Discuss the essential skill sets that you, as a contemporary nurse leader, will need to use in order to successfully lead other professionals in today’s healthcare settings.
Expectations
Initial Post:
Power points slides
Visit http://www.aha.org/advocacy-issues/communicatingpts/pt-care-partnership.shtml and review the American Hospital Association’s Patients’ Bill of Rights. Discuss how health care professionals can ensure that patients’ rights are upheld and protected.
Instructions:
Word limit 500 word . Please make sure to provide citations and references (in APA, 7th ed. format) for work. Please check plagiarism.
Respond at least 2 times each . The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to 1 of the 3 discussion prompts that your colleagues provided in their video presentations. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
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A. Patient identifiers: Age: Gender: Ht: Wt. Code Status: Isolation: |
Development Stage (Erikson): Give the stage and rationale for your evaluation |
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Health Status |
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Date of admission: Activity level: Diet: Fall risk (indicate reason) Client’s description of health status Allergies: (include type of reaction) |
Reason for admission: Past medical history that relates to admission: |
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Socio-cultural Orientation |
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Cultural and Ethnic Background with current practices: Socialization: Family system: (Support system) Spiritual: Occupation: (across the lifespan) Patterns of living: (define past and current) |
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Barriers to independent living: |
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Healthcare systems elements (continued) ALLERGIES: |
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Medications: List all medications, dosages, classifications and the rational for the medications prescribed for this patient include major considerations for administration and the possible negative outcomes associated with this medication. DEFINE 1: What the medications Mechanism of Action AND 2: Why the patient is taking the medication? Medication Classification Dosage Rationale Possible negative outcomes |
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Psychiatric Diagnosis and DSM 5 Diagnostic Criteria |
History of Present Psychiatric Illness (Presenting signs & symptoms/ Previous Psychiatric Admission / Outpatient Mental Health Services) |
CON
CEPT MAP
Pathophysiology – (to the cellular level)
Medical Diagnosis
Clinical Manifestations (all data subjective and objective: labs, radiology, all diagnostic studies) (What symptoms does your client present with?)
Complications
Treatment (Medical, medications, intervention and supportive)
Risk Factors (chemical, environmental, psychological, physiological and genetic)
Nursing Diagnosis
Problem statement: (NANDA)
Related to: (What is happening in the body to cause the issue?)
Manifested by: (Specific symptoms)
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General Appearance |
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Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane) |
Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest), |
Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise) |
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Manner and Approach |
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Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness) |
Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing). |
Speech (normal rate and volume, pressured, slow, loud, quiet, impoverished) Expressive Language (no problems expressing self, circumstantial and tangential responses, difficulties finding words, echolalia, mumbling) Receptive Language (normal, able to comprehend questions, |
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Orientation, Alertness, and Thought Process |
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Recall and Memory (recalls recent and past events in their personal history). |
Alertness (sleepy, alert, dull and uninterested, highly distractible) |
Concentration and Attention (naming the days of the week or months of the year in reverse order, spelling the word “world”, their own last name, or the ABC's backwards) |
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Thought Processes (loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization). |
Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications) |
Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong) |
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Mood and Affect |
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Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry). |
Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset) |
Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected) |
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Lab |
Range |
Value |
Reason Obtained |
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Risk Assessment: Suicidal and Homicidal Ideation (ideation but no plan or intent, clear/unclear plan but no intent) Self-Injurious Behavior (cutting, burning) Hypersexual, Elopement, Non-adherence to treatment |
Discharge Plans and Instruction: Placement, outpatient treatment, partial hospitalization, sober living, board and care, shelter, long term care facility, 12 step program |
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Teaching Assessment and Client / Family Education: (Disease process, medication, coping, relaxation, diet, exercise, hygiene) Include barriers to learning and preferred learning styles |
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NRS DX: Problem Statement: R/T: (What is the cause of the symptom?) Manifested by: (specific symptoms) |
Short term goal: Create a SMART goal that relates to hospital stay. Long term goal: Create a SMART goal that is appropriate for discharge. |
This is specific to the patient that you are caring for. A list of planned actions that will assist the patient to achieve the desired goal. (i.e. obtain foods that the patient can eat/ likes) |
Identify what the patients response or “outcome is to the goal or care that you have provided. i.e. patient ate 45% of lunch) |
Was it met or not met there is no partially met. |
References:
1) Review your state’s Nurse Practice Act and rules and regulations.
2) As a coworker, what are you required to do if you believe a nurse has a problem with chemical dependency? As the nurse manager, what are your obligations? Please cite the Nurse Practice Act.
Golden Age of Microbiology: Use the given active learning template (ALT) to connect Scientists with their discoveries in 1-2 sentences. (Slide 1; 2.5 points)
Carolus Linnaeus
Antoni van Leeuwenhoek
Alexander Fleming
Joseph Lister
Ignaz Semmelweis
Robert Koch:
(Slide 2; 3 points)
Summary of Key Work:
Organisms Studied:
Other Findings:
Postulates:
Louis Pasteur:
S-shaped Flask experiment
(Slide 3; 2 points)
Hypothesis:
Experimental Design:
Results:
Conclusion:
Note for students: Macromolecules is a review from prior courses. This topic may or may not be covered in-class or online. You may use your textbook or books from prior courses for this ALT. (Slide 4; 2.5 points)
Complete the following table by describing the terms in1-2 sentences with their function and examples
| Carbohydrates | Functions and Examples |
| Monosaccharides | |
| Disaccharides | |
| Polysaccharides |
| Lipids | Functions and Examples |
| Triglycerides | |
| Phospholipids |
| Level of protein structure | Structural organization |
| Primary | |
| Secondary | |
| Tertiary | |
| Quaternary | |
Complete the following Table by adding information on bonds that participate in creating certain level of protein structure and if biological activity is present in that level of structure (Slide 5; 2 points)
Give an example of a disease that occurs due to errors in protein folding: ___________________________________
| Type of NA | Composition of the nucleotide | Location, Function and types | Structure and sugars |
| DNA |
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| RNA |
The two types of Nucleic acids ________________ and ______________
Role of ATP _________________________________________________________
Complete the following table about the composition, structure and functions of Nucleic acids (NA).
(Slide 6; 3 points)
Student Instructions for Standardized Simulation
NR325 Mary Lou and Rob Brady Scenario 1 (NLN)
PURPOSE:
Mary Lou Brady is a 20-year-old patient who had a right-sided stroke eight days ago. She was in the hospital for four days and is now in an acute care rehabilitation center, where she is having some difficulty acclimating to her new life and body changes.
Mary Lou is a patient in the medical surgical/rehabilitation center. She is eight days post-stroke and participates in rehabilitation for three hours every morning and afternoon. Her husband and family have been an excellent support system for her, but she is struggling with the demands of her rehabilitation.
STUDENT ROLES DURING SIMULATION:
During pre-briefing, you will be assigned one of these roles according to the description below to participate in the simulation as a nurse. After completing your assessment, you are expected to document your findings as a nurses note in SBAR format.
The charge nurse is responsible for the overall organization of safe, quality patient care. You are the team leader and serve as a resource to all interdisciplinary members and are responsible for appropriate delegation of duties. You will serve as the point person for communication and can anticipate speaking with the physician or other primary care provider, ancillary support services, and others directly involved with the care being provided. You must be knowledgeable about the patient’s condition and able to dictate orders obtained and assist with implementation if needed. Additionally, be prepared to prioritize care and anticipate future needs.
The documentation nurse is responsible for recording of all patient event activities during the simulation with the exception of medication administration. You are responsible for documenting assessments, interventions, and outcomes on the designated tool (paper or electronic). Be prepared to read back and verify your documentation when requested and/or clarifying the details. Additionally, you will be part of the interdisciplinary team and will contribute observational assessment findings to include but not limited to changes in vital signs, alerts, psychosocial needs, and anticipated care.
Assessment Nurse:
The assessment nurse is responsible for overseeing a comprehensive assessment of the patient. This includes but is not limited to obtaining vital signs, head-to-toe assessment of all systems, and psych/social assessment of the patient. You will be prioritizing care, executing independent interventions, collaborating with interdisciplinary team members, anticipating the needs of the patient/family, and re-assessing or continually monitoring the patient for any changes in condition. You are responsible for implementing all non-medication-related interventions, verbalizing your findings to the team, and recommending any actions/interventions required. Additionally, you will be providing appropriate education to the patient and family/significant others.
The medication nurse is responsible for all actions and documentation related to safe administration of medications. You will identify and correct any medication errors related to prescribing or distribution. This may include speaking with the physician or primary care provider. Prior to administering medication, you will assure the “Rights of Medication Administration”. You must be knowledgeable regarding the action and expected effects of the medications being administered and are responsible for monitoring and reporting any adverse reactions or unforeseen consequences of administration. Part of your role includes verifying medication calculations with a colleague and identifying any incompatible drug combinations.
The observer is a non-participant role and will not communicate directly with the simulation team. The observer nurse will view the simulation in the briefing room through Learning Space as it is occurring. There may be multiple observer nurses in each scenario. The observer nurse will be given an observation guide to complete during the simulation. The data you collect will help the team during the debriefing process and facilitate an open and active discussion regarding the simulation experience. You will be an active participant in the debriefing and will be encouraged to share your observations and thoughts. Please keep in mind that your observations should be conveyed in a respectful, educational manner. The goal is to work together as colleagues in providing safe and effective care.
CONFIDENTIALITY:
To preserve the educational value, integrity and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.
You will not view, discuss, share, record or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program.
FICTION AGREEMENT:
You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.
1. Complete a neurological assessment of a patient who has had a stroke.
2. Complete a psychosocial assessment of a patient who has had a stroke.
3. Provide appropriate nursing interventions for a post-stroke patient who is experiencing grief and loss related to having a stroke.
4. Use appropriate communication techniques during interactions with a post-stroke patient who is experiencing grief and loss and is attempting to cope with changes in body image.
5. Recognize the implications of the patient’s existing disability on the patient’s current and future healthcare needs.
The NR325/NR330 standardized simulation enables the student to meet the following priority course outcomes:
CO 1: Provide effective professional nursing care for adult patients and their families in acute care settings using the nursing process. (PO 1)
CO 4: Apply critical thinking strategies to make good clinical decisions in the adult patient clinical setting. (PO 4)
CO 6: Relate knowledge and principles of legal, ethical, and professional standards to clinical practice in the acute care setting, with adult patients and their families. (PO 6)
**Although this scenario can address multiple course outcomes, faculty and students should focus on the course outcomes listed above**
DUE DATE:
The standardized simulation will be conducted during
Week 5
to ensure students are prepared to meet the objectives.
· Pre-brief: 20 minutes
· Prebrief Skills Review (OPTIONAL): 30 minutes
· Run Time: 30 minutes
· Debrief: 60 minutes
In order to prepare for the simulation, you should complete your assigned reading for the course. In addition, you should be prepared to complete and document a thorough nursing assessment along with completing the following skills:
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Neurological Assessment
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Therapeutic Communication
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Grief and Loss
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Utilizing I-SBAR for reporting
Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.
Therefore, in order to prepare for the simulation, you are
required to complete the pre-briefing questions below and submit them to the faculty facilitating the simulation before the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to the faculty facilitating the simulation before the start of pre-briefing, you will
not be permitted to participate in the simulation.
Use textbook and other resources to answer questions:
1. What are some causes of strokes in younger women?
2. What do you need to focus on when completing a neurological assessment for someone who just experienced a stroke?
3. What do you educate the patients about the signs and symptoms of a Stroke and when to call 911?
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Remediation for Students
Expand all categories by clicking “Expand All” to see all categories under the topic areas.
Create a Word Document with headings that correlate with the missed Knowledge Area, Question Topic, and Domain on the Pre-Predictor Exam Summary Report. (See Diagram 1 below).
Use resources such as your textbook, or a reputable standard of care website, such as the American College of Cardiology, etc.to remediate. Summarize the missed content topic in 2-3 paragraphs and include a hyperlink to the reference.
All missed questions must be addressed to earn all points. Missed questions are red color written on the other score report paper.
Remediation should begin as soon possible.
It needs the first page bank paper for my cover sheet.
