1) **********minimum 2 full pages-Each 1-page answer ( not words)**************************** (cover or reference page not included)

2)¨**********APA norms  (All paragraphs must be narrative and cited in the text- each paragraphs)

3)********** It will be verified by Turnitin and SafeAssign 

4) References not older than 5 years

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You must answer (1) one question2 times. 

You must submit 2 documents (each one 1 page).

Copy and paste will not be admitted. 

You should address the questions with different wording, different references, but always, objectively answering the questions.

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Question:

Suppose you were planning to conduct a statewide study of the work plans and intentions of nonemployed registered nurses in your state (Florida). 

1) Would you ask mostly open-ended questions or closed-ended questions? 

Defend your answer (Mandatory).

Disasters

Instructions:

1. Choose one of topic below and post your response. 
   1. Think about your own community and its residents or neighboring countries. What are some host factors that might increase its risk of experiencing a disaster? What environmental factors might be significant? In each case, identify the likely agent. What interventions could be included in a disaster plan to reduce these factors? 
   2. Provide a weblink to a story about a recent disasters and discuss the impact on human lives. 
   3. Access one or both of the Internet sites listed here. Report on the change in statistics for disasters or terrorism since the year 2000. Have the rates increased or decreased? What factors might be involved?
      • Disasters – http://www.infoplease.com/ipa/A0001437.html
      • Almanac of Disasters – http://www.disasterium.com
2. Your response should be 200 – 250 words. APA Format, 1 reference at least. (This is for a community nursing course)

1-Emotional self-awareness has a great impact on the effectiveness of leadership.  Knowing one’s own emotional state and mood is crucial in building a professional and productive relationship with one’s staff (Huber, 2014). Leaders who have the capability of being self- aware of their emotions are better able to recognize when their emotions are having a negative affect on people which then allows them to address it effectively (Goleman, 2017).

Such behaviors such as being confident, involved and leading by example as well as being humble and honest, and admitting to one’s own mistakes and taking responsibility for what we do not know and knowing when to ask for help, I feel are characteristics of a leader that not only encourage, but also motivate people in wanting to do their best. I feel that people respond to leaders that make them feel as an integral part of the team. Allowing people to provide feedback is one way of doing so, as it shows them that as a leader we care about their input, their ideas and/or suggestions in moving forward with a certain project.

Reference

Goleman, D. (2017). Self-Awareness: The Foundation of Emotional Intelligence. Retrieved from

https://www.linkedin.com/pulse/self-awareness-foundation-emotional-intelligence-daniel-goleman

Huber, D.L. (2014). Leadership and Nursing Care Management. (5th ed.). [VitalSource Bookshelf Version]. Retrieved from

https://evolveebooks.elsevier.com/books/9781455740710

2-Leadership is more than just being a point of authority and telling people what to do. Nurse leaders need to be even more developed with working with multiple titles within the health care team such as: Doctors, nurses, patient care assistants and so many other positions held within the hosptial. Poor leadership can be recognized easily and can have an impact on how an organization operates. According to Romanowska (2014) “Developing leadership competence is a serious responsibil- ity. Poor leadership is common and may cause severe human suffering, resulting in substantial costs for business and society. When organizations invest time and money in programs for improvement of their leaders’ ability to assume responsibility, they expect improvement in employees’ performance and health” (p.97). 

In order for a leader to be successful they need to possess certain skills with self awareness being one of them. Self awarenss by definition is one’s ability to recognize and conscious one’s own character, feelings, motives and desires. As a leader this is important because leaders often need to separate emotion to make sound decisions and judgments. A self aware leader is more likely to not act on impulses. Being more aware of one’s own emotions helps a leader to better understand the emotions and feelings of the perople around them as well. 

Having strong nursing leaders are an essential part of organizing safe patient care and a happy staff. Through experience I have found that you can encounter many different egos within the hospital. The most effective nursing leaders are the one’s who are able to admit when they are wrong and are open to other staff member’s input and advice. Havign self awareness helps the nurse leader to set good examples for other staff members by using safe practice and staff being more open to input from that leader. 

References:

Romanowska, J., Larsson, G., & Theorell, T. (2014). An art-based leadership intervention for enhancement of self-awareness, humility, and leader performance.  Journal of Personnel Psychology ,  13 (2), 97–106. https://doi-org.lopes.idm.oclc.org/10.1027/1866-5888/a000108

3-One’s self awareness and behaviors’ have the potential influence us by the different things that can factor us like our culture, belief and our values. According to Edwards and Daniel “varies factors have a potential impact in the formulation of one’s self awareness and behaviors’ (2009) they also define values as “generals’ beliefs about the importance of normatively desirable behaviors’ and actions” (p.655). A few years ago as a unit manager my beliefs were no matter what the issues and problems were on the unit all staffs seems to work it out every morning we had a meeting about things that gone wrong and what can be done to get things better, I never had a problem getting staffs doing their job because, they knew that I am always there to help and what I didn’t like for myself I don’t believe on doing it to others. Some nurses always complained that the staffs do not respect them and never do what is asked I can truly say this I never had a problem with getting staff to do their job, because they know that what ever is asked of them I, as the manager can and will do. As manager and or leaders we lead my examples to me that means whatever is asked of staffs to do managers we have no issues doing it ourselves. Sometimes staff will say to me what makes you tick meaning getting upset I always laugh and say you will never know, having and knowing our self-awareness will help to keep emotions and behaviors under control no matter how upsets and angry we get our emotions and what we feel should never be displayed before other staffs, patients and or family members. If staffs need to be at work early managers needs to be their early too. We need to be honest with our self don’t say one thing a another. My weakness is I am unable to come to work and job in and work I have to be at work a few minutes early at least 30 mins where I can calm by mind, do my walking rounds, get my thoughts together and be prepared before I start some nurses have problems with that because the seems to come to work late and that throws my whole day off but that is something that I need to work on and currently doing. While I was doing the unit manager I got written up the reason for that was I was told by the DON that I was spoon feeding the nurses too much because I do thier job for them I am not the one that seems to delegate and then return to make sure its done, at times I will help the nurses by helping them to do and get the job done and I was told that it’s the nurses job and I am there to make sure it’s done not to do it for them. The impact of improving value congruence itself may not be as successful a strategy as focusing on the resultants of value. (Edwards& Daniels,2009)

Edwards, & Daniels. (2009). 655. Retrieved October 17, 2018.

 Reply  |  Quote & Reply 

Our cells are filled with intracellular and surface cell receptors (Berg & Clarke, 2018).  These receptor proteins are delineated by structure and bind to a variety of substances responsible for creating a reaction or lack thereof. When a ligand binds to the appropriate receptor, signal transduction activates the receptor and produces a biological response ( Berg & Clarke, 2018).  Changes in shape or activity after binding allow signal transmission outside the cell or significant changes within the cell, creating an altered chemical when binding to a ligand-gated-ion channel ( Berg & Clarke, 2018). This post will discuss the agonist/ antagonist spectrum of psychopharmacological agents, G-proteins and ion-gated channels, and epigenetics and their relevance to practice. 

Agonists act like ligands, binding to receptors and causing action (Berg & Clarke, 2018).  Ligands or agonists consist of pharmaceuticals, drugs, light, hormones, and nerve impulses. Ligands and agonists jump in and out of receptors, increasing signaling or changes in the cell.  Antagonists block the standard action of ligands, preventing a response from the receptor (Berg & Clarke, 2018).  Competitive antagonists bind to receptors and prevent ligands from attaching to its preferred receptor, inhibiting stimulation, and leaving the receptor unchanged (Berg & Clarke, 2018).  Naloxone is a competitive antagonist to opiate receptors London, 2017).  The naloxone has a stronger affinity for the receptor, making it more desirable.  The medication discontinues the effects of the opiates by taking their place on the receptor. The higher the dose of opiates circulating the more naloxone required. Due to the excess amount of continued competition for receptors, some patients require multiple doses of naloxone before regaining the ability to breath or regain consciousness (London, 2017). 

G-protein coupled receptors (GPCRs) target 30-50% of psychotropic medications (Stahl, 2013).  As the most abundant protein family, GPCR ligands include neurotransmitters such as serotonin, norepinepherine, and dopamine. After  aligand binds to a GPCR, the GPCR undergoes a conformational change (London, 2017).  Alpha subunit exchanges Guanyl nucleotide phosphates, GTP, GPP, and Alpha unit disassociates and regulates target proteins (London, 2017).  Regulation of neurotransmission is imperative in medication management (London, 2017).  The target proteins can then relay signals via a second messenger, and GTP is finally hydrolyzed to GPP (Lambert, 2004). G-protein receptors tend to have a delay in effect due to a requirement for the accumulation of changed cellular function (London, 2017).  

Ion gated channel linked receptors open and close in response to a chemical message changing signal transduction in the synaptic cleft. These ion channels act like pores in the cellular membrane to allow ion passage (Stahl, 2013).  Transmembrane ion channels open and close in response to the binding of a ligand, differentiated by shape.  The binding will cause the channel to open or close, changing the protein conformation of the entire structure (Berg & Clarke, 2018).  When channels open, ions like potassium, sodium, chloride, and calcium can travel through and change the electrical process creating an intracellular electrical response (Berg & Clarke, 2018).  Psychopharmacology relies heavily on these ion channels in medication management.  Ion-channel linked receptors act along an agonist spectrum; medications can produce conformational changes in these receptors to create any state of the agonist spectrum (Stahl, 2013).

The genetic material in the body is referred to as a genome (Stahl, 2013).  Every cell in the body carries the same DNA but only expresses specific genes required for its domain (Stahl, 2013).  For this reason, cells in the dermis only produce cells required to maintain and rejuvenate the dermis.  Epigenetics is the reason why skin cells differ from brain cells or cardiac cells.  Epigenetics is a term used for the external modifications to the DNA affecting the way it is recognized by cells (Stahl, 2013).  There are thee different methods of epigenetics, DNA myelination, histone acetylation, and microRNA (Stahl, 2013).  Genomes are affected by different exposures during development, environmental chemicals, drugs or pharmaceuticals, aging, and diet (Stahl, 2013).  Alterations in genes may result from these exposures and be passed on to offspring causing a change in the epigenome (Stahl, 2013). 

Psychotropic medications target specific molecular sites to increase neurotransmission. After neurotransmitters release from neurons, they are quickly recollected and utilized again for neurotransmission (Stahl, 2013).  The five essential sites of action for psychotropic medications are 12-transmembrane-region transporter, 7-transmembrane-region-G-protein linked, enzymes, 4-transmembrane-region-ligand-gated ion channel, and 6-transmembrane-region-voltage-gated ion channels (Stahl, 2013).

When cellular alterations occur due to brain injury, neurodegeneration, changes in the extracellular matrix, and changes in voltage and ligand-gated ion channels transpire (Iori, 2018).  A variety of molecular changes, regulation of gene expression, and epigenetic modifications take place as well(Iori, 2018).  As a result, functional impairments such as epilepsy, developmental delay, cognitive/sensory-motor deficits, and drug refractoriness may occur (Iori, 2018).  Many factors affect the outcomes of medication.  Through assessment is required to determine environmental issues, incidents of trauma, and relevant health history. Understanding that many factors influence the effectiveness of the psychotropic medication is imperative when determining the appropriate treatment course (Lambert, 2004).  

Recreational drug use, in combination with prescription medication, is critical to determine.  Like antidepressants, drugs like methylphenidate and cocaine target monoamine transporters; this increases the risk for an oversaturation of serotonin, norepinephrine, or dopamine in the synaptic cleft.  Oversaturation can potentially cause an issue for signal transduction in other neurotransmitters (Stahl, 2013).  This oversaturation of serotonin may cause a toxic level of serotonin, referred to as serotonin syndrome.  Patients with serotonin syndrome/toxicity present with neuromuscular, autonomic, and mental status changes.  Stopping drugs that target monoamine transporters will help decrease levels of serotonin and should return the individual to their normal state of health (Foong, Grindrod, Patel, & Kellar, 2018). 

In conclusion, neurotransmission is the cornerstone of psychopharmacology.  Although enormously complicated, it is imperative providers understand that small changes in cellular function, additional drugs present in the body, and electrolyte imbalances affect prescription medication functions and desired effects.  With a shortage of psychiatric prescribers and a mental health crisis around the world, all healthcare providers must have a proper understanding of psychopharmacology and interactions with other body systems.

References

Berg, K. A., & Clarke, W. P. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. The international journal of neuropsychopharmacology, 21(10), 962–977. https://doi.org/10.1093/ijnp/pyy071

Foong, A. L., Grindrod, K. A., Patel, T., & Kellar, J. (2018). Demystifying serotonin syndrome (or serotonin toxicity). Canadian family physician Medecin de famille canadien, 64(10), 720–727.

Iori, V. (2018). Epigenetic and pharmacological targeting of neuroinflammation as novel therapeutic interventions for epilepsy. Retrieved from
https://hdl.handle.net/11245.1/98bfe10f-44d2-4f42-bc1b-2f3e605c3ece

Lambert, D. G. (2004). Drugs and receptors, Continuing Education in Anaesthesia Critical Care & Pain, 4(6), 181–184, https://doi.org/10.1093/bjaceaccp/mkh049

London, E. D. (2017). Imaging drug action in the brain. Place of publication not identified: Routledge.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press 

Case

Fire the Facilities Manager?

John Faber is the facilities manager employed at a 240-bed nursing home for the past 3 years. Before John, the facility had one supervisor over both housekeeping and laundry and a separate maintenance supervisor. Hiring John to supervise all three departments resulted in an annual savings of $7,000 in labor and materials. Prior to joining this facility, John was the maintenance supervisor at a 120-bed skilled care nursing home. Before that, he was a small business owner of a home cleaning service that employed six people. He sold that business 4 years ago. John’s background also includes ownership of a coin laundromat that he disposed of several years ago.

It is time for the annual performance review for all associates. For department heads, the corporate office has authorized a wage increase of between 0% and 6% based on performance. As the administrator (NHA) mulls over John’s performance during the past year, she is pleased with the ongoing cost savings and on-budget performance in facilities services. However, the NHA thinks that she has to hold John accountable for the citation in housekeeping during the certification survey just 2 months ago (rated as E on the Severity/Scope Grid). Last year also the facility had been cited for housekeeping (rated as H on the Severity/Scope Grid), and a resident who had tripped and fallen over a vacuum cleaner cord had sued the facility. Earlier this year, the corporation had settled the claim for $20,000.

The corporate vice president of operations just called and suggested that John should be fired for his poor performance, but the NHA does not share the same view. Her response to the VP of operations was, “I would like to think it over and get back to you tomorrow.” Now, the day has arrived for the NHA to have a phone conference with the VP of operations and a face-to-face meeting with John.

Questions

1.  How should the NHA resolve the conflict with the VP of operations? Provide adequate details, and incorporate in your response the leadership style you suggest using with John.

2.  The NHA’s decision is to not give John a wage increase, which leads to a disagreement between John and the NHA because he regards it as unfair. How should the NHA handle this conflict in which the objective should be to arrive at a win–win solution? Again, provide adequate details.