wk3/y

Being a change agent is a nurse that brings about change (positive change) into the work environment and helps facilitate the change.  They facilitate the change by helping bring about the change in a positive manner and show why the change is necessary and what improvements it will make in their day-to-day work. I have recently been a change agent in the implementation of a new labeling process for our specimen and blood collection process.  We needed to change the way we labeled our specimens to help facilitate the way they were processed at the core lab.  This was going to impact our work flow in the clinic dramatically though.  First, I talked with the staff about the upcoming change (which was going to cause a slight increase in work for my staff).  Then, to show the impact of the change to our staff I took them to the core lab where our specimens are processed and showed them how much extra work goes into the current process vs. the new process.  After seeing the decrease in work that it causes the core lab our staff was willing to take on the slight increase in work to help them out. Another example of being a change agent was when we implemented LEAN into our work flow several years ago.  This was a process that done over a whole year, but over this year we had to introduce new process to the staff and help them see the LEAN way of trying things.  We would get staff impute when we were drafting the process changes to help with the understand of the why the changes were important and needed to be done.  With LEAN one big development was the development of standard work so that all patients were to receive the same standard of care every time they walked through the doors.  We had staff help us with the processes and so when we rolled it out, they understood the importance and we all had the same goals in mind, which was the patient.  I’m sure that we all are change agents everyday with small things we do, but they affect someone or somebody at some point.  Change is hard but we should always remember that change is often for the good.     

 Healthcare
: Undergraduate
: Essay
: English (U.S.)
: 3 pages/825 words
:APA 

2 sources due in 3 hours

 Environmental Health and Human Health
: Using the South University Online Library or the Internet, research on the following topics: Physical Agents Chemical Agents Biological Agents On the basis of your research and understanding of the topic, answer the following questions: Identify and describe five factors that affect responses to a toxic chemical. What determines the toxicity of a chemical? To what extent do you agree with the assumption that “all substances are poisons”? What is human exposure assessment? Explain some of the methods of exposure assessment. Why is epidemiology important to research studies of environmental health? Give reasoning to support your answer. What are some of the important limitations of the epidemiologic approach with respect to the study of environmental health problems? 

   Building a Health History 

Thorough and accurate pediatric history is a challenging and very important to children’s wellbeing that allows nurses and patients to establish a nurse-patient therapeutic relationship. History building is also essential in the interpretation of physical examination (Ball et al., 2019). Completing a comprehensive health history and physical examination is a tool used to document patient medical history, physical examination findings, and diagnosis (Sullivan, 2019). Using good communication skills to obtain this information is very important as communication creat a positive patient relationship. In other to develop this positive patient relationship, the nurse practitioner needs to build on courtesy, connection with the patient/guardian, ensure comfort and provide an opportunity for confirmation of what has been discussed to ensure understanding (Ball et al., 2019). Performing an assessment and history taking in children can bring upon anxiety, so practitioners should try to ease the anxiety by making sure the child is in the room with the parent, especially preschoolers (Ball et al., 2019).

Interview and Communication Techniques 

Children in rural areas face risk factors that are particular to their demographic features. Children living in rural areas are more at risk for health and developmental conditions. Performing an assessment and history taking in children can bring upon anxiety, so practitioners should try to ease the anxiety by making sure the child is in the room with the parent, especially preschoolers (Ball et al., 2019). Gaining confident and building practitioner-patient–caregivers relationship that is based on trust is very important as it facilitates with data collection (Mărginean et al., 2017). The practitioner should be empathetic as this will improve communication, be an active listener and observer to pick up any cues that patients might not share like grimacing, use open-ended questions. The use of questionnaire is encouraged too where the parent fills it out and by freely writing down patient concerns without having to answer the questions in person (Ball et al., 2019). 

 Risk Assessment Tool

According to Chung et al. (2016), 20 percent of US children live in poverty in rural, urban, and suburban, so it is critical to know the social determinant of the health of children to assess them better and provide safe and appropriate care needed (Chung et al., 2016). This social determinant includes family financial support, child maltreatment, and child education. Chung et al. (2016), also continues to explain that children who live in poverty are exposed to adverse childhood experiences like toxic stress, developmental delay, and health conditions like asthma and heart diseases. Rural people are usually poor and experience healthcare disparities. According to the center for disease control and prevention (2016), younger children are more likely to experience fatal abuse and neglect than older kids. Risk factors for victimization include child age and special needs that may be as a result of increased caregiver burden from developmental and intellectual disabilities, mental health issues, and chronic physical illnesses (Center for Disease Control and Prevention, 2016).

Targeted Questions

Does your child have any allergies?

Does your child have a good appetite to eat?

Does your family has enough food?

What is the child living situation, has there being any change in the child living situation within the past one month?

What are your family concerns or needs?

Does your child take vaccinations?

Is there anything I can do for you? 

                                                                                      References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Center for Disease Control and Prevention (2016). Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities. Retrieved from https://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf

Chung, E. K., Siegel, B. S., Garg, A., Conroy, K., Gross, R. S., Long, D. A., Lewis, G., Osman, C. J., Jo Messito, M., Wade, R., Jr, Shonna Yin, H., Cox, J., & Fierman, A. H. (2016). Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. Current problems in pediatric and adolescent health care, 46(5), 135–153. doi:10.1016/j.cppeds.2016.02.004

Mărginean, C. O., Meliţ, L. E., Chinceşan, M., Mureşan, S., Georgescu, A. M., Suciu, N., Pop, A., & Azamfirei, L. (2017). Communication skills in pediatrics – the relationship between pediatrician and child. Medicine, 96(43), e8399. doi.10.1097/MD.0000000000008399

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

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Comment1

Leadership and management are both necessary for the success of any organization.  These terms are often used interchangeably by some while others see them as separate. Leaders are the inspiration, mentors, praises, and give directions to problems. Leaders may be more open with communication and participative in their encouragements of employing new concepts to help resolve a crisis. Managers are the planners, problem finders and solving, communication with team solving the problems. Managers may be known as having a stronger talent in solving problems and making use of scientific methods to come up with substantial solutions they the team may face every day (Huber, 2014).

I believe that the overlap between leadership and management are necessary for success. As a nurse manager and leader, I see this every day. Our nurse managers are also considered part of the leadership team. Our A-team, administration, would be considered the leaders in regards to this question. We are a rural hospital so we all work every close together and have an open communication among us. An example that I witnessed lately in the overlap is the construction on my psychiatry floor. We are in the process of updating our unit. There are construction workers in and out of the unit who does not understand that psychiatry is locked down for a reason.  As a manager, I have spoken with them and explained the rationale; I have spoken with their supervisors and explained the rationale. They all state they understand but I continue to witness the misbehavior entering and exiting the unit on the cameras in my office. I then go to my administration for guidance and help with the outside contractors. I experience guidance, open communication, and the administration goes to “manage” the construction crew.

Comment2

Leadership is the process of influencing people accomplish goals .The key concepts related to leadership are influence, communication, group process, goal attainment and motivation (Huber, 2013). Management is the coordination and integration of resources through planning, organizing, coordinating, directing and controlling to accomplish specific institutional goals and objectives (Huber, 2013).

Leadership is one of the most important factors that determine the survival and success of groups and organizations. Effective leadership is important in nursing because of its impact on the quality of nurses’ work lives, being a stabilizing influence during constant change, and for nurses productivity and quality of care. In leadership quality of life depends on quality of leaders. The leadership focus is on people, human relationship aspects while management focuses on systems, structure and tasks accomplishment (Huber, 2013).

ZE

 

Public health nursing involves working with communities and populations as equal partners, and focusing on primary prevention and health promotion (Kulbok, Thatcher, Park, Meszaros, 2012). There are many types of public health nurses in the area I live in including home health nurses, health department nurses, free clinic nurses, and home hospice nurses. Community based nursing involves collaboration and partnerships with communities and populations to address health and social conditions and problems.  The nurse I interviewed for this discussion, Jennifer, is a registered nurse who takes home call for Community Hospice, a locally owned hospice service in the Vidalia area.  I have dealt with this facility on a personal and professional level and there is no greater community centered facility in our area more so than Community Hospice.

Q: What are your job responsibilities?

A: As an on-call nurse, my main job is new patient intakes after business hours.  This includes going into the homes of patients who are admitted under hospice care.  During these intake assessments it is my job to record and take vital signs, educate families and patients on the disease, prognosis, treatments, and hospice care, and to ensure that families and patients understand and agree with the plan of care.  On routine visits it is my responsibility to again assess patients, record vital signs, as well as monitor any changes from previous visits and report changes to our providers on staff.

Q: Does a correlation exist between your job description and your practice?

A: Although she has a very clear job description laid out for her, she explains that her duties go far beyond the typical hands on patient care the typical nurse sees in the office or hospital setting.  She explains hospice is a special kind of job where you not only care for the patient but patient’s families as well.  She explains sometimes the care for the patient includes caring for them family and helping them cope with the prognosis of death.

Q: Are you involved in policy formulation that affects client services?

A: Jennifer describes her work environment and boss as exceptional.  All staff are seen as equals and their opinions valued to the fullest.  Each day they have a meeting where all staff who reports to the Hospice House that day go through reports as well as ideas to make their jobs successful.  She states having supportive staff members makes it easy to help policy implementation and change.

Q: Do you belong to a professional organization related to your current job position?

A: Currently Jennifer explains she is not involved in an organization related to hospice care. However there is an organization that several of her fellow employees are members of which is the National Hospice and Palliative Care Organization (NHPCO). This organization’s mission is the largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end-of-life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America and their loved ones (NHPCO 2018). This organization helps support and update hospice based nurses on any advances in their area of nursing as well as provide support.