What risk factors does John have for risk of opioid withdrawal during this hospitalization?

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-APA FORMAT REQUIRED

John, a 46-year-old African American male presents for admission to your hospital for hemi colectomy for colon polyps. He is complaining of chronic back pain. Patient is on disability from work-related injury. History of two previous back surgeries with relief of numbness in RLE, but pain has not been relieved. His current medications include Methadone, Neurontin, and Norco. John states he takes Tylenol PM every night in addition to his prescribed medications. John is a smoker and smokes 1 PPD. John confides in you that he is considering a spinal cord stimulator for the chronic pain.

  • What risk factors does John have for risk of opioid withdrawal during this hospitalization?
  • Is there a stigma connected to being disabled and/or methadone?
  • Does the nurse need to be concerned about acetaminophen use?
  • What are the differences in acute and chronic pain?
  • REFERENCE:
  • Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Philadelphia, PA: Saunders.
  • Chapter 10: Pain Assessment: The Fifth Vital Sign

What are Red’s strengths? What are your concerns for this patient?

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Red Yoder is an 80-year-old farmer who lives alone in the farmhouse where he grew up. It is located 20 miles outside of town. Red has been a widower for 10 years. Red rarely cooks for himself and mainly eats packaged or processed foods. His son, Jon, manages the farm now, but Red is still involved in the decision making. Red’s current medical problems include insulin-dependent diabetes complicated by an open foot wound. He also has some incontinence and difficulty sleeping.

Red is awaiting a visit from the home health nurses. He relates that he has an open wound on his big toe that developed after walking in a new pair of shoes. When his daughter-in-law, Judy, saw the wound, she called the family doctor, who suggested a visit by the wound care nurse, who works with the home health agency. Red agreed as long as his VA benefits cover the costs. Red is aware that his son and daughter-in-law have concerns about him living alone, but Red insists that while he needs a little help from Jon and Judy at times, he is still capable of caring for himself.

  • What are Red’s strengths?
  • What are your concerns for this patient?
  • What is the cause of your concern?
  • What information do you need?
  • What are you going to do about it?
  • What is Red experiencing?
  • APA FORMAT REQUIRED
  • REFERENCE:
  • Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Philadelphia, PA: Saunders.
    • Chapter 11: Nutritional Assessment

Identify five (5) clinical or service quality studies an HMO might conduct. Explain why they would be helpful to the quality improvement process of the HMO. You may contact a local HMO and query the quality management director. 

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Quality studies, a key quality management process, are routinely completed on clinical and service issues and are required by the various accreditation agencies. Some examples include the following: analysis of member complaints, clinical study of readmissions to the hospital within four weeks, and drug usage for hypertensive patients.

 

Identify five (5) clinical or service quality studies an HMO might conduct. Explain why they would be helpful to the quality improvement process of the HMO. You may contact a local HMO and query the quality management director.

 

Must be in APA format with references

Predatory pricing or “low-balling” (i.e., premium rates are intentionally set well below the actual cost of providing care) occurs between managed care organizations. What would be two (2) reasons for predatory pricing? Discuss each.

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Predatory pricing or “low-balling” (i.e., premium rates are intentionally set well below the actual cost of providing care) occurs between managed care organizations. What would be two (2) reasons for predatory pricing? Discuss each.

 

Reflect on how decision support technologies, including databases, might assist nurses in clinical practice.

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Clinical Decision Support Systems

Decision support systems were first designed and implemented in the corporate world to support business management. The integration of support systems into health care organizations brings a sharpened analysis capacity to data warehousing and data mining. This refined data analysis capability can lead to improved patient care and diagnoses through evaluation of various symptoms, prediction of certain drug interaction outcomes, and much more.

In this Discussion, you explore the use of clinical decision support systems and consider their value in assisting advanced practice nurses in making informed decisions and providing quality health care.

To prepare:

  • Review the information in the Learning Resources focusing on the use of clinical decision support systems.
  • Consider where you seek support for clinical decisions. Do you seek advice from other health care professionals in your organization? Do you use computerized clinical decision support systems? Do you perform your own research? Assess the advantages and disadvantages of each approach.
  • Reflect on how decision support technologies, including databases, might assist nurses in clinical practice.
  • Consider how you can validate the integrity of the data you are using in a clinical decision support system.
  • Peruse the information presented at the Open Clinical website presented in this week’s Learning Resources. Locate an article that focuses on how clinical decision support systems can be used to support or improve patient care. How does the information in the article align with or differ from your own experiences?

ASSIGNMENT: WRITE a description of how you currently seek support for clinical decision making and how you determine the integrity of the information you gather. Analyze the advantages and disadvantages of using computerized clinical decision support systems in clinical practice. Justify your response. Finally, summarize the article you selected from the Open Clinical website and include an evaluation of how computerized clinical decision support systems can be used to improve care.

What are the benefits and challenges of using CDS systems? How can this assist nurses in providing evidence-based care to their patients?

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Evidence-Based Practice

On occasion, some processes have crept into nursing and medical practice without appropriate evidence to back up their use. For example, consider tetanus shots. In the past, tetanus shots were given to patients who stepped on a rusty nail. It was assumed—at the time—that if the nail was rusty, it must have had some contact with the barnyard soil outside, which meant that it would be contaminated with bacteria. For a while this thinking made sense. As time went on, however, tetanus shots continued to be given to patients who cut themselves on rusty objects, regardless of where the rusty object had come from. And, of course, fewer and fewer people lived within close proximity to barnyards and associated contamination.

As this week’s examples highlight, not all practices that nurses engage in are tied to evidence. For this reason, clinical decision support (CDS) systems have been created. CDS systems support the decision-making tasks of nursing professionals. As the nurse inputs patient information into the CDS system, evidence-based content is provided back to the nurse. The nurse can then combine this content with their own nursing knowledge to diagnose and treat the patient. One of the most useful characteristics of CDS systems is that they are available during the point of care. No longer do nursing professionals have to consult thick research books; a great deal of information can be accessed with a few strategic clicks!.

In this Discussion, you continue to explore CDS systems. In addition, you investigate whether or not a health care practice with which you are familiar is grounded in evidence-based practice.

To prepare:

  • Review this week’s Learning Resources and consider how nurses can determine if they are using evidence-based practices in patient care.
  • Select one health care practice (e.g., using alcohol swabs before giving an injection) with which you are familiar. Conduct research to determine if this practice is grounded in research.
  • Consider how a clinical decision support system provides evidence-based content to its users.
  • What are the benefits and challenges of using CDS systems? How can this assist nurses in providing evidence-based care to their patients?

ASSIGNMEN: WRITE a description of the health care practice you selected.  Explain whether the evidence you found supports or opposes the practice and whether you believe this process is grounded in evidence-based practice. Next, explain how informatics technologies, such as CDS systems, can facilitate nurses moving toward evidence-based practices. Justify your response.

Describe three actions should a woman take during pregnancy to maintain optimum health for her baby and for herse

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Assignment 1

Briefly answer the following questions in the space below inline.

1.  Discuss three actions that a woman can take to maintain her reproductive health.

2.  List three methods of contraception and describe the advantages and disadvantages of each.

3.  Describe three actions should a woman take during pregnancy to maintain optimum health for her baby and for herself.

The relationship between strategic planning and marketing in long-term care

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write a critical analyses paper demonstrating understanding and application of key concepts learned on chapters 18-20. Your paper must be 3-4 pages in length excluding references pages, 12p font, and double spaced. Adherence to APA guidelines must be demonstrated where appropriate. Your paper will include a critical analyses of the questions below. A critical analyses entails a comprehensive examination of key concepts and/or theories. Please critically analyze the following:

  • The importance of marketing in long-term care organizations
  • The relationship between strategic planning and marketing in long-term care
  • The major challenges that have faced the long-term care system in recent years
  • The success of the system in responding to the challenges outlined
  • The challenges and opportunities future long-term care managers are likely to face

identify a timely issue/dilemma that requires you to perform the leadership role of moral agent or advocate to improve a situation (e.g., speaking or acting on behalf of a vulnerable patient, the need for appropriate staffing, a colleague being treated unfairly).

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Effective leaders have a high degree of self-awareness and know how to leverage their strengths in the workplace. Assessments are a valuable tool that professionals can use to learn more about themselves and consider how their temperament and preferences influence their interactions with others.

 

 

 

As you engage in this learning process, it is important to remember that everyone—regardless of temperament type or related preferences—experiences some challenges with regard to leadership. The key to success is being able to recognize and leverage your own strengths while honoring differences among your colleagues.

 

 

 

At some point in your leadership career, you will encounter an ethical or moral dilemma that requires you to take a stand and defend your position.

 

 

 

For this Assignment, you evaluate an issue and consider how you could act as a moral agent or advocate, facilitating the resolution of the issue for a positive outcome.

 

 

 

To prepare:

 

 

 

  • Consider the examples of leadership demonstrated in this week’s media presentation and the other Learning Resources. (Democratic, authoritative, or Laissez-Faire)
  • To further your self-knowledge, you are required to complete the Kiersey Temperament as indicated in this week’s Learning Resources. Consider your leadership style (Democratic), including your strengths for leading others and include your results from Kiersey Temperament Sorter to describe potential challenges related to your leadership style.
  • Mentally survey your work environment, or one with which you are familiar, and identify a timely issue/dilemma that requires you to perform the leadership role of moral agent or advocate to improve a situation (e.g., speaking or acting on behalf of a vulnerable patient, the need for appropriate staffing, a colleague being treated unfairly).
  • What ethical, moral, or legal skills, dispositions, and/or strategies would help you resolve this dilemma? Define the differences between ethical, moral, and legal leadership.
  • Finally, consider the values and principles that guide the nursing profession; the organization’s mission, vision, and values; the leadership and management competencies addressed in this course; and your own values and reasons for entering the profession. What motivation do you see for taking a stand on an important issue even when it is difficult to do so?

    To complete:

    Write a 4 to 5 page paper (page count does not include title and reference page) that addresses the following:

    1) Introduce the conceptual frameworks of the ethical constructs of ethics, moral, or legal standards and the purpose of the paper.

    1) Consider  an ethical, moral, or legal dilemma that you have encountered in your work environment and describe it. ( an example is ” a Jehovah witness refusing blood even though it is needed to save his or life”)

    2) Analyze the moral, ethical, and legal implications utilized in this situation. Describe your role as a moral agent or advocate for this specific issue.

    3) Consider your leadership styles (Democratic) identified by your self-assessment and determine if they act as a barrier or facilitation during this dilemma.

     

     

     

    Required Resources

     

    Readings

     

 

  • Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
    • Chapter 4, “Ethical Issues”

      This chapter examines ethical frameworks for decision making and principles of ethical reasoning. You are also introduced to the ANA Code of Ethics and Professional Standards, MORAL decision-making model, and ethics committees.

    • Chapter 5, “Legal and Legislative Issues”

      Chapter 5 provides an overview of the many legal and legislative issues of which leaders and managers need to be aware. As you read this chapter, keep these issues in mind.

    • Chapter 6, “Patient, Subordinate, and Professional Advocacy”

      Nurses are the best advocates for patients and the profession. This chapter examines more closely the role of becoming an advocate, patient rights, subordinate advocacy, whistle-blowing, professional advocacy, advocacy in legislation and public policy, and media.

  • Cianci, A. M., Hannah, S. T., Roberts, R. P., & Tsakumis, G. T. (2014). The effects of authentic leadership on followers’ ethical decision-making in the face of temptation: An experimental study. The Leadership Quarterly, 25(3), 581-594. doi:10.1016/j.leaqua.2013.12.001

    Abstract excerpt: The present research investigates the impact of authentic leadership on followers’ morality, operationalized as ethical decision-making, in the face of temptation. This experiment finds that authentic leadership and temptation interacted to affect individuals’ ethical decision-making. Specifically, authentic leadership significantly inhibited individuals’ from making unethical decisions in the face of temptation, whereas followers of neutral or less authentic leaders were more likely to succumb to temptation..

  • Disch, J. (2014). Using Evidence-Based Advocacy to Improve the Nation’s Health. Nurse Leader, 12(4), 28-31. doi:10.1016/j.mnl.2014.05.003

    Abstract excerpt: Evidence-based practice is 1 of the 5 competencies that the Institute of Medicine has identified for all health professionals. Its intent is to employ evidence-based practice and integrate best research results, clinical expertise, and patient values to make patient care decisions. This article will explore the concept of evidence-based advocacy and describe ways in which one prominent nursing organization, the American Academy of Nursing, uses evidence-based advocacy to positively impact the nation’s health and advance the nursing profession

  • Martin, M. B. (2014). Transcultural Advocacy and Policy in the Workplace: Implications for Nurses in Professional Development. Journal for nurses in professional development, 30(1), 29-33.  doi: 10.1097/NND.0000000000000027

    Abstract: This article introduces the role of nursing professional development specialists in serving as a resource for both patient and staff advocacy regarding cultural and linguistic matters. The impact of changing demographics, support for civil rights, and established policy related to culture and linguistics is emphasized. An overview of policy at local, state, and national levels is suggested to promote nursing professional development in the interest of culturally and linguistically compliant nursing practice.

  • Woods, M. (2014). Beyond moral distress preserving the ethical integrity of nurses. Nursing Ethics, 21(2), 127-128.

     

    This guest editorial discusses the difficulties involved in dealing with those sometimes-painful moral problems encountered in practice.

     

    Media

     

 

  • Laureate Education, Inc. (Executive Producer). (2012a). Ethical, moral, and legal leadership. Baltimore, MD: Author.

    Note: The approximate length of this media piece is 8 minutes.

    In this week’s media presentation, expert Terry Buttaro discuss how today’s health care organizations can capitalize on the strengths of nurse leaders to plan for and navigate change effectively.