Describe a recent challenging presentation of a sick child in your current clinical setting. Explore your feelings about the assessment and management of the patient requiring emergency care. Evaluate or make a judgement about what has happened.

/in /by

The purpose of this assessment is to reflect on clinical learning related to an episode of care for a paediatric patient that presented to your facility. At times, nurses encounter events that they find clinically and professionally challenging. It is important to see these situations as opportunities that contribute to life-long learning and improvement in clinical practice. Reflection is a fundamental component of learning. It integrates the learning experience, the emotional context and the resultant changes in our clinical skills and professional practice. It also, enables us to evaluate the quality of care provided in our clinical setting.

  • Describe a recent challenging presentation of a sick child in your current clinical setting.
  • Explore your feelings about the assessment and management of the patient requiring emergency care.
  • Evaluate or make a judgement about what has happened. Consider what was good about the experience and what did not go well.
  • Analyse the components of the situation which impacted significantly on the care you provided
  • Conclude the reflection process by outlining what you have learned from the experience, what could have been done differently?
  • Formulate an action plan for further learning to meet your clinical practice requirements. What strategies or documentation might be needed to better support you in providing care to sick children and their family?

In hospitalized psychiatric patients (Population of patients), how does the use of restraints (Intervention) compared to de-escalation techniques (Comparison) decrease aggression (Outcome) during hospitalization (Time)?

/in /by

Restraints are currently used as a last resort measure when psychiatric patients are at severe risk of harm to themselves or others. Many procedures must be followed once a patient is restrained. Legal paperwork such as restriction of rights’ documents must be filed that explain what methods were used to restrain the patient (mechanical restraints, medication, or seclusion), and the criteria for restraining the patient.  Within fifteen minutes of a patient being restrained, an order must be obtained from the physician. A new treatment plan must be initiated that declares the patient as an imminent risk of harm to self or others. While a patient is restrained, 15-minute documentation is required. During 15 minute checks, patients must be assessed for comfort, circulation, neurological state, skin integrity, and behaviors. Patients must be offered/provided toileting, comfort measures, education, food, and readiness for discontinuation. Within an hour of a patient being restrained, a physician must perform a “face-to-face” assessment of the patient to ensure the patient is in good shape.

Restraints should be discontinued as soon as patients resolve behaviors and no longer presents as harm to themselves or others. Within twenty-four hours of a patients’ restraints being discontinued, mental health staff provides patients with a survey about their restraint experience to assess what measures could have been taken to improve their restraint experience. All staff that participated in restraining the patients attend a debriefing session. During that meeting, they discuss preventative measures to avoid restraining patients in the future. Many patients view being restrained as a traumatic experience. Using de-escalation techniques when patients present with aggressive behaviors will help avoid restraining patients.

De-Escalation is defined as “talking with an angry or agitated service user in such a way that violence is averted and the person regains a sense of calm and self‐control” (Spencer & Johnson, 2016; p.2). In the mental healthcare sector, various talk-down and de-escalation techniques are employed in diffusing the aggressive behavior by the patient. Some recognized de-escalation techniques include verbal and non-verbal strategies and stature. The verbal techniques include the use of a calming tone, which may guide the patient to a calmer personal space. The non-verbal techniques include personal safety, self-awareness, eye contact, and an appropriate body stance. In practice, however, there is quite scanty scientific backing supporting the use of these de-escalation techniques in the mental health sector (Price & Baker, 2012; Spencer & Johnson, 2016).

In hospitalized psychiatric patients (Population of patients), how does the use of restraints (Intervention) compared to de-escalation techniques (Comparison) decrease aggression (Outcome) during hospitalization (Time)? (Appendix 1, check for Intervention-based question).

Define and research the frequency of HAI’s. Create a proposal to a hypothetical hospital administrative board that outlines three practices that minimize microbial growth, which then minimizes the occurrence of HAI’s.

/in /by

Define and research the frequency of HAI’s. Create a proposal to a hypothetical hospital administrative board that outlines three practices that minimize microbial growth, which then minimizes the occurrence of HAI’s. Your proposal should be crafted into a word document following the expectations below.

    • Practice 1 (Describe how the method limits microbial growth, particular microbes that are most affected by the method, and how this method should be applied to patient care standard operating procedures).
    • Practice 2 (Describe how the method limits microbial growth, particular microbes that are most affected by the method, and how this method should be applied to patient care standard operating procedures).
    • Practice 3 (Describe how the method limits microbial growth, particular microbes that are most affected by the method, and how this method should be applied to patient care standard operating procedures).
    • Review the information presented about Healthcare-Associated Infections (HAIs). Provide a paragraph that aligns your proposal with data presented.
    • Summary (Briefly summarize the three practices and the benefit to both patient health and hospital operations).
  • Support your content with at least (5) citations. Make sure to reference the citations using APA writing style for the presentation.

Explain the cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms. Explain any racial/ethnic variables that may impact physiological functioning.Explain how these processes interact to affect the patient.

/in /by

An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.
Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

Case Study/Scenario

76-year-old female patient complains of weight gain, shortness of breath, peripheral edema, and abdominal swelling. She has a history of congestive heart failure and admits to not taking her diuretic, as it makes her “have to get up every couple hours to go to the bathroom.” She now must sleep on two pillows in order to get enough air.

In your Case Study Analysis related to the scenario provided, explain the following
• The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient

Define the terms “benchmark & dashboard” as they relate to their use in healthcare . Provide one example of a benchmark. Describe the purpose of using benchmarks & dashboard in healthcare . Provide one example of a dashboard used in healthcare.

/in /by

A. Which hospital needs the most improvement in RN staffing? Hospital A
B. Which hospital needs the most improvement with the 3 nosocomial infections? Hospital A

2. For Table 3:
A. Which hospital’s data showed the greatest improvement in its indicators overall from 2017 to 2018 survey? Hospital C

B. Describe the trend in data for Hospital A indicators from 2017 to 2018. Be specific…do not state “some indicators improved while others did not”.

Catheter associated UTI- Decline
Central Line associated blood stream infection- Decline

Ventilator associated pneumonia-Decline
RN staffing-Decline
Injuries from falls –Stayed the Same
Hospital acquired pressure ulcers-Stayed the Same

C. Describe the trend that is shown in the data for Hospital C from 2017 to 2018. What one indicator’s data might have had an impact on this trend?

D. Questions related to Terms:
1. Define the terms “benchmark & dashboard” as they relate to their use in healthcare (minimum 2 paragraphs). Provide one example of a benchmark.

2. Describe the purpose of using benchmarks & dashboard in healthcare (minimum 2 paragraphs). Provide one example of a dashboard used in healthcare. NOTE: Provide minimum of two (2) scholarly sources to support your answers to Questions 1 and 2 under “Terms”

After touring Sentinel City, select a specific vulnerable or minority population group and identify one of the most common diseases, chronic condition, injury, or health concern that impacts your population group.

/in /by

Explore how determinants of health such as poverty, behavior, education, and income are related. One common element underlies poor health: poverty. Money is required to purchase the essentials of health such as food, clothing, shelter, clean water, education, and access to preventative health services. Each day in nursing, you are faced with persons from varying economic, social, and cultural backgrounds. In addition to varying backgrounds, you will also experience differing patient values and preferences related to their individual health and behavior. Caring for the vulnerable, at-risk, and aging populations is an essential competency for nursing. Therefore, we need to explore the interrelationships of socio-cultural influences, behavioral influences, as well as economic and non-economic barriers to healthcare to improve our knowledge. In doing so, we will be able to plan specific interventions designed to help achieve healthier outcomes. You will have the opportunity to examine poverty, behavior, and other determinants of health in Sentinel City®. As providers of care, BSN nurses need to understand how these are related and impact the health of our patients.

Activity Instructions:

Review course textbook and other resources.
Review World Health Organization (2017). The determinants of health, Health Determinants.
Review Sentinel City® demographics and neighborhood demographics. Meet with Mayor Hill who can provide some information about Sentinel City® economics. Enter Sentinel City® and begin the bus tour. After touring Sentinel City, select a specific vulnerable or minority population group and identify one of the most common diseases, chronic condition, injury, or health concern that impacts your population group. Then list a total of 3 determinants of health from the Healthy People website. During your tour of the city, describe 1 observation related to the 3 selected determinants of health. (a total of 3 observations must be described). Note indicators of high or low employment. Consider education levels, number of female head of households, and median household incomes for example. Finally, describe a total of 3 strategies or evidence-based recommendations to help reduce or eliminate the selected observations noted during your Sentinel City® tour

Demonstrate knowledge of the concepts of biology and chemistry as they relate to microbiology. Identify characteristics and types of common microorganisms. Examine modes of transmission and methods for preventing the spread of microorganisms.

/in /by

This project is intended to help you to utilize and refine your information literacy skills to seek out information about a specific public health issue relating to microbiology, and to develop your thinking abilities by completing a self-evaluation of your project and preparation process. You will also be performing data analysis on statistics reported by the CDC. The workplace capability of technological skills will be developed through the use of computer software to develop your public health brochure in the appropriate format and will also help you develop time management and productivity skills as well.

By completing this project, you will fulfill course outcomes #1-7 (see below for details). Because this is a public health project, you will base your article selection on tying it to the healthcare field. Through project completion, you will develop the following institutional outcomes: information literacy and communication, thinking abilities, and community and career. You may submit your project under any of these in your e-portfolio.

Course Outcomes:

  1. Demonstrate knowledge of the concepts of biology and chemistry as they relate to microbiology.

How: By developing a brochure that outlines a relevant public health topic in microbiology and presenting it to your peers.

  1. Identify characteristics and types of common microorganisms.

How: by discussion of causal organism(s) and its (their) characteristics.

  1. Examine modes of transmission and methods for preventing the spread of microorganisms.

How: by identifying how the microorganism is spread and how to prevent the spread (public health focus).

  1. Articulate host inflammatory and immune processes.

      How: by explaining how the human body responds to the pathogen(s).

  1. Explain treatment of infectious diseases: antimicrobial medications and bacterial resistance.

How: by explaining how the pathogenic disease(s) discussed in brochure are treated in clinical practice and issues with treatment.

  1. Categorize infectious diseases of body systems of current epidemiological concern.

How: by presenting/ developing a brochure on a topic that is of current epidemiological relevance either locally, nationally, or worldwide.

  1. Outline basic procedures in clinical microbiology lab practice and evaluate effective learning strategies.

How: by outlining diagnostic procedures in the brochure and completing a self-reflection of the project.

A patient is stressed about an upcoming surgery and asks you to pray with her.Would you feel comfortable doing this based on your own spiritual/religious preferences? Is this the role of the RN? How could you facilitate prayer with the patient?

/in /by

Is there any element of your spirituality that might prevent you from caring for a patient? Could you provide nursing care for a patient who is a known sex offender and jailed for murder of a child? How would you handle this situation?

A patient is stressed about an upcoming surgery and asks you to pray with her. Would you feel comfortable doing this based on your own spiritual/religious preferences? Is this the role of the RN? How could you facilitate prayer with the patient?

What are three benefits of a diverse healthcare workforce? Name three barriers to a diversity in the nursing profession? How does a American Caucasion culture as a background affect nursing care provided by this culture?

/in /by

Why are culturally competent healthcare organizations needed? name 3 health disparities and if they can be decreased or eliminated ? What are organizational cultures? How can organizations develop cultural competency? How can you analyze diversity trends in the nursing health care workforce?

 Define diversity. What are three benefits of a diverse healthcare workforce? Name three barriers to a diversity in the nursing profession? How does a American Caucasion culture as a background affect nursing care provided by this culture?

Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, re-admissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?

/in /by

Landmark studies To Err is Human (1999) and Crossing the Quality Chasm (2001) from the Institute of Medicine (IOM) identified medical errors are causing harm and death to almost 45,000 Americans and costing over $29 billion every year. Other studies have indicated preventable healthcare associated conditions (HACs) such as infections, sepsis, CHF, and pneumonia are main contributors for increasing the length of patient stays, the cost of care, and the likelihood of mortality (death).

Margret Spinner-Ramirez is a 66 y/o female Hispanic-American who speaks both Spanish and English fluently. She is retired, lives alone, and has Medicaid as her primary insurance. Ms. Spinner-Ramirez was scratched by a stray cat that she feeds on her back porch daily. She has been cleaning the wound daily; however, after 2 days she went to her local ER for increased pain, redness, and swelling in her left lower leg wound where she was scratched by the stray cat. Ms. Spinner-Ramirez explained she recently had her left knee replaced about 6 months ago and verbalized new difficulty with baring weight on that extremity to the point that she was having to use her cane again. Her vital signs at the ER visit were stable. Her left leg wound was cleaned and redressed. After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home on oral Keflex for her left lower leg infection and was instructed to call her primary care physician for a follow-up appointment. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance. Her neighbor found her lethargic, short of breath, and was experiencing difficulty being able to move. A CT scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. She was admitted as an inpatient for sepsis. She needed to have a second left knee replacement surgery with wound irrigation and debridement, which extended her inpatient stay to 3 weeks. Once she was discharged to home, she required six weeks of IV antibiotics, extensive rehab, and home health.

If you were in charge of a healthcare insurance company:

Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, re-admissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?
Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety.
Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.