This is a 2 part question and the guidelines are attached for each part 7-1 Final Project Part One Submission: Critical Analysis Portfolio AssignmentSubmit your final portfolio—an analysis of an iss

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This is a 2 part question and the guidelines are attached for each part

  • 7-1 Final Project Part One Submission: Critical Analysis Portfolio Assignment

Submit your final portfolio—an analysis of an issue or event in diversity through the four general education lenses: history, humanities, social sciences, and natural and applied sciences.

Note: Be sure to incorporate instructor feedback from your final project milestones into this final submission, particularly Milestones One, Two, and Four.

To complete this assignment, review the Final Project Part One Guidelines and Rubric PDF document.

  • 7-2 Final Project Part Two Submission: Multimedia Presentation Assignment

Submit your final multimedia presentation. In this presentation, you’ve had a chance to reflect on what you have learned about your issue or event, yourself, and diversity through analyzing its impact on society through the four general education lenses. You will also be able to apply your communication skills and integrate multimedia elements to communicate your message to an audience.

Note: Be sure to incorporate instructor feedback from your final project milestones, particularly Milestone Three (the presentation draft), into this final submission.

To complete this assignment, review the Final Project Part Two Guidelines and Rubric

You Have Just Taken Over An Organization Which Your Senior Manager

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You  have just taken over an organization which your senior manager has  categorized as having low morale, high turnover, poor quality and  service results, low productivity, negative attitudes both from  employees and managers, high levels of resistance to change, poor  communications, high levels of distrust, low levels of teamwork, no  loyalty, and an I don’t care attitude permeates the organization.

Your manager wants your plan on what you are going to do to turn the culture around.   Sequence your steps.

Instructions: 

As a new manager what are the specific Top 10 actions you would take to improve a negative organizational culture? 

Sequence your action steps.  What would you do 1st, 2nd, 3rd, etc.

) Discuss the differences between the process of sensation and the process of perception. Then provide assertions for how the perceptual process has a certain degree of subjectivity to it. Provide empirical evidence to support your assertions.

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) Discuss the differences between the process of sensation and the process of perception. Then provide assertions for how the perceptual process has a certain degree of subjectivity to it. Provide empirical evidence to support your assertions.

2) After you have studied the material covering psychopharmacology, post your views concerning drug legalization of psychoactive substances in the United States. For example, would you legalize certain psychoactive drugs or all types? Elaborate on the possible consequences of your decisions.

Compare two leadership theories. Provide an overview of each and discuss the strengths and weakness in relation to nursing practice.

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Compare two leadership theories. Provide an overview of each and discuss the strengths and weakness in relation to nursing practice.








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Leadership Development in the Deaf Community

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Coaching situation

Deaf community Leadership development



Scenario topic

Community Communication Access



Topic Focal point

Interpreter Shortage



Demographics

Various Deaf individuals with little or no prior leadership expertise



Key findings

Deaf and Hard of Hearing (D/HH) leaders tend to lack a full understanding of leadership or else have a limited scope of leadership, which has continuously led to unfulfilled community objectives or else inaction by community leadership groups. This “failure of leadership” has led to the reliance on those with little or no understanding to dedicate how policy is formed as it relates to the D/HH Community.



Background

Americans with Disabilities Act (ADA) was signed into law in 1990 and amended in 2008. ADA is a civil rights law aimed at helping people with disabilities fair opportunities to live prosperous and fulfilling lives as citizens of the United States. ADA includes a section covering effective communication to help the D/HH in their communication needs related to employment, medical, and various other services.  Two of the most often used communication auxiliaries used by those with hearing loss are Communication Access Real-time Translation (CART) and Sign Language Interpreters. On the street, these resources are critical as they allow D/HH people to become inclusive into the society in which they reside. While CART and interpreters are plentiful in the state of Nebraska, the supply has not been able to keep pace with the demand. D/HH leaders have long left the responsibility of advocating for these resources to state and federal organizations. While policies have been helpful, the actual work of implementing those state and federal regulations and policies starts at the street level. When D/HH leaders chose to remain inactive in advocating for the needs of their communities, they allow those who are illiterate to influence policymaking that impacts their lives and communication needs despite the protections forded to the D/HH community by ADA.



Formulation

There are various organizations at the street level that have many excellent policy ideas that never come to fruition due to community leaders’ inability to create and carry through with action plans.



Interventions and Plans

Provide group leadership development through coaching methodology (ACHIEVE Model) and team rapport to educate street-level leaders that they may come to understand how to use their skills and talents to be effective leaders.

The objective being to inspire street-level leaders to assemble a harmonious and creative team to spur action at the street-level.



Reason for Intervention

Intervention in D/HH leadership issues at the street-level is long overdue. Many D/HH people aspire to become leaders in the community, but they do not know how to lead, build sustaining relationships, or establish transforming policies. When they finally figure out how to lead the community, their time has come and the lessons learned are not being passed to the next generation of leaders. This cycle needs to stop; coaching can help leaders realize their potential and how to apply it; thus starting a new cycle of passing the expertise to up and coming leaders.



Applying ACHIEVE Coaching Model

The Deaf and Hard of Hearing community is a unique association of different people from a diversity of backgrounds unified by a single thread. The thread which unites the D/HH community is hearing loss. Many individuals may not subscribe to the same ideals, but they are generally supportive of their peers with hearing loss. D/HH people share a common thread, which is having the inability to communicate effectively without some auxiliary aid. The auxiliary aids can range from hearing aids to sign language interpreters.

In order to coach the D/HH leaders, one must first understand the culture and community background. As Hamill and Stein (2011) point out, many people in the D/HH community have historically been marginalized, received inadequate education, and experienced unjust treatment. These experiences should be enough to explain the community’s resistance to receiving support from their hearing peers. Despite these dire life-impacting ordeals, many D/HH community members have been resilient and overcome many barriers to succeed in life.  Hamill and Stein (2011) also indicate that D/HH members tend to identify themselves as members of an “ethnolinguistic minority” instead of “disabled” (Note – Capitol D identifies cultural identity and lowercase d references hearing loss (Hamill and Stein 2011)). While this is positive and empowering, D/HH community members still must “negotiate their views and values within the larger dominant social narrative” (Hamill and Stein 2011). Through group think, many innovative and brilliant D/HH individuals have abounded transformative ideas, which could lead the community to a better status among the dominant society.  Thus traditional means of leadership, which have been ineffective, dominate community organizations at the street levels. It is critical to understand all this as a coach should one wish to aid D/HH leadership teams in their goal to help the D/HH community achieve better status and standing among the dominant social structure.

This author’s empirical observation of D/HH leaders has been that such individuals seek change and have good intentions, but do not carry through on their intentions. Action is only taken when a/the situation(s) attain a breaking point. In other words, D/HH leadership action is comparable to a fire department. Meaning the community leaders are dormant when it comes to advocating for the needs of their fellow D/HH citizens until a situation is at a breaking point. When things reach the “breaking point,” a situation has surpassed the preparation phase of the crisis life cycle and jumped right to the emergency phase. At this point, leadership teams scramble to contain the situation and seek support at the national level to manage a street-level crisis.

In the field of organizational management, research shows that the crisis life cycle has three main parts which are preparation phase, emergency phase, and adaptive phase which can be broken down further as depicted in the following diagram:

(Chandler, 2010)

The author’s empirical observation has detected that street-level D/HH leaders tend to bypass the preparation phase (which includes the warning and risk assessment segments of the phase) and jump straight to the response segment of a crisis. This is similar to a fire department; they remain dormant until they receive a phone for help. However, unlike a fire department, the D/HH community never reaches the recovery segment of the adaptive phase. Leaders tend to combat the crisis (response segment of Emergency phase), get it under control with external assistance (management segment of Emergency phase) and make sure the situation has little or no chance of returning (resolution segment of emergency phase) then the cycle ends. This is an ineffective way to handle a crisis. D/HH leaders lack the awareness and understanding of how to avoid getting to the emergency phase and how to recover from the crisis so that it is a win-win situation for both the organization they represent and the community they support. Kinley and Jonsen (2012) noted that:

it is entirely natural for decision-making groups, whatever their motivations and guidelines, […] to suppress information flow, have more extreme attitudes, make more extreme judgments, be less flexible in adapting their approach to changing circumstances and – yet amazingly – have greater confidence in their decisions

this statement is very true in the D/HH community. The authors’ observations have detected that such attitudes are the results of “Groupthink.” In so many words, groupthink is the act of making collective decisions “together,” thus discouraging individuality and creative thinking, which could spur transformation. In the D/HH community, leadership development has revolved around tradition from past leaders who were successful during their representative era’s. Kinley and Jonsen (2012) also state that groupthink tends to lead to bad decisions as opposed to individual leader decisions. They also recommend the use of coaching as one solution to avoiding group think (Kinley and Jonsen, 2012, pp 714).

To apply a coaching model in a team coaching situation, a coach should first get to know the team and build rapport using  Bruce Tuckman’s Group Development model known as Forming-Storming-Norming-Performing for the team initialization then follow up with Coaching methodology.

In the case of the D/HH community ACHIEVE was chosen, the seven stages are as follow:


  • A

    ssess the current situation

  • C

    reative brainstorming of alternatives

  • H

    one goals

  • I

    nitiate options

  • E

    valuate options

  • V

    alid action programme design

  • E

    ncourage momentum

(Dembkowski, Eldridge, and Hunter 2006)

The ACHIEVE model, which gets its roots from the GROW model (Ben-Hur, Kinley, and Jonsen 2012); seems to be the most effective choice to coach the D/HH community toward its leadership development goals and help them break from past leadership traditions which have been ineffective. The first step of Assessing the current situation will force leaders to recognize that they are following an ineffective leadership system that stymies growth. In the process the leaders can also be made aware of how things stand in terms of the goals and issues they seek to tackle (e.g. the interpreter shortage issue). Each step after that will provide a different focus on both leadership development needs and community goal pursuing. The coach will take into account all the variables related to culture and history to guide leaders while following the steps of the ACHIEVE model. All the while, the coach will document how the team progresses through Tuckman’s Group Development model and eliminate group think habits such as:

  • suppress dissent
  • focus discussion on things that they already agree about rather than things they disagree about
  • have more extreme attitudes and judgments on a wide array of issues and decisions than the individuals within the group
  • have greater confidence in the correctness of their decisions and attitudes than individuals
  • lead individuals to publicly endorse decisions and attitudes that they view as normal for the group, despite privately holding reservations

(Ben-Hur, Kinley, and Jonsen 2012)

This coaching process can be challenging as it relies on how the group progresses from the forming stage to the norming stage of Tuckman’s Group Development Model.  Progress through the seven steps of the ACHIEVE model may prove to be easier once the group reaches the norming stage in the team development life cycle.

References

  • Ben-Hur, Shlomo, Nikolas Kinley, and Karsten Jonsen. 2012. “Coaching Executive Teams to Reach Better Decisions.”

    The Journal of Management Development; Bradford

    31(7): 711–23.
  • Dembkowski, Sabine, Fiona Eldridge, and Ian Hunter. 2006.

    The Seven Steps of Effective Executive Coaching

    . London: Thorogood.

    https://viewer.books24x7.com/assetviewer.aspx?bookid=14754&chunkid=1#

    (October 6, 2019).
  • Hamill, Alexis C., and Catherine H. Stein. 2011. “Culture and Empowerment in the Deaf Community: An Analysis of Internet Weblogs.”

    Journal of Community & Applied Social Psychology

    21(5): 388–406.
  • Hastings, Ross, and William Pennington. 2019. “Team Coaching: A Thematic Analysis of Methods Used by External Coaches in a Work Domain.”

    International Journal of Evidence Based Coaching & Mentoring

    17(2): 174–88.

Cholecystitis; laprascopic cholecystectomy

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Introduction

This assignment is based on case study one. Case study one is about a 37 year old woman called Sylvia who had been experiencing abdominal pain, nausea and vomiting. After going to the doctors; a number of tests were carried out. Sylvia was diagnosed to having cholecystitis. Cholecystitis is when the gallbladder wall becomes inflamed and the lining of the abdomen which is near to the gallbladder (University of Varginia Health system, 2008). Sylvia had to go for a laprascopic cholecystectomy because of her cholecystitis. A Laparoscopic cholecystectomy is when the gall bladder is removed keyhole, through “a small incision which is made at the naval and a thin tube carrying the video camera is inserted” (Sieglbaum. 2008). There will be a screen in theatre where the surgeon can look and see what he is doing. The surgeon also inflates the abdomen with carbon dioxide to allow him more space to perform the surgery and so that it easier to view. Another two instruments are inserted into the abdomen so that the gallbladder can be picked up. Another instrument will be inserted at another point on the abdomen “to clip the gallbladder artery bile duct, and to safely dissect and remove gallbladder stones.” The gallbladder will then be brought out of the body through the navel incision (Sieglbaum. 2008).

This assignment will focus on the post-operative care of Sylvia. Post-operative care is very important as many complications can occur after surgery and a patient may deteriorate rapidly. An example of a complication which may occur is they may haemorrhage to it is important to monitor the patients observations (Sages, 2004). The model which will be discussed in this report is

Roper, Logan and Tierney

and the nursing process will be used to express how to give the best care possible using a person centred approach. Also included in this report will be three nursing actions that are carried out post-operatively. The three nursing skills which will be included in this assignment are Observations, fluid balance and pain.

Planning and Assessing

The nursing process is a continuous process that assesses the patient’s needs and looks at the patient holistically. The nursing process goes round a continuum which is Assess, Plan, Implement and Evaluate this is a continuous process. This is important as any patients need’s can change frequently. An assessment framework can then be put in place using model such as Roper Logan and Tierney (2003). This specifically looks at meeting the patients’ need the nursing staff should have a wider view of how to care for the patient and the patient should be treated as a whole person. The NMC code of conduct (2004) states that you must respect and treat the patient as an individual. This means we have to look at the different areas that make up the patient – their feelings, body and mind this gives us the base of holism (Siviter. 2007, p. 41). The Roper Logan and Tierney model had 12 Activities of daily living the factors which influence these are biological, psychological, sociocultural, and environmental and politicoeconomic. The 12 Activities of living are: Maintaining a safe environment, communication, breathing, eating and drinking, elimination, personal cleansing and dressing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying all though each of these activities are separate in there own way they are also linked to each other; for example you can not eat and drink without elimination or breathing (Roper, Logan and Tierney. 2003, p. 13). These activities are important for Sylvia. Sylvia has had surgery so may be facing some problems/potential problems. A care plan has been constructed using the nursing process and 12 activities of daily living to enable nurses to work better as a team and be more away of problems that may occur for Sylvia. In addition to this care will be of a higher quality if the nursing staff are following the same care plan. This care plan is specific to Sylvia and should be reviewed regularly as changes will need to be made as Sylvia will hopefully progress and soon be well enough for discharge home (Appendix 1).The 12 activities of daily living affect every patient as to whether they are meeting them or not. They will affect them at different levels. Sylvia’s day to day lifestyle will be affected by her surgical procedure that she has had to remove her gall bladder because of the cholecystitis. The 12 activities of daily living were used to assess Sylvia when she was admitted to set up the care plan. When assessing any one patient we can ask questions or observe them, however asking the patient questions isn’t always a reliable as they may not tell you the whole truth or for pain everyone’s perception of pain is different. Also when observing someone they may feel conscious of you observing them so will possibly act differently. To provide Sylvia with the best care possible nurses would concentrate more on some activities of daily living than others. These would include: Maintaining a safe environment, communication, breathing, eating and drinking and mobilising.

Maintaining a safe environment

In hospital maintaining a safe environment is key for both the patients and the visitors. It is important that you use the correct equipment for patients to prevent any hazards or injury for the patient in particular. One which is assessed on admission is the waterlow score this score takes into account many factors too see whether the patient will require a special mattress e.g. air mattress to prevent pressure sores. The waterlow score is one that is often missed along with the must score when the patient is being admitted and often nurses forget to reassess (Waterlow, 2008). When a student nurse was on placement an audit was carried out to see how well the waterlow and must scores were being recorded, the result of this was poor as it had not been getting assessed in the patients notes; it is important to prevent pressure sore and make the patient as comfortable as possible. Wards should be getting 100% as it is important to give the best care possible to every patient to do this they need to be assessed regularly; this is a prime example of were the nursing process should be used. Sylvia may be at risk of falling out of bed due to anaesthetic so nurses should put the cot sides up on the bed. If Sylvia’s surgery had gone to open surgery when she returned to the ward she should be in a side room to prevent her wound from being at risk of getting infected or contracting MRSA.

Communication

Communication between staff and patients is extremely important, so that the patient knows what the plan is and can start to build trust in the staff. The more trust the patient has in the staff the more likely they are to ask questions and feel less embarrassed. “Humans are essential social beings and spend the major part of each day communicating with other people. The activity of communication is therefore an integral part of all human relationships and all human behaviour” (Roper, Logan and Tierney. 2003, p. 19). This shows that communication is the most important activity of living as without communication it would be impossible to give or receive information. When Sylvia is first out of theatre she will be unable to communicate fully due to the anaesthetic, so it is important to closely monitor her to make sure that there is no problems occurring. When Sylvia arrived back on the ward, the staff that was with her in the recovery room would handover how the operation and her recovery had gone so far. Communication can be both verbal and non-verbal. For example Sylvia had a sore abdomen after the operation she may have had her hand over it and her facial expression may have been expressing pain. When Sylvia was getting ready to be discharged home, when she got up she went pail and was feeling faint and was advised to stay in overnight. The nurses would have to get in contact with someone such as social work to arrange care for Sylvia’s children. “Good communication among professionals in the post operative period is essential” (Gibson 2006 p 936). It is useful if the nurse has back ground knowledge on the procedure as the patient may not understand some of the doctor’s terms.

Breathing

Breathing is fundamental to every human being. “Breathing seems effortless and people are not usually consciously aware of the AL of breathing until some abnormal circumstances forces it to their attention” (Roper, Logan and Tierney. 2003, p. 22). Sylvia was being assisted to breathe with the aid of oxygen therapy after her operation. The organs of the respiratory system provide cells of the body with oxygen through the external and internal respiration process. To allow this to work, “the blood, together with the vessels and organs compromising the circulatory and lymphatic systems, is also required.” We need both the “respiratory system and the cardiovascular system” to allow us to breathe (Roper, Logan and Tierney. 2003, p. 22). Nurses can encourage Sylvia to deep breath which will expand the lungs and clear the anaesthetic.

Eating and Drinking

“Eating and drinking play a significant part in the everyday living pattern of all age groups, and for most people they are pleasurable activities” (BUPA, 2009). If an individual in unable to eat for reasons beyond their control they may be given a nasal gastic tube and fed through this and given IV fluids. Eating and drinking is essential to stay alive, without food and drink you would die. Eating and drinking also helps in the healing process. Protein and vitamins which we get in some food will help wounds to heal more quickly and also glucose for energy. It is also important to keep hydrated so that the wound heals quicker (BUPA, 2009). So this is vital after an operation when able that Sylvia eats to help heal her wound areas that she will have. If Sylvia does not eat and drink the wound will take longer to heal and will increase the risk of infection.

Mobilising

“The capacity for movement is a characteristic of all living things and the ability to move the body freely is a necessary and much valued human activity” (Roper, Logan and Tierney. 2003, p. 38). Sylvia’s mobility may be limited due to the cholecystectomy and anaesthetic; because Sylvia’s operation was laparoscopic her wound will heal quicker so she will regain full mobility quicker. If Sylvia needs the toilet quite soon after the operation she may need assistance as she will still be under anaesthetic. This may be embarrassing for her so it is important to maintain privacy and dignity. When Sylvia returns hope caring for her children may prove quite difficult as she will not be able to lift them. She will require some assistance with this from family or friends. If there is no one who can help her, the nurses can get in contact with the social work to see if she can get help with her children while recovering. Sylvia needs to take care when caring for her children because of her wound.

Nursing Actions

Nurses have to carry actions out to make sure that everything is going in the right direction for Sylvia and if there are any problems they can deal with them quickly.

Observations

When Sylvia arrives back to the ward from surgery it is very important that a nurse checks ABC (Airways, Breathing, Circulation) immediately and continues to monitor this. If Sylvia is alert and conscious this is a good sing that she has an airway and that she is breathing, if Sylvia is warm and good colour e.g. not blue or grey and her heart rate is within the average rate her circulation is good. The nurse may also press on the finger nail to see how quick it goes from being white to red this is to see how good the capillary refill is. If it is good it should change from white to red within 2 seconds. If it had taken longer than two seconds to change back this may be due to dehydration, shock peripheral vascular disease or hypothermia (Dugdale, 2009). When Sylvia arrived back on the ward all the nurses would be given a handover to say how the surgery had went and if everything had gone as planned. On Sylvia coming back to the ward her observations must be checked. Sylvia will be on a SIRS chart since she has been to theatre. The observations on this are (Blood pressure, temperature, respiratory rate, Spo2 level, heart rate, urine output pain score and PCA (patient controlled analgesia). The normal/average ranges for each of these observations are:

* Blood pressure – “100/60 – 140/90” (Marieb and Hoehn 2007, cited in Dougherty and Lister 2008, p.622)

* Temperature – “36-37.5oC” (Tortora and Derrickson 2008, cited in Dougherty and Lister 2008, p.656)

* Respiratory rate – “15-20” (Weber and Kelley 2003, cited in Dougherty and Lister 2008, p.613)

* Spo2 level – “95%-98%” (Woodrow 1999, cited in Dougherty and Loster 2008. P.648)

* Heart rate – “55-90” beats per minute (Weber and Kelley 2003, cited in Dougherty and Lister 2008, p.613)

* Urine output – “>1803 ml/6hr” (Gibson, 2006 pg922)

Sylvia’s observations will be checked regularly: “every 15 minutes for the first hours, every hour for the next 4 hours and every 4hours for the next 48 hours” (Lippincott Williams & Wilkins, 2007 pg 379). The every 15 minutes checks will be done in the recovery room rather than it the ward. Looking at Sylvia’s observations on returning to the ward her blood pressure was slightly high – 145/90, respiration rate was also high at 23 per minute as was heart rate at 100 beats per minute, because of Sylvia’s high heart rate and high respirations we have to monitor her closely because if her blood presser was to be low that would be a sign haemorrhage. Sylvia had a high pain score of 7/10 this score is based on 0 being no pain and 10 being unbearable. Sylvia was given Morphine to try and relieve the pain that she had. It is important to ask Sylvia about nausea as many patients do feel nauseous after surgery this may be because the surgery is in the abdomen area or because of the drugs used for the general anaesthetic this includes anaesthetic gases.(Selby, 2006). Sylvia was prescribed Ondansetron for nausea.

Fluid Balance

Before Sylvia went for surgery she would of have to have fasted. Post-operatively Sylvia would be on a fluid balance chart. SIGN 2004 states that “the principles of fluid balance” after a patient has had an operation are:

* “ to correct any pre-existing deficiency

* To supply basal needs

* To replace unusual loses…

* To use the oral route where possible; there is often an unnecessary delay in commencing oral intake after surgery” (SIGN, 2004 pg 28).

Sylvia may be dehydrated due to having been fasted. She may have IV fluids running which would have been prescribed by the doctor and put up and checked by the nursing staff. About 52% of a female’s body weight is fluid in the body. A loss of fluids can case major effects. If there is as little as 10% loss it can cause death, 8% illness and 5% thirst (Carroll, 2000). This shows how important it is to monitor Sylvia’s intake (IV fluids, oral fluids when able) and out take. (Urine, Fluid from drain site, feces, vomit and sweating but this would be impossible to measure). This should be recorded hourly. Unusual loses such as fluid from the drain sight needs to be replaced. This may be done with IV fluids. When Sylvia returned to the ward she had not passed urine, if this continued she would have to be catheterised but fortunately she passed urine at 6pm. The stress of the surgery may have caused strain on the kidneys and could be the cause of the delay in excretion of urine. This would have been measured and recorded on the fluid balance chart. Sylvia would possibly have a drain from her wound so it is also important to record the volume of fluid that is coming from the wound. There was no sign of soakage from the wound site when she returned to the ward which is a positive sign. This should be continuously monitored. At the end of each night everything that Sylvia has taken in has to be added up and her total out put needs to be taken away from this to see if she has a positive or negative fluid balance.

Pain Assessment and how to control pain

Patients are often very concerned about what their pain level will be after surgery (Gibson, 2006 pg 929). Many patients often expect to feel pain postoperatively and are show that they are satisfied even if the pain is still present. (Sherwood et al 2003, Cited in Gibson, 2006 pg 929)

There are many pain assessments that can be used. Every patient is an individual and perceives pain differently. What is a pain score of 5 may be a pain score of 8 to someone else. When Sylvia returned to the ward the nurses used the pain assessment of asking her what her pain was on a scale of 0-10 with 0 being no pain and 10 being unbearable. Sylvia’s pain score was 7/10. This is quite a high pain score. The doctor reviewed Sylvia and prescribed 2.5mg of Morphine to be given by subcutaneous injection. According to the BNF (2007) the dosage Sylvia was prescribed is adequate to start with as the maximum dosage is “10mg every 2-4 hours if necessary” (BNF, 2007 pg 228). Morphine is a controlled drug so has to go through the controlled drug book and has to be checked by two registered nursing staff. If Sylvia’s pain was to continue the doctor may decide to give her a PCA to control the pain. A PCA is Patient controlled analgesia and is given through the rout of IV. Sylvia would have a button that she would be able to pres when she felt she required something for the pain. The patient is unable to overdose on this as the machine has a lock on it and will only allow the patient to press the button for example once every five minutes. The amount of medication the patient has used from the pca is recorded on the observation chart. On the machine it will also tell us how many good attempts Sylvia has had and how many bad. If there is a lot of bad this means that her pain must be bad and she is pressing the button more often than she is allowed. The doctor would have to review this (Macintyre, 2001).

Conclusion

To conclude this assignment it is important to work as part of a team and communicate with the multidisciplinary team to give Sylvia the best care possible. It is important to treat the patient holistically. In addition to this, this assignment shows how the nursing process works and how it can be used along with Roper, Logan and Tierney’s 12 activities of daily living. It shows how well the use of the activities of living fit in with the nursing process in making a care plan.

References

BOOKS

BNF (2007). Brittish National Fourmulary. 53rd ed. London: BMJ Publishing Group Ltd and RPS Publishing. P228.

Carroll, H. (2000) In: Sheppard, M., Wright, M.(eds) Principles and Practice of High Dependency Nursing. Edinburgh: Baillière Tindall.

Gibson, C. (2006). The Patient Facing Surgery. In: Alexandre, M. Fawcett, J.

Runciman, P Nursing Practice Hospital and Home The Adult. 3rd ed. China: Churchill Livingstone. p922-936.

Lippincott Williams & Wilkins (2007). Lippincott Manual of Nursing Practice Pocket Guide: Medical-surgical Nursing. USA: Lippincott Williams & Wilkins. p379

Marieb, E.M. and Hoehn, K. (2007) In: Dougherty, L and Lister S (2009). The Royal

Marsden Hospital Manual of Clinical Nursing Procedures, Student Edition. Oxford: Wiley-Blackwell . p622.

Roper, N. Logan, W. Tierney, A. (2003). The Roper Logan Tierney Model of Nursing. China: Churchill Livinggstone. p13-38.

Sherwood G D, McNeil J A, Stark P I et al (2003) In: Gibson, C. (2006). The Patient Facing Surgery. In: Alexandre, M. Fawcett, J. Runciman, P Nursing Practice Hospital and Home The Adult. 3rd ed. China: Churchill Livingstone. p922-936.

SIGN (2004). Postoperative managment in adults. Edinburgh: SIGN. p28.

Siviter. B (2004). The Student Nurse Handbook. China: Bailliere Tindall. p41.

Tortora, G.J. and Derrickson, B. (2008) In: Dougherty, L and Lister S (2009). The Royal Marsden Hospital Manual of Clinical Nursing Procedures, Student Edition. Oxford: Wiley-Blackwell . p656

Weber, J and Kelley, J (2003) In: Dougherty, L and Lister S (2009). The Royal Marsden Hospital Manual of Clinical Nursing Procedures, Student Edition. Oxford: Wiley-Blackwell . p613

Woodrow, P.(1999) In: Dougherty, L and Lister S (2009). The Royal Marsden Hospital Manual of Clinical Nursing Procedures, Student Edition. Oxford: Wiley-Blackwell . p648

JOURNAL

Macintyre, P. (2001). Safety and efficacy of patient-controlled analgesia. Brittish Journal of Anaesthesia. 87 (1), p34-36.

WEBSITES

BUPA. (2009). Caring for Surgical Wounds. Available: http://hcd2.bupa.co.uk/fact_sheets/html/surgical_wounds.html. Last accessed 6 December 2009.

Dugdale, D. (2009). Capillary nail refill test. Available: http://www.nlm.nih.gov/medlineplus/ency/article/003394.htm. Last accessed 6th December 2009.

NMC. (2004). The NMC code of professional conduct: standards for conduct, performance and ethics. Available: www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=338. Last accessed 1 November 2009.

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Siegelbaum, J. (2008). Laproscopic Cholecystectomy. Available: http://www.gicare.com/endoscopy-center/laparoscopic-cholecystectomy.aspx. Last accessed 20 October 2009.

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NURS 693B Assignment Significance and Summary

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NURS 693B Assignment Significance and Summary

NURS 693B Assignment Significance and Summary

 

This week, you will
submit the final portion of your paper for review. Please make sure to review
all of your instructor’s feedback and prepare your research for final
submission in week 7.

In 3–4 pages, summarize
your study. Provide a summation of evidence (referencing your literature) that
the problem is current, relevant, and significant to the discipline. Reiterate
the gap in the literature and how your project contributes to social or
organizational change in nursing and nursing informatics.

Within your summary,
state the significance of your research by identifying potential contributions
of the study that advance knowledge in the discipline. This is an elaboration
of what the problem addresses. Provide a strong “take home” message that
captures the key essence of your research.

Last, describe
recommendations for further research that are grounded in the strengths and
limitations of the current research as well as the literature you reviewed.
Ensure recommendations do not exceed the research boundaries.

Statistical Significance Summary

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This post gives the most important points to understand for statistical significance.  If you want to see the rest my content for statistics, please go to this table of contents

What Is Hypothesis Testing – In 3 Sentences

Hypothesis testing is a way of determining if some measured effect is a real difference, or likely just statistical noise.  The baseline belief is always that any difference in measurements is just statistical randomness.  We use the hypothesis testing equations to demonstrate that any measured differences are large enough that they are very unlikely to be merely random variations.

 

Hypothesis Testing – As An Image

Hypothesis testing is essentially placing an error band (the bell curve below) around a point that you measured (orange dot) by using a modification of the normal curve, determining where another point would be located on that chart, and seeing how much area is under the modified normal curve up until that location

basic hypothesis testing

The width of the curve can change as you get more data

hypothesis testing with a narrower width

And sometimes you have error bands around both points

two sample t test error bands

When Is Hypothesis Testing Used?

Hypothesis testing is used in scientific studies of all kinds to determine if an effect exists.  This is synonymous with the term “Statistical Significance”.   It is used, for instance, to show the difference between a real medicine and a placebo.  This is also used in things such as A/B tests for advertising to determine which ads are most effective.

Hypothesis Testing In More Detail

  • Hypothesis testing always has two sets of measurements. (i.e. measure 10 samples from over here, and 15 samples from over there) Each of those two sets of measurements will have some average value.  So there are always two averages.
  • Those two averages will always have some difference between them.
    • Sometimes that difference is very large, i.e. if I measure the maximum weight lifting ability of a group of people before they start training vs. after they spend a year training
    • Sometimes the difference is very small. Sometimes the difference can be so small it is within the precision limits of the data and shows up as zero.
  • Hypothesis testing is determining if
    • There is some systematic cause which results in the observed difference between the two averages or
    • If it is likely that the observed difference is solely due to statistical noise, i.e. the typical fluctuations in results you get when you take measurements. This is the “Null Hypothesis”
      • Example – I have a coin that I know is a fair coin and will thus come up heads 50% of the time. I flip it 100 times and get 53 heads.  The difference between 53 heads and the expected 50 heads is small enough that it is probably statistical noise rather than “Someone gave me a weighted coin”  Hypothesis testing is a way of putting concrete numbers to the statement “Probably statistical noise”
    • Our default assumption is the “Null Hypothesis”. We assume that any difference in the average results is merely statistical noise until we show that to be more unlikely than a certain threshold.
      • We get to decide what we want that threshold to be. A typical value is that there must be less than a 5% the results are merely random noise before we assume that the results are systematic differences.  (Less than 1% chance, and less than 0.1% chance are also common thresholds used)
    • Note, even if we determine that there is a systematic difference, our calculations won’t tell us what is causing the difference in the average value between the two sets of data, just that there is at least one systematic difference
      • e. if we are confident that certain groups of people are stronger after a year spent lifting weights, that doesn’t tell us if the training actually caused the difference. It could have been something different like secret steroid usage.

 

 Hypothesis Testing Equations

  • There are 5 different types of hypothesis tests, each with their own equations. However don’t get hung up on that yet, they are only small differences between all 5 of the tests.
  • All hypothesis tests compare two sets of data. Call them the baseline set and the test set.
  • Each of those two sets of data has 3 attributes, for a total of 6 attributes.
    • The first attribute is the average of that set
    • The second is the standard deviation of that set
    • The third is the number of measurements in the data set
  • There are 5 different types of hypothesis tests (1 Z-test, and 4 T-Tests) and the only reason there is more than 1 type of hypothesis test is that they all make different assumptions about the 6 attributes. It isn’t important to know all the different assumptions yet, but here are some examples
    • One of the tests assumes that you don’t know anything about any of the 6 attributes other than what you measured
    • One of the tests assumes that the only thing you know is that both sets have the same standard deviation
    • Another test assumes that you have infinite measurements of the baseline set. For instance, you know the average height of people in a certain state with certainty because you looked it up in the government census results
    • Other tests have different assumptions. It isn’t important to know any of these yet other than to know that the equations are doing the same thing with different assumptions

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  • In most cases, all 5 different types of hypothesis tests will give a similar answer. This is a good thing, and it means that if you understand how any of them work, you basically understand all of them
  • This free PDF cheat sheet has the equations for the 5 different types of hypothesis tests, as well as an example of when you would use each one.

 

Hypothesis Testing And The Normal Curve

  • It is pretty important to have some knowledge of the normal curve. (i.e. bell curve), as well as a general understanding of what a standard deviation is.   See this blog post for an overview.   (blog post TBD)
  • Remember that we have a baseline set of data, and a test set of data. Each of those sets has an average, a standard deviation, and a number of measurements.
  • What hypothesis testing is all about is “How well do we know the average values of the populations that we took our measurements from?”
    • e. even though we have an average value of our measurements, that is just the average of the samples we took, not the full population
    • There will always be some difference between our sample average and the true population average
    • Our average has a range of uncertainty, and we can use the normal curve and standard deviation to quantify that uncertainty
  • This blog post shows how to quantify the uncertainty you have in your average value. The examples given are dice outcomes that you are already familiar with.  (i.e. that the most likely roll using 2 dice is a 7) http://www.fairlynerdy.com/intuitive-guide-statistical-significance/

 

T-Test Degrees Of Freedom

  • Compared to the Z-test, T-tests have an additional equation, where you calculate the degrees of freedom.
  • Degrees of freedom is just a way of determining how many overall measurements you have in your data set, which is used to determine how accurate your calculated standard deviation likely is.

 

Hypothesis Testing Examples

 

 

 Level 2

That’s it for the first block of information.  If you work through a couple of examples and understand most of those points you will have a good grasp of hypothesis testing.  I recommend coming back and learning this second section in a few days or a week.

 

T Distribution vs Z Distribution

What is the difference between a T-Distribution and a Z distribution?

  • The point of having any distribution at all is that there is a range of values that your average could be. e. having a normal distribution accounts for the fact that you don’t know your average exactly.  But you also don’t know the standard deviation of your data exactly.
    • To be more precise, you know the standard deviation of your measured data. However, you don’t know the exact standard deviation of the population it was drawn from
  • A Z distribution uses a normal curve and ignores any uncertainty in your standard deviation. This is because it assumes you have enough data that your standard deviation is quite accurate.
  • A T distribution takes into account the fact that you have a range of error in your standard deviation. It does this by changing the shape of the distribution
  • It based the shape of the curve on the degrees of freedom, which is a way of calculating how many measurements you have.
  • With a T-distribution, Instead of the typical normal curve, you get a curve with fatter tails
    • This applet lets you play with the shape of a T distribution vs a Z distribution assuming different number of samples http://rpsychologist.com/d3/tdist/
      • To use it, slide the slider above the charts to the right or the left to change the degrees of freedom assumed in the T-Distribution
      • This will change the shape of the T-distribution
      • You will see that with a low number of degrees of freedom, the T distribution has much fatter tails than the normal distribution. However as the number of degrees of freedom  (i.e the number of measurements, i.e. the confidence you have in your measured standard deviation) increases the T distribution becomes nearly identical to the standard normal distribution
    • Once you get around 30 data points, or so, the difference between the T Distribution and the Z distribution mostly goes away, which is why 30 degrees of freedom is a common rule of thumb on when to switch to a Z-test instead of a T-test. (Note, there other important considerations as well, such as whether you have a baseline measurement or are measuring both the baseline and the test sets of data)

 

When To Use Each Test

This block summarizes when you would use any given test.  As we go down this list we know less and less information and have to rely on what we measure.   I.e. instead of looking up from the government census what the average age of a region is  (i.e. knowing it), we go ask 100 people what their age is (measure it)

 

Z Test

  • You know baseline average
  • You measure sample average
  • You know baseline standard deviation
  • You assume sample standard deviation is the same as the baseline standard deviation

1 Sample t-test

  • You know baseline average
  • You measure sample average
  • You don’t care about baseline standard deviation  (because we have so many baseline samples that it doesn’t matter)
  • You measure sample standard deviation

2 Sample t-test – equal variance

  • You measure baseline average
  • You measure sample average
  • You measure both sample standard deviation and baseline standard deviation but assume that they are the same as each other so you just measure them all together and do the calculations as a group

2 Sample t-test – unequal variance

  • You measure baseline average
  • You measure sample average
  • You measure baseline standard deviation
  • You separately measure sample standard deviation

The last hypothesis test is slightly different because the previous ones all assumed that what you were measuring was different groups.  The paired t-test assumes that each data point in the two sets of data are tied together.  I.e. each data point measuring the same people before and after

Paired T-test

  • The average value is the average of the difference between the before and after data
  • The stander deviation value is the standard deviation of the difference in before and after values

 

Truthfully, in many cases, you aren’t going to get very much difference no matter which of these equations you use.   Some of the equations pretty much reduce into the other equations as you get more and more information, i.e. if you measure at least 30-50 data points the difference between the 1 sample T-test and the Z test is pretty small.

 

 

Level 3 – Morphing Equations Into Each Other

It turns out that many of the equations for the 5 different hypothesis tests are just simplifications of each other.  They can be morphed into each other as you make assumptions, such as that the number of measurements goes to infinity for one of the datasets.

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Within the paper’s introduction, explain your interview selection.

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Within the paper’s introduction, explain your interview selection.
Details:

Refer to the “Master’s Prepared Nurse Interview Guide_student” as you prepare this assignment.

Interview a nurse who is master’s-prepared in nursing and is using this education in a present position. Preferably, select someone who is in a position similar to your chosen specialty track. The purpose of the interview is for you to gain insight into the interplay among education, career path, and opportunities. Be certain to identify specific competencies that the MSN-prepared nurse gained, and is presently using, that reflect advanced education. Organize your interview around the topics below:

1 Overview of the master’s-prepared nurse’s career

2 Reason for seeking graduate education

3 Description of present position and role

4 Usefulness of graduate education for present role

5 Pearls of wisdom he/she is willing to share

In 750-1,000 words, write the interview in a narrative format. Use the following guidelines:

1 Within the paper’s introduction, explain your interview selection.

2 Do not identify the individual by name.

3 Use centered headings to separate parts of the interview.

4 In the conclusion, identify one or more competencies from the interview that are consistent with GCU program competencies and/or AACN education essentials. In addition, provide a statement that reflects what you gained from the interview.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to

a) Decipict Saras optimal stock of health capital at age 18 with a high scho Show more Answer the following. a) Decipict Saras optimal stock of health capital at age 18 with a high school diploma and a wage of $8 per hour. b) Suppose that she invests in a college education expecting to get a better and higher wage job.

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a) Decipict Saras optimal stock of health capital at age 18 with a high scho Show more Answer the following. a) Decipict Saras optimal stock of health capital at age 18 with a high school diploma and a wage of $8 per hour. b) Suppose that she invests in a college education expecting to get a better and higher wage job.

Show how her optimal stock of health capital changes by the age of 30 due to the increased wage. Then show how her education would affect her optimal health stock if education also made her a more efficient producer of health. c) Suppose that after age 30 her wage stays the same. As she ages show what happens to her optimal stock of health capital assuming that the depreciation rate of health increases with age. Show less

Explain your motivation to seek a career in MEDICINE?

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Explain your motivation to seek a career in MEDICINE?

 

Medical School Personal Statement Project description Explain your motivation to seek a career in MEDICINE. Be sure to include the value of your experiences that prepare you to be a physician. Need a Professional Writer to Work on this Paper and Give you Original Paper? CLICK HERE TO GET THIS PAPER WRITTEN; Medical School Personal Statement Project description Explain your motivation to seek a career in MEDICINE. Be sure to include the value of your experiences that prepare you to be a physician. Need a Professional Writer to Work on this Paper and Give you Original Paper?