The Neuman System Model uses a systems approach that is focused on the human needs of protection or relief from stress (Neuman & Fawcett, 2009). Neuman believed that the causes of stress can be identified and remedied through nursing interventions. She emphasized the need of humans for dynamic balance that the nurse can provide through identification of problems, mutually agreeing on goals, and using the concept of prevention as intervention. Neuman’s model is one of only a few considered prescriptive in nature. The model is universal, abstract, and applicable for individuals from many cultures (Neuman, 1995; Neuman & Fawcett, 2009).  Neuman used concepts and theories from a number of disciplines in the development of her theory. In her works, she referred to Chardin and Cornu on wholeness in systems, von Bertalanfy and Lazlo on general systems theory, Selye on stress theory, and Lazarus on stress and coping (Neuman, 1995; Neuman & Fawcett, 2009).

In her work, she defined human beings as a “client/client system, as a composite of variables … physiological, psychological, sociocultural, developmental, and spiritual (Neuman & Fawcett, 2009, p. 16). Environment in the model represents the three environments, internal, external, and created environments, which influences the client’s adaptation to stressors. Neuman’s System Model in the nursing realm, is to maintain client system stability through accurately assessing environmental and other stressors and assisting in client adjustments to maintain optimal wellness. Neuman model consisted of  a three-step nursing process model in which nursing diagnosis (the first step), nursing goals as determined with the client and family (the second step), and lastly, nursing outcomes that confirm and evaluate the client’s healthcare goals. I have always look at the total picture when encountering individuals from a personal standpoint, professionally in the clinical setting, and in the community to address issues that constitutes the total person outside of the health/illness continuum.

Neuman’s System Care Model can be used in a practical setting where I work on the stepdown unit.While caring for a 67 yr old AA male who was post-op day1 prostatectomy with a hx of hypertension, diabetes, colon cancer, TIA, anxiety, and depression became symptomatic during shift change. The patient’s family called to the nurse’s station because he became weak and unable to ambulate back to his bed. Upon arriving to the patient’s room I found him sitting on the commode with c/o nausea and vomiting which is common after this type of surgery. With further assessment, I noted the client became diaphoretic and dizzy while attempting to stand. Vitals were stable at this time but I my intuition told me that something just wasn’t right.First thing that came to mind was that the pt vasovagal while trying to have a bowel movement. The Scip protocol was in place at this time, IV fluids infusing, foley in place with adequate urinary output noted, telemetry on with no ectopy noted. I told the family to call the nurse’s station to bring a wheelchair to the room to assist with transferring the pt back to bed. The patient had expressed to me that he was under a lot of stress due to  the lost of his mother, his second bout with cancer, and the financial strain he was under for being out of work for his health conditions. While attempting to place the patient in the bed he had another diaphoretic episode with generalized weakness. My intuition lead me to believe this patient was having an MI. I took an additional set of vitals, revisited the lab work, placed the pt on oxygen at 2 liter, and ordered a stat EKG. I viewed the EKG and noted an elevated ST segment and paged the cardiologist on call; while simultaneously informing the house supervisor of my findings. Within 10 minutes or less the client was in route to the cath lab for stent placement.

Re examining Neuman’s System Model, I was able to utilize the three step nursing process to 1.) identifying a nursing diagnoses that includes but not limited to: risk for decreased cardiac output, anxiety, activity intolerance, ineffective coping, risk for falls, nausea, and imbalanced nutrition just to name a few. 2.) Establishing patient/family centered goals that constitutes their beliefs, values,and  customs such optimizing cardiac output with stent placement, ensuring the client is hemodynamically stable, addressing nutritional status with the interdisciplinary team to ensue dietary requirements are met, providing counseling to assist with helping the client cope with his loses that internally and externally precipitated stress. 3.) Evaluation and clarification of the client’s outcomes. The patient underwent angioplasty with stent placement and was transferred to the ICU without incident. Neuman’s model allowed me to assess the patient from a holistic point of view that lead to favorable outcomes. The physicians, house supervisor, and staff was so impressed with my knowledge and skills that I received the Daisy’s Award for exceptional nurses that year. 

To this present day, that patient stills comes to the facility I work at to thank me for saving his life. Often healthcare professional become overwhelmed with the everyday task of the discipline that little signs such as nausea/vomiting goes unnoticed. The patient did not complain of pain at anytime during the assessment. Neuman’s model can be used in any nursing setting because it directly ties the patient to the nurse and the environment that are in constant motion either propelling towards health, where energy is conserved or towards illness that depletes the storage of energy. The clinical and critical skills I’ve acquired and taking an holistic approach while caring for patients and families allowed me to be present with the patient and family thus addressing his healthcare needs while optimizing his overall quality of health.

References:

McEwen, M. (2014). Theoretical Basis for Nursing, 4th Edition. [VitalSource Bookshelf version]. Retrieved from http://online.vitalsource.com/books/9781469899992

Neuman B, Fawcett J. The Neuman Systems Model. 5th ed. Upper Saddle River, NJ: Prentice Hall; 2010.

Question 1: Manuscripts of the Early Middle Ages

Before the invention of the printing press, books were copied by hand one at a time by illuminators, and the vellum was often embellished with beautiful calligraphy and intricate patterns and designs.

Using your course textbook locate three examples of illuminated manuscripts from the early Middle Ages. Read about each one in your textbook, course lectures, and through reliable internet resources

First, completely identify each manuscript and/or manuscript page by title, date, and location where it was created.

In a minimum of 2 well-developed paragraphs address the following questions:

1. Who commissioned the creation of the manuscript? Why?
2. What was the purpose of the manuscript?
3. How do the visual characteristics of each manuscript contribute to or enhance its message or meaning?
4. How do the reasons these manuscripts were created compare with religious texts created today?

Be sure to explain your ideas clearly and support them by discussing specific details about each manuscript.

Question 2: Romanesque and Gothic Cathedrals

Both Romanesque and Gothic architecture displayed distinctive characteristics and features. For this assignment, select one example of Romanesque church architecture and one example of Gothic church architecture from your course textbook. Read about each one in your textbook, course lectures, and through reliable internet resources.

First, completely identify the two cathedrals you have selected by name, date, and location.

Then, in a minimum of 3 well-developed paragraphs, address the following questions:

1. What architectural details are evident in each cathedral that make it representative of either the Romanesque or Gothic style?
2. What sort of decoration (interior and exterior) was employed in each cathedral? What was the meaning of the sculptures, paintings, windows that adorned each cathedral?
3. What was the visitor or viewer experience in each cathedral?

Respond to both questions as thoroughly as possible, making sure to use information from the readings and the lectures. All responses should be in complete sentence form, using proper spelling and grammar.

Consider your experiences at work, school, and in your personal life. You have, at some point, been asked to work with a group to achieve a particular goal. It might have been a group research project, a new marketing plan, a learning plan, a schedule to roll out new technology, planning a wedding, or even planning and creating a large family meal. In many collaborative efforts like these, there are disagreements. Select one collaborative experience from your past that involved some disagreements or significant differences of opinion.

Write a short (2-page) paper in APA style discussing the following elements:

1. Describe the project that you were working on, including the people involved.
2. Explain the problem that you encountered with the group. How was that problem overcome? What was the end result of encountering and dealing with that problem?
3. What do you think was the cause of the problem? How much of the problem came from miscommunication, either from you or from other people involved? What did you do to help resolve the problem?
4. If you were able to relive that experience, how would you change the way that you approached the encountered problem? How would you communicate differently?
5. How, ultimately, was the conflict resolved?

Comparison of APN Practice

Interviews of Two APNs 

The work for this paper entails interviewing in person (not by telephone or e-mail), TWO different categories of advanced practice nurses (APNs). One APN has to be a primary care nurse practitioner (e.g., family NP, adult NP, pediatric NP); that is, the NP cannot be one who is an acute care NP. Furthermore, the NP must work in a primary care setting such as a “doctor’s office” or community health center—that is, in a setting the buzz-word for which is now medical home. An NP who works in a retail clinic or free-standing urgent care center would also be acceptable (but NOT an emergency department). Yes, there are many APNs who are prepared as FNPs or adult NPs who take jobs in non-primary care settings (e.g., as hospitalists and as providers in nursing homes). But a common premise with health care reform and the Affordable Care Act is that there already is and will be a huge need for primary care providers, thus paving the way for even greater opportunities for NPs in this area. It is important that you get a firm grasp of how NPs are prepared for primary care, and thus why NP organizations assert an important solution to the primary care provider shortage is educating more NPs which is why every state should allow full independent practice authority for APNs, especially NPs. 

The other APN may be your choice of one of the following: a certified nurse midwife (CNM) or a certified nurse anesthetist (CRNA) or a clinical nurse specialist (CNS). There is no limitation regarding the types of settings these APNs might work. Be sure to indicate the state(s) where the APNs practice.

Although the information gathered from these APNs will be acquired via an interview, the paper should be written in summary format (i.e., it should not look like a dialogue between you and the APN). Information on both interviews should be in a single document. It is not necessary to provide the APNs’ full names. Most elements of APA format should be used, including a title page and abstract. Most students’ papers that address all of these questions for both APN are about five double-spaced pages, without counting the title page or abstract (be sure to read your APA manual regarding what an abstract should look like!). An exception to the APA format requirement is that a reference list is not required, since all of the information will be derived from two sources (the APNs whom you interviewed). Although you have free range to discuss other topics about advanced practice nursing, you must address the following issues with each APN (please follow the order of list below):

1. Reason for their choosing their specific APN specialty.

2. Descriptions of: (a) the type of setting where they work (e.g., community hospital, major medical center, private primary care practice, clinic for the underserved, etc.), and (b) a “typical” day as they render care. 

3. Level of satisfaction with their role in general, and specifically within the system where they are currently employed.

4. The type of APN certification that they hold, including identifying the accurate name of the certifying body with which they are certified (Note: Review your textbooks for the correct names of these certifying bodies. Also note there are several different certifying bodies for NPs).

5. Whether they have prescriptive authority and whether they prescribe controlled substances. If they do prescribe controlled substances, you must indicate from which schedules of controlled substances they are allowed prescribe.

6. Whether they must practice according to an agreement with a physician. If so, is the relationship supervisory or collaborative?

7. Are they credentialed and privileged by a hospital or health system?  If the answer is “yes,” ask them to explain what the credentialing and privileging process entails at their organization (e.g., are the documents reviewed by only the human resources department, the nursing department, or the medical staff office, a combination of all three, etc.).

8. Whether they belong to a professional organization(s) that specifically addresses APN issues. If so, which one (s)? If not, why not?

9. Their understanding about the DNP degree (i.e., have them actually explain what they know about the degree) and whether they have this degree already or intend to pursue it. Be sure to probe to see if they have positive or negative feelings about the DNP—and why.

10. Final grading criterion: Paper’s adherence to APA format (with the exception that references are not required for this particular paper), including grammar, spelling, punctuation, sentence structure, etc. 

Total points for this assignment is 100; each question above is worth 10 points. 

Instructions

Organizational change initiatives  are a team effort. It is the job of the leadership team to ensure that transition is a success. To do so, the right leaders must be put in place,  and each must hold a thorough understanding of their roles and responsibilities.

Examine the Delta Pacific Case Study, then analyze the following:

• What are the challenges facing Delta Pacific?
• What change initiative would be most effective to implement within this organization? (Use the Rasmussen Resource Library if you need assistance with identifying change models.)
• What type of change leaders need to be put in place? (Ex.: Change Lead, Change Managers, Change Analyst, etc.) 
• What departments, areas, and stakeholders will each leader be responsible for?
• Where will each change leader be most effective?
• What roles will each change leader need to play at their level of influence?

Leadership Structure Plan

Utilizing the above information, create a Leadership Structure Plan that includes the following:

• At least three change leader positions to be put in place for the change initiative.
• Description of each change leader’s roles and responsibilities.
• Account of departments they will lead.
• A short description of how each position will effectively aid in the success of the initiative.

Note: When creating  your plan, think in terms of a job description and job analysis, and the detail used to specifically identify the roles and responsibilities of each particular job assignment. Â While this particular project does not have a page requirement, keep in mind that a thorough plan  should be no less than 3 pages in length.

The paper should include an APA formatted cover page and reference page.

MUST INCLUDE 

1.Provides the required three change leadership roles including a detailed explanation of their roles and effectiveness towards initiative success.

2.Provides a detailed description of at least three change leadership roles and 

responsibilities.

Provides detailed account of areas of departmental leadership responsibility.