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December 13, 2024
December 13, 2024

Proposed Change Project

Author By Academic Wizard Categories Blog

Proposed Change Project

The purpose of this assignment will be to begin developing an implementation plan for your project.

In 750-1,000-words, include the following in your plan:

Proposed Change Project

  1. In 1-2 sentences, summarize the problem or issue being addressed by your proposed change project.
  2. Based on the assessment of your practicum site and the literature evaluation you completed in Topic 4, propose how you will address the identified problem or issue (this will be the solution). Solutions should include sociocultural and linguistic considerations and affect nursing practice.
  3. Discuss steps for how the nursing practice intervention will be implemented in the capstone project change proposal proposed above. In your discussion include the impact it will have on nursing practice.
  4. Write a list of three to five objectives for your proposed intervention. Remember, objectives serve as the goals of your project.
  5. Based on your objectives, develop a list of three to five measurable outcomes for your proposed intervention. Remember, outcomes serve as the tangible, measurable results of implementing your project and should align with your objectives.
  6. Provide a rationale for how your proposed project, objectives, and outcomes demonstrate respect for autonomy (self-determination) for individuals and diverse populations.

You are required to cite a minimum of two peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice. Proposed Change Project

Prepare this assignment according to the guidelines 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.

The purpose of this assignment will be to begin developing an implementation plan for your project.

In 750-1,000-words, include the following in your plan:

  1. In 1-2 sentences, summarize the problem or issue being addressed by your proposed change project.,
  2. Based on the assessment of your practicum site and the literature evaluation you completed in Topic 4, propose how you will address the identified problem or issue this will be the solution.,  Solutions should include sociocultural and linguistic considerations and affect nursing practice.
  3. Discuss steps for how the nursing practice intervention will be implemented in the capstone project change proposal proposed above. ,In your discussion include the impact it will have on nursing practice.
  4. Write a list of three to five objectives for your proposed intervention. Remember objectives serve as the goals of your project.,
  5. Based on your objectives, develop a list of three to five measurable outcomes for your proposed intervention., Remember, outcomes serve as the tangible, measurable results of implementing your project and should align with your objectives.
  6. Provide a rationale for how your proposed project, objectives, and outcomes demonstrate respect for autonomy (self-determination) for individuals and diverse populations.

You are required to cite a minimum of two peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice. Proposed Change Project

Prepare this assignment according to the guidelines 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.

December 13, 2024
December 13, 2024

Analyzing Group Techniques

Author By Academic Wizard Categories Blog

Analyzing Group Techniques

Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.

As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.

Analyzing Group Techniques

Select one video among the following

In a 3- to 4-page paper, identify the video you selected and address the following:

  • What group therapy techniques were demonstrated?, How well do you believe these techniques were demonstrated?,
  • What evidence from the literature supports the techniques demonstrated? ,
  • What did you notice that the therapist did well?,
  • Explain something that you would have handled differently.,
  • What is an insight that you gained from watching the therapist handle the group therapy?,
  • Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?
  • Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Analyzing Group Techniques

Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.

As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.

Select one video among the following

In a 3- to 4-page paper, identify the video you selected and address the following:

  • What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?
  • What evidence from the literature supports the techniques demonstrated?
  • What did you notice that the therapist did well?
  • Explain something that you would have handled differently.
  • What is an insight that you gained from watching the therapist handle the group therapy?
  • Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?
  • Support your reasoning with at least three peer-reviewed evidence-based sources and explain why each of your supporting sources is considered scholarly., Attach the PDFs of your sources.
December 13, 2024
December 13, 2024

Purchasing in Organizations 

Author By Academic Wizard Categories Blog

Purchasing in Organizations 

Write an academic paper of  4  pages in APA 7th edition style to address each of the three (3) purchase situations commonly encountered by organizations for a typical purchase for the following organizations:

  • Wendy’s or McDonald’s
  • Mercedes-Benz or another automobile dealerships in the U.S.
  • Target or a supermarket chain

Purchasing in Organizations 

Assignment Questions

  1. How do these organizations typically respond to one of the different purchase situations?,
  2. Explain the selection and steps involved in the organization’s purchasing and the types of employees that might be involved in the purchase decision.,
  3. Evaluate the potential influence of corporate culture on the purchasing decisions in these organizations. , How might cultural factors like risk aversion or innovation orientation affect the process?,
  4. What motivates the organization’s purchasing decisions?, How does the organization’s purchasing decisions relate to its identity?,
  5. Assess the impact of external factors e.g., economic conditions regulatory environment competitive landscape on the purchasing decisions of one of these organizations.,
  • Cite eight (8) peer-reviewed articles not including your textbook.
  • Use specific examples and scenarios to illustrate your points.
  • Incorporate relevant theories and models of organizational buying behavior in your analysis.

Purchasing in Organizations Assignment  

Write an academic paper of  4  pages in APA 7th edition style to address each of the three (3) purchase situations commonly encountered by organizations for a typical purchase for the following organizations:

  • Wendy’s or McDonald’s
  • Mercedes-Benz or another automobile dealerships in the U.S.
  • Target or a supermarket chain Purchasing in Organizations 

Assignment Questions

  1. How do these organizations typically respond to one of the different purchase situations?
  2. Explain the selection and steps involved in the organization’s purchasing and the types of employees that might be involved in the purchase decision.
  3. Evaluate the potential influence of corporate culture on the purchasing decisions in these organizations. How might cultural factors like risk aversion or innovation orientation affect the process?
  4. What motivates the organization’s purchasing decisions? How does the organization’s purchasing decisions relate to its identity?
  5. Assess the impact of external factors (e.g., economic conditions, regulatory environment, competitive landscape) on the purchasing decisions of one of these organizations.
  • Cite eight (8) peer-reviewed articles not including your textbook.
  • Use specific examples and scenarios to illustrate your points.
  • Incorporate relevant theories and models of organizational buying behavior in your analysis.
December 13, 2024
December 13, 2024

Role of Play in the Lives of Infants 

Author By Academic Wizard Categories Blog

Role of Play in the Lives of Infants

As the long-time director of an infant/toddler care and education program, you have worked with caregivers who have innately understood the value of play to children’s healthy development and translated that understanding into fostering children’s exploration, discoveries, and growth. You have also worked with caregivers who haven’t been able to understand the complex yet exciting relationship between play and children’s growth. You have seen caregivers with the best of intentions limit children’s explorations, challenge their play endeavors inappropriately, over direct their activity, and, often due to great enthusiasm, take the lead in children’s play, limiting their opportunities for creative expression, independence and safe risk-taking. Because you deeply believe in offering a stellar play-based program, you’ve decided to draw on a variety of strong resources in order to create a PowerPoint presentation synthesizing the inter-relationship between infant/toddler play, exploration, and learning while underscoring three vital roles: 1) the role children have in their own play;, role of adults in truly fostering play and development while honoring children’s individuality initiative interests and imaginations;,  role of appropriate and inspiring play spaces in fostering children’s growth. ,Role of Play in the Lives of Infants

Role of Play in the Lives of Infants 

You decide to create your PowerPoint and include narration, substantiated by current resources, so your current staff will benefit from hearing your passion and sincerity along with quotes, examples, and narrative prose to better illustrate the points you want people to understand and think about. Use the Play PowerPoint template to create a PowerPoint presentation with narration, using the following structure: Role of Play in the Lives of Infants

  • First Slide: Introduction explaining your definition of infant/toddler play based on current resources
  • At least 5 slides synthesizing the inter-relationship between infant/toddler play, exploration, and learning (with examples from varying age levels and insights substantiated by resources)
  • At least 5 slides explaining 1) the vital role children have in their own play, and 2) the role of adults in truly fostering play and development while honoring children’s individuality, initiative, interests, and imaginations (with examples from varying age levels and insights substantiated by resources)
  • At least 5 slides synthesizing the role of appropriate and inspiring play spaces in fostering children’s growth (with examples and insights substantiated by resources)
  • At least 2 slides synthesizing the inter-relationship between child-directed/independent play, play spaces in infant/toddler care and education programs, and children’s healthy development and learning (with examples and insights substantiated by resources)

As the long-time director of an infant/toddler care and education program, you have worked with caregivers who have innately understood the value of play to children’s healthy development and translated that understanding into fostering children’s exploration, discoveries, and growth. You have also worked with caregivers who haven’t been able to understand the complex yet exciting relationship between play and children’s growth. You have seen caregivers with the best of intentions limit children’s explorations, challenge their play endeavors inappropriately, over direct their activity, and, often due to great enthusiasm, take the lead in children’s play, limiting their opportunities for creative expression, independence and safe risk-taking. Because you deeply believe in offering a stellar play-based program, you’ve decided to draw on a variety of strong resources in order to create a PowerPoint presentation synthesizing the inter-relationship between infant/toddler play, exploration, and learning while underscoring three vital roles: 1) the role children have in their own play; 2) the role of adults in truly fostering play and development while honoring children’s individuality, initiative, interests, and imaginations; and 3) the role of appropriate and inspiring play spaces in fostering children’s growth.

You decide to create your PowerPoint and include narration, substantiated by current resources, so your current staff will benefit from hearing your passion and sincerity along with quotes, examples, and narrative prose to better illustrate the points you want people to understand and think about. Use the Play PowerPoint template to create a PowerPoint presentation with narration, using the following structure: Role of Play in the Lives of Infants

  • First Slide: Introduction explaining your definition of infant toddler play based on current resources,
  • At least 5 slides synthesizing the inter-relationship between infant/toddler play, exploration, and learning (with examples from varying age levels and insights substantiated by resources)
  • At least 5 slides explaining 1) the vital role children have in their own play, and 2) the role of adults in truly fostering play and development while honoring children’s individuality, initiative, interests, and imaginations (with examples from varying age levels and insights substantiated by resources)
  • At least 5 slides synthesizing the role of appropriate and inspiring play spaces in fostering children’s growth with examples and insights substantiated by resources,
  • At least 2 slides synthesizing the inter-relationship between child-directed independent play play spaces in infant toddler care and education programs and children’s healthy development and learning, (with examples and insights substantiated by resources)
December 13, 2024
December 13, 2024

Gynecology focused note

Author By Academic Wizard Categories Blog

Gynecology focused note

Patient histories are a building block of the diagnosis and treatment. By effectively interviewing patients in their care, advanced practice nurses  can piece together facts to construct a relevant history that can lead to assessment and treatment.

For this Focused Note Assignment, you will select a patient with gynecologic conditions from your clinical experience and construct a patient history, assess and diagnose the patient’s health condition(s), and justify the best treatment option(s) for the patient.

Gynecology focused note

 

Note: All Focused Notes must be signed, and each page must be initialed by your preceptor. When you submit your Focused Notes, you should include the complete Focused Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your Focused Notes using Turnitin.

Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

Resources

  • Fowler, G. C. (2019). Pfenninger and Fowler’s Procedures for Primary Care(4th ed.). Elsevier.
    • Chapter 136, “Insertion and Removal of Nexplanon” (pp. 946–951)
    • Chapter 137, “Pessaries” (pp. 952–959)
    • Chapter 138, “Treatment of Noncervical Condylomata Acuminata” (pp. 960–969)
    • Chapter 139, “Vulvar Biopsy” (pp. 970–973)

Practicum Resources 

Clinical Guideline Resources 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.  Gynecology focused note

WEEKLY RESOURCES

To prepare:

  • Use the Focused SOAP Note Template found in the Learning Resources for this week to complete this Assignment.
  • Select a patient that you examined during the last three weeks. With this patient in mind, address the following in your Focused Note Template. Gynecology focused note

Assignment

  • Subjective:,What details did the patient provide regarding her personal and medical history?,
  • Objective:,What observations did you make during the physical assessment?,
  • Assessment:,What were your differential diagnoses? ,Provide a minimum of four possible diagnoses. ,List them from highest priority to lowest priority., What was your primary diagnosis and why?,
  • Plan:,What was your plan for diagnostics and primary diagnosis?, What was your plan for treatment and management including alternative therapies?, Include pharmacologic and nonpharmacologic treatments alternative therapies and follow-up parameters, as well as a rationale for this treatment and management plan.,
  • Reflection notes:What would you do differently in a similar patient evaluation?

 

December 13, 2024
December 13, 2024

Gynecologic health

Author By Academic Wizard Categories Blog

Gynecologic health

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms., Such case studies enable nurse learners to apply concepts lessons and critical thinking to interviewing screening diagnostic approaches as well as the development of treatment plans.,

For this Case Study Assignment, you will analyze a case study scenario to obtain information related to a comprehensive well-woman exam, and determine differential diagnoses diagnostics and develop treatment and management plans.,

Gynecologic health

 

Resources

Clinical Guideline Resources

Required Media

  • Gynecologic Health – Comprehensive Well-Woman Exam
    Phyllis Morgan discusses the comprehensive well-woman exam and any pertinent information related to this topic (27 mins).
  • SeattlePTC (2015). Examination of Vaginal Wet Preps [Video]Links to an external site.. https://www.youtube.com/watch?v=8dgeOPGx6YI&t=3s
    • Note:This media program is approximately 15 minutes.
    • Note: As you review this video, consider this as a basic microscopy (yeast, BV).

Optional Resources

  • Hatcher, R. A., Nelson, A. L., Trussell, J., Cwaik, C., Cason, P., Policar, M. S., Kowal, D. (2018). Contraceptive technology(21st ed.). PDR Network, LLC. Gynecologic health

Note: In Weeks 1-10, these resources are optional for your review. In Week 11, you will be required to review each of the PowerPoint slides from the text Gynecologic Health Care (4th ed.).

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

  • Review the 4 case studies in this week’s Learning Resources. Select one of the cases to prepare your written assignment.
  • Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills., Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
  • Carefully review the clinical guideline resources.

Assignment:

  • Use the Assignment Template from the Learning Resources to complete your assignment., The template must be filled out and incorporated into the body of your paper (not submitted separately), ensuring all required information is included.
  • The assignment should be written in paragraph format, including a title page and a reference page, and must address all the criteria outlined in the rubric.
December 13, 2024
December 13, 2024

Observation Setting

Author By Academic Wizard Categories Blog

Observation Setting

Part 1: Infants

  • Introduction: A brief overview of your observation setting. (1-2 paragraphs)
  • Summary of information from the teacher in the infant setting. (2-4 paragraphs)
  • Evaluation of infant routines and transitions you observed for safety, consistency, responsiveness, respect, and whether/how they fostered responsive and respectful relationships including attachment and/or autonomy appropriately. Be sure to substantiate your thinking with evidence-based resources. (2-4 paragraphs)
  • Three recommendations for enhancing or improving the opportunities in routines and transitions for infants’ healthy development specific to fostering respectful and responsive relationships and appropriate attachment and autonomy. Be sure to substantiate your thinking with evidence-based resources. (2-3 paragraphs)

Observation Setting

 

Part 2: Toddlers

  • Introduction: A brief overview of your observation setting. (1-2 paragraphs)
  • Summary of information from the teacher in the toddler setting. (2-4 paragraphs)
  • Evaluation of toddler routines and transitions you observed for safety, consistency, responsiveness, respect, and whether/how they fostered responsive and respectful relationships including attachment and/or autonomy appropriately. Be sure to substantiate your thinking with evidence-based resources. (2-4 paragraphs)
  • Three recommendations for enhancing or improving the opportunities in routines and transitions for toddlers’ healthy development specific to fostering respectful and responsive relationships and appropriate attachment and autonomy. Be sure to substantiate your thinking with evidence-based resources. (2-3 paragraphs)

Observation

Part 1: Infants

  • Introduction: A brief overview of your observation setting. (1-2 paragraphs)
  • Summary of information from the teacher in the infant setting. (2-4 paragraphs)
  • Evaluation of infant routines and transitions you observed for safety, consistency, responsiveness, respect, and whether/how they fostered responsive and respectful relationships including attachment and/or autonomy appropriately. Be sure to substantiate your thinking with evidence-based resources. (2-4 paragraphs)
  • Three recommendations for enhancing or improving the opportunities in routines and transitions for infants’ healthy development specific to fostering respectful and responsive relationships and appropriate attachment and autonomy. Be sure to substantiate your thinking with evidence-based resources. (2-3 paragraphs)

Part 2: Toddlers

  • Introduction: A brief overview of your observation setting.,
  • Summary of information from the teacher in the toddler setting.,
  • Evaluation of toddler routines and transitions you observed for safety consistency responsiveness respect and whether how they fostered responsive and respectful relationships including attachment and or autonomy appropriately., Be sure to substantiate your thinking with evidence-based resources. (2-4 paragraphs)
  • Three recommendations for enhancing or improving the opportunities in routines and transitions for toddlers’ healthy development specific to fostering respectful and responsive relationships and appropriate attachment and autonomy., Be sure to substantiate your thinking with evidence-based resources., (2-3 paragraphs)
December 13, 2024
December 13, 2024

Performance management and career management 

Author By Academic Wizard Categories Blog

Performance management and career management

Select any one of the following starter bullet point sections. Review the important themes within the sub questions of each bullet point. The sub questions are designed to get you thinking about some of the important issues. Your response should provide a succinct synthesis of the key themes in a way that articulates a clear point, position, or conclusion supported by research. Performance management and career management

 Performance management and career management 

 

  • Opinions in organizational literature about performance appraisals (PA) as part of performance management are mixed. Some suggest PA is a crucial feature for HRM. Others criticize PA as counter to other organizational goals.
    • Assess the role of PA ., What are its potential benefits to both individuals and organizations?, What are some of its potential drawbacks?,
    • How should we assess the difference between performance appraisal and performance management?, What are the best practices to consider? ,
    • How might performance appraisal and performance  management contribute to strategic HRM?,
  • Global economic forces, shifting preferences, and changing demographics are all presenting challenges to organizations and individuals trying to effectively manage careers. In this challenging environment, some suggest that employees are responsible for their own career management. Others suggest that organizations have responsibility for the career management of the workforce. Assess the responsibility of both employers and employees for career management.Performance management and career management
    • What are the critical steps an employee needs to take to manage his/her own career?
    • What are the critical, strategic factors an organization needs to consider when making decisions about how to support employees’ career management?
  • When organizations downsize or go through other dramatic events leading to a reduction in force (RIF), employees are often caught unprepared for the day when they receive their layoff notice. Defend at least three ideas for how employees can be prepared for a loss of their jobs (consider the performance and career management issues).
    • What assistance should employers be expected to provide for terminated employees?
    • How does the WARN Act affect employer responsibility?
    • Justify at least three ideas for assistance that employers should provide to their laid off employees.
  • 360-degree feedback has become an important part of many performance management systems. It provides employees with performance feedback from supervisors, co-workers, peers, and customers, and for managers, their direct reports. The performance feedback is      usually a part of a developmental plan and is often a part of the organization’s performance appraisal process, as well. However, 360-degree feedback has come under criticism in many organizations.
    • Evaluate the benefits and criticism that 360-degree feedback has encountered.,
    • What are the pros and cons of the method as well as the organizational requirements for success?,
    • If your company uses a 360-degree process, include your own personal experience with the method and your assessment of its value. If your company does not use a 360-degree feedback process, analyze whether you think that it could be successful in your organization.

The final paragraph (three or four sentences) of your initial post should summarize the one or two key points that you are making in your initial response.Performance management and career management

Your posting should be the equivalent of 1 to 2 single-spaced pages (500–1000 words) in length.
Submission Details:

Due by 12/12/24 at 6:00pm CST

Requirements:

  1. Make certain to include in text citations from your course text in addition to your outside leadership resources within your main  post. This adds credibility to your argument. [Textbook]:Cascio, W. F. (2021). Managing human resources: Productivity, quality of work life, profits (12th ed.). McGraw-Hill. ISBN: 978-1260681352
  2. No plagiarism will be tolerated. Must be in 7th Edition APA format with cited sources within the last 5 years.
  3. No AI support, score must be 0% and less than < 10% score on Turnitin
December 13, 2024
December 13, 2024

Self-Reflection Essay

Author By Academic Wizard Categories Blog

Self-Reflection Essay

The Self-Reflection Essay will reflect upon your experiences at your employment site during this internship course and what you have learned. Include how these experiences may have furthered your career or caused you to rethink your career goals. Your essay should include your experiences, observations, and key concepts based on the internship and business course experience. The Self-Reflection Essay will be a Turnitin paper of 3 to 4 pages.

Self-Reflection Essay

 

While writing your self-reflection, consider the following points:

  1. Describe your overall experience during the internship and internship course.
  2. What do you now understand best about the focus of this internship course?
  3. Where do you still have the most room to grow in the focus of this internship course?
  4. What is the most important single piece of knowledge you have gained during this experience?
  5. What new skills did you gain?
  6. What old skills were improved? In what way?
  7. How have your abilities to solve problems, think, reason, and research changed?

Your paper should be formatted in APA style. Include at least two (2) peer-reviewed sources related to courses from your academic program or scholarly journals.

Self-Reflection – Working as an accountant at the company

The Self-Reflection Essay will reflect upon your experiences at your employment site during this internship course and what you have learned. Include how these experiences may have furthered your career or caused you to rethink your career goals. Your essay should include your experiences, observations, and key concepts based on the internship and business course experience. The Self-Reflection Essay will be a Turnitin paper of 3 to 4 pages.

While writing your self-reflection, consider the following points:

  1. Describe your overall experience during the internship and internship course.,
  2. What do you now understand best about the focus of this internship course?,
  3. Where do you still have the most room to grow in the focus of this internship course?,
  4. What is the most important single piece of knowledge you have gained during this experience?,
  5. What new skills did you gain?,
  6. What old skills were improved?, In what way?
  7. How have your abilities to solve problems, think, reason, and research changed?

Your paper should be formatted in APA style. Include at least two (2) peer-reviewed sources related to courses from your academic program or scholarly journals.

December 12, 2024
December 12, 2024

Madeline: Pain and Suffering

Author By Academic Wizard Categories Blog

Madeline: Pain and Suffering

Madeline S. is a 66-year-old German woman admitted to a home care agency for care related to end-stage cardiac disease and renal failure.  She has complained of chronic generalized chest pain, frequent cramps in her legs, and worsening arthritis pain related to her immobility.  The home care nurse has been in contact with Madeline’s physician almost daily for the past week and her analgesics have been steadily increased with little pain relief but an increase in nausea, constipation and sedation.  The nurse feels frustrated as she observes Madeline declining rapidly with worsening depression, withdrawal and weeping.  Madeline’s neighbor has noticed that her lights are left on 24 hours a day and the nurse has noticed that Madeline has several rosaries and prayer books now at her bedside.  Madeline has refused referral to hospice but the home care nurse has requested a team conference with assistance from the local hospice affiliated with the home care agency. Madeline: Pain and Suffering

Madeline: Pain and Suffering

 

Discussion Questions:

  1. What disciplines should be included in the case conference?
  2. What additional assessment might the nurse obtain?
  3. How can this patient’s pain and suffering best be treated?

Assignment #2

Ms. Smith: Anorexia/Depression/Anxiety

Ms. Smith is an 85-year-old woman with end-stage cardiac disease in a home hospice program. She has been very comfortable, not experiencing any other symptoms, and has been quite functional until the last two weeks. Her family contacts the home hospice nurse concerning her lack of appetite, “continual sadness,” and anxiety which they feel is affecting her ability to function.

During a routine home visit by the hospice nurse, the patient relates she has no appetite and is quite comfortable just having occasional “snacks” when she pleases. However, her family remains adamant that she requires better nutrition, and they request an IV be inserted. In addition, the family believes Ms. Smith is depressed and “too antsy,” and these contribute to her lack of appetite. Mrs. Smith states that she has had trouble with depression for many years, but has always tried to find “the brighter side” to fight off the sadness. She also acknowledges that she becomes anxious when her children come to visit, as they “don’t want to admit I am dying,” she says. She reports that she does not always sleep well at night, because she is afraid to die and leave her family behind. She says, “I wish I had raised my children better. If I had, there might not be all of this fighting going on about my care. I wish they would leave me alone, so I can die the way I want to.” Madeline: Pain and Suffering

Discussion Questions:

  1. How might the hospice nurse incorporate interdisciplinary care for this patient?,
  2. What additional assessments would be needed?,
  3. What interventions might be considered?,

Assignment #3

Case Study

Perhaps the one case study that best depicts the effect that therapeutic jurisprudence might have involves the case of Theresa (Terri) M. Schiavo.  Ms. Schiavo suffered a cardiac arrest in February 1990.  She was without oxygen for approximately 11 minutes, or 5 to 7 minutes longer than most medical experts believe is possible to sustain without suffering brain damage. At the insistence of her husband, she was intubated, placed on a ventilator, and eventually extubated and received a tracheotomy. The cause of her cardiac arrest was later determined to be a severe electrolyte imbalance caused by an eating disorder, as Ms. Schiavo had lost approximately 140 pounds, going from 250 to 110 pounds, in the months before her cardiac arrest.

Ms. Schiavo was in a coma for the first 2 months after her cardiac arrest.  She then regained some wakefulness and was eventually diagnosed as being in a persistent vegetative state (PVS).  She was successfully weaned from reflexive behaviors.  Characteristic of persistent vegetative state, Ms. Schiavo was not able to eat food or drink liquids, and a permanent feeding tube was placed so that she could receive nutrition and hydration.

Once the media became aware of Ms. Schiavo’s condition, court battles regarding the removal or retention of her feeding tube were initiated.  During these hearings and trials, sufficient medical and legal evidence to show that Ms. Schiavo had been correctly diagnosed and that she would not have wanted to be kept alive by artificial means was introduced.  Laws in the state of Florida, where Ms. Schiavo resided, allowed the removal of tubal nutrition and hydration in patients with PVS.  The feeding tube was removed, but was later reinstated following a court order.

Questions:

  1. What legal issues concerning the scenario do you see?,
  2. Do you see how the families desires conflict with Terry’s intended wishes? ,Identify the legal issues involved with this situation and then instruct a group of nurses about advanced directives and the lessons learned from Terry Schiavo.,
  3. Finally, if you could make a law and put it into the Florida Legislation, what kind of law would you write that gives tribute to the suffering that Terry went through? Let’s call it Terry’s law in respect for her…
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