COMPETENCIES

726.10.2 : Manager of the Healing Environment

The graduate responds to unpredictable situations and events common in the healthcare environment with appropriate flexibility and creativity.

726.10.3 : The Nurse as Scientist

The graduate correctly interprets and applies scientific evidence when planning and providing safe, quality, and culturally sensitive care for patients and families.

726.10.4 : The Nurse as Detective

The graduate detects subtle changes and deviations from expected health patterns while managing the care of patients.

740.2.8 : Interprofessional Practices

The graduate analyzes the impact of new and diverse advanced nursing and care provider roles on interprofessional practice.

INTRODUCTION

Nursing is a practice discipline that includes direct and indirect care activities that affect health outcomes. As a baccalaureate nursing student, you are developing new competencies in leadership, and in order to achieve mastery, you must apply those competencies to live practice experiences and situations. This Leadership Learning Experience (LLE) is designed to allow you to choose a clinical focus (e.g., practice, policy, education, population) in which you apply your leadership problem–solving skills. The LLE requires engagement with other people within the setting to complete. 
 

You will develop a project within a practice setting that allows you to develop these leadership skills. You will identify a problem area in a practice setting that you specifically want to address (e.g., practice, policy, population, education) that aligns with organizational priorities. Example sources for the problem area may include the following:

             •  Practice: joint commission standards, core measures as quality indicators, other data

             •  Policy: legislation, staffing ratio, regulations from state boards

             •  Population: children with diabetes, adult obesity

             •  Education: future of nursing, Benner’s recommendations about nursing education

You will focus on a real-life solution for the problem. You should choose a topic that is timely, manageable, and realistic to the current healthcare environment. An external resource person (i.e., manager, clinical leader, clinical educator, policy expert, or population expert) must confirm the relevance of the selected project and your engagement in the setting as part of project completion. As with all projects, you should think how you, as a nurse, function in the following roles: detective, scientist, and manager of the healing environment.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Note: Any information that would be considered confidential, proprietary, or personal in nature should not be included. Do not include the actual names of people, stakeholders, or other personally identifiable information. Fictional names should be used. Also, agency-specific data, including financial information, should not be included but should be addressed in a general fashion as appropriate.

Note: Your submission may be in a variety of formats (e.g., report, multimedia presentation).

A.    Develop a written proposal by doing the following:

1.    Identify a problem or issue related to practice, policy, population, or education that aligns with the organizational priorities you seek to solve.

Note: You may need to meet with your organization or practice setting, your manager, or your supervisor to help choose a current problem or issue.

a.    Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare environment.

2.    Discuss your investigation of the problem or issue.

a.    Provide evidence to substantiate the problem or issue (e.g., organizational assessment, national source documents, evidence from a stakeholder).

3.    Analyze the state of the situation using current data.

a.    Analyze areas that might be contributing to the problem or issue.

4.    Propose a solution or innovation for the problem or issue.

a.    Justify your proposed solution or innovation based on the results of your investigation and analysis.

5.    Recommend resources to implement your proposed solution or innovation. Include a cost-benefit analysis of your proposed solution or innovation.

6.    Provide a timeline for implementation based on your proposal.

7.    Discuss why each key stakeholder or partner is important for the implementation of the solution or innovation.

a.    Summarize your engagement with the key stakeholders or partners, including the input and feedback you received.

b.    Discuss how you intend to work with those key stakeholders or partners in order to achieve success.

8.    Discuss how your proposed solution or innovation could be implemented, including how the implementation could be evaluated for success.

B.    Explain how you fulfilled the following roles during your process of investigation and proposal development:

1.    scientist

2.    detective

3.    manager of the healing environment

C.    Submit the completed attached “Professional Verification Form” from the organizational leader advising you in your leadership experience.

D.    Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

E.    Demonstrate professional communication in the content and presentation of your submission.

File RestrictionsFile name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
RUBRICA1:PROBLEM OR ISSUE

NOT EVIDENT

An identification of the problem or issue is not provided.

APPROACHING COMPETENCE

The identified problem or issue is not related to practice, policy, population, or education, or it does not align with organizational priorities that are in need of solving.

COMPETENT

The identified problem or issue is related to practice, policy, population, or education, and it aligns with organizational priorities that are in need of solving.

A1A:EXPLANATION OF PROBLEM OR ISSUE

NOT EVIDENT

An explanation of the problem or issue is not provided.

APPROACHING COMPETENCE

The explanation addresses the problem or issue, but it does not include an appropriate, logical rationale for why the problem or issue applies to the chosen area of practice and the healthcare environment.

COMPETENT

The explanation of the problem or issue includes an appropriate, logical rationale for why the problem or issue applies to the chosen area of practice and the healthcare environment.

A2:INVESTIGATION

NOT EVIDENT

A discussion of the investigation of the problem or issue is not provided.

APPROACHING COMPETENCE

The discussion of the investigation of the problem or issue is illogical or vague, or the discussion is trivial or missing key details. Or the discussion of the investigation is irrelevant to the problem or issue.

COMPETENT

The discussion of the investigation of the problem or issue is logical and sufficiently detailed. The discussion of the investigation is thorough and relates to the problem or issue.

A2A:EVIDENCE OF PROBLEM OR ISSUE

NOT EVIDENT

Evidence to substantiate the problem or issue is not provided.

APPROACHING COMPETENCE

The provided evidence fails to substantiate the problem or issue because it is not an appropriate form of evidence, or the evidence does not logically support the problem or issue.

COMPETENT

The provided evidence substantiates the problem or issue because it is an appropriate form of evidence (e.g., organizational assessment, national source documents, or evidence from a stakeholder), and it logically supports the problem or issue.

A3:ANALYSIS

NOT EVIDENT

An analysis is not provided.

APPROACHING COMPETENCE

The analysis addresses the state of the situation, but current data is not used to support the analysis. Or the analysis is implausible or is not supported by specific examples.

COMPETENT

The analysis addresses the state of the situation using current data, and it is plausible and well supported with specific examples.

A3A:CONTRIBUTORS TO PROBLEM OR ISSUE

NOT EVIDENT

An analysis is not provided.

APPROACHING COMPETENCE

The analysis is limited to addressing minor areas that contribute to the problem or issue, or the analysis is implausible or is not supported with specific examples.

COMPETENT

The analysis addresses all the areas that potentially contribute to the problem or issue. The analysis is plausible and well supported with specific examples.

A4:PROPOSED SOLUTION OR INNOVATION

NOT EVIDENT

A proposal for a solution or innovation for the problem or issue is not provided.

APPROACHING COMPETENCE

The proposal of a solution or innovation to the problem or issue is illogical, inappropriate, or missing significant components.

COMPETENT

An appropriate solution or innovation is proposed for the problem or issue. The solution or innovation is logical, well reasoned, and includes all significant components.

A4A:JUSTIFICATION OF PROPOSED SOLUTION OR INNOVATION

NOT EVIDENT

A justification of the proposed solution or innovation is not provided.

APPROACHING COMPETENCE

The justification of the proposed solution or innovation does not make logical connections between the problem and the solution, or it is not based on the results of the investigation or analysis.

COMPETENT

The justification of the proposed solution or innovation makes logical connections between the problem and the solution, and it is based on the results of the investigation and analysis.

A5:RESOURCES AND COST-BENEFIT ANALYSIS

NOT EVIDENT

A recommendation or a cost-benefit analysis is not provided.

APPROACHING COMPETENCE

The resources recommended for implementation of the proposed solution or innovation are inappropriate for the needs of the solution or innovation, or the recommendation is missing key resources. Or a cost-benefit analysis is not included, or the analysis is illogical or not an accurate representation of the needs of the proposed solution or innovation.

COMPETENT

The resources recommended for implementation of the proposed solution or innovation are appropriate for the needs of the solution or innovation. The recommendation includes all essential resources. A cost-benefit analysis is included, and it is a logical and accurate representation of the needs of the proposed solution or innovation.

A6:TIMELINE

NOT EVIDENT

A timeline for implementation is not provided.

APPROACHING COMPETENCE

The timeline is not accurate or not achievable given the needs of the proposed solution or innovation.

COMPETENT

The timeline is accurate and achievable for the needs of the proposed solution or innovation.

A7:IMPORTANCE OF KEY STAKEHOLDERS OR PARTNERS

NOT EVIDENT

A discussion is not provided.

APPROACHING COMPETENCE

At least 1 of the stakeholders or partners that are identified in the discussion are inappropriate for the implementation of the solution or innovation, or essential stakeholders or partners are missing in the discussion, or the discussion does not address why each identified stakeholder or partner is important for the implementation of the solution or innovation.

COMPETENT

All of the key stakeholders or partners that are identified are appropriate for the implementation of the solution or innovation, and there are no missing essential stakeholders or partners. The discussion also addresses why each identified stakeholder or partner is important for the implementation of the solution or innovation.

A7A:ENGAGEMENT WITH KEY STAKEHOLDERS OR PARTNERS

NOT EVIDENT

A summary is not provided.

APPROACHING COMPETENCE

The summary of the engagement with the key stakeholders or partners is vague or trivial, or the summary does not include the input and feedback received from them.

COMPETENT

The summary of the engagement with the key stakeholders or partners is sufficiently detailed and meaningful, and it includes the input and feedback received from them.

A7B:SUCCESS

NOT EVIDENT

A discussion is not provided.

APPROACHING COMPETENCE

The discussion ineffectively addresses how to work with the key stakeholders or partners discussed in part A7 in order to achieve success. The discussion is illogical or is missing supportive details.

COMPETENT

The discussion effectively addresses how to work with the key stakeholders or partners discussed in part A7 in order to achieve success. The discussion is logical and includes supportive details.

A8:IMPLEMENTATION

NOT EVIDENT

A discussion is not provided.

APPROACHING COMPETENCE

The discussion ineffectively addresses how the proposed solution or innovation could be implemented, or the plan for implementation is illogical or missing key details, or the discussion does not include an appropriate, well-supported, or well-reasoned plan for how the implementation could be evaluated for success.

COMPETENT

The discussion effectively addresses how the proposed solution or innovation could be implemented. The plan for implementation is logical and thorough. The discussion includes an appropriate, well-supported, and well-reasoned plan for how the implementation could be evaluated for success.

B1:ROLE OF SCIENTIST

NOT EVIDENT

An explanation is not provided.

APPROACHING COMPETENCE

The explanation ineffectively addresses how the role of the scientist was fulfilled during the investigation process and proposal development, or the explanation is vague or lacks specific, relevant examples.

COMPETENT

The explanation effectively addresses how the role of the scientist was fulfilled during the investigation process and proposal development. The explanation is detailed and includes specific, relevant examples.

B2:ROLE OF DETECTIVE

NOT EVIDENT

An explanation is not provided.

APPROACHING COMPETENCE

The explanation ineffectively addresses how the role of the detective was fulfilled during the investigation process and proposal development. The explanation is vague or lacks specific, relevant examples.

COMPETENT

The explanation effectively addresses how the role of the detective was fulfilled during the investigation process and proposal development. The explanation is detailed and includes specific, relevant examples.

B3:ROLE OF MANAGER OF THE HEALING ENVIRONMENT

NOT EVIDENT

An explanation is not provided.

APPROACHING COMPETENCE

The explanation ineffectively addresses how the role of the manager of the healing environment was fulfilled during the investigation process and proposal development. The explanation is vague or lacks specific, relevant examples.

COMPETENT

The explanation effectively addresses how the role of the manager of the healing environment was fulfilled during the investigation process and proposal development. The explanation is detailed and includes specific, relevant examples.

C:VERIFICATION FORM

NOT EVIDENT

A submission is not provided.

APPROACHING COMPETENCE

The “Professional Verification Form” from the organizational leader advising leadership experience is submitted, but the submission is incomplete.

COMPETENT

The submission of the “Professional Verification Form” from the organizational leader advising leadership experience is complete.

D:APA SOURCES

NOT EVIDENT

The submission does not include in-text citations and references according to APA style for content that is quoted, paraphrased, or summarized.

APPROACHING COMPETENCE

The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized but does not demonstrate a consistent application of APA style.

COMPETENT

The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized and demonstrates a consistent application of APA style.

E:PROFESSIONAL COMMUNICATION

NOT EVIDENT

Content is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic.

APPROACHING COMPETENCE

Content is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective.

COMPETENT

Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding.

Patient rounds involve various disciplines coming together to discuss the patient’s condition and coordinate care. They are used as an educational tool and also help keep everyone on the same page when it comes to the treatment plan. The following case is found in the textbook (Pharmacotherapy: Principles and Practices. Chisholm-Burns et al, eds.  5th edition.  McGraw-Hill.  New York 2019. ISBN-978-1-260-01944-5; Chapter 34. “Patient encounter”).

After reading the assigned chapters in the textbook, resources identified in Dynamed and Evidence based practice guidelines, please present the case to your peers in the form of a discussion. This will be your initial post. Please be sure to address all parts of the case and ensure your responses are well researched [including supporting, evidence based guidelines such those of the WHO, CDC, APS, etc.]. 

Part 1:

HPI:  A 78-year-old man who is to undergo a left above the knee amputation due to a limb abscess

PMH: Peripheral artery disease for 18 years; cardiomyopathy, benign prostatic hypertrophy for 13 years

FH: Mother had osteoporosis; father had diabetes

SH: Lives with wife; has two grown children

Meds: Aspirin 81mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; pantoprazole 40 mg daily; tamsulosin 0.4 mg daily

Pain Assessment: Patient rates pain as 8 on a scale of 0 to 10.

• Based on the type of injury, what type of pain is this patient likely to experience?
• What type of pain management regimen would you suggest in the postoperative period? Explain your answer

Part 2:

Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 55 mg of morphine/24 hours with adequate pain control; however, he developed redness and itching on his neck that is believed to be due to the morphine.

Current Meds:  Morphine PCA; aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily; heparin 5000 units twice daily until discharged home. He will be discharged to a skilled nursing facility for rehabilitation therapy.

You would like to convert him to a combination preparation of hydrocodone and APAP for as-needed pain relief.

• What dosing regimen would you suggest?
• What would your monitoring plan include for this patient?
• How would you assess pain response?
• The patient is concerned about the redness and itching that he developed while on morphine. Would you document this as an allergic reaction?
• What other interventions or education may be necessary at this time?

Part 3:

The patient was discharged to a skilled nursing facility and is receiving physical therapy and occupational therapy 6 days each week.

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home, hydrocodone/acetaminophen 5/325 mg every 6 hours as needed for pain.

Pain Assessment: Patient reports pain of 7 out of 10; worse with movement.

Physical therapy notes indicate the patient is unable to complete therapy goals due to complaints of pain.

• Based on this information, what would you recommend to optimize pain control?
• Prescribers play a critical role in prescription drug misuse and abuse prevention. What steps can be taken to identify signs of dependence and abuse and what education can you provide to the patient regarding the negative effects of medication misuse?

Part 4:

The patient has been at the skilled nursing facility for 4 weeks and is making progress toward rehabilitation goals; however, he complains that his leg is throbbing and feels like pins and needles. As a result, he requests to rest several times during her therapy sessions. During unit rounds, his therapist inquires whether her previous pain medication should be reordered.

Pain Assessment: 4 out of 10

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home,

• What additional recommendations would you have at this time regarding pain management?
• Are there any other therapeutic issues that should be addressed?

The answer to this question must center primarily on Laudato Si, but should also include other material from throughout the course relating to reverence for creation, as well as the other Franciscan values.  Be sure to cite specific readings, and in the case of Church documents, such as Laudato Si, specific section numbers as found in the document.  (Relevant passages from Laudato Si should be chosen from throughout the document, especially the assigned sections, and not merely from the first few paragraphs.)  NOTE WELL:  Your answer is to be BASED on — and ONLY on — the course material: the reading assignments, notes, and other items posted in this course on Blackboard.  The use of other sources is not permitted and will cause a deduction in your grade.  You are also expected to explain the material in your own words and use quotations only to support or illustrate your points.  Your score will be based on both quantity and quality, but especially on how well you explain fundamental concepts, how well you make and explain these connections, and on how thoroughly you integrate the various course materials into your discussion.  I value solid thinking, but also vision and informed imagination. (Recommended MINIMUM length:  c. 750 words)

Question:  The question has two main parts:  a) Explain and discuss the meaning of and deep connections between REVERENCE FOR CREATION (aka ECOLOGICAL JUSTICE) and SOCIAL JUSTICE, especially as brought out by Pope Francis and by the other course readings.  (In other words, discuss how Laudato Si and other course readings emphasize the connections between reverence for creation and social justice.)  b) Then expand these connections to include how perspectives from other religious traditions (at least two others) tie into these.  In other words, what insights on ecology and social justice are offered by other religious traditions?  

https://www.vatican.va/archive/hist_councils/ii_vatican_council/documents/vat-ii_cons_19651207_gaudium-et-spes_en.html

https://www.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20150524_enciclica-laudato-si.html

Directions: Identify an outcome of nursing practice in your area of practice that can be improved.  For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent.  You may be able to use the problem that inspired the theory concepts that you developed in week two.

Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate.

Create a clinical nursing (not medical) theory in the form Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses.

This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.

Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” or “or” in your theory, you are probably too complex.

If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B). 

Conclude with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize t in the conclusion.

Expectations

• Due: Monday, 11:59 pm PT
• Length: 5 to 7 pages including title and reference pages
• References: 3 to 10.  There should be enough to support the links between the concepts of the problem and the concepts of Watson’s Theory of Caring.