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. 

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 

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.
General Systems Theory – Imogene King
Modeling and Role Modeling Theory – Erickson, Tomlin, and Swain
Transcultural Nursing (formerly Culture-Care) – Madeleine Leininger
Conservation Model – Myra Estrine Levine
Health as Expanding Consciousness – Margaret Newman
Nursing Process Theory – Ida Jean Orlanda
Theory of Human Becoming – Rosemarie Rizzo Parse
Humanistic Nursing – Josephine Paterson and Loretta Zderad
Interpersonal Relations Model – Hildegard E Peplau
Science of Unitary Human Beings – Martha E Rogers
Roy Adaptation Model – Sister Callista Roy
Philosophy and Theory of Transpersonal Caring – Jean Watson
Emancipated Decision Making in Health Care – Wittman-Price
Self-Care Theory – Dorothea Orem
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.

General Systems Theory – Imogene King
    Modeling and Role Modeling Theory – Erickson, Tomlin, and Swain
    Transcultural Nursing (formerly Culture-Care) – Madeleine Leininger
    Conservation Model – Myra Estrine Levine
    Health as Expanding Consciousness – Margaret Newman
    Nursing Process Theory – Ida Jean Orlanda
    Theory of Human Becoming – Rosemarie Rizzo Parse
    Humanistic Nursing – Josephine Paterson and Loretta Zderad
    Interpersonal Relations Model – Hildegard E Peplau
    Science of Unitary Human Beings – Martha E Rogers
    Roy Adaptation Model – Sister Callista Roy
    Philosophy and Theory of Transpersonal Caring – Jean Watson
    Emancipated Decision Making in Health Care – Wittman-Price
    Self-Care Theory – Dorothea Orem

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

    The Framework of Systemic Organization – Marie-Louise Friedemann
    Theory of Group Power within Organizations – Christina Sieloff
    Theory of Comfort – Katharine Kolcaba
    Theory of Maternal Role Attainment- Ramona Thieme Mercer
    Nurse as Wounded Healer – Marion Conti O’hare
    Synergy Model – AACN
    Behavioral Systems Model – Dorothy Johnson
    Quality of Nursing care Theory – June H Larrabee
    Theory of Unpleasant Symptoms – Elizabeth R Lenz and Linda C Pugh
    Advancing Technology, Caring, and Nursing – Rozzano C Locsin
    Health Belief Model – Blanche Mikhail
    Theory of Uncertainty in Illness – Merle Mishel

– No plagiarism

– Minimum two references APA style

– Minimum 300 words

 What is a normal distribution and what does it look like? Why is the normal distribution important in statistics? 

Answer the following questions using at least 2 apa references. answer using at least 2 pages. proper 7th edition apa format must be followed

1.What steps might the local population health nurse take to address the problem of intimidation by landlords?

2. what community groups might be appropriate coalition partners in resolving this problem?why?

3. what approaches might be taken in terms of policy development to deal with intimidation?

4.Are there particular government agencies that should become involved? if so, what are they and how would you promote their involvement?

5. how might local residents become actively involved in resolving the issue?

6. what cultural considerations have relevance for this situation and its resolution?

Create a poster for a presentation about a quality improvement (QI) project or plan that builds on the work you completed in the first two assessments. Include an abstract of 100–250 words about the QI plan and key information in your poster.

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, it is recommended that you complete the assessments in this course in the order in which they are presented.

SHOW LESS

The ability to propose and promote quality improvements in care is a vital skill for a master’s-prepared nurse. One aspect of this is understanding strategies for implementing best practice changes in a team, department, or care setting. Another is understanding how best practices can help lead to a continuous quality improvement cycle. Additionally, it is important to grasp how successful change strategies can be leveraged to help in the creation or implementation of clinical best practices. Part of this is considering the audience when proposing quality improvement projects or new best practices. Another part of this is being able to effectively communicate the goals, rationale, and benefits of a project.

For this assessment you will create a presentation poster to communicate a quality improvement project.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.
  • Evaluate specific evidence that supports the quality improvement methods proposed.
• Competency 2: Develop change strategies for improving the care environment.
  • Explain how the project is grounded in successful change strategies.
• Competency 3: Apply quality improvement methods to practice that promote safe, equitable quality of care.
  • Propose quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration.
• Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired healthcare improvement outcomes.
  • Analyze the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project.
• Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
  • Communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience.
  • Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

As a master’s-level nurse you will be responsible for promoting equitable quality of care. In the biopsychosocial model of care, there are a number of areas where you can have an impact on improving the quality, safety, and equitablility of care. One example area where equitable quality of care is an issue is with medications, especially considering the cost of various medications to treat the same condition versus the effectiveness and potential side-effects of the medications. A further pharmacological concern for safe and quality care is medication errors. This could include considerations like a patient getting the wrong medication or a dangerous interaction due to other aspects of a patient’s health and treatment situation. An example could be vitamin or herbal supplements the patient has not disclosed as part of the medication reconciliation process.

One way to communicate the need for quality improvements, and your plans for achieving specific improvements, is through a presentation poster. This type of communication tool is used both in the work place and at professional and academic conferences. Being able to convey the essence and value of a project in a compelling and succinct way is a valuable skill, and it is vital within the constraints of a single poster.

Questions to Consider

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

SHOW LESS

The assessment will be built around creating a professional and compelling poster to present a quality improvement project that may have grown out of your change initiative in the second assessment.

• Who will be the primary audience of your poster? Who might be the wider, or outreach, audience that will be relevant to consider when creating your poster?
  • What details or information will be most important and compelling to your audiences?
  • How might you craft the design of your poster so that it better speaks to your audiences?
• What steps might a nurse take to implement best practice changes in a care setting while respecting the multidisciplinary team?
  • What does each member bring to the care of the client or community?
  • How might recognizing the contributions of the multidisciplinary team help build buy-in or collaboration?
    • Why is buy-in important to the success of a quality improvement project?

Assessment Instructions

Scenario

For this assessment, you may take one of two approaches:

• The first is to build upon the clinical issue that was the focus of your Change Strategy and Implementation assessment, and turn it into a full, organization- or community-wide quality improvement initiative.
• The second is to identify a new issue related to a biopsychosocial (BPS) clinical issue, or a clinical issue related to one of the items from the list of conditions, diseases, and disorders presented in the Resources section for the Concept Map assessment. The focus should be on a community rather than on a specific patient or health care setting.

As a master’s level nurse, your specific focus is on reviewing the implications of the data relevant to the clinical issue you are trying to address. Once you research this, review the aggregate data, and understand the BPS considerations relevant to the clinical issue, you can suggest strategies for improving the quality, equitability, and safety of care around the issue. You should act as an advocate for the value and need to pursue quality improvements to leadership and executives, as well as be able to present potential projects to a wide range of colleagues and community stakeholders.

Instructions

Create an abstract and a poster for a presentation to executive-level leadership of the organization, to the community, or to your colleagues that will sell them on your quality improvement plan.

Abstract Requirements

• Your abstract should be 100–250 words.
• It should summarize the key information in your poster.
• Do not put your abstract on your poster itself; submit it as a separate document. Or, if you are using PowerPoint to help create your poster, create a new slide that is clearly labeled as your abstract.

Poster Requirements

• Your poster should include the following sections:
  • Quality Improvement Methods.
  • Evidence Supporting QI Methods.
  • Change Strategy Foundation.
  • Interprofessional Team Benefits.
  • Overall Project Benefits.
• There are templates in PowerPoint or on the Internet that can help you get a start designing your poster.

The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your presentation addresses all of them. You may also want to read the Quality Improvement Presentation Poster scoring guide and the Guiding Questions: Quality Improvement Presentation Poster document to better understand how each grading criterion will be assessed.

• Propose quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration.
• Evaluate specific evidence that supports the quality improvement methods proposed.
• Explain how the project is grounded in successful change strategies.
• Analyze the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project.
• Communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience.
• Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

• Assessment 3 Example [PPTX].

Additional Requirements

• Length of submission:
  • Abstract: 100–250 words. Your abstract should be succinct and precise.
  • Poster: Make sure your poster fits entirely onto a single poster template page (or slide) and contains all of the sections described in the assessment instructions.
• Number of references: Cite a minimum of 5–7 sources of scholarly or professional evidence that support your considerations and plans. Resources should be no more than five years old.
• APA formatting: Resources and citations are formatted according to current APA style. 

Grading Rubric:

1-  Propose quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. 

Passing Grade:  Proposes quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. Acknowledges potential difficulties and discusses how those challenges will be met.
 

2-  Evaluate specific evidence that supports the quality improvement methods proposed. 

Passing Grade:  Evaluates specific evidence that supports the quality improvement methods proposed. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis). 

3-  Explain how the project is grounded in successful change strategies. 

Passing Grade:  Explains how the project is grounded in successful change strategies. Acknowledges potential difficulties and discusses how those challenges will be met. 

4-  Analyze the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. 

Passing Grade:  Analyzes the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. Identifies assumptions upon which the analysis is based. 

5-  Communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. 

Passing Grade:  Communicates quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. The structure of the communication enables the audience to grasp complex concepts and encourages buy-in. 

6-   Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style. 

Passing Grade:   Integrates relevant sources to support assertions, correctly formatting citations and references using current APA style. Citations are free from all errors. 

I need response for the following peers

peer 1 yed

Practice

Effective pain and symptom management is an important part of patients with life-threatening diseases and their families. Reducing pain and other symptoms does not only provide relief to suffering patients but will also eases the grief that families will face after the patient’s death (Sun et al., 2015). Nurses play a huge role in reversing the treatment of pain and other associated symptoms and should therefore possess basic competencies in the management of symptoms. To achieve quality outcomes, nurses need to use patients and family fears together with the knowledge and skills regarding symptom management using pharmacological, nonpharmacological, and integrative therapies (Paice et al., 2018).

Education

Nurses need to learn about the seriously ill , other vulnerable populations and the required prioritization. According to the American Nurses Association (2017), Content about palliative care should be included in any curricula including the academic and development settings. Nurses also need to utilize palliative care learning materials as provided by nursing organizations and agencies.

Research 

Given that healthcare resources are limited, it is important that end of life care is evidence-based rather than solemnly based on the provider’s intuition. Chronically ill patients deserve quality, person-centered and evidenced-based care whether they are at the home, hospital, or any other facility. Evidence-based interventions help guide nurses in their choices of the most appropriate treatment plan (Black et al., 2015). Research also helps nurses highlight and be aware of the potential benefits and harms and make informed decisions based on the expected outcomes (Black et al., 2015).

Administration

An unhealthy work environment can lead to medical errors, conflicts and stress among healthcare teams, and ineffective care delivery (AACN, 2016). Due to these reasons, healthcare providers need to promote a healthcare environment that will benefit both the patient and the family. The goal is to provide quality care and leave the patient and family members fully satisfied.

peer 2 lin

End of life care constitutes several aspects, including pain and symptoms management, ethical decision-making, and cultural sensitivity.  Advanced practice registered nurses as the superiors in clinical practice and care delivery at the system level. Nevertheless, challenges are emerging in palliative care clinicians’ current surroundings necessitating the advanced training of registered nurses to provide care for every patient and their families.

Practice– Identity, assess, and treat psychosocial and spiritual issues conceded with palliative care. 

 APRN nurses strive to improve their primary standards of palliative care. Thus, compelling them to seek palliative care knowledge for an overall improvement in providing care for a patient and people close to them (Hoerger et al., 2018). In their practices, especially among dying patients, they designate specific care and preferences. Such consideration would improve their technique and recognition of conditional changes and compassion and support to the patients and those important to them.

Education– Advances knowledge about palliative care.                                                        

Availability of End-of-Life Nursing Education Consortium (ELNEC) improves palliative care by offering new directions and improving the preceding techniques. According to Dahlin and Coyne (2018), ELNEC advances knowledge about end of life care among nurses through various projects, including train-the-trainer course, professional development seminars and conferences, and hosting a regional training session to help nurses from both rural and underserved communities to improve their innovative ways in caring for dying patients.

Research– Asses the bonding of patient, family satisfaction, and their utility of health care resources for palliative care choices.                                                                                       

According to Weave et al. (2019), improving nursing care for dying patients extend to research constituting investigation and evidence-based recommendations. Therefore, the research assesses and reassesses challenges conceded with palliative choices, the objectives, and disseminating standards for palliative care (Ferrell et al., 2018). Hence, it offers credible information for improving comfort and quality of life among palliative patients.

Administration– Support palliative care.

Precisely, the administration supports the development and incorporation of palliative care for patients and families by coordinating tools, equipment, and medical staff to ensure smooth running during palliative care. Tertiary-level healthcare providers are obliged to provide inpatient services, including radiotherapy and other treatment care, for people with intractable complications and suffering. However, the role of the family is critical in palliative care. Medical staff aceturate that the patient and their families understand the essence and prognosis and the medication prescribed. The support of health workers and the family member contribute the effective collective decision-making (Ferrell et al., 2018)

THE ORIGINAL ASSIGMENT WAS THE FOLLOWING:

 End of Life  

End-of-Life Care (including advanced directives, palliation) Topics to review: Article: Nurses roles and responsibilities Providing care and support at end of life. https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics /endoflife-positionstatement.pdf

 Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management 

Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.

Education

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.

Research

1. Increase the integration of evidence-based care across the dimensions of end-of-life care.

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.

Administration

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.

4. Support the development and integration of palliative care services for all in- and outpatients and their families.