The setting is an 82-bed hospital located in a small city. One day an employee of the maintenance department asked the supervisor, George Mann, for an hour or two off to take care of some personal business. Mann agreed, and he asked the employee to stop at the garden equipment dealership and buy several small lawnmower parts that the department required. While transacting business at a local bank, the employee was seen by Sally Carter, the supervisor of both human resources and payroll, who was in the bank on hospital business. Carter asked the employee what he was doing there and was told the visit was personal. On returning to the hospital, Sally Carter examined the employee’s time card. The employee had not punched out to indicate when he had left the hospital. Carter noted the time the employee returned, and after the normal working day she marked the card to indicate an absence of 2 hours on personal business. Carter advised the chief executive officer (CEO), Jane Arnold, of what she had done, citing a long-standing policy (in their dusty, and some would say infrequently used, policy manual) requiring an employee to punch out when leaving the premises on personal business. The CEO agreed with Sally Carter’s action. Carter advised Mann of the action and stated that the employee would not be paid for the 2 hours he was gone. Mann was angry. He said he had told the employee not to punch out because he had asked him to pick up some parts on his trip; however, he conceded that the employee’s personal business was probably the greater part of the trip. Carter replied that Mann had no business doing what he had done and that it was his—Mann’s—poor management that had caused the employee to suffer. Mann appealed to the CEO to reopen the matter based on his claim that there was an important side to the story that she had not yet heard. Jane Arnold agreed to hear both managers state their position. 

Present a 12 – 15 slide PowerPoint answering the case study questions. The number of slides exclude the title and reference pages. Substantial Speaker Notes are required throughout the entire presentation.  Below you will find articles with more info on speaker notes.

1. Develop the argument you would be advancing if you were in George Mann’s position.
2. In similar fashion, thoroughly develop the argument you would advance if you were in Sally Carter’s position.
3. Assuming the position of the CEO, Jane Arnold, render a decision. (Document your decision in whatever detail may be necessary, complete with explanation of why you decided in this fashion)
4. Based on your responses to Questions 1 to 3, outline whatever steps—policy changes, guidelines, payroll requirements, or something else—you believe should be considered to minimize the chances of similar conflict in the future.

Reference your readings and include a minimum of 5 peer-reviewed, scholarly, or similar articles.

Format your PowerPoint according to APA guidelines.

Initial Post Instructions
You are an advisor to the President tasked with cutting at least $300 billion from the budget. The president wants your recommendations to cut lines, not large categories. Submit your recommendations and your reasoning for such recommendations using these guidelines:

– Use evidence (cite sources) to support your recommendations from assigned readings or online lessons, and at least one outside scholarly source.

– Use the format provided below to present your numbers and totals followed by an explanation below the chart.

– Please note that these are not true US budget numbers, but are reasonable hypothetical numbers to help us consider the budget processes complexities.

 

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

1. Temperature: 37.1 degrees C
2. BP 123/78 HR 93 RR 22 Pox 99%
3. Denies pain
4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

1. WBC: 19.2 (1,000/uL)
2. Lymphocytes 6700 (cells/uL)
3. CT Head shows no changes since previous scan
4. Urinalysis positive for moderate amount of leukocytes and cloudy
5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe the clinical manifestations present in Mr. M.
2. Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
4. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
5. Discuss what interventions can be put into place to support Mr. M. and his family.
6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract 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. 

Please two paragraphs and two references no more than 5 years, including doi or http in the references. 

Nursing is always evolving and with that comes knowledge gaps if continuous research is not made to find new knowledge used as evidence for practice. it is important as advanced practice nurses to identify these knowledge gaps and fill them. According to Kitson and Straus (2010), one of the maiden steps of translating knowledge has always been measuring the gap between evidence and practice. This process is therefore the first process I would use to identify knowledge gaps. This step begins with data collection from relevant and reliable sources. It is research data that is used to develop new knowledge and for that matter serves as a very important part of bridging the knowledge gap in nursing practice. This new knowledge is used as evidence and guidelines that can be translated into practice to improve quality of care. it is important to acknowledge that before the one thing to do to ensure improvement of quality of care is assessing the current care in the most reliable way (Kitson and Straus, 2010). This way of assessing gaps can be done by using quality indicators. Quality indicators monitor, assess and improve quality of care and functions of organizations affecting patient outcomes (Kitson and Straus, 2010). These are strategies that can be used to overcome all identified knowledge gaps.

One way to maximize potential of others in an effort to overcoming knowledge gaps in nursing practice training and sensitization of staff/team to properly apply theory and academic knowledge into practice. differences exist between what is learned in theory and the practical world. However, through education and training, there will be proper application of clinical practice guidelines. This will help bridge the gap between theory and practice (Safazadeh et al, 2018).

As an advanced practice nurse and a leader, it is important to acknowledge and enforce the use of evidence-based practice at the workplace because using evidence-based decision making enables access to date, both internal and external, as well as information necessary for the evaluation of the nursing practice environment (Sevy Majers and Warshawsky, 2020). One way of leading EBP and decision-making at my workplace is guiding my teammates to adopt the 6-step process designed by the Center for Evidence-Based Management. the steps include asking the right questions when presented with a nursing problem, systematically acquiring evidence, appraising the evidence, aggregating the evidence through synthesis, applying the evidence and assessing its outcomes (Sevy Majers and Warshawsky, 2020). This will essentially bridge the knowledge gap as well as theory-practice gap.

References

Kitson, A., & Straus, S. E. (2010). The knowledge-to-action cycle: identifying the gaps. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 182(2), E73–E77. https://doi.org/10.1503/cmaj.081231

Safazadeh, S., Irajpour, A., Alimohammadi, N., & Haghani, F. (2018). Exploring the reasons for theory-practice gap in emergency nursing education: A qualitative research. Journal of education and health promotion, 7, 132. https://doi.org/10.4103/jehp.jehp_25_18

Sevy Majers, J., & Warshawsky, N. (2020). Evidence-Based Decision-Making for Nurse Leaders. Nurse leader, 18(5), 471–475. https://doi.org/10.1016/j.mnl.2020.06.006