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Nursing care: Concept Analysis Critique

Introduction

The concept analyzed in this article is nursing care. Evidently, nursing scholars, theorists, and healthcare professions have varying interpretations of the concept. However, in the middle of these disparities, nursing care is a vital aspect of nursing practice and a beneficial factor for both patients and nurses.

Several studies have explored the meaning of the concept (from both nurses and patients perspective) with the aim of identifying the relationship between nursing caring and patient satisfaction. Most textbooks, scientific articles, ethical codes and legal documents use the term nursing as a synonym to caring which are characterized as a nurse’s main ethical obligation (Dalpezzo, 2009).

Therefore, the aim of this concept analysis critique is to help clarify the vague concepts such that every person using it speaks the same thing. This is important in healthcare discipline because it helps people to develop knowledge related nursing concepts.

The overall intention of this analysis to provide a meaningful nursing care concept that can be used by nurse researchers and theorists to get its deeper insights and to identify better means that can be used to assess this complex nursing concept. The specific aims for this concept analysis article critique is; a) to clarify the nursing care concepts, b) identify the strengths of this article in clarifying the nursing concepts and c) to identify the weakness and d) to highlight its implication for practice.

Strengths

The concept analysis criterion background and purpose is clearly described which is to explore the concepts of nursing care and its essence with the aim of developing an operational definition of nursing care (Dalpezzo, 2009, p. 256). Also, the article analyzes the relevant literature to determine the definitions of the nursing care concept terms and in arriving at the core defining attributes of the nursing concept.

For instance, the researcher uses Dictionary.com Unabridged v 1.1, 2006a and the American Heritage Dictionary of the English to define the term ‘care’ and ‘nursing.’ The article also explores the basic definitions of the words ‘caring’ and ‘nursing’ in major nursing models and nursing theories (Dalpezzo, 2009, p. 259).

The author also explores the definition of the concept nursing care from the allied health literature; where he reviewed 16 randomly selected peer-reviewed articles. This research ensured that the analysis of the concept is done extensively, making it clear, distinct and is unambiguously differentiated from the other nursing concepts.

The author develops the definition of the nursing concept in logically, and the discussions of the empirical referents and antecedents are clear. For instance, the author begins by identifying the purpose of the study. This is followed by a brief description of Walker and Avant’s concept analysis method. To start with, the rationale for the selection of the concept nursing care is well outlined which is the lack of clear definition within the nursing literature (Dalpezzo, 2009).

The article describes the purpose of the analysis and clearly identifies the uses of the nursing care concepts in different disciplines. The author also determines concepts defining attributes which include a) nursing care procedures- those needed by patients, b) nature of nursing care – including the high quality of care, nursing skills, safe, holistic and evidence-based, and c) the core functions of nursing care including listening, assessing, preventing, advocating.

The concept is further developed by reviewing additional cases to identify the antecedents and the consequences and to define the concepts empirical referents. This extensive research to define nursing care concept ensures that the analysis of the concept is accurately developed and illuminated (Dalpezzo, 2009).

Weakness

Nursing discipline has set forth an explicit desire to serve the public and commitment to the overall well-being of the society. Therefore, concept analysis is performed to refine the definition of nursing care, with the aim of differentiating it from other similar or dissimilar concepts. The concept analysis of nursing care outlines the focus and boundaries of nursing discipline and also highlights the aspects of the concept that are significant to nursing practice, and can be traced back to the nursing field fundamental concepts(Dalpezzo, 2009).

The terms, meanings, usages, definition and attributes are derived from the nursing care concept analysis is derived from dictionaries, thesauruses, Walker and Avant (2005) method and the current literature. The term nursing care is used throughout the disciplines allied to health, but its meaning is not clear. There are varied themes of nursing care concepts in the literature which present the world’s views and perceptions about nursing care.

However, the concept analysis is limited in that the definition of nursing care concept is a context- based activity; however, the activities differ between the operational environments and the measures or methods used to assess the nursing care outcomes (Koy, Yunibhand, Angsuroch, 2015).

Also, the concept analysis is limited because the attributes gathered from the literature are the only ones used to define nursing care concepts. For instance, the description of nursing care concept from the literature ranges from general conceptions of just being helpful to include divine oriented interventions.

Therefore, the lack of clear definition of nursing care concept in the context of socio-cultural and religious aspects is the greatest dilemma associated with quality nursing practice because it hinders nurse’s efforts to meet patient’s socio-cultural needs. Therefore, future nursing care concepts should put into consideration the cultural contexts (Koy, Yunibhand, Angsuroch, 2015).

Implication for practice

Caring is a complex universal phenomenon and is deeply rooted in the primitive society. For instance, women care for their children and other dependent members of the family. Women involvement in all aspects of care is common in many cultures (Sarpetsa, Tousidou, & Chatzi, 2013). Also, the word ‘nursing’ is highly connected to the term ‘care.’

Nurses deliver nursing care to other people with the aim of maintaining and promoting their health during illness, ordeal or disability. Care is an important element of nursing; and that the conception of the term ‘care’ in nursing affects the way it is delivered. Therefore, people’s perception, experiential, and socio-political aspects of nursing influence provision of care (Schrijvers et al., 2012).

Nursing care is a continuous phenomenon that follows human existence since the time they are born to death. According to Institute of Medicine (IOM) study, nursing care is patient-centric and is directly linked to quality and safety. Nurses have the potential to foster a quality healthcare environment through various ways (Kvist et al., 2014). Nursing care starts with non-verbal communication between the nurses and patients.

It has been found that emotions expressed by nurses towards their patient have an effect on their outcomes, with positive emotions improving their recovery rate. Also, it is through emotional empathy, a respectful, and trusting relationship with the patients is established. Patient-centric care provides a distinct advantage of consistent daily assessment of the patient’s health condition which allows the nurses to detect slightest changes in patients health that require them to proactively make some modifications to the patient care plan when needed (Cheung et al., 2008).

Addressing the variance in nursing care perception is important when interpreting inconsistencies of the concept in nursing literature because it affects patient care outcomes. Nursing care also influences the quality of interaction by the healthcare team (Samina et al., 2008).

While caring is vital between patients and nurses, it is equally important for the healthcare staff because it helps the team to adapt and work together and to understand each person’s individual responsibilities and to provide constructive feedback. Every nurse is a leader because they are in a unique position to make a difference in patient’s recovery. The concept of nursing care facilitates communication, especially when implementing care plans for the patients (Sarpetsa, Tousidou, & Chatzi, 2013).

At administration level, nurses utilize their hands on experience (nursing care) to identify the most effective strategies to delegate the available healthcare recourses to ensure positive patients outcome. Therefore, this concept analysis ensures that one gain the knowledge and technical know-how so that they car skilfully integrate their knowledge into practice (Sarpetsa, Tousidou, & Chatzi, 2013).

Understanding the concepts of nursing care helps one understand the nursing discipline, its culture and the changes needed to make changes that positively impact on the patient’s health outcomes. Tapping into the sufficient knowledge developed by the nursing care concepts analysis, nurses can foster a combination of personal skills, evidence-based practice to collaboratively improve patient outcomes (Schrijvers et al., 2012).

References

Cheung, R. B., Aiken, L. H., Clarke, S. P., & Sloane, D. M. (2008). Nursing care and patient outcomes: international evidence. Enfermeria Clinica, 18(1), 35–40.

Dalpezzo, N.K. (2009). Nursing Care: A concept analysis. Nursing Forum 44(4); 256- 264

Koy, V., Yunibhand, J., Angsuroch, Y. (2015). Nursing care quality: a concept analysis. International Journal of Research in Medical Sciences 3(8): 1832- 1838 DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150289

Kvist, T., Voutilainen, A., Mäntynen, R., & Vehviläinen-Julkunen, K. (2014). The relationship between patients’ perceptions of care quality and three factors: nursing staff job satisfaction, organizational characteristics, and patient age. BMC health services research, 14(1), 466.

Samina, M., GJ, Q., Tabish, S., Samiya, M., & Riyaz, R. (2008). Patient’s Perception of Nursing Care at a Large Teaching Hospital in India. International Journal of Health Sciences, 2(2), 92–100.

Sarpetsa, S., Tousidou, E., & Chatzi, M. (2013). The Concept of” Care” as Perceived by Greek Nursing Students: a Focus Group Approach. International Journal of Caring Sciences, 6(3), 392.

Schrijvers, G., van Hoorn, A., & Huiskes, N. (2012). The care pathway: concepts and theories: an introduction. International Journal of Integrated Care, 12(Special Edition Integrated Care Pathways), e192.

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Nursing theories

Nursing theories Question 1

Nursing is a field that has been changing rapidly over the years and along with its good transition is the coming up of various nursing theories (Cowen, 2014). These theories are what the advanced nursing practitioners keep in mind d use as a guide to either give them a sense of direction during work or help them understand and grasp most valuable lessons of nursing. Science based nursing theories specifically have been a backbone of clinical care.

Self-efficacy is a theory by Alberta Bandura that came about from the socio-cognitive approach (Maddux, 2013). This theory acclaims that there exist three aspects that affect self-efficacy, these are the environment, habits as well as personal factors. Schwarzer, (2014) states that self-efficacy theory is exceedingly important for advanced nursing practitioners in that, the goal of all healthcare providers is for people to manage their health (self-efficacy) particularly those patients with chronic illnesses such as diabetes, asthma or hypertension. T

his in a way goes in line with what Bandura concluded in his theory that motivation, performance, and feelings of frustration associated with repeated failures impact an individual’s perception of health.

Another important theory is the tidal model theory by Phil Barker, which emphasizes on helping people to reclaim the personal story of mental distress by recovering their voice. Barker here gives a philosophical approach to the discovery of mental health (Alligood, 2014). For nurses to start using this model in the engagement process, some requirements need to be agreed upon such as change is unavoidable, the patient, in the end, understands what it is best for him or her, and recovery is possible (Monteiro et al., 2015).

For this reason, the tidal model theory is useful for any nursing practitioner since it helps people recover from mental illness. Kurt Lewin born in 1890 came up with the change theory (Burnes, 2017). This theory has three main concepts: Main thrusts, controlling strengths and harmony. What makes or course change to occur are the main thrusts, they bring about the change since they push a patient to in the desired direction.

Controlling strengths are those that hinder the patient since they push the patient in the opposite direction (Monteiro et al., 2015). Harmony is a condition where the main thrust forces equal the controlling strengths forces, and thus no change occurs. This theory inspires nurses to push patients in the desired direction by all possible means.

Finally, The Helvie Energy theory addresses the notion of energy. In this theory, the person might be seen as an energy field influencing and being influenced by all other energy fields in the synthetic, physical, organic situations (Alligood, 2014). It has been noted here that the mentioned science-based nursing theories help advanced nursing practitioners positively in performing their work.

Nursing theories Question 2

To become a doctorate-prepared nurse, one needs to have enough clinical nursing experience and good memory of several nursing theories at hand (Hunt, 2013). It is critical to know what other scholars who are in the nursing field have done so as to avoid replication. Studying the several nursing theories can assist one to also come up with their science-based nursing theories.

Nursing everywhere has been committed to a rigorous scientific need that provides a significant set of knowledge to advance nursing practice (Blais, 2015). Many science-based theories have been documented over the past decade. Any Ph.D. in the nursing field is built upon doctoral programs including research methods, nursing theory, policy, and economics. Science-based nursing theories over time have aided many people in getting their doctoral degrees.

Madeleine Leininger came up with the Transcultural Nursing Theory, which emphasizes that nurses work on as per the patient’s social choices (Rav, 2016). It begins with the nurse assessing the patient while considering the patient’s cultural background after which a nursing care plan is also given according to the logical cultural assessment. In this theory, it is the responsibility of nurses to comprehend the part of the culture in a patient’s well-being.

Leininger used three nursing activities to accomplish culturally loving care for the patient, which are: Cultural maintenance, cultural negotiation, and social care patterning (Mallela, 2015). Madeleine is now a registered nurse with several degrees such as Doctor of Philosophy, Doctor of Human Sciences and Doctor of Science. She also is a certified transcultural nurse. All these achievements of Madeleine could not have come about if it were not for her coming up with the nursing mentioned above theory.

The Humanistic nursing theory by Paterson and Zderad integrates both humanity and existentialism to nursing theory. Butts & Rich, (2013) elaborate that humanism tries to understand people from the contexts of their experiences while existentialism, then again, is the acceptance that pondering begins with the acting, feeling and living person. In this theory, the nurse assists and cares for the patient. Any nurse applying for a doctorate needs to have such good values so as to achieve the doctorate.

All things considered, any nurse in practice slowly realizes that the work they do, the care they provide is all based on their theory of what is right for their area of nursing. Their philosophies for their jobs, work ethics, treatment of patients, and their behavior all fall in the realms of some nursing theorists whom they learned in school.

References

Alligood, M. R. (2014). Nursing theorists and their work. Elsevier Health Sciences.

Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.

Burnes, B. (2017). Kurt Lewin: 1890–1947: The Practical Theorist. The Palgrave Handbook of Organizational Change Thinkers, 1-15.

Cowen, P. S., & Moorhead, S. (2014). Current issues in nursing. Elsevier Health Sciences.

Hunt, E. C., Sproat, S. B., & Kitzmiller, R. R. (2013). The nursing informatics implementation guide. Springer Science & Business Media.

Maddux, J. E. (Ed.). (2013). Self-efficacy, adaptation, and adjustment: Theory, research, and application. Springer Science & Business Media.

Mallela, R. G. (2015). TRANSCULTURAL NURSING THEORY. NARAYANA NURSING JOURNAL, 4(1), 43-46.

Monteiro, A. R. M., Martins, M. G. Q., Lobô, S. A., de Freitas, P. C. A., Barros, K. M., & de Fátima Tavares, S. (2015). Systematization of nursing care to children and adolescents in psychological distress. Revista de Pesquisa: Cuidado é Fundamental Online, 7(4), 3185-3196.

Ray, M. A. (2016). Transcultural Caring dynamics in nursing and health care. FA Davis.

Schwarzer, R. (2014). Self-efficacy: Thought control of action. Taylor & Francis.

Butts, J. B., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

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Time management

Time management, self-assessment information

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

Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in Nursing Practice. Materia Socio-Medica, 26(1), 65–67. http://doi.org/10.5455/msm.2014.26.65-67

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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Porter-O’Grady, T. (2016). Leadership in Nursing Practice, 2nd Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781284091557/

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

History and physical examination: Case Study

History and physical examination

Identification

Name: Mrs. Tiffany Jones

Age: 32

Sex: Female

Referring physician: Self-referred, seems reliable

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

Allergies: Aspirin causes gastrointestinal discomfort

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.

References

Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Mosby (ISBN: 978-0-323-11240-6).

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Comprehensive patient assessment

General Patient Information

Name: Mrs. Joy Smith

Age: 38 y/o

Gender: Female

Ethnic group: African American

Chief complaint

“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):

Image result for rheumatoid arthritis diagnostic criteria

(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.

Centers for Disease Control and Prevention (CDC. (2013). State prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation. Retrieved from https://www.cdc.gov/arthritis/data_statistics/national-statistics.html

Healthy People.gov. (2013). Arthritis, osteoporosis and chronic back conditions. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Arthritis-Osteoporosis-and-Chronic-Back-Conditions/objectives

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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NHS: Reflective Pieces

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).

References

England, N. H. S. (2015). NHS England launches new framework for commissioning support services.

Jackson, D., Sibson, R., & Riebe, L. (2014). Undergraduate perceptions of the development of team-working skills. Education+ Training, 56(1), 7-20.

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Nursing fundamentals

Facilitating Learning in the 21st Century

Four Competency Statements

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.

Ierardi, J. A. (2014). Taking the ‘sting’ out of examination reviews: A student-centered approach. Journal of Nursing Education, 53(7): 428. doi:10.3928/01484834-20140619-13. Retrieved from PubMed Central.

Ihm, J., Choi, H. & Roh, S. (2017). Flipped-learning course design and evaluation through student self-assessment in a predental science class. Korean Journal of Medical Education, 29(2):93-100. doi: 10.3946/kjme.2017.56. Retrieved from PubMed Central.

Javid, L. (2014). The comparison between multiple-choice (MC) and multiple true-false (MTF) test formats in Irarian intermediate EFL learners’ vocabulary learning. Procedia: Social and Behavioral Sciences, 98(6):784-788. Retrieved from ScienceDirect.

Kharb, P., Samanta, P. & Singh, V. (2013). The learning styles and the preferred teaching: Learning strategies of first-year medical students. Journal of Clinical and Diagnostic Research: JCDR, 7(6):1089-1092.doi:10.7860/JCDR/2013/5809.3090. Retrieved from PubMed Central.

Lewis, D., Stephens, K. & Ciak, A. (2016). QSEN: Curriculum integration and bridging the gap to practice. Nursing Education Perspectives, 37(2): 97-100. Retrieved from PubMed.

Lock, B., McNaught, C. & Young, K. (2015). Criterion-referenced and norm-referenced assessments: Compatibility and complementarity. Assessment & Evaluation in Higher Education, 41(3):450-465. doi: 10.1080/02602938.2015.1022136. Retrieved from PubMed Central.

Papathanasiou, I. V., Kleisiaris, C. F. & Kourkouta, L. (2014). Critical thinking: The development of an essential skill for nursing students. Acta Informatica Medica, 22(4):283-286. doi:10.5455/aim.2014.22.283-286. Retrieved from PubMed.

Quinn, B. & Peters, A. (2017). Strategies to reduce nursing students test anxiety: A literature review. Journal of Nursing Education, 56(3): 145-151. doi: 10.3928/01484834-20170222-05. Retrieved from PubMed.

Rosenblum, R. & Sprague-McRae, J. (2014). Using principles of Quality and Safety Education for Nurses in school nurse continuing education. The Journal of School Nursing, 30(2): 97-102. Retrieved from PubMed.

Shawwa, L., Abulaban, A. & Balkhoyor, A. (2015). Factors potentially influencing academic performance among medical students. Advances in Medical Education and Practice, 6: 65-75. doi:10.2147/AMEP.S69304. Retrieved from PubMed Central.

Sutherland, K., Schwartz, J. & Dickison, P. (2012). Best practices for writing test items. Journal of Nursing Regulation, doi: 10.1016/S2155-8256(15)30217-9. Retrieved from PubMed Central.

Yengo-Kahn, A., Backer, C. E. & Lomis, A. K. (2017). Medical students’ perspective on implementing curriculum change at one institution. Academic Medicine, 92(4):455-461. Doi:10.1097/ACM.0000000000001569. Retrieved from PubMed.

The IOM Future of Nursing Report

Implementation of the IOM Future of Nursing Report

Summary of the key messages of the IOM report

Following a comprehensive assessment of the major challenges facing the nursing profession, the Robert Wood Johnson Foundation (RWJF) came up with some recommendations that would help to make the nursing profession relevant and efficient in future. Furthermore, it identified four key messages that acted as the cornerstone for recommendations.

The key messages that were designed by the RWJF and that the recommendations were to focus on include; nurses should fully apply the knowledge and skills acquired through training and education as well as nurses should work in collaboration with other healthcare professionals to bring meaningful changes to the health care system of the United States.

Other recommendations were that nurses should seek to obtain higher levels of education that enhance academic progress by attending new academic institutions; and those nursing institutions can formulate the right policies and plan their workforce effectively through the use of improved technology to collect data (Altman, Butler and Shern, 2015).

Discussion of the work of the Robert Wood Johnson Foundation Committee Initiative

The Robert Wood Johnson Foundation (RWJF), in collaboration with the Institute of Medicine, held a meeting in 2008 to examine and take appropriate actions to address some of the pertinent issues facing the nursing profession. This meeting led to the documentation of the IOM report on “Future of Nursing: Leading Change, Advancing Health” that acts a foundation for today’s nursing practice.

According to the Committee, nurses in the United States are faced with several challenges that prevent them from meeting the health care needs of the nation, and which make them face difficulties as they attempt to fulfill the goals of health care reforms in the country (Altman, Butler and Shern, 2015).

The particular role of the RWJF committee initiative was to produce a report that details key recommendations for improving the nursing profession to make it fit the future needs of the United States citizens. The committee was also charged with the responsibility of highlighting policy changes that should be made by public and private institutions to foster an improvement in the nursing profession.

As a sign of its commitment towards improving the nursing profession in the United States, the RWJF Committee provides recommendations related to eight different areas namely and removal of practice barrier. Other indicators were; expansion of opportunities for nurses, implementation of residency programs for nurses, increasing the percentage of nurses with baccalaureate degrees, doubling the percentage of nurses with doctorate degrees, promoting lifelong learning for nurses, preparing nurses to become change leaders, and in improving nurses’ abilities to collect relevant health care related data (The Institute of Medicine, 2010).

The importance of the IOM “Future of Nursing: Leading Change, Advancing Health.”

The IOM report entitled, “Future of Nursing: Leading Change, Advancing Health” is extremely crucial to the field of nursing because it contains information that is relevant to improving nursing practice, nursing education, as well as in the development of the nursing workforce. Firstly, the report is important to nursing practice in the sense that, it defines transformed roles of nurses in the whole workforce in a manner that effectively addresses shortage of nurses, the need to integrate cultural and societal issues into practice, as well as the need to provide care using tools that match the ongoing technological trends.

Additionally, the report examines the innovative solutions that can help to improve care delivery in future (Altman, Butler and Shern, 2015).

Second, the IOM report is critical to nursing education in the sense that, it acts as a guide to the nursing industry by providing information on how the industry can expand nursing faculty in order increase the number of institutions of higher learning. The institute of medicine believes that qualified academic institutions will produce graduate nurses with nursing knowledge and skills that can enable them to meet the health care needs and demands of today’s population (The Institute of Medicine, 2002).

Third, the IOM report is essential to workforce development in the sense that, it details how nursing organizations should attract, train, and retain competent nurses who can provide various levels of care to meet public demand (The Institute of Medicine, 2010).

The intent of the Future of Nursing Campaign for Action

The Future of Nursing Campaign for Action was devised with an intention to help influence States to make health care reforms that are aimed at improving the nursing profession in the United States (AARP, 2011). For instance, the Campaign for Action is intended to push the Congress to push for expansion of programs that will enable nurses to practice to their full potentials as per the education and training that they possess.

Also, the intent of the Campaign for Action is influence both private and public funders to facilitate accomplishment of projects that will increase both training and learning opportunities for nurses (Campaign for Action, 2013).

Moreover, the Nursing Campaign for Action intends to put pressure on the federal government, accrediting bodies as well as state boards of nursing to support the implementation of curricula that allow nurses to complete transition-to-practice or residency programs (AARP, 2011).

Again, the campaign intended to encourage health care organizations, academic nurse leaders, as well as accrediting bodies to develop additional institutions of higher learning for nurses to increase the number of nurses who enroll for baccalaureate degrees. In this manner, the institute of medicine believes that the number of nurses with baccalaureate degrees will increase to 80 percent in the next three years (AnneMarie, 2016; & The Institute of Medicine, 2010).

Additional intentions of the Future of Nursing Campaign for Action include; influencing stakeholders in the nursing education sector to create additional academic institutions that provide doctorate degrees for nurses as this will help to double the number of nurses who graduate with doctoral degrees in the next three years.

Other intentions include; implement nursing education programs that will promote lifelong learning for the nurse, and to take responsibility of training nurses to become change leaders who can successfully implement reforms in the ever-changing health care environment (The Institute of Medicine, 2002).

Most importantly, by creating the campaign for action, the institute of medicine believes that the campaign would influence the National Health Care Workforce Commission to build infrastructure and provide necessary technology that future nurses can use to collect and analyze health care data (Campaign for Action, 2013; & The Institute of Medicine, 2010).

The rationale of state-based action coalitions

The main role of the state-based action coalitions is to ensure that various states in the United States enact laws that will facilitate the realization of the recommendations documented in the IOM report entitled, “Future of Nursing: Leading Change, Advancing Health”(AARP, 2011). Additionally, these state-based coalitions work hard to ensure that the IOM recommendations are being implemented at regional and local level.

First, these coalitions work hard to make sure that possible barriers to nursing practice are removed in both educational and healthcare organizations (AARP, 2011). Second, action coalitions based in various states of the United States ensure that relevant programs that expand learning and training opportunities for nurses are implemented. Third, state-based action coalitions ensure that various states have programs in place to support nurse residency (Goode and Williams, 2004).

The fourth role of state-based action coalitions is to make sure that their respective states have enough academic institutions that offer baccalaureate and doctorate degrees for nurses. Additional functions of the state-based action coalitions are to ensure that states of the United States implement; programs that promote lifelong learning for nurses, programs that prepare nurses to become change leaders, and infrastructure that allow nurses to collect and analyze health care related data that can be used to improve nursing practice in future (Campaign for Action, 2013; & The Institute of Medicine, 2010).

Action Coalition Initiatives

An example of a state-based action coalition is the Alaska Action Coalition. This coalition comprises of individuals and organizations with a common goal of transforming the health care system of Alaska State. In Alaska, quite some nurse champion organizations work together in the Alaska Action Coalition to place the state forward as one of those regions that are committed to implementing the Future of Nursing recommendations (Alaska Action Coalition).

One of the initiatives spearheaded by Alaska Action Coalition is supporting the full realignment of the Advanced Practice Registered Nurse courses with recommendation documented by the Institute of Medicine. This initiative significantly contributed to the advancement of the nursing profession in the sense that it promotes the production of nurse graduates who are competent enough to deliver care that meets the need of the current population.

The other initiative that is being spearheaded by Alaska Action Coalition is the implementation of programs that educate nurses to lead change in their organizations. This initiative greatly contributes to the advancement of the nursing profession in the sense that it contributed to the preparation of nurses who can effectively lead change (Campaign for Action, 2013).

The main barrier to advancement that is commonly faced by action coalitions in Alaska is limited finances to facilitate all the procedures required to ensure full compliance with existing regulations. Nursing advocates in Alaska can overcome this barrier by asking the state to review and try to reduce the financial expenses incurred by coalitions that are committed to implementing the Future of Nursing recommendations (Alaska Action Coalition).

References

AARP. (2011). Future of Nursing: Campaign for Action. Washington, DC: AARP Public Policy Institute

Alaska Action Coalition. Retrieved from https;//campaignforction.org/state/Alaska/

Altman, S., Butler, A. & Shern, L. (2015). Assessing progress on the Institute of Medicine report “The future of nursing.” Washington, DC: The National Academies for Sciences.

AnneMarie, P. (2016). The future of nursing: Leading change, advancing health…how are we doing? Nursing Critical Care, 11(3):4.

Campaign for Action. (2013). The future of nursing IOM report. Retrieved from https://www,campaignforaction.org

Goode, C. J. & Williams, C. A. (2004). Post-baccalaureate nurse residency program. Journal of Nursing Administration, 34(2): 71-77.

The Institute of Medicine. (2002). The future of the public’s health in the 21st century. Washington, DC: The National Academies Press

The Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

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Evolving Nursing Practice and Patient Care Delivery Models

“This presentation will begin by welcoming remarks that are extended to everyone who is present in this session. The topic that will be explored in this presentation is, ‘The anticipated growth and changes in nursing practice over the coming years.”If you take your time to compare the health care delivery in traditional health care organizations with the one used in contemporary organizations, you will learn that modern approaches to care are better than the ones that were used in the past.

It is also important to recognize that the mode of care delivery in future will be far much better than it is today. Rapid health care reforms are currently taking place to enable nurses to provide care that meets the needs of the ever-changing population. As nurses, we must be conversant with the changes and growth that are expected to take place in nursing practice in the near future for us to be in a position to contribute positively to the reorganization of the United States’ health care delivery system (Salmond and Echevarria, 2017).

For instance, it is anticipated that the number of nurses who will be required to deliver care in acute care hospitals will decrease while the number of those nurses who will be required to serve in the community will increase. Furthermore, it is expected that future health care organizations will reward nurses based on the quality of care they deliver, a system known as Accountable Care Organizations (Song, 2014).

In order to effectively meet the health care needs of the future community, nurses will be required to posses the right knowledge and skills to enable them to deliver quality care in accountable care organizations. Nurses are required to prepare adequately to deliver care both in hospital-based and community-based settings. The best way through which nurses can prepare for the future is by obtaining the highest level of academic qualifications from relevant academic institutions which have been accredited to provide nursing education in the United States. This way, they will adequately be equipped to deliver quality care that matches the trends and issues in United States healthcare system (Shortell, Colla, and Ramsay, 2017).

Today’s society needs clinical advice on how it can effectively manage new infections that have a negative impact on health. As Kovner and Walani (2010) point out, the increasing need for health education among the current and future populations greatly influences the creation of nurse-managed clinics in the community. Advanced practice nurses will be assigned clinical roles in nurse-managed clinics from where they will be required to educate community members on how they can effectively manage infections which are affecting their health.

Since more jobs will be available in nurse-managed clinics in the community, nurses must be prepared enough to work as community nurses and to teach clients on how they can prevent and manage infections (Kovner and Walani, 2010).

We should also recognize that the rates of deaths that are associated with chronic infections are on the rise in today’s society. It is anticipated that incidences of chronic infections such as cancer and diabetes will continue to rise in the near future due to the anticipated changes in lifestyle and because very few people are adequately informed of how they can effectively manage their health problems outside the hospital setting (Suter, Oelke and Armitage, 2009).

Therefore, advanced practice nurses will be expected to possess the right knowledge and skills to provide a continuum of care to patients who need clinical guidance after they will have been discharged from the hospital. In this manner, nurses will play a big role in reducing deaths that occur from ineffectively managed chronic infections (Haggerty, Reid and McKendry, 2003).

It is anticipated that the future community will be in need of more personalized care than the current society. As Scribner and Kehoe (2017) explain, it is expected that patient-centered medical homes will be used more than hospitals in the next few years. From these medical homes, nurses will be deployed to offer constant personalized care as well as medical consultations to the community. For this reason, nurses will only be able to retain their job positions if they are competent enough to work in patient-centered medical homes and in hospital settings (Reynolds, Klink and Davis, 2015).

Based on the anticipated growth and changes in nursing practice over the coming years, I urge all of you to seek for training on how to deliver quality care in areas related to Accountable care organizations, nurse-managed clinics, continuum of care, and patient-centered medical homes in order to prepare adequately to fit in the job market in future. Thank you.”

Nurse One supports the idea that nursing practice is expected to change and grow in the next few years, and that nurses are required to prepare adequately to deliver health care that will meet the needs of the future generation. According to Nurse One, the rate of deaths that occur as a result of chronic infections is on the rise in today’s society. It is reported everywhere in the media that the number of people who die of cancer, diabetes, and high blood pressure continue to increase each day as a result of poor health management practices.

The main reason why the number of deaths associated with chronic infections continues to rise is due to lack of knowledge on how these conditions can be managed once a patient leaves the hospital. For instance, some patients may suffer severe health consequence associated with either drug side effects or non-adherence to drugs. In order to reduce deaths that are associated with chronic health problems from affecting the community in future, nurses will be expected to be competent enough to deliver continuum care to clients in the community.

Additionally, the number of nurses who will be expected to provide health care services in nurse-managed homes will be greater than that required to serve in hospitals. In Nurse One’s opinions, nursing practice is expected to grow and change in the next few years and only competent nurses will be able to find jobs. The views of this nurse are consistent with ideas presented by Haggerty Reid and McKendry (2003) and by Suter, Oelke, and Armitage (2009) concerning the need for nurses to be prepared to deliver continuum care in the community over the coming years.

References

Haggerty, J. L., Reid, R. & McKendry, R. (2003). Continuity of care: A multidisciplinary review. The British Medical Journal, 327(7425): 1219-1221.

Kovner, C. & Walani, S. (2010). Nurse-managed health centers. Nursing Research Network: Robert Wood Johnson Foundation.

Reynolds, P., Klink, K. & Davis, M. (2015). The patient-centered medical home: Preparation of the workforce, more questions than answers. Journal of General Internal Medicine, 30(7): 1013-1017.

Salmond, S. & Echevarria, M. (2017). Health care transformation and changing roles for nursing. Orthopedic Nursing, 36(1): 12-25.

Scribner, M. N. & Kehoe, K. (2017). Establishing successful patient-centered medical homes in rural Hawaii: Three strategies to consider. Hawaii Journal of Medicine & Public Health, 76(3): 18-23.

Shortell, S., Colla, C. & Ramsay, P. (2017). Accountable care organizations: The national landscape. Journal of Health Politics, Policy, and Law, 40 (4): 647-668.

Song, Z. (2014). Accountable care organizations in the US health care system. Journal of Clinical Outcomes Management: JCOM, 21(8):364-371.

Suter, E., Oelke, N. & Armitage, G. (2009). Key principles for successful health systems integration. Healthcare Quarterly, 13(1): 16-23.

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