Answer the following question: • How has this course (Health Care Policy) changed or not changed your views on becoming involved in the political process surrounding health care? USE THE PAPER BELOW WHICH IS MY ORIGINAL FEELINGS ABOUT THE POLITICAL PROCESS TO ANSWER THE QUESTION.

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Reflections on the Political Process
Points: 20

Directions:
Answer the following question:
• How has this course (Health Care Policy) changed or not changed your views on becoming involved in the political process surrounding health care? USE THE PAPER BELOW WHICH IS MY ORIGINAL FEELINGS ABOUT THE POLITICAL PROCESS TO ANSWER THE QUESTION.

Text and Materials
READINGS AND RESOURCES
REQUIRED READING
• Estes, C. L., Chapman, S. A., Dodd, C., & Hollister, B. (2012). Health Policy: Crisis and Reform in the U.S. Health Care Delivery System. (6th ed.) Jones and Bartlett Publishers: Sudbury, Massachusetts. ISBN: 978-0763797881.
• Milstead, J.A. (2014). Health Policy and Politics: A Nurse’s Guide (5th ed). Jones and Bartlett Publishers: Sudbury, Massachusetts. ISBN-13: 9781284048865.
• American Psychological Association. (2009). Publication Manual for the American Psychological Association (6th Ed.). Washington, DC: The American Psychological Association. ISBN: 978-1433805615.
• Various articles linked within the course.

Week Eight
READINGS AND RESOURCES
REQUIRED READING
o Chapter 11 from Health Policy and Politics: A Nurse’s Guide.
o Chapter 13, pages 693-751 from Health Policy: Crisis and Reform in the U.S. Health Care Delivery System.

REQUIRED RESOURCES
o Use the World Health Organization’s website to inform your assignments for this week.

THIS IS THE PAPER: Nursing/Health Care Issues and Politics

Why Nurses are Generally Reluctant to Become Involved in Nursing/Health Care Issues and Politics
The reluctance to participate in the nursing, healthcare issues, and political processes that affect them is widespread. The profession needs a vibrant and united voice concerning the political processes now more than ever. Most of the nurses feel like being vocal in the political processes touching on healthcare issues would jeopardize their jobs, as they might appear to be ‘opposing the system’ (Milstead, 2004). They fear that they might be witch hunted for supporting or opposing legislations that are not are not friendly to their profession. Another reason for their reluctance could be a due to the fact that they might find it as waste of their time; they feel that politicians are in better position to handle the matter and not them. Some also think that there is no need for their involvement in political activism because it does not come with financial benefits. The barriers to nurses’ participation in political processes that affect their careers encompass a wide spectrum, ranging from feelings of powerlessness to their lack of their knowldege on intricate political topics (Milstead, 2004).
The Nursing’s Profession’s Responsibility to Be Politically Active
The nurses’ have to know that they have an inherent power as a group of health care industry workers to bring changes and amendments in all health policies. It is the nurse’s professional duty to ensure they participate actively in the process of coming up with policies. They have to make sure that they put efforts to come up with and uphold high quality benchmarks of the healthcare industry (Boswell, Cannon, & Miller, 2005). They need to work collaboratively with the policy makers and all the industry stakeholders to vote for adoption of policies that genuinely meet the Americas’ health care demands. The nurses also ought to lobby for establishment of laws that protect the patients from the rogue, unqualified or unethical treatment by any health provider. It is important to know that both patients and the public reap the benefits of enhanced health care standards that come as a result of results the nurses’ getting involved in the formulation and enactment of health policies. The nurses have a duty to share professional skills with state and federal policy makers since health care industry workers are well educated and polished in their knowledge about the best policies (Boswell, Cannon, & Miller, 2005).
Strategies That Can Be Taken To Increase Nurses’ Involvement in the Political Process
There needs to be concerted efforts to raise the number of politically brave and active nurses so that the profession achieves common goals. One of the best strategies to achieve it is to outline to nurses the importance of political involvement. In addition, there need to be actions on the part of the policy makers to improve nurses’ engagement in decision-making by establishing increased opportunities for nurses to have their input on the policy-making processes (Congress, 2015). The policy makers should increase the number of nurses represented on consortiums that make recommendations to policy changes and amend the health care law to have nurses competitively hired for positions of leadership in the nation (Congress, 2015). Another strategy would be to enlighten nurses via training and seminars to help them to have a better knowledge and engage in policy enactment. Lastly, healthcare workers have to take action themselves to improve their capacity to be involved in the formulation of policies.

References
Milstead, J. A. (2004). Health policy and politics: A nurse’s guide. Burlington, MA: Jones &
Bartlett Learning.
Boswell, C., Cannon, S., & Miller, J. (2005). Nurses’ political involvement: Responsibility
versus privilege. Journal of Professional Nursing, 21(1), 5-8.
The Congress. (2015). Bills and Resolutions. Retrieved from http://thomas.loc.gov

 

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What will bethe plan for your legislative visit?  When, where, and how? What is the message you want to give to your selected policymaker/legislator? Can you present a compelling ‘story’? Can you convey your passion and experience with the policy issue? Can you present basic research data in an easy-to-understand and interesting way? What is your ‘Ask’? What are you recommending? Please review the

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Planning Your Visit

Worksheet #2 (ungraded)
Specific Requirements
Review what has been done in the past by others regarding your chosen policy issue. What was the result of their actions related to this policy issue? Why is this

issue important to nursing?
Who are thefederal, state, and local policymakers involved in your chosen policy issue? How can you contact your policymaker? Do you have phone numbers, addresses,

immediate staff contacts, and more? Be sure you single out a policymaker whom you know is interested in your issue.
What will bethe plan for your legislative visit?  When, where, and how?
What is the message you want to give to your selected policymaker/legislator? Can you present a compelling ‘story’? Can you convey your passion and experience with the

policy issue? Can you present basic research data in an easy-to-understand and interesting way? What is your ‘Ask’? What are you recommending? Please review the

examples of a policy brief in your text or on the American Nurses Association website. What are your expectations of the policymaker and for your visit in general?
How do you plan to convey your message? What considerations must you have in place with respect to time constraints, availability of policymaker, and contingency

plans?
Can you include a presentation using PowerPoint, flip chart, or overheads in some way (email or mail ahead of the call)? Include the actual presentation slides (max of

5 slides) in your final course presentation due week 7 (total 15 slides).
What feedback did you get from your policymaker? What actionsare you expecting of him/her/them? How did you leave things? Carefully review the Guidelines and Example

below.
Guidelines for Legislative Visits
Most nurses are uncomfortable approaching policymakers, regardless of how prepared they are and how knowledgeable or passionate they are about their policy issue.

Nurses tend to grossly underestimate their power and don’t initially understand that policymakers are receptive and anxious   to have their input.
After you have selected your policy issue and have thoroughly researched it, develop a message or proposal that is clear and succinct.  Be sure that you know the

appropriate policymaker and the staff that you approach for your issue.  Most students in this course will select a local-level policymaker such as a member of their

city council or their local school board.
Example
Student Y is enrolled in NR506: Healthcare Policy. This student has worked for several years as an emergency department nurse at a local hospital and also volunteers

his time at the local community teen center. Student Y is passionate about preventing motor-vehicle accidents in the teen population. He has adolescent children of his

own and has seen firsthand the tragic results of careless/distracted driving among teens. Of special interest to student Y is the issue surrounding using cell phones

and especially text messaging while driving. Student Y believes this to be a significant and growing problem—both locally and nationally.
After carefully researching the issue, Student Y identified his local city-council representative(s) as a policymaker to plan a meeting with. He is interested in

proposing a city ordinance that will stop the use of handheld cell phones while driving within city limits. He has analyzed this policy issue, researched what has been

done in other parts of the country, and has also researched nursing organizations’ websites in order to assess/track any legislation related to this issue. Student Y

carefully strategizes his plan for approaching his policymaker(s), and constructs a compelling story and proposal for change He schedules the meeting as soon as

possible, given time constraints of all parties, and prepares for all aspects of the meeting prior.
Student Y uses his experiences from the emergency department to illustrate and describe how devastating and common these accidents are, especially among teens (this

adds credibility). He mentions in his presentation that he himself has adolescent children and that he also volunteers at ateen center,which shows personal involvement

and commitment. His research data is simple and easy to follow, and his presentationdiscusses how other regions of the country have passed legislation and the outcomes

of that legislation. He also identifies in his presentation materialthat his nursing organization (Emergency Nurses Association) is stepping up lobbying efforts at

both state and national levels regarding this issue,which adds professionalism and strength to his message. He makes a clear recommendation and then asks for feedback

and suggestions for his continued advocacy efforts.
While it may take months or possibly years for this issue to be satisfactorily addressed, student Y has done a fine job in preparing forhis advocacy efforts. He can

continue to track legislation via websites and email alerts, and he can make calls and writeletters- at all phases of this process. Perhaps these policymakers would

have suggested that he also make this presentation to the local school board. Perhaps, he may also want to ask his state lawmakers to introduce a bill targeting this

issue. He can also prepare to address his nursing organization at a meeting or conference and even publish this project. In the meantime, he can also address teens at

the community center, as well as in their schools.
There are countless ways to make change happen!

Planning Your VisitGuidelines

Graded Assignment 2
Purpose
The purpose of this assignment is to: (a) identify and articulate a plan for a legislative/policymaking visit (CO #2);(b) deliver a message andask/recommendations (CO

#2,3), and (c) communicate ideas in a clear, succinct, and scholarly manner. (CO#3)
Course Outcomes
This assignment enables the student to meet the following course outcomes:
(CO #2) Employ strategies to affect the development, implementation, and consequences of policies at the institutional, local, national, and international levels. (PO

4, 8, 10)

(CO #3) Communicate with policymakers to advocate for effective policies that affect nurses and nursing, consumers, or the health care system. (PO 2,3,10)

(CO #4) Analyze the historical, ethical, and political contexts of health care policy and the consequences of policy implementation. (PO 6, 10)

(CO #5) Advocate for institutional, local, national, and international policies that influence health care and its consumers and nurses and their nursing practice.

(PO2,10)
Due Date: Sunday 11:59 p.m. MT at the end of Week 5
Total Points: 175 points
Requirements
Assignment Criteria for Presentation
Introduce your chosen policy issue, the current status, and an overview of your plan for a legislative visit.
Articulate key strategies involved in your plan, message, and recommendations under each of the Planning Your Visit Ungraded Worksheet 2 sections using headings in

your paper.
Provide an analysis of empirical evidence supporting your approach strategies including plan, message, and follow-up.
Provide specific examples of the impact and/or importance of a successful visit and follow-up to nursing.
Provide concluding statements summarizingthe content.
Paper will be five (5) pages, excluding title and reference pages, and in APA format 6th edition.
Preparing the Paper
Following completion of Planning Your Visit Ungraded Worksheet 2, develop a plan for visiting your policymaker, including the message/ask, and the recommendation(s)

you will deliver. Include a minimum of five (5) classic references or current references (published within the past 5 years) that support your plan, the message,

recommendations, and follow-up.

Category    Points    %    Description
Introduction and Conclusion    35    20    Introduction clearly introduces your policy-priority issue. Concluding statements summarizecontent.
Key Strategies    40    22    Articulate key strategies involved in your plan, message, and recommendations under each of the Planning Your Visit Ungraded Worksheet

2 sections using headings in your paper.

Empirical Evidence    35    20    Provide an analysis of empirical evidence supporting your approach strategies including plan, message, and follow-up.

Specific Examples    35    20    Provide specific examples of the impact and/or importance of a successful visit and follow-up to nursing.

APA Format    15    9    Text, title page, and references are consistent with APA format 6th edition.
Writing Quality    15    9    Rules of grammar, word usage, sentence and paragraph format, and punctuation are followed. Paper length appropriate.
Total     175    100    A quality assignment will meet or exceed all of the above requirements.

Grading Rubric

Assignment Criteria    A
(100–92%)
Outstanding or highest level of performance    B
(91–84%)
Very good or high level of performance    C
(83–76%)
Competent or satisfactory level of performance    F
(75–0%)
Poor or failing or unsatisfactory level of performance
Content
Possible Points = 145 Points

Introduction and Conclusion
35–32Points    31–29Points    28–27Points    26–0Points
Introduction clearly introduces your policy-priority issue, current status, and overview of plan for legislative visit.Concluding statements summarizing

content have no inaccuracy.
Introduction of your policy-priority issue, current status, and overview of plan for legislative visit has rare inaccuracy.Concluding statements lack

occasional important element or specificity.    Introduction of your policy-priority issue, current status, and overview of plan for legislative visit lacks occasional

important element or specificity.Concluding statements lack occasional important element or specificity.    Introduction of your policy-priority issue, current

status, and overview of legislative visit has multiple instances of inaccuracies or is lacking content.Concluding statements have multiple instances of inaccuracies or

lacks content.
Key Strategies    40–37Points    36–34Points    33–30Points    29–0Points
Identification of all key strategies of your policy-priority issue plan, ask, and recommendations are clearly analyzed and fully articulated.
Identification of key points of your policy-priority issue plan, ask, and recommendations has rare inaccuracy or lack of detail/clarity.    Identification

of key points of your policy-priority issue plan, ask, and recommendations lacks occasional important elements or specificity.    Identification of key points of your

policy-priority issue plan, ask, and recommendations has multiple instances of inaccuracies, lacks content or clarity.
Empirical Evidence    35–32 Points    31–29 Points    28–27 Points    26–0 Points
Empirical evidence supporting your approach strategies to your policy-priority issue has no inaccuracy and is clearly articulated.     Empirical evidence

supporting your approach strategies to your policy-priority issue lacks occasional important elements or specificity.    Empirical evidence supporting your approach

strategies to your policy-priority issue has multiple instances of inaccuracies or lacks detail/articulation.    Empirical evidence supporting your approach strategies

to your policy-priority issue is missing.
Specific Examples    35–32 Points    31–29 Points    28–27 Points    26–0 Points
Provides specific examples of the impact and/or importance of a successful visit and follow-up to nursing and has no inaccuracy and is clearly articulated.
Provides specific examples of the impact and/or importance of a successful visit and follow-up to nursing and lacks occasional important elements or

specificity and/or lacks clarity.    Provides specific examples of the impact and/or importance of a successful visit and follow-up to nursing and has multiple

instances of inaccuracies and/or lacks clarity.    No specific examples of the impact and/or importance of a successful visit and follow-up to nursing.
Points    Points    Points    Points
Content Subtotal        _____of  points
Format
Possible Points =  30 Points
APA Format:    15–14 Points    13 Points    12–11 Points    10–0 Points
Text, title page, and reference page(s) are completely consistent with APA format.    There are 1–2 APA format errors in the text, title page, and/or

reference page(s).    There are 3–4 APA format errors in the text, title page, and/or reference page(s).    There are 5 or more APA format errors in the text,

title page, and/or reference page(s).
Writing Quality.     15–14 Points    13 Points    12–11 Points    10–0 Points
Paper is appropriate in length. References include the minimum of five (5) scholarly references, excluding the course text.Rules of grammar, spelling, word

usage, and punctuation are consistent with formal written work.    Paper is short or long in length and/or contains fewer than 5 but more than 1 scholarly reference,

excluding course text, or references utilized are not scholarly. Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work

with1–2 exceptions.    Paper is short or long in length and contains only 1 scholarly reference. Additional references are not scholarly. Rules of grammar, spelling,

word usage, and punctuation are consistent with formal written work with 3–4 exceptions.    Paper is two or more pages short or long in length and does not contain

scholarly references. References utilized are not scholarly. Rules of grammar, spelling, word usage, and punctuation are not followed with 5 or more errors.
Format Subtotal    _____of  points
Total Points        _____of  points

 

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Questions: 1. What exactly is the nursing issue? a. Describe the issue ( improper or non-compliance with hand hygiene to control the infection) b. Explain why there is an issue; in other words explore why the issue exists c. Engage in critical reflection by incorporating what you have observed in clinical practice ( an incident that shows how a nurse was careless about maintaining hand hygiene ) d. Discuss what research findings report about the issue. ( Examine both UAE and International literature)

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hand hygiene

Order Description

.
You are required to develop recommendations for future professional development for nurses.
Chosen topic is :
(non- compliance and/or improper ) Hand hygiene
Your essay will need to incorporate your reflection on your clinical experience over the
past 2 years and is what should guide your topic of choice.

Your essay should include responses to the following
Questions:
1. What exactly is the nursing issue?
a. Describe the issue ( improper or non-compliance with hand hygiene to control the infection)
b. Explain why there is an issue; in other words explore why the issue exists
c. Engage in critical reflection by incorporating what you have observed in clinical practice ( an incident that shows how a nurse was careless about maintaining hand hygiene )
d. Discuss what research findings report about the issue.
( Examine both UAE and International literature)
2. What recommendations would you make for future professional development for nurses?
a. Base recommendations on your own experiences (critical reflection) and evidenced – based literature so that you can support your recommendations with 15 references

 

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While there are still many, many more databases that you have access to, these are the top 10 databases you should know about beyond those that you’ve already used. For this assignment, you will work with one of these databases (see the Database List for the title of the database you have been assigned). You will get to know the database, learn different aspects of the database, and then create a video of how to use the database. It is important to create this video with the audience in mind – you are teaching this database to other students. Discover at least the following about the database you are assigned: ? What years of literature does this database cover?

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ASSIGNMENT Database Video/Education Source

This semester you’ve learned how to search multiple databases: Books & More, Academic Search Premier, and PubMed to name a few. But there are many, many more databases that you have access to through the UNC Libraries. The research areas of speech language pathology and audiology are interdisciplinary, spanning from education to medicine. Below is a list databases you may find helpful when researching speech language pathology and audiology topics:
Education
Sociology
Psychology
Health & Medical
Education Source
Social Sciences Full Text
PsycINFO
CINAHL
Linguistic and Language Behavior Abstracts
Social Services Abstracts
Psychology & Behavioral Sciences Collection
Nursing and Allied Health Source
ProQuest Education Journals
Sociological Abstracts
While there are still many, many more databases that you have access to, these are the top 10 databases you should know about beyond those that you’ve already used. For this assignment, you will work with one of these databases (see the Database List for the title of the database you have been assigned). You will get to know the database, learn different aspects of the database, and then create a video of how to use the database. It is important to create this video with the audience in mind – you are teaching this database to other students.
Discover at least the following about the database you are assigned:
? What years of literature does this database cover?
? What speech language pathology and audiology topics would this database be useful for?
? What types of documents does this database index (journal articles, books, dissertation, etc.)?
? Is it possible to limit to just peer-reviewed articles in this database?
? What other limiters are available in this database?
? How does someone figure out if an article is available from a citation in this database?
? Can a person search by only keywords in this database, or are subject headings available?
? Is there an advanced search available?
After you get to know the database and discover all the answers to these questions, create an outline of your video. Pick an appropriate topic to search and while completing the search, show all the relevant features of this database.
There is a variety of equipment and software available to you as outline below. However, you can make this which just screen capture videoing (such as Screencast-O-Matic and your voice narrating), but if you want to make it flashy, you are welcome to do so.
What are the hardware and software possibilities?
Your final video must be saved in a digital format that the instructor can open and view. Check with the instructor before using a software or hardware that is not listed below.
Possibilities:
? use personal digital camera for still photos &
? video camera for live action
? create title slides & credits with PowerPoint
? use Camtasia to combine
? use personal digital camera for still photos
? use PowerPoint to put captions on photos
? create video with Windows Movie Maker or Jing or Screencast-O-Matic
? live action only taped with Flip Video Camera
? use Flip editing software to edit, add title & credit info
Software available in the Library Tech Study Rooms:
Flip Video Camera editing software
Camtasia
Windows Movie Maker
Jing
PowerPoint
Library Tech Study Rooms
2nd Floor Michener Library
Rooms 226, 249, & 258
(Make reservations or check out key at the Circulation/Access Services Desk on the main floor)
How do I know if my video is good?
A good video will include the following:
Content:
o Brief introduction of yourself
o Correctly describe and demonstrate a library database so that it can be easily understood by your peers
o Library staff members nor student workers are featured
Engaging:
o Creative videos will appeal to other students
o Visuals are highly visual – so there is no or very little text to read on the video
Mac Labs on campus have iMovie and GarageBand available for video and music production.
Technical Requirements:
o Videos should be 2-4 minutes long
o Clear audio/visuals
o Title
o Credits
o If music is used, any voice components must be clear and easy to hear over the music
How do I save my video?
Check out a portable hard drive from the library Access Services Desk and save all works in progress.
How do I turn in my video for a grade?
Submit your finalized project to Blackboard.
Grading Category Specific Criteria Pts. Possible
Content
Demonstrates how to search the database efficiently and effectively, and points out major features of the database useful to students
30
Introduction of self
5
Creativity
Video is engaging
20
Technical
2-4 minutes in length, clear audio, clear video, title, credits
10
Total Possible Points
65

 

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In the process of interviewing employees of the Interventional Radiology department, I found that there are multiple ways in which employees interpret the process of the department as a whole.  Based on their own experience and knowledge, they may believe that something is adequate, if not faultless, even though there may be seemingly obvious faults to the outside looking in.

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Organizational Development Diagnosis

Paper details:
INSTRUCTIONS: Students will conduct an organizational development diagnosis. From the diagnosis, develop an OD problem statement, collect and analyze data, and identify appropriate interventions to effect change. This paper must be original for this class. 8 pages not including cover or bibliography, APA format.

Organization Diagnosis and Intervention Plan

GentechInterventional Radiology
Student
MGMT 5325
Organizational Development and Change
Dr. Tim Parker

April 25, 2015

Abstract
Understanding the need for organizational development in many different businesses and organizations, the Interventional Radiology department within a healthcare system was selected for improvement.  After interviewing employees of the department, a diagnosis is made including a number of different issues that need to be addressed.  After a diagnosis, areas and processes that needed intervention are given a plan and approach for each.  Ultimately, with two effective interventions, the department will grow in areas of communication and process improvement, having an open mindset to future growth.

Gentech Interventional Radiology
Background on Case Study Organization
Gentech Medical Center is a hospital that provides a wide variety of services for those in need.  One general department within this organization is the Interventional Radiology department.  Interventional Radiology provides a variety of diagnostic and interventional studies.  Mainly in diagnostic exams, a contrast liquid that shows up on x-rays is injected into veins or arteries in order to highlight them and visualize what cannot be seen otherwise.  With interventional procedures, according to the lead technologist, there is a wide variety of actions that can take place, including: placing cement into fractured bones in order to relieve pain and prevent further fracture; placing dialysis catheters in the veins of patients with kidney failure; action taken against plaque build-up in arteries (stent placement, ballooning and expanding the vessel, or removal of plaque); and the sampling of spinal fluid to allow lab tests to be performed.  All of this is done with at least one radiologist, one radiology technologist, and one radiology nurse in the room for each procedure (R. Calvo, personal communication, April 16, 2015).  After some procedures, mostly the ones requiring intervention, there is a recovery period in which a nurse monitors a patient while they are waiting on sedation to wear off.
Inputs within the department consist of human capital, physical use of machinery, use of supplies from outside sources, and raw materials and information from its own environment.  The human capital is composed of three technologists, four nurses, and one radiologist.  There are two different rooms in which these procedures can take place, serving as a physical location for the environment.  The machinery used includes: monitoring equipment for patient health statistics; digital radiography equipment allowing for the visualization of activity taking place within the patient using radiation; and a computer system in order to store imaging, access a patient’s chart, and make changes to the chart.  Supplies are ordered on a daily basis in order to have necessary sterile supplies when needed.  These come form a variety of companies, based on their specialty and knowledge.  Raw materials consist of the patient chart that is given from the attending physician within the hospital or the ordering physician from outside the hospital.
According to the charge nurse, the general environment consists of competition between the radiologist and cardiologists, recalls on products and supplies, and unexpected cancellation of procedures.  In the task environment, there is some supplier power with new products and companies that have patents on effective ones (C. Lathrop, personal communication, April 16, 2015).  Understanding the importance of having advanced technology for the sake of the patient, patented products can easily be sold for thousands of dollars apiece, depending on the product.  Some products may be used, but approval for reimbursement of the surgical action may not be given yet.  This approval is by Medicare, and without it the organization can lose money based on the amount spent on a patented product.
Transformations occur, according to the radiologist, when radiological services are performed.  After these procedures take place, the patient is charged for the supplies utilized as well as the action of diagnosing with x-rays and intervening in a surgical manner for the patient’s benefit.  The financial return to the organization is used in order to fund the purchase of necessary supplies, as well as upgrades in machinery when needed (G. Yoder, personal communication, April 16, 2015). With the ability to fund the purchase of high-quality machinery and the salary/wages of the employees, this organization transforms financial gain into high-quality patient care.
The structure is designed with one nurse being in charge of the other three, one technologist in charge of the other two, and the radiologist is not employed by Gentech Medical Center, but has the final say in exam performance since he is the physician actually performing the procedures.   The nurse in charge designates a nurse to be in the recovery area for most of the day, and designates patients to the other nurses to monitor during procedures.  The lead technologist coordinates with the charge nurse as far as exam scheduling and procedure order is concerned.  He also orders supplies, while all three restock the room as supplies come in.  All three technologists assist the physician during the procedure, one for each procedure, and apply charges to the patient’s exam chart after the procedure is performed.  The radiologist performs the procedures and dictates, according to Medicare standards, in the patient exam chart regarding the procedure performed.  According to the lead technologist, the Human Resources department originally is who selects employees, with the help of the supervisor, and monitors the annual evaluation of the employees.  Employees receive an annual raise following their evaluation.  The amount of their raise can be up to three percent of their current hourly rate, but is dependent on their current ability to meet or exceed expectations voiced upon the start of the employee/employer relationship (R. Calvo, personal communication, April 16, 2015).
Team’s Definition of Diagnosis
Organization Issues
The radiology x-ray machines used during the procedure are over ten years old and have their issues.  The imaging seems outdated and limiting compared to more modern machines. Dependability is also an issue.  Sometimes, mid-procedure, the machine needs to be reset in order to continue use.
There are no issues with structure or the Human Resources Management.  Strategic issues, on the other hand, do have their place.  With the scheduling of exams and procedures, the charge nurse has poor communication skills with his plan and changes made throughout the day.  In addition to this, each of the nursing staff do not work together well, so there is even more lack of communication when necessary.
Finally, there is a continual issue with patent cancellations on the day of the procedure.   Understanding there are always unpredictable occurrences that prevent things from going as planned, there are numerous incidences in which cancellations could have been prevented had proper communication occurred with the patient.
Case Study Problem Statement
The staff of Gentech Interventional Radiology work together in a somewhat organized manner; however, there are communication issues that cause unnecessary problems.  There are unforeseen cancellations with patients that have a tendency to be prevented in advance.  Finally, the machines used during the procedure are not as reliable as they should be.
Effectiveness Criteria
With machine issues, there are times that procedures cannot be performed due to low imaging quality or unforeseen issues with the mechanics.  The inability to use a machine as intended can result in: cancelled procedures; wasted supplies; lost time and effort; and the rescheduling of patient procedures.
With the issue of poor communication, there is delay in patient care resulting from confusion/lack of inclusion with the technologists and nurses. In addition, Uddin and Hossain state, “From the perspective of patient perceptions of quality of care, coordination is identified as one of the most important factors” (Uddin & Hossain, 2014).  With delay in patient care, there are sometimes supplies wasted and unnecessary overtime pay that results.  According to Ang, Swain and Gale, “Communication influences health outcomes such as health status, adherence, and satisfaction.  It is also highly modifiable, so it should be a target of intervention studies” Swain (Ang, Swain, & Gale, 2013)
Cancellations immediately before a procedure is scheduled to begin results in wasted supplies as well as time spent in preparation for a procedure that never occurs.
Case Study Purpose Statement
The purpose of this case study organization diagnosis is to develop research questions and identify data collection instruments to assess the causal variables of poor communication, patient cancellations, and machine issues to determine the best change interventions to implement.
Case Study Diagnostic Research Questions
Questions askedin order to guide research include:
1)    How can issues with the machine be solved?
2)    What is the cause of poor communication and what prevents it from happening as it should?
3)    Is there a way to prevent or minimize patient cancellation?
Research Methodology
Considering the questions asked and the casual variables to be addressed, there are a number of different methods of collecting needed data.  With the issue of poor communication, the best method of data collection is that of a survey.  With a survey, employees are free to give their personal opinion more freely and are not limited to specific answers.  This is not a quantitative issue, rather a qualitative one, and therefore can be addressed appropriately.  Concerning patient cancellation, quantitative data will be collected regarding the reason of cancellation for each patient, then addressing any issues that can be improved, thereby reducing or preventing these cancellations.  The machine issues are both quantitative and qualitative, since there is poor image quality as well as mechanical issues.  There will be a survey administered for the quality of imaging, then data collected by observation/survey for the reasons of mechanical failure.
In surveys with the employees about the machine issues, there was a unanimous consensus that the machine itself is outdated and inadequate.  Abbam states, “There is also mounting evidence that investing in medical devices reduces overall healthcare expenditure and contributes towards better patient outcomes” (Abbam, 2014).  In communication with the technologists and the radiologist, it was determined that the hospital is in the process of purchasing a new machine for interventional use in the months to come.
Upon surveying the employees, there is a general consensus that communication is poor due to a lack of set protocols in that area. According to Rybkin and Wilson, “The multitude of applications dedicated to electronic communication reflects the complexity of radiology workflow. Radiologists need to communicate with various members of the healthcare team, for a variety of purposes, under a variety of conditions” (Rybkin & Wilson, 2011). When proper coordination is assumed to happen in a desired manner, this does not always happen.  The largest issue continually stated was communication in the transition period between patients.  From the four nurses, there is inadequate notification of the time the procedure commences, as well as the time the procedure ends.  With this failed communication, turnover time between patients is extended longer than necessary.  From the three technologists, there was a great emphasis on the lack of needed coordination with the technologists as far as the scheduling is concerned.  There is a difference in logical opinion between the charge nurse and the lead technologist at times, and this could be resolved with consistent communication when needed.
In the process of quantifying reasons for cancellation, which were logged in the charge nurse’s schedule book, the following results were shown from the last six months:
1)    Twenty-eight percent of scheduled patients cancel on average.
2)    Six percent of the cancellations are due to an allergy that was not addressed and the patient pre-medicated for, resulting in a rescheduled exam.
3)    Sixty-two percent of the cancellations were due to the patient taking medications that are contra-indications for the procedure, resulting in a rescheduled exam.
4)    Twelve percent of cancellations were due to fever/infection, delaying the procedure until after the infection is gone.
5)    Fifteen percent were patients that did not show up for their procedure as scheduled and without notice.
6)    Five percent cancelled with advance notice on a day prior to the scheduled procedure.
Considering these percentages, the employees are able to visualize the true ability to discourage unnecessary cancellations.  In preparation for intervention, one must consider what the authors Souzdalnitski and Narouze state on the subject.  They state, “Thus far, the most reliable solution to this dilemma has been to analyze the details of cancellations for each organization, apply general rules from studies conducted on cancellations, and set reasonable expectations” (Souzdalnitski & Narouze, 2014).
Organization Interventions
Understanding the need of quality healthcare within a healthcare facility, issues affecting the patient are of great importance.  In order to save valuable time and costly supplies, it is apparent that proper communication must occur between co-workers.  Additionally, addressing the issue of patient cancellations will affect both factors as well, ultimately benefitting the patient, the employees, and the facility.  The quality of imaging and the machine issues are being addressed financially by the organization; that being said, there seems to be no need to intervene in that area.  In the areas that will need intervention, namely communication and cancellations, the leading and managing of these interventions are addressed.
In the communication intervention, there will be process consultation in order to establish a standard method of communication, allowing consistent and reliable communication throughout the day.  Nurses, as well as technologists, will form together during this consultation in order to bring them together in solving process problems and finding solutions.  This will be necessary; for, as Elf, Frost, Lindahl, and Wijk state, “The importance of collaboration cannot be overemphasized when fostering ownership of and participation in . . . decisions by users” (Elf, Frost, Lindahl, & Wijk, 2015).  With the issue of organization between the charge nurse and the lead technologist, team building intervention will occur.  This will allow the employees to better understand each other’s role, approach, and mindset, allowing for increased quality of communication between them.
In addressing unnecessary cancellations, sixty-eight percent of cancellations could have been prevented had proper communication occurred in days leading up to the procedure.  Fifteen percent, the no-call no-shows, may have been reduced had the patient been contacted in days prior to the procedure as well.  The percentage that cancelled due to unpredictable fever and/or infection, as well as the five percent that cancelled ahead of time, cannot be affected or prevented.  Once again, looking at the eighty-three percent of cancellations that can be affected in ways that benefit the organization, an increase in communication will help.  According to Singhal, Warburton, and Charalambous, “Cancellations on the day of surgery represent a major wastage of resources and can impose significant distress on patients.  Minimi[s]ing same day cancellations can improve cost effectiveness and operation theatre running” (Singhal, Warburton, & Charalambous, 2014).  Process consultation will be applied, allowing the group the opportunity to discover methods of increased, timely, and effective communication with the patient.
Diagnosis Organization’s Readiness for Change
Within this department, there are varying degrees of seniority that may affect change.  The charge nurse has been employed for sixteen years, which is longer than any other employee within this department.  That being said, he has seniority over the other three nurses and has the most say considering changes that may occur.  However, he does seem to be one of the most resistant to the idea of change, being uncertain about its actual benefit. According to Caruth and Caruth, “This uncertainty results in resistance, especially on the part of individuals with insufficient coping skills.  Acquiring both the ability to cope with change both personally and professionally is essential” (Caruth & D, 2013).  The lead technologist has been employed in this department for six years, and welcomes the idea of change for the better.  The radiologist has been with the current healthcare system for five years, and is ready for change and improvement.
While the charge nurse is the most resistant to change, both nurses and technologists are eager to meet the radiologist’s needs.  The charge nurse and the lead technologist are the power bases that can enforce change overall, with great influence from the radiologist.  With these interventions including all of the employees, all will be able to feel they had a part in this improvement.  This is extremely important for the change to be effective to the utmost extent.  Umble and Umble state, “Physcological ownership is critical to generating true enthusiasm and commitment to the project.  Therefore, the ideal situation is that every key player gains some psychological ownership of the project” (Umble & Umble, 2014).Once intervention takes place and processes are improved, the employees will see how the benefits of actions affect the workflow process and contribute to patient care.  Patients, who are also stakeholders in this system, will unknowingly benefit from these two interventions and a greatly improved department in the healthcare system.
Discuss three lessons learned.
1)    In the process of interviewing employees of the Interventional Radiology department, I found that there are multiple ways in which employees interpret the process of the department as a whole.  Based on their own experience and knowledge, they may believe that something is adequate, if not faultless, even though there may be seemingly obvious faults to the outside looking in.
2)    With experience, comes knowledge, but resistance to change can be grown as well.  In speaking with the charge nurse of sixteen years, his attitude seemed to be that of one that simply knew the organization to function as is currently does without any need or ability to change.  Even though other employees presented with the desire to change for the better, the charge nurse seemed blind to this idea.  However, with proper intervention, I believe that all will see and appreciate the value of changes that are made and see the value in teamwork and communication in the end.
3)    Finally, I found that employees were excited about the process of change, but felt a lack of efficacy in creating change by themselves.  Galinski, Matos, and Sakai-Oneill state that one of their core principles for bringing about change is, “Unexpected messengers make people pay attention” (Galinsky, Matos, & Sakai-O’Neill, 2013). This was evident in that, although there are leaders within the department, no person felt the ability to initiate without the help of someone new or from the outside, such as an OD practitioner.  These interventions show how change can occur for the better, and hopefully will encourage action from the entire group when needed in the future.

References

Abbam, G. (2014). What role does technology play in improving access to healthcare? Diversity & Equality in Health & Care, 11 (3/4), 173-175.

Ang, W., Swain, N., & Gale, C. (2013). Evaluating communication in healthcare: Systematic review and analysis of suitable communication scales. Journal of Communication in Healthcare, 6 (4), 216-222.

Caruth, G., & D, C. (2013). Understanding resistance to change. Turkish Online Journal of Distance Education, 14 (2), 12-21.

Elf, M., Frost, P., Lindahl, G., & Wijk, H. (2015). Shared decision making in designing new healthcare environments–time to begin improving quality. BMC Health Services Research, 15 (1), 1-7.

Galinsky, E., Matos, K., & Sakai-O’Neill, K. (2013). Workplace flexibility: a model of change. Community, Work & Family, 16 (3), 285-306.

Rybkin, A., & Wilson, M. (2011). A Web-Based Flexible Communication System in Radiology. Journal of Digital Imaging, 24 (5), 890-896.

Singhal, R., Warburton, T., & Charalambous, C. (2014). Reducing same day cancellations due to patient related factors in elective orthopaedic surgery. Journal of Perioperative Practice, 24 (4), 70-74.

Souzdalnitski, D., & Narouze, S. (2014, November 2). Evidence-based approaches toward reducing cancellations on the day of surgery. Saudi Journal of Anaestesia , S6-S7.

Uddin, S., & Hossain, L. (2014). Social Networks in Exploring Healthcare Coordination. Asia Pacific Journal of Health Management, 9 (3), 53-62.

Umble, M., & Umble, E. (2014). Overcoming resistance to change. Industrial Management, 56 (1), 16-21.

 

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Develop three Nursing Diagnoses for this client based on the health history and screening. Include: one actual nursing diagnosis, one wellness nursing diagnosis, one “Risk For” nursing diagnosis, and your rationale for the choice of each nursing diagnosis for this client. 8.Using the three nursing diagnoses you have identified, develop a wellness plan for the adolescent/young adult client

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Benchmark Assignment – Health Screening and History of an Adolescent or Young Adult Client

Order Description

In this assignment, you will be completing a comprehensive health screening and history on a young adult. To complete this assignment, do the following:

Select an adolescent or young adult client on whom to perform a health screening and history. Students who do not work in an acute setting may “practice” these skills with a patient, community member, neighbor, friend, colleague, or loved one.

Complete the “Health History and Screening of an Adolescent or Young Adult Client” worksheet.

Format the write-up in a manner that is easily read, computer-generated, neat, and without spelling errors.

Complete the assignment as outlined on the worksheet, including:
1.Biographical Data
2.Past Health History
3.Family History: Obstetrics History (if applicable) and Well Young Adult Behavioral Health History Screening
4.Review of Systems
5.Include all components of the health history
6.Use correct acronyms or abbreviations when indicated
7.Develop three Nursing Diagnoses for this client based on the health history and screening. Include: one actual nursing diagnosis, one wellness nursing diagnosis, one “Risk For” nursing diagnosis, and your rationale for the choice of each nursing diagnosis for this client.
8.Using the three nursing diagnoses you have identified, develop a wellness plan for the adolescent/young adult client

Health History and Screening of an Adolescent or Young Adult Client

Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include the relevant data for your client.
Student Name:    Date:
Biographical Data
Patient/Client Initials:    Phone No:
Address:
Birth Date:    Age:    Sex:
Birthplace:                                                          Marital Status:
Race/Ethnic Origin:
Occupation:    Employer:
Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance? Employment disability?)

Source and Reliability of Informant:

Past Use of Health Care System and Health Seeking Behaviors:

Present Health or History of Present Illness:

Past Health History
General Health: (Patient’s own words)

Allergies: (include food and medication allergies)

Reaction:

Current Medications:

Last Exam Date:    Immunizations:

Childhood Illnesses:

Serious or Chronic Illnesses:

Past Health Screening (see “Well Young Adult Behavior Health Assessment History Screening” below)
Past Accidents or Injuries:

Past Hospitalizations:

Past Operations:

Family History
(Specify which family member is affected.)
Alcoholism (ETOH use/abuse):
Allergies:
Arthritis:
Asthma:
Blood Disorders:
Breast Cancer:
Cancer (Other):
Cerebral Vascular Accident (Stroke):
Diabetes:
Heart Disease:
High Blood Pressure:
Immunological Disorders:
Kidney Disease:
Mental Illness:
Neurological Disorder:
Obesity:
Seizure Disorder:
Tuberculosis:
Obstetric History (if applicable)
Gravida:    Term:    Preterm:    Miscarriage/Abortions:
Course of Pregnancy (length of pregnancy, delivery date, method of delivery, length of labor, complications, baby’s weight, baby’s condition):

Well Young Adult Behavioral Health History Screening
Socio-Demographic Content and Questions:

What organizations or activities (community, school, church, lodge, social, professional, academic, sports) are you involved in?

How would you describe your community?

Hobbies, skills, interests, recreational activities?

Military service: Yes_______ No_______
If yes, overseas assignment? Yes________ No_________

Close friends or family members who have died within past 2 years?

Number of relatives or close friends in this area?

Marital status: Single______ Married________Divorced_________Separated_________
In serious relationship________Length of time_________

Environmental Content and Questions:

Do you live alone?  Yes________ No ________

When did you last move?

Describe your living situation?

Number of years of education completed?

Occupation?
If employed, how long?
Are you satisfied with this work situation?
Do you consider your work dangerous or risky?
Is your work stressful?

Over the past 2 years have you felt depressed or hopeless?

Biophysical Content and Questions

Have you smoked cigarettes? Yes_______ No________

How much?
Less than ½ pack per day_____ About 1 pack per day?______ More than 1 and ½ packs per day______

Are you smoking now? Yes_______ No________ Length of time smoking?______________

Have you ever smoked illicit drugs? Yes__________ No_________

If yes, for how long? ___________ Do you smoke these now?  Yes__________ No __________

Do you ingest illicit drugs of any kind? Yes_________ No__________
If so, what drugs do you use and what is the route of ingestion?_________
How long have you used these drugs_________________

Review of Systems
(Include both past and current health problems. Comment on all present issues.)
General Health State (present weight – gain or loss, reason for gain or loss, amount of time for gain or loss; fatigue, malaise, weakness, sweats, night sweats, chills ):

Skin (history of skin disease, pigment or color change, change in mole, excessive dryness or moisture, pruritis, excessive bruising, rash or lesion):

Health Promotion (Sun exposure? Skin care products?):

Hair (recent loss or change in texture):

Health Promotion (method of self-care, products used for care):

Nails (change in color, shape, brittleness):

Health Promotion (method of self-care, products used for care):

Head (unusual headaches, frequency of headaches, head injury, dizziness, syncope or vertigo):

Eyes (difficulty or change in vision, decreased acuity, blurring, blind spots, eye pain, diplopia, redness or swelling, watering or discharge, glaucoma or cataracts):

Health Promotion (wears glasses or contacts and reason, last vision check, last glaucoma check, sun protection):

Ears (earaches, infections, discharge and its characteristics, tinnitus or vertigo):

Health Promotion (hearing loss, hearing aid use, environmental noise exposure, methods for cleaning ears):

Nose and Sinuses (discharge and its characteristics, frequent or severe colds, sinus pain, nasal obstruction, nosebleeds, seasonal allergies, change in sense of smell):

Health Promotion (methods for cleaning nose):

Mouth and Throat (mouth pain, sore throat, bleeding gums, toothache, lesions in mouth, tongue, or throat, dysphagia, hoarseness, tonsillectomy, alteration in taste):

Health Promotion (Daily dental care – brushing, flossing. Use of prosthetics – bridges, dentures. Last dental exam/check-up.):

Neck (pain, limitation of motion, lumps or swelling, enlarged or tender lymph nodes, goiter):

Neurologic System (history of seizure disorder, syncopal episodes, CVA, motor function or coordination disorders/abnormalities, paresthesia, mood change, depression, memory disorder, history of mental health disorders):

Health Promotion (activities to stimulate thinking, exam related to mood changes/depression):

Endocrine System (history of diabetes or insulin resistance, history of thyroid disease, intolerance to heat or cold):

Health Promotion (last blood glucose test and result, diet):

Breast and Axilla (pain, lump, tenderness, swelling, rash, nipple discharge, any breast surgery):

Health Promotion (performs breast self-exam – both male and female, last mammogram and results, use of self-care products):

Respiratory System (History of lung disease, smoking, chest pain with breathing, wheezing, shortness of breath, cough – productive or nonproductive. Sputum – color and amount. Hemoptysis, toxin or pollution exposure.):

Health Promotion (last chest x-ray, smoking cessation):

Cardiac System (history of cardiac disease, MI, atherosclerosis, arteriosclerosis, chest pain, angina):

Health Promotion (last cardiac exam):

Peripheral Vascular System (coldness, numbness, tingling, swelling of legs/ankles, discoloration of hands/feet, varicose veins, intermittent claudication, thrombophlebitis or  ulcers):

Health Promotion (avoid crossing legs, avoid sitting/standing for long lengths of time, promote wearing of support hose):

Hematologic System (bleeding tendency of skin or mucous membranes, excessive bruising, swelling of lymph nodes, blood transfusion and any reactions, exposure to toxic agents or radiation):

Health Promotion (use of standard precautions when exposed to blood/body fluids):

Gastrointestinal System (appetite, food intolerance, dysphagia, heartburn, indigestion, pain [with eating or other], pyrosis, nausea, vomiting, history of abdominal disease, gastric ulcers, flatulence, bowel movement frequency, change in stool [color, consistency], diarrhea, constipation, hemorrhoids, rectal bleeding):

Health Promotion (nutrition – quality/quantity of diet; use of antacids/laxatives):

Musculoskeletal System (history of arthritis, joint pain, stiffness, swelling, deformity, limitation of motion, pain, cramps or weakness):

Health Promotion (mobility aids used, exercises, walking, effect of limited range of motion):

Urinary System (recent change, frequency, urgency, nocturia, dysuria, polyuria, oliguria, hesitancy or straining, urine color, narrowed stream, incontinence; history of urinary disease; pain in flank, groin, suprapubic region or low back):

Health Promotion (methods used to prevent urinary tract infections, use of feminine hygiene products, Kegel exercises):

Male Genital System (penis or testicular pain, sores or lesions, penile discharge, lumps, hernia):

Health Promotion (performs testicular self-exam):

Female Genital System (menstrual history, age of first menses, last menstrual cycle, frequency of cycles, premenstrual pain, vaginal itching, discharge, premenopausal symptoms, age at menopause, postmenopausal bleeding):

Health Promotion (last gynecological checkup, pap-smear and results, use of feminine hygiene products):

Sexual Health (presently involved in relationship involving intercourse or other sexual activity, aspects of sex satisfactory, use of contraceptive, is relationship monogamous, history of STD):

Health Promotion (safe-sex practices):

Nursing Diagnoses:

Based on this health history and health screening, identify three nursing diagnoses that would be applicable for this client as well as your rationale for your selection of each nursing diagnosis. Include:

One “actual” nursing diagnosis with rationale for choice of this diagnosis.

One wellness nursing diagnosis with rationale for choice of this diagnosis.

One “risk for” nursing diagnosis based on the health screening with rationale for choice of this diagnosis.

 

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Identify a senior citizen (age 65 or older) and schedule an hour to talk with him/her face to face. Be sure to tell the person that you are completing the interview as part of a class assignment and that the content of the interview is completely confidential (no names will be used). Conduct an informal interview, focusing on the participant’s health and wellness.

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This required Portfolio assignment will give you experience observing and interacting with people outside of the classroom. It has been designed to provide you with the opportunity to develop skills, synthesize knowledge, and integrate learning in a real world setting. This assignment accomplishes that goal by challenging you to:
•    conduct a semi-structured interview with an elderly individual
•    analyze his/her responses in a systematic manner
•    integrate this real-world experience with your knowledge of the aging process based on evidence from journal articles and other scholarly sources.

Read the following articles on the behavioral determinants of healthy aging. The full-text articles are available in the Week Five Electronic Reserve Readings:
•    Hartman-Stein, P. E., & Potkanowicz, E. S. (2003). Behavioral Determinants of Healthy Aging: Good News for the Baby Boomer Generation. Online Journal Of Issues In Nursing, 8(2), 127-146.
•    Potkanowicz, E. S., Hartman-Stein, P., & Biermann, J. S. (2009). Behavioral Determinants of Health Aging Revisited: An Update on the Good News for the Baby Boomer Generation. Online Journal Of Issues In Nursing, 14(3), 11.
•    Masotti, P. J., Fick, R., Johnson-Masotti, A., & MacLeod, S. (2006). Healthy naturally occurring retirement communities: A low-cost approach to facilitating healthy aging.  American Journal of Public Health, 96 (7), 1164-1170.

Identify a senior citizen (age 65 or older) and schedule an hour to talk with him/her face to face. Be sure to tell the person that you are completing the interview as part of a class assignment and that the content of the interview is completely confidential (no names will be used). Conduct an informal interview, focusing on the participant’s health and wellness.
When interviewing the individual, ask questions that correspond to the following categories:
•    Physical activity, past and present: Ask about exercise routines as well as ordinary activities that involve physical exertion such as yard work, house cleaning, walking, and so on. Try to determine whether or not the participant has maintained an active lifestyle over the years.
•    Mentally stimulating activities, past and present: Ask the participant what he/she does to stay sharp. This might include card games, crossword puzzles, reading, taking courses, and so on. Try to determine the extent to which the participant has challenged him/herself to engage in ongoing, active learning.
•    Social support and social interactions: Ask the participant about his/her social contacts, past and present. This could include his/her spouse or partner, friends, relatives, social clubs, social activities, etc. Try to determine whether the participant has a strong base of social support.
•    Meaningful activities: What gives life meaning? Ask the participant to recall his/her most meaningful activities and ask if he/she is still engaged in such activities. This will vary from person to person but could include helping others, teaching younger people, religious or spiritual activities, giving back to his/her community, sharing talents or skills, creative activities, and so on. Your task is to determine if the participant is still actively engaged in activities that matter to him/her.
•    Recreational/leisure activities:  What does the participant do for fun? Try to get a sense of what he/she still enjoys and how frequently he/she participates in enjoyable activities.
•    Living environment.  What is the individual’s home environment like?  Does he/she live in a retirement community?  If so, what is it like?  Does he/she still drive?  If not, how does the individual manage transportation challenges such as running routine errands, getting to doctor’s appointments and attending social events?  What environmental challenges does he/she face?
Try to keep the interview process light and fun. Focus on what the participant is doing well.

Part I:  Document the questions you asked and the participant’s responses. This is your interview ‘transcript’ which will be turned in along with your reflective paper.

Part II: Write a 1,000-word reflective paper based on the interview. In your paper, include a discussion on the following points:

•    Most notable aspects of the interview: What topics did your interviewee respond most strongly to and why?
•    Most surprising aspects of the interview: Did any of the interviewee’s responses surprise you? Explain.
•    A commentary about the participant’s overall functioning: Use the information from the required readings to make a general assessment of the participant’s health and well-being. Would you use the term ‘healthy aging’ to describe the participant? Why or why not? What is he/she doing well? What areas could use improvement? What suggestions would you make, based on your knowledge of the determinants of healthy aging?
•    A discussion of what you learned from this experience.

Use the literature in gerontology, wisdom, and successful aging to supplement your paper and support your points. Format your paper consistent with APA guidelines and be sure to cite your sources in a reference section at the end of your paper.

 

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 Adam is suspected of having neurogenic shock. Explain the pathophysiology of neurogenic shock and how neurogenic shock is different from hypovolemic shock.  Which vital sign(s) correlate with this diagnosis? (1.25 point)

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NAME: ____________________________DATE: ________________Score:____________

WEEK 9: Case Scenario (FALL 2015) SCI (Adam)
Adam, a 22-year-old college student, was rock climbing when he fell 30 feet to the ground.  EMS found him in the supine position and he was unable to move any of his extremities.  He complained that he could not feel his arms and legs. His pupils were equal and reactive to light.  He showed no other signs of injury except for several scrapes on his arms. His vital signs at the scene of the injury revealed a blood pressure of 111/65, heart rate of 86 beats per minute, respirations of 18 per minute.  A cervical collar was applied and he was placed on a back board, and transported by helicopter to the hospital with a suspected spinal cord injury (SCI).
Upon examination in the emergency department, his stretch reflexes in the upper and lower extremities were absent.  He said everything felt numb from his nipple line across and down his entire body.   He had some sensation in his arms, but could not localize touch.  He was able to raise his shoulders and tighten his biceps slightly in each arm.  He could not raise either arm against gravity. His lower extremities were flaccid and he was unable to move them. Vital signs were taken again and were as follows: blood pressure 94 / 56, heart rate 59, respiratory shallow 18/min. His oral temperature was 102.2 degrees F, and O2 sat of 93% on room air.   His color was dusky and his skin was warm and dry to the touch.
X-rays taken upon arrival revealed a fractured vertebra at C5. A chest X-ray showed a decreased lung expansion.  Blood tests were normal, with the exception of acidosis (blood pH 7.25). The neurosurgeon inserted tongs into his skull above the ears to hold his neck in a safe position.  Allen was transferred to intensive care and his condition was stabilized.
Content: Wagner and Hardin-Pierce (2014) Chapters: 18 and 19
???????????????????????????????????????????????????????????????
1.    Adam is suspected of having neurogenic shock. Explain the pathophysiology of neurogenic shock and how neurogenic shock is different from hypovolemic shock.  Which vital sign(s) correlate with this diagnosis? (1.25 point)

2.    Explain in detail what the rationale is for Adam having a fever and dry skin upon admission to the hospital. (0.5 points)

3.    Explain the use of skull tongs in the SCI patient. (0.5 points)
4.    What pulmonary complications are prevalent in the SCI patient?  Does Adam have any signs of pulmonary complications and if so, what are they? (1 point)

5.    Explain how to conduct a sensory assessment on Adam. (1 point)

6.    Explain the complication of thromboembolism in the SCI patient.  What clinical practice is recommended to reduce the risk of a DVT? (1.5 points)

7.    Adam is prescribed Lovenox 0.5mg/kg subcutaneous injection every 12 hours.  Explain the action, uses, major adverse effects, and nursing implications of Lovenox. (1 point)

8.     24 hours after Adam is hospitalized his manual blood pressure is 210/99 and the nurse is suspecting autonomic dysreflexia.  What is autonomic dysreflexia and what can trigger autonomic dysreflexia in the SCI patient? (1.25 points)

Reference

 

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Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis.

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Week 7 Discussion/Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders

To prepare:
•    Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
•    Review and select one of the six provided case studies. Analyze the patient information.
•    Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
•    Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
•    Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.
Please address the following with bold headings:
An explanation of the differential diagnosis for the patient in the case study you selected.
Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis.
Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments.
Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.

Assessing, diagnosing, and treating pediatric patients for many cardiovascular and genetic disorders can be challenging. As an advanced practice nurse who facilitates care for patients presenting with these types of disorders, you must be familiar with current evidence-based clinical guidelines. Because of the clinical implications, you have to know when to treat patients with these disorders and when to refer them for specialized care. In this Discussion, you examine the following case studies and consider appropriate treatment and management plans.
Case Study 6:
You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign.

 

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