Please, write a response to the following discussion by using one reference from English peer-reviewed Journal that is not older than 5 years.

 

Hardiness Theory

It is of no surprise that many nurses who start working in the profession feel a sense of stress and burnout after working a long fast-paced shift in the hospital. The responsibility of making sure that every patient is receiving the highest level of care can be quite overwhelming when also being responsible for responding to the answers of concerned family members, receiving medical orders from doctors, delegating tasks to the patient care assistant, managing the pain of a trauma or post op patients, and ensuring the safety of a confused patient. Although this profession can be very satisfying, given that it involves helping patients in their most vulnerable state, the level of stress that nurses have to endure can be quite alarming. It is for this reason that many theorists have come into play when seeking to find a way to help individuals cope with difficult situations in the workplace. Susan Kobasa’s non-nursing theory known as Hardiness Theory, has been incorporated into a nursing theory when seeking to help nurses deal with the stresses of the profession (Henderson, 2015). 

            The theory of hardiness states that individuals must possess all three hardy attitudes, commitment, control, and challenge, in order to withstand any difficult life or professional situation and must learn how to turn any negative experience into an opportunity for personal and professional growth (Henderson, 2015). Commitment, being the first component of the theory of hardiness states that an individual must be active in every situation that comes in the way. In other words, the individual must never ignore the problem, but must instead be a participant in problem solving (Henderson, 2015). Control, is when an individual believes that his/her actions can result in a positive or negative outcome. The person has a sense of power over the situation (Henderson, 2015). Lastly, challenge is when an individual accepts the difficulties that comes along and uses them as opportunities to become a stronger and wiser (Henderson, 2015). 

            The components of this theory have been incorporated into a nursing theory because it has been used to provide nurses with effective strategies to manage the ongoing stresses that they face in the workplace. The humanistic nursing theory also includes the concept of authentic commitment, which means the nurse is actively present both personally and professionally in the decisions that are made when caring for a patient (George, 2011). It is highly important to implement the components of the theory presented because it serves as a tool to help reduce the incidence of developing any physical or mental illness (Henderson, 2015). 

 

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respond to this discussion in one paragraph using one peer-reviewed Nursing Journal not older than 5 years old as a reference, APA needed,no cover page.

 

Literature is a way to convey information to the people that are providing health care to the community. Research and clinical articles are shared with the health care providers, but before it reaches the public eye these articles undergo peer reviews which is to make sure that the information being shared is current, accurate and that it relates to the readers that will be reading the journals (Connelly, 2017). Generally, there are two or more peer reviewers that look over the articles that were submitted. It is important to have a double-blinder review process which means that the reviewer and the author do not know each other. This is done so the review is unbiased. To be a reviewer, nurses can take courses to help them gain knowledge on how to evaluate the quality of the evidence that was provided in the articles (Polit & Beck, 2018). The peer review process is necessary because it helps look for information that is useful from the study, what research methods were used, the ethical conduct that was applied, how thorough and accurate the study was (Connelly, 2017). Along, with the previously mentioned tasks, it is important that the reviewer also look at that statics were used to get values and any figure examples that were used in the study to show data. Reviewing literature is important because once it has been reviewed then the article can be send to editing and later published where it can be read by other nurses for evidence and research.

 

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Peer 1 

Participation in the elections, namely, in the voting process is “contribution” in shaping the future of the country. A willingness to participate in the election process is an indicator of belonging to a political life that affects our daily work and family life. Everyone has a particular political position. The same applies to the health care system, because it is constantly evolving and nurses must constantly keep up with the times and offer the best options for improving the quality of life. 

           Policies, strategies and plans in health care are not the ultimate goal. The target of this action is to create a circumstance in which all people everywhere might have accession to high-quality health services and expect a long and healthy life (Toofany S, 2015). Health workers play an important role in social and political life of citizens (Akram Arabi, Forougj Rafii & Shahrzad Ghiyasvandian, 2014). And they understand the importance of the development of the health system and the need to comply with the new trends in the development of medicine. The reason that may force them to lobby Congress and get involved on political campaigns – sharp social and political issues that are directly related to the medical field (American Nurse Association, 2012). For example, a law that prohibits representatives of the LGBT community to be blood donors.  

           This political decree violate human rights and reduce the likelihood of getting the needed blood to people who need it. Because of this, nurses can join in a political campaign, which opposes such a ban. Also, as the cause of accession can serve an increase of investment in different medical programs, or funding programs associated with LGBT adolescents, who need medical care or funds to improve the quality of sexual education among adolescents. Among the strategies we can identify several: the first one is civic engagement with the help of mass-media, also they can hand out flyers to people in order to make them know about the existence of such a question. And probably the most radical method is to hold meetings (American Nurse Association, 2012). 

           In conclusion, it should be noted that the political life of society is inseparably connected with the medical field. Some social or political issues can attract nurses to make them a part of a political campaign. Such a decision may lead to improving the quality of life of the population, as health care providers primarily operate for the benefit of society. 

Peer 2 

The role that the electoral process and government plays in one’s daily work and family life is evident in many ways.  Many issues that affect daily life, such as family planning, is often structured through policies set by the government; an example includes funding and defunding of Planned Parenthood. 

Nurses make up the largest portion of the health care workforce. Nurses also represent a significant proportion of staff at health facilities, schools, community practices and other clinical settings focused on health (Martin, 2018).  Nurses offer a multitude of experience and unique expertise that bring perspective to the electoral process and processes in the government (Martin, 2018).  An important aspect of health policy advocacy is in establishing networks and developing relationships that allow the nurse advocate to learn from others and share what she/he knows (Mason, Gardner, Outlaw & O’Grady, 2016). 

           Some of the policy issues that might drive nurses to lobby Congress that directly affect the patient, family, and community relate to advocating to combat childhood obesity and fighting the opioid epidemic.  Nurses can influence policy at both the national and local levels by becoming part of the agenda of action for health promotion.  Another pressing issue affecting my community right now is insuring the uninsured and expanding services to vulnerable populations.  Many development projects and programs have succeeded because of the strategies developed by nurse advocates and the relationships cultivated both within and outside government with key decision-makers and people of influence.   

Response must be minimum 150 words each, doble space APA(6th) 

Bellow is the original activity if you needed: 

Reflect on the role that the electoral process and government plays in one’s daily work and family life. As nurses, health policy can influence both arenas of our lives. What policy issues might drive nurses to lobby Congress and/or get involved in campaign politics? What strategies might nurses use to have their voices heard? 

 

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Sonia,

 

Asthma is a frequent health problem in children. It is chronic. There are more than 3 million cases per year in the USA. It can be a minor problem or it can interfere with daily activities. In some cases can be life-threatening. As adults get older the illness can decrease in frequency and severity. We need to instruct our patients that certain foods can trigger asthma symptoms, for example milk, eggs, shellfish, peanuts, soy, and wheat might be responsible. Children with asthma should have a humidifier in their rooms, avoid sleeping with pets, avoid dust, and avoid dust mites, that can get in sheets and pillows. 

We need to tell the parents as well as the child to try to always have inhalers available. The most common are beta agonist, which give quick bronchodilatation, also useful are steroids and leukotrine modifiers.
We as nurse practitioners are in a unique place to give appropriate health care advice, by instructing the patient and their parents or caregivers what to avoid in the environment and the diet, and what things would be beneficial. On of the most common question is what foods to avoid and which ones to use. All exercises are useful but never to over do it. Some individuals can have an attack trigger by vigorous exercise. Also avoid changes in temperatures,because it is well known that bronchospasm occurs in colder temperatures. 

In my personal experience I had a 5 year old that developed attacks of difficulty breathing, which was treated successfully in the emergency room on several occasions, when we got involved with the family, we were able to obtain an extensive history, including the fact that they had recently moved to a new house, which turned out to have lot of mold, when this was addressed then the frequency and severity of the attacks diminished.

Reference:

Stucky, B. D., Sherbourne, C. D., Edelen, M. O., & Eberhart, N. K. (2015). Understanding asthma-specific quality of life: moving beyond asthma symptoms and severity. The European respiratory journal, 46(3), 680-7.

Van Aalderen W. M. (2012). Childhood asthma: diagnosis and treatment. Scientifica, 2012, 674204.

Lisette,

 

NAME: E.B  AGE: 50 y/o SEX: male 

*SUBJECTIVE INFORMATION*

CHIEF COMPLAINT : ”I have cough and expectoration every morning for month”

HISTORY OF PRESENT ILLNESS:

Pt is a 50 y/o hispanic male with past medical history of infertility for which it was studied years ago and was diagnosed with α1 antitrypsin deficiency, non-smoker who comes with a chief complaint of cough and morning sputum for month. The espectoria is abundant and smells of wet plaster, thick. Also in these last days he has presented fever of 102 F and the cough has become constant and annoying and sputum more green and abundant.

PAST MEDICAL HISTORY: α1 antitrypsin deficiency

IMMUNIZATIONS:

Vaccine updated

ALLERGIES: to Dust, type of reaction: runny noise.

CURRENT MEDICATION: Vitamin C PO 500 mg daily.

FAMILY HISTORY:

Mother: Bronchial Asthma

Father: CVD, PVD

SOCIAL HISTORY:

Denies illicit drugs, or drink alcohol.

MARITAL STATUS: married without child for infertility

REVIEW OF SYSTEMS

• • RESPIRATORY: Productive cough and smelly expectoration with a smell of wet plaster

*OBJECTIVE INFORMATION*

VITALS SIGNS: Blood Pressure: 110/65 Pulse: 60 bpm Respiration: 22rpm Temperature:102 F O2 saturation: 93% at room air.

Weight: 1300 lb.

Pain level: 0/10

RESPIRATORY:  Crackles and wheezing on lung auscultation. No dyspnea noted.

MUSCULOSKELETAL: Clubbing of the digits

• ⎫ Dieses/Condition 

DIAGNOSIS: BRONCHIECTASIS WITH (ACUTE) EXACERBATION

Bronchiectasis refers to an irreversible airway dilation that involves the lung in either a focal or a diffuse manner and that classically has been categorized as cylindrical or tubular (the most common form), varicose, or cystic.

DIFFERENTIAL DIAGNOSTIC:

1- COPD

3- Strep Pneumonia 

4- Tuberculosis

• ⎫ Population affected:

The overall reported prevalence of bronchiectasis in the United States has recently increased, but the epidemiology of bronchiectasis varies greatly with the underlying etiology. For example, patients born with CF often develop significant clinical bronchiectasis in late adolescence or early adulthood, although atypical presentations of CF in adults in their thirties and forties are also possible. In contrast, bronchiectasis resulting from MAC infection classically affects nonsmoking women >50 years of age. In general, the incidence of bronchiectasis increases with age. Bronchiectasis is more common among women than among men.
The most affected population is:

1. 1. People that aspirated foreign body or had a tumor mass
2. 2. People with recurrent infection (bacterial, nontuberculous mycobacterial)
3. 3. People with Immunodeficiency (hypogammaglobulinemia, HIV infection, bronchiolitis obliterans after lung transplantation)
4. 4. People with genetic causes (cystic fibrosis, Kartagener’s syndrome, α1 antitrypsin deficiency) 
5. 5. People that suffer from Autoimmune or rheumatologic causes (rheumatoid arthritis, Sjögren’s syndrome, inflammatory bowel disease); immune mediated disease (allergic bronchopulmonary aspergillosis)
6. 6. Recurrent aspiration of toxics agents
7. 7. People with α1 Antitrypsin Deficiency.

• ⎫ Impact on Quality of Life. 

Manifestations The most common clinical presentation is a persistent productive cough with ongoing production of thick, tenacious sputum.

The aspect that most affects people with bronchiectasis are recurrent respiratory infections that can limit their quality of life due to a compromise of respiratory function.

Outcomes of bronchiectasis can vary widely with the underlying etiology and may also be influenced by the frequency of exacerbations and (in infectious cases) the specific pathogens involved. In one study, the decline of lung function in patients with non-CF bronchiectasis was similar to that in patients with COPD, with the forced expiratory volume in 1 s (FEV1) declining by 50–55 mL per year as opposed to 20–30 mL per year for healthy controls.

• ⎫ Current EBP that will benefit this patient with the specific disease. 

Bronchiectasis doesn’t have reversibility; however, we can compensate it with an adequate therapeutic. After I have carried out a search, such as FNP, the therapeutic alternatives within our reach are the following:

1. 1. clearance techniques: Manual techniques may be offered to enhance sputum clearance when the patient is fatigued or undergoing an exacerbation.
2. 2. Mucoactive: Consider the use of humidification with sterile water or
3. 3. Normal saline solution to facilitate the purification of the respiratory tract. You can also use some mucolytic mucinex.
4. 4. Anti-inflammatory therapies: Do not routinely offer corticosteroids to patients with bronchiectasis without other indications (such as ABPA, chronic asthma, COPD and inflammatory bowel disease) 
5. 5. Antibiotic: Consider long-term antibiotics in patients with bronchiectasis who experience 3 or more exacerbations per year and in the short term in case of exacerbations. The choice of antibiotic depends on the type of patient: 

P. aeruginosa colonised patients  

1. a. Use inhaled colistin for patients with bronchiectasis and chronic Pseudomonas aeruginosa infection. 
2. b. Consider inhaled gentamicin as a second line alternative to colistin for patients with bronchiectasis and chronic P. aeruginosa infection. 
3. c. Consider azithromycin or erythromycin as an alternative (eg, if a patient does not tolerate inhaled antibiotics) to an inhaled antibiotic for patients with bronchiectasis and chronic P. aeruginosa infection. 
4. d. Consider azithromycin or erythromycin as an additive treatment to an inhaled antibiotic for patients with bronchiectasis and chronic P. aeruginosa infection who have a high exacerbation frequency. 

Non- P. aeruginosa colonised patients  

1. a. Use azithromycin or erythromycin for patient with bronchiectasis. 
2. b. Consider inhaled gentamicin as a second line alternative to azithromycin or erythromycin. 
3. c. Consider doxycycline as an alternative in patients intolerant of macrolides or in whom they are ineffective. 
4. 6. Bronchodilators: Use of bronchodilators in patients with bronchiectasis and co-existing COPD or asthma should follow the guideline recommendations for COPD or asthma,
5. 7. Pulmonary rehabilitation: Offer pulmonary rehabilitation to individuals who are functionally limited by shortness of breath (Modified Medical Research Council (MMRC) Dyspnea Scale ≥ 1)

• ⎫ Recommendation for treatment.

In the case of this patient as FNP I indicated: 

1. 1. Tylenol PO 400 mg every 8 hours PRN
2. 2. Azithromycin PO 500 mg daily per 3 days
3. 3. Mucinex 1 tablets every 12 hours.
4. 4. Follow-up with pneumology.
5. 5. Follow-up with physiotherapeutic for specialized respiratory physiotherapy

• ⎫ How as the FNP caring for this patients (teaching)

As FNP I can contribute to the quality of life of the patient by educating him in avoiding the factors that trigger an exacerbation and how to control his illness 

1. 1. Educate on medication compliance.
2. 2. Chest physiotherapy (eg, postural drainage, traditional mechanical percussion in the chest through palms in the chest hand)
3. 3. Drink plenty of liquid
4. 4. Reversal of an underlying immunodeficient state (e.g., by administration of gamma globulin for immunoglobulin-deficient patients) and vaccination of patients with chronic respiratory conditions (e.g., influenza and pneumococcal vaccines) can decrease the risk of recurrent infections. 
5. 5. Patients who smoke should be counseled about smoking cessation.
6. 6. After resolution of an acute infection in patients with recurrences (e.g., ≥3 episodes per year), the use of suppressive antibiotics to minimize the microbial load and reduce the frequency of exacerbations has been proposed, although there is less consensus with regard to this approach in non-CF-associated bronchiectasis than in patients with CF-related bronchiectasis. Possible suppressive treatments include (1) administration of an oral antibiotic (e.g., ciprofloxacin) daily for 1–2 weeks per month; (2) use of a rotating schedule of oral antibiotics (to minimize the risk of development of drug resistance); (3) administration of a macrolide antibiotic (see below) daily or three times per week (with mechanisms of possible benefit related to non-antimicrobial properties, such as anti-inflammatory effects and reduction of gramnegative bacillary biofilms); (4) inhalation of aerosolized antibiotics (e.g., tobramycin inhalation solution) by select patients on a rotating schedule (e.g., 30 days on, 30 days off ), with the goal of decreasing he microbial load without eliciting the side effects of systemic drug administration; and (5) intermittent administration of IV antibiotics (e.g., “clean-outs”) for patients with more severe bronchiectasis and/or resistant pathogens.

References 

1. 1. Haworth C, Banks J, Capstick T, et al. BTS Guidelines for the management of nontuberculous mycobacterial pulmonary disease. Thorax 2017;72:1–64.
2. 2. Seitz AE, Olivier KN, Steiner CA, et al. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993-2006. Chest 2010;138:944–9
3. 3. Bibby S, Milne R, Beasley R. Hospital admissions for non-cystic fibrosis bronchiectasis in New Zealand. N Z Med J 2015;128:30–8
4. 4. Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016;47:186–93
5. 5. van der Bruggen-Bogaarts BA, van der Bruggen HM, van Waes PF, et al. Screening for bronchiectasis. A comparative study between chest radiography and highresolution CT. Chest 1996;109:608–11.

 

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