Category: Nursing

 
What is the PICO question? Does hourly rounding of nurses reduce patient fall?

Define each element of the question below:
P- (Patient, population, or problem): nurses, hospitalized patients, falling
I- (Intervention): hourly rounding
C- (Comparison with other treatment/current practice): lack of defined rounding. Nurses do the rounds on personal initiative, when they want to
O- (Desired outcome): the number of falls in patients reduces

 
My institution have zero tolerance for plagiarism.

Please read the instructions on the assignment properly.

1. Please do not use the clinical outcomes provided to write this paper. this outcomes is attached just for you to know the course/clinical outcomes for this class.

2. You are to create 3 NEW outcomes that are NOT a repeat of the course outcomes provided.

3. The outcomes must be specific to the clinical environment provided (Medical-surgical/orthopedic) unit.
4. Please be thorough in describing the outcomes and follow instructions attached concerning APA format and other specific instructions to write this paper.

 

 

 
For this assignment, you will research an advanced nursing practice role and summarize your findings in a 3- to 5-page paper (excluding the title page, references and appendices):
Assignment 4 Grading Criteria
Maximum Points
Described the advanced practice nursing role from South University.
20
Distinguished the role as clinical or non-clinical and how it promotes patient safety according to the NPSGs.
20
Summarized two research articles.
20
Summarized one expert opinion article.
20
Used correct spelling, grammar, and professional vocabulary. Cited all sources using APA format.
20
Total: 100

 
“Barriers to Palliative Care Related to Physicians/ Nurse Practitioners not ordering it”

1. Abstract. Provide a concise (120 word or less) abstract summarizing the paper. Content should include purpose, methods, results (review/analysis of literature and implications for practice), and conclusions.
2. Introduction. The body of the paper begins with presentation of the specific phenomenon/topic under investigation. This section should address why exploration of this topic is important and the potential implications of such exploration. What is the problem? What question are you posing? A purpose statement and rationale should be delineated.
3. Methods. Identify approach to literature review (keywords, databases). How many and what categories of papers did you locate? What is strength of evidence (level, consistency, currency)?
4. Review of literature. Provide an integrative review of pertinent empirical and theoretical literature. What are the key points to be made? How would you summarize the findings? What conclusions can be drawn? Assess gaps or limitations in current knowledge.
5. Implications for Practice. Formulate specific nursing implications as a result of completion of this exploration. Discuss implications within the context of the literature and the nursing area of study. How might this exploration influence clinical reasoning or patient/nurse management skills? What is the relevance to primary care? What is the relevance to nursing management? To your future practice?
6. Conclusions. Evaluate achievement of the purpose of the paper. Did the literature review answer your question and address the problem? Discuss the contribution of this paper to the advancement of nursing knowledge or practice.
7. References. (This section does not count towards the paper page length). At least 20 references are required. Only the following peer-reviewed references are allowed: 1) primary research reports; 2) evidence-based practice guidelines and algorithms; 3) systematic reviews and meta-analyses; and 4) professional websites with supportive references. One or two general review articles to introduce the problem from peer-reviewed journals are acceptable. Your literature is to be synthesized and integrated through-out the paper. The literature review is NOT to be a series of paragraphs, each summarizing one publication. The literature is to be used to support the points you are making. The following are NOT acceptable references: Wikipedia, websites without identified authors, websites with “.com,” textbooks or encyclopedias (online or offline), patient education brochures or website that were meant for consumer information. Government sites are acceptable only if material is targeting professionals, are authored, and include references. Reports MUST be from last 5 yr. If critical for your paper, you may go back 10 yr & note significance of this work. No more than two sources can be more than 5 yr old.
Project Plan Guideline: This is a 2 page summary of the paper. See example below this.

Introduction

-what are you proposing to investigate?

-identify problem

-pose question

– outline purpose

-why is this topic important/what is rationale? (e.g., need for change in practice, emerging health concern, major issue with morbidity or mortality)

-how project could potentially contribute to nursing knowledge and practice (brief)

Review/Analysis of Literature

-what approach did you take to review literature?

-how many papers did you locate? What categories (EBP guideline, primary research, etc.)?

-what is their quality? How strong is the evidence? Are the reports current and valid?

-what are gap/limitations in knowledge?

-what are the main points to be made?

-how would you summarize the literature? What conclusions does it allow you to draw?

Implications for Practice
-what are the implications?

-what relevance do the stated problem and the EBP review have to primary care?

-how will this information influence your future practice?

Conclusions -did literature answer your question? Address the problem?

-how will it advance nursing knowledge or practice?
Project Plan for Capstone (EXAMPLE) (2 pages after the whole paper is completed)
Introduction

Problem: Subclinical hypothyroidism is mild thyroid failure and usually progresses to overt hypothyroidism. It is a fairly common clinical problem with a prevalence rate of 4.3 to 9.5% in the U.S. population of according the NHANES III and Colorado study. Subclinical hyperthyroidism can be mild (TSH of 4.5-9 mIU/L) or severe (TSH> 10mIU/L). Screening and management for the disease is controversial as clinical recommendations differ between professional organizations and expert opinions.

Question: What reference points should be used to treat subclinical hypothyroidism and what management strategies should be used to prevent cardiovascular and neuropsychiatric sequellae?

Purpose: (Rationale): Several cardiovascular risk factors have been identified in some patients with subclinical hypothyroidism and include hypercholesterolemia, atherosclerosis, hyperlipidemia, and cognitive symptoms such as depression and memory loss. Subclinical hypothyroidism often progresses to overt hypothyroidism. The progression from subclinical to overt hypothyroidism is subtle and untreated hypothyroidism can lead to irreversible cardiovascular and neuropsychiatric symptoms.

Review/Analysis of Literature

After defining subclinical hypothyroidism an area of interest, pertinent articles were identified by searching CINAHL, OVID NURSING, MEDLINE, National Guideline Clearing House, the Cochrane Database, and the National Health Services Database (UK). Key search terms were hypothyroidism, thyroid deficiency, thyroid insufficiency, underactive thyroid, subclinical hypothyroidism, euthyroid, thyroid peroxidase antibodies, Hashimoto’s thyroiditis. Other key words used were screening, diagnostics, therapy, treatment, management, consequences, sequelae, hyperlipidemia, hypercholesteremia, cardiovascular, and cognitive. Research articles produced from 2009 to January 2014 were reviewed. Two older research studies from 2007 and 2008 were also reviewed. Twenty-six articles were identified as pertinent to the project and assessed for strength of evidence. Eight of the articles are Level I, four are level II nine are level IV, and five are level V.

Main Points: Subclinical hypothyroidism (SCH) is defined as serum thyroid stimulation hormone (TSH) concentration > 4.05 mIU/L with free T4 between 0.89-1.79 ng/dL. The prevalence of SCH is more common in women and increases with age. SCH has been shown to be associated with several health problems such as
PROJECT PLAN FOR CAPSTONE 2
hyperlipidemia, cardiac dysfunction, cognitive function and progression to overt hypothyroidism. The most common cause for SCH is autoimmune thyroiditis or Hashimoto’s disease. Eighty percent of those diagnosed with SCH have anti-thyroid peroxidase antibodies (TPOAb). TPOAb laboratory testing along with TSH, T3, T4 was found in the literature to be a recommendation in the evaluation and monitoring of the SCH patient.

Several studies have shown conflicting results in evaluating and treating SCH and currently there is no consensus on how to manage the disease. Clinical guidelines of professional societies indicate that the disease must be managed on an individual case basis including empirically treating symptomatic patients. Many descriptive studies point out that the sequelae of prolonged untreated SCH may impact an individual’s quality of life. More research is needed to determine if treating SCH prevents hyperlipidemia and other cardiovascular problems and whether early treatment prevents progression to overt hypothyroidism

Implications for Practice

Primary care clinicians equipped with an understanding of the clinical course of SCH and management options based on evidence-based practice will be able to monitor and manage the SCH patient to achieve optimal treatment outcomes.

Conclusion: The literature has answers the question as to which reference points should be used to treat subclinical hypothyroidism, however management strategies to prevent cardiovascular and neuropsychiatric sequelae need further investigation. Answers to these questions inform the advanced practice nurse on evaluation and management of this common disease to prevent progression to overt hypothyroidism and irreversible problems.

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).
• 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.
• Data collection: Explain plans for data collection including:
o Methods of collection, i.e., interviews, paper and pencil testing, etc.
o Testing frequency. Will you gather baseline data prior to the intervention? Will you employ repeated measures such as pre- and posttests?

Assignment 2 Grading Criteria Maximum Points
Described study design 5
Described the setting and study participants 5
Described protection of participants’ confidentiality 5
Detailed description of intervention and procedures 15
Described measurement instruments to be used 10
Explained plans for data collection in detail 5
Used current APA style guidelines consistently and accurately. 5

 
According to the American Medical Association:
Ethical, social, and legal problems may arise in surrogacy arrangements. Surrogate motherhood may commodify children and women’s reproductive capacities, exploit poor women whose decision to participate may not be wholly voluntary, and improperly discourage or interfere with the formation of a natural maternal-fetal or maternal-child bond. Psychological impairment may occur in a woman who deliberately conceives with the intention of bearing a child which she will give up.
American Medical Association, Updated June 1999.
Legal since 2002, gestational surrogacy is thriving in more than 1,000 clinics in India. According to a World Bank report, the commercial surrogacy industry in that country will reach $2.5 billion by 2020.
State and describe at least three (3) ethical, social, or legal problems that may arise in surrogacy arrangements. Consider exploitation of women in poor circumstances in the U.S. or abroad.

 
COURSE WORK ONE
Course work one requires student to produce two, one thousand word reflective assignments. Each assignment must address at least one of the areas identified by the NMC e.g. communication, compassion etc. The word limit suggests one area per essay would be best. It may be reasonable to address the same topic in both essays as a comparative study but this must be approved by a lecturer before commencing the work and must demonstrate extensive development of the theme.
Each of these assignments should investigate an area of nursing outside of the domain for which the student is training. Adult nurses may select from mental health nursing, childrens nursing, maternity care, care of the elderly or learning disabilities. Mental health nurses clearly must choose anything other than mental health. Learning disabilities is an option available for mental health students.
A reflective model should be demonstrated and be used to structure the work. Accordingly, these assignments should emphasise the first person singular (‘I’ statements) rather than the detached third person analytical expressions usually associated with academic work in Nursing. Since both assignments will be submitted as one unit of work it is unnecessary to replicate the chosen reflective model in both essays,- indeed marks may be lost for unnecessary repetition. A tip is to offer the reflective model as a precursor to both reflective accounts. Each reflective analysis account thus becomes a derivative of the common descriptive stem (the reflective model).
The reflections, regardless of the model used, should account for the Affective, Cognitive and Behavioural elements of the experience being analysed. Emphasis is on analysis rather than description of the event and the marks will be awarded accordingly. This assignment though is a ‘Pass or Fail’ exercise.
Examples of previous assignments include;-
• Communicating with a learning disabled client relating to their diet,
• Expressing compassion to relatives of a dying child
• Explaining a pre-operative checklist to a non-English speaking patient.
• Administering an injection for the first time
• Undertaking a wound dressing for the first time
• Bathing a member of the opposite gender.
• Communicating with distressed and angry relatives
• Delivering a patient summary at staff shift handover.
THINGS NOT TO DO:-

a) BROADENING PERSPECTIVE EXPERIENCES

DON’T;
• Put yourself into a dangerous situation;- avoid war zones and areas of civil unrest / conflict. Also consult with local supervising personnel about safety issues.
• Depend on the University for expenses or other financial support
• Work in isolation or unsupervised
• Engage with vulnerable service users
• Try to cover all of the NMC requirements in all of the essays / reflections. One subject per assignment will suffice.
DO;
• Respect the needs of all patients, clients, service users and service providers.
• Investigate the organisation NOT the clients
• Provide details of your proposed experience to lecturers BEFORE embarking upon it.
• Produce your posters to demonstrate and validate your activities
• Record your experiences in your portfolio

b) COURSE WORK 1

DON’T;
• Identify individuals or organisations either directly or by implication unless they either agree to it or they are a public body… and even then discuss this with lecturers before writing.
• Try to accommodate all of the areas of nursing in all of the assignments. One per assignment will suffice.
• Offer only superficial description;- you must investigate and analyse deeply in order to pass these essays.
• Be late with your submission
DO;
• Analyse and criticise
• Discuss the work with lecturers as required
First 1000 words essay
Use Gibbs reflective module to reflect how communication is been implemented in maternity service. I have selected the use of an interpreter as a mode of communication with a woman with limited English. Please use Harvard style referencing and UK research

Second 1000 words essay
Use Gibbs reflective module to reflect on how safeguarding is been implement in maternity service. I have selected a woman undergoing domestic abuse. Please adapt every part of it to the uk.
FACULTY OF SOCIETY AND HEALTH

GENERIC ASSESSMENT CRITERIA Society & Health: LEVEL 7

A
(85-100%) (70%-84%) B
(60-69%) C
(50-59%) D
(40-49%) E
(34-39%) F
(33% – 0%)
Level 7 Criteria >8.5 7-8.4 6-6.9 5-5.9 4-4.9 3.4-3.9 <3.4
1. Presentation

10

All work should be presented to a high level. Work must be appropriately structured and demonstrate fluent articulation and clarity of expression. Spelling and grammar must be correct
Within the word limit
Word count declared All work should be presented to a high level. Work must be appropriately structured and demonstrate fluent articulation and clarity of expression. Spelling and grammar must be correct
Within the word limit
Word count declared Demonstrates exceptional academic writing style for this level of work Work is clearly presented and grammatically correct with no spelling errors
Demonstrates fluent articulation and clarity of expression
Within the word limit
Word count declared Work is clearly presented, fluent and grammatically correct
Thoughts and ideas are clearly expressed
Within the word limit
Word count declared Work is clearly presented. Minimal errors in grammar and spelling
Thoughts and ideas are clearly expressed
Within the word limit
Word count declared Some inconsistencies in the standard of presentation.
Minimal errors in grammar and spelling.
Meaning apparent but not always clearly expressed
Within the word limit
Word count declared Work is poorly presented and/or marred by errors affecting comprehensibility
Inadequate proof reading. Length not within required limits
Word count declared
>12.7 12.6-10.5 9-10.4 7.5-8.9 6-7.4 5.1-5.9 <5.1
2. References

15
The Harvard system must be used consistently and accurately throughout the work.
It is expected that students will demonstrate a range of reading appropriate to the topic and the academic level. Although difficult to prescribe, it is anticipated that students will draw on a range of literature, and other forms of evidence, using this to extend perspectives and elaborate on current thinking. The Harvard system must be used consistently and accurately throughout the work.
It is expected that students will demonstrate a range of reading appropriate to the topic and the academic level. Although difficult to prescribe, it is anticipated that students will draw on a range of literature, and other forms of evidence, using this to extend perspectives and elaborate on current thinking. Able to extrapolate from a diverse range of evidence. Harvard System used consistently and accurately.
Wide range of reading evident and utilised appropriately throughout the work. Harvard System used consistently and accurately.
Wide range of reading evident and utilised appropriately for the majority of the work. Harvard System used consistently and accurately in the majority of the work. Some evidence of wide reading within the work. Harvard System used with minimal errors in referencing evident.
Some evidence of wide reading to support parts of the discussion.
Harvard System used but referencing incomplete and multiple errors evident. References not always utilised appropriately to support the work.
Limited evidence of wide reading to support discussion.

Using Gibbs: Example of reflective writing in a healthcare assignment
• Description
In a placement during my second year when I was working on a surgical ward, I was working under the supervision of my mentor, caring for a seventy-two year old gentleman, Mr Khan (pseudonym), who had undergone abdominal surgery. I had been asked to remove his wound dressing so that the doctor could assess it on the ward round.
I removed the dressing under my mentor’s supervision, using a non-touch procedure, and cleaned the wound, as requested by the doctor. My mentor was called to another patient at this point, so at her request I stayed with Mr Khan while we waited for the doctor to come to see him.

The doctor had been with another patient, examining their wound, and I noticed that she came straight to Mr Khan to examine his wound, without either washing her hands or using alcohol gel first. I also noticed that she was wearing a long-sleeved shirt, and I was concerned that the cuffs could be contaminated. I thought for a moment about what to do or say, but by the time I had summoned enough courage to say something, I thought it was too late as she was already examining Mr Khan.

Feelings
I was alarmed by this, as I had expected the doctor to wash her hands or use alcohol gel before examining Mr Khan. However, I felt intimidated because I felt that the doctor was more experienced than me as a second year nursing student; and I didn’t want to embarrass her. Also, I didn’t want to make Mr Khan concerned by confronting the doctor in front of him.

Later, I spoke to my mentor about the incident. She suggested that we speak to the doctor together about it. My mentor took the doctor aside, and asked her whether she had washed her hands before examining Mr Khan. She looked quite shocked. She said that she had been very busy and hadn’t thought about it. My mentor discussed the importance of hand hygiene with her, and the doctor assured her that she would wash her hands before examining every patient in the future.

Evaluation
The incident was extremely challenging for me. I regret that I did not act to challenge the doctor’s practice before she examined Mr Khan. However, I am pleased that the doctor responded so positively to the feedback of my mentor, and I have observed that she has now changed her practice as a result of this incident. I too have learned from the incident, as it has taught me the importance of acting assertively with colleagues, in a sensitive manner, in order to safeguard patients’ well-being.

Analysis
The Royal College of Nursing (2005) states that hand hygiene is the single most important activity for reducing cross-infection, and points out that many health care professionals do not decontaminate their hands as often
as they should. Recent guidance published by the Department of Health (2007) highlights the possibility of staff transmitting infections via uniforms, and the need to review policies on staff dress. The Nursing and Midwifery Council Code of Professional Conduct (2004, section 8) states that as a nurse ‘you must act to identify and minimise the risk to patients and clients’. As the student nurse caring for Mr Khan under my mentor’s supervision, this also applies to my own practice as a student nurse.

Conclusion
Looking back on this incident, I can see that I should have acted sooner, and that I should have ensured that the doctor washed her hands before examining Mr Khan. I can now see that my inaction in this incident put Mr Khan’s well-being at risk. After discussion with my mentor, I recognise that I need to develop the confidence to challenge the practice of colleagues, putting the well-being of clients at the forefront of my mind. I realise that I need to be supportive to colleagues, understanding the pressures that they may be under, but ensuring that their practice does not put clients at risk.

Action Plan
In future, I will aim to develop my assertive skills when working with colleagues, in order to ensure that the well-being of clients is maintained. In my next placement, I will make this a goal for my learning, and will discuss this with my mentor to work out strategies.

a
For this Application assignment, write a 2- to 3-page paper summarizing your interview with a quality manager in an acute care or long-term care agency of your choice, focusing on the impact of the direct care nurse’s role in clinical outcomes for the organization. Use the following guidelines and evaluation criteria and the headings below for each section. Use a minimum of three references from the professional nursing literature in the assigned course readings . If they are relevant, you may use one or two professional Web sites in addition to the literature references.
• Overview – 20 points

Begin this paper with a brief paragraph that provides an overview of the assignment and its purpose. There is no separate heading for this paragraph; the heading for this paragraph is the same as the title of the paper. This paragraph will be about 2–3 sentences. The last sentence in this paragraph is a sentence that begins “The purpose of this paper is to¨.
• Summary of the interview – 50 points

Describe the individual you interviewed and the setting. Summarize the manager’s insights on the role of the direct care nurse in supporting the outcomes for the organization. This section is 2–3 paragraphs.

• Impact on nursing practice – 50 points

Outline how the information gained from the interview and this week’s resources may influence your nursing practice specifically, or nursing practice in general. Specifically note those practices that you may change based on what you have learned. Provide an analysis of how this information impacts the profession of nursing. This section is 2–3 paragraphs.

• Summary – 30 points

End the paper with a one-paragraph summary of the main points of the paper.
IMPORTANT!!!

Here are some tips for the week 1 assignment based on errors that students have made in the past.
Read the assignment carefully and use the rubric to make sure that you have covered every point asked for.
You must have three (3) references from nursing literature, that means articles from nursing journals, not textbooks, videos or web sites. Web sites may only be in addition to articles. You may use any of the articles in the assigned reading.
Make sure you do not use first person as that is not used in APA.
Please do not use quotes. I will take points off for more than one quote in any paper.

 
Personal Statement describing my objectives in undertaking family nurse practitioner doctor of nursing practice program FNP DNP( main areas of clinical study and/ or health issues i wish to pursue, specific focuses within this area, short and long term goals,outcomes i wish in relation to my identified area of clinical study, facilitating my career goals i.e how the program will help in attaining my career goals and educational goals, e.t.c), my special interest, plans, strengths and weakness in my chosen field. Significant life experiences that have contributed to my development such as honors, activities, and accomplishments that make me a unique applicant, describe experience with evidence based practice.

Comment on my clinical practice experiences and how they have informed my choice of speciality . Describe how i will contribute e.g through education, research, and practice to enhance the health and quality of life for people of all cultures, economic levels, and geographic locations. Describe how you and the program is a good match ( why did i select the school)? Please address your specific interest in your chosen program.

The mission of the University is to transform healthcare and policy through knowledge and education of future leaders from diverse backgrounds. The vision is to be a preeminent leader in advancing global health and nursing. Please comment on how i can contribute to the mission and vision as a student and future alumnus.

Please comment on what i see major challenges that i will need to overcome (i.e financial constraints, family responsibilities, job) in pursuing the degree. what are my plans for addressing these challenges.

What does it mean to have a commitment to diversity and how would you develop and apply my commitment to diversity at the school

 
After completing this week’s Practicum Experience, select a patient whom you examined during the last 3 weeks. With this patient in mind, address the following in a SOAP Note:
Subjective: What details did the patient provide regarding his or her personal and medical history?
Objective: What observations did you make during the physical assessment?
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management including alternative therapies?
Reflection notes: What would you do differently in a similar patient evaluation?
Please refer to the Learning Resources in Week 3 for guidance on writing SOAP Notes.