Category: Nursing

Instructions
Review the following case study.
Construct a subjective data set for the case study on the provided SOAP note template from the information provided.  
Structure the subjective data set on the SOAP note template in the format provided in your lecture materials.  
Submit the Word file containing your subjective data set on the SOAP note template into Canvas.

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.
Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum. Refer to the “Population-Focused Nurse Practitioner Competencies” found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
Refer to your Clinical Skills Self-Assessment Form you submitted in Week 1, and consider your strengths and opportunities for improvement.
Refer to your Patient Log in Meditrek, and consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.
JOURNAL ENTRY (450–500 WORDS)
Learning From Experiences
Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
Reflect on the three (3) most challenging patients you encountered during the practicum experience. What was most challenging about each?
What did you learn from this experience?
What resources were available?
What evidence-based practice did you use for the patients?
What would you do differently?
How are you managing patient flow and volume?
How can you apply your growing skillset to be a social change agent within your community?
Communicating and Feedback
Reflect on how you might improve your skills and knowledge, and communicate those efforts to your Preceptor.
Answer the questions: How am I doing? What is missing?
Reflect on the formal and informal feedback you received from your Preceptor.

I would like the quality improvement or change to be something to do with obstetrics and a  
labor patient. Ideas include wireless monitoring systems or being able to eat while in labor in the hospital. Another idea is c-section statistics. I have included the syllabus for the requirements

Scenario
Hilary Jones is a 72-year-old obese white female admitted three days ago with a chief complaint of hip pain after falling at home. An open reduction and internal fixation (ORIF) of the right hip was performed to repair a fracture on admission. Mrs. Jones developed a pulmonary embolism (PE) on post-op day 2.
PMHx: HTN, DM, GERD, and anemia
PSH: Cholecystectomy
Current Medications: Metoprolol, Glucophage, Prevacid, and Dilaudid
PRN Allergies: NKDA
72, Caucasian, Female, Obese
I forgot to mention, her husband keeps getting in the way, and she is constantly on the call light. When I assessed her: she is alert and oriented x3 in no apparent distress. Vitals are stable: T 99, P 80, R 20, BP 150/90, and Oxygen on at 4 L via NC. Heparin is infusing at 8 mL/hr. Foley is patent and draining clear yellow urine. C/O pain at 4 AM, rated pain a 10 on a scale of 0-10, medicated X 1 with Dilaudid. She can receive 2mg IVP Q6 PRN. Mrs. Jones keeps complaining of pain. The monitor showed normal sinus rhythm, abdomen soft, non-tender with BS present in all quads. Her abductor pillow has been in place throughout the night.
Clinical Application Questions
After reading the scenario, answer the following questions in a Microsoft Word document. Refer to the learning material presented in this module for guidance.
After actively listening to the night shift nurse’s report, what important data was omitted from the night shift nurse? What other information should have been provided by the night nurse to give quality and safe client care?
What was inappropriate about the night RN’s report?
What can you do to change behaviors like this in your nursing unit? How could factors such as effective listening, assertiveness, and teamwork play a role in changing behaviors of unit staff?

You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers. 
Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice. 
Case Study Questions: 
What are the potential ethical and legal implications for each of the following practice members? 
Medical assistant
Nurse Practitioner
Medical Director
Practice
What strategies would you implement to prevent further episodes of potentially illegal behavior? 
What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.
A scholarly resource must be used for EACH discussion question each week.

For this assignment, you will draft a Legislative Letter to a specific legislator and offer support or a constructive argument against pending or passed policy or legislation that you are passionate about.   
Your letter must include three (3) evidence-based references that support your position.

Identify the role of patient safety and its influence on federal initiatives that are used to prevent unintentional death as a result of medical mistakes.
2. The majority of health care errors occur in inpatient settings. Errors are becoming increasingly common in outpatient settings.  Discuss at least two (2) reasons for the increasing errors in outpatient settings. 

elect a NUTRIENT and an area of concern (disease state, metabolism. treatment, etc.) in a disease  or a special population we have studied  
******PAPER IS ON IRON deficiency and ANEMIA*******

As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in health care settings. Effective quality improvement measures result in systemic and organizational changes, ultimately leading to the development of a patient safety culture.
The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures that address a safety quality issue in a health care setting. This will be within the specific context of patient safety risks at a health care setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in health care settings from organizations such as QSEN and the IOM.
Looking through the lens of these professional best practices to examine the current policies and procedures currently in place at your chosen organization and the impact on safety measures for patients surrounding a specific safety quality issue, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote medication administration safety in the context of your chosen health care setting.
As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in health care settings. Effective quality improvement measures result in systemic and organizational changes, ultimately leading to the development of a patient safety culture.
The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures that address a safety quality issue in a health care setting. This will be within the specific context of patient safety risks at a health care setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in health care settings from organizations such as QSEN and the IOM.
Looking through the lens of these professional best practices to examine the current policies and procedures currently in place at your chosen organization and the impact on safety measures for patients surrounding a specific safety quality issue, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote safety in the context of your chosen health care setting.

Prepare an analysis (5-7 pages) of an adverse event or a near miss from your professional nursing experience and outline a QI initiative that would address it.
Despite technological advances, quality care initiatives, oversight, ongoing education and training, legislation, and regulations, medical errors continue to be made. Some are small and easily remedied with the patient unaware of the infraction. Others can be catastrophic and irreversible, altering the lives of patients and their caregivers and unleashing massive reforms and costly litigation. The goal of this assessment is to allow you to focus on a specific event in a health care setting that impacts patient safety and related organizational vulnerabilities and to propose a QI initiative to prevent future incidents. It will give you the chance to develop your analytical skills in the problem-solving contexts you likely find yourself in as a health care professional.
Health care organizations strive for a culture of safety. Yet, despite technological advances, quality care initiatives, oversight, ongoing education and training, laws, legislation, and regulations, medical errors continue to occur. Some are small and easily remedied with the patient unaware of the infraction. Others can be catastrophic and irreversible, altering the lives of patients and their caregivers and unleashing massive reforms and costly litigation.
Historically, medical errors were reported and analyzed in hindsight. Today, QI initiatives attempt to be proactive, which contributes to the amount of attention paid to adverse events and near misses. Backed up by new technologies and reporting metrics, adverse events and near misses can provide insight into potential ways to improve care delivery and ensure patient safety.
For clarification, the National Quality Forum (n.d.) defines the following:
Adverse event: An event that results in unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient.
Near miss: An event or a situation that did not produce patient harm, but only because of intervening factors, such as patient health or timely intervention. Prepare a comprehensive analysis of an adverse event or a near miss from your professional nursing experience that you or a peer experienced. Provide an analysis of the impact of the same type of adverse event or near miss in other facilities. How was it managed, who was involved, and how was it resolved? Be sure to:
Analyze the implications of the adverse event or near miss for all stakeholders.
Analyze the sequence of events, missed steps, or protocol deviations related to the adverse event or near miss using a root cause analysis.
Evaluate QI actions or technologies related to the event that are required to reduce risk and increase patient safety.
Evaluate how other institutions integrated solutions to prevent these types of events.
Incorporate relevant metrics of the adverse event or near miss to support need for improvement.
Outline a QI initiative to prevent a future adverse event or near miss.
Ensure your analysis conveys purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.
Be sure your analysis addresses all of the above points. Length of submission: A minimum of five but no more than seven double-spaced, typed pages, not including the title page or References section.
Number of references: Cite a minimum of three sources of scholarly or professional evidence that support your evaluation, recommendations, and plans. Current source material is defined as no older than five years unless it is a seminal work. Review the Nursing Master’s Program (MSN) Library Guide for guidance.
APA formatting: Resources and citations are formatted according to current APA style. Review the Evidence and APA section of the Writing Center for guidance.