Nursing

Others suggested that those who drank should be: D hung by the tongue beneath an airplane and flown over the country o exiled to concentration camps in the Aleutian Islands o excluded from any and all churches o forbidden to marry tortured o branded o whipped o sterilized o tattooed o placed in battleship cages in public squares o forced to swallow two ounces of caster oil a executed, as well as their progeny to the fourth generation. ; A major prohibitionist group, the Women’s Christian Temperance Union (WEST) taught as “scientific fact” that the majority of beer drinkers die from droopier (edema or swelling). Prohibition agents routinely broke the law themselves. They shot innocent people and regularly destroyed citizens’ vehicles, homes, businesses, and vii other valuable property. They even illegally sank a large Canadian ship. Bathtub gird’ got its name from the fact that alcohol, glycerin and juniper jug was mixed in bottles or jugs too tall to be filled with water from a sink tap so they were commonly filled under a bathtub tap. The speakeasy got its name because one had to whisper a code word or name through a slot in a locked door to gain admittance.

Prohibition led to widespread disrespect for law. New York City alone had about thirty thousand (yes, 30,000) speakeasies. And even public leaders flaunted their disregard for the law. They included the Speaker of the united States House of Representatives, who owned and operated an illegal still. Some desperate and unfortunate people during Prohibition falsely believed t hat the undrinkable alcohol in antifreeze could be made safe and drinkable by filtering it through a loaf of bread. It couldn’t and many were seriously injured or xi killed as a result.

In Los Angels, a jury that had heard a bootlegging case was itself put on trial after it drank the evidence. The jurors argued in their defense that they had simply been sampling the evidence to determine whether or not it contained alcohol, which they determined it did. However, because they consumed the evidence, the defendant charged with bootlegging had to be acquitted. When the ship, Washington, was launched, a bottle of water rather than xiii Champagne, was ceremoniously broken across its bow. Prohibition led to a boom in the cruise industry.

By taking what were advertise deed as “cruises to nowhere,” people could legally consume alcohol as soon as the ship entered international waters where they would typically cruise in circles. National Prohibition not only failed to prevent the consumption of alcohol, buy led to the extensive production of dangerous unregulated and untaxed alcohol 01, the development Of organized crime, increased violence, and massive political irruption. The human body produces its own supply of alcohol naturally on a continuous basis, 24 hours a day, seven days a week. Therefore, we always have alcohol in our bodies.

Prohibition clearly benefited some people. Notorious bootlegger AY Capons made sixty million dollars… Per year (untaxed! ) while the average industrial worker earned less than $1 ,OHO per year. But not everyone benefited. By the time Prohibition was repealed, nearly 800 gangsters in the City of Chicago alone had been killed in battleground shootings. And, of course, thousands of citizens were killed, blinded, or xviii realized as a result of drinking contaminated bootleg alcohol. The “Father of Prohibition,” Congressman Andrew J. Evolutes, was defeated shortly after Prohibition was imposed.

| Delivering Bad News: Helping your patients retain dire details| Modern Medicine Oct 1, 2009| | The purpose: This article focuses on providing healthcare professionals with suggestions that will help their patients remember important information immediately after receiving bad news. Although nurses usually don’t deliver the bad news, they are often in the room when it is given and are often the person that has to give the patient instructions immediately afterward. Research supports the fact that patients might not hear much of the nurse or physician tells them at this time, therefore they retain very little of the valuable information.

Patients with poor prognoses are especially at risk and retain even less than patient with fair to good prognoses. This research also revealed that the more information given to the patient the less they retained. Information data: The first suggestion that will help patients retain information in the event of bad news is to prepare the patient ahead of time for how they will hear the results. Ask them to bring a spouse, supportive friend or a tape recorder. The second suggestion is to have a face to face conversation with the patient. This will enable you to watch the patient’s body language.

Nonverbal language plays a big role in the assessment of a patient’s well being of state of mind at the time. This meeting should be during a reserved time period, so that you or the patient doesn’t feel rushed. A third suggestion is to decide on a few key points to make and stick with presenting these few only. Giving a patient too much information will result in them retaining even less. The fourth suggestion is start with the prognosis, not the diagnosis. Say something like “you have a condition that is very treatable with medication. If it is a grim diagnosis start with empathy and then convey the commitment to the patient. State “we’re here to talk about what the test showed and I want you to know that I am committed to working with you closely throughout the course of your treatment. ” The fifth suggestion is use simple language so that the patient can understand what is being explained to them. Many times Dr will use many words that the patient’s just don’t understand. It is important to remember that everyday language in the hospital or Dr Office setting may not be so in the everyday setting for the patient.

Explaining valuable information in a language that patients can understand is important in helping them retain the information. The sixth suggestion is to use a “teach back” or “chunking and checking” teaching strategy. This method gives the patient a small piece of information and asks them to explain it back in their own words. One good way to do this is have them explain to you how they are going to relay the information just give to their spouse or another family member not present at the meeting. Another way would be for them to show you how they are going to teach others about their treatment plan.

The seventh suggestion is to use handouts in simple language as supplements to verbal teaching. These work well as references that can be referenced at a later time. The eighth suggestion is to give the patient resources to help them with further coping. Resources such as websites, support groups or social workers can be very helpful in promoting coping. The ninth and finial suggestion is to set up follow up visits to assess how the patient is feeling as well as answer any additional questions the patient may have.

This is very important in order make the patient feel as if they are not alone in dealing with this issue and that you are committed to working closely with the patient throughout the prescribed treatment. Conclusions reached by author: Today healthcare providers are doing better at communicating information, but there are still areas to improve. These nine suggestions have contributed to the improvements and will continue to impact the way healthcare professionals communicate.

In the authors opinion the most important thing is being honest and open. As nurses it is important to take the time to get to know the individual and appreciate the journey with the patient. Critique This article was very easy to read and had a good flow with the presentation of the information. I was able to read the article easily and did not have to stop to clarify much of the information. I liked that the author summarized the suggestions in a numbered list at the end of the article. This made it easier to present each suggestion in my summary.

The article seemed to be more directed at Physicians, however I think the suggestions could be very valuable to any healthcare professional involved with direct patient care. Any healthcare professional that is involved in the teaching or communicating the treatment plan to the patient could benefit with the application of these suggestions. As a nurse I can apply these suggestions anytime I need teach patients about treatment plans. Good communication is a very important skill to develop and will be beneficial not only with the patients but with coworkers as well.

Effective Leadership is the key to long term organizational growth and sustainability. According to Hulsmans (2011), employees today demand personal growth and learning that will engage and stimulate them. They want to be challenged, and they need to be trusted and held accountable. Leaders today are challenged to meet the professional growth needs of staff, maintain transparency of organizational goals, vision, mission, and values, in order to create an environment of trust and sound communication, while also improving efficiency and effectiveness of workforce teams to improve overall organizational performance. Effective leaders sustain their authenticity . Today’s pressing leadership issue of developing and sustaining effective leadership, requires the discovery of one’s own authenticity.

Bill George, former chairman and CEO of Medtronic, analyzed more than 3,000 pages of transcripts from the interviews of 125 leaders, half of which were CEOs, and found the leadership styles of the most effective leaders emerged from their life stories. The analysis gleamed that the leaders were consciously and subconsciously testing themselves through their experiences and continued to reframe their life stories to understand who they were at their core . George (2007) further discerned that the leaders, by continually analyzing who they were, discovered the purpose of their leadership and learned that being authentic made them more effective. The road to effective leadership requires the detection of one’s authenticity which requires a commitment to developing one’s self. Self-awareness, personal vision and purpose, and leading with the principles that support one’s value base, stabilizes authenticity and strengthens effective leadership.

On the road to effective leadership, authentic leaders build strong support teams, ground themselves in who they are and allow themselves to be the same person in each personal and professional environment in which they interact. The ability of the authentic leader to balance personal and professional life is essential to their effectiveness as a leader, and to their ability to lead others to improved performance. Leadership is a partnering relationship with the follower. Without followers, leadership does not exist (Goffee, 2009). Wong and Cummings (2009) draw a positive relationship between the authentic leader and follower partnership, and the creation of healthy work environments. Wong and Cummings (2009) further allude that the combination of authenticity and trust in the leader-follower relationship creates sustainable changes in work environments.

Goffee (2009) describes authentic leaders as those able to modify their behavior to respond to the needs of their followers and the situations they encounter while simultaneously remaining true to who they are. If authentic leaders maintain situational awareness, a sense of true self, build empathetic relationships and successfully communicate with followers, then they are better equipped to instill trust, strengthen communication, and empower others (Goffee, 2009). An empowered, passionate, and committed workforce is the reward of the authentic leader. Authentic leaders demonstrate and sustain a passion for purpose, practice their values consistently, and lead with their hearts and their heads (George, 2007, p.1). Authentic leaders practice self-discipline and maintain meaningful relationships. According to George (2007), “they (authentic leaders) know who they are”. Authentic leaders are better prepared to achieve and sustain performance excellence over time making their leadership style highly effective and deeply fulfilling.

The Doctorate of Nursing Practice (DNP), a practice-focused doctoral education, focused on innovative and evidence-based practice, while reflecting the application of credible research findings (AACN, 2006 ), will provide the foundational competencies for authentic leadership within a framework for organizational and systems leadership. Integrative practice experiences and intense practice immersion are essential components of the DNP, and will provide a scholarly skill set to achieve my goal of improving health outcomes through excellence in practice, in an environment of safety. The competencies I seek to acquire in the scholarly DNP program at Salisbury University will prepare an authentic nursing leader for the highest level of leadership while procuring excellence not only in practice but also in the development of self.

References

1. American Association of Colleges of Nursing (2006). The Essentials of Doctoral Education for Advanced Nursing Practice. Washington D.C. http://www.aacn.nche.edu/dnp/Essentials.pdf
2. Hulsmans, L. (2011) Corporate Leadership: Are you up to the challenge? Banff Centre. Retrieved from http://www.banffcentre.ca/departments/leadership/library/pdf/corporate_leadership_article.pdf.
3. Goffee, R., Jones, G., Authentic Leadership. Leadership Excellence. Retrieved from http://www.blessingwhite.com/content/articles/Authentic_Leadership_Goffee_Jones.pdf
4. George, B., Sims, P., McLean, A., Mayer, D. (2007) Discovering Your Authentic Leadership Harvard Business Review. www.HBR.ORG. February.
5. Wong, C., Cumming, C., (2009) Authentic Leadership: A new theory for nursing or back to basics? Journal of Health Organization and Management, 23(5): 522-38.

Moore The following paper will discuss the ways in which understanding my competencies will help me to improve my group communication skills. I will discuss how knowing these competencies help me become a better communicator in groups while helping me determine sources of conflict in group communication. I will review with you the result of my Career Interest Profiler. By understanding my competencies I am better able to determine where my strengths and weaknesses lye.

The results of my competencies show that my strengths are researching, taking initiative, innovating, adapting to change, coping with pressure, and applying expertise. I believe that the assessment was accurate. Knowing where my strengths are will help me become a better communicator by giving me the confidence that a person receives from knowing one’s self. One of my strengths is being able to cope with pressure and being a people person I could use this to help defuse a situation by asking questions o help clarify a possible misunderstanding or suggest addition ideas that may be more acceptable to the group as a whole.

By using my strengths to move communication along in a positive and productive manner can help avoid possible conflict. My Career Interest Profiler results states that I am conventional, enterprising, and social. It points out that some of the fields of study I could possibly excel in are freight forwarding, Associates/BBS in Criminal Justice, Master’s and Doctorate in Business, and BBS/Psychology. I am currently enrolled in Bachelor of Science in Accounting which was not listed in any of the recommended career hoicks for me.

I find it interesting that accounting did not fall as one of my choices since I have been in the field for over a decade. In conclusion, this paper discussed the ways in which understanding my competencies will help me to improve my group communication skills, how knowing these competencies help me become a better communicator in groups while helping me determine sources of conflict in group communication. While I may not have agreed with the Career Builder Profiler I felt that they were able to inform me of other career options if I so choose to follow its advice.

Florence Nightingale Act of utilizing the environment of the patient to assist him in his recovery. Martha Rogers humanistic science for maintaining and promoting health, preventing illness, caring for and rehabilitating the sick and the disabled. Sister Callista Roy a health care profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole “… the science and practice that expands adaptive abilities and enhances person and environmental transformation.

Imogene King s a process of human interactions between nurse and patients who communicate to set goals and then agree to meet the goal. Betty Neuman unique profession in that it is concerned with all of the variables affecting an individual’s response to stress.A Science Knowledge of underlying principles of nursing care based on biological sciences. 2. An Art Skilled techniques in giving adequate care. 3. An Occupation Job requires concentration, learning and dedication to practice as means of livelihood. 4. As a Profession Intellectual capacity Learning: research-based

Practical activities: skill-base Organized group practitioner. Nursing is a continuous caring b) Involves close personal care with recipients of care c) Nursing is concerned with service for the human individual as: Physiological Sociological Spiritual organisms ANA (American Nurses Association) (2003) Nursing is the protection, promotion and optimization of health and abilities, preventions of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations.

Kimberly Blatnica Preceptor Site: Surgery Center at Regency Park Clinical Reflection 4 17 October 2012 Today’s clinical experience allowed for new education and skill practice. I was able to precept in post-op, which was a great change. Being in pre-op, we are responsible for receiving clients from the OR. We then monitor them, reeducate, prepare for and perform discharge, and cleaning the area that was used by disinfecting, tossing and replacing linens, and moving the bed to an empty room in pre-op. We receive report from the circulating nurse and the nurse anesthetist when they first bring the patient to recovery.

Together we hook the patient up to the monitors and record the first set of vitals together. These include: blood pressure, heart rate, respirations, temperature, pulse ox, pain (if patient is conscious), and an ECG reading if they were general. When I first arrived to clinical today- I was told we were going to be busy. I was also able to work with clients’ receiving urology and ENT procedures, not just cataracts. Urology was new for me but I was excited to be doing something different. Learning needs identified for this experience were only regarding urology patients.

They differ due to the use of general anesthesia, the need to void before discharge, education of post-op care, and pain medication administration. Learning needs I identified from this experience includes education about the different urology procedures and education, how to effectively care for a general anesthesia patient during recovery, and complications. I met my needs by asking many questions during clinical and the use of our textbook. One of my client’s primary concerns occurred after he received a cystoscopy with the insertion of an indwelling urethral stent.

This patient was a 52 year old male, with mild hypertension. No other health concerns were noted in his chart. He originally scheduled the procedure in order to remove a very large stone. However after waking up and speaking with the surgeon, he was told he had been too inflamed for the procedure. The surgeon asked him to schedule a second attempt for the removal for next week, in hopes the stent would decrease the swelling. This client also did not know how to care for the stent. The stent will make a patient feel the constant urge to void. This sensation is often relieved by pain medication.

It is very uncomfortable and can easily be dislodged while passing stool, wiping, cleaning the area, and getting dressed. This specidic stent is attached to a string that hangs outside the patient’s body. The stent can lead to infection if the area is not kept clean. These were important concepts to discuss with the client. Main points I helped to educate were: take pain medication every 6 hours to eliminate the likelihood of increased pain, drink plenty of fluid to help flush the renal system, no bathes, signs of infection, situations when to calling the doctor is a must, and how to care for the stent.

I also helped administer 2 rounds of Fentanyl and two Percocet to help relieve his discomfort and urge to void. He was then able to void which resulted in blood tinged urine. We assured the patient this was normal for the first void following surgery. He was in a lot of pain during this process. It was more comfortable for him to stand, but during his stay he spent most of his time sitting. He also had a forty-five minute drive home, which is why we decided to administer two Percocet, instead of one. One course objective I met today was: demonstrate effective communication skills.

This was completed during every education session I had with my patients and their family member/friend prior to discharge. Regardless of the procedure, every person is provided with post-op care instructions. A second course objective I met was: collaborate with patients, families, health care team members, and others in the provision of care. I worked side by side with great nurses all day. We worked as a team with interventions, time management, discussions about the patient’s needs and concerns, reports, and preparations. We also worked close with those working in the OR.

Also, while educating patients, sometimes there is a need to collaborate alternatives. This is important to maintain outstanding health care. Report on one patient at least 3 times throughout the semester| The 52 year old male described previously received surgery today in hopes of removing a painful stone. He was experiencing abdominal pain and has had a history of past stones requiring surgery. Diagnostic studies for this patient included a previous x-ray and today’s cystoscopy. The indications for surgical stone removal include: stones too large for spontaneous assage, stones associated with infection or impaired renal function, stones which cause persistent pain, nausea, or ileus, a patient’s inability to be treated with medication, or a patient with only one kidney (Lewis, 1137). Those associated in this case were size, risk for infection, renal function, and pain. An aspect that differed from a typical care was the inability for stone removal and severe inflammation (Lewis, 1137-8). The passageway was so swollen; the surgeon could not even get near the stone’s location.

Furthermore, usually patients will know why they have the reoccurrence of stones, while this patient did not. They hope after removing the stone, they will be able to prevent further episodes by testing the actual stone’s composition. Another patient I cared for today was a 17 month old male. His diagnosis was unspecified chronic nonsupportive otitis media. He received a typanostomy. Many symptoms and complications of otitis media in our text are congruent with this patient’s history- even though this patient is not an adult.

The patient has a history of purulent exudates, bilateral hearing loss, and inflammation of the middle ear (Lewis, 426). Differentiating from our text, the child was often times seen pulling on his ears as a result of pain; while our text states it’s more likely to be painless (Lewis, 426). Complications of this disorder results in chronic inflammation which was most likely the cause of his pain. Typanoplasty, ear irrigations, antibiotics, analgesic, and surgery are all recommendations for those with Otitis media (Lewis, 426). These interventions were in the patient’s file.

Today, he had the tubes removed from both ears and left with a prescription for Tylenol and antibiotics. This procedure was recommended if medication was not successful (Lewis, 426). | Report on at least ONCE throughout the semester | Today during the recovery of the 52 year old male mentioned above, we noticed he did not have his two prescriptions written. It was important we found the surgeon before he left (this happened to be his last case). The patient was missing his prescription for his antibiotic and pain medication. Both important for his recovery and duration between surgeries.

My preceptor paged for the surgeon, and he happened to return before she returned to the patients area. I was feeding the patient ice cubes when he asked me what the call was for. I was able to show the surgeon his orders and blank scripts. He filled them out and I began to explain the use of and directions for both medications. I was able to communicate with the surgeon both effectively and professionally. Furthermore, it helped the surgeon was very nice- to staff and patients. I did not think or feel much about the interaction ahead of time. It happened so fast, but once it was over I was proud of myself.

I feel even as a student nurse, you still have to be prepared for anything. If I could, I would change the fact the prescriptions were written out ahead of time. At the surgery center we have receptionists that organize our charts. These staff members keep the jobs of nurses and doctors organized and effective. A couple weeks ago, I was going through a chart and noticed a patient’s medication reconsolidation form was missing. By speaking to the receptionists, they were able to obtain another copy. This form is very important when discussing medication regimens with patients in post-op.

It is important for new medications to be explained and checked for incompatibilities with other medications the patient is prescribed. I felt speaking to the receptionists was not much of a challenge; however, without their help we could have had a more serious complication. I do not feel receptionists get enough credit in the medical setting. They may not be running around all day; however, without them at the surgery center (which does not have EMRs) they play a role in patient safety and allow everyone else to perform their duties. |

The term Evidence-based practice is relatively new, yet in the last decades, EBP had a great impact on nursing practice, education and as a science in general. There is a broad agreement by scholars and publications upon EBP definition as “problem-solving approach to clinical decision-making that integrates the best available evidence and clinical expertise, along with patient preference and values” (Hain & Haras, 2015).

Meanwhile, ethics is rooted in ancient Greek philosophical inquiry of moral life and relates to a system of principles that can considerably change previous thoughts, actions, and decisions (Doody & Noonan, 2016). More particularly, The nursing code of ethics stands as a central and necessary mark of a profession. It functions as a general guide for the profession’s members and as a social contract with the public that it serves. The code list nine provisions that makes explicit the primary goals, values, and obligations of the nursing profession and expresses its values, duties, and commitments to the society of which it is a part.

The relationship between evidence-based practice and ethics is obvious in many ways. Empirics and ethics are fundamental patterns of knowing in nursing: Empirics and ethics are actively participating in being fundamental patterns of knowing that shaped nursing as distinguish discipline. We gain empirical knowledge from research and objective facts.

This knowledge is systematically organized into general laws and theories. One of the ways we employ this knowledge is through the use of evidence-based practice (EBP). likewise, ethical knowledge helps one develop our own moral code; our sense of knowing what is right and wrong. For nurses, our personal ethics is based on our obligation to protect and respect human life. Our deliberate personal actions are guided by ethical knowing (Vaughan, 2014).

The “Code of Ethics for Nurses” can guide us as we develop and refine our moral code. Certainly, empirical knowledge is essential to the purpose of nursing, but nursing also required to be alert to the need to express the uniqueness of individual and to have an appropriate parameter that can judge and appraise these evidence on ethical manners. The knowledge of ethical code can provide answers to the moral question during the application of EBP. According to Carnago ; Mast (2015), each pattern of knowledge in nursing is separated but interrelated and interdependent to each other, and none of them alone should be considered sufficient. The overall purpose of EBP and nursing code of ethics is almost identical: The second provision of the code clearly states that “The nurse’s primary commitment is to the patient, whether an individual, family, group or community” (ANA, 2015).

This commitment is to the health, well-being, and safety of the patient across the lifep and in all settings in which health care needs are addressed. The principle of beneficence, which promote the well-being of others and non-maleficence which refers to the ”obligation to not inflict harm on others. Once again, many statements in our Code reflect this important concern for avoiding harm to those we serve. The nurse upholds patients’ interests by influencing and managing those who provide direct care and fostering positive team approaches to facilitate safe, quality care. Similarly, the definition of evidence-based practice emphasize the use of best available evidence which most probably will benefit the patient and ensure the safety of that course of action through utilizing only approved and extensively tested evidence.

While, a great attention to preserve the uniqueness of individual values and preferences. the Code of Ethics basic principles and definition of EBP simultaneously stress the importance of using best current evidence that ensures achievement of the desirable outcome (Stokke, Olsen, Espehaug, & Nortvedt, 2014). To conclude, Nurses encounter and address many ethical dilemmas on a daily basis. Since nursing actions aim to improve the health and wellbeing of patients which best manifested by using EBP, it is inevitable and expected that nursing practice has an ethical dimension. Nurses, therefore, have a duty to develop not only an awareness of the ethical dimension of practice but also strategies to practice ethically.

Fortunately, The original ANA Code of Ethics for Nurses With Interpretive Statements was released in 2001, and it was revised in 2015. This update ensures that the Code of Ethics continues to be relevant to the transformations in health care delivery and modern clinical practice advances. No matter how important technical and scientific expertise in nursing may be, providing nursing care must always be characterized as an ethical founded undertaking.

By incorporating evidence-based decision making and intersecting it with traditional principles of ethics (beneficence, non-maleficence and justice), nurses are fostering care strategies for individuals and populations while addressing underlying systems issues that may impact care including facilitating a culture of safety that supports reporting errors and near misses which is vital for modern date practice (EBP) and promoting a healthy work environment of respect.