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MSN5270 Theories of Nursing Reflective Analysis Paper

Reflective Analysis: Theories of Nursing

Nursing practice has evolved and transformed from an era when patient care was hazy and met with illusory practices to the current epoch when care has advanced significantly. One of the ways that ancient caregivers could have an epiphany and gain a better understanding of various aspects of care was through the development of nursing theories. The middle-range nursing theories, which fall between the grand theories and the practice theories, are of particular interest.

The middle-range theories have fewer concepts and encompass a more limited range of reality; however, despite their immanence, they aid in explaining and understanding various aspects of care (Leandro et al., 2020). Throughout the course, I have had an incredible time moving from one theory to the next and applying each to a different aspect of patient care. In this reflective essay, I reflect on what I have learned throughout the course and incorporate some of my peers’ thoughts on some of the course issues.

Reflection on What I have Learned

Nurses play an important role in patient care delivery as well as knowledge development. I have had the opportunity to learn about the process of developing knowledge that influences nursing practice, all of which begin with a nursing theory. Some of the theories I have found particularly interesting and applicable in contemporary practice are attachment and comfort theories, as well as the concepts of proxy subjective healthcare status.

According to John Bowlby’s attachment theory, a child’s behavior is associated with the attachment figure, and the quality of the relationship, in terms of proximity to and the attachment figure’s behaviors, is responsible for future child’s behavior, thoughts, and actions (Ali et al., 2021). This has altered and influenced how child psychotherapeutic interventions are delivered, as well as aiding in the understanding of children’s personalities as they grow.

Also, during my rotation on the surgical ward, a patient scheduled for a breast lump excision expressed her concerns about the pain after surgery, potential complications, and cosmesis because she was newlywed. This prompted us to reach an agreement with her via a formal patient comfort contract, in which she expected pain-free post-surgery sprees, no or limited complications, and a return of cosmesis to near normal. The theory of comfort helped me understand that patients’ comfort is a highly valuable outcome of nursing care, and that ensuring it is a collaborative effort between the care provider, the patient, and family members.

Regarding proxy symptom reporting, it is true that a patient may be physically or mentally incapacitated to provide a history of illness. As a result, the assistance of a proxy is required, who is assumed to provide relevant information that would be close to the patient’s narration. This has made me appreciate the dynamics of life, in which a person may be critically ill, lack cognitive ability, or be unable to communicate, necessitating assistance with trivial matters such as speaking on their behalf.

Finally, I had the opportunity to hear some of my coursemates’ thoughts and perspectives on a variety of course topics. In one of their points of view, patient comfort extends beyond the hospital and into the patient’s home, with which I agree. This can be aided by providing a quiet environment, dimming the lights in the patients’ rooms, reminding them of their medications, turning them on the bed to prevent bedsores, and using music therapy (Khatri et al., 2020).

This was especially useful during the Covid19 period when home healthcare services increased exponentially. Moreover, a peer’s perspective on proxy reporting suggested that a proxy could be human or non-human. Indeed, a non-human intervention of patient assessment, the health-related quality of life (HRQoL) tool, is increasingly being used.

Conclusion

A reflective essay depicts one’s experience and feelings about an event. In this case, the experience I had with the course was impactful. I have learned about several aspects of knowledge development, with nursing theories as a starting point. While several theories were learned, I only included theories that directly impacted my clinical rotations in the various departments in this reflective assay, which are the theory of attachment and the theory of comfort, as well as the concepts of proxy subjective health status.

The perspectives of one’s peers are also important for maximizing understanding because they shape and sculpt one’s thinking. As a result of the course materials, educators, and classmates I had, my critical thinking has greatly improved.

References

Ali, E., Letourneau, N., & Benzies, K. (2021). Parent-child attachment: A principle-based concept analysis. SAGE Open Nursing, 7, 23779608211009000. https://doi.org/10.1177/23779608211009000

Khatri, P., Seetharaman, S., Phang, C. M. J., & Lee, B. X. A. (2020). Home hospice services during COVID-19: Ensuring comfort in unsettling times in Singapore. Journal of Palliative Medicine, 23(5), 605–606. https://doi.org/10.1089/jpm.2020.0186

Leandro, T. A., Nunes, M. M., Teixeira, I. X., Lopes, M. V. de O., Araújo, T. L. de, Lima, F. E. T., & Silva, V. M. da. (2020). Development of middle-range theories in nursing. Revista Brasileira de Enfermagem, 73(1), e20170893. https://doi.org/10.1590/0034-7167-2017-0893

Also Read:

Theory of Unpleasant Symptoms Essay

Theory of Nursing Reflection Instructions

Please reflect on what you have learn during the last 15 weeks throughout this course. Please include 400 words in your initial post with 2 scholarly references by Wednesday midnight. Please include 200 words in two answers to your peers by Saturday midnight.

1 Week : Making judgement as to whether a theory could be adapted for use in research is very important. Describe the internal and external criticism that is used to evaluate middle range
theories.

2 Week: Theory of Pain .

3 week: Theory of unpleasant symptoms .

4 Week: Theory of Self-Efficacy using the internal and external criticism evaluation process.

5 Week: Theory of Chronic Sorrow.

6 Week: Use of spirituality in nursing practice is not new. However, it is more studied and utilized in a more structured format in nursing. Identify and discuss tools used to evaluate spirituality.

7 Week: Analyze the potential effectiveness resulting from professional or nurse-provided social support versus enhancement of social support provided by personal relationship and social networks for parents of children with chronic mental illness.

Week 8: Middle Range Nursing Theory .

Week 9 :The surrogate role is not one that is frequently mentioned in recent nursing practice literature. Is that role as defined by Peplau relevant to nursing practice as currently experienced. If so, in what way. If not, why?

Week 10 :Based on the theory of attachment, what behaviors would a nurse attempt to stimulate when working with parent to promote health attachment?

Week 12 :Conducted a literature review on the use of integrative theory in clinical practice or research studies.

Week:13 Postsurgical overall comfort, and also where they can specify chronic discomforts and interventions that they use at home for relief.

Week 14 :Discuss the underlying assumptions and potential ramifications of having proxy subjective health status or evaluation measures for children or those unable to speak for themselves.

Week 15:

MSN5270 Theories of Nursing Reflective Analysis Paper Example 2

Self-Assessment Advanced Theoretical Perspective for Nursing

Advanced theoretical perspectives for the nursing class is the foundation of the formation of professional nursing. It provides a framework for nursing practices. Throughout this semester, this course helps me explore theories related to nursing which includes analyzing the philosophical underpinnings of nursing theories and critiquing nursing’s conceptual models, grand theories, and mid-range theories. This course also helps me understand the etiology of professional nursing and what it means to be an FNP.

One of the main topics this course encompasses is the middle-range nursing theory which is underlying the practice of nursing education and constitutes a tool for bridging the theory-practice gap and suggests approaches to generate active growth in nursing education to inform and promote optimal client health outcomes using concept linkages in theories. The middle-range nursing is bifurcated into nine sub-theory that describe the concepts of health, the nursing process, the nursing client, stressors, and responses.

They also identify the phenomena in which a nursing science should be concerned which include educational programs and nursing administration used, and the nursing workplace. The middle-range theory underlying structures of health care organizations and the social psychology of health and health care. The latter includes studies of stress, coping and social support, health and illness behavior, and practitioner-patient relationships.

This course also helps me develop a perfect understanding of the theory of pain. I have learned that pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Besides that, modern research considered evidence that supports the theory that pain is not only a physical phenomenon but rather a biopsychosocial phenomenon, encompassing culture, nociceptive stimuli, and the environment in the experience and perception of pain.

I have also learned about unpleasant symptoms and described the complexity of symptom experiences of the patients and how integrated nursing actions can be effectively managed. Three major concepts that have been developed throughout this theory are physical, spiritual, and psychosocial factors, which include dyspnea, pain, nausea, vomiting, anxiety, and hopelessness. The theory generates several applicable approaches to support nursing practice and research (Moore & Kenefick, 2022).

This course makes me understand nursing as a whole and how healthcare professionals can contribute to supporting our community by empowering health. Now, I know how to integrate nursing and related sciences into the delivery of care to clients across diverse healthcare settings and analyze quality initiatives to improve health outcomes across the continuum of care. I also understand the illness and disease management to provide evidence-based care to clients, communities, and vulnerable populations in an evolving healthcare delivery system (Advanced theoretical perspectives, 2022).

References

Moore and Kenefick, A. (2022). The Holistic Theory of Unpleasant Symptoms, Retrieved from

MRU., (2022). Advanced theoretical perspectives

MSN5270 Theories of Nursing Reflective Analysis Paper Example 3

Advanced Theoretical Perspectives for Nursing

The last 15 weeks have been very insightful, and I have learned many things that are useful in my nursing practice also in my personal life. I have learned that a theoretical perspective in nursing is crucial as it allows nurses to plan and implement proactive and purposeful care. A theoretical perspective allows users to practice systematically, making them more efficient in their practice, and as a result, they have better control of their outcomes.

With the changes in technology and patient needs, it has become necessary for nurses to offer patients personalized care that ensures that their needs are well met. Meeting patient needs cannot be met easily if a nurse does not have the best system to perform effectively. The course has taught me the importance of communicating with others in healthcare to ensure success. A nurse cannot work alone to obtain patient outcomes (Heinen et al., 2019). Still, they have to work alongside other professionals in healthcare and communicate with patients and their families to offer tailored care, improving patient outcomes.

The course has been very interactive through the different discussions we have had. The discussions have helped me understand my peers’ different perspectives, and they have all made me better in my discussions. The assignments have helped improve my research skills and how to incorporate the gathered research in my work and support my arguments. Nursing relies heavily on theories, and nursing theory helps nursing to understand their patients’ unique needs.

Advanced theoretical perspective in nursing help nurses to know what they can do and how to do it. Advanced theoretical perspective has given me foundational knowledge to enable me how to care for my patients. I have learned that I cannot approach different patient needs using the same approach, which is why I need to use the established guidelines for my practice and the issues I am handling, whether they are broad or specific.

The course has made me realize and appreciate the nursing theories designed to help improve the profession and understand why nurses and institutions employ different nursing theories in their practice. I will use the advanced theoretical perspectives to evaluate patient care and make the right decisions for the best nursing interventions based on the current situation (Mudd et al., 2020). As much as patient outcomes are of priority in emergencies, it is important to allow patients to express their control and independence in their care through their decisions.

References

Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of advanced nursing, 75(11), 2378-2392.

Mudd, A., Feo, R., Conroy, T., & Kitson, A. (2020). Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts. Journal of clinical nursing, 29(19-20), 3652-3666.

Theories of Nursing Reflective Analysis Paper Example 3 Student Response

A theoretical perspective in nursing enhances patient outcomes and quality care. Nursing philosophies have directed practice in western and eastern nations and are more practical than traditional nursing practices. Nurses should practice based on the nursing theories’ perspectives as they assess the usefulness of nursing theory-led practice. A theoretical perspective enables users to practice systematically and control outcomes better.

Good communication is also crucial in healthcare and augments efficiency. Effective and open communication among nurses promotes success and better decision-making. Successful communication amongst nurses and other healthcare professionals promotes care coordination and continuum. The form of the nurse-doctor relationship and internal communication’s efficacy contributes to the eminence of patient care (Amudha et al., 2018).

Coordinated care applies far-reaching approaches such as care management and teamwork and detailed coordination actions like assessing patient requirements and goals and making a practical care plan. Care coordination, if well-planned and targeted, is a strategy to progressing the health care system’s safety, practicality, and proficiency.

Nursing theories facilitate nurses’ understanding of their patients’ needs. Essentially, theory-based nursing applies numerous philosophies, concepts, and models from nursing science to clinical practice. Nursing theories integrate grand, middle-range, and micro-range theories. Micro-range theories provide outlines for possible results, implementation basis, and nursing practice impacts. Nursing theories are practical in nursing education because they direct and define nursing care, encourage evidence-based practices, and offer a foundation for clinical decision-making.

Nursing theories progress practice by positively impacting the patient’s health and life quality. Middle-range philosophies support nurses in accomplishing their goals of leading all-inclusive nurse research (Risjord, 2019). Middle-range models help nurses comprehend their roles, contributing to nursing education. Nursing theories provide nurses with the groundwork in making healthcare verdicts, direct evidence-based research and practice, and simplify learning.

References

Amudha, P., Hamidah, H., Annamma, K., & Ananth, N. (2018). Effective communication between nurses and doctors: Barriers as perceived by nurses. J Nurse Care, 7(03), 1-6. DOI: 10.4172/2167-1168.1000455

Risjord, M. (2019). Middle?range theories as models: new criteria for analysis and evaluation. Nursing Philosophy, 20(1), e12225. https://doi.org/10.1111/nup.12225

MSN560 University Access Cost and Quality for APNs Discussion

MSN560 University Access Cost and Quality for APNs Discussion

• Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1 Vocabulary of Quality Please see chapter attached).
• The student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.

Length: 4 pages, double-spaced, excluding title and reference pages (required)

Chapter 24 of Joel, L.A., (2018). Advanced practice nursing. Essentials for role development (4th Ed.). Philadelphia, PA: F.A. Davis. [ISBN-13: 978-0-8036-6044-1]

Format: APA 6th Edition

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MSN560 University Access Cost and Quality for APNs Discussion Learning Outcomes

Learning outcomes expected as a result of this chapter:

• Describe the value, quality, and accountability context surrounding advanced practice registered nurse (APRN) practice.
• Understand APRN performance expectations in general and those specific to specialty practice.
• Develop quality and performance measures for use in practice at the individual, group, systems, and societal levels.
• Demonstrate the ability to design a model for assessing structures, processes, and outcomes within a framework of national standards.
• Plan actions to enhance the APRN impact in patient care, education, research, administration, and advocacy or policy.
• Chapter 24 • Measuring Advanced Practice Nurse Performance 367

MSN560 University Access Cost and Quality for APNs Discussion Introduction

Performance measurement in the health-care system is ubiquitous and complex. Whomever the provider, whatever the geographic location, whatever the setting, whatever the organization, whomever the stakeholder, whomever the payer, advanced practice nurses (APNs) can expect to have their performance evaluated.

APNs, along with other individuals and organizations, must demonstrate that their performance enhances the triple aims of improving care experiences for patients and families, improving the health of populations, and reducing the per capita costs of health care (Berwick, Nolan, & Whittington, 2008).

As Whittington, Nolan, Lewis, and Torres (2015) suggest, the triple aims are an integral part of the United States’ strategies to improve health outcomes and health care. These aims provide a framework for state and federal initiatives and the work of credentialing, accrediting, and regulatory agencies at all levels influencing the organization, delivery, and financing of health-care services.

To improve care experiences, individual patients and families are encouraged to become more engaged in care and to participate in planning and assuring they receive quality, safe care. To improve outcomes for population health, providers and communities are expected to transform the organization and delivery of services.

To reduce health-care costs, care providers and payers are engaged in payment reforms and developing more cost-effective interventions. Reimbursement structures are also being modified. These aims are influenced by several trends related, in part, to the implementation of the Patient Protection and Affordable Care Act (PPACA; Public Law [PL] 111-148) and subsequent policy and administrative changes.

Trends and issues include increased access and, thus, more demand for services; drug pricing; mergers of providers, organizations, and insurers; technologies such as telehealth and mobile apps; and data security (Blumenthal, Abrams, & Nuzum, 2015; Lorenzetti, 2015). Superimposed on all these changes—and influencing them—are political and power issues.

Given the demands facing the health-care system, the voice of nurses and the leadership of APNs are essential to meet our professional and societal obligations to improve health and health care. APNs are uniquely positioned to contribute critical knowledge, skills, and attitudes, as well as their values of civic professionalism and compassion, to political and decision-making dialogues.

The purpose of the health-care system is to continuously reduce the impact and burden of illness, injury, and disability and to improve the health and functioning of the people of the United States. Although providing direct care and influencing the direct care provided by others are necessary work and contribute to meeting this goal, they are not sufficient to meet growing professional and societal quality and accountability demands.

By demonstrating their contributions; continuously improving their performance; and being accountable to the profession, employers, and the public for all components of their role, APNs can make a difference.

As the nurse moves from novice to expert, responsibility for and accountability to self and others for the structures, processes, and outcomes of health care increase proportionally. Achieving the status of APN is not a terminal event and the role assumes ongoing and increasing professional and societal obligations.

Responsibility for meeting the triple aims means that the APN must serve the profession and society as a primary agent contributing at the level of individual care, in the practice setting, and at the tables where organizational and public policies are made and implemented. In addition, the professional and societal trust afforded to the APN obliges meaningful contributions—beyond individual patient care—to meet the purpose of the health-care system.

APNs must not only do good, they must demonstrate their value to society through performance assessment and its documentation and dissemination at every level of care and decision making so their voices are heard. The importance to health outcomes, the profession, and society cannot be underestimated or ignored. The Case for Accountability Why should APNs be concerned about these issues?

A Web search of the terms health care AND accountability resulted in more than 130 million hits. This reflects the importance of this issue in our society. The search revealed that accountability for the quality and costs of health care—its value—are of interest to consumers, purchasers/payers, employers, insurers, the government, and professional provider organizations.

Although the demand for accountability for the value of health care is not new, growing complexity and changes in the health-care 368 Unit 4 • Ethical, Legal, and Business Acumen of pay-for-performance determinations. The Institute of Medicine (IOM) (1999, 2001, 2006) identified problems with the quality of care and safety concerns that continue to be reported in the literature.

Reports of consumer satisfaction or experience with the health-care system, such as those of the Commonwealth Fund (Commonwealth Fund, 2016b; Davis et al, 2002), found that patients were not satisfied with the quality of care they were receiving and reported continuing concerns on their summaries of assessment data.

Hero, Blendon, Zaslavsky, and Campbell (2016) found that concerns about access to preferred care were a major concern. Managed care, cost concerns, and the growing consumer movement in health care have increased the demand for information about the value (quality in relation to cost) of health-care services and the performance of health-care providers in delivering quality, cost-effective services across all components of the health-care system.

Led by advocacy organizations, consumers are demanding greater accountability from health-care providers and the health-care system. They want quality, cost-effective services delivered from a patient-centered perspective. Federal and state government agencies and other purchasers want to know if the services they pay for are achieving the best possible outcomes at the best price.

Organizations that accredit health-care organizations are increasingly seeking evidence that the structures and processes of care produce positive health outcomes. All these demands to demonstrate and be accountable for value- and cost-effective high-quality care require individuals and groups of providers to measure performance and share their assessments with stakeholders.

Organizations such as the National Committee for Quality Assurance (NCQA), the National Quality Forum (NQF), The Joint Commission (TJC), and several agencies of the federal government lead efforts to measure and report on the quality of care provided by various health-care system components.

Federal and state agencies, independently and in collaboration with private sector organizations, are collecting and disseminating information about the quality of services provided by the health-care system’s various providers. Health-care “report cards” are mechanisms widely employed to address the concerns of consumers, payers, employers, and others about the quality of health care being provided.

Report cards are done for hospitals, system raise the issue to a level that cannot be denied or minimized. This demand requires the APN to measure and disseminate information on the value of the role. Nurses in advanced practice, similar to other providers and health-care system components, need knowledge and skills to assess and measure quality and determine the costs of their services if they are to demonstrate value.

It is not enough to “do good”; the APN must demonstrate how “doing good” translates into outcomes and costs. Accountability for practice has been and continues to be embedded in APN standards, education, and position descriptions. As Buerhaus and Norman (2001) suggest, the improvement of health-care quality is an “authentic commitment” (p. 68) for all stakeholders and will shape how health-care services are delivered.

Given the definition of advanced practice and its role components, APNs must contribute to and lead broad efforts to improve quality. Their actions in defining, measuring, and reporting on their performance will determine their future and that of the health-care system. The advanced practice framework includes patients, health care, nursing, and individual outcomes.

Thus, the APN is accountable for performance in all these domains. These concepts and obligations are further reflected for the graduate-level student (American Association of Colleges of Nursing [AACN], 2011).

Prepared at this level, the nurse is expected to have advanced role skills, possess refined analytical skills, operate from a broad-based perspective, have the ability to articulate views and positions, and connect theory and practice. He or she is expected to engage in quality and safety initiatives and collaborate inter-professionally to improve patient and population health outcomes.

The Quality Context If the health-care system is to reduce the effect and burden of illnesses, injuries, and disabilities and improve outcomes and functioning, all involved in the system must be responsible for identifying and improving the structures and processes for achieving positive outcomes. Research has shown that consumers and society are not getting what they want or need from the health-care system.

Errors continue to occur and patient experiences with care continue to be issues with outcomes becoming part Chapter 24 • Measuring Advanced Practice Nurse Performance 369 health plans, and provider groups with the intent of informing consumers and improving quality. Public reports of health-care quality are done by state and federal governments and private sector organizations.

Implementation of the PPACA has resulted in greater reporting at the state and federal levels. Although these reports, especially those related to patient satisfaction and experience with care, remain controversial (Rosen & Chen, 2016), they are being widely reported and linked to pay-for-performance initiatives.

Quality in service is demanded by anyone seeking that service. This is especially true for health-care services, both by the person receiving services and also for regulating bodies. Nurses must recognize the part they play in quality and safety in an obvious way, measuring, reporting, and articulating their role.

The importance of quality and safety is evident in the APN Consensus Document (NCSBN, 2008) that articulates the parameters and standards for licensure, accreditation, certification, and education (LACE). The APN’s performance will be measured and reported; thus, he or she must be engaged in determining best practices to meet patient and outcome expectations.

Values and Value in Health Care To contribute effectively to fulfilling the purpose of the health-care system, the APN needs a clear vision derived from personal and professional values. The APN needs to embrace society’s mandate for health-care value and clarify how the quality and cost issues relate to personal and professional goals.

Explicit incorporation of quality and cost values and critical thinking about these issues will result in actions and activities consistent with social demand. Therefore, the APN role can be justified and the needs of society will be better served. APNs will be well positioned to provide leadership in affecting quality and costs, the “bottom line” of health-care system performance.

To be effective leaders and advocates for value issues associated with patients and the role, the APN must know and appreciate what other stakeholders want. Thus, it will be easier to understand their behavior and thinking about health and health care and to develop and implement strategies to address value conflicts, thereby resulting in better health-care outcomes.

For example, the APN’s employer may value reducing costs to ensure organizational survival, whereas the APN’s highest value is meeting the diverse needs of patients served by the organization. Negotiation, compromise, and collaboration are necessary to incorporate both values into strategic planning efforts. Awareness of the importance of values, understanding the value equation, and possessing the skills to address value conflicts are critical for APN survival and health-care system improvement.

The purposes of this chapter are to introduce APN students to quality frameworks, performance measurement, and accountability and to suggest approaches to current issues and responses to trends. For the graduate APN, this chapter can enhance knowledge and skills that will promote the quality activities, better demonstrate accountability, and foster actions to justify the role of the APN in meeting societal demands for quality, cost-effective health care.

The complexity of the quality movement and the value equation are discussed. As the health-care system becomes increasingly complex, as stakeholders’ values and visions clash, and as there is growing dissatisfaction with the health-care system, APN leadership is critical. The challenge to establish value and be accountable at all levels may appear daunting, but it is exciting and potentially rewarding for the APN, the profession, and our society.

MSN560 University Access Cost and Quality for APNs Discussion: The Quality Environment

Beginning with Florence Nightingale, nursing has always given attention to quality issues. Despite our historical roots as leaders in this area, the profession has drifted to a more internal, narrow perspective. Until recently, this mirrored the attention our society gave to the quality of health care.

In the United States especially, the values of individualism and self-determination, science and technology, a disease and medical focus, the free-market economy, and nongovernmental interference shaped both the structures and processes of the health-care system, thus influencing its outcomes. Access and cost issues have, until recently, received more attention than quality, particularly at the societal level.

As cost concerns increased and new delivery systems—such as managed care—were implemented, greater attention focused on quality and value. In addition, industry and quality theories and practices in business suggested that lessons learned in these arenas could be applied to the health-care sector. 370 Unit 4 • Ethical, Legal, and Business Acumen practice behavior, collaboration, and APN satisfaction.

The outcomes related to APN structures and processes include mortality, morbidity, patient knowledge, patient satisfaction, service use, and health status. Quality of care can be viewed from a micro or macro perspective. At the micro level, quality is conceptualized and assessed for the patient, the provider, or the institution. Clinical and technical care, satisfaction with care, and quality of life represent components of a micro view (Shi & Singh, 2005).

MSNFP6016 Capella University Quality Improvement Initiative Evaluation

MSNFP6016 Capella University Quality Improvement Initiative Evaluation

Overview

Deliver a 5–7-page analysis of an existing quality improvement initiative at your workplace. The QI initiative you choose to analyze should be related to specific disease, condition, or public health issue of personal or professional interest to you.

Too often, discussions about quality health care, care costs, and outcome measures take place in isolation—each group talking among themselves about results and enhancements.

Because nurses are critical to the delivery of high-quality, efficient health care, it is essential that they develop the proficiency to review, evaluate performance reports, and be able to effectively communicate outcome measures related to quality initiatives.

The nursing staff’s perspective and the need to collaborate on quality care initiatives are fundamental to patient safety and positive institutional health care outcomes.

Context

The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Nurses and other health professionals with specializations and/or interest in the condition, disease, or the selected issue are your target audience.

MSNFP6016 Capella University Quality Improvement Initiative Evaluation Assessment Instructions

PREPARATION

You have been asked to prepare and deliver an analysis of an existing quality improvement initiative at your workplace. The QI initiative you choose to analyze should be related to a specific disease, condition, or public health issue of personal or professional interest to you. The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics.

Your target audience consists of nurses and other health professionals with specializations or interest in your selected condition, disease, or issue. In your report, you will define the disease, analyze how the condition is managed, identify the core performance measurements used to treat or manage the condition, and evaluate the impact of the quality indicators on the health care facility:

Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

Analyze a current quality improvement initiative in a health care setting.

• Evaluate a QI initiative and explain what prompted the implementation. Detail problems that were not addressed and any issues that arose from the initiative.

Evaluate the success of a current quality improvement initiative through recognized benchmarks and outcome measures.

• Analyze the benchmarks that were used to evaluate success. Detail what was the most successful, as well as what outcome measures are missing or could be added.

Incorporate interprofessional perspectives related to initiative functionality and outcomes.

• Integrate the perspectives of interprofessional team members involved in the initiative. Detail who you talked to, their professions, and the impact of their perspectives on your analysis.

Recommend additional indicators and protocols to improve and expand quality outcomes of a quality initiative.

• Recommend specific process or protocol changes as well as added technologies that would improve quality outcomes.

Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.

Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

SUBMISSION REQUIREMENTS for MSNFP6016 Capella University Quality Improvement Initiative Evaluation

• Length of submission: A minimum of five but no more than seven double-spaced, typed pages.
• Number of references: Cite a minimum of four sources (no older than seven years, unless seminal work) of scholarly peer reviewed or professional evidence that support your interpretation and analysis.
• APA formatting: Resources and citations are formatted according to current APA style and formatting.

MSNFP6016 Capella University Quality Improvement Initiative Evaluation Sample Paper

Quality Improvement Initiative Evaluation

As primary caregivers and care coordinators, nurses play important roles in ensuring quality and safety in patient care. In fact, health care organizations rely on nurses’ knowledge and insight to design and implement quality improvement (QI) initiatives. However, QI initiatives tend to focus solely on patients’ well-being, creating a stressful work environment for nurses.

As a result, nurses suffer from poor nursing outcomes such as burnout and job dissatisfaction that can affect their ability to achieve QI goals. Hence, to ensure a QI initiative’s success, the quality of a nurse’s work environment has to be improved. The importance of nursing quality in a successful QI initiative will be discussed using the example of TrueWill General Hospital (TGH), a multispecialty hospital in the United States.

The hospital launched a QI initiative with the goal of improving patient safety, and thereby patient outcomes, in its medical and surgical units. The initiative’s framework was based on the Institute for Healthcare Improvement (IHI) Triple Aim, which is an approach to optimize health system performance by the simultaneous pursuit of three aims (IHI, n.d.).

However, early evaluations showed that the initiative led to poor nursing outcomes. As nursing performance declined, patient outcomes deteriorated as well, which contradicted the initiative’s goal.

In the QI initiative evaluation, the units’ nursing workforce will be analyzed for quality issues that may have been caused by the Triple-Aim-based initiative. The objective is to examine how nursing quality influences patient outcomes, which patient outcomes are most affected, and what quality benchmarks or measures are relevant to the success of the QI initiative.

Based on the findings, the report will recommend more protocols and indicators that will overhaul the QI initiative and improve the initiative’s clinical and organizational outcomes.

Analysis of the Quality Improvement Initiative

The QI initiative at TGH started with a series of reforms to promote the three Triple Aim goals to address existing safety issues in the medical and surgical units. The Triple Aim’s three goals—improve the health of the population, improve patient experiences, and reduce per capita cost of health care (IHI, n.d.)—were implemented in primary care or care given by nurses and physicians.

Initially, the hospital achieved QI benchmarks in the medical and surgical units— adverse events decreased, patient satisfaction increased, resources and infrastructure utilization optimized, and health care costs reduced. However, the Triple Aim’s patient-centric goals overworked the units’ nurses and put them under a lot of stress.

They had trouble balancing their clinical duties with other aspects of their jobs such as mentoring new staff, undertaking self- improvement plans, auditing the units, and compiling reports for the senior management.

High levels of job dissatisfaction among the units’ staff, especially nurses, affected their ability to ensure quality in patient care, which had costly implications on the hospital such as high nursing turnover rates and shortages in the units. As a result, the existing nursing staff were unable to manage their patient panels, forcing them to work longer hours in the units.

Delays in the review and follow-up of laboratory results increased the length of inpatient and outpatient stays and burdened the limited facilities and resources such as beds and medical equipment.

Burnout reduced the nursing staff’s adherence to treatment plans and made them less empathetic toward patients. The overworked nurses were also unable to notice important changes in their patients’ conditions (Bodenheimer & Sinsky, 2014).

The analysis of the QI initiative reveals the fact that an inefficient initiative can adversely affect nursing outcomes, which is detrimental to quality care and patient safety. The quality of the analysis can be improved with more data that bridge knowledge gaps or areas of uncertainty. For example, the data gathered from early evaluations do not provide details about the educational qualifications of the nursing workforce or the kind of training they have received.

Hospitals with inadequately trained nurses and unlicensed nurses have more patient safety issues and poorer staff outcomes. Furthermore, early evaluations do not mention the hospital’s investments in improving the quality of nursing staff and other primary care providers (Aiken et al., 2014). Further evaluation can bridge these gaps in knowledge and provide evidence that supports the QI initiative’s improvement.

The next step in the evaluation is assessing the success of the QI initiative against recognized measures, outcomes, and benchmarks. The evaluation will also justify why nurses are the most relevant staff group to the QI initiative’s success using certain assumptions about nursing. Concepts such as quality in nursing and indicators of quality will be explored as well.

Evaluation of the Quality Improvement Initiative Against Standard Benchmarks and Outcomes

A crucial point revealed in the analysis of the QI initiative is that a majority of the nurses in the medical and surgical units felt dissatisfied with their jobs because of overwork. Poor nursing outcomes at TGH are symptomatic of quality issues in the hospital’s nursing workforce. Therefore, prioritizing the quality of nursing is the first step to a successful QI initiative.

The statement is supported by certain assumptions about the value of nursing in achieving better patient outcomes:

• Nurses are the largest workforce in any health care setting and deliver most of the bedside patient care (Stalpers, de Brouwer, Kaljouw, & Schuurmans, 2015)
• Negative nursing outcomes reduce nursing quality, which can be improved by changing the work environment
• Poor nursing outcomes cause similar outcomes in other health care professionals as the latter depend on nurses to a large extent
• Improved nursing quality translates to improved quality of care and patient safety and depends on factors such as strong leadership, adequate staffing and infrastructure, and high standards in nursing education (Huber, 2017).

Guided by these assumptions, TGH evaluated the initiative using the IHI’s plan-do-study- act model (PDSA), which is a simple model that focuses on setting aims and selecting or developing benchmarks, outcomes, and measures that indicate if a new process or product resulted in improvement (Agency for Healthcare Research and Quality, 2017).

The PDSA’s cycle of systematic steps are as follows:

• Plan—involves developing goals and action plan
• Do— involves selecting measures to monitor progress
• Study—involves testing and refining actions on a small scale
• Act—involves expanding implementation to achieve sustainable improvement.

In accordance with the PDSA model, nursing quality was evaluated across three measures—structure, process, and outcomes—to understand neglected patient outcomes. The hospital focused on nurse-sensitive outcomes in patients—delirium, malnutrition, pain, patient falls, and pressure ulcers—that are the benchmarks of nursing quality (Stalpers et al., 2015).

Nurse-sensitive outcomes describe patient outcomes that rely on the quantity and quality of nursing. Additionally, the three measures are made up of nurse-sensitive quality indicators, which are indicators that quantify quality and capture nurse-sensitive outcomes (Heslop & Lu, 2014). These indicators are separate from medical indicators of care quality and are specific to nursing (Montalvo,2007).

The quality indicators were adapted by TGH for internal use in its medical and surgical units from the American Nurse Association’s National Database of Nursing Quality Indicators (NDNQI) and the National Quality Forum’s NQF 15.

Examples of some of the nurse-sensitive quality indicators used in the QI evaluation include

• Total number of nursing hours per day
• Details about nurse staffing—skill mix and staff ratios
• Records of patients’ characteristics
• Documentation of care plans by nurses
• Rate of adverse events
• Patients’ length of stay and level of satisfaction with care
• Average waiting time for nursing care (Heslop & Lu, 2014).

Using these nurse-sensitive indicators in the evaluation allowed TGH to determine the nursing structures and processes that were underperforming and needed improvement.

The evaluation revealed three nurse-sensitive patient outcomes occurring in the units— pain, patient falls, and pressure ulcers—that directly result from a fall in nursing quality and are evidence of an unsuccessful QI initiative. To form a better understanding of quality in nursing and nursing care, certain interprofessional perspectives on initiative functionality and results must be identified. Examining the perspectives will help ascertain the underlying factors in health care that nursing depends on to function well.

Interprofessional Perspective on Initiative Functionality and Outcomes

Various studies have attempted to understand the different processes and systems driving nursing quality and nursing care. These studies have become more relevant in health care because of the shortage of nurses globally. One perspective that is important in TGH’s context is acknowledging the phantom limb (Spinelli, 2013) of the Triple Aim.

In his groundbreaking study, Spinelli observed that the Triple Aim suffers from a phenomenon similar to the condition wherein patients experience twitching, pain, or other sensations in a previously amputated limb. By solely focusing on the quality of patient experience, the Triple Aim isolated and ignored the well-being of the health care professionals who are directly responsible for delivering care.

The phantom limb pain often manifests as job dissatisfaction and burnout (Spinelli, 2013) and is an important factor behind the functionality and type of outcomes in a QI initiative.

Another perspective that is a deciding factor in the success or failure of a QI initiative is organizational leadership. Health care professionals, including nurses, depend on their organizational leaders and management to organize and improve human resources, infrastructure, patient policies, and lines of communication and health technologies that help with the smooth functioning of an initiative (Huber, 2017).

Inadequate or inefficient leadership and management can be responsible for stressful working conditions that result in job dissatisfaction and overwork, leading to staff burnout.

The third perspective relevant to TGH’s nursing workforce and optimum QI performance is nursing characteristics. These characteristics are factors such as nursing leadership, staffing, nurse–physician collaborations, nurse experience, and nurse education that are inherent to the nursing work environment and influence nursing quality.

These characteristics should function properly for attaining good patient outcomes (Stalpers et al., 2015). The staffing characteristic also addresses problems caused by unlicensed nurses. The subject of unlicensed nursing is central to another perspective of functionality: nursing regulations.

Often, regulatory barriers prevent nurses from providing quality care for their patients. The lack of regulatory standardization on the ideal ratios of unlicensed nurses to unlicensed nurses causes confusion among health care professionals and increases chances for malpractices such as negligence.

Moreover, regulations do not offer any guidance on the definition and scope of nursing practice. The lack of clarity means that nurses are unsure about the boundaries of professional practice (Owsley, 2013) and become vulnerable to committing errors. These problems suggest a need for regulatory reform in nursing.

Even though these perspectives are valid in today’s health care context, there are areas of uncertainty. Hospitals are often unable to address the Triple Aim’s phantom limb and improve nursing quality because that would result in an increase in health care costs, which is borne by patients. Training, updating infrastructure, hiring more licensed nurses over unlicensed nurses, and redesigning units and staffing patterns need financial support and time, which can affect per capita health care costs and patient satisfaction.

Additionally, the lack of clarity on the scope of practice limits nurses’ opportunities for self-improvement. Nurses may feel discouraged from using their intuitiveness and creativity to go beyond their professional competencies if such actions benefit their patients.

The field of nursing and QI will benefit from separate studies that add to the current literature and bridge gaps in knowledge. The expanding evidence base provides opportunities for innovation in QI in the form of improved quality indicators, measures, and strategies.

Correspondingly, the QI evaluation will use the evidence to recommend additional indicators and protocols to improve and expand the outcomes of the initiative.

Additional Indicators and Protocols to Improve Quality Outcomes

Nurses need to practice in an environment where providing safe care is a conscious act. As part of the fourth and final step of the PDSA model, the initiative’s indicators and protocols will be expanded to achieve sustainable improvement. TrueWill General Hospital’s QI initiative, which was based on the Triple Aim framework’s goals of quality care and safety, affected nurses’ abilities to achieve patient outcomes.

The QI framework can be improved by introducing a fourth dimension to solve the problem of the phantom limb. The resultant Quadruple Aim will address the needs and expectations of those individuals who deliver care for patients (Bodenheimer & Sinsky, 2014).

A few strategies can promote the Quadruple Aim:

• Expanding nursing roles to assume preventative care under physician-written standing orders
• Collocating teams so that physicians, nurses, and ancillary staff work in the same space, thereby improving collaborative relationships
• Implementing team documentation, where staff members involved in a patient’s care enter documentation, assist with order entry, and process prescriptions
• Avoiding burnout by training staff and eliminating unnecessary steps in practice (Bodenheimer & Sinsky, 2014).

Apart from these strategies, TGH can benefit from evidence-based quality care and patient safety protocols such as those mentioned in the National Patient Safety Goals (NPSG). Examples of the NPSG’s categories include introducing steps to identify patients correctly, improving the effectiveness of communication among caregivers, improving the safety of high- alert medications, and reducing the risk of health-care-acquired infections.

Orienting medical and surgical units to the NPSG helps improve nursing quality and nurse-sensitive patient outcomes. A well-functioning unit and nursing workforce, in turn, increase job satisfaction among all staff and lower the risk of burnout (The Joint Commission, 2016).

The changes to TGH’s QI initiative should be supplemented with appropriate nurse- sensitive indicators. The additional indicators will ensure that organizational or clinical changes do not eclipse the needs of the health care professionals, especially nurses.

The nurse-sensitive indicators can be described as follows

• Level of nurse education, certification, and years of experience
• Nursing competency level and support by leadership
• Level of positive communication between physicians and nurses
• Extent of organizational support for nurse education
• Availability of facilities and budget for quality nursing care
• Level of nurse satisfaction with their jobs
• Safety of nursing job
• Rate of nurse turnover and voluntary vacancy (Heslop & Lu, 2014).

While the benefits of implementing the strategies, protocols, and indicators are evident, the drawbacks of including them in TGH’s QI initiative need to be discussed. The main drawback is the fact that these solutions come with a risk of widening the gap between society’s expectations of quality and safety in primary care and primary care’s available resources.

The risk is equally great if the emphasis on the well-being of health care professionals comes at the expense of patients’ needs (Bodenheimer & Sinsky, 2014). Health care professionals at TGH have to ensure that any changes in the hospital’s system benefit all stakeholders.

Conclusion

Quality improvement initiatives carry a large risk of failure if the goals and expectations of different stakeholders do not align. Nursing professionals are crucial to achieving the objectives of quality care and patient safety. Devaluing the nursing workforce and implementing policies or programs that cause nurse dissatisfaction are detrimental to QI efforts, which was the case at TrueWill General Hospital.

Nursing outcomes also affect the productivity of the entire unit and the competencies of other health care professionals who rely on nurses for help in completing the delivery of quality patient care. It is important to remember that quality health care services are a product of a symbiotic relationship between the care providers and patients.

MSNFP6016 Capella University Quality Improvement Initiative Evaluation References

• Agency for Healthcare Research and Quality. (2017). Section 4: Ways to approach the quality improvement process. In The CAHPS ambulatory care improvement guide: Practical strategies for improving patient experience. Retrieved from https://ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi- process/sect4part2.html#4c
• Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., . . . Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824– 1830. Retrieved from https://search-proquest- com.library.capella.edu/docview/1527455250?pq- origsite=summon&https://library.capella.edu/login?url=accountid=27965
• Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. Retrieved from https://ncbi.nlm.nih.gov/pmc/articles/PMC4226781/
• Heslop, L., & Lu, S. (2014). Nursing-sensitive indicators: A concept analysis. Journal of Advanced Nursing, 70(11), 2469–2482. Retrieved from http://onlinelibrary.wiley.com.library.capella.edu/doi/10.1111/jan.12503/full
• Huber, D. L. (2017). Leadership and nursing care management (6th ed.) Philadelphia: W.B. Saunders. http://dx.doi.org/10.7748/nm.21.6.13.s14
• Institute for Healthcare Improvement. (n.d.). The IHI Triple Aim. Retrieved from http://ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
• Montalvo, I. (2007). The national database of nursing quality indicators(TM) (NDNQI®). OJIN: The Online Journal of Issues in Nursing, 12(3). Retrieved from https://search-proquest- com.library.capella.edu/docview/229585708?pq- origsite=summon&http://library.capella.edu/login?url=accountid=27965
• Owsley, T. (2013). The paradox of nursing regulation: Politics or patient safety? Journal of Legal Medicine, 34(4), 483–503. Retrieved from http://web.b.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=e0 d93d8f-1115-438c-af38-91b8ba53cba4%40sessionmgr103
• Spinelli, W. M. (2013). The phantom limb of the triple aim. Mayo Clinic Proceedings, 88(12), 1356–1357. https://dx.doi.org/10.1016/j.mayocp.2013.08.017
• Stalpers, D., de Brouwer, B. J. M., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of literature. International Journal of Nursing Studies, 52(4), 817–835. Retrieved from http://sciencedirect.com.library.capella.edu/science/article/pii/S0020748915000061?_rdo c=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa 92ffb&ccp=y
• The Joint Commission. (2016). National patient safety goals effective January 1, 2016: Hospital accreditation program [Government report]. Retrieved from The Joint Commission website: https://jointcommission.org/assets/1/6/2016_NPSG_HAP.pdf

MSU Social Determinants of Health Assignment

College of Nursing and Health Sciences F 23

Evidence-Based Discussion Forum 1: Social Determinants of Health

15 Points

GOAL: Students explore the impact of the social determinants of health that result in health inequities among at-risk and marginalized populations in order to identify social justice and advocacy actions they might take to mitigate health inequities.

OBJECTIVES:

1. Describe the social determinants of health.
2. Identify the impact of the social determinants of health on at-risk and marginalized populations and resulting health inequities.
3. Identify social justice and advocacy actions that could be taken by the nursing profession in collaboration with others to reduce or eliminate the health inequities that are a result of one or more social determinants of health.
4. Propose actions you might take to become more aware of the impact of social determinants of health if you are working in one of the PHN/CHN specialty roles.

DIRECTIONS:

1. READ AND VIEW
   296. Read Schoon & Porta, (2024). Chapter 13, Evidence of Commitment to Social Justice, pp. 285-296.
   297. Review Healthy People 2030 Social Determinants of Health content at Social Determinants of Health – Healthy People 2030 | health.gov. Read about the five domains of the SDOH and some of the related evidence (research) and efforts to address the SDOH in different communities.
   298. See D2L Module 2/Week 2 Social Determinants of Health Expanded folder.

• Review the Social Determinants of Health (Schoon) power point presented in Week 1 class.
• Review one or more of the additional CDC SDOH websites:
  1. SDOH Public Health Actions
  2. Public Health Professionals Gateway

• Equitably Addressing Social Determinants of Health and Chronic Disease.

1. Review University of Kansas. (2020). Community Toolbox – Addressing Social Determinants of Health and Development at

Chapter 17. Analyzing Community Problems and Solutions | Section 5. Addressing Social Determinants of Health and Development | Main Section | Community Tool Box (ku.edu)

1. See D2L Module 2/Week 2 PHN/CHN Specialty Roles.

1) View the PHN/CHN power point (Eardley & Schoon, 2022).

2) Review the two additional resources on school health.

2. Review Grading Rubric criteria before writing post.

3. Post your responses in D2L Open Discussion Forum: EBDF 1 Social Determinants of Health (This discussion forum is open to all class members).
   1. Individual Post

Respond to the questions below in the open discussion forum:

1. Describe the social determinants of health as defined and how they are organized into different segments. Discuss the disparate impact they have on one or more specific at-risk and marginalized populations. Cite Healthy People 2030 Social Determinants of Health and Schoon & Porta textbook.
2. Discussed one or more social justice and advocacy actions that could be taken by the nursing profession in collaboration with others to reduce or eliminate the health inequities that result from specific social determinants of health with citations from textbook, one or more of the additional SDOH websites, and the Community Toolbox.
3. Identify a PHN/CHN specialty role and the at-risk population served by nurses in that PHN/CHN specialty role. Describe at least two SDOH that affect the health status of that at-risk population and the impact of these SDOH on the health status of that population. Make sure you have reviewed the power point by Eardley & Schoon on PHN/CHN specialty roles.
4. Discuss one or more social justice and advocacy actions that could be taken by you if you were practicing in the specialty role you identified to reduce the negative impact of the SDOH on your clients/patients. How would you work collaboratively with others to reduce or eliminate the health inequities experienced by that at-risk population? Cite Chapter 13 in your textbook and the Community Toolbox.

• Cite sources of information and include a Reference List in APA format.

1. Peer Review Response Postings

1. Respond to two classmates who have selected a different PHN/CHN specialty role.
2. Compare one or more points from your initial discussion with the initial discussion of two of your peers.
3. Compare how the social determinants of health affected the health of the at-risk populations your peers discussed with how the social determinants of health impacted the population you discussed.
4. Compare the social justice and advocacy actions you identified for your at-risk population with the advocacy and social justice advocacy actions of your peers.
5. Cite sources of information and include a Reference List in APA format.

NURS 459 EBDF Social Determinants of Health Grading Rubric

Student:                                                          Instructor:            

Grade: ____/15

1.    Described the social determinants of health and impact they have on different at-risk and marginalized populations with citations from textbook, Healthy People 2030 and/or Community Toolbox. (2 pts.)

2.    Discuss important points your learned from one or more of the following websites: SDOH Public Health Actions, Public Health Professionals Gateway, Equitably Addressing Social Determinants of Health and Chronic Disease. How could you use this information in your own nursing practice or in your community? (2 pts.)

3.    Discussed one or more social justice and advocacy actions that could be taken by the nursing profession in collaboration with others to reduce or eliminate the health inequities that result from specific social determinants of health with citations from two of the following: textbook, Healthy People 2020, and/or Community Toolbox. (2 pts.)

4.    Identify the PHN/CHN specialty role and the at-risk population served. Cite Eardley & Schoon’s power point. Describe at least 2 SDOH that affect that at-risk population’s health. (1 pt.)

5.    Describe what and what social justice and advocacy actions you could take if you were practicing in that PHN/CHN specialty role to reduce the impact of the SDOH on the at-risk population’s health status. Cite Chapter 13 in textbook to support your actions. (2 pt.)

1.    Compare one or more of the points you made in your initial discussion with the initial discussions of two peers. (1 pt.)

2.    Responded to two peers comparing how the social determinants of health affected the health of the populations your peers discussed with the impact of the social determinants of health on the population you discussed in your initial post. (1.5 pts.)

3.    Compare the advocacy actions you described with the advocacy actions your peers described. when working in a specific PHN/Specialty role. (1.5 pts.)

·       Citations and References are included and in correct APA format with 2 mistakes or less in both initial and peer responses. (1 pt.)

·       Discussion demonstrates critical thinking, and is organized with correct spelling and grammar. (1 pt.)

Multidimensional Care Week 7

Multidimensional Care Week 7

Anna is a 45-year-old female that presented to her physician’s office for her annual check-up. Anna has a history of diabetes, obesity, and noncompliance with diet and medications to control her diabetes. She is a diesel mechanic, a single mother of three teenagers, and smokes regularly.

During the history review, Anna shared that she has not felt like herself for the past six months; she has been unusually tired and has a cough that won’t go away. In fact, for the last few weeks, she’s had a cough so bad that she coughed up rust-colored sputum.

She stated, “I am very busy with my children; I haven’t had time to get it checked out. When I had bronchitis before, the doc just gave me some antibiotics and they didn’t help.” Anna has a positive family history of bladder cancer; her mother and grandmother were also smokers who have been treated for breast cancer.

Anna has never had a mammogram. She has recently been experiencing a lack of appetite. During the examination, the practitioner noted she’d had a 15-pound weight loss since she was last seen and swollen lymph nodes in the neck. Based on the physical findings, Anna will undergo a diagnostic CT scan of the chest.

Instructions

In a 2-page paper, describe the care that Anna would require and address the questions below.

1. What risk factors does Anna have that could predispose her to cancer development?

2. What signs and symptoms could indicate that Anna has developed cancer?

3. Based on Anna’s risk factors and presenting problems, identify three multidimensional care strategies that you would use to provide quality care to Anna. Provide a rationale to explain why you chose these strategies.

Resources

For assistance with citations, refer to the APA Guide.

For assistance with research, refer to the Nursing Research Guide.

Bottom of Form

ORDER THROUGH BOUTESSAY

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort, and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in, and make corrections as necessary. Often, having a friend proofread your paper for obvious errors is advantageous. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. Letting your essay run over the recommended number of pages is better than compressing it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on each page’s top, bottom, and sides. When submitting a hard copy, use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Multiple Mental Health Disorders Paper

Appropriate Drug Therapy for Major Depressive Disorders, MDD.

Arguably, there is an association between alcohol use and depressive illnesses, one that often results into poor health outcomes. The assessment and treatment of patients with depression cooccurring with alcohol use has many challenges. When considering treatment of such patients, several approaches have been proposed with each having both its advantages and disadvantages. The FDA approves the use of selective serotonin reuptake inhibitors (SSRIs) as first-line agents for the treatment of depressive illnesses (American Psychiatric Association, 2013).

SSRIs are tolerated better and are safer in MDD patients who have a history of alcohol use. Sertraline is an example of an SSRI used for the management of MDD. Studies have shown that patients, especially those with severe symptoms, benefit the most from sertraline. The recommended dose of sertraline is a maximum of 200 mg/d.  SSRIs can also be combined with drugs used for the treatment of alcohol dependance such as Naltrexone (Gasparyan, 2021).

A study by McHugh & Weiss (2019) concluded that a combination of sertraline and naltrexone produced a more desired effect of reduced depressive symptoms and a longer delay before relapse of alcohol use. Combination therapy of both drugs yielded a longer relief when compared to single-medication. It is generally not advised to take SSRIs concurrently with alcohol as this may worsen the symptoms of depression. Also, it increases the risk of overdose, thereby increasing the chances of occurrence of such side effects as drowsiness and dizziness. It should take around 4- 6 weeks before the effects of treatment can be appreciated (McHugh & Weiss, 2019).

Predictors of Late Onset Generalized Anxiety Disorder

Within the health sector, anxiety disorders remain largely underrecognized despite their immense contribution to mental and physical disability among geriatric patients. In fact, being a chronic disorder, generalized anxiety disorder (GAD) has direct association with increased disability and suicide attempts. GAD is a multifactorial disorder and usually precedes major depression, and if often characterized by high stress levels. Among the risk factors for GAD draw from both proximal and distal factors, some of which can be modifiable by healthcare intervention.

Noteworthy though is that treatment of GAD is not easy, hence the need for early identification of the predictors of the disease among elderly patients. Aging is may be associated with psychosocial risk factors such as physical illness and disability. Aging also can be protective against anxiety due to the development of better coping strategies over the years changes in life perspectives which render certain anxiety triggers as less provoking. Principle predictors of late onset GAD are therefore:

• Alterations in the hypothalamic pituitary adrenal (HPA) axis may interfere with stress resilience and thus be a potential mediator of anxiety and mood disorders.
• Being female. Female specific social and biological factors tend to affect the course of anxiety disorders. Estradiol has been implicated in the pathogenesis of anxiety as it “modulates fear learning and fear extinction,” (Hellwig & Domschke, 2019).
• Recent adverse life events. Adverse events may expose one to massive trauma which might interfere with their subsequent coping mechanisms. This leaves one always weary and on the lookout and this can be severe to the extent that it becomes pathological. With increasing age, the risk of experiencing losses, such as death of a spouse, increases. This impedes maintenance of relationships and subsequent loneliness. Loneliness has been linked to the development of anxiety.
• Having a chronic physical and mental disorder. These disorders include depression, phobias, dyslipidemia, heart failure, respiratory disorders.
• Past medical history of GAD
• Parental loss and low affective support, especially in childhood.
• History of mental illness in the family such as in the parents.
• Poverty

Potential Neurobiology Causes of Psychotic Major Depression

As a mood disorder, MDD presenting with psychotic features has been associated with substantial morbidity and mortality. Structural and functional abnormalities of the brain are associated with MDD. Some of the potential neurobiology causes implicated in the pathogenesis of psychotic major depression are:

• The glutamatergic hypothesis. This explains how glutamate-mediated toxicity plays a role in the development of psychosis. Elevated glutamatergic neurotransmission has been implicated in the pathogenesis of schizophrenia. Glutamate neurotoxicity (GNT) is damage of cell components which leads to cell death (Olloquequi et al., 2018).
• Dopamine is thought to play a major role in the pathogenesis of MDD. Environmental threats increase the levels of dopamine in the brain. Local inhibitory feedback mechanisms kick in to return the dopamine levels to desired levels and achieve homeostasis. Severe stressors however disrupt this feedback mechanism by altering the striatal levels of brain-derived neurotrophic factor therefore resulting in an abnormal striatal dopamine system feedback (Hellwig & Domschke, 2019).
• Alterations in the hypothalamic pituitary adrenal (HPA) axis may interfere with an individual’s resilience to stress, thus predisposing them to anxiety and mood disorders. Abnormal function of the HPA axis also play a role in the development of MDD. The HPA system is directly activated by stress. The hypothalamus produces corticotropin-releasing factor which results in the release of corticotropin in the pituitary. Corticotropin stimulates the adrenal glands to release cortisol which is the stress hormone. Glucocorticoid receptors in the hippocampus are sensitive to cortisol and this helps the hippocampus to regulates the HPA axis. Chronic stress causes a downregulation of the glucocorticoid and corticotropin -releasing factor receptors and increases their respective agonists. These changes result in chronic disinhibition of the HPA axis (Hellwig & Domschke, 2019)
• In a study conducted by Croarkin (2018), a reduced hypothalamic and subgenual cortex connectivity was noted in patients with psychotic depression. This was noted on a resting-state functional MRI scan. Structural imaging studies also reveal a reduction in the size of the hippocampi in MDD patients. Overall, neuroimaging studies indicate general brain atrophy in MDD patients. Abnormalities in the interconnectivity of subcortical and cortical regions of the brain have also been noted.

Five Symptoms of An Episode of Major Depression

The DSM-5 (2013) outlines an episode of major depression as lasting at least 2 weeks with one or more symptoms of depressions. At least one of the symptoms should be a depressed mood or anhedonia (loss of pleasure). Other symptoms associated with major depression are:

• Fatigue or loss of energy occurring for the better part of the day, almost every day.
• Diminished interest in activities occurring for the better part of the day, almost everyday
• Depressed mood occurring for the better part of the duration
• Diminished concentration and indecisiveness.
• Recurrent suicidal ideations

Classes of Drugs that Precipitate Insomnia

Insomnia is a sleep disorder that can result in unrefreshing and non-restorative sleep. Various medication can precipitate the onset of this disorder. Some of these drug-classes include;

• Alpha-blockers. These drugs are used for the treatment of conditions such as hypertension and benign prostatic hyperplasia (BPH). They inhibit the action of vasoconstrictors such as noradrenaline therefore producing a vasodilatory effect. An example is prazosin. These drugs cause insomnia by decreasing REM sleep especially in the elderly (Neel, 2021).
• Selective serotonin-reuptake inhibitors (SSRIs) which are used to treat symptoms of moderate to severe depression. They act by blocking the reuptake of serotonin in the brain. An example of SSRI is Fluoxetine. SSRIs cause agitation which can lead to sleep insomnia deprivation
• These drugs are used as anti-inflammatory agents. They are used to treat rheumatoid arthritis and inflammation of muscles and blood vessels. An example of a corticosteroid is Prednisone. Corticosteroids cause insomnia by stimulating the adrenal glands to release cortisol, the stress hormone. The body presumes that it’s under stress and therefore will stay awake and one becomes unable to sleep and relax (Neel, 2021).

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). DSM-5. Accessed from https://www.psychiatry.org/psychiatrists/practice/dsm.
• Croarkin, P. E. (2018). Indexing the neurobiology of psychotic depression with resting state connectivity: Insights from the STOP-PD study. Ebiomedicine, 37, 32–33. Https://doi.org/10.1016/j.ebiom.2018.10.010
• Gasparyan, A., Navarrete, F., & Manzanares, J. (2021). The administration of sertraline plus naltrexone reduces ethanol consumption and motivation in a long-lasting animal model of post-traumatic stress disorder. Neuropharmacology, 189(), 108552. https://doi.org/10.1016/j.neuropharm.2021.108552
• Hellwig, S., & Domschke, K. (2019). Anxiety in Late Life: An Update on Pathomechanisms. Gerontology, 65,465-473. Doi: 10.1159/000500306
• McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research: current reviews, 40(1). https://doi.org/10.35946/arcr.v40.1.01
• Neel, A. B. (2021). Insomnia – 10 medications that can cause sleeplessness. Retrieved from https://www.aarp.org/health/drugs-supplements/info-04-2013/medications-that-can-cause-insomnia.html.
• Olloquequi, J., Cornejo-Córdova, E., Verdaguer, E., Soriano, F. X., Binvignat, O., Auladell, C., & Camins, A. (2018). Excitotoxicity in the pathogenesis of neurological and psychiatric disorders: Therapeutic implications. Journal of Psychopharmacology, 32(3), 265–275. https://doi.org/10.1177/0269881118754680

Mursion Simulation Reflection Sample Essay

Evaluate how well the following social-emotional intelligence power skills were demonstrated during the Mursion simulation:

• Self-Awareness

I was the service headline director of the Emergency Department (ED) during the simulation. I facilitated the meeting with the ED nursing manager, Raymond, and the ED pharmacy manager, Jenna. I was mindful, patient, confident, and I showed gratitude to practice self-awareness. I was always attentive and present-minded during the meetings. I built trust by allowing these managers to raise their concerns.

I maintained confidence and calmness during the meeting. I gave a listening ear to them as they raised their concerns and expressed their frustrations. I refrained from interrupting. I expressed my concerns to them after they were done. We had a dialogue thereafter. Before the meeting was over, I commended both departments and urged them to continue with the good work and emphasized gratitude for their service to the organization.

• Self-Management

I paid attention to details, used impulse control, and set goals for the meeting, elements that are essential in self-management. The goal was to settle the conflict between the pharmacy ED and nursing ED. Setting this objective was useful in giving us the direction of the discussion and creating the necessary environment. I encouraged Raymond and Jenna to express their concerns about the institution’s initiative to reduce the labor workforce by 10%.

I noted the differences between the tone and conduct of the two managers. Raymond was incredibly aggressive and had a frustrated tone. Jenna, on the other hand, was soft-spoken and calm. Jenna was the first to speak but was harshly interrupted by Raymond. I kindly requested Raymond to allow Jenna to express herself to maintain Jenna’s psychological state’s stability. Impulse control, paying attention, and focusing on the set goals ultimately enabled us to resolve the conflict between the two departments.

• Interpersonal skills

I practiced active listening in the discussion and was actively involved. I was compassionate to the two managers and I allowed each one of them to express their concerns about the meeting topic exhaustively. I acknowledged their contribution using verbal and nonverbal communication cues such as nodding, smiling, and positive comments. I allowed the managers to share their inputs after expressing my strategies to create a better working environment.

This action aimed to make the managers feel acknowledged and to assure them that their concerns were valuable. By allowing the two managers to share their respective understanding of the issue, I had the objective of demonstrating that I was intervening to help solve the problem in an amicable manner. The goal was to ensure the environment in the Emergency department was calm, the tone reconciliatory and the outcome joyous.

• Executive Function

I portrayed critical thinking, planning, organization, and problem-solving attributes that I believe are useful in exercising the executive function. Raymond was concerned about nurses’ ability to deliver safe patient care. He argued that nurses should take additional tasks. He singled out on medication reconciliation as one of the tasks which he believed would increase safety of patient care. I critically thought about the issue putting into consideration the rationality surrounding his thoughts and concerns.

I suggested that the two managers should organize ana staff in-service training designed to impart valuable knowledge on medical reconciliation. The primary goal of the in-service training would be to improve the nurses’ confidence and competency. The nurses would, in turn, offer safe, effective, and efficient patient care in the short- and long-term. The managers embraced the idea, and eventually, we came up with a realistic goal for the department’s benefit. They both agreed to my recommendation to set another meeting to monitor our goal’s progress and achievement and implement new strategies where need be.

• Social Awareness

During the meeting, I demonstrated empathy and cultural awareness. I was non-judgmental and culturally sensitive. I showed no favors or discrimination based on culture, religion, nor background. I listened to Raymond and Jenna with equal precision and showed emotional concern to both equally. I have realized that for me to become an excellent leader, I need to effectively leverage the information I have learnt from the Mursion simulation experience.

1. Analyze three strategies for implementing the “IHI Framework for Improving Joy in Work” in the workplace

Physical and psychological safety is the first strategy for implementing the “IHI Framework for Improving Joy in Work.”  According to Mehrdad and Farhana (2020), high infection rates, work-related injury, assault, and insults are some occupational challenges that healthcare workers must contend with when executing their duties. An organization can adopt several interventions to create a safe working environment.

These interventions could entail providing personal protective equipment, educating workers on policies and procedures, and offering extensive support to the employees. The workers should be psychologically safe to air their concerns without fear of humiliation or punishment. To provide a joyful work environment and promote a collaborative relationship, nurse leaders should listen to the employees and provide feedback.

Recognizing and rewarding positive actions is the second strategy that organizations canpursue. Recognition of hard work and provision of positive feedback helps ensure everyone feels important (Hammedi, Leclerq & Van Riel, 2017). Celebrating an achievement motivates employees to work harder and joyously in the workplace. It also promotes happiness and work productivity (Ertan & Sesen, 2019).

A nurse leader should recognize hard work and provide rewards to the colleagues. A leader can form a habit of congratulating the nurses and recognizing their hard work even in times of increased workflow as recently witnessed in various hospitals across the country due to Covid-19 outbreak. The simple act of recognizing and rewarding employees has the effect of enhancing employee satisfaction, which creates joy at the workplace and consequently increases productivity.

Leveraging participative management approach is the third strategy. Decision-making also requires the workers’ inputs and leaders should involve them in decision making (De Brún, O’Donovan & McAuliffe, 2019). All members should be allowed to participate in decision-making process when implementing new policies and procedures. For example, a nurse leader would involve all units’ nurses in implementing the SBAR tool report.

The nurses can listen, understand the concept, and share their views. Nurses could commit to newly implemented policies or procedures if they were involved in the decision making and implementation processes. Such direct participation enhances the nurses’ understanding of the proposed policies, thereby reducing the likelihood of change rejection. When the nurses are engaged, they feel supported, an aspect that promotes the creation of a joyful working environment that increases job satisfaction.

1. Reflect on the lessons you learned from completing the Mursion simulation, the mind map, and the force field analysis. Explain how you will apply these lessons to current and future practice in the workplace.

During the Mursion simulation, I portrayed a leadership role with the task of dealing with a difficult situation in the workplace. A meeting took place between the ED nurse managers

Raymond Mullin MSN, RN and the ED pharmacy manager Jenna Zielinski, PharmD to discuss the frustration nursing is feeling due to the reduction in workforce (RIF) that has caused an increase in workload. Medication reconciliation, a function of the pharmacy department has now shifted to the ED nursing staff due to the RIF. In the leadership role five social/emotional power skills were utilized to help resolve conflict and incivility between the two departments. The five social/emotional power skills utilized were self-awareness, self-management, interpersonal communication, executive function, and social awareness.

At the start and throughout the meeting, self-awareness was demonstrated by being mindful and patient. This was going to be a challenge as I was listening to both parties’ thoughts and feelings. Being mindful helped to be non-judgmental and compassionate during the conversation. It was apparent that Raymond was upset and speaking in an aggressive tone when explaining his side of the situation.

Remaining non-judgmental allowed him to express his feelings and for me to be completely engaged while listening to what he was saying. Initiating the conversation with social awareness in mind I asked open-ended questions to both Raymond and Jenna not only for my perspective taking, but in hopes that all would be able to empathize with the current situation and understand all point of views.

Hearing both perspectives helped to open the dialog about the state of the current situation and validate that feeling and concerns are being heard. The next important power skill utilized was executive function. Using the sub skills of problem solving and adaptability, I

expressed that I understood the frustration of both parties and given the current state of changes both departments have to be able to adapt effectively, and collectively come up with a plan that will produce a positive and better work environment. Additionally, planning and organizing was key to opening the conversation of securing a team of members from both departments to organize, analyze, and implement a plan of action that could cohesively change the current process of medication reconciliation.

After coming up with a possible solution to ease the tension between the departments the next step would be to encourage interpersonal communication. In an effort to build relationships between the departments I suggested that both work together to form a new process that includes team collaboration within the departments and other staff such as providers who may also be able to help with medication reconciliation, easing some of the workload.

I also suggested that both managers talk with each other first to try and resolve any issues versus bringing up any frustrations to other staff. Having compassion, caring and consideration, and actively listening is important in resolving conflict resolution. Each participant can be heard and hear what the other is experiencing as well as come up with solutions to the problem.

Analyzing the difficult situation, the skills of self-management were very important in this scenario. To come to a resolution, I demonstrated initiative taking by offering my assistance with the plan of action. This was done by offering to assist with recruiting team members and talking with other departments to get involved with the process. Finally, having self-discipline exemplified the positive attitude and behaviors needed to achieve goal setting and complete tasks.

Creating joy in the workplace is a concept that organizations and health institutions such as the Institute of Healthcare Improvement (IHI) believe is important in reducing burnout and improving morale and satisfaction in healthcare. In a whitepaper written by Perlo et.al (2017)

IHI Framework for Improving Joy in work, it states “Perhaps the best case for improving joy is that it incorporates the most essential aspects of positive daily work life” (p.7). The framework was created with the goal of improving joy in the workplace listing nine critical components and steps leaders can take. Weighing in on what matters and what is important in the daily lives of employees. The four-step approach first asks staff what matters to you.

The second step identifies unique impediments to joy in work in the local context. The third step is the commitment to a systems approach to making joy in work a shared responsibility at all levels of the organization. The fourth and final step is the use of improvement science to test approaches to improving joy in work in your organization (p.8). This four-step approach is a tool leadership of an organization can use to overcome potential obstacles to create joy in the workplace.

To ensure successful implementation of the four-step process, several approaches should be taken by the leaders. One such approach is the “Get Ready strategies” (Perlo, 2017, p5). It ensures the conversation is set for the subject matters. It designates an overseer to a conversation, and sure all leaders participate in the conversation at all levels. The three functions contribute to the creation and implementation of a joyful work environment. Sticking to the subject matter is essential in building trustful relationships and boosting morale. It also helps optimize the work environment by changing processes, employees, and patients/consumers that are detrimental to the working environment.

Furthermore, when the organization supports employs at all levels, they feel valued and appreciated. It is imperative to be involved in the change process rather than being informed about change that one was not consulted. Being involved has its advantages. It minimizes costs the organization incurs in filling positions lost and creates room for advancement among the employees. The overseer of a process of change is responsible for relaying information about the process, improvements it entails, and any necessary adjustments and that require implementation.

I learned a lot from the course exercises, and the information shall be useful in my future practice. The Mursion simulation, for example, was instrumental in presenting the experience of conflicts that occur at work. Leading the procession was a challenge, and it requires in-depth practice and skill for me to be a proficient leader in the future. Patience and mindfulness were the two most important factors during the simulation. The two factors were instrumental in determining the issue’s root cause and developing an effective plan to solve the issue at hand. “Being mindful at work simply refers to doing a task consciously and all concentration, paying attention, keeping your mental and emotional state in check” (Alidina, 2018).

During the meeting, both department leaders created tension and being emotionally neutral. I focused on finding and developing a solution that would favor all the teams despite the emotional tension. As the leader, I had to keep my emotions off the situation to ensure I offered sound advice. The Mindmap and the force field analysis were vital tools in determining factors that contribute to the lack of joy at the workplace during the simulation. Specifically, the Mindmap enabled me to develop a better understanding of the experience of conflicts at work, and that a proficient leader must be one with the relevant practice skills to lead the procession.

Additionally, the force field analysis equipped me with the necessary skills to assess the different forces within an organizational setting, and how they impact joy at the workplace. Through this, I believe I can comfortably translate the information in identifying the root cause of conflict and develop an effective intervention plan. Overall, from the simulation, I have learned that many factors contribute to conflicts at the workplace. The Identified issues coupled with other factors such as opposition or support from all levels in the organization require prior preparation. Despite the much effort done, the controlling aspect of leadership lacks data follow-up. Commitment to the change process is very minimal.

Mindful behavior has become a part of me in my current workplace. I take time to explore what is happening around me and my subjective feelings in all situations. I usually take in between task breaks, breathe fresh air and, at times, meditate. The article Getting Started with Mindfulness (Mindful.org, n.d) states that “Mindfulness meditation asks us to suspend judgment and unleash our natural curiosity about the workings of the mind, approaching our experience with warmth and kindness, to ourselves and others,” (para. 5).

Open-mindedness shall ensure I take in other people’s perspectives and reason from their point of view compassionately without judging them. The force field analysis and the Mindmap shall be essential tools in informing my advanced practice in the future in situations demanding change and adjustments. I shall use the tools to showcase factors that would potentially contribute positively to change or be a barrier to change.

References

• Alidina, S., (2018). 10 Ways to Be More Mindful at Work. Retrieved from https://www.mindful.org/10-ways-mindful-work
• De Brún, A., O’Donovan, R. & McAuliffe, E. (2019). Interventions to develop collectivistic leadership in healthcare settings: a systematic review. BMC Health Services Research, 19, 72. https://doi.org/10.1186/s12913-019-3883-x
• Ertan, S. S. & Sesen, H. (2019). Positive organizational scholarship in healthcare: The impact of employee training on performance, turnover and stress. Journal of Management & Organization, 1-20. doi:10.1017/jmo.2019.61
• Hammedi, W., Leclerq, T. and Van Riel, A.C.R. (2017). The use of gamification mechanics to increase employee and user engagement in participative healthcare services: A study of two cases. Journal of Service Management, 28(4), 640-661. https://doi.org/10.1108/JOSM-04-2016-0116
• Mehrdad, R. & Farhana, Z. (2020). Introduction to occupational hazards. The International Journal of Occupational and Environmental Medicine, 11(1), 59-60. https://dx.doi.org/10.15171%2Fijoem.2020.1889
• Mindful.org. (n.d.). Getting Started with Mindfulness. Retrieved from https://www.mindful.org/meditation/mindfulness-getting-started/
• Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. (2017) IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. Retrieved from ihi.org

N3345 Transition to Professional Nursing Information Retrieval Paper 3

Module 5 Assignment – Information Retrieval Paper, Part 3

Overview:  “Information Retrieval Paper: Part 3”

This week, you will complete Part 3 of the Information Retrieval Paper, which you worked on in Module 3 and 4. You are using the template provided, do not create a new word document.

So far, you have developed a research question, identified the PICO components of your research question, included your rationale for selecting your research question, created a title page for your paper in APA format, located three peer-reviewed articles, summarized each article in APA format, and critically analyzed the articles.

In this module, you will summarize and synthesize the key points of the peer-reviewed, evidence-based articles and develop a reference page in APA format.

Be sure to review the previous assignments that relate to the Information Retrieval Paper. Incorporate your Coach’s suggestions and corrections so you won’t make the same mistakes again in this last section of the Information Retrieval Paper.

Performance Objectives:  

• Synthesize the key points of peer-reviewed, evidence-based articles.
• Develop a reference page in APA format.
• Use correct grammar, punctuation, and American Psychological Association (APA) format in writing professional papers.

Rubric

Use this rubric to guide your work “Information Retrieval Paper, Part 3.”

?

“Information Retrieval Paper: Part 3” (100 points total)

Task #1:

Conclusion: Summarize Key Points (Total 60 points)

(0 points)

Reference Page and In-text Citations

(Total 40 points)

Correct Grammar and APA Format are graded heavily.

(30 points)

Uses 3 properly formatted in-text citations to support thoughts.

(10 points)

 (25 points)

Uses 2 properly formatted in-text citations to support thoughts OR 1-2 APA errors r/t citations

(7 points)

(15  points)

Uses 1 properly formatted in-text citations to support thoughts OR 3-4 APA errors r/t citations

(3 points)

(0 points)

No use of in-text citations to support thoughts OR >5 APA errors r/t citations

(0 points)

Week 5 Application

Information Retrieval Paper: Part 3

In this week’s assignment, you will complete your Information Retrieval Paper. Review the outline for the entire assignment before your begin.

Citations in the body of the paper

Headings

Grammar

Spelling

Paragraphs of at least three well-written sentences

Organization and flow

Identification of clinical problem in a workplace setting

Research question stated correctly

Rationale for question

Title page

Overview: Where did you search? How did you decide on the 3 articles?

3 article summaries

Completeness of analysis

    Synthesis of key points for the 3 articles

    Alphabetized

    Sources cited in APA format

    References complete

Task #1 – Conclusion: Summarize Key Points

In this part of the Information Retrieval Paper, you will synthesize the main points from the three peer-reviewed, evidence-based articles.

Directions:

In this section write a paragraph or two to synthesize the key points of the articles.  Consider this section a conclusion of your findings.

For full credit, each of the 3 articles needs a minimum of 3 sentences. Each article topic requires an in-text citation (3 total).

Synthesis Points from Articles (Type Below)

The first article was a retrospective study exploring the Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates. COPD accounts for the majority of chronic disease hospitalizations that are associated with substantial economic and social burdens in the form of impaired quality of life and increased healthcare utilization costs. COPD comprehensive case management program is a vital intervention that can be executed to counter the consequences of COPD hospitalizations. The COPD comprehensive case management program encompassing patient education, follow-ups, and home visits significantly reduces the length of hospital stay as well as readmission rates among COPD patients (Alshabanat et al., 2017). Consequently, nurse leaders should implement the program to improve the overall quality of care for COPD patients.

The second article was a systemic review and meta-analysis investigating the impact of health coaching on hospital readmissions and health-related quality of life among COPD patients. This systemic review and meta-analysis demonstrated that implementation of health coaching, a self-management intervention comprising of goal setting, motivational interviewing, and COPD-related health education, exceptionally reduces hospital readmissions and improves the health-related quality of life among COPD patients (Long et al., 2019). Nurse leaders should establish the most effective health coaching components and delivery modality to accrue its benefits among COPD patients.

The final article looked into the role of respiratory care education in reducing readmissions in COPD patients. This research conducted at Houston Methodist Hospital exhibited that respiratory care education in COPD patients remarkably reduces hospital readmissions (RajtakMuller & Berger, 2018). However, offering respiratory education to COPD patients should be a multidisciplinary approach with nurses as active and critical participants. Subsequently, nurse leaders should consider a multidisciplinary task force including respiratory therapists in the identification, development, and implementation of a care plan that educates the patients as well as their families on COPD as a disease process.

Task #2 – Reference Page

In this part of the Information Retrieval Paper, you will create the reference page for the entire paper in APA format.

Directions:

• Develop the reference page for your Information Retrieval Paper. Make sure that references are:

– cited in APA format.

– alphabetized.

• Complete the reference page in the space below.

– Must have 3 peer-reviewed, evidence-based articles

Reference Page (Type Below)

References

• Al-Jundi, A., & Sakka, S. (2017). Critical appraisal of clinical research. Journal of Clinical and Diagnostic Research: JCDR, 11(5), JE01–JE05. https://doi.org/10.7860/JCDR/2017/26047.9942
• Alshabanat, A., Otterstatter, M. C., Sin, D. D., Road, J., Rempel, C., Burns, J., van Eeden, S. F., & FitzGerald, J. M. (2017). Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates. International Journal of Chronic Obstructive Pulmonary Disease, 12, 961–971. https://doi.org/10.2147/COPD.S124385
• Cathala, X., & Moorley, C. (2018). How to appraise quantitative research. Evidence-Based Nursing, 21(4), 99–101. https://doi.org/10.1136/eb-2018-102996
• Collinsworth, A. W., Brown, R. M., James, C. S., Stanford, R. H., Alemayehu, D., & Priest, E. L. (2018). The impact of patient education and shared decision-making on hospital readmissions for COPD. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1325–1332. https://doi.org/10.2147/COPD.S154414
• Long, H., Howells, K., Peters, S., & Blakemore, A. (2019). Does health coaching improve health-related quality of life and reduce hospital admissions in people with the chronic obstructive pulmonary disease? A systematic review and meta-analysis. British Journal of Health Psychology, 24(3), 515–546. https://doi.org/10.1111/bjhp.12366
• RajtakMuller, L., & Berger, M. (2018). Respiratory care education: A vital role for Respiratory Therapists in reducing readmissions in COPD patient population. Respiratory Care, 63(Suppl 10). http://rc.rcjournal.com/content/63/Suppl_10/3007422
• Tawfik, G. M., Dila, K. A. S., Mohamed, M. Y. F., Tam, D. N. H., Kien, N. D., Ahmed, A. M., & Huy, N. T. (2019). A step-by-step guide for conducting a systematic review and meta-analysis with simulation data. Tropical Medicine and Health, 47(1), 46. https://doi.org/10.1186/s41182-019-0165-6

Submit this Assignment Document into Canvas for grading.

N 595 FOCUSED SCHOLARLY PROJECT FSP CONTRACT

Project Identification and Objectives

Title of Project: Nurse Burnout: Strategies / Interventions to Reduce Stress During the COVID-19 Pandemic.

Type of Project: Education module.

Rationale for Project

Nurses comprise the hugest percentage of the healthcare workforce in an epidemic, and they carry out many of the responsibilities regarding infectious disease containment. They are considered the backbone of healthcare and usually must cope with profound burnout levels (Ross, 2020). The COVID-19 pandemic has intensified the nurse burnout situation, with most nurses reporting high levels of physical and emotional fatigue ((Shanafelt et al., 2020).

The prolonged exposure of nurses to stress related to the pandemic crisis has a possibility of causing insidious long?term health effects such as an increased risk of physical and mental disorders, impaired cognitive function, and reduced productivity and absenteeism at work (Ross, 2020). According to Callus et al. (2020), higher levels of distress were reported by healthcare workers during the SARS pandemic, such as burnout, psychological stress, post-traumatic stress, hostility, and somatization.

Nurses have endured compassion fatigue when handling traumatic events and patients affected by the COVID-19. Therefore, they must be provided with adequate support programs to meet their emotional needs and well-being (Fessell & Cherniss, 2020). Stress?management interventions for nurses may be a useful approach in reducing burnout caused by emotional fatigue. According to a study in China by Que et al. (2020), insidious psychological problems were observed among health providers during the COVID-19 pandemic. The study found that the prevalence of anxiety, depression, insomnia, and the widespread psychological problems among health providers during the COVID-19 pandemic was 46.04, 44.37, 28.75, and 56.59%, respectively.

According to Chen et al. (2020), strategies such as staff training on the psychological aspect of patient care and relaxation techniques can help reduce stress.  Furthermore, positive mental health can reduce work-related stress and burnout and should be fostered among healthcare workers in COVID-19 ((Shanafelt et al., 2020).Strategies suggested for decreasing the workload include mindfulness and promoting self-care. Mindfulness training is commended for nurses because it can foster self-care and well-being (Fessell & Cherniss, 2020). Besides, mindfulness programs are praised since they improve resilience to stress, quality of professional life, and self-compassion.

Project Objectives

1. Conduct a literature search to identify strategies or interventions that have been useful in reducing stress and emotional burnout during a pandemic.
2. Develop a psychological support program based on the literature search strategies to facilitate psychological well-being and self-care among nurses.
3. Working as frontline healthcare workers in the COVID-19 pandemic, Nurses will be enrolled in the psychological support program and educated on strategies to reduce stress and psychological burnout when caring for patients.
4. Apply the Behavioral Learning Theory using the systematic desensitization technique to teach nurses relaxation techniques to reduce fear and anxiety.
5. Evaluate the psychological support program’s impact in enhancing nurses’ knowledge and attitude on stress reduction strategies during the pandemic.

Section I

• Background and problem identification
• Purpose of the project
• Significance of the project to nursing practice
• Discussion of the conceptual model

Section II

• Method used for literature search
• Literature Review
• Matrix

Section III

• Project’s implication for nursing practice, future research, and education.
• Design the psychological support program.
• Barriers to Implementation

Section IV:

• Abstract
• Final document
  

STUDENT: ____LaQuinta Legania_________________________DATE: __02/05/2021

(Electronic signature acceptable)

FACULTY: _________________________________________________ DATE: _____________

References

• Callus, E., Bassola, B., Fiolo, V., Bertoldo, E. G., Pagliuca, S., & Lusignani, M. (2020). Stress Reduction Techniques for Health Care Providers Dealing with Severe Coronavirus Infections (SARS, MERS, and COVID-19): A Rapid Review. Frontiers in psychology, 11, 3325. https://doi.org/10.3389/fpsyg.2020.589698
• Fessell, D., & Cherniss, C. (2020). Coronavirus disease 2019 (COVID-19) and beyond: micro-practices for burnout prevention and emotional wellness. Journal of the American college of radiology, 17(6), 746-748. https://doi.org/10.1016/j.jacr.2020.03.013
• Que, J., Le Shi, J. D., Liu, J., Zhang, L., Wu, S., Gong, Y., … & Lu, L. (2020). Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. General psychiatry, 33(3). https://doi.org/110.1136/gpsych-2020-100259
• Shanafelt, T., Ripp, J., and Trockel, M. (2020). Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA 323, 2133–2134. https://doi.org/10.1001/jama.2020.5893
•   Ross, J. (2020). The Exacerbation of Burnout During COVID-19: A Major Concern for Nurse Safety. Journal of Peri-Anesthesia Nursing, 35(4), 439-440. https://doi.org/10.1016/j.jopan.2020.04.001