Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, heartburn, and occasional regurgitation. Answering his nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.

Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax.

The nurse practitioner diagnoses gastroesophageal reflux disease (GERD) and tells Mr. Berger to do the following:

• Take proton-pump inhibitor drugs to reduce gastric acid.
• Elevate the head of his bed.
• Avoid eating large meals, especially near bedtime.
• Enter a weight-loss program.
• Reduce his use of caffeine and alcohol.

Answer the following questions about Mr. Berger and gastroesophageal reflux disease.

1. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?

2. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime? 

3. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?

4. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD?

5. In addition to discomfort, what is a danger of untreated GERD?

6. What is the mechanism by which obesity contributes to GERD?

Prepare a 10-15 slide PowerPoint presentation, with speaker notes, that examines the significance of an organization’s culture and values. For the presentation of your PowerPoint, use Loom to create a voice-over or a video. Refer to the Topic Materials for additional guidance on recording your presentation with Loom. Include an additional slide for the Loom link at the beginning, and an additional slide for References at the end.

1. Outline the purpose of an organization’s mission, vision, and values.

2. Explain why an organization’s mission, vision, and values are significant to nurse engagement and patient outcomes.

3. Explain what factors lead to conflict in a professional practice. Describe how organizational values and culture can influence the way conflict is addressed.

4. Discuss effective strategies for resolving workplace conflict and encouraging interprofessional collaboration.

5. Discuss how organizational needs and the culture of health care influence organizational outcomes. Describe how these relate to health promotion and disease prevention from a community health perspective.

RUBRIC:

Purpose of organizational mission, vision, and values is accurate and clearly outlined.

A detailed explanation of why organizational mission, vision, and values are significant to nurse engagement and patient outcomes is presented. Sound rationale is provided for support. The significance is clearly established.

An explanation of factors leading to conflict in a professional practice is clearly presented. How organizational values and culture influence the way conflict is addressed is described in detail. Strong rationale and evidence are provided for support.

Effective strategies for resolving workplace conflict and encouraging interprofessional collaboration is discussed. Strong support and rationale are provided to support each strategy.

How organizational needs and the culture of health care influence organizational outcomes is clearly discussed. How these relate to health promotion and disease prevention from a community health perspective is described in detail. The relationship among these is established. Rationale and evidence  

Instructions

Developing a Care Plan—Continued

In a Microsoft Word document of 4-5 pages formatted in APA style, you will submit your final comprehensive care plan for the aggregate based on the health risks faced by the aggregate, incorporating feedback from your instructor on your Week 5 paper and your continued work.

In your paper, address the following:

• Propose two (2) priority-nursing diagnoses based on the major health risks identified during the risk assessment for the aggregate .
  • Include strategies to address the nursing diagnoses and identified risks of aggregate.
  • Support your strategies with at least two journal articles.
• Develop a disaster management plan with the following components:
  • List of disasters that might affect your aggregate (take into consideration the geographical location of the aggregate, past history, etc.).
  • Strategies for handling at least two disasters from the list.
  • Recommendations for a disaster supplies kit.

On a separate references page, cite all sources using APA format. Please note that the title and reference pages should not be included in the total page count of your paper.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

Job burnout is a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity (Mayo Clinic Staff, 2018).  Nursing burnout/turnover is negatively impacting healthcare at a national level. With recent reports of pervasive “burnout” and depression among healthcare professionals and the pressure that many influential healthcare organizations exert on clinicians to deliver high-quality, safe care under increasingly heavy patient loads, the use and teaching of EBP may be key not only to providing outstanding care to patients and saving healthcare dollars, but also to reducing the escalating turnover rate in certain healthcare professions (Melnyk & Fineout-Overholt, 2018). This is devastating, yet important, due to the impact this has on patient care and safety.  This being said, my topic of nurse burnout/turnover formed into a PICO(T) question is:

P: Registered Nurse’s in the ED

I: Nurse burnout and turnover rate

C: Other areas of nursing

O: Patient safety and satisfaction

Question: Does Registered Nurse burnout/turnover in the ED impact patient safety and satisfaction?

Databases and Results

When searching for this topic the databases used were MEDLINE, PubMed, and EBSCO through the Walden Library.  The search terms used for MEDLINE and PubMed were nurse burnout narrowing the search to 5 years, humans, journal article, English, and full text.  That generated approximately 813 articles.  After incorporating the Boolean terms AND nurse turnover, it then narrowed the search articles to 402.  Through the Walden Library, the search terms nurse burnout in the ED were used, narrowing to peer-reviewed only and full text.  This generated 8 articles.  To improve these results strategies such as incorporating more Boolean terms, using more specific search terms, and trialing more databases could benefit in a more efficient and effective search.

Conclusion

Clinicians with burnout may have impaired attention, memory, and executive function that decrease their recall and attention to detail placing them and their patients at higher risk for errors and safety (Heath, 2018).  Happy and healthy employees promote happy and healthy patients.  This topic is in need of clinical inquiry at a national level, but also where this nurse is employed.  The turnover rate has been significantly increased where this nurse is employed, leading to short staffing, thus increased workload and unhappy patients.  This kind of work environment is unsafe and warrants change not only for the healthcare professionals sake, but more importantly the patients sake.

References

Heath, S. (2018, September 5). How does provider burnout impact patient care quality, care access? Retrieved from https://patientengagementhit.com/news/how-does-provider-burnout-impact-patient-care-quality-care-access

Mayo Clinic Staff. (2018, November 21). Know the signs of job burnout. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare (4th ed.). Philadelphia, PA: Wolters Kluwer.

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