We are all individual person living in the world, or the earth, our environment. We all somehow in our life get sick sometimes, which means we require nursing care. These four metaparadigm are cooperate with each other and they are connected together. However, the one of the most important metaparadigms is environment in my nursing practice. 

The first week of my orientation on the floor is to learn the safety check in each room at the beginning of the shift. I was taught to check whether there are oxygen tubing, suction and bed alarm for high fall risk patients are set up and I have to make sure that there should be a clear pathway to walk around the patient’s rooms and there should not be any cords on the floor that possibly trip people. Keeping with the current healthcare focus of patient care quality and safety in acute and intensive care environments is very important. There is one time we have a patient that is in airway emergency and we need to suction him. However, the room was not ready with all the suction tubing and set up. The patient ended up with brain death because of delay intubation.

A lot of long-term hospitalization patients would like to decorate their room with their own stuffs, putting up all their own pictures with family, friends and have their ADLs, like toothbrush and pajama. They feel more relax and comfort when they have the quiet and warm environment provide then with safety and security.

According to Nightingale’s environment theory, it entails fresh air, pure water, effective drainage, cleanliness and light are the key elements in functioning of life’s processes and health status. It is involving the nurses’ initiative to configuring environmental settings appropriate for the gradual restoration of the patients’ health, and the external factors associated with the patient’s surroundings affect life or biologic and physiologic processes, and his development (Selanders, 1998).

Virginia Henderson’s “Need Theory” on one hand has the same goal as Nightingale’s environment theory. They both addressing the needs of patients is crucial in providing quality care.  “Need theory” not only included providing the safe/secure environment to patients, it also considered close to realism and it is aiming to enable nurses to improve standard of caring by assessing patient needs including physiological, psychological, spiritual and moral (Ahtisham & Jacoline, 2015).  Comparing these two theories, nurses have a unique ability to apply their observational skills to understand the role of the designed environment to enable healing in their patients.  As a bedside nurse, by comparing the similarities and differences between these two theories, it put me up to in a better position to provide the holistic care to my patients.

Reference

Ahtisham, Y., & Jacoline, S., (2015) Integrating Nursing Theory and Process Into Practice; Viginia’s Henderson need Theory. International Journal of Caring Sciences. May-August 2015 Vol. 8 Issue 2 pp 443-450

Selanders, L., (June, 1998). The Power of Environmental Adaptation. Florence Nightingale’s Original Theory for Nursing Practice. Journal of Holistic Nursing

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THIS IS A DISCUSSION RESPONSE APA 6TH ED. USING IN TEXT CITATIONS AND REFERENCES.

According to Chinn and Kramer (2014), personal knowing is a process of Self-knowing that is conscious; it is developed deliberately to know fully who you are and to understand your actions and relationships. Personal knowing allows you to take past experiences and reflect on that to develop yourself into a better person to more adequately care for patients. Personal knowing is not just internal reflection of also how people perceive you through your actions. In order to develop personal knowing you can ask the questions “Do I do what I know?” and Do I know what I do?” This allows the person to recognize and hold themselves accountable for providing the best, unbiased care.

A professional strength that I possess would be that I have a great attention to detail when it comes to patient care and my job. When it come to patient assessment, I can quickly notice a change in condition or behavior. I pay attention to a patient’s appearance such as grooming, edema to extremities, or gait. My co-workers always say, “Jen doesn’t miss anything!” My second professional strength is that I strive to be the best at what I am doing. I want to go the extra mile to do what is right for the patient and the people I work with. I do not want to be told twice or reminded on how to do something. When I work in the recovery room, I know what the doctor’s preferences are in caring for the patient.

My first weakness and biggest downfall is that I am critical. I put a lot of pressure on myself and other people to do things correctly. This is something that I continuously must check myself on. Just because it isn’t my way doesn’t mean that it isn’t being done correctly. I have found that through my work and personal experience that if you are constantly picking at someone, they may just give up! My second weakness is that I am not very confident. When I feel insecure and unsure about myself or my skills, I try to talk myself out of it. I clam up in uncomfortable situations.

Benner’s model of skill acquisition theory helps to improve my confidence and attention to detail. My base knowledge and experience help to provide me with the confidence boost that I need. According to McEwen and Wills (2014), expertise develops when the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations.  I know that in my current position, I am an expert. This makes me feel comfortable that I am making the right decisions for my patients. This can also apply to my weakness of criticism. A novice nurse may not seek advice from me if I am constantly critical of them and their work.

Chin, P. & Kramer, M. (2014) Integrated Theory and Knowledge Development in Nursing: Theory and Process. (9th Ed.); Elsevier.

McEwen, M. & Wills, E. (2014). Theoretical Basis for Nursing (4th Ed.); Lipincott Williams and Wilkins ISBN 9781451190311

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 Approx 150-180 words APA format with references and in-text citations response to the discussion below. 

The term “Evidence-Based Practice” (EBP) was fairly new when I was entering nursing school in 1999.
Although it made sense that nursing practice was based on academic research and findings, many nurses have passed down traditions simply based on the notion that “it has always been done this way”. I can remember this new term, and the exciting thought that nursing would be more valued and respected with a greater emphasis on practice based in facts and best outcomes. I became an RN in 2004, and I have worked in the psychiatric field for the majority of my career. The American Psychiatric Nurses Association (APNA) was my chosen healthcare organization website. This can be found at https://www.apna.org/i4a/pages/index.cfm?pageid=1 . Although I was already somewhat familiar with what the website had to offer, I gained a greater understanding and admiration for this site as I dug a little deeper.

The Institute of Medicine’s Roundtable on Evidence-Based Medicine put an emphasis on three major areas: a learning healthcare system, generating evidence to support effective healthcare strategies, and improving public awareness regarding the importance of EBP in healthcare (Melnyk, & Fineout-Overholt, 2018). The APNA website contributes to the IOM’s goal of improving public awareness related to EBP. This is evident in the numerous resources on the website from academic journals, continuing education (conferences and CEU’S), standards of practice updates, and also the ability to find information about academic programs and scholarships. The Journal of the American Psychiatric Nursing Association is a peer-reviewed journal which publishes original research, practice-focused articles, editorials, and interviews. One tab entitled “Reports & Surveys” shares the latest national reports and surveys covering topics related to the future of nursing and nurses’ health.

Although the website is not entirely based in EBP (some tabs are related to the organization and membership) it is clear that its goal is to promote the understanding of psychiatric nursing through the recent solid research. One item available for free via ebook to members (and for sale to non-members) is “Psychiatric-Mental Health Nursing: Scope and Standards of Practice”. This spells out important aspects of psychiatric-mental health nursing- the who, what, when, where, and how of practice- at various levels and in multiple settings. The latest edition was published with the input and expertise of psychiatric nurses from the APNA and the International Society of Psychiatric-Mental Health Nurses (ISPN). Goals established prior to the easy access of the internet are able to be met not only through scholarly articles, but with new styles of sharing information and with a culture of networking to filter out the most relevant, and timely information.

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–175. doi:10.1111/wvn.12126

https://www.apna.org/i4a/pages/index.cfm?pageid=1

Laureate Education (Producer). (2018). Introduction to Evidence-Based Practice and Research [Video file]. Baltimore, MD: Author.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

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150-180 words APA format with references and in-text citations. 

Within the healthcare field we as nurses and future practitioners are faced daily with changes in our field. Whether it be current trends in healthcare, changes within our organizations or laws we embrace the changes to aid in the improvement of quality of care for the patients. Along with changes we are also faced with the many stressors that occur within our practice of work. Many stressors can occur such as issues with nurse patient ratios, healthcare breaches, and most importantly nursing shortages. The main stressor here I would like to focus on is nursing shortages with increased workloads. Retention is a key topic when addressing nursing shortage. According to Laureate Education, issues within healthcare will become more and more of a challenge for healthcare workers, therefore it is imperative to be able to adapt to the stressors (Laureate Education, 2015).

My organization is a non-profit healthcare facility. Located in Norfolk, VA we are a Level one trauma center as well as Magnet recognized organization. Working in such a facility in the heart of our community, we are faced with many challenging work shifts, difficulty workloads and most importantly a nursing shortage. I have seen in my organization units working understaffed, nursing managers and other members of leadership forced into staffing to take on patient assignments to not place the entire burden on bedside nurses. The assignments are heavier at times, the patients are a lot sicker and we seem to feel that we don’t have enough help in certain areas to properly treat our high acuity workloads. These types of issues place major stresses on staff members. Everyone becomes overwhelmed, displayed angers amongst staff, longer working hours, while feeling unappreciated at times.  Over the years the nursing shortage has been a huge issue with some of the factors being lack of properly trained educators, an abundance of turnover rates as well as challenging workloads (Haddad & Tony-Butler, 2019).

Addressing Issues  within Organizations

For such current issues within my organization, being in a leadership role I have seen the forefront of all that is being done to address our nursing shortage. For instance, we hold daily meetings that incorporate our staffing support services. This allows all members in our organization at the leadership level the insight on what extra staff help we have for the next few shifts. This allows everyone to critical think and plan ahead about areas where shortages may be occurring to plan for coverage of the gaps. Another area of tackling staffing issues within my organization has been incentive pay. Staffs are offered “call pay” which is extra pay for working extra shifts. Staff will be paid double pay for providing their time with covering staff shortages on certain units. This has allowed nurses to pick up extra hours to cover shortages decrease intense workloads, as well as offering a pay incentive. My organization has also extended contracts to travel nurses to work different assignments ranging 10-13 weeks. Having these nurses come in also works because those units critically short are offered help from a nurse assigned to them and only them for this period of time. Now although this is a temporary fix, we have had some of these nurses become our own staff nurses which increases our staffing.  With nursing shortages in our organization, it has been more common for staff to adjust and work with what they have. The Affordable Care Act (ACA) has made various ways to implement measures within healthcare to support the many struggles faced in this field, therefore allowing organizations to change delivery systems for improvement of patient care (Pittman & Scully-Russ, 2016). Although we still may seem to not see much change happening, many organizations such as my own are working hard to support their team members.

References

Haddad LM, Toney-Butler TJ. Nursing Shortage. [Updated 2019 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14, 1–15. https://doi-org.ezp.waldenulibrary.org/10.1186/s12960-016-0154-3

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Scenario 2:

A 44-year-old obese female is admitted to the emergency room with fever and severe abdominal pain on the upper right side that radiates to the scapula. She states that she feels nauseated. She states that the pain began at a friend’s house during a party and is becoming more severe. You can see that she is quite uncomfortable.

1. What could be the underlying cause of these symptoms?
2. What examinations would you perform? Why?
3. What laboratory tests would be needed to confirm possible differential diagnoses?
4. What pharmaceutical drugs are approved for treating the diagnosis that you concluded for this case?

Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

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