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Responses to at least two classmates’ postings should be approximately 200 words and should be thoughtful, substantial, polite and more extensive than a simple “well done” phrase or “I agree.” Consider points of agreement, disagreement, assumptions, and value judgments. You will be able to respond to others after you submit your initial post. Your grade will be affected by how thoughtful your replies and initial questions are answered.

Read and watch the lecture resources & materials below early in the week to help you respond to the discussion questions and to complete your assignment(s).

Read

• Meiner, S.E., Yeager, J.J. (2019).
  • Chapter 15
    Chapter_015.pptx
  • Chapter 16
    Chapter_016.pptx

Watch

• Health Care in Danger: Why medical ethics matters (Part 2/3) (2:13)
  International Committee of the Red Cross (ICRC). (2014, May 8). Health Care in Danger: Why medical ethics matters (Part 2/3) [Video]. YouTube. Health Care in Danger: Why medical ethics matters (Part 2/3) (Links to an external site.)

After studying Module 4: Lecture Materials & Resources, discuss the following:

• Therapeutic drug monitoring is a frequent practice in health care. How does age affect drug absorption, metabolization and excretion?
• The use of salt substitutes can cause hyperkalemia in older adults when use in conjunction with what types of drugs?
• Describe how you would prevent and evaluate risk factors for medication nonadherence in older adults?

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.

Week 3 Contemporary Issue Position Essay

Choose a case from the AMA Journal of Ethics Case Index and take a position. For this assignment you will evaluate the ethical arguments for or against the issue. Identify the potential legal arguments (consider current federal guidelines), indicate any potential professional code conflicts you foresee, and support your position with an explanation of your own ethical/moral foundation.

In your 2-3 page paper:

• Identify the issue and state your ethical position.
• How might this scenario play out or impact you in your role as a nurse practitioner? 
• Defend your position with legal, ethical, and professional evidence.
• As part of your position, propose strategies and solutions for addressing the issues.
• What other ethical issues does this case bring to light, if any?

Support your position with at least one scholarly source (it may be your text).  Be sure to cite the article you choose, use APA format, and include a title page and reference page.

Review the rubric for further information on how your assignment will be graded.

Due: Sunday, 11:59 p.m. (Pacific time)

Points: 60

Week 8–REPLY TO THIS:ONE PAGE ONE   REFERENCE//////

COLLAPSE

Top of Form

    Registered nurses and Advanced practice nurses, play a huge roll when it comes to health care and policy changes. One of the

ways RNs and APRNS make head way, is by being a part of the American Nurses Association (ANA), or something similar. Being a

part of a bigger organization would give them more of advantage and a louder voice. Additionally, health care organizations are in

the favor of the nurse, so a push for policy changes, would make it easier in their favor. Another way nurses make an impact, is by

expressing their beliefs, at their workplace. Being a nurse, makes you already a great role model. But being a nurse and good one,

now thats tough to find. A good nurse knows who her place, and looks out for others and does not think about themselves. Making

them leaders and giants in their industry. With this, they can push for change and help with hospital programs in their workplace if

needed. Like helping to develop fall programs for patients, or creating a charge nurse committee for the units. 

    Now with these advantages, comes greater obstacles. One of the issues, would be to try and get accepted into a health care

organization. Whether it be membership fees, issues with your nursing license in the past, or the simple fact of getting chosen.

Sometimes trying to become a member is not a very task and it becomes a complex process. Another issue, would be having your

voice heard and having it fall on deaf ears, at the work place. For example, what is the point of fighting for your unit, when the staff

it self, only looks out for themselves and it does not make you feel like you are part of a team. Then, having bad management who

only care about the unit numbers and the unit budget. Making you feel like no matter how hard you try, you can always be

replaced. 

    In order to overcome these challenges, like any good relationship, their has to be trust and above all, communication. Voicing

your opinion on items or procedures you do not agree with. If you are not heard by your own manager, then take it to the next

level. You did not work this hard to achieve this nursing license, to risk it for a policy or a procedure that you believe is not ethical.

With it, more training for veteran and future nurses, should be implemented. To be given the opportunity to be aware of new

changes or medications, that will affect their place of work. Additionally, having great leadership and courage to speak up for the

unit staff and the safety of patients. 

References:

-Congress.gov.(n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

please follow instructions

thanks

Read the following scenario and answer the question:

You started as the new HIM Manager a couple of weeks ago.  Your department began using workflow technology about 2 months ago with an imaging system that has been used for 1 year.  With the implementation of workflow, the department started coding and analyzing charts online.  One of the first things that you noticed when you started work was the stress level of the coders – they are panicking.  When you meet with them, both as a group and independently, you find out that they hate the new system.  They say they do not feel comfortable using it, they only had a short training period, and they were not involved in the selection or the implementation. 

• What are your plans to improve the situation?

(300-350 words)

Instructions

Develop: Persuasive Speech Outline

Evaluation Title: Persuasive Speech Outline Final and Reflection

Using the persuasive outline created for the Unit 6 discussion, review the instructor and/or peer feedback to finalize the persuasive speech outline for submission. Consider this feedback to address your challenges and revise. Revisions are a key step in the speech writing process. Be sure to take this step.

The outline should be written in the full-sentence outline method using one of the persuasive organizational patterns (Problem-Solution, Cause-Effect or Monroe’s Motivated Sequence). The outline should have enough content to deliver an 8-10 minute persuasive speech, which you will complete in Unit 7. Once again, please use the sample outline document (attached here) to help build your formal outline.

Step 1:  Finalize the Persuasive Outline

The outline should include the following:

• Specific Purpose
• Central Idea (aka:  Thesis Statement or Preview Statement)
• Introduction – capture attention, establish YOUR speaker credibility, preview the speech
• Body – key points (minimum of 3), transitions between main points, supporting materials from at least 3 sources including in-text references to the sources.
• Conclusion – signal the end, summarize main points
• Researched supporting material references (minimum 3) – include works cited at the end of your outline, use APA format.
• Identification of a presentation aid (visual)
• Use persuasive techniques and language

Step 2:  Complete the Reflection Questions

Answer the following reflection questions, in addition to the finalized persuasive speech outline. You can include the answers at the end of your works cited:

1. What types of persuasion did you choose to include? Why? How would they best persuade your target audience?
2. What challenges did you have crafting our outline? How did you overcome them?
3. What do you think is the strength of this outline? Why?

Review the grading rubric before submission. This assignment is valued at 85 points.

Submit to the appropriate submission area in Canvas:

• The finalized persuasive speech outline as an attached document
• Answers to reflection questions on the outline document OR in the submission comments area

This assignment will help prepare you for conversations with clients with a mental health condition.

Course Competency

Describe the foundations of mental health nursing.

Transferable Skill

Communication: Displaying capability in writing, reading, and oral communication; understanding of non-verbal language.

Instructions

It will be carried out with two students working together. This is a “role play exercise,” in which one student is the student nurse, and the other will role play as a client. In this assignment, the nursing student will be demonstrating the therapeutic nurse-client relationship and analyzing the therapeutic and nontherapeutic techniques used. You will take turns in the roles.

This is not about always having therapeutic responses. It is about learning from practice and review. It is expected that you will think of other ways to respond or interact with the client that may be more therapeutic after the interaction is terminated. After the conversation is over, you will complete in IPR form.

The client roles are:

1. Mr. Jones is a 69-year-old retired engineer. He was admitted to the in-patient psychiatric unit the previous day. His daughter had called the police when he locked himself in his bathroom and refused to come out. She thought he was suicidal. He was brought to the hospital by the police and was admitted on involuntary status. He has been reticent since admission but told his daughter he had no reason to live since his wife died.
   Diagnosis: MajorDepressive Disorder
   Nursing Diagnosis: Risk for suicide.
2. Mrs. Alvarez is a 34-year-old female who has lived in this country for the past 10 yrs. She is a stay at home mom with three small children. Her husband works two jobs to support the family. Lately, she has been extremely anxious and fears that her children will become ill or injured. This seems to be an unrealistic concern, but she has been unable to sleep well and has lost 15 lbs. in the past month. She is a voluntary admission and states she knows she needs help.
   Diagnosis: Generalized Anxiety Disorder
   Nursing Diagnosis: Ineffective coping

You will select the role you wish as a client and take turns switching roles. After the conversation, you will document the interactions using the form provided and following the guidelines instructions for each column.

IPR Form Explanation

The IPR is completed with the form to guide you, and the rubric to explain the grading process for content.

The IPR Form is linked here.

• The first column is for you, the nursing student’s, comments/ questions, and responses. You may want to include the introduction process. It is understandable if the initial conversation is more superficial to establish rapport. You may not want to include all of this but move on to the more focused interaction. Your nonverbal communication is included here.
• Then, the conversation will move to a focus on the client’s feelings, concerns, issues as he/she has identified them. After the introduction, it may be beneficial to establish with the client a short- term goal for the interaction.
• The second column is for the client’s comments, questions, responses. Also, the nonverbal reactions of the client are included in this column.
• The middle column is for you to write what you are thinking or feeling.
• The last two columns are for you to document the technique that you used in that portion of the conversation. If it is a nontherapeutic response, you are to write the response and think of how you could revise to more therapeutic response. You can change any response if you think of how you could have responded differently but, identify and change all nontherapeutic responses.

Remember, this is an assignment that will assist you in all communication with others.

Explanation of the Rubric Criteria for Interpersonal Process Recording (IPR)

• Communication (20 verbal entries, ten nonverbal, ten techniques)
• Criteria 1 Nursing Interaction (verbal and nonverbal)
  Nursing statements and questions demonstrate a positive, caring approach and show insight into the client needs. These interchanges will include the introduction process, but not the more superficial interchanges. Nonverbal communication techniques are also recognized. Thoughts and feelings are identified and documented.
• Criteria 2
  The client verbal statements and questions are documented. Nonverbal communication is also observed and interpreted. You may also identify defense mechanism(s) used by the client.
• Criteria 3
  All communication techniques used are identified (using titles previously reviewed).
• Criteria 4
  All non-therapeutic techniques to be identified and changed to a therapeutic method. If in the review of the interaction, a more appropriate or therapeutic approach (verbal or nonverbal) is identified, document how this response/ statement would be changed

TASK

Learning Theories and Personal Motivation

a. Describe learning theories as they relate to your personal motivation to successfully increase your nursing knowledge.

b. Discuss potential barriers to learning.  

To support your work, use your course and text readings and also use resources from the University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format. You may use this APA Citation Helper as a convenient reference for properly citing resources.

REPLY1

For the topic of asthma, there are six articles on asthma that will help formulate on the project. Each have their strengths and weakness.

Article #1

“Improving care of inner-city children with poorly controlled asthma: what mothers want you to know.”

Strength: The article highlights on the perspectives of parents with children with asthma and the management ability. This is important as it can determine what is needed to help improve care and participation.

Weakness: The study only targeted poor families and asthma is a broad area that can affect all incomes with exposure to different things and circumstances, and it is good to look at other perspectives based on their lifestyles to compare.

Article #2

“Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study.”

Strength: The article focuses on the effects high traffic and highway areas in relation to asthma. Rates are calculated with those who live in close proximity versus those who are further away from them.

Weakness: The article measured those who live within 100meters of major roadway, but I believe asthma rates should be compared not only to those living within 100meters but also those who live even closer. Then look at the severity of the symptoms based on location.

Article #3

“Asthma-related school absenteeism, morbidity, and modifiable factors.” 

Strength: The articles is a great one to reference as it gives insight on school absenteeism and it’s relation to asthma and its morbidity, while determining which areas can be modified to improve outcome.

Weakness: The study was conducted using a Behavioral Risk Factor Surveillance System Child Asthma Call-back Survey. This is a random-digit dial survey which is made to help assess the health and experiences of children ages 0–17 years with asthma. Although this is a good approach, it also can lead to inaccurate responses by the children or their parents.

Article #4

“A school nurse-led asthma program Reduces Absences: Evaluation of easy breathing for schools.”

Strength: The article helps to understand the importance of school nurses within school setting and the use of asthma programs like Easy Breathing for Schools, in how they impact a reduction in asthma symptoms, more management.

Weakness: Based on the training of nurses in easy program prior to study, application, surveys, and collaboration with physicians and the satisfaction scores, small but very important things for the impact of the study were a bit weak. From 51 nurses only 28 nurses participated, one nurse per school where over 200 children were enrolled, possibly making it difficult to gather information in short period of time. In addition, not all children with asthma were enrolled in the program.

Article #5

“Building bridges for asthma care: Reducing school absence for inner-city children with health disparities.”  

Strength: This is another article that supports nurses in using and assessing the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control. The Inhaler Technique Assessment Tool was used to standardize the assessment of inhaler technique by school nurses, and elementary schools from 2 different states were considered, which shows diversity of location and outcomes.

Weakness: Children were enrolled in the Building Bridges Program for 2 consecutive years, but only data from their first year of enrollment were included in the analysis of absenteeism. School absence data were challenging to analyze, due to the variety of age/grade, race/ethnicity, and asthma status.

Article #6

“Solutions for asthma disparities.” 

Strength: Disparities in asthma outcomes have been documented for many years and this is important to recognize as it can help to find solutions to the issues. This article helps to address disparities in the health care sector, evidence-based guidelines detail essential elements that providers and health care organizations should deliver for high-quality asthma care.

Weakness: One limitation of the article it explains that wide-scale payment policies may not affect all systems equally and care must be taken to avoid widening disparities if financial penalties are on the line. And payment systems should incentivize and reward the reduction of disparities not be the cause of.

References

Bellin, M. H., Newsome, A., Lewis-Land, C., Kub, J., Mudd, S. S., Margolis, R., & Butz, A. M. (2018, July-August). Improving care of inner-city children with poorly controlled asthma: what mothers want you to know. Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners, 32(4), 387–398. https://doi-org.lopes.idm.oclc.org/10.1016/j.pedhc.2017.12.009

Hauptman, M., Gaffin, J. M., Petty, C. R., Sheehan, W. J., Lai, P. S., Coull, B., Gold, D. R., & Phipatanakul, W. (2020, January). Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study. The Journal of Allergy and Clinical Immunology, 145(1), 119–126. https://doi-org.lopes.idm.oclc.org/10.1016/j.jaci.2019.08.038

Hsu, J., Qin, X., Beavers, S. F., & Mirabelli, M. C. (2016, July). Asthma-related school absenteeism, morbidity, and modifiable factors. American Journal of Preventive Medicine, 51(1), 23–32. https://doi-org.lopes.idm.oclc.org/10.1016/j.amepre.2015.12.012

Simoneau, T., Langton, C. R., Kuo, C.-L., Marrero, J., Gherlone, N., Cloutier, M. M., & Hollenbach, J. P. (2020, January-February). A school nurse-led asthma program Reduces Absences: Evaluation of easy breathing for schools. Academic Pediatrics, 20(1), 73–80. https://doi-org.lopes.idm.oclc.org/10.1016/j.acap.2019.07.007

Szefler, S. J., Cloutier, M. M., Villarreal, M., Hollenbach, J. P., Gleason, M., Haas-Howard, C., Vinick, C., Calatroni, A., Cicutto, L., White, M., Williams, S., McGinn, M., Langton, C., Shocks, D., Mitchell, H., & Stempel, D. A. (2019, February). Building bridges for asthma care: Reducing school absence for inner-city children with health disparities. The Journal of Allergy and Clinical Immunology, 143(2), 746. https://doi-org.lopes.idm.oclc.org/10.1016/j.jaci.2018.05.041

Volerman, A., Chin, M.H., & Press, V.G. (2017, March). Solutions for asthma disparities. Pediatrics. Official Journal of the American Academy of Pediatrics. 139(3). DOI: https://doi.org/10.1542/peds.2016-2546

REPLY2

Six article summary on patient safety include:

Heather V., Shin Hye, P., & Sandra, B.-B. (2018). Characteristics of the Nursing Practice Environment Associated with Lower Unit-Level RN Turnover. The Journal of NursingAdministration, 6(1), 31-86.

This article shows the relationship between staff rate turnover and environment. The main advantage of the above article is that it expounded on the linkage between sufficient staffed unit and lower turnover rates. However, the authors failed to show methods of changing work environment to a conducive environment preferred with all nurses.

Buljac-Samardžić, M., & van Woerkom, M. (2018). Severity and workload of nursing.Escola Anna Nery 22(1), 53-134.

The authors of severity and workload of nursing tried to provide as much information on nursing workload and that served as their great strength. However, they failed to consider the wide aspects in the field of nursing and concentrated only on patient safety and its effects on healthcare professionals.

Romig, C. (2016). Health Policy Issues: The nursing shortage demands action now—state and federal legislation passed. AORN Journal,74, 733–738. (06)61776-6

The authors of this article tried to show the need of addressing nursing shortage stating their effects on patient safety and general healthcare. Nonetheless, they did not give examples of the benefits the passed laws to salvage nursing shortage.

Shekelle, P. G. (2015). Nurse-patient ratios as a patient safety strategy: A systematicreview.Annals of Internal Medicine, 15(8), 404–409. -158-5-201303051-00007

Nurse- patient ratios as a patient safety strategy journal was known for using comprehensive data to analyze and support evidence on lower nurse or patient ratios. However, the journal received a lot of criticism from other researchers because it failed to consider the importance of patient acuity in the process of assigning patients to nurses.

Swiger, P. A., Vance, D. E., & Patrician, P. A. (2016). Nursing workload in the acute-caresetting: A concept analysis of nursing workload.Nursing Outlook, 64, 244–254.

The journal of nursing workload in the acute- care setting gain its popularity since it used extensive numerical data supporting the effects of high workloads on both patients and nurses. Nevertheless, the journals main weakness is that it only obtained data from one healthcare facility thus was based on a narrow scope of the required comprehensive for any random sample study.

Wolf, L. A., Perhats, C., Delao, A. M., Clark, P. R., & Moon, M. D. (2016). On the Threshold of Safety: A qualitative exploration of nurses’ perceptions of factors involved in safe staffing levels in emergency departments.Journal of Emergency Nursing 2(5),134-147.

Lastly is the article of Threshhold of safety and it absolute strength is that it can be measured in its perceptive form. However, it has one weakness in that it only based on opinion and assumptions of nursing staff working in emergency rooms.

Reference

Heather V., Shin Hye, P., & Sandra, B.-B. (2018). Characteristics of the Nursing Practice Environment Associated with Lower Unit-Level RN Turnover. The Journal of NursingAdministration, 6(1), 31-86

Buljac-Samardžić, M., & van Woerkom, M. (2018). Severity and workload of nursing.Escola Anna Nery 22(1), 53-134.

Romig, C. (2001). Health Policy Issues: The nursing shortage demands action now—state and federal legislation passed. AORN Journal, 74, 733–738. (06)61776-6