Category: Nursing

4. Clinical Judgment – Incorporate clinical judgment to ensure quality outcomes when managing patient care.
Your outcomes progress evaluation is an important part of the evaluation process. The specific purposes of the outcomes progress evaluation are to (1) help you plan, organize, and document your learning during the clinical practicum; (2) help faculty understand the degree of insight you have into your learning; and (3) help you and the faculty to evaluate how you are meeting program outcomes.
1. A summary discussion of experiences and patients cared for. We consider families, parents, and significant others important to discuss along with the primary patient. 2. Discuss utilization or incorporation of concepts from all previous courses – Include care related growth and development, caring, advocacy, teaching, communication, culture and spirituality.
3. This one is very important: Note what you would do differently if you had the opportunity. We are interested in decisions, actions, statements, and any other patient/community-oriented actions and clinical decisions made.
4. When the outcome progress evaluation is returned respond to comments (with contrasting color ink) made on your work. This is critical, to ensure that you have an ongoing written dialogue. Use the opportunity to reflect on both the transferable skills that you are developing, as well as the course-specific skills you are putting into practice in the clinical area.
Here are some questions you could ask yourself to aid reflective self-evaluation:
✓ In what areas/situations do you feel you have made progress? ✓ Specifically what have you learned? ✓ What strengths can you identify?
✓ How will you use the information to care for your patient, promote health, and, when disease is present, provide for early diagnosis and prompt treatment, and/or restore and rehabilitate the health.
✓ What has contributed to this progress? ✓ What have you learned about the way you learn?
✓ What would you do differently next time? ✓ What other options were there in that situation? ✓ What would have been the consequences of another action? ✓ Has another similar incident arisen again and how did you react? ✓ Think about some events/ situations that have taken place and how you felt at the time, e.g. confident, tense, frustrated, certain, doubtful etc. Use these reactions to identify strengths, and areas that need development. ✓ Have you identified any areas of weakness? ✓ Are there potential situations where you can work on these? How

A hospital in a religiously and ethnically diverse community invites local religious leaders, including those belonging to religions with significant health-related beliefs and practices, including Judaism, Islam, Jehovah’s Witnesses, Church of Jesus Christ of Latter-Day Saints (Mormonism), and Roman Catholicism, to participate in a panel discussion on religion and health care practices. The panel is asked various questions about health-related beliefs and practices such as diet; medications; medical procedures; practices related to birth, reproduction, and death; religious organizational infrastructure for visiting the sick; healing rituals; specific needs during illness and hospitalization; and other health-related issues.
1.  Are spirituality and religion the same? Explain the rationale for your answer.
2.  What is meant by ethnoreligious beliefs and practices? Provide an operational definition using your own words.
3.  How are a client’s religious and cultural practices interconnected?
4.  What scientific evidence is there that clients’ religious beliefs and practices influence their overall health, prevent or alleviate certain diseases, and/or contribute to longevity?
5.  How does your knowledge of a client’s health-related cultural beliefs and practices influence your nursing care for him or her?
Submission Instructions:
Due by Tuesday.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 
No peer response.
All replies must be constructive and use literature where possible.

All assignments in this course build upon each other. Assignment 1 builds on the PICOT question submitted by the student and approved by the instructor in Week 1 of the discussion board. The PICOT format for this course is an intervention question. The interventions must be nursing interventions and not medical. 
Step one (1) of the evidence-base practice (EBP) process is to formulate a burning PICOT question. Step two searches for the best scientific evidence (external evidence) by considering the elements of the PICOT question.
Assignment Criteria: 
Students will develop a scholarly paper and include the following criteria.
1.    Construct the PICOT question in the intervention format based on the feedback and approved in Week 1
2.    Describe the clinical problem related to the PICOT question. 
a.    Discuss why the problem is important to nursing practice
b.    Discuss the chosen intervention
3.    Elaborate on how the intervention may impact the stated outcome
4.    Discuss two (2) barriers that a master’s prepared nurse might encounter before implementing the intervention.
5.    The scholarly paper should be in narrative format, four (4) to five (5) pages excluding the title and reference pages.
6.    Include an introductory paragraph, purpose statement, and a conclusion. 
7.    Include level 1 and 2 headings to organize the paper.
8.    Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used. 
9.    Include a minimum of three (3) references from professional peer-reviewed nursing journals to support the paper. References should be from scholarly peer-reviewed journals (review in Ulrich Periodical Directory) and be less than five (5) years old.
10.    APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).
11.     Submit the assignment to Turnitin prior to the final submission. Please be sure to review the originality report and make any needed changes.
12.    Submit by posted due date.
The PICOT question that I picked is:
“In hospitalized adults, how does turning patients compared with pressure-reducing devices affect the occurrence of pressure injury development during hospital stays over 2 weeks?”
It should be 4-5 pages, excluding the title and reference page.
Attatched is an example layout of the essay headings. 

In a 5–7 page written assessment, define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective. Plan to spend approximately 2 direct practicum hours meeting with a patient, family, or group of your choice to explore the problem and, if desired, consulting with subject matter and industry experts.
Choose firat the topic to write about from the pdf list that  I will upload. Use in-text citation when needed
Instructions
Complete this assessment in two parts.
Part 1
Use Assessment 01 Supplement: Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations [PDF] Download Assessment 01 Supplement: Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations [PDF]to define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective and establish your evidence and research base to plan, implement, and share findings related to your project.
Part 2
Connect with the patient, family, or group you’ll work with during your practicum. During this portion of your practicum, plan to spend at least 2 hours meeting with the patient, family, or group and, if desired, consulting with subject matter and industry experts of your choice. The hours you spend meeting with them should take place outside of regular work hours. Use the Practicum Focus Sheet [PDF] Download Practicum Focus Sheet [PDF]provided for this assessment to guide your work and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Preparation
In this assessment, you’ll assess the patient, family, or population health problem that will be the focus of your capstone project. Plan to spend approximately 2 hours working with a patient, family, or group of your choice to explore the problem from a leadership, collaboration, communication, change management, and policy perspective. During this time, you may also choose to consult with subject matter and industry experts about the problem (for example, directors of quality or patient safety, nurse managers/directors, physicians, and epidemiologists).
To prepare for the assessment, complete the following:
Identify the patient, family, or group you want to work with during your practicum. The patient you select can be a friend or a family member. You’ll work with this patient, family, or group throughout your capstone project, focusing on a specific health care problem.
Begin surveying the scholarly and professional literature to establish your evidence and research base, inform your assessment, and meet scholarly expectations for supporting evidence.
In addition, you may wish to complete the following:
Review the assessment instructions and scoring guide to ensure that you understand the work you’ll be asked to complete and how it will be assessed.
Review the Practicum Focus Sheet: Assessment 1 [PDF] Download Practicum Focus Sheet: Assessment 1 [PDF], which provides guidance for conducting this portion of your practicum.
Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
Define a patient, family, or population health problem that’s relevant to your practice.
Summarize the problem you’ll explore.
Identify the patient, family, or group you intend to work with during your practicum.
Provide context, data, or information that substantiates the presence of the problem and its significance and relevance to the patient, family, or population.
Explain why this problem is relevant to your practice as a baccalaureate-prepared nurse.
Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to the patient, family, or population problem you’ve defined.
Note whether the authors provide supporting evidence from the literature that’s consistent with what you see in your nursing practice.
Explain how you would know if the data are unreliable.
Describe what the literature says about barriers to the implementation of evidence-based practice in addressing the problem you’ve defined.
Describe research that has tested the effectiveness of nursing standards and/or policies in improving patient, family, or population outcomes for this problem.
Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
Describe what the literature says about a nursing theory or conceptual framework that might frame and guide your actions during your practicum.
Explain how state board nursing practice standards and/or organizational or governmental policies could affect the patient, family, or population problem you’ve defined.
Describe research that has tested the effectiveness of these standards and/or policies in improving patient, family, or population outcomes for this problem.
Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of this problem.
Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to the patient, family, or population problem you’ve defined.
Discuss research on the effectiveness of leadership strategies.
Define the role that you anticipate leadership must play in addressing the problem.
Describe collaboration and communication strategies that you anticipate will be needed to address the problem.
Describe the change management strategies that you anticipate will be required to address the problem.
Organize content so ideas flow logically with smooth transitions.
Apply APA style and formatting to scholarly writing.
Use the resources linked below to help complete this assessment.
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Leadership
The following article provides an in-depth review of the effect of transformational leadership in nursing:
Fischer, S. A. (2016). Transformational leadership in nursing: A concept analysis. Journal of Advanced Nursing, 72(11), 2644–2653.
The following article presents a mental model of effective health care leadership competencies, using a concept mapping approach:
Hargett, C. W., Doty, J. P., Hauck, J. N., Webb, A. M. B., Cook, S. H., Tsipis, N. E., Neumann, J. A., Andolsek, K. M., & Taylor, D. C. (2017). Developing a model for effective leadership in healthcare: A concept mapping approach. Journal of Healthcare Leadership, 9, 69–78. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774455/
The following article presents a comprehensive review of the literature related to decision making in nursing:
Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5/6), 917–928.
Watch the following videos:
Preparing Nurses to Lead in a Changing Healthcare Environment.
This video presents strategies that an RN-to-BSN–prepared nurse can employ to lead and address health care problems.
Principles of Crucial Conversations.
This video explores how to successfully address conflict in the workplace and address health care problems with a patient and family.
Psychology of Change Framework.
This video depicts the effect of change on nursing and health care.
Health Policy
This website provides a search function to assist you in finding individual state nurse practice acts.
National Council of State Boards of Nursing. (n.d.). Find your nurse practice act. https://www.ncsbn.org/npa.htm
Health Issues
Use the following resources to begin exploring patient, family, or population health problems that you might choose as the focus of your capstone project. They provide information on a number of problems common to today’s health care systems.
Bindman, A. (2016, December 5). AHRQ’s role in improving care for patients with multiple chronic conditions. LinkedIn. https://www.linkedin.com/pulse/ahrqs-role-improving-care-patients-multiple-chronic-andy-bindman?trk=mp-reader-card
This blog post focuses on patient-centered care for individuals with complex care needs.
Centers for Medicare & Medicaid Services. (2016). CMS releases guide to preventing readmissions among racially and ethnically diverse Medicare beneficiaries. https://www.cms.gov/newsroom/press-releases/cms-releases-guide-preventing-readmissions-among-racially-and-ethnically-diverse-medicare
This press release discusses the CMS Guide to Reducing Disparities in Readmissions and includes links to the guide and additional information about readmissions that you may choose to review.
Joint Commission. (n.d.). http://www.jointcommission.org
The Joint Commission website provides resources addressing a variety of health care problems, any one of which you may want to choose as the focus of your capstone project.
Leapfrog Group. (n.d.). https://www.leapfroggroup.org/
The Leapfrog Group website provides data on hospital performance for a variety of services and patient outcomes. The data presented focus on common health care problems. Hospitals are graded on how well these problems are addressed. You may want to choose one of these problems as the focus of your capstone project.
Wang, Y., Kung, L., Gupta, S., & Ozdemir, S. (2019). Leveraging big data analytics to improve quality of care in healthcare organizations: A configurational perspective. British Journal of Management, 30(2), 362–388.
This article explores the use big data analytics (BDA) in addressing health care financial performance. Data are used to identify problems in health care, drive decisions about how to address these problems, and monitor the success of associated solutions. Think about how you can use data to identify the focus of your capstone project, determine an intervention, and measure the success of the solution.
You may use your sources but within 5 years and peer reviewed journals.

Role of Nursing as a Science through the development of theories and research.
Write an essay  analyzing the role of the Advanced Nursing professional (ARNP) in the general public health and the focus on the health of the Hispanic Community. 
Use the APA style and send it via CANVAS for evaluation. Your essay must have a minimum of 800 words and use at least three current bibliographic references.
assignment will be run through TurnItIn to check for plagiarism

Instructions
Answer the following questions in a Microsoft Word document based upon your assigned chapter topic and PICOT activity from module 1. How did you find the evidence supporting the nursing assessment or intervention?
How do you conclude the evidence was sufficiently strong to support the nursing practice?
How you would promote the adoption of this clinical practice by nurses in your hypothetical healthcare setting?
How would you recommend that the organization evaluate the adoption of the practice change?
Note: The clinical practice you recommend should be an autonomous (or relatively autonomous) nursing action (e.g., an assessment or an intervention). This does not include delegated interventions such as administering medication or a provider’s decision to give a medicine versus counseling ( e.g., collaborating with physicians to initiate physician orders such as removing a urinary catheter).
What is the committee (you and your group) expected to do?
Review the Evidence-Based Report Overview page if needed for more information regarding this group project.

Initial Post (For context)
Using 500 to 750 words, address the following prompts:
Why are there racial and ethnic disparities in health in the United States?
What are two policies to improve health equity in the United States? Make clear if these policies are adopted, proposed, or ones you would recommend.
Replies (This assignment)
Reply to at  two of your classmates. Each of your reply posts should be 200 to 400 words. You should cite one to two sources that add new information in response to your classmate’s post, with at least one of the sources from the Week 3 Learning Materials.
This week’s sources:
Derose, K., Gresenz, C., & Ringel, J. (2011).Understanding disparities in health care access.
You cannot get to the full article in Health Affairs to this reading. However, if you sign in and cut and paste the following into the search engine on the Regis College library website, after a few clicks to the FULL TEXT you will get to the full text article: Derose, K., Gresenz, C., Ringel, J. (2011). Understanding Disparities in Health Care Access.
Hayes, S., Riley, P., & Radley, D. (24 August, 2017). Reducing racial and ethnic disparities in access to care. Has the Affordable Care Act made a difference? The Commonwealth Fund.
Munoz, P., Kim, M., & Chang, M. (2015). The color of wealth in Boston.
Ndugga, N., & Artiga, S. (2021, May 11). Disparities in health and health care: 5 key questions and answers. Kaiser Family Foundation.
Robert Wood Johnson Foundation. (May 1, 2017). What is health equity?
Seervai, S. (2022, June 3). A strong public health system depends on making the invisible visible (26:36 minutes). [Audio podcast]. The Commonwealth Fund.
A transcript for this podcast is available on the site.
Classmate 1:Health equity is something that every nation strives for, yet few achieve it. Unfortunately, the United States has some of the worst health outcomes while spending the most on healthcare per capita. There are many factors involved when looking at racial and ethnic disparities in health. Our nation was born under colonialism and racism; we discriminated against American Indians and enslaved African Americans until the end of the Civil War. There is an underlying structural racism that has yet to be dealt with. In addition to this, many decades of policy decisions at the local, state, and federal level has created economic suppression, unequal access to education, and residential segregation. 
Health care disparities are the differences in health and health care between groups that began with broader inequities (Ndugga & Artiga, 2023). Health disparities are driven by economic and social inequalities. Health outcomes include those factors as well as genetics, health behaviors, and access to care. A person’s choice to use health services includes many facets including demographics, whether they have health insurance, their health beliefs, income, and illness level (Derose et al., 2011). There are other factors that are specific to underserved populations including the homeless, rural populations, immigrants, migrant workers, and American Indians. Disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Research also suggests that disparities occur across the life course, from birth, through mid-life, and among older adults (Ndugga & Artiga, 2023).  
The passage of the ACA helped reduce some of the healthcare disparities by increasing coverage for many, but the people of color and other marginalized groups are still most likely to be uninsured. There have been policies implemented to improve health equity in recent years especially during and after the pandemic. The Office of Climate Change and Health Equity started the UNITE Initiative to address structural racism and racial inequities in biomedical research (Ndugga & Artiga, 2023). This will help improve funding for research projects that will help improve the health outcomes of minority ethnic groups. The current administration has been taking steps to address the Maternal Health Crisis which includes high rates of maternal mortality and morbidity among Black people. One action was to extend Medicaid coverage of postpartum care from sixty days to twelve months; the other was the Human Resources and Services Administration announcing $12 million in awards for the Rural Maternal and Obstetrics Management Strategies Program (RMOMS), which is designed to develop models and implement strategies to improve maternal health in rural communities (Ndugga & Artiga, 2023). 
References 
Derose, K., Gresenz, C., & Ringel, J. (2011). Understanding Disparities In Health Care Access–And Reducing Them–Through A Focus On Public                                        Health. Health Affairs, 30(10). https://doi.org/10.1377/hlthaff.2011.0644  
Ndugga, N., & Artiga, S. (2023). Disparities in Health and Health Care: 5 Key Questions and Answers. KFF. Retrieved May 15, 2024, from                                                     https://www.kff.org/racial-equity-and- health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question- and-answers/  
Shi, L., & Singh, D. (2021). Delivering Health Care in America: A Systems approach. Jones & Bartlett Learning. 
Classmate 2:Racial and ethnic disparities within the United States are still prevalent today, and unfortunately, these are characteristics that predispose populations to vulnerability (Shi & Singh, 2021). It is shown that races and ethnicities such as African American and Hispanics overall tend to have a lower quality of health, care, access and lower insurance coverage (Kumar & Encinosa, 2021). This is due to preexisting problems within the Unites States, as both structural and interpersonal racism are shown to be causes of health inequities, disparities and disease (Centers for Disease Control and Prevention, 2023). These populations are at higher risk for prejudices and racism, affecting their social determinants of health and ultimately impacting their health in a negative manner (Mass.gov, 2024).  
In order to counteract this, Massachusetts developed a team, called the Health Policy Commission or HPC, that assesses health care spending growth and provides policy recommendations to ensure equitable health through independent policies (Mass.gov, 2024). One policy they have proposed is the reduction of health care disparities using four principles – research and report, convene, partner, and market monitor (Mass.gov, 2024). For research and report, the HPC’s goal is to find data that highlights areas of inequality and ensure that they are brought to attention. Convening focuses on hosting or attending events to raise awareness and further discuss inequalities found through their research. They then attempt to partner with other programs who also have the drive to fix our health care system to limit inequalities by developing standards of care. Finally, they market monitor, or review market changes and their impact on access and equity (Mass.gov, 2024). 
Health care systems are in place to target health disparities and ensure health care is being provided equally, however when looking at the bigger picture, equity needs to take place externally as well (Shi & Singh, 2021). This brings us back to the social determinants of health. The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) understands that approaching health care as a “one-size-fits-all” does not promote equal care but can actually widen disparities (Centers for Disease Control and Prevention, 2022). To counteract this, they focus on health equity approaches to prevent and manage chronic disease. They are doing so by addressing social determinants of health that can ultimately lead to poor health, such as those living in poverty, unsafe or unhealth environments, lack of food security, and limited access to education or careers that pay livable wages (Centers for Disease Control and Prevention, 2022). From there, they are creating partnerships throughout society whether it be individually or through communities and organizations. Health care should be equal and accessible by all, regardless of a person’s ethnicity or race. Policies can be proposed and put in place by many to ensure good health becomes more equitable, and these two examples given are only the start of change that has been proposed thus far. 
References:
Centers for Disease Control and Prevention. (2022, December 8). NCCDPHP’s approach to Advancing Health Equity. Centers for Disease Control and Prevention. https://www.cdc.gov/health-equity-chronic-disease/nccdphps-approach-to-health-equity.html 
Centers for Disease Control and Prevention. (2023, August 16). Impact of racism on our nation’s health. Centers for Disease Control and Prevention. https://www.cdc.gov/minorityhealth/racism-disparities/impact-of-racism.html 
Health equity. Mass.gov. (2024). https://www.mass.gov/info-details/health-equity 
Kumar, V., & Encinosa, W. (2021). Racial disparities in the perceived risk of covid-19 and in getting needed medical care. Journal of Racial and Ethnic Health Disparities, 10(1), 4–13. https://doi.org/10.1007/s40615-021-01191-5  
Shi, L., & Singh, D. A. (2021). Delivering Health Care in America: A Systems Approach (8th ed.). Jones & Bartlett Learning. https://ecampus.vitalsource.com/books/9781284249484 

Group 3
Your clinical group is on their assigned unit and are present for a staff huddle.
The team leader presents an update on a quality improvement project initiated to reduce falls on the unit.  The presentation includes data of the presenting problem and interventions developed and implemented. The unit leader reports there has been ZERO falls in 2 months. 
1. Describe an experience in clinical where you have seen a new initiative on your unit of practice or clinical related to an adverse trend of poor outcomes.
2. Discuss why it was initiated and how it impacts safer, more efficient nursing care.
3. You, as a student, are developing your leadership and quality improvement project. Discuss the goal of impact for your project to improve nursing profession or nursing care.
Zerwekh, J., & Garneau, A. Z. (2023). Nursing today: Transition and trends (11th ed.). Elsevier. ISBN-13: 9780323810159

A 24-year-old Pakistani immigrant woman has given birth to a healthy boy. She expresses sadness that her family cannot be there to see him. The nurse is confused about why the mother is not happy.
a.   What is the cultural context of her sadness?
b. What can the nurse do to assist her?
2.A 55-year-old man is hospitalized for an opportunistic infection and asks for his partner to be with him overnight. He stated that previous hospitals did not allow his partner to visit and that is why he chose your hospital.
a.   What are the ethical issues and what framework would you use to analyze the situation?
b. Describe the research that may support the request.
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. 
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. 
All replies must be constructive and use literature where possible.

-Shoulder dystocia
-Uterine rupture
Identify intervention supported by evidence for the client. What additional education and support can you provide to the patient while they are going through this situation? Amniotic fluid embolism : 3 nursing interventions for their client with support from evidence. Post-partum hemorrhage : 3 nursing interventions for their client with support from evidence. Resources: APA/IN-text citation from scholarly sources at least one for each topic