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 Criteria:

ü  Lawrence’s levels and stages of moral development 

ü  Periods of life 

Real world example  

Read Chapter 5

1. Describe the organizational characteristics of the facility in which you currently have a clinical assignment. Include the following:

a. Type of organization

b. Overall climate of the facility 

c. How the organization is structured 

d. Formal and informal goals and processes of the organization 

2. Why is the work climate of an organization important to nurse leaders and managers?

3. What are the ways in which a nurse can enhance his or her expertise?

4. Explain “shared governance,” and describe how it can affect the power structure of a health-care organization. 

5. Why is it important for staff nurses to understand the culture and real goals of the organization in which they work? 

1. Describe your ideal organization. Explain each feature and why you think it is important.

2. Interview one of the staff nurses on your unit. Find out what practices within the organization help to empower the nurses. Compare this list of practices with those discussed in the textbook. 

3. Recall the last time you walked into a hospital, clinic, or physician’s office for the first time. What was your first impression? Did you feel comfortable and welcome? Why or why not? If you could change the first impression this facility makes, what would you do?

4-What changes could be made at a very low cost? What changes would be expensive? Finally, discuss why it is important for a health-care facility to make a good first impression

Learning to manage stress for good health

 This is the ongoing project discussion portion of this class. My population is geriatric/elderly. The problem is BP…

I will attach previous discussions because it all needs to tie in together

350 words

at least 3 references cited in the discussion.

must be last 5 years

Overview: Dr. Marcia Stanhope (2020) explained that evidence-based public health practice refers to those decisions made by using the best available evidence, data and information systems and program frameworks; engaging community stakeholders in the decision-making process; evaluating the results; and then disseminating that information to those who can use the information.

Practicum Discussion: This week, your assignment will be to incorporate all of the information you have gathered from the community—including the population itself, health data, interviews/conversations with interested community members, and your community assessment, including your Windshield Survey—as well as what you have gathered from scholarly literature to propose measureable interventions. Measureable interventions mean that the results can be measured through some data that could be collected (Stanhope, 2020). This requires thinking in terms of actions and then measuring results. An evaluation of interventions is important to see whether or not they are effective in solving a health care problem. Remember, you will need to use the data you gathered to determine whether or not a problem exists in your community and to then determine whether your interventions might be effective.

Please discuss the following points in your Practicum Discussion:

• Identify one evidence-based behavior change that would promote health in your selected population.
• Suggest one specific culturally sensitive, evidence-based, measureable intervention to address the health problem for your selected population.
• Think in terms of measuring outcomes. What outcomes would you expect to see once the intervention(s) are in place? Be specific.

By Day 4

Post your response to this Discussion.

Support your response with references from the professional nursing literature.

GOAL of PRACTICUM PROJECT

Overall Purpose for Practicum: Develop a potential project to improve the health of a specific population of interest or a population at risk.

This practicum is designed to help you develop as a scholar practitioner and health leader to promote positive social change in your own community. In this practicum experience you will focus on primary prevention of a health problem in your community (see text for definition.)  You already possess the knowledge and skills to help those who are acutely ill. This experience will help learn how to prevent a health problem in a specific population at risk at the community and system level of care (see text for definition). Consequently, because you are well aware of how to care for individuals you will now develop leadership and advocacy skills to improve the health of the community.  Collaborating with other professionals and community members in your community will be the key to a successful practicum and project. Collaborate with each other in the discussions, with your instructor, with health care professionals (nurses and other disciplines), with local and state departments of health, and most importantly with the population you hope to help. As an advocate, you will promote positive social change through collaboration with families, communities, and professionals in the health care system. You will develop a culturally relevant proposal that could improve health outcomes for a specific population at risk in your community. 

WK 1

I live in a small community located in northwest metropolitan Atlanta, Georgia. The population as of 2019, was 21,760 people. The breakdown of the population is 31% under the age of 18, 14.9% 65 years or older, 51.2% are women. 73% White, 20.8% Black/African American, 12.7% Latino/Hispanic. I am currently practicing at a privately owned hospice company where we provide services to adult patients in their homes and facilities in North Georgia.

Race is a major social determinant of health. African Americans have a higher rate of significant health problems and functional limitations.  Economic resources are also a social determinant of health. As poverty increases, mortality rates increase. Economic resources are also needed to provide basic needs such as housing and food, and is required to obtain health care and medications. Social isolation and loneliness also are social determinants that have profound effects, especially during the COVID 19 pandemic.

As a hospice nurse, the majority of my patients are the geriatric population and the population at risk I am choosing to focus on for this project. The most prevalent health problems include heart disease, respiratory diseases, stroke, cancer, diabetes, and dementia.  Depression is also a problem that occurs, leading to increased suicide rates of the geriatric patient. Injuries or death related to falls is a perpetual problem in the elderly. Malnutrition is widespread and seen in nearly every older patient, which is related to access to food, decreased physical ability to shop, cook, or eat. Malnutrition could also happen due to other comorbid conditions that the senior has such as dementia.

References

U.S. Census Bureau QuickFacts: Cartersville city, Georgia. (n.d.). Www.Census.Gov. Retrieved September 7, 2020, from https://www.census.gov/quickfacts/cartersvillecitygeorgia

Equity and Social Determinants of Health Among Older Adults | American Society on Aging. (n.d.). Www.Asaging.Org. Retrieved September 7, 2020, from https://www.asaging.org/blog/equity-and-social-determinants-health-among-older-adults#:~:text=Race%20long%20has%20been%20known%20to%20be%20a

10 common elderly health issues – Vital Record. (2018, June 25). Vital Record. https://vitalrecord.tamhsc.edu/10-common-elderly-health-issues/

WK2

According to the CDC (FastStats – Hypertension, 2019), 63.1% of adults age 60 and over have high blood pressure, which is three times higher than adults aged 20-44. Georgia ranks #33rd in the nation.  (Explore High Blood Pressure in the United States | 2019 Annual Report, n.d.). High blood pressure is one of the leading risk factors in heart attack and stroke.

As a person ages, the size of the liver decreases, and the blood flow is reduced, which reduces how quickly the liver metabolizes medication. Kidney size is reduced, and blood flow is less, resulting in low renal clearance (Beers Criteria: Some Medications to Avoid in the Elderly, 2012). Because of these physiological changes, controlling blood pressure in geriatric patients can be challenging. Cognitive impairments due to age-related dementia can result in medication noncompliance and not being able to recognize symptoms of hyper/hypotension. Physical limitations result in difficulty going to regular doctor appointments, regular physical activity, and not being able to cook a healthy heart diet, all leading to uncontrolled blood pressure.

The geriatric patient needs to be closely monitored due to drug sensitivity. Because of increased sensitivity to medication, orthostatic hypotension is a significant concern for the elderly population. Orthostatic hypotension can result in falls, syncope, or death. (Arik & Yavuz, 2014)

In looking for information for this discussion, I utilized Google Scholar for my search engine. I found much of my statistics through CDC website.

References

ARIK, G., & YAVUZ, B. B. (2014). Hypertension in Older Adults-Geriatrician Point of View. Journal of Gerontology & Geriatric Research, 03(05). https://doi.org/10.4172/2167-7182.1000182

Beers Criteria: Some Medications to Avoid in the Elderly. (2012). Tmc.Edu. https://www.uth.tmc.edu/HGEC/GemsAndPearls/medications_BeersCriteria.html

Explore High Blood Pressure in the United States | 2019 Annual Report. (n.d.). America’s Health Rankings. Retrieved September 13, 2020, from https://www.americashealthrankings.org/explore/annual/measure/Hypertension

FastStats – Hypertension. (2019). https://www.cdc.gov/nchs/fastats/hypertension.htm

WK3

We all know the top risk factors for getting or becoming more severely ill from Covid-19 include age, heart disease, or diabetes. Surprisingly, there may be a genetic link to being more susceptible or getting more severely sick from Covid-19 according to researchers. (Willingham, 2020).  Researches have recently tied the severity and susceptibility of COVID-19 to two genetic links associated with a person’s immune system. One is a persons blood type, the other is a gene that regulates chemokines (Willingham, 2020). Researchers warn that this genetic knowledge is not 100% and does not factor in the social and economic inequalities that increase risk of susceptibility and severity, rather it reveals information about the disease susceptibility which may help identify therapeutic drugs to target those biological pathways and lead the way to a cure for the entire populations, not just those with specific genes (Willingham, 2020).  Chromosome 3 hold genes that encode chemokines to attract immune cells and proteins that interact with our gatekeeper into cells, angiotensin-converting enzyme 2, also known as ACE2 (Willingham, 2020).  On chromosome 9 lies DNA that determines a person’s blood type.  Compared with other blood types, type A are at a higher risk of getting Covid-19 and have a 1.5 times higher risk of respiratory failure and those with type O had the lowest chance of all blood types for getting Covid-19 or experiencing respiratory failure (Willingham, 2020). 

By 2050 the population of adults 65 and older is expected to be 83.7 million, almost double the population in 2012 (Journal of the American Geriatrics Society). The minority population of older adults is expected to rise from 20.7% in 2012 to 39.1% in 2050 with the largest increase in Asian, Native Hawaiian, and other Pacific Islander populations , and the Hispanic population over 65 will have doubled (Journal of the American Geriatrics Society).  This means that our elderly care will also have to be ethnically diverse, culturally sensitive, and unbiased.

Culturally sensitive interventions that would be top priority would be asking the patient their preferred language and offering interpreter service in that language for any education (Journal of the American Geriatrics Society, 2016).  This is important with any education but can be lifesaving for Covid-19 prevention education. It is equally important to know the patient’s education level, cognition, and hearing to ensure understanding as well as knowing if they have a surrogate or who all will be involved in decision making (Journal of the American Geriatrics Society, 2016).  Customizing care to and individual’s cultural and language preferences will result in a more positive health outcome for this diverse population (Journal of the American Geriatrics Society, 2016).

Achieving High-Quality Multicultural Geriatric Care. (2016). Journal of the American Geriatrics Society, 64(2), 255-260.  https://doi.org/10.1111/jgs.13924

Willingham, E. (2020). Genes May Influence Covid-19 Risk, New Studies Hint.  Scientific America. Retrieved from: https://www.scientificamerican.com/article/genes-may-influence-covid-19-risk-new-studies-hint/#:~:text=Combing%20through%20the%20genome%2C%20researchers,2%20coronavirus%20into%20our%20cells

1. Is the type of design used appropriate? Your rationale?

2. What are the threats to internal and external validity

3. Is the design appropriately linked to the evidence hierarchy?

• PowerPoint Presentation Template.

Note: Review the PowerPoint Presentation Template available through the Walden Writing Center (http://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-2774362). While this template provides a general outline that may be used to help inform your presentation, you are urged to use individual creativity in the development of your presentation to the hospital administrator.

To complete the assessment, read the following instructions. Then, create a 12-to-15 slide presentation (excluding the cover and reference slide) that presents performance comparisons of two healthcare facilities.

Scenario:

The administrator for your healthcare organization is asking nurse leaders to understand how quality of care is measured as well as determine what each nurse can do to make an impact on areas that need improvement in healthcare organizations. Each nurse leader is asked to gather pertinent data from two organizations and to compare this data to assess performance. State and national averages should be identified when using the benchmark data from the Compare sites and should be used to compile a presentation to the hospital administrator.

In response to your administrator’s request, you will brainstorm and create a presentation that will highlight performance comparisons for two healthcare organizations. Note, you should compare two of the same healthcare organization type (example: if you select a hospital, you will need to select an additional hospital for the comparison; if you select a home health agency, you will need to select an additional home health agency for the comparison).

Be sure to base the information for your presentation on your clinical experience. Review the data from the Compare sites and brainstorm on what the data may be highlighting and indicating relative to each healthcare organization’s performance. Your presentation should contain the following sections:

1. Cover slide with name and title (1 slide)
2. Identify and describe any potential factors that may account for differences in performance measures. (2-3 slides)
3. Explain how these differences in performance measures might impact nursing practice. (2-3 slides)
4. Describe the publicly reported data on the quality and safety of care for TWO of the following organizations. Select hospitals, nursing homes, OR home health agencies, and describe the data listed under the organizations in your comparison: (6 slides)
   1. Hospitals
      (Choose one of the following to compare two hospitals)
      1. Patient Survey Results
      2. Timely and Effective Care
      3. Readmissions, Complications, and Deaths
      4. Linking Quality to Payment
      5. Medicare Volume
   2. Nursing Homes
      (Choose one of the following to compare two nursing homes)
      1. Overall Rating
      2. Health Inspections
      3. Staffing
      4. Quality Measures
   3. Home Health Agencies
      (Choose one of the following to compare two home health agencies)
      1. Quality of Patient Care
      2. Patient Survey Results
5. Provide recommendations that are supported by the research literature for clinical decisions systems that may potentially explain why the healthcare organizations are performing well, including an explanation of what you, as a nurse leader might continue doing to sustain a high level of performance OR why the healthcare organizations are not meeting standards, including an explanation of what you, as a nurse leader might do to help reach standards in the selected healthcare organizations. Be sure to cite at least 3 scholarly resources to support your recommendations. (2-3 slides)
6. Reference slide that cites all resources consulted and used to support the development of your presentation (1 slide)

 “Veterans Nearing the End of Life: Distinct Needs, Specialized Care 

1 page at least 1 reference

reply1

The impact of evidence-based practice (EBP) in health care cannot be overemphasized. It is has been endorsed in research and practice as a method that obtains the highest level of care for patients, reduces the cost of health care, reduces medical errors and injuries, and encourages individual and professional advancement for nurses and other health professionals because it encourages research and educational progression. Consequently, the Institute of Medicine (IOM) recognizes the fact that achieving a safe and quality-driven healthcare system in the United States by the year 2020 would require that 90% of clinical decisions must be supported by accurate, timely, and up-to-date clinical information, that will reflect the best evidence in clinical practice literature (Institute of Medicine, 2009). This is the concept of evidence-based practice.

However, according to HealthyPeople.gov, the United States is very far away at reaching this goal, at approximately 15%. Research has identified a number of individual and organizational obstacles limiting nursing practice from achieving this goal (e. g. Mahmoud and Abdelrasol, 2019; Solomons and Spross, 2011). These obstacles include inadequate time to read literature, intense workload, shortage of staff qualified in EBP, and shortage of nursing faculties to inculcate the knowledge of EBP in nurses. The shortage in the supply of nursing faculties is one significant barrier that is holding nursing practice from achieving the EBP goal. Nurses need to be trained in EBP, but the numbers of nursing instructors or faculties are limited due to inadequate remuneration. To address this obstacle, more nurses should be encouraged to seek educational advancements to the level of a PhD and their salaries must be reviewed upward.

In addition to shortages in nursing faculties, shortage of the number of staff qualified in EBP is another barrier that might be holding nursing practice from achieving the EBP goal of 90% evidence-based practice by 2020. When there are no adequate nursing faculties to instill the knowledge of EBP in nurses, and when there is lack of funds for motivated nurses to pursue advance degrees, then it will be difficult to achieve the EBP goal, To address this obstacle, more funding should be made available for well motivated nurses in the form of loans, grants, scholarships, fellowships.

                                                                                       References

Institute of Medicine. (2009). Roundtable on Evidence-Based Medicine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK52847/

Matmoud, M. H., & Abdelrasol, M. (2019). Obstacles in Employing Evidence-Based Practice by Nurses in their Clinical Settings: A Descriptive Study. Frontiers of Nursing, 6(2); pp. 123-133.

Solomons, N. M., & Spross, J. A. (2011). Evidence-Based Practice Barriers and Facilitators from a Continuous Quality Improvement Perspective: An Integrative Review. Journal of Nursing Management, 19: 109-120

reply2

By using evidence-based practice (EBP), nurses are providing safe, quality patient care. Although all health care professionals would prefer using the latest, updated EBP for their practice, understanding and staying up-to-date on all the emerging EBP is impossible. According to Whitney (2018), nurses play a primary role in transforming how the health care system works for the community. Nurses need to take the time out of their work schedule and personal time to stay updated on the EBP which applies to their practice. This requires a lot of time and energy from the nurse and not all nurses have ample time to look into new research and EBP for their own scope of practice. Another issue for EBP practice to reach 90% is that the working environment is already fast paced for all nursing and changes that need to be made need to help the nurse stay efficient while providing safe patient care. If these changes are not fully understood by the administration implementing these changes, then the staffing runs into issues trying to adapt to the new changes based off EBP. The changes need to happen in proper steps so that the organization and the staff working directly for the organization are able to make the transition smooth and reliable for themselves and their patients.

References

Whitney, S. (2018). The future of nursing in an evolving health care system. In GCU’s (Eds.), Trends in health care: A nursing perspective. Retrieved from: https://lc.gcumedia.com/nrs440vn/trends-in-health-care-a-nursing-perspective/v1.1/#/home