Preparing for Change

What steps might be utilized to move a practice issue from development and design through implementation to the realization of positive outcomes? How does theory provide a framework? What barriers might you encounter?

To prepare:

• Review the theories and frameworks (i.e.,      change, organizational, behavioral) presented in Chapter 3 of the course      text, Translation of Evidence into Nursing and Health Care      Practice, and conduct additional research of your own. What insights do      these theories provide regarding how to take your practice issue from      development and design through implementation to the realization of      positive outcomes?
• Think about your practicum setting and evaluate      the readiness for change in this environment. Identify barriers and      facilitators for change.
• Consider strategies to address the barriers and      assess why they might be effective based on theory.

By tomorrow Wednesday 10/17/18 at 12 pm, write a minimum of 550 words essays in APA format with at least 3 references (see attached files) from the list of REQUIRED READINGS below. Include the headers as numbered below:

Post a cohesive scholarly response that addresses the following:

1) Assess the readiness for change in your hospital environment. Discuss those factors: (a) barriers and (b) facilitators that need to be considered (see attached chapter 15 in the file area)

2) Identify a theory or framework that will guide your change efforts. (see attached chapter 3 in the file area)

3) Discuss strategies to address barriers and provide one or more insights regarding why you think they might be effective based on theory.

Required Readings

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

• Review      Chapter 3, “Change Theory and Models: Framework for Translation” (see attached file)
• Chapter      14, “Creating a Culture That Promotes Translation”
• Chapter      15, “Best Practices in Translation: Challenges and Barriers in      Translation” (see attached file)

Darling, F. (2016). Practitioners’ views and barriers to implementation of the Keeping Birth Normal tool: A pilot study. British Journal of Midwifery, 24(7), 508-519. (see attached file)

Sadeghi-Bazargani, H., Tabrizi, J.S., & Azami-Aghdash, S. (2014). Barriers to evidence-based medicine: a systematic review. Journal of Evaluation in Clinical Practice, 20, 793-802. (see attached file)

Smith, E.L., Rice, K.L., & Agrell-Kann, M. (2015). Improving quality outcomes using a champion model for ancillary nursing staff, Journal of Continuing Education in Nursing, 46(12), 539-541. (see attached file)

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients 

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients 

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

   A Global Perspective and the Future 

Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.

Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3. Consider the discussions and any insights gained from it.

4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.

Assignment:

Describe the global issues leading to vulnerable populations and disparity at present time. What factors are responsible and what steps can we take as healthcare professionals to advocate for the vulnerable people at a global level?

Assignment Description: This assignment will be at least 1500 words or more

This week you will reflect upon global issues in healthcare to answer the following questions:

• Briefly define the Sustainable Development Goals.
• How can you do your part upholding the Sustainable Development Goals?  
• Reflect on your future responsibilities involving ethical norms in healthcare.

Assignment Expectations: 

• Length:
  • 1500-2000 words (6-8 pages); answers must thoroughly address the questions in a clear, concise manner
• Structure:
  • Include a title page and reference page in APA style
• References:
  • Two scholarly references are required; you should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions
• Format:
  • Save your assignment as a Microsoft Word (.doc or .docx), Open Office (.odt) or rich text format (.rtf) file type
• File name:
  • Name your saved file according to your last name, first initial and the week (for example, “jonesb.week1”)
• Submission:
  • Submit your assignment to the Drop Box

In this assignment, you will be completing a health assessment on an older adult. To complete this assignment, do the following:

1. Perform a health history on an older adult. Students who do not work in an acute setting may “practice” these skills with a patient, community member, neighbor, friend, colleague, or loved one. (If an older individual is not available, you may choose a younger individual).
2. Complete a physical examination of the client using the “Health History and Examination” assignment resource. Use the “Functional Health Pattern Assessment” resource as a guideline to assist you in completing the template.
3. Document findings of complete physical examination in Situation-Background-Assessment-Recommendation (SBAR) format. Refer to the sample SBAR Template located on the National Nurse Leadership Council website at https://www.ihs.gov/nnlc/includes/themes/newihstheme/display_objects/documents/resources/SBARTEMPLATE.pdf as a guide.
4. Document the findings of the physical examination in the assessment worksheet.
5. Using the “Health History and Examination” assignment resource, provide the physical examination findings summary with planned interventions for the client. Include any community services in the interventions.

APA format is not required

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

NRS-434VN-R-Functional-Health-Pattern-Assessment-Student.docx NRS-434VN-R-IndividualHealthHistoryandExaminationAssignment-Student.docx 

 NR 507 Week No. 5 Discussion:

 

PART No. 1:

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:

  

Sodium (Na+) 

156 mEq/L H

Potassium (K+)

4.0 mEq/L N

Chloride (Cl–)

115 mEq/L H

Arterial blood gases (ABGs)

pH- 7.30; Pco2-40; Po2-70; HCO3-20

METABOLIC ACIDOSIS with respiratory compensation, High anion gap

Normal values

Sodium (Na+)

136-146 mEq/L

Potassium (K+)

3.5-5.1 mEq/L

Chloride (Cl–)

98-106 mEq/L

Arterial blood gases (ABGs)

pH- 7.35-7.45

Pco2- 35-45 mmHg

Po2-80-100 mmHg

HCO3–22-28 mEq/L

• List      three (3) reasons on why she may have become bed ridden? 
• Flu?      Pneumonia? 
• Based      on these reasons what tests would you order? 
• Accu      check? CXR? Lactic Acid level, serum and urine ketone levels
• Describe      the molecular mechanism of the development of ketoacidosis. (p. 744) *Pt’s      who develop DKA do so bc bicarbonate buffering does not occur, which      begins the development of metabolic acidosis

pH 7.30 = acid

CO2 40 = Normal

O2 70 = Low

HCO3 20 = acid

PART No. 2:

A three-month-old baby boy comes into your clinic with the main complaint that he frequently vomits after eating. He often has a swollen upper belly after feeding and acts fussy all the time. The vomiting has become more frequent this past week and he is beginning to lose weight.

• Write      three (3) differential diagnoses at this time?
• Is      there any genetic component to the top of your differentials?
• What      tests would you order?

PART No. 3:

Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis?

PEER:

NR 507 Week No. 5 Quiz:

1. Aldosterone synthesis and secretion are primarily regulated by the (Points : 2)

2. A surgical individual just arrived on the unit from the postanesthesia care unit. This person’s respirations are 4 per minute and shallow. As the nurse calls for assistance, the person suddenly feels jittery and breathing quickens. Which of the following feedback loops is operating for the nurse in this situation? (Points : 2)

3. What effect does aldosterone have on fluid and electrolyte imbalances? (Points : 2)

4. What effect does hyperphosphatemia have on other electrolytes? (Points : 2)

5. Where is oxytocin synthesized? (Points : 2)

6. Which mineral is needed for the synthesis of thyroid hormones? (Points : 2)

7. The portion of the pituitary that secretes oxytocin is the _____ pituitary. (Points : 2)

8. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of a _____ effect by a hormone. (Points : 2)

9. Which of the following hormones acts on its target cell via a second messenger? (Points : 2)

10. Target cells for parathyroid hormone (PTH) are located in the (Points : 2)

11. Which hormone is involved in the regulation of serum calcium levels? (Points : 2)

12. A person who has experienced physiologic stresses will have increased levels of which hormone? (Points : 2)

13. The first lab test that indicates type 1 diabetes is causing the development of diabetic nephropathy is (Points : 2)

14. A deficiency of which of the following may result in hypothyroidism? (Points : 2)

15. Diagnosing a thyroid carcinoma is best done with (Points : 2)

16. The effects of syndrome of inappropriate antidiuretic hormone (SIADH) include solute (Points : 2)

17. Which of the following clinical manifestations is not common to both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS)? (Points : 2)

18. The signs of thyroid crisis resulting from Graves disease include (Points : 2)

19. What causes the microvascular complications of clients with diabetes mellitus? (Points : 2)

20. A man with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, there is no change in his polyuria. These are indications of (Points : 2)

21. Amenorrhea, galactorrhea, hirsutism, and osteopenia are each caused by a (Points : 2)

22. The most common cause of hypoparathyroidism is (Points : 2)

23. The level of thyroid-stimulating hormone (TSH) in Graves disease is usually (Points : 2)

24. The most probable cause of low serum calcium following a thyroidectomy is (Points : 2)

25. Hyperpituitarism is generally caused by (Points : 2)