Nursing

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SPIRITUAL CARE EXEMPLAR

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1. Describe the main concepts behind the theory of spiritual well-being in illness. 

2. Provide a specific exemplar of a time when you, as a nurse, showed a ministry of care in your relationships with patients. 

3. Provide an explanation of the caring elements you employed, such as prayer, care, touch.  

4. Provide a description of the patient scenario and their response.

5. Provide a brief overview of your feelings on the scenario discussed, areas you perceived as your strengths and your weaknesses, and your plans for improving your ability to provide spiritual care.

Document this assignment in a 4 page word document, Include at least 5 articles published in last 5 years, 

maternal m3

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Case Study: A 25-year-old presented to the labor and delivery unit with complaints of uterine cramping and lower back pain. The client denied any vaginal bleeding and had a history of preterm birth at 32 weeks (about 7 and a half months) gestation with her last pregnancy. The baby from that pregnancy is three years old has no developmental issues. The client’s gestational age is 30 weeks (about 7 months). She is O+, and all other lab values are normal. No evidence of sexually transmitted infections (STI’s).

(Group Beta Strep is missing from the labs and most often is obtained at 35 – 37 weeks (about 8 and a half months) gestation. Without this information, it is often determined to treat the patient anyway, to protect a premature baby from the risk.)

  • What additional information should the nurse obtain from the client?
  • What nursing intervention is most appropriate in this situation?
  • What screening tests should be obtained to determine the risk for preterm labor?
  • If the client is in preterm labor, what medications would the nurse expect to be ordered, and what are the priorities for the nurse to assess post-administration? (Include dose, side effects and expected outcomes of the medication).

reply

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Post an explanation of how you anticipate enacting personal and professional commitment for advocacy to positively impact your patients, communities, and the profession. Be specific. Then, explain how your role as a DNP-prepared nurse contributes to advocacy for positive social change.

1. 

 My personal and professional commitment to advocacy includes both short and long-term goals within the nursing profession. From a professional standpoint, I am afforded the opportunity to offer input on ways to continuously improve the patient care experience and care delivery. Providing feedback offered directly from patients as well as discussing barriers I experience as a prescriber, including but not limited to coordination with other members of the care team or barriers within technology, will be at the forefront. Openly discussing setbacks provides the opportunity to brainstorm improvements, ultimately improving patient care outcomes.

            Personal commitments to the nursing profession and patient advocacy include the accountability to remaining current within my knowledge of medications and therapies available to treat the mental health population. The formal education provided within the Doctor of Nursing practice (DNP) program provides the structure and skills needed to employ within professional practice. These skills ensuring that the DNP is seeking out and utilizing quality, evidence-based measures to treat patients with interventions supported by adequate science and research (American Association of Colleges of Nursing, 2006). Networking with other mental health professionals both within the nursing field and in other capacities will also expand and enact my commitment to patient advocacy and social change. Learning from other professionals, hearing their perspectives on current events, and in exchange offering my perspective will offer a broad view of treatment approaches and current topics (Hann et al., 2020).

The Doctor of Nursing as a Social Change Agent

            As a DNP, I would like to employ my skills as a social change agent by engaging in educational opportunities within the mental health community, driven by research opportunities. Engaging in the research that guides evidence-based practices improves outcomes for the millions of patients impacted by care delivery and would exercise the practice-based research skills formed in DNP education (Iwama et al., 2023). Utilizing the terminal DNP degree to its utmost while continuing to engage in patient care would combine the aspects I found most rewarding of my MSN-PMHNP career and the completion of the DNP program. Advocating for improved treatment measures within the mental health community, as well as for increased access to appropriate care and diagnostic assessments, are all ways in which I would like to engage in DNP research opportunities. Providing education, facts, and data related to how patients are impacted by lack of access to specialized psychiatric care due to barriers such as telehealth restrictions and lack of full practice authority for nurse practitioners will continue to increase awareness of these topics and lobby for change. The DNP offers specialized insight into these topics as a professional working not only for but within the field, and holds significant weight when discussing these topics with both other professionals as well as non-professionals. 

References

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Hann, K., Heather Pearson, Campbell, D., Sesay, D., & Eaton, J. (2020). Factors for success in mental health advocacy. Global Health Action, 8(0), 1–9. https://doi.org/10.3402/gha.v8.28791

Iwama, K., Travis, A., Nowlin, S., Souffront, K., Finlayson, C., Gorbenko, K., & Cohen, B. (2023). Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research. Nursing Outlook, 71(5). https://doi.org/10.1016/j.outlook.2023.102031In the nursing profession, advocating for our patients is something that is deeply ingrained in us.  One of the five key areas of the social determinants of health is access to healthcare (Centers for Disease Control and Prevention, 2021).  Unfortunately, approximately one in ten patients do not have health insurance (Berchick et al., 2018).  In the field of mental health, we often see patients who are too disorganized to navigate the health insurance system and experience lapses in insurance.  In Massachusetts, we are required to abide by the Expedited Psychiatric Inpatient Admissions (EPIA) Policy, which mandates that “no individual boarding in an ED waiting placement in a psychiatric hospital will wait more than 96 hours before Department of Mental Health has been notified, regardless of whether the individual is uninsured or has coverage not regulated by Division of Insurance” (Executive Office of Health and Human Services, 2023).  The pressure to decompress emergency rooms and move psychiatric patients out as quickly as possible means that we often receive patients who are uninsured.  In order to help our patients get the services they need, nurses and social workers assist our patients in taking the necessary steps to obtain health insurance.  This often means lengthy phone wait times on phone calls, but as advocates, we do what is necessary to ensure positive outcomes for our patients.   

                                                                     Advocacy in my Community

As an agent of positive change, I will advocate at the community level for residents who suffer from mental illness.  In spite of the “growing recognition of the burden associated with mental illnesses and the availability of cost-effective treatments, they are not yet afforded the same policy or program priority as comparably disabling physical conditions” (Stuart, 2017).  I aim to increase access to mental health services by expanding my organization’s service lines to include outpatient services for mental health and substance use disorders.  In order to gain buy-in from the community, I plan to attend town meetings to advocate for increased services as well as partnering with local Emergency Departments to educate them about the mental health services that my organization offers.  I plan to seek meetings with local politicians to advocate that resources be invested into increasing services for mental health and substance use disorder services. 

                                                                     Advocacy in my Profession

            According to a recent survey conducted by the American Psychiatric Nurses Association (APNA), “only 4% of licensed registered nurses (RNs) work in psychiatric-mental health, If that percentage is still consistent, then there are approximately 154,000 RNs working in psychiatric-mental health, which is not nearly enough to meet the demand” (APNA, 2018).  As a doctorally prepared nurse, it is critical that I take steps now to increase the number of nurses who specialize in mental health.  I aim to do this on the local level by partnering with local nursing schools to invite them into my organization for their psychiatric clinical rotations.  Additionally, I will attend local universities’ career fairs so that I can provide information to nursing students about the advantages of working in the field of mental health.

                                                                          Advocacy and Social Change

As a doctorally prepared nurse, I aim to help close the gaps in the inequities of access in the field of mental health.  To do so, I must first identify opportunities to advocate for my own patients by assisting them in obtaining health insurance so that they are able to have access to outpatient services.  At the community level, I aim to increase access to mental health services by expanding my organization’s service lines to include more outpatient services for psychiatry and substance use disorders.  With regard to the profession of nursing, specifically psychiatric nursing, it is imperative that I identify ways to increase interest for newly graduated RNs to join the field by promoting the field at local nursing schools.  By acting as an advocate on all three levels, I will be able to effect positive social change in the field of psychiatric nursing.

                                                                                   References

American Psychiatric Nurses Association. (2018). Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey. https://journals.sagepub.com/doi/abs/10.1177/1078390318777873?journalCode=japa

Berchick, E.R., Hood, E., & Barnett, J.C. (2018). Health Insurance Coverage in the United States: 2017. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdfLinks to an external site. [PDF – 1.4 MB]

Centers for Disease Control and Prevention. (2021). Social determinants of health: Know what affects health. https://www.cdc.gov/socialdeterminants/index.htmLinks to an external site.

Executive Office of Health and Human Services. (2023). Expedited Psychiatric Inpatient Admissions (EPIA) Policy. https://www.mass.gov/info-details/expedited-psychiatric-inpatient-admissions-epia-policyLinks to an external site.

Stuart, H. (2017). Reducing the Stigma of Mental Illness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314742/

2. 

 My personal and professional commitment to advocacy includes both short and long-term goals within the nursing profession. From a professional standpoint, I am afforded the opportunity to offer input on ways to continuously improve the patient care experience and care delivery. Providing feedback offered directly from patients as well as discussing barriers I experience as a prescriber, including but not limited to coordination with other members of the care team or barriers within technology, will be at the forefront. Openly discussing setbacks provides the opportunity to brainstorm improvements, ultimately improving patient care outcomes.

            Personal commitments to the nursing profession and patient advocacy include the accountability to remaining current within my knowledge of medications and therapies available to treat the mental health population. The formal education provided within the Doctor of Nursing practice (DNP) program provides the structure and skills needed to employ within professional practice. These skills ensuring that the DNP is seeking out and utilizing quality, evidence-based measures to treat patients with interventions supported by adequate science and research (American Association of Colleges of Nursing, 2006). Networking with other mental health professionals both within the nursing field and in other capacities will also expand and enact my commitment to patient advocacy and social change. Learning from other professionals, hearing their perspectives on current events, and in exchange offering my perspective will offer a broad view of treatment approaches and current topics (Hann et al., 2020).

The Doctor of Nursing as a Social Change Agent

            As a DNP, I would like to employ my skills as a social change agent by engaging in educational opportunities within the mental health community, driven by research opportunities. Engaging in the research that guides evidence-based practices improves outcomes for the millions of patients impacted by care delivery and would exercise the practice-based research skills formed in DNP education (Iwama et al., 2023). Utilizing the terminal DNP degree to its utmost while continuing to engage in patient care would combine the aspects I found most rewarding of my MSN-PMHNP career and the completion of the DNP program. Advocating for improved treatment measures within the mental health community, as well as for increased access to appropriate care and diagnostic assessments, are all ways in which I would like to engage in DNP research opportunities. Providing education, facts, and data related to how patients are impacted by lack of access to specialized psychiatric care due to barriers such as telehealth restrictions and lack of full practice authority for nurse practitioners will continue to increase awareness of these topics and lobby for change. The DNP offers specialized insight into these topics as a professional working not only for but within the field, and holds significant weight when discussing these topics with both other professionals as well as non-professionals. 

References

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Hann, K., Heather Pearson, Campbell, D., Sesay, D., & Eaton, J. (2020). Factors for success in mental health advocacy. Global Health Action, 8(0), 1–9. https://doi.org/10.3402/gha.v8.28791

Iwama, K., Travis, A., Nowlin, S., Souffront, K., Finlayson, C., Gorbenko, K., & Cohen, B. (2023). Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research. Nursing Outlook, 71(5). https://doi.org/10.1016/j.outlook.2023.102031

mental health

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Rasmussen University – Mental Health Care Plan

A. Patient identifiers:

Age: Gender: Ht: Wt. Code Status:

Isolation:

Development Stage (Erikson): Give the stage and rationale for your evaluation

Health Status

Date of admission:

Activity level: Diet:

Fall risk (indicate reason)

Client’s description of health status

Allergies: (include type of reaction)

Reason for admission:

Past medical history that relates to admission:

Socio-cultural Orientation

Cultural and Ethnic Background with current practices:

Socialization:

Family system: (Support system)

Spiritual:

Occupation: (across the lifespan)

Patterns of living: (define past and current)

Barriers to independent living:

Healthcare systems elements (continued) ALLERGIES:

Medications: List all medications, dosages, classifications and the rational for the medications prescribed for this patient include major considerations for administration and the possible negative outcomes associated with this medication.

DEFINE 1: What the medications Mechanism of Action AND 2: Why the patient is taking the medication?

Medication Classification Dosage Rationale Possible negative outcomes

Psychiatric Diagnosis and DSM 5 Diagnostic Criteria

History of Present Psychiatric Illness

(Presenting signs & symptoms/ Previous Psychiatric Admission / Outpatient Mental Health Services)

CON
CEPT MAP

Pathophysiology – (to the cellular level)

Medical Diagnosis

Clinical Manifestations (all data subjective and objective: labs, radiology, all diagnostic studies) (What symptoms does your client present with?)

Complications

Treatment (Medical, medications, intervention and supportive)

Risk Factors (chemical, environmental, psychological, physiological and genetic)

Nursing Diagnosis

Problem statement: (NANDA)

Related to: (What is happening in the body to cause the issue?)

Manifested by: (Specific symptoms)

General Appearance

Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane)
Basic Grooming and Hygiene (clean, disheveled and whether it is appropriate attire for the weather)

Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest),
posture (slouched, erect),
any noticeable mannerisms or gestures

Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise)

Manner and Approach

Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness)

Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing).
Coping and stress tolerance.

Speech (normal rate and volume, pressured, slow, loud, quiet, impoverished)

Expressive Language (no problems expressing self, circumstantial and tangential responses, difficulties finding words, echolalia, mumbling)

Receptive Language (normal, able to comprehend questions,

Orientation, Alertness, and Thought Process

Recall and Memory (recalls recent and past events in their personal history).
Recalls three words (e.g., Cadillac, zebra, and purple)
Orientation (person, place, time, presidents, your name)

Alertness (sleepy, alert, dull and uninterested, highly distractible)
Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)

Concentration and Attention (naming the days of the week or months of the year in reverse order, spelling the word “world”, their own last name, or the ABC's backwards)

Thought Processes (loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization).
Values and belief system

Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications)

Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong)

Mood and Affect

Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry).
Affect or how they felt at a given moment (comments can include range of emotions such as broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation.

Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset)
Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful, pessimistic, optimistic)

Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected)
Impulsivity (poor, effected by substance use)
Anxiety (note level of anxiety, any behaviors that indicated anxiety, ways they handled it)

Lab

Range

Value

Reason Obtained

Risk Assessment:

Suicidal and Homicidal Ideation

(ideation but no plan or intent, clear/unclear plan but no intent) Self-Injurious Behavior (cutting, burning) Hypersexual, Elopement, Non-adherence to treatment

Discharge Plans and Instruction: Placement, outpatient treatment, partial hospitalization, sober living, board and care, shelter, long term care facility, 12 step program

Teaching Assessment and Client / Family Education:

(Disease process, medication, coping, relaxation, diet, exercise, hygiene) Include barriers to learning and preferred learning styles

NRS DX:

Problem Statement:

R/T: (What is the cause of the symptom?)

Manifested by: (specific symptoms)

Short term goal: Create a SMART goal that relates to hospital stay.

Long term goal: Create a SMART goal that is appropriate for discharge.

This is specific to the patient that you are caring for. A list of planned actions that will assist the patient to achieve the desired goal. (i.e. obtain foods that the patient can eat/ likes)

Identify what the patients response or “outcome is to the goal or care that you have provided. i.e. patient ate 45% of lunch)

Was it met or not met there is no partially met.

References:

Role of the outcomes in evaluating Practice Change

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Please see the attachment for the  instructions

Nursing telehealth assignment

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Describe trends in telehealth and its impact on nursing practice and patient care.

Requires a minimum of two references: 

1) one from a peer-reviewed NURSING journal (less than five years old) and 

2) one from the course textbook.

Additional peer-reviewed journal articles and professional, governmental, or educational organizations websites (.org, .gov, or .edu) may be used as supplemental references. 

The maximum number of references is three.  

deductive

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Module 03 Content

1.

Top of Form

You are a Training Specialist hired by Universal Medical Supplies, Inc. This organization has been experiencing low productivity and errors in communication in the workplace. As part of an ongoing professional development series, the Vice President of the Human Resources department has tasked you with creating Critical Thinking training materials. The materials will be presented in many forms and by various means to help improve productivity and communication in the organization.

For a short training presentation during a regional meeting, you have been asked to create a 3- to 5-minute video presentation illustrating the differences between deductive and inductive argument.

Instructions

Use PowerPoint and a video recording program such as Screencast-O-Matic to create a training video that is 3-5 minutes in length and includes the following elements:

· Bullet points with brief text that outlines deductive reasoning.

· Bullet points with brief text that outlines inductive reasoning.

· Clip art or images to accompany your text. You may use characters, cartoons, drawing tools, or other technologies to be creative.

· Narration related to the bullet points to explain:

· The principles underlying both deductive and inductive reasoning.

· Clear examples of both deductive and inductive reasoning in a workplace setting.

· References to your sources at the end of the video.

Your PowerPoint

Slide 1) Title slide 

Slides 2-3) Deductive reasoning. You’ll want to provide an example or two. Talk about the value of deduction and why it’s useful. 

Slides 4-5) Inductive reasoning. Again, provide an example or two. Discuss the value of induction and how it is used. 

Slide 6) References. Yes, they count.

Bottom of Form

DP for brilliant

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1

Week 6 Discussion Forum

A theoretical framework provides a rationale for predictions about the relationship
among variables. Discuss the variables you will use in your change project and the
specific steps that are necessary to implement your change project in your
organization.

  • Week 6 Discussion Forum

Nutritional Principles in Nursing

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Module 04 Content

1.

Top of Form

Create an outline of your project (1 page). The outline should only contain topic headings and a brief description of what it will cover. See the link below for an APA formatted outline. Remember that your outline will be a guide as you write your paper to keep you on topic and organized.

Required paragraph topics include but are not limited to: the role nutrition plays in the prevention of the disease, etiology, progression, treatment, recommended diets, nursing assessment, nursing interventions, client education, and adherence. Please use library resources to find out more about Nursing Assessment, Interventions, and Client Education.