Initial Post: Toddlers have behavioral characteristics that often present challenging situations for parents and/or caregivers.
Describe challenges parents and/or caregivers would encounter with these specific characteristics.
The American Nurses Association’s (ANA) overall aims are to advance the nursing profession and improve healthcare for all. They appeal to each legislative session of the U.S.Congress, Democrats and Republicans alike, to address nursing legislative priorities.
Six main legislative priorities were identified by the ANA for the 117th Congress. Each priority has several items
Review each and choose two items that you believe are the most important and discuss why you chose them.
Student Instructions for Standardized Simulation
NR325 Mary Lou and Rob Brady Scenario 1 (NLN)
PURPOSE:
Mary Lou Brady is a 20-year-old patient who had a right-sided stroke eight days ago. She was in the hospital for four days and is now in an acute care rehabilitation center, where she is having some difficulty acclimating to her new life and body changes.
Mary Lou is a patient in the medical surgical/rehabilitation center. She is eight days post-stroke and participates in rehabilitation for three hours every morning and afternoon. Her husband and family have been an excellent support system for her, but she is struggling with the demands of her rehabilitation.
STUDENT ROLES DURING SIMULATION:
During pre-briefing, you will be assigned one of these roles according to the description below to participate in the simulation as a nurse. After completing your assessment, you are expected to document your findings as a nurses note in SBAR format.
The charge nurse is responsible for the overall organization of safe, quality patient care. You are the team leader and serve as a resource to all interdisciplinary members and are responsible for appropriate delegation of duties. You will serve as the point person for communication and can anticipate speaking with the physician or other primary care provider, ancillary support services, and others directly involved with the care being provided. You must be knowledgeable about the patient’s condition and able to dictate orders obtained and assist with implementation if needed. Additionally, be prepared to prioritize care and anticipate future needs.
The documentation nurse is responsible for recording of all patient event activities during the simulation with the exception of medication administration. You are responsible for documenting assessments, interventions, and outcomes on the designated tool (paper or electronic). Be prepared to read back and verify your documentation when requested and/or clarifying the details. Additionally, you will be part of the interdisciplinary team and will contribute observational assessment findings to include but not limited to changes in vital signs, alerts, psychosocial needs, and anticipated care.
Assessment Nurse:
The assessment nurse is responsible for overseeing a comprehensive assessment of the patient. This includes but is not limited to obtaining vital signs, head-to-toe assessment of all systems, and psych/social assessment of the patient. You will be prioritizing care, executing independent interventions, collaborating with interdisciplinary team members, anticipating the needs of the patient/family, and re-assessing or continually monitoring the patient for any changes in condition. You are responsible for implementing all non-medication-related interventions, verbalizing your findings to the team, and recommending any actions/interventions required. Additionally, you will be providing appropriate education to the patient and family/significant others.
The medication nurse is responsible for all actions and documentation related to safe administration of medications. You will identify and correct any medication errors related to prescribing or distribution. This may include speaking with the physician or primary care provider. Prior to administering medication, you will assure the “Rights of Medication Administration”. You must be knowledgeable regarding the action and expected effects of the medications being administered and are responsible for monitoring and reporting any adverse reactions or unforeseen consequences of administration. Part of your role includes verifying medication calculations with a colleague and identifying any incompatible drug combinations.
The observer is a non-participant role and will not communicate directly with the simulation team. The observer nurse will view the simulation in the briefing room through Learning Space as it is occurring. There may be multiple observer nurses in each scenario. The observer nurse will be given an observation guide to complete during the simulation. The data you collect will help the team during the debriefing process and facilitate an open and active discussion regarding the simulation experience. You will be an active participant in the debriefing and will be encouraged to share your observations and thoughts. Please keep in mind that your observations should be conveyed in a respectful, educational manner. The goal is to work together as colleagues in providing safe and effective care.
CONFIDENTIALITY:
To preserve the educational value, integrity and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.
You will not view, discuss, share, record or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program.
FICTION AGREEMENT:
You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.
1. Complete a neurological assessment of a patient who has had a stroke.
2. Complete a psychosocial assessment of a patient who has had a stroke.
3. Provide appropriate nursing interventions for a post-stroke patient who is experiencing grief and loss related to having a stroke.
4. Use appropriate communication techniques during interactions with a post-stroke patient who is experiencing grief and loss and is attempting to cope with changes in body image.
5. Recognize the implications of the patient’s existing disability on the patient’s current and future healthcare needs.
The NR325/NR330 standardized simulation enables the student to meet the following priority course outcomes:
CO 1: Provide effective professional nursing care for adult patients and their families in acute care settings using the nursing process. (PO 1)
CO 4: Apply critical thinking strategies to make good clinical decisions in the adult patient clinical setting. (PO 4)
CO 6: Relate knowledge and principles of legal, ethical, and professional standards to clinical practice in the acute care setting, with adult patients and their families. (PO 6)
**Although this scenario can address multiple course outcomes, faculty and students should focus on the course outcomes listed above**
DUE DATE:
The standardized simulation will be conducted during
Week 5
to ensure students are prepared to meet the objectives.
· Pre-brief: 20 minutes
· Prebrief Skills Review (OPTIONAL): 30 minutes
· Run Time: 30 minutes
· Debrief: 60 minutes
In order to prepare for the simulation, you should complete your assigned reading for the course. In addition, you should be prepared to complete and document a thorough nursing assessment along with completing the following skills:
·
Neurological Assessment
·
Therapeutic Communication
·
Grief and Loss
·
Utilizing I-SBAR for reporting
Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.
Therefore, in order to prepare for the simulation, you are
required to complete the pre-briefing questions below and submit them to the faculty facilitating the simulation before the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to the faculty facilitating the simulation before the start of pre-briefing, you will
not be permitted to participate in the simulation.
Use textbook and other resources to answer questions:
1. What are some causes of strokes in younger women?
2. What do you need to focus on when completing a neurological assessment for someone who just experienced a stroke?
3. What do you educate the patients about the signs and symptoms of a Stroke and when to call 911?
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To Prepare:
The Assignment (Evidence-Based Project)
Part A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template attached below. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest. (please APA title page)
Part B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page APA format critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research. (please provide at least 4 references)
(Remember that part A is the appraisal matrix completed with your four articles.)
Part B is a 1-2 page p a p e r in which you suggest the best practices (an intervention recommendation) that you base on the findings within the four articles you are using.)
DKA
Mrs. S is a 28-year-old patient, with a 12-year history of type I diabetes mellitus. Her husband states that she has had a “bad cold” for several days. Yesterday she stayed in bed and slept all day. She was “too ill” to check her blood sugar, and since she was not really eating, she did not take her insulin. This morning, she was not able to stand up and vomited twice. A Gram stain of Mrs. S’s blood contains gram-positive cocci in clusters. Her admission vital signs are: BP = 90/60; HR = 118 bpm (sinus tachycardia); RR = 32/min; T = 102.3° F; O2 sat via pulse oximetry = 96%. Her serum glucose is 398 mg/dl, and she is positive for serum ketones. She is admitted with a diagnosis of DKA.
Her baseline ABGs on 2 L of oxygen are: pH = 7.25; PCO2 = 28; HCO3 = 14; PaO2 = 92; O2 sat = 96%. Her respirations are deep, rapid, and labored. She has bronchial breath sounds in the right axillary area. There is bilateral chest expansion and no evidence of cyanosis.
A regular insulin bolus is given, and a regular insulin drip is initiated. Mrs. S’s IV fluids are infusing at 800 ml/hr. Her vital signs after 2 hours in the unit are: BP = 120/70; HR = 78 bpm (normal sinus rhythm); RR = 22/min; O2 sat = 100%. Her serum glucose is 250 mg/dl and serum potassium is 4.0 mEq/L. She is more alert and is feeling hungry.
Within the Discussion Board area, write 500-1000 words that respond to the following questions with your thoughts, ideas, and comments. Your primary response is the foundation for future discussions by your classmates. You are required to use two scholarly resources from peer-reviewed journals no more than 3-5 years old, in addition to your course textbooks. Be substantive and clear, and use examples from the literature to reinforce your ideas.
For the past 100 years, nursing education has been the focus of numerous reports (e.g. the Flexner Report, the Institute of Medicine, the QSEN Initiative, the Carnegie Report) and academic organizations (e.g. AACN, NLN) have issued position statements and/or developed guidelines regarding where nursing education should take place and what its focus should be. Please answer the following:
Relative to the current trends in nursing education, how would you construct a curriculum that is innovative and relevant, able to fully engage learners and facilitate student growth, reflect evidence-based practices, and reflects are a collaborative experience?
Consider the following in your response:
See attached instructions
Create a PowerPoint based on HEALTH BEHAVIORAL THEORIES.
Submission Instructions:
My background: I am a Psychiatric Mental Health Nurse Practitioner. I work at mental health clinic (outpatient services) where I provide direct patient care, diagnose, and prescribe pharmacological treatments for patients with mental health disorders.
please use the attached book.
Create a PowerPoint slide show with notes pages discussing their PICOT question, literature review, and recommendations for change.
In a PowerPoint Presentation, address the following.
1.
Title Slide
2.
Introduction (1 slide): Slide should identify concepts to be addressed and sections of the presentation. Include speaker’s notes that explain, in more detail, what will be covered.
3.
Practice Issue (1-3 slides)
: Describe the area of interest and practice issue/problem related to NP practice selected in week 2. Explain why the issue/concern is important to nurse practitioner practice and its impact on health outcomes. Provide speaker notes. Provide scholarly references to support your ideas.
4.
PICOT Question (1 slide)
: Provide the PICOT question developed in week 2. Describe each element of your PICOT question in one or two sentences, being sure to address all the following:
1.
P-Population and problem – What is the nursing practice concern or problem and whom does it affect?
2.
I–Intervention – What evidence-based solution for the problem would you like to apply?
3.
C–Comparison – What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or alternative solutions.
4.
O–Outcome – Very specifically, how will you know that the intervention worked? Think about how you will measure the outcome.
5.
T–Time frame – What is the Timeframe involved for the EBP initiative or the target date of completion?
5.
Literature review (2-4 slides):Summarize the literature review completed in week 5. Discuss themes and special concerns. Discuss any unique insight or perspective offered from the literature. Provide speaker notes. Speaker notes and/or slides include citations from scholarly nursing literature which support the assertions presented.
6.
Recommendations (3 slides):
1. Slide 1: Identify the evidence-based recommendation for the identified practice change. Speaker’s notes should fully explain the recommended change and rationale for the change. Provide support from scholarly references to support the recommendation.
2. Slide 2: Identify the key stakeholders impacted by the recommended change. Speaker’s notes add detail.
3. Slide 3: Analyze the recommendation in terms of fit, feasibility, and appropriateness as discussed by Dang and Dearholt (2018), Ch. 8. Speaker’s notes add detail. *Note: information regarding stakeholders, fit, feasibility, and appropriateness may be based on personal experience or on information you found in your research. If the identified factors come from the literature, provide reference citations to support your ideas.
7.
Conclusion: (1 slide)Slide provides summary points of presentation. Speaker’s notes provide final comments on the topic.
8.
References: Reference elements provided in APA format, may use bullets. Hanging indents not required.
