4-The functions of management include planning, organizing, staffing, directing, and controlling. Within each of these functions, decisions must be made to optimize the care provided while remaining fiscally responsible.

Leadership is a more challenging role to define. At times, leaders may not have formal authority, but they may have power through their ability to influence others. A leader’s emphasis is on interpersonal relationships; they may be known as mentors, coaches, advocates, or role model. (Lecture 1)

Management and leadership may coexist in one, though they may not at all. Some managers are leaders as well, and some are not. You may think they would go together, but we have all had experience with a manager that is NOT a leader. You know the one. The one who is the boss, and handles business, but not one that inspires, advocates or mentors staff.

One the other side of the coin, you may have had the pleasure of experiencing a manager that is a leader as well, someone who is part of the team and inspires, mentors, and coaches staff. The inspiration and the management. The boss who rally’s the troops and makes you WANT to be there and WANT to work for them. The two overlap in multiple areas.

As a nurse leader, I do believe I can expand my influence to create change by taking advantage of this overlap. I feel that I am inspiring and able to mentor and encourage and advocate for not only my patients, but my coworkers, company, and my profession. I would take advantage of the overlap by using my leadership abilities to continue to mentor, inspire, and encourage others in doing their best and being team players. A huge part of this is leading by example, which I strive for daily.

Resources

Lecture 1. (2018). NRS-451V. Theories and Concepts in Leadership and Management. Phoenix, AZ: Grand Canyon University.

  

5-management and leadership does overlapped to be a good manager you must have good leadership skills, managing is also means to lead making things happen,leader shares what he/she knows with others so that they can follow willingly. good leadership and  managment together can build a successful organization

  

6-Although often used interchangeably leadership and management are very different. “management and leadership do share many similar duties which consist of working with people and influencing others to achieve goals. Management skills are used to plan, build, and direct organizational systems to accomplish missions and goals, while leadership skills are used to focus on a potential change by establishing direction, aligning people, and motivating and inspiring.”(Algahtani, 2014). As a nurse leader you can expand your influence to create change and accomplish goals by overlapping your leadership and management skills. By using your leadership skills you can motivate other nurses to go above & beyond when caring for patients and encourage them to come up with solutions to our everyday problems. Leadership skills will also help you when developing your nurses to become future leaders or to meet their personal goals, doing so will in turn provide them with a sense of fulfillment. By using your management skills you can also ensure that your nurses have the adequate staffing and supplies needed to get perform their duties. A managers main function is “to provide services to the community in an efficient and sustainable manner”(Algahtani, 2014).

Algahtani, D. A. (2014). Are Leadership and Management Different? A Review. Journal of Management Policies and Practices,2(3). doi:10.15640/jmpp.v2n3a4

APA format 3 peer review article references Due 10/12/18 at 5pm

 

Patient Information:

Mr. H, Age 58, Male, White

S.

CC:  Chest Pain “Shortness of breath with severe pain on deep inhalation” (according to Dains, Baumann, & Scheibel, (2016) before a complete HPI is taken this patient must be a quickly assessed as this complaint can have rapid, life-threatening consequences).

HPI: Reports a constant chest pain for two days ago, taking a full breath makes it worst (inhalation), pain is sharp and severe with a current PIS of 8. Subject feel like his heart is racing. Nothing makes the chest pain better. The patient also has exhibited signs and symptoms of a cough, “spit up blood,” right leg swollen and red. He recalls being stationary for an eight-hour period while on a plane, in the economy section middle row, recently from vacationing in Europe, without bathroom overall usually has a sedentary lifestyle mostly due to working 9 am -5 pm as a customer service representative at a call center. After work he sits in front of the television and watches various programs for about four hours while eating dinner, drinking a can of beer or two and smoking a cigarette before bed. It started two days ago when the patient was running to clock in at work, to avoid being late.

Location: right chest pain

Onset: 2 days ago

Character: Sharp and constant

Associated signs and symptoms: a cough, elevated heart rate, and most recently expectoration of blood.

Timing: running to avoid being late for work

Exacerbating/ relieving factors: activity makes it worst. Nothing relieves the pain.

Severity: 8/10 pain scale

Current Medications: Hydrochlorothiazide 25 mg daily for six months, and Norvasc 5 mg twice daily from one month ago for hypertension, Lipitor 80 mg daily for high cholesterol; However, has not been compliant. The patient also stated that he was taking thiamin 100 mg, folic acid 250 mcg and vitamin D 5000 daily as supplements. Currently, he only takes ginseng to boost sexual performance.    

Allergies: Patient is allergic to latex and mold both cause SOB chest tightening

PMHx: diagnose with hypertension and high cholesterol 10 years ago, left hip replacement 2 years ago. Immunization is up to date.  

Soc Hx: Patient works at a call center as a customer service representative for the past thirty years. Married has no children.  They live in their two-bedroom mortgage-free house.  He currently smokes and has just reduced to 3 cigarettes per day after over forty years of smoking two packs per day. On the weekends he usually goes to the casino with his two college friends to gamble and have a good time. He has no special diet and will eat “anything from anywhere.” Drinks 2 six packs beer per week, and a bottle of vodka on weekends.

Fam Hx: His father died of lung cancer 15 years ago.  

ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue. 

Head: Symmetrical, no swollen lymph nodes, no signs of sinus infection

Eyes:  Does wear glasses due to myopia, no blurred vision, double vision or yellow sclerae.

Ear: No hearing loss.

Nose: Cough present, no congestion, runny nose.

Throat: No sore throat or difficulty swallowing.

SKIN:  No rash or itching. Some redness and swelling to right leg.

CARDIOVASCULAR:  Right side chest pain, chest pressure, and chest discomfort. Racing heart palpitations.

RESPIRATORY:  shortness of breath, chest tightening, increased pain when inhaling, labored breathing.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Some frequency in urination, wakes twice at night to urinate.

NEUROLOGICAL: headaches and numbness and tingling of fingers. MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No known history of splenectomy.

PSYCHIATRIC:  Endorse feeling anxious

ENDOCRINOLOGIC:  reports cold sweat

ALLERGIES:  latex and mold

O.

General: steady gait. Flushed face with a facial grimace. Appears anxious

Vital signs:

Temperature: 97.9 oral

Respiratory rate: 32, labored

Heart rate: 112, tachycardic

BP right arm: 148/88

Oxygen saturation: 90% on room air

Weight: 210 lbs., stable

Height: 5’8”

Skin: Cool, diaphoretic

Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds to the left lung

Cardiovascular: Heart rate is irregular with good S1, S2; no S3 or S4; no murmur or jugular vein distention.

Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants

Peripheral vascular: Right calf with 2+ edema, erythema; warmth and tenderness

on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally

Neurologic: Anxious; awake, alert, and oriented to person, place, and time

Diagnostic results: EKG shows Atrial fibrillation. He is waiting to do an angiography, chest x-ray and a ventilation/perfusion scan (V/Q) to examine blood flow in the lungs. Labs for collection are complete blood count, complete metabolic panel, lipid panel, troponin, creatinine kinase, creatine phosphokinase.  D-dimer test to check for DVT and pulmonary embolism are needed, and a cardiac MRI to fully view the heart. (Dains, et al., loc 3494. 2016)

A.

The provider states that the patient may have a pulmonary embolism. While this may be accurate, it is good to rule out other illnesses before giving a definitive diagnosis without proper analysis as misdiagnosis can cause a delay in treatment leading to great consequences. There are other possible differential diagnoses such as GERD, anxiety, and angina; however, listed below are three sudden, life-threatening differential diagnoses listed below.

Differential Diagnoses:

            Right side Congestive Heart Failure where according to Ball, Dains, Flynn, Solomon, & Stewart, (2015) the heart is unable to properly pump the blood to the body causing backflow to the lung and congestion in the heart. Hussein, A., & Staufenbiel, R. (2014) noted in their study of 59 cows with heart failures, that with right-sided heart failure the blood venous blood returning to heart is disrupted hence patient ends up with edema to the legs, shortness of breath, increased urination, rapid heartbeat which the patient is currently exhibiting and needs to be further investigated so proper treatment can be done.

            Myocardial Infarction occurs due to the heart thickening thus causing decrease blood flow (Ball, et al. p.323. 2016). In Bahall, Seemungal, & Legall, (2018) controlled case study which focused on first time myocardial infarction in the same hospital in Trinidad and their risk factors. The writers look at the risk factors which includes diabetes mellitus, hypertension, hypercholesterolemia, smoking, alcohol consumption, obesity, and sedentary lifestyle, most of which is applicable Mr. H. the writers also reported with myocardial infraction no seen all over the globe therefore region, ethnicity and culture has no bearings on who may fall, victim, especially when they identify with one or more of the listed risk factors.

             Pericarditis is when there is an inflamed pericardium due to infection. (Ball, et al. p.322. 2016). Per Dybowska, Kazanecka, Kuca, Burakowski, Czajka, Grzegorczyk, … Tomkowski, (2015) pericarditis is life-threatening and has a high death rate; urgent care is needed to prevent fatalities. While the patient does not have a fever the presentation of pericarditis symptom of chest pain, shortness of breath and chest pressure which the patient presents with should be completely ruled out as soon as possible.  

References

Bahall, M., Seemungal, T., & Legall, G. (2018). Risk factors for first-time acute myocardial infarction patients in Trinidad. BMC Public Health, 18(1), 161. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-018-5080-y

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Dybowska, M., Kazanecka, B., Kuca, P., Burakowski, J., Czajka, C., Grzegorczyk, F., … Tomkowski, W. (2015). Intrapericardial fibrinolysis in purulent pericarditis–case report. International Journal of Emergency Medicine, (1), 1. https://doi-org.ezp.waldenulibrary.org/10.1186/s12245-015-0087-y

Hussein, A., & Staufenbiel, R. (2014). Clinical presentation and ultrasonographic findings in buffaloes with congestive heart failure. Turkish Journal of Veterinary & Animal Sciences, 38(5), 534–545. https://doi-org.ezp.waldenulibrary.org/10.3906/vet-1404-111

comment1

Retail clinics have become a more mainstream part of
healthcare than previously thought possible. The idea of retail clinics was
initially downplayed by the healthcare industry. Retail clinics offer basic
services, from immunizations to walk in clinics for basic needs such as sore
throats or bladder infections. One will see retail clinics in places like
Walgreens, that offer a multitude of immunizations, no appointment necessary,
and will submit claims to insurance companies as well so that portion is not an
issue. Another example of retail clinics are similar to places like Urgent
Care, or Quick Care, FastCare, where local hospitals have an extension of
themselves placed in a retail space for patients to walk in. This usually
includes hours that the retail space is open for business, clients can walk in
and have a throat culture done, or a urinalysis to determine if they have
infections. Immunizations can be given. If someone is sick or injured instead
of going to an emergency room clients can utilize one of these retail clinics.
Retail clinics usually have hours that appeal to clients that work during the
day, that can not get into see their own doctor or those that want to avoid the
cost or wait in an Emergency Room setting. The retail clinics are overseen by
an interdisciplinary health care team, depending on the setting, there are
medical assistants, nurses, nurse practitioners, pharmacists, all overseen by a
specific doctor, reviewing cases as they occur.

comment2

ACOs is a group of care providers, who willingly come together, to help provide the best care to a patient while working together as a team (Daly, 2013). ACOs stands for Accountable Care Organizations. ACOs work together to take care of Medicare patients, while planning to providing the right care for patients, helping manage chronic illnesses, and attempting to prevent duplications of medical treatments and preventing medical errors (Centers for Medicare and Medicaid services, 2018).

                This approach to care can greatly improve the quality of patient care and increase safety. By having all cares provided by one group, it can cut down on many different problems that could arise. By getting all cares done by one group, medication errors and prescribing can be controlled by limited number of providers. This can decrease risks of drug interactions and medication errors. Also by having all cares done by one group, all medical treatments and cares records are readily available to the providers at this facility. By having all the care providers in one group, communication of care can easily be spread between the group, which can help improve care and help the care team. By using the group care, overall care of the patient can improve and improve safety of the patient.

A. Read the three articles below before answering the discussion questions.

•  “It’s Only Natural — Mother’s Love. Mother’s Milk.” BF barriers in the African American communityhttp://www.womenshealth.gov/blog/its-only-natural-mothers-love-mothers-milk.html (链接到外部网站。)链接到外部网站。
• Using a Wellness Program to Promote a Culture of Breastfeeding in the Workplace: Oregon Health & Science University’s Experience, Antoinette Magner; Carrie Anne Phillipi , Journal of Human Lactation (链接到外部网站。)链接到外部网站。, Vol. 31, Iss. 1, February 2015, pp. 40-4
• Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review,
• Olukunmi Omobolanle Balogun, 2015 John Wiley & Sons Ltd Maternal and Child Nutrition (2015), , pp. 433–451 11

B.  Complete the discussion questions:

1. List the barriers to breastfeeding mentioned and others you recognize based on the review study, “Factors influencing breastfeeding exclusivity during  the first six months” (Olukunmi), and the video link, “It’s only Natural.”

Which of these barriers are surmountable?

2. Explain how you would you set up a community program to encourage breastfeeding. Choose a platform for this program.

Refer to the article above, Üsing a Wellness Program to Promote a Culture of Breastfeeding in the Workplace: Oregon Health & Science University’s Experience”for additional ideas.  

Oregon Program analysis

Do you have suggestions to improve their breastfeeding implementation program?

How well did they address the cultural/ethnic challenges?

Your program objectives

What group will you target (ethnic, socioeconomic, health status) ?

 How will you incorporate nutrition intervention?

 What will your goals be considering some of the barriers mentioned in the articles?

What are some challenges of promoting breastfeeding in another cultural or ethnic group?

3. Submit your comments, then respond to two other student submissions. 

  (4-5 paragraphs)  

What has contributed to limited pharmacologic research across different ethnic groups?

Discuss differences in cultural values/beliefs regarding acceptance of psychotropic medications. 

With the rise in migration mental instability may present at any given time. As we know Mental stigma is not well embraced in many cultures, yet patients and clinicians must face presented underlying mental cases that are perceived differently in each culture. Many factors affect full acceptance due to language barrier, cultural commitment and value in traditional medications and side effects. Patients presenting for somatic symptoms sometimes have no medical explanation and may be affected by a psychiatric condition. The sealed culturally beliefs may block the connection to mind and body existence to accept a dual diagnosis (Bhugra et al. 2011).

How does this affect engagement, adherence rates, medication selection, patient education?