1st 

The Theory of Goal Attainment and Transactional process is a theory that guides nurses to practice nursing based on a personal approach. It is a Grand Theory based on Interactive Process.  The purpose of this theory is to be able to achieve patients’ goals by forming a relationship with the client or patient. To be able to form a relationship with a patient/client there are several factors that have to be consider.  One of the main factors that has to be consider is the fact that the patient is a unique individual and as such nurses must think how to approach this patient to form a therapeutic relationship that will involve the patient in his/her own healthcare goals.

The goal of attainment has impacted research, education, and the nursing. However, it has impacted nursing education in particular. “For example, it served as a frame work for the baccalaureate program at the Ohio State University School of Nursing where it determined the content and process taught at each level of the program” (McEwen & Wills,2023, p. 177).

The development of this theory was created by Imogene King in the 1960’s.  “During this time nursing practice was not so much based on theory.  Nursing practice was generally prescribed by others and highlighted by traditional, ritualistic tasks with little regard to rational” (McEwen & Wills, 2023, p.25).

It is interesting to know that this theory has been used not only for the purpose of education, research and nursing practice but it has also help to develop other theories.   “In addition to application in practice and research described previously, King’s work has been the basis for development of several middle-range nursing theories.  For example, was used by Rooda (1992)  to develop a model for multicultural nursing practice” (McEwen & Wills, 2023, p. 117)> 

2nd 

Virginia Henderson was born in Missouri and raised in Virginia. She grew up to receive her diploma in nursing from the Amy School of Nursing located at Walter Reed Hospital. Within two years of working as a bedside nurse her passion for the profession grew immensely.  She applied to and was offered a nurse educator position at a hospital in Virginia. From that day Henderson embarked on a lifelong mission to educate nurses on her concept of the nursing profession. Over a decade she had  went on to obtain her Bachelors of Nursing degree in 1932 and her Master’s degree in 1934. Her concept and theories evolved and was imitative of her passion, practice and education. 

The philosophical and structural components of her theory was focused on educating nurses and providing patient care in an encouraging environment. Henderson was introduced to physiologic principles during her graduate education. The study of these principles was the fundamental basis of her framework for patient care (Henderson, 1965, 1991). The physiologic principle implies that the patient’s biology, psychology and sociology (biopsychosocial) all had to be taken into consideration when providing care. As her studies and work experience progressed, she was also introduced to “Thorndike’s fundamental needs of a man” (McEwen, Grand Nursing Theories Based on Human Needs 2022), in which she gave credit to as having a direct influence on her beliefs. Another major concept of her theory is that nurses should assist patients with otherwise daily activities of life in times of illness until the patient is back to their optimistic level of health. Overall, helping the patient to regain independence by providing a supportive environment. Her concept of nursing included the nurse assisting the patient with 14 activities.

Henderson’s theory of nursing has immensely affected nursing education, nursing research and nursing practice.  Lucier (2018), for example, described how Henderson’s model could be used to enhance the nurse−patient relationship to provide holistic care at the end of life. Similarly, Waller-Wise (2013) found that Henderson’s theory assisted nurses in attaining excellence in childbirth education, and Miranda et al. (2018) used Henderson’s assumptions and model in their analysis of the concept of “nursing care of overweight children.” (McEwen, Grand Nursing Theories Based on Human Needs 2022). Her contribution to nursing textbooks extended from 1930-1990’s. Her contributions to nursing had a global impact by strengthening the focus on nursing practice and confirming the value of tested interventions in assisting individuals to regain health (McEwen, Grand Nursing Theories Based on Human Needs 2022). Researchers internationally continue to be influenced by Henderson’s model as a framework.

Rubric

Criteria for Grading Discussion Participation
Interactions should be thorough, thoughtful and facilitate the learning community’s growth.
Behaviors will be reviewed on a weekly basis. Contribution toward the course grade total
will be based on the pattern of demonstrating these characteristics.
Please remember, initial posts should be submitted by midnight by deadline. Your
responses to two of your peers’ initial posts should be made by deadlines, and then
responses to questions or comments made to you on your posts or discussion responses
should be made by deadlines also, per syllabus above.
Rubric for evaluating Discussion Participation
Characteristic of the Response Point Value
 No response 0
 Responses are noncontributory (e.g., “I agree with the comment;”
“I was thinking the same thing:” “I had a similar experience.”
2
 On-time response to all points
 Response is not relevant to other statements or the discussion
thesis
 Response shows minimal understanding of the topic
4
 On-time response to all discussion points
 Response reflects the point being discussed; builds on ideas of
other participants
 Facts and examples are appropriate to each thesis and are
accurate
 Rules of communication, language, etc. are utilized so as not to
distract the flow of discussion
6
 All elements in the 6-point division (above) and
 Responses reflect complete understanding of topic and assigned
readings
 Uses greater detail, examples and other sources to support
discussion
 Initiates another question (which may/may not be discussed by
group0
8
 All elements in the 8-point division (above) and
 Analyses, discussions and conclusions explicitly linked to the
10

Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities, and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with 7th edition APA format. 

Neuro Case Study

You are consulted to visit a 72 year old male client who had a stroke last year which left both his upper and lower right sided extremities weakened. He is obese and has a history of smoking for 57 years. His history also includes being diagnosed with type 2 diabetic, high blood pressure, coronary artery disease, polycythemia, and atrial fibrillation. His father died of an MI at age 53. Both of his parents had type 2 diabetes. His mother dies of cancer. His paternal grandfather had 2 strokes, 0neyear apart, dying two weeks after the second stroke.

1. What types of extremity paralysis ( weaknesses) can occur in strokes and how do they differ? What type of weakness does this patient exhibit?

2. The lesion that caused the motor function problem in this patient is located on which side of the brain? Why does it occur in this manner?

3. Given the history of this patient, what type of stroke did this patient have,

ischemic, or hemorrhagic? Please provide your rationale.

4. What is the relationship between atrial fibrillation, and the stroke

5. What other risk factors are identified for this patient and what is the relationship of these to a stroke?

6. Your patient’s wife tells you “My husband’s grandfather had a stroke and could not talk, but he could talk> My husband can not walk, but can talk. I do not understand Why?” The APN would address this issue in what manner? What information is shared?

7. The patient’s wife adds, the doctor said to call him if he suffered a TIA. I thought TIA’s go away. Why is this important and how will I know it is happening? The APN addresses this situation in what manner. What information will be shared?

8. How do adult strokes differ from pediatric strokes?

Case Study:

https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html

Examine
 Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

References:

· Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

· Chapter 8,  “Anxiety, Trauma, and Treatment” (pp. 359-378)

· American Psychiatric Association. (2010a). 

Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder
Links to an external site.
. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

· American Psychiatric Association. (2010c). 

Practice guideline for the treatment of patients with panic disorder
Links to an external site.
 (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf

 Michelle, a 21-year-old female, has been admitted informally to an acute mental health unit this is her first admission.  

Assignment topic for Communication:

Under the communication topic is the idea of advanced directives. The  advance directive idea has grown from basic forms that can be found in  the state statutes to very refined documents such as Five Wishes or  POLST or MOLST. But to start this topic we can access the Florida State  statutes and see what the State of Florida has to offer as a advance  directive. Here is the direct link to the Florida State Statute 765.101 https://www.caringinfo.org/planning/advance-directives/by-state/florida/ 

 Links to an external site. 

Scroll down to “Download Florida Advance Directive” This will give  you an idea about the contents of the standard State form using the  Florida one as an example. If you list the main parts it will give you  an idea about the types of choices these forms allow for which are not  exactly detailed or extensive in content. Now if you were to open a Five  Wishes form: https://www.fivewishes.org/five-wishes-sample.pdf 

 Links to an external site. and compare to the earlier State form it becomes obvious the difference. 

As a variation on the same theme there is also the POLST form which  also gives several choices as a type of advance directive form. This  will be our discussion for the communication module.

Assignment: Compare  the two methods of Advanced Directives, that is the State of Florida  form with either the Five Wishes or the POLST form and describe the  following:

a) What are the differences between the forms?

b) Why do you think that there are differences between the forms?

c) What is accomplished by the newer generation of advanced directive (eg. Five Wishes or POLST)?

d) Which form would you rather have as a patient? and why?

Your answer should be at least 300 words and have a reference to it.  You should comply with APA 7th ed guidelines and answer all of the  questions clearly and completely.