Rumi was a 13th century Sufi, a member of an ecstatic, whirling-dervish sect of Islam that engages in trance-worship and poetry as a path to God. Sufism tries to blur the line between love of God and love of human, though this can be seen as blasphemous and sacrilegious by some—why so? How does Rumi manage to respect his God and respect his mortal lovers in a single breath? Why might this effort seem suspicious to some?

Aimee Bender’s “Fruit and Words” is an odd short story about actual words taking on the appearance of what they “refer” to, as if the word “thorn” were sharp and the word “poison” was toxic to consume. What sort of moral effect does the author seem to be aiming for here? What is the danger in thinking that our words are the same as the objects they point toward? What is the opposing danger of thinking that our words aren’t “actual” things in the “real” world?

FAMILY-CENTERED CARE DURING OUTPATIENT SURGERY 1

FAMILY-CENTERED CARE DURING OUTPATIENT SURGERY 2

This sample paper gives students an idea of how to address the content of the CAP. Please be sure to focus on the content and not the formatting. This paper has not been updated to reflect the 7th edition APA rules! Please make sure you use 7th edition APA for this project

Family-Centered Communication in Day Surgery

Three Quality of Care key drivers for (OLR) Surgical Services department are measured quarterly. The Surgical Services Department has met or exceeded targets for two of the three key drivers. However, for the past six months, the department has not met the goal for a third key driver: explanations provided about progress following surgery. Meeting the goal for the third key driver is dependent on effective communication processes from staff and surgeons to patients and their families. A communication process exists, but by looking at areas in which the process is broken, relatively easy and effective fixes can be put into place. Comment by Carina Piccinini: Topic introduction, overview of issue, choice of topic.

The charge nurse for preoperative and recovery care has identified difficulty in adhering to the current process due to difficulty in locating family members if they leave the waiting room and due to the volume and acuity of patients that enter the recovery area. The nurse manager has also identified meeting the third key driver as a priority for the institution and supports the project. Comment by Carina Piccinini: Pertinence of issue to the unit and preceptor and unit manager buy-in

Increasing patient satisfaction—and thereby increasing the likelihood of returning to the facility for healthcare needs—can benefit the unit and the organization by increasing revenues. The profession of nursing can also benefit by increasing staff and improving technologies for patient care with additional revenues. Comment by Carina Piccinini: Benefit to the unit/organization

Literature Review of Problem

Much research on factors influencing patient satisfaction in perioperative care has been conducted. A driving factor identified is communication to patients and families during care.

Yellen (2003) surveyed ambulatory surgery patients to determine the influence of the nurse-sensitive variables of age, gender, culture, previous hospital admissions, nurse communication, pain, and satisfaction with pain management on overall patient satisfaction. Results showed that nurse communication was the most significant indicator of patient satisfaction, and satisfaction with pain management was the second most significant indicator. Furthermore, patients who were satisfied with nurse communication also reported satisfaction with pain management.

Fry and Warren (2005) conducted a qualitative study to determine the needs of family members in the waiting room of a critical care unit. Results showed that all participants sought some information about the patient’s outcomes during the stay. In addition, an element of trust was essential to a family member’s sense of well-being, especially with nurses. The study concluded that an environment that supports a nurse’s interaction with patients and families enhances trust. Conversely, a lack of information or trust of nurses can reduce a sense of well-being and, ultimately, patient satisfaction.

Literature Review of Solution

Implementing a family-centered communication process during surgery can take many forms. The approach can be as formal as a nurse liaison whose only job is to communicate with and to families during surgery or as informal as periodic phone call updates.

The Children’s Hospital of Philadelphia implemented a Family Liaison Model that utilized current staff to communicate to families during operative procedures with subsequent admission to a cardiac intensive care unit (CICU). A CICU nurse was designated family liaison during surgery. Duties included 1) meeting the patient and family in the holding area, 2) escorting the family to the waiting area, reviewing with the family what they can expect, 3) obtaining updates from OR staff every 45-60 minutes, 4) relaying progress information to the families in the waiting area, 5) admitting the child to the CICU, 6) ensuring the family could be at bedside within 35-40 minutes post-op, and 7) providing care until the end of shift. Patient satisfaction with staff and nursing support increased over a two-year period. However, 96% of nurses found time management with the additional duties challenging (Madigan, Donaghue, & Carpenter, 1999).

The University of Virginia Health System implemented phone calls to families every two hours during surgery to provide updates. A follow-up study on the program’s effectiveness revealed that 95% of families who received the calls reported a “good OR experience,” while only 84% of the families who didn’t receive phone calls rated the experience favorably (University of Virginia Health System, 2008).

The solution proposed for OLR will be a modified combination of the two solutions reviewed. These modifications are necessary because of cost limitations, OLR nurse workloads, and OLR environmental restrictions that do not allow support people to be with families in pre-op and recovery. Similarities to the solution used at Children’s Hospital of Philadelphia will be setting expectations of the patient’s family members through a new brochure, using current nursing staff, and relaying information in a timely manner. The primary mode of communication to families will be through telephone contact, similar to the solution implemented at the University of Virginia Health System. Obtaining cell phone information from families on a consistent basis is another significant modification.

Implementation

The solution to the problem involves enhancing the current process at four key communication opportunities. Comment by Carina Piccinini: Description of intervention.

During outpatient registration, obtaining the family’s cell number is inconsistent and expectations during surgery are set verbally. The enhanced process involves developing a brochure which informs families what to expect during the patient’s perioperative experience, and it offers them an opportunity to provide their contact information to the nurse in writing. The contact information would be attached to the front of the chart.

In preoperative holding, delays sometimes take place, and the current process does not include communication to families about delays. The enhanced process requires the preoperative nurse to make a phone call if delays longer than 45 minutes occur.

If the family leaves the waiting room for any reason, surgeon contact with the families following surgery may not take place. With the family-provided cell phone contact information on the front of the chart, the surgeon has the option of calling the family to update them about the patient.

During recovery, the volume and acuity of patients sometimes prevents recovery nurses from updating families. The enhanced process will enable the surgical and recovery room nurses to work collaboratively in deciding which nursing role should complete the task for each patient.

Changes to the family communication process during the perioperative period will start with development and approval of the brochure. The roll-out schedule would be contingent on completion of the brochure, but it should be done as soon as possible. The unit manager and charge nurses in all phases of care will schedule and conduct in-services about the new process for all nurses in perioperative services. In addition, the unit manager will document the new process and display reminders of it prominently at the nurses’ stations and the breakroom. Comment by Carina Piccinini: Rollout and timeline.

To measure the effectiveness of the new process, pre-intervention, baseline data for the Quality of Care key drivers will be compared to post-intervention data three months after implementation. A small standing committee of nurses will analyze data and patient comments every three months to determine if refinements to the process are needed. Comment by Carina Piccinini: Measurement of effectiveness.

Family-centered communication processes have been proven to increase patient satisfaction and will improve the explanations of progress during surgery, which is a Quality of Care key driver. This new process allows for family mobility during surgery while still maintaining contact with staff, which has been a problem in the past. Enhancing current processes is cost-effective, and it eliminates the need for retraining to entirely new processes. Also, this process ensures that no one nursing role is overburdened with communication responsibilities to families. Comment by Carina Piccinini: How the new process will improve the clinical issue

Critically evaluate a body of evidence or research in relation to your chosen environment. ( How can we prevent retained surgical items in surgical patients intraoperatively, in operation theatres)

Case 1

A 50-year-old man comes to your office for a routine physical examination. He is a new patient to your practice. He states his father died at the age of 73 of a heart attack. His mother is alive at the age of 80. He has hypertension, which he takes chlorthalidone 25 mg PO daily. Takes Tylenol as needed for pain. Denies seasonal or drug allergies. He has two younger siblings with no known chronic medical conditions. Last eye and dental exam two years ago. He is married in a monogamous relationship without children. Has a high school diploma. Works full-time for local landscaping business. He does not smoke, drink alcohol, use any recreational drugs and does not exercise. He denies fever, chills, weight loss or weight gain. He denies hearing changes, headaches or dizziness. He reports some visual changes when reading close-up. He denies shortness of breath, dyspnea on exertion, swelling or chest pain. He reports increase urination and thirst. Denies abdominal pain, nausea, vomiting or changes in appetite. He reports daily BM. Denies rashes or bug bites. Uses sunscreen daily due to working outside.

Denies anxiety or depression. On examination his blood pressure is 126/82, pulse is 80 beats/min, respiratory rate is 18. Height is 67 inches and weight is 190lbs. Does not appear in acute distress, responses are appropriate and appears reliable source. Alert, oriented to person, place, time and situation. Well-nourished, skin warm, dry and intact. Normocephalic. Pupils size 3 mm, equal and reactive to light. Extraocular eye movements intact to six directions.

Tympanic membranes gray with adequate cone of light bilaterally. Mucous membranes pink and moist. No palpable masses, thyromegaly, lymphadenopathy or JVD. Regular heart rate and rhythm, S1 and S2. No bruits auscultated. Capillary refill less than 3 seconds. Breath sounds clear bilaterally to auscultation. No use of accessory muscles or purse lip-breathing. Soft, non- tender, non-distended, normoactive bowel sound. No organomegaly or guarding. Denies numbness or tingling. He reports he has not had HIV or PSA screenings.

Case 2

A 40-year-old woman presents with 10 episodes of watery, non-bloody diarrhea that started last night. She vomited twice last night but has been able to tolerate liquids today. She is complaining of intermittent abdominal cramping, rating pain 4 out of 10. She also reports having muscle aches, weakness, headache, and low-grade fever of 99.7 at home. She states her son has had the same symptoms that started this morning. She has no significant medical history, denies surgeries, and does not take any prescribed medications. Last wellness examination was 2 years ago when cervical screening was completed. She does not smoke, use alcohol, or illicit drugs. She does report that her and her family returned home yesterday after spending a week in Cancun. On examination she is not in acute distress, blood pressure is 110/60, pulse 98, respiratory rate is 16, and temperature is 99.1. Bowel sounds are hyperactive, and her abdomen is mildly tender throughout but there is no rebound tenderness and no guarding. Her mucous membranes are dry. A rectal examination is normal, and stool is guaiac negative. Reports trying Pepto-Bismol this morning without relief. Denies food, seasonal or drug allergies. Last menses 3 weeks ago, currently single and not sexually active. Heart rate regular rate and rhythm with S1 and S2. Breath sounds clear to auscultation bilaterally with symmetrical chest expansion. Alert and oriented, does not appear acutely ill. Needs a work excuse, works part-time at community college.

Case 3

A 40-year-old single male presents to your office complaining of left knee pain that has started last night. He says that the pain started suddenly and was severe within about 3 hours’ time. He denies injury, fever, systemic symptoms, or prior episodes. He has a history of hypertension and does take hydrochlorothiazide 12.5 mg PO daily to control it. He admits to consuming a large amount of wine with dinner last night. He currently is not working. Has allergy to Percocet which he reports reaction is urticaria. Upon examination his temperature is 98, pulse is 90, respirations are 22 and blood pressure is 129/88. Heart and lung examinations are unremarkable. The patient is reluctant to flex the left knee and does wince with pain at touch. He has passive range of motion. The knee is edematous, hot to touch, and has erythema of the overlying skin. No crepitation or deformity is apparent. No other joints are involved. Inguinal lymph notes are not enlarged. He denies trauma or previous injury to his left knee. He denies weight loss or weight gain. He reports in the past having swelling to his big toe that went away on its own. He tried ibuprofen without relief of the pain this morning. Rates the pain about six out of ten that is constant. Denies any family history of joint or musculoskeletal issues. He denies smoking or illicit drug use. Was recently seen in the office 6 months ago for wellness exam with normal blood pressure reading and A1c. He is alert and oriented to self, place, time and situation. Well-nourished on exam reports eating keto diet. Thoughts are coherent, mood and affect appropriate.

The development of nursing knowledge is an ongoing process. Discuss the case for the ongoing development and use of nursing grand theories and conversely, make a case for the obsolescence of nursing grand theories for today’s practice and research.

Topics

· Philosophy

· Metaparadigm

· Conceptual Models

· Theory: General Issues

· Grand Theory

· Middle Range Theory

· Practice Theory/Micro Theory/Situation-Specific Theory

Weekly Objectives

By the end of the lesson, the learner will:

· Critique nursing’s conceptual models, grand theories, and mid-range theories.

· Examine the influence that nursing models and theories have upon research and practice.

· Apply nursing theory or theories to nursing research.

Student Learning Outcomes: (Outcomes 2, 3, 5)

After completing this course, the learner should be able to:

· Critique nursing’s conceptual models, grand theories, and mid-range theories.

· Examine the influence that nursing models and theories have upon research and practice.

· Apply nursing theory or theories to nursing research.

End of Program Outcome:

· Integrate nursing and related sciences into the delivery of care to clients across diverse healthcare settings.

** Please note that I expect 400 words in your initial post by Wednesday 23:59pm with 2 scholarly references. Please include an answer to two peers by Saturday 23:59pm. Please see the discussion rubric.