Mrs. Dolan is a 46-year-old female who presented to the emergency department with complaints of episodic abdominal pain, a low-grade fever, and diarrhea for almost two weeks. Mrs. Dolan was on vacation in another country when she developed pain in the left lower quadrant of her abdomen. Mrs. Dolan delayed seeking health care because of fear of the country’s unfamiliar medical system and the assumption that bad water or food she had while on vacation must have given her a stomach “bug.” Mrs. Dolan also reports a recent onset of painful urination. Upon examination in the emergency room, Mrs. Dolan is found to be dehydrated with a fever of 102.58F (39.2 8C). Vital signs are blood pressure (BP) 106/58, pulse 88, and respiratory rate of 22. Her potassium (K1) level is 2.8 mEq/L, erythrocyte sedimentation rate (ESR) is 37 mm/hr, and white blood cell (WBC) count is 16,000 cells/ mm3. A urinalysis showed a positive urinary tract infection (UTI) and an abdominal/pelvic computed tomography (CT) scan revealed diverticulitis with a question of an ileus. Mrs. Dolan is admitted and started on intravenous (IV) fluid of D51/2 normal saline (NS) with 20 mEq of potassium chloride (KCl) at 50 mL per hour. Two IV antibiotics (cefoxitin sodium and metronidazole) are prescribed. Her admitting orders include nothing by mouth (NPO), bed rest, IV morphine sulfate for pain management, stools to be checked for occult blood, strict intake and output (I & O), and repeat blood work in the morning to monitor her K+. Her height and weight on admission are 5 feet 7 inches and 170 lbs (77.3 kg). She is prescribed diphenoxylate hydrochloride with atropine sulfate, propantheline bromide, and acetaminophen as “as needed” pro re nata (prn) medications.

1. Explain how Mrs. Dolan’s symptoms might be related to her urinary tract infection.

2. The emergency department health care provider considered several differential diagnoses for Mrs. Dolan and a diagnosis of diverticulitis was determined. What diagnostic test confirmed Mrs. Dolan’s diagnosis of acute diverticulitis?

 3.  Mrs. Dolan’s abdominal/pelvic CT scan revealed diverticulitis with a question of an ileus. What is an ileus?

Evidence-based practice is essential to providing safe, quality care to a diverse population in the acute care setting as well as in the community. Understanding the health care system at the local level is essential to consider when planning the implementation of evidence-based practice (EBP) because it helps those implementing changes understand and execute the move in an area of greatest need. Franklin and Hopson (2007) write that implementing evidence-based practice change in the community setting is challenging. Interventions that work in research or acute care setting are often very challenging to implement locally in the community setting due to the struggle with “building partnerships between clinical practitioners and researchers” (Franklin & Hopson, 2007, p. 379). Maintaining the effectiveness and reliability of interventions once moved to the community setting is difficult thus careful attention to the specific needs of the local community health care system is imperative (Franklin & Hopson, 2007).

Information from my course mentor that I will consider for my project is to ensure that I am following the hospital’s shared governance model to allow other nurses on the unit to have a voice in the project change (T. Brock, personal communication, August 20, 2019). The hospital where I am implementing my project change is a Magnet culture and uses a shared governance model when considering implementation of evidence-based practice change. My practice change does not only affect me, so it is imperative to share accountability and partnership with my unit manager, peers, and unit-based council members when implementing a project change on the unit for effective outcomes (T. Brock, personal communication, August 20, 2019).

Reference

Franklin, C., & Hopson, L. M. (2007). Facilitating the use of evidence-based practice in 

community organizations. Journal of Social Work Education, (3), 377-404. Retrieved 

from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?

direct=true&db=edsgao&AN=edsgcl.170506618&site=eds-live&scope=site

• Develop a 6-8 page reflection on your life, applying the sociological imagination and using specific sociological concepts to better understand your life experiences.
  While we may not notice, society is constantly changing. For sociologists, social change is the continual change of society’s culture, structure, and institutions over time. Every society experiences change—it is through this change that the norms and understandings in a society become altered. Fashion is a great example of social change, as what we wear is dependent on the culture at the time. One hundred years ago it was not common for women to wear pants. Now it is perfectly acceptable. While most women are in favor of being able to wear pants, social change is sometimes not always welcome by members of a society. Can you think of any groups or organizations in the United States that are actively opposed to some kind of social change?
  Most social change is the result of conflict, demographic change, and technology.
  • Conflict and change: Conflict in a society (such as a war or even an election) can create significant change in a society.
  • Demographic change: Changes in the make-up of a population can also affect society. As the makeup of our society in terms of sex, race, age, et cetera, changes, so do many structural and cultural elements of society. How would our society be different if most of the population was under the age of 10? Or over the age of 70?
  • Ideas and Change: Technology is often a driving force behind social change and has brought significant changes to our society. Think back to twenty years ago—how different was society in terms of technology? How did that impact your everyday life? In our current time, our cell phone alarm wakes us up, we check our smart phone, make some coffee in our Keurig, remote start our car, and then use our navigation system to get us to work. This is a significantly different experience than we had twenty years ago.
  • As you reflect on your life and experiences in Assessment 6, consider how much has changed over the course of your lifetime. What are some major social changes? What do you think had changed for the better? For the worse?
    Demonstration of Proficiency
    By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
  • Competency 3: Explain the significance of social inequality for the individual and society. 
    • Explain one’s own educational experience from a sociological perspective.
  • Competency 4: Analyze the influence of culture on both the individual and society. 
    • Examine the impact of culture and socialization on one’s own life.
  • Competency 5: Analyze the impact of social change on society and social institutions. 
    • Analyze the impact of social structure, social change, and groups on one’s own life.
    • Explain sociological issues that affect one’s own field of study.
    • Analyze the role of technology and media in one’s own life.
  • Competency 6: Compose text that articulates meaning relevant to its purpose and audience. 
    • Develop text using organization, structure, and transitions that demonstrate understanding of cohesion between main and subtopics.
  • For this assessment, reflect on the question, “Who am I?” and conduct a micro-level analysis to explain and analyze your everyday experiences. In doing so, you will look at the impact of social forces on your individual life. Using your sociological imagination requires you to apply many of the concepts, theories, and applicable sociological understandings that you have encountered in the course.
    Deliverable
    Reflect on your everyday experiences that relate to concepts encountered in this course. For example, have you encountered any element of inequality in your life? Have you encountered any norms? Consider how a sociologist would explain these experiences.
    Write an essay in which you complete all of the following:
  • Introduction: Introduce yourself and what you plan on discussing in your paper.
  • Culture and Socialization: Examine the impact culture and socialization has had on your life. Include the following when creating this section: 
    • How did you develop a sense of self?
    • What agents of socialization had the biggest impact on you? How?
    • How has culture influenced your life?
  • Social Structure and Groups: Analyze the impact of social structure and groups on your life. Include the following: 
    • How have various groups (primary, secondary, reference, et cetera) guided your behavior?
    • What statuses have you held? What roles have you played?
    • How have social hierarchies shaped your life choices?
  • Education: Explain your educational experience from a sociological perspective. In doing so, include the following: 
    • What major functions has education had for you?
    • How has education been related to your life outcomes?
    • What experiences with inequality have you had in education?
  • Professional Field (NURSING): Explain sociological issues that affect your field of study or the field you intend to study at this point in your education. Be sure to include any social changes that may impact your field.
  • Technology and Media: Analyze the role technology and media have in your everyday life. 
    • What impact have new communication technologies and social media had on your life?
    • What messages have the media and popular culture communicated to you? 
    • What role has globalization played in your life?
  • Summary: Briefly describe your experience with this assessment.
  • Additional Requirements
  • Written communication: Develop text using organization, structure, and transitions that demonstrate understanding of cohesion between main and subtopics. Written communication is free of errors that detract from the overall message. Write in a professional style using references and correct grammar, usage, and mechanics.
  • Sources: Cite at least five scholarly sources.
  • Length: 6–8 pages, not including title and reference pages.
  • Format: Include a title page and reference page. Use in text citations to cite your sources. [Example: Writing becomes better as the child matures (Britton, Thomas, & Miller, 1996).]
  • Font and size: Times New Roman, 12-point.

Write a one-page summary and response to the article that you selected from the Walden Library. A template is provided in the Learning Resources to guide you in formatting your paper.

As you reflect on the findings in your chosen article, consider how the findings compare to your own professional nursing experience with Magnet, or, if you have no personal experience with Magnet, your thoughts concerning Magnet:

• Paraphrase and integrate information from the article into paper.
• Include an introduction, body, and a summary (conclusion).
• Consider factors or principles from the article that hold true for or resonate with you.

Comment 1

I have never personally been put in this kind of situation but we have education every year about this at our hospital. A scenario, a young child, age 8, is brought into the emergency room twice in one week for “falling” and his arm is hurting again. The first visit’s xray of his arm was normal, no broken bones seen. The child is discharged. The second visit, the xray shows a broken clavicle. The nurse and doctor assess the child and notice bruises all over the child’s body under his clothes. The nurse and doctor know that they must be caution at this point. Start with questions to the child: How did you fall? Do you fall often? Ask where a particular bruise came from. The child shys away and start to hide his face.  The healthcare team then turn to the mother and again are cautious with the way the questions are asked. The mother is reluctant to answer the questions but she does in a hesitant way but does not make eye contact. The healthcare team dismiss themselves stating they would return soon. The nurse and doctor have a private conversation and they both are suspecting child abuse and know that it is their duty to mandatory report their suspicions after their assessment. Our hospital policy for mandating reporting is to follow they chain of command before reporting. The manager must be notified and the administration on call must be notified along with the risk officer. When all has been notified then the local police station and DHR will be notified. This can flow very easily if done properly. The State of Alabama had changes to the mandatory reporting law in 2013. The changes are: 1.) The State of Alabama mandates that the person who assess and has the suspicion on that assessment must be the one to support it to the police and DHR. 2.) Any public or private employer who discharges, suspends, disciplines, or penalizes an employee solely for reporting suspected child abuse or neglect will be guilty of a Class C Misdemeanor (National, 2018).

Comment 2

The State of Texas has a law that mandates anyone who thinks a child, a person 65 years or older, or any adult with disabilities is being abused, neglected or exploited must report it to the department of Family and Protective Services (DFPS). The abuse report can be made by phone 1-800-252-5400 or online at Texas Abuse Hotline 24 hours, seven days a week or call 911 the Local Law enforcement.

A person who reports abuse in good faith is immune from civil or criminal liability. The DFPS keeps the name of the person making report confidential. Anyone who does not report suspected abuse could be held liable for a misdemeanor or felony.

In the State of Texas, nurses and doctors are mandated to report any suspected child or elderly abuse to the department of Family and Protective Services or the Local law enforcement agency. They also document all findings including physical findings in the patient’s chart. Both nurses and doctors are also expected to report the suspected abuse to their immediate supervisors like nurse managers or senior doctors respectively (Texas Department of Family and Protective Services, n.d.).

Scenario

I was working in ER one evening when a 6-year boy was brought in by his parents with complaints of a painful leg secondary from fall. On assessment, the child looked frightened and withdrawn from the environment.  Multiple bruises at healing stages, black eye and swollen left leg was noted. When I asked the parents what could have caused the findings, both mother and father stated “ the boy is” messy” with himself and falls most of the time when playing”. When I asked the boy what happened to his leg and skin, he just stared at me. The doctor ordered an x-ray of the left leg, which reviewed spiral fracture of the femur.