This case study documents an ongoing interaction between a wife and her husband who live in a spacious home in a gated community.

When Dan (now 80) and Jane (now 65) began dating more than 15 years ago, both were emotionally charged to begin their lives anew. Well-educated and financially secure, they had a lot in common. Dan was a protestant minister, and Jane’s deceased husband had been a protestant minister. Both had lost their spouses. Jane’s first husband had suffered a catastrophic cerebral aneurysm 2 years earlier. Dan had conducted the funeral service for Jane’s husband. Dan’s wife had died of terminal cancer a little over a year earlier. Dan’s first wife had been a school counselor; Jane was a school teacher. Both had children in college. They shared a love for travel. Dan was retired but continued part-time employment, and Jane planned to continue teaching to qualify for retirement. Both were in great health and had more than adequate health benefits. Within the year they were married. Summer vacations were spent snorkeling in Hawaii, mountain climbing in national parks, and boating with family. After 7 years, Dan experienced major health problems: a quadruple cardiac bypass surgery, followed by surgery for pancreatic cancer. Jane’s plans to continue working were dropped so she could assist Dan to recover and then continue to travel with him and enjoy their remaining time together. Dan did recover—only to begin to exhibit the early signs and symptoms of Alzheimer’s disease. One of the early signs appeared the previous Christmas as they were hanging outdoor lights. To Jane’s dismay, she noted that Dan could not follow the sequential directions she gave him. As time passed, other signs appeared, such as some memory loss and confusion, frequent repeating of favorite phrases, sudden outbursts of anger, and decreased social involvement. Assessments resulted in the diagnosis of early Alzheimer’s disease. Dan was prescribed Aricept, and Jane began to prepare herself to face this new stage of their married life. She read literature about Alzheimer’s disease avidly and organized their home for physical and psychological safety. A kitchen blackboard displayed phone numbers and the daily schedule. Car keys were appropriately stowed. It was noted that she began to savor her time with Dan. Just sitting together with him on the sofa brought gentle expressions to her face. They continued to attend church services and functions but stopped their regular swims at their exercise facility when Dan left the dressing room naked one day. Within the year, Jane’s retired sister and brother-in-law relocated to a home a short walk from Jane’s. Their intent was to be on call to assist Jane in caring for Dan. Dan and Jane’s children did not live nearby so could only assist occasionally. As Dan’s symptoms intensified, a neighbor friend, Helen, began to relieve Jane for a few hours each week. At this time, Jane is still the primary dependent-care agent. She prides herself in mastering a dual shower; she showers Dan in his shower chair first, and then, while she showers, he sits on the nearby toilet seat drying himself. Her girlfriends suggested that this was material for an entertaining home video! Although Jane is cautious in her care for Dan, she often drives a short distance to her neighborhood tennis court for brief games with friends or spends time tending the lovely gardens she and Dan planted. During these times, she locks the house doors and leaves Dan seated in front of the television with a glass of juice. She watches the time and returns home midway through the hour to check on Dan. On one occasion when she forgot to lock the door while she was gardening, Dan made his way to the street, lost his balance, reclined face-first in the flower bed, and was discovered by a neighbor. Jane has given up evenings out and increased her favorite pastime of reading. Her days are filled with assisting Dan in all of his activities of daily living. And, often, her sleep is interrupted by Dan’s wandering throughout their home. At times, when the phone rings, Dan answers and tells callers Jane is not there. Jane, only in the next room, informs him “Dan, I am Jane.” Friends are saddened by Dan’s decline and concerned with the burdens and limitations Jane has assumed as a result of Dan’s dependency.

Critical thinking activities

1. Examine this case study through the dependency cycle model (Fig. 14.3). The outer arrows show a progression through varying stages of dependency. The inner circle represents who can be involved in the dependency cycle. Where are Jane and Dan in this cycle?

2. Using the basic dependent-care system model (Fig. 14.4), assess Dan and Jane. Identify the basic conditioning factors (BCFs) for each. What is the effect of Dan’s BCFs on his self-care agency? Is he able to meet his therapeutic self-care demands? Continue on to diagnose Dan’s self-care deficit and resulting dependent-care deficit. Now assess Jane’s self-care system.

3. Design a nursing system that addresses Jane’s self-care system as she increases her role as dependent-care agent for Dan.

Reply to this discussion post (site sources if applicable)

Independent and dependent variables are essential to any evidence based practice project. An independent variable is something that you can change, or that is controlled in a scientific study. A dependent variable is the variable that is being tested, measured within the study. In my project I discussed decreasing medications errors. The independent variable is mandating staff to scan all administered medications, the dependent variable is the medication error. I would need to collect the amount of medication errors within a quarter or year to be able to compare it to the after change numbers. Knowing the numbers we are starting with will allow us to see if the errors decreased. The independent variable would be the staff administering the medications. This can be measured by reviewing their scan rate data of patients and medications administered. The medication error can also be measured by data that is reported within the computer system. This data will be extremely important in my research to make sure that it was successful, or to see what needs to be adjusted. 

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

You are not required to submit this assignment to LopesWrite.

Select three bills of interest to you. Track the progress of one on the Internet and Do a brief legislative analysis of one of the bills. Document results in journal form. Include contact with your representative in the Illinois General Assembly. 

3.Discuss analysis of bill in class

4. Legislative analysis:

• written clearly, succinctly, using correct grammar, punctuation, sentence structure 

•organized

•includes a summary of the highlights of the bill.

•includes your thoughtful and critical analysis on the content of the bill

1-page discussion, at least 2 in-text references (1 must be from the book, posted in file the book used)…see the file uploaded for the topic questions.

Hi

I need a power point with no more than 20 slides about hematologic disorders in pediatric patient. The disorders are:

Anemia

Iron deficiency anemia

Thalassemia

Hemolityc anemia

Sicklemia

Glucose 6 phospate dehydrogenase deficiency

ITP

Hemophilia A-B

Leukemias

Yuo can chose the 4 to 5 more frequent disorders to develop the PP. Talk about risk factor, cause, symtomps, diagnosis, treatment 

Change Theory and Models for Change Intervention

I selected a behavioral change theory as a framework to guide my practice problem intervention.  The Theory of Reasoned Action (TRA) originated in the 1960s, has been used in past to guide clinical practice intervention in behavioral related changes (Chamberlain College of Nursing, 2020). For example, it has been used in smoking cessation, dieting, the use of seat belts, voting, breastfeeding, as well as HIV/AIDS intervention both in and outside the United States (Fishbein et al,1994 as cited in White et al., 2016).

The theory of reasoned action has four key components. They are behavior, intention, attitude, and norms (White et al., 2016). The theory is based on the belief that people are rational creatures and that their willingness to change behaviors have a lot to do with their conscious commitment. The following variables according to Fishbein et al, (1994 as cited in White et al., 2016) are interrelated; They are

1. Behavior – what is needed to happen so that the person understands what has to be done to achieve change.

2. Intention – The person’s readiness to change the behavior. That behavior change depends on the last two components attitude and norms.

3. Attitude – what are the approval and disapproval feeling the person may have about the behavior.

4. Norms (subjective)– How does that person who is about to undertaking that particular behavioral change believes others will feel about the behavior.

In this particular theory, there is no clear component for networking with the stakeholders during the phases of the practice changes. I was unable to find ways to evaluate the evidence. I was not able to identify any component for identifying nor addressing barriers to implementation. However, TRA has been implemented successfully in multiple clinical interventions to adopt healthy behavior. In a recent research study using TRA to understanding teen pregnancy in the American Indians communities, they found that the subject’s attitude about using birth control and the favorable or unfavorable opinions of others indicate whether or not these teenagers used contraceptives (Dippel et al., 2017).

For the practice intervention to be successful, the individuals have to be prepared to change their beliefs and attitudes towards obesity. The perspective participants, who are one of the key stakeholders in this project have to be vested in the plan. There need to be a desire to lost weight and work towards maintaining it. They also have to know that their support system, that is family and friends will be supportive throughout. For any change to occur, the door to communicating with all key stakeholders need to remain open throughout the implementing and evaluation phase of the practice change intervention and beyond.

References

Chamberlain College of Nursing. (2020). NR-701 Week 4: Change theory and models for change intervention [Online lesson]. Adtalem.

Dippel, E.A., Hanson, J.D., Mchahon, T.R., Griese, E.R. & Kenyon, D.B. (2017). Applying the theory of reasoned action to understanding teen pregnancy with American Indians communities. Maternal Child Health Journal, 21 1449-1456. doi:10.1007/s10995-017-2262-7

Family Health International. (1996). Behavior change: A summary of four major theories. http://www.fhi360.org/resource/behavior-change-summary-four-major-theories.

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). New York, NY: Springer Publishing Company.

I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO-THREE  PARAGRAPH AND TWO SOURCES NO LATER THAN FIVE YEARS

Choose a nursing theory and research an article that includes a nursing theory and its utilization in nursing practice or nursing research. Write a two paragraph summary of the article highlighting the application of the selected nursing theory to nursing practice and reaserach 

Article should be current, peer reviewed and within a five year span.

-Use APA format for your references and citations

Submit trough turn it in 

I uploaded the nursing theory.

Reply 1

Technology is plying a vital role in health care system for providing safe and quality care. Its not helping to collect and save data but also sharing the data between health care providers involved in patient care for effective outcomes of care. Technology is an integral part of health screening diagnosis, and treatment.

In my health organizations technology has become important part of patient care. We start using technology the time we step in the building as we scan our chip ID to enter in our locked dementia unit which enhance patient’s safety because only authorized staff can enter in the unit. Technology is used for electronic shift report which help us to keep track how was the patient’s condition in previous shift and if there is any big changes in patient’s health, any fall happens during previous shift hours. We use software to keep the track of medication administration every day for each patient. Technology is used to keep the records of each patient e.g. health records, history, physicals, any incident, admission or discharge records, any information related to patient are recorded, using the online software which makes it so much easier for all staff who is authorized to use information. Pharmacy can check the medication orders for the patients and recommend accordingly which is only possible because of technology, the moment we get orders it is verified with the pharmacy, and medication orders are processed faster than ever, and the medication was sent by pharmacy on time without any delay. We can imagine if there is no such technology how long it will take to get one order and then how long it will take to reach pharmacy and get medication. Technology helps to process the things faster, which makes it possible to provide the best possible care to the patients. 

Reply 2

   Digital innovations have radically transformed the healthcare system. Information technology plays a growing role in the delivery of healthcare and helps in addressing the health problems and challenges encountered by clinicians and other health professionals in practice (Campanella, Lovato, Marone, Fallacara, & Mancuso, 2015). Electronic health records (EHRs) have been widely applied in the United States to document and gather patient information. An electronic health record refers to a systematic electronic collection of patients’ health information such as their medical history, medication orders, laboratory results, medical procedures, vital signs, radiology reports, and physician and nurse notes. EHRs also help healthcare professionals to make sound clinical decisions as EHRs also include decision support systems (DSS) which provide up-to-date medical knowledge, reminders, and other actions (Campanella, Lovato, Marone, Fallacara, & Mancuso, 2015).

         Evidence supports that EHRs can improve the quality of healthcare, increase time efficiency, improve adherence to guidelines, and reduce medication errors and adverse drug events (Campanella, Lovato, Marone, Fallacara, & Mancuso, 2015). Consequently, can also reduce costs associated with medical errors, adverse drug events, and time inefficiency. Considerable reduction in costs occurs when the quality of patient care is improved and patient harm reduced. Adherence to guidelines by healthcare professionals has a direct impact on the use of resources and the cost of healthcare as DSS supports clinicians in clinical decision making (Miriovsky, Shulman, & Abernethy, 2012). This reduces medical errors, adverse drug events, and resource wastage. HER guidelines are promoted to decrease variability in clinical practice and the use of ineffective therapies in clinical practice. The use of appropriate information technology in healthcare delivery improves the efficiency of hospitals as benefits exceed operational costs.

References

Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia, M. L. (2015). The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. The European Journal of Public Health, 26(1), 60-64.

Miriovsky, B. J., Shulman, L. N., & Abernethy, A. P. (2012). Importance of health information technology, electronic health records, and continuously aggregating data to comparative effectiveness research and learning health care. Journal of Clinical Oncology, 30(34), 4243-4248

Assessment 3

• Disaster Plan With Guidelines for Implementation: Tool Kit for the Team

• Overview: Develop a disaster preparedness tool kit for a community or population. Then, develop a 5-slide presentation for your care coordination team to prepare them to use the tool kit to execute a disaster preparedness plan.
  Note: The assessments in this course build upon the work you completed in previous assessments. Therefore, complete the assessments in the order in which they are presented.
  Disaster planning is vital to ensuring effective and seamless coordination, throughout the recovery period, among those affected by the disaster and an extensive array of health care providers and services. Care coordination, as part of an overall disaster response effort, helps ensure that victims receive needed care as access to providers and services are gradually restored over time.
  SHOW LESSThis assessment provides an opportunity for you to develop a disaster preparedness tool kit for a community or population of your choice, and prepare your care coordination team to use the tool kit to execute that plan.
  By successfully completing this assessment, you will demonstrate proficiency in the following course competencies and assessment criteria:
  • Competency 1: Propose a project for change, for a community or population, within a care coordination setting. 
    • Identify the key elements of a disaster preparedness tool kit for providing effective care coordination to a community or population.
  • Competency 2: Align care coordination resources with community health care needs. 
    • Assess the care coordination needs of a community or population in a disaster situation.
    • Identify the personnel and material resources needed in an emergency to provide the necessary coordinated care.
  • Competency 3: Apply project management best practices to affect ethical practice and support positive health outcomes in the delivery of safe, culturally competent care in compliance with applicable regulatory requirements. 
    • Describe standards and best practice methods for safeguarding the provision of ethical, culturally-competent care in challenging circumstances.
    • Identify applicable local, national, or international regulatory requirements governing disaster relief that influence coordinated care.
  • Competency 4: Identify ways in which the care coordinator leader supports collaboration between key stakeholders in the care coordination process. 
    • Analyze the interagency and interprofessional relationships essential to coordinated care in a disaster.
  • Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards. 
    • Prepare a care coordination team to use a disaster preparedness tool kit for implementing a disaster preparedness project plan.
    • Support main points, arguments, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
  • Competency Map
    CHECK YOUR PROGRESSUse this online tool to track your performance and progress through your course.
• Assessment Instructions
• Note:Your work in Assessments 1 and 2 will inform your work in this assessment. Therefore, complete the assessments in the order in which they are presented.
  Preparation
  For this assessment, you will assume the role of Care Coordinator for Disaster Care in the same practice setting you chose for Assessment 1. Within this context, you will develop a disaster planning tool kit to provide comprehensive community health care disaster relief or to meet the care needs of a specific population within the community. Choose a current event or hypothetical disaster scenario as the basis for your  tool kit. Explore past and recent disasters and lessons learned.
  After completing your disaster planning tool kit for your particular situation, you will then develop a short presentation for your care coordination team to prepare your team for using the tool kit.
  Note:Remember that you can submit all—or a portion of—your draft documents to Smarthinking for feedback before you submit the final version of this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
  Presentation Tools
  You may use Microsoft PowerPoint or any other suitable presentation software to create your slides. If you elect to use an application other than PowerPoint, check with your instructor to avoid potential file compatibility issues.
  Use the speaker’s notes section of each slide to develop your talking points and cite your sources, as appropriate. If you need help designing your presentation, you are encouraged to review the various presentation resources provided for this assessment. These resources will help you to design an effective presentation, whether you choose to use PowerPoint or other presentation design software.
  You have the option of either recording a voiceover track for your presentation or creating a video. In either case, you may use Kaltura Media or other technology of your choice for your audio or video recording
  • If using Kaltura Media, refer to Using Kaltura for directions on recording and uploading your video in the courseroom.
  • Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services to request accommodations.
    Requirements
    For this assessment:
  1. Develop a disaster planning tool kit that includes:
     • The policy for the disaster preparedness plan.
     • Guidelines on how to employ the policy in practice.
     • Recommendations for identifying and working with stakeholders to achieve buy-in and support to implement and sustain the plan.
  2. Develop a presentation for your care coordination team to prepare them to use the disaster planning tool kit to implement a disaster preparedness plan.
  3. Use the care coordination project plan you developed in Assessment 1 as a model for your tool kit in this assessment. You may choose to develop an overarching plan for the entire community or to address the care needs of a specific population within the community. You may address the same population you chose in Assessment 1 or Assessment 2.
     Tool Kit Documents and Presentation Format and Length
     Format your tool kit using APA style.
  • Your tool kit should consist of a one page summary explaining what you did and why. Place as appendices the policy, guidelines, and recommendations.
  • Your document should also include: 
    • A title page and references page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
  • Be sure that the content of your document is clear, well-organized, and does not exceed 3–5 pages.
  • At a minimum, your presentation must include the following slides:
  • Title.
  • Purpose (the reasons for your presentation).
  • References (at the end of your presentation).
  • Use the speaker’s notes section of each slide to develop your talking points and cite your sources, as appropriate.
  • Your slide deck should consist of approximately 5 slides, not including the title, purpose, and references slides.
    Supporting Evidence
    Cite 5–7 sources of scholarly or professional evidence to support your project plan.
    Developing Your Disaster Planning Tool Kit and Presentation
    Note:The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that, at a minimum, you address each criterion. You may also want to read the Disaster Plan With Guidelines for Implementation: Tool Kit for the Team scoring guide to better understand how each criterion will be assessed.
  • Assess the care coordination needs of a community or population in a disaster situation. 
    • What key challenges is the community or population likely to face?
    • What lessons learned are offered by similar disasters?
    • What evidence supports your conclusions?
  • Identify the key elements of a disaster preparedness project plan for providing effective care coordination to a community or population.
    • What are the potential effects of the disaster on care coordination?
    • What factors should your plan address? For example, consider training, coordination with outside organizations, or evacuation.
    • What resources might aid your planning process? For example, a facility risk assessment or hazard vulnerability analysis?
  • Identify the personnel and material resources needed in an emergency to provide the necessary coordinated care. For example, consider the following: 
    • First responders.
    • Critical access points for care.
    • Ambulance transport.
    • Types of critical supplies and equipment, such as ventilators with generators.
    • Medicine and other life support needs.
  • Describe standards and best practice methods for safeguarding the provision of ethical, culturally-competent care in challenging circumstances. 
    • What standards and practices are most applicable in this instance? Why?
    • How do they safeguard the provision of ethical, culturally-competent care?
  • Analyze the interagency and interprofessional relationships essential to coordinated care in a disaster. 
    • What role do particular agencies or organizations play in a disaster?
    • Why are these relationships essential?
  • Identify applicable local, national, or international regulatory requirements governing disaster relief that influence coordinated care. 
    • What are the implications and consequences for care coordination?
  • Prepare your care coordination team to implement the project plan. 
    • Clearly communicate the important aspects of plan implementation, including specific actions and their underlying rationale.
    • What questions, objections, or resistance might you expect? How will you respond?
    • Express your main points, arguments, and conclusions coherently.
    • Proofread your slides to minimize errors that could distract the audience and make it more difficult to focus on the substance of your presentation.
  • Support main points, arguments, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style. 
    • Is your supporting evidence clear and explicit?
    • How or why does particular evidence support a claim?
    • Will your audience see the connection?
  • Additional Requirements
    Be sure that you have used the APA Style Paper Template [DOCX]to format your project tool kit and that your document includes:
  • A title page and references page.
  • A running head on all pages.
  • Appropriate section headings.
  • In addition, be sure that:
  • Your slide deck consists of approximately 5 slides, not including the title, purpose, and references slide.
  • You have cited 5–7 sources of relevant and credible scholarly or professional evidence to support your project plan.
  • Use the speaker’s notes section of each slide to develop your talking points and cite your sources, as appropriate.
  • Portfolio Prompt:You may choose to save your project plan, presentation, and guidelines to your ePortfolio.