our assignment this week will be an APA paper to include title page, level headings, and a reference page.

Case study #1 

Mrs. Franklin-Jones was admitted from the Emergency Room to Cardiac Intensive Care one week ago with a diagnosis of acute myocardial infarction. She has recovered as expected and is moving to the cardiac step down unit today. She is talking with Nurse Julie Hernandez, as she gets settled in her new room, “I was really surprised when I got that bad pain in my chest! I knew I had high pressure but I just didn’t think it was that bad. I try to take my medicine like they told me to in the clinic but sometimes I forget. I guess that I need to study those papers they gave me about what foods I should eat and not eat. I better take care of myself! Momma had bad pressure and it killed her! Who knows—I may even have to learn to cook different than I was taught in Jamaica! I may have to let Tomas do the cooking. He’s got more time at home now than I do since he lost his job. There isn’t too much time between my shifts at the school cafeteria and my new housecleaning job. You know my sister is coming up from Jamaica to see me. I think she is bringing me some bush tea. That’ll set me right!”

• Using Leininger’s Culture Care Model, what factors in the story shared by Mrs. Franklin-Jones should be considered by Nurse Hernandez when planning for the patient’s discharge?
• Why is the theory of Culture Care Diversity important in the delivery of nursing care for all patients?
• Using Leininger’s Theory of Culture Care Diversity and Universality, develop a plan of care for Mrs. Franklin-Jones.
• Discuss the strengths and limits to Leininger’s Theory.

Case Study #2

Claude Jean-Baptiste is recovering from post-hip replacement surgery and has been transferred to the Rehabilitation Institute adjacent to the hospital. When he enters the unit, he sees welcoming signs written in several languages including his own, Creole. Since there are no nurses on that shift that speak Creole, they use a language line to ask for translation services. During this initial nursing assessment, the translator informs Mr. Jean-Baptiste that the nurses invite him to have a relative at his side so that they can be sure to understand and meet his needs. He is asked about Haitian customs and beliefs that they might honor. Mr. Jean-Baptiste is encouraged to bring food and spiritual care items, and to share the warmth of his culture with the nursing staff.

• Discuss assumptions of the Transpersonal Caring relationship. What is the nurse’s role?
• How is love, as defined by Watson, evident in this caring moment?
• How can the nurse creatively use self to create a healing environment?
• Discuss the strengths and limits to Watson’s Theory.

This paper should include 2 outside references and your book. The essay should be between 1500 and 1750 words in length.

 EW

The two types of elder abuse I decided to discuss are emotional abuse and exploitation.  Emotional abuse is inflicting mental pain, anguish, or distress on an older person through verbal and nonverbal acts.  Examples of emotional abuse are as follow: name calling, verbally telling someone they are worthless, intimidation, and playing mind games.  Exploitation is taking, misusing, or concealment of funds, property, or assets of an older adult for one’s own personal gain.  Examples of exploitation are as follow:  taking money from an older person, borrowing the older person’s vehicle and not returning it, moving in with an older person without consent and treating the poverty as your own.  I consider the types of abuse discussed as crucial because they are difficult to prove.  These types of abuse can be done without physical evidence.  The abuser can easily deny the allegations.  As we discuss the elderly, we often assume that there’s cognitive impairment and memory difficulties. With there being cognitive impairment, the accuser can easily detour the mistreatment.  Growing population of the elderly, the demand for elderly care, workload of social welfare agencies, and age-related changes in the elderly such as cognitive and mobility impairments are challenges in abolishing the abuse.  The elderly client often has a decline in mobility and cognition; making if difficult to effectively communicate with others.  Elderly clients can easily be retained and controlled, contributing to easy target for abuse without it being known.  Social welfare agencies often have overwhelming workload, contributing to insufficient assessments and follow-up of the alleged abuse and possible overlooked abuse.  There are ways to protect the elderly, while in the community and workplace.  While in the workplace, being familiar with the patient and their behavior is helpful.  Often the abuse victim will exhibit abnormal behaviors when being abused.  The patient may be withdrawn, fearful, and shameful.  The facility social worker is then involved for assessment for psychological factors such as depression.  The assessment is on-going. The care team along with the abuse coordinator for the facility will continue the investigation.  When in the community; neighbors, family, friends, and primary care physicians are our main sources that will help with possible abuse of an elderly.  If the elderly has not had a routine doctor’s visit over an amount of time; this should be reported for follow-up to assess the reason for no doctor visits.  If a neighboring elderly person has not been seen in a while, alert police and local social welfare agencies for courtesy checks.  Families should check on their elderly family members (uncles, aunts, grand dad, grand-mother, etc,); and the same for elderly friends.  If anything suspicious, report it. 

#1:

 Based on how you will evaluate your EBP project, which independent and dependent variables do you need to collect? Why? 

#2:

 Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project? 

 LG

 Caring for the ethnically diverse older adult can prove to be challenging in efforts to maintain function and provide comfort. I will use an older African American male with hypertension. For this patient, the two strategies that I would implement would be diet and exercise. According to healthy people 2020, heart disease is the number 1 cause of death, and hypertension is a modifiable risk factor. 

      African Americans use a lot of seasonings, in particular salt, and this greatly impacts their chronic illness management. I would implement a dietary education strategy that includes salt substitution, and seasoning alternatives that keep food appetizing yet healthy. Also, we must integrate healthier meal choices, and refrain from fast food, frozen meals, and  In order to maintain compliance with dietary changes and substitutions, food must taste good. Education is needed on reading food package labels and choosing lower sodium options.

      The second strategy will be to educate and help implement an exercise regimen. Many older adults are hesitant to exercise because they feel that it may be time consuming, but there can be ways to incorporate it in small steps through out the day. The Mayo Clinic staff states that regular physical activity makes your heart stronger to pump more blood with less effort, and the end result is decreased blood pressure. Discuss adding walking during breaks and before and after work, then increase or add an activity at intervals to create a program catered to them.

Please provide a 3-4 sentence reply to the below discussion question answer.

Answer: One of the identified barriers from last weeks discussion was a lack of understanding of the literature or research process. Nurses, in general, believe in the evidence-based process to improve clinical practice and patient outcomes but without knowing how to perform research or how to critique research studies this will continue to perpetuate the issue of implementation. One solution is to provide research workshops to provide foundational knowledge, research ethics, and literature review techniques (Black et al, 2015). Another solution would be employing the use of facilitators, those that can help guide nurses in the research process, framing precise questions, assisting in literature review, aid in the critical appraisal process of the literature. The facilitator would have had to have some training in evidence-based practice methods (Dalheim et al, 2012).

Original Question: Consider an obstacle or barrier to the implementation of evidence-based practice you identified in last week’s discussion. What are two ways to address this problem?