APA format 2 pages 3 references 1 from walden university library

due Thursday 10/10/19 at 7pm EST

 

Simulated Learning Experiences

“We really have to improve the teaching and upgrade the sciences in basic nurse education. We have a problem—classroom and clinical instruction are drifting too far apart. We need to integrate classroom and clinical learning much better. Clinical coaching in practice settings and simulations should correspond to knowledge gained in the classroom. The emphasis on simulation is going to be very useful in developing clinical imagination so that students can be more flexible and astute in their use of knowledge in practice.”
—Patricia Benner, renowned nurse educator and author

Clinical imagination asks students to step outside of the [sometimes] ‘narrow box’ of academia to develop multiple solutions to a situation. In the above quote, Patricia Benner notes how simulations can transition students from knowledge acquisition to knowledge use. However, in order for nurse educators to transform simulations into a teaching technique, they must make every effort to ensure the simulation technology is invisible. To do this, nurse educators should prepare students for the simulation by reiterating that that the goal is not how the simulation works, but rather the how the clinical process works. In addition, highlighting the clinical expertise, critical thinking, collaboration, and technical prowess needed during simulated clinical experiences (SCE) is the true key to bridging the gap between classroom and clinical instruction. Allowing focus to shift too much towards the simulation itself might cause learners to lose sight of the actual objectives of the lesson- thus failing to prepare them for the real demands and consequences of the health care environment.

To prepare

• Review this week’s Learning Resources on simulated clinical experiences (SCE). Specifically, examine how each category of SCE (games, simulations, and simulation games) is tailored towards achieving a certain level of Bloom’s Taxonomy or domain of learning.
• Reflect on your past learning experiences in both academic and clinical settings that did not include a simulation. For example, a specific class, lesson, group project, doctor’s visit, or staff training might come to mind.
• Select one past learning experience to use for this Discussion. Then, identify the learning objectives that your Instructor or health care professional might have had in mind. In addition, identify the type of learning environment in which the lesson was conducted (on-site, online, hybrid).
• Consider how a specific SCE such as interactive games, virtual reality, task trainers (low-fidelity mannequins), human patient simulators (high-fidelity mannequins), etc. might have enhanced your learning during this experience.
• Conduct further research to learn more about a specific SCE technology that might achieve the same learning objectives of your selected learning experience.

Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment

PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.

Scenario for Week 7 Case:

You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

Learning Objectives

Students will:

• Evaluate clients for voluntary commitment
• Evaluate clients for involuntary commitment based on state laws
• Recommend actions for supporting parents of clients not eligible for involuntary commitment
• Recommend actions for treating clients not eligible for involuntary commitment

To Prepare for this Practicum:

• Review the Learning Resources concerning voluntary and involuntary commitment.
• Read the Week 7 Scenario in your Learning Resources.
• Research your state’s laws concerning voluntary and involuntary commitment.

The Assignment (2–3 pages):

• Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
• Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.
• Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
• If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
• If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.

2 postsCAT: Brainstorm & discussion. ( points considered for participation)

Class, what is the most vulnerable population that you work with, specific to your facility and specialty? Please elaborate and give me an example of a situation in which you served this population, the outcome, and the continuing education provided.

  Two separate responses 200 words each

I find myself to be most comfortable working with older adults between the ages of 70-85. As a nurse I have really only worked with the geriatric population. I work at a hospital in Arizona that is close to many different retirement communities. Our hospital’s average patient age is 74. This makes working with younger patients little more uncomfortable for me. I wonder if it is because younger patients are generally not as used to being in the hospital and I worry about not being able to calm their fears.

Cultures that are very different than mine also make me a little uncomfortable to communicate with them. I worry that I will offend the patient with something like eye contact. I work with a lot of Navajo patients. At first, I was nervous to work with Navajo patients because I did not know a whole lot about their culture, but as I have learned and worked with the Navajo, I have felt more comfortable being able to effectively communicate with them.

I had a patient from India and was nervous to be working with them for the same reason. This patient was one of the most kind hearted people I have ever met. By the time she was ready to be discharged I had learned a lot about her culture and enjoyed getting to know her.

            I do not feel uncomfortable communicating with other races, I feel more uncomfortable communicating with cultures that are different than mine. I think it is more that I am worried about possibly offending someone because of my own culture’s customs, and I can be unaware of other culture’s customs.  

            Communicating with someone of a different living situation is generally pretty easy for me as well. I have lived in communities that have a lot of diversity and that has helped me to understand the different living situations that people have.

            One thing I have recognized is that as a nurse, we work with so many different people. Everyone at some point in their life is going to need medical attention, and a nurse will be there to take care of them. As nurses we have to learn how to communicate with people who are very different from us and learn to adapt to the many different cultures and personalities we work with.

            When I was growing up, many of my experiences with how older adults are treated is mostly with respect. However, I also felt like older adults were seen as to be a burden on the family. I grew up learning that it may be best for older adults to be in an assisted living place. It has been found that many adult children are around the age of 60 or 70 when they are taking care of their 90-year-old parent (Graham, 2018, p. 1).  According to Graham (2018) Caregiving at the age of 60 or 70 can be very hard on the body and adds extra mental and physical stress (p. 1). I am not sure if having older adults in an assisted living is the best place for older adults, but I am interested in learning more about this topic this week.

Reference:

Graham, J. (2018, August 23). A late-life surprise: Taking care of frail, aging parents. Retrieved

from https://khn.org/news/a-late-life-surprise-taking-care-of-frail-aging-parents/.

2) 

Working in the healthcare settings, we come across many different people from different backgrounds, races, and living situation. The philosophy of any public space is the equality and standard way of thinking and feeling about others, but in reality, these differences could often cause tension and/or stress during the interaction of two people. When I come across a patient around my age group, I find that I speak to them as if they were a friend, often using slang and other gestures as I would with friends outside of the workplace. In contrast, with older adults I tend to speak a bit slower and professional due to the age difference. Being a 27-year-old Intensive Care RN, often times older patients initially feel as if my age will affect their care in a negative way because they relate young with inexperienced, therefore the tone and word choice are changed in order to instill confidence thru proper communication. The difference in gender can also have its changes of personality during a patient interaction. Being a male, I tend to talk to the guys a bit more straight forward and not so much emphasis on emotion, while with females, I tend to be more compassionate and understanding of their situation. As for the other factors that make a difference in people, race, sextual preference, living situation, that does not play a factor during patient communication as those are not important to me, instead I may feel the urge to ask more questions to get to know them and their culture or preferences if their difference interest me. 

             While growing up, the Latin culture has great respect for older adults. A young family member is always expected to take care of their older family members, especially the older females. Grandma’s, Aunt’s, and Mom are always the first to have priority in any situation, starting with the eldest one. The older males in the Latin culture are not left out behind, but typically are carefree to many situations, just wanting everyone to be happy regardless of where they stand. When I was about 5 years old in 1997, the respect for adults was already instilled in me. Always making sure that adults are respected and listened to what they asked of me. In 2007 I was 16, and things started changing, I would be able to challenge adults’ questions and figure out why things are the way that they are; this was a rebellious stage, but I was just trying to figure out why. Fast forward from the rebellious stage, 2011 I was 20 years old, and now had the knowledge as to why adults did what they did, and I understood the meaning behind it. The older adults in the family would now see me as an adult, and although the respect continued as such, I was now an adult as well with my own opinion and choice, regardless of their input. 

            The way we act and treat others is highly influenced by the upbringing that we have experienced as children, in my opinion, and therefore it is especially important for me to continue what I have been taught as a child, in the workplace, and continue the line of respect with those that surround me. In 2017, my niece was born, and now I find myself also educating her in what is acceptable and not acceptable in our eyes, to continue the same respect and behavior towards other, with her. For us, it doesn’t matter what color you are, which gender you like, where you live, which car you drive, which gender you are, what matters to us is the quality of person you are in the world and how you treat those that surround you.  
 

  

APA format with References

Case Study 

Diabetic Ketoacidosis

Patient Profile.

N.B., a 34 year-old Native American man, was admitted to the emergency department after he was found unconscious by his wife in their home.

Subjective Data

· Was diagnosed with type 1 diabetes mellitus 12 months ago

· Was taking 50 units of insulin daily; 5 units of lispro insulin with breakfast, 5 units with lunch and 10 units with supper plus 30 units of glargine insulin at bedtime

· Has a history of flu for 1 week with vomiting and anorexia

· Stopped taking insulin 2 days ago when he was unable to eat

Objective Data

Physical Examination

· Breathing is deep and rapid

· Acetone smell on breath

· Skin flushed and dry

Diagnostic Studies

· Blood glucose level of 730 mg/dL (40.5 mmol/L)

· Blood pH of 7.26

Discussion Questions

1. Briefly explain the pathophysiology of the development of diabetic ketoacidosis (DKA) in this patient

2. What clinical manifestations of DKA does this patient exhibit?

3. What factors precipitated this patient’s DKA?

4. Priority Decision: What is the priority nursing intervention for N.B.?

5. What distinguishes this case history from one of hyperosmolar hyperglycemic syndrome (HHS) or hypoglycemia?

6. Priority Decision: What is the priority teaching that should be done with this patient and his family?

7. What role should N.B.’s wife have in the management of his diabetes?

8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?