Category: Nursing

• Briefly describe moral distress and moral residue. In your particular health care setting how do individuals experience moral distress and moral residue? Have you? Discuss at least three examples. Include how these relate to autonomy and justice.
• Have you noticed healthcare professionals ignoring these concepts at work or failing to report their concerns to the appropriate person? What strategies combat moral distress and residue for health providers?
• Health information management present new ethics challenges for healthcare professionals. For example, computers allow people to be anonymous and forget about ethics. Using the information in Chapter 7, choose an example where one can forget ethics when using a computer. Then, explain how your example violates autonomy, beneficence, nonmaleficence, and justice.
• IBM Watson is touted as being the best thing for medicine in the future. However, it also causes concern and even fear for some individuals. Discuss at least two ethical concerns that physicians have about IBM Watson. Discuss two patient ethics concerns about this technology.
only credible sources from the last 5 years can be used
login for book will be shared with the assigned writer
https://bookshelf.vitalsource.com/reader/books/9781284164664/epubcfi/6/60[%3Bvnd.vst.idref%3Di11_Chapter03]!/4/2[ch3]/4/2/8/2/1:60[oga%2Ccy]
source for book
Celentano, D. D. & Szklo, M. (2019). Gordis Epidemiology (6th ed.). Elsevier Saunders.

demonstrate the application of a nursing theory
to practice, communicate the analysis of and proposed strategies for the use of a theory in nursing practice, and demonstrates logical and creative thinking in the analysis and application of a theory to nursing practice. Review the clinical case and apply your chosen theory to the case. The final paper is to be typed according to APA format and no more than 5 pages in length. The paper should include a title page and reference list; however, these pages are not to be included in the final count.

Qualitative Annotated Bibliography
For this assignment you will continue to review current research from South’s Online Library and provide a critical evaluation on that research through an annotated bibliography. An annotated bibliography is a brief summary and analysis of the journal article reviewed. For more information on annotated bibliographies please visit Purdue’s OWL: Purdue Online Writing Lab
A total of two annotated bibliographies are to be submitted (not to exceed one page each). The articles must come from nursing scholarly literature and may not be older than 5 years since publication. Please note that the articles must be research based and reflect a qualitative methodology (review our reading assignments). Web pages, magazines, textbooks, and other books are not acceptable.
Each annotation must address the following critical elements:
Explanation of the main purpose and scope of the cited work
Brief description of the research conducted
Value and significance of the work (e.g., study’s findings, scope of the research project) as a contribution to the subject under consideration
Possible shortcomings or bias in the work
Conclusions or observations reached by the author
Summary as to why this research lends evidence to support the potential problem identified specific to your role specialization.
My role is a nurse practitioner and I choose central venous catheters for dialysis patients are high-risk for infection opposed to an arterial Venus fistula. Or you can discuss infection.
Below are the reading assignments that discuss qualitative methodology
Quantitative Methods
Quantitative Methods
Quantitative designs can either be descriptive, correlational, quasi-experimental, or experimental. While descriptive studies only describe the variables as they are found, correlational research examines relationships among variables. Experimental research and quasi-experimental research examine causal relationships between variables of interest.
Descriptive Research
Conducted to describe new situations, events or concepts
Conducted without researcher control because subjects are examined as they exist in their natural setting
The outcomes of descriptive research include the description of concepts, identification of relationships and development of hypotheses that provide a basis for future quantitative research
Correlational Research
Conducted to examine relationships among concepts or ideas, such as the relationship between wine consumption and cholesterol level
Involves the systematic investigation of relationship between or among two or more variables
Primary intent is to explain the nature of relationships in the real world, not to determine cause and effect
Correlation is not Causation
Quasi-Experimental Research
Conducted to examine causal relationships or determine the effect of one variable on another
Involves implementing a treatment and examining the effects of this treatment
Quasi-experimental studies differ from experiment studies by the level of control achieved
When studying human behavior, researchers are frequently unable to manipulate or control certain variables or settings
Experimental Research
Objective, systematic, controlled investigation
Tests the effectiveness of various treatments under strictly controlled conditions
Often associated with studies of animals in laboratory settings
Used for the purpose of predicting and controlling phenomena
Causality between the independent and dependent variables is examined under highly controlled conditions
Most powerful quantitative method
Three Things Necessary for Experimental Research
Controlled manipulation of at least one treatment variable (independent or experimental variable)
Exposure of some subjects to the treatment (experimental group) and some not exposed (control group)
Random selection of subjects for the study.
Qualitative research
What are Qualitative Data?
Data in the form of words, language in the form of extended text
Observations of settings and events
Purposes for Collecting Qualitative Data
When only a few cases or events are available (e.g., new disorders, accidents)
The problem has complexities which are not clearly understood To understand context, processes, and events in everyday settings
Preliminary investigation of topic with little previous research Common Styles of Qualitative Methods
Grounded Theory: Researcher attempts to derive theory by using multiple stages of data collection and the refinement and interrelationship of categories of information.
Ethnography: Researcher studies an intact cultural group in a natural setting during a prolonged period of time by collecting, primarily, observational data.
Phenomenology: Human experiences are examined through the detailed descriptions of the people being studied (“lived experience”).
Case Studies: Researcher explores a single entity or case, collects detailed information by using a variety of data collection procedures during a sustained period of time.
Historical Research: Researcher examines events of the past by using letters, newspaper accounts, and individuals who were present at the time.

Barbara Carper’s influence on nursing practice is significant. As all theorists do, she has a perspective through which she views nursing care and practice. Respond to the following in a minimum of 175 words:
Describe Carper’s 4 ways of knowing.
Explain how they are applied in nursing practice.
Cite a practice scenario in which you could or do apply the theory to patient care
then respond to the following posts:
post 1: In the 1970’s Barbara Carper introduced the four patterns of knowing which offer a comprehensive framework that underscores the many sides of nursing practice.
In my nursing practice, these four ways of knowing guide me on a daily bases. I have a hospice patient that is in severe pain and is alert and oriented and refuses high doses of narcotics because of the side effects and the family at bedside requesting and demanding me to administer pain medication. I use empirics to respect my patient wishes. My Jehovah witness patient that refuses blood transfusion according to my Nurse code of Ethics I must respect my patients’ beliefs and religious practices. Personal knowing -is the ability to know my weakness and strength. I am great at assessing wound and staging it but not great at applying the wound vac to wound. Aesthetics is describing the art in nursing and I must say when I just graduated from nursing school, I could not start an IV, today I am the nurse my co-worker call on when they are unable to start an IV,I have developed that skilled over the years.
Embracing these patterns of knowing enables health professionals to uphold the highest standards of professional practice while promoting healing, empathy, and compassion in their interactions with patients.
ncbi.nlm.nih.gov
Carper BA. Fundamental patterns of knowing in nursing
post 2:
rbara Carper proposed four fundamental patterns of knowing in nursing: empirical, ethical, personal, and aesthetic. Empirical knowing involves the scientific understanding gained through observation, experience, and evidence-based practice. Ethical knowing relates to understanding moral principles and values and making decisions based on ethical considerations. Personal knowing refers to the nurse’s self-awareness, intuition, and understanding of the patient as a unique individual. Aesthetic knowing involves appreciating the artistry and subjective elements of nursing care, such as the nurse-patient relationship and the beauty of nursing interventions.
Barbara Carper’s four ways of knowing provide a framework for nurses to understand and approach their practice. With Empirical knowing, a nurse can use tools they have learned through research and apply the scientific knowledge with evidence-based practices to assess, diagnose, and treat patients.
Ethical Knowing, nurses navigate ethical dilemmas by considering moral principles and values in their decision-making process. This involves respecting patient autonomy and advocating for patient’s rights. In personal knowing, nurses must recognize one’s biases, emotions, and experiences, and integrate them into patient care to better understand and meet the individual needs of each patient. Aesthetic knowing also involves recognizing the importance of holistic care, creativity in problem-solving, and the significance of the nurse-patient relationship in promoting healing.
A common scenario where all 4 “knowings” are used is if a patient is noncompliant with their home medications. A nurse could use the empirical data they have collected to educate the patient on the importance of medication compliance. One could give all risks involved and strategies to regain compliance. ethically one can also consider the wants and needs of the patient and respect their decision-making autonomy. One can also refrain from taking the patient’s issues personal. And deliver facts and use logic to provide the best care for the patient as an individual.

Instructions
Approach with nursing holism. In other words, consider what the case individual needs: To achieve optimum wellness; And, develop into an adult with their best outcomes physically, mentally, emotionally, spiritually, occupationally, and more. How might the nurse help the patient preserve, increase, and maximize their health protective factors, while minimizing health inhibiting factors? Remember you are partnering with the patient and/or family. What information do you need to gather from them, or other resources? How do you assure standards of care while maintaining a patient/family centered plan of care? Take into account health promoting and inhibiting factors, as well as cultural, socioeconomic, legal, health care access, etc.. What nurse-patient teaching is indicated? The nursing ADPIE (assessment, diagnosis, plan, intervention, evaluation) model may be helpful in designing your post. The initial post should be about 200-350 words, with APA formatted citations and references. Case Study Blake is 11 years old, the middle child of three kids living with their mom, Faith; Blake’s dad lives in another state. Although they live within an urban city, their home was situated on the outskirts of town, giving it a more rural feel… Blake shared his joy of cats, art, and rock collecting, as well as experimenting with make-up and fancy clothes. In clinic, the family often has spirited conversations, sometimes openly disagreeing with each other’s take on situations, but also demonstrating closeness and care.
Blake has been exploring his gender and sexuality for a few years. He reported feeling both like a boy and non-binary, as well as bisexual, but expressed no desire to change his name or pronouns from those assigned at birth. He described liking make-up, high heels, and dresses. At times, Faith questioned this and Blake would respond adamantly that liking these things did not make him a girl. He is about to start 6th grade, and wants to wear makeup to school, like his sister did at the same age.
However, Blake has indicated no desire for any medical transition or gender-related care at this time. (Paceley, et. al., 2021).

Write a paragraph about an issue regarding medication administration to a specific patient population. You will then find an evidence-based article on this topic from the last five years. Summarize the article and end with a prescribing recommendation. Your initial post must be at least 500 words. You must include a minimum of two references, with one of them being your textbook.

Define community nursing as it relates to nurse practitioner practice. Describe the nurse practitioner’s role in screening and promoting health for people in the community. Support your answer with evidence-based research (At least one high-level scholarly reference in APA from within the last 5 years)

I need two responses to two different Students post for this week’s discussion. The topic for this week’s discussion thread is called client challenges. Each response can be 150 to 200 words reply with at least one scholarly article attached.
STUDENT 1 POST:Cassandra
: Ivona Y
STUDENT POST:
1. Create a scenario depicting an interaction between an NP and a client. Describe the setting and type of encounter. Scenario: Talkative Client
Setting: Primary care clinic.
Encounter: Mr. Johnson, a 45-year-old male client is scheduled for a routine check-up. As the nurse practitioner (NP) enters the examination room, she finds Mr. Johnson already seated and engaged in a lively conversation with the nurse.
1. Describe the client’s challenging behaviors related to the topic assigned.
Mr. Johnson is extremely talkative, dominating the conversation with jokes, stories, questions, and tangents. He interrupts frequently and struggles to stay on topic, making it difficult for the NP to gather necessary information and provide effective and timely care.
1. Examine the potential impact of the client’s behavior on the client-provider relationship.
Mr. Johnson’s talkativeness may lead to frustration and impatience on the part of the NP. The NP may feel overwhelmed or rushed, while Mr. Johnson may perceive the NP as dismissive or uninterested in his concerns, straining the provider-patient relationship.
1. Analyze techniques to enhance communication with the client and address the client’s behavior.
Providing excellent, patient-centered care is the goal for the NP. Research shows, more than 75% of patients prefer a patient-centered approach to communication. Patient-centered care involves prioritizing patients’ perspectives on their treatment, encouraging their active participation in healthcare decisions, and empowering them to take charge of their own well-being. When dealing with talkative patients, it’s crucial to understand the underlying reason for their talkativeness and adjust communication methods accordingly (Noordman et al., 2019). The following techniques can be employed:
1. Setting boundaries: Politely redirecting the conversation back to the relevant topics and setting expectations for the appointment’s duration can help manage Mr. Johnson’s talkativeness.
2. Closed-ended summaries: Using closed-ended summaries, the NP can summarize key points of the discussion in a concise manner to keep the conversation focused. Closed-ended summaries, can help prevent interruptions and keep the conversation on track (Noordman et al., 2019)
3. Empathetic interruptions: When necessary, the NP can interrupt Mr. Johnson with empathy and understanding, gently guiding the conversation back on track.
4. Humor: Using appropriate humor can help diffuse tension and create a more relaxed atmosphere, making it easier for both parties to communicate effectively. Humor can be a helpful strategy to maintain a positive provider-patient relationship (Noordman et al., 2019).
1. Create sample documentation for the encounter.
Chief Complaint: No specific complaint. Routine check-up appointment.
History of present illness: Mr Johnson is a 45 year-old male with no past medical history who presents today for his routine check-up. He is talkative and engaged in conversation upon entering the examination room.
Review of Systems: Limited due to patient’s talkativeness. Patient reports no new symptoms since last visit.
Management Plan: Continue current home prescriptions with no changes. Implement communication strategies to manage patient’s talkativeness during future visits. Patient scheduled for routine follow-up in six months. Reference:
Noordman, J., Post, B., Dartel, A. A. M., Slits, J. M. A., & Olde Hartman, T. C. (2019). Training residents in patient-centred communication and empathy: Evaluation from patients, observers and residents. BMC Medical Education, 19(1), 128. https://doi.org/10.1186/s12909-019-1555-5Links to an external site. STUDENT POST 2: IVONA Y
Argumentative client
46 y. o. F Pt presents for an outpatient visit with URI symptoms of a sore throat, cough, and nasal congestion for 5 days. Pt is Negative for tonsillar exudates, cervical adenopathy, and fever. The NP used the Modified Centor Clinical Prediction Rule for Group A strep infection and has determined the patient has a -1 score. According to the Modified Centor Clinical Prediction Rule for Group A Strep Infection, a score of 0 or -1 points indicates to not test for, nor treat strep (Hollier, 2021). The patient is demanding a prescription for a “Z-Pack” because “It has helped in the past”. When the NP indicates that the patient does not need an antibiotic to treat her symptoms, the patient argues that she needs the “Z-Pack” in order to get getter.
This is a challenging behavior because the patient is convinced that she needs an antibiotic and feels she needs to argue with the provider until she receives the prescription. The argumentative behavior may elicit some providers to just prescribe the antibiotic to please the patient and improve patient satisfaction scores.
The impact on the patient/provider relationship from argumentative patients can be detrimental for both the patient and the provider. The patient can lose trust in their provider thus affecting overall health care. On the provider end, the provider may be tempted to succumb to the patient’s demands due to time constraints or satisfaction scores. It has been shown however, that offering delayed antibiotic prescribing if symptoms worsen can alleviate patient concerns, thus improving satisfaction (Tonazzi, Prenovost, & Scheuermann, 2022).
Communication techniques to use when engaging with an argumentative patient includes allowing the patient to express their opinion by actively listening to them, acknowledging their opinions with restating the opinion, and provide empathy for their concerns. Allowing patients to share their thoughts and providing validation to their concerns, can restore the collaborating patient/provider relationship. Once the collaborating patient/provider relationship is restored, the provider is more likely to have the opportunity to explain evidence-based practices in health care treatment.
Sample documentation in this case might be as follows:
46 y.o F patient presents for an outpatient visit with URI symptoms of a moderate sore throat, mild cough and clear nasal discharge x 5 days. Pt is negative for tonsillar exudates, cervical adenopathy, fever, rash, and nuchal rigidity. The Centor score for GABHS is -1 indicating no treatment or testing. Upon explanation to the patient that antibiotics are not indicated for her symptoms, she persisted antibiotics are needed. Upon allowing the patient to voice her concerns and partnering with her in her health care treatment, the patient became receptive to the explanation of antibiotic resistance and the need for antibiotic stewardship. Additionally, the patient was provided education on viral infection signs and treatment, versus bacterial infection signs and treatment. Delayed antibiotic prescribing is offered to this patient in the event her symptoms worsen indicating bacterial infection. Patient is instructed to call the office in 3-5 days if symptoms worsen or to call sooner if she develops severe fever or cough, purulent mucus, moderate to severe facial pain, nuchal rigidity, rash, swollen lymph nodes, or inability to swallow.
References
Hollier, A. (2021). Clinical Guidelines in Primary Care (Fourth ed.). Lafayette: Advanced Practice Education Associates.
Tonazzi, S., Prenovost, L., & Scheuermann, S. (2022). Delayed antibiotic prescribing to reduce antibiotic use: An urgent care practice change. BMJ Open Quality, 11(1). doi:10.1136/bmjoq-2021-001513

Discussion QuestionCase Study: A 65-year-old woman was just been diagnosed with Stage 3 non-Hodgkin’s lymphoma. She was informed of this diagnosis in her primary care physician’s office. She leaves her physician’s office and goes home to review all of her tests and lab results with her family. She goes home and logs into her PHR. She is only able to pull up a portion of her test results. She calls her physician’s office with this concern. The office staff discussed that she had part of her lab work completed at a lab not connected to the organization, part was completed at the emergency room, and part was completed in the lab that is part of the doctor’s office organization.
The above scenario might be a scenario that you have commonly worked with in clinical practice. For many reasons, patients often receive healthcare from multiple organizations that might have different systems.
As you review this scenario, reflect and answer these questions for this discussion.
What are the pros and cons of the situation in the case study?
What safeguards are included in patient portals and PHRs to help patients and healthcare professionals ensure safety?
Do you agree or disagree with the way that a patient obtains Personal Health Records (PHRs)?
What are challenges for patients that do not have access to all of the PHRs? Remember, only portions of the EHRs are typically included in the PHRs.

My 3 points of focus for change and measuring the outcome after change has been implemented are: Higher patient fall incidents, Increased Medication Errors and Staff Burn out. These are the 3 references that I used:
Annamaraju P., Haddad, L M., Toney-Butler, T J., Nursing Shortage. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/
Ghanbarzehi, N., Heydarikhayat, N., Sabagh, K. (2024). Strategies to prevent medical errors by nursing interns: a qualitative content analysis. BMC Nurs 23, 48 (2024). https://doi.org/10.1186/s12912-024-01726-1
Syed, Sana, (2023) The Impact of Staffing Shortages in Healthcare. Honors Theses. 3691. https://scholarworks.wmich.edu/honors_theses/3691
As a nurse leader, you must be able to access, identify, and describe outcome measures as they relate to safety and quality problems in your organization.
This assessment provides an opportunity to examine existing outcome measures, assess their strategic value, and present your findings to executive leaders in a manner that will help you gain their support. Focus on existing outcome measures and their relationship to the systemic problem you are addressing. For this assessment, you have been asked to draft a summary of existing outcome measures for your organization’s executive team to raise awareness of the problem and the strategic value of existing measures. Explain key quality and safety outcomes.
Determine the strategic value to an organization of specific outcome measures.
Analyze the relationships between a systemic problem in your organization or practice setting and specific quality and safety outcomes.
Determine how specific outcome measures support strategic initiatives related to a quality and safety culture.
Determine how the leadership team would support the implementation and adoption of proposed practice changes affecting specific outcomes.
Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.