Use the questions in the table in chapter 3 on page 101 of your textbook as a guide as you write your personal philosophy of nursing. The paper should be three typewritten double spaced pages following APA style guidelines. The paper should address the following:

1. Introduction that includes who you are and where you practice nursing
2. Definition of Nursing
3. Assumptions or underlying beliefs
4. Definitions and examples of  the major domains (person, health, and environment) of nursing
5. Summary that includes:
   1. How are the domains connected?
   2. What is your vision of nursing for the future?
   3. What are the challenges that you will face as a nurse?
   4. What are your goals for professional development?

Grading criteria for the Personal Philosophy of Nursing Paper:

Introduction                                                                            10%

Definition of Nursing                                                                20%

Assumptions and beliefs                                                         20%

Definitions and examples of domains of nursing                        30%

Summary                                                                               20%

Total              100%

Running Head: PHILOSOPHY OF NURSING

PHILOSOPHY OF NURSING 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am a nurse practitioner working at Texas Health Hospital. I am an autonomous and licensed clinician who focuses on managing the health conditions of the people and shunning the diseases. In most of the times, I specialize in offering health care services to the patients. I work directly with patients who are experiencing chronic diseases with the aim of diagnosing and managing their health conditions.

Additionally, according to the International Council of Nurses, nursing can be termed as the central or integral component of the health care system which entails promotion of the health, illnesses’ prevention, taking care of disabled people, mentally ill, and physically one in the healthcare settings (Alligood, 2017). The nursing typically exists just to make sure that public health of the people is upheld by the nurses. Nursing exists to take care of health conditions of the public, prevent people from illness, and upholding healthy society. More so, I practice nursing with a passion for seeing a transformed society where most of the people are living a healthy life. It is my profession, and I wish to deliver the best out of me just for the sake of lives of people and to meet my goals as a nurse practitioner of making people live healthy lives.

According to my beliefs regarding nurse, I believe that as a nurse a unique role or function is diagnosing, managing, and curing various kinds of illnesses. Furthermore, I also believe that a nurse is that person who happens to complete the basic and generalized nursing education, and later being authorized by a regulatory body or authority to practice the nursing in the country (Alligood, 2017). Additionally, the patients can be termed as the person or individual who is registered to receive the medical treatment. Furthermore, other healthcare providers, are the personnel who are always available to offer health care services to the people to the people. A healthcare provider can be termed as any person who is working at the healthcare facility, and his or her purpose is diagnosing and managing illnesses faced by the clients. More so, communities can be termed as all entities that take part in the delivery of the healthcare services. The community is made up of health care providers, nurses, doctors, patients etc.

In the nursing, metaparadigm, it is made of the four key concepts, namely: health, person, nursing, and environment. Firstly, the person is known for putting the focus on the patient is believed to be the recipient of the care (Branch et al., 2016). More so, the metaparadigm of a person may consist of person’s family, culture, spirituality, friends etc. Secondly, the environment refers to external and internal factors that are linked to the patient. This consists of the interaction that is established between the visitors and patients and more so, their surroundings. In addition, when we consider the metaparadigm of health it can be termed as the quality and the wellness of the patients (Branch et al., 2016). This entails accessibility of health care by the patients.

Summary

After researching on the domains of nursing, these domains are connected in different ways. For instance, when we consider the person, they can be termed as the health care providers who offer the health care services to the patients. In addition, when we consider the patients they are offered health care services by the persons (health care providers). More so, the metaparadigm of health is the one that determines the wellness of the patients to determine the kind and quality of health care services to be offered to the patients. Furthermore, the health status of the patient is affected by the environment which one lives at. Environmental factors are key factors that affect the health conditions of the patient (Blais, 2015). More so, when I consider the vision of nursing in future, I expect the fled of medicine to invest in research with the aim of researching more regarding the different kinds of diseases and modes of treatment that should be adopted to improve the public health. The challenge is curing the new diseases that may arise as a result of poor living, and new kinds of foods people are eating. In future, it is expected that types of diseases will increase. Thus, it requires serious attention to address kind of behaviours people are involved in curbing future diseases. In my career, I expected to advance my education and specialized in surgery for the sake of curing the most daring and deadly diseases and taking care of the people who might be suffering from accidents. In my childhood, I wished to become a surgeon; thus, bearing in mind that I am in line with my passion, I would ultimately pursue my childhood goal.

 

 

 

 

 

 

 

 

 

 

 

 

References

Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.

Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.

Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four Nursing Metaparadigms. IU South Bend Undergraduate Research Journal, 16, 123-132.

Preliminary Data

Definition of Staffing Terms: To build a body of knowledge regarding the development of a staffing budget and later be able to create actual staffing plans, the registered nurse must first be familiar with the following terms and their definitions.

 

Nursing Hours Per Patient Day (NHPPD): A unit of measure that defines the average number of hours of nursing care delivered to each patient in a 24-hour period.

 

Hours Per Workload Unit (HPWU): A unit of measure that defines the average number of hours worked per workload unit. The workload unit can be number of visits, number of meals served, number of square feet cleaned, number of operating room minutes, and others, depending on the department worked.

 

There is a direct relationship between the workload and the amount of resources (RNs, LVNs, Aides, Dietary Aides, OR staff, etc.) needed.

 

Patient Day (PD): One patient occupying one bed for one day. Typically, counted at midnight. For example, a patient admitted to a nursing care unit at 11:50 p.m. will be counted in the midnight census for that unit; therefore will be counted as one patient day.

 

Average Daily Census: Patient days in a given time period (daily, weekly, monthly, or annual) divided by the number of days in the time period. It is also used to define the average number of total inpatients on any given day.

 

Variable Hours of Care: A component of NHPPD that measures the amount, in time, of care directly provided to the patient by a caregiver, e.g. RN, LVN, aide. It does not take into account fixed hours of care. Variable hours of care are also referred to as caregiver hours.

 

Fixed Hours of Care: A component of NHPPD that reflects the indirect care provided by nursing staff, e.g. unit secretary, nurse manager, clinical nurse specialist. This unit of measure is a constant, meaning that it is not dependent upon the acuity of the patient, or the volume of patients when calculating the staffing pattern.

 

Full-Time Equivalent (FTE): The equivalent of one full-time employee working for one year. It is calculated based upon 40 hours per week for 52 weeks, or 2080 hours. It includes both productive and nonproductive time. One employee, working full-time for one year (2080 hours) is one FTE. Two employees, each working 20 hours per week for one year (1040 hours each), are the equivalent of one FTE.

 

Replacement FTE: The number of FTEs required to replace non-worked hours.

 

Worked Hours: The actual number of hours worked, including both regular and overtime hours, orientation hours, on-call hours, callback hours, and training/education hours. Also known as productive hours.

 

Non-Worked Hours: The hours for which an employee is paid, but are not worked. Examples include vacation, sick, jury duty, holidays, funeral leave, paid time off, etc. The Fair Labor Standards Act dictates what an institution must include as non-worked hours. Also known as nonproductive hours.

 

Paid Hours: The total amount of worked and non-worked hours an employee is paid for.

 

Position: One person working one job, regardless of the number of hours that person works. A position is not the same as an FTE.

 

Shift: A designated number of hours that an employee works in a 24-hour period. A shift could be 4, 8, 10, 12, or even 16 hours in length. In this module, one shift will be considered as 8 hours.

 

Paid to Worked Ratio (PWR): Paid hours divided by the difference between paid and non-worked (nonproductive) hours. The PWR is calculated to determine the number of paid FTEs required. For example, one FTE is paid 2080 hours in one year. This FTE has 265 nonproductive hours (vacation, holiday, sick, etc.). PWR=2080/(2080-265)=1.15.

 

Worked FTE: The number of FTEs required to provide patient care on a daily, weekly, monthly, or annual basis.

 

Paid FTE: The actual number of worked FTEs plus the replacement FTEs needed during vacation, education, training, etc. to staff a cost center.

 

Cost Center: A unit or department in an organization.

Putting the Definitions to Use

Use the Excel™ Spreadsheet provided to document your answers. All calculations must be done using formulas in the spreadsheet, where applicable. Be sure to check your worksheet before submitting the assignment to ensure that when the reader clicks in a cell, the formula used to calculate the response is visible in the function bar.

 

Calculating an FTE

Remember, an FTE is based upon the designated number of hours needed to cover a specified number of shifts during a specific time period. The time period may be per week, per pay period (usually two weeks) or per year. A shift is 8 hours of worked time. Below are some examples of how an FTE is calculated:

· FTE = Number of shifts assigned to work every pay period. A Full-time employee works 10 shifts every two weeks, and this equals 80 hours in a pay period. An employee who is full-time would not necessarily have to work 10 shifts as long as they worked 80 hours. However, for the purposes of this module, all shifts are to be considered 8 hours long, so the employee must work 10 shifts to be considered full-time.

· FTE = Worked hours hours per pay period for full-time employee

FTE = 40 worked hours 80 hours = 0.50 FTE

· Hours = FTE x Hours paid per pay period for full-time employee

· Hours = 0.50 FTE x 80 = 40 hours (number of hours that a 0.50 FTE would be scheduled to work in a pay period)

· Shifts = Hours per pay period Hours in a shift

Shifts = 80 hours per pay period 8 hours = 10 shifts per pay period

10 shifts = 80 hours per pay period = 1.00 FTE

9 shifts = 72 hours per pay period = 0.90 FTE

8 shifts = 64 hours per pay period = 0.80 FTE

7 shifts = 56 hours per pay period = 0.70 FTE

6 shifts = 48 hours per pay period = 0.60 FTE

5 shifts = 40 hours per pay period = 0.50 FTE

4 shifts = 32 hours per pay period = 0.40 FTE

3 shifts = 24 hours per pay period = 0.30 FTE

2 shifts = 16 hours per pay period = 0.20 FTE

1 shift = 8 hours per pay period = 0.10 FTE

For each of the following scenarios, complete your answers using your knowledge of Excel basic formulas on the Worksheet provided in the Assignment Drop Box:

 

FTEs	ONE WEEK HOURS	ONE WEEK SHIFTS	ONE PAY PERIOD HOURS	ONE PAY PERIOD SHIFTS
0.2	8	1	16	2
0.4
0.6
0.8
1.0
2.0

Great!!! You have now mastered being able to calculate the number of shifts and hours that a designated FTW works in one week and in one pay period. Using the same principles, you could also calculate the number of hours and shifts an FTE would work in a month, quarter, or year.

 

The next step is to be able to compute the number of FTEs needed to staff for one week based on the number of shifts required. To be able to calculate this number, you need to know the following:

 

· FTEs = Total Shifts 5 shifts (shifts worked by 1 FTE per week)

· FTEs = An RN works 5 shifts per week. How many FTEs are required?

FTE = 5 5 = 1.00 FTE

Now, it’s your turn again!!! Fill in the missing shifts and FTEs, using Excel formulas:

STAFF	S	M	T	W	T	F	S	SHIFTS	FTEs*
NM	0	1	1	1	1	1	0	5	1.0
RN	5	6	6	6	6	6	5
LVN	4	3	3	3	3	3	4
NA	4	4	4	4	4	4	4
US	1	1	1	1	1	1	1
TOTAL	14	15	15	15	15	15	14

*Format FTEs to 1 decimal place.

Calculating NHPPD

Were the previous calculation exercises easy for you to complete? Great!! The next few are just as easy, but they begin to combine the elements of required nursing hours per patient day and the unit’s FTE requirements. But, before we get to that, you need to know how to derive the NHPPD and its related components.

Let’s get started!

The numbers of FTEs allocated to a nursing unit are based upon the NHPPD for that particular unit’s patient population and acuity. A variety of sources are available to compare your unit’s NHPPD with other units. In many cases there are national nursing standards that can be used as comparative data (like units, with the same type of patient population, are compared to each other). These units with the same or similar patient types usually have common nursing care requirements. When this is true, those nursing unit’s NHPPD are averaged to create a standard NHPPD. This number can only be used as a guide to determine the NHPPD for your unit, because differences such as geography, nursing care delivery system, support services available, and other variables may not be accounted for.

Why is it important for RNs to understand the concept of NHPPD and know their unit’s hours? Simply put, NHPPD defines how much nursing care each patient on the unit requires in a 24-hour period. In a sense, it defines the level of care required. Without it, the staffing might be based upon volume, rather than patient needs, and nursing care in acute care units should be based upon the needs of the patient.

In one example, a total of 103 shifts were worked by the distribution of staff given for one week. For a particular week, this unit experienced 85 patient days. From this data, one can calculate the NHPPD:

 

· NHPPD = Total shifts per week x 8 hours per shift

Number of Patient Days

NHPPD = 103 x 8 = 9.69

85

Now, here is one for you to figure out. Please calculate the NHPPD for the following unit, using Excel formulas to complete your calculations:

Unit 3A has had 61 patient days in the past week, with a total of 98 shifts staffed. What was 3A’s NHPPD for that time period?

 

NHPPD* = ___________________________________

*Format NHPPD to 2 decimal places.

As we said earlier, NHPPD is a compilation of different types of hours, one of which is Variable Hours of Care or Caregiver Hours. Remember, variable hours of care delineates those hours of care that are directly provided to the patient by a caregiver, defined as the RN, LVN, or nurse aide. Calculating Caregiver Hours gives us how many hours within the NHPPD are spent providing direct nursing care. It is calculated:

 

· Caregiver Hours = Total shifts of RNs, LVNs, & NAs x 8 hours per shift

Patient Days

 

In one example, the total shifts calculated = 103. There were 12 non-caregiver shifts (NM and US), which leaves 91 Caregiver shifts. Assuming the same number of patient days (85) from above, calculate the Caregiver Hours:

 

Caregiver Hours = 91 x 8 = 8.56

85

Using the situation described previously for Unit 3A, calculate the Caregiver Hours where there were 54 RN shifts, 14 LVN shifts, and 13 NA shifts. Use formulas in Excel for your calculations.

 

Caregiver Hours* = __________________________

*Format the Variable Hours of Care (Caregiver Hours) calculation to 2 decimal places.

 

We hope that you noticed that your Variable Hours of Care did not equal the number you got for NHPPD. Great!! That is because we have not taken into account yet the Fixed Hours. Fixed Hours of Care are the hours required for indirect care for every patient on a unit. Fixed hours are comprised of the secretarial work, management of the unit, and non-direct patient care (e.g. patient teaching done by a CNS). Remember, this number is constant, since it is not affected by acuity or volume.

 

· Fixed Hours of Care = Total shifts of NM, US, etc x 8 hours per shift

Patient Days

 

From our first example, calculate the number of shifts worked by the NM and US. Using the same patient days of 85, calculate Fixed Hours of Care for this unit:

 

Fixed Hours of Care = 12 x 8 = 1.13

85

 

Are you ready? Using the same situation for 3A and knowing that there are 5 Nurse Manager shifts, 5 CNS shifts, and 7 Unit Secretary shifts, calculate the Fixed Hours of Care: Again, use formulas in Excel to complete your calculations.

 

Fixed Hours of Care* = ______________________

*Format calculation to 2 decimal places.

 

Hopefully, when you add your answers for the Caregiver Hours and Fixed Hours of Care, you came up with the answer you originally got for your NHPPD. Remember, this occurs because NHPPD is a combination of Variable (Caregiver) Hours and Fixed Hours of Care.

 

Calculating Paid FTEs and Positions

WOW!!! Your brain is probably already on overload, but the best is yet to come!!! Now, if you believe that, we have some beach front property in Arizona for sale… Interested?

Seriously, to complete the determination of staffing process, you must know how to figure paid FTEs and the number and type of positions needed. Paid FTEs differ from the FTEs you have previously figured because paid FTEs include both worked and non-worked hours. What you have done so far is to calculate worked FTEs.

 

· Non-worked Hours = Total shifts non-worked x 8 hours per shift

 

An example of calculating Non-worked Hours for a full-time employee is as follows:

 

Sick leave = 10 shifts per year

Vacation = 15 shifts per year

Holidays = 8 shifts per year

Training = 5 shifts per year

Misc. = 2 shifts per year

Total = 40 shifts per year

 

Non-worked Hours = 40 shifts x 8 hours = 320 hours per employee

 

Note: The number of non-worked hours for an employee is determined by the organization, which ensures consistent allocation of non-worked hours allocated. Although employees with seniority might have more vacation hours than new employees, for the purposes of this module, all employees have the same allocation of non-worked hours.

 

Here goes! Is your computer smoking yet??? Calculate the number of Non-worked Hours for any employee of 3A, using formulas in Excel, based upon the following data:

 

Sick leave = 12 shifts per year

Vacation = 10 shifts per year

Holidays = 6 shifts per year

Training = 3 shifts per year

Misc. = 3 shifts per year

Total = 34 shifts per year

 

Non-worked Hours = _________________

 

Calculating the non-worked hours is essential prior to figuring the Paid-to-Worked Ratio (PWR) for an organization. The PWR allows you to determine the total number of paid FTEs required to staff your nursing unit. As explained earlier, paid FTEs is a combination of worked FTEs and the replacement FTEs needed when, for example, someone is on vacation, ill, or at an education seminar. Replacement FTEs are necessary in order to maintain established staffing patterns by replacing an employee (who is calculated in Caregiver Hours) who is off, on vacation, etc. with a person of equal skill classification (RN for RN, LVN for LVN, etc.). Replacement FTEs need to be budgeted when the staffing pattern is established so that you are not using overtime to staff the unit, or staffing at levels below requirements. Paid FTEs is a requirement for being able to put a dollar figure to a staffing plan.

 

· PWR = Annual Paid Hours for a full-time employee

(Annual Paid Hours) – (Non-worked Hours)

 

Using an example of 320 non-worked hours per employee,

PWR = __2080___ = 2080

2080-320 1760

 

PWR = 1.18

 

To calculate paid FTEs required, multiply the worked FTEs for each classification of employee times the PWR.

 

· Paid FTEs = Worked FTEs x PWR

 

Using an example of having 6.6 worked FTEs of NA, and the PWR calculated above, calculate the number of Paid FTEs required:

 

Paid FTEs = 6.6 x 1.18 = 7.79

*Format Paid FTEs to 2 decimal places

 

Remember that when an employee who is off is not replaced with another comparable employee, such as the nurse manager or clinical specialist, the Paid FTEs are equal to Worked FTEs.

Calculate the Paid FTEs (Worked FTEs plus replacement) in the following staffing plan, using PWR = 1.18. Put your formula in the appropriate cells in Excel.

 

STAFF	S	M	T	W	T	F	S	SHIFTS	WORKED FTEs	PAID FTEs*
NM	0	1	1	1	1	1	0	5	1.0
RN	5	6	6	6	6	6	5	40	8.0
LVN	4	3	3	3	3	3	4	23	4.6
NA	4	4	4	4	4	4	4	28	5.6
US	1	1	1	1	1	1	1	7	1.4
TOTAL	14	15	15	15	15	15	14	103	20.6

 

*Format Paid FTEs to 2 decimal places.

 

Easy, isn’t it? Well, you are almost done with this section. Close your eyes, take a deep breath, and forge onward! Now we are going to learn how to assign positions to a staffing pattern.

 

Positions do not designate time: they designate space or the number of employees needed for a specific skill type, e.g. RN. A position is not the same thing as a FTE! As obvious as it may seem, let us say that it is important to have the correct number of positions so that you will have the correct number of staff to implement the staffing pattern.

 

In a staffing pattern that gives every other weekend off, the number of positions required is equal to the total number of shifts worked on weekends. As before, assume each shift worked is an 8-hour shift. Let’s say that on a typical nursing unit at your facility the number of RN shifts worked every Saturday and Sunday are five, and six RN shifts are worked Monday through Friday. The number of RN positions required would be 10. For positions that are not replaced by another comparable employee (e.g. Nurse managers), the number of positions needed for that skill classification is equal to the actual number of employees in that classification. For example, if you have one Nurse Manager, you only need one position of NM.

 

Determine the number positions required for each skill classification in the staffing pattern below. Watch out!! If you determine the total number of positions needed by adding the total shifts for Saturday and Sunday you will be WRONG because the NM doesn’t work on those days; you will not have counted that “position!” To get the accurate number of total positions, add the column of positions for each skill classification:

 

STAFF	S	M	T	W	T	F	S	SHIFTS	WORKED FTEs	PAID FTEs	POSITIONS
NM	0	1	1	1	1	1	0	5	1.0	1.0	1
CNS	0	1	1	1	1	1	0	5	1.0	1.0	1
RN	2	3	3	3	3	3	2	19	3.8	4.48	4
LVN	3	3	3	3	3	3	3	21	4.2	4.96
NA	2	4	4	4	4	4	2	24	4.8	5.66
US	3	3	3	3	3	3	3	21	4.2	4.96
TOTAL	10	15	15	15	15	15	10	95	19.0	22.06

PWR = 1.18

 

Putting it all Together

Okay. Now it’s time to give you a real brain teaser. Let’s see if you can put it all together.

 

Complete the information for the following staffing pattern. Assume 8 hour shifts, PWR = 1.15, and 220 patient days for a one-week period:

 

STAFF	S	M	T	W	T	F	S	SHIFTS	WORKED FTEs	PAID FTEs	POSITIONS
NM	0	1	1	1	1	1	0
CNS	0	1	1	1	1	1	0
RN	6	6	6	6	6	6	6
LVN	2	3	3	3	3	3	2
NA	6	8	8	8	8	8	6
US	2	2	2	2	2	2	2
TOTAL

 

Inserting the appropriate data from above, calculate the following using formulas in Excel:

Calculate NHPPD: _____________________

 

Calculate Variable Hours: _________________

 

Calculate Fixed Hours: ____________________

Determining Paid NHPPD

Up to this point, you have been learning how to determine Worked NHPPD and its components. Below are formulas for calculating the Paid NHPPD. For each question below, use formulas in the Excel answer sheet to display your answer.

 

· Paid NHPPD = Worked NHPPD x PWR

Using an example where a unit had a NHPPD of 9.69, and the allocated PWR of 1.12, calculate the Paid NHPPD:

Paid NHPPD = 9.69 x 1.12 = 10.85

What is the Paid NHPPD with a Worked NHPPD of 15?

· Paid Caregiver Hours = Worked Caregiver Hours x PWR

The Variable Hours for that unit was 8.56. With a PWR of 1.12, calculate the Paid Caregiver Hours:

Paid Caregiver Hours = 8.56 x 1.12 = 9.59

What are the Paid Caregiver Hours with Worked Caregiver Hours of 7.25?

· Paid Fixed Hours = Worked Fixed Hours x PWR

The Fixed Hours for our earlier example was 1.13. With a PWR of 1.12, calculate the Paid Fixed Hours:

Paid Fixed Hours = 1.13 x 1.12 = 1.26

What are the Paid Fixed Hours with Worked Fixed Hours of 1.6?

Note that you can calculate the Worked elements of NHPPD by dividing the paid NHPPD by the PWR. For example, if you know the Paid NHPPD is 10.85 and the PWR is 1.12, then the Worked NHPPD is 10.85 1.12 = 9.69.

 

Acuity and its Influence

Just knowing your average daily census (ADC) and NHPPD may not be enough to create an accurate staffing pattern because these elements do not take into account the actual severity of the patients. If you are currently using an acuity system that assigns a numerical score to the severity level of the patients on your unit, you can adjust your staffing pattern to take into account the influence of patient severity.

· Acuity = Average Acuity Score x Patient Volume for a Specified Time

The Specified Time Period

You have calculated 12.85 NHPPD for a unit that has 61 patient days in one week (ADC=8.7). Assume an acuity on that unit of 2 (on average, each patient requires 2 RVUs); calculate Adjusted Daily Census (reflects acuity):

Acuity = 2 x 3176 Annual Patient Days

365 Days

Acuity = 6352 Adjusted Patient Days

365 Days

Acuity = 17.4 Adjusted Daily Census

This value equals an adjusted average daily census that reflects the acuity of that patient population. The staffing pattern is then configured based on this adjusted average daily census. For example, with an ADC of 8.7 and NHPPD of 12.85, you would need 13.97 FTE. Factoring in the acuity value would indicate that you now need 27.9 FTE (17.4 patients * 12.85 NHPPD ÷ 8 hour shifts) to care for those 8.7 patients because of the acuity level.

To further see how FTEs change in relation to the addition of acuity, please follow this example:

A nursing unit has been told that they must maintain a worked NHPPD of 6.62 hours. The baseline workload unit volume is 12,500 patient days, requiring 39.78 worked FTEs. Remember how to calculate that? 6.62 NHPPD x 12,500 patient days = 82,750 hours/year. 82,750 2080 (hours worked by 1 FTE) = 39.78 worked FTEs. The workload unit volume, with an acuity of 1.08 factored, is now 13,500 patient days. The worked FTEs that would be required to care for this adjusted patient day volume would be:

FTEs = NHPPD x Adjusted Workload Volume

2080 hours

FTEs = 6.62 x 13,500 = 42.97

2080

An additional 3.19 FTEs are needed to account for the acuity of the patient population and to maintain a worked NHPPD of 6.62.

How many more FTEs would be needed with an acuity level of 3.0 for this same volume of patients and 6.62 NHPPD? Use formulas in Excel to calculate your answer.

• Write a 500-word APA reflection essay of your experience with the Shadow Health virtual assignment(s). At least two scholarly sources in addition to your textbook should be utilized. Answers to the following questions may be included in your reflective essay:
  • What went well in your assessment?
  • What did not go so well? What will you change for your next assessment?
  • What findings did you uncover?
  • What questions yielded the most information? Why do you think these were effective?
  • What diagnostic tests would you order based on your findings?
  • What differential diagnoses are you currently considering?
  • What patient teaching were you able to complete? What additional patient teaching is needed?
  • Would you prescribe any medications at this point? Why or why not? If so, what?
  • How did your assessment demonstrate sound critical thinking and clinical decision making?

CASE STUDIES

 

CASE # 1 About: History of Public Health and Public and Community Health Nursing

Michael works as a home health nurse in his suburban community. He visits 7-10 clients each day. On today’s visitations, Michael will provide care for four clients who are recovering from hip replacement surgery and three clients who are recovering from heart surgery, and he will provide intravenous (IV) antibiotics for a man with an infected wound.

 

Among this list of clients, Michael visits Mrs. T., an 87-year-old white woman who lives alone and is recovering from triple bypass surgery that she underwent a month ago. Michael’s goals are to check on her recovery progress, reload her medications in her weekly medication container, and administer an influenza vaccine.

 

Upon entering Mrs. T.’s small house, Michael finds the house in disarray: clothes are scattered about, dirty dishes with crusted food line the kitchen counters, and no lights are on. Michael finds Mrs. T. lying in bed watching television. Mrs. T. complains to Michael of feeling too tired to do anything; she eats only what is already prepared (e.g., frozen dinners or snack foods like potato chips) because cooking requires too much effort. She spends most of her days lying in bed and has not bathed in a week.

 

Michael helps Mrs. T. out of bed and assists her with a bath. After the bath, Michael fixes Mrs. T. a quick lunch and refills her medication box while she eats. Michael encourages Mrs. T. to start getting some exercise by doing the household chores so that her heart can get stronger. “The stronger your heart is, the more energy you will have,” Michael tells Mrs. T. Michael also enlists several services for Mrs. T.: A home health aide will come to the house three times a week to help Mrs. T. bathe, and Meals-on-Wheels will bring her breakfast and lunch. Finally, Nurse Michael administers the influenza vaccine.

 

During Nurse Michael’s visit the following week, Mrs. T. is showing improvement. She tells Michael, “I just love that little girl who comes to help me; she is just so sweet. And the Meals-on-Wheels program is a blessing, I now have more energy to keep this place clean the way I like it.”

Questions

1. What challenges did Nurse Michael face in his first visit with Mrs. T. that public health nurses (PHNs) in the late 1800s also faced?

 

 

2. From your knowledge about the history of public health, compare an example of care displayed by nursing leaders of the past versus the current activities of Nurse Michael. For example, how was Nurse Michael’s nursing care similar to what Mary Breckinridge provided in the Frontier Nursing Service (FNS)?

 

 

3. How do the types of illnesses of Nurse Michael’s clients differ from the types of illnesses that were experienced by clients of PHNs in the early 1900s?

 

 

CASE STUDY # 2 ABOUT CULTURAL DIVERSITY IN THE COMMUNITY

 

Nurse Betty is teaching a health-promotion class to a group of Hispanic migrant workers. Nurse Betty is white, and this is her first time interacting with people of Hispanic culture. Nurse Betty speaks a little Spanish, but not enough to teach the whole class in Spanish. Most of the migrant workers speak only Spanish. Nurse Betty understands that she needs to provide culturally competent care to make her health-promotion class most effective but is not sure where to start.

Questions

1. What is the first step that Nurse Betty should take to prepare for her health-promotion class?

 

 

2. What are the language barriers, specific risk factors, and traditional healing practices that Nurse Betty must be aware of if she is to successfully interact with the group of Hispanic workers?

 

 

3. How can Nurse Betty involve the community to improve the effectiveness of her health-promotion class?

 

 

CASE # 3: ABOUT ENVIROMMENTAL HEALTH

John J. is a school nurse at Jackson Elementary School, which was built in 1960. Nurse John has noticed that many students from Ms. Zee’s second grade class have come to the clinic complaining about coughing, sneezing, runny nose, and watery eyes. Nurse John has also observed that Steven Tea, the only asthmatic student in Ms. Zee’s class, has had more asthma attacks this year than he did last year. Because the rest of the school is not experiencing the same respiratory problems, Nurse John is concerned that something in Ms. Zee’s classroom is causing students to feel ill.

 

Nurse John decides to visit Ms. Zee’s classroom. Upon entering the classroom, one of the few located in the school’s basement, John is struck by the powerful musty smell that inhabits the room. While talking to Ms. Zee, John learns that the classroom has “smelled bad for years,” and that students from previous years have complained about respiratory problems. Nurse John notes that Ms. Zee has stuffed a blanket at the base of the classroom’s small rectangular window near the ceiling because the window does not close completely.

 

John suspects that Ms. Zee’s classroom walls are contaminated with mold. Upon further research, Nurse John learns that if water gets between the exterior and the interior of a building’s wall, mold can grow in the moist environment. This situation can occur as the result of construction defects in the building (e.g., leaky windows). Nurse John also learns that people who are exposed to extensive mold growth may experience allergic reactions, such as hay fever-like allergy symptoms, and that people who already have a chronic respiratory disease, such as asthma, may experience difficulty breathing when exposed to mold. Nurse John is concerned about the possible mold contamination effect on his asthmatic student, Steven.

Questions

1. Identify the agent, host, and environment in this case study, and describe how they interacted to bring about the occurrence of disease.

 

2. Is the mold contamination in Ms. Zee’s room a point-source pollutant or a non–point-source pollutant?

 

3. What can Nurse John do to learn more about indoor air quality (IAQ) and about what to do in case of mold?

 

4. What are some possible interventions that Nurse John could apply to address the mold contamination in Ms. Zee’s room?

 

 

CASE # 4: ABOUT INFECTIOUS DISEASE PREVENTION AND CONTROL

 

Hilary S. is a nurse health inspector at the county health department. Nurse Hilary visits businesses in the community that have the potential to spread infectious diseases to large and/or vulnerable populations. Today, Nurse Hilary will visit the We Love Kids daycare center and a nearby seafood restaurant.

 

The daycare center cares for children ages 1 month to 6 years. To enroll a child in daycare, parents must show proof that the child is up-to-date on all age-appropriate immunizations or must show proof of medical or religious exemption. Nurse Hilary finds the records in the office area and confirms that all children have received the necessary immunizations. She observes that employees use gloves when changing diapers, cleaning a baby’s spit-up, and tending to a scratched knee from a playground accident. Employees also wash their hands after each of these events, before and after giving a baby his bottle, and before entering the 1- to 6-month-old room after leaving the 2- to 3-year-old room. Nurse Hilary also notices a flyer posted in the employee break room that informs staff of the upcoming mandatory in-service that will be held to discuss the importance of checking bottles, especially those that contain breast milk, for the correct name before feeding a child.

 

The seafood restaurant is a chain restaurant that has become less popular over the past couple of years. Many customers have complained about the quality of the food. Recently, 20 cases of severe diarrhea were reported to the health department by people who had just eaten at the restaurant. Nurse Hilary observes the cooks in the kitchen. The refrigerator and the freezer are kept at appropriate temperatures for storing food. Food is stored in airtight, plastic containers. Nurse Hilary watches as the cook who is preparing the chicken for broiling is also in charge of prepping the plates that are going out to the customers. Upon cutting into a piece of chicken about to go out to the dining room, Nurse Hilary notes that the center looks pink and undercooked. Pieces of wilted lettuce are scattered on the countertops. During her 2-hour visit, the main chef washes his hands twice, although he leaves the kitchen four times for a smoking break.

Questions

1. How is the daycare center providing infectious disease control?

 

2. Describe the outbreak of diarrhea.

A. Endemic

B. Epidemic

C. Pandemic

 

3. Which of the five keys to safer food does the restaurant not follow?

 

 

CASE # 5: ABOUT FAMILY HEALTH RISK

The M. family consists of Mr. M. (Harry), Mrs. M. (Shirley), 18-year-old Annie, 15-year-old Michelle, 13-year-old Sean, and 7-year-old Bobby. Harry is the pastor of Faith Baptist Church, where he has served for the past 15 years. Shirley is a housemother and is the primary caretaker for the children.

 

For the past year, Shirley has felt tired and “rundown.” At her annual physical, Shirley describes her symptoms to her physician. After several tests, Shirley is diagnosed with stomach cancer. Shirley starts to cry and says, “How will I tell my family?”

 

Shirley’s primary physician refers the family to Trisha F., a mental health nurse specialist. Nurse Trisha calls the household and speaks to Shirley. Nurse Trisha tells Shirley that she was referred by the physician, and she can help Shirley cope with the diagnosis. Shirley confides in Trisha that it has been 2 weeks since she received the diagnosis, but she has yet to tell her husband and children. Shirley asks Trisha if she can help her tell her family and explain what it all means. Nurse Trisha makes an appointment to go to the M. household and facilitate the family meeting.

Questions

1. Use the five interacting variables (physiological, psychological, sociocultural, developmental, and spiritual) of the Neuman Systems Model to assess the family’s ability to adapt to this life event. Think of one question Nurse Trisha can ask the family regarding each variable.

 

2. Is this life event a normative event or a nonnormative event?

 

 

3. Which phase of the home visit has Nurse Trisha reached (initiation phase, previsit phase, in-home phase, termination phase, or postvisit phase)?

 

 

 

CASE # 6: ABOUT CHILD AND ADOLESCENT HEALTH

 

Glenda R. is a parish nurse for Holy Cross Catholic Church. The church’s youth group teacher has overheard several of the 13- and 14-year-old teenagers talking about dating and sexual behaviors. The youth group teacher invites the parish nurse to speak to the group about sex and abstinence. Nurse Glenda sends letters to the parents describing when she will speak to the group about these topics and what will be discussed. Parents who would like their child to attend this class are asked to fill out the permission form.

 

On the night of the class, 18 of the 20 youth group members arrive for the class with their consent forms in hand. The room is set up with chairs in a circle and a computer with projector next to Nurse Glenda’s chair. Using pictures on the computer, Nurse Glenda illustrates the basic anatomy of the reproductive system and discusses what should be expected during puberty. Most of the class time is then spent discussing reasons for abstinence, how to know when you are ready for sex, and how to say no if you are not.

Questions

1. 1. Which teaching intervention designed to gather questions and feedback about the lesson would be most effective for this age group?

A. A confidential question box passed around for students to submit any questions they have about sex. Each student is asked to write something on a piece of paper, even if it is not a question or a comment, and to place it inside the box. Nurse Glenda reviews the papers and answers questions at the end of the class.

B. An open forum where students raise their hands and ask questions. Nurse Glenda responds appropriately.

C. A survey completed at the end of the class that students give to Nurse Glenda as they leave.

 

2. After the class has been given, Nurse Glenda talks to the parents and the church’s religious education teacher. Nurse Glenda believes that she can do more with this age group and would like to offer her services to them. She suggests that an evening of preventive screenings should be offered. What should Nurse Glenda screen for in this group of teenagers?

 

3. How can Nurse Glenda use interactive health communication (IHC) to reinforce the lesson?

 

 

CASE # 7: ABOUT POVERTY AND HOMELESSNESS

 

The community of Finnytown has identified the need for a shelter to serve homeless women and children. Finnytown currently has a homeless shelter for men. Women and children can obtain health care services there but are not allowed to stay overnight. The Finnytown health care task force performed a community assessment that revealed that a higher number of homeless men than women reside in Finnytown, but the percentage of homeless women is steadily increasing. Results further showed that more women with children than men are living in poverty. The task force speculated that many women who are living in poverty are being overlooked and thus are becoming women without homes.

 

The task force and the community of Finnytown decide to open a homeless shelter for women and children. The new shelter will primarily serve women with children who are homeless or in poverty. Georgia B. is the community health nurse who is a member of the task force team. Nurse Georgia and other health care professionals are charged with planning health care services for women with children to be provided at the new homeless shelter.

Questions

1. What common health problems should Nurse Georgia and the task force be aware of when planning health services to be provided at the new shelter?

 

2. What effects of poverty on the health of children should Nurse Georgia and the task force be aware of when planning appropriate services?

 

3. After the shelter opens, Nurse Georgia becomes one of the nurses who works in the clinic. What strategies are important for Nurse Georgia to implement when working with this population?

 

 

 

CASE # 8: ABOUT THE NURSE LEADER IN THE COMMUNITY

 

Ann T. is the state school nurse consultant. Nurse Ann provides guidance for school nurses across the state and organizes policy development for school nursing. Many of Nurse Ann’s hours are spent communicating by phone, face-to-face, or by e-mail with nurses and families who have questions regarding health services in the schools.

 

Terry L. contacts Nurse Ann. This is Terry’s first year as a school nurse, and she is working in a rural high school. She is worried about delegating medication administration to unlicensed personnel. “What exactly can be delegated, to whom, and how should I document it?” asks Nurse Terry.

 

Nurse Ann explains to Terry that some state laws specify who may delegate tasks, and the State Board of Nursing gives advice on which nursing tasks can be delegated. Nurse Ann tells Terry where on the Internet she can find these laws along with advisory opinions, and she e-mails copies to Terry. Nurse Ann shows Terry how to use the delegation decision tree and discusses some of Nurse Terry’s more challenging delegation issues. Nurse Terry must then use the materials to decide what she is comfortable delegating. Nurse Ann also gives Nurse Terry some sample training materials and documentation forms that other nurses in the state are currently using.

Questions

1. Which type of consultation model did Nurse Ann use? Explain your answer.

 

2. What can Nurse Ann do to reduce for other school nurses the confusion that surrounds delegation in school nursing?

 

3. What should Nurse Ann do to communicate effectively with the nurses and families whom she encounters?

 

 

 

CASE # 9: ABOUT FORENSIC NURSING IN THE COMMUNITY

 

Amanda J. is a forensic nurse who has been trained as a sexual assault nurse examiner (SANE). Amanda works part-time in the emergency room, where she occasionally examines victims of rape and sexual assault. Amanda also works part-time as a consultant for a local domestic-violence shelter for women and children. Every year Nurse Amanda helps to organize a Walk to Prevent Domestic Violence in her community. Proceeds raised from the walk go toward the domestic-violence shelter. Nurse Amanda provides literature about domestic violence at the walk as well as at other organizations in town.

Questions

1. Which levels of prevention does Nurse Amanda address in her practice?

A. Primary only

B. Secondary only

C. Tertiary only

D. Two of the above

E. All of the above

F. None of the above

 

2. What are the most common types of trace evidence of victims of violence, including those who are raped?

 

3. The concepts in forensic nursing theory include, but are not confined to, safety, injury, presence, perceptivity, victimization, and justice. How might Nurse Amanda address these concepts in her nursing practice?