Learning Objectives for this assignment include:

• Apply the principles of delegation in the healthcare setting.
• Demonstrate the use of clinical reasoning in prioritizing and evaluating the delivery of client care.
• Demonstrate principles of collaborative practice within the nursing and healthcare teams fostering mutual respect and shared decision-making to achieve stated outcomes of care. 

For this discussion, we are going to focus on delegation in the workplace. Read the following scenario, review the 2019 Regulations Governing the Practice of Nursing document from the Virginia Board of Nursing, Part VI (pages 20-23. see attached and then submit your answers the three questions below (Be sure to reference your information source in APA format!) You are working the night shift on a medical unit and have been assigned charge nurse responsibilities. You are working with four RNs, one LPN, and two CNAs (nurse’s aides or care partners).  A patient becomes pulseless and is not breathing, and the nurse assigned to the patient’s care calls a code. The nurse is occupied at this patient’s bedside for 1.5 hours until the patient is stabilized and transferred to the intensive care unit. The nurse also has four other assigned patients. In addition to the nurse assigned to the patient requiring resuscitation, two of the other RNs working on your unit are assisting in the code. 

(1) During the time of the resuscitation efforts, what tasks could be delegated to the UAP (NCP) in order to help with the care of the patients that are assigned to the three RNs that are involved in the resuscitation? 

(2) How will you, as the charge nurse, maintain the safety of the other patients on your unit while the three RNs are occupied with the resuscitation efforts?

(3) How might effective delegation to other team members contribute to care for the patients on the unit? 

Your response should be scholarly, between 150 and 200 words for each question, and include at least one peer-reviewed nursing journal article to support your comments. (Your in-text citations and reference should in in correct APA format.) Be sure to use correct grammar and sentence structure. 

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3 of Week 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Learning Resources

Required Readings (click to expand/reduce)

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.

Chapter 1, “The History and Interviewing Process”  (Previously read in Week 1)This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

Chapter 2, “Cultural Competency”This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 2, “Evidenced-Based Clinical Practice Guidelines”

Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605
Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.

The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.

Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence

This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website. 

United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/

From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.

Espey , D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311. 

The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.

Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109–120.

The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving healthcare services at primary healthcare centers.

Required Media (click to expand/reduce)

Module 2 Introduction
Dr. Tara Harris reviews the overall expectations for Module 2. Consider how you will manage your time as you review your media and Learning Resources for your Discussion, Case Study Lab Assignment, and your DCE Assignment (3m).
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Functional Assessments and Cultural and Diversity Awareness in Health Assessment – Week 2 (10m)

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use 3 sources for this discussion

 

Discussion:

Compare and contrast the growth and developmental patterns of two toddlers of different ages using Gordon’s functional health patterns. Describe and apply the components of Gordon’s functional health patterns as it applies to toddlers.   

Instructions: 

Please Word limit 500 words.  Support your answers with the literature and provide citations and references in APA format. 

Please do not forget add references in APA format.

Scenario Case Study: Scenario 1: A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. Patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg po every Friday morning and prednisone 5 mg po qam. He states that he has had a fever up to 101 degrees F for about a week and admits to chills and sweats. He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After extensive work-up, the patient was diagnosed with Invasive aspergillosis.

To prepare:

The specific case study for this Case Study Assignment is above.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

· Explain why you think the patient presented the symptoms described.

· Identify the genes that may be associated with the development of the disease.

· Explain the process of immunosuppression and the effect it has on body systems.

Part 1: 

Confronting Sexual Harassment

You are a new female employee at Valley Medical Center’s intensive care unit and love your job. Although only 25 years old, you have been a nurse for 4 years, and the last 2 years were spent in a small critical care unit in a rural hospital. You work the 3:00 PM to 11:00 PM shift. Ever since you came to work there, one of the male physicians, Dr. Long, has been especially attentive to you. At first, you were flattered, but more recently, you have become uncomfortable around him. He sometimes touches you and seems to be flirting with you. You have no romantic interest in him and know that he is married. Last night, he asked you to meet him for an after-work drink and you refused. He is a very powerful man in the unit, and you do not want to alienate him, but you are becoming increasingly troubled by his behavior.

Today, you went to your shift charge nurse and explained how you felt. In response, the nurse said, “Oh, he likes to flirt with all the new staff, but he’s perfectly harmless.” These comments did not make you feel better. At approximately 7:00 PM, Dr. Long came to the unit and cornered you again in a comatose patient’s room and asked you out. You said no again, and you are feeling more anxious because of his behavior.

ASSIGNMENT:

Outline an appropriate course of action. What options can you identify? What is your responsibility? What are the driving and restraining forces for action? What support systems for action can you identify? What responsibility does the organization have? Be creative and think beyond the obvious. Be able to support your decisions.

Part 2:

LEARNING EXERCISE  18.7

A Chief Nursing Officer’s Dilemma

You are the chief nursing officer of County Hospital. Dr. Martin Jones, a cardiologist, has approached you about having an intensive care unit/critical care unit (ICU/CCU) nurse make rounds with him each morning on all of the patients in the hospital with a cardiac-related diagnosis. He believes that this will probably represent a 90-minute commitment of nursing time daily. He is vague about the nurse’s exact role or purpose, but you believe that there is great potential for better and more consistent patient education and care planning.

Audrey, one of your finest ICU/CCU nurses, agrees to assist Dr. Jones. She has always wanted to have an expanded teaching role. However, for various reasons, she has been unable to relocate to a larger city where there are more opportunities for teaching. You warn Audrey that it might be some time before this role develops into an autonomous position, but she is eager to assist Dr. Jones. The other ICU/CCU staff agree to cover Audrey’s patients while she is gone, although it is obviously an extension of an already full patient load.

After 3 weeks of making rounds with Dr. Jones, Audrey comes to your office. She tearfully reports that rounds frequently take 2 to 3 hours and that making rounds with Dr. Jones amounts to little more than “picking up his pages and being a personal handmaiden.” She has assertively stated her feelings to him and has attempted to demonstrate to Dr. Jones how their allegiance could result in improved patient care. She states that she has not been allowed any input into patient decisions and is frequently reminded of “her position” and his ability to have her removed from her job if she does not like being told what to do. She is demoralized and demotivated. In addition, she believes that her peers resent having to cover her workload because it is obvious that her role is superficial at best.

You ask Audrey if she wants you to assign another nurse to work with Dr. Jones, and she says that she would really like to make it work but does not know what action to take that would improve the situation.

You call Dr. Jones, and he agrees to meet with you at your office when he completes rounds the following morning. At this visit, Dr. Jones confirms Audrey’s description of her role but justifies his desire for the role to continue by saying, “I bring $10 million of business to this hospital every year in cardiology procedures. The least you can do is provide the nursing assistance I am asking for. If you are unable to meet this small request, I will be forced to consider taking my practice to a competitive hospital.” However, after further discussion, he does agree that eventually he would consider a slightly more expanded role for the nurse after he learns to trust her.

ASSIGNMENT:

Do you meet Dr. Jones’s request? Does it make any difference whether Audrey is the nurse, or can it be someone else? Is the amount of revenue that Dr. Jones generates relevant in your decision making? Should you try to talk Audrey into continuing the position for a while longer? While trying to reach a goal, people must sometimes endure a difficult path, but at what point does the means not justify the end? Be realistic about what you would do in this situation. What do you perceive to be the greatest obstacles in implementing your decision?

Part 3:

LEARNING EXERCISE  19.12

Memo to Chief Executive Officer Leads to Miscommunication

Carol White, the coordinator for the multidisciplinary mental health outpatient services of a 150-bed psychiatric hospital, feels frustrated because the hospital is very centralized. She believes that this keeps the hospital’s therapists and nurse-managers from being as effective as they could if they had more authority. Therefore, she has worked out a plan to decentralize her department, giving the therapists and nurse-managers more control and new titles. She sent her new plan to Chief Executive Officer Joe Short and has just received this memo in return.

Dear Ms. White:

The Board of Directors and I met to review your plan and think it is a good one. In fact, we have been thinking along the same lines for quite some time now. I’m sure you must have heard of our plans. Because we recently contracted with a physician’s group to cover our crisis center, we believe this would be a good time to decentralize in other ways. We suggest that your new substance abuse coordinator report directly to the new Chief of Mental Health. In addition, we believe your new director of the suicide prevention center should report directly to the Chief of Mental Health. He then will report to me.

I am pleased that we are both moving in the same direction and have the same goals. We will be setting up meetings in the future to iron out the small details.

Sincerely,

Joe Short, CEO

ASSIGNMENT:

How and why did Carol’s plan go astray? How did her mode of communication affect the outcome? Could the outcome have been prevented? What communication mode would have been most appropriate for Carol to use in sharing her plan with Joe? What should be her plan now? Explain your rationale.