APA style

300 words

10% maximum plagiarism  

Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had been suffering from emphysema for several years and had had frequent hospitalizations for respiratory problems. On the last hospital admission, her pneumonia quickly progressed to organ failure. Death appeared to be imminent, and she went in and out of consciousness, alone in her hospital room. The medical-surgical nursing staff and the nurse manager focused on making Mrs. Smith’s end-of-life period as comfortable as possible. Upon consultation with the vice president for nursing, the nurse manager and the unit staff nurses decided against moving Mrs. Smith to the palliative care unit, although considered more economical, because of the need to protect and nurture her because she was already experiencing signs and symptoms of the dying process. Nurses were prompted by an article they read on human caring as the “language of nursing practice” (Turkel, Ray, & Kornblatt, 2012) in their weekly caring practice meetings.

The nurse manager reorganized patient assignments. She felt that the newly assigned clinical nurse leader who was working between both the medical and surgical units could provide direct nurse caring and coordination at the point of care (Sherman, 2012). Over the next few hours, the clinical nurse leader and a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The clinical nurse leader asked the nurse manager whether there was a possibility that Mrs. Smith had any close friends who could “be there” for her in her final moments. One friend was discovered and came to say goodbye to Mrs. Smith. With help from her team, the clinical nurse leader turned, bathed, and suctioned Mrs. Smith. She spoke quietly, prayed, and sang hymns softly in Mrs. Smith’s room, creating a peaceful environment that expressed compassion and a deep sense of caring for her. The nurse manager and nursing unit staff were calmed and their “hearts awakened” by the personal caring that the clinical nurse leader and the volunteer nurse provided. Mrs. Smith died with caring persons at her bedside, and all members of the unit staff felt comforted that she had not died alone.

Davidson, Ray, and Turkel (2011) note that caring is complex, and caring science includes the art of practice, “an aesthetic which illuminates the beauty of the dynamic nurse-patient relationship, that makes possible authentic spiritual-ethical choices for transformation—healing, health, well-being, and a peaceful death” (p. xxiv). As the clinical nurse leader and the nursing staff in this situation engaged in caring practice that focused on the well-being of the patient, they simultaneously created a caring-healing environment that contributed to the well-being of the whole—the emotional atmosphere of the unit, the ability of the clinical nurse leader and staff nurses to practice caringly and competently, and the quality of care the staff were able to provide to other patients. The bureaucratic nature of the hospital included leadership and management systems that conferred power, authority, and control to the nurse manager, the clinical nurse leader, and the nursing staff in partnership with the vice president for nursing. The actions of the nursing administration, clinical nurse leader, and staff reflected values and beliefs, attitudes, and behaviors about the nursing care they would provide, how they would use technology, and how they would deal with human relationships. The ethical and spiritual choice making of the whole staff and the way they communicated their values both reflected and created a caring community in the workplace culture of the hospital unit.

Critical thinking activities

Based on this case study, consider the following questions.

1. What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.

2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.

3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?

4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring

Lecture

What is the difference between grand theory and middle-range theory?
Grand theory is broader and provides an overall framework for structuring ideas. In description, Grand Theories are broad and complex in scope. They present a conceptual framework for identifying the key principles and concepts of the nursing practice. Even though they are known to provide intuitions useful for practice, they cannot be used for empirical testing.

On the other hand, middle-range theories are focused on a particular phenomenon or concept. They are limited in scope and deals with tangible and reasonably operative concepts. Their propositions and concepts are more specific to the nursing practice and they can be used for empirical testing.

Middle-range theory addresses more narrowly defined phenomena and can be used to suggest an intervention.

Ray’s Theory of Bureaucratic Caring
 

Marilyn Anne Ray

Improved patient safety, infection control, reduction in medication errors, and overall quality of care in complex bureaucratic health care systems cannot occur without knowledge and understanding of complex organizations, such as the political and economic systems, and spiritual-ethical caring, compassion and right action for all patients and professionals.”

The theory was generated from qualitative research involving health professionals and patients in the hospital setting,

The theory implies that there is a dialectical relationship (thesis, antithesis, synthesis) between the human (person & nurse) dimension of spiritual-ethical caring and the structural (nursing, environment) dimensions of the bureaucracy or organizational culture (technological, economic, political, legal and social). 

The Model is holographic, illuminating the holistic nature of caring & synthesis of the humanistic systems and technologic, economic, political, legal systems.

Major Concepts

Caring: a complex, transcultural, relational process, grounded in an ethical, spiritual context. Caring is the relationship between charity and right action, between love as compassion in response to human suffering and need, and justice or fairness in terms of what ought to be done. Caring occurs within a culture or society, including personal culture, hospital organizational culture, or society and global culture (Ray, 1989; Ray in Coffman, 2006; 2010, 2013). 

Spiritual-Ethical Caring: Spirituality involves creativity and choice revealed in attachment, faith, hope, love, and community. The ethical imperatives of caring that join with the spiritual & relate to our moral obligation to others. Spiritual- ethical caring for nursing focuses on how the facilitation of choices for the good of others (caring, healing, well-being that should be accomplished or can be 

Educational: Formal and informal educational programs, use of audiovisual media to convey information, and other forms of teaching and sharing information are examples of educational factors related to the meaning of caring. 

Physical: Physical factors relate to the physical state of being including biological and mental patterns. Because the mind and body are interrelated, each pattern influences the other. 

Socio-cultural: Social-Cultural factors are ethnicity and family structures; intimacy with friends and family; communication; social interaction and support; understanding interrelationships, involvement, and structures of cultural groups, community and society. 

Legal: Legal factors relating to the meaning of caring include responsibility and accountability; rules and principles to guide behaviors, such as policies and procedures; informed consents; right to privacy; malpractice and liability issues; client, family, and professional rights; and the practice of defensive medicine and nursing.

Technological: Technological factors include nonhuman resources, such as the use of machinery to maintain the physiological well-being of the patient, diagnostic tests, pharmaceutical agents, and the knowledge and skill needed to utilize these resources. Also included with technology are computer assisted practice and electronic documentation and social media. 

Economic: Economic factors relating to the meaning of caring include money, budget, insurance systems, limitations and guidelines imposed by managed care organizations and in general, allocation of scare resources including to maintain the economic viability of the organization. Caring as an interpersonal resource (love, communication, professional knowledge) should be considered, as well as goods, money and services. 

Political: Political factors and the governance & power structure within health care administration influence how nursing is viewed in health care and include patterns of communication and decisions in the organization; role and gender stratification among nurses, physicians, and administrators, union activities, including negotiation and confrontation; government and insurance company influences; uses of power, prestige, and privilege; and in general, competition for scarce human and material resources. 

Major Assumptions

Nursing/Caring

Person/Cultural Being

Health

Environment/Culture of Organization

Nursing

Nursing is holistic, transcultural & relational, spiritual, and ethical caring that seeks the good of self and others in complex community, organizational, and bureaucratic cultures. 

Dwelling with the nature of nursing reveals that the foundation of spiritual caring is love. Love calls forth a responsible ethical life that enables the expression of concrete actions of caring in the lives of nurses and for health & healing. 

Person

A person is a spiritual and cultural being. Persons are created by God, the Mystery of Being, a higher power and engages co-creatively in human organizational and transcultural relationships to find meaning and value. 

Health

Health is a pattern of meaning for individuals, families and communities. Beliefs and caring practices about health & illness are central features of culture. The social organization of health and illness determines how persons are recognized as sick or well, how health or illness is presented to health care professionals and the way health is interpreted by the individual. 

Environment

Environment is a complex spiritual, ethical, ecological and cultural phenomenon. This conceptualization embodies knowledge & conscience about the beauty of life forms & symbolic systems or patterns of meaning.

 Nursing practice in environments embodies the elements of the social structure and spiritual and ethical caring patterns of meaning. 

Theoretical Assertions

Caring is the essential construct and consciousness of nursing.

The meaning of caring is love and is highly differential depending on its context–structures (social-cultural, educational, political, economic. physical, technological and legal) as expressed in complex organizations. 

Caring is viewed as love and bureaucratic, given the extent to which its meaning can be understood in relation to science & the complex organizational structure. 

Application to Practice/Education/Research

Practice: Ray’s research has shown that nurses, patients and administrators value caring science, & the caring intentionality that is co-created in the nurse-patient or administrator relationship. 

By creating spiritual-ethical caring relationships, clinical nurses & administrators can transform the workplace into moral communities within the culture of humanistic, social, economic, political and legal values. 

Education: The theory is useful to nursing education because of its broad focus on caring & complexity science /s in nursing and the conceptualization of the health care system—used as an organizing framework for curricula.

Universities and hospitals have incorporated Ray’s Model of Bureaucratic Caring in the framework for the baccalaureate nursing programs, and clinical environments to guide nursing evolution, practice, research, and administration.

Research: Through Ray’s extensive experience with research, she has developed a phenomenological-hermeneutical approach (caring inquiry) that continues to guide her research and has been adopted by many researchers for the humanistic approach, using a lens of caring & caring science to study the human experience in health situations. 

Presenting Caring Inquiry Method August, 2013 at 32nd International Human Science Research Conference, Aalborg, Denmark

NURSING PICO QUESTION

1. Formulate a PICO question for your “Design A Research Study” assignment. Use the following formulated question as PICO question to create the Concept Map:

Which form of oxytocin administration during the third stage of labor is most effective in reducing the risk of postpartum hemorrhage?

1. Create a concept map for your PICO question, using the module resources on concept mapping. Using guidelines from the concept mapping topic of this module, create a new concept map based on your PICO question. See resources and guidelines attached below 
2. The first step is in concept mapping to create boxes with the four pieces of your PICO.
3. Then begin making connections between the population, intervention, comparison, and outcomes for your question. 
4. Expand your map by including additional levels of concepts, ideas, and search terms (synonyms) for each subtopic. 
5. You should have at least three levels of sub-concepts in addition to your main PICO concepts. This process will help you tremendously when you begin to search the databases for literature on your paper topic. 

PICO and Concept Map Assignment Grading Rubric: 

Possible Points

Points Given

Comments

PICO and Search   Query Worksheet attached and complete

5

Well-written   PICO of nursing relevance

5

PICO represented as main concept boxes on concept   map an Contains at   least 3 additional levels of concepts beyond the main boxes

5

Map Appears   thorough and neat

5

   Discussion 3

I remember when I was in nursing school; high blood pressure was referred to as “the silent killer”. A person with high blood pressure may or may not display any symptoms therefore the person is at increased risk for a stroke, heart failure, and many other conditions that affect other organs in the body.  Ten years ago, normal blood pressure was considered to be systolic of 120 mm Hg and diastolic of 80 mm Hg. According to the American Heart Association, blood pressure readings are grouped in categories including the following;

Normal Blood pressure: systolic less than 120 mm Hg and diastolic less than 80 mm Hg

Elevated blood pressure: systolic 120-129 mm Hg and diastolic less than 80 mm Hg

High blood pressure (Hypertension Stage 1): Systolic 130-139 mm Hg and diastolic 80-89 mm Hg

High Blood pressure (Hypertension Stage 2.): Systolic 140 MM Hg or higher and diastolic 90 mm hg or higher

Hypertensive Crisis:  Higher than 180 mm Hg and/or diastolic higher than 120 mm Hg

There are many drugs used alone or in adjunction to treat high blood pressure. There are five main classifications of drugs used in antihypertensive therapy which includes diuretics, ACE inhibitors, Angiotensin receptor blockers, Calcium channel blockers, and sympathetic nervous system drugs. Diuretics work by accelerating the rate of urine formation that result in the removal of sodium and water from the body. Some examples of diuretics are loop diuretics (furosemide), Potassium sparing diuretics (spirolactone), thiazide and thiazide-like diuretics (chlorothiazide), and Carbonic anhydrase inhibitors (acetazolamide).  ACE inhibitors (vasotec, menopril, lisinopril) inhibit angiotensin converting enzyme, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and induces aldosterone secretion by the adrenal glands. Aldosterone stimulates sodium and water reabsorption, which can raise blood pressure. This process is known as the renin-angiotensin-aldosterone system (RAAS). The primary effects of ACE inhibitors are cardiovascular and renal. ACE inhibitors can be used alone or in combination for treatment in hypertension and heart failure. Angiotensin receptor (cozaar, teveten, diovan) blockers block the binding of angiotensin II to angiotensin I, therefore blocking vasoconstriction and the secretion of aldosterone, leading to vasodilation. Calcium channel blockers (Procardia,) work by causing smooth muscle relaxation by blocking the binding of calcium to its receptors, which thereby prevents contraction (Collins et al., 2019). Sympathetic Nervous system drugs are drugs that include beta adrenergic blockers (Lopressor, atenolol).  Beta blockers reduce blood pressure by blocking central and peripheral beta receptors, which results in decreased cardiac output and sympathetic outflow. Beta blockers that mostly bind to beta 1 receptors, are referred to as cardio selective because they do not significantly block beta 2 receptors (Arcangelo et al., 2017)

The goal of therapy should always be discussed with the patient.  A blood pressure within normal limits, or a pressure that is less than 140/90 mm Hg should be ideal. The consequences that can occur if the patient is not compliant with the medication regime in controlling blood pressure such as having a stroke, heart failure, kidney failure and etc. Important points that should be discussed during patient education on anti-hypertensive medications is to always   check blood pressure throughout the day and keep a log of the blood pressure to show to the provider on the next visit. Monitor for side effects of hypotension, especially postural hypotension, which is common among the geriatric population. Adverse effects like angioedema (for ex. Swelling of the tongue or lips) when taking ACE inhibitors, or signs and symptoms of hypoglycemia, need to be reported immediately or patient is to go to the nearest Emergency room to get evaluated.  When taking diuretics, patients must remember to hydrate to keep from getting dehydrated. The patient also need to know that several different agents  may be tried before finding the one that best controls  his or her blood pressure with minimal or no side effects. Patient should also be educated on following a healthy diet, restrict sodium, quit smoking, maintain a healthy weight, and exercise regularly. (Arcangelo et al., 2017)

                                                                   Reference

Snyder, J. S., Rainforth Collins, S., Lilley, L. L., Souter, S. (2019). Study Guide for Pharmacology and the Nursing Process. United Kingdom: Elsevier – Health Sciences Division.

Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach (4th Ed.). Wolters Kluwer/Lippincott Williams & Wilkins.

Post:

• Explain the diagnostic criteria for your  assigned Sleep/Wake Disorder. (Nightmare Disorder)

• Explain the evidenced-based  Psychotherapy and Psychopharmacologic Treatment for your assigned sleep/wake disorder. (Nightmare Disorder)

• Describe at WHAT  point you would refer the patient to their Primary Care Physician for an additional referral to a Neurologist, Pulmonologist, or  Physician Specializing in sleep disorders. (Nightmare Disorder)

• Explain WHY.

• Support your rationale  with references to the Learning Resources or other academic resource.

Assignment: Change Implementation and Management Plan

It is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.

As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.

To Prepare:

• Review the Resources and identify one change that you believe is called for in your organization/workplace.
  • This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
• Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6 slides PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides that presents a comprehensive plan to implement the change you propose.

Your Change Implementation and Management Plan should include the following:

• An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
• A description of the change being proposed
• Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
• Details about the type and scope of the proposed change
• Identification of the stakeholders impacted by the change
• Identification of a change management team (by title/role)
• A plan for communicating the change you propose
• A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose