RUBRIC FOR GRADING

 Subjective Documentation in Provider Note Template: Subjective narrative documentation in Provider Note Template is detailed and organized and includes: Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS)ROS: covers all body systems that may help you formulate a list of differential diagnoses. You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe. =  Documentation is detailed and organized with all pertinent information noted in professional language….Documentation includes all pertinent documentation to include Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS). 

 Objective Documentation in Provider Notes – this is to be completed using the documentation template that is provided. Document in a systematic order starting from head-to-toe, include what you see, hear, and feel when doing your physical exam using medical terminology/jargon. Document all normal and abnormal exam findings. Do not use “WNL” or “normal”. You only need to examine the systems that are pertinent to the CC, HPI, and History. Diagnostic result – Include any pertinent labs, x-rays, or diagnostic test that would be appropriate to support the differential diagnoses mentioned. Differential Diagnoses (list a minimum of 3 differential diagnoses). Your primary or presumptive diagnosis should be at the top of the list (#1). =  Documentation detailed and organized with all abnormal and pertinent normal assessment information described in professional language….Each system assessed is clearly documented with measurable details of the exam. 

 Esophageal Reflux Case Studies A 45-year-old woman complained of heartburn and frequent regurgitation of “sour” material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative. Studies Results Routine laboratory studies Negative Barium swallow (BS), p. 941 Hiatal hernia Esophageal function studies (EFS), p. 624 Lower esophageal sphincter (LES) pressure 4 mm Hg (normal: 10–20 mm Hg) Acid reflux Positive in all positions (normal: negative) Acid clearing Cleared to pH 5 after 20 swallows (normal: <10 swallows) Swallowing waves Normal amplitude and normal progression Bernstein test Positive for pain (normal: negative) Esophagogastroduodenoscopy (EGD), p. 547 Reddened, hyperemic, esophageal mucosa Gastric scan, p. 743 Reflux of gastric contents to the lungs Swallowing function, p. 1014 No aspiration during swallowing Diagnostic Analysis The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient’s symptoms of reflux necessitated esophageal function studies. She was found to have a hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms. Critical Thinking Questions 1. Why would the patient be instructed to avoid tobacco and caffeine? 2. Why did the physician recommend 6 weeks of medical management? Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved. 2 3. How do antacid medication work in patients with gastroesophageal reflux? 4. What would you approach the situation, if your patient decided not to take the medication and asked you for an alternative medicine approach? 

2

Understanding and Optimizing the Rights of Delegation in Management

Student Name

Institutional Affiliation

Course

Instructor’s Name

Date

Understanding and Optimizing the Rights of Delegation in Management

Understanding the Rights of Delegation

Delegation is a pivotal skill set in the management landscape, as it enables leaders to distribute tasks to enhance organizational efficiency. Derived from the video “Delegation” and supplemented by the textbook readings, the Rights of Delegation emerge as a framework guiding this essential managerial function (Motacki & Burke, 2022). The Rights of Delegation encompass five core aspects: the right task, the right circumstance, the right person, the right communication, and the right supervision.

Beginning with the right task, errors might arise if a task not suited for delegation gets passed down. This can lead to inefficiencies and potential mistakes. The right circumstance, on the other hand, pertains to assessing the situational appropriateness of delegation. Inappropriate delegation during crises, for instance, can exacerbate the problem. Identifying the right person is equally crucial, as delegating to someone ill-equipped can result in subpar outputs and decreased morale. The right communication explicitly outlines expectations, and any ambiguities can lead to misunderstandings and potential mistakes (Motacki & Burke, 2022). Lastly, the right supervision underscores the importance of monitoring and feedback. Neglect in this realm can leave the delegate feeling unsupported and can give rise to mistakes.

Preventing Delegation Errors

To forestall these errors, several preventive measures can be implemented. Foremost, managers should exercise discernment in identifying tasks suitable for delegation. This requires an in-depth understanding of the task and the broader organizational context. It's also crucial to continually assess team members' skills and readiness levels, thus ensuring the delegation aligns with their capabilities. Clear, concise communication is indispensable, accompanied by regular check-ins to clarify doubts and offer support. Finally, feedback mechanisms should be robust, enabling the manager and the delegate to learn and grow from the experience (Crevacore et al., 2023). By adhering to these principles, managers can effectively harness the power of delegation to drive organizational success.

Conclusion

Effective delegation is not merely about distributing tasks but requires a strategic alignment of the right task, circumstance, person, communication, and supervision. By understanding and respecting these Rights of Delegation, managers can navigate the common pitfalls associated with the process. Implementing rigorous preventive measures ensures the smooth completion of tasks and fosters growth, collaboration, and trust within teams, thereby solidifying delegation as an indispensable tool for organizational success.

References

Crevacore, C., Jacob, E., Coventry, L. L., & Duffield, C. (2023). Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing. 
Journal of advanced nursing, 
79(3), 885-895.

https://doi.org/10.1111/jan.15430

Motacki, K., & Burke, K. (2022). 
Nursing Delegation and Management of Patient Care-E-Book. Elsevier Health Sciences.

suggesti an additional perspective on what it means to be a nurse with a practice doctorate, offer support to the expectations with obtaining the degree that your colleague posted, or expand upon your colleague’s post. Use 2 references 

The Doctor of Nursing Practice (DNP) degree has only been available to nursing scholars since 2004.  It was deemed necessary by the American Association of Colleges of Nursing (AACN) because “changing demands of this nation’s complex healthcare environment require the highest level of scientific knowledge and practice expertise to assure quality patient outcomes” (American Association of Colleges of Nursing, 2023).  Because the degree is relatively new, the significance of the DNP is not yet widely understood.  A recent study determined that “DNP-prepared nurses typically function as APRNs in clinical care or as health care system leaders, while there is a low number of DNPs in clinical practice settings” (Beeber et al., 2019).  That being said, there is a great opportunity here for the DNP-prepared nurses of the future.  Tussing (2018) identified that there is “great potential for innovation around new care delivery models, interdisciplinary projects, and community involvement for a healthier society” if healthcare leaders consider the potential of redesigning or creating new roles for the DNP-prepared nurse.

Expectations of Doctor of Nursing Practice versus Doctor of Philosophy in Nursing

            The DNP degree is founded in nursing practice whereas a Ph.D. in nursing is rooted in research and teaching.  I chose to pursue the DNP because I believe it will allow me to effect social change on a larger scale and I enjoy the clinical side of nursing.  As a DNP-prepared nurse, I will “hold a broad foundation of knowledge from nursing, ethics, psychosocial and biophysical sciences, as well as from organizational and change theories” (Hartjes et al., 2019).  My professional goal is to serve as a Healthcare organization’s Chief Nursing Officer (CNO).  Nurses who hold a Ph.D. tend to pursue research opportunities or serve as professors at Universities.  Obtaining my DNP aligned with my professional goal of becoming a CNO.  Additionally, Walden University offers an executive nursing track which will set me up for success.

                                        Addressing a Gap in Practice

            As a nurse executive, it will be my role to identify and address gaps in practice.  At my current organization, one gap I will address is the workflow of admitting patients.  I work at an inpatient psychiatric hospital.  The current practice is that patients arrive to the hospital via ambulance and are rolled directly onto the unit.  There is minimal communication between the intake department, which accepts the patient, and the nurses who receive the patient on the floor.  I aim to create an admissions unit that will house the intake department.  This will help facilitate communication and create a better experience for the patient. 

                                                  References

American Association of Colleges of Nursing. (2023). Fact sheet: The Doctor of Nursing Practice (DNP). https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/DNP-Fact-Sheet.pdfLinks to an external site.

      Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of Doctor of Nursing Practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354–364. https://doi.org/10.1016/j.outlook.2019.02.006Links to an external site.

Hartjes, T. M., Lester, D., Arasi-Ruddock, L., McFadden Bradley, S., Munro, S., & Cowan, L. (2019). Answering the question: Is the Doctor of Philosophy or Doctor of Nursing Practice right for me? Journal of the American Association of Nurse Practitioners, 31(8), 439–442.               https://doi.org/10.1097/JXX.0000000000000273

Tussing, T., Brinkman, B., Francis, D., Hixon, B., Labardee, R., & Chipps, E. (2018). The impact of the Doctorate of Nursing practice nurse in a hospital setting. The Journal of Nursing Administration, 48(12), 600–602. https://doi.org/10.1097/NNA.0000000000000688

Math 225: week 1

·
Week 1: Evidence Claims and Study Types

Week 1: Variables and Measures of Data

Week 1: Sampling Methods

Week 1: Comparing Sampling Methods