Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.

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Health Care Delivery Models and Nursing Practice

Assessment Description
Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

-Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.

-Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.

-Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.

-Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

Describe the functions and structures of the central nervous system. Describe the different structures that make up the neuron. Explain the function of neurons in intracellular communication.

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Neuroanatomy

  1. Describe the functions and structures of the central nervous system.
  2. Describe the different structures that make up the neuron.
  3. Explain the function of neurons in intracellular communication.

 

Is nursing theory important to the nursing profession? In particular, is it important for nurse practitioners? Does theory inform nurse practitioner practice? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession? 

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WEEK 1 Discussion

Is nursing theory important to the nursing profession? In particular, is it important for nurse practitioners? Does theory inform nurse practitioner practice? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession?

Describe the typical patient population in your practice setting.What are some special considerations that you have used for obtaining an accurate health history and physical assessment in this patient population?

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Reflection on the Nurse’s Role in Health Assessment

Paragraph One: Briefly describe the type(s) of nursing health assessments you commonly perform.
Explain how your nursing health assessments are focused or comprehensive.Provide examples of key subjective and objective data collected by nurses in this setting.

Paragraph Two: Describe the typical patient population in your practice setting.What are some special considerations that you have used for obtaining an accurate health history and physical assessment in this patient population?

Examples may include age, lifestyle, financial status, health status, culture, religion, or spiritual practices.

Would the use of a word such as Mexican, Filipino, Polish, Arab, Russian, or Black or African American be discriminative? What is the difference between descriptive and discriminative?

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CRITICAL THINKING EXERCISES

1. Consider the beliefs of at least three cultures regarding illness and health. How do they compare with your personal beliefs?

2. Your nursing instructor uses the word “Mexican” in a sentence when describing a client. Would the use of a word such as Mexican, Filipino, Polish, Arab, Russian, or Black or African American be discriminative? What is the difference between descriptive and discriminative?

3. Quickly write your initial and immediate reactions to each of the following situations. Do not change or amend your initial answer after writing it. After you have responded to all the situations, evaluate and discuss your responses in terms of the transcultural nursing concepts presented in this chapter. How might any of the following situations be modified to be more comfortable for the client, you, and the healthcare staff?

  • A Native American man wants to burn herbs in his room and wants to see a healer from his tribe while in the facility.
  • A lesbian is at your clinic for artificial insemination, accompanied by her female partner.
  • A Jehovah’s Witness is seriously hemorrhaging and refuses to have a blood transfusion.
  • A man is accused of child abuse after performing religious healing rites that left bruises on his child; the father is in the hospital for mental health evaluation to determine if he is competent to stand trial.
  • An Amish woman refuses to take off her customary clothing and put on a hospital gown before a diagnostic test.
  • A family from Somalia refuses to leave their child alone in the hospital

Describe the clinical manifestations present in Mrs. J. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

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Health History and Medical Information for Mrs. J.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

  • Is very anxious and asks whether she is going to die.
  • Denies pain but says she feels like she cannot get enough air.
  • Says her heart feels like it is “running away.”
  • Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  • Height 175 cm; Weight 95.5kg.
  • Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  • Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
  • Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  • Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  • IV furosemide (Lasix)
  • Enalapril (Vasotec)
  • Metoprolol (Lopressor)
  • IV morphine sulphate (Morphine)
  • Inhaled short-acting bronchodilator (ProAir HFA)
  • Inhaled corticosteroid (Flovent HFA)
  • Oxygen delivered at 2L/ NC
  • Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

Describe the clinical manifestations present in Mrs. J.

Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.

Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.

Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.

Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders.

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Management of diabetes in Dialysis patient

Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated.

Analyze opportunities and challenges relating to public health, promoting health and preventing ill health when caring for children and young people.

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Breastfeeding

Analyze opportunities and challenges relating to public health, promoting health and preventing ill health when caring for children and young people.

Examine safety, ethical, legal and non-discriminatory practices in the delivery of care to children and young people classed as vulnerable and those with enduring health care needs and their families in a range of community, health and social care and education settings.

Examine the processes of learning and teaching in public health for children, young people and families and develop a health improvement resource

Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion.

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Cardiac or respiratory issue

Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion.

What questions on employment questionnaires or during employment interviews is the nurse allowed not to answer and should never have been asked? What is the polite way to avoid answering questions that should not have been asked during an interview? How can you avoid asking questions that should not be asked when you are interviewing someone?

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Discussion 7 & 8 N520

Discussion 7 & 8

Discussion Question 7: N520

Respond to ONE of the following prompts.

  • Debate why nurses should and should not donate their services.

OR

  • What advice should be given to nurses seeking employment as occupational health nurses or school nurses about their potential legal liability?

Discussion 8

Discussion Question: 8

Respond to ONE of the following prompts.

  • What questions on employment questionnaires or during employment interviews is the nurse allowed not to answer and should never have been asked? What is the polite way to avoid answering questions that should not have been asked during an interview? How can you avoid asking questions that should not be asked when you are interviewing someone?

OR

  • How does the doctrine of indemnification further the concept that individuals are ultimately responsible for their own actions?