For this Assignment, you will work with a patient with a gastrointestinal condition that you examined during the last three weeks. You will complete your second Episodic/Focused Note Template Form for this course where you will gather patient information, relevant diagnostic and treatment information, and reflect on health promotion and disease prevention in light of patient factors, such as age, ethnic group, PMH, socioeconomic, cultural background, etc. In this week’s Learning Resources, please review the Focused Note resources for guidance on writing Focused Notes.

Note: All Focused Notes must be signed, and each page must be initialed by your preceptor. When you submit your Focused Notes, you should include the complete Focused Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your Focused Notes using SAFE ASSIGN.

Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

To prepare:

• Use the Episodic/Focused Note Template found in the Learning Resources for this week to complete this Assignment.
• Select a patient that you examined during the last three weeks based on any gastrointestinal conditions. With this patient in mind, address the following in a Focused Note:

Assignment:

• Subjective: What details did the patient provide regarding her personal and medical history?
• Objective: What observations did you make during the physical assessment?
• Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
• Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
• Reflection notes: What would you do differently in a similar patient evaluation?

Note: Your Focused Note Assignment must be signed by Day 7 of Week 6.

 

1. Classify each of the following as an element, a compound, or a mixture

a. Milk

b. Diamond (pure carbon)

c. Pure water (H2O)

d. Sea water

e. Air

2. Identify each of the following as solid, liquid, or gas.

a. Ice

b. Air in a tire

c. hot tea in a cup

d. A bar of gold

e. water in a shower

3. Identify each of the following as a physical or chemical change.

a. Melting ice

b. Wood burns in wood stove

c. Wood is chopped for the fire place

d. In contact with the air, a copper pipe becomes green

e. When a bar of zinc is submerged in hydrochloric acid, a gas bubbles form this mixture

4. Classify the following mixtures as homogenous or heterogeneous

a. Tea

b. sugar completely dissolved in water

c. Water with sand

d. Steel (a mixture of iron and carbon)

e. Air

5. Give the period and group numbers for each of the following

a. Chlorine

b. Calcium

c. Helium

d. Copper

e. Sulfur

f. Xenon

6. Write the name and symbol of the elements with the following atomic number

a. 11

b. 17

c. 30

d. 24

e. 6

f. 34

g. 19

h. 26

7. For the following atoms determine the number of protons, neutrons, and electrons.

a. 23Na

b. 35Cl

c. 78Rb

d. 14C

e. 32S

8. Place the following elements in order of increasing atomic size

a.  Ca, Ra, Be, Sr, Mg

b. Ge, Fe, Cr, Mo, Br

9. Classify the following elements as alkali metal, alkali earth metal, transition element or a halogen

a. Rb

b. I

c. Fe

d. Be

e. Au

f.  F

10. Write the group number and electron arrangement for each of the following

a. Phosphorus

b. Nitrogen

c. Magnesium

d. Aluminum

e. Chlorine

Submission status

 

Word totals for each post should be in the 100-200 words range.  Whether you agree or disagree explain why with supporting evidence and concepts from the readings or a related experience.  Include a reference, link, or citation when appropriate. APA 6th edition format for references as well as in-text citations is expected.

 

Identify a population to assess and develop an evidence-based, primary care health promotion recommendations to deliver in their own communities (Hispanics-Diabetes)

Strategies & Quality Practice

A theory has been defined as statements or set of analytical principles that are designed to structure people’s understanding, observation, and explanation of the reality in the world (Nilsen, 2020). In most cases, theories apply some relationships between multiple variables and some specific predictions. A successful theory provides a clear explanation of how and why some relationships can lead to specific events. Theories can be described based on the abstraction continuum. 

Nursing profession is transforming in the modern society. Strong leadership is important in attaining the anticipated transformative changes in the health care system. Nurses have various professional roles in the clinical setting. The professional roles of nurses are centered in ensuring provision of safe and quality care that meet the health needs of individual patients. Nursing theories are based on the four nursing metaparadigm concepts (Nilsen, 2020). Florence Nightingale introduced a number of nursing theories that have provided the basis for development of other theoretical frameworks; thus, helping in improving quality of patient care. Quality is an important consideration in the provision of holistic care that meet the needs of the individual clients. Florence Nightingale is considered as the “mother of nursing” due to her remarkable contributions to the profession of nursing (Nilsen, 2020).

Various strategies have been proposed for ensuring that professional nurses can effectively use their work environment to advocate for the integration of nursing theory as one an important framework for quality practice (Mitchell, 2013). First, developing a vision and mission statement is important in ensuring successful implementation of nursing theories for attaining quality practice. Nurses can set a vision and mission statement related to the implementation of various theoretical concepts. Implementation science is important in developing vision and mission statement in the adoption of various nursing theories into clinical practice. Implementation science allows nurses to address challenges associated with the integration of research to attain more evidence-based practice (EBP) in the health care system (Mitchell, 2013). The vision and mission statement for implementing various nursing theories are based on the scope of each theory or model. 

Second, nurses can undertake a benchmark to determine the efficacy of some nursing theories in improving quality practice. Through implementation science, nurses may conduct various benchmarks to assess how the nursing theories can be implemented into the nursing practice to improve quality of care. Nursing theories are important for implementation since they guide in the clinical practice towards providing quality, safe, holistic, and patient-centered (Nilsen, 2020).  Through benchmarks, professional nurses can develop practice guidelines.  Nursing theories are also significant in developing standard of practice.  

Determining the viability of as specific nursing theory is another strategy in the implementation of various nursing theories as frameworks for improving quality practice in the profession of nursing (Nilsen, 2020). The viability of various concepts, variables, or constructs of specific nursing theories should be assessed before implementing these theoretical frameworks in nursing practice.

References

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1).

Nilsen, P. (2020). Making sense of implementation theories, models, and frameworks. In Implementation Science 3.0 (pp. 53-79). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-03874-8_3

REPLY 2

What strategies might a professional nurse use in his/her work environment to advocate for implementing nursing theory as a framework for quality practice?

Nursing is an important profession in the healthcare sector. The success of the healthcare sector in delivering quality and patient-centered healthcare services relies on nurses’ proficiency and prowess.   One of the fundamental building blocks of the nursing profession is nursing theories. Nurses’ effectiveness in their work depends on how effective they use their working environment to advocate for the implementation of nursing theory as a framework aimed at attaining quality nursing and healthcare practice. Several strategies can be used by nurses to enhance such a process. 

It is important to note that there are different types of nurses. As an ICU nurse, being in an ICU, most of the time, has shown me the need to show a high level of professionalism by using such an environment to practically implement nursing theories. Implementing such theories in an ICU unit is the best since it proves that you can do so even in other nursing departmental units as a nurse. 

The strategies for implementing nursing theories are just drawn from the nursing theories’ requirements. One of the strategies is providing and working hard to create a good environment for patients. For instance, the ICU is one of the critical units of the healthcare facility. Patients in such units are usually in critical condition, and taking care of them requires a high level of professionalism. Hence, a strategy of implementing nursing theory implies that as a Nurse in ICU, you need to create a good working environment according to the Florence Nightingale environmental theory (Lawrence, 2011). A good working environment should consist of good and proper ventilation, light, warmth, and coolness. As a nurse in ICU, you need to ensure that patients are free from external disturbances (Lawrence, 2011).

            The second strategy through which nurses can use to implement nursing theories in their working environment is by applying human relations principles.  ICU patients face serious health challenges. As a nurse in such a unit, it is important to understand your behaviors and help other people identify their health challenges. This is because patients in ICU face serious health conditions that require assistance in every moment. According to the Hildegard Peplau nursing theory, as a nurse, you need to be always sharp at identifying patients felt a need and want (McAndrew, Schiffman, & Leske, 2020).  In such a case, nurses in ICU are good examples of healthcare professionals who need high problem-solving skills through incorporating human relations principles (McAndrew, Schiffman & Leske, 2020).

Another strategy that nurses can use within their working environment is establishing a good and close relationship with their patients.  The latter statements are broad statement which describes several activities a nurse should always do. First of all, it implies that as a nurse, you should always have the desire and motive to assist patients in critical conditions and play a significant contribution towards their recovery process (Lawrence, 2011).  Besides, nurses can use their working environment resources to help patients gain their independence as quickly as possible. In other words, nurses can establish a deep and strong connection with patients in critical conditions by getting inside their patient’s skin to know their needs.

Moreover, nurses need to ensure that they understand the behaviors of their patients. Patients in ICU display behaviors that represent the call for help and assistant.  Many patients’ behaviors in the ICU environment are nonverbal and usually signal the nurses that they need assistance. As a nurse in such an environment, your actions should be deliberate and not automatic (Aliakbari et al. 2015).  Similarly, nurses can also participate in policy changes meant to enhance the ICU nursing working environment for the patient’s benefit.

In conclusion, nursing is not a simple profession as it may be thought to be. Such a professional’s success, especially for healthcare professionals in critical units such as the ICU, requires a high level of professionalism being displayed. Hence, it implies that nurses need to ensure that as they work, there are implementing nursing theories guide in their working environment for the benefit of patients in critical condition and urgently seeking recovery.

References

Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in nursing education. Journal of education and health promotion, 4. https://dx.doi.org/10.4103%2F2277-9531.151867 (Links to an external site.)

Lawrence, L. A. (2011, October). Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses. In Nursing forum (Vol. 46, No. 4, pp. 256-268). https://doi.org/10.1111/j.1744-6198.2011.00237.x (Links to an external site.)

McAndrew, N. S., Schiffman, R., & Leske, J. (2020). A theoretical lens to view the facilitators and disruptors of nurse-promoted engagement with families in the ICU. Journal of Family Nursing, 1074840720936736. https://doi.org/10.1177%2F1074840720936736 (Links to an external site.)

All replies must be constructive and use literature where possible.

Your assignment will be graded according to the grading rubric.

respond 

 

The case of Jim is a great example of how value based reimbursement structures are driving improvements in healthcare.

With fee for service, or volume based reimbursement, the hospital will receive reimbursement for providing care on two separate admissions, despite the fact that the second admission could possibly have been avoided.  Additionally, with fee for service, there is  no incentive to return the patient to the community or recover health in a timely manner.  Physicians and hospitals receive more benefit from greater length of stay and additional tests and consults.  With volume based reimbursement, there is no incentive to reduce costs or improve quality which negatively impacts patient satisfaction.   While this form of reimbursement provides maximum profits for providers, it results in epidemic unaffordable and inaccessible healthcare for populations. 

With value based reimbursement, the hospital will receive a flat fee for Jim’s diagnosis regardless of how care is provided.  The hospital will also be penalized for readmission additionally reducing reimbursement.  In the case of value based reimbursement, the hospital is incentivized to diagnose, treat, and recover the patient as quickly and efficiently as possible.  This reduces the chances of imposed unnecessary costs to the patient and improves the likelihood of quality care and thereby patient satisfaction, which is known as the Triple Aim (Martin, 2017).

With nearly 50% of the payer mix at my institution coming from government funded healthcare, value based reimbursement has a significant impact on how we deliver care with a large focus on quality and cost reduction improvement strategies.  One of the ways our hospital has tried to reduce cost is through merger.  Advocate merged with Aurora Healthcare last year and the large volume of providers has allowed us to negotiate lower contracts with vendors and suppliers.  Additionally, they are reducing costs by partnering with physician groups to provide services to patients and employees at reduced costs under a large HMO.