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One thing I have learned is that nursing student life is chaotic. Juggling between personal life, school responsibilities and other essential physiological needs are challenging. Therefore, time management skills a vital component of every great nurse.
This is because effective time management and task ease the transition process. In the time management assessment, my score was 28, which indicates that I have above average time management skills. This implies that there is still room for improvement (Ghiasvand et al., 2017).
The roles and responsibilities of a nurse practitioner are limitless. One has to be proficient in all healthcare aspects including financial management, interpersonal effectiveness, and leadership. To effectively manage all these responsibilities, it is important to have excellent time management skills. To start with, I will have to learn on ways to set priorities. Learning how to prioritize my tasks has been my greatest challenges.
This includes thinking through the situations using the following the following questions: which task is important? What is the consequence of not acting now? What is important? Although this feels like one is just dawdling, the process helps one learn how to prioritize activities through questioning, dialogue, and reflection. Through critical thinking process, one can break down the demands of the situation efficiently and quickly (Kourkouta & Papathanasiou, 2014).
However, it is also important to exercise some flexibility and patient. This is because part of the nursing profession is to confront the unknown. I have also learned that it is important to create a mental space so as to create a good tone for the rest of the day as it allows one to calmly assess the environment which helps one to prepare and plan. Lastly, it is important to take a break. I always find it difficult to take a break as I consider it time wasted. However, after this course, I have practiced taking 5 minutes breaks whenever necessary which greatly improves productivity and mental concentration (Ghiasvand et al., 2017).
Leadership theory that describes the leadership style
Nursing leadership plays an integral role in the healthcare institution. The leadership styles affect their productivity and patient outcomes. It is important to understand the various types of leadership styles found in the workplace as it influences nurse’s ability to work as a team and to deliver quality care. Nurse leadership goes beyond care planning, organizing and care coordination of the patients. It entails leading the nurse team and subordinates and facilitates smooth flow of healthcare processes (Vesterinen et al., 2013).
Many leadership theories have evolved including trait theories, behavioral theories, contingency theories and the recently contemporary theories. My leadership style is informed by transformational theories. These are theories that focus on the relationship between leaders and group.
I feel more obliged to help the team members to fulfill their potential. As a leader, I understand that my roles and responsibilities include promoting teamwork between team members, encouraging positive self-esteem and empowering the team members to become more involved in the development and implementation of policies and procedures (Porter-O’Grady, 2016).
Comparison between management and leadership
Leadership and management terms are often used interchangeably in many disciplines; however, there is a big difference between two terms. According to my perception, nursing is a calling to leadership. Across the continuum, nurses are looked as leaders because we inspire, empower and motivate others. Nurses possess excellent communication and interpersonal skills and are risk takers.
These are the core responsibilities of a leader. Nurses do not need to be in a managerial position to deliver these responsibilities; they are energetic and devote their entire life to serve the society. Therefore, nurses are inherently leaders and are a mandatory role in healthcare (Nancarrow et al., 2013).
However, there are various types of leadership. Authoritarian leadership is dictatorial whereas democratic leadership involves democracy where team members are included in the decision-making process. The other types of leadership are delegated where the leader allows everyone to make independent decisions. From my assessment, I am a democratic leader.
This is because I listen to other people ideas and incorporate them during the decision-making process. On the other hand, nurse management focuses mainly in fields that deal with the management of staff and the service users. In this capacity, nurse managers are expected to fulfill the assigned tasks and projects. However, nurse managers and nurse leaders do complement each other (Porter-O’Grady, 2016).
Application of leadership concepts in work environment
Throughout this course, the concept of health-promoting leadership in workplace focuses on the interaction between the leadership behavior and the working environment. From my research, I have learnt that successful leaders are those who create healthy workplace. This is achieved by promoting positive climate among employees such as gratitude, compassion, and forgiveness. The main aim is to create an environment that respects each and brings out a sense of responsibility and integrity. This, in turn, creates a sense of commitment, peace, and the creation of healthy environments that are a representation of our life and values (Al-Sawai, 2013).
References
Al-Sawai, A. (2013). The leadership of Healthcare Professionals: Where Do We Stand? Oman Medical Journal, 28(4), 285–287. http://doi.org/10.5001/omj.2013.79
Ghiasvand, A. M., Naderi, M., Tafreshi, M. Z., Ahmadi, F., & Hosseini, M. (2017). The relationship between time management skills and anxiety and academic motivation of nursing students in Tehran. Electronic Physician, 9(1), 3678–3684. http://doi.org/10.19082/3678
Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary teamwork. Human Resources for Health, 11, 19. http://doi.org/10.1186/1478-4491-11-19
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Vesterinen, S., Suhonen, M., Isola, A., Paasivaara, L., & Laukkala, H. (2013). Nurse Managers’ Perceptions Related to Their Leadership Styles, Knowledge, and Skills in These Areas—A Viewpoint: Case of Health Centre Wards in Finland. ISRN Nursing, 2013, 951456. http://doi.org/10.1155/2013/951456
Chief Complaint: “I have been having severe headaches for the last two days.”
History of Present Illness (HPI)
For the previous five days, Mrs. Jones has been experiencing frontal headaches. She describes the pain as bifrontal, throbbing and moderately severe. The pain began after a minor accident when she slid from a ladder and fell and hit her head. The accident was minor states that she did not see the need for review. She has been taking Tylenol as painkillers, but it is no longer effective. The headaches are not associated with nausea and vomiting. The pain is aggravated by activity and is relieved by rest and put a damp towel on her forehead. The patient denies associated paresthesias, motor-sensory deficits or visual changes.
Medications: Tylenol 400 mg 1 tablet after 4-6 hours
Tobacco: About five cigarettes per day (Since the age of 18)
Alcohol: Takes wine on rare occasions
Past Medical History (PHM)
Childhood illness: Chickenpox, Mumps, Measles
Adult Illness: None
Surgeries: Tonsillectomy at age 6
Ob/GYN: G200P2, normal vaginal deliveries, two living children. Menarche at the age of 13years and LMP a month ago. Not sexually active, No psychiatric disorders.
Health maintenance: Not up to date
Family History
Father died at age 46 in an accident. Mother is 67 alive and diagnosed with dementia. She has one brother 30 years old, alive and healthy. Her two daughters age 6 and four years are alive and healthy. No family history of TB, diabetes, cancer, or cardiovascular disease.
Physical examination:Psychosocial History
She is born and raised in Deltroit, finished college and married her high school boyfriend. She works as a librarian in a nearby college. She lives with her family in their mortgaged house. She gets little exercise but is watchful of her diets. She feeds on homemade foods only. She uses seat belt regularly and sunscreen lotions.
Review of System
General: Denies fever, night sweats or chills
Skin: Pale and dry. Patient denies bruising rashes or skin discolorations
Eyes: Patient use corrective lenses
Ears: No ear pain, discharge or any hearing changes
Nose/Mouth/Throat: No sinus complication, no nose bleeds, no dysphagia, or throat pains
Breast: Deferred
Heme/lymph/ Endo: No anemia or bleeding issue. No swollen glands. She does not feel excessive thirst or present cold intolerances
Cardiovascular: She denies orthopnea, peripheral edema or chest pains
Respiratory: She denies SOBs, wheezing, dyspnea or hemoptysis. She has no history of TB or pneumonia
Gastrointestinal: Denies NVD, has no abdominal pains, constipation or hemorrhoids. Denies eating disorders
Genitourinary/Gynecological: no hematuria, no night-time urination or changes in urine quantity
Musculoskeletal: Denies muscle pains, has mild back aches, no history of fractures of osteoporosis
Neurological: No seizures or syncope of transient paralysis
Psychiatric: No distress, no depression, psychosocial disorders or suicidal thoughts.
Objective data
Vital signs: Height 5’2”, Wt 143lb, BMI 39.0, Bp 130/70 right arm seated, HR 88, RR 18, t 98.6F
General Appearance: Patient is alert and oriented. Denies acute distress, she is well groomed and generally healthy
Skin: Skin is intact, pale and dry. No bruising, rashes or lesions
HEENT:
Head: Normocephalic and atraumatic
Eyes: Intact EOMs and PERRLA, no sclera infection or lesions
Ear: Positive reflex, no discharge, infection or foreign bodies, visible umbo and short process
Nose: bilateral canals, no rhinitis in both nares, oral pharyngeal mucosa is pink, moist and not erythmatous. No dental prosthesis, nodules or thyromegally.
Cardiovascular: S1 and S2 is heard with normal and regular rate, no peripheral edema, no murmurs or edema
Respiratory: No chest pain, wheezing, or un-labored respirations
Gastrointestinal: abdomen soft and non-tender, No palpable masses, no abdominal pain, normal bowel sounds, no change in elimination frequency or change of color.
Breast/Chest: no lymphadenopthy, nipples with no discharge, chest unremarkable
Genitourinary: Bladder is non-distended, no hematuria or dysuria, no changes in urine color or elimination frequency
Musculoskeletal: Normal gait, good stability, no complaints of foot pain or edema
Neurological: Clear speech, good tone and posture normal and erect. Intact cranial nerves II to XII
Psychiatric: Well groomed, alert and oriented, maintained eye contact and answers questions appropriately.
Despite the promulgation of anti-corruption laws, corruption remains a menace in international business. Historically, cases of corruption in the international business arena have dominated news headlines, mostly as international firms seek to enter foreign markets or maintain market share. According to Transparency International, all countries are corrupt, and it is only the degree of corruption that differs.
Corruption in international business can be associated with increasing global competition which encourages unethical practices aimed at gaining market traction and rigidity in international laws that motivate businesses to use short-cuts to navigate the legal systems. This makes it difficult for companies that are attempting to maintain integrity to compete in a fair environment.
Consequently, corruption has created a negative impact on international trade by debasing the relevance of business ethics, which has to a great extent created a culture of corruption in international trade. Corruption costs the economy significantly, and as reported by Transparency International in 2013, approximately $2.6 trillion or 5% of the world’s GNP is lost through corruption (Makhlouf, 2016). Companies also lose significantly through increased project costs.
Despite the consented efforts to deal with corruption that impacts international business, it is also notable that this remains the most difficult moral issue to fight. This is because as much there are smart anti-corruption strategies put in place across the world, the impact of corruption on international business still prevails. This paper is a discussion of corruption in International trade including the history, forms of corruption, the impact of corruption, anti-corruption strategies and possible solutions to corruption in international business.
2. History
Corruption in international business is as old as the business itself. Its origin can be associated with stringent rules placed on foreign entrants by different countries and the difficulties associated with penetrating new markets, such that bribing government officials helps companies in circumventing legal and social huddles (Eicher, 2012).
In the early days of international trade, bribery was not illegal, and it was considered normal for companies that sought to do or retain business in foreign countries to bribe government officials. Indeed, foreign bribes in some European countries were considered a cost of doing business and would be deducted from corporate tax returns.
As globalization continued to rise, the international business also grew at a high rate, and this propagated the growth of corruption. This was further enhanced by free market reforms led by international financial institutions and donor governments. More companies were investing internationally, and the trend of bribing government officials to facilitate entry of businesses or competitive advantage in the host country became a norm. It was so common that bribes were budgeted for as part of a company’s overseas operations.
In December 1975, the earliest international anti-corruption movement began when the U.N Assembly’s resolution titled “Measures against Corrupt Practices of Transnational and Other Corporations, their Intermediaries, and Others Involved” was passed (Ala’I, 2017). This resolution was a means of condemning corrupt practices that violated host country laws and regulations, by transnational corporations and others.
The UN Working Group was formed by the U.N. Economic and Social Council in the quest to provide recommendations for eliminating corruption. The Group called for international action, after discussions between 1976 and 1980.
The United States became the first country to implement anti-bribery law following the passage of the Foreign Corrupt Practices Act, which explicitly outlawed the practice in 1977 (SEC, 2012). The business community considered the decision by U.S. a wrong move because it would disadvantage the United States regarding competitive advantage, thus leading to major protest. However, the Act was passed, and this marked the beginning of a change in international business practices. Companies and individuals using the U.S financial system, according to the Act, were required to refrain from bribing or offering to bribe foreign officials for purposes of retaining or gaining business.
Interestingly, other countries did not follow suit until over 20 years later, an indication that bribery played a considerable role in international business. In Europe, corruption associated with foreign business was not given much attention as bribery was considered a necessary business expense. The same was applicable in a majority of countries, and it is not until recently when this perception changed globally, giving rise to anti-corruption laws that regarded bribing foreign officials a criminal offense (Hauser & Hogenacker, 2014).
In 1999, the OECD Convention on the Bribery of Foreign Public Officials in International Business Transactions came into being, with 29 members and five non-members signing the agreement. The convention provided guidelines for legislation implementation and tasked governments to criminalize active bribery in international business. This convention has led to the implementation of various other conventions across the world in a bid to fight corruption. Also, this has resulted in increased awareness of the negative impacts of corruption, and global efforts to prevent bribery and corruption have increased as observed today.
3. Forms of corruption
Corruption in international business can be classified into two broad categories: corruption associated with foreign market entry and corruption that influences competitive advantage within the market. Foreign market entry mostly involves complex procedures and barriers to entry, perpetrated by the bureaucracy and rigid rules and regulations governing the entry of foreign organizations. Once in the market, firms still face significant challenges in the form of laws governing foreign companies and high levels of competition from local firms. This may trigger corruption because government officials are aware of the frustrations faced by foreign companies and the owners are desperate to gain market traction. In both of the categories described above, corruption may be executed in various forms as follows:
Bribery: Offering money in exchange for a favor
Extortion: Asking for money or other payments in return for services
Kickbacks: Percentage of income given to an individual for facilitating a business process.
Facilitation payments: These are payments made with the aim of achieving faster results.
Grand corruption: Payments to politicians, policy makers, and other high-level officials.
Petty schemes: Payments to lower and middle-class officials with influence and power.
Influence peddling: Obtaining money with the promise of connecting an individual to power influencers.
Nepotism: Requiring that the company hires friends and relatives in return for favors.
4. Effects of corruption
Corruption can have grave consequences on international business as established in the discussion below.
Restricted entry
The corruption that impedes market entry can be a great deterrence for honest firms. In such situations, entry requirements are normally very complicated or marred by bureaucracy, thus creating room for corruption. This means that corrupt government officials may entice organizations to pay bribes to have the registration processes speeded up or some of the entry requirements overlooked (Eicher, 2016).
Unfair competition
Corruption affects the competitive environment by altering the competitive conditions. Corruption allows large corporations to control the market because they can bribe their way out of various legal circumstances or bypass certain regulations required in operation of their businesses (Makhlouf, 2016). This disadvantages honest dealers and thus creates an asymmetrical market environment. An example is where a corrupt company pays government officials to overlook the company’s potential environmental pollution and offer a clearance certificate in support of the organization’s activities.
Honest firms, on the other hand, may have to invest heavily in reducing environmental pollution to comply with the government requirements or have to pay fines for any deviation. When the two firms are compared, the corrupt firm has a competitive advantage because it will record higher profitability.
High prices for consumers
Where corruption is prevalent, it also means that organizations must incur high costs in meeting their objectives. This translates into higher costs of production, which are consequently transferred to the consumer for the company to make desirable profits. This affects not only customers but also the economy at large because of reduced customer purchasing power.
Poor quality products
Corruption creates loopholes for the production and import of inferior products. When companies can get away with poor standards and the use of subnormal raw materials through corruption, the customer suffers due to the poor quality of products they receive. Also, corrupt officials allowing cheap goods to be imported into the country could be risking the lives of citizens.
Corrupt business culture
Thede & Gustafson (2012) notes that self-sustained unethical behavior is likely to result from corruption in international trade. This is because the more corrupt deals are made, the higher the corruption prevalence becomes. According to Thede & Gustafson (2012), corrupt agents are more likely to interact with corruptible agents for business, and these behavioral patterns end up being sustained as the norm. This further worsens corruption to the disadvantage of honest agents. A corrupt culture tends to raise honest exchange transactions, such that it is more expensive to find an honest business partner due to higher search costs.
5. Corruption and economic growth
Corruption can have deleterious effects on economic growth. A majority of literature studies the negative impact of corruption, mostly as an ethical issue and a factor that impacts equilibrium of the business environment. Corruption is a costly affair, and it could limit economic growth, and as established by OECD (2014), corruption accounts for the loss of approximately 5% of the world’s GDP. This may be evidenced by inefficiencies resulting from corrupt practices. Also, the unequal distribution of income and resources that result from corruption leads to the rise of poverty rates (Makhlouf, 2016).
Corruption limits economic gains from international business. This is because only firms that are financially capable and which are corrupt get access to foreign market entry while the honest and less financially endowed are locked out. Based on this, corruption can be seen as a limiting factor for international business because the country may end up losing on entrants with great potential because the opportunities were given to those who could pay (Eicher, 2016). This further impacts domestic production opportunities due to obstruction of competition (Thede & Gustafson, 2012).
Corruption impacts governance and control of the business environment. The existence of corruption makes it difficult for authorities to implement regulations and controls, thus making governance difficult. Rotberg (2017) notes that it undermines the efficiency of state institutions and undermines a country’s regulatory environment, thus distorting decision-making processes. This results in a skewed business environment, and it becomes difficult to provide a level playing ground for all firms in the market including incentives.
6. Legal/political systems
A country’s legal and political systems greatly influence the prevalence of corruption and the extent to which this influences international business. In countries where strict measures are placed to control corruption, the levels of corruption are lower. This is because legal systems discourage such illegal practices. Further, political systems the level of control within government agencies, such that corruption may be lower in countries where the governing political body is committed to fighting corruption (Eicher, 2012).
In the initial periods of international business growth, foreign official bribery for purposes of business was not considered illegal in any country, and it is not until recently that legal and political systems were put in place to manage corruption. As a result, it is possible to state that the legal and political systems at the time perpetrated the occurrence of corruption, given that there were no laws to govern the practice (PBS, 2017).
The discussions above also establish that the main catalyst of corruption is the existence of trade barriers that limit the entry of foreign companies and effective business operations in the host countries, thus encouraging businesses to seek easier alternatives. By maintaining such conditions, governments played a significant role in promoting corruption, thus creating the menace observed today.
Given the high level of corruption emanating from international business, countries have taken different measures aimed at combating corruption. This represents a change in trends that has influenced legal and political systems through the development of laws that prohibit corruption and which promote prosecution of perpetrators. In the United States which was the first country to implement legal systems to deal with corruption, the Security Exchange Commission implements the Foreign Corrupt Practices Act through investigations and audit procedures aimed at discovering any possible bribery of foreign officials (SEC, 2012).
Political systems across the globe have also increasingly relaxed their international trade barriers to promote smoother processes that eliminate the need for corruption and bribery. According to Eicher (2012), reduction in trade barriers has been instrumental in reducing corruption because they eliminate incentives to corruption which were previously brought about by difficult processes, bureaucracy, and strict international business laws.
Countries are increasingly participating in international conventions that encourage the implementation of legal systems to curb corruption in their countries. Examples of popular conventions against corruption and bribery include the OECD Convention on the Bribery of Foreign Public Officials in International Business Transactions, United Nations Convention against Corruption, EU Convention on the Fight against Corruption, The Inter-American Convention against Corruption and the African Union Convention on Preventing and Combating Corruption among others (UK Anticorruption Forum, 2017).
These conventions have played a significant role in the development of more solid legal systems to deal with corruption and thereby improved international trade.
7. Anti-corruption strategies
Regulations: These are laws and regulations developed to govern international business and which ban the use of corruption to achieve business objectives in the international markets.
Trade barriers relaxation: This is aimed at promoting international trade by eliminating trade barriers that often limit business between countries. It may involve reducing taxes, registration charges, policies and regulations that limit international business. The result has reduced the incentive to give or receive bribes because the processes are not limiting.
Anti-corruption Conventions:These convene officials and business people from different countries to discuss and develop an agreement on how corruption can be combated.
Accounting practices and audit: To limit corruption, governments have continuously introduced strict accounting practices to discourage corruption. Public companies are also subjected to auditing to determine the existence of unscrupulous business practices.
Trade agreements: These are agreements between countries to eliminate barriers to trade and thus ease international business. This may be in the form of mutual agreements to reduce regulations for businesses from the countries involved or tying of conditions to the benefitting country’s contribution to the host country. An example is where developing countries ease trade barriers in exchange for infrastructure loans.
Mobilization of public opinion: This strategy involves civil society engagement, mostly through non-governmental organizations to influence private and public organizations to end corruption by demonstrating its negative impacts.
8. Cures of corruption
Corruption has been singled out as one of the moral issues that is difficult to control and which may never be successfully eliminated. However, efforts towards corruption elimination should mostly focus on the cause of corruption.
Internationalization: Internationalization is a possible cure for corruption in international business. This is the process of in which barriers are eliminated or at least reduced to promote trade. This would encourage free investment across the world, and this would reduce the motivation for corruption.
Leadership and political will: Leaders have the ability to influence the end of corruption in their countries through influencing moral behavior, promoting political good will and setting up laws that discourage corruption. Rotberg (2017) notes that leaders have influence over their followers and that they can influence their actions if they are committed to ending appropriate behaviors. When a country’s leadership is committed to ending corruption, they will do anything in their capacity to achieve this objective.
Anti-corruption commissions: Anti-corruption commissions are formed with the objective of creating an independent body to investigate and prosecute companies and government officials involved in corruption. According to Transparency International (2017), an anti-corruption agency that is independent and well financed can play a vital role in fighting corruption.
Unfortunately, anti-corruption commissions still face the threat of political influence and will only be effective if their permanence is legally guaranteed and independence of the commission is assured through the appointment of leaders who are competent, have an apolitical stance and demonstrate impartiality, independence, neutrality, and integrity (Transparency International, 2017).
Self-regulation: This approach to corruption is informal and mostly aims at promoting self-governance among businesses to end corruption. Such may be achieved through internal policies and codes of conduct. This approach is more about promoting moral duty among organizations by calling on organizations to be more responsible in their business dealings.
9. Conclusion
Corruption in international business has mostly been associated with barriers to market entry in international markets. As a result, organizations seeking entry into such markets may be forced to bribe foreign officials to facilitate their entry and circumvent the regulations.
Once an entry is achieved, there are market dynamics that often make it difficult for foreign companies to operate including business laws and regulations, foreign business taxation policies, business marketing practices, sales and distribution, and competition dynamics among other factors. These limit foreign business operations and expansion, and consequently influence the perpetration of corruption, to ease business in foreign countries and speed up business growth.
Despite the increasing efforts towards fighting corruption, it remains a great menace that may hinder international business for a long time. In this paper, the history of corruption in international business, economic impact of corruption, legal and political systems and different anti-corruption strategies that have been utilized over the years are discussed. This paper also establishes various solutions that may eventually cure corruption including internationalization, leadership and political will, anti-corruption commissions and self-regulation of international firms.
10. References
Ala’i, P. (2017). Controlling corruption in international business: the international legal framework. International Sustainable Development Law – Vol. II. Retrieved from https://www.eolss.net/Sample-Chapters/C13/E6-67-03-07.pdf
Eicher, S. (2012). Corruption in International Business: The Challenge of Cultural and LegalDiversity. Farnham, UK: Gower Publishing, Ltd.
Hauser, C., & Hogenacker, J. (2014). Do Firms Proactively Take Measures to Prevent
Corruption in Their International Operations?. European Management Review, 11(3/4), 223-237. doi:10.1111/emre.12035. Retrieved from web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=0&sid=4d18121e-f6b7-4cfd-98a2-91ab92914251%40sessionmgr120
Makhlouf, H. H. (2016). Corruption in the International Business Environment. The Journalof Human Resource and Adult Learning, 12(1), 32-39.
“I feel increasing pain around the left thigh and buttock. I feel fatigued and have noticed some swelling in the affected part.”
History of Present Illness
Joy reports that the pain and swelling in her left hip and buttocks that begun a week ago. The 38 y/o African American has been experiencing pain and swelling in multiple joints for the past three months. She has experienced active bilateral synovitis in her wrists and ankles. She has also observed small nodules on her left elbows. The hip joint swelling began five days ago.
She has been treating the pain using acetaminophen. Since then, she has been experiencing increasingly severe pain and edema in the affected region. The pain is relieved by rest but aggravated by mobility and physical activity. She reports the pain at scale 8 in 0-10 pain scale. She denied any history of trauma. She occasionally experiences morning stiffness that lasts for 30 minutes and low back pain that usually worsen at night. She has not experienced had any flares.
She is asthmatic and suffers from seasonal allergies. She is also allergic to aspirin as it causes gastrointestinal discomfort. The medication she has used recently is acetaminophen 500mg for pain management and Proventil HFA to manage an asthma attack. She has no chronic illness and has not undergone any surgeries. The only time she has been hospitalized is during delivery of her two daughters.
She does not smoke but occasionally takes a glass or two of wine. She has no appetite changes. She has been experiencing urinary tract infections occasionally but has no history of sexually transmitted illness. She denies no psychological disorders.
She began her menarche at age 13 years. Her LMP was last month, which she describes as a regular flow that lasted for three days. She is Gravida 2POO2. She carried all her pregnancy with no complication and breastfed all her children. She has sex 2 to 3 times a week but with no protection. She has been using IUD method of contraception which she removed six months ago.
She does not engage in any health maintenance screenings such as mammogram or Pap test. Her father is 72 years old and hypertensive. Her mother is 68 years old and is diagnosed with diabetes. She is happily married and lives with her husband and two daughters. She lives with her husband and her two daughters (age 12 and eight years old). She is a housewife whereas her husband works as sales manager at a local supermarket.
She has a good rapport with her neighbors and is actively involved in local community programs especially those that promote healthy living. Her family is financially and socially stable. She is physically active and tries to eat homemade food as much as possible.
Review of systems
The patient is alert and oriented. She denies fever or chills. She has no skin rashes, lesions or any discolorations. She uses corrective lenses and denies any changes in her vision and has the normal hearing ability. She denies dental complications, throat pains, dysphagia or nose bleeds. She denies skin discolorations, breast lumps, and breast masses. She denies SOB, chest pains, palpitations, or edema. This indicates that her respiratory system is in great shape. She denies wheezing, dysponea or hemoptysis. She has no history of pneumonia or TB.
She feeds on homemade foods. She denies any changes in appetite. She denies NVD. She has not seen any changes in bowel movement and elimination frequency. She denies heartburn, constipation or presence of hemorrhoids. She denies changes in urine quality and quantity. She denies hematuria. She complains of frequent muscle pain and complaints of a backache.
She has no history of fracture or trauma. She reports that she is unable to lift her arms without extreme pain in the shoulder. In the last five days, it has been difficult to stand for long periods of time due to ankle and foot pain. Although acetaminophen 500 mg three times a day has helped her manage the pain and stiffness, it is no longer effective.
She denies syncope of transient paralysis and seizures. She denies bleeding and has never been diagnosed with anemia. She denies presence swollen glands or excessive thirst. She looks slightly distressed but denies the history of psychosocial disorders or depression.
Objective data
The patient is in acute distress. However, she is well groomed, alert and oriented. Her vital signs are as follows; Weight 220 lb, Height 5’3”, BMI 39, BP 130/70 (taken on the right arm when seated), HR 80, RR 18 unlabored, T 97.5, SATs 99% at room temperature. The patient skin is moist and warm. No discoloration observed. The skin color is normal, intact and with no rashes, lesions or bruises.
The head is normocephalic and atraumatic. EOMs and PERRLA are intact with no lesions. The ears have positive reflex, bilateral TMS with no discharge or infection. Umbo and short process are visible with no foreign body. Nose canals are bilateral with no rhinitis in both of the nares. The nasals turbinate’s are not swollen.
The oral-pharyngeal mucosa is moist and non-erythmatous pharynx. No nodules or dental prosthesis observed. S1 and S2 are regular with normal rate. No murmurs or peripheral edema noted. The respirations are normal and unlabored. Wheezing sounds are absent in all of the four quadrants. She has normal bowel in all four quadrants. The abdomen is soft and non- tender. No palpable masses noted.
The chest and breast region is unremarkable with no lymphadenopathy. The bladder is non-distended. No changes in urine quality or quantity. No hematuria. The gait is not normal. She is limping as she walks across the exam room which indicates discomfort or pain in the affected limb. The left hip is swollen and painful. The pelvic exams indicated no inguinal adenopathy, lesions or erythma on the genitalia. Vaginal discharge is normal.
The cervix is normal without palpable masses. The lower quadrants are tender. The adnexal and uterine are tender. No pain is indicated with cervical motion. The anterior and midline of the uterus is smooth and not enlarged. She has clear speech, good tone and intact cranial nerves II. She appropriately maintains eye contact.
Differential diagnosis
Based on the signs and symptoms, the patient is likely to be suffering from infections arthritis, psoriatic arthritis, gout or osteoarthritis. This is because these diseases are collectively grouped as arthritis as they commonly affect the small joints, hips, hands, lumber and cervical spine. Differentiating these diseases is challenging as they all present with joint stiffness and pain that worsen with activity (Buttaro, et al., 2013).
Psoriatic arthritis is suspected because of clinical manifestations such as generalized fatigue, swollen and painful joints, and limited range of motion. The disease will be confirmed by laboratory tests. Similar to Psoriatic arthritis, Rheumatoid arthritis and infection arthritis is suspected because of the presence of signs and symptoms such as joint stiffness, pain, fatigue, tenderness and limited range of motions.
Gout is suspected because of patient’s complaints about intense throbbing joint pains, discomfort and inflammation. However, gouts normally affect the large joints of the big toe. The disease will be confirmed by the laboratory findings. Similar to out, the patient may experience joint pain that hurt during and after movement. Joint stiffness is noticeable especially in the morning or after long periods of physical inactivity (Buttaro et al., 2013).
To reach a definitive diagnosis, it is important to undertake differentiating diagnostic investigations. For instance, diagnosis of psoriatic arthritis is supported by skin biopsy of the affected lesions. Infectious arthritis is self-resolving within six weeks whereas gout is confirmed by serum uric acid that is above 416 micromols/L. Rheumatoid arthritis, on the other hand, is confirmed by whereas osteoarthritis is distinguished from others by the rheumatoid factor, C-reactive protein, and erythrocyte sedimentation whereas osteoarthritis by radiographs that indicate loss of joints space, osteophytes and subchondral sclerosis (Kordasiabi et al., 2016).
Lab tests
Diagnosis should be conducted as early as possible to optimize patient’s outcomes. The patient presents with painful and swollen hip joint. In this case, appropriate laboratory tests include; CBC, Renal function, erythrocyte sedimentation (ESR), C- reactive protein (CRP), Level of RhF and citrullinated peptide antibody (CCP). Imaging tests such as radiography and X-rays will also be ordered to make the definitive diagnosis. Also, these tests are used to evaluate the particular erosive changes to assess the disease progression (Buttaro et al., 2013).
According to my preceptor, some lab tests such as complete blood count and renal function are necessary as they influence treatment options. For instance, if the patient is diagnosed with renal insufficient or thrombocytopenia, the healthcare provider must avoid prescribing a non-steroidal anti-inflammatory drug (NSAID). Some medications are also contraindicated with some hepatic disease.
Definitive diagnosis: Rheumatoid arthritis
The onset of the disease peaks between the ages of 30 and 50 years. It is the most common cause of disability in the USA. It is reported that 35% of people diagnosed with RA reports disability within ten years (Centers for Disease Control and Prevention, 2013). RA typically presents with pain and stiffness in multiple joints in the body. As the disease progress, other small joints including the interphalangeal joints and metacarpophalangeal become affected.
In most patients, they may experience morning stiffness that may last more than 30 minutes. In some cases, Boggy swelling may become visible caused by synovitis and subtle synovial thickening. Systemic symptoms include low-grade fever, fatigue and weight loss (Buttaro et al., 2013).
According to the American College of Rheumatology and European League against Rheumatism 2010, RA diagnostic criteria are as indicated below (Aletaha et al., 2010):
(Source: Aletaha et al., 2010)
The laboratory findings were as follows; CRP 5.7 mg/ dL(normal 0.1-0.9 mg/ dL); ERS 26 mm/h (normal 0-15mm/h) RhF 33.4 (normal 0-29 IU/mL) and CCP 40 (normal0-20). Radiography results were still pending. The other parameters were within the normal limits. Rheumatoid arthritis (RA) is the most common type of arthritis. Based on this guideline, the patient complaint is 1-3 small joints with the involvement of a large joint (score 2); the serology tests indicates low positive RhF and High positive ACPA (score 3) and abnormal CRP and ESR levels (score 1).
The total score is 6 out of 10 which is the score needed for classification of the patient as having RA. RA is a progressive disease, and it is difficult to know when the disease first developed. Most patients experience periods of alternating bothersome symptoms. Onset, severity and disease symptoms vary greatly from one person to another. Therefore, treatment should b tailored to meet individual medical needs (Buttaro et al., 2013).
Treatment and management of the disease
Once diagnosed, the initial treatment and evaluation should begin immediately. Due to different disease presentations, a patient specific and effective care plan was developed. The goal of this treatment was to minimize joint pain and swelling, slow disease progression, prevention of deformity and maintenance of quality of life. With the help of my preceptor, the pharmacological treatment was initiated using oral Methotrexate (MTX) 7.5mg per week (divided in 2.5 mg orally after 12 hours in 3 doses) plus 5 mg Prednisone per day. She was also given Diclofenac 50mg three times a day. She was advised to continue using acetaminophen when required.
Secondly, I noted that the patient was obese (BMI 39). Therefore, the patient was advised to feed on healthy diets and to perform regular exercises. The diets recommended for this patient include eating plenty of fruits, whole grain cereals, and vegetables. The patient was also advised to feed on foods rich in omega -3 such as fish oils, and to feed a low-fat diet. She was also advised to limit alcohol intake and to consume moderate sugars and foods that have added sugars (Dains, Baumann, & Scheibel, 2012).
Whereas there is limited evidence-based practice on the impact of diet on RA, my preceptor advised that patient education on dietary modifications is acceptable. Therefore, it is always important to encourage parents to adopt and maintain healthy diet and weight. This intervention is particularly important for this patient because she has high body mass index (BMI).
Moreover, weight reduction helps reduce the weight bearing of joints and prevention of other disease comorbidities such as high blood pressure. It has also been indicated that people with unhealthy weight have poorer functional status; further emphasizing the need for healthy weight control in general disease management (Kordasiabi et al., 2016).
Another important factor in weight control is physical activeness. The patient was referred to a physiotherapist for services relating to exercises s it has been statistically shown significant improvements in patients diagnosed with RA body functions and social component. This is because exercises are well accepted to have a big role in combating the adverse effects associated with RA on muscle endurance, strength and aerobic capacity (Rudan et al., 2015).
However, fatigue is also common in patients diagnosed with RA. The patient was advised to rest their inflamed joints. The patient was also advised on other strategies such as the application of heat and cold therapy to relieve pain. The patient was also advised on passive and active exercises to maintain range of motion in the affected joints (Dains, Baumann, & Scheibel, 2012).
Complementary therapies have been associated with some favorable outcomes. These include the use of acupuncture, use of gamma-linolenic acid from black currant seed oil, evening primrose and thunder god vine. However, the patient was informed about the potential adverse effects associated with the herbal therapy (Kordasiabi et al., 2016).
The patient was also given folate or folic acid (400 mg). This is important because some RA medications such as methotrexate interfere with absorption of folic acid. Research also indicates that patients under corticosteroids make it difficult to absorb calcium; therefore, the patient was given calcium supplements (Buttaro et al., 2013).
Patient education
The main goal of health promotion is to empower patients with practices that empower them and makes them improve their well-being holistically ranging from mental and spiritual mental wellbeing. The patient was educated on the importance of participating in preventive care such as Pap test and mammogram screening. She was advised to perform Pap test and mammogram screening at least twice a year to facilitate early detection of the disease and effective management of the disease (CDC, 2013).
The patient stated that she had removed IUD six months ago as it was making her bleed uncontrollably and developed frequent urinary tract infections. When asked if she is ready to have another child, she was hesitant saying that they had planned to have only two children. I advised her on the alternative contraceptive methods such as hormonal birth control methods that have been found to be effective.
These contraception methods cause the cervical mucus to thicken making it difficult for the sperm and pathogens to reach the uterus. The patient was also taught about hygiene practices such as wiping herself front to back after visiting the toilet to avoid introducing colon pathogens into her vagina (Buttaro et al., 2013).
Follow up care
Remission occurs in 10 to 50% of RA patients. It is more likely in males, people below 40 years, nonsmokers and the late onset of the disease. If the disease is well controlled, the medication dosages will be cautiously reduced to the minimum amount necessary (Healthy People 2020, 2013). Long-term monitoring of the disease is important because although RA is considered a disease of joints, it is also the disease that involves multiple organ systems.
For instance, patients diagnosed with RA are likely to have increased risk of lymphoma which is believed to be caused by underling inflammation and not a consequence of the disease. Patients diagnosed with RA have increased risk factors such as high blood pressure, high cholesterol. Also, caution is needed with the continued use of DMARDs as it is associated with malignancy. Lastly, the disease is associated with depression which affects more than 40% of people diagnosed with RA; which is associated with long-term use of corticosteroids (Kordasiabi et al., 2016).
Therefore, ongoing monitoring of the patient will be done after every two weeks. This is important in assessing the patient progress and the overall management goals such as treatment efficacy, disease activity, other comorbidities and patient’s quality of life in general. It is also important to run the laboratory tests to monitor toxicity and adverse effects of the modification. The referral was made to a rheumatologist for further evaluation.
References
Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., … & Combe, B. (2010). 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism, 62(9), 2569-2581.
Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2013). Primary Care: A collaborative practice. Elsevier Health Sciences.
Dains, J, E., Baumann, L.C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4ed.) St. Louis, Mo.: Elsevier Mosby.
Kordasiabi, M. C., Akhlaghi, M., Baghianimoghadam, M. H., Morowatisharifabad, M. A., Askarishahi, M., Enjezab, B., & Pajouhi, Z. (2016). Self-Management Behaviors in Rheumatoid Arthritis Patients and Associated Factors in Tehran 2013. Global Journal of Health Science, 8(3), 156–167. http://doi.org/10.5539/gjhs.v8n3p156
Rudan, I., Sidhu, S., Papana, A., Meng, S., Xin–Wei, Y., Wang, W., … Global Health Epidemiology Reference Group (GHERG). (2015). Prevalence of rheumatoid arthritis in low– and middle–income countries: A systematic review and analysis. Journal of Global Health, 5(1), 010409. http://doi.org/10.7189/jogh.05.010409
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The parietal lobe is located at the top region near the back of the brain. There are two parietal lobes – left and right parietal lobe. This part of the cerebral cortex is involved in vision, speech, sensation and interaction with other regions to connect sensory input from external environment and interpretation of the stimuli. Parietal lobe stroke occurs when the blood vessel supplying blood to this region ruptures or gets blocked.
This interferes with sensation of the entire opposite sides. This is because motor system of the brain is mainly found in the frontal lobes (Knoefel, 2011). It starts with promoter regions for coordination of complex movements to the primary motor cortex where output is transmitted into the spinal cord leading to contraction and movement of the muscles.
The primary motor cortex located on the left side of the brain is responsible for the movement and muscle contractions in the right side of a person’s body and the primary motor cortex on the right controls movement of the left side. This explains why patient with right parietal stroke gets return of voluntary movement in the left hand (Migliaccio et al., 2014).
Question 2
Fronto parietal stroke affects the frontal and parietal lobes part of the brain. A right fronto-parietal stroke patient with better movement in the left hand side is also likely to may not necessarily have better attention of the side. This is because the frontal lobe is responsible for solving skills, emotions, and selective attention behavior. On the other hand, the parietal lobes control sensations such as touch and pressure.
Therefore, the indication of stroke will depend on the region of the brain involved. Stroke on the right hemisphere cerebrum affects left side whereas stroke in the left hemisphere affects the right side. In addition, injury in the left lobe disrupts the patient understanding of the written and spoken word (Knoefel, 2011).
Question 3:
Visual motor integration refers to a person’s ability to perceive visual information, process it and move the motor system accordingly. The idea that the front ends of visual system is responsible for breaking down stimulus for down into their constituent’s parts such as pattern, shape, motion, color and to glue the feature in the parietal lobe neuron.
Therefore, patients with right front parietal stroke make it challenging to grasp coordination. Visual- motor integration involves three processes; a) visual stimulus analysis, b) fine-motor control and c) conceptualization. Deficit in any of the three processes influence the final outcome. For instance, if fine motor control and visual analysis are within the normal range, then the challenge lies in the conceptualization (Johansson, 2012).
Question 4:
It can be challenging to farm with Parkinson’s disease because of tremors and rigidity that makes it difficult to hold hand tools and increases the likelihood of accidental injuries to self and others. In addition, the increased diminishing balance can increase risk for secondary injuries due to fall, slip or trip.
In addition, the medications used to treat the disease are associated with light headedness, confusion, insomnia and dizziness can dramatically reduce the patient’s energy. Therefore, these are the safety risks to consider when supporting the patient engage in his chosen hobby (Santos-García & de la Fuente-Fernández, 2013).
Question 5
Parkinson disease is a neurodegenerative disease described by non motor and motor symptoms that negatively impact the patient’s quality of life. Most of PD patients are stigmatized because of the visible motor and non motor symptoms. The symptoms of this disease are difficult to hide and are perceived as unscrupulous by the public. This includes observable traits such as gait difficulties, tremor and drooling. These symptoms disrupt the autonomous integration into the society due to their exterior conditions. In addition, the deteriorated self esteem evokes feelings of embarrassment and shame which results into isolation (Santos-García & de la Fuente-Fernández, 2013).
In addition, stigma and seclusion is not only associated with the observable signs and symptoms but also due to progressive loss of functionality. This factor further contributes to bad self image, self efficacy and autonomy. In fact when interviewed about their life history, most of the patients explain symptoms as the key issue for seclusion and low self esteem due to increased physical dependence.
Stigma also arises from awkwardness and inability to do activities that require simple motor actions. This reduction to functionality results into increased social disengagement associated to stigmatization. Stigmatization may also occur due to hindrances to communication. PD patients may be mislabeled for instance as drunkards. In addition, the delayed thinking and difficulty to convey their opinions easily can make them feel frustrated and isolated. The difficultness to decipher PD patient’s mute expressions makes them feel alienated and disconnected from others (Maffoni et al., 2017).
References
Johansson, B. B. (2012). Multisensory Stimulation in Stroke Rehabilitation. Frontiers in Human Neuroscience, 6, 60. http://doi.org/10.3389/fnhum.2012.00060
Maffoni, M., Giardini, A., Pierobon, A., Ferrazzoli, D., and Frazzitta, G. (2017). “Stigma Experienced by Parkinson’s Disease Patients: A Descriptive Review of Qualitative Studies,” Parkinson’s Disease, Article ID 7203259, doi:10.1155/2017/7203259
Migliaccio, R., Bouhali, F., Rastelli, F., Ferrieux, S., Arbizu, C., Vincent, S., … & Bartolomeo, P. (2014). Damage to the medial motor system in stroke patients with motor neglect. Frontiers in human neuroscience, 8, 408.
Santos-García, D., & de la Fuente-Fernández, R. (2013). Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson’s disease. Journal of the neurological sciences, 332(1), 136-140.
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Public service is at the core of the ability to deliver critical social services to its citizens by the government. Committed civil servants are the key stakeholders in this expected social contract between the government and its citizenry. As a public servant, my commitment is to provide service according to the competency of my academic qualifications to the best of my ability for not less than twenty years. According to Farrel & Goodman (2013), this will require discharging my duties with rationality, analytically and with the somberness expected with this social responsibility.
My commitment is driven by the passion for helping people and for making a difference and not by the paycheck alone. This commitment to delivering services with excellence is underpinned by knowing that my effectiveness will determine the success or failure by the government in its mandate. Knowing that I will be a role model for new public servants in the future drives me to commit to working while improving my skills so as to better impart knowledge (Besel, Williams, Bradley, Schmid, & Smith, 2016). My commitment is to provide quality service that gives value back to the taxpayers.
The following will constitute my plans which will assist me to meet the minimum requirements of the EHLS. This involves improving my computer literacy and my language skills to level two or higher on the interagency language roundtable (EHLS, 2017). Completing my bachelor’s degree is also part of my plan towards fulfilling this requirement. Committing myself to 6 months of full-time study in Washington together with an additional two months online survey is part of my plan to meet the demands of the EHLS program as well as working for the government after that.
References
BESEL, K., WILLIAMS, C., Bradley, T., Schmid, A., & Smith, A. (2016). The State of Public Service in America. In Passing the Torch: Planning for the Next Generation of Leaders in Public Service (pp. 3-8). Fayetteville: University of Arkansas Press. Retrieved from http://www.jstor.org/stable/j.ctt1ffjgmt.5
Since its creation, NHS England has committed itself to the principle of developing national health strategies with the voluntary, non-governmental sectors and the citizens. NHS England, being an independent body, it is responsible for setting priorities and giving directions of the Health sector and improving the health care to the citizens of England (England N. H. S, 2015). NHS is composed of different sections with various professional groups as explained below (England N. H. S, 2015);
NHS: Reflective pieces
The Secretary of State for Health: The Secretary of State has an oversight responsibility for everything that is undertaken in the Department of Health. That includes providing strategic leadership for the health sector and social care in England.
Department of Health: The Department provides strategic leadership and funding to both social care and health in England. It is a ministerial department and thus receives funds from the government.
Clinical Commissioning Groups (CCGs): This is clinically guided statutory NHS groups that are responsible for the development and commissioning of healthcare activities in their local area. The CCG members include the GPS and other professional clinicians like the consultants and the nurses. They are allocated more than 60% of the NHS budget because they play a big part in the secondary care and the establishment of GP services. The secondary care they undertake includes Community health services, rehabilitative care, emergency care, mental health services, hospital care and health and Wellbeing Boards.
Reflective Pieces: Professional skills
For students to understand professional skills, they must attend work based training. The relevance of joint learning is highlighted by the government NHS plan where they provide a one-day training to the students so that they can interact with the professionals. IPE acts as a platform for the commissioners in the social care and public health to interact. I attended the IPE that worked on enhancing the confidence of pre-registration of the health care professionals as they are enrolled in their workplace.
This is especially important to students who consider entering in placement areas where public health sectors where ethos are poor. The aim of these training is to foster professional interactions to improve their confidence level. Personally, from the interaction, my confidence level has improved. Through this inter-professional learning activity, I have learnt strategies to enhance democratic decisions in the health sector and strategies to strengthen the working environment and relationship between the health system and social care (Jackson 2014).
I also learnt the expert services and leadership skills vital to public health. From this experience, I can comfortably co-ordinate national health services and to guide the public to make healthier choices. I also learnt some aspects on the health sector are shared amongst various bodies. For instance, NHS Improvement- is an umbrella organization tasked with bringing together Patient Safety, NHS Development Authority, quality care, and intensive Support teams which similar responsibilities are provided by individual professional regulatory bodies such as the bodies such as General Medical Council, Nursing and Midwifery Council, and General Dental Council.
The provision of quality healthcare for the patients relies on the cooperation of the high, different professionals. For healthcare to be considered complete, the contribution of each of the above bodies must be considered and implemented. Embracing teamwork is therefore of paramount concern (England N. H. S, 2015).
Reflective pieces: Lessons learnt
From this experience, I have learnt that communication underpins everything in professionalism. For instance, it affects the quality of care and can result in bad patient experiences. Also, good communication skills encourage teamwork; poor communication is the greatest barrier towards co-operation of various members of staff or professional bodies. Some of the factors that affect communication include excessive use of professional jargons and unnecessary abbreviations. Staff members with poor skills of communication create breakdowns that work against quality interaction amongst various groups (Jackson, 2014).
Informal interactions between the students and professional group strengthen their IPE experience as they move into proactive. I feel the experience strengthened by including perspective which acts as a link of theory to practice. Good communication also helps the team to develop clear objective and also encourages the cooperation amongst members in the department as the goal will act as a unifying factor. A department with unclear goals will have its members concentrating on various activities that only concerns them and thus causes a breakdown in the relationships (Jackson, 2014).
I now understand the importance of fostering teamwork in their departments. One aspect that I have not well mastered is managerial skills. Managers are expected to foster teamwork in their departments. A good manager can take his or her members through a common task giving them the motivation to achieve what is required of them. I feel my managerial skills are inadequate and will enrol in professional programs that promote proper managerial skills (Jackson, 2014).
The Nursing Fundamentals course will be guided by competency statements which are based on contemporary professional nursing standards and guidelines. The four competency statements that are unique to the Nursing Fundamentals course include;
The Nursing Fundamentals course must prepare graduates to make clinical decisions using current best evidence.
The course must train graduates to demonstrate the ability to work efficiently with inter-professional and nursing teams and to make clinical decisions that are aimed at achieving quality patient care.
The Nursing Fundamentals course must prepare graduates to maximize benefits and minimize risks for patients through improved individual performance and system effectiveness.
The course must teach graduates to use information and technology to support clinical decisions and to minimize medical errors.
A1. Nursing Fundamentals: Explanation of Four Competencies
The four competencies listed in part A above are aligned with the national nursing standards and guidelines documented by the Quality and Safety Education for Nurses (QSEN). Competences i, ii, iii, and iv are aligned with QSEN standards related to evidence-based practice, teamwork and collaboration, safety, and informatics respectively. First, the nurse educator for the Nursing Fundamentals course will have to teach learners how to use current best evidence to make clinical decisions.
This will help the institution to maintain compliance with QSEN’s evidence-based practice standards. Moreover, nurse educator for the course will have to ensure that graduate nurses are competent enough to function with inter-professional and nursing teams to share knowledge that is aimed at achieving quality patient care. This way, the institution will have observed QSEN’s standard related to teamwork and collaboration (Rosenblum and Sprague-McRae, 2014)
Additionally, the nurse educator for the Nursing Fundamentals course will be compelled to teach graduates to maximize benefits and minimize risks for patients through improved individual performance and system effectiveness.
This will help the academic institution to comply with the safety standards set by QSEN. Furthermore, the nurse educator will ensure that graduate nurses are competent in using information and technology to mitigate medical errors and to promote improved care delivery. This will enable the institution to demonstrate adherence to QSEN’s standard related to informatics (Lewis, Stephens and Ciak, 2016).
A2. Three Learning Objectives
Clear learning objectives must be developed for the Nursing Fundamentals course to help students to master the four competencies listed above. The three learning objectives for course competency number ‘iv’ which is related to informatics are outlined below;
At the end of the course;
The learner must be able to explain the importance of information and technology skills in promoting safe and quality patient care.
Also, the student must be able to identify crucial health information that should be kept in electronic systems to support patient care
the learner must have the capacity to describe the relationship between patient safety and effective management of electronic health information
A2a. Discussion of Criterion
The criterion that will be used to select appropriate learning resources to achieve the learning objectives listed in part A2 is consistency. The chosen learning resources must be consistent with educational standards set by national, state, and local agencies. According to Burns, Noonan, Jenkins, and Bernardo (2017), an effective learning resource for a nursing course must be coherent and consistent with the standards set by national, states, and local agencies in the nursing education sector.
Furthermore, the content of these learning resources must match the needs of learners irrespective of the program level in which they are to be used. By focusing on consistency when selecting learning materials for the Nursing Fundamentals Course, the nurse educator will choose only those resources that highlight the specific contexts in which they are to be used, and that explicitly explain nursing concepts that are to be covered in the course.
Furthermore, the nurse educator will be sure to select learning resources that specify the types of learners who can utilize those resources. Also, the nurse educator should consider the appropriate method of instruction that must be used in the classroom to ensure compliance with educational standards set by national, state, and local agencies (Burns et. al., 2017).
A3. Approaches to Course Design
The Nursing Fundamentals course will be developed based on the principles of the contemporary approach to course design. The contemporary approach to course design that will be used to develop the course is the learning-centered approach. According to Ihm, Choi, and Roh (2017), a learning-centered approach is based on the principle that the ability of a student to efficiently acquire new knowledge is mainly dependent on the teaching process utilized by the instructor.
Here, the learner uses the information provided by the instructor to build upon a given concept based on the knowledge that had been acquired previously. Learning-centered approach to course design is appropriate for learners who are being taught to achieve certain competencies which have been set by relevant accreditation bodies (Ihm, Choi, and Roh, 2017).
In the Nursing Fundamentals Course, nursing students are expected to achieve the competencies outlined by QSEN. As a contemporary approach to course design, the learning-centered approach will help learners in the Nursing Fundamentals Course to acquire the competencies listed in part A of this paper.
B.Strategies to Evaluate Learning Outcomes Role playing, as well as papers and essays, will be used to evaluate whether students have achieved the intended learning outcomes in the Nursing Fundamentals Course. Papers and essays is an evaluation strategy that involves the issuance of exam topics to students and asking them to write their answers on papers in essay form.
It is a form of summative assessment because it often conducted at the end of a course and it covers all topics covered in the course. Using papers and essays evaluation strategy, the nurse educator will judge student performance in the Nursing Fundamentals Course based on documented standards (Harrison, Konings, Schuwirtg, Wass & Vleuten, 2017).
C1. Criterion-Referenced Tests
Criterion-referenced tests will be used in the Nursing Fundamentals Course to evaluate student outcomes. When using criterion-referenced tests, the nurse educator will document learning standards which students will be expected to meet for them to be considered competent. Only students who meet the set standards after answering given tests will be deemed proficient (Lock, McNaught and Young, 2015).
C2. Norm-Referenced Tests
Apart from criterion-referenced tests, norm-referenced tests will be used to assess student outcomes in the Nursing Fundamentals Course. When using norm-referenced tests, the nurse educator will compare student performance with that of an imaginary average student who will be selected from a group of learners who had completed similar tests before. Students who manage to perform better that the imaginary average student will have passed their exams. Conversely, learners who score grades below that of the imaginary average student will have failed the test (Lock, McNaught and Young, 2015).
D1. Advantages of True-False Test Items
Advantages of true-false test items will influence their use in the Nursing Fundamentals Course. The nurse educator may choose to use true-false test items because individual test items are easy to compose and organize. Also, true-false test items are easy to tally because they display students’ answers very clearly. Moreover, true-false test items will enable the nurse educator to examine students on some concepts because they allow sampling of information from several topics (Javid, 2014).
D3. Advantages of Multiple-Choice Test Items
One of the advantages of using multiple-choice test items of the course is that they will allow the nurse educator to assess many learning objectives in a single examination. Also, when multiple choice test items are used, the nurse educator will easily evaluate results of a large population of learners. Moreover, using multiple-choice tests in the Nursing Fundamentals Course will help to improve student performance in subsequent tests (Sutherland, Schwartz and Dickison, 2012).
F. Cultural and Societal Factors
The ability of students to effectively learn the Nursing Fundamentals Course in the classroom can be impacted by both cultural and societal factors. In this regard, a student’s learning ability may either improve or decline as a result of influence from factors inherent in their cultures (Shawwa, Abulaban, and Balkhoyor, 2015). For example, the level of concentration of a female student who comes from a community that does not support girl-child education may negatively be affected because such student will face rejection from the community.
G2. Learning Activity Meeting Learning Styles
The learning activity described in part G1 effectively meets kinesthetic learning style of students in the Nursing Fundamentals Course. According to Kharb, Samanta, and Singh (2013), students who apply kinesthetic learning style enjoy learning through movement and making contact. These students always want to engage in activities that make them move their hands during the lesson as this helps to break teaching boredom. The activity in part G1 will get learners moving and will help them to break from teaching monotony.
H. Importance of Learning Activity Promoting Critical Thinking Skills
When teaching Nursing Fundamentals Course, the nurse educator will create learning activities that improve critical thinking skills of learners. According to Papathanasiou, Kleisiaris, and Kourkouta (2014), today’s nursing institutions must strive to promote critical thinking skills of students to produce graduates who can effectively keep up with the rapid technological advancements in the contemporary world.
Therefore, learning activities that improve critical thinking skills of learners are important because they will enable students to understand and analyze issues more effectively, with the aim of solving complex problems that they increasingly encounter in the ever-changing world (Papathanasiou, Kleisiaris, and Kourkouta, 2014).
H1. Critical Thinking Strategy
The nurse educator will use collaborative learning to facilitate the development of self-reflection skills among students in the Nursing Fundamentals Course. Collaborative learning is a critical thinking strategy that involves allowing nursing students to work in teams to solve complex problems related to specific course concepts that they have been taught in the classroom.
H2. Implementation of Selected Strategy
Collaborative learning strategy will be implemented in the Nursing Fundamentals Course by following four steps chronologically. First, the nurse educator will teach students a new course concept and allow them to ask questions. Second, the nurse educator will identify an article that talks about a complex issue related to the taught concept. Third, he or she will ask students to form groups.
Each group will be invited to read the article, analyze its contents, identify the problem, and come up with a solution or solutions to the identified problem. Fourth, the nurse educator will use the solutions generated by each group to help students to understand the course concept further (Rosenblum and Sprague-McRae, 2014).
I. Examples of a Best Practice
The nurse educator should have a system in place to provide feedback to learners in the clinical setting. There are several acceptable approaches for providing feedback to students. For instance, in the Nursing Fundamentals Course, the nurse educator can provide written feedback to learners at the end of the course, that is, in a summative manner. The feedback should contain an explanation of observed desirable behaviors as well as undesirable behaviors and actions that students can take to improve on them (Anderson, 2012).
C1. Evaluation Method
Formative evaluation method will be used to assess if the curriculum design is effective for the Nursing Fundamentals Course. This assessment strategy involves assessment of the curriculum design during implementation. Formative evaluation of curriculum design will enable the nurse educator to make relevant changes that match ongoing trends in the nursing education field (Burns, et. al., 2017).
References
Anderson, P. A. (2012). Giving feedback on clinical skills: Are we starving our young? Journal of Graduate Medical Education, 4(2): 154-158. doi:10.4300/JGME-D-11-000295.1. Retrieved from PubMed Central.
Burns, H., Noonan, L., Jenkins, D. P. & Bernardo, L. M. (2017). Using research findings to design an evidence-based practice curriculum. Journal of Continuing Education in Nursing, 48 (4): 184-189. doi: 10.3928/00220124-20170321-09. Retrieved from PubMed.
Harrison, C., Konings, K., Schuwirtg, L., Wass, V. & Vleuten, C. (2017). Changing the culture of assessment: The dominance of the summative assessment paradigm. BMC Medical Education, 17:73. doi: 10.1186/s12909-017-0912-5. Retrieved from BioMed Central.
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Mayo Clinic, Wisconsin receives accreditation from Wisconsin Accreditation Organization for Hospitals and The Joint Commission. Before offering accreditation, The Joint Commission evaluates health care organizations for compliance with the set standards. Wisconsin Accreditation Organization for Hospitals evaluates health care organizations at an interval of three years.
Accrediting is mandatory for Mayo Clinic, Wisconsin because the organization cannot be allowed to provide medical services to patients if it is not accredited. The main purpose of accrediting, therefore, is to validate if the Clinic meets quality standards documented by the two accrediting bodies. Accreditation supports Mayo Clinic to make improvements on its systems to meet the set quality standards (Mayo Clinic Health System, 2016).
Accrediting of Mayo Clinic by Wisconsin Accreditation Organization for Hospitals and The Joint Commission is important to heath care because it results in improved care across all departments of the organization. Additionally, accreditation helps patients to receive the highest and best quality health care.
Furthermore, accrediting influences Mayo Clinic, Wisconsin to engage in socially responsible behaviors thereby promoting the safety of the community. Again, since Accreditation encourages Mayo Clinic to maximize quality in all its health care delivery processes, it has contributed significantly to the clinic’s expansion and growth (Alkhenizan and Shaw, 2011).
The accrediting requirements for Mayo Clinic include safe and high-quality patient care, effective communication with stakeholders, high level of coordination and planning to promote mitigation of risks, facility safety, and effective leadership. Mayo Clinic, Wisconsin requires highly performing technology systems and competent employees to maintain accreditation. If the organization loses accreditation, it will lose clients due to reduced quality of care and compromised patient safety. Failure to make improvements on its systems will result in closure (Mayo Clinic Health System, 2016).
Mayo Clinic should be accredited to offer medical services related to prevention, treatment, and control of infections. The organization requires licensure in the following areas; perinatal care, disease-specific care, palliative care, medication compounding, and health care staffing (Mayo Clinic Health System, 2016).
Licensure
Mayo Clinic has been licensed to provide Acute Stroke Management and Diabetes Management services which fall under disease-specific care. These two licensures are mandatory because, without them, the clinic will not be authorized to offer acute stroke management and diabetes management services. The purpose of the licensures is to confirm that Mayo Clinic meets the standards required for an organization to offer acute stroke management and diabetes management services (Mayo Clinic Health System, 2016).
The licensures are important to Mayo Clinic because they help it to implement strategies that are aimed at improving the quality of care for acute stroke and diabetes management. Furthermore, the licensures contribute to the provision of the highest and best quality health care for patients (Alkhenizan and Shaw, 2011).
Moreover, they are essential to heath care in the sense that, it results in improved health care across all departments of the organization. Additionally, the licensures help Mayo Clinic, Wisconsin to become a socially responsible organization by influencing it to engage in activities that promote safety of the community (Rooney and Ostenberg, 1999)
The licensure requirements for Mayo Clinic about the provision of acute stroke and diabetes management services include care delivery, admission, discharge and referrals, a continuum of care, and emergency management. Mayo Clinic, Wisconsin needs three significant resources to maintain these licensures, and they include competent and enough medical practitioners, highly performing technological systems, and a safe facility (Mayo Clinic Health System, 2016).
Suppose the Clinic loses the licensure, it will no longer be authorized to provide acute stroke and diabetes management services. While the loss of accreditation will prevent Mayo Clinic from serving as a health care organization in Wisconsin, loss of licensure will only prevent the organization from providing care services related to acute stroke management and diabetes management (Rooney and Ostenberg, 1999).
References
Alkhenizan, A. & Shaw, C. (2011) Impact of accreditation on the quality of healthcare services: A systematic review of the literature. Annals of Saudi Medicine, 31(4): 407-416. doi:10.4103/0256-4947.83204.
