A 39-year-old homeless man presents to the emergency department for cough and fever. He says that his illness has been worsening over the past 2 weeks. He originally had dyspnea on exertion and now is short of breath at rest. On questioning, he tells you that he lives in a homeless shelter when he can, but he frequently sleeps on the streets. He has used IV drugs (primarily heroin) “on and off” for many years. He denies medical history but the only time he gets medical attention is when he comes to the emergency department for an illness or injury. On review of systems, he complains of fatigue, weight loss, and diarrhea. On examination, he is a thin, disheveled man appearing much older than his stated age. His temperature is 100.5°F (38.0°C), his blood pressure is 100/50 mm Hg, his pulse is 105 beats/min, and his respiratory rate is 24 breaths/min. His initial oxygen saturation is 89% on room air, which comes up to 94% on 4 L of oxygen by nasal cannula. Significant findings on examination include dry mucous membranes, a tachycardic but regular cardiac rhythm, a benign abdomen, and generally wastedappearing extremities. His pulmonary examination is significant for tachypnea and fine crackles bilaterally, but no visible signs of cyanosis. His chest x-ray is read by the radiologist as having diffuse, bilateral,

interstitial infiltrates that look like “ground glass.”

Answer the following questions

What is the most likely cause of this patient’s current pulmonary

complaints?

➤ What underlying illness does this patient most likely have?

➤ What testing and treatment should be started now?

Respond 

Hiring more nursing assistants to assist during registered nurses'(RNs) shortage can be very challenging. Currently, I am working in the critical care unit (CCU), where we always used total patient care delivery assignments. The staff work 12-hour shifts, and each nurse is assigned for two patients, depending on the patients’ acuity. According to Marquis and Huston (2017), total-patient-care (TPC) nursing is the oldest patient-delivery model. With this model, one bedside nurse oversees the total care of patients during the assigned shift. The total responsibilities of the bedside nurse for a patient’s care include bathing, bed making, administering medications, vital signs, carrying out all ordered treatments, dressing changes, patient teaching, discharge planning, and updating patient care plan, etc (Marquis & Huston, 2017). We do not have nursing assistants in the CCU to help our nurses with all these responsibilities. Unfortunately, two months ago, we have about six nurses who resigned due to professional advancement and relocation.

Since we have a nurses shortage and hiring nurses is a long process, we (CCU leaders and the senior executive leadership) decided to collaborate with other departments to give us task nurses or nursing assistants which we called clinical partners (CP). Since both task nurses and the CPs will work under the supervision of the supervisor or the charge nurse, this delivery care model will fall under the functional-care model. A task nurse is a medical-surgical or telemetry nurse who is responsible for giving medications according to her job descriptions, checking blood sugar, etc. The nursing assistants’ tasks are to help CCU nurses in bathing the patients and foley care, changing linens, answering call lights, etc. 

Marquis and Huston (2017) noted that functional-care model (FCM) was found to be more cost-efficient due to the lower number of RNs required per shift. FCM involves assigning tasks to various team members based on the patients’ complexity or acuity of care needed. Generally, routine tasks are done by persons who are not RN, and the RN oversees more complex patients’ needs. With this model, the unit charge nurse makes the patients’ assignments for the team because she/he has more knowledge of all the patients’ needs (Marquis & Huston, 2017). However, switching from TPC to FCM has a significant impact on the patients’ quality of care in our unit. Our patients’ satisfaction dropped this month by 30%. Marquis and Huston (2017) outlined that the FCM quality of care was found to be less than with the total-patient-care model (Marquis & Huston, 2017). In my experience, hiring more nursing assistants to assist during nurses shortage will help to lessen the nurses’ workload in the CCU temporarily. On the other hand, having more certified critical nurses improve patients’ safety and outcomes. 

Meanwhile, hiring more nursing assistants to assist during nurses’ shortage can impact patients’ quality of care and staff satisfaction on St. Louis Medical Center (SLMC). As a nurse administrator at SLMC, I will use evidence-based practice, current literature, and scientific research to analyze proposed changes in nursing care delivery models. I will also make changes in work design to facilitate meeting organizational goals. Also, I will arrange a departmental meeting involving staff-led representatives from all nursing departments to ensure that everyone has a voice. Finally, I will empower each unit-based practice councils/members to be involved in unit problem solving such as short staffing and develop action plans to resolve the issues. During the meeting, I will seek feedback from my direct reports and the staff and ask them “what’s working well and what is not?” and to know what I can offer for them. 

One of the mechanisms used to promote employees’ growth and development in an organization’s long-term plan is empowerment and to support staff during times of difficult transitions (Choi, Goh, Adam, & Tan, 2016). Johnston and Villa (2018) outline that the Chief Nursing Officer should ensure successful engagement by integrating a shared governance council (SGC). SGC involves monthly meetings with bedside nurses to express issues, share best practices, develop action plans, and raise specific challenges to administration (Johnston & Villa, 2018).

References

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application. (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

Choi, S. L., Goh, C. F., Adam, M. B. H., & Tan, O. K. (2016). Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment. Human Resources for Health, 14(1). doi: 10.1186/s12960-016-0171-2

Johnston, D., & Villa, J. (2018). Shifting culture: A new CNO leading to nursing excellence. Journal of Nursing Administration, 48(9), 422. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=edb&AN=131663203&site=eds-live&scope=site

1 Explain the role of the community health nurse in partnership with community stakeholders for population health promotion. Explain why it is important to appraise community resources (nonprofit, spiritual/religious, etc.) as part of a community assessment and why these resources are important in population health promotion.

2  

Discuss how geopolitical and phenomenological place influence the context of a population or community assessment and intervention. Describe how the nursing process is utilized to assist in identifying health issues (local or global in nature) and in creating an appropriate intervention, including screenings and referrals, for the community or population.

Me    6 posts   Re: Topic 4 DQ 1  I agree with you that the first step to bringing about change in the community is to know the community. One should acknowledge and understand the need for such change. It is usually very tempting to see that something needs fixing and quickly jump into a solution. One should resist this temptation and instead take the time to study the community to get a clear understanding of all the needed change.I, further, agree with you that understanding the healthcare system at the local level involves important questions such as those you mentioned. One needs to understand the services offered in the community so that they can be effective while implementing evidence-based practice. To implement the right change in the community, it is important for the healthcare professionals to put their biases aside and talk to the people on the ground, to get a good understanding of what matters most to the citizens. In the long run, this prevents the implementation of underused EBP initiatives (Saunders & Vehviläinen-Julkunen, 2018). Carrying out such an assessment for the community will help in the identification of the available community resources and how those services can be accessed for the benefit of the patient.I also agree with the insights of your mentor about the importance of focusing on lead education especially in this day and age. I think than this is an area that has not received a lot of attention and tends to be ignored yet it is very important especially for community health. Basing your research in this field will add to the exiting limited knowledge hence contribute to the future body of research. Generally, I find your post to be very informative. All the best.  References  Saunders, H., & Vehviläinen-Julkunen, K. (2018). Key considerations for selecting instruments when evaluating healthcare professionals’ EBP competencies: A discussion paper. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/30019462

This is what I need 

Terri O’Brien    25 posts   Alimatu – substantive credit and APA  Alimatu  As your link contains the journal name and other information, please revisit the link and then provide a complete reference in APA format so I can give you credit for this post.  Thank you.

this is what  i need