Discussion question Wednesday

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The Form and Function of the Family

Introduction

The family has an important place in the health promotion paradigm. The roles family members play in providing care to a loved one are crucial to the health and well being of the family system. In order to adequately assist families in achieving health, it is important for the nurse to assess the family as a whole as well as its individual members.

Family Evaluation

When providing care, nurses evaluate families within three domains. First, families are viewed in relation to caring for the individual, with the family as a support system for the person needing care. The perspectives and information provided by the family is important in clinical decision making. Ejaz, Straker, Fox, and Swami (2003) posited that assessing family members’ views on the quality of care provided gives a human face to care, which complements research obtained by statistical measures. Secondly, the family is considered the client, and care is aimed at all members collectively. Lastly, the family is viewed as a system within the community.

Family Function

Family members are the first influence on a person’s view of health. What people are familiar with seeing and experiencing at home is, typically, what they will continue to carry out on their own. Families function as support systems for one another; they assist with providing basic human needs and help younger members learn to socialize with one another and with the world around them. Therefore, families define both acceptable and unacceptable values and behavior.

Family Structural Theory

Salvador Minuchin designed family structural theory through his work with families in crisis. The basis for his theory is that a family is an open social and cultural system that reacts and adapts to the demands placed on it through what is known as transactional patterns of behavior. These transactional patterns define how family members interact and create patterns that demonstrate when, how, and with whom they relate (Vetere, 2001).

Many of the concepts of this theory are familiar and include family rules and roles, family organization, stabilization, boundaries, subsystems, and change. The nurse uses this theory to assess the family in the here and now. Furthermore, this information assists the nurse in planning for family health promotion education and/or behavior changes needed (Vetere, 2001).

Family Developmental Theory

Nursing practice has a foundation of using developmental theory to assist patients through every stage of life. Duvall built upon the theoretical framework of Erikson in his eight stages of psychosocial development. Duvall also created eight stages in her family development theory. Stage one begins with the family as a married couple with no children. Stage two includes childbearing families with children up to 30 months of age. Stage three represents families with preschool children. Stage four is made up of those with school-aged children, 6 through 13 years old. Families with teenagers are at stage five, and those families assisting their young adults out into the world are at stage six. Stage seven is empty nest couples, and stage eight represents old age, from retirement to death (University of North Texas, n.d.).

In addition, Duvall’s theory utilizes a set of eight tasks that families move through in each stage (University of North Texas, n.d.). The successful completion of the task depends on building upon the previous developmental stage. Adaptation and new responsibilities come with each developmental stage and the tasks associated with it. The nurse uses this theory to analyze the family’s progress to anticipate opportunity for health promotion and intervention.

Systems Theory

With systems theory, the family is viewed as a whole unit through which the action of each member influences the others. Within this theory, it is assumed that the family unit is greater than the sum of its members. Nurses familiar with systems theory view the individual client as a functioning and contributing member of a larger family system whereby each member influences the other. Essentially, the nurse must focus attention of the family as a whole instead of only the individual. When there is a change in health status of any individual person, the entire family must adapt.

Gordon’s Functional Health Patterns

Gordon’s functional health patterns are founded on 11 principles that are incorporated within the nursing process. They serve as a framework for clinical assessment and can be applied to the individual, family, and community. Through this framework, data is collected and assessed, allowing for the application of nursing diagnoses and interventions that encompass a holistic view of the client. There are 11 patterns, and within each pattern there are four focal areas.

When used together, the 11 functional health patterns can formulate the basis for a comprehensive nursing assessment and allow for identification of actual or potential health concerns. These functional health patterns will promote holistic nursing care through the evaluation of many physical, social, environmental, and spiritual domains. In order to facilitate effective nursing interventions, it is necessary for the nurse to implement critical thinking skills. This allows for the adequate and accurate assessment of clients based on the data and cues provided by the client.

Provided below is a listing of Gordon’s (1994) functional health patterns (FHPs).

            Pattern of Health Perception and Health Management

            Nutritional − Metabolic Pattern

            Pattern of Elimination

            Pattern of Activity and Exercise

            Cognitive − Perceptual Pattern

            Pattern of Sleep and Rest

            Pattern of Self Perception and Self Concept

            Role − Relationship Pattern

            Sexuality − Reproductive Pattern

            Pattern of Coping and Stress Tolerance

            Pattern of Values and Beliefs

Conclusion

Whether caring for individuals or for entire families, nurses must be cognizant of developmental and system theories that apply to family units. Having an understanding of the family as an integrated, living system provides the nurse with the tools needed to promote healthy living. In addition, recognizing the vital role that families play in ensuring the health and well being of children and family members of all developmental ages poises the nurse to promote a healthy community.

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planned change in department or unit

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To prepare:

Review Chapter 8 in the course text. Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies.

Reflect on problems, inefficiencies, and critical issues within a specific department, unit, or area in your organization or one with which you are familiar. Select one issue as a focal point for this assignment, and consider a change that could be made to address the issue.

Think about how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.

Using one of the change models or strategies discussed in Chapter 8, begin formulating a plan for implementing the change within the department/unit. Outline the steps that you and/or others should follow to facilitate the change effort. Align these steps to the change model or strategy you selected.

Determine who should be involved in initiating and managing the change. Consider the skills and characteristics that are necessary to facilitate this change effort.

 

To complete:

By Day 7

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

  1. Identify a problem, inefficiency, or issue within a specific department/unit.
  2. Describe a specific, realistic change that could be made to address the issue.
  3. Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
  4. Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection.
  5. Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy.
  6. Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort.

only scholarly references at least 4

see sample paper attached

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Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

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Psychotic disorders change one’s sense of reality and cause abnormal thinking and perception. Patients presenting with psychotic disorders may suffer from delusions or hallucinations or may display negative symptoms such as lack of emotion or withdraw from social situations or relationships. Symptoms of medication-induced movement disorders can be mild or lethal and can include, for example, tremors, dystonic reactions, or serotonin syndrome.

For this Assignment, you will complete a focused SOAP note for a patient in a case study who has either a schizophrenia spectrum, other psychotic, or medication-induced movement disorder.

 

  • Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
  • Review the video, Case Study: Sherman Tremaine. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.

The Assignment

Develop a focused SOAP note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

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Assignment: Policy/Regulation Fact Sheet

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The Assignment: (1 page)

Create a 1-page fact sheet that your healthcare organization  could hypothetically use to explain the health or nursing informatics  policy/regulation you selected. Your fact sheet should address the  following:

  • Briefly and generally explain the policy or regulation you selected.
  • Address the impact of the policy or regulation you selected on system implementation.
  • Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.
  • Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.

 

This week you will complete the Week 11 Assignment, ” Policy/Regulation Fact Sheet“. For this Assignment, you will examine a recent nursing informatics-related healthcare policy  and share relevant details via a fact sheet designed to inform and  educate colleagues in your organization. First you want to  concisely explain the policy/regulation you selected. Then you need to  explain the impact of the policy/regulation on four areas:

  • System implementation
  • Clinical care
  • Patient/provider interactions
  • Workflow

Finally you will identify organizational policies and procedures that are or will be in place at your healthcare organization to address the policy/regulation you selected. Below are the instructions from Module 6.

 

class.

It  has come to my attention that the assignment rubrics do not specify the  number and types of resources required for the following assignments:

Module 1: Week 2 Assignment

Module 2: Week 3 Assignment

Module 5: Week 10 Assignment

Module 6: Week 11 Assignment

The  syllabus does require you to integrate credible, outside and course  specific resources to demonstrate critical thinking and lend support to  your ideas in your assignments. As a guide, you should integrate 3 or  more peer-reviewed sources and 2 or more course resources for these four  assignments. The full statement on assignments from the syllabus is  also provided below. If you have any questions, please feel free to  contact me.

2.  Assignments: The Assignments provide you with the opportunity to apply  the skills and knowledge gained through the Learning Resources and the  practicum experience. See the Assignment area of specific weeks for  detailed descriptions of the assignments. In grading the required  Assignments, your Instructor will be using rubrics located in the Course  Information area.

Note:  The course Assignments will require that you completely and accurately  demonstrate critical thinking via assimilation and synthesis of ideas  when using credible, outside and course specific resources (i.e. video,  required readings, textbook), when comparing different points of view,  highlighting similarities, differences, and connections, and/or when  lending support to your Assignment responses.

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Priority Problem

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Instructions

Identifying a priority problem is an essential skill for nurses to develop. Write 200–250 words using the discussion prompts to guide the content for your initial post. Then, reply to at least two of your peers’ posts.

Discussion Prompts

  • Choose three PRIORITY PROBLEMS, and identify what assessment cues would prompt someone to choose that problem.
  • Select Priority Problems that have not already been discussed by your peers.
  • Of the problems you selected, what is their order of priority and why did you prioritize them in this order?

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Week 5: Assignment 1: “Captain of the Ship” Project – Bipolar Disorders

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In 4 pages, write a treatment plan for your client. In which you do the following:

Introduction and Theses statement

Describe the HPI and clinical impression for the client.

Recommend psychopharmacologic treatments and describe specific and therapeutic end points for your psychopharmacologic agent. (This should relate to HPI and clinical impression.).

Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

Identify medical management needs, including primary care needs, specific to this client.

Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.

Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

Summary

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Nursing 6568 wk 3 case study assignment

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 To Prepare:

· Consider what physical assessments and diagnostic tests would be appropriate in order to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.

· Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.

· Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

· Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with HEENT conditions.

The Assignment

Case study

A mother brings in her 11 year old son, Branch, because he has had a nosebleed.  She is concerned about it because they have been applying pressure by pinching it and the nosebleed won’t stop.  He has no history of nosebleeds.  He has no significant medical history and no known allergies.  He is on no medications.  Mom and Branch deny trauma to the nose.  He says he just woke up with a nosebleed and it won’t stop.  He tells you that the left side is the side that is bleeding.

Vital signs:  BP 110/70 P 84 R 14 T 97.8 oral Pulse ox 99%

You recognize that simple pressure is not going to stop the nosebleed so you know that you will not have to intervene.

  1. Prior to any      type of procedure, you have the mother sign an informed consent for a      procedures.  What are the three major areas you must discuss      when doing any type of procedure?
  2. Nosebleeds can      be divided into three groups.  What are they?
  3. 90% of      nosebleeds fall into which group?
  4. Name 4 indications      for intervention by a provider for a nosebleed.
  5. You place      Branch on the assessment table at approximately 45 degrees.  You      drape him appropriately.  You have him blow his nose gently to      remove clots.  You then inspect the right side to familiarize      yourself with his anatomy.  You then inspect the left side using      a nasal speculum.  When using the nasal speculum, it      is important to use it ______________ (HORIZONTALLY/VERTICALLY).
  6. Why is it      important to use the nasal speculum a certain way?
  7. You note that the      bleeding is coming from an area on the septum.  You know that      the next step is to apply a vasconstrictive solution to the      nose.  What are two ways you can deliver      the vasoconstrictive solution?
  8. You note that      the area that is the source of the bleeding is about 3 mm in      diameter.  You make the decision to use a silver nitrate      stick.    How long should you apply pressure with the      stick?
  9. Why it is it      important not to use the silver nitrate for over that time frame?
  10. After hemostasis is      obtained, what are three types of treatment methods that can be used to      protect the cauterization site?
  11. If that had not      stopped the bleeding and you had to make the decision to use a nasal      sponge or nasal tampon, the sponge/tampon should be coated in      _____________ and left in place for __________ hours.
  12. After putting in the      nasal sponge/tampon, approximately 2 ml of ________ or _______ should be      dripped onto the tip to help the sponge expand.
  13. After placing the      nasal sponge/tampon, the patient should be closely monitored for 3-5      minutes.  Why is that?
  14. After the close      monitoring, the patient should be kept in observation status for ______      minutes.
  15. If a sponge/tampon      is used, it is not necessary to use antibiotics.
  16. If it is      necessary to pack the nose, it may be advisable to give the patient a      narcotic or sedative medication (unless a contraindication      exists).  Why?
  17. Name 5 complications      of the above procedures.
  18. After the procedure,      you tell the pt and his mother that he can take acetaminophen for any      pain/discomfort.  Why is it important not to have him take      ibuprofen?
  19. What is the leading      cause of nosebleeds in adolescents?
  20. What CPT code would      you use for the above procedure?
  21. What is the      definition of the above code?

Address the following:

Create documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned.
In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Current medications
• Allergies
• Patient medical history (PMHx)
• Review of systems
In the Objective section, provide:
• Physical assessment documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses
In the Assessment section, provide:
• At least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.
In the Plan section, provide:
• A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other healthcare providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits.
• A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors.
• Reflections on the case describing insights or lessons learned.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care.

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Communication Change Challenge (CCC) Part 5 & 6

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In Part 5, you will imagine implementing the new behaviors you identified in 4E. In Part 6, you will practice your new behavior by role-playing with a family member or close friend who is not directly involved in your goal. It is still not time to actually implement your new behaviors, as Parts 5 and 6 will help you to iron out the wrinkles.

Note: Submit both CCC Part 5 and CCC Part 6 in one document, but start a new page for CCC Part 6.

Project Timeline

Part

Description

Due

1

Selecting a communication goal

Week 1

2

Describing communication patterns

Week 2 & 3

3

Establishing behavioral goals: What will it look like when I am doing it well?

Week 3

4

Analyzing the goal

Week 4

5

Covert Rehearsal: Practicing in your imagination

Week 5

6

Behavioral Rehearsal: Practicing your new behavior

Week 5

7

Actual Implementation: Performing your behavior in real-life situations

Week 7

8

Evaluating your progress

Week 8

Instructions: Part 5

5A. Covert Rehearsal
Covert Rehearsal is an effective way of trying out new communication behaviors. Think about a time that you were daydreaming, or dreaming at night. You can use your imagination to think about an experience or situation that is not really happening at that time or in that place. You can do the same type of simulation on purpose to think about a time and place that will allow you to practice your new interpersonal communication skill to meet your goal as outlined in your new behaviors listed in CCC Part 4E.

By covertly rehearsing, you make it much more likely that you will be actually performing the behavior comfortably and effectively in real life situations. This surprising effect of covert rehearsal has been shown in numerous studies. What makes covert rehearsal particularly useful is that you can carry it around and do it anywhere – in the shower, cleaning, cooking, and so forth. The more you vary covertly rehearsing a particular episode, the more likely you will be able to perform well in the actual situation. For example, if you are planning to initiate and maintain a conversation with your neighbor, you should think through a number of possible topics and questions before finally choosing what you perceive to be the best options. In other words, think before you speak. Plan what you will say and do in a particular situation where you can practice your goal.

Covert rehearsal can be used both to prepare for an upcoming communication event, and to evaluate and revise an event that has already occurred – as in instant replay. This is done all the time for sports teams. Each player watches the game again and decides how he or she could do it better next time. Both planning ahead before a conversation and reflecting after a conversation will increase the probability that you will perform your new skill effectively the next time you use it.

Note that some people initially find it difficult to imagine specific conversations with others. Keep with it if you have difficulty. You will eventually succeed with practice, and when you do, you will be amazed at the effect. If you are having a hard time talking to people in your mind, speak to yourself out loud or speak to your reflection in the mirror. Think about the following:

  • Identify the situation you would like to practice; do you want to plan a new conversation, or replay a past situation but change the outcome?
  • Where will you have this conversation – in the kitchen, on the bus, in the cafeteria at lunch, at school in a classroom, in the board room, in your manager’s office, or at a friend’s house?
  • Provide a detailed narrative that identifies your selected communication event.
  • Write a description of your surroundings – date, time, location, specific room, physical surroundings and so forth, and the people who will participate in this communication event.
  • Name the people involved, what you will talk about, where it takes place, when it takes place, how it should occur, and why you need to plan for a better conversation next time.
  • How will your physical surroundings affect your rehearsal?

For this section, you are to select a communication event, related to your goal, for which you will prepare covertly. Choose one or more behaviors to work on that are listed in CCC Part 4E. Choose a communication event that you would like to prepare for privately or secretly – covertly. As you imagine yourself practicing your new skill, focus hard on specific interactions. Actually, think about an interpersonal communication exchange – what you say, and how the other person responds. Don’t just go through the motions. Really see yourself asking specific questions, making specific comments, and hearing the other person replying. As you imagine the sequence, practice precisely what you want to say and how you want to say it. Experiment with what feels to be the most effective and comfortable way for you to implement your new behaviors.

Submit a detailed narrative that identifies your selected communication event and include the following:

  • Description of your surroundings – date, time, location, specific room, physical surroundings and so forth
  • Explanation of how your physical surroundings will affect your rehearsal
  • Description of the people who will participate in this communication event
  • What you will talk about
  • How it should occur
  • Why you need to plan for a better conversation next time

5B. Covert Practice
In a quiet place, begin thinking about the conversation event from Part 5A, as you would like to see it evolve. When you hit rough spots, try a variety of options until you find a response that pleases you. If you are having trouble with this, pretend you are an author planning to write the dialogue for a reality TV episode, or you are composing lines for characters in a play or movie or book. Use the mirror technique and take turns role-playing both people in the conversation. You can also use puppets, stuffed animals, socks on your hands, or different hats or coats to take the parts of two people having a conversation.

What can you see in the background? The scenery department needs to know how to create the setting for the play, movie, or reality TV show. The illustrator needs to know what to draw or paint for the book you are writing. You need to know exactly what type of situation you are dealing with before you can write the dialogue for the characters.

When you are satisfied with your imagined scene, write it out so you can see how it looks and read it aloud so you can hear how it sounds. If you are writing a one-act play, you can plan and add stage directions.

Enter left: The wife enters the kitchen to angrily scream at the dawdling children who won’t eat their supper.

Then, write her exact words down so your actor will know what to do and say. Identify each speaker and use quotation marks for their exact words.

Wife, using a loud and angry voice: “Aren’t you children finished eating your supper yet?”

Plan and write down your nonverbal and verbal behaviors and responses, including your own behaviors and responses and the reactions of the other person in the communication event.

5C. Reflection
Reflect on this experience. Address your observations and reactions to the private covert rehearsal experience. (1-2 paragraphs)

  • How did you feel at first as you prepared for your private covert rehearsal?
  • How did you feel after you finished it?
  • What behaviors or patterns did you use from Part 4E?
  • Did you notice any new behaviors or patterns that you have not noted previously?

Instructions: Part 6
In Part 6, you will take your rehearsal a step further by role-playing with someone who is willing to lend you a hand. Practicing implementation of the new behaviors you identified in 4E will give you insight into how another person might react in a real-life situation, preparing you to respond or adapt when necessary.

6A. Shared Behavior Rehearsal
Shared behavior rehearsal is also known as “role-playing.” Rehearsing communication behavior is useful both before and after an event. Practicing before an event allows you to enter a communication situation in your most prepared state. Rehearsing a disappointing situation after it occurs gives you a chance to discover and remedy aspects of your own behavior that were less than satisfactory.

Like covert rehearsal, practicing the new communication behaviors that you identified in CCC Part 4E through role-play increases the likelihood that you will be successful in Part 7 when you actually implement the changes in real-life situations. Again, it may feel silly at first, but if you take the role-playing seriously, you will be amazed at what you will take away from it. Role-play your imagined scene for your conversation event with a friend or family member who is not directly involved in your communication problem. Say your lines as you planned them. Your practice partner may not really say what you thought he or she would say. Then, show him or her the written script, and have him or her read or act out the scenario. You can practice this a few times both with and without the script.

Write a detailed narrative of what happened in the behavior rehearsal.

  • What did you do?
  • How were your behaviors received?
  • How satisfied were you with your performance of the behaviors in your goal from Part 4E?

6B. Reflection on Observations and Reactions
Address your observations and reactions to the shared behavior rehearsal experience of role-playing with a friend or family member who is not directly involved in your communication problem. (1-2 paragraphs)

  • How did you choose your shared behavior rehearsal partner?
  • Does he or she know about the person or situation being focused on for your CCC goal?
  • Does he or she normally offer guidance and advice in a trustworthy manner already in your established relationship with this person?

6C. Reflection on Planning
Write your observations and reactions to the shared behavior rehearsal experience as far as planning is concerned. (1-2 paragraphs)

  • Did your shared behavioral rehearsal go as planned, or was it totally different than you imagined it would be?
  • How did you feel at first as you prepared for your shared behavioral rehearsal?
  • How did you feel after you finished it? What behaviors or patterns did you use from Part 4E?
  • Did you notice any new behaviors or patterns that you have not noted previously?

Writing Requirements (APA format)

  • Length: 4-5 pages (not including title page or references page)
  • 1-inch margins
  • Double spaced
  • 12-point Times New Roman font
  • Title page
  • References page

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Reflection 1

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One  of the key points of learning from experience is to reflect on what you  did. Reflect on choosing an article. Answer the following questions in a  document of between 250 and 500 words. Save your response as a word  document and include a 7th edition APA cover page. Upload the document  to complete the assignment. Do not cut and paste from any document of  quote from any source. This is a reflection on your own experiences, so  you should not need to do this.

A. How did you choose the question?

B. What difference could the answer to the question make?

C. Who will be affected by the answer to the question?

D. Could anyone else be affected?

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NUR-621E1

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The purpose of this assignment is to create an operational budget presentation identifying key components of budgeting and possible capital purchases that may be required.

Scenario: You have been asked to create an operational budget for a 20-bed nursing unit and present it to the senior leaders of your organization.

Create a presentation of 10-12 slides, including comprehensive speaker notes that detail the budget.

  1. Provide the key components of budgeting, including the cost of staff, activities, services, and supplies.
  2. Identify and describe a relevant capital purchase this unit may require, including the need, the return on investment, benefits, etc.

Use at least three references, including your textbook.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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