Legal and Ethical Issues Related to the Workplace: Board of Nursing – Nurse Practice Act and the efficacy of the BON’s

/in /by

Legal and Ethical Issues Related to the Workplace: Board of Nursing – Nurse Practice Act and the efficacy of the BON’s

Workplace Related Legal and Ethical Issues
Due Day 7 of Week 5
Write a four to five page paper addressing how your chosen work-related issue/problem from the week two discussion is addressed by your state Board of Nursing (BON) and other professional nursing organizations. Use the following guidelines and evaluation criteria.
Include level-one APA headings in your paper using the section headings below. Use a minimum of five references from the professional nursing literature in the assigned course readings and other references in the Walden Library. In addition, you may use one or two professional web sites if relevant to your topic.
Begin this paper with a brief paragraph that provides an overview of the assignment and its purpose. The heading for this paragraph is the same as the title of the paper. This should be no more than two to three sentences. The last sentence in this paragraph is a sentence that begins “The purpose of this paper is to. . . . The introductory paragraph is worth 20 points.
Workplace Issue – 40 points
Describe your chosen workplace issue from the week two discussion board. Provide a background to the issue and discuss why it is important to address.
The BON and Workplace Issue – 60 points
Explain your state’s Board of Nursing (BON) approach to your work-related issue in the BON’s Nurse Practice Act and the efficacy of the BON’s approach in the context of your workplace issue/problem. For example, how does your state BON’s approach to threats of patient abandonment apply to the issue of mandatory overtime?

The American Nurses Association and Your Workplace Issue – 60 points
Describe two American Nurses Association (ANA) sources from the ANA publication that address your work-related issue and the efficacy of the ANA’s approach in the context of your work environment. Resources are provided in the Week 5 Resources areas of the course,
Summary – 20 points
End the paper with a one-paragraph summary of the main points of the paper.
Format/Style
Proofread the paper and correct any typos, grammar, spelling, punctuation, syntax, or APA format errors before submitting your pape. Up to 30 points can be deducted from the grade for this assignment for these types of errors, or for not using at least the minimum number of required professional literature references.

Discuss the differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level.

/in /by

Discuss the differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level.

Write a formal paper of 750-1,000 words that addresses the following:
1.Discuss the differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level.
2.Identify a patient care situation in which you describe how nursing care or approaches to decision-making may differ based upon the educational preparation of the nurse (BSN versus a diploma or ADN degree).

Care Planning for Adolescent Patient

/in /by


AC 1.1

Explain the job role in relation to your patient. What exactly will they do and why?


Tanisha

, Tanisha, 16, has been waiting with a friend to be seen. She hurt her wrist at the local skate park practicing on the ramps and also has a cut to her left leg. The triage nurse is trying to persuade her to give the contact details for her parents.

Charlie Rutter, the Children’s Nurse is called to assess Tanisha. The patient is 16 years old, which means that she is grown-up enough to give consent to her own treatment. “Like adults, young people (aged 16 or 17) are presumed to have sufficient capacity to decide on their own medical treatment, unless there’s significant evidence to suggest otherwise” (NHS, 2019). However, the Children’s Nurse plays an important role in trying to encourage the teen patient to involve the parents in their decision. If, despite the encouragement, Tanisha refuses to share information with her parents, her wish must be taken into consideration by a healthcare professional (Great Britain, Department of Health, 2001). Nurses must comply with the

NMC Code

which clearly states that all nurses ‘’owe a duty of confidentiality to all those who are receiving care. This includes making sure that (…) information about them is shared appropriately’’ (NMC Code, 2015).

Charlie will provide Tanisha with all the information about the treatment that can be offered. Firstly, the Children’s Nurse will do the observations, such as taking the pulse, respiration, saturation, blood pressure, temperature, weight, and height. She will prepare and make up a folder with patient’s notes and details such as GP address, patient’s address and any kind of allergies. She will check if the patient is wearing an appropriate wristband and also classify the pain score of the patient. As the patient has a cut in her left leg, the Nurse must assure that the patient is not bleeding any further and then attend to the wound. After this intervention, Charlie will pass over all the information about Tanisha to the Junior Doctor who will follow up the patient. Afterwards, if any surgical procedure is necessary, the Children’s Nurse will be responsible for monitoring and administering medications and intravenous infusions.

The competent Nurse must have the ability to deal with various challenges, thinking critically and being able to apply her knowledge and skills into her practice as well as work within a multidisciplinary team (Storey, Gillies and Howard, 2002). Additionally, according to Bowcott (2009), the basics of nursing care encompass dignity, compassion and, above all, safety.

(306 words)


AC 1.2

Choose at least two other practitioners from the case study who will be involved with your patient and analyse the similarities and differences between their job roles and that of your chosen practitioner. Include at least one non-professional role from those listed over page.

Two other practitioners who will be involved in Tanisha’s case are Dr Dan Foster (Junior Doctor) and Sunni Hasan (Health Care Assistant). In the same way as nurses, they are committed to deliver a positive experience of care to Tanisha, ensuring she will have the competent staff with the right skills working towards her well-being.

Communication is also important when treating a child or dealing with parents. Nurses, Doctors, and Health Care Assistants need to make sure that their communication is understandable and clear. All of these professionals must use the 6Cs values which are: care, compassion, competence, communication, courage, and commitment (Bennett, 2013).

On the other hand, they have specifics roles to be played when it comes to looking after a patient. Tanisha will be assessed and supported by her Children’s Nurse Charlie, who is regulated by the NMC. She is specialized in the Paediatric field and trained to perform a complex variety of clinical tasks. She is responsible for caring and supporting the patient’s needs before and after the surgical procedures and administrating medications. Some experienced nurses who have completed a Prescribing Course might even prescribe the medications (Dowden, 2016).

Doctors are also registered and regulated professionals. Compared to nurses, their roles include much more decision-making especially when it comes to diagnosing and treatment. Nurses do not decide which treatment the patient will receive but they deliver care and carry out interventions ordered by doctors.

Similarly to Nurses, HCAs also give care to the patients, such as feeding, washing and monitoring, however, their job is non-professional. They are not regulated and do not have a professional register. HCAs cannot administer drugs and they perform tasks delegated by nurses within their level of competence. Sunni Hasan, the HCA, will assist Charlie Rutter, the paediatric nurse, giving the necessary care and support within her limitations as HCA. She must also encompass the 6Cs values in her practice (Bennet, 2013).

(319 words)


AC 2.1

Analyse at least 4 important professional qualities/values (not skills) which your chosen professional should demonstrate with your chosen patient (what, why, how?)

Skills, abilities and knowledge can be developed, but qualities and values are built at home within family and/or social environment. Some values can be considered intrinsic such as solidarity, compassion, tolerance, respect for others and responsibility. In 2012, the Department of Health published the document “Compassion in Practice” which sets out six keys values for healthcare professionals: care, compassion, competence, commitment, communication and courage.

Tanisha, is a 16-year old child, in the emergency department, scared, with pain in her wrist and with a cut in her left leg. Surely, she is afraid of both her pain and her parents’ reaction. Having Charlie as her Children’s Nurse will help her to calm down and make her feel safe. The nurse must show compassion which requires empathy, respect and dignity. Charlie must demonstrate solidarity, tolerance, and respect as her patient does not agree to contact her parents.

Junior Doctor Dan Foster has the responsibility to diagnose accurately the patient’s wrist. He needs to make the decision whether he is sending Tanisha home with any prescribed medications or whether the patient needs more investigations like an X-ray. He will precisely make use of the competence value.

When it comes to Sunni Hassan, she will follow the instructions from the Nurse Charlie and Doctor Dan. She needs to be a good listener. Effective communication which is one of the 6Cs values, is essential to effective team working (Great Britain, Department of Health, 2012).

(239 words)


AC 3.2


Evaluate the importance of supervision and teamwork for the professionals caring for your patient.

The teamwork in the healthcare field is essential for the quality of care delivered. It is a process that involves a group of professionals and non-professionals working towards a common and shared objective: the patient’s wellbeing. The team needs to know and understand the roles of the particular team members in order to work efficiently.

To deliver efficient and high quality care, it is crucial to understand the roles. In Tanisha’s case, these roles are performed by Children’s Nurse, Healthcare Assistant and Junior Doctor. They all have different responsibilities and they will participate in Tanisha’s care. They will make some of the decisions jointly as the care is made up of a collaboration of all members. Poor communication or conflicts between the team members may result in less efficient patient care.

Another important aspect improving the quality and communication among professionals is the supervision (The NMC Code, 2015). The appropriate delegation of responsibilities and tasks considering the team members’ knowledge and capabilities is imperative. The team is supervised by a leader who delegates, guides and motivates the members. Charlie will supervise HCA to make sure she performs her tasks accordingly.

(190 words)


Reference


Bibliography

Explain stress management programme in reducing stress of midwives

/in /by

Explain stress management programme in reducing stress of midwives

 

 

I need to reorganize the search strategy. remaning part i need paraphrasing. Search strategy:

AMED, CINAHELL, MIDLINE, PUBMED, HMIC and British Nursing Index

They are used in searching for last updated data, e-books and journals that related to assignment topic. Additionally, some books was found via manual type of searching through libraries, such as Oman nursing Specialized Institute library and Grant Mosque library in Oman. Published Journals in English language within specific time between 2005-2015 included which talk about stress in nursing and midwifery only. Throughout searching, 128 articles were found, however, 108 articles were canceled according to specific exclusion criteria : not in English, more than 10 years , stress not for nurses and midwives and not published journals. As a result 38 articles have been involved in dissertation. They were ranged within quantitative, qualitative, systematic review, explorative and cross-sectional types of literature review. The key words that have been used are: stress, work-related stress, nursing, midwifer, midwives, burnout, turnover, coping strategy and stress management. Throughout searching process, developing of three themes was occurred: causes of work-related stress, effect of work-related stress for midwives and effect of coping strategy and stress management.

2-chapter

As for being a transformational leader, it is vital to communicate, educate, train, motivate and share the task and provide a supportive climate to move the actual change process onwards. Supervision is needed, however, to assess the task, illuminate the enquiry; help the midwives when necessary and encourage them. Generally, effective communication skills are imperative for the leader to overcome conflict to carry on the change process.

Effective communication helps in building interpersonal relationships which allow the leader to identify the barriers. These barriers should be discussed between the team members. For example, midwives have a negative response to reporting WRS, long working hours, fatigue (Lim et al. 2010a). It may also be derived from fear, insecurity, biases, prejudices, loss of power, financial, social, cultural and religious barriers, time and refusal to accept any change. In this dissertation, the leader predicts all the barriers to overcome to increase the productivity and job satisfaction to reduce WRS and burnout. The leader can utilise some approaches to conquer these barriers such as setting effective objectives, cost effectiveness and an economic setting to promote the organisation to implement the change (Marquis and Huston 2012 ; Roussel 2012).

Moreover, uncertainty of the role can exaggerate the conflict. Therefore, the leader could use Powerpoint presentations to develop members’ knowledge, skills and to converse about ideas, responsibilities and decisions (vhYoder-Wise 2011). The National Institute for Health and Clinical Excellence (NHS) (2007) stated that awareness is a useful concept throughout the change plan accordingly; education materials such as research papers will be useful (NHS 2007). In fact, supporting the change with evidence will aid in improving midwives’ well-being and satisfaction with the organisation.

3.3.3 Norming stage

In this stage, a feeling of team members’ cohesion develops and the change is sustained at the same level (Kelly 2012). The team masters the capability to resolve conflict to facilitate the change. Although comprehensive resolution and agreement may perhaps not be achieved all the time, leader and group members learn to respect others opinions and can work together to attain team goals. They have to keep the change advanced and if restraints arise the leader has to identify the effective solution to minimise it.

The planned change will be implemented in this stage. This stage is similar to Lewins moving phase where the driving and restraining forces take place. Besides this,’Lewin’s model underlined that the accurate balance is vital among those forces for change to arise. In this proposal, evidence-based practice is the driving force which comes across at the causes, effects and coping strategies of WRS stressed in the above literature review (Lim et al. 2010a; Kalicinska et al. 2012). Additionally, this change idea is to build a support team and to keep midwives away from damage.

In this stage, team unity, teamwork and harmony are obvious. Team members know their roles and responsibilities and they also rely on each other to accomplish the task. Moreover, continuing and improving interpersonal relationships is one of the strengths for this stage. ONMC (2011) highlights the importance of teamwork among midwives in facilitating positive outcome. The transformational leader can use this opportunity to delegate the task to the followers and encourages their creation of new ideas. Particularly, team work, task distribution and work organisation aid in the driving force. This will aid the leader to move to the fourth stage.

3.3.4 Performing stage

This is the final stage where team cohesion, collaboration and maturity are obvious (Kelly 2012). Moreover, the leader of the team is working to achieve the goals without any disagreement. The team members adjust and take part in roles that will improve the task activities. Roles become more flexible and practical, and team energy is directed to the task.

Lewin’s refreezing phase concerns the evaluation of the accomplished task and outcomes to make sure the change is in the organisational plan. Evaluation considers that the whole thing is done according to the plan (Marquis and Huston 2012). In the evaluation, the effectiveness of the performance is assessed and modifications are arranged to ensure the goals achievement (Kelly 2012). Reports, questionnaires and records are examples of evaluation that aid the successful progress and use of suitable resources. Evaluation also maintains the change as stable and effective due to its continuous process. Here the transformational leader’s role is to summarise the team’s accomplishments and should provide feedback about team process to ensure a sense of task accomplishment in the team members. As well as reporting any midwives’ absenteeism, turnover and burnout to compare to earlier reports and this also benchmarks all health institutions where the change is not practised. The setting will be reassessed and checked for any misplaced materials to re-evaluate midwives’ satisfaction and provide more education if required.

The evaluation will be carried out after three months to ensure the effectiveness of the introduced changes. The primary outcome will be minimising WRS following using the team support as a coping strategy. This will increase midwives’ efficiency, job satisfaction and reduce burnout within the ward. The feedback will be discussed with the team members to maintain the introduced changes. Obviously, evaluation is a continuous process where the leader has to express specific goals, expectations principles and also plans to formulate a successful change. All team members must know the vision and mission as well as the anticipated outcomes (Ellis and Abbott 2011). Finally, this process will compare the reduction of midwives’ burnout and sickness rate and increase job satisfaction.

3.10 Conclusion

The reviewed literature showed the value of following a change process to minimise stress. Tuckman’s Model has been used as a framework to build a team and implement change. Additionally, informing the team regarding the change and using driving force could help in overcoming the barriers (Huber 2006). Moreover, change is necessary to provide the best midwifery care based on evidence-based practice.

Chapter Four

4.1 Conclusion

Stress has been known as a vital problem that influences midwives in organisations. The midwives suffer from stress because of recurring exposure to stressful events which according to the literature are conflict, workload, night shift, and long working hours. These influence the midwives’ well-being, physical and psychological conditions which in turn affect the organisation. The evidenced literature suggested some strategies to minimise WRS among midwives. These include support and early training and education about stress to overcome it. Gates and Gillespie (2008) stated that early training and education can be done through assigning different responsibilities to staff, supervisors and administration.

Tuckman’s Model, Lewin’s theory and transformational style to leadership was utilised for the change to take place. Leadership style, effective communication, suitable environment, adequate support, appropriate selection of approaches and use of the change model are essential components to guarantee that the change takes place. Tuckman’s model of change was clearly utilised and its application was explained. The four stages were used to agree with the accomplishment of a change (forming, storming, norming and performing) were used. The leader was recognised to lead the change throughout the change process. The change plan was explained in detail and the change process was identified. Conflict to change was anticipated throughout the change process and conversely the leader will invest in the actual change and adjust it according to the requirements.

This dissertation developed the knowledge and skills in leadership and change management and helped in application of leadership style, change model and strategies in the healthcare setting to improve midwifery practice and empower evidence-based practice. The proposed plan of change will be submitted to the local hospital administration for approval to implement the change in the DS.

The reviewed literature suggested that the organisation ought to pay attention to midwives’ health and well-being. Moreover, it is recommended that the midwives should receive continuous education and training. Finally, a leader is a change facilitator and may face many challenges and resistance in the change process.

Mental Health Case Study: Generalised Anxiety Disorder (GAD)

/in /by

Mental health, Amir Daud case study


  1. Later in your initial discussions with Amir you think he may be having an anxiety disorder. Identify the character of anxiety disorder Amir is likely to be experiencing and what constituents in his history indicate this type of upset.

Amir is highly likely to be experiencing Generalized Anxiety Disorder (GAD) which results from too much sympathetic activation of the neural system. It makes the person experiencing it gets constant nervousness that leads to a negative impact on both physical and emotional health status. It significantly interferes with the normal behavior path of the individual at its mercy. Amir spent two years in torturous detention in Afghanistan, which was a time of constant uncertainty and anxiety followed by a perilous journey to Australia. While he was in detention, he witnessed many episodes of self-harm by fellow detainees who had lost hope and pessimistic about their future welfare which have contributed to increasing Amir’s trauma and anxiety state. The fact that he felt powerless in his situation aggravated his stress levels because he lacked hope or someone or something that would help secure it in that hopeless state of personal business.

Amir is also battling with mild depression from worrying too much about the family he left behind as he says he feels guilty because he is aware they are still facing persecution. He blames himself for not being able to rescue them from that situation. In addition, Amir is required to secure himself employment, only he feels quite the opposite due to his impatience and poor absorption.

The major symptoms of this disorder include restlessness, exaggerated startle response, sleep disturbance, difficulty in concentrating, irritability and tremor. The symptoms must have occurred days than not for at least 6months and must cause clinically important distress or impairment in social, occupational or other significant areas of functioning’ (APA, 2000). According to Sigmund Freud, His type falls under Neurotic category of which is defined as the anticipation of negative consequences that activate defensive processes. This is as a consequence of his experience in the detention which he says makes him sleep poorly and development of negative intrusive thoughts during his waking time in the morning.

Possible Treatments that could be administered to Amir include pharmaceutical medication (SSRIs and Benzodiazepines) or herbal extracts made from a relaxant made from the root of the kava plant (Hall, 1998).


References

Derek Hayes, A. G., Suhaini, M. J., & Kassim, K. K. (2014).

Hope and Mental Health Nursing.

LinkedIn Corporations.

Hall, R. H. (1998).

Anxiety Disorders.

Psychiatryonline. (2014).

Neurobiology of Anxiety Disorders

. Retrieved March 31st, 2014, from

www.psychiatryonline.org

:

http://psychiatryonline.org/content.aspx?bookid=29&sectionid=1361949

School, I. S. (2008). Neurobiology of Anxiety Disorders. In I. S. School. Russia: St. Petersburg.


  1. Explain what is meant by the neurobiology of anxiety.

Anxiety is a psychological and a behavioral state commonly characterized by avoidance behavior which affects a patient emotionally and psychologically. Neurobiology of anxiety is the classification of all anxiety disorders that affect the brain emotional states. These emotional states could be anxiety about the future, fear of the present or depression about events that occurred in the past. There are many different categories of the neurobiology of anxiety as listed below.

Generalized anxiety disorder (GAD) which is most common in young adults like Amir. It’s the fear, anxiety and depression associated with reaction to any dangerous situation

.

(Psychiatryonline, 2014)

.

GAD is more likely than not to be confused with other anxiety disorder types. For one to conclude that a patient has it, they must identify four symptoms from the first rank list and at least one from the second list.

First rank

  • Inability to relax or restlessness
  • Fatigueability
  • Exaggerated sudden response
  • Muscle tension
  • Poor sleeping habits
  • Poor concentration
  • Easily irritable

Second

  • Nausea or abdominal complaints
  • A Dry mouth
  • Tachycardia
  • Tremor

Stress disorders

(

Post traumatic stress disorder- PTSD) and Phobias which are divided into specific and social phobia. These are characterized by a general feeling of dissociation from reality.

Panic disorders (With or without agoraphobia) -Attributes are manifested by intense apprehension, terror, fear often associated with feelings of hopelessness and intense physical discomfort. Attacks usually last for a short while and rarely take hours. In case they are accompanied by agoraphobia, there is a fear of being in places or Situations from which escape might be hard or in which help might not be available in the event of a panic attack (Diagnostic and statistical manual of mental health, 2000)

Agoraphobia without history of panic disorder- The (Diagnostic and statistical manual of mental health, 2000) identifies the essential feature of this disorder as fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of suddenly developing a symptom that could be incapacitating or extremely embarrassing.

Obsessive-Compulsive Disorder (OCD) –This is characterized by involuntary recurring thoughts or images that the patient is not able to dispense. The victims feel powerless despite them knowing that it’s irrational behavior. The four general categories are: counting, checking, cleaning and finally avoidance. They happen frequently, which consequently interferes with normal daily activities.

Acute Stress Disorder-It’s an anxiety disorder due to a general medical condition. Symptoms of are judged to be the direct physiological consequence of a general medical condition. They may include prominent generalized anxiety symptoms, panic attacks, or obsessions or compulsions (APA, 2000)


References

APA. (2000).

Diagnostic and statistical manual of mental health

(4th Ed.). DSM-IV-TR: American Psychiatric Assocaition press.

Psychiatryonline. (2014).

Neurobiology of Anxiety Disorders

. Retrieved March 31st, 2014, from

www.psychiatryonline.org

:

http://psychiatryonline.org/content.aspx?bookid=29&sectionid=1361949

School, I. S. (2008). Neurobiology of Anxiety Disorders. In I. S. School. Russia: St. Petersburg.


  1. Why is hope relevant in mental health nursing practice? How might you incorporate this concept in subsequent therapeutic communication with Amir? What other elements of communication might you employ?

Hope is a vital element in any human’s life and is a pivotal act in any mental health nurse. It helps people with any medical problem get assurance about their situation, whether or not the treatment or recovery is complete. Kylma and Vehvilainen-Julkunen (1997) described it as an experience, emotion or need. The term in nursing is regarded as being dynamic and helps in rebuilding a patient’s self-worth and how they regard themselves which acts as a complementary treatment.

Amir needs to be shown unconditional acceptance, understanding and tolerance to help him overcome his disorder condition. A patient who believes that their situation can change through professional guidance and hard work from their end does find a way out of their situation. The reason the placebo effect is important when dealing with patients like Amir. The nurse-client relationship with Amir’s case needs to be on a personal level, to breed trust and a sense of value. Recognizing that Amir’s case is difficult will be the first step to helping him since for him to feel inspired by the therapeutic communication; he must feel the same energy from the nurse. There are different ways in which one can inspire hope especially in Amir’s case. They include:

Educating Amir of his condition, treatment and assuring him that he can still achieve all his goals and objectives like any normal human being.

Group therapy –This is where the assessor tries to interact with the patient with a group of other patients with more or less similar anxiety disorders with the aid of a leader to help them resolve interpersonal problems. Groups bring a sense of security and trust that they not battling their condition alone. More often, this results in positive outcomes in almost all cases.

Humor-Using humor to help Amir arouse happy thoughts and avoid the negative thoughts he gets during his waking time. Humor results to laughter which has been proven to be therapeutic.

Spiritual aspect-Here one tries to introduce spirituality, faith in the patient, which is a form of faith in all religions.

Psychoanalysis-The main goal will be to reduce his anxiety and guilt through verbal processes.

Conduct Humanistic therapy to help him fulfill his full potential and improve self concept.

Conduct Behavior and cognitive therapy to help him change unwanted abnormal behaviors and acquire desirable ones through revising his thoughts and behavioral training.

Later, Amir can be engaged in the assessment of his hope level to monitor any progress. Use of Herth Hope Index (HHI) rating where higher rate shows a high level of hope and subsequent opposite are an indication of low self-worth and depression.

Amir detachment from the normal world could drive him to commit suicide and thus the nurse need to do a full assessment on his level of hope. Effective communication of the management plan and encouraging self-help strategies will also play a big role during management discussion with Amir.


References

Derek Hayes, A. G., Suhaini, M. J., & Kassim, K. K. (2014).

Hope and Mental Health Nursing.

LinkedIn Corporations.

Psychiatryonline. (2014).

Neurobiology of Anxiety Disorders

. Retrieved March 31st, 2014, from

www.psychiatryonline.org

:

http://psychiatryonline.org/content.aspx?bookid=29&sectionid=1361949


  1. Define what is meant by ethnicity. Given Amir’s ethnic background explain what cultural assessments you might make in planning his ongoing care.

Ethnicity refers to a state in which an individual belongs to a certain social group which happens to share common national, customs or cultural traditions. Amir is ethnic Hazara. The Hazara people have for a long time been the victim of discrimination in Afghanistan. At the refugee camp the people there are more likely to be of the same ethnicity with Amir. This will make it easier for Amir since he will feel a sense of belonging while interacting with people who share his cultural values and origin.

I would use a cultural assessment tool to help me get all the information about Amir cultural background. Details I would include in the assessment area include: –

The primary language spoken by Amir, how he communicates with other people who speak a different language, whether he requires an interpreter or not, the highest level of education he has attained, whether his condition has ever occurred before, if it did in what manner was it handled, what are his normal ways of coping with stress?

Let Amir describe his family living arrangements, the major decision maker in the family, his religious beliefs and any religious requirements or restrictions that may place limitation to his care, any special belief and practices that may vary from the conventional ways, from whom has the family been seeking help from.

Additionally, the following questions should help in cultural assessment.

  • Are there any topics that are particularly sensitive or unwilling to discuss (because of cultural taboos)
  • Are there any activities in which Amir is unwilling to participate (because of cultural customs or taboos)
  • What are the Amir’s personal feelings regarding touch?
  • What are his personal feelings regarding eye contact?
  • What is his personal orientation to time? (Past, present, future)
  • Any particular illnesses to which the Amir may be bioculturally susceptible?

All the above questions will help gather any possible information regarding the Hazara ethnic group which will help in treatment program recommended to Amir while he is in Australia. It will also help the employer of his religious and ethnic practices to avoid stigmatization.


References

Mary C.Townsend, D.-B. (2011).

Nursing Diagnoses in Psychiatry Nursing

(8th Edition Ed.). Philadelphia, 1915 Arch Street: F. A Davis Company.

Psychiatryonline. (2014).

Neurobiology of Anxiety Disorders

. Retrieved March 31st, 2014, from

www.psychiatryonline.org

:

Watson’s theory

/in /by

Watson’s theory

admin | March 24, 2016
In Watson’s article, Intentionality and Caring-Healing Consciousness: A Practice of Transpersonal Nursing, she asserts that intentionality informs our choices and actions both in our daily lives and nursing practice. She invites us to create our own intentions that affirm what is important to us and reflect our value system. On pp. 18-19, Watson gives us some examples of intentions that can guide our “intentional caring-healing practice”.

1. In one paragraph of at least 5 sentences, create your own unique intention that you will practice daily to help you to develop your caring-healing practice.

2. In one paragragh of at least 5 sentences: Why did you choose this intention? What are your important values that this intention is affirming and cultivating for your nursing practice?

Ally is a 17 year old female with a two year history of Crohn’s Disease,

/in /by

Ally is a 17 year old female with a two year history of Crohn’s Disease,

Ally is a 17 year old female with a two year history of Crohn’s Disease, and currently studying Year 12. Ally arrived for admission to the Day Surgery Unit (DSU) at Lakewood Drive Medical Centre for a routine colonoscopy and biopsy scheduled for theatre at approximately 10.00 hrs.

Ally was admitted to the DSU by the registered nurse (RN), Sharon. The consent was checked as part of the procedure, and Sharon noted that consent had been given by Ally’s father for colonoscopy and biopsy. Ally’s vital signs were recorded as: temperature: 37.2; pulse: 70 bpm; respirations: 16bpm; and blood pressure 110/75 mmHg.

Ally was transferred to theatre for the procedure at midday because an emergency surgical case earlier in the morning caused a significant delay for all elective procedures. Following the colonoscopy, Ally returned to the DSU ward at 1400hrs. Her condition was haemodynamically stable and she was fully conscious although complaining of mild abdominal pain (pain score 3/10). She also said she felt she was ‘leaking slightly’ from the bowel and thought it might be some diarrhoea. Routine (half hourly) observations were commenced.

The shift was chaotic due to the earlier disruption to the surgical list, and at 1450 hrs, Sharon realised that Ally’s observations were behind schedule. She quickly took Ally’s pulse and noted it was slightly tachycardic. She estimated the pulse rate as 108 and also noted some tachypnoea but did not chart this observation. Ally’s blood pressure was slightly lower than on admission at 90/50 mmHg and the abdominal pain had increased (pain score 7/10). She also stated she felt slightly light headed but Sharon suggested it was probably due to the fasting and bowel preparation (liquids only for 24 hours).

:L.N. is a 49-year-old white woman with a history of type 2 diabetes obesity hypertension and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia.

/in /by

:L.N. is a 49-year-old white woman with a history of type 2 diabetes obesity hypertension and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia.

L.N. is 5’4 and has always been on the large side with her weight fluctuating between 165 and 185 lb. Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with Lisinopril starting at 10 mg daily and increasing to 20 mg daily yet her BP control has fluctuated. One year ago microalbuminuria was detected on an annual urine screen with 1943 mg/dl of micro-albumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes and HTN.Subjective data reveals that she is experiencing increased exertional SOB. She expresses concern because when this happens it takes her awhile to get her breath back to normal. Denies any pain or dizziness with these episodes.Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm. Otherwise exam is unremarkable.CC: I am more short of breath when walking up stairs than I used to be.
Questions NEED TO BE ABOUT 3-4 SENTENCES BUT THOROUGH ANSWERS
1. What are the effects of controlling BP in people with diabetes?
2. What is the target BP for patients with diabetes and hypertension?
3. Which antihypertensive agents are recommended for patients with diabetes?
4 What testing does this woman need ordered due to her change in status both SHORTNESS OF BREATH and BLOOD PRESSURE? (USE CASE STUDY ABOVE FOR THIS QUESTION)
5. What is the significance of microalbuminuria in this woman? How does this affect her cardiovascular risk?
Write this case study up as a clinical note including all elements of plan of care regarding issues presented in the case.

Determine which theory is most appropriate for addressing your clinical practice problem.

/in /by

Determine which theory is most appropriate for addressing your clinical practice problem.

As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.

This Application Assignment, due in Week 10, asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem. You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem.

NOTE: This Application will serve as your Major Assessment for this course.

To prepare:
• Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources.
• Select a clinical practice problem that can be addressed through an evidence-based practice project. NOTE: You may continue to use the same practice problem you have been addressing in earlier Discussions and in Assignment #4.
• Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
• Formulate a preliminary clinical / practice research question that addresses your practice problem. If appropriate, you may use the same research question you formulated for Assignment #4.
You will continue working on this Application in Weeks 8, 9, and 10 using material presented in those weeks to consider interdisciplinary theories that may be appropriate for exploring your practice problem and research question.
To complete:
In a 8- to 10-page paper (including references):
• Briefly describe your selected clinical practice problem.
• Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.
• Evaluate both theories using the evaluation criteria provided in the Learning Resources.
• Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question.

Case Study Into Female Pain During Childbirth

/in /by

SUMMARY

Delivery is a one of the miracle of every women’s life. The mothers suffer much distress. After child birth due to painful perineum. Perineal pain is most commonly associated with child birth by vaginal delivery. Pain following episiotomy appears to be universal. The mother undergoing episiotomy is characterised by greater blood loss in conjunction with delivery, and there is a risk of improper wound healing and increased pain during early puerperium. Various interventions are found to aid the healing process, which include cleanliness, applying ice pack, topical application by dry heat (infrared therapy), sitz bath performance of kegel’s exercise and perineal care. Any outward incident in the family may cause shees and stain which in turn will affect the psychological well being of the mother.

Aromatherapy is effective for reducing labor pain, decreasing stress hormones, alleviating depression and anxiety, and increasing interactive behaviors between parent and child. Lavender oil is a great aid to perineal healing. So, the investigator assessed the effectiveness of lavender oil sitz bath on reduction of episiotomy wound healing and psychological wellbeing among postnatal mothers in Gani hospital, Tirunelveli district, Tamil Nadu.

Objectives of the study were

  • To assess and compare the pre and post test level of episiotomy wound status and psychological wellbeing among the experimental group of postnatal mothers.
  • To assess and compare the pre and post test level of episiotomy wound status and psychological wellbeing among the control group of postnatal mothers.
  • To compare the pre test level of episiotomy wound status and psychological wellbeing between the experimental and the control group of postnatal mothers.
  • To compare the post test level of episiotomy wound status and psychological wellbeing between the experimental and the control group of postnatal mothers.
  • To associate the post test level of episiotomy wound status and psychological wellbeing among the control group of postnatal mothers with selected demographic variables

The assumptions of this study were

The assumptions of the study were.

  • Unhealing and inadequate care of episiotomy wound may predispose to vulval haematoma, infection, wound dehiscence and scar endometriosis.
  • Lavender oil sitz bath may improve the wound healing psychological wellbeing.

Hypotheses of the study were

RH1 – There is a significant difference between pre and post test level of episiotomy wound status and psychological wellbeing among the experimental group of postnatal mothers.

RH2 – There is a significant difference between pre and post test level of episiotomy wound status and psychological wellbeing among the control group of postnatal mothers.

RH3 – There is a significant difference in pre test level of episiotomy wound status and psychological wellbeing between the experimental and the control group of postnatal mothers.

RH4 – There is a significant difference in post test level of episiotomy wound status and psychological wellbeing between the experimental and the control of group of postnatal mothers.

RH5 – There is a significant association of post test level of episiotomy wound status and psychological wellbeing among the experimental and the control group of postnatal mothers with selected demographic variables.

Review of literature collected for the studies related to

The literature gathered from exclusive review is depicted under the following heading.

Section A: Literature related to episiotomy.

Section B: Literature related to episiotomy wound healing.

Section C: Literature related to psychological wellbeing of mother with episiotomy.

Section D: Literature related to lavender oil sitz bath on episiotomy wound healing and psychological wellbeing

The conceptual frame work opted for the study was based Ludwig Von Bertalarffy `s general system theory and it provided a complete framework in order to achieve the objectives of the study.

The research design selected for the study was true experimental pre and post only design was used and the study was conducted in the postnatal ward in Gani Hospital, Tirunelveli Dist, and Tamil Nadu. The tool used for data collection consisting of demographic variables which include age, education status, work pattern, type of the family and parity. The assessment level of episiotomy wound and psychological wellbeing among the experimental group and the control group were measured by using REEDA scale and structured observation check list . The tool was validated by 2 experts in the field of obstetrician and gynecologist and 3 experts in obstetrician and gynecologist nursing personnel and the reliability of the tool was established by interpreter reliability method. The value of the reliability was r=0.9. The tool was highly reliable to conduct the main study.

The pilot study was conducted in Gani Hospital, Tirunelveli district among 6 samples out of which 3 were in the experimental group and 3 were in the control group of postnatal mothers. The experimental group received lavender oil sitz bath but no one had lavender oil sitz bath in control group. The finding revealed the feasibility, reliability and practicability of the tool for conducting main study. No modification was made after pilot study. Pilot study period was 4 consecutive days from28-4-2010 to1-5-2010 from 9am to5pm.

The main study was conducted at Gani Hospital, Tirunelveli district. Tamil Nadu. The 60 postnatal mothers who fulfilled the inclusive and exclusive criteria were selected for the study ,out of which 30 mothers were the experimental group and 30 of them were the control group . Sample was selected by using simple random sampling method by Lottery method. Mothers who came under group A lottery will come under the experimental group of mother and mother who came under group B lottery will come under the control group of mothers. The investigator gave lavender oil sitz bath to the experimental group . Lavender oil sitz bath is Lavender oil is added with warm water in a basin and asked the mother to sit for 15 minutes 2 times per day about 3 days in the experimental group. Hospital routine care was given to the control group. The collected data was analyzed and interpreted based on the objective by using descriptive and inferential statistics.

The findings of the study revealed that the calculated ‘t’ value was 8.75 which showed highly statistical significant difference in post test level of episiotomy wound status and psychological wellbeing among the experimental group and the control group of postnatal mother at p<0.05 level was retained.

Association of post assessment level of episiotomy wound status and psychological wellbeing with selected demographic variables of the experimental group and the control group showed that there was no statistical significance at p<0.05 level was retained.

CONCLUSION

The present study assessed the effectiveness lavender oil sitz bath on episiotomy wound healing and psychological wellbeing among postnatal mothers in Gani Hospital, Tirunelveli. Tamil Nadu. The results of the study concluded that rendering the lavender oil sitz bath was effective for episiotomy wound healing and psychological wellbeing. The lavender oil sitz bath is cost effective, easy to apply, not harmful and can enhance comfort in mothers. So, it could be easy to adopt a regular intervention. Therefore, the investigator felt that more importance should be given to episiotomy wound healing and improve psychological wellbeing following the intervention of lavender oil sitz bath which can be given as a non-pharmacological measure to enhance reduction of episiotomy infection and improve psychological wellbeing.

IMPLICATION:

The investigator has derived from the study, the following implications, which are of vital, concern in the field of nursing practice, nursing education, nursing administration and nursing research.

NURSING PRACTICE

The midwives have a vital role in providing safe and effective nursing care to enhance episiotomy infection and psychological wellbeing.

This can be facilitated by motivating the nurse midwives to

  • Have an in depth knowledge on physiological changes during puerperium and management of puerperium for mother with episiotomy
  • Have an in depth knowledge regarding episiotomy wound care and its healing process and for improvement of psychological wellbeing of the mother.
  • Learn about accurate assessment of episiotomy wound and psychological wellbeing with the use of standard and appropriate scales.
  • Develop skill in providing efficient nursing care for effective management episiotomy wound healing and psychological wellbeing of postnatal mothers.
  • Teach the mothers during antenatal period about the effectiveness of various non pharmacological measures for episiotomy wound healing and psychological wellbeing.

NURSING EDUCATION

Ensure that the students learn the normal physiological changes during puerperium and its management.

Provide adequate clinical exposure for the students to give effective and safe nursing care in postnatal care with episiotomy.

Make use of available literatures and studies related to non-pharmacological measures for episiotomy wound healing and psychological wellbeing.

Educate the students about various complementary and alternative therapies for episiotomy wound healing and psychological wellbeing.

Encourage the students for effective utilization of research based practices.

NURSING ADMINISTRATION

Collaborative with governing bodies to formulate standard policies and protocols to emphasize nursing care during puerperium and mother with episiotomy.

Conduct in-service programme and continuing education programme for effective management during puerperium and episiotomy wound healing and psychological wellbeing .

Ensure and conduct workshops ,conferences ,seminars on non-pharmacological methods to promote episiotomy wound healing and psychological wellbeing .

NURSING RESEARCH

As a nurse researcher, promote more research on effective management during puerperium regarding episiotomy wound healing and psychological wellbeing.

Disseminate the finding of the research through conferences, seminars and publishing in nursing journal.

Promote effective utilization of research findings on puerperium management especially episiotomy wound healing and psychological wellbeing.

RECOMMENTATION

The study recommends the following future research…

The similar study can be conducted with larger samples for better generalization.

A comparative study can be conducted to compare the episiotomy wound healing and psychological wellbeing between primi and multi mothers.

A study can be conducted to assess the knowledge and practice of nurse midwives with regard lavender oil sitz bath for episiotomy wound healing and psychological wellbeing .

A study can be conducted to assess the knowledge and attitude of nurse midwives on complementary and alternative therapies for episiotomy wound healing and psychological wellbeing .

A study can be conducted to assess the effectiveness of other nursing measures such as music, warm water bath, breathing exercise on episiotomy wound healing and psychological wellbeing .

LIMITATION

Only limited literatures and studies was obtained from the Indian context.

Due to time constraints, the investigator was unable to take samples for the study.