The RN to BSN program at Grand  Canyon University meets the requirements for clinical competencies as  defined by the Commission on Collegiate Nursing Education (CCNE) and the  American Association of Colleges of Nursing (AACN)

/in /by

The RN to BSN program at Grand  Canyon University meets the requirements for clinical competencies as  defined by the Commission on Collegiate Nursing Education (CCNE) and the  American Association of Colleges of Nursing (AACN), using  nontraditional experiences for practicing nurses. These experiences come  in the form of direct and indirect care experiences in which licensed  nursing students engage in learning within the context of their hospital  organization, specific care discipline, and local communities.

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest in your region. Perform a physical assessment of the community.

  1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
  2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype.

Develop  interview questions to gather information about the role of the  provider in the community and the health issues faced by the chosen  community.

Complete the “Provider Interview Acknowledgement Form”  prior to conducting the interview. Submit this document separately in  its respective drop box.

Compile key findings from the interview, including the interview questions used, and submit these with the presentation.

PowerPoint Presentation

Create  a PowerPoint presentation of 15-20 slides (slide count does not include  title and references slide) describing the chosen community interest.

Include the following in your presentation:

  1. Description  of community and community boundaries: the people and the geographic,  geopolitical, financial, educational level; ethnic and phenomenological  features of the community, as well as types of social interactions;  common goals and interests; and barriers, and challenges, including any  identified social determinates of health.
  2. Summary of community assessment: (a) funding sources and (b) partnerships.
  3. Summary of interview with community health/public health provider.
  4. Identification of an issue that is lacking or an opportunity for health promotion.
  5. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.

While  APA style is not required for the body of this assignment, solid  academic writing is expected, and documentation of sources should be  presented using APA format ting guidelines, which can be found in the  APA Style Guide, located in the Student Success Center.

This  assignment uses a rubric. Please review the rubric prior to beginning  the assignment to become familiar with the expectations for successful  completion.

You are required to  submit this assignment to LopesWrite. A link to the LopesWrite technical  support articles is located in Course Materials if you need assistance.

Chronic renal insufficiency

/in /by

1) Minimum 6 full pages  (Follow the 3 x 3 rule: minimum three paragraphs per part)

             Part 1: Minimum 1 page

             Part 2: minimum 3 pages

             Part 3: Minimum 1 page

             Part 4: Minimum 1 page

Part 2: Education Teaching Practicum

Audience: Newl  

             Part 4: minimum 1 page

Submit 1 document per part

2)¨******APA norms

All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

Dont copy and pase the questions.

Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.do

__________________________________________________________________________________

Part 1: Pharmacology

Anemias

M.W. is a 69-year-old African American man and was referred to clinic for evaluation of increasing shortness of breath.

Past medical history 

Chronic renal insufficiency

Hypertension

Congestive heart failure

Diabetes mellitus type 2, poor control

Deep vein thrombosis

Alcohol abuse

Chronic obstructive pulmonary disease with respiratory failure

Family history

Noncontributory

Physical examination

Height 69 inches, weight 205 lb

Blood pressure: 138/88

Pulse 86 beats/min, regular

Lungs clear, neck supple negative for jugular venous distention

Lower extremities +1 edema

Laboratory findings

Scr = 2.8 K+ = 5.1

BUN = 56

Na+ = 147

WBC = 5.0

Hb = 8.2

Hct = 24.6

Serum ferritin 189 mg/dL

Social history

Tobacco: 52 pack-years

Alcohol: distant past

Diagnosis: Anemia Of Ckd: Answer the following questions in full sentences using APA citations.

1. List specific goals of treatment for M.W.

2. What drug therapy would you prescribed? Why?

3. What are the parameters for monitoring success of therapy?

4. Discuss specific patient education based on the prescribed therapy.

5. List one or two adverse reactions for the selected agent that would cause you to change therapy.

6. What over-the-counter and/or alternative medications would be appropriate for M.W.?

7. What dietary and lifestyle changes would you recommended for M.W.?

Part 2: Education Teaching Practicum

Audience: Newly recruited nurses in the pediatric ICU

Topic: Coping strategies for the death of patients in the pediatric ICU

Theory: Elisabeth Kuebler Ross

Pupose:Encourage adequate strategies in nurses to face the death of pediatric patients.

Make an outline for a lesson that will be taught in the future.

Provide headings to delineate the topics

1. The objectives (4) and standards of the lesson (include QSEN).

2. Describe the nursing theory that will guide this lesson (Elisabeth Kuebler Ross).

3. Describe the student audience (Novice nurses-Newly recruited)

4. Learning level:

a. What are the demographics of the students (30-40 YO, nurses, men, and women-Nicklaus Children’s Hospital).

b. what, if any, interventions may be needed to account for varied learning styles? (VARK Model)

5. Make a road map for presenting the concepts and content:

a. How will you present the information to the student

b. What visuals will you source, and how will you relay the content clearly and concisely?

6. Preliminary ideas for assessing students, both informally during the lesson and a summative component that can be administered upon completion of the lesson or unit

7. A list of materials that you will reference or hand out during your lesson

Part 3: Womens health

 

Topic

Chronic pelvic pain can be caused by any number of conditions. In primary care, nurse practitioners should be able to outline the basic approach to initial evaluation of and management of these disorders. As you have learned in this unit, there are many causes of chronic pelvic pain.

 

1. Select one of the causes of chronic pelvic pain and describe the symptoms.

2. Why would you refer this patient for consultation, and to whom?

3. What are the steps to writing a referral, and what is the NP’s responsibility in follow-up?

Part 4:  Advanced Primary Care of Family Practicum

 

Check:

http://www.aanp.org/imag es/documents/publication s/ContractNegotiations.pdf

State of Florida Example ARNP protocol

http://floridasnursing.gov/f orms/arnp-protocolformat.pdf

https://www.aanp.org/practice/practice-management/employment-negotiations

1.What are the main questions, you need to ask your employer during negotiation meeting?

2.What could be some problems you might encounter during contract negotiation?

3. How would you approach those problems?

Discussion Question Rubric – 100 Points

/in /by
Discussion Question Rubric – 100 Points

CriteriaExemplary Exceeds ExpectationsAdvanced Meets ExpectationsIntermediate Needs ImprovementNovice InadequateTotal Points
Quality of Initial PostProvides clear examples supported by course content and references. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. All instruction requirements noted. 40 pointsComponents are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints. Meets all requirements within the discussion instructions. Cites two references. 35 pointsComponents are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development. Is missing one component/requirement of the discussion instructions. Cites one reference, or references do not clearly support content. Most instruction requirements are noted. 31 pointsAbsent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. No references cited. Missing several instruction requirements. Submits post late. 27 points40
Peer Response PostOffers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation. All instruction requirements noted. 40 pointsEvidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post. Response is supported by course content and a minimum of one scholarly reference per each peer post (minimum of two). All instruction requirements noted. 35 pointsLacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight. Missing reference from one peer post. Partially followed instructions regarding number of reply posts. Most instruction requirements are noted. 31 pointsPost is primarily a summation of peer’s post without further synthesis of course content. Demonstrates incomplete understanding of content and/or inadequate preparation. Did not follow instructions regarding number of reply posts. Missing reference from both peer posts. Missing several instruction requirements. Submits post late. 27 points40
Frequency of DistributionInitial post and two peer posts made on three separate days. All instruction requirements noted. 10 pointsInitial post and two peer posts made on two separate days. 8 pointsMinimum of two post options (initial and/or peer) made on two separate days. 7 pointsAll posts made on same day. Submission demonstrates inadequate preparation. No post submitted. 6 points10
OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas 5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow. 4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points5
APA, Grammar, and SpellingCorrect APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 pointsThree to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 pointsFive or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points5
Total Points100

Discussion Question Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

CONCEPTUAL FRAMEWORK PILLARS

/in /by

CONCEPTUAL FRAMEWORK PILLARS

 

In addition to the purpose and philosophy, the nursing faculty believes in five integrals

components to nursing practice. These components are viewed as the Conceptual Framework

Pillars. The philosophy is built upon these pillars and they support the structure of the nursing

profession. Without the strength of the pillars the foundation will weaken and fail. These pillars

are used within the constructs of each nursing course at South University and shape the way the

student will learn, develop and practice.

The Conceptual Framework Pillars of South University are: Caring, Communication, Critical

Thinking, Professionalism, and Holism.

Each pillar is defined separately and then interdependently to demonstrate their interconnectedness.

 

Caring – Encompasses the nurses’ empathy for and connection with the patient as well as the ability

to translate the values of altruism, autonomy, human dignity, integrity, and social justice into

compassionate, sensitive, appropriate care.

Communication – Is a dynamic, complex, interactive circular process by which information is

shared between two or more individuals. Conveyed formally or informally, communication may

be verbal, nonverbal, or written in a social, personal, or therapeutic manner. Three elements

included in the communication process are the sender, the message and the receiver.

Communication is a learned process influenced by an individual’s past experiences, sociocultural

background and competency.

 

Critical Thinking – Is highly developed thought, the outcome of which reflects assimilation of

inquiry, reasoning, analysis, research and decision making. Knowledge is generated and learning

occurs with the application of critical thinking relevant to the discipline of nursing.

Professionalism –is a multifaceted process involving competency, legal, ethical, political and

economic issues. Nurses utilize the fields of law and ethics in reference to standards of practices,

legal interpretations, and shared beliefs concerning health-related behaviors. Professional issues

play an ever-increasing role in the standards and delivery of health care by the contemporary nurse.

Holism – is the unity and completeness of person. Holism recognizes that persons are entire entities

composed of complex, integrated systems. Conditions of the body, mind and spirit are influenced by

culture, religion, education, environment, standard of living, interpersonal relationships, gender and

developmental stage. Holistic nursing practice focuses on the whole being in the attempt to achieve

optimal wellness through comprehensive health promotion, disease/illness prevention and

restorative care of person, family, and community.

what strategies would you recommend encouraging culturally competent care of African Americans? 

/in /by

what strategies would you recommend encouraging culturally competent care of African Americans?

post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

Respond to at least two of your colleagues who were assigned to a different case than you.  Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

/in /by

Respond to at least two of your colleagues who were assigned to a different case than you.  Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

Case #29 The depressed man who thought he was out of options.

The patient is a 69-year-old male with unremitting chronic depression. He has suffered from depressive episodes for 40 years and has always had a good response to treatment until 5 years ago when he relapsed on venlafaxine. Two years ago, he underwent nine treatments of ECT with partial response. He has tried every known antidepressant and augmentation available in the past few years.

The patient should be asked about recent stressful life events, consumption of illicit drugs, alcohol abuse, current medical conditions and prescribed medications (Preda, 2018). If the patient was in my office, I would also want to ask questions to gain an understanding of the severity of his depression. It is important to assess the overall severity of depression symptoms because symptom severity corelates with suicide risk (Preda, 2018). The PHQ-9 screening could be used, and this screening asks about feelings of hopelessness, loss of pleasure in doing things, and feelings of being better off dead. A focused severity assessment for hopelessness, suicidal ideation, and psychotic symptoms is recommended; these symptoms independently increase the risk for suicide (Preda, 2018). This patient reports feeling severely depressed and demoralized, as well as, helplessness, hopelessness, and worthlessness. His depression is the worst it has ever been.

Family members are helpful informers, they can ensure medication compliance, and can encourage patients to change behaviors that continue depression (Halverson, 2019). Some questions I would ask family members would include whether the patient is taking their medication and I would ask the family to provide some insight as to how the patient behaves at home. The wife reports that she feels he is letting go and giving up.

There are no lab tests that will confirm depressive disorder, however, labs can be ordered to rule out illnesses that may present as depressive disorder such as endocrinological or neurological diseases. Labs tests may include TSH, B12, RPR, HIV test, electrolytes, BUN and creatinine, blood alcohol, and blood and urine toxicology screening. Neuroimaging can help clarify the nature of the neurologic illness that may produce psychiatric symptoms, but these studies are costly and may be of questionable value in patients without discrete neurologic deficits (Halverson, 2019). CT scanning or MRI of the brain should be ordered for suspected organic brain syndrome. PET scans provide a means for studying receptor binding of certain ligands and the effect a compound may have on receptors (Halverson, 2019).

Differential diagnosis would include major depressive disorder, bipolar disorder, and/or poor or rapid metabolism. From 25-50% of cases of Treatment Resistant Depression (TRD) are associated with bipolar disorder; this is by far the most common individual cause of TRD (Preda, 2018). The remaining 50-75% are associated with noncompliance, poor or rapid metabolism, or misdiagnosis (Preda, 2018). This patient is exhibiting signs and symptoms consistent with major depressive disorder, such as anhedonia, loss of energy, feelings of worthlessness, depressed mood, which have been consistent for more than a two week period. TRD is defined as MDD that fails to respond to at least two antidepressant trials that are of adequate dose and duration; the two antidepressants may belong either to the same class or to different classes (Preda, 2018).

SSRIs, which include fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine, have become the first-line treatment for major depression (Brown, 2011). SSRIs work by selectively blocking the reuptake of serotonin to increase the amount of serotonin available in synapses in the brain (Brown, 2011). The STAR*D trial examined various strategies for treatment resistant depression in patients who did not respond to an initial SSRI, including switching to another SSRI antidepressant, changing medication class, and switching to CBT. Fair quality studies have indicated a trend toward greater effectiveness when switching to an SNRI such as venlafaxine than with citalopram, fluoxetine, or paroxetine (Halverson, 2019).

For patients with major depressive disorder, I would start the patient on citalopram 20mg and increase the dose to a maximum of 40mg. If the patient failed to respond, I would change to venlafaxine 75mg daily extended release tablet and increase dose if tolerated. I could not find any contraindications or dosing alterations needed for Citalopram or venlafaxine related to ethnicity.

Week 20 follow-up concluded with ordering venlafaxine levels. This had been considered 20 weeks prior. I agree with ordering this lab and I would have opted to do this before pursuing ECT. A lab is much less invasive, less expensive, and without the side effects he is experiencing at this point.

The patient’s aphasia and mood are improving but his mood is still low. He hadn’t had labs completed. The venlafaxine stayed at 225mg and aripiprazole was increased. Aripiprazole was increased to 15mg. When used to augment treatment with an SSRI or SNRI for depression, the dose would be no greater than 10mg. I disagree with this change.

By week 28 the patient labs show low levels of venlafaxine on a 225mg dose. The dose was increased to 300mg. Up to 600mg/day has been given for heroic cases (Stahl, 2014). I agree with this change. His aripiprazole was discontinued. I agree with discontinuing since the venlafaxine was not at a therapeutic level.

The patient was still not showing improvement by week 32. Another blood level was drawn. At week 36, the level was low on a 300mg dose. The dose was increased to 375mg. The patients BP is good and there have not been any side effects. He has shown some improvement after the dose increase. An increase to 450mg was made and levels ordered. By week 40, the patient was feeling hopeful and mood was improving. His lab values were in the low therapeutic range. At 450mg/day, the patient was still within the dosage for a heroic case. He was tolerating well. The suggestion at this point was to raise dose by 75mg/day, redraw level and raise again to 600mg if still in therapeutic range. I think this is a good strategy based on the patient’s improvement and his ability to tolerate the dose. Lessons learned include the importance of therapeutic drug level monitoring when this is an option. Possible reasons for low levels could be: pharmacokinetic failure, genetic variant causing pharmacokinetic failure, or noncompliance. Finally, never give up.

 

References

Bienenfeld, David. (2018). Screening tests for depression. Medscape. Retrieved from https://emedicine.medscape.com/article/1859039-overview

Brown, Charles. (2011). Pharmacotherapy of major depressive disorder. US Pharmacist, 36(11), HS3-HS8. Retrieved from https://www.uspharmacist.com/article/pharmacotherapy-of-major-depressive-disorder

Halverson, Jerry. (2019). Depression. Medscape. Retrieved from https://emedicine.medscape.com/article/286759-overview

Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05. Retrieved from Walden Library databases.

Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06. Retrieved from Walden Library databases.

Preda, Adrian. (2018). Major depressive disorder: Disabling and dangerous. Medscape. Retrieved from https://reference.medscape.com/slideshow/major-depressive-disorder

Pigott H. E. (2015). The STAR*D Trial: It Is Time to Reexamine the Clinical Beliefs That Guide the Treatment of Major Depression. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(1), 9-13.

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

 

DQ1.  During your practicum, determine what clinical problem or issue the organization is facing. Discuss two implications for nursing.

/in /by

DQ1.  During your practicum, determine what clinical problem or issue the organization is facing. Discuss two implications for nursing.

DQ2. What is the main issue for your organization in addressing a solution to evidence-based nursing practice? Discuss what might be the first step in addressing and resolving this issue.

Below are some common delegation issues with examples. Give your own examples of over-delegation, under-delegation, and refusal to accept a legitimate delegation, and explain what you would do in each case.   

/in /by

Below are some common delegation issues with examples. Give your own examples of over-delegation, under-delegation, and refusal to accept a legitimate delegation, and explain what you would do in each case.

1) Over-delegation. (Would you pass my medications for me and sign off my orders? I’m really busy).

2) Under-delegation. (I’ll do it myself. The nursing assistant argues with me when I ask her to do something/I always have to do it over).

3) Refusal to accept the assignment of legitimate delegation. (I don’t know how to do that very well/I have too much work already/It’s always me that gets the work; ask someone else/I’m too busy/I won’t be able to do a very good job, but if that’s what you want…)

Your initial posting should be at least 400 words in length and utilize at least two scholarly source other than the textbook

Mrs. Walsh, a woman in her 70s, was in critical condition after repeat coronary artery bypass graft (CABG) surgery.

/in /by

“Mrs. Walsh, a woman in her 70s, was in critical condition after repeat coronary artery bypass graft (CABG) surgery. Her family lived nearby when Mrs. Walsh had her first CABG surgery. They had moved out of town but returned to our institution, where the first surgery had been performed successfully. Mrs. Walsh remained critically ill and unstable for several weeks before her death. Her family was very anxious because of Mrs. Walsh’s unstable and deteriorating condition, and a family member was always with her 24 hours a day for the first few weeks.
The nurse became involved with this family while Mrs. Walsh was still in surgery, because family members were very anxious that the procedure was taking longer than it had the first time and made repeated calls to the critical care unit to ask about the patient. The nurse met with the family and offered to go into the operating room to talk with the cardiac surgeon to better inform the family of their mother’s status.
One of the helpful things the nurse did to assist this family was to establish a consistent group of nurses to work with Mrs. Walsh, so that family members could establish trust and feel more confident about the care their mother was receiving. This eventually enabled family members to leave the hospital for intervals to get some rest. The nurse related that this was a family whose members were affluent, educated, and well informed, and that they came in prepared with lists of questions. A consistent group of nurses who were familiar with Mrs. Walsh’s particular situation helped both family members and nurses to be more satisfied and less anxious. The family developed a close relationship with the three nurses who consistently cared for Mrs. Walsh and shared with them details about Mrs. Walsh and her life.
The nurse related that there was a tradition in this particular critical care unit not to involve family members in care. She broke that tradition when she responded to the son’s and the daughter’s helpless feelings by teaching them some simple things that they could do for their mother. They learned to give some basic care, such as bathing her. The nurse acknowledged that involving family members in direct patient care with a critically ill patient is complex and requires knowledge and sensitivity. She believes that a developmental process is involved when nurses learn to work with families.
She noted that after a nurse has lots of experience and feels very comfortable with highly technical skills, it becomes okay for family members to be in the room when care is provided. She pointed out that direct observation by anxious family members can be disconcerting to those who are insecure with their skills when family members ask things like, “Why are you doing this? Nurse ‘So and So’ does it differently.” She commented that nurses learn to be flexible and to reset priorities. They should be able to let some things wait that do not need to be done right away to give the family some time with the patient. One of the things that the nurse did to coordinate care was to meet with the family to see what times worked best for them; then she posted family time on the patient’s activity schedule outside her cubicle to communicate the plan to others involved in Mrs. Walsh’s care.
When Mrs. Walsh died, the son and daughter wanted to participate in preparing her body. This had never been done in this unit, but after checking to see that there was no policy forbidding it, the nurse invited them to participate. They turned down the lights, closed the doors, and put music on; the nurse, the patient’s daughter, and the patient’s son all cried together while they prepared Mrs. Walsh to be taken to the morgue. The nurse took care of all intravenous lines and tubes while the children bathed her. The nurse provided evidence of how finely tuned her skill of involvement was with this family when she explained that she felt uncomfortable at first because she thought that the son and daughter should be sharing this time alone with their mother. Then she realized that they really wanted her to be there with them. This situation taught her that families of critically ill patients need care as well. The nurse explained that this was a paradigm case that motivated her to move into a CNS role, with expansion of her sphere of influence from her patients during her shift to other shifts, other patients and their families, and other disciplines”
Critical thinking activities
1. Discuss the clinical narrative provided here using the unfolding case study format to promote situated learning of clinical reasoning (Benner, Hooper-Kyriakidis, & Stannard, 2011).
2. Regarding the various aspects of the case as they unfold over time, consider questions that encourage thinking, increase understanding, and promote dialogue, such as: What are your concerns in this situation? What aspects stand out as salient? What would you say to the family at given points in time? How would you respond to your nursing colleagues who may question your inclusion of the family in care?
3. Using Benner’s approach, describe the five levels of competency and identify the characteristic intentions and meanings inherent at each level of practice.

Below are some common delegation issues with examples. Give your own examples of over-delegation, under-delegation, and refusal to accept a legitimate delegation, and explain what you would do in each case.   

/in /by

Below are some common delegation issues with examples. Give your own examples of over-delegation, under-delegation, and refusal to accept a legitimate delegation, and explain what you would do in each case.

1) Over-delegation. (Would you pass my medications for me and sign off my orders? I’m really busy).

2) Under-delegation. (I’ll do it myself. The nursing assistant argues with me when I ask her to do something/I always have to do it over).

3) Refusal to accept the assignment of legitimate delegation. (I don’t know how to do that very well/I have too much work already/It’s always me that gets the work; ask someone else/I’m too busy/I won’t be able to do a very good job, but if that’s what you want…)

Your initial posting should be at least 400 words in length and utilize at least two scholarly source other than the textbook