Anxiety- Anger And Depression in Nursing

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I FEEL DEJECTED, The patient spoke out morosely. Nurse looked over at his miserable condition, and felt to deal with his anger, anxiety and depression. It is very interesting to conform with such cases, dealing with difficult emotions is a challenge for nurses in clinical setup. Emotion includes a widespread range of apparent behaviors and expressed feelings. According to West and turner (2009) emotion is the critical inner organization that orients us to and involves us with what matters in our lives: our feelings about ourselves and others.

As nurses are in the business of caring and health-giving. They have the ability to see the requirements of patients and help. But there are some patients in clinical setting that nurses find hard to deal with them. Nurses need to maintain a generous, attentive manner for every patient, But when the patient’s behavior is unsociable, For example feeling frustrated, anger, anxiety and depressive which makes them difficult to connect with people. These complications can come from the patient’s side as well as from the nurse’s side. If there is a patient who has some boundary issues, anger issues or anxiety and depression, on any day a patient can become difficult for nurses. So, Nurses must find a way around these kinds of issues to provide the finest care as a nurse.

According to Locsin and Purnell (2009) when the patient meet good nurses, patients relational comfort is elevated, negative emotions and discomforts are dismissed, and patients are enabled to deal with life positively. The patient will often try to share with the nurse that what he or she is feeling or how he or she is living the difficult life. Patient may be short of interest in health, feel ignored and neglected, Because of which he’s depressed and having aggression and anxiety. So, Nurses should identify the real parameters of the situation before the problem can worsen.

Feeling of fear in an exam, going into hospital, beginning of a new job or entering into a new environment, feeling uncomfortable, In turn, these conditions can affect your sleep and ability to think and focus. Anxiety is a normal reaction to worrying or stressful situations. It affects a person’s whole being, how a person feel, how he or she behave. According to Stein et al. (2009) Anxiety is: “characterized by an un pleasant affective experience marked by a significant degree of apprehensiveness about potential appearance of further aversive or harmful events” (p.104). Anxiety can also be described as an unpleasant state of tension from dissatisfaction in personal relations (Columbus, 2008.). Anxiety may be caused by a physical and mental condition, the effects of drug or substance abuse or combination of these. In Fatemi and Clayton (2008) for some people, the depersonalization marijuana often provokes anxiety.

It has been observed at the clinical settings in hospitals that when a patient enters in the hospital environment for the routine checkup and suddenly doctor recommend him/her to get admitted in the hospital, at that time patient become anxious about his/her health. When patient got to know that he/she will be going for any surgical procedure and nurse is giving the pre-operating teaching, the anxiety level will be at its peak. In the light of an article, Allen et al. (2002) “Hospitalization for surgery is associated with increased anxiety” (p. 7). Raised anxiety levels also have clinical significance; they unfavorably impact on intra and post operative outcomes such as pain. In addition, it indicates that surgical anxiety and post-operative pain can be challenging for the patients.

Nurses do their best to ease patient stress and anxiety through a correct assessment, diagnosis and through care with patients. Nursing process includes a systematic assessment which is the initial step. First, nurses set up the anxious client’s opinion about the situation. This is accomplished by asking questions recently and listening carefully to the response. Anxiety is an experience which is subjective and cannot be directly observed. There are a lot of goals and outcomes appropriate for the patients for example: Identify situations when stress and anxiety increase. White (2005) emphasizes that nurses should meet the basic needs of the patients such as patients who are in pain, cold or hungry have higher anxiety levels. The nurse should in fact progress the potential for recovery by reducing patients anxiety. There are other methods also like: Minimizing the environmental stimuli. He also emphasizes on using the stress management techniques by nurses which includes exercise, done on the regular basis encouraged by the nurse. Furthermore, relaxation techniques can help patients to feel fine and relax; it includes guided imaginary activity and meditation. These techniques are useful in helping patients to relieve anxiety. Another way of reducing anxiety is “cognitive behavioral therapy”, It is defined in Norton (2012) the goal of CBT for anxiety is to help the patients with anxiety to re-orient his or her perceptions of dangerousness. Psycho education is a trans-diagnostic anxiety treatment described in his book, helps to correct the misconceptions about why he/she is experiencing the problems with anxiety.

Dealing with an angry patient is an uncomfortable condition for many health care practitioners. Austin and Boyd (2010) states that the “Anger is a strong, uncomfortable emotional response to a provocation that is unwanted and incongruent with one’s values, beliefs or rights.” (p. 884). Anger can be beneficial for patients. It gives a way to express false feelings or motivate you to find solutions. But extreme anger can cause complications. Increased blood pressure and other physical changes are connected with anger, which can harm your physical and mental health.

In reference to, Suls et al. (2010) anger is associated with greater psychosocial vulnerability for example increased interpersonal conflict, lack of social support and more stressful events. As it is discussed above in a clinical scenario that patient is going for a surgical procedure and that could be stressful event for the patient. Besides this, the post-operative pain can become a reason for the patient’s anger. Fishman (2009) states that: “Anger has been widely observed in people with chronic pain” (p. 753). It is also noted that, rejection of patients by nurses in the clinical setup is also a leading cause of patient’s anger and aggression. There are also cultural and religious beliefs from which this rejection is taking place, it should be avoided by nurses because it can create a barrier between a nurse and a patient, the patient care should not be compromised. The nurse should know about the cultural norms of patient to provide cultural competent care. According to Videbeck (2010) the rejection can lead to anger and aggression and it can be a threat to self-esteem of the patient.

Patient’s anger can be able to control by pharmacotherapy. It includes medications such as haloperidol and lorazepam, these drugs are commonly used for reducing the anger and psychotic symptoms. There are other many strategies which a nurse can adopt for anger management of patients. It is mentioned in Damon et al. (2012) One-to-one contact is an effective a strategy, nurse will assess the patients understanding about anger and patient’s perceptions about angry behavior. Patients who demonstrate no suffering from angry behavior may not ready to change or manage it. On the other hand, some patients will express and say that they want to cope with it and they want to learn coping skills. Patients who discuss their feelings, thoughts and triggers with nurse are more likely to be able to learn anger management techniques. Another strategy is to provide education about the emotion of anger, Nurse will identify the patient’s teaching needs and explain the purpose of anger, physiological sign or symptom that the patient may experience when angry and the importance of identifying the patient’s unique triggers and reactions to anger. By these strategies a nurse can help a patient to cope with anger and facilitate the patient in the continuity of healthy life.

Another challenging emotion is depression, which is linked to anxiety and anger. It is mentioned in an article Busch (2009) that research studies have shown the link between depression and anger have indicated either increase outwardly directed anger or increased degree of suppressed anger in patients with depression. Depression can be described as feeling sad, dejected or miserable. Steptoe (2006) defined Depression as “Condition that primarily entails a disturbance of mood; this affective disturbance is often characterized by a mood that s sad, hopeless, discouraged or simply depressed” (p. 299). A complex mixture of causes can lead to depression. The death of loved one, any financial issues or the stress of work can lead to depression. Disturbed sleep, interruption of body chemistry and illness can complex the problem. In psychoanalytic theories, according to Freud (1917) depression results from a fantasized or actual loss of an individual to whom the patient experienced ambivalent feelings.

In the management of depression, the ultimate goal is straight forward – To return from depression to a state of full health. Planning interventions for a client with depression can be done with optimism. Patients with depression can be stabilized by medications and different therapies that enable the patient to achieve a healthier life. Appropriate nursing interventions for patients with depression should be taken, such as assistance in meeting basic needs of the patient. It is stated in (Shives, 2008, p. 341) “The severity of the client’s symptoms directly influences the degree of importance of physical care”. Nurse’s assistance in hygiene, grooming and selection of appropriate attire is necessary and also evaluate the patient’s rest and activity. Likewise, medication management and observing for adverse effects is a challenging intervention for nurses. Patients who are new to anti-depressants are at greater risk of discontinuing their medication from which the depression can become more compound.

In conclusion, the stability of emotions is essential in daily life for every human being. Even though, these emotions help in the survival. People can express their feelings to others by the help of emotions but on the other hand, it can create a huge change in life. In today’s world, emotional instability is common among people around the world which lead them to some severe psychiatric illness. As we are in nursing profession and we work for the well-being of people, we should be aware about some provoking factors. We should approach the patient holistically and should not feel reluctant to assess the emotional status of patients under our care. A nurse’s duty is to be competent enough to provide the finest care. There are numerous effective strategies for the patients which should be in-cooperate, some of them are discussed in the paper above. Hence, it is must to deliver a patient centered holistic approach in every clinical setting to facilitate the continuity of a healthy life.

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Reflecting Personal Experience Of Wound Management In Rehabilitation Nursing Essay

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This essay will discuss my experience of wound management, while working alongside my mentor on a rehabilitation unit, for a 72-year-old patient who was admitted to the unit for the management of a Grade 3 sacral sinus pressure ulcer. The patient has multiple sclerosis (MS) and is wheelchair bound. In accordance with the Nursing and Midwifery Council (2008) Guidelines on Confidentiality, I will refer to the patient as Ben.

Aetiology of pressure ulcers is complex and caused by many factors but mainly a combination of unrelieved pressure, shear and friction; or pressure combined with the effects of other intrinsic elements which include disease, medication, malnourishment, age, dehydration/fluid status, lack of mobility, incontinence, skin condition, weight; and extrinsic variables, external influences which cause skin distortion like pressure, shearing forces, friction, moisture (Niezgoda and Mendez-Eastman 2006).

Pressure ulcers occur most commonly to bony or cartilaginous regions such as the sacrum, heels, etc. Pressure ulcers cause pain and discomfort and affect quality of life. Although easily preventable through regular relief of the pressure on areas of the body at risk of developing pressure ulcers, they are one of the leading iatrogenic causes of death, second only to adverse drug reactions (NICE 2005). The costs of pressure sore development can be counted in both monetary terms and in terms of distress caused to the patient (Brem et al 2004).

Pathophysiological abnormalities that may predispose the formation of pressure sores include compromised tissue perfusion as a consequence of impaired arterial supply (peripheral vascular disease) or impaired venous drainage (venous hypertension) and metabolic diseases such as diabetes mellitus (NICE 2005).

Pressure ulcers develop when persisting pressure on a bony site obstructs healthy capillary flow and blood cannot circulate, causing a lack of oxygen and nutrients to the tissue cells, leading to tissue necrosis. In addition, the lymphatic system cannot function properly to remove waste products. The pressure ulcer can range from a very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on the area, to a very deep wound extending to and sometimes through internal organs and into bone (Gunnewicht and Dunford 2004).

Grade 3 pressure ulcers develop to full thickness wounds involving necrosis of the epidermis/dermis and extend into the subcutaneous tissues. All epidermal appendages are destroyed (Gunnewicht and Dunford 2004). The NICE (2005) guidelines for the management of pressure ulcers suggest the treatment priority is the prevention or reduction of the pressure leading or contributing to skin damage.

Flanagan (2000) states that age, reduced mobility, malnutrition, incontinence, skin integrity, friction, moisture, and pain can lead to skin breakdown and ulcers developing and prolong wound healing. On admission Ben’s pressure sore risk factors were assessed to plan his nursing care and wound management by the multidisciplinary team.

Ben’s wound had caused extensive destruction of his tissues and damage to his muscle and supporting structures. On examination, there was a large necrotic plaque and ulceration on the right buttock 11cm by 12cm. The wound was malodorous; a swab was taken and reports confirmed that his wound was infected with (Methicillin-resistant Staphylococcus aureus) MRSA.

Other risk factors noted from his medical history which increase the risk of pressure ulcer development, included rheumatoid arthritis and ischaemic heart disease. His medication regime also includes methotrexate and prednisolone, both known to have an inhibitory effect on wound healing (NICE 2005). The treatment aims therefore were to review his medication related to rheumatoid arthritis and the possible factors compromising wound healing such as nutritional status, pressure relief, reducing bacterial load, sustaining skin integrity and providing skin closure.

Initial laboratory investigations requested by the medical team included a complete blood cell count to rule out underlying haematological disorders, erythrocyte sedimentation rate (which is elevated in patients with many diseases including connective tissue diseases and associated vasculitic ulcers, and infectious processes), and a fasting blood glucose test. Serum albumin and transferrin levels are very helpful in assessing the nutritional status in elderly patients (NICE 2005, Perkins 2000).

Ben’s cardiovascular and respiratory observations were taken regularly and were stable, although he did have mild pyrexia. He had a supra pubic catheter, his urine output was monitored on regular basis, and catheter care was given daily to minimize the risk of infection and monitor the tissue viability of the site. Ben’s bowel motion was also assessed and care taken that the wound would not be contaminated by providing full personal hygiene care.

The aim of wound management in this instance was infection control through strict hand washing policy and aseptic technique. A vascular surgeon performed staged sharp removal of necrotic tissue to reduce bacterial load and wound dressings with an antimicrobial agent were utilized. Necrotic tissue can prevent wound contraction and inhibit healing. Ben was also prescribed a course of IV antibiotics for systemic control of the infection (Gunnewicht and Dunford 2004).

To aid continuity of care (NICE 2005), a local wound assessment chart was used for documenting the management of the wound and it was updated every time the wound was redressed. All changes and appearance of the wound were noted down in the chart, according to the wound assessment guidelines (NICE 2005). On assessment of his wound on admission, my mentor identified that the wound was not being managed with the appropriate dressing and the integrity of the skin surrounding his wound was at risk. It was also distressing for Ben because he could “smell” his wound.

According to Ennis and Weness (2000), excess of exudates within the wound can also inhibit healing. Control of exudates is therefore essential. This is usually achieved by selecting a dressing of the appropriate absorbency. An Aquacell “Silvercel” dressing was selected for Ben’s wound because the British National Formulary (BMA & RPS 2009) suggests it is an appropriate dressing for moderate to heavily exuding wounds, and the hydrocolloid facilitates autolytic debridement in necrotic wounds and is suitable for promoting granulation. Silver is recommended for infected wounds and promotes the reduction of the bacterial load (BMA & RPS 2009).

Gunnewicht and Dunford (2004) suggest that if the wound is clean, healthy and granulating it does not require cleaning because the wound exudate itself has beneficial bactericidal properties, which may be inappropriately removed. The general strategy of my mentor in the cleansing of Ben’s wound was based on providing minimal necessary intervention. She was using normal saline to clean the wound. Griffiths et al (2001) stated that the solution should be of a non-irritant and free of bacteria. Normal saline is the most commonly used wound cleaner and it is best to use the solution at body temperature (Ennis and Weness 2000).

Ben’s ulcer had been developing over several months. Due to the progression of the MS he is unable to change his position himself while in his wheelchair, and due to his increasing immobility has increasing dependence on his carers to manage pressure relief as well as the other activities of daily living such as his nutritional needs.

Ben is therefore particularly prone to pressure ulcers. The clinical guidelines (NICE 2003) state that this patient should receive pressure relieving support surfaces such as pressure mattress and should be actively mobilized, with close observation of skin changes and a documented positioning and repositioning regime. Skin injury due to friction and shear forces should be minimized through correct positioning, transferring and repositioning techniques (NICE 2003). Patients should be repositioned every two hours when bed-bound and wheelchair bound patients need to shift their weight every 15 minutes if possible by self adjusting or reclining (NICE 2003).

Pressure ulcers are often slow to heal, and there is a plethora of research which states that nutrition plays a crucial role in wound healing. On admission we identified that Ben’s nutritional status was compromised. A daily food chart was used to document Ben’s intake. Ben was referred to the dietician to help plan interventions to improve Ben’s nutritional status. This was to provide a pureed diet high in protein, nutritional multivitamin and zinc supplements were prescribed and the supervision of his meal times planned, to aid optimum recovery and wound healing (Perkins 2000).

Williams and Leaper (2000) state that B complex vitamins are co-factors or co-enzymes in a number of metabolic functions involved in wound healing, particularly in the energy release from carbohydrates. Fats and vitamins have a key role in cell membrane structure and function, certain fatty acids are essential as they cannot be synthesized in sufficient amounts, so must be provided by diet.

Minerals like zinc, iron and copper play a vital role in wound healing. For example zinc is required for protein synthesis and also has an inhibitory effect on bacterial growth (Williams and Leaper 2000).

Ben’s wound management involved assessment of his pain which was done before and after analgesia was given. Pain is often significant and disabling for those with pressure ulcers. Paracetamol may be sufficient, but patients often require stronger analgesia especially when the wound is redressed. Non-steroidal anti-inflammatory drugs may increase peripheral oedema and are inappropriate for patients with pressure ulcers (NICE 2001).

Collier and Hollinworth (2000) suggest information should be provided so that patients can improve their knowledge and skills in the prevention and management of pressure sores. My mentor and I were spending time with Ben, providing support and reassurance and educating him about the process of his wound healing and the importance of medication, nursing interventions and nutrition. According to an article in Quality and Safety in Health Care (2008) communication looks easy when it is done well. It requires engagement, empathy, an ability to listen and respond, and it requires time. Calne (1999) suggested that it is the simplest measures of pressure relief that are often the most effective or have the most impact but guidelines should not replace clinical judgement and individualized patient care.

In conclusion, I feel that wound care requires a broad spectrum of evidence based knowledge and skills, and a collaborative multidisciplinary approach to wound care management. Caring for Ben’s provided me the opportunity to improve my knowledge, understanding and confidence about wound management in clinical practice.

What Is Plantar Fasciitis and How Is It Treated

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Scott Densley

August 1, 2019

PTA146S – 10 Musculoskeletal-Orthopedics

What is Plantar Fasciitis and how is it treated?

What is Plantar Fasciitis (PF)?  You may have heard Plantar Fasciitis being deemed or  associated with heel spur syndrome, plantar heel pain syndrome, painful heel syndrome.

1

“Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).”

2

PF is usually diagnosed and common with runners, but can also be related to those that are obese.

2

Stabbing pain is a characteristic that is related to PF and is at its worst in the morning when weight bearing and early ambulation.

2

The pain can eventually subside with time, but without the proper support, substantial periods of standing, and after exercising, the condition can become evident once again.

2

The anatomy to PF is essentially inflammation of fibrous tissue (plantar fascia) on the bottom of the foot that extends from the toes to the heel.

2

The best way to describe plantar fascia is to know that it “acts as a shock absorber bowstring, supporting the arch of the foot.  If tension and stress on that bowstring becomes too great, small tears can arise in the fascia.  Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn’t clear.”

2

However, the risks of PF include the older generation, primarily the ages ranging from 40-70.

2,3,5

,Pes Planus, limited ankle dorsiflexion, reduced ROM in the ankle and first metatarsophalangeal joint.

2

Excessive pronation is another factor to consider when addressing individuals with PF and foot deformities in general.

2

PF results from repetitive trauma to the plantar fascia and is known to impact millions globally.

4

In fact, the United States has reported around 2 million to be affected.

2

Plantar fasciitis is the leading cause of heel pain with 10% of patients dealing with this ailment for the majority of their life and is responsible for 11-15% of symptoms involving the foot.

2



Again, with no clear cause, a variety of treatments and modalities have been used to treat this condition and each have had their own clinical response.

1

In regards to treating PF, several options can be prescribed.

4

Some methods studied have deciphered better ways to treat plantar fascia with some providing better results than others.

4

These options include, but are not limited to, Myofascial Release Technique (MFR), static stretching techniques, dry needling, orthoses, night splints, steroid injections, taping, laser therapy, anti-inflammatories, acupuncture, ultrasound, Estim, chiropractic therapy, extracorporeal therapy, MRI, soft tissue massage and ultimately surgery.

2,4,6

Discussion in this paper will be more specifically related to the MFR technique, stretching, surgery, MRI, taping and ultrasound.

2,3-4

A Magnetic Resonance Imaging (MRI) can be a vessel to incorporate within this diagnosis.

3

Why? The imaging offered is one of the most sensitive imaging equipment offered.

3

This equipment has its advantages in that it can identify changes with neighboring soft tissues or bone marrow and can help medical experts with the extent and exact location of the inflammation.

3

This benefit includes the understanding of the thickness, fluid-sensitive sequences and inflammation to the soft tissue and bone marrow of the plantar fascia.

3

Ultrasound is a financially effective and common modality used to control pain, inflammation and can regulate quick results to improve function.

3-4

The MFR is a pressure technique that is known as a manual technique that allows healing by fibroblast proliferation with the results of increased lymphatic drainage and blood flow and provide a distraction to restricted tissue.

4

In fact, based on the Foot Function Index and the visual analogue scale, MFR showed better results than with stretching.

4

The PreOperative 5.2 mean to PostOperation 2.3 VAS difference in MTR was a significant improvement to a 5.8 Preop mean to 3.89 VAS difference in stretching.

4

Both techniques showed effectiveness for PF but MFR has provided better results.

4

No evidence has been offered, but it’s believed in theory that MFR also hydrates dehydrated tissues and because of that, it helps with overall ROM.

4

The effectiveness proven to stretching would also result in strengthening, increasing flexibility and reducing stress to the foot.

4

Another technique provided to PF patients is taping and it simply assists with the muscular activity and promotes healing with the protection ofeach dynamic or static movement.

5

When interventions or the conservative approach to treat PF fails, surgery is an option to provide relief.

6

During a recent study, a surgery called fasciotomy is considered to remove that stress and pressure by cutting the fascia.

6

It’s been determined that 5 % of patients don’t find relief from the interventions mentioned and that is when a fasciotomy should be considered.

6

The results from the surgery were encouraging and based on the AOFAS scale based on pain, function and alignment.

6

The postoperative score improved from 43.56 to 83.33 and 75.6% of heels evaluated experienced minor to no pain.

6

Patients improved in means of pain and function proving that surgery can be a safe procedure and alternative option if all else fails.

6

PF doesn’t discriminate by gender and is a serious impairment of foot deformities ranging from sedentary to active lifestyles.

1

Several case studies have been performed to determine the best approach to treat PF but with no real cause that makes things difficult.

1

A conservative approach would be to perform appropriate stretches to the Achilles and plantar fascia to help lengthen the muscles while improving flexibility and decreasing stress.

1



An MRI helps begin the process by determining the exact location of inflammation to the plantar fascia.

3

By performing ultrasound therapy to promote healing to improve blood circulation and decrease pain has been beneficial when performing treatments.

3-4

Those treatments can include MFR that release restricted tissues and stress from the trauma to the plantar fascia that can create those tears.

4

PF can become a significant issue and shouldn’t be pushed aside.

2

When treatments do not manage your symptoms, surgery can be a topic of discussion.

6

Surgery is a feasible option with early results of managing pain and provide function without changing your gait or posture to alleviate pain that can ultimately lead to other issues involving your hips, knees and feet.

2

References:

  1. Gurmeet Singh Sarla.  Treatment Modalities of Planter Fasciitis:  A Two Years’ Experience.  Research & Reviews:  Journal of Surgery.  2018;7(3):  21-23p.
  2. Plantar Fasciitis. Mayo Clinic.


    https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846


    .   Published 2018. Accessed July 31, 2019.
  3. AbdKadhim M, Al-deen NJ. Ultrasound and MRI Findings in Patients with Planter Fasciitis. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS).


    https://asrjetsjournal.org/index.php/American_Scientific_Journal/article/view/4914


    . Published 2019. Accessed July 31, 2019.
  4. Satish C. Pant, Dr. Dheeraj Lamba, Ritambhara K. Upadhyay, Dejene Kassahun.  Effect of Myofascial Release and Stretching Exercise on Plantar Fasciitis-A Randomized, Comparative Study.  International Journal of Current Research.


    http://www.journalcra.com/sites/default/files/issue-pdf/30912.pdf


    .  Published 2018. Accessed July 24, 2019.
  5. Natalia Sanchez, Brayan F. Contreras, Jose M. Garcia, Ruben D. Hernandez, Oscar F. Aviles.  Plantar Fasciitis Treatments:  A Review.  International Journal of Applied Engineering Research.


    http://ripublication.com/ijaer18/ijaerv13n17_39.pdf


    .  Published 2018. Accessed July 24, 2019.
  6. Huyer RG, Bittar CK, Carlos Daniel Candido de Castro Filho, Mattos CA, Cillo MSPde, Ribeiro JHT. Outcomes of plantar fasciotomy to treat plantar fasciitis. Scientific Journal of the Foot & Ankle.


    https://scijfootankle.com/ScientificJournalFootAnkle/article/view/899/1043


    . Published 2019. Accessed July 31, 2019.

Ethical Performance

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Using Leadership to Improve Ethical Performance

At this point, you should have identified the leader you would like to interview. You should also have already contacted him / her and have scheduled an interview time / date. If not, do it as soon as possible. The intention of this assignment is to describe leadership skills, ethics, and communication which impact motivation and improve ethical performance.

Write a three to four (3-4) page paper in which you:

Create five to seven (5-7) questions to ask your chosen leader to determine his / her views of motivation, ethical leadership and performance. Then, conduct the interview based on your selected questions.

HINT: The following are some examples of questions. Feel free to select them from here. However, we urge you to revise your Assignment 2 for some ideas of what you would like to know from an experienced leader.

How would you define leadership?

As a leader, what do you do when people on your team arent pulling their weight?

What is one of the greatest leadership challenges you have ever faced? What did you do? What was the result?

How would you describe your communication style?

Describe a situation in which effective interpersonal communication skills contributed to your success.

Describe your personal actions by which you convey to your staff that ethics/ethical behavior is a high priority with you and that you also expect it to be a high priority with your staff.

Related to the previous question, describe how your personal actions (demonstrating ethics is a priority) have impacted your staff and/or colleagues.

Describe a situation where you recognized a need to communicate clear expectations for ethical practice. How did you recognize that expectations had to be clarified? What did you do or say to clarify the expectations?

Analyze the leadership, motivation, and ethical values of the leader interviewed and assess its impact in the ethical performance of the organization.

HINT: You should summarize the answers that you gathered in your interview. Thereafter, you should compare and contrast his / her point of view about leadership with your own perception of it.

NURSING WAYS OF KNOWING CUSTOM ESSAY

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NURSING WAYS OF KNOWING CUSTOM ESSAY

There are several purposes for this assignment:
1. To provide you with an exploration of the concepts of nurses’ ways of knowing.
2. To provide an opportunity to reflect about your own ways of knowing.
3. To evaluate your written communication skills and your ability to organize your thoughts in a logical presentation.
4. To determine your mastery of APA format.

Requirements for this paper include:
1. Before beginning this assignment, please read the following documents (located in module two – Patterns of Knowing in Nursing – under the weekly learning modules button in blackboard):
a. Fundamental Patterns of Knowing in Nursing
b. Pedagogical Evolution
2. Before beginning this assignment, please read the following document (located in module three – The Art and Science of Nursing – under the weekly learning modules button in blackboard):
a. The Art and Science of Nursing: Similarities, Differences, and Relations
3. This assignment should state your understanding of nurses’ ways of knowing.
a. Define the 4 patterns of knowing (empirics, ethics, personal knowledge, and esthetics) described by Barbara Carper. Compare definitions that you find in the literature with those described by Barbara Carper.
b. Describe why these patterns of knowing are essential to the professional nurse.
c. Reflect upon how one of these patterns was used by you in the practice setting.
4. Length must be three (3) to four (4) content pages plus the title page and references page(s).
5. There must be at least five (5) references. You are expected to use the readings listed above as references and then locate an additional 2 or more references in the literature. You must include a minimum of three (3) journal articles from scholarly resources.
Note: A scholarly resource is defined in NURS486 as a publication written by academics, researchers, or other scholars. This publication communicates new research and scholarly ideas and may be called ‘refereed’ or ‘peer-reviewed’

Discuss cultural variations of health practices that can be misidentified as child abuse. Child abuse and maltreatment is not limited to a particular age and can occur in the infant, toddler, preschool, and school-age years.

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Discuss cultural variations of health practices that can be misidentified as child abuse.
Child abuse and maltreatment is not limited to a particular age and can occur in the infant, toddler, preschool, and school-age years.

Choose one of the four age groups (infant, toddler, preschool, or school age) and discuss the types of abuse that are most often seen in this age.

Discuss warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse.

Discuss cultural variations of health practices that can be misidentified as child abuse.

Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse.

Post at least 250 words (no introduction or conclusion) an explanation of your understanding of interprofessional practice.

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Post at least 250 words (no introduction or conclusion) an explanation of your understanding of interprofessional practice.

Interprofessional practice requires that health care practitioners recognize that patient outcomes are better when there is a collaborative team approach in addressing patient health issues. Also, there are barriers to interprofessional practice that must be addressed among health care practitioners. The Interprofessional Education Collaborative (IPEC) is an initiative including multiple professions designed to advance interprofessional education so that students entering health care professions are able to view collaboration as the norm and seek collaborative relationships with other providers (IPEC, 2011).

This week your Discussion will focus on interprofessional practice. This Discussion is an opportunity for you to examine your perspective and experiences with interprofessional collaborative practice and to apply your knowledge to managing patient care.
To prepare:

Identify a professional nursing organization and review their position on inter-professional practice

Review the following case study:

Case Study:

Ms. Tuckerno has been diagnosed with multiple sclerosis (MS). The patient receives care at an internal medicine clinic. Her internist is not in the office today and she is being treated by the nurse practitioner. The patient is on two medications for her MS, three different blood pressure medications, one medication for thyroid disease, one diabetic pill daily, insulin injections twice a day, she uses medical cannabis, and uses eye drops for glaucoma. Upon assessing the patient, the nurse practitioner (NP) decides her treatment plan should be adjusted. The NP discontinues some of the patient’s meds and discontinues medical cannabis. She orders the patient to follow up in two weeks.

The patient returns and is seen by her internist. The internist speaks with the patient and reviews her medical chart. The internist states to the patient, “I am dissatisfied with the care you received from the nurse practitioner.” The internist places the patient back on originally prescribed medications and medical cannabis.

Post at least 250 words (no introduction or conclusion)

an explanation of your understanding of interprofessional practice.

2. Also, explain the position on interprofessional practice for (The American Association of College of Nursing)

3 Then, explain what you think is the best collaborative approach to manage Ms. Tuckerno’s care.

Resources

Bankston, K., Glazer, G., (November 4, 2013) “Legislative: Interprofessional Collaboration: What’s Taking So Long?” OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 1.

DOI: 10.3912/OJIN.Vol18No01LegCol01

Hain, D., Fleck, L., (May 31, 2014) “Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign” OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 2.

DOI: 10.3912/OJIN.Vol19No02Man02

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative

Buppert, C. (2015). Appendix 11-D: Sample Professional Services Agreement. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (417-422). Burlington, MA: Jones & Bartlett.

Buppert, C. (2015). Legal Scope of Nurse Practitioner Practice. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (37-78). Burlington, MA: Jones & Bartlett.

What Does it Mean to be Healthy Reflective Essay

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Health, like beauty, lies in the eyes of the beholder and a single definition cannot capture its complexity. To this end, this essay aims to explore what health means to me and how it has been influenced by the experience of coping with my mother’s chronic illness. To me, health transcends the absence of disease to include the physical, psychological and social well-being of a person; it means the empowerment of the individual, and is the foundation of a fulfilling life; it also means caring about the people who care about you and whom you care about.

Describe

For a period of time, my mother has been complaining of pain in her joints, hips and more recently, her back. I always had a bad feeling that there was something sinister about her pain even though our general practitioner could not pinpoint anything serious after several differential diagnoses. However, as she has a family history of joint pains, I chose to be in a state of denial to her pain and attributed it to a ‘genetic’ condition she had that would go away with time.

However, that was not the case. My family observed that my mother was getting more emotionally irritable as time went by, and the nagging pain meant that she often found reasons not to take part in social activities that we organized. It got to the extent that she was constantly lying in bed and could not do her favourite activities, such as going to the market, without considering the amount of movements she would have to go through. The radiating pain also gave her sleepless nights and all these were taking a toll on her quality of life, among many other factors. It was debilitating. And as her daughter, I felt helpless. More so because I was studying medicine, and was plagued with the guilt of not being able to relieve the suffering of the person I loved the most.

The persistent pain worsened and my family decided to consult a specialist for a second opinion. A tumour was suspected. While the specialist made his diagnosis, I was very worried for my mother. I tried to prepare myself mentally to cope with the worst case scenarios, and this affected me emotionally and psychologically. I had no one to turn to as I did not want to worry others, and was at a loss of what to do. The results later revealed that my mother was diagnosed with a benign tumour (spine haemangioma). The specialist said that it was the lesser evil because it was not malignant, but that she would feel chronic pain throughout her life. What provided comfort to my family was the knowledge that there were treatments available to contain the tumour through methods such as radiotherapy and physiotherapy.

Reflect

It pains me to know that the person I love would be put through suffering both from the disease and its treatment, and I wished I could be the one going through it instead. Upon reflection, I realize that I had not been dealing with my emotions effectively. The fear of finding out more and my escapist mentality had prompted me to create an internal barrier, such that I could not provide the care and support for my mother as I would have liked her to have felt.

Health means the holistic wellbeing of a person

Witnessing her chronic suffering has made me realise that health does not merely mean the absence of disease but it requires a more holistic view which encompasses the physical, psychological and social well-being of a person. I used to think of health as merely the absence of physical pain that arose from diseases, and to this extent, the physician’s task of relieving “suffering” was merely to alleviate the immediate physical pain and discomfort. However the literature I was exposed to on the nature of suffering in ill persons made me come to the realisation of my limited understanding of the term “suffering”. Through my research to understand the multi-faceted dimension of a person, and what suffering entails, I hope to be able to better understand what my mother is going through (albeit only the tip of the ice berg).

Health means the empowerment of the individual, and is the foundation for a fulfilling life

As the Catalan proverb goes, “from the bitterness of disease, man learns the sweetness of health”. I have too often taken for granted the gift of health that empowers a healthy individual to pursue things that matter in life – not only one’s aspirations or happiness, but down to the little things that affects our everyday living. For instance, I have seen how the chronic pain influenced my mother’s daily routine, and brought much discomfort when travelling or doing household chores. I have come to appreciate that health enables individuals to use their body as a vessel to fulfil their dreams and satisfy their needs without being tied down or be restricted by suffering. Health is thus the basis which enables people to pursue happiness and wealth, aptly worded by Elbert Hubbard, who said, “If you have health, you probably will be happy, and if you have health and happiness, you have all the wealth you need, even if it is not all you want”. It takes a loss of health to appreciate these words of wisdom.

Health means caring about the people who care about you and whom you care about

I always thought of Health as merely a personal responsibility and a duty that an individual owed only to himself. However, this experience has prompted me to comprehend how the absence of health in individuals will affect the mental, social and physical health of their loved ones as well.

Research, analyse and connect

The academic literature available allows me to gain a deeper insight on what health means to me and allows me to make sense of my experience in a broader context through considering the perspectives of others.

Through examining the concept of human suffering brought about by the absence of good health, I learnt about the distinction between suffering and pain. A person who is in pain may not feel a proportional sense of suffering it is similarly possible for one to suffer even in the absence of pain. (Sanders 2009) In light of my mother’s chronic illness, I was prompted to examine the literature on human suffering which made me realised that my understanding of the word ‘suffering’ was limited at best. While I had always aspired to be a doctor to relieve the “pain and suffering” of people, I was of the view that human suffering was synonymous with physical pain brought upon an ill person due to diseases. However, literature has shown that suffering goes beyond the physical pain, and suffering defined merely as pain, disregards the “broader significance of the suffering” experienced by the ill. (Charmaz 2008)

Suffering includes physical pain, but it is not limited to it. It can be understood by examining the many aspects of a “holistic person” and when any of these aspects is threatened, suffering ensues. These aspects may include a person’s past, his or her role in society, relationships with others, day-to-day behaviour, and perception of the future. (Cassell 2004) The persistent pain my mother experienced affected her ability to do things that she had long associated herself with, such as playing tennis or climbing the stairs. In addition, my mother may have seen herself as being defined by several societal roles, such as being a wife, mother, caregiver to her parents, and a useful member of society. If the pain overwhelms her and restricts her from fulfilling these roles, she may see herself as being less than ‘whole’, and this may contribute to her perpetual suffering.

In considering the “holistic person” and the suffering which impacts upon the many aspects of a person other than physical afflictions, it confirmed my understanding that health should also mean the physical, psychological and social well-being of a person. By understanding the multiple aspects of a personhood, I now better appreciate why medical education is shifting its emphasis from the traditional reductionist biomedical model of medicine to the biopsychosocial model of health. The limitations of the biomedical model is that it treats diseases in terms of abnormal physical mechanisms (Engel 2002) and this is inadequate in relieving sufferings in patients, as we now understand it to transcend the physical mechanisms to also encompass the holistic well-being of a person. The implications of the failure of physicians to understand the nature of sufferings can “lead to medical interventions that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself”. (Cassell 2004)

This reflective practice also gives me a timely opportunity to evaluate my emotions and thoughts against that of the wider community. Relevant academic studies have shown that chronic illnesses also has an impact of the lives of caregivers. (Jung-Won & Zebrack 2004) The emotions and thoughts that I felt were validated by researchers that show that receiving news of the chronic illness of a loved one can provoke emotions such as sadness, denial, grief and guilt. This may be due to guilty feelings of not giving adequate support to the ill person or it could be due to the emotional pain of feeling the loss of a loved one’s health. (McIntyre 2005) It is important to attend to the impact of chronic illness on caregivers as research has shown that the holistic health of a caregiver has the potential to influence the health outcomes of persons with chronic illness. (WE 1999) Suggested methods of coping with these emotions include talking to someone; being informed about the disease as it gives the caregiver a sense of control; and accepting that there is a limit to the relief that a caregiver can provide. (familydoctor.org 2010)

Decide, act and evaluate

In light of the reflective writing and the academic literature reviewed, I hope that this will help me to come to terms and cope with the negative emotions I felt since receiving news of my mother’s tumour. I can approach this by confiding in someone I am comfortable with, confronting my escapist mentality by finding out more about my mother’s spinal haemangioma, and being aware of the treatments that she is going through. Her treatment is likely to expand over a long period of time, and she would need much emotional support and love from me. I have to be open to discussions about her illness and not evade any conversation on the topic as I did before.

This reflective practice has also helped me to be more understanding and sensitive to the suffering of patients and their families. As a medical student, I have been made aware that the suffering of patients extends beyond physical pain, and that it is necessary for physicians to focus on patient-centred medicine and attend to the biopsychosocial model of health. It is also important to be aware of the impact that caring for a chronic ill patient has on the caregiver. To this end, I can be proactive as a future practitioner in asking caregivers how they are coping, and provide them with support services that they can turn to. I have also realised the important roles that practitioners play in preparing caregivers for the transition of roles to care for the ill, and in helping them anticipate changes that may occur in their lives. This gives caregivers a better sense of control over the situation, and increases their confidence in caring for the patient.

A major takeaway from reflecting on what health means to me has been my understanding of the importance of medical practitioner to focus not only on curing diseases but also to relieve the sufferings of patients, understood holistically. To me, health transcends the absence of disease to include the physical, psychological and social well-being of a person; it means the empowerment of the individual, and is the foundation of a fulfilling life; it also means caring about the people who care about you and whom you care about.

Strategies for teaching phonological awareness

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Strategies for teaching phonological awareness.

Part 1: Strategies

Research and summarize, in 250-300 words, a minimum of five strategies for teaching phonological awareness, identifying the conditions under which they are intended to be delivered (e.g., content area, class setting, required resources, if intended for a specific type of disability) for students with exceptionalities.

Include a minimum of 2-3 scholarly resources to support your findings.

Part 2: Activity

Identify a group of 2-3 students, using the “Class Profile,” who would benefit from phonological awareness review.

Upon identifying your group, review the foundational skills within the Common Core English Language Standards.

Create a worksheet that emphasizes phonological awareness and is aligned with the Common Core foundational skills standards. Your worksheet should also emphasize at least one of the identified strategies from Part 1 of this assignment, and be appropriate for your chosen small group.

Include a 250-300-word rationale for your instructional decisions, applicable to the chosen small group.

Prepare this assignment according to the APA guidelines found in the APA Style

critique a quantitative and either a qualitative or a mixed methods research study and compare the types of information obtained in each.

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Critique a quantitative and either a qualitative or a mixed methods research study and compare the types of information obtained in each.

 

Critiquing Quantitative, Qualitative, or Mixed Methods Studies

Critiquing the validity and robustness of research featured in journal articles provides a critical foundation for engaging in evidence-based practice.. For this Assignment, you critique a quantitative and either a qualitative or a mixed methods research study and compare the types of information obtained in each.

To prepare:

• Select a health topic of interest to you that is relevant to your current area of practice and that is different from your Course Project (course project is on hand washing)

• locate two articles in scholarly journals that deal with your topic. One article should utilize a quantitative research design while the other should utilize either a qualitative or a mixed methods design.

• Locate the following documents in this week’s Learning Resources to access the appropriate templates, which will guide your critique of each article:

o Critique Template for a Qualitative Study

o Critique Template for a Quantitative Study

o Critique Template for a Mixed-Methods Study

• Consider the fields in the templates as you review the information in each article.

• Begin to draft a paper in which you analyze the two research approaches as indicated below.

• Reflect on the overall value of both quantitative and qualitative research. If someone were to say to you, “Qualitative research is not real science,” how would you respond?

To complete this Assignment:

• Complete the two critiques using the appropriate templates.

• Write a 3-page paper that addresses the following:

o Contrast the types of information that you gained from examining the two different research approaches in the articles that you selected.

o Describe the general advantages and disadvantages of the two research approaches featured in the articles. Use examples from the articles for support.

o Formulate a response to the claim that qualitative research is not real science. Highlight the general insights that both quantitative and qualitative studies can provide to researchers. Support your response with references to the Learning Resources and other credible sources.

Critique Template for a Quantitative Study

NURS

Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies (due by Day 7 of Week 7)

Date:

Your name:

Article reference (in APA style):

URL:
What is a critique? Simply stated, a critique is a critical analysis undertaken for some purpose. Nurses critique research for three main reasons: to improve their practice, to broaden their understanding, and to provide a base for the conduct of a study.

When the purpose is to improve practice, nurses must give special consideration to questions such as these:

• Are the research findings appropriate to my practice setting and situation?

• What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness?

• How might a proposed change in practice trigger changes in other aspects of practice?

To help you synthesize your learning throughout this course and prepare you to utilize research in your practice, you will be critiquing a qualitative, quantitative, or mixed methods research study of your choice.

For your critique, select one of the research articles that you included in your literature review. you must e-mail the article as a PDF or Word attachment to your Instructor.
QUANTITATIVE RESEARCH CRITIQUE

1. Research Problem and Purpose
What are the problem and purpose of the referenced study? (Sometimes ONLY the purpose is stated clearly and the problem must be inferred from the introductory discussion of the purpose.)

2. Hypotheses and Research Questions
What are the hypotheses (or research questions/objectives) of the study? (Sometimes the hypotheses or study questions are listed in the Results section, rather than preceding the report of the methodology used. Occasionally, there will be no mention of hypotheses, but anytime there are inferential statistics used, the reader can recognize what the hypotheses are from looking at the results of statistical analysis.)
3. Literature Review
What is the quality of the literature review? Is the literature review current? Relevant? Is there evidence that the author critiqued the literature or merely reported it without critique? Is there an integrated summary of the current knowledge base regarding the research problem, or does the literature review contain opinion or anecdotal articles without any synthesis or summary of the whole? (Sometimes the literature review is incorporated into the introductory section without being explicitly identified.)
4. Theoretical or Conceptual Framework
Is a theoretical or conceptual framework identified? If so, what is it? Is it a nursing framework or one drawn from another discipline? (Sometimes there is no explicitly identified theoretical or conceptual framework; in addition, many “nursing” research studies draw on a “borrowed” framework, e.g., stress, medical pathology, etc.)
5. Population
What population was sampled? How was the population sampled? Describe the method and criteria. How many subjects were in the sample?
6. Protection of Human Research Participants
What steps were taken to protect human research subjects?
7. Research Design
What was the design of the study? If the design was modeled from previous research or pilot studies, please describe.
8. Instruments and Strategies for Measurement
What instruments and/or other measurement strategies were used in data collection? Was information provided regarding the reliability and validity of the measurement instruments? If so, describe it.

9. Data Collection
What procedures were used for data collection?
10. Data Analysis
What methods of data analysis were used? Were they appropriate to the design and hypotheses?11. Interpretation of Results

What results were obtained from data analysis? Is sufficient information given to interpret the results of data analysis?

12. Discussion of Findings
Was the discussion of findings related to the framework? Were those the expected findings? Were they consistent with previous studies? Were serendipitous (i.e., accidental) findings described?
13. Limitations
Did the researcher report limitations of the study? (Limitations are acknowledgments of internal characteristics of the study that may help explain insignificant and other unexpected findings, and more importantly, indicate those groups to whom the findings CANNOT be generalized or applied. It is a fact that all studies must be limited in some way; not all of the issues involved in a problem situation can be studied all at once.)
14. Implications
Are the conclusions and implications drawn by the author warranted by the study findings? (Sometimes researchers will seem to ignore findings that don’t confirm their hypotheses as they interpret the meaning of their study findings.)

15. Recommendations

Does the author offer legitimate recommendations for further research? Is the description of the study sufficiently clear and complete to allow replication of the study? (Sometimes researchers’ recommendations seem to come from “left field” rather than following obviously from the discussion of findings. If a research problem is truly significant, the results need to be confirmed with additional research; in addition, if a reader wishes to design a study using a different sample or correcting flaws in the original study, a complete description is necessary.)

16. Research Utilization in Your Practice

How might this research inform your practice? Are the research findings appropriate to your practice setting and situation? What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness? How might the utilization of this research trigger changes in other aspects of practice?

Recommended Litreture

• Cantrell, M. A. (2011). Demystifying the research process: Understanding a descriptive comparative research design. Pediatric Nursing, 37(4),

The author of this article discusses the primary aspects of a prominent quantitative research design. The article examines the advantages and disadvantages of the design.

• Schultz, L. E., Rivers, K. O., & Ratusnik, D. L. (2008). The role of external validity in evidence-based practice for rehabilitation. Rehabilitation Psychology, 53(3), 294–302..

This article details the results of a study that sought to balance concern for rigor with concern for relevance. The authors of the article derive and determine a rating format for relevance and apply it to cognitive rehabilitation.
• Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18–25..

• Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of Nursing Care Quality, 24(4), 325–331.
• Yuan, S.-C., Chou, M.-C., Hwu, L.-J., Chang, Y.-O,, Hsu, W.-H., & Kuo, H.-W. (2009). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing, 18(10),1,404–1,411.