Read the article “Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing” by Christine Tanner, which is attached below:

In at least three pages, answer the following questions:

1. What do you feel are the greatest influences on clinical judgment? Is it experience, knowledge, or a combination of those things?
2. In your opinion, what part does intuition play in clinical judgment? How do you think you’ll be able to develop nursing intuition?

Student Instructions for Standardized Simulation

NR325 Mary Lou and Rob Brady Scenario 1 (NLN)

PURPOSE:

The following information is to be used in guiding your preparation and participation in the scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

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.

Charge Nurse:

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.

Documentation Nurse:

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.

Medication Nurse:

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.

Observer Nurse:

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.  

LEARNER OBJECTIVES:

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.

COURSE OUTCOMES:

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.

SIMULATION TIMING:

· Pre-brief: 20 minutes

· Prebrief Skills Review (OPTIONAL): 30 minutes

· Run Time: 30 minutes

· Debrief: 60 minutes

REVIEW AND COMPLETE BEFORE THE START OF PRE-BRIEFING:

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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Respond to the four colleagues
 with preference to colleagues who selected different translation science frameworks or models from the one you chose. Recommend another framework/model they might consider and/or clarify their explanation of translation science. Cite sources to support your posts. PLEASE INCLUDE AT LEAST 2 REFERENCES OF EACH RESPONSE

 1 . One of the prominent theories that has been very effective in the incorporation of learned information into action is the Knowledge to Action (KTA) model. Spooner et al. (2018) stated that this model is the conceptual layout recommended to help individuals perturbed by the process of knowledge implementation to evidence-based practice. Knowledge creation and action cycle are the two major parts of the KTA model used to translate the knowledge obtained into clinical settings and the barriers encountered during this process are based on the practice conditions. When the KTA model is utilized one can ascertain that the knowledge obtained is from reliable research with long-lasting outcomes (Spooner et al., 2018).   

            The ease of translation of knowledge to action is the reason the KTA model is more popular among clinicians. Working in the correctional facility as a Nurse Practitioner, allows me to see a variety of inmates from minor to more serious crimes. Most of these inmates suffer from different mental health disorders including Schizophrenia and Bipolar disorder and their manner of voicing their anger is significant. The complexity and interdisciplinary nature of correctional facilities necessitates a conceptual framework or model to help translate evidence-based information into action. Field et al. (2014) pointed out that the KTA framework was made to address the various complexities utilized in explaining the method of theory implementation into action. Achieving optimal health requires an increase in the quality of healthcare services and products delivered. Kastner and Straus (2012) opined that the information implementation process including synthesis, dispensing, interchange, and effective use is crucial in the advancement of healthcare

                                                                   Relevancy To my practice

              Due to the hierarchy in correctional facilities, working as a Nurse Practitioner in this space can be very demanding as the county sheriff is in charge of operations while the detention officers apply different rules in dealing with inmates with psychiatric illnesses. The “Use of Force” is the most likely used process by detention officers when managing violent and mental health patients and this unsafe practice can lead to injury on both parties. Moreover, utilizing force is dehumanizing, does not promote support, and is not a holistic approach. Although, assessing and stabilizing these types of patients can be tough for healthcare providers due to their presentation, abnormal vital signs, and violence against the care team. Relating the KTA model to my practice issue can be done by incorporating the two parts of the model the knowledge creation and the action cycle. For knowledge creation, pinpointing the “Use of force” as a limitation to the delivery of efficient care to inmates and the action part is the transformation model to dismiss the use of force. This action promotes social support in the setting and the change team consists of sergeants, nurses, nurse practitioners, and several mental health professionals. A specific example of the effective use of the KTA model was highlighted when a bipolar patient was accompanied to the clinic due to a psychotic episode. The patient had refused to respond to the officer's question during intake and was identified as a high risk for suicidal ideation/attempt. While the suicidal process was being implemented the patient became violent and aggressive. The change team took over the situation and incorporated the “action cycle” of the KTA model by leading the inmate to a quiet area and reassuring him of his safety. This deed by changing them caused the patient to become compliant with his admission and provided willingly all the needed information for the process. Horesh and brown (2020) emphasized that there is an imminent need to close the disparaging gaps in care delivery in major areas as the care team addresses the barriers and creates innovative ways to support individuals in need.

2 . The translation science framework/model I chose is the Iowa model for Evidence-based Practice framework because of the detailed algorithm. The Iowa Model algorithm is user-friendly and straightforward, guiding nurses to use research to improve care. The Iowa Model centers around complete organizational support for transitioning current practices with top priority triggers to current evidence-based practice. The model is designed as a pilot test instead of an instant practice change. The process begins with stating the trigger or purpose identified. The process then determines if it is a priority; once established as a priority, the next step is addressed. This step includes appraising and analyzing the evidence and determining if there is sufficient evidence. If the answer is yes to the sufficient evidence question, the design of the pilot is developed. Once the pilot is appropriate for a change in practice, the change is implemented.  

An example of a trigger appropriate for the Iowa Model use is the change in practice for pressure ulcers. The organization accepts pressure ulcers as a top priority. The next step is evidence-based practice research and determining if the information is substantial. Once evidence is validated as appropriate, the design pilot integrating pressure ulcer preventative equipment is developed. Once approved, the pilot is evaluated again for appropriateness and implemented into practice. In conclusion, I chose this model because of the straightforward algorithm.

3 : The integration of evidenced-based strategies into practice can be challenging, especially in behavioral health. Knowledge translation frameworks provide a systematic approach for translating knowledge into practice, which promotes and sustains practice change (White et al., 2019). The knowledge-to-action (KTA) framework is one of the most popular conceptual frameworks used in healthcare settings to support the implementation of evidence-based practice (White et al., 2019). The framework incorporates existing change theories from health, social sciences, education, and management fields to provide user-friendly action phases to consider during the knowledge translation process.

The KTA framework comprises two components: knowledge creation and action. Knowledge creation is the production of knowledge and consists of three phases: knowledge inquiry, knowledge synthesis, and creation of knowledge for best practice (Davison et al., 2015). The Action component guides the implementation process for change and sustainability consisting of the following phases: identify the problem; adapt knowledge to the local context; assess barriers to knowledge use; select, tailor, and implement interventions; monitor knowledge use; evaluate outcomes; and sustain knowledge use (Davison et al., 2015).

The practice problem that I am looking to address issues facing mental healthcare that negatively affect access to mental health services (Andrade et al., 2014). Inequalities in health and social circumstances perpetuate social and economic exclusion that leads to unequal access to health and its determinants (Marmot et al., 2008). The utilization of the KTA model allows us to critically examine and support the move towards health equity by addressing the causes of health inequities in addition to acknowledging the gap between knowledge and action to improve health equity.

4.The Knowledge to Action (KTA) framework is a prominent concept that emphasizes translating research findings into practical therapeutic applications. The primary objective of this strategy is to prioritize evidence-based interventions, particularly in contexts where the effective dissemination of knowledge is of utmost importance (Spooner et al., 2018). The KTA framework is primarily centered around two fundamental processes: generating and disseminating knowledge, followed by its practical implementation. The applicability of this paradigm is contingent upon the specific characteristics of the context. Nevertheless, its primary objective is establishing long-term treatments grounded in rigorous research (Spooner et al., 2018).

Within the domain of critical care nursing, the interplay between generating knowledge and implementing practical insights holds immense value. Critical care units manage many situations, encompassing life-threatening disorders and post-operative care. The intricate and interdisciplinary character of critical care environments necessitates the development of a systematic framework that integrates evidence-based ideas into tangible interventions. Field et al. (2014) acknowledge that the KTA framework is appropriately structured to manage the complexities associated with knowledge translation effectively. To improve patient outcomes and the healthcare system, engaging in successful knowledge translation is crucial, which involves the ethical sharing and application of research findings (Kastner & Straus, 2012).

Application In My Practice

Managing the difficulties encountered in a critical care environment is inherently arduous. In this context, the potential consequences are significant, and the implementation of therapies based on timely and evidence-based practices can determine the outcome between survival and mortality. For example, the selection of ventilation systems, sepsis management approaches, and hemodynamic monitoring techniques necessitates a foundation in empirical research while also considering the unique requirements of each patient.

The KTA model, comprising the elements of “Learning Paths” and “Action Cycle,” provides a framework for implementing evidence-based practice in the critical care setting. During the initial stage of learning, it is imperative to find optimal methods or standards tailored to specific medical diseases such as acute respiratory distress syndrome (ARDS) or septic shock. In contrast, the “action” step involves the customization and execution of these optimal methodologies by individual patient circumstances.

Let us contemplate a hypothetical situation when a patient afflicted with septic shock exhibits an inadequate response to the initial administration of fluids for resuscitation purposes. By employing the Knowledge-to-Action (KTA) paradigm, a critical care nurse can effectively incorporate current research about initiating vasopressors. This approach allows for the adjustment of interventions based on empirical evidence while also considering the specific circumstances of the individual patient. The need for knowledge translation is heightened in healthcare teams as they confront increasing difficulties, particularly in high-pressure settings such as critical care units, where adherence to evidence-based treatment is crucial (Horesh & Brown, 2020).

  write 1-2 paragraphs reflecting on your learning for the week 

• In your experience, how have changes in healthcare affected nurses’ ability to provide person-centered, holistic care?
• As you think ahead to your future practice as an NP, which of the concepts covered this week resonates most with you?  (I chose Culture Humility)  Why?
• How do you anticipate that the concept of cultural humility will affect your practice?

The Assignment (Evidence-Based Project)

Part 3A: 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. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page 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.