SELECT ONLY ONE QUESTION TO WORK ON !!!!!!!!!!!!!!!!!!!!!

·      Follow the discussion questions participation and submission guidelines.

·      Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

·      Minimum of two references, not older than 2015.

Chapter 6: Advancing and Managing Your Professional Nursing Career

1.  Do you view nursing as a career or as a job? What are your professional goals related to nursing?

2.  What kind of first impression do you make when searching for a new position?

3.  Do you plan to be a part of a professional organization after graduation? Why or why not? What do you anticipate will be your level of involvement?

4.  Do you have the courage to ask for honest feedback? Do you have the courage to give honest feedback to a friend or colleague? How do you respond to negative feedback?

READINGS

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Education-Resources/AACN-Essentials (Links to an external site.)

Dang, D., & Dearholt, S. L. (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International.

·  Chapter 1: Evidence-Based Practice: Context, Concerns, and Challenges

·  Chapter 7: Evidence Appraisal: Nonresearch

·  Appendix F: Nonresearch Evidence Appraisal Tool

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). Springer Publishing Company.

·  Chapter 4: Translation of Evidence to Improve Clinical Outcomes

REFLECTION ON LEARNING

Reflective inquiry allows for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals. Each week, you will reflect upon what you have learned and complete a reflective journal assignment: Reflection on Learning. Each weekly reflection is placed in one document, which will be submitted for grading at the end of Week 7. There is no weekly reflection in Week 8 because a reflection is incorporated into the discussion question. Create a document where you will keep your weekly reflection.

In your document, reflect upon your Week 1 learning journey in NR701 and consider the following in one or two paragraphs.

·  Provide one specific example of how you achieved the weekly objectives.

·  What did you learn from this week to challenge your beliefs or attitudes?

·  How will this knowledge improve your effectiveness as a practice scholar?

: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

• Metformin 500mg BID 
• Januvia 100mg daily 
• Losartan 100mg daily 
• HCTZ 25mg daily 
• Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

• List three questions you might ask the patient if she      were in your office. Provide a rationale for why you might ask these      questions. 
• Identify people in the patient’s life you would need to      speak to or get feedback from to further assess the patient’s situation.      Include specific questions you might ask these people and why. 
• Explain what, if any, physical exams, and diagnostic      tests would be appropriate for the patient and how the results would be      used. 
• List a differential diagnosis for the patient. Identify      the one that you think is most likely and explain why. 
• List two pharmacologic agents and their dosing that      would be appropriate for the patient’s antidepressant therapy based on      pharmacokinetics and pharmacodynamics. From a mechanism of action      perspective, provide a rationale for why you might choose one agent over      the other. 
• For the drug therapy you select, identify any      contraindications to use or alterations in dosing that may need to be      considered based on the client’s ethnicity. Discuss why the      contraindication/alteration you identify exists. That is, what would be      problematic with the use of this drug in individuals of other ethnicities?
• indicate any therapeutic changes that you might make      based on possible outcomes that may happen given your treatment options      chosen. 

Post 1

Brunette B

Middle Range Theory Illuminates Concepts in Health and Health Care Delivery

  The middle-range theory develops as the practical theory that provides an abstract perspective based on literature and science, which provides a relevant approach than the grand theory (McEwin, & Wills, 2019). The middle-range theory focuses on purposes for examining a particular phenomenon, therefore, illuminating nursing conceptual by creating the research that analyzes specific variables (Fawcett & Garity, 2009). It changes the clinical setting to best practice by examining continuous nursing education, utilization research to process significant provide quality care to patients (Jacelon et al., 2011). Middle-range theory aids in developing a specific and relevant concern with the health situation; therefore, enhancing theory regarding specific nursing matters considerably present the potential to increase advanced nursing knowledge meaningful to the clinical environment (Fawcett & Garity, 2009).

Role with Middle Range Theories and Importance to Advancing Nursing

 The middle-range theory guides information to the advantage of collecting on improving the nursing discipline that theoretically applies significance research theory to increase understanding of the specific disease or situation within the nursing profession to improve people’s lives (Fawcett & Garity, 2009). According to McEwin, & Wills (2019), middle-range theory systems’ properties are simple and straightforward, which provides room for additional research study. 

My goal as a Doctor of Nursing Practice student is to be able to efficiently address current and future health care issues, provide quality care to patients, and implement research methods to improve patients’ health. It is essential as a doctorate-level student to examine sufficient and substantial research study focusing on patient well-being and generate theory that concentrates on straightforward design to influence and transform people’s lives (Jacelon et al.,2011). The middle-range theory helps with a simplification of the research theory for nursing practice. The middle-range theory is crucial for evidence-based clinical judgment to practice through a scientific approach, examination of theory laws, nursing concepts, and nursing practice approach (McEwin & Wills, 2019).

References:

Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating research for evidence-based nursing (pp. 73-88). Philadelphia, PA: F. A. Davis.

Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53-60.

McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing. (5th ed.) Philadelphia, PA: Wolters Kluwer Health.

POST 2

Dori M

Middle Range Theory Illuminates’ Concepts in Health and Health Care Delivery

               Middle range theory is a crucial part in the entire healthcare system and for the developmental of nursing research. Middle range theories have the potential to guide nursing interventions and change conditions of a situation to enhance nursing care (Melanie & McEwen, 2019, p. 209). A major role of middle range theory is to define or refine the substantive components of nursing science (Melanie & McEwen, 2019, p. 209). Middle range theories guide nurses to provide Evidenced based practice (EBP) while evaluating patient outcomes. Murrock and Higgins (2009) stated around the world, healthcare professionals use evidence-based guidelines to determine appropriate interventions expected to improve health outcomes. EBP is the gold standard in the healthcare system; as a result of that ongoing research, evaluations of patient outcomes are necessary. Middle range theory plays an important role in nursing care; it enables healthcare providers to provide care based on EBP, understanding the rationales, thinking critically and promote rooms for researches for the better patient outcomes.  

Professional Role and Participation in Improving Clinical Practice

               As a healthcare provider, Nurse Practitioner (NP) and currently perusing Doctor of Nursing Practice (DNP) degree; It is my ultimate goal to provide EBP care throughout my practice and engaged in researchers in order to provide safe, quality and holistic care direct and indirect to patients and to the healthcare system in general. Evaluating and utilizing middle range theory is essential; this will enable and guide me as a healthcare professional to the right path now and in the future to come. Middle range theory is vital for the ongoing development of the nursing professional (McEwin & Wills, 2019, p. 225). Middle range theories focus primarily on client problems and likely outcomes as well as the effects of nursing interventions on client outcomes (McEwin & Wills, 2014, p. 2019).  There are several types of middle range theories that empower nurses to provide holistic care to patients. These middle range theories guide the nurses to provide care in different aspects in life such as physiologically, culturally, emotionally, Psychotically, spiritually, promote health and diseases preventions in to patients. As we discussed in the previous  weeks from McEwen and Wills (2019) there are several middle range theories which includes Pender’s Health Promotion Model, Synergy Model, Leininger’s cultural care diversity and universality theory, Benner’s model of skills acquisition in nursing, Kolcaba’s theory of comfort middle range and many more. These middle range theories are critical in nursing and patient care, I utilize middle range theories in my practice daily with positive outcomes. Understanding the development of concepts and middle range theories is a great step in to more advanced in the practice and research as well. A supported by the authors sources used to generate middle range theory include literature reviews, qualitative research, filed studies, conceptual models, taxonomies of nursing diagnoses and interventions, clinical practice guidelines, theories from other disciplines, and statistics analysis of empirical data. 

                                                                       References

McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing. (5th ed.) Philadelphia, PA: Wolters Kluwer 

                   Health.

Murrock C.J. & Higgins P.A. (2009). The theory of music, mood and movement to improve health 

       outcomes. Journal of Advanced Nursing 65 (10), 2249–2257.doi: 10.1111/j.1365-2648.2009.05108.x

EXAMPLE REPLY 

A creation of a middle-range theory, with music as an intervention, was focused upon to increase physical activity and improve health outcomes. Reviewing the theory, it showed that pain and agitation are decreased through music’s emphasis upon psychological responses. Music is seen as a science and art, attaining five components of rhythm, melody, pitch, harmony, and interval (Murrock & Higgins, 2009, p. 2250). In evaluation of the middle-range theory, it presented social significance within those individuals that require further interventions for pain and agitation by providing mood and movement. It appeared to be a reasonable theory by how it modified the internal and external environments, which was noted to be a nurse’s responsibility. Additionally, music interrupted the stress response and encourages social interaction (Fawcett & Garity, 2009; Murrock & Higgins, 2009). There seemed to be concise explanations that showed findings of a “safe, cost-effective, non-invasive” approach (Murrock & Higgins, 2009, p. 2252). Presentation of the theoretical model, as a figure visual, provided a thorough insight to show what is being correlated. This visual component resembled the depiction of a simple concept map. With review of the last component of the middle-range theory, being testability, do you feel it met the evaluation aspect within this article (Fawcett & Garity, 2009)?

References

Fawcett, J. & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating research for

evidence-based nursing (pp. 73-88). Philadelphia, PA: F.A. Davis.

Murrock, C.J., & Higgins, P.A. (2009). The theory of music, mood and movement to improve health

outcomes. Journal of Advanced Nursing, 65(1), 2249-2257. Doi: 10.1111/j.1365-2648.2009.05108.x