Describe the role the patient history and physical exam played in the diagnosis.

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Case Study 4:

 

A middle-aged female presents to the office complaining of strep throat. She states she suddenly developed a sore throat yesterday afternoon, and it has gotten worse since then. During the night she felt like she was chilled and feverish. She denies known recent contact with anyone else who had strep throat, but states she has had strep before and it feels like she has strep now. She takes no medications, but is allergic to penicillin. The physical examination reveals a slender female lying on the examination table. She has a temperature of 101 degrees Fahrenheit, heart rate of 112, respiratory rate of 22, and blood pressure of 96/64. The head, eyes, ears, nose, and throat evaluation is positive for bilateral tonsillar swelling without exudates. Her neck is supple with bilateral, tender, enlarged anterior cervical nodes.

 

 

 

To prepare:

 

•Review this week’s media presentations and Parts 5–8 of the Buttaro et al. text.

 

•Reflect on the provided patient information including history and physical exams.

 

•Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.

 

•Reflect on potential treatment options based on your diagnosis.

 

 

 

POST 1 TO 2 PAGES ON  :

 

Explanation of the differential diagnosis for the patient in the case study that you selected. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

 

 

 

Describe what topic you selected, the search term(s) that you used, and the number of results found at each level of the hierarchy.

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Literature Searches

An important step in the EBP process is reviewing the current body of literature to better understand the subject or topic in which you are interested. By conducting a review of the literature, you are building foundational knowledge about the topic; later, you can use this background to build new insights. Developing a strong grasp of a topic can only be garnered by taking the time to thoroughly search for relevant information and resources.

For this Discussion, you will practice searching the literature to find evidence on a specific topic.

To prepare:

  • Choose a simple search term(s) relating to a topic of your PICOT question.
  • Review the information on the evidence hierarchy discussed in Chapter 2 of the course text, in the article, “Facilitating Access to Pre-Processed Research Evidence in Public Health,” and in the multimedia presentation “Hierarchy of Evidence Pyramid,” found in this week’s Learning Resources.
  • Review the information on the Walden Library’s website, “Levels of evidence.” Take a few minutes to explore the different types of databases available for each level of evidence and focus on the meaning of filtered and non-filtered resources.
  • Conduct a literature search in the Walden Library on your selected topic using the databases that you reviewed. Use at least one database for each of the three levels of filtered information and at least one unfiltered database. Record the number of hits that you find at each level of the hierarchy of evidence.
  • Select one article from the results at each level of the hierarchy. Compare the articles based on the quality and depth of information. What would be the value of each resource if you were determining an evidence-based practice?

Post on or before Day 3: 

  • (1)a summary of your search.
  • (2) Describe what topic you selected, the search term(s) that you used, and the number of results found at each level of the hierarchy.
  • (3) Compare the types of information found in the articles from different levels and the value of the information from each level.
  • (4) Highlight a useful tip that you could share with your colleagues about conducting an effective literature search.

REQUIRED RESOURCES

How will you address each area and improve understanding, collaboration, motivation, and positive attitude?

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Conflict may occur in any work environment, whether it is in the clinical setting, another department, or another organization. It is important to understand how conflict arises and how conflict is managed through effective communication.

The behavior of a leader has a direct impact on the motivation of his or her team. It is crucial for a leader to understand how his or her behavior and conflict-handling ability impact the care of patients.

Here is a scenario of a leader who is willing to handle conflicts in his or her workplace.

You are promoted to a management position in a small organization. There are four full-time members and three part-time members. You have a department manager currently overseeing the operations. You are excited to begin with your new assignment and have completed orientation. You heard some rumblings from the staff development team, “You have your work cut out for you in this department!” It does not sound promising, yet you are filled with energy, a positive attitude but a bit concerned as you do not want to appear bossy. You lack a bit of confidence since they are seasoned team members and you are new to the organization.

Once you begin your first day, you decide to meet with everyone as a group and individually over the next few days. What you are uncovering is disturbing and you quickly realize that the team members have lots of conflicts within the department. In a nutshell, this is what you have discovered:

  • The department manager thinks she is in charge since clients, customers, or patients have specialized needs. She is stern faced and does not seem to smile, yet she does not admit it is her or her department’s fault if there is an error. She seems to enjoy the increasing conflict among the unit as it takes any “pressure” off her and she can continue to “tell people what to do.”
  • Two full-time administrative staff members do not like each other and refuse to work together. One feels the other cooks “strange food” and cannot understand her when she speaks, and she is too quiet. The other staff member feels the first one is too outspoken and not gracious and hurries through her assignments. They share a small office and their work is critical to the success of the organization as they oversee all billing, accounts payable and receivable, and schedule the large projects and services to other organizations. The rest of the staff members avoid going to this office as the tension is clearly increased in this room.
  • The part-time staff feel they are not being offered any extra shifts and sometimes they are asked not to come to work if the day is slow. They feel they are not valued and are demotivated by less pay. This is a critical time for them due to the economy crisis. When they are at work, they often bring their home problems with them and seem stressed when they have to work with the other team members.

Answer the following questions:

  • How will you address each area and improve understanding, collaboration, motivation, and positive attitude?
  • How does emotional intelligence play a role in encouraging the staff to cooperate and to be willing to make behavior changes?
  • What behavior theory will you research to develop your thoughts when you speak to each staff member?
  • How important is decreasing overall conflict in the workplace?
  • How can you develop a win-win approach?

Why is it important for you to take this course in biostatistics?

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Search for 2 or 3 SPSS tutorials to help you learn how to use SPSS.  Answer the following about the websites.  Provide the website for the 2 or 3 tutorials that you found on SPSS?  What specific things were you searching for in these tutorials?  What did you like or dislike about the tutorials?  What did you find the most useful in these tutorials?

 

 

200 words

This course is designed to provide you with the knowledge and skills in application, evaluation, analysis, and interpretation of biostatistical data used to inform public health programs, policy, and practice. View the online video, “Careers in Biostatistics.” The video describes the education that a professional biostatistician receives at the University of North Carolina. More than likely you will be working with professional biostatisticians. Why is it important for you to take this course in biostatistics?

 

Discuss the future of public health and how your selected issue will affect the people of the United States.

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As discussed throughout this course, there are many factors that contribute to the success of an effective public health response. A prompt response, accurate documentation of the event, and communication with both personnel and the public are intertwined. Once the event has passed the critical stage and disaster recovery begins, a thorough evaluation needs to be completed to reflect on what went well and what did not. These evaluations will provide crucial information to public health professionals to improve performance for the next disaster.

You have learned more about public health issues, environmental factors, behavioral health and wellness, immunization, and social determinants of health. In this assignment, you will research and develop a PowerPoint presentation to address the future of public health and the implications of public health issues for future generations.

Select a current public health issue. You can select an issue addressed in this course or one of your choice (e.g., chronic diseases, immunization, obesity, heart disease, and/or an environmental issue). Identify at least five scholarly resources (peer-reviewed references) to support your assertions. Analyze the current status of your selected issue to determine how this issue will impact the future of public health including the implications for future generations and public health involvement.

Include the following in your presentation:

  • Describe the problem and how the issue has been addressed. List the advantages and disadvantages of the method(s) used to address it. Explore how you might handle these components and include three reasonable approaches to address the issue.
  • Discuss the future of public health and how your selected issue will affect the people of the United States.
  • Describe how this situation might be handled in a different manner. Recommend ways by which public health involvement can improve handling of the issue in future occurrences and identify some examples to change the status quo.
  • Support your statements using scholarly literature and evidence-based information from at least five authoritative resources.
  • Be sure to state major points clearly and support with specific details, examples, or analysis.

Analyze how political arenas (government, workplace, professional organizations, and community) shape health care delivery.

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Organizational Structure, Strategic Planning

Care Delivery Models, Safety Culture

Learning Objectives

Module I concentrates on the following course outcomes—

· Analyze how political arenas (government, workplace, professional organizations, and community) shape health care delivery.

o The concept of the organization is introduced to provide context to the planning component of nursing management. Mission, philosophy, vision and values are discussed as impacting the nurse’s practice. Planning patient care in specific team configurations is also discussed.

Federal and consumer directives have forced healthcare organizations to examine current practice models and both organizational structures and processes that account for increasing efforts to develop models and systems that contribute to patient safety. Patient safety is at the forefront of issues for organizations and efforts have begun to identify safety culture dimensions.

The importance of communication within the organization and specifically within structured work teams is discussed. Typical patterns of communication are identified.

Reading Assignment

Sullivan: Chapters 1, 2, 3

Supplemental Readings (See Resources Section)

Beyea, S. C. (2005). High reliability theory and high reliable organizations. AORN Journal. 81(6), 1319-1322.

Cooke, H. (2009). Theories of risk and safety: what is their relevance to nursing? Journal of Nursing Management. 17:256-264.

Air Safety Support International. (2006) Safety Culture. Available at: http://www.airsafety.aero/safety_development/sms/safety_culture/ (Links to an external site.)Accessed July 25, 2012

Overview

Understanding the organizational context of professional nursing practice is an important part of leadership and management. The nurse will participate in determining the most effective strategic plan for implementing care at the bedside or for an entire patient population of a facility. Other contextual factors include the mission, vision and philosophy and organizational culture of the organization. It is important for the nurse to know the mission and vision of the organization and have a philosophy that is consistent with that of the organization in order to support its efforts. Organizational structure relates to how work is organized and and provides for how work is communicated. Classic organizational structures include centralized, decentralized, matrix and combinations of these types. Centralized organizations (tall, with many layers) tend to have decision making at the “top.” While, decentralized organizations (flat) have decision making closer to the level of care. The military is an example of a centralized organization. Modern healthcare have moved toward a more type flat type of structure with decentralization and shared decision making. A concept appropriate to professional personnel. The organizational chart defines chain of command, line versus staff positions, and span of control. These are key concepts to know for this course. System’s Theory, Humanistic Theory, Chaos Theory, Contingency Theory and Complexity Theory are theoretical frameworks used to guide the processes within an organization. Cultural Diversity within organizations relates to both care provider and recipient. The changing demographics require non-biased understanding and appreciation of the difference of others.

Safety Culture has become a major issue for organizations since the IOM report in 1999 citing thousands of hospital errors and patient deaths and establishing a culture of safety has become a healthcare priority. Safety culture has its origin in high risk organizations such. Health care organizations are considered high risk organizations similar to aviation, nuclear plants and chemical process industry. Organizations that perform successfully under exigent conditions are termed high reliable organizations (HRO). Characteristics of high reliable organizations include for example: 1) preoccupation with failure, 2) reluctance to accept simplification and 3) deferring to expertise. Preoccupation with failure is an effort to avoid drifting into failure and becoming complacent. Safety culture is a central foundation of HROs and is measured with a variety of tools to assess communication, teamwork, frequency of error reporting. Expectations of manager behaviors to promote safety and more. The Agency for Health Research and Quality (AHRQ) published the Hospital Survey on Patient Safety Culture (HSOPSC) in 2004 and to date hundreds of hospitals with thousands of healthcare employees have reported perceptions of hospital safety culture with de-identified data reported in aggregate. See information about safety and the HSOPSC at http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Jones_29.pdf (Links to an external site.). Safety and safety culture information will be discussed again in Module V along with Quality improvement and literature related to healthcare errors.

“Nursing work” is organized according to different models for care delivery. Functional, Team Leading, Differentiated Practice, Primary Nursing and Care Management Method are common delivery models. Differentiated practice is a model more commonly seen within Magnet hospitals systems and includes provision for the different levels of educational preparation and skill of the Registered Nurses with different job descriptions for each. The type of delivery system depends on a number of factors, including availability of staff, staff mix, type of patients and organizational philosophy. The ultimate goal is a safe environment with quality and financially sound outcomes.

Strategic planning is vital to any organization and is carried out in a systematic process. It includes identifying the organization’s strengths and weaknesses through assessment of the internal and external environment. The process screens for influencing markets, competition, technology, healthcare trends, financial resources and information systems to name a few.

Assignment questions: Post answers in Forums Module I. See calendar for due date.

1. Discuss one of the organizational theories from the readings and how you see this theory used or could be used in an organization. What are the merits of the theory?

2. Discuss what is meant by the terms, organizational span of control and chain of command.

3. Describe three types of organizational structures and some characteristics. Which type of organizational structure have you seen used in an organization and what are its advantages and limitations.

4. Which type of organizational structures do we see most frequently in acute care hospitals?

5. Cite common factors used for strategic planning and how nurses are involved in the process.

   Analyze the components of the nursing management process within a clinical context.

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Module II concentrates on the following course outcomes—

1.    Analyze the components of the nursing management process within a clinical context.

The management process of planning, organizing, directing, controlling, and staffing is introduced. The process is used by leaders and managers in the performance of positions. The process is also used as the guiding framework for this course.

2.    Critique the professional nurse’s leadership role in guiding a diverse care team.

The nurse’s leadership role is described and explored. The emphasis is on the leadership role of the professional staff nurse as well as other levels of nursing leadership in an organization.

3.    Integrate management concepts into the competent provision of client care.

The nurse’s management role is also described in the module. The differentiation between leadership and management tasks and behaviors is explored. The emphasis is on the leadership and management role of the professional staff nurse as well as other levels of nursing management in an organization.

Reading Assignment

Sullivan: Chapters 4, 7, 17

Overview

Leading, managing and following are integral parts of professional practice. Constructive behaviors associated with these concepts will influence patient care and organizational outcomes, regardless of titles. Leadership and management behaviors can be learned. It is important to recognize that leadership and management are two different concepts. One can be a manager and not be a leader, and vice versa. Leadership behaviors used by managers greatly affect followers and may be positive or negative. Both leaders and managers use power and influence to accomplish organizational goals. Dynamic leaders are those who mentor, coach, respect and positively contribute to the development of others. Think about people that you have known who are positive leaders, what characteristics and behaviors do they exhibit to influence others. What types of communication styles do leaders typically use?

There are a number of theories of leadership, managementand motivation that may be applied within an organization. Some of the common leadership theories include: Transformational Theory, Situational Contingency Theory, and motivation theories such as Herzberg’s, Maslow’s and Expectancy and Goal Setting Theory. In organizational behavior, there has been much research over the years in relation to what motivates people with the conclusion that there are two broad categories of motivation: 1) content and 2) process. Content theories are referred to as “needs theories” as they explain the specific factors that motivate people. These theories give insight into the question of “what drives people.” Process theories are also called cognitive theories and focus on what cognitive thinking motivates or drives the individual to initiate, redirect or halt behavior (Borkowski, 2005). Motivation is about providing an organization and culture that satisfies both of the employees intrinsic and extrinsic needs.

There are a number of concepts available related to leadership, management and organizational behavior. Power, one such concept, is used in the organization to influence the behavior of others. Yoder-Wise describe five behaviors that nurses use in relation to power related to political and professional practice. These include: 1) apathy, buy-in, self-interest, political sophistication and leading the way. These power related behaviors can positively or negatively influence organizational behavior. Empowerment has received much recognition in the healthcare community in the past two decades. It relates to personal and professional power or control for practice. It is seen in conjunction with autonomy, shared leadership, decentralized organizations and those with Magnet status.

Clinical leadership offers many challenges; one is to recognize the effect of personal and professional needs that motivate staff to perform job duties and reach desired outcomes. Finding out what motivates staff fosters empowerment through approval, satisfaction, accomplishment, and self-esteem, which fuel individual motivation. Individuals bring to the workplace different needs and goals, the type and intensity of motivators vary among employees. Motivated employees are more likely to be productive than are non-motivated workers. This is one reason that motivation is an important aspect of enhancing employee performance. It is imperative with the constant change within the health care settings with cost containment, cutbacks and reimbursement. As a leader much of the success in directing or delegating to staff less qualified than will depend on people-management skills—your ability to motivate those around you. The most successful motivators often become the most successful leaders. They are the leaders who cause things to happen with their ability to influence others. Methods used to motivate others are to establish credibility. Follow up on problems and when you keep all promises your credibility becomes firmly established. Be a role model by setting the tone and pace for your team. You set the standard for ethical behavior and support the view of what is important. Take an interest in others, as one of the greatest motivators is caring. Make sure it is genuine interest. Overzealous or insincere praise is as meaningless as no praise at all. Reward positive behaviors, which only reinforce the behavior and set the example for others. Share decision making with the staff. Staffs perform better when they feel they are contributing to a team effort, making a difference and work better when they are included. Offer constructive criticism. Sometimes it is necessary to offer constructive criticism to improve performance. Criticism should be directed toward the observed behavior and not toward the individual and should be in private.

Classic management functions include: planning, organizing, directing, controlling and staffing. Within these four broad categories are more specific management and organizational concepts as are pointed out in the Module I Power Point presentation. It is important to know the four broad categories of management. Contemporary management is outcome oriented and supports the missions and values of an organization. Key management functions to be familiar with include recognition, delegation, decision making, reporting, budgeting, problem solving and critical thinking. Each of these activities will be addressed in this course.

Assignment questions: Post answers in Forums Module II. See calendar for due date.

1. Select one of the leadership, management or motivational theories from the readings and discuss how you think it applies within the organization.

2. Describe your own leadership behaviors. Discuss leadership behaviors that you most admire.

3. Discuss leadership traits that you would like to acquire.

4. What are differences in management roles and leadership roles differ?

5. Discuss various types of power seen in an organization and which are advantageous and which are detrimental.

 

Explain the patient’s history including drug treatments and behavioral factors.

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Hypertension

 

 

 

In clinical settings, advanced practice nurses frequently use various strategies to treat and manage patients with hypertension and other cardiovascular disorders. These strategies often include pharmacologic and nonpharmacologic therapies, natural remedies, and/or changes in patient behavior. For hypertension patients, behavioral changes including increased exercise, healthier diet, and smoking cessation have proven to be particularly beneficial. However, it is important to recognize that treatment and management plans centered around changes in behavior often require greater patient commitment. This creates the need for patient-provider collaboration, as well as appropriate patient education. When patients are actively involved in their own care and better understand implications of their disorders, they are more likely to adhere to treatment plans.

 

 

 

To prepare:

 

•Review Part 11 of the Buttaro et al. text and the National Heart Lung Blood Institute article in this week’s Learning Resources.

 

•Reflect on your Practicum Experiences and observations. Select a case from these experiences that involves a patient who presented with a hypertension problem. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

 

•Think about the patient’s history including drug treatments and behavioral factors such as diet, exercise, smoking, etc.

 

•Review the National Heart Lung Blood Institute article in the Learning Resources. Reflect on health promotion strategies for the patient. Consider ways to reinforce hypertension management.

 

 

 

Post  1 to 2 pages on : Choose your own patient and a description of a patient who presented with a hypertension problem during your Practice as a nurse practitioner  Experience. Explain the patient’s history including drug treatments and behavioral factors. Then, suggest two health promotion strategies for the patient. Include suggestions for reinforcing hypertension management.

Discuss the value of statistical significance vs. pragmatic usefulness.

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Details:

1) Write a paper of 1,000-1,250 words regarding the statistical significance of outcomes as presented in Messina’s, et al. article “The Relationship between Patient Satisfaction and Inpatient Admissions Across Teaching and Nonteaching Hospitals.”

2) Assess the appropriateness of the statistics used by referring to the chart presented in the Module 4 lecture and the resource “Statistical Assessment.”

3) Discuss the value of statistical significance vs. pragmatic usefulness.

4) Prepare this assignment according to the APA guidelines found in the APA Style Guide located in the Student Success Center. An abstract is not required.

5) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.