The Nurse Leader As Knowledge Worker

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The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book, The Landmarks of Tomorrow (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

  • Review the concepts of informatics as presented in the Resources.
  • Reflect on the role of a nurse leader as a knowledge worker.
  • Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:

  • Explain the concept of a knowledge worker.
  • Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.
  • Develop a simple infographic to help explain these concepts.

    NOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources.

  • Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses.

hypothetical scenario originally shared in the discussion forum is:

Nursing, as with all other professional fields, has seen an amazing speed in which technological changes in the last 25 years.  Information systems provide limitless possibilities for learning and exploring, connecting and bringing the world to within reach.  For nursing, the widening range of available technology enables the opportunities for research and reform unproven clinical practices to evidence-based practices.  Nursing informatics is synthesis of nursing science, information science, computer science, and cognitive science for the purpose of managing, disseminating, and enhancing healthcare data, information, knowledge, and wisdom to improve collaboration and decision making provide high quality patient care; and advance the profession of nursing.( McGonigle & Mastrian, 2017).

Nursing Informatics also needs to stay updated on policies and processes, so they know how to correctly build them in the systems. Technology in hospitals are ever growing, which means that nursing informatics is just scratching the surface and will continue to grow over the year.

Sweeny, 2017 define informatics as “the integration of healthcare sciences, computer science, information science and cognitive science to assist in the management of healthcare information” (p. 223). The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account. Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data. The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account.

According to Nagle et al,(2017) Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data. Using The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account. Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data.

A clarified scenario is patient admission to the hospital, patients with a medical or surgical condition may not be identified as having a substance abuse problem. Nurses need to be able to recognize alcohol withdrawal syndrome and start appropriate interventions within the first 24 hours. Otherwise, such complications as seizures and substance withdrawal delirium may arise.  Most hospitals have implemented this practice by including it in initial nursing assessments by checking the vital signs every three hours. But because not all patients are identified on admission as having the potential for alcohol withdrawal, you must stay alert for signs and symptoms. These may arise 4 to 12 hours after the patient’s last drink and may emerge while the patient’s still intoxicated. Many patients with long-term alcohol dependence don’t allow their blood alcohol level (BAL) to drop below a comfortable level, so withdrawal may begin when BAL is still in the intoxication range.autonomic hyperactivity (such as sweating or a pulse faster than 100 beats/minute), increased hand tremor, insomnia, nausea or vomiting transient visual, tactile, or auditory hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures. Consider the rapid action on the patient, nurses relied on the immediate data and information that the patient as shown during the initial rapid assessment to deliver appropriate care to the patient. Message send to on call- doctors via telehealth. Using the technology like the pulse oximeter and blood pressure machine and breathalyzer with assist with the support of the delivery care.

References:

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide and Related Professional Support Resources. www.niaaa.nih.gov/Publications/EducationTrainingMaterials/Pages/guide.aspx. Accessed May 15, 2012.

Nagle, L. M., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Studies In Health Technology And Informatics, 232, 212–221. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=28106600&site=eds-live&scope=site

Sweeney, J. (2017). Healthcare informatics.(1)Online Journal of Nursing Informatics, 21

Resources:

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

  • Chapter 1, “Nursing Science and the Foundation of Knowledge” (pp. 7–19)
  • Chapter 2, “Introduction to Information, Information Science, and Information Systems” (pp. 21–33)
  • Chapter 3, “Computer Science and the Foundation of Knowledge Model” (pp. 35–62)

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Note: You will access this article from the Walden Library databases.

Rubric:

 

Develop a 5- to 6-slide PowerPoint presentation that addresses the following:

·   Explain the concept of a knowledge worker.
·   Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.–

Levels of Achievement:Excellent 32 (32%) – 35 (35%) The presentation clearly and accurately explains the concept of a knowledge worker.

The presentation clearly and accurately defines and explains nursing informatics with a detailed explanation of the role of the nurse leader as a knowledge worker.

Includes: 3 or more peer-reviewed sources and 2 or more course resources.Good 28 (28%) – 31 (31%) The presentation explains the concept of a knowledge worker.

The presentation defines and explains nursing informatics with an explanation of the role of the nurse leader as a knowledge worker.

Includes: 2 peer-reviewed sources and 2 course resources.Fair 25 (25%) – 27 (27%) The presentation inaccurately or vaguely explains the concept of a knowledge worker.

The presentation inaccurately or vaguely defines and explains nursing informatics with an inaccurate or vague explanation of the role of the nurse leader as a knowledge worker.

Includes: 1 peer-reviewed sources and 1 course resources.Poor 0 (0%) – 24 (24%) The presentation inaccurately and vaguely explains the concept of a knowledge worker or is missing.

The presentation inaccurately and vaguely defines and explains nursing informatics with an inaccurate and vague explanation of the role of the nurse leader as a knowledge worker or is missing.

Includes:  1 or fewer resources.Feedback:

·   Develop a simple infographic to help explain these concepts.–

Levels of Achievement:Excellent 14 (14%) – 15 (15%) The presentation provides an accurate and detailed infographic that helps explain the concepts related to the presentation.Good 12 (12%) – 13 (13%) The presentation provides an infographic that helps explain the concepts related to the presentation.Fair 11 (11%) – 11 (11%) The presentation provides an infographic related to the concepts of the presentation that is inaccurate or vague.Poor 0 (0%) – 10 (10%) The infographic provided in the presentation related to the concepts of the presentation is inaccurate and vague, or is missing.Feedback:

·   Present the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data you could use, how the data might be accessed/collected, and what knowledge might be derived from the data. Be sure to incorporate feedback received from your colleagues’ replies.–

Levels of Achievement:Excellent 32 (32%) – 35 (35%) The presentation clearly and thoroughly includes the hypothetical scenario originally shared in the Discussion Forum, including a detailed and accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data.Good 28 (28%) – 31 (31%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data.Fair 25 (25%) – 27 (27%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague or inaccurate.Poor 0 (0%) – 24 (24%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague and inaccurate, or is missing.Feedback:

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.–

Levels of Achievement:Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity.Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.Feedback:

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation–

Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.Good 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors.Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors.Poor 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback:

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–

Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct APA format with no errors.Good 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors.Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors.Poor 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors.Feedback: Total Points: 100

HYPOTHYROIDISM SOAP NOTE

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Hypothyroidism SOAP NOTE

Patient Initials: Age:  Gender:

SUBJECTIVE DATA:

Chief Complaint (CC): “ ”.

History of Present Illness (HPI):

Medications:

Allergies:

Past Medical History (PMH):

Current medication:

Past Surgical History (PSH):

Family History:

Personal/Social History:

Immunization: up to date.

Lifestyle:

Review of Systems:

General:

HEENT:

Neck:

Breasts:

Respiratory:

Cardiovascular/Peripheral Vascular:

Gastrointestinal:

Genitourinary:

Musculoskeletal:

Psychiatric:

Neurological

Skin:

Hematologic:

Endocrine:

OBJECTIVE DATA:

Physical Exam:

Vital signs: Temperature: ; BP:  mmHg; HR: bpm; RR:  /min; Oxygen Saturation: %; Pain: (0-10 scale), Weight lb; Height; BMI

General:.

HEENT:

Neck:

Chest

Lungs:

Heart:

Peripheral Vascular:

Genital/Rectal:

Musculoskeletal:

Neurological:

Skin:

ASSESSMENT:

Differential Diagnosis

1. Hyperthyroidism.

2.

3.

From both the subjective and objective data, it is clear that the main diagnosis is

PLAN:

Treatment Plan: (please prescription with dose)

Non-pharmacological approaches

For the follow-up, the patient should get back to the hospital after

References: 2 or 3 with APA format

 

Soap Note 2 Chronic Conditions (15 Points)

Pick any Chronic Disease from Weeks 6-10

Follow the MRU Soap Note Rubric as a guide:

Use APA format and must include minimum of 2 Scholarly Citations.

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Please use the sample templates for you soap note, keep these templates for when you start clinicals.

The use of templates is ok with regards of Turn it in, but the Patient History, CC, HPI, The Assessment and Plan should be of your own work and individualized to your made up patient.

PICOT (Childhood Obesity)

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 Formulate a PICOT statement for your capstone project. (Childhood Obesity)

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 750 -1000 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

health histories, genograms, and assessments to formulate an individualized plan of nursing care

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This assignment assesses intended course outcome(s)

 

#4 Use information found in patients’ health histories, genograms, and assessments to formulate an individualized plan of nursing care that focuses on the patient’s individual health promotion and disease prevention needs

 

Students will use the information found in Tina’s history, physical exam, and problem list to formulate an individualized health promotion and disease prevention plan of care. Recommendations should be evidence-based and from credible sources. The readings in module eight contains some suggested sources for obtaining health and screening recommendations for your patient.

 

The plan for addressing the health promotion and disease prevention needs for your patient should include:

 

Demographics:

 

–          Age, gender and race of patient

 

–          Education level (health literacy)

 

–           Access to health care

 

Insurance/Financial status

 

–          Is the patient able to afford medications and health diet, and other out-of-pocket expenses?

 

Screening/Risk Assessment

 

–          Identified health concerns based on screening assessments and demographic information

 

Nutrition/Activity

 

–          What is the patients activity level, is the environment where the patient lives safe for activity

 

–          Nutrition recommendations based on age, race gender and pre-existing medical conditions

 

–          Activity recommendations

 

Social Support

 

–          Support systems, family members, community resources

 

Health Maintenance

 

–          Recommended health screening based on age, race, gender and pre-existing medical conditions

 

Patient Education:

 

–          Identified knowledge deficit areas/patient education needs (medication teaching etc).

 

–          Self-care needs/ Activities of daily living

 

* The paper should be written and referenced in APA format and be no longer than 4 pages (excluding cover page and references).

 

Your paper will be evaluated based on the following criteria:

 

Criteria Level 3 Level 2 Level 1
Demographics

(5%)

 Includes age, race and gender of patient Missing one data item Missing 2 or more data items
Insurance/Financial status

(10%)

 Includes information regarding patient’s insurance status and ability to afford medications and other  out-of-pocket expenses Missing some information regarding insurance status and ability to pay for medications and other out-of-pocket expenses. Missing information regarding the patients insurance status, ability to pay of medications and other out-of-pocket expenses
Screening /risk assessment

(10%)

 Identifies health concerns based on screening assessments and demographic information. Missing some information regarding health concerns, by excluding information from screening assessments and demographics Health concerns are not identified due to information missing from screening assessments and demographics
Nutrition/activity

(20%)

 Completely asses patient’s nutrition and activity levels and makes recommendations based on age, race, gender and pre-existing medical conditions Missing some information regarding the patients nutrition and activity levels, make recommendations based on age, race, gender and pre-existing medical conditions Most of the information regarding the patient’s nutrition and activity levels are missing, recommendations are missing or not based on the patient’s age, race, gender and pre-existing medical conditions
Social support

(10%)

 Identifies support systems such as family members and community resources Missing some information regarding support systems such as family members and/or community resources Little to no information regarding social support
Health Maintenance

(20%)

 Overall health maintenance recommendations made based on age, race, gender and pre-existing medical conditions Missing some recommendations, mostly based on age, race, gender and pre-existing medical conditions Missing many recommendations, loosely related to age, race, gender and pre-existing medical conditions
Patient Education

(20%)

 Identified knowledge deficit areas/patient education needs including self-care needs and activities of daily living Missing one or more areas of knowledge deficit/patient education needs including self-care and activities of daily living Lacks identification of knowledge deficit areas/patient education needs. Does not consider self-care needs or activities of daily living.
Organization, spelling and grammar, APA

(5%)

 Organized, easy to read, no spelling or grammar mistakes, appropriate use of APA Organized and easy to read, few spelling or grammar mistakes, few errors in APA Disorganized, difficult to read, many spelling and grammar errors mistakes. Does not use APA
Overall score Points

(60-100)

 Points

(24-59)

 Points

( 0-23)

 

 

 

 

 

 

 

Health History

 

Student Documentation Model Documentation
Identifying Data & Reliability

Tina Jones is a 28 year old African american female AOX4. Pt is reliable historian

 Ms. Jones is a pleasant, 28-year-old African American single woman who presents for a pre-employment physical. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Speech is clear and coherent. She maintains eye contact throughout the interview.
General Survey

Alert and oriented X4. Feels tired because she was just coming from her other job.

 Ms. Jones is alert and oriented, seated upright on the examination table, and is in no apparent distress. She is well-nourished, well-developed, and dressed appropriately with good hygiene.
Reason for Visit

Presenting to shadow health hospital clinic for a complete health assessment for a pre-employment physical.

 “I came in because I’m required to have a recent physical exam for the health insurance at my new job.”
History of Present Illness

Tina Jones is a 28year old African America female with a history of diabetes and Asthma presenting to get a complete health assessment for a pre-employment physical.

 Ms. Jones reports that she recently obtained employment at Smith, Stevens, Stewart, Silver & Company. She needs to obtain a pre-employment physical prior to initiating employment. Today she denies any acute concerns. Her last healthcare visit was 4 months ago, when she received her annual gynecological exam at Shadow Health General Clinic. Ms. Jones states that the gynecologist diagnosed her with polycystic ovarian syndrome and prescribed oral contraceptives at that visit, which she is tolerating well. She has type 2 diabetes, which she is controlling with diet, exercise, and metformin, which she just started 5 months ago. She has no medication side effects at this time. She states that she feels healthy, is taking better care of herself than in the past, and is looking forward to beginning the new job.
Medications

Metformin 850mg twice daily Yaz birth control daily in the morning Flovent MDI twice daily proventil 90mcg/spray 2 puffs as needed for wheezing

 • Fluticasone propionate, 110 mcg 2 puffs BID (last use: this morning) • Metformin, 850 mg PO BID (last use: this morning) • Drospirenone and ethinyl estradiol PO QD (last use: this morning) • Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (last use: three months ago) • Acetaminophen 500-1000 mg PO prn (headaches) • Ibuprofen 600 mg PO TID prn (menstrual cramps: last taken 6 weeks ago)
Allergies

Penicillin- Rash, hives cats- sneezing, itchy watery eyes, asthma exacebation No Known food allergies No latex allergies

 • Penicillin: rash • Denies food and latex allergies • Allergic to cats and dust. When she is exposed to allergens she states that she has runny nose, itchy and swollen eyes, and increased asthma symptoms.
Medical History

Asthma- diagnosed at age 2 1/2 Diabetes Type 2 – diagnosed at 24 was on metformin but stopped due to side effects

 Asthma diagnosed at age 2 1/2. She uses her albuterol inhaler when she is around cats. Her last asthma exacerbation was three months ago, which she resolved with her inhaler. She was last hospitalized for asthma in high school. Never intubated. Type 2 diabetes, diagnosed at age 24. She began metformin 5 months ago and initially had some gastrointestinal side effects which have since dissipated. She monitors her blood sugar once daily in the morning with average readings being around 90. She has a history of hypertension which normalized when she initiated diet and exercise. No surgeries. OB/GYN: Menarche, age 11. First sexual encounter at age 18, sex with men, identifies as heterosexual. Never pregnant. Last menstrual period 2 weeks ago. Diagnosed with PCOS four months ago. For the past four months (after initiating Yaz) cycles regular (every 4 weeks) with moderate bleeding lasting 5 days. Has new male relationship, sexual contact not initiated. She plans to use condoms with sexual activity. Tested negative for HIV/AIDS and STIs four months ago.
Health Maintenance

Has been eating healthy and trying to stay active by walking 30-40 mins two times per week and also swimming once a week

 Last Pap smear 4 months ago. Last eye exam three months ago. Last dental exam five months ago. PPD (negative) ~2 years ago. Immunizations: Tetanus booster was received within the past year, influenza is not current, and human papillomavirus has not been received. She reports that she believes she is up to date on childhood vaccines and received the meningococcal vaccine for college. Safety: Has smoke detectors in the home, wears seatbelt in car, and does not ride a bike. Uses sunscreen. Guns, having belonged to her dad, are in the home, locked in parent’s room.
Family History

-Father died 2 1/2 ears ago in a car accident. History of high blood pressure,type 2 diabetes and high cholesterol -Mother is still alive. has history of hypertension and high cholesterol. -Brother is overweight -Sister has asthma

 • Mother: age 50, hypertension, elevated cholesterol • Father: deceased in car accident one year ago at age 58, hypertension, high cholesterol, and type 2 diabetes • Brother (Michael, 25): overweight • Sister (Britney, 14): asthma • Maternal grandmother: died at age 73 of a stroke, history of hypertension, high cholesterol • Maternal grandfather: died at age 78 of a stroke, history of hypertension, high cholesterol • Paternal grandmother: still living, age 82, hypertension • Paternal grandfather: died at age 65 of colon cancer, history of type 2 diabetes • Paternal uncle: alcoholism • Negative for mental illness, other cancers, sudden death, kidney disease, sickle cell anemia, thyroid problems
Social History

she does not have any children, has never been pregnant and has never been married. she lives with her mother and sister. currently works but is hoping to start a new jop as an accounting clerk at smith, stevens, steward silver company. drinksa alcohol ocassionally when she goes out with friends

 Never married, no children. Lived independently since age 19, currently lives with mother and sister in a single family home, but will move into own apartment in one month. Will begin her new position in two weeks at Smith, Stevens, Stewart, Silver, & Company. She enjoys spending time with friends, reading, attending Bible study, volunteering in her church, and dancing. Tina is active in her church and describes a strong family and social support system. She states that family and church help her cope with stress. No tobacco. Cannabis use from age 15 to age 21. Reports no use of cocaine, methamphetamines, and heroin. Uses alcohol when “out with friends, 2-3 times per month,” reports drinking no more than 3 drinks per episode. Typical breakfast is frozen fruit smoothie with unsweetened yogurt, lunch is vegetables with brown rice or sandwich on wheat bread or low-fat pita, dinner is roasted vegetables and a protein, snack is carrot sticks or an apple. Denies coffee intake, but does consume 1-2 diet sodas per day. No recent foreign travel. No pets. Participates in mild to moderate exercise four to five times per week consisting of walking, yoga, or swimming.
Mental Health History

Denies any history of depression or suicidal thoughts. denies any problems with mood. no overall safety concerns.

 Reports decreased stress and improved coping abilities have improved previous sleep difficulties. Denies current feelings of depression, anxiety, or thoughts of suicide. Alert and oriented to person, place, and time. Well-groomed, easily engages in conversation and is cooperative. Mood is pleasant. No tics or facial fasciculation. Speech is fluent, words are clear

Politics and the Patient Protection and Affordable Care Act

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Politics and the Patient Protection and Affordable Care Act

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

 

The suppliers of legislative benefits are legislators, and their primary goal is to be re-elected. Thus, legislators need to maximize their chances for re-election, which requires political support. Legislators are assumed to be rational and to make cost-benefit calculations when faced with demands for legislation. However, the legislator’s cost-benefit calculations are not the cost-benefits to society of enacting particular legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur as a result of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support legislation. (page 27)

 

Source: Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Chicago, IL: Health Administration Press.

 

To Prepare:

 

Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).

Consider who benefits the most when policy is developed and in the context of policy implementation.

 

Post an explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).

Assignment: Legislation Comparison Grid and Testimony/Advocacy Statement

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Assignment: Legislation Comparison Grid and Testimony/Advocacy Statement

As a nurse, how often have you thought to yourself, If I had anything to do about it, things would work a little differently? Increasingly, nurses are beginning to realize that they do, in fact, have a role and a voice.

Many nurses encounter daily experiences that motivate them to take on an advocacy role in hopes of impacting policies, laws, or regulations that impact healthcare issues of interest. Of course, doing so means entering the less familiar world of policy and politics. While many nurses do not initially feel prepared to operate in this space effectively, the reward is the opportunity to shape and influence future health policy.

 

The Assignment: (1- to 2-page Comparison Grid; 1- to 2-page Legislation Testimony/Advocacy Statement)

 

Part 1: Legislation Comparison Grid

 

Based on the health-related bill you selected, complete the Legislation Comparison Grid Template. Be sure to address the following:

 

Determine the legislative intent of the bill you have reviewed.

Identify the proponents/opponents of the bill.

Identify the target populations addressed by the bill.

Where in the process is the bill currently? Is it in hearings or committees?

Is it receiving press coverage?

Part 2: Legislation Testimony/Advocacy Statement

 

Based on the health-related bill you selected, develop a 1- to 2-page Legislation Testimony/Advocacy Statement that addresses the following:

 

Advocate a position for the bill you selected and write testimony in support of your position.

Describe how you would address the opponent to your position. Be specific and provide examples.

Recommend at least one amendment to the bill in support of your position.

Interaction Between Nurse Informaticists and Other Specialists

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Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

                                                  To Prepare: 

Review the Resources and reflect on the evolution of      nursing informatics from a science to a nursing specialty.

Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization

 

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

                                    

                                   Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

· Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

· Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf 

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf 

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05.

Note: You will access this article from the Walden Library databases.

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019.

Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Executive Producer). (2012). Data, information, knowledge and wisdom continuum [Multimedia file]. Baltimore, MD: Author. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6051/03/mm/continuum/index.html

Public Health Informatics Institute. (2017). Public Health Informatics: “shipping” information for better health [Video file]. Retrieved from https://www.youtube.com/watch?v=q1gNQ9dm0zg.

Public Health Informatics Institute. (2017). Public Health Informatics: knowledge “architecture” [Video file]. Retrieved from https://www.youtube.com/watch?v=sofmUeQkMLU.

P (patient/problem) I (intervention/indicator) C (comparison) O (outcome)

/in /by

Write a summary of the significance and background of a healthcare problem

P (patient/problem)

I (intervention/indicator)

C (comparison)

O (outcome)

Here are some search words that will focus on a single intervention for each topic. You should consider trying these exact search words to begin the search.

hand hygiene education

patient education on fall risk

patient education on smoking cessation

patient education to prevent CHF readmission

non-pharmacological behavioral interventions to reduce pain

non-pharmacological behavioral interventions to reduce anxiety

pet assisted therapy

palliative care education

patient education to prevent elective C-section

skin to skin to improve breastfeeding compliance

CHG to prevent surgical site infection

repositioning and turning to prevent pressure ulcer

prophylactic dressings to prevent pressure ulcer

assessment for early removal of urinary catheter

bundles to prevent CAUTI

Implementation Of The IOM Future Of Nursing Report

/in /by

In a formal paper of 1,000-1,250 words you will discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.” Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?

Explore the Campaign for Action webpage (you may need to research your state’s website independently if it is not active on this site): http://campaignforaction.org/states

Review your state’s progress report by locating your state and clicking on one of the six progress icons for: education, leadership, practice, interpersonal collaboration, diversity, and data. You can also download a full progress report for your state by clicking on the box located at the bottom of the webpage.

In a paper of 1,000-1,250 words:

  1. Discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”
  2. Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development.
  3. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?

Summarize two initiatives spearheaded by your state’s action coalition. In what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers?

A minimum of three scholarly references are required for this assignment.

RUBRICS

1 Provided an original summary of the key messages of the IOM report, Future of Nursing: Leading Change, Advancing Health. Any specific references should be cited.

2 Identify the role of the Robert Wood Johnson Foundation Initiative and the American Association of Retired Persons on the Future of Nursing Campaign for Action and the State Based Action Coalitions

3. Identify the importance of the IOM FON report related to the nursing workforce

4 Discuss the intent of the Future of Nursing Campaign for Action

5 Identify the rationale of state-based action coalitions

6 Discuss one state-based action coalition and two initiatives

Organizational Systems and Quality Leadership

/in /by

 

Explain the general purpose of conducting a root cause analysis (RCA).

A root cause analysis (RCA) is a process for classifying the cause of a problem, and then a good way to approach and respond to the problem. The goal is to examine what happened, how the issue happened, and why it happened so that actions can be put into place to prevent a reoccurrence from happening (Institute for Healthcare Improvement).

Explain each of the six steps used to conduct an RCA, as defined by IHI.

Most often and RCA team involves four to six individuals from a mix of different professions. Each person should have fundamental knowledge of the problems and procedure involved in the accident. There is a total of six steps. The first step is to identify what happened. The team needs to explain what happened by organizing the information to clarify exactly what took place. The second step is to determine what should have happened. The team can create a chart to better understand what should have happened in an ideal situation. Number three is to determine causes (“Ask why five times”). This is how the team determines the factors that lead to the event. They look at the direct causes and the contributory factors as to why the incident happened. The fourth step is to develop causal statements. This is how they explain how the contributory factors lead to the bad outcomes. Step number five is to generate a list of recommended steps to prevent the recurrence of the event, which are changes that the team thinks will aid in preventing the error from happening again. The final sixth step is, write a summary and share it. This can help to engage people to aid in the steps of improvement (Institute for Healthcare Improvement).

Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome.

The first step is to identify what happened: Mr. B is a 67-year-old male who is 175lbs with a past medical history of, chronic back pain which he was taking oxycodone for, impaired glucose tolerance, prostate cancer, high cholesterol, and high triglycerides. He was brought to the Emergency department (ED) by his son and neighbor complaining of pain in the left leg and left hip. He states he lost balance and tripped over the dog causing him to fall. When he had arrived at the ED, his blood pressure, heart rate and temp were all within normal limits, and his respirations were noted to be elevated at 32 which could be from the severe pain he was experiencing, which he rated 10/10. He was noted to have shortening of the left leg, edema, ecchymosis, and limited range of motion. There were two nurses (an LPN and an RN), an ER doctor, one secretary, and hospital respiratory therapist on staff at this rural hospital. Mr. B was the third patient in the ER at the time of arrival. The doctor evaluated Mr. B and ordered the RN to give 5mg of diazepam IV push, when that did not have an effect after 5 minutes the doctor then ordered the RN to give Hydromorphone 2mg IV push which was given 10 minutes later. The doctor was still not happy with the results after 5 minutes so, he then ordered to give another 2mg of Hydromorphone and an additional 5mg of diazepam both IV push. The sedation goal of the doctor was finally achieved, and he performed a reduction of the left hip. The patient had tolerated the procedure and he was still sedated, without any supplemental oxygen placed. The ED was then notified of a patient on the way in for acute respiratory distress, so the nurse put the patient on an automatic blood pressure and pulse oximeter reading every 5 minutes and she left the room leaving the son to sit with the patient. Five minutes after the procedure had ended the patients blood pressure had decreased to 110/62 and his oxygen saturation decreased to 92%, remaining without supplemental oxygen, and without ECG and respiration monitoring. While the RN and LPN were occupied with the new arrival, Mr. B’s oxygen monitor was alarming to indicate his oxygen had dropped to 85%. Then Mr. B’s son came out to alarm the nurse that the monitor was ringing again, she finally entered the room to find his blood pressure at 58/30 and oxygen level at 79%, Mr. B had no signs of breathing and there was no palpable pulse. The nurse called a STAT code and resuscitative efforts were started, he was intubated, defibrillated, given reversal agents, given IV fluids, and given vasopressors. This lasted 30 minutes, the ECG returned to normal sinus rhythm, blood pressure was 110/70. Mr. B was fully dependent on the ventilator, his pupils were fixed and dilated, and he was not responding to stimuli. Mr. B was then transferred to a different hospital for care upon the families wishes. Seven days after this ER visit, Mr. B was given a “brain dead” diagnosis, the family decided to remove life support and Mr. B had passed away.

The second step is to identify what should have happened. The doctor and nurse needed to be trained on the conscious sedation protocols in place, as well as known the proper dose and proper drugs to be used in this situation. If the nurse knew the drug dosing, she should have questioned the medication that was ordered to give to this patient. The nurse should of abided by the hospital protocol and placed the patient on continuous blood pressure, ECG, and pulse oximeter reading throughout the procedure and until the patient meets the criteria for discharge which was, being fully awake, vital signs being stable, no nausea or vomiting, and able to void. When Mr. B’s oxygen saturation was dropping the LPN should have notified the RN, instead she just silenced the alarm from going off which defeats the purpose of the alarm. Finally, the ER should have called for additional nurses and staff to assist with the current patients to prevent any accidents from happening.

The third step is to determine the causes of the event. The direct cause of death would be the irreversible brain damage due to lack of oxygen for a prolonged period of time. The the contributory factors to the patient’s death would be the lack of staffing, the doctor over sedating the patient for the procedure, not adhering to the protocol for proper conscious sedation monitoring, and ignoring the patients alarm for low oxygen saturation.

Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome.

The first thing that I would propose as an improvement plan to prevent a reoccurrence of this scenario is to conduct a mandatory training for the physicians, RNs, LPNs, and Respiratory Therapist regarding the conscious sedation protocol, that way everyone has the information needed including how to monitor, and what vitals to be monitoring. Then the only ones available to care for a patient that requires conscious sedation would be the ones who have successfully completed the training. I would propose to upper management that patients who have undergone conscious sedation require mandatory one on one monitoring until the criteria is met.

Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan.

The Lewin’s change theory has three steps; including unfreeze=change=refreeze. Individuals are not open to change, they get comfortable with their routine and tend to resist any change. However, revealing that there is a problem in the system requires the proper steps to change and make things more effective. In this scenario the staff need to be aware of the issues that have taken place, and then convinced of the benefits of change to them as well as the patient. Hosting a meeting to discuss the event and what took place and what needs to take place to improve care and prevent this from reoccurring. Change is not easy for anyone but taking the proper approach to initiate the change, provide support for the change, and then monitor to make sure the change is being used will make it easy for everyone in this process (Mind Tools, 2019).

Explain the general purpose of the failure mode and effects analysis (FMEA) process.

The Failure Mode and Effects Analysis (FMEA) is a step by step approach to identify possible problems before they occur. It is used to take action in reducing and eliminating failures. They also document the current knowledge about the risk of failures to continue improvements (Institute for Healthcare Improvement, 2020).

Describe the steps of the FMEA process as defined by IHI.

The first step of the FMEA process identified by the IHI is, define the scope and topic of the FMEA. The second step is to assemble a multi-disciplinary team of involved professionals. The third step is charting the steps of the process. The fourth step is hazard analysis which the team analysis completes the chart showing all the possible ways the process could fail, which includes the likelihood and severity. The fifth and final step is uses risk profile numbers (RPNs) to plan improvement, which identifies ways to keep the high-risk plans from failing (Institute for Healthcare Improvement, 2020).

Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B.

 

List 4 steps in your Improvement Plan Process List 1 Failure Mode per step Likelihood of Occurrence (1–10) Likelihood of Detection (1–10) Severity

(1–10)

 Risk Priority Number

(RPN)
1. All physicians, RNs, LPNs, and Respiratory therapist do mandatory conscious sedation training

 

 

 

 The protocol will not be followed as directed 6 7 6 252
2. Utilizing continuous O2 monitoring during and after the conscious sedation procedure until criteria is met

 

 

 

 staff may take off monitor prior to criteria being met 7 6 9 378
3. Monitoring Blood pressure, and pulse before, during and after procedure

 

 

 

 The patient’s vitals will fall or rise into abnormal values 6 4 8 192
4. Nurses and Doctors need to have mandatory training on medication to give for conscious sedation procedures They will not abide by the medication administration rules in place causing patients to be at risk 8 6 10 480
          Total RPN (sum of all RPN’s): 1,302

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explain how you would test the interventions from the process improvement plan from part B to improve care.

To test the interventions from the process improvement plan, there would need to be intense monitoring taking place to confirm that the staff are complying. There would need to be someone conducting a chart review of patients who underwent conscious sedation to show and prove that the staff is using the new policies and procedures. Analyzing these patients’ vital signs to measure improvement and compliance as well. Supervisors could do random checks to make sure staff are abiding by the protocols.

Explain how a professional nurse can competently demonstrate leadership in each of the following areas:

• promoting quality care – Professional nurses can demonstrate leadership in promoting quality of care by advocating for the patient. Some of the patients are in their most vulnerable state, and if the nurse is listening to their concerns and speaking up for them when needed if the patient is at a compromised state then this is giving quality care to that patient.

• improving patient outcomes- Professional nurses can demonstrate leadership in improving patient outcomes by adhering to the set protocols to ensure patient safety. The nurse should always have the patient’s best interest at heart so providing compassionate, caring, safe care should improve patient outcomes, so they feel they are taken care of in the best way possible.

• influencing quality improvement activities- Professional nurses can demonstrate leadership in influencing quality improvement activities by constantly educating yourself and evolving with the standards of care. As a nurse leader you will have the quality indicators examined regularly and be ready to change as needed.

Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities.

The professional nurse should be involved in the RCA and FEMA processes because they are a part of the team. Nurses should implement and evaluate plans and processes continuously. As a nurse you are constantly using your critical thinking skills to best assist the patient and you are an advocator for the patients. So, if you are involved in these two processes most likely patient outcomes will be improved because nurses are on the forefront of patient care.

 

 

 

 

References

Institute for Healthcare Improvement. (2020). Failure Modes and Effects Analysis( FMEA) Tool. Retrieved

from http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx

 

Institute for Healthcare Improvement. Patient Safety 104: Root Cause and Systems Analysis. Retrieved

on February 4, 2020 from app.ihi.org/LMS/Content/f99b4ea2-aeea-432d-a3573ca88b6ae886/Upload/PS%20104%20SummaryFINAL.pdf

Mind Tools. Lewin’s Change Management Model – Understanding the Three Stages of Change

(October 5, 2019) Retrieved from https://www.mindtools.com/pages/article/newPPM_94.htm