“Mrs. Walsh, a woman in her 70s, was in critical condition after repeat coronary artery bypass graft (CABG) surgery. Her family lived nearby when Mrs. Walsh had her first CABG surgery. They had moved out of town but returned to our institution, where the first surgery had been performed successfully. Mrs. Walsh remained critically ill and unstable for several weeks before her death. Her family was very anxious because of Mrs. Walsh’s unstable and deteriorating condition, and a family member was always with her 24 hours a day for the first few weeks.
The nurse became involved with this family while Mrs. Walsh was still in surgery, because family members were very anxious that the procedure was taking longer than it had the first time and made repeated calls to the critical care unit to ask about the patient. The nurse met with the family and offered to go into the operating room to talk with the cardiac surgeon to better inform the family of their mother’s status.
One of the helpful things the nurse did to assist this family was to establish a consistent group of nurses to work with Mrs. Walsh, so that family members could establish trust and feel more confident about the care their mother was receiving. This eventually enabled family members to leave the hospital for intervals to get some rest. The nurse related that this was a family whose members were affluent, educated, and well informed, and that they came in prepared with lists of questions. A consistent group of nurses who were familiar with Mrs. Walsh’s particular situation helped both family members and nurses to be more satisfied and less anxious. The family developed a close relationship with the three nurses who consistently cared for Mrs. Walsh and shared with them details about Mrs. Walsh and her life.
The nurse related that there was a tradition in this particular critical care unit not to involve family members in care. She broke that tradition when she responded to the son’s and the daughter’s helpless feelings by teaching them some simple things that they could do for their mother. They learned to give some basic care, such as bathing her. The nurse acknowledged that involving family members in direct patient care with a critically ill patient is complex and requires knowledge and sensitivity. She believes that a developmental process is involved when nurses learn to work with families.
She noted that after a nurse has lots of experience and feels very comfortable with highly technical skills, it becomes okay for family members to be in the room when care is provided. She pointed out that direct observation by anxious family members can be disconcerting to those who are insecure with their skills when family members ask things like, “Why are you doing this? Nurse ‘So and So’ does it differently.” She commented that nurses learn to be flexible and to reset priorities. They should be able to let some things wait that do not need to be done right away to give the family some time with the patient. One of the things that the nurse did to coordinate care was to meet with the family to see what times worked best for them; then she posted family time on the patient’s activity schedule outside her cubicle to communicate the plan to others involved in Mrs. Walsh’s care.
When Mrs. Walsh died, the son and daughter wanted to participate in preparing her body. This had never been done in this unit, but after checking to see that there was no policy forbidding it, the nurse invited them to participate. They turned down the lights, closed the doors, and put music on; the nurse, the patient’s daughter, and the patient’s son all cried together while they prepared Mrs. Walsh to be taken to the morgue. The nurse took care of all intravenous lines and tubes while the children bathed her. The nurse provided evidence of how finely tuned her skill of involvement was with this family when she explained that she felt uncomfortable at first because she thought that the son and daughter should be sharing this time alone with their mother. Then she realized that they really wanted her to be there with them. This situation taught her that families of critically ill patients need care as well. The nurse explained that this was a paradigm case that motivated her to move into a CNS role, with expansion of her sphere of influence from her patients during her shift to other shifts, other patients and their families, and other disciplines”
Critical thinking activities
1. Discuss the clinical narrative provided here using the unfolding case study format to promote situated learning of clinical reasoning (Benner, Hooper-Kyriakidis, & Stannard, 2011).
2. Regarding the various aspects of the case as they unfold over time, consider questions that encourage thinking, increase understanding, and promote dialogue, such as: What are your concerns in this situation? What aspects stand out as salient? What would you say to the family at given points in time? How would you respond to your nursing colleagues who may question your inclusion of the family in care?
3. Using Benner’s approach, describe the five levels of competency and identify the characteristic intentions and meanings inherent at each level of practice.

Assess the culture of the organization for potential challenges in incorporating the nursing practice intervention. Use this assessment when creating a strategic plan.

Write a 150-250 word strategic plan defining how the nursing practice intervention will be implemented in the capstone project change proposal.

APA style is not required, but solid academic writing is expected.

Assignment 1: Practicum – Assessing Client Family Progress (Due in Week 8)

Learning Objectives

Students will:

• Create progress notes
• Create privileged notes
• Justify the inclusion or exclusion of information in progress and privileged notes
• Evaluate preceptor notes

To prepare:

• Reflect on the client family you selected for the Week 3 Practicum Assignment.

Assignment

Part 1: Progress Note

Using the client family from your Week 3 Practicum Assignment, address in a progress note (without violating HIPAA regulations) the following:

• Treatment modality used and efficacy of approach
• Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the treatment plan for progress toward goals)
• Modification(s) of the treatment plan that were made based on progress/lack of progress
• Clinical impressions regarding diagnosis and or symptoms
• Relevant psychosocial information or changes from original assessment (e.g., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job)
• Safety issues
• Clinical emergencies/actions taken
• Medications used by the patient, even if the nurse psychotherapist was not the one prescribing them
• Treatment compliance/lack of compliance
• Clinical consultations
• Collaboration with other professionals (e.g., phone consultations with physicians, psychiatrists, marriage/family therapists)
• The therapist’s recommendations, including whether the client agreed to the recommendations
• Referrals made/reasons for making referrals
• Termination/issues that are relevant to the termination process (e.g., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)
• Issues related to consent and/or informed consent for treatment
• Information concerning child abuse and/or elder or dependent adult abuse, including documentation as to where the abuse was reported
• Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

Part 2: Privileged Note

Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment.

In your progress note, address the following:

• Include items that you would not typically include in a note as part of the clinical record.
• Explain why the items you included in the privileged note would not be included in the client family’s progress note.
• Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

Watch the following YouTube interview with mathematician and Nobel prize winner John Nash Jr. and his son, both diagnosed with schizophrenia.  Answer the questions below regarding John Nash Jr.’s son. Link to the video below

• Considering the history provided and what you can observe in the video, what symptoms of schizophrenia, positive and negative, does Johnny Nash have? 
• What medications would be prescribed for Johnny Nash, and why?
• Discuss the etiology of schizophrenia.  How does it apply to John and Johnny Nash’s case? 

Description:

This Assignment provides an overview of how to evaluate evidence-based practice quality improvement in a practice change.

Directions:

1. Introduce an overview of a healthcare system practice guideline, preferably where you work or have worked.
2. Discuss how different professionals in the healthcare system (Nurses, Pharmacists, Technicians, Nurse Educators, CFO, etc.) are held to this guideline.
3. Identify the research/reference used by the system to adopt the guideline.
4. Define the evidence used to define the guideline.
5. Determine the level of evidence used in the EBP identified.
6. Provide an opinion on how well this guideline is followed by professionals in the system.
7. Conclude with a concise overview of the guideline and the discussion in the paper.
8. Write the paper in 8–10 pages, using APA format.

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 (under the Course Resources) to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors; and

Your writing Assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and;
• use APA 6th edition format

https://www.youtube.com/watch?v=iZHJjf9oYZk&feature=youtu.be

 As an advanced registered nurse, you will serve as a leader within your organization. Part of this role will entail being a change agent, and spurring positive change on behalf of patients, colleagues, and the industry.

Consider a situation you experienced previously where change did not go as planned in your health care organization. Create a 10-15-slide PowerPoint presentation in which you will assess the situation and the steps that should have been taken to successfully implement change.

1. Describe the background of the situation, including the rationale for and goal(s) of the change.
2. Identify the key interprofessional stakeholders (both internal and external) that should be involved in change efforts.
3. Discuss an appropriate change theory or model that could be used to achieve results.
4. Outline how you would initiate the change.
5. Describe the impact to the organization if the change initiative is unsuccessful again, and potential steps the interprofessional team could take if the change is unsuccessful.

Make sure to include slide notes of 100-250 words for each slide.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

There’re two worksheets attached below, for the first one all questions need to be answered, for the second one only questions that are highlighted in red color need to be answered. 

Instructions

Develop: Persuasive Speech Outline

Evaluation Title: Persuasive Speech Outline Final and Reflection

Using the persuasive outline created for the Unit 6 discussion, review the instructor and/or peer feedback to finalize the persuasive speech outline for submission. Consider this feedback to address your challenges and revise. Revisions are a key step in the speech writing process. Be sure to take this step.

The outline should be written in the full-sentence outline method using one of the persuasive organizational patterns (Problem-Solution, Cause-Effect or Monroe’s Motivated Sequence). The outline should have enough content to deliver an 8-10 minute persuasive speech, which you will complete in Unit 7. Once again, please use the sample outline document (attached here) to help build your formal outline.

Step 1:  Finalize the Persuasive Outline

The outline should include the following:

• Specific Purpose
• Central Idea (aka:  Thesis Statement or Preview Statement)
• Introduction – capture attention, establish YOUR speaker credibility, preview the speech
• Body – key points (minimum of 3), transitions between main points, supporting materials from at least 3 sources including in-text references to the sources.
• Conclusion – signal the end, summarize main points
• Researched supporting material references (minimum 3) – include works cited at the end of your outline, use APA format.
• Identification of a presentation aid (visual)
• Use persuasive techniques and language

Step 2:  Complete the Reflection Questions

Answer the following reflection questions, in addition to the finalized persuasive speech outline. You can include the answers at the end of your works cited:

1. What types of persuasion did you choose to include? Why? How would they best persuade your target audience?
2. What challenges did you have crafting our outline? How did you overcome them?
3. What do you think is the strength of this outline? Why?

Review the grading rubric before submission. This assignment is valued at 85 points.

Submit to the appropriate submission area in Canvas:

• The finalized persuasive speech outline as an attached document
• Answers to reflection questions on the outline document OR in the submission comments area

 Using the information discussed in class for how to create an outline, please read the attached document titled “Is the American Dream Over?” and create an outline of it.

https://www.washingtonexaminer.com/cal-thomas-is-the-american-dream-over