Nursing

Legal Ramifications for Exceeding One’s Duties FO
You have been the evening charge nurse in the emergency department at Memorial Hospital for the last 2 years. Besides yourself, you have two LVNs and four RNs working in your department. Your normal staffing is to have two RNs and one LVN on duty Monday through Thursday and one LVN and three RNs on during the weekend. It has become apparent that one of the LVNs, Maggie, resents the recently imposed limitations of LVN duties because she has had 10 years of experience in nursing, including a tour of duty as a medic in the first Gulf War. The emergency department physicians admire her and are always asking her to assist them with any major wound repair. Occasionally, she has exceeded her job description as an LVN in the hospital, although she has done nothing illegal of which you are aware. You have given her satisfactory performance evaluations in the past, even though everyone is aware that she sometimes pretends to be a “junior physician.” You also suspect that the physicians sometimes allow her to perform duties outside her licensure, but you have not investigated this or actually seen it yourself. Tonight, you come back from supper and find Maggie suturing a deep laceration while the physician looks on. They both realize that you are upset, and the physician takes over the suturing. Later, the doctor comes to you and says, “Don’t worry! She does a great job, and I’ll take responsibility for her actions.” You are not sure what you should do. Maggie is a good employee, and taking any action will result in unit conflict.
ASSIGNMENT: What are the legal ramifications of this case? Discuss what you should do, if anything. What responsibility and liability exist for the physician, Maggie, and yourself? Use appropriate rationale to support your decision.
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Solution
Brief Summary of the Case
In this paper, I will be seeking to solve the case of the legal ramifications for exceeding one’s duty. In the case study presented, the LVN on duty, which is known as Maggie, is caught by the charge nurse performing duties that are outside her licensure, as the supervising physician looks on. Maggie has also been accused numerous times of pretending to be a junior physician in the healthcare facility.
Legal Ramifications
The legal ramifications in the case where an LVN is caught performing duties that are outside her licensure include malpractice lawsuits that can befall a healthcare facility. In the case that the LVN performs activities that are not under their licensure and patients experience adverse outcomes, such patients can decide to sue a healthcare facility for malpractice. The malpractice lawsuit will therefore be directed to the supervising physician who would be liable for delegating duties to professionals that do not have the necessary qualifications and license to perform such duties. In the case of adverse outcomes among patients as a result of having received inadequate healthcare services from qualified staff such as LVN, the liability that exists for the charge nurse would be related to deciding to cover up for the irregularities noted (Renkema et al., 2016). If the charge decided not to report an LVN who performs duties and responsibilities that are beyond her licensure, they would also be liable for malpractice. On the other hand, the supervising physician would also be liable for malpractice as they allowed a junior staff member such as an LVN to perform duties beyond their licensure. Finally, the LVN would be liable for malpractice for knowingly performing duties and roles beyond their licensure (Renkema et al., 2016).
Integrated Ethical Problem-Solving Model
As a charge nurse in the emergency department, I would utilize the integrated ethical problem-solving model to determine the actions that I will take in the case where an LVN is caught performing roles that are outside her licensure. Utilizing the integrated ethical problem-solving model, the first step would therefore be to determine whether there is an ethical issue or dilemma (Park, 2017). The case study presented ethical issues related to beneficence, and nonmaleficence, which would therefore be noted (Stone, 2018). In the case study, the LVN would therefore endanger the patient by performing duties that she’s not qualified for and be going against the principles of beneficence and nonmaleficence. The LVN would also be abusing the principle of autonomy of patients by pretending to be a junior physician. In my professional judgment, I would therefore rank the ethical principles of beneficence and nonmaleficence as being the most important and most relevant to the ethical dilemma (Park, 2017). As a charge nurse, I would also develop an action plan based on the different ethical priorities that have been determined central to the ethical dilemma. The ethical principles of beneficence and nonmaleficence would be central to my action plan. Considering the lack of principles of beneficence and nonmaleficence, the charge nurse should therefore consider the option of reporting the LVN to the responsible authorities in a workplace. This would be done through drafting an incidence occurrence report which would imply that the reported incident would be stopped immediately and the involved parties committed to following ethical principles. Finally, I would reflect on the ethical decision-making process and evaluate the consequences of the process involved for the different stakeholders such as patients, healthcare practitioners, and the healthcare facility in general (Stone, 2018).
References
Park, E. J. (2017). An integrated ethical decision-making model for nurses. Nursing Ethics, 19(1), 139–159. https://doi.org/10.1177/0969733011413491
Renkema, E., Broekhuis, M., & Ahaus, K. (2016). Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety. BMC Health Services Research, 14(1). https://doi.org/10.1186/1472-6963-14-38
Stone, E. (2018). Evidence-Based Medicine and Bioethics: Implications for Health Care Organizations, Clinicians, and Patients. The Permanente Journal. Published. https://doi.org/10.7812/tpp/18-030

NRS 440 Grand Canyon All Week Assignments
NRS 440
NRS 440 Grand Canyon Topic 1 Assignment
Benchmark – Implementation of the IOM Future of Nursing Report
Details:
In a formal paper of 1,000-1,250 words you will discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.” Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?
Explore the Campaign for Action webpage (you may need to research your state’s website independently if it is not active on this site): http://campaignforaction.org/states
Review your state’s progress report by locating your state and clicking on one of the six progress icons for: education, leadership, practice, interpersonal collaboration, diversity, and data. You can also download a full progress report for your state by clicking on the box located at the bottom of the webpage.
NRS 440 Grand Canyon Weekly Assignments
In a paper of 1,000-1,250 words:
Discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”
Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development.
What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?
Summarize two initiatives spearheaded by your state’s action coalition. In what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers?
A minimum of three scholarly references are required for this assignment.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
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NRS 440 Grand Canyon Topic 2 Assignment
Evolving Practice of Nursing and Patient Care Delivery Models
Details:
As the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and fewer will be available in acute care hospitals.
Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.
Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.
In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.
A minimum of three scholarly references are required for this assignment.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
NRS 440 Grand Canyon Topic 3 Assignment
Reflection Paper
Details:
In a reflection of 450-600 words, explain how you see yourself fitting into the following IOM Future of Nursing recommendations:
Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
Recommendation 5: Double the number of nurses with a doctorate by 2020.
Recommendation 6: Ensure that nurses engage in lifelong learning.
Identify your options in the job market based on your educational level.
How will increasing your level of education affect how you compete in the current job market?
How will increasing your level of education affect your role in the future of nursing?
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
NRS 440 Grand Canyon Topic 4 Assignment 1
CLC – Pros and Cons of Mandatory Continuing Nursing Education
View Rubric
Details:
This is a Collaborative Learning Community (CLC) assignment.
In your CLC group, create a PowerPoint presentation of 10-15 slides in which you compare the pros and cons of continuing nursing education related to the following:
Impact on competency.
Impact on knowledge and attitudes.
Relationship to professional certification.
Relationship to ANA Scope and Standards of Practice.
Relationship to ANA Code of Ethics.
Take a position with your CLC group: Should continuing nursing education be mandatory for all nurses? Support your position with rationale.
A minimum of three scholarly sources are required for this assignment.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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NRS 440 Grand Canyon Topic 4 Assignment 2
How a Bill Becomes a Law
Details:
As you have discovered through this course, nurses are influential members of the community and the political system. Therefore, for the purposes of this assignment you will identify a problem or concern in your community, organization, etc. that has the capacity to be legislated. You will conduct research and state a proposal. Through the legislative process, your proposal for the problem or concern may influence an idea for change into a law.
First, refer to the “How a Bill Becomes a Law” media.
http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs440v_how-a-bill-becomes-a-law-v2.1.php/.
Then, view the “Bill to Law Process” to watch the scenario.
After viewing the scenario, refer to the “Legislative Assignment.” You will need to save the document first in order to use it.
Submit the assignment to the instructor. You also reserve the right to submit your completed proposal to the respective government official. However, this is optional. If you select to submit your proposal as a part of the legislative process, refer to “Find Your Representative” or research the contact information on your own.
NRS 440 Grand Canyon Topic 5 Assignment
Combining Nurse Leader with Advocacy
Details:
Rate yourself using the results from the “Nurse Manager Skills Inventory”:
http://www.aone.org/resources/nurse-manager-skills-inventory.pdf
Write a reflection of 750-1,000 words in which you identify your strengths and weaknesses related to the four content areas below:
Personal and professional accountability
Career planning
Personal journey disciplines
Reflective practice reference behaviors/tenets
Discuss how you will use your current leadership skill set to advocate for change in your workplace.
Identify one personal goal for your leadership growth and discuss your implementation plan to achieve that goal.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Florence nightingales environmetal theory
Identify a theory that uses a concept of interest to you that can be applied in research and nursing practice (clinical, education, or administration). This is a professional paper in which headings, full sentences, paragraphs, correct grammar and punctuation, and correct citation of sources are required.
The theory you select will be the same theory used for each assignment in the future modules.
Theory Description:
Provide a brief description of the theory using an original source or as close to the original source as possible. Include a brief discussion of the origins of the theory and the scope/level (grand, middle range, practice/situation specific) of the theory. Identify the major concepts of the theory and discuss how they are related (propositions). Pick two of the concepts, including your concept of interest, and state theoretical definitions of these concepts.
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Solution
Transcendent Pluralism
Transcendent pluralism is a middle-range theory that explains how human dignity occurs and its connection among diverse groups of people in society through non-violent changes. The theory suggests that curing is required through progressive self-respect (Reischer et al., 2021). The theory shows how the modern social problems that adversely affect health are embedded in the human-environmental and deflation conditions.
Origin of the Theory
Transcendent pluralism originated in logical and inductive ways. Meaning, it uses both processes to conclude a study. For instance, in deductive, the theory begins with a hypothesis testing and examines the possibilities of the research being true or not before making a concrete conclusion. In contrast, it uses an inductive process to try and make general decisions based on observations the researcher has seen. Therefore, the theory is crucial in nursing as it helps nurses make concrete decisions on dignity and acknowledge the appropriate principles to care for the patients.
Transcendent pluralism is generally developed from middle range theory because of the various frameworks and emphasis on human dignity that comprises an individual’s self-care. Furthermore, the middle-range theory expounds more on the importance of this theory as it tends to focus more on the experimental and observational methods to make a conclusion that can be easily understood and used in interpreting a patient’s health condition. Hence, acts as a guideline in developing a patients’ diagnosis and treatments. Based on the above assumptions it is clear that the theory aims in improving the health and patients’ outcomes.
Major Concepts of the Theory and their Relations
Self-care and self-management are likely the major concepts of the theory. Self-care activities such as behaviour regarding eating, physical activities and substance use can lead to a greater impact on the well-being of an individual, thus affecting healthcare in general (Matarese et al.,2018). Therefore, self-care is important in managing one’s health and ensuring stable health at all times. As long as the negative factors such as alcohol and substance use are not controlled, human dignity will continue diminishing, negatively affecting the population’s health.
Self-management works hand in hand with self-care to contribute to the effectiveness of the transcendent theory. The concept entails more of an individual understanding one’s health and acknowledging the changes, thus taking appropriate action in seeking professional care and treatment before their health is critical. The approach of this concept also helps nurses understand their patients and manage their condition in a caring manner to achieve in the end.
The mid-range concepts such as self-care and adaptations help interpret the theoretical framework in understanding the effective change created by the social behaviours of different individuals in society. Therefore, to understand the different behaviours and activities of the people, it is important to focus on their self-care and the activities influencing diverse changes in their dignity.
Transcendent pluralism is effective in research and nursing practice. Health practitioners can conduct and analyze the patients’ condition based on physical activities, mental stability, substance use, eating habits, and hygiene to manage their care and assign them for the right treatment. Through the theory, health practitioners can also provide counselling to those patients who show symptoms of the dire need for counselling and therapy (Foli, 2021).
References
Foli, K. J. (2021). A Middle-Range Theory of Nurses’ Psychological Trauma. Advances in Nursing Science. https://journals.lww.com/advancesinnursingscience/Abstract/9000/A_Middle_Range_Theory_of_Nurses__Psychological.99792.aspx
Matarese, M., Lommi, M., De Marinis, M. G., & Riegel, B. (2018). A systematic review and integration of concept analyses of self?care and related concepts. Journal of Nursing Scholarship, 50(3), 296-305. https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/jnu.12385
Reischer, H. N., Roth, L. J., Villarreal, J. A., & McAdams, D. P. (2021). Self?transcendence and life stories of humanistic growth among late?midlife adults. Journal of Personality, 89(2), 305-324. https://onlinelibrary.wiley.com/doi/full/10.1111/jopy.12583

Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:
New practice approaches
Intraprofessional collaboration
Health care delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

California Registered Nurse Staffing Ratio Law PO
Review of a Bill Assignment ( CALIFORNIA RN STAFFING RATIO LAW)
Select an active bill at the state or federal level( CALIFORNIA RN STAFFING RATIO LAW) that impacts the professional practice of nursing. In a 3-4 page paper (excluding the title and reference pages), summarize the provisions of the bill and clearly explain what the bill will accomplish. The paper should be no more than 4 pages, typed in Times New Roman using 12-point font, and double-spaced with 1? margins.
Your review of a bill paper should:
Discuss the major provisions of the bill.
Demonstrate an in-depth understanding of the legislation by explaining the background and all relevant facts.
Discuss any relevant history related to the legislation, pertinent votes, and issues that are stalling the legislation, etc.
Use primary sources for this information.
Identify key supporters and those who do not support the bill. Explain why some of these individuals support the bill and why some do not.
Explore the positions of the key stakeholders in the bill, both pros and cons. Do not make assumptions about potential key stakeholders. Examine this area carefully so you are correctly reflecting the stakeholders positions.
Discuss how the bill would impact a nurse’s ability to provide safe and quality care or to practice to the highest scope of the nursing license.
Explain specific actions that nurses can take to assist with the passage or defeat of the legislation
Use Current APA Style, headings and references as appropriate.
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Solution
California RN Staffing Ratio Law
Major Provisions of The Bill
California registered nurses’ staffing ratio law was enacted in 1999. This law establishes that healthcare facilities should have a minimum number of registered nurses to patient ratios. Healthcare facilities operating in California are therefore required to meet specific staffing ratios depending on the demand for healthcare services that they experience frequently. California registered nurses staffing ratio law AB 394 provides a clear numerical nurse to patient ratios for acute psychiatric, acute care, and specialty hospitals across California. The ratios represent the maximum number of patients that registered nurses can be assigned to during their working shifts (Kasprak, 2017). The AB 394 requires additional registered nurses to be hired and assigned in Healthcare facilities based on previously documented demands and patient classification systems that evaluate the need for nursing care. California registered nurses’ staffing ratio law also requires healthcare facilities to consider the complexity and severity of illness as they normally deal with in hiring extra nurses to ensure adequate nursing staffing ratios (Kasprak, 2017). AB 394 also restricts healthcare facilities from assigning nursing staff and unlicensed staff to two different areas where they do not have demonstrated training competency and orientation. An example of the different nurse-patient ratios provided in the California law includes one registered nurse for two patients in the critical care and intensive care unit, one registered nurse for two patients in the neonatal intensive care unit, one registered nurse to one patient in the operating room one registered nurse for two patients in the post-anesthesia recovery one registered nurses for two patients in the labor and delivery unit 1 registered nurse for four patients in the emergency room one registered nurse for four patients in the pediatric department one registered for six patients in the postpartum unit of a healthcare facility and one registered nurse for1 in the trauma section and one registered nurse to four patients in the emergency room (Kasprak, 2017).
Background of Legislation
Before the adoption of the law governing registered nurse staffing ratios in California at the turn of the millennium, most of the existing laws and policies in the state regulated the registration licensing and the scope of practice for nurses. The California law to regulate the registered nurse staffing ratios was therefore adopted in a bid to prevent health care facilities, including acute psychiatric hospitals, acute care hospitals, and special hospitals, from assigning and unlicensed persons to perform registered nursing roles and to prevent unlicensed personnel from performing registered nurses roles even under the supervision of such nurses (Kasprak, 2017). The registered nursing staff ratio law was therefore adopted in the state of California to build on previous laws such as the laws prohibiting the operation of healthcare facilities without licenses issued by the state department health services and subsequent regulation of social care facilities. The law regulating the registered nurse staffing ratios in California required the state department for health services in California to adopt regulations that would establish a minimum nurse-to-patient ratio in acute care special hospitals and an acute psychiatric hospital. The law would also require healthcare facilities to adopt procedures and policies for the orientation and training of nursing staff (Kasprak, 2017).
Relevant History
The bill to regulate registered nursing staffing ratios in the state of California was first introduced in the state legislature of California on February 2, 1999. Eventually, the bill was referred to the committee on health on February 25, 1999. After numerous committee hearings, the bill was read for a second time on September 1, 1999, and read for that time on September 8, 1999. Senate amendments were introduced to the bill on September 9, 1999, with the Senate approving the bill (Kasprak, 2017). Finally, the bill was approved by the California governor on October 10, 1999. During the approval of the bill in the California senate, 46 representatives supported the bill, while 29 opposed the bill (Kasprak, 2017).
Proponents and Opponents of the Bill Positions
There are numerous proponents of the California nurse staffing ratios who include numerous representatives in the California State legislature, professional nursing organizations, and non-governmental organizations that advocate for better healthcare services among populations. The main reason that professional nursing organizations supported the California nursing ratio law was because of the long history of overworking among nurses in the state. Most nurses across California there were reported that they did not have adequate time to provide sufficient emotional support and comfort to their patients or family members (Livanos, 2018). Limiting the number of patients that nurses can attend to would therefore force healthcare facilities to hire more nurses and therefore improve the quality of care to patients. Different studies have therefore supported higher nursing staff ratios as a way of ensuring safety in healthcare facilities and helping to boost the number of positive outcomes among health care providers (Livanos, 2018).
On the other hand, the opponents of nursing staffing ratio laws argue that such laws can play a significant role in hindering access to healthcare services. The main opponents to nursing staffing ratio laws included the coalition to protect patient safety, healthcare owners associations, and some members of the California state legislature. Those opposing the nursing staffing laws argued that implementing such laws without providing the necessary funding to health care facilities would instigate significant cuts in critical programs such as mental health services and opioid treatment in healthcare facilities. Implementing nursing staff laws would also have a significant negative impact on community hospitals that would be forced to close because of not being able to absorb added costs (Livanos, 2018).
Positions of Key Stakeholders
The key stakeholders affected by the nursing ratio laws include the management of healthcare facilities, patients, and nurses. Nursing ratios with health nurses to provide all the necessary quality care to patients. On the other hand, nursing ratios would have a significant impact on the management of healthcare facilities due to the high costs required to hire extra nurses. Nursing staff ratios could have a significant impact on the delivery of quality services to patients, as some patients would receive quality care while others would not have any nurses to attend to them (McHugh et al., 2020).
Impact of the Bill or Nurse’s Ability to Provide Safe and Quality Care
The nurse staffing ratio law increases the ability of nurses to provide quality and safe care to patients. This is because the bill helps to manage the workload of nurses and therefore increases their ability to provide quality healthcare services (McHugh et al., 2020).
Action by Nurses to assist in Passage or Defeat of the Legislation
Nurses can play a significant role in introducing reforms that can make the California RN staffing ratio law that has already been adopted to be more effective. This would include lobbying set legislature representatives to make the necessary amendments to the law through various professional nursing organizations.
References
Kasprak, J. (2017). California Rn Staffing Ratio Law. Cga.Ct.Gov. Retrieved December 15, 2021, from https://www.cga.ct.gov/2004/rpt/2004-r-0212.htm
Livanos, N. (2018). A Broadening Coalition: Patient Safety Enters the Nurse-to-Patient Ratio Debate. Journal of Nursing Regulation, 9(1), 68–70. https://doi.org/10.1016/s2155-8256(18)30056-5
McHugh, M. D., Aiken, L. H., Windsor, C., Douglas, C., & Yates, P. (2020). Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study. BMJ Open, 10(9), e036264. https://doi.org/10.1136/bmjopen-2019-036264

Case Study 1:
Mr. Perkins, age 81, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he uses a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.
Discussion: Evaluation Plan
As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario.
To prepare:
Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
Consider immunization requirements that may be needed for this patient.
By Day 3
Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.
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Solution
Evaluation Plan for a Geriatric Patient
This male patient is an octogenarian aged 81 years old. He is in relatively good health judging by the fact that he is only taking Tylenol medication for his arthritic pain. This means that he does not have any comorbidities to warrant taking a plethora of medications. The main problem that he has is osteoarthritis whose pain he confesses to have increased and that is why he is walking with a cane. On this visit, he requests also for immunization against flu. This paper looks at his evaluation plan in terms of assessment tools, required immunizations, and additional factors such as language and education.
Explanation of the Evaluation Plan and Types of Assessment Tools
My evaluation plan for this octogenarian is to carry out a holistic evaluation that is not only restricted to the physical. It will cover his psychiatric status, cognitive ability, functional ability, home safety, neurologic function, pain, nutritional status, and overall health (University of Maryland, 2021).
Types of Assessment Tools to Use for the Patient
The types of assessment tools that I might use for this patient are outlined below depending on the area of interest for the assessment. They are (University of Maryland, 2021):
For functional ability – Global Assessment of Functioning (GAF) scale
This assessment tool will enable the evaluation of whether this patient can still perform for himself the activities of daily living (ADLs) such as bathing, feeding, and dressing.
For cognitive ability – Mini-Mental State Examination
This assessment tool will be crucial as it will enable the identification of any neurocognitive disorder that may not ye be apparent but present. An example is Alzheimer’s disease (APA, 2013).
For hearing – Hearing Handicap Inventory
At the age of 81 years, it is expected that this patient has some sort of hearing problem. This assessment tool will be invaluable in determining this or otherwise.
For neurologic function – Abnormal Involuntary Movement Scales (AMS)
Assessment of neurologic function using this tool will also be important to rule out conditions such as stroke and Parkinsonism.
For home safety – Home Safety Checklist
The home safety checklist tool is another important tool to use with this patient. This is because for instance patients above the age of 65 years are at great risk of accidental falls at home and in the healthcare setting (McCarthy, 2016).
For mood – Geriatric Depression Scale
Elderly patients are often suffering from depression due to the fact that most of them feel lonely. This assessment tool will determine if this patient is suffering from depression or not.
For pain – Pain Assessment
Pain assessment is important with this patient to determine the extent of his arthritic pain. He says the hip pain has increased steadily over the last six months.
For nutritional status – Nutrition Checklist for Older Adults
Elderly patients often suffer malnutrition. Assessing for their nutritional status is a wise move as it may reveal potential malnutrition that could cause lowered immunity.
For psychosis – Pittsburgh Agitation Scale
Determining the psychological status of this patient is important, just because of the ramifications were there to be a psychotic condition.
For overall health – aging Quiz
Lastly, assessing the octogenarian’s overall health is also vital to determine where he stands in the overall scheme of things.
Validation of Tools and Accompanying Issues
All the ten tools mentioned above have been validated for use with this geriatric patient population. If this was not the case, of course, there would have been issues with the validity and reliability of the tests.
Additional Factors
The additional factors that might present issues when performing the above assessments for this patient include language barrier and level of education. Since he is not accompanied, language would present a significant barrier to communication. In the same way, the low educational achievement will present the challenge of simplifying everything for the patient to understand.
Immunization Requirements
In the case of this patient, these are (NCA, 2021):
Influenza or flu vaccine
Pneumococcal vaccine for pneumonia
Shingles vaccine
Hepatitis B vaccine
References
American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
McCarthy, M. (2016). Falls are leading cause of injury deaths among older people, US study finds. BMJ, 354 (i5190). https://doi.org/10.1136/bmj.i5190
National Council on Aging [NCA] (November 24, 2020). Four important vaccines for seniors covered by Medicare. https://www.ncoa.org/article/4-important-vaccines-for-seniors-covered-by-medicare
University of Maryland (2021). Geriatric assessment tools. https://www.pharmacy.umaryland.edu/centers/lamy/clinical-initiatives/medmanagement/assisted_living/geriatric-assessment-tools/

Assignment 1: Practicum Professional Experience Plan (PPEP)
Success comes from knowing that you did your best to become the best that you are capable of becoming.
— John Wooden, My Personal Best: Life Lessons from an All-American Journey
As you considered in this week’s Discussion, your experiences in the practicum can provide a vital avenue for professional development.
For this Assignment, you develop a Practicum Professional Experience Plan (PPEP) to outline how your involvement in the practicum will contribute to your growth as a professional and allow you to hone your specialization knowledge and skills. The PPEP consists of two or three objectives related to professional development that you will address during your Practicum Experience.
Note: In the practicum manual these are referred to as your individualized learning objectives.
To prepare:
As necessary, review the information related to developing objectives provided in this week’s Learning Resources.
Revisit the objective(s) you crafted for this week’s Discussion, and reflect on the ideas exchanged in this forum. Refine the objective(s) as needed, making sure they reflect the higher-order domains of Bloom’s Taxonomy (i.e., Application level and above). Note: You will be developing two to three professional development objectives for this assignment.
Think more deeply about areas for which you would like to gain application-level experience and/or continued professional growth. How can your experiences in the practicum help you achieve these aims?
Discuss your professional aims and your proposed practicum professional development objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.
Download and save the Practicum Professional Experience Plan Form provided in this week’s Learning Resources.
NURS 6600: Practicum Professional Experience Plan (PPEP)
To complete your Practicum Professional Experience Plan:
Record the required information in each area of the Professional Practicum Experience Plan, including two or three objectives you will use to facilitate your professional development during the practicum.
Required Readings
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Cipriano, P. F., & Murphy, J. (2011). The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 286–289.
Note: Retrieved from the Walden Library databases.
“Technology tools will continue to revolutionize how we plan, deliver, document, review, evaluate, and derive the evidence about care” (p. 289). This article examines how nurses can use information technology to transform nursing and redesign the health care system. It focuses on the use of technology to promote quality and notes that technology can also be used to address challenges in education, research, leadership, and policy.
McKimm, J., & Swanwick, T. (2009). Setting learning objectives. British Journal of Hospital Medicine, 70(7), 406–409.
Note: Retrieved from the Walden Library databases.
This article clarifies the terminology associated with learning objectives and explains how learning objectives relate to professional development and the transformation from novice to expert. It also introduces common pitfalls when setting learning objectives and provides suggestions for avoiding them.
Murphy, J. (2011). The nursing informatics workforce: Who are they and what do they do? Nursing Economic$, 29(3), 150–153.
Note: Retrieved from the Walden Library databases.
The author examines the nursing informatics workforce, explaining that professionals in this well-established specialty area can play an integral role in transforming health care.
Sørensen, E. E., Delmar, C., & Pedersen, B. D. (2011). Leading nurses in dire straits: Head nurses’ navigation between nursing and leadership roles. Journal of Nursing Management, 19(4), 421–430.
Note: Retrieved from the Walden Library databases.
“Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity” (p. 421). In this article, the authors examine how individuals in key professional roles negotiate between and apply nursing and leadership skills.
Warm, D., & Thomas, B. (2011). A review of the effectiveness of the clinical informaticist role. Nursing Standard, 25(44), 35–38.
Note: Retrieved from the Walden Library databases.
The authors investigate the application of specialized knowledge and expertise to facilitate the appropriate use of emerging technologies in clinical settings. They argue for informaticists’ involvement in strategic development and delivery of information management and technology initiatives to promote patient-centered outcomes.

Supporting the Interdisciplinary Team
After reading through your chosen scenario: Post an explanation of how you would support the interdisciplinary team. Specifically, recommend and justify a strategy for addressing the central conflict or issue. Explain how a strengthened interdisciplinary approach relates to the quality of care and patient outcomes in the scenario. Then explain what diversity (e.g., different generation cohorts, levels of experience, specialties, backgrounds, races, and genders) brings to the team and how you would leverage that in the scenario. Be specific and provide examples.
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Solution
Interdisciplinary team members work together to ensure the quality and safety of patient care. This discussion explains how one would support the interdisciplinary team, how the quality of patient care and health outcomes in the selected scenario relates to strengthening the interdisciplinary approach, and the impact of diversity on team members.
The selected scenario is B, about Monica, a new social work graduate working at Meridien Medical Center. She is spotted on the phone repeatedly during interdisciplinary rounds. The central issue presented in this scenario involves the perception of other healthcare providers towards Monica. Other team members, including the physician, the nurse, and Fran, feel that Monica is not doing what is expected and portraying unprofessionalism. This issue can be addressed through interdisciplinary collaboration best practices, particularly communication. Hence, another interdisciplinary team member should speak to Monica about her behavior and its impact on the functioning of the entire team and the quality of patient care, and overall health outcomes. According to Mao and Woolley (2016), all interdisciplinary team members should perform their roles well to enhance the functioning and contribute to the entire team’s success. A well-coordinated interdisciplinary team then improves the quality of patient care and health outcomes (Johnson & Sollecito, 2020). Various aspects of diversity affect interdisciplinary teams adversely. In this case, the function of the multidisciplinary team is compromised by differences in team members’ experience levels. Experienced practitioners, including the physician, the nurse, and Fran, are committed to providing quality care to their patients. On the contrary, the new social work graduate seems to be less committed to patient care, evidenced by her tendency to spend most of her time on the phone even when attending to patients. Diversity in the scenario can be addressed by meeting with all the team members and resolving their differences to enhance team functioning and productivity (Bridges et al., 2016).
References
Bridges, D., Davidson, R. A., Soule Odegard, P., Maki, I. V., & Tomkowiak, J. (2016). Interprofessional collaboration: three best practice models of interprofessional education. Medical education online, 16(1), 6035.
Johnson, J. K., & Sollecito, W. A. (2020). McLaughlin & Kaluzny’s continuous quality improvement in health care (5th ed.). Burlington, MA: Jones and Bartlett.
Mao, A. T., & Woolley, A. W. (2016). Teamwork in health care: maximizing collective intelligence via inclusive collaboration and open communication. AMA journal of ethics, 18(9), 933-940.

Basic Concepts in Public Health Statistic-Classmate (Sharon) response (2) Topic 1 DQ 1
QUESTION- TOPIC 1 DQ 1 -Statistics is an important component of public health. Explain the relevance of statistics in the planning, implementation, and evaluation of a health promotion intervention. How do you envision using statistics in your current or future career?
Classmate Response- (Sharon Cole) Response (2)
Accurate, comprehensive, high-quality data and statistics are not the only central elements of evidence-based public health policy. Data and statistics help raise health awareness among the general public; they can also help achieve better social and health outcomes and reduce health inequalities (Guidi et al., 2021). Thus, integrating statistics and analytic techniques into public health research is a critical asset to the agency. It has resulted in important applications in various disciplines, such as epidemiology, economics, and the behavioural and social sciences. Since CDC’s inception, an essential function of the agency has been the compilation, analysis, and interpretation of statistical information to guide actions and policies to improve health. Data sources include vital statistics, medical, personal interviews, telephone and mail surveys, physical examinations, and laboratory testing. In addition, public health surveillance data have been used to characterize the magnitude and distribution of illness and injury; track health trends; and develop standard curves, such as growth charts (Sieber et al., 2006).
Statistics are essential in public health and is used all the time; it is a part of public health practices; as a public health practitioner, it would guide me to have a more objective approach in my discipline. It would also help me communicate factual findings to others, whether to the agency I am employed or to the population. This will help promote health and prevent people’s sicknesses.
References
Guidi, C.F, & Umbach, G. (2015). The importance of Statics in Public Health Sector Analysis. Retrieved September 11, 2021, from https://epthinktank.eu/2015/11/25/the-importance-of-statistics-in-public-health-sector-analysis/
Sieber, W.K, Green, T, & Williamson., G.D. (2006). Statistics and Public Health at CDC. Retrieved September 11. 2021, from https://www.cdc.gov/mmwr/preview/mmwrhtml/su5502a9.htm
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Solution
Classmate Response- (Sharon Cole)
I agree with you that statistics is the foundation of public health and other related disciplines such as epidemiology. Statistics in public health can therefore be compared to the taking of vital signs of a patient such as heart rate, blood pressure, and temperature in clinical practice. Public health practitioners monitor the health of communities through statistical methods, which include collecting and analyzing different forms of health data (Hayat et al., 2017). The collected data is then referred to as health statistics. Health statistics, therefore, make up the assessment function of public health. The assessment function of public health is important for populations and communities in that it helps in the detection of new health threats, identification of risk groups in a given population, the planning of various public health programs, and the subsequent evaluation of such programs. Authorities in communities such as local state and federal authorities also rely on statistics to prepare an adequate budget for public health interventions (Hayat et al., 2017). Public health, therefore, relies on statistics to provide data and also relies on such statistics to adequately interpret such data. Statistics also help to present complex numerical information that is relevant, reliable, and comparable in a complete and up-to-date manner. In most instances, the need for different public health interventions in different communities or populations is not normally evident. However, through statistics and data analysis, the need for public health interventions in given communities or populations becomes evident. For example, a community may not be able to tell it has an issue with high cardiovascular disease rates unless it analyses health records from various healthcare facilities. The recognition of a public health issue through statistics makes it easy for public health leaders to convince authorities to fund public health interventions (Hayat et al., 2017).
References
Hayat, M. J., Powell, A., Johnson, T., & Cadwell, B. L. (2017). Statistical methods used in the public health literature and implications for training of public health professionals. PLOS ONE, 12(6), e0179032. https://doi.org/10.1371/journal.pone.0179032

Nsg5003 Advanced Pathophysiology
Sample Question 1
Mom is a carrier for hemophilia but does not have the disease. Dad does not have hemophilia . 1) In Cystic Fibrosis, how would the responses be different to the questions in the Post? Give a detailed explanation supporting your response.
Response # 2 Down Syndrome is another genetic disorder. Why is the Punnett Square not a good tool for predicting if offspring will have Down Syndrome? Why does the risk for Down’s Syndrome increase with maternal age?
Sample Question 2
1) List the additional questions you would need to ask this patient. Explain.
2) What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women? What are the possible complications to the pregnant woman and her fetus?
3) What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan?
4) Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.
5) How does ethnopharmacology apply to this patient if she were NOT pregnant? Explain.
6) What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment?
7) Would you treat this patient or refer her? Explain. If you refer, where would you refer this patient?
Sample Question 3
1) Describe the pathophysiology of depression.
2) Discuss the phenomenon of depression effects on appetite. Describe from a pathophysiologic basis why some people with depression experience a lack of appetite resulting in weight loss while others will experience increased food intake and have weight gain.
3) Discuss two additional clinical findings of depression and present the pathophysiologic basis of these symptoms.
Sample Question 4
1)Summarize the pathophysiology of Peptic Ulcer Disease as compared to GERD and explain which one his symptoms most closely represent. Support with evidence. 2) Explain the body’s natural protection against peptic ulcers from a pathophysiology standpoint. 3) What diagnostic testing may be used to further evaluate the symptoms and what might this test tell the healthcare provider?