Leadership Discussion 6
Geneva Guadalupe is a new manager on the busiest medical and surgical unit in a tertiary hospital. There are 39 beds on 9 Tower, which has a high volume of diabetes patients. She is excited to improve the quality and outcomes on this unit. During her interview, she learned that under the previous leadership the quality was deteriorating, as reflected in Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) scores and absenteeism and turnover rates. It was costing the unit between $42,000 to $65,000 to replace a nurse.
While making rounds, Nurse Guadalupe observed complaints about missed nursing care from all shifts and decided to make staff accountable for ensuring that patient care is completed. She asked a CNL to monitor the types of patient care activities that were being omitted. After 1 week, the CNL stated that it was difficult to make that determination because everyone had a different opinion on which interventions were being omitted. Additionally, staffing was an issue. The manager’s initial response was, “What’s wrong with staffing? Why would you blame staffing for omitting patient care?”
In your own words:
1. What is your first approach to showing a link between missed nursing care and staffing?
2. What questions could you pose to frontline nurses to understand how their staffing experience related to missed care?
3. Whom will you engage institutionally to understand the issue fully? Why them?
4. Which data elements may be required to build a case for staffing and missed nursing care?
5. What ideas would you propose to the administration to reverse the financial effects and improve HCHAPS scores?
Case study
Case Study Scenario Paul had been in the psychiatric unit for two days. He has a history of anger since his traumatic brain injury (TBI) a few years ago. On the morning of Paul’s second day there, a new client was admitted. Her name was Gwen, and he heard the nurse say that she had psychosis with delusions. As soon as she saw Paul standing near her in the hallway, Gwen stared at him and began to yell. Paul felt instantly on edge. He tried to remain calm but could not understand why she had specifically targeted him. The staff calmed Gwen and distracted her attention. Paul voluntarily went to his room for some quiet time. Throughout the day every time Gwen saw Paul, she would say something hurtful. The nurse said, “She is confused, don’t let her upset you.” Paul tried not to let her comments bother him, but Gwen would not stop. He tried avoiding her, but she seemed to find him and would interrupt whatever he was doing to say rude comments. Even though the words didn’t always make sense, her intent was obvious. Paul became more irritated until he felt he might say something he shouldn’t. His goal was to be discharged soon, and he realized that out-of-control behavior would keep him in the hospital longer. He tried to ignore Gwen even when she kept insisting, he answered her questions and comments. 1. Which phase of the aggression cycle is Paul in? 2. What are the signs, symptoms, and behaviors of this cycle? 3. Explain the nursing interventions for a client in this phase? Paul started answering Gwen’s accusations. He tried telling her to stop. He tried reasoning with her, but that made no difference. He paced in the hallway, hitting his fist on his hand. He was breathing fast and perspiring. The nurse asked Paul what was going on. She said, “You seem tense, please tell me about it.” Paul replied, “If that woman doesn’t stop being rude, I’m going to slug her!” 4. Which phase of aggression is Paul in? 5. What are the signs, symptoms, and behaviors of this cycle? 6. Explain the nursing interventions for a client in this phase? That evening Paul felt weary with enduring Gwen’s taunts. She had threatened to “beat him up” which he didn’t think she could actually do. He was sitting at a table in the day room reading when Gwen came into the room. She went directly to him and made offensive comments. When he ignored her and wouldn’t look up, Gwen shoved him, hard. Paul jumped to a standing position from his chair. “Knock it off,” he said. Gwen punched him in the chest and then Paul lost control. He and Gwen were on the floor Mental Health Case Study #4 – Instructor’s version / answer sheet fighting. Other peers and staff pulled them apart. Paul felt so angry. He yelled at Gwen and threatened to kill her. He kept trying to get away from staff to attack her again. 7. Which phase of the aggression cycle in Paul in? 8. What are the signs, symptoms, and behaviors of this cycle? 9. Explain the nursing interventions for a client in this phase? Paul was put in the seclusion room with four-point restraints. Staff forced him to receive an injection. The nurse said, “This will help you calm down.” As the medication took effect, Paul did feel calmer. His tense muscles relaxed and he started to fall asleep. He no longer wanted to kill Gwen. 10. Which phase of the aggression cycle in Paul in? 11. What are the signs, symptoms, and behaviors of this cycle? 12. Explain the nursing interventions for a client in this phase? The nurse asked Paul if he felt like he could get out of the restraints and go to his room to rest on his bed. He nodded and went with staff to lie down. He was worrying about how this incident was going to stop him from getting discharged soon. He needed to get home so he could return to work as soon as possible. He apologized to the nurse; he realized he was crying. He thought maybe it was due to all the stress. He was embarrassed and felt so tired. He just stayed in his room the rest of the night. 13. Which phase of the aggression cycle is Paul in? 14. What are the signs, symptoms, and behaviors of this cycle? 15. Explain the nursing interventions for a client in this phase? Paul’s Medications The injection the RN gave to calm Paul down contained haloperidol. 16. What type of medication is this and which drug class? What are the side effects of this medication? What are the names of some other meds in this drug class? The new medication Paul’s psychiatrist in the hospital prescribed and started him on is risperidone. 17. What type of medication is this and which drug class? What are the side effects of this medication? What are the names of some other meds in this drug class? Answer the following from “Critical Thinking Questions” on p. 183 18. Many community-based residential programs will not admit a client with a recent history of aggression. Is this fair to the client? What factors should influence such decisions? 19. If an aggressive client injures another client or a staff person, should criminal charges be filed against the client? Why or why not? 20. Many consumer and family support groups support the total abolition of restraints and seclusion. Is that realistic? Without restraint or seclusion options, how should aggressive/assaultive clients be managed?
Leadership Discussion 5 Response
PLEASE RESPOND TO THE FOLLOWING POST OF A CLASSMATE IN 100 WORDS, Remember that your posts must be substantive and contribute to the dialogue that is taking place and Response posts must offer at least one new piece of information or insight.
Please also include references!
According to Edmonson & Zelonka, bullying in nursing begins in nursing schools, where nursing students may encounter aggressive behavior during their clinical rotations (2019). One of the recent studies showed that 77% of nursing students were bullied over a year. Another study revealed that 59% of RNs leave their first jobs because of lateral violence and aggression of their colleagues. Bullying can range from verbal abuse to physical threatening. Often bullying can be easy to recognize. This may include unnecessary remarks, verbal humiliation of a person, excessive control. However, sometimes it can be difficult to recognize bullying. For example, giving RN unfair workload with “more difficult” patients or gossiping about him/her. Bullying can occur based on age and experience differences. For example, older RNs can bully novice RNs because they lack practical knowledge. Younger RNs can bully older RNs for some physical limitations. Bullying can also be based on gender. For example, male RNs can be more dominant and bully female RNs. Bullying can also be based on the personal trauma of the bully, which is projected onto his/her colleagues. I’ve been lucky so far with my coworkers. Everybody has been helpful from day one when I started working as RN. I always have support from my coworkers and can rely on them in difficult times. The hospital where I work promotes this type of relationship between colleagues. In case if I was bullied by someone at my workplace, I would get manager involved right away. I think it would be the best way of self-protection.
References
Edmonson, C., & Zelonka, C. (2019). Our Own Worst Enemies: The Nurse Bullying Epidemic. Nursing administration quarterly, 43(3), 274–279. https://doi.org/10.1097/NAQ.0000000000000353Links to an external site
Nursing
,"- https://docs.google.com/document/d/1vSwavAxCHRfKlAAcLV9-_Ot93N2dNPQW/edit
Read the link above to see the grading Rubric and the link below is an example of how i would want the work done.
https://docs.google.com/document/d/12UKuuk4zRBTEJpXHVZEg3vaQbLD5xUEa/edit#bookmark=id.gjdgxs
Open the second link to see the example how exactly it should be done. Use the topic of Drug toxicity or any related to health to teach the patient. APA format, 3 to 4 page excluding work cited page. use any other two source and use this one in the bracket to make a total of 3 source(
Harding, M. M., (2020). Lewis's medical-surgical nursing: Assessment and management of clinical problems (11th ed.). Elsevier.) this is the text book link to the source in bracket to use below. https://online.vitalsource.com/reader/books/9780323792332/epubcfi/6/26[%3Bvnd.vst.idref%3Dsection_sn1]!/4/8[outline]/4/12/2/1:51[r%5E%2C%20%2CQue]
Nursing LEADERSHIP ASSIGNMENT
Students will choose from one of the predetermined topics for this assignment. Using the literature, national/international organizations, and .org/.gov websites, students will draft the WHITE ASSIGNMENT including a problem statement, proposed solution, and a relevant Change Model to assist with implementation. The problem should be explained in detail using the literature. The proposed solution should also be described in detail as a rationale for implementation. Given that change can be difficult, students will then explain the change model they have selected from the list and provide information on how it will facilitate the implementation of the proposed solution. Assignment should be APA formatted & 5-7 pages long, excluding title and references. Turnitin must be under 35% compatibility.
Grading Rubric for Leadership White Paper
Nursing Problem – explain the scope of the problem broadly (15), use literature to provide relevant statistics, facts, and overall impact of the issue (15).
30 points
Proposed Solution – explain the proposed solution in detail (20). Is the proposed solution evidence-based? Provide a few examples from the literature detailing how the solution has been successfully integrated (20).
40 points
Change Model – explain the proposed change model in detail (10), then tell the reader how the model will be used to assist with buy-in and implementation (10).
20 points
APA formatting, grammar, punctuation, flow
Community health resource flyer
1. Community Resource Survey Informational Flyer
You will conduct a survey of resources within your Fayetteville community, cumberland county, NC 28314 etc. that offer assistance to elderly adults, particularly those in underserved populations, in ONE of the following areas listed below. Your task is to create a one-page informational flyer about your selected topic.
Healthcare services, obtaining prescription drugs, medical rehabilitation
2. Guidelines/Instructions: PLEASE READ CAREFULLY. POINTS WILL BE DEDUCTED FOR FAILURE TO FOLLOW INSTRUCTIONS.
Community Resource Survey Informational Flyer
Student Learning Outcomes (SLOs) for this assignment.
1. Examine political, legislative, and policy issues affecting the health of older adults.
2. Collaborate with clients and other health care professionals in the care of the older
person in the home, acute care, long-term care, or alternate community settings.
3. Investigate barriers to health promotion and health maintenance strategies for older
adults.
Flyer Guidelines
You are to create a 1-page informational flyer that can be displayed or handed out as a
resource for older adults in your community, particularly those that may live in under-resourced
or under-served areas. You should limit your survey to the community in which YOU live—
and that could be a small town, your county, or a specific community within a town or county
(Example: ""Steel Creek"" area of Charlotte), etc.
Your flyer should focus on ONE of the following areas listed below.
Healthcare services, obtaining prescription drugs, medical rehabilitation
Transportation services, shopping/errands
Groceries/nutrition/food security
Companion care, adult daycare
Housing/Assisted living and/or nursing home facilities/ memory care
Recreation/social activities/Educational activities for the elderly
Spiritual/faith communities & services geared toward the elderly community
Flyer is to be creative, colorful, and eye catching.
Rubric for grading is included in canvas.
The flyer should include the following:
1. Create a slogan for your informational campaign. Ex. ""Step Up for Seniors in Steele
Creek - Companion Care Resources"" (preferably, something a lot more creative than
that!)
2. What is the exact location (street address) & contact information of the services/facility?
3. What populations are served?
4. Specifically, what services are available to the seniors?
5. Is there a cost associated with the service(s)? If so, what type of payment is accepted?
6. Who is the owner/sponsor of the business/service?
7. Is the service run by volunteers or paid employees?
8. Is the service associated with any governmental agency or program? If so, identify the
agency.
9. Any references used should be in APA format (7th edition) at the bottom of the flyer.
10. Please include your name on the flyer itself.
3. NSG 400 community Resource Flyer Rubric
Leadership Discussion 5 Response 2
PLEASE RESPOND TO THE FOLLOWING POST OF A CLASSMATE IN 100 WORDS, Remember that your posts must be substantive and contribute to the dialogue that is taking place and Response posts must offer at least one new piece of information or insight.
Please also include references!
Yes, bullying can be present in nursing, as it can be in any profession. Bullying in nursing might include behaviors such as verbal abuse, intimidation, undermining, or humiliation. It can be perpetrated by colleagues, superiors, or even patients and their families. Bullying can create a hostile work environment and negatively impact the quality of patient care. According to a systematic review collects and analyzes recent evidence from previous workplace violence studies in primary healthcare settings. The study found that the prevalence of violence ranged from 45.6% to 90%, with verbal abuse being the most commonly reported form of violence. (Hanizah, Y. 2023)
The worst workplace violence came from a doctor. She screamed at me so loud I cried and really wanted to quit my job. According to a study it found that workplace violence was positively correlated with turnover intention and job burnout, and negatively associated with job. (Duan, X.,Ni,2019)
There are several strategies that nurses, and healthcare organizations can implement to prevent bullying and workplace violence. Providing training on recognizing and managing bullying and violence can empower nurses to address these issues when they arise. Having clear, well-communicated policies against bullying and violence can help create a culture of respect. Establishing safe and confidential ways for nurses to report incidents can ensure that issues are addressed promptly and appropriately. Leaders who model respectful behavior and take reports of bullying and violence seriously can help foster a positive work environment.
Encouraging supportive relationships among colleagues can help nurses feel more comfortable addressing issues of bullying or violence. Remember, it’s important for everyone in the healthcare environment to work together to create a safe and respectful workplace.
Hanizah, Y 2023Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review Hum Resource Health 21, 82
Duan, X., Ni, X., Shi, L. et al. 2019 the impact of workplace violence on job satisfaction, job burnout, and turnover intention: the mediating role of social support. Health Qual Life Outcomes 17, 93 (2019). https://doi.org/10.1186/s12955-019-1164-3Links to an external site
Evidence based practice
Evidence based practice - article appraisal,"Conduct a literature search on your selected topic. Conduct the search using an external source [use the library databases] vs. internal source [use the hospital's Policy & Procedure Policies]. Select appropriate articles for critique from articles with research conducted in the USA and non-USA countries (the global perspective).
Include at least four (4) different articles [1 systematic review, 1 quantitative, 1 literature review, and 1 Quality Improvement report]. Use only current literature published within the past 5 years (2019 – 2024) with evidence to answer the PICO question.
PICOT question: In adult patients, how does ambulation within the first 12 hours after an operation, compare to delaying ambulation beyond 12 hours post-op, affect patient outcomes within 30 days after surgery?
The purpose of EBP Part 2 is to begin (rather to continue) your search for research evidence to answer your PICO question from EBP Part 1. To find the best evidence available, post your selected articles early to ensure inclusion/exclusion criteria 1) no duplicated articles; 2) each Team member must submit (4) different articles - 1 systematic review, 1 quantitative, 1 literature review, and 1 QI report; 3) current literature published in the past 5 years with evidence to answer the PICO; and 4) out of the 4 quantitative research articles, at least one study was conducted in the United States and at least one study was conducted internationally.
Appraise the level & quality of each article selected using Research Evidence Appraisal Tool and Hierarchy of Evidence Guide. (documents attached)
Follow the prompts; answer the questions; complete one sheet for each of the four (4) different articles.
**Fill out Research Evidence Appraisal Tool (DOCUMENT ATTACHED)
**Create a Reference page using APA 7th edition formatting
The purpose of this step is to begin critiquing the research evidence to answer your PICO question from EBP Part 1. To find the best evidence available, post your selected articles early to ensure inclusion/exclusion criteria 1) no duplicated articles; 2) submit (4) different articles - 1 systematic review, 1 quantitative, 1 literature review, and 1 QI report; 3) current literature published in the past 5 years with evidence to answer the PICO; and 4) out of the 4 quantitative research articles, at least one study was conducted in the USA and at least one study was conducted in a non-USA country.
Individual Evidence Summary Tool (DOCUMENT ATTACHED) ***available alternative summary table*** The alternative table is a word doc with the same headings as the Johns Hopkins Table.
Each person will provide the information for four (4) articles they selected.
The table headers indicate the important elements of each article that will contribute to the synthesis. The data on each cell should be complete enough that the other team members are able to gather all relevant information related to the evidence without having to go back to each article again.",######
Peer Review,"Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights
Philo discussion 6
Examine the science and art of theory development and evaluation.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources
QSEN Competency & Professional Practice
QSEN stands for Quality and Safety Education for Nurses and it's been around a while. Having current training in quality and safety in nursing is critical to your competence as an RN.
Apply what you learned to an excellent case in the Lewis Blackman Story.
View the videos below:
YouTube: QSEN Institute: Lewis Black Story Parts 1, 2, 4 and 5. (Video links below)
https://youtu.be/WElE_hRucpo?si=VY9f7ArfiMsW5YoE
https://youtu.be/OofpjxReEgM?si=EMHKhGvSKAiEx8cy
https://youtu.be/Gpg7FyWcXSM?si=jSabN1_Jg1GT0Gvf
https://youtu.be/QKk96qoN5Qs?si=6ahqYBZ8Td2crQ4t
Post must be a minimum of 200-400 words.
1. What did you learn about patient safety and professional nursing practice from completing the modules and watching the Lewis Blackman Story?
2. How do you see yourself applying the QSEN knowledge in your own professional practice?
3. What experience do you have from practicing as an RN in preventing harm and keeping your patients safe by going the extra mile at work?
4. What safety measures do you use in your personal practice to prevent errors?
Approved Resources to Use in Writing Discussion Posts:
The course textbook
Grove, S., Gray, J. (2019). Understanding Nursing Research, 7th Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9780323532051
any published peer-reviewed full-text article from the CINAHL database
.org, or .gov website with published credible information.
The use of AI is not permitted in this DQ.
All sources must be published within the last 5 years.
The initial DQ response must include the course textbook
