4 references not more than five years

Zero plagiarism

Reflect on your overall practicum experience in this course. Then, address the following in your Practicum Journal:

• Explain whether your therapeutic theory has changed as a result of your practicum experiences. Recall the theories you selected in Week 1.
• Explain how you integrated the therapeutic approaches from this course in your clinical practice. Include how this helped you achieve the goals and objectives you developed in Week 1.
• Explain how you might impact social change through your work with clients who have mental health issues.
• Support your approach with evidence-based literature.

Evaluating Organizational Change

Description:

This Assignment provides an overview of how to evaluate evidence-based practice quality improvement in a practice change.

Directions:

1. Introduce an overview of a healthcare system practice guideline, preferably where you work or have worked.
2. Discuss how different professionals in the healthcare system (Nurses, Pharmacists, Technicians, Nurse Educators, CFO, etc.) are held to this guideline.
3. Identify the research/reference used by the system to adopt the guideline.
4. Define the evidence used to define the guideline.
5. Determine the level of evidence used in the EBP identified.
6. Provide an opinion on how well this guideline is followed by professionals in the system.
7. Conclude with a concise overview of the guideline and the discussion in the paper.
8. Write the paper in 8–10 pages, using APA format.

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements:

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors; and

Your writing Assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and;
• use APA 6th edition format

How to Submit:

Submit your Assignment to the unit Dropbox by 11:59 pm ET on Sunday of the unit.

When you are ready to submit your Assignment, submit to the unit Dropbox. Make sure to save a copy of your work and be sure to confirm that your file uploaded correctly.

PART B

During this course, you must complete a mandatory clinical process training. This training will provide important information that you will need to prepare for your clinical experience. You must complete the training and submit a screenshot of your completion to the course dropbox. If you do not complete the training, you will not be permitted to register for any clinical course and you will receive a “0” for the week 10 assignment, regardless of what is submitted for “Part A”.  The link to the training can be found in course announcements.  

Conditions of the Ear

Objective data is the information gathered by the physician through the use of instruments and by assessing the normal and altered physiological functions in a patient. On the other hand, subjective data is what the patient says for instance how they feel and what could be the cause of the problem (Ozkaya et al., 2020). In this discussion, the focus is on the collection of both subjective and objective data in the diagnosis of a patient.

            Another thing that the patient could explain is the time in which the pain started and how long it lasted before the drainage happened. By knowing when this pain started helps the physician to determine the extent to which the effect of the condition had gone as well as the kind of condition in which the patient is likely to suffer from. Another subjective data is the scale of the pain, on a scale of 1to 10 the patient can rate their pain so that the physician can know the kind of analgesics that the patient should be prescribed (Ozkaya et al., 2020). Another subjective data is the color and amount of the drainage from the ear so that if it was puss then they can be treated for infection, if it was blood then the physician can check for any injuries and in case of a clear fluid then there is need to assess the spinal cord integrity to determine what may be the cause of the cerebrospinal fluid flow.

            On the objective data collection, the physician should use a source of light to visualize the internal ear so that a clear vision of what is wrong can be found. The lab examinations that can be done for this diagnosis are like culture and sensitivity for the fluid drained to be sure of the kind of infection or identify the DNA of the microorganisms. Another diagnostic test that can be done is the earing and balance test. These tests often are used to check on the efficacy of the auditory nerve which is responsible for hearing and transmission of sound waves (Abdullah & Hamed, 2020). The balance issue in the ear depends on the fluid found in the ossicles that are responsible for the balance in the cerebellum. In a case where the fluid draining from the ear is blood then there is a need to do some blood tests to determine some immune problems hence finding the necessary solutions to them.

            The diagnoses that can be made based on the presentation the patient could be suffering from cerumen impaction which is defined as the accumulation of cerumen or rather ear wax in the ear preventing the assessment of the ear. Another diagnosis for this condition could be otosclerosis which is a condition in which there is abnormal bone growth around one of the small bones inside the ear(Abu-Naser,& Abu Hasanein, 2016). Another probable condition is menieres disease which a condition in which there is excess fluid in the inner ear. For our case, the patient claimed to have had drainage earlier before coming to the hospital.

For the case of cerumen impaction, the physician cannot visualize the internal ear because of the excessive ear wax. For this reason, it could be the wax that is causing the ear problem. For the case of otosclerosis, the physician claims that on trial to visualize the internal earl the bones were overgrown making it impossible to do so (Indius et al., 2018). And as for the menieres disease the patient claimed to have had a drainage that actually helped to ease the pain.

In conclusion, the ear may have several conditions depending on the presenting signs thus it is important to keenly obtain both the objective and subjective data to enhance appropriate ear problems (Indius et al., 2018).

References

Abdullah, B. A., & Hamed, G. Y. (2020). Relationship of TMJ Clicking with Ear Problems and Headache. International Journal, 8(5), 119-122.

Abu-Naser, S. S., & Abu Hasanein, H. A. (2016). Ear Diseases Diagnosis Expert System Using SL5 Object.

Indius, J. H., Alqaderi, S. K., Kjeldsen, A. D., & Heidemann, C. H. (2018). Middle ear disease in Danish toddlers attending nursery day-care–Applicability of OM-6, disease specific quality of life and predictors for middle ear symptoms. International Journal of Pediatric Otorhinolaryngology, 110, 130-134.

Ozkaya, N. K., Mert, D. G., Bitgen, M., & Cepni, M. (2020). Prospective Evaluation of Psychological Healing in Adults Who Underwent Otoplasty for Prominent Ear. AESTHETIC PLASTIC SURGERY.

Goal:

Analyze and evaluate a middle range theory.  You will select a middle range theory and identify application of nursing theories into clinical practice.

Content Requirements:

1. Components of the theory
   • Discuss the major concepts of the theory
   • Philosophical basis or worldview change, advancing health
2. Structural aspects of the theory
   • Discuss the framework of the theory.
3. Identify an area of your practice where this theory could be applicable
   • What question does the theory help to answer?
   • Describe the area of interest in relationship to the theory/theoretical model.
   • Is it appropriate for the practice setting and is it applicable?
   • Discuss the strength and weakness of the theory. If there is weakness, discuss what makes it difficult to be used in practice.
4. Use of theory in clinical practice.
   • Performing a literature review is essential to completing this section. If there is no literature available about the application of this theory in practice, address reason(s) why based on your findings.
5. Evaluation of theory
   • Is this theory used to understand and apply into practice?
   • What difficulties did you encounter or would anticipate encountering in using this theory?
   • What would make this theory more usable or applicable to practice?

Submission Instructions:

• The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
• The paper should be formatted per current APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions.)
• The paper is to be 3 – 5 pages in length, excluding the title, abstract and references page.
• Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to current APA style.

*this assignment will be submitted by turnitin

Week 2 Discussion Questions

· From a local perspective, how does the practice problem impact nurses, nursing care, healthcare organizations, and the quality of care being provided?

· Identify the local key stakeholders related to the selected practice problem.

· Describe one approach used at your unique setting to address this problem. From your perspective, is this intervention effective in addressing the problem? Why or why not? If this practice problem is not addressed at your workplace, propose an intervention that could be implemented on a local scale to address the problem.

In Skagit County, WA, where I live and work, the prevalence of obesity is on the rise. According to the Institute for Health Metrics and Evaluation (2020), in 2012, the prevalence of obesity was 36.48% for women in Skagit county, 34.81% in Washington, and 33.85% in the U.S. For males, in Skagit county, the prevalence was 33.79%, 33.6% for Washington, and 33.85% for the U.S. This means that more than 1/3 of the population in my area is obese. This is not just a health problem felt by the individual, but repercussions are noted within the entire realm of health care.

Obesity itself is an epidemic. But there are many co-morbidities that accompany obesity such as cardiovascular disease, diabetes, kidney disease, cancer, and respiratory illnesses. In obstetrics, obesity often leads to pregnancy-induced hypertension, gestational diabetes, preeclampsia/eclampsia, and thromboembolisms. The risks are higher for cesarean section, failed induction, and other delivery complications such as shoulder dystocia (Cochrane, 2019). These threaten the lives of both mother and baby. Because care for obese patients is more complex, they are at a very high risk of developing pressure ulcers and wound infections (Hahler, 2002). Simple acts of getting out of bed, mobilization, and even changing the bed linens require the help of at least 2 or more nurses. This is not just to protect the nurses from physical injury, but to also avoid adverse events such as patient falls. In a recent study, it was concluded that there must be an increase in nursing staff in order to provide adequate care to the ever-increasing obese patient population (Carrara, et al., 2016). Therefore, the nursing staff is overworked, especially on Med/Surg units where nurse-to-patient ratios are 1:6. In addition, if one of those 6 patients requires 70% of the nurse’s time, patient care for the other 5 will suffer. This will lead to adverse events such as falls, medication errors, and death which can end up costing the hospital large amounts of money in litigation. Morale in the nursing unit will decrease leaving many unhappy nurses who are burnt out. It is important that more nurses be hired to accommodate the growing numbers of obese patients. This will also cost money for the health care organization as the amount of reimbursement will not increase.

The key stakeholders in all this are first and foremost the patient and family. The poor health of yourself or a loved one can cause great stress to all those involved. And it is important that they receive high-quality health care. Those participants in the micro-, meso-, and macrosystems are all stakeholders. This includes nurses and other clinicians who work at the bedside, middle management, upper management and administration, and board of directors of the health care organization. Even further, leaders at the local level, such as politicians, lobbyists, clergy, and public health officials can help create and support local health initiatives in the community (Folta, et al., 2015).

As discussed earlier, obesity has many negative implications in pregnancy. Therefore, it is important, that as providers, we address this problem during the first intake visit and at every subsequent prenatal visit. When the patient meets with the nurse at approximately 8 weeks gestation, they discuss BMI and appropriate weight gain throughout the pregnancy. If the patient is obese, a referral to the nutritionist is ordered along with first-trimester glucose screening and TSH. The nurse also informs the provider to update the problem list to indicate a high-risk pregnancy. Whether or not this is an effective means to control obesity in pregnancy remains to be seen. Most women welcome the referral to nutrition because they want to take an active part in the health of the pregnancy. Also, they usually adopt a more nutritious diet when pregnant. There are still those women who refuse to follow up appropriately or, follow provider recommendations. And because I practice in a rural setting, transportation issues are prominent.

Carrara, F., Zanei, S., Cremasco, M., & Whitaker, I. (2016). Outcomes and Nursing Workload Related to Obese Patients in the Intensive Care Unit. Intensive and Critical Care Nursing 35, pp 45-51.

Cochrane, L., Brumpton, K., Winter, S., Bell, K., Brunham, H., Wadwell, K., & Kitchener, S. (2019). Prevalence and Outcomes of Overweight and Obesity among Pregnant Women in Rural Queensland. Australian Journal of Rural Health, 27, pp 164-169.

Folta, S., Koomas, A., Metayer, N., Fullerton, K., Hubbard, K., Anzman-Frasca, S., Hofer, T., Nelson, M., Newman, M., Sacheck, J., & Economos, C. (2015). Engaging Stakeholders from Volunteer-Leg Out-of-School Time Programs in the Dissemination of Guiding Principles for Healthy Snacking and Physical Activity. Preventing Chronic Disease, 12, pp 1-7.

Hahler, B. (2002). Morbid Obesity: A Nursing Care Challenge. Dermatology Nursing, 14(4), pp 249-256.

Institute for Health Metrics and Evaluation. (2020). US health. http://www.healthdata.org/us-health

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