Clinical Supervision

I NEED A RESPONSE TO THIS ASSIGNMENT 

2 REFERENCES

I agree with the relaxation and breathing methods used to help the patient. You mentioned that the patient is wheelchair-bound and has gained weight. These can be a result of low physical activity and immobilization.  Studies have shown that treatment techniques such as relaxation, massage, and active exercises are used for nominalizing respiration and muscular control and helping the patient to become aware of how the body and mind interact ( Breitve, Hynninen & Kyale 2010).

Looking at the age of your client (65 years), as a middle-aged older adults, the stepped-care approach may be effective for her. According to Meuldijk & Wuthrich (2019), stepped-care models are effective in treating depression and anxiety with this population. The goal of stepped care is to offer the most effective but least resourceful intensive intervention for the patient. The starting step of treatment depends on the severity of the patient’s characteristics, and the patients can be stepped up and down during treatment as needed. Thus, having the right service in the right place, at the right time delivered by the right person is important in treating older adults with both depression and anxiety (Meuldijk & Wuthrich 2019).  

References

Breitve MH, Hynninen MJ, & Kvåle A. (2010). The effect of psychomotor physical therapy on subjective health complaints and psychological symptoms. Physiotherapy Research International15(4), 212–221. https://doi-org.ezp.waldenulibrary.org/10.1002/pri.462

Meuldijk, D., & Wuthrich, V. M. (2019). Stepped‐care treatment of anxiety and depression in older adults: A narrative review. Australian Journal of Rural Health27(4), 275–280. https://doi-org.ezp.waldenulibrary.org/10.1111/ajr.12524

Answer to essay-200 words minimum (OmHDEZ)

Use at least 2 references, not the same. Write an answer based on this assignment.

Question 1

Establishing clear and effective communication in the medical setting has proven essential to provide high-quality medical care and also to ensure greater safety for the patient Communication is one of our best weapons to provide quality patient-centered care. Nurses have to be aware of the barriers to this effective communication as well as the new challenges posed by care adapted to the patient’s culture, which can become more than a problem, but an opportunity to grow in our profession. We have to remember that the purpose of the patient meeting is to provide information and confirm understanding of that information later. One strategy for better understanding is for us to explain the information to you slowly and in small doses, giving patients enough time to process the information. Gently ask the patient what he has understood during the conversation. If the purpose of the interaction is to do health education, include empowering patients to be the main doers in their care, giving them access to all the information about their disease process. Communication involves verbal and nonverbal message, emotional state of involved individuals, and the cultural background that influences message interpretation. Nurses need to observe nonverbal behavior as they communicate with fellow healthcare workers and patients. Most importantly, they should always ensure that their own nonverbal behavior harmonizes with their verbal interactions (Ali, Rahnavard, Salsali, & Negarandeh, 2016). 

Question 2

During patient stay at hospital, they interact with different healthcare workers within the hospital. Efficient clinical practice entails accurate communication of critical information. Lack of effective communication among healthcare professionals puts the patients’ safety at risk. Some of the reasons for this include misinterpretation of critical information, lack of critical information, neglected changes in patients’ condition, and imprecise orders over phone. Medication errors is a common consequence of ineffective communication in a healthcare setting. Such errors can lead to severe harm or unforeseen death of the patient.

Question 3

When congruence the verbal signals are congruent with each other and always congruent with nonverbal ones. When there is congruence between them, communication is clear. A serious context is accompanied by a limited emission of non-verbal signals, while an informal context calls for greater expressiveness. The impact a healthcare professional makes on their colleagues and patients during face-to-face communication is largely accounted by their nonverbal behavior. These first impressions are critical in any communication and include; maintaining eye contact, and maintaining consistent vocal patterns, which can be speaker with more volume and a bit faster, or speaking slower with less volume. Additionally, a nurse must ensure they use vocal pauses strategically in order to enhance an impression of confidence.

Question 4

Electronic communication is widely being utilized in nursing practice. Through the use of electronic records, patient information can be retrieved and distributed precisely and quickly. However, wrong information may be retrieved and distributed leading to miscommunication. Most organizations have information systems that support access to current data, exceptional clinical and research data to enhance evidence-based practice. I believe if e-mail is kept professional, it would be more effective method of communication. Many systems allow for easier sending of emails to everyone within the healthcare facility. In order to use e-mail competently and effectively, it is necessary to have effective writing skills.

Question 5

Good communication skills and having firsthand information is very helpful when discussing patient needs. SBAR is an abbreviation for Situation, Background, Assessment, and Recommendation. In my clinical experience I have seen the use of SBAR utilized to offer a framework for communicating critical patient information in a manner that is systematic and organized. the SBAR method center on the immediate situation so as to allow quicker and safe making of decisions concerning patient care (Simamora & Fathi, 2019).

Question 6

Patient handoffs are very important in ensuring the continuity and safety of patient care. This should support the transition of vital information and continuity of care as well as treatment. Ineffective handoffs lead to undesirable effects and patient safety risks. To successfully communicate patient needs from one nurse to another, the change-of-shift report is highly recommended. The report should address relevant information related to events that transpired, and be handed over to individuals tasked with providing continuity of care. Examples of what to include would be patient information, diagnosis, past medical history, allergies, advances directive, detailed aspects of the patient care and health, including vital signs, pending and critical tests, as well as recommendations that you consider appropriate for the care and safety of the patient.

Question 7

As a nurse I would check the doctor’s order immediately and I would make sure to call the laboratory to request the laboratories and deliver them to the doctor as it should have happened in the first instance. In the same way, I would make sure to speak in private with the doctor and demand respect for my work, which was probably a bit delayed due to circumstances beyond my control, this would be of course after establishing patient safety as a priority.

Question 8

Accountability forms part of delegation whereby a registered member of the staff delegates a task to a given staff member and that member accepts the task. Both the registered member of the staff who has delegated the task and the staff member accepting the task are accountable in making sure that the task delegated is correct and will cause no harm to the patient. Registered practitioners are accountable to regulatory bodies based on principles of practice and patient care. Thus, accountability involves protection of patients, healthcare providers, and employers from the effects of nursing practice that is dreadful, inattentive, and unsafe. Registered nurses have a legal liability to the patients they serve. Activities like HCA, or AP, need to be delegated appropriately (Whitehead, Weiss, & Tappen, 2009).

Question 9

Delegation is a central nursing responsibility, and RN’s are entitled to delegate several tasks. Nurses mostly delegates tasks to LPN’s and UAP. Factors such as; the scope of practice in relation to the task, task complexity and predictability, possibility of any harm, and level of critical thinking needed to do the task must be accounted for before RNs deciding when and what to delegate. The UAPs and LPNs have the ability to practice patient care and assistive tasks (Whitehead, Weiss, & Tappen, 2009). They will be motivated by the fact that they frequently work under the supervision of a registered nurse, hence Dennie and Elias effectively delegate client care tasks and ensure their safety.

Question 10 

Direct delegation involves verbal direction by the RN registered member concerning an activity or task in a particular nursing care scenario. On the other hand, indirect delegation involves an approved outline of tasks or activities that have been instituted in the policies and procedures of a healthcare facility.

1.A Most state nurse practice acts authorize RNs to delegate. The act outlines the legal parameters of nursing practice. The RN is required to assign and delegate tasks while considering the needs and state of patient, possibility of any harm, task complexity, stability of the patient’s condition, delegated staff’s abilities, predictable outcomes, and the context of other patient needs (Whitehead, Weiss, & Tappen, 2009). The decisions regarding delegation and assignment base on the core principles of health safety and wellbeing of the public.

2.A Prioritizing is extremely important, since each situation requires a timely and specific intervention depending on its seriousness, and the patient safety is at stake.

3.A my patients may need help with their personal hygiene and grooming, with their meals and daily maintenance of comfort.

3.B She was very effective and dedicated in carrying out her work when it comes to delegating, always on the basis that the resolution to delegate a task is aimed at improving patient care.

3.C Since responsibility is not delegated, unless is appropiate to do it, the delegated task must be continuously monitored and alerted to any situation, through supervision of the work carried out the nurse preceptor can ensure that the tasks were completed safely and appropiately.

References

Ali, F., Rahnavard, Z., Salsali, M., & Negarandeh, R. (2016). Exploring nurse’s comunicative role in nurse-patient relations: A qualitative study. Journal of Caring Sciences , 5 (4), 267-268.

Simamora, R., & Fathi, A. (2019). The Influence of Training Handover Based SBAR Communication For Improving Patient Safety. Indian Journal of Public Health Research & Development , 10 (9), 1280-1285.

Whitehead, D., Weiss, S., & Tappen, R. (2009). Essentials of Nursing Leadership and Management . FA Davis.

Case Study 3 & 4 .Urinary Obstruction • Irritable Bowel Disease

  • Urinary Obstruction • Irritable Bowel Disease 

 

Case Study 3 & 4 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

 Case Study 3 & 4 S Inflammatory Bowel Disease and Urinary Obstruction 

The answers must be in your own words with reference to journal or book where you found the evidence to your answer. Do not copy paste or use a past students work as all files submitted in this course are registered and saved in turn it in program.

Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted.  

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

All answers to case studies must have reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study

Grief

 discuss the following:

  • Grief: define and describe the physical symptoms, psychological and social responses and its spiritual aspects.
  • Summarize the types of grief.
  • Although death is a universal human experience, please specify culture-specific considerations that exist regarding attitudes toward the loss of a loved one, including age (child or older adult) and cause of death.

Submission Instructions:

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

Advocacy and Cultural Competence

 

Go to the link https://www.thinkculturalhealth.hhs.gov/clas/standards (Links to an external site.).

View the National Culturally and Linguistically Appropriate Services Standards (CLAS) categories aimed at equity and quality care (HHS, n.d.). Notice how these standards overlap with many of the expectations and standards in professional nursing practice!

  • In what ways are you and your peers using these standards in your areas of nursing practice?
  • Discuss one nursing action you might incorporate to improve cultural competence in your organization.

Discussion post

Reply to this discussion post…

An issue in my organization in addressing a solution to evidence based practice is time constraints. he hospital I am employed at has been having problems with nurse retention. There is a high turn over of nurses. This makes it difficult to look into evidence based practice  that are continuing to be introduced within the organization. Lack of enough staff leads high nurse-patient ratio the work load does not allow nurse the time to access the research available. Heavy work loads leads to fatigue, frustration and even resistance to changes. By the end of a long work day the nurses just want to go home relax and prepare to return the next day and start all over again. 

The first step in addressing nurse shortage is hiring and offering competitive compensation packages that will help retain staff. Once this is achieved the organization will increase employee satisfaction and improved patient outcomes.

NUR504-REPLT YO NICOLE

WEEK 6

This week discussion involves a 68 -year-old Caucasian male who complained of burning when urinating.  He admits to the pain increasing with the more he urinates and it has been going on for the past 5 days.  His past medical history includes prostatic hyperplasia, high cholesterol and hypertension. The medications he is prescribes are Olmesartan 20mg and Crestor 20 mg. He has been diagnosed with nocturia and dysuria. The subjective data I would inquire is his diet. How much water does he consumes daily? Was there an odor present when urinating?  Due to your history of UTI’s, are you taking any probiotics as needed and were you prescribed with antibiotics, if so, how long? With his systolic Blood pressure in the 150’s, when is the last time you took the Olmesartan. Did the fever occur before or after the Burning started, and did you take any acetaminophen or Motrin to break it?

             The Labs that I would order is a urine culture with sensitive, CBC, BMP and lipid panel. A kidney, ureter, and bladder (KUB) X-ray may be performed to assess the abdominal area for causes of abdominal pain, or to assess the organs and structures of the urinary and/or gastrointestinal (GI) system. A KUB X-ray may be the first diagnostic procedure used to assess the urinary system.

           A few diagnoses that can relate to the symptoms will include Bladder infection. They are the most common type of urinary tract infection caused by bacteria and can lead to problems like pain in your lower belly and having to pee way more often than usual (Rhoads, 2021). Symptoms may include Pain in the bladder, groin, lower abdomen, or pelvis that can occur during urination or during sexual intercourse.  The body may experience fatigue, fever, or malaise. Chronic Kidney Disease is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke (CDC,2019) CKD can cause Anemia, increased infections, abnormal electrolytes, loss of appetite or depression.

         A Kidney infection (pyelonephritis) is a type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels to one or both of your kidney. Symptoms observed in a kidney infection are Fever, Chills, Back, side (flank) or groin pain, Abdominal pain, Frequent urination, Strong, persistent urge to urinate and Burning sensation or pain when urinating.

                    Furthermore, patient teaching would include increasing intake of water and/or cranberry juice. Fluids can help remove bacteria from your body when you urinate. Kidney scarring can lead to chronic kidney disease, high blood pressure and kidney failure. When the infection remains in the blood, septicemia can occur.  Your kidneys filter waste from your blood and return your filtered blood to the rest of your body.  Urinate as soon as you need to. Avoid delaying urination when you feel the urge to urinate. It is important to empty the bladder after intercourse. Urinating as soon as possible after intercourse helps clear bacteria from the urethra, reducing your risk of infection (CDC, 2019).

References: 

Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System website. https://nccd.cdc.gov/CKD. Accessed January 7, 2019.

Rhoads, J., & Wiggins Petersen, S. (2021). Advanced Health Assessment and Diagnostic Reasoning. Burlington, MA: Jones and Bartlett Learning. ISBN: 9781284105377