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This is another student post to which i have to react adding some extra information related this post. 

short answers. 

Whistleblowing bad behavior or risky situations is a fact that requires great courage since the person puts ethics and good behavior first before the organization and its relationship with the people involved in bad procedures. In fact, according to Miceli et al (1991), people who are more committed to work are more likely to whistleblowing, than people who feel less committed to work.

However, in order to whistleblowing this type of situation, it is necessary to avoid groupthink, since there is a risk that the appropriate decisions will not be made due to pressure from the colleagues themselves, or that they think that the complaining nurse is being unfair or is betraying the organization or the workgroup, it can also happen that if someone in the group was the one who committed the wrong procedure, this person would begin to victimize himself to avoid being reported. For these reasons, it is better to make the decision alone and present the necessary evidence that evidences the situation before the organization or an external regulatory body. (Miceli et al, 1991)

Whistleblowing can create an ethical dilemma that sometimes makes people think about the pros and cons before deciding whether or not to blow the whistle. The main pro of these situations is that whistleblowing the poor performance or fraudulent acts is doing the right thing, and therefore the person can feel good about himself when making the right decision since he is seeking to protect patients and improve the quality of the health service provided. Another point in favor is that legal protection is offered to those who blow this type of activity and it is possible to get to the bottom of the matter with the help of the necessary entities in the event that it is a fraudulent act. (Anvari et al. 2019)

As for the cons, the main factor that affects these decisions is that it can affect the work environment, both with the organization and with co-workers. In some cases, if the evidence of the complaint is not sufficient, the nurse can even lose her or his job. Another very important factor is that it usually produces high levels of stress and anxiety, since it is not known how the situation will be resolved, generating uncertainty in the complainant (McDonald & Ahern, 2000).

In case a nurse comes across a situation that she or he thinks should whistle blow, she or he should initially remain calm and think through whether there really is a problem, if there really is, the nurse should take into account the possible results of whistleblowing such a problem. In case the nurse wants to consult with her or his colleagues, you should avoid groupthink because as mentioned before, this type of thinking tends to complicate the situation. It is important to follow the chain of command to make this type of complaint, and if it is not resolved with the supervisors of the organization, go to external entities (McDonald & Ahern, 2000).

It is essential to know the rights that protect whistleblowers and consider that to obtain protection it is better to contact a state or national regulator. When the case is presented either before the organization or with another external organization, it is important to present only the evidence and leave it to others to interpret the situation, for this reason, it is important to document each step that was taken to carry out the complaint.

References:

Anvari, F., Wenzel, M., Woodyatt, L., & Haslam, S. A. (2019). The social psychology of whistleblowing: An integrated model. Organizational Psychology Review, 9(1), 41–67.

McDonald, S., & Ahern, K. (2000). The professional consequences of whistleblowing by nurses. Journal of Professional Nursing, 16(6), 313-321.

Miceli, M. P., Near, J. P., Schwenk, C. R. (1991). Who blows the whistle and why? Industrial & Labor Relations Review, 45, 113–130. doi:10.1177/001979399104500108

 I NEED A RESPONSE FOR THIS ASSIGNMENT

2 REFERENCES

Group Therapy with Older Adults

Psychotherapy, according to Wheeler (2014), can be used to treat varying psychological disorders throughout the lifespan of an individual. In general, psychotherapy must be adapted to address and fit the specific needs of the age groups. Researches have indicated in older group therapy that one can socialize with peers who share similar symptoms. It also creates an opportunity to increase one’s altruism and empathy and feel useful by helping others (Tavares & Barbosa, 2018). However, the elderly often may have neurological deficits and comorbidities that may affect their ability to fully participate and benefit from psychotherapy (Wheeler, 2014). Studies indicated that some of these older adults live in isolation and have lost their relationships, occupation, and capacity. Group therapy allows them to connect to people and be useful while receiving help (Wheeler, 2014). The discussion will include a description of a group therapy session with older adults, the group’s stage, any issues or resistances present, therapeutic modalities utilized, and challenges resulting from working with the group.

Group Description

This group includes ten members whose ages range from 64 to 80, including females and males, each with different diagnoses such as depression, sleep disorders, anxiety disorders, personality disorders, alcohol, drug use disorders, and neurocognitive disorders. Some of the patients were hyperactive, while some were depressed. Currently, the group comprises patients in different stages, such as forming, storming, norming, performing, and adjourning. The orientation stage still ongoing as new members joins the group while some are in their terminal adjourning phase. This group did not follow the predictable pattern of the average group staging. However, the patients introduce their names, ages, professions, and family backgrounds. The group went back and forth, elaborating on more background aspects of individual lives. Individuals were encouraged to share as much as they feel comfortable sharing. The group ran for 60 minutes, from 1030 to 1130 in the morning. It is modified to bring the best out of the patients. The therapy session time was divided and organized to allow note-taking, summarization, memory aids, and mnemonics devices to help in their recovery (Tavares & Barbosa, 2018).

Resistance or Issues Present

The cohesiveness of the group met a few resistances. One group member, a 70-years-old male, did comment on the newness of therapy. His comment was: “back in the day; people did not meet with each other to talk about everyday life hurdles; we dealt with it, that is what is expected of us as men.” I had a 65-year-old female who said she is not crazy and should not be in the group; this was her second day. She laughs, smiles, and shakes her head when others are speaking. She moved her chair further away from how the chairs were spaced-out due to the coronavirus pandemic. 

The compilation of both hyperactive and depressed patients made it often difficult for every patient to participate and achieve their expected goal at the same time. Some patients were hyperactive, intrusive, and monopolizing. They tried to control everything and respond to every question asked, which sometimes increased anxiety and tension to other group patients. While depressed and quiet, patients feel irritated, intimidating, and sad. 

Therapeutic Techniques

Cognitive-behavioral therapy (CBT) is a practical approach for a wide range of problems affecting older adults (Secker et al., 2020). As a therapeutic approach in group therapy sessions, CBT has proven to be beneficial to the elderly. It helps them build an interpersonal relationship with others, improve socializing skills, improve the symptoms of depression, and help manage stressful life events (Tavares & Barbosa, 2018). CBT aims to have the patients and the counselor in agreement on markers of progress in therapy. Domhardt and Baumeister (2018) stated that the CBT coping strategy helps the patient identify negative thoughts and replace more functional views. CBT equips the patients with internal resources and enhances their coping skills (Wheeler, 2014). In this manner, the individual’s symptoms reduce, and behaviors change as they learn to control their feelings.

Challenges

I encountered different challenges in conducting therapy with the age group. There was an issue with the seat arrangement; because of COVID-19, the patients were spaced six fits apart to maintain social distance. With some of the patients being intrusive and exhibiting poor boundary behavior, it became difficult to keep the space. Some patients had physical declines that affected therapy, some with cognitive impairment, hearing impairment, and decreased eyesight. Thus, requiring the facilitator to speak more slowly, louder and to explain more clearly. To accommodate those with low vision, I had to provide large print worksheets for the patients. Some patients remained in the forming and storming stages for a prolonged period due to their cognitive state. The group dynamic also affected this group outcome due to new admissions and discharges, which hinder the group’s progress.

No matter what population of people being counseled, it is necessary to recognize the challenges they face and change practices accordingly. CBT is feasible and highly effective in geriatric patients. Early diagnosis, good access to psychotherapy, and early intervention could improve care for older patients.

References

Domhardt, M., & Baumeister, H. (2018). Psychotherapy of adjustment disorders: current state and future directions. The World Journal of Biological Psychiatry, 19(sup1), S21-S35.

Hummel, J., Weisbrod, C., Boesch, L., Himpler, K., Hauer, K., Hautzinger, M., … & Dutzi, I. (2017). AIDE–acute illness and depression in elderly patients. Cognitive-behavioral group psychotherapy in geriatric patients with comorbid depression: A randomized, controlled trial. Journal of the American Medical Directors Association, 18(4), 341-349.

Secker, D. L., Kazantzis, N., & Pachana, N. A. (2020). Cognitive behavior therapy for older adults: Practical guidelines for adapting therapy structure. Journal of rational-emotive and cognitive-behavior therapy, 22(2), 93-109.

Tavares, L. R., & Barbosa, M. R. (2018). Efficacy of group psychotherapy for geriatric depression: A systematic review. Archives of gerontology and geriatrics, 78, 71-80.

Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

please follow the instructions attached 

Create a pamphlet using your choice of publishing software to educate the staff for which you are the nurse leader. The pamphlet must cover a current patient safety issue.

Examples include:

• Teaching aging adults to care for themselves at home
• Teaching patients about the possible implications of polypharmacy and providing the skills to avoid self-medication errors
• Other appropriate safety issues such as workplace safety

If you have a question about a specific topic, check with your instructor.

Your pamphlet must include the following items:

1. At least five tips describing preventive care for the patient
2. Information that should be shared with family or caregivers
3. Local resources in the community that might be available for this type of safety concern
4. At least three references published in the last five years; APA format must be used

Complete only the History, Physical Exam, and Assessment sections of the Aquifer virtual case: Family Medicine 27: 17-year-old male with groin pain.

Discussion Question 1

Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.

Discussion Question 2

Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.

Discussion Question 3

Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.

Discussion Question 4

Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.

Discussion Question 5

Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.

Health care delivery and clinical systems

Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

Learning Resources

Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 7, “Patient Concerns, Choices and Clinical Judgement in Evidence-Based Practice” (pp. 219–232)

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
Note: You will access this article from the Walden Library databases.

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
Note: You will access this article from the Walden Library databases.

Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483
Note: You will access this article from the Walden Library databases.

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x
Note: You will access this article from the Walden Library databases.

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

i sent you the old assign via word document

• Identify a disaster scenario, outline the disaster preparedness steps that should be used, and relate them to the nursing process.

  Based on the readings, viewing the online materials & resources on the Module 4: Lecture Materials & Resources page, and your own experience, what strategies would you recommend encouraging culturally competent care of Native Americans? 

Read and watch the lecture resources & materials below early in the week to help you respond to the discussion questions and to complete your assignment(s).

(Note: The citations below are provided for your research convenience. Students should always cross reference the current APA guide for correct styling of citations and references in their academic work.)

Read

Ritter, L.A., Graham, D.H. (2017). Multicultural Health (2nd ed.). Burlington, MA: Jones and Bartlett Learning.
ISBN: 9781284021028
Chapter 8

 Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. 

CASE STUDY #2

CHEIF OF COMPLAIN: A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12-day history of a runny nose

SUBJECTIVE: States that her symptoms began about 12 days ago. She suffers from allergies; she gets a runny nose during the spring-time, pollen season. However, in the winter, her allergies are not a problem.

OBJECTIVE  DATA: 

VS: (BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air

GENERAL: No signs of acute distress. Patient appears mildly fatigued. She is breathing through her mouth. Breathing easily. Voice has a nasal quality to it.

HEENT:Ear canals: normal; EYES: normal; NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages

RESPIRATORY : CTA AP&L

NECK/THROAT: Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no cobblestoning

HEART: Regular rate and rhythm, no murmur, S3, or S4

answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.