Monthly Archives: May 2023

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Leadership Profile

     In their research, Gallup scientists found that people have specific areas where they have a greater potential for finding success, so they should focus on improving their strengths rather than their weaknesses (Rath, 2007). The results from my strength finder assessment showed that my top five themes are strategic, input, belief, empathy, and developer. For the most part, I find these results to be accurate. I am strategic in that I have a very logical way of thinking, and can adapt my thoughts to different situations (Rath, 2007). My second strength was the theme of input, and this is accurate in that I am inquisitive and am always seeking new information (Rath, 2007). I find that the belief theme is a very accurate strength because I have strong beliefs that guide my life and give it meaning (Rath, 2007). I also have a great deal of empathy, as many nurses do (Rath, 2007). Lastly, the developer theme fits me because I can always find and see potential in others (Rath, 2007). While I found these results accurate, they were not exactly what I anticipated or would have applied to myself. I hope to take advantage of these new insights into my strengths and build on them to become a strong leader.

Core Values

     Leaders must be grounded in a set of core values that guide their behaviors and leadership style and ensure they have the best interests of their coworkers at heart; otherwise, there is no real and effective leadership (Marshall & Broome, 2017). With that in mind, I need to identify my core values and work on strengthening them. I need to work on becoming more candid. I am often so concerned with others’ feelings that it holds me back from being frank and sharing my opinion. A leader must possess this ability, as leaders often have difficult situations with those under them, and must be candid. However, this must be offset with a certain amount of grace and kindness to ensure one does not come off as being overly harsh or rude. A second core value that I feel I could strengthen would be optimism. I have always been a very optimistic person, but over the years of being a nurse have become less so. Optimism is a value that is essential for a leader. It is essential to be optimistic to encourage those who are under you and keep their spirits high.

Strengths

     In Tom Rath’s book, he explains 34 themes leaders might possess where they are exceptionally talented (2007). The command theme is an area that I need to work on improving (Rath, 2007). An effective leader needs to be able to take command. I can do this, but I am more than happy to sit back and let others take charge. I do not like to impose my ideas on others. If it is warranted, I can take command, but it is my instinct to give others the chance to do so first. While I do not want to be pushy, I do need to work on strengthening my ability to take command. Another theme in which I would like to improve upon is the theme of being deliberative (Rath, 2007). Typically, I make decisions quickly and move on them without overthinking the situation. While this can be good, I do believe that as a leader, I need to work on weighing all the options and being more deliberate in my decisions.

Characteristics

     A nurse leader’s characteristics not only affect those they lead but can also influence patient outcomes as well (Adams et al., 2018). This is just another reason why I must work on improving both my strengths and my weaknesses to become the best leader I can be. A leader must have a high level of self-esteem, or those who follow them will have a more difficult time believing in them. I could most definitely work on improving my self-esteem as a leader. Leadership is not a role I fall into naturally, so it is easy to second guess myself. I need to have more confidence in myself as a leader to ensure that others can place their confidence in me. Another characteristic I could strengthen is my engagement. A leader must be engaged to encourage those under them to want to become engaged. This is an area where I could improve upon, as I am not always the most engaged.

Conclusion

 A leader must determine their strengths and their weaknesses so that they can play to their strengths and work on strengthening their weaknesses. In preparation for becoming a nurse leader, this is necessary for me to do. The strength finder assessment found my strongest themes to be strategic, input, belief, empathy, and developer. This offered me a new insight into my strengths and identified areas for me to grow. Two fundamental core values I would like to strengthen are my candor and optimism. Two strength themes I would like to work on improving are command and deliberative. Two characteristics that I believe would make me a better leader if I strengthened are my self-esteem and engagement. Improving upon these strengths will not only make me a better leader but a better person.  

References

Adams, J., Djukic, M., Gregas, M., & Fyrey, A.-K. (2018). Influence of nurse leader practice characteristics on patient outcomes: Results from a multi-state study. Nursing Economics, 36(6). https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=5&sid=8b99c48f-0f7d-4659-8209-df1a23be25df%40sdc-v-sessmgr03

Marshall, E., & Broome, M. E. (Eds.). (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). Springer Publishing Company.

Rath, T. (2007). Strengthsfinder 2.0 (1st ed.). Gallup Press.

For this Assignment, you will work with a patient with a gastrointestinal condition that you examined during the last three weeks. You will complete your second Episodic/Focused Note Template Form for this course where you will gather patient information, relevant diagnostic and treatment information, and reflect on health promotion and disease prevention in light of patient factors, such as age, ethnic group, PMH, socioeconomic, cultural background, etc. In this week’s Learning Resources, please review the Focused Note resources for guidance on writing Focused Notes.

Note: All Focused Notes must be signed, and each page must be initialed by your preceptor. When you submit your Focused Notes, you should include the complete Focused Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your Focused Notes using SAFE ASSIGN.

Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

To prepare:

• Use the Episodic/Focused Note Template found in the Learning Resources for this week to complete this Assignment.
• Select a patient that you examined during the last three weeks based on any gastrointestinal conditions. With this patient in mind, address the following in a Focused Note:

Assignment:

• Subjective: What details did the patient provide regarding her personal and medical history?
• Objective: What observations did you make during the physical assessment?
• Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
• Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
• Reflection notes: What would you do differently in a similar patient evaluation?

Note: Your Focused Note Assignment must be signed by Day 7 of Week 6.

For this assignment you will be given a case study about a young lady named Sarah Smith. Review the information provided and answer the questions following. Be sure to cite your references. Look at Sarah as if she is a patient in your office seeking care. What are your immediate concerns? What needs to be done for her? Be thorough and succinct in your responses.

Case Study:

Sarah Smith is a 28 y/o African American female who presents to the office with c/o wound to her left foot for the past few days. States she had tripped and fell while barefoot scraping the top of her foot on the pavement. She denies any other injury from the incident. Over the past 24 hours the wound has had “smelly” drainage. Has been experiencing generalized achiness, but denies fever and chills. Did not seek medical attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she takes her medications when she remembers, and does not always check her blood sugar.

PMHx:

Asthma: no hospitalizations for exacerbation.

DM II

PSHx:

Denies

SHx:

Former tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 years

ETOH: socially

Illicit drugs: denies

FHx:

Significant for paternal DM, otherwise unremarkable

Medications:

Metformin: 500mg BID po – did not take the last few days

Albuterol MDI: 2 puffs every 6 hours prn – last use just PTA

Singulair: 10mg po daily

Trinessa: 1 tab po daily – last taken this am

Allergies:

PCN: hives

LNMP: 2 weeks ago.

G0p0

ROS:

General: denies any weight changes, fatigue or fever; + body aches

Skin: denies any rashes; + wound to left foot

HEENT: denies headache, head injury, dizziness, lightheadedness;

            Denies any vision changes

            Denies any hearing changes, tinnitus, vertigo, earache

            Denies any nasal congestion, discharge, nose bleeds or sinus tenderness

            Denies any sore throat, difficulty swallowing

Neck: denies any swollen glands, pain

Breasts: denies any pain, discharge

Respiratory: denies any dyspnea; positive cough and wheezing

CV: denies any chest pain, edema

GI: denies any nausea/vomiting/diarrhea/constipation; denies bloody stools

PV: denies claudication, swelling to LE

GU: denies frequency, urgency, burning;

            Denies vaginal discharge, itching, sores

            Denies penile discharge, itching or sores

MS: positive pain to left foot

Psych: denies nervousness, depression

Neuro: denies Headache, dizziness, vertigo, syncope, weakness; + numbness to right LE

Heme: denies any easy bruising

Physical Exam:

Vital signs: 100.5 (tympanic), 162/88, 118, 22, O2 sat 95% on RA

                        Height: 5’5”     Weight: 250 lbs.

            Blood glucose: 230 (Fasting; states has not eaten yet today)

patient awake, alert, oriented x 4 in NAD

Skin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and purulent drng; + surrounding erythema extending up 7 cm proximally

HEENT: head nontraumatic, normocephalic

Pupils PERRLA, EOMs intact; disc margins sharp, without hemorrhages, exudates; no AV nicking noted

Ears: bilateral TM with good cone of light and intact

Nose: mucosa pink, septum midline; no sinus tenderness appreciated

Mouth: mucosa pink, moist; tongue midline; tonsils 1+ without exudate

Neck: supple; trachea midline; no LAD

Resp: regular and unlabored; lungs with end expiratory wheezing throughout

CV: RRR, S1 and S2 noted; no s3, s4 or murmur appreciated

Abdomen: soft, non-distended; Bs + x 4; no tenderness with palpation; no CVA tenderness with percussion

Genitalia: deferred

Rectal: deferred

Extremities: warm and without edema; calves supple, non-tender

PV: no LE edema

MS: + swelling to left foot; + tenderness of 2-4th left metatarsals; + left pedal pulse; CMS intact; Cap refill < 2 sec.

Neuro: alert, cooperative; thought coherent; oriented x 4; cranial nerves II-XII intact

Questions:

1. List your differentials for her current problems. Remember you should have at least three different differentials for each problem. Include rationale for each differential.

2. At this time what medical diagnoses are you most concerned about? Do they impact other diagnoses? If so, how?

3. What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out?

4. What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each.

5. What is your comprehensive plan of care? Include your rationales.

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

Assignment:

Complete ALL of the bullet points below:

Compare and contrast each of the three questions related to Managed Care Organizations, Medicare, and Medicaid with one another and explain how they were similar and different to each other.

• Managed care organizations emphasize physicians’ responsibilities      to control patient access to expensive hospitalization and specialty care,      a principle dubbed “gatekeeping.” Some argue that      “gatekeeping” is unethical because it introduces financial      factors into treatment decisions. Others say it improves quality by      promoting the use of the most appropriate levels of care.
• Medicare is an area that often gets overlooked and is      seen as a burden financially. Discuss alternatives to ease the drain on      Medicare resources.
• Medicaid is shouldering an ever-increasing burden of      cost for long-term care for the elderly, with enormous impacts on state      budgets throughout the nation. Discuss alternatives to ease this drain on      Medicaid resources.

Please submit one APA formatted table, (minimum 750 words) that highlights the above content make sure to include a title and reference page. The assignment should have a minimum of two (2) scholarly sources, in addition to the textbook.

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

   An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.
 

In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the mplications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

• Explain why you think the patient presented the symptoms described.
• Identify the genes that may be associated with the development of the disease.
• Explain the process of immunosuppression and the effect it has on body systems.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.

 Complete the two financial health activities (The True Cost of a New Car and  The True Cost of Credit Card Use) presented in Unit 7 Topic “Financial Health” related to spending money you do not have.

• Share your experience with “The True Cost of a New Car” activity with your peers
  • Change the size of the loan, years to pay it back, and the interest rate three (3) to four (4) times.
    • Start with the lowest loan amount you might need for your new care and increase by $5000 to $10000 each turn.
    • Start with a 3% loan (entered as .03) and increase by one (1) or two (2) percent each turn.
    • In each case choose between 5 and 7 years to pay it back.
  • Describe one of the monthly payments you would have to make based on your selections.
    • Loan amount?
    • Interest rate?
    • Years to pay it back?
    • Monthly payment?
    • Total car cost?
  • Discuss the potential impact a car payment of that size might have on your monthly budget.
    • Describe the other monthly expenses you would have to remove or reduce to make your payments.
    • Why Is or isn’t the car worth the sacrifices you might have to make given the size of the monthly payments?
  • What other options do you have to avoid taking out a car loan?
• Share your experience with ” The True Cost of Credit Card Use” activity with your peers
  • Consider the following scenario:
    • You spend an extra $50 a month using a credit card for the first year after graduation to make ends meet.
    • The interest rate charged by the credit card company is 18%.
    • The minimum payment you are required to send each month is $20.
  • Now consider the real cost of that $50 dollars a month by the end of that first year provided to you in the exercise.
    • How might the continued use of a credit card to fund an extra $50 of spending per month affect your long-term financial health?
    • Describe two ways you could avoid the long-term consequences of spending more than you have on a regular basis.

Please be sure to validate your opinions and ideas with citations and references in APA format.

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course. 
• Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
• Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
• Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

• The full citation of each peer-reviewed article in APA format.
• A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
• A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
• A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
• A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

Part I: Confidentiality and Patient’s Rights

In your opinion. 

• Why do you think that confidentiality is such an important part of patient rights? Give an example, either professional or personal, which illustrates why this right is so important to protect. 

 Part II: Using Ethical Frameworks to Make Decisions

Apply what you know.

The readings provide an overview of two ethical frameworks to use in decision-making in the healthcare setting. Let’s unpack the ethical dilemma(s) presented in the emerging genre of real-time hospital dramas. In one of the first episodes of a real-time hospital drama, a wife allegedly initially found out about her husband’s death when she watched an episode of a real-time hospital drama in which his death was televised. Although his face was blurred out, his wife was able to recognize him in the episode.

Let’s look at an episode of a real-time hospital drama. You can choose any episode that you wish, below is just a sample of one. Episodes can be found in many areas including Hulu and Amazon Prime.

• Television Series: Boston Med. (2010). Season 1 Episode 08. (Summary) (Links to an external site.) (Transcripts) (Links to an external site.)

I’ll guide us through our questions. We will discuss the questions as a group, starting with the first question:

1. Decide with your classmates what are the ethical dilemmas presented in this type of series? Consider in your answer the initial episode where the man’s death was allegedly televised. 
2. Discuss who are the stakeholders? Remember to consider individuals, families, communities, and organizations in your answer. 
3. Come to a consensus on what your recommendations would be to address the ethical dilemmas that you, as a class, have identified. Consider and include each applicable component below in your response: 
   • Ethical principles
   • Ethical theories
   • PYTHON principle
   • Six step process (Doherty & Purtilo) for ethical decision-making
   • Laws pertaining to confidentiality and/or patient rights

Incorporate health outcomes of the health promotion, detection of disease and disease prevention.  Organize an interdisciplinary plan of care for your client and the delivery of safe and effective care. Choose a patient, a gender, a medical condition and a situation of patient condition and their disease process and apply standards that are evidenced based which help support for the protection of your client.  

Incorporate concepts from Care of the Aging weekly powerpoints and the book-Gerontological Nursing and Healthy Aging (Toughy & Jett, 2018).

Paper should be 3 pages not including title and reference page.  

Paper should follow APA guidelines with a minimum of 5 references within 5 year span.sic