures/intervention” section and before the “Instruments/scales and measurement of outcomes” section.

Week 10 assignment 2

Evidence-Based Project

Overview/Description:

Learners will develop a scholarly project that will demonstrate an application of evidence to practice for a substantive change. This project emphasizes application of evidence-based methodology, scholarly writing, and critical thinking. The scholarly project will be submitted as a written paper in APA format/style. In addition, learners will present a summary of the final project orally and/or with a PowerPoint presentation.

Learners will select one of the following projects related to their specific advanced role specialization that addresses a health promotion and disease prevention of a target population: Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Educational program

Evidence-based healthcare policy change

Evidence-based clinical issue or protocol

Criteria for scholarly EBP project proposal

Over the past 11 weeks, students have developed a proposal for an evidence-based project in their area of specialization. This final paper is the culmination of this scholarly activity. All papers must be written using APA format and a professional writing style. The proposal should include the following sections and content.

Abstract

Part 1 – Introduction – Week 2

Introduction

Practice issue

Summarize the practice issue in need of change providing background information about the organization (setting) and the perceived significance and severity of the problem. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Describe the specific aims of the project – what improved outcomes do you hope to achieve

PICOT question – State your question in PICOT format, labeling each part with P-I-C-O-T in parentheses

Significance – what is the significance of the issue in terms of poor outcomes, cost, etc.

Part 2 – Evidence review and synthesis – Week 3, 4, & 5

List the names of the databases you searched and if limited to a span of time, i.e., less than 5 years old

Summarize “keeper” studies

Summarize the synthesis of the body of evidence

Part 3 – Purpose of the project – Week 6

Purpose of the project – include intervention

Theoretical framework

Clinical questions

Part 4 – Methods – Week 7

Study design

Setting/sample

Confidentiality

Procedure/intervention

Aligning stakeholders

Instruments/scales and measurement of outcomes

Data collection

Part 5 – Data analysis – Weeks 8 & 9

Outcomes to be analyzed and how they will be analyzed

Outcomes expected (hypothesized)

Appendices

Evaluation Table – turned in Weeks 3 & 4

Synthesis Table – turned in Week 5

Oral and/or PowerPoint Presentation

Students will present a summary of their project using Microsoft PowerPoint.

The presentation for onground campus students will be done orally in a 20-minute presentation

Online campus students will include speaker notes in their PowerPoint slides and will defend their presentation in a discussion board. Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing

Criteria:

Assemble the presentation to present all required criteria sections of the EBP project.

Quality of presentation is professional and provides evidence of graduate level scholarship.

Evidence Based Project (EBP) & PICOT Question: NSG6999 Graduate Project in Nursing